Diabetes and Metabolic Syndrome
Diabetics have a problem with insulin, the hormone that keeps blood sugar within healthy levels.
|Type 1 diabetes, previously called insulin-dependent diabetes mellitus or juvenile-onset diabetes.
It is a malfunction of the pancreas, a progressive autoimmune disease, in which the beta cells that produce insulin in the pancreas are slowly destroyed by the body's own immune system. There is no consensus as to what is the autoimmune trigger. Without insulin to move glucose (blood sugar) into cells, blood glucose levels become excessively high - hyperglycemia.
The body cannot utilize the sugar; it spills over into the urine and is lost.
Type 2 diabetes, previously called non-insulin-dependent diabetes mellitus or maturity-onset diabetes.
It begins with insulin resistance – much more insulin is required to move glucose into cells. In time, the pancreas "burns out," it cannot produce enough insulin to overcome resistance. There is usually an abnormal rise in blood sugar after a meal. Eventually, the cycle of elevated glucose further impairs and possibly destroys beta cells, thereby stopping insulin production completely and causing full-blown diabetes.
An estimated 85-90 percent of those who have diabetes have type 2 diabetes. It used to be called the "adult" version of the disease because it comes after decades of eating an unhealthy diet. However, increasing numbers of children are now developing type 2 diabetes, partly because today's kid-food is laden with sugar, refined carbohydrates, and bad fats. In addition, the children's mothers (and sometimes grandmothers) also ate diets laden with sugar, refined carbohydrates and unhealthy fats, thus modifying their genetic expression. By so doing, they were able to pass the predisposition for diabetes on to following generations, whether they themselves developed diabetes or not.
If for years you eat more sugar than is needed by the muscles for exercise, you strain the pancreas, asking it to make excess insulin constantly to lower your blood sugar level. Eventually, the pancreas cannot make enough insulin, and the blood sugar level remains chronically high. At this point, the patient is diagnosed with diabetes.
Controlling blood sugar is one of the most fundamental requirements of life. When blood sugar levels are too low – less than 80 – that is hypoglycemia. When levels are too high – over 110 – that is hyperglycemia. Insulin is the hormone that "unlocks" the cells of the body, allowing glucose to enter and turn food into energy.
A fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes.
So why doesn't everyone develop diabetes? Why can some people eat junk food for years without problems, where others develop diabetes in their youth? Part of it is in your genes. We know that more than 50% of the relatives of diabetics demonstrate insulin resistance decades before they develop overt diabetes.
The Killing Effect of Diabetes
Diabetes can lead to multiple complications including blindness, kidney failure, nerve damage, heart disease, and Alzheimer's.
Diabetics have two times the incidence of an acute coronary syndrome (ACS) and two times the mortality rate after ACS compared with patients who do not have diabetes. Diabetes appears to blunt some of the effects of estrogen, which may increase the risk for heart disease. Studies have shown that many diabetics suffer from depression, which sometimes interferes with self-care. Other studies link diabetics to a 65 percent higher risk of developing Alzheimer's disease.[4,5]
Uric acid is often elevated with metabolic syndrome and diabetes because of the high blood sugar level. Hyperuricemia is presumed to be a consequence of insulin resistance rather than its precursor. Excess uric acid levels can lead to gout, kidney stones, and heart disease.
Too much sugar causes the small blood vessels throughout the body to narrow. That is your body's way of trying to head off damage to organs by minimizing the ability of the excess sugar to reach them. The higher the blood sugar level, the less nitric oxide is available , and the more the small blood vessels narrow. Circulation is impaired. If there is adequate glutathione in the system for dealing with free radicals, the negative circulatory effect does NOT occur. But in the relative absence of glutathione, poor circulation develops, in turn resulting in complications such as: kidney disease, poor wound healing, and foot and eye problems. High sugar levels damage the kidneys so that they can no longer fully cleanse the blood of waste. Sugar imbalance also alters fat metabolism, causing people to gain weight. When sugar sticks to proteins, it changes their structural and functional properties. Wounds do not heal because they have trouble making good collagen, the connective tissue that is the major structural protein in the body.
This is also why sugar is sometimes called, "the aging drug."
