Diabetes - Part 2: Rectifying Metabolic Errors

This feature length article discusses research that is revealing ways to correct nutritional imbalances and errors of metabolism in both forms of diabetes.

Treatment Options for Diabetics

The role of diet in treating both Type 1 and Type 2 diabetes is vital for effective management. The amount of scientific literature on diet and essential nutrients for diabetics is phenomenal, leaving diabetic patients with a wide choice of foods, herbs, nutrients and other therapies to help stabilise their appetite and blood sugar levels.

The emphasis on the protective effect of the Mediterranean diet, a diet rich in olive oil, grains, fruits, nuts, vegetables, and fish continues. This diet is also low in dairy products and alcohol.1 By having a higher intake of legumes, fish, shellfish and olive oil, people over 70 years can directly increase their longevity.2
Each patient has his or her own unique nutritional needs, so only some of the nutrients mentioned below are applicable in any individual situation. A full nutritional assessment is needed for every diabetic. If each diabetic patient were to have his or her nutritional status assessed and appropriately treated, it might delay or even circumvent the need for taking oral hypoglycaemic medication or insulin injections. The information on nutrients below is brief from necessity, but hopefully offers some guidelines and treatment possibilities for readers.

TYPE 1 (INSULIN DEPENDENT) DIABETES

NEW HORIZONS


The increasing incidence of Juvenile Onset, or Type 1 diabetes, has now elevated it to the status of the most common chronic childhood disease in developed countries. Research is offering a range of reasons as to why the incidence of Type 1 diabetes may be increasing, most of which are nutritionally related. Nutritional deficiencies and imbalances in Type 1 diabetes are prominent, leaving nutritional assessment and dietary measures high on the list of treatment options.

As we know, Type 1 diabetes is kept in check by regular insulin injections, which are necessary for the lifetime of the patient. A medical ‘cure’ that is in its early stages of development, is to transplant the Islet, or insulin-producing cells of the pancreas to enable the patient to produce insulin normally again. Along with this promising approach, are some studies that shed light on why a child or young adult develops this devastating form of diabetes in the first place.

Milk; A1 versus A2
Some 100,000 Australians have Type 1 diabetes, (where the body destroys its own insulin-producing cells.) Professor Bob Elliott, a paediatrician in Auckland New Zealand, has noted that children in Samoa do not get Type 1 diabetes, yet Samoan children living in Auckland do get Type 1 diabetes. The difference in their diet is higher milk consumption, leaving Professor Elliot to conclude that milk is a contributing cause of Type 1 diabetes.
In most European and developed countries where the incidence of Type 1 diabetes is increasing, it is ‘A1’ cows that produce the milk. In countries like Africa (the Masai people virtually live off milk and don't get Type 1 diabetes) and Samoa, it is ‘A2’ cows that produce milk. Boyd Swinburn, Professor of Population Health at Deakin University in Melbourne, explains the genetic difference between cows that produce ‘A1’ and ‘A2’ milk. (A1 & A2 refers to an enzyme in the milk) As a result of this research, dairy farmers in New Zealand are gradually changing their herds to ‘A2’ cows.
Professor Elliot recommends that where there is Type 1 diabetes in the family, children should be given A2 milk, which is now easily available.3

Vitamin B3
Relatives of children who have Type 1 diabetes have an increased risk of developing diabetes in the future. Studies in the prestigious medical journal, The Lancet, show that Nicotinamide (Vitamin B3) protects islet cells.4
In another trial, 64 children from 4-18 years of age who took vitamin B3 over a two-year period had reduced their insulin requirements. The children had improved beta cell function and metabolic control when supplemented with vitamin B3 or Vitamin E.5,6(See ‘Glucose Tolerance Factor’ below)

Vitamin D
Vitamin D supplementation in early childhood may offer protection against the development of Type 1 diabetes. Type 1 diabetes was significantly reduced in infants who were supplemented with vitamin D compared to those who were not.7
Vitamin D deficiency is becoming increasingly common in sunny Australia. Sensible sun exposure (without sunscreen) is necessary to absorb Vitamin D. Those with dark skin need a greater amount of sun exposure in order to get enough vitamin D.

