Diabetes and Metabolic Syndromes: Understanding Your Condition, Dietary Control, and Treatment Options in Complementary Medicine

Paul Reller, L.Ac.

Diabetes is a term that has been misused and poorly understood in recent decades. The term diabetes has been used since the second century, and derives from the Greek word meaning siphon, referring to the symptom of frequent urination that accompanies true diabetic states. The origin of the problem was traced back to the hormone secreting pancreas, with deficient secretion of insulin hormone pushing protein and fat breakdown over carbohydrate use in the body, which caused excess dumping of protein metabolites, as well as sugars, in the urine, causing excess urination and thirst, as well as wasting. The eventual threat to health in chronic cases came from kidney dysfunction, electrolyte imbalance, acidosis, and blood vessel degeneration. It was diagnosed primarily with excess circulating blood values of glucose, or sugar, which is called hyperglycemia. Unfortunately, in the last century, less than 10% of these patients with hyperglycemia had a true diabetes, and a second form of metabolic disorder was then called Diabetes type II, which is now properly called Metabolic Syndrome for most patients. By paying attention to what is actually going on in the body, and progressing past misconceptions of the past, both the patient and the physician can better address this health problem with the most comprehensive and specific course of therapy.

When the term diabetes comes up in your health profile or diagnosis, this term could signify a wide variety of scenarios and problems. The intelligent patient will not ignore the complexities of diabetes, but will try to gain a full understanding of this health imbalance, understand the specific type of diabetes that he or she has, and thus form a protocol that addresses the disease in the individualized way that will best restore healthy function and prevent serious consequences.

Kevin Patterson is a medical doctor and writer that has worked around the world treating patients, most recently as an internist and intensive care specialist in Afghanistan for the Canadian Combat Surgical Hospital. In 2010, he noted in an essay in Maisonneuve journal that “Type 2 diabetes historically did not exist only 70 to 80 years ago, and what has driven it, of course, is the rise in obesity, especially the accumulation of abdominal fat. That fat induces changes in our receptors that cells have for insulin. Basically, it makes them numb to the effect of insulin.” Dr. Patterson described how surgical patients in Afghanistan, and in many parts of Africa, had little or no visible fat beneath the typical fatty layer under the skin, but that patients from the United States, Canada and Europe typically had most of the organs encased in fat. He stated that “it had a visceral potency to it when you could see it directly there.” Dr. Patterson noted high rates of Type 2 diabetes, or Metabolic Syndrome, in every culture that adopted a modern Western diet, and stated that “no country in the world has the resources to continue to treat diabetics the way that they are being treated now, if the prevalence rates increase at the rates that they are increasing for much longer.” Changes in our modern diet and adoption of holistic protocols to treat Metabolic Syndrome and Type 2 diabetes are becoming a matter of survival, not only concerning our health, but concerning our economy. Complementary and Integrative Medicine presents a significant part of the solution to this problem, and patient and public understanding is vital to the proactive partnership between the Complementary Medicine physician and the patient to both treat and prevent this now common and devastating health problem. Once insulin resistance and accumulation of fatty tissues in and around our organs occurs, though, this problem is no longer easy to reverse.

The hormone insulin is part of an elaborate feedback network of relatively simple molecules called steroid hormones that trigger responses at a variety of hormonal cell receptors in our bodies. The various receptors perform the variety of functions triggered by the same simple insulin molecule. The phsyiological responsibilities of this hormone insulin includes primary regulation of the metabolism of fats and sugars, but to assume the this cellular energy regulation is the sole function of insulin, or that insulin alone regulates energy usage is a misconception. A variety of hormones and hormonal balance maintains our complex regulation of the energy metabolism. A relative excess of insulin inhibits the ability to utilize stored fats as a source of energy by conversion to glucose, while a relative abscence of insulin, as in true diabetes, results in glucose not being taken up by body cells, and the excess use of stored fat as an energy source. When true diabetes occurs, the patient thus becomes thin, suffers dangerous metabolic deficiency, and depends upon exogenous insulin injections to survive.

In the most prevalent form of what we call diabetes, type 2, or Metabolic Syndrome, the patient is not able to use stored fats due to insulin resistance, and becomes obese. This insulin resistance at the target cells usually, but not always, precedes obesity and the development of hyperglycemia, or high circulating blood sugar. A very few of these patients develop a relative insulin deficiency, and require exogenous insulin to control blood sugars. On the other hand, almost all of these patients instead experience fluctuating excess insulin effects due to insulin resistance stimulating excess need for insulin, and slow uptake of insulin at fat and muscle cell receptors. The negative health effects of this fluctuating excess insulin and insulin resistance at cell receptors are much broader than just poor usage and storage of sugars and fats. Insulin also has a variety of effects besides regulation of sugar and fat metabolism, acting with other hormones to regulate amino acid uptake by cells, various anabolic processes, and important regulatory processes in the brain. Anabolic processes are the cellular processes that create important molecules from simpler components. We see that in metabolic syndrome, insulin resistance at the cells is extremely important, and must be addressed to restore health, not only to regulate circulating blood sugar and decrease stored fats, but also to restore overall health and function.

Insulin is not only produced in the pancreas, but also in the brain, and influences brain function, such as learning, memory and cognition, as well as vascular compliance (the elastic ability to respond to needed changes in blood pressure), rates of breakdown of proteins (the main messengers or regulating molecules in our cells), DNA replication, modification of enzyme activities, and even the rate of degradation of damaged cell components called organelles (linking metabolic syndrome to neurodegeneration). Insulin is widely stored in fat cells as well, and so there is more to our insulin metabolism than just the hormone that is released from the pancreas, and more to the effects of insulin than just regulation of blood sugars. Most of the insulin released by the pancreas produces this effect of blood sugar regulation and is destroyed in less than 10 minutes, and almst all of it within an hour, mostly within the liver. Liver function is thus very important to insulin metabolism and balance, but as we see, insulin in the brain, hormonal balance, and overall metabolic function is also very important to the healthy insulin metabolism in your body. By merely controlling the circulating blood sugar and insulin levels, the patient achieves the basic need in staying alive, but the needs of the body to restore full health and relieve a wide variety of health problems related to insulin metabolism and insulin resistance are not addressed. Complementary Medicine is making great leaps forward in research to help the patient achieve these goals, especially in decreasing insulin resistance and the causes for insulin resistance and obesity.

In true diabetes, where the blood sugar levels are not managed, and hyperglycemia results, the long-term injury is mostly seen in the cardiovascular system and kidney dysfunction. In 1993, the results of a 10-year multicenter study found that by rigorously managing blood sugar levels, diabetics could substantially reduce the long-term complications of the disease, especially peripheral neuropathies, kidney dysfunction, degeneration of the eye, and other cardiovascular problems. Heart attacks are one of the most common causes of death in the United States, and patients with diabetes and metabolic syndromes comprise over one third of these heart attack victims. Managing blood sugar levels is best handled on an individualized basis, and there are many ways to achieve the best and healthiest regimen depending on the individual paramenters of the disease. It is not recommended that the patient depend on insulin injections alone, but rather adopt a holistic proactive approach to improving overall health and managing energy usage via stricter dietary and excercise control. Complementary Medicine could play a big role in this healthier proactive approach for insulin-dependent, and non-insulin dependent, Diabetes type 1 patients.

Insulin-dependent Diabetes Type 1

One form of diabetes eventually results in pancreatic beta cell damage, probably due to autoimmune disorder, but also now shown to be due to heavy metal toxins in the environment, such as arsenic and mercury from coal fired power plants, and other heavy industries. The pancreatic damage results in the inability to produce enough insulin hormone. Synthetic insulin is usually injected daily by these patients with careful monitoring. The vast majority of patients, though, who are not dependent on insulin injections, may manage their sugar metabolism with a program of sensible dietary and excercise habits, herbal and nutrient medicine, and perhaps acupuncture. This routine can also improve sugar metabolism in the insulin dependent group, and lead to a lower dosage need for the synthetic insulin. Even patients who take various diabetic medications to help control their disease or syndrome, should consider the sensible integration of Complementary Medicine to achieve the best results and decrease dependence on medications.

The causes and contributors for insulin dependent diabetes mellitus (IDDM or type 1) include genetic propensities (although the genetic risk of inheriting is only 1-10% from parents with IDDM, and even identical twins had concurrent IDDM in only 30-50% of cases studied), post-surgical stress, adverse effects of medications (e.g prednisone, some antibiotics, chemotherapy agents, and drugs used to treat HIV), stressful diseases (e.g. Graves), environmental chemicals (especially poisons, heavy metal toxins, and herbicides), hormonal changes (e.g. pregnancy), autoimmune responses (four antibodies are highly associated), as well as deep chronic viral infections. Diabetes Type 1 is now considered a syndrome of diseases that are related to immune responses. A number of associations and triggers, such as Vitamin D hormone deficiency, immune responses to proteins in cow milk, a lack of early immune memory from insufficient breast feeding and lack of colostrum, fatty acid imbalances, and exposure to more complex solid foods at too early of an age, have been noted in studies. This long list of causes and contributors does not make it easy for the patient or physician to assess the individual with diabetes and arrive at a course of therapy to reverse the disease. There is hope of such a reversal, or cure, though. The assumption that pancreatic beta cells that produce insulin which were destroyed by the disease could not regrow has been finally shown to be a false notion. While the search for specific allopathic chemicals to stimulate regrowth is being heavily researched, it is more likely that a thorough approach with Complementary Medicine will be necessary to achieve healthy pancreatic regrowth and functional restoration, perhaps combined with specific allopathic chemicals.

Although true diabetes is classified as either insipidus or mellitus, when the doctor uses the term diabetes, he or she generally is referring to the more common Diabetes Mellitus, or even more commonly, to the condition that is now classified as Metabolic Syndrome. Mellitus was a term coined in 1675 and taken from the Greek work meaning honeyed, referring to the phenomena of the sickly sweet smell of the diabetic's urine. Primary, or essential diabetes, refers to a disease of the pancreas, and has a relatively high degree of genetic propensity. Secondary diabetes, which occurs secondary to another cause, may occur with (A) pancreatitis or other pancreatic destruction, (B) with endocrine disorders, and (C) with drug-induced diabetic states from prescription of synthetic corticoid or thyroid hormones, among other causes. As stated, over 90% of diagnoses of diabetes, though, are actually referring to Metabolic Syndrome, which usually involves a combination of dysfunctions, including insulin resistance at the fat cell receptors linked to chronic inflammation, liver dysfunction, and endocrine imbalance. Treatment and managment of insulin-dependent Diabetes type 1 differs from the protocol needed to address this more prevalent type 2 and Metabolic Syndrome. The more the patient understands these differentiations, the more successful an individualized therapeutic protocol will be.

Perhaps more than any other disease, diabetes mellitus is associated with diet, both in relation to cause and to control of the disease. There is rarely a cure for diabetes mellitus, but the mechanisms of the disorder may be controlled successfully by a change in habits, especially dietary and exercise routines, and consequently, the disease state presents little danger as long as these healthy habits are maintained. If the pancreatic beta cells are destroyed, as in the autoimmune type 1, a patient may be insulin dependant, but the need for insulin will decrease with increased control of the blood sugar metabolism by the patient. The vast majority of diabetes patients are not insulin dependant, though, and these patients should gain an understanding of the sugar metabolism and take healthy steps to control it with dietary habits, exercise, nutrient therapy, herbs and acupuncture.

