I have, as a practicing physician, increasingly found that the role of nutrition and nutritional supplementation is a key factor in creating health and preventing disease. The American Journal of Clinical Nutrition, reported a study performed at the Centre for Metabolic Disease and Atherosclerosis, in Italy, that the worldwide incidence of childhood type-1 diabetes varied according to dietary patterns. It also noted a direct correlation with energy from animal sources — meat and dairy. It further recommended that dietary risk factors during pregnancy and early neonatal life be explored to confirm whether and to what extent diet co-operates with genetic susceptibility in the early onset of type-1 diabetes.
A study in Nursing Research stated that the major cause of morbidity and mortality in individuals with type-1 insulin-dependent diabetes mellitus [IDDM] is premature with extensive atherosclerotic cardiovascular disease [CVD]. While this may not seem surprising news concerning adult disease, the shocking fact is that this study was focusing on children in the US that had been diagnosed with IDDM. Furthermore, statistics in the US indicates that approximately 20 million people have diabetes, but that only 15 million [65 per cent] have been diagnosed, and that approximately 950,000 new cases are diagnosed per year. It is the most common chronic disease in children under 16, and reports from the World Health Organisation [WHO] indicate that diabetes mellitus is also one of the major killers of our time, with people in South-East Asia and the Western Pacific being most at risk.
One of the key reasons for the prevalence of this condition is the lack of monitoring of blood glucose, and checking for early signs and risk factors, such as obesity and hypercholesterolaemia. This should be done from childhood onwards. Research has shown that even a pregnancy complicated with diabetes can cause maldevelopment of the embryo, because of the potentially damaging role of free-oxygen radicals. So, physicians are urged to monitor maternal serum concentrations of glucose as well as oxidative substrates.
Free Radicals
Free radical damage to tissues is a significant catalyst for most major contemporary diseases, particularly diabetes. Diabetes mellitus [DM] is a syndrome initially characterised by a loss of glucose homeostasis. The disease is progressive and is associated with high risk of atherosclerosis, kidney and nerve damage as well as blindness. People tend to avoid seeing a doctor, even for an annual check-up, until they experience some problems that may be causing them concern. But, with conditions such as the above, if the early warning signs had been monitored, complications could probably have been prevented.
That having been said, I would like to discuss briefly the approach that I take when a patient presents with symptoms of diabetes.
One of the major underlying causes of the terrible damage associated with chronic diabetes is the damage to the walls of blood vessels throughout the body. This damage, which is the result of daily surges in insulin and blood sugar, can affect an astonishing variety of body organs and parts. Eyes are damaged, producing retinopathy. Circulation, in general, is damaged, which leads to gangrene and cellutitis. The delicate network of vessels in the kidneys can become damaged, resulting in kidney failure that requires organ transplants, or dialysis. And, not surprisingly, the heart can become damaged, leading to heart attacks.
It was in 1988 that researchers at Harvard University isolated a powerful substance called Ginkgolide B, found in Ginkgo. This substance has specific and potent pharmacological activity. It seems to increase circulation and help quench the clumping of platelets. One of the most powerful substances in Ginkgo has proven helpful in diabetic animals. This is especially good news for diabetics, many of whom suffer with claudication, or vascular insufficiency.
One of my patients, a 57-year-old male, came to me because he was experiencing impotency. He had a family history of diabetes and was beginning to show borderline elevations in glucose. His resistance to insulin was rising and his triglycerides and cholesterol [over 300mg total] were dangerously high. Although his previous doctors had told him to stop eating sweets, he was extremely anxious about his diet, and wanted to know what he could do to regain his sexual potency.
We changed his diet, eliminating sweets and cakes, and recommended nutrient-packed foods, such as fish, lean chicken, vegetables and salads. In addition, I recommended a variety of supplements to enhance circulation. This included the amino acid arginine and the B vitamin, niacin, both of which help dilate blood vessels. The third nutrient in my arsenal was Ginkgo, at 120mg a day, in two divided doses. Ginkgo stimulates the endothelium-derived relaxing factor [EDRF], a substance that causes cells in blood vessels to relax and ultimately dilate blood vessels [We now know that EDRF is actually nitric oxide, which is crucial for erections]. It took a while. But, after three months of treatment, I received a call late one evening to let me know the treatment was working. [Note: Always check, if a patient is taking any type of blood-thinning medication, before recommending Ginkgo, since it can augment the effects of anticoagulants].
