Diabetes

by John G. Connor, M.Ac., L.Ac. edited by Barbara Connor, M.Ac., L.Ac.

1.   Introduction
2.   What is Diabetes?
3.   What is Insulin Resistance?
4.   Chinese Medical Treatment
5.   Research on how Acupuncture and Chinese Herbs Benefit Diabetes
6.   Dietary Recommendations
7.   Foods to Avoid
8.   Useful Herbs
9.   Nutritional Support
10. Lifestyle Recommendations
11. References

1. INTRODUCTION
· Barbara and I hope this article will give you a better understanding of what diabetes is, how to prevent it and the various options open to you of how you can overcome this condition if you have it. In addition to the recommendations listed below we also find that craniosacral acupuncture treatments do a lot in and of themselves to promote improved blood sugar levels and, of course, overall optimal health. For more information on diabetes please read our article entitled Insulin Resistance, Diabetes and High Triglycerides.

· It is estimated that over 6% of adult Americans have diabetes, with 90% suffering from Type 2 diabetes.  The overall incidence of diabetes is growing, apparently because of increased rates of obesity.

· CAUTION:  If you have diabetes, you should never suddenly stop using diabetic drugs, especially insulin.  However, if you have Type 2 diabetes it may be possible, under the guidance of your doctor, to gradually reduce the dose substantially.

2.  WHAT IS DIABETES?
· Diabetes Mellitus is a syndrome characterized by hyperglycemia resulting from impaired insulin secretion and/or effectiveness, associated with risks for diabetic ketoacidosis (DKA) or nonketotic hyperglycemic-hyperosmolar coma (NKHHC) and a group of late complications including retinopathy, nephropathy, atherosclerotic coronary and peripheral arterial disease, and peripheral and autonomic neuropathies.  Hypertension, hyperinsulinemia and hyperlipidemia are often associated with diabetes.  The normal fasting plasma glucose level range is between 60 to 109 mg/dl.

· Type 1 Diabetes (formerly known as insulin-dependent diabetes mellitus) accounts for 10% of all cases of diabetes mellitus and is clinically characterized by hyperglycemia and a propensity to DKA.  Its control requires chronic insulin treatment.  Although it may occur at any age, it most commonly develops in childhood or adolescence.

·    Type 2 Diabetes (formerly known as non-insulin–dependent diabetes mellitus) is characterized clinically by hyperglycemia (fasting plasma glucose level >126mg/dL) that is not associated with a propensity to DKA, but some patients intermittently or persistently require insulin to control or prevent symptomatic degrees of hyperglycemia which might lead to NKHHC.  It is usually found in patients over the age of 30 but it also occurs in children and adolescents.  It is commonly associated with obesity.  Type 2 diabetes is a heterogeneous group of disorders in which hyperglycemia results from both an impaired insulin secretory response to glucose and decreased insulin effectiveness. 

· Symptoms of Type 1 Diabetes include irritability, frequent urination, abnormal thirst, nausea or vomiting, weakness, fatigue, weight loss despite a normal intake of food and unusual hunger.

· Symptoms of Type 2 Diabetes include blurred vision, itching, unusual thirst, drowsiness, fatigue, skin infections, slow wound healing, tingling or numbness in the feet.

· Causes of Type 2 Diabetes:  Type 2 diabetes has been long considered to be a problem of insulin sensitivity, dependent on the proper functioning of the insulin receptors in the peripheral tissue.  However, researchers are also considering the possibility of a dysfunction of the pancreatic beta-cells, similar to Type 1 diabetes, as the primary dysfunction in Type 2.  Today it is recognized that both factors contribute to the disease.  Beta-cell malfunction can be traced to various levels of mitochondrial dysfunction.  Mitochondria are known as the “power house of the cell” and they are an integral part of the insulin system found in the islet cells of the pancreas.  Mitochondrially mediated Type 2 diabetes is often genetically expressed via mutations in the mitochondrial DNA (mtDNA).  A second aspect of mitochondrial contribution involves the quantitative decrease in mtDNA in response to oxidative stress which in turn leads to decreased insulin secretion.  There is evidence of a more global effect of mitochondrial dysfunction at the glucose transporter level.