Insulin run Amok
A study reported in 2009 [5a] shed new light on the conventional wisdom that when we eat a calorie-restricted diet, we live longer. But this new study looked deeper and found that the underlying reason for longevity is – less sugar, thus fewer surges of insulin.
Researchers studied 31 patients referred for the treatment of diabetes, cardiovascular disease, excessive weight, fatigue, and other chronic diseases of aging. The group ate a very specific diet for 3 months:
"The diet included unlimited amounts of certain fats and oils, a restricted amount of protein, and a very limited amount of carbohydrate. Patients were told to eat when they were hungry. Calories were not explicitly restricted; calorie intake was determined only by levels of hunger. Recommended sources of fat included raw nuts and seeds, avocados, olives and olive oil, flax oil and cod liver oil. The intake of protein was told to be limited to approximately 1.0 grams/kg lean body mass per day (increased for exercise to 1.25 grams/day). As a result, most patients were instructed to eat from 50-80 grams of protein per day. Recommended sources of protein included sardines, fish, eggs, tofu, chicken, turkey, wild meats, low-fat cheeses (cottage, ricotta, swiss), seafood, and veggie burgers. Only non-starchy, fibrous vegetables were acceptable: lettuce, greens, broccoli, cauliflower, cucumbers, mushrooms, onions, peppers, sprouts, asparagus, and seaweed. Though not explicitly stated, the general dietary intake as percent daily caloric intake from macronutrients for most people ended up by history to be approximately 20% carbohydrate, 20% protein, and 60% fat. For drinking, 6-8 eight ounce glasses of water and/or herbal tea were recommended.
And what happened on this "high fat, adequate protein, low carbohydrate diet"?
"Nutritional supplements to support fat metabolism and enhance insulin sensitivity were recommended to all patients to be taken on a daily basis: L-carnitine 2000mg, alpha-lipoic acid 400mg, coenzyme Q10 100 mg, 1 tbsp cod liver oil, magnesium 300mg, potassium 300mg, vitamin C 1000mg, vitamin E 800mg daily, and a multivitamin consisting of all essential B vitamins and minerals."
• Patients lost an average of 7 pounds
• Insulin levels dropped almost in half
• Leptin levels dropped almost in half
• Triglyercides and blood pressure levels dropped
These great results were achieved on a high fat diet, the antithesis of what Americans are told to eat. Note there were no starchy carbs (corn, potatoes, bread), no grains (rice, wheat, gluten), no modern fats (margarine, vegetable oils) no fried foods, and no sugar. Seaweed served as a natural source of iodine.
This is a clear illustration of the dietary wisdom from centuries ago when natural fats were a much higher percentage of the diet. It has been known for some time that different dietary fats appear to have varying effects on insulin-sensitive tissues.
Less starchy food, less sugar and carbohydrate in the blood lowers triglycerides and fatty acids in the blood by simply not producing them - because these are produced in response to high glucose levels. Less sugar and carbohydrate promotes the break-down of fats (to use as calories, or energy) in the liver, fatty tissue and blood.
The researchers also pointed out that centenarians – people who live to be more than 100 – have lower blood glucose, insulin, leptin, and serum triglycerides than those who do not live to be over one hundred years old.
Reducing sugar consumption can add years to your life.
The "civilized" diet has been so full of sugar, refined carbs that rapidly turn into sugar, and trans fats, that many people have become "pre-diabetic." The medical term for this is metabolic syndrome, and it is a disease of the 21st Century.
|Refined carbohydrates – most or all of the fiber, bran, hull, vitamins, minerals, essential fatty acids, and phytochemicals have been removed during milling or processing.
The process prolongs shelf life, but it also removes important nutrients, such as B vitamins and fiber.
If any of the B vitamins are not available, the conversion of carbohydrates to energy is blocked. Instead, the carbs are converted to fat in the human body.
Refined carbohydrates are made from flour, corn, rice, beets, cane, and fruit.
Refined carbohydrates have a higher sugar content.
