Dysglycaemia (Metabolic Syndrome and Diabetes).

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imagesKeeping your blood sugar in check by Dr Carrie Decker ND.

In this article, learn more about diabetes, and natural ways to support blood sugar balance. Key Points:

  • Relationship of diabetes with food economics
  • Diabetes statistics and complications
  • Metabolic syndrome as a risk factor for diabetes
  • Holistic interventions for blood sugar management including dietary choices, exercise, and evidence based supplementation

Type-2 diabetes (T2DM), or insulin-resistant diabetes, is unfortunately a condition that is all too common in many modern cultures. With countless choices of foods at our disposal, and with occupations, or lifestyles that are far more sedentary than generations of our ancestors, it isn’t surprising. Cost of food also plays a role, as subsidised industries with products such as corn, soy, and wheat are able to produce products cheaply that are calorically dense and nutritionally deficient. Subclinical nutritional deficiencies are increasing, however, with this, waistlines and blood sugar levels are unfortunately increasing. Increases in cardiovascular disease, diabetes, and obesity all have been shown to be associated with consumption of cheaper, subsidised commodity based foods.[1], [2]

Insulin-resistant diabetes is not a condition that develops overnight; for most people it is a long course of a decreasing response of the body to insulin due to excess consumption of foods that increase blood sugar and other potential predisposing factors. Medications such as prednisone can put the body at a much higher risk for the development of diabetes, and certain blood pressure medications that are commonly taken may do so as well, albeit to a much lower extent.[3]

Learning more about diabetes and the related health complications can foster motivation to make changes, as there are many things one can do to improve blood sugar levels and recover from a condition such as T2 diabetes.

  • Associated with the recent World Health Day in April 2016, the World Health Organization (WHO) published the first “Global Report on Diabetes.”[4] The highlighted statistics on diabetes are alarming: diabetes has almost quadrupled since 1980 from 108 million to an estimated 422 million adults, and diabetes is the number one cause of death, with 1.5 million deaths directly associated with diabetes in 2012. More than 43% of these deaths occurred in individuals under the age of 70 years old. The increase in T2DM has been observed to mirror the increasing prevalence in individuals who are overweight and obese. These numbers are also concerningly high, with 1 in 3 adults over the age of 18 being overweight and 1 in 10 being obese.
  • An overlapping syndrome of excess abdominal weight, elevated blood sugar, hypertension, elevated triglycerides and low HDL cholesterol is known as metabolic syndrome.[5] Metabolic syndrome often precedes the development of diabetes and cardiovascular disease. In a 2001 population survey of 8841 adults from the United States, the overall prevalence of metabolic syndrome was found to be 22 percent, with an age-dependent increase.[6] The relative risk (RR) of developing diabetes ranges from 3.53 to 5.17 in individuals with metabolic syndrome.[7] The risk of cardiovascular disease all-cause mortality is also increased in individuals with metabolic syndrome, but not nearly to this extent.
  • The risk of additional health complications associated with diabetes is high. Ongoing management is necessary to manage blood sugars and monitor for damage to the small blood vessels that affect the retina of the eye, kidneys, and peripheral nervous system (enables the body to feel sensations in the extremities such as the hands and feet). Changes to the larger vessels occur as well, with increased atherosclerosis and coronary artery disease. Lower limb amputation rates are 10 to 20 times higher among people with diabetes,[8] and 7% of individuals with diabetes experience vision-threatening retinopathy.[9] The estimate of end stage renal disease (which often leads to the need for dialysis) due to diabetes alone is 12 – 55%, about 10 times the risk of a population without diabetes.[10]  Finally, the rates of cardiovascular disease in individuals with diabetes is 2 to 3 times that of a population without diabetes.[11]
  • The gut flora also may be connected with the development of diabetes and obesity. An imbalance in the intestinal bacterial population could result in obesity, systemic inflammation, and the development of diabetes.[12] Obesity has been shown to be associated with changes in the relative abundance of the two dominant bacteria that are present in the gut (the Bacteroidetes and the Firmicutes) as well as a lower diversity of gut flora than individuals having a healthy weight.[13] Dietary choices affect the gut flora, and the mechanism by which some therapies improve blood sugar metabolism may be via changing the flora in the gut.[14],[15]

Getting things back on track!

Core interventions for the management of diabetes and the related complications include lifestyle changes (healthy diet, exercise, smoking cessation), blood sugar management, regular exams for early detection of complications, and medications to control hyperglycemia and cardiovascular risk, if necessary. Nutritional supplements are also effective at reducing blood sugar and supporting healthy cholesterol levels, as dyslipidemia is common among metabolic syndrome and diabetics.

