Acupuncture, Herbs and Foods for Diabetes

by Barbara Connor, M.Ac., L.Ac.

I would like to share with you today studies on some of the natural ways you can maintain healthy blood sugar levels. These include studies on foods that are beneficial as well as harmful for type 2 diabetes, as well as studies on specific herbs and nutrients for diabetes and studies showing how acupuncture can be beneficial in treating diabetes. I hope you find this article helpful.

Table of Contents

• Introduction
• Foods to Eat that are Beneficial in Reducing the Risk of Type 2 Diabetes
• Food to Avoid in Order to Reduce the Risk of Type 2 Diabetes
• Studies Relating to Dietary Considerations in Insulin Resistance and Diabetes
• Beneficial Herbs, Nutrients and Foods for Insulin Resistance and Diabetes
• Studies on Beneficial Herbs, Nutrients and Foods for Insulin Resistance and Diabetes
• Studies on the Beneficial Effects of Acupuncture on Diabetes
• Blood Markers in Insulin Resistance and Diabetes

Introduction

In order to ensure normal body function, the human body is dependent on a tight control of its blood glucose levels. The pancreas plays a key role in this by secreting the blood sugar-lowering hormone insulin and its opponent glucagon. Disturbances in the interplay of the hormones and peptides involved may lead to metabolic disorders such as type 2 diabetes mellitus (T2DM). (Roder et al 2016)

Insulin resistance is a primary defect that is a characteristic feature of type 2 diabetes. The state of insulin resistance leads to increased insulin secretion by pancreatic β-cells and compensatory hyperinsulinemia. As long as compensatory hyperinsulinemia is sufficient to overcome the insulin resistance, fasting glycemia and glucose tolerance remain relatively normal. In patients predestined to progress to type 2 diabetes, β-cell compensation efficiency declines and relative insulin insufficiency develops, leading to impaired glucose tolerance and, eventually, type 2 diabetes. Consequently, type 2 diabetes results from the progressive failure of pancreatic β-cells in a setting of chronic insulin resistance. (Park et al 2013)

Reactive oxygen species (ROS) play an important role in insulin resistance and pancreatic β-cell dysfunction, a highly prevalent condition implicated in the development of type 2 diabetes. Under a diabetic condition, chronic hyperglycemia may induce large amounts of ROS that are responsible for the progressive dysfunction of β-cells, worsening insulin resistance and further promoting relative insulin deficiency ROS. β-Cells, in particular, are particularly sensitive to ROS because they are low in free-radical quenching (antioxidant) enzymes such as catalase, glutathione peroxidase, and superoxide dismutase. (Park et al 2013)

Prior studies have exhibited that the prevalence of obesity and T2DM in people with coronary heart disease (CHD) exceeds that of the general population. Different factors have been involved in the progression of T2DM and CHD such as little glycemic control and dyslipidemia. In addition, low-grade inflammation resulting from free radicals and reactive oxygen species (ROS) may help to the expansion of metabolic complexity in diabetic vascular disease. (Raygan et al 2016)

There is no argument that improving mean level of glycemic control, assessed by glycated hemoglobin (HbA1c), reduces the risk of microvascular complications and cardiovascular disease (CVD) events in patients with T2D. Chronic sustained hyperglycemia has been shown to exert deleterious effects on the β cells and the vascular endothelium. (Huang et al 2017)

Diabetes mellitus (DM) is associated with a wide range of microvascular complications including diabetic retinopathy (DR). One of the main risk factors associated with development of DR is poorly controlled blood sugar as assessed by glycated hemoglobin levels (HbA1c)—the higher the HbA1c, the greater the risk of developing retinopathy. (Pusparahah et al 2016)

Studies have found that peripheral neuropathy (which includes any disorder of the peripheral nervous system, including polyneuropathy, polyradiculopathies, and mononeuropathy) occurs in up to half of the population with diabetes. (Dy et al 2017 )

Progression of diabetes, and especially poor glycemic control, leads to numerous potentially life threatening complications. Almost half of the adults with chronic kidney disease are derived from diabetic population. Likewise, 9.8% of diabetics have experienced heart attack, 9.1% suffer from coronary artery disease (CAD), 7.9% have congestive heart failure, 6.6% have stroke while more than a quarter of them 27.8% suffer from chronic kidney disease, almost a quarter 22.9% have foot problems and last but not least 18.9% have eye damage. (Trikkalinou et al 2017)

