Vanessa Laird
Naturopath Calanna Pharmacy Woree
Type 2 Diabetes Mellitus: A Disease of the Modern
World
Diabetes mellitus is a
chronic metabolic disorder affecting blood sugar regulation and utilisation. It occurs due to a deficiency in producing or
using insulin, a hormone that controls blood glucose levels, and leads to high
blood glucose (Australian Bureau of Statistics 2011).
There are three types
of diabetes:
·
Type 1 Diabetes:
Associated with autoimmunity, viral &/or chemical exposure that attacks the
β-cells of the pancreas.
·
Type 2 Diabetes:
A dietary & lifestyle related condition, with links to genetic
predisposition.
·
Gestational diabetes:
Diabetes occurring during pregnancy, with no previous history of the condition,
with the potential to develop Type 2 diabetes.
Type 2 Diabetes is becoming an epidemic throughout Australia. There has been an increase from 1.1% in 1995 to 3.3% in 2007-2008, with percentages expected to rise. Men are almost two times more likely to develop diabetes than women, especially after the age of 45 (Australian Bureau of Statistics 2011). Australians in lower socio-economic areas are twice as likely to have or develop diabetes, due to limited resources and lack of basic health education (Australian Bureau of Statistics 2011).
(Table taken from Australian Bureau of Statistics
2011)
Causative Factors Associated with Type 2 Diabetes:
High Intake of
Refined Carbohydrates, Saturated Fats and Low fibre intake:
According to the UK Nutritional
Working Group of Diabetic Medicine, a diet high in red meat, processed meats,
refined sugars and fried foods, increases the risk of developing Type 2
Diabetes (Dyson, Kelly,
Deakin, Duncan, Frost & Worth 2011).
Obesity:
Overweight or obese individuals are
three times more likely to develop Type 2 Diabetes. Weight loss is paramount
for improving glycemic control and reducing cardiovascular risks in these
individuals (Dyson, Kelly,
Deakin, Duncan, Frost & Worth 2011).
High Alcohol Consumption
& Poor Liver Detoxification:
High alcohol
consumption affects the liver’s ability to produce glucose, causing blood
glucose levels to drop (hypoglycaemia). Hypoglycemia
is thought to be a pre-diabetic condition causing insulin desensitisation resulting
in type II diabetes (Murry & Pizzorno 2011).
Overconsumption of alcohol can contribute to increased oxidative stress and
reduce the liver’s detoxification capacity.
Smoking:
Research shows that
quitting smoking can reduce the risk of developing Type 2 diabetes. Smoking
increases the risk of developing diabetic complications such as cardiovascular
disease, stroke and kidney disease (Australian Bureau of Statistics 2011).
Oxidative
Stress:
High oxidative stress has been linked with the development and
progression of Type 2 Diabetes due to altered glucose sensitivity and lipid
metabolism (Bahadoran, Mirmirian, Hosseinpanah, Hedayati & Azizi 2011).
Long term oxidative stress can cause secondary conditions, and lead to
cardiovascular problems, disability and even death (Bahadoran, Mirmirian,
Hosseinpanah, Hedayati & Azizi 2011). Toxin
containing foods (PCB’s, Dioxins and Organochlorines) are also linked to Type 2
Diabetes (Osiecki, H. 2008).
Prenatal
Factors & Genetic Predisposition:
Maternal nutrition is paramount before, during and after pregnancy. An
undernourished fetus may alter its ‘programming’ or epigenes, resulting in
chronic diseases later in life (Le Clair, Abbi, Sandhu & Tappia 2009). Maternal
nutritional deficiencies can slow down cell division, disrupting fetal growth.
This delay interrupts insulin and growth hormones resulting in low birth weight
(LBW) babies. LBW babies may have an increased risk of developing Type 2
Diabetes and cardiovascular disease in their adult years (Le Clair, Abbi,
Sandhu & Tappia 2009). Maternal obesity may influence the central appetite
regulatory system and create ‘fat-cell programming’ in an unborn child. This is
thought to predispose the child to Obesity and increase the risk of CVD and
Type 2 Diabetes (Le Clair, Abbi, Sandhu & Tappia 2009). Please note that if
a mother or father is small the baby may also be small, even with excellent nutrition.
This also applies to bigger babies. The significant message to take away from
this is the importance of nutrition and it’s role in the prevention of Type 2
Diabetes, CVD and Obesity.
Complications Associated with Type 2 Diabetes:
Nephropathy, Neuropathy and Retinopathy:
Long-term secondary complications are the main cause of morbidity and
mortality in diabetic patients. Secondary problems associated with Type 2
Diabetes are nephropathy (kidney damage), neuropathy (nerve damage) and
retinopathy (damage of the retina of the eye, potentially leading to
blindness). Aldose reductase (enzyme)
inhibition has shown to alleviate and/or prevent secondary complications
associated with Type 2 diabetes (Saraswat, Muthenna, Suryanayana, Petrash &
Bhanuprakash Reddy 2008). High blood glucose causes an accumulation of this
enzyme resulting in abnormal glucose conversion pathways. Aldose reductase has
demonstrated to be actively involved in tissue injury as seen in nephropathy, neuropathy
and retinopathy (Saraswat, Muthenna, Suryanayana, Petrash & Bhanuprakash
Reddy 2008).
