Metabolic Syndrome, and Pre-Diabetic State — Understanding Your Condition, and How to Restore a Healthy Metabolism with Complementary Medicine

Paul Reller, L.Ac.

Metabolic Syndrome has been well established as one of the most significant health threats to the overall population since late 1970s, but in the United States, there has been little public education of this disorder, and a stubborn refusal by the medical establishment to separate it from the concept of Diabetes. For a number of years, diabetes has been a growing problem in the United States, and the explosive growth of this disease state has been called Diabetes Type II and pre-Diabetic state. Diabetes is a disease defined by an inability to regulate blood sugar, or glucose, and is characterized by frequent or profuse urination and increased thirst, hyperglycemia (high circulating blood sugar), and dyslipidemia (unhealthy lipid metabolism). The Center for Disease Control (CDC) estimates that about 7% of the U.S. population has been diagnosed with Diabetes Mellitus, and and another 3% are still undiagnosed. Over 93% of these patients have what is termed Diabetes Type II, though, which is still not clearly distinguished from Metabolic Syndrome. To learn more about Diabetes Mellitus, go to the article on this subject on this website.

What actually separates Metabolic Syndrome from Diabetes Mellitus? Problems of insulin deficiency versus insulin excess, the classifications of disease versus a syndrome of dysfunctions, and the problems associated with insulin resistance at the cellular receptors are the key factors in distinguishing true diabetes from Metabolic Syndrome. Diabetics are divided into insulin-dependent and non-insulin-dependent patients when treating. Insulin-dependent patients must manage the inability of the pancreas to produce insulin by injecting synthetic insulin in dosages that relate to the monitored blood sugar. Although insulin injections will help the patient to manage the circulating blood sugar levels and sugar metabolism, is does not correct all aspects of an unhealthy metabolic state, and often there is both a diabetic state and a Metabolic Syndrome seen in these patients. Non-insulin-dependent patients are given a variety of drugs to help normalize sugar metabolism, as well as to protect against cardiovascular risk, and manage lipid dysfunction, and their care is not clearly distinguished from the management of Metabolic Syndrome. Patients with Metabolic Syndrome, which is not diabetes, and may not actually be a pre-diabetic state for many patients, are routinely told that they have diabetes.

There is an overlap, obviously, with diabetes and metabolic syndrome, but these disease mechanisms are increasingly distinguished from one another as research progresses. This failure to clearly define the disease and distinguish it from the syndrome presents an alarming and confusing state for the patients, and does not help them to make decisions concerning a proper course of care. The standard course of care with pharmaceuticals, which often involves prescribing the same five drugs to every patient regardless of the individual parameters of the disease or syndrome, is obviously inadequate to decrease the incidence of Diabetes Type II and Metabolic Syndrome, as the incidence of these disease syndromes is rising very fast in recent years. This is where Integrative and Complementary Medicine can come into play, as well as changes in public health, patient education, and regulation of the food industry.

Metabolic syndrome is defined by a group of signs and symptoms, including high blood pressure, elevated insulin levels, abnormal cholesterol, or lipoprotein, levels, and excess body fat around the midsection, due to insulin resistance and inability to burn this fat. It is estimated that more than 25% of the population could be diagnosed with Metabolic syndrome, and an alarming incidence in our children is causing much concern. The term Metabolic Syndrome was already in use by the medical establishment in 1977, when Herman Haller M.D., a Dean of Medical Education at Hanover Medical School, in Germany, published a paper in a medical journal describing Metabolic Syndrome as obesity, diabetes mellitus, hyperlipoproteinemia (high LDL), hyperuricemia (high uric acid excretion), and steatosis hepatitis (commonly referred to a fatty liver). Since then, the diagnosis has been debated and refined, and Diabetes Mellitus is no longer a significant part of the syndrome, although it may be related. Guidelines for diagnosis in recent years suggested that the patient must meet 3 of 5 diagnostic factors: 1. difficulty losing weight and large waist size, 2. blood sugars sustained at greater than 110, 3. triglycerides sustained at greater than 150, 4. HDL sustained at less than 50 for women, and less than 40 for men, and 5. high blood pressure sustained at greater than 130/90. The complexity of the syndrome is overwhelming to many patients, and understanding of metabolic dysfunction is very important to the patient when choices need to be made to correct this metabolic dysfunction and achieve a healthy state again. The consequences of metabolic syndrome include a long list of increased risks for serious diseases, especially stroke, as well as diminished quality of life.

Metabolic Syndrome is the most prevalent health threat in our population today, and although this syndrome is variable between patients and difficult to understand, it does address the core of your health and the need for a holistic and thorough approach to patient understanding and action.

