Diabetes is a chronic disease characterized by majority of Americans with diabetes do not believe to prevent type I diabetes in persons at high risk …
Prevention and Treatment of Diabetes with Natural Therapeutics
– Fourth Edition –
Published as a public service by
ML226FD-REP
National Diabetes Fund
a program of Project Cure PO Box 96673 Washington, DC 20090-6673
02/07
Introduction:
Diabetes is a chronic disease characterized by elevated blood glucose levels and disturbances in carbohydrate, fat and protein metabolism These metabolic abnormalities result in part from a deficiency of the blood sugar-lowering hormone insulin or from insulin resistance a defect in the bodys capacity to respond to insulin Type 1 diabetes, also known as insulindependent diabetes mellitus IDDM, usually begins in childhood and is thought to be a result of autoimmune destruction of the pancreatic beta cells the cells that produce insulin; also called islet cells Destruction of the beta cells results in a complete or almost-complete loss of insulin production, thereby necessitating insulin injections to maintain blood sugar control Type 2 diabetes, also known as non-insulindependent diabetes mellitus NIDDM, is usually diagnosed after 40 years of age Type 2 diabetes is frequently associated with insulin resistance and normal or even elevated levels
of insulin, although subnormal insulin levels are also seen in some type 2 diabetics Gestational diabetes is characterized by hyperglycemia elevated blood sugar during pregnancy and usually disappears after the child is delivered However, even though gestational diabetes may be relatively short-lived, it can compromise the health of both mother and fetus Diabetes is associated with a number of significant medical problems Severe hyperglycemia may result in coma or even death Milder hyperglycemia, if present for many years, increases the risk of cardiovascular disease, which can manifest as a heart attack, congestive heart failure, stroke, gangrene of the extremities necessitating amputation in some cases, or kidney failure Atherosclerosis accounts for up to 60 of all diabetes-related deaths1 In addition, as many as 33 of all cases of kidney dialysis and 50 of all amputations in the United States and Europe are a result of complications from diabetes2 Individuals with diabetes are 2-to-20 times more likely to develop cardiovascular disease or stroke than are people who do not have this condition
Visual loss due to retinopathy damage to the retina of the eye or cataract is
also common among diabetics About 6 of all diabetics develop glaucoma, a leading cause of blindness Diabetes is the leading cause of blindness among American adults between ages 20 and 74 years, and is responsible for as many as 40,000 new cases of blindness annually in the United States Neuropathy nerve damage occurs in about half of all diabetics during the course of their disease Diabetics also tend to suffer from poor wound healing Impotence is a common complication of diabetes in men
Despite these potential serious complications, a majority of Americans with diabetes do not believe they are at serious risk for cardiovascular disease, according to a recent survey3
Conventional Therapy
It is now well accepted that maintaining blood glucose levels as close to the normal range as possible will reduce the incidence of these complications Conventional physicians attempt to regulate blood glucose through a combination of dietary modification, weight loss when appropriate, exercise, and blood sugar-lowering medications, including insulin and so-called oral hypoglycemic agents Although this approach is helpful to some extent, it has limitations First, the conventional dietary
approach often fails to emphasize highfiber, high-complex-carbohydrate foods, or specific foods such as legumes, which have been shown to improve glycemic blood glucose control see below Consequently, the standard diabetic diet is frequently not as effective as it could be Furthermore, insulin therapy may not achieve satisfactory glycemic control in patients with insulin resistance, and oral hypoglycemic agents may lose their efficacy after five or more years of treatment When these drugs are effective, they must be used with caution, because an excessive dose can cause medically significant hypoglycemia For these and other reasons, the conventional treatment of diabetes often produces less-thanadequate blood glucose control In addition, insulin
itself is believed to be a cause of cardiovascular disease, 3,4 so safer methods of lowering blood glucose are urgently needed Furthermore, a recent study found that using insulin injections as a means to prevent type I diabetes in persons at high risk for developing this condition failed to prevent the development of disease4 Metabolic Abnormalities in Diabetics It should be noted that the blood glucose concentration is not the only
determinant of diabetic end-organ damage ie, neuropathy, retinopathy, nephropathy, etc Diabetic complications still occur albeit with a lower frequency in patients who carefully maintain their blood sugar near or even completely within the normal range A number of metabolic abnormalities and pathological changes that are associated with diabetes may be at least partly independent of blood sugar levels These include increased production of oxygen-derived free radicals, excessive platelet aggregation and protein glycosylation, and intracellular accumulation of sorbitol see below Although these abnormalities are not fully understood, it is possible that taking measures to correct them will help prevent some of the complications of diabetes
It is possible, therefore, that supplementing with foods, nutrients, and herbs that have antioxidant activity would help prevent diabetic end-organ damage
Glycosylation of Proteins
Another factor that contributes to the complications of diabetes is a process called glycosylation of proteins Known to chemists as the Maillard reaction and to bakers as the browning reaction, glycosylation involves the irreversible binding of glucose or other sugars
to a protein molecule A growing body of evidence indicates that glycosylation of tissue proteins is one of the mechanisms whereby diabetics develop organ damage7 Although glycosylation occurs continuously in all human beings, the reaction is accelerated when blood sugar is elevated One of the reasons that maintaining tight blood sugar control prevents complications is that the rate of tissue glycosylation is lower when the average blood sugar is lower However, studies have shown that certain nutritional supplements also inhibit glycosylation independently of any effect they may have on blood glucose levels Supplementation with these nutrients might therefore be expected to reduce the risk of diabetic end-organ damage
Free-Radical Damage
Oxygen-derived free radicals are normal byproducts of metabolism However, these compounds are highly reactive and can cause significant damage often called oxidative damage to cell membranes and other cellular structures Free-radical damage is believed to play a role in atherosclerosis, cataract formation, and some of the other complications of diabetes A recent study found that men who eat a diet rich in bacon, bologna, and hot dogs are 50 percent
more likely to develop type 2 diabetes than men with similar levels of risk who had low consumption levels of these foods5 To counteract the destructiveness of free radicals, the body possesses a complex system of antioxidant defenses that utilize various vitamins, minerals, and other naturally occurring substances Diabetics have been reported to have significantly higher free-radical activity, as well as significantly lower concentrations of antioxidants, compared with healthy controls6 These changes were of greater magnitude in patients with disease complications than in those without complications
Sorbitol Accumulation
Another process that leads to diabetes-related organ damage is the accumulation of sorbitol in certain tissues and organs Sorbitol is manufactured in the body from glucose When glucose levels are elevated, sorbitol is produced inside the cells faster than it can be broken down Since sorbitol cannot cross cell membranes, it builds up inside the cells and draws water in by the process of osmosis This sorbitol-induced osmotic swelling is believed to be one of the main causes of tissue damage in diabetics Glucose is converted to sorbitol by the enzyme aldose
reductase A drug called sorbinil, which inhibits this enzyme, was shown to reverse both diabetic neuropathy and diabetic cataracts However, because of its severe toxicity, sorbinil was rejected by the Food and Drug Administration for use as a prescription drug Substances which can safely prevent the accumulation of intracellular sorbitol would therefore be welcomed 1
Strategies for Treating Diabetes and Preventing Complications
