Carbohydrate diabetes connection

Diabetes is a major problem in America, affecting an estimated 10 million people, and is increasing worldwide. There are two types of diabetes, one in which the pancreas has ceased production of insulin altogether (and in fact, the cells that produce it are often found to be destroyed), and the other in which the cells of the body have become insulin resistant - as explained in my article on Insulin Resistance, this means that blood sugar cannot be conveyed into the cells, with a consequent rise in both blood sugar and insulin levels.

This latter form of diabetes is the more common, and is almost always connected with obesity, more than 80% of those affected being overweight. Nutritionists now believe that obesity is the common factor in the increase of many chronic diseases in the United States, despite the extraordinary fact that there are the number of overweight people is increasing at the same time a Health Club a day opens, and people are eliminating fat from their diets with almost religious fervor.

Insulin is a hormone, a messenger in our body, and it is released by the pancreas to help cope with high levels of sugar in the blood. Its role is to stimulate the cells to capture sugar from the blood, and either burn it for energy as needed then and there, or produce a storage forms of carbohydrate called glycogen. When the cells are blocked from accepting insulin, it is left free in the blood where it cannot perform its function of lowering blood sugar levels, and the pancreas is therefore stimulated to produce more insulin. This leads to a condition called Hyperinsulemia, which in turn can lead to diabetes and heart disease.

and that is either to be stored as fat, or to be made into triglycerides: and as we all know, obesity and high triglycerides present us with many undesirable bills, which eventually have to be paid.

As insulin levels rise and insulin resistance in the body increases. the situation develops its own momentum: the activity of the delta desaturase enzymes which break down essential fatty acids declines, increased amounts of saturated fats become part of our cell membranes, and insulin sensitivity decreases again. The enzyme pathways shut down through which Arachidonic acid is converted to the friendly GLA. This in turn means the messengers (eicosanoids) which promote insulin sensitivity in the cells are not sent to do their jobs, more insulin is produced to take care of the added carbs, and a vicious cycle leading potentially to diabetes and cardiovascular problems (Syndrome X, or Insulin Resistance) is set in motion.

An important ratio for total health is the amount of lean muscle compared to the amount of body fat: the higher your ratio of lean tissue versus fat, the lower your risk for diabetes. (See RESOURCES at right)

The link between vitamin D3 and diabetes has been known for quite a while, though the mechanism is not yet explained. It makes me wonder whether the new phobia about sun exposure may in the long run have unexpected consequences, particularly for our children who would normally be out romping in the vitamin D rich sunshine all summer..

Don't overlook the fact that diabetics are at greater risk for osteoporosis: to quote information provided by Dr. Steven Schneider in answer to a question in Medscape, "it is clear that there is an increased risk for low bone mineral density and particularly for bone fractures in patients with type 1 and, to a lesser extent, type 2 diabetes mellitus. These abnormalities may be related at least in part to prolonged periods of poor metabolic control and might be decreased by more aggressive treatment regimens.......Certainly women with diabetes need to pay special attention to the prevention of osteoporosis by maintaining an adequate calcium and vitamin D intake. This will often require calcium supplementation, which may need to be started at an early age while peak bone mass is still developing."

Onion and garlic have significant blood sugar lowering action, because their double sulfur (Thiole) bonds bind to enzymes which deactivate insulin, allowing it to be active longer. The oils have active effects, but flavonoids such as Quercetin in onions may also come in to play, and the principal active ingredients are allyl propyl disulphides (APDS), and diallyl disulphide oxed
(Allicin) which appear to compete with insulin for docking sites in the liver, thus making more free insulin available in the blood stream and lowering glucose levels

Onion extract has been found to reduce blood sugar levels during oral and intravenous glucose tolerance. The effect improved as the dosage was increased; however, beneficial effects were observed even for low levels that used in the diet (eg., 25 to 200 grams). The effects were similar in both raw and boiled onion extracts. Onions also affect the hepatic metabolism of glucose and/or increases the release of insulin, and/or prevent insulin's destruction.

In supplement form, studies have shown that the garlic needs to be standardized for its allicin content, when 800mg per day can significantly lower fasting blood glucose levels.