Preexisting diabetes in cancer patients at the time of diagnosis was associated with a hazard ratio of 1.41 for the risk of all-cause mortality compared with individuals without diabetes when pooled across 23 studies of various types of cancer. While the association of diabetes and site-specific mortality risk reached statistical significance only for cancers of the endometrium, breast, and colorectum, diabetes appeared to be associated with some additional mortality risk for all types of cancer. (Barone et al 2011)

Foods to Eat that are Beneficial in Reducing the Risk of Type 2 Diabetes:

• Beans/legumes
• Dairy
• Dairy products
• Dietary fiber
• Dried fruits
• Fish
• Fruits
• Low glycemic index foods
• Low glycemic load dietary pattern combined with a traditional Mediterranean diet
• Nuts
• Plant protein (decreases the risk of type 2 diabetes in females)
• Polyunsaturated fats
• Seafood omega-3s
• Seeds
• Soy
• Vegetables
• Whole grains
• Yogurt

Foods to Avoid in Order to Reduce the Risk of Type 2 Diabetes

• High glycemic index and high glycemic load foods
• Nonnutritive sweeteners
• Processed meats
• Red meat and processed meat
• Sugar-sweetened beverages
• Total protein and animal protein
• Trans-fats
• Unprocessed red meats

Studies Relating to Dietary Considerations in Insulin Resistance and Diabetes

The results of this meta-analysis show that total protein and animal protein could increase the risk of type 2 diabetes mellitus (T2DM) in both males and females, and plant protein decreases the risk of T2DM in females. The association between high-protein food types and T2DM are also different. Red meat and processed meat are risk factors of T2DM, and soy, dairy and dairy products are the protective factors of T2DM. Egg and fish intake are not associated with a decreased risk of T2DM. This research indicates the type of dietary protein and food sources of protein that should be considered for the prevention of diabetes. (Tian et al 2017)

Only 8 identified dietary factors had probable or convincing evidence for causal effects on diabetes, including protective effects of nuts/seeds, whole grains, yogurt, and dietary fiber, and harms of unprocessed red meats, processed meats, sugar-sweetened beverages (SSBs), and glycemic load. SSBs and glycemic load were most frequently studied. Processed meats had the strongest estimated effect, with 1.51 relative risk (RR) per daily serving; other foods had more modest effects, such as 0.82 and 0.88 RR per daily serving of yogurt and whole grains, respectively. SSBs had a small but statistically significant etiologic effect on body weight, with smaller effects in normal weight (per daily serving, 0.10 kg/m2 increase in BMI) vs. overweight or obese (0.23 kg/m2) individuals. (Mischa et al 2017)

Undoubtedly, the specific composition of nuts and dried fruits means that they can be used to efficiently counteract metabolic diseases such as type 2 diabetes. Their unique profile of macronutrients, micronutrients and other bioactive compounds may explain the beneficial effects observed in clinical and epidemiological studies. However, the exact mechanisms by which they modulate glucose and insulin metabolism and influence T2D have yet to be fully discovered. (Hernandez-Alonso et al 2017)

Restricted carbohydrate (RC) diet (43-49% carbohydrate and 36-40% fats) diet in overweight T2D with  coronary heart disease (CHD) had beneficial effects on fasting plasma glucose (FPG), hs-CRP,  total antioxidant capacity (TAC), and glutathione (GSH) values. This study demonstrated that compared with a high-carbohydrate diet, adherence to a RC diet for 8 weeks decreased serum hs-CRP and increased plasma TAC and GSH concentrations. (Raygan et al 2016)

Consumption of most carbohydrates increases blood glucose and blood insulin, but to varying extents, depending on carbohydrate type and processing, amount consumed, and presence of other nutrients. These variations are captured by the glycemic index (GI), which ranks carbohydrate foods according to their ability to raise blood glucose levels. High GI foods, like white bread, are rapidly digested and cause a rapid peak in blood glucose. Low GI foods like pulses and pasta, are digested more slowly, prompting a more gradual rise in blood glucose. Glycemic load (GL), the product of a food’s GI and its available carbohydrate content, was introduced to incorporate the effect of the total amount of carbohydrate consumed: it is a measure of total glycemic effect, and is hence an indicator of the insulin demand of the diet. (Sieri et al 2017)

High glycemic index was associated with increased risk of colon and bladder cancer. High glycemic load was associated with: increased risk of colon cancer; increased risk of diabetes-related cancers; and decreased risk of rectal cancer. (Sieri et al 2017)

Glycemic load measures carbohydrate absorption in relation to insulin demand — in other words, it measures how quickly a food’s carbohydrates are turned into sugars by the body (glycemic index) in relation to the amount of carbohydrates per serving of that food. Some examples of foods with a high glycemic load are white breads, white rice, brown rice pasta, white rice cakes, popcorn and rice milk.