3.  WHAT IS INSULIN RESISTANCE?
 · Decreased insulin effectiveness is known as insulin resistance.  The early stage of Type 2 diabetes is characterized by insulin resistance in insulin-targeting tissues, mainly the liver, skeletal muscle and adipocytes. Insulin resistance in these tissues is associated with excessive glucose production by the liver and impaired glucose utilization by peripheral tissues especially muscle.  High blood levels of glucose and triglycerides are both markers of insulin resistance.  In people with insulin resistance a combination of genetic and lifestyle factors — such as improper diet, inactivity, obesity and smoking — dulls the cells’ response to insulin over time, causing the pancreas to pump out higher, unhealthy levels of insulin.

· The Link between Heart Disease and Insulin Resistance. 
Insulin resistance, estimated to occur in about 25% of the general population, has been associated with hyperinsulinemia, abnormal glucose tolerance, type 2 diabetes, high triglycerides, decreased HDL (good) cholesterol levels, hypertension and polycystic ovarian syndrome.  This constellation of signs and symptoms, particularly hypertension, high triglycerides and impaired glucose tolerance has been designated as metabolic syndrome or Syndrome X.

· Syndrome X. 
This cluster of heart-disease risk factors triggered by insulin resistance comprises a condition called Syndrome X.  It’s symptoms include high triglycerides, low HDL (good) cholesterol, high levels of glucose, poor ability to break up blood clots, central obesity and high blood pressure.

According to Andrew Weil a high level of insulin in the blood can have devastating effects on the body:   1) It causes the liver to dump artery-clogging triglycerides into the bloodstream. 2) It triggers the release of substances that can cause blood clots.3) It makes the blood vessels narrower and less elastic and forces the kidneys to retain sodium and water, which can lead to high blood pressure.

· Insulin Resistance, Oxidative Damage and Fatty Liver.  
Insulin resistance contributes to the increased entry of fat into liver cells by increasing the intra hepatic production of free fatty acids from glucose not taken up by the peripheral adipocytes and myocytes.  Obesity also contributes to fatty liver, or steatosis,  by increasing the amount of free fatty acids entering the liver cells.  The usual pathway for free fatty acid metabolism in the liver is through β-mitochondrial-oxidation.  Under the stress of increasing free fatty acid influx to the liver, this pathway is insufficient and excess fatty acids are converted to triglycerides and stored in the cytoplasm, leading to fatty liver.  Medications known to cause fatty liver are glucocorticoids, synthetic estrogens, methotrexate, tetracycline, depakote and aspirin.

4.  CHINESE MEDICAL TREATMENT
· Chinese medical treatment of diabetes includes herbal prescriptions, acupuncture, dietary and lifestyle recommendations.

· 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

· According to Subhuti Dharmananda, PhD, there is no evidence that diabetes drugs and Chinese herb therapies are incompatible, but there is a concern that when combining the two, the blood sugar may decline too far.  If the herbs are added gradually over a few days with continued monitoring of blood sugar, this problem can be avoided.  When herbs successfully contribute to lowering blood sugar, drug dosage may be reduced under a physician’s instructions.

5.  RESEARCH ON HOW ACUPUNCTURE AND CHINESE HERBS BENEFIT DIABETES
· 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.

· Another study using a Chinese herbal decoction reported by Gao in The Journal of the Zhejiang Traditional Chinese Medical College 1989; 13(1):15-16 found that generally blood glucose decreased after 1 – 2 weeks of treatment and became steady after one month, and the blood glucose changes were followed by symptomatic improvements.

· 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.

· 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.