Metabolic disorder is a health problem that is not isolated to a particular organ or mechanism in the body, and does not have one particular cause. In fact, recent research in Japan has shown that metabolic syndrome is even variable with the seasons. At the University of Occupational and Environmental Health School of Medicine in Naka-gun, Japan, 1202 male workers were monitored and blood serum levels of glucose and HDL, and blood pressure, were all significantly higher in winter than in summer, while triglyceride and waist circumference did not vary significantly. Seasonal variation of metabolic health problems is a topic that was integral to the physicians practicing Traditional Chinese Medicine, or holistic health, and reveals that metabolic health balance is indeed a complex multifactorial health problem. The effects of seasonal variance on individual health problems is discussed extensively in the earliest complete medical text of TCM, the Nei Jing de Huang Di. These new statistics show that more patients would be diagnosed and prescribed a variety of prescription medications if they had their exam and check-up in winter than in summer. A thoughtful individualized diagnosis and treatment strategy is needed for this complex health problem, and integration of Complementary Medicine into the overall treatment protocol is becoming the hallmark of such a patient centered approach. Working toward improved health of the metabolism involves an interdisciplinary approach and multifactorial focus, which is a hallmark of holistic medicine and TCM science. A public health approach and effective preventative strategy also desperately needs to be implemented. China was the first country in history to adopt a significant public health preventative approach to health problems at the urging of holistic physicians.

Metabolism is the sum of chemical and physical changes that occur in tissue to maintain life. We generally think of metabolic changes as chemical breakdown, or catabolism, and chemical construction, or anabolism. These terms may also be applied to the breakdown of aging tissues, and the rebuilding of new healthy tissues. Of course, catabolic and anabolic processes need to be balanced to maintain health, since the body uses the products of chemical and physical deconstruction to supply it with the raw materials for construction of new chemicals and tissues. The hormone insulin is an anabolic hormone and is integral to the metabolic homeostatic balance our bodies try to maintain. In Traditional Chinese Medicine, this is an example of Yin and Yang balancing. Yin Qi refers to the process of constructing chemicals and tissues, and Yang Qi refers to the utilization of these chemicals and tissues to power the body. Physicians in ancient China that studied this holistic medicine that we now call TCM realized the need for metabolic balance to maintain optimal health, and centuries of therapeutic protocol are designed to achieve this goal. Science is discovering that many common health problems have at their core an imbalance between the anabolic and catabolic processes in the body, leading to degeneration of cells and tissues. Improving metabolic function may be the most important preventative measure that the patient could take today.

The rate of metabolism is largely controlled by protein enzymes and hormones. Protein enzymes are catalysts for specific cellular reactions, and allow the chemical construction or deconstruction to occur at very accelerated rates by increasing the energy efficiency. Our genes express proteins, and protein enzymes are created in response to metabolic needs for chemicals and cellular molecules. Many enzymes are created in the liver, but all cells also create enzymes within an elaborate feedback mechanism. Hormones are simple molecules that do not have actions of their own, but rather stimulate receptors to control metabolic processes, and insulin, cortisol, estrogen and testosterone are just some of the wide array of hormones that our body creates, transforms, and utilizes to control metabolism. These hormonal processes are constantly in motion and act in concert, in a sort of quantum field of reactions within the endocrine system. Hormone production and secretion, called endocrine activity, is tightly regulated in a feedback system that involves organs and tissues spread throughout the body. These two factors are the key to metabolic regulation, but are just a small part of the complicated human metabolic physiology. One can see from this simplified description that metabolism is very complex in its interactions, and needs a complex balance in the body to function properly, including healthy raw materials.

While metabolism occurs in all cells of our body, the busiest metabolic organ is the liver. Most of the tissues and molecules of the body are composed of three basic classes of molecule, the amino acids (protein), carbohydrates (sugars) and lipids (fats). The liver both constructs and deconstructs many of these amino acids, carbs and lipids, and also converts one form to another, especially to create fuel for these processes in the form of glucose. Glucose provides much energy in our body, but is not stored as glucose. Energy stores are largely in the form of lipids and proteins, and lipoproteins carry these molecules to the fat cells in our body to store them, and then carry them back to the liver to convert them as needed. Low density lipoproteins (LDL) generally carry the molecules out to the cells, and high density lipoproteins (HDL) generally carry the molecules back to the liver. A balance is of course needed in our metabolism between LDL and HDL, and this is one of the most important laboratory values to analyze in metabolic syndromes. Triglycerides are essentially fatty acids combined with glycerol. Both of these lipids, or fats, can be converted to glucose in the liver, and this process is continuous. Triglycerides are the form of stored energy that is primary in our fat cells. Levels of triglycerides in circulation are also an important indicator of the healthy function of the liver, reflecting the rate of liver metabolism, along with the liver enzymes (ALT, AST, SGOT, SGPT) that convert one amino acid to another to form needed proteins and enzymes. High triglycerides and liver enzymes imply that the liver function is slow, possibly due to chronic inflammation, fatty accumulation, or cellular damage from disease. Another marker, the C-reactive protein (CRP), indicates that the liver is struggling to keep up with inflammatory regulation, which is integral in the pathophysiology of Metabolic Syndrome.

