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:
- Exercise
- 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
- Stress
reduction
- A wide variety
of supplements, herbs, and medications
Exercise
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.
Diet
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.
Stress Reduction
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. |