· Biotin may help reduce blood glucose levels in individuals with either type 1 or type 2 diabetes. (Maebashi et al, 1993) and (Coggeshall et al, 1985)

· In a systematic review by Yeh et al (2003) on herbs and dietary supplements for glycemic control in diabetes they concluded that the best evidence for efficacy is available for ivy gourd (Coccinia indica) and American ginseng. 

Other supplements with positive preliminary results include Gymnema sylvestre, Aloe vera, vanadium, bitter melon (Momordica charantia) and prickly pear cactus (nopal).

· A study published in 2001 found that alpha-lipoic acid is effective in the prevention of early diabetic glomerular injury and suggests that it may have advantages over high doses of either vitamin E or C. (Melham, 2001)

· Bitter Melon may improve glucose control in type 2 diabetes.

· Chromium has been shown to increase the number of insulin receptors in peripheral tissues; to increase the binding of the insulin to receptors and to decrease  fasting glucose and serum lipids.  It may also increase HDL cholesterol. (Anderson, 1998)

6.  DIETARY RECOMMENDATIONS
· Eat a high-complex-carbohydrate, low-fat, high-fiber diet including plenty of raw fruits and vegetables as well as fresh vegetable juices. This reduces the need for insulin and also lowers the levels of fats in the blood.  See the HCHF diet described below.

· Fiber helps to reduce blood sugar surges. Adding wheat bran to the diet has been shown to lower blood sugar levels.  For snacks, eat whole food snacks such as oat or rice bran crackers with nut butter or cheese.

· Legumes, root vegetables and whole grains are also good.  Get your proteins from vegetable sources such as legumes and grains.

· Eat foods which help to normalize blood sugar such as spirulina, berries, brewer’s yeast* quality dairy products (especially cheese), egg yolks, fish, garlic, kelp, sauerkraut, soybeansand vegetables. * Brewer’s yeast is the richest known source of glucose tolerance factor (GTF).

· High-chlorophyll foods–especially wheat or barley grass, spirulina and chlorella–increase the utilization of all nutrients and therefore may greatly enhance the treatment of diabetes. 

· Onion and garlic (Allium sativum, A. cepa) have significant blood sugar lowering action.

· A low-protein diet containing less than 40 grams of protein each day is recommended for prevention and treatment of diabetic nephropathy.

The High Carbohydrate High plant-Fiber (HCHF) diet
· The high carbohydrate high plant-fiber (HCHF) diet developed by James W. Anderson, M.D. is high in cereal grains, legumes and root vegetables and restricts simple sugar and fat intake. 70-75% of the calories come from complex carbohydrates, 15-20% from protein and only 5-10% from fat, with a total fiber content of almost 100 grams per day.  This diet has been shown to be considerably more successful than the conventional mainstream diabetic diet.  The HCHF diet results in reduced blood sugar after meals and later in the day, increases insulin sensitivity, reduces cholesterol and triglycerides, increases HDL (good) cholesterol and promotes weight loss all of which reduces the need for insulin.  Diabetics who have adopted the HCHF diet and reaped the benefits, but who then resumed the conventional diabetic treatment diet, saw their insulin requirements return to prior levels.

· According to the home HCHF diet, 50% of available carbohydrate calories come from grain products, 48% comes from fruits and vegetables and 2% comes from skim milk. 50% of the protein is provided by fruits and vegetables, 36% by grain products and 14% by skim milk and lean meat. 60% of the fat is derived from grain products, 20% from fruits and vegetables, and 12% from skim milk and meat.

The Modified High Fiber Content (MHCF) diet:
· The modified high fiber content (MHCF) diet recommends a higher intake of legumes along with restriction of several foods allowed in the HCHF diet, namely processed grains, and it excludes fruit juices, low fiber fruits, skim milk and margarine. The reason for this is because legumes are low in fat and high in complex carbohydrates and fiber and are proved to be effective in treating diabetes. Fruit juices, low fiber fruits and processed grains (i.e. flour) induce a rapid elevation of serum glucose and insulin levels, and the casein in skim milk appears to raise cholesterol levels. The trans-fatty acids in margarine also have significant injurious effects.

