by Kim Schoenhals
Diabetes Facts · Diabesity References
The overwhelming number of Americans who are obese is coupled with an equally startling number of Americans who are being diagnosed with Type II diabetes. Because the link between diabetes and obesity is so strong, the combination has been termed "diabesity." Although the numbers are growing, not all hope is lost. There are several dietary, lifestyle and supplemental options available for reducing the risk of developing Type II diabetes, even in this day and age of fast food and channel surfing.
Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action or both," according to the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), a branch of the National Institutes of Health (NIH). Simply put, diabetes is a metabolic disorder in which food is inefficiently converted into energy. Diabetes is generally diagnosed in two forms: Type I and Type II.
Type I diabetes occurs when the body's immune system attacks the pancreas, which is responsible for making the insulin that regulates blood glucose (blood sugar). This form of diabetes is most commonly diagnosed during childhood, hence its former moniker "juvenile-onset diabetes." Type I diabetes, which is treated with daily insulin injections, accounts for 5 percent to 10 percent of all diagnosed diabetes cases, according to NIDDK.
Type II diabetes, on the other hand, accounts for approximately 90 percent of all diabetes cases. Type II is known as non-insulin-dependent (formerly adult-onset) diabetes. "It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly," NIDDK noted. While the need for insulin increases, the pancreas has a harder time producing it.
Type II diabetes has reached pandemic proportions in the United States, according to Earl Mindell, R.Ph., Ph.D., author of Earl Mindell's Natural Remedies for 101 Ailments (Basic Health Publications, 2002). The increasing number of diabetics in the United States is arguably due to poor diet and nutrition, as well as a cultural sedentary lifestyle. "When you have 37 million people now out of the approximately 300 million in the United States and Puerto Rico, you have 10 percent of the population with diabetes, and [experts] expect it to double within the next 10 years," Mindell said. "That's pretty frightening, and it's getting younger. So what can you do about it? Diet and weight are the biggest things."
According to researchers from the Harvard School of Public Health in Boston, the Western diet that consists of highly processed sugars and carbohydrates, red meat and fried foods is associated with a "substantially increased risk" for Type II diabetes in men. However, a "prudent" diet consisting of vegetables, fruit, fish, poultry and whole grains is generally associated with a decreased risk, as is regular exercise.1
As for obesity, body weight is the No. 1 predictor of Type II diabetes: an estimated 80 percent of all Type II diabetics are overweight. However, losing weight can significantly reduce the risk of Type II diabetes. The Diabetes Prevention Program at the Department of Health and Human Services (HHS) found that diet and exercise resulting in a 5-percent to 7-percent loss of body weight lowered the incidence of Type II diabetes by 58 percent.
There are several red flags that can crop up to indicate Type II diabetes may become a problem in the foreseeable future. "Pre-diabetes," as it was labeled by NIDDK, is a condition in which blood glucose levels are higher than normal, but not yet diabetic. Pre-diabetes affects an estimated 16 million Americans, according to NIDDK, and it sharply increases the risk of developing Type II diabetes. HHS-supported research showed that most people with pre-diabetes will develop diabetes within a decade unless they change their diet and level of physical activity.
"The good news is if you have pre-diabetes, you can do something about it," HHS Secretary Tommy Thompson said in a press release from NIDDK. "We want people to know that pre-diabetes is a serious condition that can be reversed or alleviated with modest changes in their daily routines--such as eating fewer calories and walking regularly for exercise."
Another indicator of a potential Type II diabetes diagnosis is metabolic syndrome--characterized by abdominal obesity, elevated triglyceride levels, low levels of high-density lipoprotein (HDL or "good") cholesterol, high blood pressure and high blood sugar. Researchers who analyzed data from the Third National Health and Nutrition Examination Survey found that 21.8 percent of 8,814 men and women exhibited at least three symptoms of metabolic syndrome. Age was a significant indicator for the presence of more than three symptoms. Almost half (43.5 percent) of the oldest participants in this study (aged 60 to 69) had at least three symptoms of metabolic syndrome, while only 6.7 percent of the younger participants (aged 20 to 29) did. "These results from a representative sample of U.S. adults show that the metabolic syndrome is highly prevalent," the researchers concluded. "The large numbers of U.S. residents with the metabolic syndrome may have important implications for the health care sector."2
Because Type II diabetes generally begins as insulin resistance and is associated with obesity and a poor diet, nutritional and dietary changes may improve the body's resistance to insulin and reverse the final outcome of Type II diabetes. In the case of pre-existing diabetes, diet and lifestyle changes may improve glucose tolerance, as well as reduce the risk of chronic disease states that are associated with Type II diabetes. Currently, there are several dietary supplements touted for being able to accomplish these goals, and the research behind these ingredients is promising.