The above evidence suggests that appropriate goals in the management of diabetes include maintaining blood glucose levels as close to the normal range as possible, minimizing the adverse effects of free radicals by enhancing antioxidant defenses, and reducing the glycosylation of proteins and the intracellular accumulation of sorbitol A number of different interventions that are currently considered to be in the realm of alternative medicine have been shown to accomplish one or more of these goals In addition, specific methods of preventing or treating diabetic complications such as cardiovascular disease and neuropathy have been identified These will be discussed below
Dietary Factors
A considerable body of evidence indicates that a diet high in fiber and
complex carbohydrates helps improve glucose regulation in diabetics In one study, 20 insulin-treated diabetics who were not overweight consumed a standard diabetic diet providing 43 of calories as carbohydrate for 7 days, followed by a high-complex-carbohydrate, high fiber HCF diet for 16 days8 The HCF diet provided approximately 70 of calories as carbohydrate and was designed to maintain body weight The daily dose of insulin was lower for each patient on the HCF diet than on the control diet and the mean insulin dose was reduced significantly from 26 to 11 units/day On the HCF diet, insulin therapy could be discontinued in nine patients who had been receiving 15-20 units per day and in two patients who had been receiving 32 units per day Blood glucose levels in the fasting state and three hours after meals were lower in most patients on the HCF diet, even though the insulin dose had been reduced The mean serum cholesterol concentration also fell significantly from 206 to 147 mg/dl This study demonstrates that a HCF diet can reduce blood sugar levels and insulin requirements in diabetics and that this effect is not dependent on weight loss In a follow-up study, the beneficial
effects of this diet were maintained for periods ranging from 26 to 86 months8 A HCF diet has also been found to reduce insulin requirements in patients with type I diabetes9
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In another study, 16 diabetics consumed a conventional carbohydrate-restricted diet or a diet which excluded refined carbohydrate but allowed unrefined carbohydrate10 On the unrefined-carbohydrate diet, the mean postprandial after-meal plasma glucose concentration fell significantly by 20 Supplementation with 78 g/day of wheat bran has also been shown to reduce the insulin requirements of insulin-dependent diabetics by 8-1011 Ingestion of legumes appears to be particularly effective at control blood sugar Eighteen noninsulin-dependent diabetics and nine insulindependent diabetics received a high-complexcarbohydrate diet containing leguminous fiber, and a standard low-carbohydrate diet, each for six weeks, in random order12 In both groups, the mean concentrations of blood glucose preprandial and 2-hour postprandial and serum cholesterol, and the urinary excretion of glucose were all significantly lower on the diet containing legumes than on the standard diet In another study, breakfasts containing lentils
or whole meal bread of identical carbohydrate content were consumed by seven healthy volunteers13 Compared with bread, the lentils produced a significant 71 reduction in the area under the blood glucose curve and flattened the plasma insulin response These changes are indicative of improved glucose metabolism In addition, the lentil breakfast lowered the blood glucose response to a standard bread lunch four hours later This study demonstrates that the beneficial effect of legumes on glucose control extends to the meal after which they are consumed Certain individual foods have also been shown to lower blood glucose or to improve carbohydrate tolerance in diabetics Ingestion of 100 g/day of whole barley flour for four weeks by healthy volunteers significantly reduced the blood-glucose response to a test meal bread14 In another study, addition of 600 g/day of green beans or 60 g/day of fresh onions to the diet for one week significantly lowered blood sugar levels in a group of patients with poorly controlled diabetes15 Ingestion of an onion extract has also been shown to reduce the rise in blood sugar in healthy volunteers during a glucose tolerance test16 Both garlic and onions
reduced the hyperglycemic effect of glucose feeding in experimental animals17 The inclusion of garlic and onions in the diet
of diabetics may be desirable for reasons other than their potential to lower blood glucose Garlic has been reported to decrease serum cholesterol levels,18 to prevent the oxidation of LDL cholesterol,19 to inhibit platelet aggregation,20 and to lower blood pressure21 Each of these effects would be expected to prevent the development of disease, one of the most important complications of diabetes Onion extracts have also been shown to inhibit platelet aggregation22 and to lower blood pressure in patients with hypertension23 In addition, onions contain relatively large amounts of quercetin,24 a flavonoid compound that inhibits aldose reductase25 Since aldose reductase inhibition has been shown to reverse diabetic cataracts and neuropathy, inclusion of onions in the diet of diabetics seems desirable Brewers yeast may also be useful for diabetics, as it has been reported to contain at least two-blood sugar-lowering compounds26 The capacity of yeast to reduce blood glucose was reported as early as 1923, although the type of yeast used was not specified in that
report27 A recent study found that 90 percent of adult type 2 diabetes cases could be prevented if people ate healthier food, exercised more regularly, stopped smoking, and implemented a few other basic health behaviors28 A recent controlled study found that intensive dietary interventions, such as consuming less than 26 of total energy from fat, increasing fiber intake, and exercising aerobically five times per week, can increase insulin sensitivity by 23 compared to only 9 in a modest intervention group29
postulated that ingestion of cows milk results in the production of antibodies that cross-react with and damage pancreatic insulin-producing cells However, other studies have found no association between ingestion of cows milk and the risk of developing type I diabetes34 A recent study found that a diet with high levels of dairy products may decrease insulin resistance syndrome in young adults35 Further research is needed to resolve the conflicting data
Nutritional Supplements
Glucose regulation depends on a wide range of vitamins, minerals, and other micronutrients Many of these nutrients are in short supply in the typical refined, processed American diet In addition, some
nutrients have been shown to exert effects that might be expected to reduce the risk of end-organ damage Supplementation with appropriate vitamins and minerals may therefore be of value in the prevention and treatment of diabetes The following is a review of specific nutrients:
Chromium
Chromium is a component of a molecule called glucose-tolerance factor GTF, which occurs naturally in the body and enhances the action of insulin at the cellular level36 Rats fed a chromium-deficient diet developed hyperglycemia and glycosuria37 Monkeys maintained on a low-chromium diet had abnormal glucose metabolism, which was corrected by chromium supplementation38 Chromium also protected guinea pigs against experimentally-induced pancreatic beta-cell destruction39 and reduced insulin resistance in genetically obese mice40 A newer study found that chromium supplementation increased insulin sensitivity in diabetic rats A randomized study in cats found that glucose concentrations ad glucose half-life were significantly lower in cats who received chromium supplementation than in a control group that did not receive the supplement41 Chromium deficiency is known to occur in man Individuals maintained
on parenteral nutrition developed a complex metabolic disorder including impaired glucose tolerance, which was reversed by chromium supplementation42,43 Less severe forms of chromium deficiency may be common in the United States Because of farming 3
Vegan Diet for Diabetic Neuropathy
Twenty-one patients with diabetic neuropathy consumed a vegan diet free of meat, chicken, fish, eggs, and dairy products consisting of unrefined foods; these patients also participated in an exercise program In 17 of the 21 cases, the sharp, stabbing, shooting, and/or burning pains were completely alleviated within 4-16 days Numbness persisted, but was noticeably improved within two days The improvement in diabetic neuropathy did not appear to be a result of better blood glucose control30
The Role of Cows Milk
Epidemiologic studies have found an increased risk of type I diabetes among children who consumed cows milk early in life31,32,33 It has been