B Vitamins & ALA
A study reports that many sufferers of type-2 non-insulin-dependent diabetes mellitus develop macrovascular disease and hyperhomocysteinaemia, which also seems to be a risk factor for diabetic retinopathy. One of the major culprits complicating hyperhomocysteinaemia are the saturated and unhealthy, hydrogenated fats that soak the contemporary diet, particularly the fast-foods like hamburgers, french fries, and the packaged snack foods, like potato chips, popcorn etc., Non-fat carbohydrates can be even more of a problem because they too can raise homocysteine levels. Deficiencies in B vitamins directly affect homocysteine levels. The best way to normalise homocysteine levels is by first lowering the intake of carbohydrates and increasing the amounts of fruits and vegetables. For supplements, I recommend daily doses of folate and B vitamins. These simple changes can go a long way to protecting a person’s health.
Peripheral neuropathy can often accompany adult-onset diabetes. One patient came to me, alarmed, because she had awoken one morning with a feeling of numbness in her extremities, which persisted. Tests revealed that her blood glucose was a moderately high [132], her homocysteine levels were a high 20, and she had a deficiency in B12 [cobalamin] and folic acid.
The treatment I recommended was a 10mg dose of the B complex vitamins. I prescribed 25mg of B6 [pyridoxine], 1,000mcg of B12, and 800mcg of folic acid. I added garlic pills — garlic has been shown to lower cholesterol and blood sugar — and, I suggested a low carbohydrate diet to help keep her diabetes under control. I also gave her chromium picolinate, which is thought to reduce insulin resistance. Finally, I added alpha lipoic acid [ALA] to the mix, since it may not only improve alertness and mental clarity but also enhance health of the nerves. An exercise regimen of daily walking and stretching was added to stimulate her circulation and help decrease her blood sugar levels. Six months later, her gait had improved, and though she experienced occasional ‘tingliness’ in her legs, the condition has not progressed.
ALA, also known as thioctic acid, can be beneficial in the treatment of diabetes. Many health problems, not only diabetes, can be traced to excess sugar in the diet, because sugar itself can promote free radical damage, just as oxygen can. Both are fuel for the body and primary sources of energy, but both need to be balanced by a strong antioxidant defence system. ALA is the only antioxidant that is both water and fat soluble, which means that it is easily available to all areas of the body. It readily passes through the cell membrane scavenging free radicals from sugars, not just in the bloodstream, but in the very heart of the cell, thus protecting our DNA from damage and possible mutation.
Because of its potential to protect blood vessels against the damage that excess sugar can cause, it has proved effective in treating peripheral neuropathy in diabetics, and is a recognised treatment for this condition in Europe. Another key antioxidant, N-acetyl cysteine [NAC] is a precursor of glutathione, and research has shown it to be effective in attenuating the severity of IDDM by preventing the destruction of pancreatic beta cells. Research at the Centre of Nutrition in Moradabad, India, has explored the antioxidant properties of forskolin for the treatment of cardiovascular disease and diabetes.
More and more evidence points to the critical role of free radicals in diabetic pathology. A study reported in Diabetic Medicine stated that both type-1 and type-2 diabetes mellitus indicate increased oxidative damage from free radical activity, as well as deficits in antioxidant defence enzymes and vitamins. It is a natural function of our bodies to generate free radicals to fight disease, and under ideal conditions the body is equipped to maintain a healthy balance by eliminating excess free radicals.
Our most powerful ally, and one that is readily available for reversing and healing the effects of free radical damage and, in particular, diabetes, is careful attention to diet and supplementation with nutrients, especially those with antioxidant properties. At particular risk today are our children who depend on their parents and schools for the food they are given. Paediatricians and family physicians could go a long way in preventing this condition by monitoring the diets of infants and children that come into their care and providing the necessary guidance for parents and school personnel responsible for nutritional programmes.
