Diabetes: A Naturopathic Approach

Diabetes mellitus is a chronic degenerative disease affecting multiple organ systems and that results from the inability to regulate blood sugar—also called glucose—due to problems in the function of the hormone insulin.^[1]

Diabetes had been called “the epidemic of the 21st century” because it is increasingly affecting more and more people; this year, it is estimated that approximately 13% of the Canadian population has diabetes.^[2] Natural strategies are effective in improving the management of this common but yet quite serious condition.

Diabetes is diagnosed through several tests, including a fasting blood glucose level equal to or greater to than 7.0 mmol/L; blood glucose equal to or greater than 11.0 mmol/L in response to a 75 g glucose load, 2 hours after ingestion; or a hemoglobin A1C value equal to or greater than 6.5%.^[3] Hemoglobin A1C (HbA_1c) is a blood marker that correlates with the average blood glucose levels over the previous three months. While blood glucose fluctuates rapidly in response to food intake and even from day to day, HbA_1c is a valuable indicator of blood glucose levels over a longer but recent period of time. Therefore, HbA_1c is used to assess how well diabetes is being managed, since it reflects a three-month average.

Several large studies have assessed the use of diet-and-lifestyle strategies to prevent diabetes. The Diabetes Prevention Program and the Finnish Diabetes Prevention Program examined intensive diet-and-lifestyle strategies in people with prediabetes.^[4, 5] The program was a comprehensive diet-and-lifestyle program of individualized counseling aimed at reducing weight, total intake of fat, and intake of saturated fat, while increasing intake of fibre and physical activity. At the end of three years, 11% of subjects in the treatment group developed diabetes, while 23% of the control group had diabetes, a decrease of ~58%.^[4]

Furthermore, when analyzed by how compliant subjects were in adhering to the program, those who met four of five targets throughout the program did not develop any case of diabetes, a most remarkable outcome!^[4]

Targets for these studies were:

• Weight reduction of 5% of initial body weight
• Fat intake < 30% of energy intake
• Saturated fat intake < 10% of energy intake
• Fibre intake ≥ 15 g per 1000 kcal
• Exercise > 4 h per week

In addition to diet-and-lifestyle, key nutritional supplements can benefit patients with diabetes, both with reducing risk of complications and helping to improve blood glucose levels. A good-quality fish oil supplement is most important for reducing the risk of heart disease, which is higher in diabetics.^[6]

With respect to improving blood glucose levels, vitamin D has been shown to improve insulin sensitivity in diabetic patients with low vitamin D.^[7] Two other supplements, alpha-lipoic acid (ALA) and chromium, are also of interest. ALA has been shown to improve insulin sensitivity and glucose levels in combination with inositol,^[8] and may help promote weight loss in combination with EPA from fish oil.^[9] In addition, ALA has tremendous evidence with respect to protecting nerves from damage due to high glucose and improving diabetic neuropathy, which results in severe nerve pain.^[10] Chromium has been shown to improve the activity of insulin and lower blood glucose levels.^[11]

Patients with diabetes are monitored for blood pressure as well; the goal is to keep blood pressure under 130/85. Coenzyme Q₁₀ at 200 mg per day can lower blood pressure by up to 10 points.^[12] Finally, an intriguing emerging agent for diabetes is Hibiscus sabdariffa. Recent studies have shown that hibiscus possesses an impressive profile of metabolic effects, lowering blood pressure by up to 10 points—comparable to an entry-level blood-pressure medication.^[13] In addition, hibiscus has been shown to improve blood glucose and cholesterol.^[13–15]

References

1. American Diabetes Association. “Standards of medical care in diabetes—2012.” Diabetes Care Vol. 35, Suppl. 1 (2012): S11–S63.
2. Leong, A., et al. “Estimating the population prevalence of diagnosed and undiagnosed diabetes.” Diabetes Care Vol. 36, No. 10 (2013): 3002–3008.
3. Canadian Diabetes Association. Screening & Diagnosis · http://guidelines.diabetes.ca/ScreeningAndDiagnosis.aspx
4. Tuomilehto, J., et al. “Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.” New England Journal of Medicine Vol. 344, No. 18 (2001): 1343–1350.
5. Knowler, W.C., et al. “Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.” New England Journal of Medicine Vol. 346, No. 6 (2002): 393–403.
6. [No authors listed.] “Dietary supplementation with n-⁠3 polyunsaturated fatty acids and vitamin E after myocardial infarction: Results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico.” Lancet Vol. 354, No. 9177 (1999): 447–455.
7. Belenchia, A.M., et al. “Correcting vitamin D insufficiency improves insulin sensitivity in obese adolescents: A randomized controlled trial.” American Journal of Clinical Nutrition Vol. 97, No. 4 (2013): 774–781.
8. Capasso, I., et al. “Combination of inositol and alpha lipoic acid in metabolic syndrome-affected women: A randomized placebo-controlled trial.” Trials Vol. 14 (2013): 273.
9. Huerta, A.E., et al. “Effects of α-lipoic acid and eicosapentaenoic acid in overweight and obese women during weight loss.” Obesity Vol. 23, No. 2 (2015): 313–321.
10. Ibrahimpasic, K. “alpha Lipoic acid and glycaemic control in diabetic neuropathies at type 2 diabetes treatment.” Medical Archives Vol. 67, No. 1 (2013): 7–9.
11. Paiva, A.N., et al. “Beneficial effects of oral chromium picolinate supplementation on glycemic control in patients with type 2 diabetes: A randomized clinical study.” Journal of Trace Elements in Medicine and Biology Vol. 32 (2015): 66–72.
12. Ho, M.J., A. Bellusci, and J.M. Wright. “Blood pressure lowering efficacy of coenzyme Q₁₀ for primary hypertension.” Cochrane Database Systematic Reviews No. 4 (2009): CD007435.
13. Gurrola-Díaz, C.M., et al. “Effects of Hibiscus sabdariffa extract powder and preventive treatment (diet) on the lipid profiles of patients with metabolic syndrome (MeSy).” Phytomedicine Vol. 17, No. 7 (2010): 500–505.
14. Mozaffari-Khosravi, H., et al. “The effects of sour tea (Hibiscus sabdariffa) on hypertension in patients with type II diabetes.” Journal of Human Hypertension Vol. 23, No. 1 (2009): 48–54.
15. Mozaffari-Khosravi, H., et al. “Effects of sour tea (Hibiscus sabdariffa) on lipid profile and lipoproteins in patients with type II diabetes.” Journal of Alternative and Complementary Medicine Vol. 15, No. 8 (2009): 899–903.