As for the cause of true diabetes, although genetics may predispose one to the disease, and viral infections, particularly mumps, are often linked to the disease onset by triggering of an autoimmune response, such dietary factors as overeating and obesity, and a diet low in fibrous, natural, whole foods and high in processed foods, are believed to be behind most cases of the disease. Destruction of the pancreatic beta cells from glucose toxicity, advanced glycation endproducts (AGEs), and oxidative stress, combined with lipotoxicity (high triglycerides and free fatty acids), presents the most plausible explanation for the key metabolic dysfunctions that lead to beta cell death. The modern diet with processed palmitic acids (hydrolyzed palm and coconut oils), high fructose corn syrup, AGEs, fatty acid imbalance, and a gross excess of sugars and high glycemic index carbohydrates, contributes to a variety of metabolic and genetic dysfunctions, with many individuals genetically predisposed to higher risk. The modern diet appears to be the main culprit, although a combination of factors contributes. For instance, prescription drugs are sometimes the culprit as well. Eli Lilly, by September of 2008, was settling over 8000 claims of diabetes acquired by taking the anti-psychotic drug Zyprexa, which caused massive weight gain and very high blood sugars in many patients. The company was found to have hidden this information from doctors to boost sales, and promoted the drug for many patients with mild problems of anxiety and depression. The American Diabetes Association has warned of this problem in this class of drugs for many years.

To control this disease, you must first understand what it is, what type you have, why your symptoms arise, and what a doctor is doing to control the disease. Patient education and understanding are very important. Keep in mind that the progression of the disorder to a clinical state, or state where symptoms are noticed, is usually gradual, and further progression to a state where serious health problems arise, such as cardiovascular disease, eye disease, neuropathy, skin problems, and kidney damage is also usually a gradual process. Once you are diagnosed with the disease, there is usually ample time to develop a lifestyle of controlled diet and exercise, and to utilize, or integrate, Complementary Medicine to prevent progression of the disease and symptoms. Most of the diabetic syndromes are slow and chronic, and sudden crises, such as diabetic ketoacidosis (DKA) or hyperosmolar nonketonic syndrome (HNKS), are rare in the beginning stages of clinical diabetes, and will be explained later in this paper.

Complementary and Integrative Medicine may help the patient with Type 1 Diabetes in a number of ways. Control of the sugar and lipid metabolism with improved diet and exercise habits, as well as nutrient medicine, and potentially acupuncture (see study links below), may reduce the need for injected insulin as a control. Restoration and regrowth of insulin secreting beta cells in the pancreas is now confirmed as a possibility, and a comprehensive step-by-step treatment protocol is needed to achieve this task. In the long term, the reduction of dosage of injected insulin will prevent side effects and harm from chronic use of injected synthetic insulin. To achieve a restoration of pancreatic insulin production, the less the body depends upon synthetic insulin replacement, the better. Better self-initiated control of blood sugar and fatty metabolism will also insure an optimal static health and prevent the ill effects of a fluctuating sugar and lipid metabolism. The time spent with the patient to help with establishing these individualized dietary and exercise regimes by the Licensed Acupunturist may be an important part of the integrated treatment. The combination of individualized advice for the proactive patient added to acupuncture stimulation may be particularly beneficial. In addition, a number of herbs are proving potentially beneficial for various systems and tissue involved in the disease. Autoimmune effects may be reduced, pancreatic beta cell regeneration achieved, liver function improved, and even the hypothalamic function may be improved and positively affect blood glucose control. The hypothalamus is the nerve center control of the hormonal system in our bodies, and stimulates various central hormonal releases via the pituitary gland. Vasopressin is associated with diabetic neuropathy, and studies in Korea in 2007 (see the study link below in additional information) revealed that a Chinese herbal medicine from the silkworm significantly reduced blood sugars in laboratory animals with induced diabetes by affecting the expression of vasopressin. This adds an important therapeutic tool for the professional herbalist in helping the patient afflicted with Diabetes type 1. A protocol combining various adjunct treatments such as this would benefit the patient tremendously over time.

Promoting Healthy Regrowth of the Pancreatic Beta Cells that produce insulin and glucagon

A short time ago all patients were told that once pancreatic beta cells were destroyed they could not regrow. We now know that this was based on “scientific” assumption and not scientific fact. Experts now agree that a combination of immunotherapy that downregulates autoimmune responses with stimulation of beta-cell regrowth and restoration of cellular function may restore the patient with type 1 diabetes to restoration of euglycemia, or normal homeostatic control of blood sugars (Nature Reviews Drug Discovery 10, 439-452; June, 2011: Frank Waldron-Lynch and Kevan C Herold). Unfortunately, many experts believe that we are 20-25 years away from implementing a pharmaceutical strategy to regrow or replace pancreatic islet beta cells.

The notion that we could stimulate regrowth and functional restoration of the pancreatic beta cells is not new. A 2009 study by A. Granger and JA Kushner at the University of Pennsylvania School of Medicine (Journal of Internal Medicine. 2009 Oct;266(4):325-38) found that observations and theories made over 100 years ago revealed the regenerative potential of the pancreas. Three theories of regeneration were proposed. One, that acinar cells could differentiate into islet cells; two, that islet cell neogenesis that was similar to formation during embryonic stem cell development occurred; and three, that the pancreas could simply replicate existing islet cells. These three theories are still being debated today. In recent years, evidence indicates that the neogenesis theory is sound, and that pancreatic duct cells may act as progenitors after injury to the beta islet cells, as well as progenitor cells existing within the islet tissues that are capable of differentiating into insulin producing cells. The pancreatic duct joins the pancreas to the common bile and hepatic ducts to supply the small intestinal duodenum with digestive enzymes and bile as needed. Some individuals have a second, or accessory, pancreatic duct. The pancreatic duct runs the length of the pancreas. Researchers at the Joslin Diabetes Center and Harvard Medical School in Boston, Massachusetts found in 2008 that “carbonic-anhydrase II expressing pancreatic cells act as progenitors that give rise to both new islets and acini after birth and after injury (ductal ligation). This identification of a differentiated pancreatic cell type as an in vivo progenitor for all differentiated pancreatic cell types has implications for a potential expandable source for new islets for replenishing therapy for diabetes in vivo or ex vivo.” (Biochem Soc Trans. 2008 Jun;36(Pt 3):353-6; Bonner-Weir S et al). This conclusion indicates that not only stem cell derived therapies, but also restorative therapies in vivo, or in the living pancreas, could improve the mass of hormone-producing islet beta cells in the pancreas. A follow-up study in 2009 by these researchers proved that within the exocrine pancreas (ductal and acinar tissues) there are cells that can give rise to insulin producing beta cells in vitro (see studies cited below).

The questions of the patient should include how Complementary Medicine can contribute to this process. Complementary Medicine, and particularly the integrative specialty of Traditional Chinese Medicine (TCM), may supply safe and effective treatment strategies that help decrease the autoimmune dysfunctions and promote healthy restoration of cellular regrowth, two processes that need to go hand in hand to achieve success. This could be accomplished with very minimal side effects, if any. Of course, careful monitoring and adjusting of the therapy, and a sound proactive participation in the process by the patient is essential. An integration of therapies and monitoring by the diabetic specialist, or MD, is also essential. As the pancreas function is restored, standard therapy will have to adjust. This requires knowledge and understanding on the part of the patient, who is the only person involved 24 hours per day, 7 days per week. While stem cell therapy holds promise, the potential for stem cell therapy in pancreatic restoration is still far off, and may involve potential adverse effects that could be mitigated with Complementary Medicine. As stated, if the autoimmune dysfunction is not mitigated as well, this stem cell therapy may not work in the long run. While immune suppressing drugs are available, the harsh adverse effects of these drugs need to be considered, and the use of a more conservative approach with Complementary Medicine considered as well. Initial trials in the laboratory showed that standard immunosuppressive drugs (Rapamycin and Tacrolimus) suppressed the autoimmune responses but also inhibited beta cell regrowth.

The physiological mechanisms that regulate pancreatic beta cell mass, or regenerative capacity, are being heavily researched in recent years, and this research provides the Licensed Acupuncturist and herbalist with much objective data to guide therapy. Adult beta cell mass does fluctuate in reponse to physiological cues, including pregnancy and insulin resistance, indicating that a holistic approach to homeostatic restoration could accomplish a regenerative capacity. In addition, insulin-dependent mechanisms of glucose control appear to be dependent on the function of the adrenal glands and their production of beta-endorphins. By exploring a holistic protocol, greater success is expected with restoration of the mass of insulin-producing pancreatic tissues. Specific herbal chemicals have shown great promise in the regeneration of beta cells in the pancreas, and have been used for some time to successfully treat diabetes in China and India. Research is showing that herbal chemicals in Ku gua (Momordica charantia, or Bitter Melon), Xue jie (Sanguina Draconis, or Dragon’s blood tree resin), and other Chinese herbs, exert significant effects on pancreatic beta cell regrowth, or have a protective effect, in laboratory in vitro studies. As this research continues, more herbal chemicals are expected to be found that have a proven effect and may play an important role in pancreatic restoration after beta cell damage. A thorough holistic treatment strategy that is individualized will have the greatest chance of success in this regard. Expectations of a cure with a single herb, drug, or therapy are not realistic.

Diabetes Type 2 and Metabolic Syndrome

Metabolic Syndrome or Syndrome X is another problem that has dominated the concerns of the health community in recent years, and as stated, accounts for roughly 90% of patients now diagnosed with diabetes. Previously called a prediabetic state, we now know that a combination of health factors leads to metabolic problems with poor blood sugar and cholesterol regulation that looks like diabetes and may lead to onset of a real diabetic state. This syndrome is explored in another section on this website because the patient with metabolic syndrome should take a somewhat different approach to correct this problem. Differentiation of Metabolic Syndrome from Diabetic Disease is still a problem due to the complexity of the health factors involved. This complexity is a good reason for the patient to take a more proactive approach and slowly increase physiological understanding of their metabolism and the various health problems associated. Often, in today's age of time limitations with medical doctors and treatment guidelines controlled by the insurance companies, the proactive approach by the patient is the most secure way to insure optimum treatment.

The following section of this paper will help you to understand the disease as a whole and may be too detailed for you at this time, or present information that you already have investigated. If you would like to first look at dietary and lifestyle advice, skip this section for now and come back to it when questions arise, and go directly to the dietary recommendations.

There are two basic types of diabetes. Diabetes Insipidus is a rare disorder that is generally linked to hypothalamic and pituitary disorders such as a tumor or lesion (i.e cancer and stroke), or to kidney diseases (often associated with hypertension). It involves either the deficiency of arginine vasopressin, an anti-diuretic hormone (ADH) of the pituitary, or to a failure of the kidney to respond to the ADH to properly regulate fluids in the body. When fluid loss exceeds fluid intake, cells and membranes become dehydrated, especially brain cells, causing symptoms such as lethargy, irritability, and weakness, as well as thirst and dry mouth. In a healthy body, when extracellular fluid and/or blood volume is decreased, ADH is released and less fluid is lost in the urine. At the same time thirst is stimulated as a signal to replenish fluids. Hyperglycemia is not present in diabetes insipitus. Very few patients will have this type of diabetes, but if you do, the strategy for management is very different from that of Diabetes Mellitus.