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techniques that fail to replenish trace minerals in the soil, the chromium content of food is probably lower than it was at the turn of the century Tissue chromium levels were found to decline with age in Americans,44 but not in individuals living in
other countries45 One dietary survey revealed that 90 of American diets contained less than the minimum suggested daily intake for chromium46 In a double-blind trial, daily administration of 200 mcg of chromium produced a significant reduction in 2-hour post-prandial glucose levels in elderly women with borderline glucose tolerance47 In another study of elderly patients, chromium supplementation significantly reduced plasma glucose concentrations during a glucose tolerance test and significantly improved glucose utilization48 Treatment with 150 mcg/day of chromium for four months normalized glucose tolerance in four of ten elderly individuals with abnormal glucose tolerance49 Administration of 150 to 1,000 mcg/day of chromium improved glucose tolerance in three of six diabetics The estimated safe level of daily chromium consumption has been set at between 50 and 200 mcg/day, so ingestion at higher levels could be risky50,51 A variety of studies have shown that suboptimal ingestion of chromium is associated with an increased risk of various factors linked with diabetes and cardiovascular diseases Chromium supplementation has been found to reverse glucose intolerance and severe
neuropathy in individual patients52 Newer research has found some of the underlying factors that account for the ability of chromium to promote the action of insulin and lower blood glucose levels in diabetic patients53 An additional study involving human subjects found that chromium supplementation reduces oxidative stress, a key factor in the progression of diabetes54 Other studies have produced negative results In two double-blind studies, supplementation with 150 or 200 mcg/day of chromium failed to improve glucose tolerance in diabetic patients55,56 These conflicting results may be due to several factors First, in all of the studies described above, chromium chloride was used Because absorption of this form of chromium is only about 05, the dosage may have been inadequate Second, in order to exert an effect on glucose metabolism, inorganic chromium must be converted to GTF Biosynthesis of GTF requires, among other things, an adequate supply of niacin, a nutrient which may be in short
supply in many individuals see below Ingestion of foods containing GTF may therefore be a preferred way of obtaining biologically active chromium GTF occurs naturally in brewers yeast and to a
lesser extent in other foods, including beef, chicken, bananas, lobster, shrimp, mushrooms, and cheese57 GTF chromium is also promoted as a nutritional supplement However, according to Mertz, who originally discovered GTF, analysis of one of the socalled GTF chromium products revealed no GTF activity58 The exact molecular structure of GTF is still unknown, and no one has been able to synthesize it Therefore, claims that GTF chromium supplements are superior to other wellabsorbed forms of chromium such as chromium aspartate, chromium picolinate, or chromium polynicotinate are questionable A new study has found that dietary supplementation with chromium can moderate glucose intolerance and control blood sugar in diabetic patients59 Another study found strong antioxidative effects on the oxidative stress that leads to complications in type 2 diabetic subjects60 An additional study found that chromium supplementation stabilized the effects of insulin and improved blood sugar control in a group of type 2 diabetic patients61 A newer study found that the use of chromium early in the course of therapy in diabetics reduced the degree of insulin resistance62 A different study found that
chromium-enriched yeast supplementation in type 2 diabetics reduced oxidative stress and improved blood glucose variables63 A study of patients with type 2 diabetes mellitus found that a combination of chromium picolinate and biotin improved glycemic control when added to a typical diabetes care program with hypoglycemic drugs64 The researchers also concluded that these improvements could add to reduced costs in diabetes management over time Newer studies in animals have found that chromium supplementation decreases the symptoms of hyperglycemia and improves kidney function in diabetic mice65 Another study in human with type 2 diabetics found that chromium supplementation significantly reduced oxidative stress, which is a key indicator in the progression of the disease66
Niacin and Niacinamide
As a component of GTF, niacin nicotinic acid plays an important role in carbohydrate
metabolism Many refined foods consumed by Americans are depleted of niacin Grains and other foods that are enriched usually contain added niacinamide, which is capable of performing most of the functions of Vitamin B3, but which cannot apparently be converted by the human body into niacin In addition, most
vitamin supplements contain niacinamide rather than niacin A small amount of niacin may therefore be necessary for some individuals to enable the production of adequate amounts of GTF Researchers have found that nicotinamide can protect vital pancreatic cells from diabetes-inducing factors67 In one study, 16 healthy elderly individuals received either 200 mcg of chromium, 100 mg of niacin, or both, daily for 28 days68 Fasting plasma glucose levels and glucose tolerance were not affected by either chromium or niacin individually However, the combination of chromium plus niacin produced a significant 148 decrease in the area under the glucose curve during a glucose tolerance test and a significant 68 reduction in fasting glucose This study suggests that a relatively low dose of supplemental niacin, when combined with chromium, improves glucose metabolism and may therefore be useful for preventing and treating diabetes Larger doses of niacin such as 1-3 g/day can effectively lower serum cholesterol levels and reduce the risk of cardiovascular disease Although this treatment is often prescribed by conventional physicians, many doctors are reluctant to recommend high-dose niacin for
hypercholesterolemic diabetics because it will occasionally increase blood glucose levels in diabetics69 However, the effect of high-dose niacin is variable and this vitamin has been also been reported to reduce insulin requirements in some type I diabetics70 Consequently, high-dose niacin is not contraindicated in diabetics; however, blood glucose levels should be monitored closely Both niacin and niacinamide may also help prevent the onset or progression of diabetes by protecting the insulin-producing pancreatic beta cells from being damaged In animal studies, niacinamide protected against streptozotocininduced diabetes71,72 and inhibited the development of experimental autoimmune diabetes73 Niacin administration also prevented the diabetes-inducing effect of alloxan in rabbits and rats74 There is
evidence that both experimental diabetes and type I diabetes in humans are related to a depletion of nicotinamide adenine dinucleotide NAD within pancreatic beta cells, resulting in failure of oxidative metabolism and subsequent cell death As precursors to NAD, niacin and niacinamide are apparently capable of preventing the depletion of NAD in pancreatic beta cells75 Because of its
capacity to protect pancreatic beta-cell function, niacinamide has been studied as a possible treatment for newly diagnosed type I diabetes, which is characterized by progressive destruction of beta cells76 In a double-blind study, 16 type I diabetics received either niacinamide 3 g/day or a placebo, beginning one week after the start of insulin therapy Insulin was successfully discontinued in 857 of the patients taking niacinamide, compared to 556 of those taking placebo p005 Three patients treated with niacinamide for 18 months remained in remission for more than two years Remissions of such long duration are extremely rare in type I diabetes In another study, 14 children who were at high risk of developing diabetes as determined by high levels of antibodies against pancreatic islet cells received either niacinamide 150-300 mg per year of age per day, maximum dose 30 g, while eight children at similar risk served as controls77 All eight of the untreated children developed diabetes, compared with only one of the 14 children who received niacinamide p0001 A recent meta-analysis of 10 randomized controlled trials concluded that niacinamide effectively preserves residual pancreatic
beta-cell function in children with type I diabetes, when treatment is begun at the time of initial diagnosis A new study found that nicotinamide helps prevents complications, especially infections, in type 2 diabetic patients78 A study of nicotinamide found that supplementation with this compound had effects in the body that are similar to insulin in its ability to control blood sugar79 A randomized, clinical study of children with type 1 diabetes mellitus found that the use of nicotinamide alone or in combination with vitamin E improved metabolic control in these patients80