The body assimilates refined sugar, fructose, very differently than naturally occurring sugar, sucrose. Sucrose stimulates the production of insulin and leptin, which help regulate food intake and body weight. Fructose over-stimulates insulin, causing problems with rapidly falling blood sugar levels (Bray, 2004). Leptin has also been correlated with weight gain and food cravings (Abelson, 2004).
Until the advent of agriculture some 10,000 years ago, concentrated sugars and refined grains were absent from the human diet.
Twenty-four percent of adults in the United States already qualify for this diagnosis. The syndrome is increasingly diagnosed in children. For the first time in recorded history, it is suggested that, if the current trend in obesity continues into the next generation, our children may have a lower life expectancy than we have ourselves.
Criteria for diagnosis of the metabolic syndrome include at least 3 of the following 5 things:
• a waist circumference of more than 40" in men, and more than 35" in women
• elevated triglycerides (>150),
• low HDL cholesterol (<40 in men, <50 in women)
• high blood pressure (>135/85)
• fasting blood sugar levels of 110 mg/dL or greater
So, we see the family practice doctor or internist for our high blood pressure and high cholesterol. We try to lose weight the best we can – by eating egg whites, avoiding fat whenever possible, drinking diet sodas – and still we find that we gain weight. The doctors give us prescription drugs to lower our cholesterol and blood pressure, but we do not feel well.
How many people do we all know who are chubby around the middle? How many of our friends are taking high blood pressure medicine and statin drugs for their "cholesterol"? And these are the folks who consider themselves healthy, because by all insurance-based criteria, they are healthy. Their disease is "well managed."
In fact, they do not have a defined disease. They have diagnostic codes, for which they see multiple specialists, and are given multiple drugs as a "preventative" measure. They are advised to return for follow-up, so that when they get sick enough, they can be given more drugs. As Jeffrey Bland so eloquently put it, "somewhere along the line they will develop a 'clean' diagnosis – myocardial infarction, diabetes, stroke, cardiac arrest... In the meantime, they take medicine, eat refined flour, sweets, diet sodas, low-fat manufactured foods... and become more obese, and more ill, until finally their 'diagnosis' becomes apparent."
Insulin is the transporter of glucose across the cell membrane. But it serves other functions as well.
When our bodies think they are under stress, they shift to "storage" mode – to store up fat against the hard times coming, when game is not plentiful and we need every ounce of fat we can store if we are to survive the winter season. Most of us do not have the issue of survival through the winter season any more. But unlike our caveman ancestor who had periodic bouts of stress, we have constant daily stress. We are always fighting the clock, always trying to do more in less time, always shorting ourselves on sleep, always in a hurry... And what does the body do under stress? It stores up fat for the hard times ahead.
To take it one step further – cellular signaling depends on the information coming into the cell, and the state of health of the cell itself. A cell under stress reads somewhat different signals than a healthy cell, and therefore sends out different signals. Not all calories are alike. Is it not possible that meat from animals raised under stressful conditions with hormones and steroids inevitably imparts those stress signals to those of us who eat the meat?
So, one way to treat the metabolic syndrome is to relieve stress. Set realistic goals. Learn to say "no." Read a good book. Get enough sleep. Stop putting chemicals into our bodies. Drink water, not sugar. Eat food, not chemicals.
REDUCING BLOOD SUGAR LEVELS
Besides stress, what else contributes to the body's inability to successfully regulate blood sugar levels?
High Fructose Corn Syrup (HFCS)
HFCS doesn't actually exist in nature. It is a man-made product created by using enzymes to increase the fructose content of corn syrup to about 90%. This super high fructose syrup is then blended "down" with a 100% glucose corn syrup to create various mixes. HFCS 55, for example, which is 55% fructose and 45% glucose is the mix used most commonly in beverages. HFCS 42 is the blend used more commonly in baked goods.
Fructose is absorbed differently than other sugars, and fructose isolate as found in high fructose corn syrup even more so. It causes major health problems.
• When the liver is asked to handle such large quantities of fructose, there is rapid breakdown of fats and rapid accumulation of triglycerides, which in turn contributes to reduced insulin sensitivity, insulin resistance, and glucose intolerance.
• Unlike glucose, fructose doesn't stimulate insulin production, which means it isn't utilized for energy, but rather is stored in the liver as triglycerides.