Assorted Antioxidants
Diabetes is often associated with conditions such as heart disease, diabetic retinopathy (which can lead to blindness), immune deficiencies and kidney disease. Many of these complications are arguably caused, in part, by free radical damage. For this reason, antioxidants are often thought to be helpful for diabetes patients. Additionally, in the process of normalizing insulin and glucose regulation, antioxidants become especially important. "When you start to [normalize insulin and glucose regulation], your need for antioxidants is greater than ever," Mindell said. "So, a complete multivitamin/mineral that's rich in antioxidants is essential."
The always popular antioxidant vitamin C is thought to be useful for diabetics, as the nutrient is typically found at low levels in those who have Type II diabetes.3 In addition, it is thought that the high blood sugar levels associated with diabetes may cause a deficiency of vitamin C in the body's immune cells, which could affect the patient's ability to heal.4
Taking a vitamin C supplement can improve plasma levels of the nutrient, according to researchers from the Heart Protection Study Collaborative Group. They saw a one-third increase in plasma vitamin C with supplementation in adults who had heart disease or diabetes. In addition, researchers noted that plasma alpha-tocopherol (an isomer of vitamin E) levels doubled with vitamin C supplementation.5
Vitamin E supplementation may have similar effects. When combined with insulin treatment, vitamin E supplementation may increase plasma vitamin C and E levels in patients with Type II diabetes.6
Another antioxidant, coenzyme Q10 (CoQ10), is a fat-soluble, vitamin-like compound that is thought to play a role in insulin production. In fact, a deficiency of CoQ10 may impair the function and activity of glycerol-3-phosphate dehydrogenase (G3PD), an enzyme that helps control insulin production. G3PD is not as efficient in Type II diabetics as it is in non-diabetics.7
CoQ10 is probably most well-known for its application in protecting against heart disease, which is common in diabetes cases. CoQ10 supplementation has been suggested as a helpful complementary therapy for patients with diabetes-associated heart disease, although diabetics who took 100 mg/d of CoQ10 did not exhibit a change in metabolism.8
On the bright side, CoQ10 supplementation may reduce the risk of developing Type II diabetes by enhancing the body's production of cellular energy, according to researchers from Bastyr University in Kenmore, Wash. They noted there is a link between the various hang-ups in energy production--such as genetic disturbances in mitochondrial DNA or malfunctions in mitochondrial function--and Type II diabetes.9
Alpha-lipoic acid (ALA) is an antioxidant substance produced by the body that may affect insulin and blood sugar metabolism in Type II diabetics.10 Also known as alpha-lipoate or thiotic acid, ALA may also improve glucose metabolism.11
An antioxidant mineral, selenium is commonly deficient in the immune cells of Type II diabetics.12 Selenium supplementation is thought to stave off free radical damage commonly associated with Type II diabetes, thereby protecting against chronic disease. Animal research conducted in Turkey indicated that selenium, when given in combination with vitamin E, protected against oxidative damage to the blood, liver and muscle.13
Two more minerals that have antioxidant powers are zinc and chromium. Supplementation with 30 mg/d of zinc and 400 mcg/d of chromium (as chromium pidolate) demonstrated antioxidant effects in individuals with Type II diabetes. Researchers concluded these results were particularly important in light of the negative outcomes associated with oxidative stress in people with diabetes.14
Zinc deficiency is associated with a number of metabolic disorders, including impaired glucose tolerance, insulin degradation, decreased insulin potency and reduced pancreatic insulin content.15 In clinical studies, zinc supplementation improved diabetic animals' and humans' glucose tolerance.16,17
The various forms of trivalent chromium (chromium III, not to be confused with the toxic hexavalent chromium, chromium VI, that was featured in Erin Brockovich) have been studied extensively in terms of improving insulin regulation. In fact, chromium's primary function in the body is to support the effects of insulin and enhance glucose, amino acid and fat metabolism.