Biotin
The B-vitamin biotin plays a role in the intracellular metabolism of glucose Biotin deficiency resulted in impaired glucose tolerance in
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rats81 In another study, administration of biotin 2-4 mg/kg of body weight/day to genetically diabetic mice improved glucose tolerance and lowered insulin resistance82 Biotin has also shown promise in the treatment of diabetes in humans Seven insulindependent diabetics were removed from insulin therapy and treated with biotin 16 mg/day or a placebo for one week Fasting blood glucose levels rose significantly in patients given placebo, but decreased significantly
in those treated with biotin83 In another study, serum biotin levels were significantly lower in 43 patients with non-insulin dependent diabetes than in healthy controls Eighteen diabetic patients were given 9 mg/day of biotin for one month, while 10 other patients received a placebo The mean blood glucose concentration fell by 45 p005 in patients receiving biotin, but did not change in those given placebo84 Biotin has also been used to treat diabetic neuropathy Three patients with severe diabetic peripheral neuropathy received 10 mg/day of biotin intramuscularly IM for six weeks, followed by 10 mg IM three times a week for six weeks, then 5 mg/day orally85 The treatment duration ranged from 64 to 130 weeks Within 48 weeks of the start of treatment, painful muscle cramps, paresthesias, and ability to walk improved markedly and restless legs syndrome disappeared Biotin has been found to have beneficial effects on glucokinase GK, a key factor in the proper regulation of glucose metabolism A recent clinical study in Japan found that 3 mg of biotin administered three times daily led to significantly lower fasting glucose levels in patients with type II diabetes without any substantial
side effects86
improvement in glucose tolerance in 13 women with late-pregnancy gestational diabetes93 A controlled study found that patients with diabetic polyneuropathy had a significant improvement in nerve conduction velocity after a combination regimen of vitamins B1, B6, and B129495 Other studies have failed to confirm the beneficial effect of vitamin B6 on gestational diabetes96 However, in that study, the women were hospitalized and confined to a sedentary existence It is possible that a beneficial effect of vitamin B6 on glucose tolerance was counterbalanced in that study by a lack of activity In another study, pyridoxine at a dosage of 50 mg three times per day had no effect on blood glucose but reduced the concentration of glycosylated hemoglobin HbA1c by about 6 after six weeks97 This finding suggests that vitamin B6 inhibits the glycosylation of proteins and might therefore help prevent diabetic complications Indeed, a study in diabetic rats found that pyridoxine inhibited the progression of kidney disease98 Vitamin B6 has been used to treat patients with diabetic neuropathy Eighteen such patients received 50 mg of pyridoxine three times per day or a placebo for four
months Six 67 of nine of pyridoxine-treated patients reported significant relief from neuropathic symptoms, compared with 4 44 of nine placebo-treated patients This preliminary report warrants further study99 A study in children with type 1 diabetes found that a combination of folate and vitamin B6 significantly improved the health of the endothelium of the patients, which is a measure of disease progression100
Vitamin B6
Serum vitamin B6 levels were below normal in 25 of a series of 518 mostly adult diabetics87 and in 24 of 63 childhood diabetics88 Pyridoxine vitamin B6 supplementation of diabetic patients improved glucose tolerance in some studies89,90 but was without effect in others91 Fourteen women with gestational diabetes were treated with 100 mg/day of pyridoxine for 2 weeks At the end of the treatment period, 12 of the 14 women no longer had gestational diabetes92 The same dosage of vitamin B6 also produced a significant
Vitamin E
Several decades ago, Wilfrid Shute, MD, a pioneer in vitamin E therapy, reported that vitamin E supplementation reduced blood sugar levels in some diabetics101 This observation was confirmed in one study,102 but others failed to find a
beneficial effect of vitamin E103,104 More recently, in a double-blind, placebo-controlled study, administration of 900 mg/day of vitamin E for four months to non-insulin-independent diabetics significantly improved glucose tolerance105 Vitamin E also inhibited glycosylation of proteins when administered at doses of 600 or 1200 IU/day; the
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higher dose was slightly more effective than the lower dose106 Newer research has also suggested positive effects on diabetes from vitamin E supplementation A study found that vitamin E supplementation significantly reduced oxidative stress to tissues in a study of 30 patients with non-insulin-dependent diabetes mellitus A different study found that vitamin E supplementation increased blood flow to tissues in diabetics An additional study added further weight to this evidence by suggesting 1,000 IU daily supplementation of vitamin E led to improved circulation to tissues in diabetic patients after three months107 A significant body of evidence indicates that vitamin E may help prevent heart disease, one of the main complications of diabetes108,109 A recent study found that vitamin E supplementation decreased several markers of thrombosis in
patients with type 2 diabetes110 A different study found that patients with type 2 diabetes given 600 mg per day of vitamin E had improvements in the health of nerves that control the functioning of the heart111 A study found that 500 IU of vitamin E per day given to patients with type 2 diabetes reduced the levels of factors that increase the risk of developing vascular complications112 An additional study found that 800 IU per day of vitamin E improved beta-cell function, increased plasma insulin, and may have decreased insulin resistance in 40 patients with type 2 disease who took the supplement for a month113 New evidence further gives weight to the idea that vitamin E protects against the oxidative stress effects associated with arteriosclerosis114 A new study of women with type 2 diabetes found that a combination therapy of vitamin E 1800 IU daily, vitamin C, and the amino acid L-arginine significantly improved the condition of the cardiovascular system in these women115 A new study of a large population in Singapore found that low vitamin E is a risk factor for the development of vitamin E116 A newer study found that high levels of vitamin E alpha-tocopherol in the blood are
associated with a decreased risk of type 1 diabetes mellitus in the siblings of children with the disease117 A new study has found that the combined use of vitamin C, vitamin E, and N-acetylcysteine reduced some of the oxidative stress produced from a medium-fat meal in patients with type 2 diabetes mellitus118
Magnesium
Serum magnesium concentrations were significantly lower in a group of 56 diabetics than in healthy controls119 Hypomagnesemia was more pronounced in individuals with diabetic retinopathy120 or cardiac complications121 than in diabetics without such complications Poor control of diabetes was often associated with low serum magnesium122 HbA1c levels correlated significantly with Mg concentrations in plasma, muscle, and mononuclear cells123 Magnesium deficiency has also been found to be common in children with type I diabetes124 The reduced concentrations of magnesium seen in diabetics appears to result in part from increased urinary magnesium excretions125 In addition, the American diet tends to be low in magnesium Dietary surveys have shown that 8085 of American women consume less than the Recommended Dietary Allowance RDA for this mineral126 Daily magnesium intake
in two other studies was only about two-thirds of the RDA127,128 In a double-blind study of 12 nondiabetic elderly individuals, magnesium supplementation was found to improve the secretion and action of insulin129 In addition, a considerable body of evidence indicates that magnesium can prevent cardiovascular disease, for which diabetics are at increased risk130 Magnesium supplementation has been found to improve insulin sensitivity and insulin secretion in patients with Type II diabetes131 Magnesium deficiency has been associated with insulin resistance and overall poor diabetic control in elderly individuals who are borderline diabetic132 A newer study has found that a group of persons with type 1 diabetes had insufficient levels of magnesium dietary intake133 This study also found that magnesium supplementation in these same patients led to reduced insulin-stimulated glucose uptake Low serum levels of magnesium have also been found to be associated with complications of type 2 diabetes, such as the development of foot ulcers134 A new study has found significant evidence that magnesium intake is significantly associated with a reduced risk of developing diabetes135 A new study of