7.  FOODS TO AVOID
· Eliminate sucrose and foods high in refined carbohydrates except when necessary to balance an insulin reaction. Avoid sugary junk food and processed snack food.  Refined carbohydrates give rise to high blood glucose levels stimulating the pancreas to secrete large amounts of insulin.  Eventually the high insulin levels engulf the body’s insulin receptors and cells become resistant to the hormone, making the body unable to control blood sugar levels effectively. Sucrose consumption produces elevated plasma cholesterol, triglyceride and uric acid levels, diminished glucose tolerance and increased platelet adhesiveness, all of which are associated with diabetes and atherogenesis.

· Avoid refined white flour, refined grains, sugar and hydrogenated, synthetic fats such as margarine and shortening and alcohol. Alcohol impairs insulin sensitivity.  Refined sugar, white flour products and lack of exercise can deplete chromium levels.

· Avoid late-night eating and complex food combinations. Small, frequent meals (four or five daily) help to stimulate insulin production.

· Avoid salt. Consumption of salt results in an elevation of blood sugar.

· Avoid saturated fats.  Some studies show that dietary fats have been associated with both insulin resistance and insulin sensitivity.  Saturated fatty acids are associated with insulin resistance while medium and long-chain fatty acids (especially omega-3) are associated with increased insulin sensitivity.  Data suggests that patients who replace 2% of the energy from trans-fatty acids with polyunsaturated fatty acids could decrease the risk for Type 2 diabetes by as much as 40%.  However, other studies show that supplementation with the omega-3 fatty acid eicosapentaenoic acid (EPA) may increase total cholesterol in Type 1 diabetes; and supplementation of omega-3 fatty acids in general may impair insulin secretion in Type 2 diabetes.

· Limit greasy and fatty foods such as meats, eggs, cheese, butter, excess oil, nuts and seeds.

8.  USEFUL HERBS
· In a systematic review by Yeh et al (2003) on herbs and dietary supplements for glycemic control in diabetes they concluded that the best evidence for efficacy is available for ivy gourd(Coccinia indica) and American ginseng.  Other supplements with positive preliminary results include Gymnema sylvestre, Aloe vera, vanadium, bitter melon (Momordica charantia) andprickly pear cactus (nopal).

· American Ginseng (Panax quinquefolius)  Two studies conducted by scientists at the University of Toronto (in 2000 and 2001) verified ginseng’s ability to  smooth out the after-meal blood sugar spikes that Type 2 diabetics experience.  In another study in 1985 on ginseng and its saponins involving mice it revealed a hypoglycemic effect as well as stimulating the production of insulin.  Caution:  Do not use this herb if you have high blood pressure.

· Bitter Melon (Mormordica charantia) Many studies including a 2003 study published in the American Journal of Health-System Pharmacy, have demonstrated the hypoglycemic effect of this herb.  Bitter Melon may improve glucose control in type 2 diabetes.  Bitter melon can be steamed, sautéed and eaten as food.  The fresh juice, dried herb and tea are also effective.

· Fenugreek (Trigonella foenum-graecum ) has demonstrated anti-diabetic effects in experimental and clinical studies.  Studies demonstrate benefits in both Types of diabetics.  Human studies have confirmed the glucose- and lipid-lowering effects.  In Type 2 diabetic patients, the ingestion of 15 g of powdered fenugreek seed soaked in water significantly reduced after-meal glucose levels during the glucose tolerance test.  According to a study by Gupta et al (2001) adjunct use of fenugreek seeds improves glycemic control and decreases insulin resistance in mild Type-2 diabetic patients.

