Positive Health Online

Diabetes mellitus represents a group of metabolic disorders resulting from either a lack of insulin, a hormone secreted by the pancreas, or the body's cells being resistant to insulin.

Most of the tissues in the body depend upon insulin for the flow of glucose (energy) into cells, and if insulin is not present, or present in insufficient amounts, the glucose will stay in the blood causing blood glucose levels to rise (hyperglycaemia). The metabolism of fat and protein is also dependent upon insulin. This results in the cells of the body being depleted of nutrients; an untreated diabetic would literally starve to death.

The term 'diabetes' is derived from the Greek word meaning siphon, or the passing through of water and 'mellitus' is Latin for honey sweet, which refers to the excessive flow of urine containing glucose in diabetics. The disease can be traced back to the earliest writings of civilizations in Asia Minor, China, Egypt and India where references were made to boils and infections, excessive thirst, loss of weight and large quantities of honeysweet urine. At these times, those who were affected were middle-class people on diets high in sugar and fat with few wholesome foods such as vegetables and bread. It appears that nothing has changed from that time, as epidemiologically, diabetes mellitus has been linked to the Western lifestyle, full of processed foods high in sugar and fat, and is uncommon in primitive cultures living on natural foods. The research also shows that when these cultures change their diet to the processed foods of Western society they are predisposed to diabetes.

Diabetes is such a serious diseases that it is placed among the top ten causes of death in Western nations and is the fifth leading cause of death in the USA. There are two major forms of diabetes mellitus, type 1 and type 2. Type 1, or insulin-dependent diabetes mellitus (IDDM), accounts for approximately 10% of all cases and results in the progressive destruction of pancreatic beta cells (Islets of Langerhans) and the inability to produce insulin. The onset is usually in childhood, but as the Western diet deteriorates many adults are now being affected. This form was fatal until insulin was discovered in the 1920s when injections of insulin were used to control the disease.

Type 2, or non-insulin-dependant diabetes (NIDDM), often named adult onset diabetes, accounts for the remaining 90% of cases. In this form there may be a deficiency of insulin or the action of insulin on the tissues may be impaired (insulin resistance). Diet alone or diet and drugs control this form, although occasionally a type 2 may require insulin. Obesity is present in 80-90% of individuals with type 2 and contributes to insulin resistance. A type 2 who doesn't control the symptoms can become a type 1 diabetic.

Knowledge of possible causes of diabetes is important so that preventative measures can be taken to delay and reverse the condition.

Other causes of diabetes include free radical damage, fasting, diets high in fat, protein and sugar and low in fibre, as well as irregular patterns of eating, exercising and sleeping.

Early symptoms of diabetes would include weight loss, excessive thirst, extreme tiredness, fungal infections, skin infections and blurred vision. If the condition is left untreated, more serious conditions can result. If we take a closer look at the various organs and tissues in the body influenced by diabetes we can appreciate why.

Liver functions are affected including the synthesis of cholesterol and glucose. Fat accumulates in the liver and glycogen (energy) stores are depleted. This leads to hypoglycaemia, (low blood sugar) toxicity, high cholesterol levels and subsequent heart problems.

Blood is unable to transport the nutrients into the cells. It also thickens and clots because of the elevated levels of cholesterol, glucose, glycoproteins, fatty acids, glycerol and ketones. This can adversely affect circulation, brain and heart function and cause fatigue.

Muscle cells are affected by the lack of amino acids, fatty acids and glucose causing metabolic weaknesses resulting in muscular problems.

Kidney filtration system can be damaged resulting in excess glucose, minerals and protein excreted in the urine. This may result in nephropathy, including chronic renal failure, severe toxicity and bone problems.

Eyes are affected by fat and glucose, which can accumulate in the lens, blood vessels and nerves. Derivatives of glucose, fructose and sorbitol are harmful in excessive amounts and can cause cataracts, retinopathy, glaucoma and blindness.

Nerves suffer from high levels of fructose and sorbitol disrupting the conduction of nervous impulses. This causes neuropathy, affecting sensory, motor and autonomic nerves.