Diabetes Mellitus by contrast, is a disorder where excess sugar in the urine causes an osmotic fluid loss, or dumping of water to rid the body of excess sugar, leading to greater fluid loss than intake. It too involves cell dehydration, and many of the symptoms listed above apply here also, along with severe loss of potassium. This form of diabetes is the prevalent form of the disease, and is divided into two types, type I insulin-dependent diabetes mellitus (IDDM) and type II non-insulin-dependent diabetes mellitus (NIDDM). Type 2 is the form that is occurring with alarming frequency at present because of poor dietary habits in our society. Type 2 is now frequently called metabolic syndrome to emphasize that this disorder involves more than the sugar-insulin dysfunction, and there is a need for a better differentiation between true diabetes and metabolic syndromes in order to customize care and prevent the unnecessary overprescription of drugs. Read on to gain an understanding of this most common type of diabetes, and go to the web article on this site to further read about Metabolic Syndrome and how it is differentiated from Diabetes Mellitus Type 2.

Type I or IDDM has been termed juvenile onset, but we now know that it can occur at any age, although crises (DKA/diabetic ketoacidosis) generally occur before the age of 40. Clinical manifestation of symptoms occur after a gradual process of immune destruction of insulin producing beta cells of the pancreas, when 90% of these cells are destroyed. In the past, it was assumed that these destroyed beta cells of the pancreas could not regenerate, but in recent years, research has proven this assumption wrong. Patients with IDDM (insulin-dependent diabeted mellitus) are prescribed insulin, which is monitored daily. Insulin dosage may be reduced when a holistic protocol is integrated into the treatment scheme, and this may prevent some long-term consequences that are devastating in this type of disorder. As always, insulin dosage is determined by daily testing and monitoring, no matter what overall treatment protocol is utilized. Many patients with this disorder now utilize an installed insulin pump that is controlled with digital software and eliminates the need to constantly inject with a needle. Other means of providing insuline dosage, such as aerosol delivery, are currently being worked out and tested for safety. Control of sugar metabolism with dietary habits is an important part of this holistic strategy. Simple habits, such as a short period of excercise after eating simple carbohydrates, greatly aids health sugar metabolism. The patient that assumes that all they need to do is inject insulin to achieve the best health will be sorry that they did not adopt a more holistic regimen in the future. A great number of insulin-dependent diabetics end up with serious cardiovascular problems and kidney dysfunction and end up in the hospital for these problems later in life. This can be avoided.

Type II or NIDDM is characterized by less severe defects in insulin secretion, but also involves defects in insulin binding and sensitivity, especially to fat and muscle cells, and utilization of insulin by all cells of the body, especially in the liver. This often leads to high levels of both glucose and insulin. It is considered an adult onset disease, with crises (HNKS) usually occurring after the age of 60, but in recent years, an alarming percentage of children are acquiring Type II Diabetes, which often should be correctly referred to as Metabolic Syndrome. Insulin resistance is often acquired due to chronic overstimulation of the insulin response along with chronic inflammatory dysfunction affecting the fat cells. This problem is so widespread presently, that drastic measures are being adopted in public health restricting access to simple carbohydrates and transfats in public schools. The best way to adopt healthier dietary habits in both children and adults is to educate the public concerning human physiology and the consequences of unhealthy dietary habits. Commercial food producers must also take some better moral and ethical stand on the effects of food on public health. Like the tobacco industry, people who work in this industry need to consider more than profit when they do their job.

As stated, over 90% of what is termed Type II diabetes is actually a syndrome called Metabolic Syndrome. To better understand this health problem, the reader is advised to go to the separate article on this website entitled Metabolic Syndrome and prediabetic state. The progression of the Metabolic Syndrome and prediabetic state to a true diabetic state occurs in only a small percentage of these patients.

Understanding the physiology in Diabetes and Metabolic syndromes

To understand diabetes, let’s first try to understand the pancreatic hormone insulin. Insulin, a regulatory protein, normally binds with fat cells, muscle fiber, and cells of the liver, causing not only increased transport of glucose into these cells, but also stimulating a cascade of enzyme activity that regulates storage and release of glucose. Insulin also plays a major role in fat metabolism, inhibiting the breakdown of triglycerides into fatty acids (causing a stubborn obesity in metabolic syndromes when insulin levels are high, and insulin resistance is seen in the fat cell receptors). When insulin is not available, these fatty acids are released, and are abundant in the blood, attached to lipoproteins, and storage of these fats are blocked, leading to high cholesterol and athersclerosis. In addition, the excess fatty acids are converted to large quantities of acetoacetic acid, which leads to acidosis, or ketoacidosis (DKA), a pH imbalance that causes coma and often results in death. Patients with DKA usually seek medical care within 2 days due to the severity of symptoms such as abdominal pain with nausea and vomiting, and difficult rapid breathing (dyspnea). Signs of DKA are a sweet, fruity breath and impaired consciousness. Lastly, insulin promotes protein formation and inhibits protein breakdown, and the absence of insulin leads to lack of protein storage and availability, causing neurological problems and a hyperuremic state (excess protein in the blood and urine), as well as a host of other problems.

In contrast, what we usually see in diabetes type 2 / metabolic syndrome involves a high availability of insulin but poor insulin function. When the insulin doesn’t function well, the types of symptoms are varied and your health suffers in many ways that can be indirectly linked to insulin dysfunction. The key to insulin dysfunction is a metabolic problem called insulin resistance, where the insulin hormone is not affecting the fat cells properly. When this occurs, the fat cells are not able to efficiently release fat for conversion to glucose in the liver. The fat cells become enlarged, and the patient is unable to lose weight, and often has an unusual craving for simple carbohydrates. Inflammatory dysfunction in the fat cells has been found to be a key component in this process. Dysfunction of hormone receptors also plays a key role. Since all steroid hormones are very similar molecules, the receptors for hormones may respond in part to various hormones. Imbalances of other steroid hormones may play a significant role in this receptor dysfunction.

Both hormone imbalances and inflammatory dysfunction are tied to adrenal stress. Physiologically, stress is more than just the feeling of being stressed emotionally. It is the process of increased metabolic demands that are greater than your systems can handle. One key cause of this metabolic adrenal stress occurs when normal quantities of carbohydrates are not available in the body. When a person eats simple carbohydrates, such as sugar and bread, these convert quickly to glucose to fuel the body, but in a short time, there is a lack of new carbohydrates to form glucose. When this occurs, the pituitary gland secretes more corticotropin, which signals production of large quantities of the adrenal hormone cortisol, and other glucocorticoid hormones. Cortisol stimulates the extraction of proteins from all cells to provide amino acids to the liver to make more glucose. Cortisol levels are also regulated on a diurnal basis, and poor adrenal function often creates a diurnal dysfunction that results in excess cortisol stimulation at night, with insomnia, and deficient cortisol secretion during the day, with easy fatique. Since only about 60% of amino acids can be turned into glucose in the liver, this process of cortisol stimulated protein metabolism is important to sugar metabolism, and cortisol imbalance can create enormous liver stress, as the liver copes with other pathways to provide the necessary glucose as fuel for the body. Cortisol imbalance, cellular protein depletion, and liver stress also combine to create inflammatory dysfunction that contributes to insulin resistance. When the patient consumes complex carbohydrates, with a high glycemic index, the breakdown of the carbohydrates is slow and steady, and this episodic adrenal and liver stress may be alleviated somewhat.

While there may be a number of factors contributing to adrenal stress, we see from the above explanation the importance of changing your diet when you have insulin resistance and Type II non-insulin dependant diabetes, or metabolic syndrome. When the body's metabolic systems struggle, we need to help them by adopting proactive strategies to compensate for poor autonomic function. Avoiding or decreasing sugary foods and baked goods, or flours, and increasing whole grains and honey may have a dramatic result. Excess intake of fruit also is a source of simple carbohydrates and should be avoided, such as consuming large doses of fruit juice in one setting. The way that we see that that the body is having a problem with steady glucose supply and subsequent liver stress, is that your blood tests show high triglycerides. Triglycerides are the intermediate molecule in the conversion of proteins to glucose, and also carry the fats and proteins in the cholesterol carrier, lipoproteins. A deficiency of high density lipoproteins, which carry these fuels for glucose back to the liver, inhibits this process further. When the liver is very stressed, the liver enzymes, or transanimases, GOT, SGOT, are also high on your blood tests. The pharmaceutical answer to these metabolic problems is to block genetic expression, or production, of these lipoproteins and triglycerides. Common sense tells us that this is not a healthy approach in the long run, and a more comprehensive stategy to restore healthy metabolic and hormonal function is a sensible approach with the best lasting results and optimal health. Hormonal balance, and alleviation of adrenal stress and cortisol imbalance is another subject that can be explored on this website.

To summarize, insulin activity regulates sugar, fat, and protein metabolism in the body, all of which may be converted to glucose to meet the body’s energy needs. In the absence of insulin great care must be taken to 1) regulate these metabolic balances by controlling the intake of carbohydrates, fats, and proteins, and 2) to regulate the utilization of these substances by increasing exercise when glucose levels are too high. If this is not done in an intelligent way, blood glucose levels are not maintained and cholesterol levels and subsequent cardiovascular disease becomes a real threat. In NIDDM, or type 2, or Metabolic Syndrome, glucose binding must be enhanced, and if the patient is overweight, weight reduction is often the key to improvement of insulin sensitivity, (as well as the 2 steps described above), as insulin binding to fat cells is more difficult in the obese person. Obesity has been firmly linked to insulin resistance and chronic inflammatory states in the white fat cells. Dieting has not been successful in many cases, and when dieting is unsuccessful, hormonal correction and regulation of the inflammatory process is necessary to lose weight. Since insulin is a steroid hormone of the endocrine system, your hormonal and endocrine balance must be improved to achieve proper insulin function, endocrine balance and weight loss.

Insulin binding and utilization is also a problem in diseases with abnormal fat distribution and cholesterol buildup. In AIDS patients taking protease inhibitors, fatty deposits will accumulate on the shoulders and neck, and trunk, and onset of diabetic symptoms often will follow. In hypothyroidism, Cushing’s syndrome, and other endocrine disorders, fatty deposits will accumulate on the trunk and face and this will lead to a higher risk of diabetes onset. Study of these problems has led us to conclude that obesity in diabetes type 2 / Metabolic Syndrome is linked to protein dysfunction and endocrine disorder. The interrelations of these various disorders confirms the need to adopt a more holistic strategy to bring patients with this complex syndrome back to a healthy state. A patient-centered, step-by-step, persistent, and thorough approach, with patient education and a proactive participation in therapy, may be the only way that we can reduce the extreme rise in metabolic disorder that threatens the population in the United States.

Diagnostics and treatment protocols in Diabetes and Metabolic syndromes

Standard medicine presents an often confusing diagnosis and treatment strategy to the patient. Below is a short summary of the current treatment and diagnostic guidelines in standard medicine. Complementary Medicine should integrate with these diagnostic findings and complement any prescription of drugs with the individualized herbal and nutrient therapies based on both standard lab findings and signs and symptoms.

If you are diagnosed as type I / IDDM, diagnosis is confirmed by a high random blood glucose of >200, or by 2 separate fasting blood glucose tests showing >140, and hyperglycemic symptoms, such as frequent urination, thirst, and hunger without satiation. In this case insulin is prescribed and self-administered in a combination of fast and slow acting forms, with attention paid to current blood glucose levels, measured by placing a drop of blood on a measuring device. This taking of insulin does not exempt the patient from the need to control the blood sugar with careful attention to balanced intake of food, and to controlled utilization of body sugars, fats, and proteins by timely exercise patterns associated with intake of food.