"[Chromium] seems to overcome insulin resistance," said Harry G. Preuss, M.D., M.A.C.N., C.N.S., professor of physiology, medicine and pathology at Georgetown University in Washington, D.C. "We have shown that time and again by different means. If you take enough [chromium], it overcomes insulin resistance. ... Many people feel the effect you're getting--overcoming insulin resistance with chromium--is due to overcoming a chromium deficiency. I've argued it may be over and beyond that as well. I think taking a little extra chromium could have--and then we get into semantics--a 'pharmacologic' effect. But in any sense, taking chromium can overcome insulin resistance, which is associated with a lot of problems: heart disease, diabetes, obesity, lipid problems, cholesterol problems."
Chromium deficiency, which is more likely to occur in the elderly and athletes, can also develop from consuming a high intake of simple sugars and refined foods over a long period of time. These simple sugars and carbs can increase the amount of chromium passed in the urine, thereby promoting chromium deficiency.
One form of trivalent chromium thought to support blood sugar regulation is chromium picolinate. Human subjects taking chromium picolinate supplements (as Chromax®, manufactured by Purchase, N.Y.-based Nutrition 21) exhibited significant drops in fasting blood sugar and serum insulin levels, as well as serum cholesterol levels.18 Because of its effects on insulin levels, chromium picolinate may also be useful for pre-diabetes. Supplementation with chromium picolinate (as Chromax) was found to increase insulin sensitivity by an average of 40 percent in overweight, non-diabetic volunteers.19
Niacin-bound chromium, also known as chromium polynicotinate or chromium nicotinate, is another trivalent variety of the mineral that has been studied for its possible use against Type II diabetes, insulin resistance and obesity. "Chromium polynicotinate seems to have a critical role in the proper use of sugar and may help lower blood sugar levels in people--especially those with Type II diabetes," wrote Peter A. Lodewick, M.D., in A Diabetic Doctor Looks at Diabetes: His and Yours (Southern Publishers Group, 1997). "In addition, many recent studies have demonstrated that its other important effects might include raising good HDL while lowering total blood cholesterol, lowering body fat while increasing lean body muscle mass, and reversing vascular disease."
Research combining the use of niacin-bound chromium (as ChromeMate®, manufactured by InterHealth Nutraceuticals in Benicia, Calif.) with an exercise regimen demonstrated the treatment induced weight loss and lowered insulin response to an oral glucose load in overweight women.20
Brewer's yeast is another dietary source of chromium studied in human subjects with Type II diabetes. Researchers have found brewer's yeast supplementation improved subjects' glucose control.21
Vitamins & Minerals
In addition to those nutrients that have antioxidant properties, there are several vitamins and minerals that are able to promote good health and potentially stave off insulin resistance and diabetes. "We are trained in America to be sickness experts: We know everything about sickness, nothing about health," Mindell said. "This is one of the few countries where if you are interested in your health, you are called a 'nut'--a health nut. But if you're a sickie and take every drug in the book, you are part of the establishment. And that's changing a little bit because it's very expensive to be sick. Now, what can you do to better your health? The No. 1 thing: We should all be taking a multiple vitamin and mineral."