The blood vessels are affected by the thickened blood, causing plaque build-up and leading to atherosclerosis, poor circulation, heart problems, foot problems, ulcerated skin and gangrene.

In order to detect the disease in early civilizations, the doctor had to taste the urine of patients for sweetness! Nowadays, diabetes is diagnosed by testing glucose levels in urine, glucose tolerance tests, glucose-insulin tolerance tests, glycosylated haemoglobin (HgbA1c) and fasting blood glucose levels. According to the criteria of the International Diabetes Federation and the American Diabetes Association published in1997, diabetes is present when the fasting plasma glucose is 126mg/dl (7mmol/l) or greater on two occasions. Normal fasting levels are between 3.3 mmol/l – 6.4 mmol/l.[17]

For both types of diabetes blood glucose needs to be monitored and either insulin injections or drugs should be taken to stabilize glucose levels. However, with the correct nutrition, supplement, exercise, lifestyle and relaxation programme, a near normal lifestyle and a good level of health can be achieved.

In terms of nutrition, research shows that the Dr James Anderson's diet, consisting of high carbohydrate and high plant fibre (HCF), has a positive metabolic effect in diabetes mellitus. The diet is high in cereal grains, legumes and root vegetables and restricts simple sugar and fat intake. The caloric intake includes 70-75% complex carbohydrates, 15-20% protein and 10-25% fat. The total fibre content is almost 100g each day. This diet balances blood glucose levels, increases tissue sensitivity to insulin, reduces cholesterol and triglyceride levels and encourages fat loss. In one study when 16 type 1 patients were treated with HCF diets, their average insulin requirements dropped by 38%.[18-19]

This diet can be modified further by choosing quality wholefoods especially those containing water-soluble fibre, such as beans, oatbran, psyllium husks, pears, apples and vegetables, which slow down the digestion and absorption of carbohydrates preventing rapid rises in blood sugar.[20-21] Research shows that vegetarian and vegan diets reduce the risk of both types of diabetes mellitus, and low animal protein diets lower kidney damage and improve glucose tolerance.[22] Omega 3, found in fish oils, protects against atherosclerotic processes, lowers cholesterol and triglyceride levels. Omega 6 found in vegetable oils has been shown to offer protection against the development of diabetic neuropathy. Both of these oils reduce after-meal hypoglycaemia and increase tissue sensitivity to insulin.[23-24]

Other foods to avoid are processed foods, additives, smoked and cured meats preservatives, milk, fat, cholesterol and sugar, but small amounts of fructose found in fruit do not cause rapid rises in blood sugar levels.[25] Onions and garlic also have a beneficial effect on blood glucose levels. One study on starch-free bread showed significant improvements in blood glucose and lipid levels in NIDDM.[26-27] All diabetics should have small regular meals containing both carbohydrate and protein in the ratio 2:1 to regulate and maintain glucose levels.

Diabetics should generally eat a predominance of low glycaemic index foods, to stabilize blood glucose levels. The glycaemic index was developed by David Jenkins in 1981 to measure the rise of blood glucose after eating particular foods. However, the glycaemic index should not be the only dietary guideline and quality wholefoods always need to be considered, as there are some high fat foods such as ice cream and sausage with a low glycaemic index. A diet high in fat has a detrimental effect on glucose levels and contributes to heart disease, the leading killer of people with diabetes.[28-29]

Supplementation may also help and I have grouped together the most important ones for diabetes, and for some have included extra specific information.

Improved Glucose Tolerance

Vitamin E – prevents blood clotting, protects blood vessels from damage and reduces glycosylation (sugar attaching abnormally to proteins).[30-31]
Vitamin C – helps to reduce glycosylation and sorbitol levels.[32]
Chromium – helps to lower cholesterol and triglyceride levels and increases insulin sensitivity.[33]
Vanadyl sulphate – improves glucose control in individuals with NIDDM.[34]
Niacin (Vitamin B3) – helps to restore beta cells, slows down their destruction in the early stages of diabetes, and prevents the development of type 1.[35]
Manganese – is involved in energy metabolism.