Cod Liver Oil
Cod liver oil has been associated with a decreased risk of Type 1 diabetes. Norwegian children who consumed cod liver and fish oil supplements are half as likely to develop Type 1 diabetes as those who ate less omega-3. It may be the anti-inflammatory properties of omega-3 that are protective.8 Cod Liver Oil also contains vitamin D.

Calcium
Calcium is closely connected with insulin, as the pancreas can only release insulin when an adequate amount of calcium is present.9 Calcium levels are therefore worth checking in Type 1 diabetic patients, where a lack of insulin production is the problem. (Hair Tissue Mineral Analysis is a good way of assessing the amount of calcium present in body tissues, rather than blood or urine, where the levels fluctuate more.)
Also, calcium metabolism can be disrupted by environmental heavy metals. Mercury and lead can interfere with calcium metabolism, leading to increased levels of these heavy metals being passed to newborns via their mothers.10

TYPE 2 (NON INSULIN DEPENDENT) DIABETES

EXPANDING HORIZONS


For most Type 2 diabetics, whatever the age of onset, excellent management can be achieved by normalising weight, changing to a low GI diet and exercise. Some people adopting these measures never need to take insulin. With appropriate, individualised treatment, some diabetic patients do manage to reverse insulin resistance, suggesting that nutritional therapy really can help some patients to become free of Type 2 diabetes.  
Why Is Type 2 Diabetes Epidemic in People of All Shapes and Sizes?
As previously stated, Type 2 Diabetics are insulin resistant, (unable to utilise insulin) rather than unable to produce enough insulin. But being overweight is not a prerequisite for insulin resistance. Oxidative stress can damage the pancreas, which results in insulin resistance.11 Most studies involving diabetes concentrate on genetic and lifestyle factors, ignoring the potential effects of xenobiotics (high amounts of chemicals not normally found in the body). There are an increasing number of reports suggesting a strong correlation between organic pollutants and insulin resistance. Environmental chemical compounds appear to disrupt the normal metabolism of glucose and lipids, (fats) which can also contribute to obesity, so chronic dietary exposure and accumulation of substances like organochlorines may be associated with the development of diabetes.12,13 This is called ‘oxidative stress’.
Antioxidants help with this type of oxidative stress and accordingly, low amounts of dietary antioxidants may be linked with insulin resistance. Low levels of vitamins E and A are also associated with an increased risk of developing Type 2 diabetes.14


Metabolic Syndrome X (Pre Diabetes)
Metabolic Syndrome is caused by excess insulin production to compensate for insulin resistance. People with metabolic syndrome can also suffer from obesity, high blood pressure, disordered blood fats and clotting factors; all risk factors for cardiovascular disease.
Several factors are involved in metabolic syndrome. These include neurological, endocrine and nutritional factors, which must be addressed in the prevention and treatment of this condition.15 This is assessed by a special test called Hair Tissue Mineral Analysis (HTMA). HTMA is available from some natural therapists.

MISSING NUTRIENTS

Not all diabetics have multiple nutritional deficiencies, but it would be unusual to find a diabetic who does not have at least one nutritional deficiency that affects glucose metabolism. When nutritional deficiencies can be identified, causative factors can be found and this allows targeted, effective treatment.

Zinc
It has been known for decades that mineral status is disrupted in patients with diabetes. Zinc plays a key role in insulin production and helps cells to utilise glucose. When a diabetic is deficient in zinc, these functions are compromised.16
Many diabetics excrete more zinc in their urine, increasing their daily need for this mineral. A study reporting on the level of essential minerals found in blood, urine and hair, zinc, (manganese and chromium) found significantly reduced levels in the blood and hair samples of diabetic patients compared to control subjects.17 When considering the consequences of oxidative stress in diabetics, the anti-oxidant effects of zinc (and chromium) are especially important.18,19,20 A key sign of zinc deficiency is white spots on the fingernails.