Some of the B vitamins have been studied especially for their role in insulin and glucose regulation. Niacin (vitamin B3), for example, may protect circulatory health in diabetics. While supplementation with niacin has been discouraged in Type II diabetics because high doses may worsen glycemic control, low-dose niacin therapy (1,000 to 1,500 mg/d) might alleviate diabetic dyslipidemia, a condition characterized by high triglyceride levels, low HDL levels, small and dense LDL particles, and high free fatty acid levels.22 Similar results were found by researchers in California. Niacin was deemed an effective treatment for diabetic dyslipidemia, although researchers stated niacin therapy should be used as a complement to traditional therapies such as oral hypoglycemic (glucose-lowering) medication or insulin treatment.23
Similar to hypoglycemic agents, the water-soluble B vitamin biotin may also have a glucose-lowering effect. In an animal model, biotin supplementation was found to decrease glucose levels after a meal, as well as improve glucose tolerance and insulin resistance.24 Human subjects in Japan also demonstrated this effect of biotin supplementation. Patients with Type II diabetes demonstrated significant drops in their fasting glucose levels after taking 3 mg of biotin three times per day.25
Aside from vitamins, there are a couple of minerals also purported to relieve symptoms of insulin resistance and diabetes. Magnesium, for example, is thought to be involved in glucose metabolism and insulin secretion, and low magnesium levels are known to aggravate diabetic conditions. Magnesium deficiency occurs in approximately 25 percent of diabetic patients.
The trace mineral vanadium--the active and absorbable forms of which are vanadium pentoxide and vanadyl sulfate--has been given attention recently for its potential application in the realm of diabetes treatment. Animal research has demonstrated that supplementation with vanadyl sulfate or other vanadium compounds may be useful for treating diabetes by normalizing glucose levels.26 Another study indicated vanadium supplementation may induce these beneficial effects for up to 20 weeks after therapy is stopped. Researchers surmised the vanadium supplements somehow protect pancreatic cells.27
A human study of Type II diabetes indicated oral vanadyl sulfate (50 mg twice daily for four weeks) induced a nearly 20-percent drop in fasting blood glucose levels.28 In another study, supplementation with 100 mg of vanadyl sulfate daily for three weeks resulted in improved insulin sensitivity.29
From the Garden
While micronutrients are essential to the body's process of regulating insulin and glucose levels, several herbs and plant-derived compounds are thought to assist and even improve these same processes. In addition, some botanicals may also reduce the risks of diabetes-associated chronic disease.
Ginseng, for example, is thought to reduce risk factors for heart disease, as well as improve several symptoms of diabetes. Ginseng is an adaptogen that works on a cellular level to rid the body of toxins and restore normal body function. The active constituents of ginseng, which are triterpenoid saponins called ginsenosides, are thought to be responsible for the herb's pharmacological activity. Two varieties of ginseng that have been studied in the realm of diabetes care include Panax quinquefolius (American) and Panax ginseng (Asian).
American ginseng is thought to reduce hyperlipidemia and hypertension, as well as reduce insulin resistance.30 American ginseng supplementation was also found to improve the increase in glucose levels typically seen after food intake. Researchers stated the herb improved patients' glycemic response to food, and this response was seen regardless of the dose size or when the supplement was taken with respect to a meal.31
Asian ginseng--and its active constituent ginsenoside Re--is thought to prevent high blood sugar levels and protect against obesity, as demonstrated in animal research. Investigators found that ginseng supplementation improved glucose tolerance and reduced serum insulin levels, and extract-treated mice developed normal glucose levels after 12 days of therapy.32
Another botanical that may be useful against diabetes is fenugreek (Trigonellafoenum graecum). Diabetic animals given fenugreek achieved normal antioxidant levels and had reduced diabetes-associated oxidative damage.33 In addition, fenugreek supplementation may improve glycemic control and decrease insulin resistance in cases of mild Type II diabetes.34
An extract of Lagerstroemia speciosa L. is said to benefit diabetics by helping with weight management and by controlling plasma glucose. Animal research demonstrated that supplementation with the extract had a beneficial effect on female diabetic mice.35 Additional research with Type II diabetic animals indicated supplementation with the extract lowered blood sugar levels.36
A botanical used in Ayurveda for more than 2,000 years, gymnema (Gymnema sylvestre, Gymnema inodorum) is called "Gurmar" in Indian, meaning "sugar destroyer." It attained this name because chewing the leaves neutralizes the taste buds, thereby taking away the ability to taste sugar. For this reason, gymnema is sometimes recommended for weight loss because it is said to alleviate sugar cravings.