Preventing Nerve Damage

Alpha lipoic acid – is a powerful natural antioxidant and pain reliever.[36]
Carnitine – helps to reduce cholesterol and triglyceride levels.[37]
Vitamin B6 – inhibits the glycosylation of proteins.
Selenium – promotes vascular health.[38]
Vitamin B12.
Vitamin B1.
Inositol.

Insulin Sensitivity

Biotin – functions in the manufacture and utilization of carbohydrates, fats and amino acids.
Potassium – insulin administration induces a loss of potassium, but care should be taken with supplementation.
Magnesium – important in regulating cholesterol, decreasing platelet aggregation and cell function.

Lowering Blood Glucose

Zinc – care should be taken with dosage as high levels may increase glycosylation.[39]
Co-Q10 – needed for carbohydrate metabolism.

Lowering Sorbitol

Quercetin – helps to prevent neuropathy nephropathy and retinopathy.
Vitamin C.

Herbs in the Treatment of Diabetes

Gymnema sylvestre extract may assist the pancreas in the production of insulin in NIDDM and improves the ability of insulin to lower blood sugar in types 1 and 2.[40-41]

Asian ginseng enhances the release of insulin from the pancreas and increases the number of insulin receptors.[42]
Vaccinium myrtillus (bilberry) may lower the risk of cataracts and retinopathy and helps to increase intracellular vitamin C levels.
Ginkgo biloba extract prevents diabetic neuropathy.
Aloe vera helps to lower blood sugar levels in NIDDM.[43]
Momordica charantia (bitter melon) may improve blood sugar control in people with NIDDM.
Capsaicin is the active compound in cayenne and can help to relieve the symptoms of neuropathy.[44]
Fenugreek seeds contain the alkaloid trigonelline, nicotinic acid and coumarin, which help to stabilize blood glucose levels.[45]
Atriplex halimu (salt bush) is rich in fibre, protein and chromium, which improves glucose regulation.

Exercise can be beneficial for diabetics. It helps to lower body fat and reduces total serum cholesterol and triglycerides. It improves circulation, self-esteem and self-image and reduces emotional stress. It increases tissue levels of chromium and the number of insulin receptors in IDDM to lower blood glucose. Following exercise, additional decreases in blood glucose occur as it is stored in the muscles as glycogen. However, the power to reduce the blood sugar is destroyed when glucose levels are high at the beginning of exercise, especially if ketones (by-products of fat break down) are present. For each 30-45 minutes of exercise, 10-15 grams of extra carbohydrate are needed. Regular, consistent, steady exercise for twenty minutes four times each week gives the greatest benefit.[46-47]

Care should be taken with lifestyle issues. Drinking alcohol inhibits gluconeogenesis (liver's production of glucose from amino acids). It increases the risk of hypoglycaemia in people taking insulin and causes eye and nerve damage. People with diabetes should, therefore, not drink on an empty stomach. Smokers also need to be careful as they have a high risk of kidney damage and heart disease.[48-49] Prescription drugs should be checked as they can have adverse effects on blood glucose levels. All areas of stress, emotional imbalances and self-esteem should be targeted. The biggest hurdle for most diabetics is to accept the disease and live with it rather than fighting against it, which can cause inner turmoil.

Therapeutic management of diabetes involves a multifaceted, individualized approach. It includes identifying and dealing with any of the complications of diabetes such as obesity and ruling out exposure to agents inducing glucose intolerance.[50] Other symptoms should also be addressed, for example digestion, as the pancreas produces the majority of digestive enzymes together with bicarbonates to neutralise acidity. Blood glucose levels, medication and food intake must be monitored and adjustments made to compensate for activity, stress and other irregularities. Knowledge of food values, the glycaemic index and supplements and the ability to decipher food labels are an advantage in planning an optimum nutrition programme. An active lifestyle and a personal exercise and relaxation programme should be maintained. Of paramount importance is the ability to manage stress and a commitment to continuing learning and counteracting the effects of diabetes, maintaining motivation and meeting one's emotional needs. If all these areas are considered, a diabetic can maintain health and fitness throughout his or her life. An encouraging case history on Tony who has IDDM can be read in the Nutritional Approaches column in Positive Health, issue 21, entitled 'Controlling Diabetes' and his follow up story in issue 40.

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