Alpha Lipoic Acid (also known as Thioctic Acid, another thiol), has been used for some years now in Europe for this condition. Dr. Murray says that ALA "help diabetics by facilitating better conversion of sugar into energy...Its ability to improve blood sugar metabolism is a result of its effects on glucose metabolism and an ability to increase insulin sensitivity. Diabetics taking insulin or blood sugar lowering drugs are cautioned that lipoic acid supplementation can result in changes in dosage requirements. Close monitoring of blood sugar levels is required." Doses are in the 500 to 600 mg range, and less may not be effective.

The January 2005 edition of Diabetes Care, ( vol 28: pp 96-101.) carries a study by Dr. Sima which evaluated two studies involving over 1200 patients with diabetic neuropathy. Analysis indicated significant improvement, both at the 6 month and 1 year mark using 1000 mgs of Acetyl-L-Carnitine.

People who had been diagnosed with diabetes for the shortest length of time not only experienced the highest level of pain relief, but also showed improvement in nerve structure and reactions.

The researchers said the results suggested that optimal results may be obtained by starting this therapy as early as possible in the course of the disease.

researchers from the National Institute of Diabetes and Digestive and Kidney Diseases state that chronic activation of the immune system, with upregulation of interleukin-6, may play a role in the pathogenesis of type 2 diabetes. Cortisol or sex hormones or both could also be contributing factors, the investigators add.

Jack Challem, the Nutrition Reporter, traces an interesting route for a stress/diabetes connection in his 2007 book, the Food-Mood Solution. He points out that not only does the increased stress of our lifestyles cause cortisol to be imbalanced, but also that the changes in our personalities caused by unrelenting stress lead to less time for, and less interest in, nutritious cooking and wise dietary choices.

I read a fascinating article in issue 49, 2000 of the Herbalgram (you can find it at herbalgram.org) which detailed a quest initially undertaken by 20 Native Americans of the Seri and O'odham tribes, but eventually swelling to number 120 "Desert Pilgrims"

These tribes finally tired of the probing research undertaken by the National Institute of Health into the high incidence of Diabetes in Native Americans, and decided to organize a trek through their ancestral region, eating nothing but indigenous foods and living off the land. They were full of trepidation at the start of the trek, not sure they could make it through the 12 day, 240 mile journey.

Along the way, they ate only prickly pear and other cactus, wild greens, wild game supplied both by villages they passed through and the efforts of their own hunters, beans, mescal, chia seeds and chilies. They drank only water and teas made from creosote bush, damiana and desert lavender (among other herbs).

At the end of the walk, there were reports of dramatically reduced blood glucose levels as well as improvement in cholesterol levels. This is living proof of the wisdom of the Paleolithic diet - which can be simply summed up as "if it didn't exist 100 years ago, don't eat it." I would add "if it doesn't rot with time, don't eat it"!

Of course, in Paleolithic times there were going to be days when nothing at all was on the menu - enforced, fasting, as you might say. This ties in with interesting research which suggests that fasting one day a month positively affects cardiovascular health, possibly through reduced exposure to glucose. Researchers theorize that this one day without food gives the organs time to rest and work more efficiently.

one is the 40-30-30 diet, where care is taken every day that the food you eat is always composed of 40% complex carbohydrates, 30% protein and 30% fat, with between 50 and 100 grams of fiber daily.

The other is to make sure that you are drinking at least 8 glasses of pure water every day, and that your sodium intake is adequate.

The balance of nutrients I recommend above has a very low glycemic index, which means that their entry rate into the blood stream is slow: this in turn means that the body has time to control the situation, the pancreas is not over-stimulated to produce insulin, and the mechanism that stores fat in the body is not put on high alert. What about the water and salt?

Supplements can also help: a British study (Diabetes Care 2002;25:1709-1714.) has shown that even short-term use of dietary phytoestrogens significantly and positively affects fasting insulin levels, insulin resistance, HbA1c levels, total cholesterol levels, LDL cholesterol, cholesterol/HDL cholesterol ratio, and free thyroxine (thyroid function) levels. The investigators concluded that even short term supplementation with soy phytoestrogens ( though it was not clear whether the soy protein itself, or its component isoflavones are responsible for the effect) reduces insulin resistance and improves glycemic control in type 2 postmenopausal diabetics.