The results of one study showed that a high adherence to the Mediterranean diet was inversely associated with T2DM risk (OR = 0.88, CI: 0.77–0.99, p trend = 0.021) while combining it with low glycemic load (GL) the association became stronger (OR = 0.82, CI: 0.71–0.95). These results suggest that a low GL combined with a traditional Mediterranean diet conveys 18% protection against the occurrence of T2DM suggesting that even within an overall healthy diet there may be benefits of lowering the dietary GL. (Augustin et al 2015)

The results of this study suggest that for patients with diabetes low-glycemic index diets achieve a more beneficial effect on glycemic control than that of high-glycemic index foods diets. (Wang et al 2015)

Dairy products, legumes, and fruits were found to have a low-glycemic index. Breads, breakfast cereals, and rice, including whole grain, were available in both high and low GI versions. (Atkinson et al 2008)

This meta-analysis provides high-level evidence that diets with a high GI, high GL, or both, independently of known confounders, including fiber intake, increase the risk of chronic lifestyle-related diseases. The effect was modest overall (GI RR = 1.14; GL RR = 1.09) but more pronounced for type 2 diabetes (GI RR = 1.40; GL RR = 1.27), heart disease (GI RR = 1.25), and gallbladder disease (GI RR = 1.26; GL RR = 1.41). Overall, the GI had a more powerful effect than did the GL (the product of carbohydrate and GI), with more positive associations between GI and chronic disease risk, and associations of greater magnitude, which suggests that, irrespective of the level of carbohydrate intake, the GI of contributing carbohydrate foods is important. (Barclay et al 2008)

The results of this study also extend previous meta-analyses that showed higher risks of type 2 diabetes and hypertension with regular consumption of nonnutritive sweeteners, such as aspartame, sucralose and stevioside. (Azad et al 2017)

Beneficial Herbs, Nutrients and Foods for Insulin Resistance and Diabetes

• Bitter gourd
• Curcumin
• Fenugreek
• Fenugreek and onion
• Flavonoids
• Galega officinalis
• Ginseng
• Gymnena sylvestre
• Jade Spring Pills
• Mucuna pruriens
• Mulberry leaf, fenugreek seed and American ginseng
• Olive oil
• Pterocarpus marsupiam
• Salacia reticulata
• Vitamin D

Studies on Beneficial Herbs, Nutrients and Foods for Insulin Resistance and Diabetes

Bitter gourd (Momordica charantia) increases insulin secretion of the pancreas, decreases intestinal glucose uptake, and increases uptake and utilization of glucose in peripheral tissues. Although human studies with type 2 diabetics are weak in their design and/or results, some of the studies do indicate anti-diabetic effects in patients and safety for bitter gourd treatment in humans. (Habicht et al 2014)

Bitter gourd (Momordica charantia) – Although evidence suggests possible beneficial effects of extracts of bitter melon and its active compounds in the prevention and control of diabetes, future clinical studies are needed to confirm this. (Ota & Ulrih 2017)

Curcumin has shown the confident results to be effective for the treatment of impaired glucose tolerance. Fenugreek and flaxseed may also be effective, but due to low quality of these studies the results must be interpreted with caution. (Demmers et al 2017)

Fenugreek  – Although results from clinical trials support beneficial effects of fenugreek seeds on glycemic control in persons with diabetes, trials with better methodology quality and well characterized preparation of sufficient dose are needed to provide more conclusive evidence. With its hypoglycemic and antidyslipidemic effects, fenugreek represents an attractive new candidate for treatment of type 2 diabetes, obesity, and dyslipidemia, the key components of metabolic syndrome. (Ota & Ulrih 2017)

Fenugreek and onion – This study documented the hypoglycemic and insulinotropic effects of dietary fenugreek and onion, which were associated with countering of metabolic abnormalities and pancreatic pathology. It may be strategic to derive maximum nutraceutical antidiabetic benefits from these functional food ingredients by consuming them together. (Pradeep & Srinivasan 2017)