Diagnosis of type II / NIDDM is often difficult, as the patient is experiencing only mild symptoms, and is confirmed also by 2 separate fasting glucose tests showing > 140, or by a hemoglobin A1c (HGbA1c) measure of >7.0%, or by an observed glucose tolerance test (OGTT). This diagnosis is rarely clear, and the doctor may need to monitor blood levels and adjust medications for a few months to control the disease. Differentiation between Diabetes Type II and Metabolic Syndrome is still unclear and hampers effective design of treatment protocol. The NIH has stated that the use of A1c index alone is not sufficient to diagnose and monitor diabetes, and recommends that blood sugar levels, triglyceride levels, and C-reactive protein levels be monitored also and analyzed. To better understand A1c, which is an advanced glycation endproduct (AGE), another article on this website, under Practitioners / Treatment Protocols, offers a more detailed look at current scientific findings. If standard medications to increase insulin production and utilization are ineffective, this patient may need to inject insulin also. An insulin inhaler is being developed successfully for this type of patient and may be on the market soon. Often, this type of diabetes is successfully controlled, and the patient taken off of medication, if weight is reduced and dietary/exercise patterns are successfully developed. As I stated, if weight loss is difficult, you must consider balance of the hormonal system and improved inflammatory regulation to gain success.

The problem with this treatment strategy for diabetes type 2 / Metabolic Syndrome of utilizing an insulin inhaler, is that for most of these patients the true problem is not a deficiency of insulin, but rather resistance to insulin at the receptors. While taking insulin may be an acute relief of symptomatic insulin dysfunction, the potential for problems, as well as the failure to address the overall metabolic disorder, will be a big problem for the patients. Individualized diagnosis and a patient-centered approach, rather than an assembly-line attitude, is extremely important in this field. Utilizing an integrative approach with a more holistic physician, such as a Licensed Acupuncturist, or TCM physician, is the sensible and conservative approach to solving these problems and giving each individual patient the best chance to restore a healthy metabolism.

Dietary and exercise regimens are the most direct way for patients to proactively help their body manage blood sugars in all of these disorders. These regimens need not be complicated or time consuming, and can easily be incorporated into anyone's busy lifestyle. These regimens must be understood by the patient, and individualized to each patient. Before describing dietary/exercise patterns, let me give you some final pieces of information you may want to know to fully assess the diabetic condition. This information, like much of the above information, may be too much to digest at this time, but will be of value to you later, to understand therapy and thus to achieve piece of mind and a sense that you are in control of your disease. Diabetes, more than any other disease is disease where the patient must assume full responsibility for the understanding and maintenance of the disease. Complete reliance on doctors and medications will lead to a poorly controlled disease, acceptance of symptoms that are worse than they need to be, and a sense of frustration and hopelessness as a person with an illness that seems to control and detract from your life. If you fully understand the disease and become comfortable with a diet/exercise pattern that works, you will be able to feel secure and lead a normal life.

Three types or classes of diabetes mellitus (DM) have been recognized. The above descriptions constitute the first class. Also in this class are cases of diabetes secondary to (as a result of) other diseases, such as malnutrition, pancreatic cancer, hormonal disorders such as pheochromocytoma and Cushing’s syndrome, and drug induced diabetes as commonly occurs with tuberculosis medications, estrogen therapies, dilantin, and corticosteroid use. A second class of secondary DM occurs sometimes in pregnancy due to the high levels of estrogen or relative excess of estrogen due to progesterone deficiency. This type is diagnosed by an oral glucose challenge test and can be successfully controlled during the pregnancy, often resolving after the birth. This type also occurs in other hormonal imbalances with deficient progesterone and relative excess of estrogen, which we see in PMS syndromes, irregular menstrual patterns, and menopausal states. The third class of secondary DM is impaired glucose tolerance (IGT), with fasting blood glucose levels in the normal range of <140, but abnormal OGTT (oral glucose tolerance test), which means that the blood glucose is observed to be too high (140-200) up to 2 hours after eating, but is well controlled after that. Symptoms are mild in these patients, but risk of developing coronary heart disease and diabetes mellitus in the future is still great, and some attention must be paid to diet to insure a healthy aging process. Even with this disorder, an intelligent patient will seek greater understanding and treatment with Complementary Medicine to avoid future health problems and feel better in the present.

Research is uncovering a wide variety of therapies in Complementary Medicine that will help to regulate specific metabolic dysfunctions as well as to resolve underlying health problems causing these dysfunctions. For example, if your diabetes involves impaired glucose tolerance, herbs such as Crepe Myrtle, American Ginseng, and a type of cinnamon bark used in Chinese medicine, have all been proven to increase postprandial glucose assimilation, meaning that they will help your body to restore a normal circulating blood glucose quicker after you eat. Coupled with sensible dietary and exercise routines, such as avoidance of high glycemic, or simple carbs, increased consumption of complex carbohydrates, and a little aerobic excercise following the meal, the patient should be able to control the postprandial blood sugars well, avoiding the consequences of impaired glucose tolerance down the road. With attention to research and individualized assessment, the Complementary Medicine physician is able to individualize a treatment protocol, and integrate it with standard care, to achieve the best possible medical treatment.

Clarifying the individualized diagnosis with Type II Diabetes

If you are diagnosed with type II NIDDM or IGT, your diagnosis may not be clear and you may want to monitor your laboratory results and acquaint yourself with drug regimens. Normal values of pertinent chem levels are:

fasting glucose: 70-110 mg/dL (higher in chronic cases)
glycohemoglobin: 5.5-8.5% (A1c index)
creatinine: .0-1.4 mg/dL
lipids (cholesterol): total serum: 450-850 mg/dL
cholesterol: 120-210 mg/dL, 20-30% HDL and 60-70% LDL
triglycerides: <160 mg/dL
total FA (fatty acids): 190-240 mg/dL
folate: 2-20 mg/mL
Vit B12: 200-900 mg/L
CRP: <1mg/dL or <10mg/L (c-reactive protein from the liver)
A1C: >6.5 may be used as an additional marker, but read below to understand how this marker can be misused in diagnosis; this is an advanced glycation endproduct (AGE), and more information on this subject is available elsewhere on this website

Another important marker for diabetic or metabolic disorder is the A1C index, or glycosylated hemoglobin A1C, a surrogate marker for blood glucose levels. A1C is the first important Advanced Glycation Endproduct (AGE) that is identified with metabolic disorder and indicates a problem with insulin metabolism at the cellular level (you may read my article on AGEs under the For Practitioners section on this website). The National Diabetic Association has stated that the A1C marker alone should not be used to diagnose and treat metabolic syndrome, or Diabetes type 2. The marker, which reflects chronic changes in red blood cell hemoglobin receptors in response to advanced glycosylation endproducts, which are molecules made up of sugars, fats and proteins that are abnormal to our physiology, was introduced as a diabetic marker in 1976, but not utilized in standard diagnosis until certain new diabetic medications reflecting insulin resistance therapy were introduced onto the market. A1C is proportional in most cases to the average glucose concentration over the previous 4-12 weeks, although many researchers find that it reflects average blood glucose in most patients for the last 2-4 weeks. The American Diabetes Association in 2010 finally added A1C greater than 6.5% as an additional laboratory value useful in the diagnosis of diabetes, but again cautioned that A1C should not be the only diagnostic value that is used, and could indicate other metabolic problems not addressed by standard diabetes medication. The American Diabetes Association recommends that A1C be below 7.0% for most patients, and that medicating patients with an A1C between 6.5% and 7.0% may engender more risk than benefit.

Two patients with the same average blood sugar can have A1C levels that differ by as much as 3 percentage points, and the range of levels generally found in healthy patients is 4-5.9%. Higher than expected A1C index can be seen in people with certain types of anemia, in which the red blood cell life span is longer due to abnormal shape of red blood cells, or decreased removal of old red blood cells by the spleen. This could occur with Vitamin B12 or folate deficiency, or other causes. A1C index should not be measured when there is a change of diet or phamarcological treatment in the last 6 weeks. Also, patients with chronic abnormal blood loss, abnormal shape of red blood cells (e.g. sickle cell anemia), or other more rare disorders, may show a higher than normal A1C when there is no real diabetic disorder. Careful diagnosis should be insisted upon, and the time should be spent to give each patient an accurate complete diagnosis before starting drug therapy.

Of these, glucose and triglyceride levels are initially important to monitor as these show the extent of pancreatic and liver involvement, with high triglycerides pointing to a liver problem, and requiring a different medication strategy and lifestyle change. Glycohemoglobin count will point to a protein imbalance and the carrying of sugar as a principal problem. Creatinine count will point to kidney problems. Lipid counts will point to liver and cardiovascular dangers, and folate and B12 levels will point to a need to aid cell differentiation in the presence of enzyme deficiencies. CRP levels indicate chronic inflammatory states and liver dysfunction. Many doctors will not evaluate all of these levels, and thus it is important that the patient demand attention to all of these.

Making sure that you understand the medication protocols in diabetes and work with your medical doctor to make the right treatment decisions

In Type I NIDDM your doctor may give you one type of medication, monitor your blood levels, and perhaps change medications and/or dosages if proper regulation of glucose and triglycerides are not maintained. It is important to monitor your blood glucose levels before and after meals, and discuss intelligently with your doctor the need to adjust dosage or change medication. This is important both initially, as carbohydrate metabolism is being regulated, and later as you improve your diet/exercise patterns and are able to regulate the metabolism without aid of medications that have side effects. Insulin levels are best adjusted by use of an implanted pump. By increasing your health and conscious control of blood sugars and lipids, the body will need less insulin and perhaps other pharmaceutical drugs, and the long term side effects will be decreased. Use of dietary regimens and herbs are not contraindicated or harmful if used sensibly, and large studies have shown that they play a beneficial, safe and complementary role in your treatment when monitored by a professional herbalist and knowledgeable Complementary Care physician.

Two types of medications have been typically used to control Type II NIDDM. Since most cases of Metabolic Syndrome may not have yet become a hyperglycemic state, the patient should be sure that they are not being treated prematurely with these drugs. These typical medications in type 2 diabetes are sulfonylurea agents, that stimulate insulin production and enhance insulin binding, and metformin/glucophage, that acts on the liver to decrease sugar production and also enhances insulin binding. Recently, a new class of drugs is popularly prescribed, called glitazones, that seek to correct problems with insulin sensitivity, called Actos and Avandia. Unfortunately, these drugs have numerous side effects, including weight gain, water retention, anemia and hormone inhibition. Glitazones, especially Avandia, have also been implicated in a complex plot by the drug makers to hide the significant cardiovascular risks seen in patient studies (see links to the New York Times articles on this subject below in additional information). In September of 2010, an FDA advisory panel recommended that Avandia should either be withdrawn from the market or have sales severely restricted due to health risks. Sulfonylureas have fewer side effects and act rapidly, and are thus now the usual first choice. The patient population has become wary of these new diabetic drugs, though, after the deception and public harm surrounding the glitazones has become well known. This group of new drugs, or sulfonylureas, includes:

Tolbutamide/Orinase: short (6–12 hour) duration of action
Chlorpropamide/Diabinase: longest acting (60 hours) with a greater danger of hypoglycemic state
Tolazamide, Glyburide, and Glipizide: medium duration of action (12–24 hours) and fewer adverse reactions

Actos, or pioglitazone, became the largest selling glitazone after the drug Avandia received such much negative publicity concerning cardiovascular risks, and was banned in parts of Europe. In June of 2011, though, the maker of Actos withdrew this drug from the market in France and Germany as well after pressure from food and drug regulators intensified. In the U.S., the FDA issued black box warnings concerning the risks of congestive heart failure and is considering warnings related to the risk of bladder cancer associated with long-term use. The FDA analyzed data from the first 5 years of a 10 year study and found that Actos was associated with a 40 percent increase in risk of bladder cancer. Pioglitazone is due to receive generic status in 2012, and many different names may then be applied with questions of the requirements of generic manufacturers to include the warnings that the original manufacturer was required to provide. Newer glitazones have had difficulty with approval from the FDA as well. Dr. Harlan Krumholz, a Yale School of Medicine professor who directs its Center for Outcomes Research and Evaluation stated: “It’s not clear if this (bladder cancer) risk is real (until more long-term data is collected)...The consensus already is that (Actos) should only be considered...after patients have exhausted all other products (due to links to heart risks, weight gain and possibly bone loss and fractures).”