Optimal health and function of the liver and kidney are absolutely essential to metabolic health. Many factors outside of the body contribute to increased physiological stress on the liver and kidney functions. Chief among these are heavy consumption of chemicals that are not natural to normal function, and increases on energy and metabolic demands from chronic inflammatory dysfunction. The liver is the main detoxifier in the body, and the main creator of inflammatory mediators. The current strategy in standard medicine regarding metabolic syndromes is to give the patient 3-6 types of prescription medications to cover the various metabolic concerns. The failure to see that loading the patient with complex chemical prescriptions itself presents a harsh load on liver and kidney function and threatens to worsen metabolic dysfunction is the chief blind spot in medicine today. Many medical doctors are now realizing that this strategy chiefly benefits the bottom line of the pharmaceutical industry, and may not be the best strategy in public health for lowering the incidence of Metabolic Syndrome. Of course, high alcohol consumption, smoking, drug use, high coffee and soft drink consumption, advanced glycation endproducts in processed foods, transfats, preservatives, and a growing number of toxins and hormone-like chemicals in our environment, especially in products that we willingly buy and consume, are also posing significant metabolic stress threats. As individuals, we need to both educate ourselves concerning metabolic health, and to urge our government to increase efforts in public health and regulation of the environment and food industry. The Licensed Acupuncturist is often a person that can spend the time to help you understand your metabolic health and how to best restore balance and healthy function.

Understanding the physiology in Diabetes and Metabolic syndromes

It is important for the patient to understand the physiological differences between diabetes and metabolic syndrome. In diabetes, the deficiency or lack of insulin creates serious health problems for the metabolism, but in most metabolic syndromes, is is an excess of insulin driven by insulin resistance that creates the problems. This simple fact is still largely ignored by physicians, and this is largely because we are resistant to a change of terminology, and to a change in the focus of treatment.

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). 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 accumulating in insulin deficient states are converted to large quantities of acetoacetic acid, which leads to acidosis. 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 Metabolic Syndrome is 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. 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 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. Since only about 60% of amino acids can be turned into glucose in the liver, this process can create enormous liver stress. High cortisol stimulation from poor bioavailability of carbohydrates, insulin resistance, and stress leads to protein depletion without burning fat, and this scenario can ultimately lead to hormonal and adrenal deficiency. Excess cortisol, cellular protein depletion, and liver stress also combine to create inflammatory dysfunction that leads to insulin resistance, creating a viscious cycle. Dirunal cortisol imbalance eventually creates insomnia, fatique, anxiety and depression. When the patient consumes complex carbohydrates, with a high glycemic index, the breakdown of the carbohydrates is slow and steady, and this episodic adrenal stress does not occur as easily.

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 metabolic syndrome. 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 pharmacuetical 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.

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 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 Metabolic Syndrome is linked to protein dysfunction and endocrine disorder. As stated, hormones are key to metabolic regulation, and are relatively simple molecules that easily transform one into another according to physiological need. Insulin is a steroid cholesterol-based hormone that is very similar to progesterone. Progesterone imbalance may have a significant effect on insulin bioavailability, and such problems as premenstrual syndrome, menopause, and infertility may be related to progesterone imbalance, and thus indirectly related to Metyabolic Syndrome. Prostate hypertrophy, fibrocystic breasts, and prostate and breast cancers may also be related to progesterone imbalance and indirectly linked to Metabolic Syndrome. Establishing a healthy hormonal balance may thus be an integral part to reversing Metabolic Syndrome, as well as preventing a host of serious diseases. A holistic assessment and step-by-step treatment protocol may be needed to restore a healthy metabolism, and professional guidance is absolutely necessary to achieve this goal for many patients.

An array of health problems is now associated with high insulin levels that result from insulin resistance in Metabolic Syndrome. Insulin and a related compound, IGF-1 (insulin-like growth factor), are integral parts of the mechanisms associated with malignancy in cancer cells. Insulin and IGF-1 act together in the cancer cells to drive the excess anabolic growth and spread of the cancer cells. Insulin is also found to alter the effects of pharmaceutical drugs on the cells by effecting cell membranes. Increased insulin facilitates the passage of drug molecules from the extracellular compartment to the intracellular compartment in many cells. This could increase the actions of various drugs, and create excess chemotoxic effects in cancer therapies for patients with Metabolic Sydrome. Presently, these effects are being investigated to see if chemotherapies can be enhanced with lower toxic chemical dosages and the use of insulin as an adjunct therapy in cancer chemotherapeutic regimens. Such research, though, demonstrates the problems that may occur in the patient with Metabolic Syndrome, and inexplicable increases in side effects from drugs. Breast and colon cancers cell membranes have been characterized as having plentiful insulin receptors, and chronic high insulin and insulin resistance may be a risk factor in these diseases. Insulin has also been researched in relation to brain function and immunological problems, and more and more serious health problems are showing potential links to chronic high insulin levels and insulin resistance. Insulin has long been recognized as an affector of cell membrane transport of glucose, but now research has revealed that insulin hormone also regulates transport of some amino acids, fatty acids, potassium, magnesium, and certain key monosaccharides. Health problems associated with these nutritional imbalances may be related to chronic high insulin states and Metabolic Syndrome.

While most of the insulin in our bodies is produced in the pancreas and broken down in the liver, with a lifespan for the insulin molecule mostly lasting only minutes in our bodies (the general half-life is about 10 minutes, and most insulin is catabolized in the liver within one hour), some insulin is also produced in the brain, and some is stored in fat cells. The insulin produced in the brain 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), DNA respication, modification of enzyme activities, and even the rate degradation of damaged cell components called organelles (linking metabolic syndrome to neurodegeneration). The complex role of the insulin hormone in our bodies suggests that we need to pay attention to restoration of metabolic balance if we are to address all of our health problems and maintain the healthiest functional state possible. Integrating Complementary Medicine into your health regimen will help to maintain a better metabolic balance.

