Elements of Living Well ... With Diabetes

References

It takes more than “an apple a day” to live well in today’s hectic world. This is especially true for 7 percent of the population— 20.8 million children and adults living in the United States—who have diabetes, according to the latest study done by the American Diabetes Association (ADA).

Diabetes is a chronic condition in which the body produces too little insulin or can’t use available insulin efficiently. Untreated, diabetes can cause long-term complications that affect almost every part of the body, and it can lead to premature death. But if it’s well-managed, people can expect to live long, healthy lifestyles—while enjoying a few apples along the way.

Identifying Diabetes

Diabetes develops when there is too much glucose (sugar) in the blood. Glucose is the major source of energy for the body’s cells. Insulin, a hormone made in the pancreas, controls the amount of sugar in the blood by moving it into the cells, allowing the body to use it for energy. Without insulin, the cells cannot use, or control, glucose. When the body does not have enough insulin, or cannot use it efficiently, the level of glucose in the blood rises and the result is hyperglycemia. Too much insulin and the blood sugar level drops, resulting in hypoglycemia.

There are three elemental types of diabetes: type 1 diabetes (formerly called insulin-dependent or juvenile diabetes), type 2 diabetes (formerly called non-insulin-dependent diabetes mellitus or adult-onset diabetes), and gestational diabetes, which affects pregnant women.

Type 1 diabetes develops when the body’s immune system destroys the pancreatic cells that make insulin. To survive, people must have insulin injected or pumped into their bloodstream. Type 1 diabetes usually strikes children and young adults, although onset can occur at any age, according to the Centers for Disease Control and Prevention (CDC).

Type 2 diabetes develops when the cells do not respond to insulin properly (insulin resistance). As the blood requires more insulin, the pancreas loses its ability to produce it. Type 2 diabetes is largely associated with older age, obesity, family history, physical inactivity, and race/ethnicity. It accounts for 90 percent to 95 percent of all diabetes cases.

The third type of diabetes, gestational diabetes, is a problem among pregnant women. Its onset occurs when the hormones produced by the placenta increase the mother’s resistance to insulin. If left uncontrolled, it can be dangerous for both baby and mother.

While the cause of type 1 diabetes is still under investigation, both genetics and the environment appear to influence this autoimmune condition. Type 2 diabetes, on the other hand, has a number of causes, including obesity, dietary habits, metabolic syndrome and smoking. According to the June 2007 report by the American Association of Clinical Endocrinologists (AACE),¹ the roadmap to prevent type 2 diabetes begins with early identification, continues with lifestyle modification and pharmacologic intervention, and follows up with persistent monitoring of glucose and risk reduction measures.

AACE notes there are several factors that can increase a person’s chance of developing diabetes:

Pre-diabetes is also known as metabolic syndrome or Syndrome X, and is a risk factor for diabetes. The syndrome is characterized by a group of independent risk factors such as impaired glucose regulation, high levels of cholesterol and triglycerides, high blood pressure and abdominal obesity.² Other key factors lending risk to metabolic syndrome are insulin resistance and chronic inflammation. The American Heart Association (AHA) estimates more than 50 million Americans have metabolic syndrome. The dominant underlying factors are abdominal obesity and insulin resistance. While some people are predisposed to insulin resistance, other factors such as excess body fat, physical inactivity, aging and hormonal imbalance can elicit metabolic syndrome.

The importance of a healthy diet, with a particular focus on low glycemic index (GI) foods, is necessary when preventing or reversing metabolic syndrome. The GI measures the rise in blood sugar after eating a certain food compared to the blood sugar rise caused by glucose (blood sugar).

A large sugar intake means huge amounts of rapidly digested and absorbed simple sugars (glucose and fructose) flood the body at intervals, stressing the body. For those diagnosed with diabetes, a low- GI diet offers a host of benefits, including preventing spikes and/or sudden drops in blood sugar levels. Italian researchers studied the effects of dietary treatment with increased amounts of fiber-rich, low-glycemic index natural foods in type 1 diabetics (n=63).³ After 24 weeks, patients on the high-fiber diet had improved glycemic control and a reduced number of hypoglycemic events, compared to those on a low-fiber diet.

Researchers at the University of Texas Southwestern Medical Center agree on the beneficial effects of high dietary fiber intake in patients with type 2 diabetes.⁴ In a six-week, randomized crossover study they found a high intake of dietary fiber, particularly of the soluble type, improved glycemic control, decreased hyperinsulinemia, and lowered plasma lipid concentrations in patients with type 2 diabetes.

