Understanding a Silent Killer

Diabetes is a condition often referred to as a silent killer-with good reason. Uncontrolled diabetes has disastrous consequences for multiple organ systems throughout the body. Those adverse effects are the result of consistently elevated blood sugar levels as well as from associated inflammation, oxidative stress, injury to blood vessels, and impact from insulin resistance.

A large number of diabetics and prediabetics can be classified as having metabolic syndrome, or "Syndrome X." This is characterized by several coexisting metabolic risk factors, including abdominal obesity, elevated blood sugar levels, high blood pressure, high cholesterol, chronic systemic inflammation, as well as some degree of insulin resistance.

For several years, scientists have been looking into the association of diabetes and insulin resistance with the development of cognitive problems such as dementia and Alzheimer's disease. In March 2009, Archives of Neurology published a number of articles highlighting the relationship between several metabolic risk factors and decreased cognitive function. An article by Elizabeth Helzner, PhD, and colleagues describes a study in which a cohort was followed over time and of which 156 individuals developed Alzheimer's disease. Of these individuals, a prestudy diagnosis of diabetes was found to be a predictor of faster cognitive decline with age and a possible contributory factor to the development of Alzheimer's dementia. The authors noted that diabetes may cause inflammation in brain tissue and may also contribute to the histological changes commonly seen in the brains of people with Alzheimer's disease postmortem.

In the same journal, Suzanne Craft, PhD, presents evidence that clearly suggests diabetes is an independent risk factor for the development of Alzheimer's disease and vascular dementia. Furthermore, Annette Fitzpatrick, PhD, and colleagues found that being obese in midlife increased the risk of dementia by up to 40%. Obesity is a major risk factor for the development of diabetes.

SELECTED NATURAL PRODUCTS FOR DIABETES CARE

CHROMIUM Chromium is an essential mineral for blood sugar regulation. It participates in blood sugar metabolism and is thought to support the effects of insulin. Researchers suggest that chromium may be most effective in individuals in whom blood sugar levels are low. In practice, chromium exerts a positive impact on stabilizing blood sugar levels and on lowering fasting blood sugar levels on its own and in combination with other nutrients and dietary modification. Two common supplemental forms of this nutrient are chromium picolinate and chromium nicotinate. While both of these forms seem to be effective, studies show chromium picolinate may have a slight edge.

FIBER
Fiber supplements can be very effective for controlling the spikes in blood sugar levels following a meal. One form of supplemental fiber known as PGX (marketed by Natural Factors) may reduce postprandial blood sugar levels by limiting and slowing down the absorption of carbohydrates from the digestive tract. PGX is a processed and purified fiber derived from konjac root and is taken before meals. It also increases feelings of satiety and thus may reduce cravings. Since it is a fiber supplement, it can also improve blood lipid profiles.

Natural Factors manufactures a product called WellBetX PGX with Mulberry. Mulberry contains a compound that may inhibit the enzyme alpha-glucosidase. Alpha-glucosidase is an enzyme in the digestive tract that breaks down complex carbohydrates into glucose. By blocking the activity of this enzyme, mulberry may reduce the absorption of glucose.

BOTANICALS
A number of botanicals have traditionally been used to treat diabetes and related conditions around the world. A couple of beneficial ones include ayurvedic herbs such as Gymnema sylvestre (Gymnema) and Momordica charantia (Bitter melon). Gymnema is known as "gurmaar" in Hindi, which can be translated as "sugar destroyer." Preliminary research has shown that this herb can significantly affect blood sugar levels in both animal and human studies. The potential mechanisms of action are not totally clear. The traditional use of gymnema dates back hundreds of years.

Bitter melon may also have positive benefits on blood sugar metabolism thanks to its ability to increase insulin secretion or the uptake of glucose by the tissues. An interesting combination product from Ayush Herbs, called Bio Gymnema, contains these two herbs along with other nutrients important for blood sugar metabolism.

PYCNOGENOL AND FLAVONOIDS
One of the major issues with uncontrolled diabetes is damage to veins and arteries throughout the body. Flavonoids are well known for their therapeutic role in supporting the integrity of blood vessels. Dietary and supplemental sources of flavonoids are beneficial for diabetics. Pycnogenol is a good source of flavonoids and related compounds. A number of studies show that Pycnogenol supplementation promotes the integrity of vascular function. It's also been shown in various studies to support long-term sugar metabolism, improve fasting blood sugar levels, decrease cholesterol and LDL levels, and promote healthy blood pressure control. Pycnogenol and other flavonoid-rich products are an important part of any diabetic nutritional regimen.

FISH OIL
EPA and DHA-rich fish oil is an excellent source of omega-3 fats and may help prevent cardiovascular and other potential complications of chronically elevated blood sugar levels. According to studies, fish oil may or may not reduce cholesterol levels in diabetics. We've had a number of individuals in which we have seen reductions in overall cholesterol levels; however, we've seen more-dramatic reductions in triglyceride levels with the use of supplemental fish oils.

High triglycerides are often an issue in those with poor blood sugar metabolism. Some research suggests that fish oil supplementation may also be beneficial for directly improving blood sugar metabolism. We've never used fish oil alone as a means of improving blood sugar levels. However, its benefits to the cardiovascular system make it a useful supplement for diabetics as part of a comprehensive nutritional program.

ALPHA-LIPOIC ACID
Alpha-lipoic acid is a vitamin-like nutrient with important antioxidant effects. It has been studied in diabetics and has been shown to improve the sensitivity of insulin. Because of the extensive amount of oxidative damage with diabetes, a high intake of antioxidants from both dietary and supplemental sources is recommended. Alpha-lipoic acid is a crucial antioxidant for diabetics because it functions as a water- and fat-soluble antioxidant and has the potential to protect brain and nerve tissue. Several published studies show that alpha-lipoic acid supplementation improves symptoms of peripheral nerve pain in diabetic individuals. It also plays a role in preserving the effects of other antioxidants in the body, especially vitamins C and E.

These findings paint a grave picture for the complications of uncontrolled diabetes and emphasize the need for effective treatment strategies to address this growing epidemic. Recently, President Obama lifted restrictions that were imposed by the earlier administration concerning federal funding for stem cell research. This step is seen as an extremely positive development by many researchers. Stem cell therapy may hold great potential as a treatment for several chronic diseases. However, at this time it seems that stem cell therapy may hold the best potential for those individuals with type 1 diabetes in which pancreatic beta cells have stopped producing insulin. Replacing these cells with stem cells that restore this function would allow type 1 diabetics to reduce or eliminate their need for exogenous insulin.

Most type 2 diabetics (who make up the vast majority of all diabetics) will likely not be candidates for stem cell therapy. For these individuals, dietary and lifestyle modification will continue to be the mainstays of treatment. Effective therapeutic nutritional strategies (in the form of novel functional food ingredients and dietary supplements) that support blood sugar regulation and address other factors that contribute to the development of long-term complications will continue to hold their importance.

Stressing the benefits of dietary change and lifestyle modification in the battle against this disease effectively empowers the individual to take control of his or her own health. It also offers substantial market opportunities for companies looking to carry out research and development of quality nutritional products that are both safe and effective.

Irfan Qureshi, ND, is vice president for technical and regulatory affairs at AIBMR Life Sciences Inc. (Puyallup, WA). John R. Endres, ND, is chief scientific officer.