• HFCS doesn't increase production of leptin or suppress production of ghrelin, hormones that play a primary role in appetite control. The sweet taste of HFCS encourages you to eat more. And there comes the weight gain and obesity.
Simply put, "good carbs" are vegetables, "bad carbs" are potatoes, pasta, breads, cereals, cookies, chips, crackers, donuts, instant rice and instant oatmeal. Bad carbs are pure carbohydrates that your body converts to sugar. Bombarding your system with these foods every day makes your pancreas work overtime to produce insulin - and wearing it out. So next time you see a hamburger on a bun – envision a beef patty sandwiched between two disks of sugar.
|Hydrogenation - hydrogen is forced into heated vegetable oil. This changes the chemical structure so the oil will become more solid. Fully hydrogenating oils will make them too solid, difficult to use for cooking. To keep margarine or shortening slightly soft, those oils are only partially hydrogenated. When oils are only partially hydrogenated, the molecules of the partially hydrogenated oils form trans configurations, which means the oil molecules have an unnatural shape for fat molecules.
Fully hydrogenated oils do not contain trans fat. However, if the word "hydrogenated" is used without the word "partially," that product may contain partially hydrogenated oil. Not all labeling is accurate and the word "partially" may have been omitted on some products.
Under FDA regulations, "if the serving contains less than 0.5 gram [of trans fat], the content, when declared, shall be expressed as zero." So if 4 food items on your plate contain 0.4 grams per serving, you have just consumed 1.6 grams of trans fat, despite the fact that the package claims that the product contains zero grams of trans fat per serving.
Consumer beware in the marketplace. Products labeled "whole wheat" or "whole grain" in the typical grocery store will probably not meet the criteria for lowering the risk of metabolic syndrome. Increasingly, people have an inflammatory reaction to the gluten in wheat and some other grains. Instant oatmeal is processed and is much higher on the glycemic index than the old fashioned steel cut oats which are much less processed and take 10 minutes or more to cook.
Plastic-derived chemicals like Bisphenol-A (BPA) increase the risk of diabetes and obesity. BPA is an endocrine disrupter that mimics the hormone estrogen. Testing performed by the CDC discovered that about 93% of the United States population has BPA in their body at a median concentration of 2.7 ppb.
Repeated exposure to BPA causes insulin resistance at the cell level, which leads to type II diabetes. Tissues lose their sensitivity to insulin, causing the pancreas to produce even more insulin, further increasing insulin resistance and diabetes. This leads to a progressive cycle that reinforces itself.
Partially hydrogenated oils are a leading cause of type 2 diabetes and heart disease. They change the proteins in our bodies in such a way as to reject insulin. The pancreas makes insulin, but the body can't use it.
"Good" fats such as those from grass-fed animals do not contribute to diabetes. But trans fatty acids in partially hydrogenated vegetable oils cause insulin resistance. When these man-made fats get built into the cell membrane, they interfere with the insulin receptors. Trans fats harden the cell walls, making it harder for nutrition to get in and metabolic waste (toxins) to get out. Partially hydrogenated vegetable oils are often found in processed, high-carbohydrate foods – chips, cookies, French fries, crackers, donuts, and margarine.
Some food producers are phasing out partially hydrogenated oils because trans fats have been linked to heart disease and obesity. For certain products, such as baker's shortening and margarine, some companies are turning to interesterified fats.
Interesterified fats are typically created by blending solid fats like fully hydrogenated soybean oil or palm oil with liquid oils (e.g., soybean oil, canola oil) and then using a process to interchange the fats in order to achieve specific attributes in foods such as texture, mouth feel, and structure. Interesterified fats are solid or semi-solid at room temperature. You may find them in margarines, spreads and shortenings, and in confections and baked goods.
Interesterification shuffles the fatty acids that make up each fat molecule. Like partial hydrogenation, interesterification produces molecules that do not appear in nature. In a small study, interesterified fat raised blood-glucose concentrations in the people studies and slowed the metabolism of glucose relative to the effects of either of the other fats. Both those changes are associated with increased diabetes risk.