Diagnostics and treatment protocols in Diabetes and Metabolic syndromes

As stated, there is an obvious overlap of Metabolic Syndrome with diabetes, and a confusing lack of clarity between Type 2 Diabetes Mellitus, Prediabetes, and Metabolic Syndrome. In addition, there is sometimes a lack of clarity concerning Type 1 Diabetes Mellitus, both in determining the degree of degeneration of the pancreas function, and the extent to which other factors are contributing to the difficulties in controlling blood sugar levels. The intelligent patient will understand that a proactive approach to understanding and managing their individual case will pay big health dividends down the road. There is a tendency to treat all patients alike in the modern medical system, and with diabetes and metabolic disorders no two patients are exactly alike. No matter what your current diagnosis, understanding and attention to Metabolic Syndrome is very important to the management of your condition and prevention of future health risk, as well as improving quality of life.

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. 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. 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 eventually if weight is reduced, dietary/exercise patterns are successfully developed, and metabolic function is normalized. As stated, if weight loss is difficult, you must consider balance of the hormonal system and improved inflammatory regulation to gain success. Attention to the treatment of abnormal leptin and adiponectin levels, and resolution of insulin resistance and impaired glucose tolerance is often essential if sufficient weight loss is to be achieved.

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. Understanding and improving metabolic fuction is a key part of the overall package of treatment protocol in diabetic states.

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 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, 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 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. Various herbs and nutrient medicines are now proven to help increase glucose utilization after eating, such as Crepe Myrtle, American Ginseng, cinnamon bark, and L-carnitine L-tartrate.

If you are diagnosed with type II NIDDM (non-insulin dependent diabetes mellitus) or IGT (impaired glucose tolerance), your diagnosis may not be clear and you may want to monitor your laboratory results and acquaint yourself with drug regimens. Pre-diabetic state is a very unclear diagnosis, and is often confused with Metabolic Syndrome. The Mayo Clinic states that Prediabetes is a state where blood sugar levels are higher than normal, but not consistently high enough to be clasified as Type 2 Diabetes Mellitus, and may progress in 10 years to a diabetic state. Given this timeline of progression, the patient seriously needs to consider more conservative means of restoring healthy metabolism and blood sugar regulation than going on harsh medications for the rest of their life. Taking a proactive approach and improving the health to reverse the prediabetic state, or Metabolic Syndrome, will result in avoidance of costly drug regimens with numerous chronic side effects, much improved quality of life, and avoidance of serious threats to health with aging. Patient education is the key, and understanding the laboratory tests is an important step in patient education. Normal values of pertinent blood chemistry 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 bound): 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%. The American Diabetes Association has determined that patients in a pre-diabetic state generally have an A1C level of 5.7-6.4%. Since A1C levels have a high variablility due to a variety of factors, a single high level, or an A1C level of 6.4% or lower, may not be enough evidence to base a diabetes diagnosis upon. 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 decrease 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. Patients may choose to utilize Complementary Medicine, in the form of acupuncture, herbal and nutrient medicine, along with dietary and lifestyle changes, during this period of repeated testing to confirm a diagnosis of diabetes, and see if drug dependency may be avoided. Diabetes is generally a slowly developing disease, and the risks in diabetic states are also generally long term and not immediate threats to the health, giving most patients time to improve the health to treat the disease and decrease future health risks.

Of all of the blood chemistry levels cited above, glucose and triglyceride levels are initially the most 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. In the holistic treatment of metabolic syndromes, identifying the focus of therapy with these various chemistry markers is important to the Licensed Acupuncturist and herbalist who utilizes a modern evidence-based system along with traditional TCM diagnostic methods. It is important for the patient to obtain copies of these blood tests and bring them to therapy when using the Complementary Medicine physician to help resolve metabolic syndromes and control or reverse diabetic states.

In Type I IDDM 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. In the early stages of Type I diabetes, the pancreatic beta cells may produce insulin, but the level of production may be insufficient or fluctuating. The NIH states that insulin producing pancreatic beta cells are generally not completely destroyed for 5-10 years in Type I diabetes. This means that careful monitoring of blood glucose is essential, and that patients in an early stage of the disease may take measures to delay the full destruction of the insulin producing cells in the pancreas. 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, and improved methodology in monitoring blood sugar levels allows patients greater ease of insuring that optimum insulin levels are maintained. By increasing your health and conscious control of blood sugars and lipids, the body will need less insulin and the long term side effects will be decreased. Use of dietary regimens and herbs are not contraindicated or harmful, 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. In addition, much research in the last decade has revealed that beta cells in the pancreas may regenerate in chonic diabetic states if the right protocol is utilized.