One type of novel fiber, Salba® (Salvia hispanica L.), was studied by a team at St. Michael’s Hospital, Toronto, to determine whether the addition of Salba and minerals to conventional treatment for type 2 diabetes was associated with improved cardiovascular risk factors.⁵ In a single blind, crossover design, subjects received either Salba or wheat bran while continuing conventional therapies. The study concluded long-term supplementation with Salba decreased systolic blood pressure and other emerging factors safely beyond conventional type 2 diabetes therapies while maintaining good glycemic and lipid control.

Botanical Benefits

While diet and lifestyle changes have a key role to play, increasingly, researchers are finding nutritional ingredients may also help support normal blood sugar levels and reduce risk factors for metabolic syndrome or type 2 diabetes. Several botanical ingredients may help the body to better regulate blood glucose or decrease complications of diabetes.

Gymnema (Gymnema sylvestre, G. inodorum) grows in the tropical forests of central and southern India and in parts of Africa, and may improve glucose control. In a two-part study conducted at Kobe University School of Medicine in Japan, the effect of gymnema on glucose homeostasis was studied in rats.⁶ In the first part, administration of GS4 (an extract of G. sylvestre) in non-diabetic rats significantly reduced the serum glucose response to an oral administration of glucose. The immunoreactive insulin (IRI) response was lower, but not significantly, than that of control rats. In mildly-diabetic rats, a 60- minute increment in serum glucose concentrations was significantly reduced by GS4 administration. In the second set of experiments, the chronic effect of gymnema was studied in mildly-diabetic rats. The rats were fed with either a control diet or a diet supplemented with gymnema. Results showed gymnema reduced the serum glucose concentrations in the fed state and improved glucose tolerance. These results suggest gymnema is useful in the treatment of certain classes of non-insulin-dependent diabetes mellitus.

In another study conducted at Postgraduate Institute of Basic Medical Sciences, Madras, India, the effectiveness of GS4 in controlling hyperglycemia was investigated in type 2 diabetic patients on conventional oral drugs.⁷ Patients given a GS4 supplement showed a significant reduction in blood glucose, glycosylated hemoglobin and glycosylated plasma proteins, and conventional drug dosage could be decreased. Five of the 22 patients were able to discontinue their conventional drug therapy and maintain their blood glucose with GS4 alone.

Trigonella foenum-graecum (fenugreek) seeds are high in soluble fiber, and studies have found fenugreek may help lower blood sugar levels by slowing carbohydrate digestion and absorption.⁸ Researchers at the University of Ulster, Northern Ireland, conducted a study on anti-diabetic properties of a soluble dietary fiber (SDF) fraction of fenugreek on both non-diabetic and type 2 diabetic rats.⁹ The SDF fraction suppressed the elevation of blood glucose after oral sucrose ingestion in both non-diabetic and type 2 diabetic rats. These findings indicate the SDF fraction of fenugreek seeds provide anti-diabetic effects mediated through inhibition of carbohydrate digestion and absorption, and enhancement of peripheral insulin action.

Scientists at Pt. B.D. Sharma Medical College, Rohtak, also studied the effects of fenugreek on normal and alloxan-induced diabetic rats.¹⁰ After administering oral dosages of fenugreek, both the normal and the diabetic rats showed a significant decrease in blood glucose. The hypoglycemic effect was dose related. Chinese researchers also report fenugreek extract can lower kidney/body weight ratio, blood glucose, blood lipid levels and improve hemorheological properties in experimental diabetic rats.¹¹

Known for its hypoglycemic effect, bitter melon has some 90 names around the world, including bitter gourd, balsam pear and karela. Researchers from University of Hong Kong report bitter melon, combined with a high fat diet, improves insulin resistance, lowers serum insulin and leptin, but raises serum free fatty acid concentration.¹² The study reveals multiple influences on glucose and lipid metabolism that counteract the effects of a high fat diet. Scientists at Central Food Technological Research Institute, Mysore, India, examined the effect of the edible portion of bitter gourd at a 10 percent level in the diet in streptozotocin-induced diabetic rats, and found it improved glycemic control and blood glucose measures.¹³

Cinnamon has been studied for its use in treating elevated blood sugar levels. A study published in the Journal of the International Society of Sports Nutrition examined the effects of cinnamon supplementation on body composition and metabolic syndrome.¹⁴ Twenty-two subjects with pre-diabetes and metabolic syndrome were randomly given either cinnamon (as Cinnulin PF®, from Integrity Nutraceuticals) or placebo as supplements to their diet. Those in the Cinnulin PF group showed significant decreases in fasting blood glucose, systolic blood pressure and an increase in lean mass compared to the placebo group. The Cinnulin PF group also showed a decrease in body fat. The data collected on this naturally-occurring spice suggests it may reduce risk factors associated with diabetes and other cardiovascular diseases.