A study in the Journal of the American Medical Association showed the risk of diabetes for women whose iron levels are too high increased significantly. You can access the study in RESOURCES at right.

As long ago as 1982 the American journal of Clinical Nutrition reported a correlation between serum chromium and serum insulin levels, and recent research has corroborated that, together with vanadium, it is effective in controlling blood sugar levels. A 1997 study by Anderson, in Diabetes, 46:1786-91, which was randomized and placebo-controlled showed that both fasting and post-prandial sugar and insulin levels were reduced significantly using chromium. The study got better results using a dosage of 1000 mcg. per day, where previously only 200 mcg have been routinely recommended by nutritionists.

Insulin dependant diabetics should use chromium with caution, since its very effectiveness can be dangerous for them.Perhaps the most widely used form of chromium is Chromium Picolinate, and in view of some of the rumors that have been spread about this supplement, almost always encouraged if not outright started by companies making rival forms, I want to take this opportunity of saying that both the USDA and the manufacturers have undertaken toxicity studies that meet every standard of such studies, and have never come up with any adverse results. (HPB June 99;8)

A 2001 study suggests that treatment with L-Arginine over a long period (1 month in the study) can improves insulin sensitivity in patients with type 2 diabetes. The authors of the study point out that L-Arginine, which increases nitric oxide (NO) levels, is known to stimulate insulin secretion. In this study, patients treated with 3 grams of the amino acid daily showed reductions in systolic blood pressure compared with placebo-treated patients, together with significantly increased forearm blood flow and normal levels of cyclic guanosine monophosphate, a second messenger of NO. More to the point, patients who received L-Arginine had a significant ( 34%) increase in glucose disposal and significant improvement in hepatic insulin sensitivity, as endogenous glucose production decreased significantly although glucose production in both the L-Arginine group and the placebo group remained significantly higher than in 10 normal subjects.

"Our study has shown for the first time that an increment in NO availability induced by the administration of L-arginine is able to increase insulin sensitivity, even if complete normalization is not achieved," the authors conclude.

Diabetes Care 2001;24:875-880.

this substance helps maintain healthy RNA/DNA, deterioration of which can lead to many age-related disorders, to include diabetes.

The USDA was considering applying for a use patent on Cinnamon Extract for diabetes, based on their studies showing beneficial effects on blood lipids as well as a significant 20% improvement in blood sugar levels. Read the study here. I hope this doesn't mean that certain fast food chains will now begin promoting their cinnamon rolls as nutritional supplements BUT the substantial evidence for the helpfulness of cinnamon in blood sugar control can no longer be ignored.

Another supplement that seems to help particularly with the problem of insulin resistance is Garcinia Cambogia. It comes from India, where it has been traditionally used as an appetite control, and as an aid in processing food. It is a source of hydroxy-citric acid, or HCA, which appears to work by blocking a key cellular pathway that converts glucose to fat. Certainly animals fed an HCA supplemented diet have shown reduced food intake, a decline in body fat and lowered triglyceride levels.

Traditional Ayurvedic medicine has successfully applied a herbal approach to diabetes: a herb called Gymnema Sylvestre (also recommended by Dr. Whitaker) which appears to assist the pancreas in manufacturing insulin, and in studies has been shown to be successful in helping control both type 1 and 11 diabetes - in fact, it is recommended by Natural Health professionals that you monitor your medication carefully, since this herb can lower requirements for it.. studies have been done using a specific Gymnema extract called GS4, and the results are encouraging. Using 200 mg/day cutspatients' required insulin dose in half...

Bitter Melon also helps regulate blood sugar, even for pets, and research is being done on the herb Fenugreek for its part in controlling blood sugars. Dr. Leigh Broadmoor (News from the Herbal Village, Vol. 1V, Issue 1: 11) points out that fenugreek is about 50% fiber, with 20% being mucilage and mucilage makes a significant difference to blood sugar levels. She cites a study done by the Indian National Institute of Nutrition where 10 IDDM patients were given 100 grams of debittered fenugreek seed powder per day, which led to a 30% decrease in fasting glucose and an improvement in glucose tolerance. The amount of sugar excreted in the urine dropped by 54% without a concomitant increase in blood sugar levels. She says this result cannot be explained entirely by the mucilage, and fenugreek also contains many plant phytochemicals which may be part of the effect. Be careful of Fenugreek if you have allergies to other foods n the same family, such as soy or peanuts!

which helps transport glucose and therefore balance blood sugar, evening out the highs and the lows. Companies are now coming out with combinations of the herbs and nutrients helpful for insulin control, and three I recommend are Glucoreg by Solaray, Glucocare by Ayurvedic Concepts, and Glucotrim by Nature's Plus. My own formulation, Glucose Support, contains many of these helpful nutrients.