In Type I IDDM, the American Diabetes Association defines a normal range of blood sugars in adults before meals as 70-130 mg/dL, and before bedtime of less than 180 mg/dL. After the meals (postprandial), the blood sugar is expected to rise dramatically, and optimally, fall to fasting levels within two hours. The rate that blood sugars in circulation are processed is largely dependent on the insulin system, although a variety of factors contribute to this process. Patients need to monitor the blood sugar levels two hours after eating to determine if the body is processing sugar adequately. If the levels do not fall to a preprandial level fast enough, various therapeutic means may be utilized to improve the metabolic efficiency and help the body to achieve normal metabolic utilization of sugar, or carbohydrates. High postprandial blood sugars taken before the body has a chance to process circulating sugars do not indicate that the body needs a higher dosage of insulin. Initiating excess synthetic insulin dependence too early in the disease will reduce the body's own insulin responses, and may hasten the degeneration of the pancreatic insulin production.

Using sensible protocols and careful monitoring, patients may stimulate improved natural insulin production, and greatly aid the body’s efficiency in processing carbohydrates and storing sugars as fats and proteins. For instance, avoiding excess carbohydrates in the meal, eating a careful balance of plant proteins, healthy fats and complex carbohydrates (whole grains and legumes), and avoiding excess meat and dairy consumption, will help the body to more efficiently utilize food nutrients and process them. A short brisk walk, or other simple aerobic exercise, following the meal will help the body to burn simple carbohydrates via exercise, taking stress off of the liver, and aiding efficient nutrient processing. Utilizing such herbs as medicinal cinnamon bark, crepe myrtle, Rhodiola rosacia, bitter melon, and Amercian Ginseng, before the meal, or immediately after the meal, will aid the postprandial processing of carbohydrates as well. Improvements in the digestive health, liver health, and hormonal balance will also aid the body to process food nutrients more efficiently. The experienced Complementary Medicine physician, such as the Licensed Acupuncturist, will be able to design an individualized protocol of treatment to achieve these goals. All of these methods may be utilized to achieve a state of improved natural metabolic function and result in less dependency on synthetic insulin, and each individual may tailor the program to meet their needs regarding time and cost. The time spent to improve physiological understanding and gain a more intelligent proactive control of sugar metabolism will pay enormous dividends down the road in terms of future health and avoidance of health risks in diabetes.

Two types of medications are generally used to control Type II NIDDM. These 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. Sulfonylureas have few side effects and act rapidly, and are thus the usual first choice. This group 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

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 considered essential if the triglyceride levels are too high. Studies do show that a large percentage of patients have insufficient blood sugar control after 5 years of usage of any of these drugs, though, pointing to the need for adopting an effective dietary, lifestyle and herbal regimen to increase your chances of long term success. Many patients are now opting to treat liver function, achieve hormonal balance, and lose weight, all with the help of Complementary Medicine, and then discuss with the prescribing M.D. monitoring the triglyceride levels as Metformin is withdrawn. Choosing to use improved metabolic health over excess drug dependency will pay many health dividends in the long run.

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.

Insulin resistance has been the subject of much research in recent years, and a number of therapeutic protocols have been shown to be effective in countering insulin resistance. Studies have confirmed significant benefits from specific acupuncture and electroacupuncture methods, herbal chemicals, and nutrient medicines. In addition, the complex subject of hormonal balance in insulin resistance has been intensely studied, and a variety of therapeutic protocols to improve levels of leptin, adiponectin and cortisol, as well as a better balance of progesterone and estrogens, have been developed to reverse insulin resistance. Each individual may have a different set of physiological problems that are contributing to insulin resistance, and an evidence-based modern Complementary Physician is able to develop an individualized treatment protocol to best address this complex and systemic health problem. You may go to a number of articles on this website to more fully explore insulin and insulin resistance, especially the article entitled Insulin Resistance in a Variety of Diseases. Since insulin resistance is a systemic and complex disorder involving the hormonal, immune and neurological systems, a holistic approach appears to the be a sound strategy for resolving this problem. An allopathic strategy of chemically blocking just a single pathway of this complex dysfunction does not seem to be a reasonable method of resolving or controlling insulin resistance.

Dietary Recommendations

Dietary recommendations in Metabolic Syndrome and diabetes are very similar. In all types of diabetes, loss of fluids without replenishing is a major concern, though, 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. There are some dieatary recommendations that are more pertinent to Metabolic Syndrome than diabetes, such as consuming foods that benefit improved inflammatory regulation, and achieving a balance of omega-3 and omega-6 fatty acids. The primary consideration in diet, though, is to help your body regulate sugars and lipids when normal regulation is challenged. 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:

• Meals 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. Increased chewing is recommended.
• 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 household chores. 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 exercise, heavier intake of food, especially carbohydrates is essential. You will need the extra fuel.
• 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. Carbohydrates should be eaten in the form of complex carbohydrates, meaning whole grains and unprocessed natural sugars, such as honey and maple syrup, and simple carbohydrates should be avoided. The more bitter whole grains are reknowned for arterial cleansing, such as rye, quinoa, amaranth, and steel-cut oats.
• Carbohydrates consumed should be whole grains and legumes, fresh vegetables, and some fruits in small portions (avoid large consumption of juices). Processed foods and cereals that are called whole grain are not complex carbohydrates.
• Processed food and refined sugars should be strictly avoided, especially fatty food and pastries. If you must have sweet snacks, limit these to one bite.
• 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, but a very low-fat diet may be harmful. Margarine and refined oils and fats are trans-fats and are very bad in maintenance of cholesterol buildup and should also be avoided. The key to dietary fats is the consumption of healthy fats, mainly in the form of unprocessed, cold-pressed fresh oils, as well as a small amount of fresh nuts and seeds each day. Good supplements for omega 3 and 6 fatty acids include krill oil, spirulina, bluegreen algae and chlorella. One common mistake with patients is the simultaneous consumption of omega-3 fatty acids and the sudden elimination of red meat from the diet. When you eliminate red meat, your body needs to adjust to the decrease in omega-6 fatty acids such as arachidonic acid, and a sudden shift to an omega-3 relative excess is not healthy. Health arachidonic acids are available in vegetarian diets, though, be snacking on toasted nori seaweed and peanuts fresh from the shell. Consuming the spirulina and blue-green algaes will also help achieve balance.
• 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.
  • Examples of healthy unsaturated oil sources in the diet include: almonds, pecans, hazelnuts, pine nuts, walnuts, sesame seed, flax seed, pumpkin seed, avocado, olives, soybeans, quinoa, garbanzo, miso, steel cut oats, brown rice, millet, corn and buckwheat. All of these whole foods and oils should be fresh and not rancid.
  • saturated fats (which also include peanut, coconut, and palm kernel oils) cause cholesterol to block arteries, although unprocessed coconut oil is partially saturated and easily utilized by our cells.
• Protein choices should include more fish and fowl, beans and legumes, soy products, and small portions of nuts and seeds. Beef and pork are more suited for wasting stages of the diabetic 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. Meats also will often have chemicals and hormones that are toxic these days, and the consumption of ginger will help reduce these toxins. Animal products are generally high in both saturated fats and cholesterol. Cholesterol is the most abundant hormone in the body, and essential to health, and most cholesterol is produced by the body, although a diet with too high of a percentage of meat products will cause the body to decrease cholesterol production. Sudden changes in meat consumption may have an unhealthy effect on cholesterol production and balance in the body. Also, poor quality commercial meats may have poor quality cholesterols in them. In Metabolic Syndrome, it is important to make gradual changes in dietary habits, and work toward a greater percentage of healthy vegetables and whole grains over time.
• 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 maintained by the blood, problems should be dealt with.)
• The nervous system is easily affected 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

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. Spirulina also helps to stabilize blood sugar. The best source of fish oil is krill oil, which is very concentrated in EPA and DHA, and contains a natural preservative. 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 this is also found in tofu and tempeh, walnuts, pumpkin seeds, 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. It is important to note the freshness of these oils, nuts and seeds, as rancidity produces oxidative chemicals that are unhealthy. These seeds and nuts, or fine organic cheeses with rye crackers, make an excellent snack instead of pastries and candy. 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 in a vegetarian diet.

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. If neuropathy develops, a good source of calcium and magnesium may be warranted. A vitamin B complex will aid liver function and help control HTN.

For further advice on specific diet 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:

Treatment protocols for Metabolic Syndrome should be individually tailored to the patient, especially as this syndrome presents with such a variety of potential metabolic dysfunctions. Various Chinese herbal formulas are used routinely to promote liver function and vascular health, and are backed by both centuries of empirical evidence and much research and clinical knowldege in China, as well as a growing number of research studies in Europe and the United States. High triglycerides and blood sugars can be quickly controlled in most patients with these formulas, and the treatment goal is to utilize a comprehensive course with acupuncture, herbal formula, nutrient medicines, and advice on diet and lifestyle changes that will result in lasting benefit without dependence on chronic use of the herbal formulas.

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. Bitter melon extract and Coptis chinensis (with berberine) have also been proven as hypoglycemic, and aid treatment of Metabolic Syndrome by indirect means, such as enhancing insulin sensitivity, reducing oxidative stress, stimulation of glycolysis, and improving receptor function for lipoproteins. Better utilization and transformation of sugars or carbohydrates can be helped with a number of herbs which have long been used in Chinese hospitals. 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. 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. 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. 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. 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.

Nutrient Medicines helpful in the treatment of Metabolic Syndrome

While there are many nutrient supplements on the market, particular nutrient medicines may have a marked effect on the metabolic health, often by stimulating deficient metabolic processes with a short course of therapy. While all of these vitamins, amino acids, enzymes, and essential fatty acids may help the metabolism, we can't take them all, and increased knowledge of what to take is very important. In addition, studies of the general population find that true deficiencies of most nutrient chemicals are rare, but that deficiencies of certain nutrients are very common. The common deficiencies noted in population studies are Vitamins B12, B6, B1 thiamin, folic acid, and Vitamin C. These nutrient classifications, though, encompass a variety of chemicals with the same general classification, and quality and type of these nutrients in commercial supplements have proven to be extremely varied. Utilizing the best professional companies, and professional advice from a Complementary Med physician insures that you receive the best and most effective product and course of therapy.

There are some professional formulations that combine a number of the key supplements listed below, although to obtain effective dosage and quality, purchasing individual supplements is the sure bet. One nutrient formula that is recommended is Optimum D from Vitamin Research, which contains Pantothenic acid, B3 Niacin/niacinamide, Biotin, and Chromium picolinate, along with B6, B1, B2, E, C, active folic acid (5MTHF), and various minerals.

