Diabetes - A Holistic Approach
Diabetes is a term that most of us have become well acquainted with. Unfortunately, more and more Canadians are becoming aware of diabetes through direct personal experience. It is becoming an epidemic in our country, a fact confirmed by the Canadian Diabetes Association. As of 2010, there were 2.7 million Canadians with diabetes. This number is expected to rise to 4.2 million by 2020, which means the rates are roughly doubling every decade and the increase is picking up speed. Canada’s aged population is growing and 60% of Canadians are either overweight or obese. Both of these factors, combined with an increase in sedentary lifestyle, are contributing to the increase in numbers.(1) Even more troublesome is the fact that when the numbers of pre-diabetic cases are included, we find that 9 million Canadians are struggling with this condition. That’s 1 in 4, or 25% of the population.(2)
Considering that type 2 Diabetes is 30 times more common than type 1 and that many cases of type 2 diabetes can be prevented, if we can learn to understand what diabetes is and how it works, we can reverse this trend and protect ourselves from this difficult condition. Before discussing treatment and prevention methods, we must first examine the nature of diabetes is and how it develops.
What Is Diabetes?
Diabetes is characterized by blood glucose concentrations that are high enough to overwhelm the reabsorption capabilities of the kidneys. One of the main functions of the kidneys is to decide what stays in the bloodstream and what leaves via the urine. Glucose does not get filtered out of blood at the kidneys, instead virtually all is reabsorbed into the blood and normally urinary glucose levels are negligible. When blood glucose levels get too high, the kidneys are unable to handle the excess. Glucose begins to appear in the urine and urine production becomes excessive.
In the pancreas, the cells responsible for the regulation of blood sugar are called Beta cells, which produce insulin – the hormone which lowers blood glucose by increasing the uptake and utilization of glucose by most body cells.(3) When glucose cannot be taken into the cells, the cells lack the energy they need and the glucose simply remains in the blood stream. This situation causes a host of other health problems, some of which can be fatal.
There are other causes of impaired glucose tolerance, but diabetes is by far the most common. Other causes include pregnancy (see gestational diabetes) and thyrotoxicosis (presence of excess thyroid hormones).(4 p463)
Types of Diabetes
Type 1
This type, known as Juvenile Diabetes is considered an autoimmune disorder where the immune system attacks the pancreatic beta cells. The result is that the pancreas cannot manufacture insulin and therefore this condition requires a lifetime of daily insulin therapy. That is why this is also known as Insulin-Dependent Diabetes Mellitus. There is a genetic risk for this condition, and any herbal treatment or any other form of holistic medicine will play a secondary role to orthodox medicine (insulin therapy).(5 p1083) Having said that, many of the preventative and treatment techniques discussed in this article can help to normalize blood sugar in those with Type 1 Diabetes.
Type 2
This is also known as Adult Onset, or Non Insulin-Dependent Diabetes Mellitus. In this condition, prolonged and recurrent exposure to elevated blood sugar levels (largely due to high intake of refined carbohydrates), results in sustained elevation of insulin. This creates a loss of sensitivity by cells of the body to the effects of insulin, and as a result, the glucose remains in the blood stream and cannot enter the cells where it is needed. Later, as the pancreas becomes exhausted from insulin overproduction, insulin levels drop, making the problem of glucose in the bloodstream much worse. The majority of people with Type 2 Diabetes are overweight or obese, a correlation that will be explored further in the next section.(5 p1084) Herbal Medicine can be an effective primary treatment for this condition. It can be prevented and in some cases even reversed by dietary changes, lifestyle changes and herbs alone.
Metabolic Syndrome
This is a broad term used to describe numerous abnormalities triggered by high intake of refined carbohydrates, elevated insulin and insulin resistance.(5 p1084)
Gestational Diabetes
This is a “temporary condition that occurs during pregnancy. It affects approximately two to four per cent of all pregnancies (in the non-Aboriginal population) and involves an increased risk of developing diabetes for both mother and child”.(6) Normally blood sugar levels return to normal on there own shortly after delivery.