Metformin/glucophage will have more severe gastrointestinal side effects, such as nausea, bloating, diarrhea and flatulence, and thus should be given first in a small dose, and as blood chemistry is checked, advanced to a larger dose if the patient tolerates. Metformin is beneficial in reducing cholesterol/fatty acids, and is effective if the triglyceride levels are too high. Triglyceride levels, though, may be reduced with less risky herbs and nutrient medicines, and improvement in liver function with the use of acupuncture and Complementary Medicine. Studies do show that a large percentage of patients have insufficient blood sugar control after 5 years of usage of any of these drugs, pointing to the need for adopting an effective dietary, lifestyle and herbal regimen to increase your chances of long term success. Depending completely on drug therapy has been shown to be problematic. To reduce the adverse effects of Metformin, it is often prescribed in smaller dosage in a pill combined with Glipizide, a sulfonylurea.

Another diabetic drug has been added to the regimen to increase effectiveness, called Sitagliptin, most commonly in the form of Januvia. This dipeptidyl-4 peptidase (DPP-4) inhibitor was created to degrade a protein enzyme that plays a role in modulating the hormone incretin, which helps regulate pancreatic insulin production. Unfortunately, during this same recent time period of research, scientists found that dipeptidylpeptidase-4, which Januvia inhibits, is an important enzyme in the lining of the small intestine, and deficiency of DPP-4 is highly linked to Celiac disease, or the inability to fully breakdown gluten and gliadin protein fragments in the lining of the small intestine. Research has also uncovered the fact that other gut hormones, such as enterolactone, may play a beneficial rle in modulating incretin and pancreatic insulin production. Plant lignans may stimulate more of these beneficial gut hormones, and a potent plant lignan, in the patented form of NuLignan is a nutrient medicine that may play an important role in this regard.

In 2011, in response to the problems with current medication protocols for Metabolic Syndrome or Diabetes Type 2, another type of drug therapy was introduced, dapagliflozin, which works by blocking a chemical that inhibits blood glucose excretion via the kidneys, thereby increasing the excretion of blood glucose. A federal advisory committee of the FDA voted 9 to 6 for non-approval of this drug, though, based on safety concerns. While increasing excretion of glucose may seem like a direct therapy for high levels of circulating glucose, this strategy does not resolve the underlying health problems causing the high blood glucose, and does increase risks of various health problems, including urinary tract infections, bladder and breast cancers, and kidney disease. Other safety concerns, regarding hypoglycemia and other effects of the drug on various metabolic cellular mechanisms, were also a concern. The committee advised against early FDA approval until larger studies are completed to determine the extent of long-term adverse effects and health risks. While this drug may prove useful in the future for many patients with uncontrolled high blood sugars, patients need to understand that, once again, the underlying health problems of insulin resistance and fatty growth around visceral organs is not addressed with these various drug strategies, and the smart patient wants to both control their disease manifestations and correct the unhealthy homeostatic mechanisms that created them.

This wide array of drugs prescribed to treat diabetes and Metabolic Syndrome has posed challenges to the patients who wish to understand risks and benefits, and help make the right choices in treatment protocol. With all pharmaceutical drugs, the problems of side effects over time, not the immediate side effects, is usually of greatest concern to the patient. Often, a small percentage of patients experience immediate adverse effects, but a much greater percentage experience long-term adverse effects and health risks. Complementary Medicine is able to address the concerns of side effects and decrease the negative consequences of long-term pharmaceutical management. By improving the underlying causes of diabetes and metabolic syndromes the patient may be able to either reduce the number of drugs, dosage, or even regain health enough to stop the need for medication before the long-term consequences occur. In addition, integration of evidence-based herbal and nutrient medicine into the treatment protocol may increase the success with diabetic control and metabolic normalization, which has proven to be problematic for many patients with current and past pharmaceutical regimens.

Recent concerns over new Diabetic drugs

In 2007, a well respected cardiologist at the Cleveland Clinic, Dr. Steven E Nissen, conducted a landmark study that suggested that the current best-selling diabetes drug, Avandia, raised the risk of heart attack considerably. This led to a congressional inquiry and subsequent safety warnings, with an appropriate drop in sales that was dramatic. Dr. Nissen was pressured to keep his findings out of publication in 2007, and anticipating the common maneuvering and misuse of scientific study, he secretly taped a meeting with the manufacturers of Avandia, GlaxoSmithKline, when they called him in for a meeting before his study was to be published in the New England Journal of Medicine. This story is presented in the New York Times, February 23, 2010, entitled 'A Face-Off on the Safety of a Drug for Diabetes'. In the meeting, GlaxoSmithKline referred to a yet unpublished, supposedly independent, study, that they purported had data that was contradictory to Dr. Nissen's study, and suggested that he hold off on publication, and accept an offer to perform collaborative research on this subject with their monetary help. GlaxoSmithKline was not supposed to have access to these independent studies until they were published in peer-review journals. Congressional investigations found that the company had been faxed copies of the unpublished studies by a worker at the medical journals who also was paid as a consultant for GlaxoSmithKline. Congressional investigation also revealed that GlaxoSmithKline's own scientists had concluded that Dr. Nissen's study was correct in evaluating an 11% increased risk for myocardial ischemia, or heart attack, with chronic use of Avandia, yet the company publicly claimed that Dr. Nissen's study was incorrect and poorly structured. The New York Times quotes the head of research at GlaxoSmithKline, Dr. Moncef Slaoui: “F.D.A., Nissen and G.S.K. all come to comparable conclusions regarding the increased risk for ischemic events, ranging from 30% to 43%.”

The new class of Diabetic drugs addresses insulin resistance and inflammatory dysfunction in fat cells by binding to receptors called PPAR (peroxisome proliferator-activated receptors). By antagonizing these receptor functions, the drugs reduce insulin resistance and inflammatory mechanisms. Unfortunately, these PPAR receptors are now known to be expressed in many types of cells, especially in the heart muscle, liver, blood vessel endothelium, etc. Over time, decreasing the effect of PPAR may have negative consequences in the body, and this is why ischemic problems, as well as liver dysfunction and increase bone fractures have been noted. The ischemic problems affect more than the heart muscle, with increased risk of macular degeneration in the eyes, and increased muscle and joint pathology possible. Just as non-steroidal anti-inflammatory medications were eventually noted to cause inflammatory dysfunction and increase risks of cardiovascular pathology etc. over time, these types of drugs, like Avandia, have both potential beneficial and harmful effects that need to be more carefully considered by each patient and doctor. One important consideration should be the potential use of Complementary Medicine to achieve these goals of reducing insulin resistance, either by correcting the causes underlying the problem, or by enhancing the insulin metabolism to allow the drugs to work more efficiently. A second consideration in Integrative Medicine is the reduction of side effects and risks of these drugs with the use of Complementary Medicine.

Dietary Recommendations

In all types of diabetes, loss of fluids without replenishing is a major concern, and drinking of sufficient water or fluids, but not excess (5-6 cups per day unless sweating or urinating heavily), even in the absence of thirst, is very important. Because of the inability to counter sugars or glucose from the diet, and regulate the storage and utilization of glucose, a number of basic considerations also need to be observed: (NOTE: these diabetic recommendations may not be as applicable to Metabolic Syndrome, in which the circulating glucose is not always elevated, but are generally applicable to metabolic balance):

Meals may need to be smaller and more frequent so that the body can handle the glucose loads more easily, and eating late at night should be avoided, as digestion is inhibited. All patients, though, do not need to adopt a habit of more frequent meals, and an individually adjusted protocol of eating habits needs to be designed to achieve concrete goals with monitoring. Increased chewing is recommended. Some herbal chemicals may modestly improve post-prandial sugar metabolism, and over time, improve the function of pancreatic beta cells to better handle glucose loads. The type of carbohydrate consumed, or the glycemic index, is very important in designing the right meal schedule and routine for the individual. (This is in contrast to an effective protocol in Metabolic Syndrome, where longer periods between meals may allow for improved insulin regulation and decrease stress on the mechanisms of insulin resistance.)
During periods of inactivity less food should be consumed, especially carbohydrates, which convert easily to glucose; eat complex carbohydrates and avoid simple carbs.
In response to heavier meals, increased activity or exercise is essential to consume the increased glucose. A brisk walk may serve this purpose, or even household chores or active hobbies. Use of a stationary bike or other exerciser is often quick and easy. The tendency to relax and be sedentary after the large meal is a natural response, but should be avoided
Likewise, before periods of increased activity or heavy exercise, heavier intake of food, especially complex carbohydrates is essential. You will need the extra fuel. (In Metabolic Syndrome, on the other hand, intake of fats before heavy exercise may induce increased utilization of stored fats for fuel, and consumption of protein and complex carbs following the heavy exercise may help manage the energy needs without stimulating excess insulin responses.)
A general balance between carbohydrates (50% of intake), fats (30%) and proteins (20%) should be maintained so as to supply glucose on a timely basis. Once again, complex carbohydrates, in the form of true whole grains, legumes, and fresh vegetables, will be easier for your slowed metabolism to handle. Healthy fats are important in this dietary protocol, and in general, healthy complex carbohydrates will help the body's metabolism to maintain a smoother control of metabolic utilization over time.
Carbohydrates consumed should be whole grains and legumes, fresh vegetables and some fruits in small portions (avoid large consumption of juices). Products that are processed but advertise that they are whole grain and imply that they are complex are tricking consumers, and many of these commercially processed foods are simple carbohydrates that initiate a quick increase in blood sugar.
Processed food and refined sugars should be strictly avoided, especially fatty food and pastries. If you must have sweet snacks with simple carbohydrates, limit these to one bite. The discipline will pay off. There are snacks, even sweet snacks, that are composed of complex sugars, such as honey and maple syrup, and sesame seeds, etc. If the cravings are too strong, many patients just drink a little honey in hot water or peppermint tea, and the craving is satisfied. Other patients decrease sweet cravings by eating a little toasted nori seaweed, which presents the opposite taste to the body.
Fats should be mostly polyunsaturated, such as safflower, sesame, corn, and walnut oils, but only unrefined and cold pressed versions, and these generally should not be used for frying. Monounsaturated oils, such as olive and sunflower should be used for frying. An emphasis on at least some consumption of omega-3 fatty acids from walnut oil et al, or supplements such as krill oil, is desirable to control cholesterol and aid the pancreas and immune system. Because of the poor regulation of lipids in the diabetic state, saturated fats such as butter, cheese, egg, and meat should be limited. Margarine and refined oils and fats are trans-fats and are very bad in maintenance of cholesterol buildup and should also be avoided. Good supplements for omega 3 and 6 fatty acids include krill oil, spirulina, bluegreen algae and chlorella.
Some complex fatty sugars, called advanced glycation endproducts, or AGEs, should be especially avoided in the diabetic state. In the diet, these molecules are generally created from the use of high heat and the combining of fats, proteins and simple sugars. Examples of AGEs include many snacks, such as potato or corn chips, as well as most fast foods, where sweet additives are combined with complex proteins and fats, often with deep frying or other high heat cooking methods. Processed foods are created to stimulate addictive appetite, not to insure healthy metaboism, and you would be surprised to find what the actual ingredients are in many commercial foods. Even breakfast cereals contain amounts of salts and sugars that are unbelievable, and these cereals too are processed with fast high heat that creates AGEs. AGEs not only present difficult problems for our digestive metabolism, but stress liver function, and create problems over time by stimulating the creation of excess AGE receptors. AGEs have been implicated in many diseases as primary causes, and show us that we need to change society's attitudes toward food.
These facts should be kept in mind about oils:
- polyunsaturated oils reduce low-density lipoproteins (LDL) but also decrease healthy high-density lipoproteins (HDL).
- monounsaturated oils do not deplete HDL and do not cause cholesterol to accumulate in the blood vessels.
- saturated fats (which also include peanut, coconut, and palm kernel oils) cause cholesterol to block arteries.
The bottom line on fats is that we should become a little educated concerning healthy and unhealthy fats and oils. Most fats in commercial foods today are polyunsaturated because this extends the shelf-life. Cold-pressed natural oils that are relatively fresh are monounsaturated. Some saturated fats provide great nutrition, such as butter and meat fat, but should not be overconsumed, and some heavily processed saturated and partially saturated fats can be very harmful to the health. On the other hand, fresh natural cold-pressed coconut oil is partially saturated and is proven very assimilatable and healthy to our cells, and is a good substitue, in moderation, for butter.
Protein choices should include more fish and fowl, beans and legumes, soy products (preferably fermented, cultured as in tempeh, or traditionally prepared tofu), and small portions of nuts and seeds. Beef and pork are more suited for wasting stages of the disease, and are not suitable for periods of weight gain, high cholesterol, hepatitis, nephritis, and hypertension. Meat portions should be small (2-3 oz) and the consumption of leafy greens, and sulfur vegetables such as broccoli, cabbage, onions and garlic will aid in their digestion. Proteins are not only found in meats, but a complete array of amino acids, the building blocks of proteins, as well as complex proteins themselves, are found in vegetables, whole grains, beans and legumes. These non-meat proteins are also generally easier to digest and assimilate. Meats also will often have chemicals and hormones that are toxic these days, and the consumption of ginger will help reduce these toxins.
Foods that are hypoglycemic, or sugar reducing, include garlic, onion, tomato, grape, carrot, fennel, peas, grapefruit, banana, cauliflower, black currant, eggplant and corn.