Flavonoids – There is growing evidence based on in vitro and animal research that polyphenols in general, and in particular the flavonoids, a class of polyphenols, can improve glucose homeostasis and enhance insulin secretion and sensitivity. Our observations support previous experimental evidence of a possible beneficial relationship between increased flavonol intake and risk of T2D. (Jacques et al 2013) *Examples of flavonoid compounds are quercetin, EGCG and anthocyanins

Galega officinalis (Goat’s Rue, galega) – Together with its established hypoglycaemic effects, galega has a novel weight reducing action that, in normal mice, is largely independent of a reduction in food intake. (Palit et al 1999)

Ginseng modestly yet significantly improved fasting blood glucose in people with and without diabetes. (Shishtar et al 2014)

Gymnema sylvestre (gurmar) – Several studies have reported antidiabetic effects and sugar inactivation properties of gurmar. (Ota & Ulrih 2017)

Jade Spring Pills – According to a clinical evaluation reported by Fegn et al in The Journal of the Shangdong College of TCM 1994; 18(6): 376-377 the Chinese herb formula for diabetes, Jade Spring Pills, used for the control group, was reported to be effective in reducing blood sugar for 79% of the cases treated. (Fegn et al 1994)

Mucuna pruriens – The study clearly supports the traditional use of Mucuna pruriens for the treatment of diabetes and indicates that the plant could be a good source of potent antidiabetic drug. (Majekodumi et al 2011)

Mucuna pruriens – This study shows that Mucuna pruriens has an anti-hyperglycemic action and it could be a source of hypoglycemic compounds. (Bhaskar et al 2008)

Mulberry leaf, fenugreek seed and American ginseng – Botanicals have been used in traditional Chinese medicine (TCM) for thousands of years to treat T2DM, which is named “wasting-thirst” in TCM. A novel botanical formula containing standardized extracts of mulberry leaf, fenugreek seed and American ginseng at a ratio of 1:1.3:3.4 prevented the development of insulin resistance, impaired glucose tolerance and T2DM. Given the rising need for effective non-drug targeting of insulin resistance and progression to T2DM, complementary and alternative nutritional strategies without intolerable side effects could have meaningful impact on metabolic health and diabetes risks. (Kan et al 2017)

Olive oil – The present systematic review and meta-analysis provides evidence of favorable effects of olive oil on type 2 diabetes risk and parameters of glycemic control. (Schwingshackl et al 2017) PMID: 28394365

Pterocarpus marsupium – This study justifies the traditional claim and provides a rationale for the use of Pterocarpus marsupium to treat diabetes mellitus. The antidiabetic activity of Pterocarpus marsupium can be enhanced by extracting the heartwood by non conventional method of ultrasound-assisted extraction. (Devgan et al 2013)

Salacia reticulata – Clinically significant reductions of HbA1C and plasma Insulin are reported with treatment of 6 weeks to 3 months. One clinical trial reported significant reduction of weight and BMI when Salacia is used in combination with vitamin D. Salacia reticulata effectively improves insulin resistance, glucose metabolism and reduces obesity. A larger evidence base is required from well-planned studies to confirm its efficacy and safety. (Medagama AB 2015)

Vitamin D – The present study shows that oral Vitamin D supplementation of 60,000 IU/week for 8 weeks significantly improves vascular functions and reduces oxidative stress in type 2 diabetic patients with Vitamin D deficiency. (Anandabaskar et al 2017)

Studies on the Beneficial Effects of Acupuncture on Diabetes

Diabetes is categorized in Chinese Medicine into various patterns according to the signs and symptoms of each individual case.  Diabetes is usually attributed to Deficient Kidney Essence.  Chinese Medical patterns describing diabetes include:  Deficiency of Kidney Yin, Yin Deficiency with Internal Heat, Deficiency of Spleen Yin, Deficiency of both Yin and Qi, Excessive Heat in the Lung and Stomach and Hyperactivity of Stomach Fire. The following studies show the benefits of acupuncture in diabetes and related blood sugar issues.

