Diabetes Mellitus and Syndrome X
By Stephen Holt, MD, MRCP (UK), FRCP (C), FACP, FACG, FACN, FACAM
Diabetes Mellitus and Syndrome X
Introduction
Diabetes mellitus affects nearly 16 million Americans, or 6% of the population,
and its incidence is increasing at an alarming rate. Many with diabetic
conditions may not be aware they have it, or if they are, may not know that a
change in lifestyle can considerably manage the disease or prevent it from
advancing. Diabetes mellitus is a common cause of premature death or disability;
its progression comes with the accelerated aging of the body. More than 90% of
cases of diabetes mellitus are of the Type 2 variety, also known as
"maturity-onset diabetes." The high cost of managing diabetes mellitus,
together with some disenchantment about allopathic treatments, have led to a
growing interest in the potentially safer and gentler options presented by
alternative medicine. This article seeks to review non-allopathic options for
managing Type 2 diabetes mellitus, accepting that research in this area is
emerging but is incomplete.
Understanding Diabetes Mellitus
Diabetes mellitus is a common disorder characterized by excessive levels of
blood glucose, or sugar. This happens in conditions where there is absence or
lack of effective functioning of insulin. This article will discuss the two
common types of diabetes: Type 1, or "juvenile onset diabetes," a condition
where there is damage to the cells in the pancreas that secrete insulin; this is
common in young people; and Type 2, or "maturity onset diabetes," which accounts
for more than 90% of all known cases of diabetes. This type of diabetes is
often associated in its early phases with a resistance to insulin. Insulin may
be present in early forms of Type 2 diabetes, but it is unable to do its job of
driving the glucose into cells.
Type 2 diabetes is the type of diabetes that is more relevant to our
understanding of the abnormalities of body chemistry, or metabolic disturbances,
that cause Syndrome X. The metabolic Syndrome X is the variable combination of
obesity, hypertension and hypercholesterolemia, linked by an underlying
resistance to insulin. While maturity-onset Type 2 diabetes occurs most often in
adults, a striking increase has been noted among children in recent years. This
has led to the coinage of a strange label ? "maturity onset diabetes of the
young" or MODY.
Either type of diabetes can cause similar medical complications, such as
cardiovascular disease, nerve damage (neuropathy), eye disease (retinopathy) and
kidney disorders. One cannot completely separate Type 1 and Type 2 diabetes;
some overlap exists between them. There is a third type of diabetes called the
Gestational Diabetes that occurs somewhat temporarily in pregnancy. Gestational
Diabetes involves insulin resistance. Research has characterized it to have much
in common with Syndrome X. Diabetes is a heterogeneous (multifactorial) disease.
Fiber and Diabetes
Diabetes mellitus is the oldest dietary fiber-deficiency disease observed in
humans. In 1979, my colleagues and I described the physiological effects of
soluble fiber on the absorption of glucose and model compounds in humans (Holt
S. et al., Lancet, 1, 639-9, 1979). In our study of acute dosing of soluble
fiber, we observed the rate of sugar absorption was slowed and blood glucose
tolerance curves tended to flatten. This research forms the basis of an
understanding of what is popularly termed "the Glycemic Index." Thus, soluble
fiber makes absorption efficient and delays the metabolic incorporation of
ingested glucose into the body.
Recent studies have shown the ability of the extracts of soluble oat fiber (beta
glucans) to significantly lower blood glucose levels following meals and reduce
blood cholesterol levels in a favorable manner (lower LDL, lower triglycerides,
with a tendency to raise HDL). Beta glucans function to control body chemistry
that is altered by insulin resistance and diabetes mellitus. Diabetes mellitus
is often associated with multiple risk factors for cardiovascular disabilities,
such as obesity, hypertension and high blood cholesterol. Extracts of soluble
oat fiber, or beta glucans, have an important role to play in controlling these
risk factors. Enhanced intake of both soluble and insoluble dietary fiber is a
grossly underestimated natural option that will considerably improve conditions
of patients with both Type 1 and Type 2 diabetes.
Antioxidants and Omega-3s
Antioxidants of many types may benefit an individual with diabetes mellitus
because many of the consequences or complications of diabetes are due to
oxidative stress on the body, or the generation of free radicals. In diabetes
and Syndrome X, cross-linking of sugar and protein causes advanced glycation end
products which, in turn, damage vital organs. In this circumstance, antioxidant
compounds such as vitamins C, E, beta-carotene, selenium and coenzyme Q-10 and
many plant or animal antioxidant compounds (phytonutrients, phytoantioxidants)
can exert a major beneficial effect by "mopping up" free radicals. Of particular
interest is the dietary supplement alpha-lipoic acid (thioctic acid). This
antioxidant plays a specific role in glucose oxidation and is accessible to both
water and fat components of the body. Furthermore, alpha-lipoic acid may improve
the body's sensitivity to insulin; it has been used in the prevention of
complications of diabetes and liver damage.