Principal concerns with diabetes

Always keep in mind that with diabetes the chief concerns are:

The normal mechanism to control the utilization of food is not functioning properly. You must assume control of food intake and energy use, as well as the storage of fats.
Cardiovascular problems and cholesterol are major concerns. (The skin is also maintained by the blood, and skin problems should be dealt with.)
The nervous system is easily affected by large fluctuations in circulating glucose, as well as fluctations in protein messengers and lipids, and attention should be paid to changes in mood, emotional reaction, and mental clarity.
Hormonal balance, inflammatory regulation and optimum health of the liver system is often essential to success in controlling diabetic metabolism

To address these concerns:

Cholesterol and saturated fats in the blood may be reduced by eating whole grains, especially rye, oats, amaranth, and quinoa. These may be purchased whole and cooked as cereal in the morning. This cooking takes about 20 minutes. These are the best sources of vitamin E and niacin, which together with vitamin C and lecithin, reduce cholesterol and saturated fats. Chromium, zinc, and manganese are factors which help control blood sugars, and these are found in the bran of whole grains. Adding wheat bran to the diet, especially in the absence of whole grains, has shown to be of great value. Lecithin is found in most legumes, and soy, as well as nearly all beans, peas, and lentils are blood cleansers, but especially soy, mung beans, and white pearl barley, or yiyiren. Beans should constitute 5-10% of your diet.

Omega-3 fatty acids (FA), especially eicosapentaenoic acid (EPA), and docohexaenoic acid (DHA), are particularly blood cleansing, and aid renewal of brain function and repair of nerve damage. These are plentiful in fish, especially salmon, and fish oil, as well as spirulina and micro-algae. Fish oil capsules are now very popular, but a problem exists with these, and with flax oil capsules, of oxidized fats over time. Taking fresh fish and flax oil is therefore important, as oxidants should be avoided. Krill oil is a preferred form of fish oil, containing a very concentrated level of EPA and DHA, and it has a naturally occurring preservative that inhibits oxidation. Spirulina is a plant source and also helps to stabilize blood sugar, presenting a double benefit. 4 tablespoons of ground flax seed or 1 tablespoon of flax seed oil per day is an excellent source of omega-3 alpha-linolenic acid, but these fatty acids are also found in tofu and tempeh, walnuts, pumpkin seeds (and pumpkin seed oil), dark leafy green vegetables, and milk or cheese from cows, goats, or sheep that are allowed to graze on grass, and to a lesser extent, in cold-climate nuts, seeds, grains, and legumes. These seeds and nuts, or fine organic cheeses with rye crackers make an excellent snack instead of pastries and candy. Once again, if you consume seeds and nuts, try to be sure that they are fresh and not oxidized, or rancid. Eating these foods from the shell insures freshness, and also prevents you from consuming too many in one sitting, which is not a healthy habit. If you are a vegetarian, the essential fatty acid arachidonic acid (AA), an omega-6 FA, often in excess in heavy meat eaters, may be deficient. This will show as dry skin or hair, varicose veins, brittle nails, liver problems and irritability, and low body weight. Snacking on nori seaweed or peanuts will replenish this FA. An omega-6 fatty acid more beneficial than arachidonic acid is gamma linolenic acid (GLA), and supplements derived from black currant seed oil supply a healthy amount of GLA and other essential fatty acids. In addition, the nutrient astaxanthin, a cartenoid antioxidant terpene, found in rich concentration in both krill oil and microalgaes, was found in studies to be highly protective of pancreatic beta-cell function and able to increase the ability of these cells to secrete insulin.

Numerous studies of diabetes and metabolic syndrome find that increased oxidative stress and low antioxidant capacity, especially deficiency of the intercellular antioxidant and cell detoxifier glutathione, corresponds to the transition from impaired glucose tolerance and insulin resistance to hyperglycemic states. One useful antioxidant and lipolytic aid studied is R-lipoic acid, which has been proven to prevent hyperglycemic states, reduce insulin levels, and increase free radical scavenging potential in anmial studies at the University of Pittsburgh (PMID: 14749277). Advanced glycation endproducts (AGEs) have been highly implicated in the diabetic etiology of atherosclerotic plaque formation and cardiovascular risk, and the A1C index is now widely used to aid diagnosis in modern medicine. Various amino acids and nutrient medicines have been shown to reduce AGE accumulation, especially L-carnosine, and may be purchased in nutrient formula. These nutrient formulas usually contain R-lipoic acid, N-acetyl cysteine, benfotiamine, and P5P to act synergistically.

The role of oxidant stress, advanced glycation endproducts, glucose toxicity, and lipotoxicity in the destruction of pancreatic beta cells has been well studied and documented. This leads to a number of recommendations for antioxidant therapy. Superoxide dismutase (SOD) has been used in laboratory experiments and proven to protect against oxidative stress-induced diabetes. Dried barley grass supplement is an excellent natural source for superoxide dismutase. Manganese SOD is considered a preferable form. Aloe vera gel contains both manganese and SOD, and may be consumed as a dietary supplement. An essential mineral formula with manganese may also be helpful, taken together with an SOD enhancer, such as CoQ10. SOD (superoxide dismutase) is a potent intracellular antioxidant created by our cells, and enhancement of our cellular SOD production is perhaps the best strategy in therapy. Nevertheless, both a plant and animal bioidentical SOD is now marketed as supplements. Since this complex antioxidant may be broken down by our digestive system, SOD cream is now available as well, and has shown some clinical success in studies in Japan, treating skin disease in autoimmune pathologies. N-acetyl cysteine has also been shown to protect against oxidative stress-induced diabetes in laboratory animals, and is increasingly prescribed as an amino acid boost to antioxidant effects, as is R-lipoic acid. To understand more about antioxidant therapy, go to the article entitled Antioxidants and Free Radicals on this website. Simply taking a simple antioxidant regularly, such as Vitamims A, C and E, which has been touted in standard medicine for some time, may not be an effective strategy, and there is evidence that excess consumption of one of the forms of Vitamin E for a long period may have negative health effects. For instance, a five year study of the effects of large dosage Vitamin E and selenium supplement to treat or prevent prostate cancer showed that the patients taking an excess dosage of Vitamin E has higher rates of cancer, yet when taking a selenium supplement, the excess dosage of Vitamin E did not result in increased prostate cancer rates. Nevertheless, utilizing nutritional medicine in a targeted professional course, rather than succumbing to marketing and simple strategies is advisable. Guidance by a Complementary Medicine physician will help to choose an effective course of therapeutic protocols and obtain quality products.

Summary

Small simple meals, whole grains and beans, sufficient water between meals, tofu, tempeh, fish and fowl in small portions, dark leafy greens, spirulina, salads with dressing made from walnut or grapeseed oil, fresh fruit and vegetables, snacking on peanuts, fine cheese and rye crackers, carrots, hummus, carrot juice, micro-algae juice, wheat grass juice, etc. -no late evening meals, fatty foods, processed foods, refined sugar, and no foods that stress the liver, such as alcohol and greasy foods. In short, a normal healthy diet, with an emphasis on a vegetarian theme, use of a variety of healthy unprocessed oils, soups and steamed food more often than fried food, and timely exercise will do the job.

If you want to supplement, the above mentioned vitamins C and E, zinc, manganese, lecithin, and niacin are easy to find and psyllium is a healthy addition to reduce fats. Brewer’s yeast with added chromium improves insulin efficiency and is a good source for vitamin B12. Brewer’s yeast on popcorn is an excellent snack. Vitamin B12 will help prevent neuropathy, along with folic acid, and is best utilized as as injection, or in sublingual form, preferrably liquid. If neuropathy develops, a good source of calcium and magnesium may be warranted. A vitamin B complex will aid liver function and may help control HTN. Supplement formulas are often convenient, and a reliable company, such as Vitamin Research, offers quality products based on the latest research findings. Their current formula GluControl combines Vitamin C and E (as d-alpha-tocopheryl succinate and mixed tocopheryls), bitter melon extract, N-acetyl-cysteine, Goats rue herbal extract (Galega officianalis), a patented cinnamon bark extract, and vanadium to provide aids to metabolic balance, as well as antioxidants and cardiovascular protection. AGE Block formula provides a number of essential nutrients to decrease the formation of advanced glycation endproducts, which are measured in the A1C index, an important test in diabetes and metabolic syndrome, and are a focal cause of atherosclerotic plaque formation.

For further advice on specific diets geared to your individual condition (all diabetics are not alike in body type / balance ) you must see a practitioner that can diagnose you correctly, and is skilled in the energetics of food and diet. Some acupuncturists and herbalists are thus skilled, and naturopaths with a study of traditional Chinese medicine are also a good source of advice.

Treatment options and strategies in Complementary Medicine:

Effective treatment with Complementary Medicine is important with the diabetic patient. The variety of types of diabetes and the extent of damage to the system, both from the disease and from chronic long-term use of insulin and other medications makes each individual case unique in its needs. Research continues to expand the effectiveness of herbal formulas to treat these problems, as well as acupuncture. The treatment protocol should be managed by a professional in such a complicated disease. A variety of herbal formulas and nutrient medicines are available to the physician, and need to be individualized in therapy, and often prescribed in a goal oriented, step-by-step approach.

