Health Medicine Center Article
Type II diabetes has become an epidemic, but there is a lot we can do to stop it dead in its tracks. Like so many situations in life, there are lifestyle solutions that are often challenging to sustain. In addition, there are both pharmaceutical and natural alternatives in the form of supplements and herbs that can be used to support this effort.
Few knowledgeable healthcare practitioners would argue that diet, exercise, adequate sleep, stress reduction, weight management, detoxification, and good spiritual health are vital to being healthy whether you have diabetes or not. It is well known that all of these factors have a profound effect on how well insulin works—insulin sensitivity—in the human body, and that this is a very important cornerstone in preventing and managing people with diabetes.
Several decades ago Gerald Reaven, MD, from Stanford University, pioneered the concept that insulin sensitivity is one of the earliest signs of type II diabetes, and that it has profound effects on our health. Dr. Reaven coined the term “syndrome X” to describe this disorder, but today it is more commonly known as “the metabolic syndrome.” This condition is characterized by the presence of hypertension, abdominal obesity, elevated blood fats, and the premature development of arteriosclerosis (which causes heart attacks, strokes, kidney disease, and peripheral vascular disease). There are an estimated 75 million Americans with the metabolic syndrome. Most of the time people are unaware that they have this disorder until it has already caused significant, and often irreversible, damage to their bodies.
"Diabetes puts us at risk for developing serious health issues"
The loss of insulin sensitivity develops long before there is a detectable elevation in the blood sugar level. Quite differently from type I diabetes, where there is a shortage of insulin, in type II diabetes there is just the opposite situation—high levels of insulin are found! This apparent paradox in regulation of blood sugar levels can be explained by the fact that insulin does not work as well because there is insulin resistance, and larger amounts are required to get the same job done. The bottom line in both situations is that there is a deficiency of insulin activity.
In Type I diabetes, where the insulin producing beta cells of the pancreas are destroyed by an autoimmune reaction, it is usually necessary to supply the body with insulin injections to maintain control of blood sugar levels. On the other hand, in type II diabetes it may be possible to normalize blood sugar levels by increasing the sensitivity of insulin and thereby decrease insulin resistance.
When there is insulin resistance, the associated high insulin levels put us at high risk for developing several serious health issues. First, there is a tendency for the sugar we eat to be converted into fat. Making matters worse, high levels of insulin retard the breakdown of fat in the fat cells where it is stored. High insulin levels do this by inhibiting an enzyme called lipase, which normally catalyzes a reaction allowing fat cells to release fatty acids as fuel to produce energy. Consequently, it is easy to become overweight, especially around the middle and inside the abdominal cavity with a kind of “brown” fat that is highly toxic. High levels of brown fat are associated with high blood pressure, elevated triglycerides, an increased risk for heart attacks and strokes, and central obesity. This is the metabolic syndrome.
So, it is easy to understand why it is important to maintain normal insulin sensitivity and low levels of insulin. There are many important ways to preserve or restore insulin sensitivity that include:
A diet low in carbohydrates or foods with a low glycemic index
(foods with a low tendency to be converted into glucose)
Maintaining a normal weight
A wide variety of supplements, herbs, and medications
The benefits of exercise cannot be overemphasized. It is possibly the most potent factor known to medical science that stimulates insulin sensitivity. People with the metabolic syndrome, outright diabetes, and many people over the age of 50 suffer from varying degrees of “insulin resistance,” all benefit from the increased insulin sensitivity that exercise brings.
Of course, there are countless additional benefits of exercise such as increased life span, fitness, strength, cardiac function, and vitality, as well as decreased morbidity, cholesterol levels, blood pressure, blood viscosity, depression, anxiety, difficulty sleeping, and obesity for those who exercise regularly. Even one hour a week of walking has been shown to provide clear health benefits that translate into living a longer, healthier life.