overweight women found that magnesium supplementation significantly reduced the risk of developing diabetes136 A study of patients with diabetes and
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those without the disease found that the diabetic patients had lower levels of magnesium in the blood and that magnesium supplementation stabilized blood sugar levels in those with disease137 Thus, magnesium supplementation may be an important component of the overall treatment of many diabetics
Ascorbic Acid Vitamin C
The importance of vitamin C for blood sugar regulation has been demonstrated in both humans and animals Guinea pigs fed a vitamin C-deficient diet developed diabetic glucose tolerance curves, glycosuria, and decreased pancreatic insulin content138 A study of diabetic rats found that vitamin C supplementation leads to protection against oxidative processes139 A newer study found that vitamin C supplementation decreases insulin resistance and improves glucose regulation in diabetic mice140 Diabetic blood sugar curves were also seen in humans with vitamin C deficiency; these values returned to normal after supplementation with vitamin C141 A study of 56 outpatients with noninsulin-dependent diabetics found that 2 grams
per day of vitamin C led to improved glycemic control and fasting blood glucose levels in addition to having a favorable effect on cholesterol and triglycerides142 Diabetics are at increased risk of developing vitamin C deficiency For example, the vitamin C concentrations in plasma,platelets,143 and white blood cells144 were significantly lower in diabetics than in healthy controls Vitamin C deficiency in diabetics may be more pronounced within the cells than in plasma or other body fluids That is because vitamin C is structurally similar to glucose, and may therefore compete with glucose for transport into cells In the presence of elevated blood sugar, the uptake of vitamin C into cells appears to be impaired145 This reduced entry of vitamin C into certain tissues may result in a kind of localized scurvy It is noteworthy that the vascular changes resulting from scurvy resemble those seen in diabetics In addition to maintaining the integrity of blood vessels, vitamin C has been shown to inhibit three different biochemical processes that are associated with end-organ damage in diabetics First, vitamin
C functions as an antioxidant Second, this vitamin inhibits the intracellular
accumulation of sorbitol In one study, supplementation with 2,000 mg/day of vitamin C reduced erythrocyte sorbitol accumulation by 561 and 445 in healthy individuals and diabetics, respectively146 Third, vitamin C significantly reduced the glycosylation of proteins, when given to healthy volunteers at a dose of 1 g/day147 A study of 20 diabetic patients found that 500 mg of ascorbic acid given twice daily led to significantly increased levels of ascorbic acid in the blood and decreased the albumin excretion rate, a key measure of disease progression in diabetics148 A different study of vitamin C supplementation in rats found that vitamin C inhibits the action of interferon alpha, a substance that inhibits the release of insulin149 A randomized, double-blind study of 30 patients with type 2 diabetes found that supplementation with 1250 mg of vitamin C per day slowed the progression of kidney disease that developed as a complication of diabetes150 A new study has found that vitamin C decreases oxidative stress and improves blood vessel function in diabetic patients151 A randomized, doubleblind study of 30 patients with type 2 diabetes mellitus found that improved the function of
arteries, an important finding in the prevention of complications in this condition152 An additional study found evidence that vitamin C reduces oxidative stress and improves blood vessel function in diabetics153 These studies suggest that long-term supplementation with vitamin C may help prevent many of the complications of diabetes
Vitamin B12
Injections of vitamin B12 have been used to treat retinopathy in patients with type I diabetes In one study, 15 patients added 100 mcg of vitamin B12 to their daily insulin injection After one year, all signs of retinopathy had disappeared in seven cases154 Similar results were reported by others155 Vitamin B12 has also been used to treat diabetic neuropathy In one study, 12 patients received 1530 mcg/day of vitamin B12 by injection for the first 7-14 days, followed by 15-30 mcg, 1-2 times a week156 Seven patients had complete or almost complete remission of the neuropathy and three had partial improvement The response appeared to depend more on the frequency of the injections than on the amount of each individual dose Other
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investigators have also found vitamin B12 to be helpful in the treatment of diabetic neuropathy157
vessels169
Sufficient potassium intake may help reduce vascular complications from diabetes
Copper
Copper deficiency in experimental animals resulted in impaired glucose tolerance158 and increased concentrations of glycosylated hemoglobin indicative of chronic hyperglycemia159 Because the typical American diet contains only about half of the Recommended Dietary Allowance 2 mg/day for copper,160 a deficiency of this mineral may be common Two male volunteers who consumed a controlled intake of 07-08 mg of copper per day for 5-6 months had increased 161glucose levels during a glucose tolerance test These levels returned toward normal after adequate amounts of copper were restored to the diet162 In two other volunteers, administration of 6 mg/day of copper improved glucose tolerance, suggesting that their usual diet was deficient in copper163 A study in patients with type 2 diabetes found that those with progressive kidney disease excreted higher levels of copper in urine and had lower levels in plasma than patients with less serious disease164
Zinc
Plasma zinc concentrations were reduced and urinary zinc excretion was elevated in diabetic patients170,171 Zinc plays a role in the synthesis of
insulin by pancreatic beta cells172 and in the action of insulin at the cellular level173,174 Patients with zinc deficiency resulting from gastrointestinal diseases had significantly higher glucose levels and significantly lower insulin levels than did similar patients without zinc deficiency175 Zinc supplementation increased plasma insulin levels in these patients Healthy male volunteers consuming a low-zinc diet had a significant increase in fasting blood glucose levels176 Impaired glucose tolerance also developed in rats fed a zinc deficient diet177 Diabetics often have impaired immune function manifesting as increased susceptibility to infection, which may be due in part to zinc deficiency In one study, administration of zinc to diabetic patients increased the T lymphocyte response to phytohemagglutinin a measure of immune-system function178 Zinc also plays a crucial role in wound healing, which is abnormal in many diabetics The typical American diet is low in zinc In one dietary survey, 68 of adults consumed less than two-thirds of the RDA for zinc179 Newer research in animals continues to demonstrate the important relationship between zinc ingestion and glucose stability Mice
with type 2 diabetes mellitus had normalization of previously high blood glucose levels after administration of a zinc complex180 A study in diabetic rats found that zinc along with 2 other compounds derived from prostate tissue has the ability to reduce blood glucose181 A controlled study of 50 humans with diabetes mellitus found that zinc levels in the blood were significantly lower than in normal individuals A group of 15 diabetic neuropathy patients that were given 660 mg of zinc sulfate daily for six weeks had significant improvement in fasting blood sugar levels, blood sugar levels after eating, and in nerve conduction velocity tests182 A newer study found that supplementation with 30 mg daily of zinc for six months, either alone or combined with chromium supplementation, led to improvement in at least one measure of 9
Potassium
Potassium deficiency in rats resulted in elevated blood glucose levels and a reduced insulin response to a glucose load165 Obese patients undergoing a protein-sparing modified fast without potassium supplementation had a striking reduction in peripheral glucose utilization and insulin levels These changes were reversed by potassium supplementation166