Ketoacidosis:
Ketoacidosis occurs due to a lack of
insulin production leading to a buildup of ketoids. This can lead to metabolic
problems and even coma (Osiecki 2008). Urinary keto-sticks can indicate the
amounts of ketones present.
Whole Grains:
Whole grains have been well documented in reducing risk factors
associated with cardiovascular disease, improving insulin sensitivity and
preventing Type 2 diabetes. Whole grains such as amaranth, barley, brown rice
and sorghum have a balance of macronutrients, micronutrients, fibres and
phytochemical (Dixit, Azar, Gardner & Palaniappan 2011).
This balance lowers high blood glucose levels, improves bowel function
and assists in maintaining a healthy basal metabolic Index (BMI). Other grains
including couscous, quinoa and spelt are also highly nutritious and can also
reduce or prevent Type 2 diabetes (Dixit, Azar, Gardner & Palaniappan
2011).
Herbs & Spices:
Cooking or preparing foods using black pepper, cinnamon, curry leaves,
cumin, fennel, fenugreek, lemon, orange, spinach and basil can help to inhibit
aldose reductase (enzyme involved in secondary complications of diabetes)
(Saraswat, Muthenna, Suryanayana, Petrash & Bhanuprakash Reddy 2008).
Low Glycemic Index (GI) Natural Sweeteners:
Xylitol, Stevia, Lucuma powder, Yacon syrup, Agave syrup or Mesquite
powder are all low GI natural sweeteners that contain micronutrients. They can
be used in cooking as a sugar alternative.
Broccoli Sprouts:
Sulforaphane is a bioactive compound found in broccoli sprouts. This
compound has shown to activate antioxidant enzymes via liver detoxification and
inhibiting lipid peroxidation. This
increase in antioxidant levels combined with healthy liver detoxification has
been shown to reduce oxidative stress and prevent the development of secondary
complications associated with diabetes (Bahadoran, Mirmirian, Hosseinpanah,
Hedayati & Azizi 2011). Fresh broccoli sprouts have also demonstrated to
increase Coenzyme Q10 (a potent antioxidant) levels in healthy individuals;
whereas dried broccoli sprouts have shown to increase glutathione levels (a
specific antioxidant dealing with peroxides and other lipid derived oxidants)
(Bahadoran, Mirmirian, Hosseinpanah, Hedayati & Azizi 2011).
Water-Soluble Fibre:
Water soluble fibres prevent rapid
increases in blood sugar levels and slows down digestion and absorption of
carbohydrates; increasing insulin sensitivity (Lim, Cheng, Chow, Wong & O’Sullivan 2010). Psyllium is a type of water incredibly beneficial for Type 2 Diabetics
and has also been shown to reduce LDL
levels (bad cholesterol) and triglycerides (blood fats). Other water soluble
fibres include legumes, oat bran, raw nuts, seeds, pears, apples and most
vegetables.
Exercise:
Brisk walking for a minimum of 30min daily or 1 hour 3 times a week have
shown to prevent &/or manage Type 2 diabetes, by improving glucose
tolerance and promoting weight loss (Lim, Cheng, Chow, Wong & O’Sullivan
2010).
Vitamin K1 or phylloquinone:
Vitamin K1 or phylloquinone has a beneficial role in glucose metabolism,
insulin sensitivity and Type 2 Diabetes. It has also been shown to exert
anti-inflammatory properties against disease producing cytokines.
Pro-inflammatory cytokines are recognized in the progression and development of
insulin resistance and cardiovascular disease (Juanola-Falgarona,
Salas-Salvado, Estruch, Portillo, Casas, & Bullo 2013). Vitamin K1 should
be only administered by a qualified practitioner with continuous supervision.
Magnesium:
Magnesium deficiency has been linked as a contributing factor in Type 2
diabetes. The specific mechanisms at play may be linked to ATP (energy)
production, improvement of insulin sensitivity and its role with various other
neuro-cardiovascular involvements (Wells 2008). It is not recommended as a
monotherapy, however is highly beneficial in combined treatments.
Chromium:
Chromium is an essential trace mineral that is required for carbohydrate
and lipid metabolism. Chromium deficiency may be linked to Type 2 Diabetes, due
to its involvement in the ‘glucose tolerance factor’ (Nahas & Moher 2009).