Jarrow Formulas makes a protein mix called Glycemic Balance, which has been used very successfully by many of my clients attempting to control sugar variations, and a formula called Glucose Optimizer, which in effect contains nearly everything I have mentioned to regulate blood sugar. Another herb which helps balance blood sugar is American Ginseng, which has been shown to lower blood sugar levels even in non-diabetics. (Arch.Intern.Med., Apr. 10 2000; 160(7):1009-13)

An interesting and little known fact is that the end products of sugar metabolism in the body are actually used as markers for aging. They are called AGEs, appropriately enough, which stands for Advanced Glycation End Products. The more of them you have, the older your biological age. Controlling your blood sugar, therefore, can actually address your life span. Some studies suggest American Ginseng can lower the AGE levels. So, if you want to live longer, limit your carbohydrate intake, choose any carbohydrates you eat from those containing sugars which enter the blood slowly, usually because they are accompanied by protein, fiber or fatty acids, and select supplements which will help you balance your sugars. See RESOURCES for more about Glycemic Index and Glycemic Load.

Consider the financial costs of Diabetes, as estimated by the American Diabetes Association:

Direct medical and indirect expenditures attributableto diabetes in 2002 were estimated at $132 billion. Direct medicalexpenditures alone totaled $91.8 billion and comprised $23.2billion for diabetes care, $24.6 billion for chronic complications attributable to diabetes, and $44.1 billion for excess prevalenceof general medical conditions. Inpatient days (43.9%), nursinghome care (15.1%), and office visits (10.9%) constituted themajor expenditure groups by service settings. In addition, 51.8%of direct medical expenditures were incurred by people >65years old. Attributable indirect expenditures resulting fromlost workdays, restricted activity days, mortality, and permanentdisability due to diabetes totaled $39.8 billion. U.S. healthexpenditures for the health care components included in thestudy totaled $865 billion, of which $160 billion was incurredby people with diabetes. Per capita medical expenditures totaled$13,243 for people with diabetes and $2,560 for people withoutdiabetes. When adjusting for differences in age, sex, and race/ethnicitybetween the population with and without diabetes, people withdiabetes had medical expenditures that were 2.4 times higherthan expenditures that would be incurred by the same group inthe absence of diabetes.

Smokers Beware!

Cigarette smoking is now further implicated as a culprit of impaired glucose tolerance. According to findings published recently in the Annals of Internal Medicine , risk of impaired fasting glucose and type 2 diabetes increases in a dose-dependent manner with the number of cigarettes smoked per day and the number of pack-years of exposure. Nakanishi et al (Ann Intern Med. 2000;133:183-191.)perceive the findings as evidence that smoking is a "modifiable risk factor that can be targeted" for diabetes prevention.

The risks for developing type 2 diabetes were imposing. In comparison with never-smokers, the relative risk was 1.08 for ever-smokers, 1.88 for the one-to-20-cigarette group, 3.02 for the 21-to-30-cigarette group, and 4.09 for heavier smokers -- constituting a statistically significant trend across current-smoker categories. The longer the habit has existed, the greater the increase of risk.

"The mechanism of how cigarette smoking increases the risk for impaired fasting glucose and type 2 diabetes remains to be elucidated," write Nakanishi and colleagues. They cite recent study findings suggesting that smoking causes insulin resistance in peripheral tissues, increased serum insulin and C-peptide levels, and the release of counterregulatory hormones.

Of course, they might also consider the fact that most cigarettes contain sugar.

Diabetes is a very serious health condition, and I do not to suggest that you make changes without your Doctor's consent; for many people, however, nutrition makes the difference between medication & control.