A team from the University of Birmingham, England, also conducted a study to determine the effects of cinnamon and its phenolic extracts on glucose homeostasis in humans.¹⁵ Seven lean, healthy male volunteers underwent oral glucose tolerance tests supplemented with placebo, cinnamon or cinnamon taken 12 hours prior in a randomized crossover design. Results showed reduced total plasma glucose responses, as well as improving insulin sensitivity. Not only were its effects immediate, they also appeared to be sustained for 12 hours.

According to another study by the Institute of Food Science in Hanover, Germany, cinnamon extract seems to have a moderate effect in reducing fasting plasma glucose concentrations in diabetic patients.¹⁶ Seventy-nine patients diagnosed with type 2 diabetes, and not on insulin therapy but treated with oral medication, were given either cinnamon extract or placebo three times a day for four months. The results showed a decrease in plasma glucose, indicating patients with a higher initial plasma glucose level may benefit more from cinnamon intake.

Plant extract from the bark of French maritime pine tree (as Pycnogenol®, from Natural Health Science) is known for its antioxidant properties, and may also have particular benefits for diabetics. A study published in the September 2006 edition of Angiology showed Pycnogenol supplementation significantly reduced diabetic microangiopathy (DM) in type 2 diabetics.¹⁷ The study included 60 diabetic patients who were suffering from DM and receiving insulin treatments for at least three years at the Chieti-Pescara University in Italy. Those taking Pycnogenol showed improved capillary blood flow by 34 percent, compared to 4.7 percent in the placebo group. In another study, Chinese researchers concluded adding Pycnogenol (100 mg/d) to conventional diabetes treatment lowers glucose levels and improves endothelial function.¹⁸

Aloe vera has been used since prehistoric times for medicinal purposes such as soothing sun burns and healing wounds. But clinical studies show aloe gel taken internally may produce a mild reduction in mean glucose levels. In a study conducted at the University of Istanbul, Turkey, experiments were done on three groups of rats: non-diabetic, type 1 and type 2 diabetes.¹⁹ Aloe vera leaf pulp and gel extracts were unsuccessful in lowering the blood sugar level in the non-diabetic rats; however, they showed hypoglycemic activity in both type 1 and type 2 diabetic rats compared to the anti-diabetic medication glibenclamide. In contrast, gel extract showed hyperglycemic activity in type 2 diabetic rats. Researchers concluded due to the differences in the part of the plant, the pulps of the leaves devoid of the gel may be of use in the treatment of non-insulin dependent diabetes mellitus (type 2 diabetes).

Scientists at the University of Madras, Chennai, India, evaluated the presence of hypoglycemic activity in an alcohol extract of aloe vera gel through oral administration in normal fasted rats, oral glucose-loaded rats and streptozotocin-induced diabetic rats.²⁰ The aloe maintained glucose homeostasis by controlling carbohydrate metabolizing enzymes.

Punicalagins are the major players behind the antioxidant capacity of pomegranate. The effect of pomegranate fruit extract (PFE) was evaluated in comparison to regular pomegranate juice and seed oil on the biological actions of nitric oxide (NO) and arterial function in obese Zucker rats, a model of metabolic syndrome.²¹ Results indicated supplementation with PFE or PJ significantly decreased the expression of vascular inflammation markers, thrombospondin (TSP) and cytokine TGFbeta-1, whereas seed oil supplementation had an effect only on TSP-1 expression. Further, plasma nitrate and nitrate levels were significantly increased by PFE and PJ.

Lagerstroemia speciosa L., known as banaba, is a popular medicinal plant from the Philippines and is used in folk treatments for type 2 diabetes. Banaba is high in corosolic acid and has insulin-like activity, according to researchers. One study from the Central Research Institute, Shizuoka, Japan, studied the hypoglycemic effects of banaba leaves in hereditary diabetic mice.²² A test diet containing either hot water extract (HWE) from banaba leaves, water eluent of the partial fraction unabsorbed onto HP-20 resin of HWE (HPWE), or the methanol eluent of the partial fraction absorbed onto HP-20 resin of it (HPME) was fed to the mice. Results suggest HWE, especially HPME, has beneficial effects on control of the level of plasma glucose in type 2 diabetic mice.