· Gymnema (Gymnema sylvestre) has been used in India for the treatment of diabetes for more than 2000 years.  The leaves raise insulin levels.  In a recent study at the University of Madras it showed the potential for pancreas repair by raising the output of insulin to normal levels.  Another Indian study reported that 25% of the participants were able to discontinue all diabetes medication with the use of Gymnema alone.

· Holy Basil Leaf (Ocimum sanctum also known as tulsi) treats diabetes,, normalizing both blood sugar and blood fats, including cholesterol and triglycerides.  A study published in the Journal of Clinical Pharmacy and Therapeutics showed a 17.6 percent reduction in blood sugar and led researchers to conclude that hold basil was of value in mild to moderate diabetes.  Holy Basil is normally given in tea form.

· Bilberry (Vaccinium myrtillus) leaf has been shown to reduce blood sugar levels in animal tests.  The fruit also has a beneficial effect on microvascular abnormalities of diabetes, particularly retinopathy.

· Aloe vera.  Oral administration of the juice has been reported to reduce fasting blood glucose and triglyceride levels in Type 2 diabetic patients.

· Huckleberry – helps to promote insulin production.

9.  NUTRITIONAL SUPPORT
· Alpha-lipoic acid –  According to a study by Ziegler et al (1999) short term treatment for 3 weeks using 600 mg of alpha-lipoic acid (thioctic acid) i.v. per day appeared to reduce the chief symptoms of diabetic polyneuropathy .  A 3-week pilot study of 1800 mg per day given orally indicated that the therapeutic effect may be independent of the route of administration.   Another study published in 2001 found that alpha-lipoic acid is effective in the prevention of early diabetic glomerular injury and suggests that it may have advantages over high doses of either vitamin E or C. (Melham, 2001)

· Chromium – Considerable experimental and epidemiological evidence now indicates that chromium levels are a major determinant of insulin sensitivity, as it functions as a cofactor in all insulin-regulating activities.  Chromium has been shown to increase the number of insulin receptors in peripheral tissues; to increase the binding of the insulin to receptors and to decrease  fasting glucose and serum lipids.  It may also increase HDL cholesterol. (Anderson, 1998)  Chromium facilitates insulin binding and subsequent uptake of glucose into the cell.  Supplemental chromium has been shown to decrease fasting glucose levels, improve glucose tolerance, lower insulin levels and decrease total cholesterol and triglycerides, while increasing HDL cholesterol in normal, elderly and Type 2 diabetic subjects.  Although no RDA has been established for chromium, over 200 mcg/day appears necessary for optimal blood sugar regulation.  Food sources include brewer’s yeast and barley flour.

CAUTION:  If you have diabetes consult with your physician before taking chromium.  It is not recommended that people with diabetes simply go out and buy chromium supplements and start taking them.  Anyone who has diabetes, especially Type 1 diabetes, must exercise caution with this supplement.  Its effects on insulin requirements are very real.  Blood sugar levels must be monitored carefully and the appropriate dosages of insulin and /or other drugs adjusted as needed in response.  Otherwise, a potentially dangerous insulin reaction may occur as a result of too little glucose in the blood.

· Magnesium – supplementation may improve insulin response and action.  Magnesium deficiency is the most common disturbance in mineral metabolism observed in Type 1 diabetics.  Magnesium deficiency is associated with beta cell atrophy.  Depletion of magnesium from normal cells creates cellular insulin resistance.

· Vitamin C – supplementation may improve glucose tolerance.  It may also lower cholesterol and triglycerides in Type 2 diabetics.  It may significantly depress cutaneous capillary fragility.

· Vitamin E – supplementation may reduce the risk of developing diabetes.  Vitamin E has been shown to improve insulin sensitivity in Type 2 diabetics, nondiabetics and hypertensives.  However, because it may also reduce the insulin requirement, diabetics on insulin should be started on 100 IU or less daily and the dosage raised slowly with adjustment of the insulin dose.  Supplementation may also be effective in reversing abnormal platelet aggregation (hyperaggregability) that contributes to microvascular disease and premature atherosclerosis.