While the herbal and nutrient research is extensive, and cannot be completely described on an article such as this, here are a few pieces of information that may help the patient understand how herbal and nutrient medicine may benefit them. A number of herbs are proven to help reduce your blood sugar more quickly after you eat, including Crepe Myrtle, American Ginseng and Cinnamon bark. Better utilization and transformation of sugars or carbohydrates can be helped with a number of herbs which have long been used in Chinese hospitals, and are available in professional formulas. Efficient transformation of sugars in the liver may be helped with acupuncture and herbal formulas that stimulate healthier liver function to improve triglyceride and protein metabolism as well as cholesterols and lipid metabolism. Nutrient medicines, such as L-Carnitine and Alpha-Lipoic Acid, have also been found to be helpful in improving metabolic utilization, and N-acetyl cysteine is proven to help reverse pancreatic beta cell damage from inorganic arsenic and mercury toxicity. A variety of herbs and nutrient medicines are now shown to be effective to normalize lipid metabolism and cholesterol, such as bitter melon extract and red yeast rice extract. Alone, none of these nutrient molecules may cure diabetes or Metabolic Syndrome, but in a professionally prescribed protocol, they will achieve a variety of goals and restore normal energy metabolism and homeostasis.

Since inflammation is a key problem in diabetes and insulin metabolism, anti-inflammatory herbs, anti-oxidants, amino acids, and essential fatty acid supplements etc. may make a big difference to treat the cause of diabetes and metabolic syndrome. Hormonal balance is also a key issue in healthy restoration. Since insulin is a steroid hormone and the endocrine system needs balance, use of bio-identical progesterone stimulating creams when appropriate have shown great improvement in diabetes clinically. The pioneer M.D., Dr. John R. Lee, has written extensively on this research. Acupuncture and herbal formulas, as well as supplements and creams, also are helpful to correct associated hormonal problems like adrenal stress and subclincial hypothyroid problems, which may be related, and are ongoing underlying causes of metabolic and inflammatory dysfunction. Although the herbal and nutrient medical approach is more complicated than taking a single pill, the end result may be worth the trouble.

Diabetes primarily causes inflammatory deterioration of the blood vessels and nerve sheaths, leading to peripheral neuropathy, circulatory problems, cardiovascular pathology, visual deterioration and kidney failure. On the other hand, Metabolic Syndrome primarily affects the cardiovascular system by increasing atherosclerotic plaques on arterial walls. This is largely driven by a combination of advanced glycation endproducts (AGEs) and chronic vascular inflammation and immune dysregulation. Metabolic Syndrome and insulin resistance usually causes some degree of obesity, and effects a wide variety of hormonal modulations in the body. These effects of insulin resistance may cause problems with brain function, polycystic ovary syndrome, infertility, and a host of related dysfucntions in the body. Allopathic medicine does not address these varied healthy problems that accompany Diabetes and Metabolic Syndrome. Complementary Medicine offers the patient a variety of effective treatments for these disorders as well, treating both the manifestation of the disease as well as the disorder itself, and able to individualize the treatment for each patient.

Since the array of problems in diabetes can be so broad, you need to discuss the particular therapies and options with a knowledgeable practitioner. As always, the health benefits from this treatment strategy will help you to both treat your diabetes and become a healthier and more productive person.

Resources

The most reliable resources, and the main resources for this paper are:

Healing with Whole Foods by Paul Pritchford
Prescriptions for Nutritional Healing by Phyllis and James Balch

Information Resources

A 2010 New York Times article on Avandia shows the recent concerns over new Diabetic drugs and industry manipulation of research that is being investigated by the government: http://www.nytimes.com/2010/02/23/health/23niss.html
A Wikipedia citation explains the pharmacology of Avandia and the other drugs that are a thiazolidinedione class called Rosiglitazone: http://en.wikipedia.org/wiki/Rosiglitazone
A July 13, 2010 article in the New York Times outlines the history of the hiding of serious cardiovascular risks associated with the drug Avandia, a class of glitazones designed to decrease insulin resistance and help with diabetes care. The scandal of hiding important research findings from the public and FDA by SmithKline Beecham (formerly GlaxoKline Smith) may signal a new era in FDA function: http://www.nytimes.com/2010/07/13/health/policy/13avandia.html?_r=1
A July 15, 2010 article in the New York Times reveals that the FDA, once again, allowed a drug to remain on the market despite the history of illegally hiding risks in patient studies and the enormous payouts in product liability from patient harm admitted. GlaxoSmithKline stated that it was assuming a $2.36 billion loss in one quarter for legal liability for the diabetes drug Avandia as well as the antidepressant Paxil: http://www.nytimes.com/2010/07/16/business/global/16avandia.html?src=busln

Inclusive facts on diabetes are from: Pathophysiology, Clinical Concepts and Disease Processes by Price and Wilson, Cecil’s Essentials of Medicine and the Merck Manual

Additional Information and information resources

Much evidence is accumulating to help guide the modern herbalist and Licensed Acupuncturist in the best course of therapy for the patient with Diabetes and Metabolic Syndromes. Herbal formulas and specifics, as well as novel nutrient medicines, are being heavily researched, and Complementary Medicine is being heavily utilized in many countries in this type of therapy. In addition, despite the difficulties in devising human blinded placebo-controlled clinical trials, these types of proofs of acupuncture have finally been achieved and both provide evidence of acupuncture efficacy in the the treatment of diabetes and Metabolic Syndrome, and help guide Licensed Acupuncturists in improving therapy. Most of the studies of acupuncture in the treatment of diabetes and Metabolic Syndrome utilize physiological studies because of the difficulties in devising blinded placebo, or sham, acupuncture, which is nearly impossible to actually do. Standard allopathic medicine has cynically held the acupuncture science to these types of evidenced proofs, which are only applicable to studies of pills, but today, thousands of well-designed physiological studies have finally been financed and prove that acupuncture does work in this regard, some of which are difficult to design and administer blinded placebo-controlled human trials. This overwhelming scientific evidence is too large to present here, but a few examples with links are provided.