In another study in Korea, the effects of malted barley extract (MBE) and banaba extract on blood glucose levels in genetically diabetic mice.²³ The mice (divided into three groups — control, MBE and banaba) — received oral doses of either MBE or banaba. Results showed fasting blood glucose was significantly lower in the MBE group compared with either the control or banaba group; there was no significant difference in the serum insulin level among groups; and the glucose-6-phosphatase activity in kidney was significantly lower in both the MBE and banaba groups compared with the control group, with no significant difference between the MBE and banaba groups.

Maitake (Grifola frondosa), an edible medicinal mushroom, grows in the northern hemisphere and is found in Japan, China, Europe and North America. As maitake grows, the content of crude protein rapidly decreases while the total carbohydrate weight rapidly increases. At harvest, fresh maitake contains 91-percent moisture, with beneficial proteins, carbohydrates and fiber, as well as vitamins B1, B2 and ergosterol (provitamin D). A study from Nishikyushu University, Saga, Japan, investigated the effects of maitake on insulin concentration, organ weight, serum composition, and islets of Langerhans in streptozotocin-induced diabetic rats.²⁴ The diabetes and control groups were given either diets containing 20 percent maitake (DM and CM groups) or control diets (D and C groups). During administration of the experimental diets, researchers measured body weight, food intake, amount of feces, and serum insulin concentration at glucose loading. The results showed maitake’s bioactive substances can ameliorate the symptoms of diabetes.

Another study from Georgetown University Medical Center, Washington, D.C., examined benefits of a watersoluble extract of maitake on the glucose/insulin metabolism of insulin-resistant KK mice.²⁵ The extract favorably influenced glucose/insulin metabolism.

Cissus quadrangularis, rich in vitamin C and betacarotene, is an ancient medicinal plant native to the hotter parts of Ceylon and India. Researchers studied the effect of a proprietary extract of Cissus quadrangularis (CQR- 300) to that of a proprietary formulation containing Cissus (CORE) on weight, blood lipids and oxidative stress in a two-part study.²⁶ The first part of the study investigated the in vitro antioxidant properties of CQR-300 and CORE while the second part of the study was a double blind, placebo-controlled design. Participants (n=150) received two daily doses of CQR-300, CORE or placebo, and were encouraged to maintain their normal levels of physical activity. Results showed both formulations brought about significant reductions in weight and blood glucose levels, while decreasing serum lipids, thus improving cardiovascular risk factors.

Combinations of beneficial botanicals also appear to have powerful activity in the area of diabetes management. Indus Biotech developed Glycibal™, a formula based on the principles of Ayurveda, by combining botanicals including fenugreek, Salacia reticulate, green tea (Camelia sinensis), Amla (Emblica officinalis), flax seed and Tribulus terrestris. An unpublished human clinical study conducted by Indus Biotech on 30 latestage type 2 diabetes patients found a net reduction of 27 percent external insulin injection with improved glycemic control.

Supporting Basic Nutrition

The basic elements, such as antioxidants and minerals, are also important in helping manage healthy blood glucose levels. For example, the connection between diabetes and magnesium deficiency is well known. Several clinical studies have examined the potential benefit of supplemental magnesium on metabolic control of type 2 diabetes. In one study, a cross-sectional analysis was conducted to examine the relationship between serum magnesium in 50 type 1 and type 2 diabetic patients, with or without complications; 40 healthy subjects served as the control group.²⁷ Serum magnesium levels in the diabetic population were significantly lower in comparison to the control group. Further, it was significantly lower in diabetes with complications than without complications. The National Institute of Environmental Medicine, Stockholm, Sweden, conducted a meta-analysis to assess the association between magnesium intake and the risk of type 2 diabetes.²⁸

Their findings suggest increased consumption of magnesium-rich foods such as whole grains, beans, nuts, and green leafy vegetables may reduce the risk of type 2 diabetes. And a study out of the Tehran University of Medical Sciences, Iran, suggests magnesium may help in the management of diabetes and prevent vascular complications and hyperlipidemia associated with the condition.²⁹

The human body uses the trace mineral vanadium for normal metabolic processes and for the healthy growth of bones and teeth. However, recent research suggests it may do much more than that by assisting with cholesterol reduction and stabilizing blood sugars in type 2 diabetics. Researchers at Hokkaido College of Pharmacy, Otaru, Japan, examined the effect of oral administration of vanadyl sulfate (a form of vanadium) in diabetic rats.³⁰ Diabetes was induced by intravenous injection of streptozotocin while non-diabetic control animals were injected with an equal volume of saline. Vanadyl sulfate was given orally to both groups. Glucose tolerance testing was done two weeks after vanadyl sulfate was administered. The fasting blood glucose level in the diabetic rats was higher than in the non-diabetic rats, whereas the plasma insulin level in the diabetic rats was lower. An increase in blood glucose was significantly greater in the diabetic rats, while it was not changed in the diabetic rats.