Magnesium
Magnesium deficiency is evident in many diabetic patients, and research indicates that it worsens the problem of insulin resistance. Low magnesium impairs insulin sensitivity and raises cholesterol.21 Signs of chronic magnesium deficiency that relate to diabetic patients are numbness and tingling, hypertension, atherosclerosis and heart disease.22

Chromium and the Glucose Tolerance Factor
Found in a large variety of foods, chromium is an essential nutrient for humans. It works closely with insulin in helping glucose enter the cells. Without chromium, insulin's action is blocked and blood sugar levels become elevated. Deficiency is common in Type 2 diabetes.
Chromium also increases lean muscle mass and promotes fat loss and is therefore an ideal supplement for those on a weight loss programme.23 Highly processed foods common in the Western diet, like white sugar and white flour, are almost completely devoid of chromium, which might explain the widespread problem of glucose intolerance and blood sugar disorders in developed world. Chromium deficiency causes fatigue, lack of concentration, irritability, glucose intolerance and can lead to arteriosclerosis.24
The Glucose Tolerance Factor (GTF) is a compound consisting of chromium derived from brewers yeast, Niacin (Vitamin B3) and the amino acids Glycine, Glutamic Acid and Cysteine. Chromium influences carbohydrate, lipid (fat) and protein metabolism. Unstable blood sugar levels cause sugar cravings and so GTF is used extensively as a natural treatment for diabetics to help stabilise their blood sugar levels. Chromium or GTF supplementation may enhance the effect of medications for blood sugar. People taking these medications should take chromium supplements only under professional supervision.

Vitamin E
Vitamin E is a well-known anti-oxidant and is said to have a protective effect against Type 2 diabetes. It may also protect diabetics from developing the common complications of diabetes such as cataracts and kidney disease, since it helps to improve circulation.25
Some Australians consume very little Vitamin E. As care needs to be taken with vitamin E supplements, diabetics need to make sure that they eat foods that contain vitamin E. (It’s also well-known as an anti-ageing vitamin)

Vitamin C
Vitamin C is another well-known antioxidant, and as such can help the health of blood vessels. It needs to be present in any healthy diet in the form of fresh produce. Pomegranate juice, high in vitamin C, changes the diabetic lipid (blood fat) profile and modifies the risk of heart disease.26 When researchers used vitamin C for diabetic patients, their blood lipids (fats) and insulin production was lower.27

Fantastic Fats

Omega 3
Literature abounds with the virtues of omega-3 fatty acids for protecting against both Type 1 and Type 2 diabetes.28 (See Cod Liver Oil & Type 1 diabetes) Fish is a key component in the Mediterranean diet, well known for its protective effect against Type 2 diabetes.
Fats contained in nuts, for example, increase insulin sensitivity and reduce the incidence of Type 2 diabetes.29 Nuts are also rich in magnesium and should be a part of every diabetic’s daily diet.
Some research points to a lipid, rather than glucose overload as the underlying cause of diabetes.30

Alpha Lipoic Acid (ALA)
ALA is a fatty acid that converts glucose into energy. It’s also an antioxidant, which is made by the body and found in spinach, broccoli, peas, brewer's yeast, Brussels sprouts, rice bran, and organ meats. ALA improves the blood flow to nerves, stimulating the regeneration of nerve fibres and so aids diabetic neuropathy. This is crucial to prevent diabetic ulcers resulting from (lower limb) injuries and infections that can lead to the need for amputation.