Vitamin C:
Studies have shown that vitamin C can reduce the risk of developing Type
2 Diabetes. A minimum of 2g of vitamin C taken daily may help to reduce
the accrual of sorbitol (a sugar alcohol that has been linked to diabetic
complications especially eye and nerve disorders) in red blood cells of
diabetics (Lim, Cheng,
Chow, Wong & O’Sullivan 2010).
Vitamin C rich foods
include: capsicum, citrus fruits, kiwi fruit and sprouts.
Omega-3 Essential Fatty Acids:
Omega-3 marine oils (DHA/EPA) have proven to be effective at reducing
triglyceride levels in diabetics (Dyson, Kelly, Deakin, Duncan, Frost & Worth 2011).
Herbal Medicine:
Gymnema (Gymnema sylvestre):
Gymnema is a traditional Ayurvedic herb used for more than 2000 years throughout
India. It is the pick of herbs to use in diabetics due to the vast array of
research supporting its hypoglycemic effects. Gymnema is thought to improve
pancreatic β-cell numbers and function, therefore enhancing insulin secretion
(Ulbricht, Abrams, Basch, Davies-Heerema, Foppa & Woods 2011). It may also
stimulate endogenous insulin via other hormones or may increase glucose utilisation
(Ulbricht, Abrams, Basch, Davies-Heerema, Foppa & Woods 2011). Gymnema may restore glycoprotein levels, and
prevent further complications associated with diabetes, notably organ changes
(Ulbricht, Abrams, Basch, Davies-Heerema, Foppa & Woods 2011). Gymnema has
also been reported to increase cholesterol metabolism thus reducing serum
triglycerides, total cholesterol and low density lipoproteins (VLDL’s or bad
cholesterol) (Ulbricht, Abrams, Basch, Davies-Heerema, Foppa & Woods 2011).
The taste of Gymnema has also shown to
reduce sugar cravings and suppress appetite. The peptide gurmarin is believed
to responsible (Ulbricht, Abrams, Basch, Davies-Heerema, Foppa & Woods
2011).
Prescriptive medications, certain foods and other supplements can
interact with this herb, therefore practitioner supervision is advised.
Bitter Melon (Momordica
charantia
):
Bitter Melon has demonstrated to exert hypoglycemic properties and acts
as an aldose reductase inhibitor (Saraswat, Muthenna, Suryanayana, Petrash
& Bhanuprakash Reddy 2008).
Cinnamon (Cinnamomum cassia):
Antiglycemic properties may be the main action achieved by cinnamon. It
is thought to increase insulin secretion from pancreatic β-cells and/or increasing
glucose uptake (Karel 2008).
Cacao (Theobroma cacao):
Cacao is made into dark chocolate and has shown to improve insulin
sensitivity and reduce high blood pressure. Studies recommend ingesting 100g of
pure cacao daily can help stabilise blood sugar levels (Lim, Cheng, Chow, Wong
& O’Sullivan 2010). To sweeten add a low GI natural sweetener.
Green Tea (Camellia sinensis):
Caffeine and catechins polyphenols found in Green Tea are thought to
play a role in the control of body regulation via thermogenesis (breaking down
fats). Green tea has shown to assist in weight loss and should be considered in
overweight or obese diabetics (Lim, Cheng, Chow, Wong & O’Sullivan 2010).
Turmeric (Curcuma longa):
Curcumin from turmeric may delay or prevent diabetic cataract formation
(Saraswat, Muthenna, Suryanayana, Petrash & Bhanuprakash Reddy 2008).
Other Recommendations:
Blood Glucose Monitoring:
Monitor blood glucose levels (BGL) daily.
This is best done in the morning before meals as the effect of food on BGL will
vary depending on the type of food and the quantity eaten. If you are taking
prescriptive diabetic medications, it is important to regularly monitor BGL due
to drops in BGL. Always consult your doctor regarding adjustments to your
prescriptive medications.
Acupuncture:
Acupuncture may help balance blood glucose levels and promote healthy
weight loss (Lim, Cheng, Chow, Wong & O’Sullivan 2010).
Before commencing any of the recommended suggestions listed in this
article, please always speak with a qualified practitioner, who is familiar
with natural medicines.
References:
Australian Bureau of Statistics (2011). Prevalence of Diabetes. Retrieved from:
Bahadoran, Z. Mirmirian, P. Hosseinpanah, F. Hedayati,
M. Hosseinpour-Niazi, S. and Azizi, F. (2011). Broccoli sprouts reduce oxidative stress in type 2 diabetes: a
randomized double-blind clinical trial. European Journal of Clinical
Nutrition. 65: 972-977.
Dixit, A.A. Azar, K. M.J. Gardner, C.D. and
Palaniappan, L.P. (2011). Incorporation
of whole, ancient grains into a modern Asian Indian diet to reduce the burden
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Dyson, P.A. Kelly, T. Deakin, A, Duncan, G. Frost, Z.
Harrison, D. Khatri, D. Kunka, P. McArdle, D. Mellor, Oliver, L. and Worth, J.
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