Chromium is an important mineral required in trace amounts for natural protein, fat and carbohydrate metabolism. Biologically active, chromium is known to enhance the action of insulin, but more research is needed to determine the full range of its roles in the body. The most active areas of chromium research are its use in supplement form to treat diabetes, lower blood lipid levels, promote weight loss, and improve body composition.

Researchers at Creighton University Medical Center studied longterm safety of oxygen-coordinated, niacin-bound chromium (NBC, as ChromeMate®, from InterHealth Nutraceuticals) in Sprague-Dawley rats.³¹ At six, nine and 12 months of treatment, body weight gain of the ChromeMate-treated groups was significantly reduced by 7.7 percent, 8.1 percent, and 14.9 percent in male rats, and 5.5 percent, 11.4 percent, and 9.6 percent in female rats, respectively. Treatment did not cause significant changes in organ weights, blood chemistry, histopathology, or liver lipid peroxidation and DNA fragmentation. Some evidence also points to a connection between NBC and insulin resistance, oxidative stress and high blood pressure. The effects of NBC and grape seed extract (GSE) on blood pressure, lipids and indicators of glucose regulation were evaluated in rats.³² The investigators found NBC, alone or combined with GSE, acted as an antioxidant, lowering blood pressure and enhancing insulin function in rats with normal blood pressure.

Another well-investigated form of chromium is chromium picolinate. In a randomized, double blind, placebo-controlled study, the efficacy and safety of a combination of chromium picolinate (as Chromax®, from Nutrition 21) and biotin were evaluated.³³ Results suggest the chromium picolinate/biotin combination, administered as an adjuvant to current prescription anti-diabetic medication, can improve glycemic control in overweight to obese individuals with type 2 diabetes; especially those patients with poor glycemic control on oral therapy. Another study from the University of Vermont, Burlington, suggested chromium picolinate supplementation attenuates body weight gain and increases insulin sensitivity in subjects (n=37)with type 2 diabetes.³⁴

Another study out of Chicago suggests the combination of chromium picolinate and biotin may be a valuable nutritional therapy to reduce the atherogenic index of plasma (AIP) in people with type 2 diabetes.³⁵ The study was conducted on 36 moderately obese subjects with T2DM and with impaired glycemic control.

Coenzyme Q10 (CoQ10) facilitates the energy process in cells, but also works as an antioxidant. Therefore, it appears CoQ10 can aid in the body’s response to a host of health problems, including diabetes. Researchers from Gujarat, India, studied the effect of CoQ10 on catalase activity and other antioxidant parameters in diabetic rats.³⁶ Treatment with CoQ10 produced a significant decrease in elevated levels of glucose, cholesterol, triglycerides, very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL) and atherogenic index, and increased high-density lipoprotein (HDL) cholesterol levels in the diabetic rats. The mechanism of action appears to be its antioxidant effects.

Another potentially beneficial antioxidant is alpha-lipoic acid (ALA). At its most fundamental biological level, ALA breaks down glucose in every cell and converts it to energy. In type 2 diabetes, the body over-produces insulin in response to diets high in refined carbohydrates. In turn, ALA acts as an antioxidant, neutralizing hazardous free radicals that lead to diabetic complications, such as diabetic neuropathy and cataracts.³⁷ 

Researchers from the Mayo Clinic Rochester, Rochester, Minn., assessed whether oral ALA could improve neuropathic symptoms in patients with symptomatic diabetic polyneuropathy.³⁸ Results showed oral ALA in doses of 600 mg, 1,200 mg, and 1,800 mg was effective in reducing neuropathic symptoms of diabetic distal symmetric polyneuropathy (DSP) at five weeks.

The effects of ALA on endothelial function in aged diabetic and high-fat fed rats was studied in Coimbra, Portugal.³⁹ This study was conducted to investigate the effects of ALA on endothelial function in diabetic and high-fat fed animal models, and to identify the potential benefits of ALA. The study concluded ALA restored endothelial function and significantly improved systemic and local oxidative stress.

Although diabetes can be potentially life-threatening, people with well-managed diabetes can expect to live a long and happy life. Type 2 diabetes is preventable and/or reversible through a healthy lifestyle—a lifestyle that balances healthy eating habits, daily exercise, and controlling stress. Strive for a variety in life. These are the elements essential in living well—with diabetes.

References