• Forty type 2 diabetes mellitus (T2DM) patients were recruited and randomized into either the acupuncture group or placebo control group. There was a significant reduction in random blood glucose level in the acupuncture group compared to baseline. No such significant change was observed in the placebo control group. The result of this study suggests that 30 minutes of needling at CV-12 might be useful in reducing blood glucose level in patients with type 2 diabetes mellitus. (Kumar et al 2017)
• Here, a case of type 2 diabetes mellitus in a patient with Myasthenia gravis who underwent 105 sessions of acupuncture delivered over 6 months is reported. After acupuncture treatment, the patient’s fasting plasma glucose and hemoglobin A1c levels, as well as the score on the Hamilton Depression Rating Scale, were decreased. Furthermore, no adverse effects were observed. The findings in this clinical study are encouraging and provide evidence supporting the effectiveness of acupuncture in reducing type 2 diabetes mellitus in a patient with MG. (Kim Y 2017)
• According to a review by Hui which appeared in the Journal of Traditional Chinese Medicine 1995; 15: 145-154 animal experiments have shown that acupuncture can activate glucose-6-phosphatase (an important enzyme in carbohydrate metabolism) and affect the hypothalamus.  Acupuncture can act on the pancreas to enhance insulin synthesis, increase the number of receptors on target cells and accelerate the utilization of glucose, resulting in the lowering of blood sugar.
• According to a study reported by Chen et al in the Journal of Traditional Chinese Medicine 1994 14(3): 163-166 they found that by using acupuncture for diabetes nearly 2/3 of the patients receiving acupuncture showed marked improvement.  Furthermore the patients receiving acupuncture experienced a statistically significant decline in cholesterol, triglycerides and beta-lipoproteins. The drop in triglycerides was most substantial with a decline from an average value of 151 at the start to 117 one month later.
• A study published in Diabetes Res Clin Pract 1998 Feb;39(2):115-21 on 46 patients with chronic painful peripheral neuropathy concluded that acupuncture is a safe and effective therapy for the long-term management of painful diabetic neuropathy, although its mechanism of action remains speculative.
• Another study published in Russian in the journal Probl Endokrinol (Mosk) 1991 Jul-Aug,37(4)-20-3 on diabetic angiopathy of the lower extremities on 55 patients with insulin-dependent diabetes mellitus showed a direct noticeable clinical effect with acupuncture In 78.2% of cases, determined perhaps by improved elastotonic properties of arteries of average caliber, enhanced blood outflow and regulation of lower limb vascular peripheral resistance.

Blood Markers in Insulin Resistance and Diabetes

C-reactive protein – In this study, C-reactive protein (CRP), interleukin 6 (IL6), and tumor necrosis factor alpha (TNF-α) associated with type 2 diabetes mellitus (T2DM). Our findings suggested that these inflammatory markers, especially C-reactive protein, may initiate type 2 diabetes mellitus (Phosat et al 2017)

Folate status is typically reduced in diabetic patients. (Pusparajah et al 2016)

HbA1c – Type 2 diabetes mellitus (T2DM) is a risk factor for cardiovascular disease (CVD), and T2DM patients are at increased risk of morbidity and mortality from CVD. The presence of T2DM also increases the relative risk (RR) of developing CVD in women (RR = 8.5) compared to men (RR = 3.2). Major CVD risk factors that have been identified in type 2 diabetes mellitus patients include arterial stiffening, endothelial dysfunction, hyperglycemia, and elevated glycated haemoglobin (HbA1c) concentrations. (Vijayakumar et al 2017)

HbA1c – In type 2 diabetics, recently, elevated HbA1c level has also been considered as one of the leading risk factors for developing microvascular and macrovascular complications. Improvement in the elevated HbA1c level can be achieved through diet management; thus, the patients could be prevented from developing the diabetes complications. (Sami et al 2017)

HbA1c – There is no argument that improving mean level of glycemic control, assessed by glycated hemoglobin (HbA1c), reduces the risk of microvascular complications and cardiovascular disease (CVD) events in patients with type 2 diabetes. Chronic sustained hyperglycemia has been shown to exert deleterious effects on the β cells and the vascular endothelium. (Huang et al 2017)

Homocysteine – High levels of homocysteine (Hcys) have been identified as a risk factor for CVD in type 2 diabetes mellitus (T2DM) patients. High concentrations of Hcys are associated with increased low-density lipoprotein oxidation and endothelial dysfunction. High concentrations of Hcys can worsen T2DM by inducing reversible dysfunction of β-islet cells and inhibiting secretion of insulin. (Vijayakumar et al 2017)

Vitamin B12 and folic acid – Several other studies also reported a statistically significant increase in the total plasma level of homocysteine and a statistically significant decrease in the serum levels of vitamin B12 and folic acid in diabetic retinopathy. (Srivastav et al 2016)

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