Diet and diabetes

Dietary choices that are supportive to blood sugar balance include minimising foods with a high glycaemic index such as simple carbohydrates (white flour, pasta, breads, baked goods) and sugars and focusing the diet on a balance of foods that are higher in protein, fibre, healthy fats such as olive oil, coconut, and avocado, and are nutrient dense. Selecting quality proteins including grass-fed over corn-fed beef and free range eggs over caged also impacts the composition of the nutrients that you will obtain from these foods.[16],[17] Increasing fibre intake with vegetables, whole fruit (not juices), and whole grains, also positively impacts blood sugar and the prevention of diabetes.[18],[19] Blueberries are also a food with healthful benefits for diabetes, as well as cardiovascular disease.[20],[21] Work on filling your plate with foods that will support your blood sugar balance before finding room for simple carbohydrate sides, and select a fruit to fulfill your sweet tooth, rather than the pastry or ice cream. Holiday baked goods and treats are meant to be given away, so when you make holiday delights think of this as an opportunity to share, leaving only one or two for each individual in your household.

Exercise and diabetes

Exercise is an important part of a healthy lifestyle, and supports blood sugar balance, cardiovascular health, maintenance of an appropriate weight, and even supports your mood. Walking 11.3 miles (18.2 km) per week may be as effective as a combination of dietary modification, weight loss, and exercise at preventing progression of pre-diabetes into diabetes.[22] One of the things that is important to making exercise an integral part of life is to find something you like; while some may enjoy the movement and time to think while running or cycling, others may be much happier in a group dance or fitness class setting. Find what is right for you, make a commitment to yourself and maybe a friend, and get moving!

Supplements that support blood sugar balance

There are a variety of nutritional supplements which have been studied for improving blood sugar balance and reducing insulin resistance. Lipoic acid is an antioxidant that improves insulin sensitivity,[23] reduces the risk of diabetic neuropathy,[24] and also may support weight loss goals if this is also an issue.[25] The minerals chromium and vanadium, along with the B-vitamin biotin all play a role in blood sugar balance.[26],[27],[28] A combination of chromium picolinate and biotin has been shown to improve glucose management and several lipid measurements in patients with poorly controlled diabetes.[29]

Many botanical agents also have a long history of use in different cultures for improving blood sugar balance. Berberine, found in a variety of plants including Oregon Grape, Barberry, and Goldenseal, has been shown to improve insulin sensitisation and modify the gut microbiota which may contribute to the effects seen in individuals with diabetes.[30],[31],[32] Supplementation with berberine hydrochloride has also been shown to improve cholesterol parameters, reducing total cholesterol, triglycerides, and LDL.[33]

Other herbs such as gymnema (Gymnema sylvestre),[34] an herb native to India and commonly used in Ayurvedic medicine, bitter melon (Momordica charantia),[35] a fruit commonly used in Asian and Indian cuisine, Lagerstroemia speciosa and fenugreek (Trigonella foenum-graecum),[36],[37] also common to India and the Middle East, and cinnamon,[38] all have evidence and a long history of cultural use for the management of diabetes.  Many of these herbs also have evidence for improving cholesterol balance as well. Although some of these herbs can be found and used for culinary purposes, for therapeutic use standardized supplements are often more effective as they concentrate the parts of these plants that are active.

In conclusion, diabetes does not have to be a life sentence, and there are many things that can be done to restore the body to a state of healthy blood sugar management and prevent the complications of diabetes. Being proactive and including a variety of these strategies, including dietary changes, exercise, and evidence based supplementation into your day-to-day protocol can go far to bring your body back to balance. Seeking the support of an integrative medical provider such as naturopathic doctor, integrative physician, or nutritional therapist, and personal trainer or other activity to get your body moving can help you to get on track with managing your health.

 References

[1] Siegel KR, et al. Association of Higher Consumption of Foods Derived From Subsidized Commodities With Adverse Cardiometabolic Risk Among US Adults. JAMA Intern Med. 2016 Jul 5. View Abstract

[2] Conklin AI, et al. Dietary Diversity, Diet Cost, and Incidence of Type 2 Diabetes in the United Kingdom: A Prospective Cohort Study. PLoS Med. 2016 Jul 19;13(7):e1002085. View Full Paper

[3] Rehman A, Setter S, and Vue M.  Drug-Induced Glucose Alterations Part 2: Drug-Induced Hyperglycemia. Diabetes Spectrum 2011 Nov; 24(4): 234-238.

[4] World Health Organization. Global report on diabetes. April 7, 2016. View Full Paper

[5] NIH.  National Heart, Lung and Blood Institute.  http://www.nhlbi.nih.gov/health/health-topics/topics/ms/ Accessed August 2016.

[6] Ford ES, et al. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002 Jan 16;287(3):356-9. View Abstract

[7] Ford ES, et al.  Metabolic syndrome and incident diabetes: current state of the evidence. Diabetes Care. 2008 Sep;31(9):1898-904. View Full Paper

[8] Moxey PW, et al. Lower extremity amputations–a review of global variability in incidence. Diabet Med. 2011 Oct;28(10):1144-53. View Abstract

[9] Yau JW, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012 Mar;35(3):556-64. View Full Paper

[10] Saran R, et al. US Renal Data System 2014 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2015 Jul;66(1 Suppl 1):Svii, S1-305. View Abstract

[11] Emerging Risk Factors Collaboration, Sarwar N, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010 Jun 26;375(9733):2215-22. View Full Paper