In the United States, the number of people with type 2 diabetes is increasing, while the average amount people sleep is dwindling, according to a sleep survey by the Centers for Disease Control and Prevention. Those two conditions appear to be linked.
In 2008, researchers found that a mutation called rs1387153, near a gene called MTNR1B, is associated with having an increased average blood sugar level and around a 20 percent elevated risk of developing type 2 diabetes.
MTNR1B forms part of a signaling pathway that controls the action of the hormone melatonin. This hormone regulates the body's circadian rhythm - the internal clock that controls sleeping and eating patterns - by responding to daylight and darkness.
The research places bodily rhythms, including the clock that sets human sleep cycles, squarely in the blood sugar business. Three new genomic studies show that melatonin, a major regulator of the body's sleep clock, is closely linked to increased glucose levels and diabetes.
Too few antioxidants
There is evidence that the ratio of antioxidants to free radicals plays a role in the development of insulin resistance and type 2 diabetes. Antioxidant levels are typically low in overweight people, while research shows that the production of free radicals may increase in bodies that carry too much fat.
Too little vitamin E?
As reported in the journal Diabetes Care, the Otago researchers recruited 80 overweight men and women whose ages ranged from 31 to 65. To test the effects of vitamin E on glucose and insulin, as well as ALT levels, half the group received 800 IU of vitamin E per day for three months, while the other half took a placebo. At the end of this first phase of the study, the dosage in the vitamin E group was increased to 1,200 IU for an additional three months.
At the end of the first three-month phase, both glucose and insulin levels were considerably reduced, lowering the likelihood of developing the insulin resistance that leads to type 2 diabetes. Unfortunately, the reduction in glucose and insulin levels did not remain steady through the second phase of the study. The researchers note that although vitamin E had a positive impact on oxidative stress, additional studies will be needed in order to clear up the mystery of the fluctuation in glucose and insulin. But throughout the full six months of the study, ALT concentrations had a marked decline. This is significant because elevated ALT indicates the possible onset of diabetes, as well as cancer and other liver diseases.
Too little vitamin D
Three-quarters of children with type 1 diabetes were found to have insufficient levels of vitamin D, according to a study by researchers at the Joslin Diabetes Center. The study appeared in the January 2009 issue of The Journal of Pediatrics. It measured levels of serum 25-hydroxyvitamin D in 128 youths with type 1 diabetes ranging in age from 1.5 to 17.5 years.
Vitamin D, the "sunshine vitamin," is a gene regulating nutrient. The lack of it sets the stage for autoimmune problems - including damage to the pancreas that can cause type I diabetes.
Mother's diet during pregnancy
DNA is the primary mechanism of inheritance; kids get half their genes from mom and half from dad. However, scientists are just starting to understand additional kinds of inheritance like metabolic programming, which occurs when an insult during a critical period of development, either in the womb or soon after birth, triggers permanent changes in metabolism.
UK researchers from the Royal Veterinary College, led by Dr. Stéphanie Bayol, found that feeding mother rats junk food during pregnancy and lactation to an increased preference for fats and sugars in their offspring. Perhaps the biggest surprise here came after birth. Some rat mothers were switched from the junk diet to nutritionally-balanced rat chow and spent their days nursing the rat pups. When weaned, those pups did not have the same strong preference for junk food as the pups whose mothers were still eating the junk diet while lactating. The study's authors conclude that a mother's "nutrition during lactation might play a key role in influencing the long-term appetite of the offspring" for junk food.
When we, as physicians, work with our patients, we need to realize that we may not be dealing just with the patient sitting before us, but also their children and grandchildren, whether born or yet unborn. This puts a whole new twist on the concept of "family medicine".
IS DIABETES A MEDICAL OR SOCIAL ISSUE?
The British medical Journal, The Lancet, delivered a stern editorial blast regarding the treatment of diabetes. The cover of the June 26, 2010 issue says,
"Medicine might be winning the battle of glucose control, but it is losing the war against diabetes."
The editors explain that although the June issue contains various studies that represent great progress in the understanding of how to lower concentrations of blood glucose, there is a glaring absence: no research to report on lifestyle interventions to prevent or reverse diabetes.