Much interest has focused on the omega-3 fatty acid EPA (eicosapentaenoic acid)
because of its vital role in balancing favorable eicosanoid production in the
body and exerting beneficial effects in common cardiovascular diseases. The acid
EPA is readily converted to DHA ? which is found in large amounts in cell
membranes, especially in the nervous system ? and is an effective inhibitor of
the genesis of "undesirable" forms of eicosanoids from arachidonic acid. For
these and other reasons, EPA must be considered the emperor of fatty acids; it
has an underestimated role in the management of diabetes mellitus and Syndrome X
Evidence has accumulated that the active omega-3 fatty acid EPA can favorably
affect the PPAR (receptor complex), which is involved in insulin action,
carbohydrate metabolism and lipid chemistry. Thus, EPA has emerged as a very
important way of combating insulin resistance by regulating certain components
of the PPAR receptor. EPA (found in fish oil) appears to be a natural and
powerful antidote to insulin resistance, and is emerging as a first-line option
for Syndrome X, with its cardinal components of glucose intolerance,
hypertension, hyperlipidemia and obesity (see www.combatsyndromex.com). I am
particularly impressed by the use of coenzyme Q-10 combined with relatively high
doses of EPA in the management of diabetes-complicated cardiovascular disease (a
very common combination of disabilities).
Many Natural Substances of Diabetes
The word diabetes means "siphon," and water-soluble vitamins and several
minerals are excreted in abundance by diabetic individuals. An adequate intake
of vitamins and minerals is mandatory in the management of diabetes. While
elements such as chromium and vanadium are known to assist the function of
insulin, emerging research shows that the adequate dietary intake of calcium and
magnesium is important for control of blood glucose and insulin receptor
function. The role of adequate mineral intake in diabetes is underexplored. Soy
foods are very valuable in the management of diabetes mellitus, but their value
has been wrongly impugned by the "meat and dairy lobby." Soy has a low glycemic
index, soy protein lowers blood cholesterol and isoflavones are powerful
antioxidants. Soy protein is handled efficiently by the kidneys, which are a
common target of attack in diabetes mellitus.
Several herbs or botanicals have been proposed as potential "treatments" for
diabetes mellitus. There is no doubt that some plant compounds have a
significant effect on lowering blood sugar, but their mechanism of action
remains poorly understood. Popular botanicals used to induce a hypoglycemic
effect include bitter melon (Momordica charantia), fenugreek (Trigonella
foenum-graecum), garlic (Allium sativum), corosolic acid (Lagerstroemia speciosa
or Punica granatum), stevia (Stevia rebaudiana) and Gymnema sylvestre. I believe
that the more potent botanical extracts should only be used under the
supervision of a health care practitioner, because of potential serious drug
interactions with medication.
Of particular interest is the use of fermented barley extracts (GlycoX), which
have been shown to reduce blood sugar by up to 63% and blood cholesterol by
about 21% in individuals with Type 2 diabetes mellitus. Several other botanicals
have been proposed as potential treatments for glucose intolerance, with some of
them having the added advantage of promoting cholesterol control. Examples of
these other botanicals include: Tinospora cordifolia, Pterocarpus marsupium,
Azadirachta indica, Ficus racemosa, Aegle marmelose, syzygium cumini, Cinnamonum
tamala, Atriplex halimu, Vaccinium myrtillus, Korean ginseng, Opunta ficus,
Ocimum sanctum and Silybum marianum.
Diabetes Prevention
In recent times, the American Diabetes Association has revised its guidelines on
the management of Type 2 diabetes by stressing the role of diet and exercise in
management as first-line options. Drug therapy for Type 2 diabetes, including
oral hypoglycemic drugs and insulin-sensitizing drugs, is regarded increasingly
as a "back-up plan." Syndrome X, or the metabolic syndrome, is amenable to
dietary interventions and lifestyle adjustments.
Complex dietary supplements can provide Syndrome X nutritional factors and can
promote healthy blood glucose, healthy blood cholesterol, healthy immune
function, healthy digestive function, antioxidant effects, inhibition of
carbohydrate absorption and a useful adjunctive role in the control of calorie
intake. They can do this by inducing a feeling of satiety (the
feel-full/weight-loss trick) in an individual. Dietary and lifestyle changes can
help keep diabetes under control or prevent it altogether. Public education is a
key initiative in the fight against the constellation of disorders that are
associated with the development and progression of Syndrome X, a forerunner of
the Type 2 diabetes mellitus that affects about 70 million Americans. The
cluster of disorders associated with Syndrome X - obesity, insulin resistance,
high blood cholesterol and high blood pressure - underlies the number one cause
of death and disability in Western society, which is cardiovascular disease,
including stroke and heart attack.
Conclusion
Diabetes mellitus is part of the killer combination of diseases that account for
most premature deaths or disability. To combat these problems, one would need a
multi-pronged approach beginning with simple lifestyle modifications,
particularly proper nutrition, rather than the instant prescription of drugs
that are costly and have questionable benefits. Syndrome X and its consequences
are the most important public health issues for the new millennium.
By Stephen Holt, MD, MRCP (UK), FRCP (C), FACP, FACG, FACN, FACAM
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