Gymnema is also suspected to have applications in diabetes and pre-diabetes, and it may increase insulin secretion. "We suggest that a person take gymnema as an adjuvant therapy [for diabetes] and monitor blood sugar levels to measure the response to gymnema," said P.K. Davé, president of Albany, N.Y.-based Nature's Formulary. "If the product works so well that conventional medication dosage can be reduced--and yes, there is evidence of this--we advise that this be done under the direction and supervision of a doctor."
Gymnemic acids derived from Gymnema inodorum are thought to suppress the elevation of blood glucose levels by inhibiting glucose uptake in the intestine.37 Similarly, animal research conducted in Japan demonstrated that consuming gymnemic acid IV--an extract of Gymnema sylvestre--reduced blood glucose levels in diabetic mice within 24 hours while it did not affect the blood glucose levels of healthy mice. In addition, the diabetic mice given the extract exhibited increased plasma insulin levels.38
In vitro research further elucidated the role gymnema plays in regulating insulin and glucose levels. Pancreas cell lines treated with an alcoholic extract of Gymnema sylvestre released more insulin than untreated cells.39
Similar to the gymnemic acids that can be extracted from gymnema, flavonoids can be extracted from various plants. Flavonoids are water-soluble pigments found in plants, and they are known antioxidants. In addition, several flavonoids have been suggested as potentially beneficial for diabetics.
The anthocyanosides found in bilberry are known for their benefits in heart and eye health. However, research out of France indicated that perhaps anthocyanosides can slow kidney damage in diabetic patients by reducing the amount of albumin (a serum protein) that escapes from leaky capillaries-- a condition commonly associated with diabetes. The French animal study indicated that diabetic rats supplemented with bilberry anthocyanosides had less albumin leakage than diabetic rats that were not given supplements.40
Grape seed extract also contains a group of flavonoids, which are known as proanthocyanidins. Researchers at Georgetown University in Washington investigated the effects of grape seed extract (as ActiVin, the patent for which is owned by San Joaquin Valley Concentrates in Modesto, Calif.), as well as niacin-bound chromium (as ChromeMate), for its effects on insulin resistance. They found the proanthocyanidin extract induced an improvement of insulin sensitivity and stopped free radicals from forming.41
Another group of flavonoids--the isoflavones found in soy--may be of potential use for diabetic patients. Soy isoflavones are also classified as phytoestrogens, similar to the lignans found in flaxseed, and both have been studied under the umbrella of diabetes care. A research review written by Sam J. Bhathena, Ph.D., and colleagues at the Phytonutrients Laboratory of the U.S. Department of Agriculture indicated daidzein and genistein (soy isoflavones), and matairesinol and secoisolariciresinol (flaxseed lignans) have anti-obesity and anti-diabetes actions.
"Nutritional intervention studies performed in animals and humans suggest that the ingestion of soy protein associated with isoflavones and flaxseed rich in lignans improves glucose control and insulin resistance," Bhathena and his colleagues wrote in a paper that has been submitted for review to the American Journal of Clinical Nutrition. "In animal models of obesity and diabetes, soy protein has been shown to reduce serum insulin and insulin resistance. In studies of human subjects with or without diabetes, soy protein also appears to moderate hyperglycemia and reduce body weight, hyperlipidemia and hyperinsulinemia, supporting their beneficial effects in obesity and diabetes. ... Isoflavones and lignans appear to act through various mechanisms that modulate pancreatic insulin secretion or through antioxidative actions."
Fats: The Good and the Bad
The word "fat" invariably brings to mind a negative image, and when the word is part of a food label, many consumers are turned off by its presence. The National Academy of Sciences issued a report in September saying no amount of trans-fat is healthy for human consumption, and it is well-known that saturated fat intake is a risk for heart disease. In addition, "bad" fat intake may up one's odds of developing Type II diabetes.
Researchers at the Harvard School of Public Health evaluated the Health Professionals Follow-Up Study--a cohort of 42,504 men--and found saturated and total fat intake increased diabetes risk. Specifically, processed meats were the suggested culprit behind a high risk of Type II diabetes.42
While some fats are undoubtedly bad for human health, there are several fats that are thought to improve heart, brain and metabolic health. Fatty acids, for example, are an important part of normal body function.