"Since 2000, the number of people [worldwide] with diabetes has more than doubled … even if care was widely accessible, increasing evidence suggests that glucocentric treatment might not result in better overall outcomes… Because type 2 diabetes, which accounts for 90% of diabetes, is largely rooted in reversible social and lifestyle factors, a medical approach alone is unlikely to be the solution. Moreover, medicalisation disempowers individuals and excludes communities, schools, and urban planners who have the potential to reduce diabetes incidence... To lessen the burden of diabetes requires a substantial change in diet and routine, such as that advocated by Michelle Obama's Let's Move campaign... The fact that type 2 diabetes, a largely preventable disorder, has reached epidemic proportion is a public health humiliation."[16a]
The majority of doctors in America work in environments where the average patient appointment is about ten minutes – long enough to whip out a prescription, but far too short to educate patients how to eat fresh, nutrient-dense food instead of processed products with additives in bags and boxes. The national health care reform that passed in 2010 said nothing about the creation of health through nutrition. The conventional medical school curriculum says precious little about nutrition. We have a long way to go.
Perhaps a future editorial will note that a key distinguishing feature between conventional medicine’s Standard of Care and the approach taken by most of us who practice Complementary and Alternative Medicine is the difference in the emphasis on food as medicine.
Standard medical treatment offers drugs like metformin which inhibit the absorption of high glycemic carbohydrates in the intestinal tract and enhance insulin sensitivity in the body, thereby reducing the need for extra insulin. Side effects of metformin range from mild loss of appetite, nausea, vomiting, abdominal discomfort, cramps, flatulence and diarrhea, to lactic acidosis where the cells of the body do not get enough oxygen to survive because so much lactic acid has built up in the blood.
Drugs like glyburide work by stimulating the pancreas to release more insulin. But it doesn't repair beta cells; it just forces them to work harder which speeds up the day when they break down and become dysfunctional.
At the Arizona Center for Advanced Medicine, we can often repair some of the damage to the insulin mechanism. We look first at the diet – the fuel which is being presented to the body. Then we look at the metabolism, to see where processes may be distorted – are there kinks in the fuel line? Colonics can help with that by restoring good function to the colon. We look at the information systems which direct the metabolism – are all the cables connected correctly?
For those with a stubborn weight issue – that hard to lose belly fat that drives chronic inflammation – we use a medically managed program that will cause you to shed the weight, safely. We also make use of FirstLine Therapy to easily transition you to a new way of eating for a lifetime, with emphasis on lower blood sugar levels. We modify the diet, to include lots of "clean" meats, fruits and vegetables, and eliminate the high inflammatory foods – sugars, starches, additives, colorings and chemicals. Remember, if you can't pronounce it, it probably isn't good for you, even if the FDA says it's OK as an additive. Nobody ever suffered from a deficiency of aspartame , BHA or BHT.
We also use herbal medicine to help restore the body's sensitivity to insulin, so that we can eliminate pharmaceutical medication. We monitor blood work, to make sure that the markers are improving. We may even look at total body burden of heavy metals, since it is known that heavy metal toxicity can cause "unexplained" high blood pressure.
Diabetics can't be couch potatoes; you need to work the muscles to lower your blood sugar level. You can't be a comfortable couch potato if you are constipated. And in the end, with diet change and exercise as a way of life, the syndrome is reversible. It is possible to become restored to excellent health. It simply takes resolve and some diligent work.
Sometimes, diabetes and metabolic syndrome can be addressed on an energetic level. Let me share one woman's story:
It is possible to become restored to excellent health. It simply takes resolve and some diligent work.
A woman with diabetes recalled that her parents were always fighting, that there was a lot of screaming and yelling in the house. She had a memory that when she was just one year old, she was put down for nap and said to herself, "I give up." When she awoke, she was in the hospital with acute onset Type 1 diabetes.
When I knew her, she was on her second transplanted kidney, and had lost some toes to amputation. She died at age 41.
The energetic link is that diabetes occurs in the pancreas which is located in the solar plexus chakra – our power chakra, how we deal with the world. It is almost always associated with some issue of power versus force. I have found this to be often true in Type I, and sometimes also type II, diabetes. Sometimes energetic medicine can release these kinds of blockages.