• Vitamin B5 Pantothenic acid: an essential nutrient, pantothenic acid is critical in metabolism and synthesis of proteins, carbohydrates, and lipids, as well as enzyme activation and deactivation via signal transduction acylation and acetylation; pantothenic acid is essential to the formation of Coenzyme-A, which is essential to formation of healthy fatty acids, cholesterols, acetylcholine neurotransmitter, and ACP. Marked nutritional deficiency may create insulin sensitivity hypoglycemiz, adrenal insufficiency, fatique, asthenia, restless insomnia, immune disorder, burning sensations and other paresthesias to the feet and hands, muscle cramps, and abdominal cramping. Food sources include endive, escarole, peas, cucumber, watercress, tomato, fava bean, mung bean sprout, steel cut oats, strawberry and avocodo.
• Vitamin B3, Niacin, Niacinamide, and Inositol hexacotinate: the National Institutes of Health have confirmed that niacin is very effective in lipoprotein and cholesterol imbalances, and benefits increase in HDL better than statin drugs, as well as being effective for reducing atherosclerotic plaque accumulations. Niacin and niacinamide are also helpful with gastric hypofunction, a problem frequently misdiagnosed as hyperacidic condition with acid reflux. There are some potential problems with niacin, the chief of which is the sensation of strong heat flush with use in most patients during the first few weeks. This flushing sensation with niacin has been found to be beneficial rather than harmful, though, in studies, and Niacinamide and non-flushing variations of niacin do not produce this flush. B3 Inositol hexacotinate is a niacin variation that is useful in the central nervous system. Excess niacin may worsen glycemic control, and this should be monitored with diabetes, and dosage should be less than 500 mg daily. Seaweeds, such as toasted nori seaweed, hijiki, and wakame, are good sources, as is asparagus, bean sprouts, tomatillo, peanut, and bell pepper. Unprocessed whole grains are also a good source of niacin, lecithin and the best forms of Vitamin E (tocopherols).
• L-Carnitine L-Tartrate: L-Carnitine if a B Vitamin with a structure similar to an amino acid that helps transport long-chain fatty acids, and thus helps utilize fats, prescribed now routinely for high triglycerides, fatty liver, weight loss, and heart disorders. A number of other nutrients can be taken as precursors to increase liver production of carnitine, and this formula consists of Vitamins B6, B1, and C, L-Lysine, zinc methionine, and iron rich foods. Vegetarians are more likely to experience deficiency of L-Carnitine and L-Lysine. L-Carnitine and Niacinamide are prescribed to help induce remission of autoimmune Type 1 Diabetes Mellitus.
• Biotin: This supplement showed dramatic promise in animal studies in resolving impaired glucose tolerance and excess secretion of insulin in Metabolic Syndrome (see study cited below). Biotin is also called Vitamin H or B7, and is important in gluconeogenesis, or conversion of fats and proteins to glucose. It is also vital to synthesis of fatty acids, and is used in the citric acid cycle to create cellular energy. While biotin is more well known for aiding the hair and nails, it is important to metabolic processes and maintaining a steady blood sugar. Deficiency of the enzyme biotinidase is even more common, creating difficulty in utilizing biotin from food or supplement. This enzyme is produced by healthy bacteria in the gut, and is another reason why intestinal dysfunction and bowel irritation are often seen in Metabolic Syndrome. Deficiency of biotin may cause high blood sugar, anemia, hair loss, depression, skin inflammation, and sore tongue and membranes. Biotin is found in brewer's yeast, egg yolk, soybeans, whole grains, saltwater fish and poultry, as well as milk and meat. Biotin has been found to be essential to activation of various carboxylase enzymes that catabolize cholesterol, essential amino acids, and fatty acids, and so supplementation may have quite an effect. Some patients have read that it is healthy to eat egg whites without the yolks, and this dietary habit has resulted in documented biotin deficiency. Biotin deficiency is also seen in pregnancy, liver cirrhosis, and as a side effect of anticonvulsant medications.
• L-Tyrosine: this amino acid is important to overall metabolism, helps reduce excess body fat, and aids in adrenal, hypothalamic, and thyroid function. An added benefit is that it is a precursor for the neurotransmitters dopamine and norepinephrine (adrenalin), which regulate mood and libido. Tyrosine is essential to creation of thyroid hormones by being the active link of iodine to the hormone. Food sources include pumpkin seeds, almonds, lima beans, avocados, sesame seeds, dairy and bananas.
• L-Isoleucine with L-Leucine and Valine: this amino acid helps stabilize and regulate blood sugar levels, and has been found to be deficient in people suffering from a wide variety of mental and physical disorders. A deficiency of isoleucine causes symptoms similar to those of hypoglycemia. Food sources include almonds, garbanzos, lentils, eggs, fish, rye, soy and most seeds. L-Isoleucine should always be taken with the two related branched-chain amino acids listed above, and these are often included in amino acid supplements for athletes, as they help repair muscle tissue. The protein powder Amino Edge from Vitamin Research contains these amino acids with a complete amino acid profile, iron, potassium and selenium. A little more expensive is the Smart Protein powder, with low temperature processing of naturally occurring bioactive proteins and undenature whey protein, combined with calcium, magnesium and potassium.
• Gamma Linoleic Acid plus Omega-3 Fatty Acids: GLA promotes PGE1 (prostaglandin E1), and Omega-3 sufficiency promotes PGE3, which act together to regulate the action of insulin. Avoid excess alcohol consumption, as this depletes PGE1. Sources include: Krill oil for Omega 3 fatty acids, spirulina, blue-green algae, black currants, borage seeds, evening primrose oil, and flax oil. I prefer the GLA from Vitamin Research, which is derived from black currant seed oil, and contains a desirable fatty acid profile with essential linoleic and linolenic acids, as well as the Omega-3 stearidonic acid. A number of Chinese herbs also contain these essential fatty acids in concentration.
• Chromium picolinate: chromium deficiency is still poorly understood, but is linked to poor potency of insulin regulating function. Trivalent chromium is essential for proper metabolism of sugars. Chromium is found in many green and red foods, brewer's yeast, dried beans, whole grains, blackstrap molasses, calf liver, wild mushrooms, and brown rice. It is also available in the herbs red clover, wild yam, nettle, sarsaparilla, and horsetail. Lack of chromium in our soils due to commercial farming has created widespread chromium deficiency in the United States.
• Polilipid - Sytrinol from cirtus and palm fruit extracts: This patented formula from Health Concerns has completed clinical studies that confirm cholesterol reduction, LDL reduction, and reduction of triglycerides by 34% within 4-12 weeks, with positive effects on apoprotein B and A1 levels.
• Bitter melon extract / Momordica charantia: numerous studies have demonstrated significant benefit of bitter melon extract in Metabolic Syndrome, with lowering of blood sugars, and regulation of insulin release demonstrated in cell culture, animal and human studies. This extract also has potent antioxidant and anti-inflammatory effects, and is effective to reduce herpes expression. (see the citation below)
• Turkeytail mushrooms / Coriolus versicolor: these will help regulate the blood sugars as well as act as a potent immune stimulant.