The human body can produce all but two groups of fatty acids--omega-3s and omega-6s--which are known as essential fatty acids (EFAs) because they must be obtained through the diet. These so-called "good" fats are suspected to improve the odds against developing Type II diabetes.
Researchers in Massachusetts learned that taking omega-3 and omega-6 long-chain EFA supplements suppressed the development of diabetes. Animals that were given the omega-3s eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as well as the omega-6s gamma-linolenic acid (GLA) and arachidonic acid (AA), were less likely to develop chemical-induced diabetes than the animals receiving no supplements. The EFA regimen was also found to restore the animals' antioxidant status to normal range.43
DHA has also been studied independently for pre-diabetes. Overweight, pre-diabetic subjects who took DHA supplements for 12 weeks had significantly improved insulin sensitivity. "Although these are very preliminary results from a small number of subjects, we were encouraged by the findings and plan to test the effect of DHA on a larger population," said Yvonne Denkins, Ph.D., lead investigator, in a press release from the Pennington Biomedical Research Center, in Baton Rouge, La. Denkins presented her findings in New Orleans at Experimental Biology 2002.
GLA has also been linked to improved insulin resistance, and levels of this EFA may determine diabetes risk as early as the fetal stage. The highest concentrations of insulin were seen in 7-year-old children who had both a low birth weight and a low GLA concentration.44
Evening primrose oil, which contains GLA, has also been studied in the realm of diabetes. Evening primrose oil supplementation was found to completely prevent the restriction of a metabolic pathway that is present in diabetes.45
In addition to the essential fatty acids, there are several non-essential fatty acids that are produced in small amounts in the body and may be useful for preventing diabetes and insulin resistance. Oleic acid, an omega-9 long-chain fatty acid, may inhibit the production of glucose. Animal research indicated oleic acid supplementation significantly increased insulin response to oral glucose.46 In addition, supplemental oleic acid may lead to a reduction in food intake.47
An Ongoing Battle
The battle to overcome Type II diabetes and pre-diabetes can only be won with proper knowledge. The science behind various diet and lifestyle choices, as well as the nutrients in dietary supplements, offers a light at the end of the tunnel. Type II diabetes is not unstoppable, and there are several ways to ensure and maintain good health.
The myriad options in the dietary supplement industry may seem a bit daunting to consumers, who are bombarded with hundreds of products and promises for good health. And yet, many consumers prefer to be in charge of their own health care, seeking out the latest research and products for their own benefit.
"While company literature and industry consumer information Web sites display the disclaimer 'Please see a physician before...,' the health food store consumer is looking for a natural alternative to either supplement or replace conventional medicines," Davé said. "I am sure this aspect is not new to retailers. Despite DSHEA [the Dietary Supplement Health and Education Act], retailers get put in the position of answering the question, 'What do you have for diabetes?'"
This is where having third-party literature on-hand is helpful. An up-to-date literature section allows customers to browse scientific information to make an informed decision about what supplements to buy. "Each health food store should have a good part of their store as a health information area where they're bringing this information to the public," Mindell said. "The retailer's responsibility, if they want to stay in business, is to become a health information center."
Gaining the proper knowledge is only the first step in a consumer's life-long journey to consistent health and wellness. Eating a healthy diet and sticking with an exercise routine are essential to preventing or reducing the deleterious effects of Type II diabetes. Once diabetes is established, it is forever, according to Mindell, and lifestyle changes are not to be taken lightly. "It's not going to be a week or a weekend, you have to do it every day, every meal," Mindell said. "If you're a diabetic, you're always a diabetic. And if you let yourself go, sooner or later you'll have problems with your eyesight, congestive heart failure, sexual dysfunction. It's a terrible thing that can be prevented."
Editor's notes: Some content for this story was sourced from Intramedicine (www.intramedicine.com).
Diabetes Facts
73% of people with diabetes have high blood pressure.
17 million people have diabetes (6.2% of the population).
11.1 million have been diagnosed with diabetes.
5.9 million people are undiagnosed.
1 million new cases of diabetes are diagnosed each year.
7 million age 65 or over (20.1% of all people in this age group) have diabetes.
Source: The Centers for Disease Control and Prevention, National Diabetes Fact Sheet, 2002.
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