Administration of potassium to children with protein-energy malnutrition resulted in rapid improvement in the insulin response to an intravenous glucose load167 Potassium supplementation also prevented the impairment of glucose tolerance that sometimes results from treatment with thiazide diuretics168 These studies indicate that potassium plays an important role in glucose metabolism The beneficial effect of a high-fiber diet on glucose metabolism may be due in part to the relatively large amount of potassium present in fruits, vegetables, and other high-fiber foods An additional study found that potassium levels in the body are critical to the stability of potassium ion channels, which are vital to the health of blood
disease progression183 A new study has shown that zinc can lower blood glucose and reduce toxic effects throughout the system in diabetic subjects184 An additional study found that oral zinc supplementation reduces blood sugar in diabetics with high blood sugar and stimulates more efficient glucose metabolism, especially in muscle tissue 185 A new study of diabetic patients in Tunisia found zinc supplementation prevents some of the negative effects of oxidative
stress that occur in these patients186 These data suggest that zinc supplementation may be especially important for diabetics
Selenium
Selenium-deficient rats had decreased insulin secretory reserve When combined with vitamin E deficiency, selenium deficiency resulted in glucose intolerance187 Dietary selenium protected against early stage retinopathy in rats188 In a group of insulin-dependent diabetic pregnant women, there was an inverse association between serum selenium concentration and the degree of visual impairment189 Newer research indicates selenium mimics the action of insulin190 A new study found that selenium reduces resistance in the body to the effects of insulin, thus making insulin more effective in reducing blood sugar191 An additional study found that selenium has powerful antioxidant effects against oxidative stress in diabetic patients192 Yet another study found that selenium supplementation improved blood sugar and fat metabolism in patients with type 2 diabetes mellitus193 A different study found evidence that patients with type 2 diabetes mellitus have lower levels of selenium in the blood194 Selenium may activate key proteins that are also activated by
insulin
Thiamine, in combination with other Bvitamins has been recently tested as a treatment for diabetic neuropathy Twenty-four patients received daily either a placebo or 320 mg of allithiamine a lipid-soluble derivative of thiamine found in garlic, plus 720 mg of pyridoxine and 20 mg of vitamin B12197 After two weeks, the dosages of the vitamins were reduced by about two-thirds After 12 weeks of treatment, there was a significant improvement in nerve-conduction velocity in the vitamin-treated group compared with the placebo group No significant side effects were seen Thiamine has been found to play a large role in the proper regulation of glucose metabolism and pancreatic beta-cell function A more recent study of 10 children with type 1 diabetes found that a form of thiamine administered for three months led to improved metabolic control in the children198 A new study of a mixture compound consisting of thiamine, arginine, caffeine, and citric acid found evidence that this formulation reduced body weight, improved fat metabolism, and improved blood sugar levels in diabetic subjects199
Vanadium
Vanadate, an oxidized form of the trace mineral vanadium, appears to have an
insulin-like action200 A study found that administration of vanadyl sulfate another form of vanadium at a dose of 50 mg twice daily for four weeks to patients with non-insulin dependent diabetes reduced the mean blood glucose concentration significantly by about 20201 Other research has found beneficial effects from vanadium in both non-insulin-dependent and insulin-dependent diabetics202 Animal studies have demonstrated short-term use of vanadium sulfate can improve insulin-resistant diabetes203 A newer study in rats found that a compound that included vanadium improved the ability of insulin to control blood glucose in diabetic animals204 An additional study in diabetic rats found that a form of vanadium reversed some of the chemical changes caused by the disease205 A study involving diabetic mice found that treatment with vanadium in drinking water led to significant improvement in the animals in many areas and did not produce any obvious toxicity206 A different study found that a variety of compounds that include vanadium enhance insulin activity and stabilize blood glucose207 Vanadium is currently being promoted in
Thiamine
When animals were fed a thiamine-deficient diet,
there was a significant increase in blood sugar195 Blood thiamine concentrations were significantly lower in insulin-dependent diabetics than in healthy controls, but the levels in noninsulin-dependent diabetics were normal196 Administration of 10 mg/day of thiamine for four weeks reduced blood glucose levels and urinary excretion of glucose in six 546 of eleven diabetics196
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the popular press and by some physicians as an effective treatment for diabetes However, it should be noted that the dose of vanadium used in the study mentioned above was several thousand times as much as that found in a typical diet There is no precedent for using such large amounts of a trace mineral, and there are concerns about the potential toxicity of such large doses Vanadium accumulates in the body with long-term use, and toxic effects of this trace mineral have been reported in animal studies208 A new study of diabetic subject has found that a formulation of vanadium and molybdenum, and some other metal complexes has strong blood sugar loweringproperties209 Until long-term safety studies are done with humans, high-dose vanadium cannot be recommended as a treatment for diabetes
Alpha-lipoic
Acid
A study of lipoic acid administered to diabetic patients has found that this compound has many similar properties and effects to those of insulin210 A new study of an oral time-released formulation of alpha-lipoic acid in diabetic subjects found that blood sugar levels were significantly lowered over a six-week period211 Other studies have found that alpha-lipoic acid can reduce and prevent oxidative stress damage in diabetic subjects212 A different study found that alpha-lipoic acid improves the sensitivity of insulin action in the body213
regulation in patients with type 2 diabetes217 These studies also found that lipoic acid significantly decreased a variety of diabetic pathologies, such as polyneuropathy, vascular damage, and cataract formation Studies in rats have suggested the administration of d-alpha-tocopherol vitamin E protected diabetic animals from developing albuminuria, an important complication of the disease218 A more recent study found that diabetic rats fed a diet supplemented with vitamins C and E had significant inhibition of diabetic retinopathy compared to a control group219 In another study, 111 patients with mild diabetic neuropathy were randomly
assigned to receive 12 capsules per day of evening primrose oil or placebo for 1 year in double-blind fashion220 Evening primrose oil was significantly more effective than placebo, as determined by various objective measurements of nerve function
Herbal Treatment of Diabetes
Herbal medicine has been used for many years by different cultures around the world, both for the prevention and treatment of diabetes It has only been recently that some of these herbal treatments have been studied scientifically
Trigonella foenum graecum Fenugreek
Fenugreek seed Trigonella foenumgraecum is an annual plant of the leguminous family Fenugreek seeds are commonly used as a condiment in India Yemenite Jews have traditionally used fenugreek to treat type II diabetes A study in rats found that fenugreek administered in the ratio of 2 to 8 grams per kilogram of body weight in diabetic rats led to significant reductions in blood glucose levels In a newer study involving diabetic rats, researchers found that the oral administration of a diet containing 5 fenugreek led to normalization of fasting blood glucose levels after 21 days221 In a study involving humans, 10 insulin-dependent diabetics consumed
isocaloric diets with or without 100 g/day of debittered, defatted fenugreek-seed powder, each for 10 days in random order222 The powder was divided into two equal doses and incorporated into bread Compared with the control diet, the mean fasting plasma glucose concentration was significantly lower by 28 and glucose 11
Treatment of Diabetic Neuropathy
In addition to biotin, vitamin B6, vitamin B12, and a vegan diet discussed previously several other treatments have been used for diabetic neuropathy In one study, intravenous administration of lipoic acid a B-vitamin: 600 mg/ day for 3 weeks reduced the symptoms of diabetic peripheral neuropathy, without causing significant adverse reactions214 A different study found that 10 patients with diabetic neuropathy who received 600 mg/day of lipoic acid for 70 days significantly reduced lipid peroxidation, a key factor in the diabetic disease process215 A controlled study of 12 patients with Type 2 diabetes found that daily administration of 600 mg of alpha-lipoic acid led to improvement in a variety of neuropathic symptoms such as numbness, pain, and burning216 More than one recent experimental and clinical trial has shown that