With the average American consuming 150 pounds of sugar per year, it is no surprise that insulin metabolism becomes abnormal after four or five decades of this kind of dietary challenge. Just over 100 years ago, the average intake of sugar in the US was only 2 pounds! There are many examples of cultures such as the Native American Indians and Eskimos who did not suffer from diabetes, hypertension, or heart attacks until large amounts of sugar were introduced into their diets.
It is no more than simple logic to conclude that it is beneficial to reduce the sugar load presented to the pancreas if it is already unable to produce sufficient insulin to metabolize it. This is why diets low in carbohydrate, such as the Atkin’s diet, make so much sense for people with the metabolic syndrome or type II diabetes. And, this is why so many experts in diabetes are beginning to consider lower carbohydrate diets for their diabetic patients.
One objective of the low carbohydrate diet is to shift the body’s metabolism from burning sugar for energy to burning fat. This lowers blood sugar levels and at the same time gives the pancreas a rest—if there is only a little sugar consumed, blood sugar levels will drop and less insulin will be necessary. This is exactly what happens as our bodies shift their metabolism from “sugar burning mode” to “fat burning mode.”
People on the “low carb” diet go into ketosis because ketone bodies are the end product of burning fat, and they build up as more fat is used for fuel. Ketone bodies are excreted into the urine and can be inexpensively measured in the urine with a dipstick to document their presence. If there are no ketone bodies in the urine, there is not much fat being used to make energy.
It is very important to differentiate ketosis from ketoacidosis, and many people (even some physicians) do not understand the difference. Ketosis only means that our body is in fat burning mode—that is good news if we want to lower insulin levels and burn fat. People who do not have type I diabetes do not develop ketoacidosis except in very unusual circumstances.
Ketoacidosis is a totally different condition that is associated with severely uncontrolled type I diabetes and is often lethal. In this setting, there is a complete absence of insulin and blood sugar levels may reach 10-20 times normal values. In uncontrolled type I diabetes, the body can no longer transport sugar from the blood stream into the cells of the body, where it can be used to make energy. In this setting the body is forced to go into fat burning mode, but only after other serious major metabolic abnormalities develop. These include severe acidosis, profound deficiencies in important electrolytes such as potassium and magnesium that are potentially lethal, and a wide variety of other serious chemical imbalances. There is a very big difference between type I and type II diabetes, and dietary management must be individualized by a qualified healthcare practitioner.
Maintaining a Normal Weight
We all know that there is an epidemic of obesity in the US. We also know that this is one of the reasons why the metabolic syndrome and type II diabetes and their secondary complications are on the rise. Medical science has known for a long time that obesity is an important factor that leads to insulin resistance (or loss of insulin sensitivity), but only recently have we discovered why this happens.
Recent scientific research from Columbia University in New York reveals that obesity leads to an inflammatory process that originates in the fat cell itself. Fatty tissue in the setting of obesity is characterized by an infiltration of inflammation producing cells called macrophages. These macrophages instigate the development of inflammation that leads to insulin resistance. Thus, this data suggests that obesity-related insulin resistance is in part a chronic inflammatory disease that is initiated in adipose tissue itself. We also know that hypertension and arteriosclerosis are inflammatory processes—the inflammatory process that develops in obesity is likely one of the important mechanisms that leads to heart attacks, strokes, and other vascular disorders.
The importance of reducing body fat is easy to appreciate. However, obesity is becoming more widespread and there is no indication that this trend is slowing. Between the unhealthy food ads on TV, radio, newspapers, and magazines, and the widespread abundance of foods that are full of sugar, salt, and fat, it is unlikely that Americans will take healthy eating seriously unless or until they become sick. We know that this is often too late.
Our fast-paced lives lead to overachieving behavior patterns and loads of stress. Stress causes our bodies to produce high levels of adrenalin and cortisol. Over time, high levels of cortisol lead not only to adrenal exhaustion, but also to insulin resistance, and eventually this predisposes to developing the metabolic syndrome or even type II diabetes. This may be why medical researchers discovered long ago that type A personalities are at higher risk of developing diabetes, hypertension, heart attacks, and strokes.
