Friday, July 5, 2013

JULY 2013 - Practitioner's Corner - Diabetes Information from our Naturopath Vanessa



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.

 We will focus on Type 2 Diabetes and evaluating the increasing evidence-based information for natural medicine. It is well documented that dietary and lifestyle factors contribute to 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.


 Natural Diabetic Management (Under Practitioner Supervision):

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).

 Nutritional Supplementation:

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 of chronic disease. Nutrition in Clinical Care. 69:8, 479-488.

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. (2011). Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabetic Medicine. 28; 1282-1288

Fabian, E. Toscher, S. Elmadfa, I.  and Pieber, T.R. (2010). Use of complementary and alternative medicine supplements in patients with diabetes mellitus. Annals of Nutrition & Metabolism. 58; 101-108.

Juanola-Falgarona, M. Salas-Salvado, J. Estruch, R. Portillo, M.P. Casas, R. Miranda, J. Martinez-Gonzalez, M. and Bullo, M. (2013). Association between dietary phylloquinone intake and peripheral metabolic risk markers related to insulin resistance and diabetes in elderly subjects at high cardiovascular risk. Cardiovascular Diabetology. 12:7; 1-9.

Karel, R. (2008). Ten herbs for glycemic control in Type 2 Diabetes. Journal of American Journalist Guild. 8:2; 53-63.

Le Clair, C. Abbi, T. Sandhu, H. and Tappia, P.S. (2009). Impact of maternal undernutrition on diabetes and cardiovascular disease risk in adult offspring. Canadian Journal of Physiology and Pharmacology. 87; 161-179.

Lim, C.E.D. Cheng, N.C.L. Chow, Y.K.M. Wong, W.S.F. and O’Sullivan, A.J. (2010). Complementary and alternative medicine for metabolic syndrome. Journal of the Australian Traditional-Medicine Society. 16:4; 209-214.

Murry, P. and Pizzorno, M. (2011). Encyclopedia of Natural Medicines. Three Rivers Press; USA.

Nahas, R. and Moher, M. (2009). Complementary and alternative medicine for the treatment of type 2 diabetes. Canadian Family Physician. 55; 591-596.

Osiecki, H. (2008). The Physician’s Handbook of Clinical Nutrition. Bioconcepts Publishing, Australia.

Saraswat, M. Muthenna, P. Suryanayana, P. Petrash, M. and Bhanuprakash Reddy, G. (2008). Dietary sources of aldose reductase inhibitors: prospects for alleviating diabetic complications. Asia Pacific Journal of Clinical Nutrition. 17:4; 558-565.

Ulbricht, C. Abrams, T.R. Basch, E. Davies-Heerema, T. Foppa, I. Hammerness, P. Rusie, E. Tanguay-Colucci, S. Taylor, S. Varghese, M. Weissner, W. and Woods, J. (2011). An Evidence-Based Systemic Review of Gymnema (Gymnema syvestre R. Br.) by the Natural Standard Research Collaboration.  Journal of Dietary Supplements. 8:3; 311-330.  

Wells, I.C. (2008). Evidence that the etiology of the syndrome containing type 2 diabetes mellitus results from abnormal magnesium metabolism. Canadian Journal of Physiology & Pharmacology. 86; 16-24.

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