Not So Fantastic Fats
Unsaturated fats are oils said to have an ‘unclogging effect’ on our blood vessels. But once unsaturated fats (oils) are heated and processed or ‘hydrogenated’ into solids, they contain a compound called ‘trans’ fats. Unfortunately, trans fats increase cholesterol levels and contribute to obesity. Trans fats are also capable of ‘blocking’ the beneficial effects of the good fats, like nuts, fish and avocado, undoing lots of good work that diabetics are doing with their diet. The main source of trans-fats is margarine, common on the Australian kitchen table and found in most commercially made foods that have a fat content, because margarine is a cheaper alternative to butter. Avoiding fast food and pre-cooked food helps to avoid trans fats. Some governments are so concerned about the health effects of trans fats on their population that they are legislating for takeaway food chains to stop using them.
When it comes to choosing which fats to buy; natural is best – small amounts of butter are fine. Keep an eye out for ‘hydrogenated oil’ on your food labels and avoid it completely.    

SOURCES OF NUTRIENTS FOR DIABETES
(Supplementation needs to be prescribed on an individual basis – see your health professional)

  • Calcium: Non-dairy sources include tinned salmon, sardines, dried figs, cocoa powder, parsley, potato, spinach, prunes, sultanas, nuts.
  • Chromium: Egg yolk, brewers yeast, beef, cheese, liver.
  • Essential Fatty Acids:
  • Cod Liver Oil: Supplements are available from health shops and pharmacists.
  • Omega-3: Fish, walnuts, olive and canola oils, cod liver oil. Supplementation is often necessary.
  • Lipoic Acid: Kidney, liver, spinach, broccoli, potatoes. While Lipoic Acid is naturally made in the body, supplements are often recommended.
  • Magnesium: Nuts: almonds, brazils, peanuts, walnuts, chickpeas, sesame seeds, (tahine) cocoa, whole grains, dried figs.
  • Niacin (Vitamin B3): Whole grains, baker’s yeast, tuna, salmon, sardines, meats, especially liver, peanuts, sesame seeds, vegemite and some chocolate drinks.
  • Vitamin C: Currants, citrus fruits, berries, paw paw, parsley, capsicum, Brussels sprouts, cauliflower.
  • Vitamin D: Sunlight on skin without sunscreen is the best source. Also Cod Liver Oil, sardines, tuna, eggs, butter and cheese. To avoid vitamin D toxicity supplements should be professionally prescribed.
  • Vitamin E: Nuts: hazels, brazils, almonds, peanuts, tuna, cod, olive oil.
  • Zinc: Oysters, whole grains, cocoa powder, baker’s yeast, most meats, especially beef, crab, sardines, dairy products, nuts; brazils, almonds, walnuts, peanuts. (Zinc is absorbed best from animal sources; vegetarians need a higher intake.)
Source: ‘Food Facts’ D Briggs & M Wahqvist Deakin University, Vic 1984

HERBS FOR DIABETES


Herbalists use a range of herbs to treat their diabetic patients, in conjunction with medical therapy. Some of these are culinary herbs, used in cooking – particularly curries. Diabetics can benefit from liberally adding a range of herbs to their daily diet, in cooking and drinking herbal teas.
Many of these herbs are available in supplements containing formulas that include diabetic-specific nutrients, but are best prescribed by qualified practitioners.  
Bitter Melon (Momordica Charanta)
A traditional Chinese vegetable and medicine, bitter melon is a bitter tasting, pale, warty looking cucumber that stimulates digestion. Studies are showing it to be a powerful treatment for Type 2 diabetes. The four compounds isolated in bitter melon perform a very similar action to that of exercise!31 Bitter melon has also been used by homeopaths  homoeopaths to improve cholesterol levels, due to a dramatic hypoglycaemic response (lowering blood sugar).32

Bilberry Leaf (Vaccinium myrtillus) & White Horehound (Marrubrium Vulgare)
Both of these herbs are widely used by western herbalists. When one gram of each herb is given before and after meals – they reduce the fasting blood glucose.33

Brindleberry (Garcinia Cambogia/ Gambooge)
Used in Indian traditional medicine, Brindleberry is said to be an appetite suppressant, helpful for weight control.