Supplements, Herbs, and Pharmaceutical Drugs
When blood sugar levels remain high for prolonged periods, the incidence of serious complications of diabetes skyrocket. They include heart attacks, strokes, kidney failure, blindness, neuropathy, and amputations. The good news is that most of the time these problems are preventable.
When blood sugar levels are sustained above 160-170 mg per ml, biochemical reactions occur that greatly accelerate the development and progression of these disorders. An enzyme called aldose reductase, which catalyzes the conversion of glucose to sorbitol, causes one such reaction. Sorbitol is extremely toxic to nerves and blood vessels and leads to the well-known vascular complications of diabetes. So, keeping blood sugar levels below this level is especially important.
Many supplements enhance insulin sensitivity, reduce blood sugar levels, lower the need for insulin and oral hypoglycemic drugs, and reduce the free radical damage that causes premature aging in diabetics. Some important examples include: · Vitamin C blocks the activity of aldose reductase and also helps reduce free radical activity that leads to premature aging · Magnesium deficiency is characteristic of diabetics and because it is involved in more than 300 reactions within the cell, it must be replaced to insure adequate production of energy, enzymes, hormones, and other cellular products · Chromium and vanadium increase insulin sensitivity directly as well as by increasing its receptor site sensitivity on the surface of cells · Alpha lipoic acid increases insulin sensitivity and also protects neural cells in the brain and in peripheral nerves · Omega 3 and 6 fatty acids help build healthy cell membranes and protect against peripheral neuropathy · A wide variety of herbs such as cinnamon, gymnema sylvestre, fenugreek, onion and garlic, bitter melon, and bilberry can lower blood sugar levels significantly.
The pharmaceutical industry has developed an enormous variety of drugs that work very well to help control high blood sugar levels in patients with type II diabetes. The problem with them is that none are natural. They are synthetic and have numerous side effects, warnings, and contraindications that can be highly dangerous. Some have even been taken off the market because they were found to cause more harm than good. Yet, for some people they are necessary and can reduce the complications of diabetes as well as increase life expectancy —they can get the job done.
At HMC we specialize in blending the best from conventional and alternative medicine as well as from the East and West to support the whole person—body, mind, and spirit. Our practitioners typically work together in teams that support each person’s unique individual needs. It is not uncommon for our patients to work with varying combinations of experts in internal medicine, endocrinology, nutrition, Chinese medicine, psychology, bodywork, homeopathy, exercise, and imagery as they begin their journey to good health.
One of our HMC patients was referred to us last year because he did not want to go onto insulin or other pharmaceutical drugs. His story is not unusual: Steve was referred to the HMC for treatment of possible diabetes. Over the preceding five years, he had gotten out of shape, was smoking and drinking too much, and was 25 pounds overweight. He was under considerable stress both at work and at home. At age 45, he felt that he was becoming an old man. Extensive laboratory testing revealed that he had type II diabetes with fasting blood sugars in the range of 350. He was put on a program including a low-carbohydrate diet, regular exercise, no alcohol or cigarettes, and nutritional supplements. He also agreed to see our psychologist to help him stop smoking and drinking. Over the course of the next three months, his diabetes came under perfect control without medications, his weight dropped 20 pounds, and he was able to discontinue drinking and smoking. He continued psychotherapy, began working out, and once again began feeling like his old self. At HMC we focus on early screening and diagnosis using leading-edge laboratory testing for factors such as homocysteine, fasting insulin, specialized lipoproteins, coagulation disorders, and iron levels. We also support lifestyle changes related to diet, nutrients, exercise, stress reduction, and weight management that over time often reduce or eliminate the need for medication entirely. Our teams of physicians, exercise specialists, psychologists, lifestyle coaches, and nutritionists collaborate to create programs that are specifically tailored to the individual patient and his/her situation.