A 2010 placebo-controlled human clinical trial of acupuncture in the treatment of diabetic peripheral neuropathy at Changchun University in China provided evidence that a 15-day treatment protocol significantly improved both motor and sensory function: http://www.ncbi.nlm.nih.gov/pubmed/20633522
A 2009 study of electroacupuncture showed that this treatment significantly improved lowering of circulating glucose levels when added to standard pharmaceutical treatment with rosiglitazone (Avandia). The diabetic drug did not show evidence of increasing insulin plasma concentrations until electroacupuncture stimulation was added. Since Avandia is shown to significantly increase cardiovascular risks, and now comes with stern FDA warnings, an integrative M.D. could lower the dosage, and the subsequent risk and harm, by incorporating electroacupuncture into the therapy, and utilizing the Complementary Medicine specialties of the Licensed Acupuncturist. A single acupuncture point, ST36, was used in the study to clarify the effects, but a more individualized and complex acupuncture treatment would be used in clinical practice, enhancing the effects even more: http://www.ncbi.nlm.nih.gov/pubmed/20633486
A 2010 review of scientific studies by the Kanazawa Medical University in Ishikawa, Japan, found that ample proof of effectiveness, and a number of mechanisms by which acupuncture is effective for treatment of insulin resistance has been demonstrated with well-designed randomized clinical human trials, as well as physiological studies. 234 English-language scientific studies accepted by the U.S. PubMed database were reviewed: http://www.ncbi.nlm.nih.gov/pubmed/20590731
A 2009 study at the International University of Health and Welfare in Otawara, Tochigi, Japan, reveals that electroacupuncture exerts very safe and modulatory improvement of insulin responsiveness, improving the glucose metabolism and cellular response to insulin without negatively affecting the circulating glucose balance. Unlike pharmaceutical treatment, acupuncture is shown to enhance and improve our normal physiological homeostatic mechanisms, not alter the mechanism. Diabetic drugs often induce hypoglycemic states and other negative imbalanced metabolic effects: http://www.ncbi.nlm.nih.gov/pubmed/19556171
A 2005 study at China Medical University in Taichung, Taiwan, found that 2 Hz electroacupuncture bilaterally at ST36 in laboratory animals induced significant increases in adrenal beta-endorphin and circulating insulin, and that these effects were enhanced by increased serotonin. Use of a serotonin precursor such as L-Tryptophan or 5HTP (griffonia seed extract) could be helpful: http://www.ncbi.nlm.nih.gov/pubmed/15814202
A 1999 study at China Medical College in Taichung, Taiwan, found that a 15 Hz 10 mA electroacupuncture stimulation at a single point, Ren 12, induced adrenal beta-endorphins and reduced plasma glucose concentration in type 2 diabetic laboratory animals in an insulin-dependent manner. Subsequent laboratory studies demonstrated in animal studies that removal of the adrenal glands abolished this effect, proving that the effect was indeed adrenal, and that the health and function of the adrenals is important to the regulation of blood glucose in an insulin-dependent manner: http://www.ncbi.nlm.nih.gov/pubmed/10064107
A 2011 joint study at Hubei University of Chinese Medicine in Wuhan, China, Kanazawa Medical University in Daigaku, Japan, and Huazhong University of Science and Technology in Wuhan, China, found that electroacupuncture with 3 Hz milliamp stimulation for 10 weeks induced metabolic changes that reduced insulin resistance in laboratory animals by increasing SIRT1, PGC-1alpha, NRF1 and ACOX expressions. SIRT1 levels may increase in human tissues in response to caloric restriction and exercise as well, and with the use of the herbal chemical resveratrol, and a comprehensive treatment protocol, utilizing all of these methods concurrently is recommended: http://www.hindawi.com/journals/ecam/2011/735297/
A 2008 study of the effects of the herbal chemical resveratrol, obtained from the Chinese herb Polygonum cuspidatum, or Hu zhang, demonstrated that resveratrol may increase SIRT1 activity as well as SIRT2. Numerous studies now show that this herbal chemical may prove very valuable in the treatment of diabetes: http:/journal.9med.net/qikan/article.php?id=419372
A 2007 study at the Second Military Medical University in Shanghai, China, together with Brown University in Providence, Rhode Island, found that chemicals in American Ginseng, or Panax quinquefolius, increases insulin production over time in Type 1 diabetes by improving beta cell function and immune reactivity, and improves postprandial sugar metabolism in Type 2 diabetes. The type and quality of ginseng has been found to be important in clinical utilization. Combination with Crepe Myrtle, another proven aid to postprandial sugar utilization is also recommended: http://www.cmjournal.org/content/2/1/11
A 2007 study at the Dongduk Women's University in Seoul, South Korea, found that the Chinese herb silkworm extract (Bombix mori, or Jiang Can) significantly reduced circulating blood sugar levels in laboratory animals with induced diabetes and affected the hypothalamic regulation of vasopressin to treat and prevent diabetic neuropathy: http://www.ncbi.nlm.nih.gov/pubmed/17359645?
A 2004 study at Yale University School of Medicine found that chronic Diabetes mellitus induces degeneration in the hypothalamus affecting vasopressin producing neurons, contributing to the pathology of diabetic peripheral neuropathy and other negative health effects: http://www.ncbi.nlm.nih.gov/pubmed/15006692
A 2008 study at Joslin Diabetes Center and Harvard Medical School found that carbonic anhydrase II expressing pancreatic cells act as progenitors that give rise to new islest and acini after birth and after injury, and that this identification of a differentiated pancreatic cell type as an in vivo progenitor for all differentiated pancreatic cell types shows that restoration of pancreatic hormone producing beta cells is possible: http://www.ncbi.nlm.nih.gov/pubmed/18481956
A further 2009 study at Joslin Diabetes Center and Harvard Medical School found that within the exocrine (acinar and ductal) pancreas of the mouse in laboratory studies, that there are cells that can give rise to insulin-positive cells in vitro: http://www.ncbi.nlm.nih.gov/pubmed/19183938
Cardioprotective effects of European Olive leaf tincture were identified in 2003, preventing high blood pressure and atherosclerosis, while also improving insulin metabolism and providing antioxidant clearing of arteries: http://www.ncbi.nlm.nih.gov/pubmed/12648829?
Cardioprotective effects of the unique Chinese herb, Rhodiola rosea, or Hong Jin Tian, were reviewed in 2007: http://www.ncbi.nlm.nih.gov/pubmed/18074810
Cardioprotective effects of Omega-3 fatty acids, EPA and DHA, were reviewed in Europe in 1999, and have become standard therapy following a stroke or myocardial infarction (heart attack). Krill oil presents the high quality and most concentrated type of this supplement, with a natural preservative, unlike fish oils: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)07072-5/abstract
Studies in 2010 presented by the American College of Cardiology showed that the array of medications commonly prescribed to reduce risk for patients with metabolic syndrome, or diabetes type 2, are not only ineffective, but actually increased cardiovascular risk for most patients: http://www.nytimes.com/2010/03/15/health/research/15heart.html
Meta-analysis of research in 2009 at the Pennington Biomedical Research Center at Louisiana State University found that evidence supports the use of ginseng, coptis, and bitter melon extract in the treatment of Metabolic Syndrome: http://www.ncbi.nlm.nih.gov/pubmed/18537696
Studies in 2010 by the West China School of Pharmacy in Chengdu, confirmed that saponins in ginseng, combined with saponins in Siberian ginseng (notoginseng), do indeed decrease fasting blood glucose, improve glucose tolerance, and improves insulin and leptin sensitivity at a modest dosage over 12 to 30 days. NOTE: saponins are best extracted in alcohol and/or glycerin tincture: http://www.ncbi.nlm.nih.gov/pubmed/20435129
Studies in 2009 at the Department of Pharmacologie of the University of Montreal found that silibin from Milk Thistle effectively counters the type of fatty liver disease commonly seen as a progressive disorder in metabolic syndrome, obesity and diabetes, by exerting potent antioxidant and anti-inflammatory activities (reducing TNF-alpha), as well as improving insulin metabolism, and aiding liver function (hepatoprotective): http://www.ncbi.nlm.nih.gov/pubmed/19884114
Studies in 2009 at the College of Pharmacy at Chungnam National University found that triterpenes in the Chinese herb Mud dan pi (Moutan cortex, or Paeonia suffruticosa) improved glucose uptake and glycogen synthesis in insulin-resistant liver cells, in a dose-dependant manner. NOTE: triterpenes are best extracted in an alcohol and glycerite tincture: http://www.ncbi.nlm.nih.gov/pubmed/19716700
Studies in 2006 at the Beijing Institute of Pharmacology found that extracts of Xuan fu hua (Inula japonica) exerted a significant hypoglycemic effect, lowering blood glucose levels better than the pharmaceutical drug glycazide and equal to the effects of Metformin in diabetic laboratory animals but only mildy in normal subjects. Lowering of triglycerides was also noted: http://www.ncbi.nlm.nih.gov/pubmed/16508145
Studies in 2010 at the Tajen University Department of Pharmacy in Taiwan found that the Chinese herb Abelmoschus moschatus, a type of hibiscus, was effective in improving insulin sensitivity with 2 weeks of use, and was useful as an integrative medicine for patients with insulin sensitivity: http://www.ncbi.nlm.nih.gov/pubmed/19610024
Studies in 2010 at Wenzhou University in China found that the Chinese herb Cirsium japonicum, or Da ji, produced significant antidiabetic effects, reducing circulating adiponectin, improving insulin resistance, and reducing high triglycerides and blood glucose: http://www.ncbi.nlm.nih.gov/pubmed/20361298
Studies in 2010 at the University Montpellier Center for Pharmacology and Innovation related to Diabetes, in Montpelier, France, found that an herbal chemical quercetin potentiated glucose and insulin metabolism and protected pancreatic beta cells against oxidative damage. Quercetin and isoquercetin are found in the Chinese herbs Luo bu ma, Sang ji sheng, Sang ye, rhododendron dahuricum (man shan hong), Chai hu, Yu xing cao, Bian xu, Wei mao, and Fan shi liu, and in small quantities in shallots, garlic, steel cut oats, cranberries, cabbage, kale, kohlrabi, brussel sprouts, spinach, chives, and pears, as well a evening primrose leaf oil: http://www.ncbi.nlm.nih.gov/pubmed/20860660
Studies in 2010 at Chonnam National University in Korea found that propolis, a resinous polysaccharide collected by honey bees, may be a potential antidiabetic agent for the treatment of insulin-resistant or insulin-insentive diabetic states. Propolis showed both antioxidant capacity and inhibition of the enzyme glucose-6-phosphatase (G6Pase) that is implicated in insulin resistance: http:/www.ncbi.nlm.nih.gov/pubmed/20878710
A July 13, 2010 article in the New York Times outlines the history of the hiding of serious cardiovascular risks associated with the drug Avandia, a class of glitazones designed to decrease insulin resistance and help with diabetes care. The scandal of hiding important research findings from the public and FDA by SmithKline Beecham (formerly GlaxoKline Smith) may signal a new era in FDA function: http://www.nytimes.com/2010/07/13/health/policy/13avandia.html?_r=1
A July 15, 2010 article in the New York Times reveals that the FDA, once again, allowed a drug to remain on the market despite the history of illegally hiding risks in patient studies and the enormous payouts in product liability from patient harm admitted. GlaxoSmithKline stated that it was assuming a $2.36 billion loss in one quarter for legal liability for the diabetes drug Avandia as well as the antidepressant Paxil: http://www.nytimes.com/2010/07/16/business/global/16avandia.html?src=busln
In 2010, the University of Cincinnati College of Medicine produced research demonstrating that an active chemical in American Ginseng, the ginsenoside Rb1, exerted both antihyperglycemic and antiobesity effects in a dose-dependent manner, affecting the hypothalamus, as well as the pancreas and insulin receptors and glucose transporters.: http://www.ncbi.nlm.nih.gov/pubmed/20682695
In 2005, researchers at the Pritzker School of Medicine at the University of Chicago, Illinois, found that total ginsenosides, or active ingredients of American ginseng, extracted from the leaves and stem, have potential for treating diabetes. Most studies have focused on the traditional use of the plant root, and thousands of studies over the last decades have demonstrated the anti-hyperglycemic effects of chemicals in ginseng, especially in improving postprandial glucose utilization.: http://www.ncbi.nlm.nih.gov/pubmed/16115378
In 2001, researchers at the College of Osteopathic Medicine in Athens, Ohio, found that extracts of Crepe Myrtle (Lagerstroemia speciosa) exerted significant beneficial effects on glucose uptake postprandially, and also inhibited the adipocyte differentiation that is induced by excess insulin, potentially aiding the diabetic patient in the long-term as well as the short: http://www.ncbi.nlm.nih.gov/pubmed/11533261
In 2004, the University of Pittsburgh Dept. of Pediatrics studied the effects of R-lipoic acid to reduce oxidative stress and hyperglycemic diabetic progression in Metabolic Syndrome (Diabetes type 2). R-lipoic acid was found to prevent hyperglycemia, reduce insulin levels, and increase the free radical oxidant scavenging potential in animal studies: http://www.ncbi.nlm.nih.gov/pubmed/14749277
In 2007, studies at the University of Heidelberg, Germany, Institute for Anatomy and Cell Biology, found that L-carnosine levels correlated with decreased pancreatic beta cell mass in diabetes, and that a genetic variant noted in diabetes resulted in the increased enzymatic clearance of L-carnosine, indicating that this amino acid would be recommended for all true diabetic states with decreased insulin capacity: http://www.ncbi.nlm.nih.gov/pubmed/17601992
In 2010, studies at the China Medical University in Taichung, Taiwan, found that inorganic mercury in the environment causes pancreatic beta cell death and that this is significantly reversed with N-acetyl cysteine supplementation: http://www.ncbi.nlm.nih.gov/pubmed/20006636
In 2010, studies at the Hamner Institutes for Health Sciences in Research Triangle Park, North Carolina, found that chronic exposure to inorganic arsenic in the environment provoked an adaptive oxidative stress response that damaged pancreatic beta cell function. The researchers found that this chronic inorganic arsenic toxicity was highly associated with incidence of type 2 Diabetes. Chelation therapy may be a significant addition to treatment protocol to stop the onset of type 2 Diabetes in cases of Metabolic Syndrome: http://www.ncbi.nlm.nih.gov/pubmed/20100676
In 2011, studies at the University Putra Malaysia on laboratory animals induced with diabetes showed that Bitter Melon extract, or Momordica charantia (the Chinese herb Ku Gua), alleviated pancreatic damage and increased the number of beta cells, as well as exerting a hypoglycemic effect equal to the pharmaceutical drug glibenclamide (Glyburide, a sulfonylurea). This Chinese herb could thus be an important part of a long-term treatment in renewal of pancreatic beta-cell damage in Diabetes mellitus type 1: http://www.ncbi.nlm.nih.gov/pubmed/21117023
In 2002, studies at the Kyoto Prefectural University of Medicine in Japan found that astaxanthin, a potent antioxidant carotenoid terpene found in arctic krill, microalgaes and sea cucumber, exerted potent beneficial and protective effects on pancreatic beta-cells in laboratory animals induced with diabetes (db/db), increasing the ability of the beta-cells to secrete insulin, and preserving beta-cell function: http://www.ncbi.nlm.nih.gov/pubmed/12688512
In 2004, studies at the Kyoto Prefectural University of Medicine in Japan found that astaxanthin, a potent antioxidant carotenoid terpene found in arctic krill, microalgaes and sea cucumber, also was able to ameliorate the progression of diabetic kidney damage (nephropathy) in diabetic laboratory animals: http://www.ncbi.nlm.nih.gov/pubmed/15096660
In 2011, studies at Zhejiang University in China found that anthocyanins from the Chinese herb Yang mei (Myrica rubra or Chinese bayberry) demonstrated significant protective effects for pancreatic beta-cells from oxidative damage (other anthocyanins that may be applicable may include the bilberry extracts). These chemicals are derived from the fruit, leaves or root of the myrica rubra: http:/www.ncbi.nlm.nih.gov/pubmed/21166417
In 2010, studies at the Hamner Institutes for Health Sciences in Research Triangle Park, North Carolina, found that persistent oxidative stress coupled with deficient endogenous antioxidant metabolism is highly associated with impaired pancreatic beta cell function and the creation of type 2 diabetic state in Metabolic Syndrome. Improvement in the key endogenous antioxidant metabolism in the body, the glutathione metabolism, may be the key to preventing the develpment of a true diabetes in a Metabolic Syndrome: http://www.ncbi.nlm.nih.gov/pubmed/19501608
In 2011, studies at Tsinghua University in Shenzhen, China, found that many scientific studies show significant benefit of herbal medicine in TCM for lowering blood glucose and controlling inflammation. The authors noted that the 23 herbs that show hypoglycemic effects in study contain 12 active chemicals that all have potent anti-inflammatory actions, indicating that such study may imply that diabetes may be an inflammatory disease, and that such anti-inflammatory and antidiabetic herbal therapy as is seen in these commonly used Chinese herbs may be preventive of diabetes, or inhibiting of the progression of the disease: http://www.ncbi.nlm.nih.gov/pubmed/21205111

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.