alpha-lipoic acid can improve glucose
tolerance was significantly better during fenugreek treatment Serum total-and LDL-cholesterol levels were also significantly reduced by fenugreek Similar results were achieved with a lower dose of fenugreek seeds223 A newer double-blind, placebocontrolled study involving 25 patients diagnosed with type 2 diabetes found that 1 gram per day of fenugreek led to improved blood glucose control and decreased insulin resistance222 A new study has found further evidence that fenugreek can improve cardiovascular factors in diabetic subjects224 A new double-blind study of fenugreek in diabetic subjects found that this compound improves blood sugar control and reduces resistance to insulin in the body225 The researchers found that the group receiving fenugreek had a significant improvement in these areas compared to a control group that only received the typical regimen of dietary control and exercise
liver and spleen Administration of an extract of momordica to mice with alloxan-induced diabetes significantly lowered blood sugar and delayed the onset of retinopathy, nephropathy230 and cataract231 Administration of 230 g/day of momordica for 8-11 weeks
to a group of nine diabetic patients, significantly improved the results of oral glucose tolerance tests232 New studies suggest bitter gourd has the ability to regenerate dormant pancreatic beta cells that stimulate insulin in the body
Panax Ginseng Korean ginseng
Panax Ginseng, commonly known as Korean ginseng, has a long history of use in Asian countries as a tonic It is used in China to treat diabetes At least five constituents of this herb have been shown to exert hypoglycemic effects A recent study found that diabetic mice that received daily injections of Panax ginseng berry extract for 12 days had significant improvement in blood sugar regulation233In one study, 36 non-insulin-dependent diabetics were randomly assigned to receive ginseng 100 or 200 mg per day or a placebo for eight weeks the type of ginseng was not specified Compared with placebo, treatment with ginseng lowered blood sugar levels and improved mood and psychological performance The 200-mg dose of ginseng was more effective than the lower dose A study of 9 subjects with type 2 diabetes mellitus found that 3 grams of American ginseng administered 40 minutes before an oral glucose challenge significantly
reduced blood glucose levels compared with control subjects A different study 10 men and women with type 2 diabetes found that 3 grams of American ginseng led to blood glucose reductions after eating and was effective in lower these levels as 6- and 9-gram doses A new randomized crossover study in healthy subjects found that American ginseng reduced blood sugar levels following eating in a dose-independent manner232 The researchers found that 1,2, and 3 grams were equally effective in controlling blood sugar release The ginseng was effective only when given 40 minutes before eating A different study found that 3,6, and 9 grams of American ginseng led to significant improvements in blood sugar regulation following eating in a group of 10 patients with type 2 diabetes In this study, timing of the ginseng ingestion was not as significant as in the other study Patients who took ginseng before
Aloes
The dried sap of the aloe plant is used as a traditional remedy for diabetes in the Arabian peninsula A study in diabetic mice found that the administration of 500 mg of aloe for every kilogram of body weight in the animal led to significant reductions in blood glucose after five days226
Aloe vera treatment has been found to improve wound healing in diabetic animals227 Administration of one-half teaspoon daily for 4-14 weeks to five patients with non-insulin-dependent diabetes resulted in a mean reduction in serum glucose from 273 to 151 mg/dl p005228
Arctium lappa Burdock Root
Burdock root has been used traditionally in cases of skin eruptions, gout, and rheumatism It is commonly used in Japanese cooking In an uncontrolled study, administration of burdock root in doses of 54-81 g/day reduced insulin requirements in several diabetics This effect disappeared when the treatment was discontinued; resumption of Burdock root again reduced insulin requirements229
Momordica charantia Bitter Gourd
The fruit of Momordica charantia Bitter Gourd has been used in traditional herbal medicine for the treatment of rheumatism, gout, dysmenorrhea, jaundice, and disorders of the
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or with the meal had equal blood sugar regulation benefits A double-blind, placebo-controlled study of 36 patients with type 1 diabetes found that 100 and 200 mg supplementation with ginseng led to significant improvements in body weight, mood, and fasting blood glucose levels234 A new study in
diabetic mice found that an extract from the ginseng berry, and not the root, improved insulin sensitivity, reduced body weight, and normalized blood glucose levels in the treated animals235
Mulberry
Mulberry leaves have been shown to have some anti-diabetic properties A study of diabetic mice found that hot water extracts of mulberry leaves administered in a single dose of 200 mg/kg led to significant improvements in blood sugar levels in treated animals244 A study of 24 humans with type 2 diabetes found that patients who received a compound derived from mulberry leaves had significant improvement in blood sugar control compared to a group that received glibenclamide, a commonly-used drug in the treatment of type 2 diabetes In addition, the researchers discovered that a variety of blood lipid factors, such as total cholesterol, triglycerides, and plasma free fatty acids, were improved in the mulberry group This is an important consideration in diabetics because of their increased vulnerability to cardiovascular disease
Allium cepa Onion
An active ingredient in onions has been found to have anti-diabetic properties The callus part of the onion was found to have the most
anti-diabetic activity in a study involving diabetic rats236 A different study found that diabetic rats fed a diet of 3 freeze-dried onion powder had significant improvement in a variety of diabetic measures237 These rats did considerable better than a group that received a diet containing 15 capsaicin powder A compound called SMCS, isolated from onions, produced similar effects as insulin in a group of diabetic rats238 These diabetic rats received a daily oral dose of 200 mg/kg body weight for 45 days Most importantly, a randomized comparative study performed in 260 diabetic humans found that 60 grams of fresh onion added to the diet every day led to significant decreases in blood sugar levels in a group of patients239 All of the patients in the study ate a well-controlled diet, but some of the patients received a diet supplemented with green beans rather than onions Those receiving green beans showed no significant improvements in blood sugar regulation A newer study found additional evidence that onion has powerful antioxidant properties that help prevent and treat arteriosclerosis240 Another study found that onion has antidiabetic effects on the most basic levels of tissue
function241
Grifola frondosa Maitake Mushroom
Animal studies have shown that one or more components of maitake mushrooms have blood glucose-regulating properties A group of diabetic rats had significant improvement in a variety of diabetes measures after receiving maitake for 100 days245 A different study involving diabetic mice found that the administration of 1 gram per day of maitake led to significant reductions in blood glucose An additional study involving diabetic mice found that a single administration of 140 mg FXM, a component of maitake, improved glucose/ insulin metabolism in the treated animals Increased insulin sensitivity accounted for most of this improvement
Traditional Chinese Medicine
In Traditional Chinese Medicine TCM, there are three main causes of diabetes: improper food intake fat, alcohol, and sweets, emotional impairment stress and anxiety or sexual stress Any of these may result in one of the following three distinct syndromes italicized terms refer to the TCM diagnosis, which frequently differs from the Western use of the term: 1 The Upper Jiao type of diabetes is related to a lung deficiency In TCM the function of the lung is to control breathing and
to dominate qi energy, pronounced chi This lung deficiency results in a fluid
Garlic