[12] Escobedo G, et al. Gut microbiota as a key player in triggering obesity, systemic inflammation and insulin resistance. Rev Invest Clin. 2014 Sep-Oct;66(5):450-9. View Abstract

[13] Turnbaugh PJ, et al. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006 Dec 21;444(7122):1027-31. View Abstract

[14] Esteve E, et al. Gut microbiota interactions with obesity, insulin resistance and type 2 diabetes: did gut microbiote co-evolve with insulin resistance? Curr Opin Clin Nutr Metab Care. 2011 Sep;14(5):483-90. View Abstract

[15] Simon MC, et al. Intake of Lactobacillus reuteri improves incretin and insulin secretion in glucose-tolerant humans: a proof of concept. Diabetes Care. 2015 Oct;38(10):1827-34. View Abstract

[16] Daley CA, et al. A review of fatty acid profiles and antioxidant content in grass-fed and grain-fed beef. Nutr J. 2010 Mar 10;9:10. View Full Paper

[17] Torde RG, et al. Multiplexed analysis of cage and cage free chicken egg fatty acids using stable isotope labeling and mass spectrometry. Molecules. 2013 Dec 5;18(12):14977-88. View Full Paper

[18] Bazzano LA, et al. Intake of fruit, vegetables, and fruit juices and risk of diabetes in women. Diabetes Care. 2008 Jul;31(7):1311-7. View Full Paper

[19] Meyer KA, et al. Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr. 2000 Apr;71(4):921-30. View Full Paper

[20] Stull AJ, et al. Bioactives in blueberries improve insulin sensitivity in obese, insulin-resistant men and women. J Nutr. 2010 Oct;140(10):1764-8. View Full Paper

[21] Basu A, et al. Blueberries decrease cardiovascular risk factors in obese men and women with metabolic syndrome. J Nutr. 2010 Sep;140(9):1582-7. View Full Paper

[22] Slentz CA, et al. Effects of exercise training alone vs a combined exercise and nutritional lifestyle intervention on glucose homeostasis in prediabetic individuals: a randomised controlled trial. Diabetologia. 2016 Jul 15. [Epub ahead of print] View Abstract

[23] Kamenova P. Improvement of insulin sensitivity in patients with type 2 diabetes mellitus after oral administration of alpha-lipoic acid. Hormones (Athens). 2006 Oct-Dec;5(4):251-8. View Abstract

[24] Packer L, Kraemer K, Rimbach G. Molecular aspects of lipoic acid in the prevention of diabetes complications.  Nutrition. 2001 Oct;17(10):888-95.  View Abstract

[25] Koh EH, et al.  Effects of alpha-lipoic Acid on body weight in obese subjects.  Am J Med. 2011 Jan;124(1):85.e1-8.  View Abstract

[26] Broadhurst CL, et al. Clinical studies on chromium picolinate supplementation in diabetes mellitus–a review. Diabetes Technol Ther. 2006 Dec;8(6):677-87. View Abstract

[27] Thompson KH, et al. Vanadium treatment of type 2 diabetes: a view to the future. J Inorg Biochem. 2009 Apr;103(4):554-8. View Abstract

[28] Fernandez-Mejia C. Pharmacological effects of biotin. J Nutr Biochem. 2005 Jul;16(7):424-7. View Abstract

[29] Singer GM, et al. The effect of chromium picolinate and biotin supplementation on glycemic control in poorly controlled patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized trial. Diabetes Technol Ther. 2006 Dec;8(6):636-43. View Abstract

[30] Wang Y, et al. Hypoglycemic and insulin-sensitizing effects of berberine in high-fat diet- and streptozotocin-induced diabetic rats. Metabolism. 2011 Feb;60(2):298-305. View Abstract

[31] Zhang Y, et al. Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine. J Clin Endocrinol Metab. 2008 Jul;93(7):2559-65. View Abstract

[32] Han J, et al. Modulating gut microbiota as an anti-diabetic mechanism of berberine. Med Sci Monit. 2011 Jul;17(7):RA164-7. View Full Paper

[33] Derosa G, et al.  Berberine on metabolic and cardiovascular risk factors: an analysis from preclinical evidences to clinical trials. Expert Opin Biol Ther. 2012 Aug;12(8):1113-24. View Abstract

[34] Baskaran K, et al. Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin-dependent diabetes mellitus patients. J Ethnopharmacol. 1990 Oct;30(3):295-300. View Abstract

[35] Leung L, et al. Anti-diabetic and hypoglycaemic effects of Momordica charantia (bitter melon): a mini review. Br J Nutr. 2009 Dec;102(12):1703-8. View Abstract

[36] Klein G, et al. Antidiabetes and Anti-obesity Activity of Lagerstroemia speciosa. Evid Based Complement Alternat Med. 2007 Dec;4(4):401-7. View Full Paper

[37] Gupta A, et al. Effect of Trigonella foenum-graecum (fenugreek) seeds on glycaemic control and insulin resistance in type 2 diabetes mellitus: a double blind placebo controlled study. J Assoc Physicians India. 2001 Nov;49:1057-61. View Abstract

[38] Khan A, et al. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003 Dec;26(12):3215-8. View Abstract

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