Cinnamon (Cinnamonum)
There is a large amount of research available on this common culinary spice. When supplemented with a dose of dried cinnamon after each meal, patients have a significant lowering of blood sugar and lipids, (triglycerides and cholesterol.) Cinnamon extract can also help patients who have difficulty in stabilising their blood sugar levels.34,35 Diabetics could well do with taking it off the kitchen shelf and using lots of it often.

Fenugreek
A common spice used in curry mixes, fenugreek reduces blood glucose levels and blood cholesterol. It can be used in cooking, taken as a tea, but if taken in therapeutic doses, it must be taken under professional supervision36

Maidenhair Tree (Gingko Biloba)
This ancient Chinese tree is traditionally used in China. The nuts, leaves and seeds are used in cooking and it has multiple uses in Chinese medicine. Tests show that it improves peripheral circulation, helping the circulation to many organs, and so is of crucial importance in long-standing diabetes. One study shows a benefit for patients with diabetic retinopathy, a condition which can often lead to blindness.37

Milk Thistle / St Mary’s Thistle (Silybum Marinarum)
This common herb is a useful liver tonic. It improves insulin sensitivity and glycaemic control in Type 2 diabetes.38

Pycnogenol
Pycnogenol comes from the bark of the French Maritime Pine tree. It’s an antioxidant that helps to strengthen blood vessel walls and capillaries. In the correct dose, it helps to reduce blood sugar levels.39

Which Patient Needs Which Nutrient?
It is well established that mineral and nutritional disturbances are present in the development and progression of diabetes, yet few patients receiving treatment ever have a nutritional assessment before starting their medication. The need for assessing the nutritional status via blood, urine and hair samples of each and every diabetic of all ages for deficiencies, toxicities and oxidative stress is striking. Such tests are easily accessible and non-invasive, providing valuable information for treatment. Identifying a deficiency, imbalance or toxicity gives great clarity for the therapeutic path ahead.  
If all diabetic patients had the same nutritional needs, or a few nutrients reaped benefits for most diabetic patients, then the treatment path would be straightforward. This however, is rarely the case; what leads to diabetes, in one patient, does not lead to it in another. Nutritional deficiencies rarely occur individually, and are usually related to a number of other nutrients.  
Patients can check with their health professionals to see if they conduct any nutritional assessment prior to treatment. We use Hair Mineral Analysis to assess patients’ nutritional status. As minerals are incorporated into the hair as a result of long-term metabolic activity, they are more stable than minerals circulating in the blood. Mineral relationships with vitamins, can also be identified.40

Other Therapies
The treatments described in this article fall until the category of ‘nutrition’ and ‘naturopathy.’ There are also many other therapies available that can help diabetes and its complications. acupuncture, auyurvedic medicine, chiropractic, homoeopathy, kinesiology, osteopathy and traditional Chinese medicine all have the capacity to address diabetes, in conjunction with sensible dietary and lifestyle measures.

OPTIONS GALORE

Due to the enormity of the problem of western populations developing both forms of diabetes in epidemic proportions, much research has been conducted internationally. Finding treatment solutions for diabetes is imperative to maintain the health of the ageing population and trim health budgets. So far, the emphasis of treatment has been on diet and exercise interventions, which when implemented correctly, are largely successful.

There is a huge range of therapeutic agents available for diabetics to modify their symptoms and avoid the devastating long-term effects of diabetes mellitis like blindness, kidney disease poor limb circulation, heart disease, and sudden death. Utilising the full range of treatment options could lead to quite a different long-term picture of this chronic disease.  
For some reason, the vast amount of research regarding the nutritional status of diabetics has not yet reached most medical clinics, leaving patients without the benefits of a nutritional assessment. Diabetic treatment and management would be improved if this could be applied in clinics so that patients everywhere can benefit.

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