Some garlic compounds are chemical cousins to many of the compounds found in onions Garlic is widely known to have beneficial effects on the cardiovascular system A new study has found that garlic has beneficial effects on the cardiovascular system in diabetic subjects242 A different study found that garlic oil can prevent or delay the most severe complications associated with diabetes243
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deficiency, and the prevalent symptom is great thirst 2 The Middle Jiao type of diabetes, is related to the spleen The spleen in TCM is synonymous with both the adrenal gland and pancreas of Western medicine This deficiency leads to symptoms of great hunger 3 The Lower Jail type of diabetes relates to the kidney The function of the kidney in TCM is to dominate water metabolism The kidney in TCM relates both to the kidney and the reproductive organs in Western medicine Kidney deficiency leads to symptoms of great urination
Chinese Herbal Formulas
Long-established systems of traditional medicine have evolved from recordings of human experience Although not based on concepts of modern science, they are
founded on a body of organized knowledge and have provided useful treatments for thousands of years Chinese herbal formulas usually consist of a combination of individual herbs that are believed to have synergistic effects A number of formulas have been studied in diabetic rats Administration of the formula Xuetangping at a dose of 15g/k/day lowered serum glucose to near-normal levels after 14 days Dai-saiko-to decreased blood-glucose levels at 30, 60, and 120 minutes during a glucose tolerance test246 Administration of Tang-Niao-Tung to diabetic rats significantly decreased blood-glucose levels after 2,4, and 6 hours247 Paweiwan decreased the baseline glucose concentration, and ameliorated the bloodglucose response to a glucose challenge Xiaoke tea, a traditional Chinese treatment for diabetes mellitus, lowered blood glucose concentrations in diabetic mice In human studies, Jin Pi Jang Tang Pain was administered to 40 diabetics patients After two months of treatment, fasting and postprandial blood glucose con- centrations were both significantly decreased Jiang Tang San has also been found to reduce glucose
and lipid levels, as well as blood pressure, in 30 patients
with non-insulin-dependent diabetes Sixty-eight patients diagnosed with kidney deficiency and blood statis were given Bushenhuoxue This treatment lowered serum levels of lipid peroxides, decreased blood sugar, and increased HDL cholesterol levels Twenty-three patients with diabetic retinopathy who were diagnosed with kidney and yin deficiency and blood statis responded to a Chinese herbal formula with a marked increase in visual acuity An extract of Buddlejae Flos was found to inhibit the activity of aldose reductase in rat lens tissue in vitro This effect was attributed to the flavonoid luteolin, which is found in high concentrations in this plant248 A similar effect has been reported with Glycyrrhiza uralensis fisch a species of licorice Oral administration of this herb significantly reduced the concentration of sorbitol in erythrocytes of diabetic rats, without affecting blood-glucose levels249 These herbs may therefore have value for the prevention and treatment of diabetic complications, although human studies have not yet been performed Gosha-jinkl-gan, which consists of ten herbs, has been widely used to treat neuropathy and other complications of diabetes This formula has
been shown to improve nerve conduction velocity in diabetic rats250,251 Administration of Rheum officinale to diabetic rats significantly reduced the severity of nephropathy252 A new study has found that Wen Dan Tang is effective for the treatment of diabetic microvascular complications253
Acupuncture
Traditional Chinese acupuncture treatments have been shown to relieve the pain associated with diabetic neuropathy254 A study of 55 patients with insulin-dependentdiabetes mellitus found that 10 sessions of acupuncture treatment led to improved circulation in the lower extremities of 782 of cases255 A study in diabetic rats found that electroacupuncture can induce a sustained reduction in blood sugar levels256 A study of 46 patients with painful,
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chronic neuropathy in the limbs underwent six courses of traditional Chinese Medicine acupuncture points over a period of 10 weeks257 During a one-year follow-up period, 77 had significant improvements in symptoms
New Approaches
Capsaicin, the component in peppers that makes them hot, lowers blood sugar in diabetic dogs, according to a recent study Another study demonstrated that high doses of aspirin can counteract some of the
negative effects of insulin resistance The researchers warn that such high doses have detrimental effects, but these new findings may help develop safer therapies in the future A different study recently found that a synthetic antioxidant, a molecule that protects body tissues and cells from the harmful effects of oxygen, may slow or reverse autoimmune diseases, such as diabetes In this particular study, the investigators found that this antioxidant compound protected cells in diabetic mice that are required for the production of insulin A study in a May issue of the Journal of the American Medical Association found that a couple of alcoholic drinks per day may prevent diabetes in older women The women in the study were at high risk for developing diabetes and received a controlled diet The women were compared to a similar group of women who consumed orange juice with no alcohol The researchers cautioned that additional research is needed before alcohol can be recommended in persons at risk for developing diabetes
Endnotes
Haller H, et al The role of hyperglycemia and hyperinsulinemia in the pathogenesis of diabetic angiopathy Clin Nephrol 1996;464:246-55 2 Vinikor F Is
diabetes a public health disorder? Diabetes Care 1994;17Suppl 1:22-7 3 Poll commissioned by the American Diabetes Association 2002 4 Skyler J, et al New England Journal of Medicine 2002 May 5 Kelkar SM, et al Determination of antidiabetic activity
1
in Allium cepa onion tissue cultures Indian J Biochem Biophys 2001;38:277-79 6 Sundaram RI, et al Antioxidant status and lipid peroxidation in type II diabetes mellitus with and without complications Clin Sci 1996;90:255-260 7 Brownlee M Glycosylation products as toxic mediators of diabetic complications Ann Rev Nutr 1991;42:159-166 8 Anderson JW, Ward K High-carbohydrate, high fiber diets for insulin-treated men with diabetes mellitus Am J Clin Nutr 1979;32:2312-2321 9 Anderson JW, et al Metabolic effects of high-carbohydrate, high- fiber diets for insulin-dependent diabetic individuals Am J Clin Nutr 1991;54:936-943 10 Manhire A, et al Unrefined carbohydrate and dietary fiber in treatment of diabetes mellitus J Hum Nutr 1981;35:99-101 11 Harold MR et al Effect of dietary fiber in insulin-dependent diabetics: insulin requirements and serum lipids J Am Diet Assoc 1985;85:1455-1460 12 Simpson HCR, et al A high carbohydrate leguminous
fiber diet improves all aspects of diabetic control Lancet 1981;1:15 13 Jenkins DJA, et al Slow release dietary carbohydrate improves second meal tolerance Adm J Clin Nutr 1982;35:1339-1346 14 Narain JP, et al Metabolic responses to four week barley supplement Int J Fd Sci Nutr 1992;43:41-46 15 Anonymous Eating green beans, onions appears to lower blood sugar Intern Med News, December 1, 1980, p5 16 Sharma KK, et al Antihyperglycemic effect of onion: effect on fasting blood sugar and induced hyperglycemia in man Indian J Med Res 1977;65:422-429 17 Jain RC, et al Hypoglycaemic action of onion and garlic Lancet 1973;2:1491 18 Silagy C, et al Garlic as a lipid lower agent - a metaanalysis J R Coll Physicians London 1994; 28:39-45 19 Phelps S, Harris WS Garlic supplementation and lipoprotein oxidation susceptibility Lipids 1993;28:475-477 20 Legnani C, et al Effects of a dried garlic preparation on fibrinolysis and platelet aggregation in healthy subjects Arzneimittelforsch 1993;43:119-121 21 Silagy CA, et al A meta-analysis of the effect of garlic on blood pressure J Hypertens 1994;12:463-468 22 Kawakishi S, Morimitsu Y New inhibitor of platelet aggregation in onion oil Lancet
1988;2:330 23 Louria DB, et al Onion extract in treatment of hypertension and hyperlipidemia: a preliminary communication Curr Ther Res 1985;37:127-131 24 Hollman PCH, et al Absorption and disposition kinetics of the dietary antioxidant quercetin in man Free Rad Biol Med 1996;21:703-707 25 Varma SD, Kinoshita JH Inhibition of lens aldose reductase by flavonoids: their possible role in the prevention of diabetic cataracts Biochem Pharmacol 1976;25:2505-2513 26 Held DD, et al Isolation of a non-chromium insulinenhancing factor from brewers yeast Fed Proc 1984,43:472 27 Funk C, Corbitt HB The presence of a blood-sugar reducing substance in yeast Proc Soc Exp Biol Med 1923;20:422-423 28 Hu F, et al New England Journal of Medicine 2001 Sep 29 McAuley K, et al Diabetes Care 2002 Mar
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