· Coenzyme Q10 (CoQ10) – According to an article by Lamson and Plaza (2002) early uncontrolled studies of diabetic patients have demonstrated benefit from ingestion of CoQ7 (120 mg./day, readily transformed to CoQ10) for 2-18 weeks.  Of the 39 patients, 12 patients reduced blood sugar by 20% and 12 to 30%, while ketone bodies were reduced by 30% in 13  patients.  In another study, 15 diabetic patients receiving CoQ10 (6 mg/day) were found to have an improvement in blood glucose and insulin synthesis and secretion.

· Biotin – is a B vitamin needed to process glucose.  When people with Type 1 diabetes were given 16 mg of biotin per day for 1 week their fasting glucose levels dropped by 50%.  Biotin may help reduce blood glucose levels in individuals with either type 1 or type 2 diabetes. (Maebashi et al, 1993) and (Coggeshall et al, 1985)

· Evening Primrose Oil – Supplementing with 4 grams of evening primrose oil per day for 6 months has been found to reverse the cause of diabetic nerve damage and improve this painful condition in both Type 1 and Type 2 diabetes.

· Quercetin – Flavonoids such as quercetin help to inhibit the accumulation of polyols on the membranes of the lens of the eyes. (Elevated glucose levels in the lens of the eye can result in the accumulation of substances called polyols whose presence can ultimately cause damage to the lens.)

· Manganese – is an important cofactor in the key enzymes of glucose metabolism.  A deficiency results in diabetes in guinea pigs.  Diabetics have been shown to have only ½ the manganese of normal individuals.

· Zinc – is involved in virtually all aspects of insulin metabolism –synthesis, secretion and utilization.  Zinc also has a protective effect against beta-cell destruction.  Diabetics typically excrete too much zinc in the urine and therefore require supplementation.

· Vitamin B₆ – supplementation may reduce the symptoms of diabetic neuropathy.

· Thiamine – supplementation may decrease the symptoms of sensory neuropathy in diabetics.

· L-carnitine – mobilizes fat.  In one study cholesterol and triglyceride levels of diabetics dropped 25-39%.

· L-glutamine – reduces the cravings for sugars.

· Taurine – aids in the release of insulin.

10. LIFESTYLE RECOMMENDATIONS
· A diet high in high-fiber and high complex carbohydrate-rich foods is protective against diabetes.

· Obesity is a significant factor in Type 2 diabetes. Even in normal individuals significant weight gain results in carbohydrate intolerance, higher insulin levels and insulin insensitivity in fat and muscle tissue. Weight loss corrects all of these abnormalities and significantly improves the metabolic disturbances of diabetes. A weight reduction program in often all this is required to control Type 2 diabetes.

· Exercise improves many parameters and is indicated in both Type 1 and Type 2 diabetes. Exercise reduces the need for insulin, reduces the cholesterol level and guards against overweight and obesity.  Eat more carbohydrates or reduce your insulin dosage before exercise, because exercise produces an insulin-like effect in the body. Talk to your doctor about the right approach for you.

· Proper chewing is one of the most basic ways to improve nutrient assimilation; particularly with complex carbohydrates, whose digestion begins with saliva.

· Avoid tobacco in any form – it constricts the blood vessels and inhibits circulation.

· Keep your feet clean, dry and warm and wear only white cotton socks and well-fitting shoes. Lack of oxygen (because of poor circulation) and peripheral nerve damage are major factors in the development of diabetic foot ulcers.

· Diabetics who smoke are two to three times more likely than nonsmoking diabetics to develop kidney damage. Smoking constricts blood vessels, and in people with diabetes, this helps to push large protein molecules out of the vessels into the kidney which may eventually lead to kidney failure.

· Persons with diabetes should get annual retinal examinations to check on the condition of their retinas.

 

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