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

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.

1. A German professor and medical researcher referred to Metabolic Syndrome in 1977 as a well-known combination of high lipoproteins, high blood sugar, fatty liver, obesity and excess uric acid, with abnormal clotting factors and blood viscosity increasing the incidence of atherosclerosis: http://www.ncbi.nlm.nih.gov/pubmed/883354
2. A 2008 review of research data concerning Traditional Chinese Medicine and herbal formulas and specifics in the treatment of Metabolic Syndrome at the Pennington Biomedical Research Center of Louisiana State University: http://www.ncbi.nlm.nih.gov/sites/entrez
3. A 2006 review of the scientific evidence concerning bitter melon extract and lowering of blood sugars at the Justus-Liebig University Institute of Nutritional Science in Giessen, Germany: http://www.ncbi.nlm.nih.gov/pubmed/16910221
4. A 2008 study at the Pennington Biomedical Research Center of Louisiana State University, found that a number of Chinese herbs are useful in the management of Metabolic Syndrome, including the most well-studied American Ginseng, Coptis chinensis, and bitter melon extact: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2467395/?tool=pmcentrez&report=abstract
5. A 2011 study at China Academy of Chinese Medical Sciences in Beijing, China, Guanganmen Hospital, elucidated that ways that Coptis chinensis (Huang lian) improves sugar metabalism and aids reversal of insulin resistance in Diabetes type 2 or Metabolic Syndrome. Tests revealed that herbal formula with Coptis improved glucose tolerance, lipid metabolism, reduced serum leptin levels without affecting adiponectin, and improved muscle cell utilization of glucose.: http://www.ncbi.nlm.nih.gov/pubmed/21213398
6. A 2008 study at The University of Hong Kong, York University and other institutions, found that the herb astragalus increased adiponectin production and decreased insulin resistance in the treatment of Metabolic Syndrome, in preliminary studies with animals: http://endo.endojournals.org/cgi/content/abstract/150/2/625
7. 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?
8. 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
9. 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
10. 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 are not only ineffective, but actually increased cardiovascular risk for most patients: http://www.nytimes.com/2010/03/15/health/research/15heart.html
11. Studies in 2010 of the general population found a significant variance in incidence of high blood sugar and HDL lipoprotein, as well as high blood pressure, between summer and winter, indicating that diagnosis and management is more complex than we thought: http://www.ncbi.nlm.nih.gov/pubmed/20300109
12. Studies in 1996 in Japan found that supplementing with biotin corrected impaired glucose tolerance and decreased excess insulin in laboratory animals with Type 2 Diabetes or Metabolic Syndrome: http://www.ncbi.nlm.nih.gov/sites/entrez
13. 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
14. 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
15. 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
16. 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
17. Studies in 2010 at the Chongqing Medical University in China found that electroacupuncture could significantly lower total cholesterol and triglyceride levels, acting in a similar fashion to the hypothalamic leptin stimulating effects noted with electroacupuncture. These effects were measure using just 2 points, ST40 and ST36: http://www.ncbi.nlm.nih.gov/pubmed/21090330

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.