As Type 1 is far less common and requires the supervision of a medical doctor to treat, the rest of this article will focus on Type 2 diabetes – a form that responds very well to self-care. Type 2 is commonly self-induced, as a result of poor dietary and lifestyle choices but that also means that we can make some positive changes to avoid this disease, which will have a profound effect on our overall health as well. Now that we know what it is, we need to understand why we get it.
What Puts Us At Risk?
Diet, Exercise and Lifestyle all play major roles in the development (or prevention) of Type 2 Diabetes. Whole foods that retain their natural fibre and fat contents release their glucose slowly, whereas refined, high-carbohydrate foods elevate the blood sugar quickly and to a great degree. The body must respond to this massive and rapid increase in blood sugar with an equally massive and rapid release of insulin. A yo-yo effect is created between high blood sugar and high insulin release, which puts great stress on the pancreas. It is very important that the glucose in your blood stream gets to where it’s supposed to go, rather than floating around in circulation. Glucose in the blood stream is somewhat fragile and oxidizes easily, which can cause significant damage to tissues, particularly the blood vessels. High intake of trans fats will increase oxidative stress, and a low intake of antioxidants will do the same – a perfect storm of cardiovascular trouble, all based on what we eat.(5 p1086) Eating plenty of nourishing, antioxidant-rich whole foods and limiting refined carbohydrates is a big step toward preventing, and even reversing Type 2 diabetes.
Also important is exercise. Having a sedentary lifestyle is a significant risk factor in developing this condition. Exercise improves blood glucose, blood lipid levels, blood pressure, weight loss and insulin sensitivity.(7)
In Canada in 2015, it is estimated that 80-90% of people with type 2 diabetes are overweight or obese.(8) It’s easy to see how having diabetes can result in obesity, or excess bodyweight - when our bodies can’t put glucose into cells due to decreased insulin sensitivity, that blood sugar ends up stored as fat. What we need to understand is that obesity can result in diabetes as well. In overweight people, the body sometimes needs as much as 2-3 times more insulin than it would if it were at a healthy weight. That often ends up being more insulin than the pancreas is able to produce. As the pancreas is pushed past its capacity, insulin-producing beta cells begin to die. Now, the pancreas has fewer cells that it can use for creating insulin, therefore increasing the problem. Also, fat cells of obese people, particularly where there is increased abdominal fat, actually release molecules that can be harmful to the pancreas. So the more abdominal fat you have, the higher the risk of damage to your pancreas.(9) The good news is that we don’t need to achieve ideal bodyweight to correct these problems – a goal that may seem unattainable to some (so why bother trying, right?). Studies show that even a 5% reduction in weight can result in a decrease in insulin resistance and reduce your type 2 diabetes risk by more than 50%.(10)
Another concern as a cause of diabetes is toxin exposure. Metabolized arsenic has adverse effects on insulin receptors and glucose transport. Also, TCDD (a component of Agent Orange called “dioxin”) has been found to be harmful.(5 p1086)
Finally, people who are from traditional communities are at greater risk of developing diabetes. Diagnoses of Type 2 diabetes are found at much younger ages in Native Americans, Pacific Islanders, Asian Indians, and Chinese, especially where traditional lifestyles have been replaced by modern ones.
Why Is Diabetes Dangerous?
Acute Complications
There are 2 main complications of diabetes which can be become acute and in fact, life threatening. One is called ketoacidosis. When cells don’t get enough glucose, the body begins burning fat for energy. Fat is broken down into ketones. When ketones build up in the blood, the blood becomes acidic which, if left untreated, can result in loss of consciousness and even death.
The second is Hypoglycemia. This is when your blood glucose levels get too low. Considering the brain requires glucose to function, an untreated lack of glucose can result in seizures, loss of consciousness and death.(11)
Chronic Complications
Diabetes is a condition that can affect the body in myriad different ways. Due to the complexity and synchronistic nature of the endocrine system, it can be expected that as the pancreas struggles, subsequent irregularities within the whole system will begin to appear. Common manifestations of this include negative effects to the reproductive system (male and female); cortisol fluctuations or poor stress coping abilities; emotional fluctuations; circadian rhythm disturbances; metabolic/thyroid fluctuations; and immune responses. Below are some specific chronic complications that are common.
1) Adrenal fatigue – Refined sugars absorb quickly into the blood stream, causing rapid rise in blood sugar. The body responds with a great increase in the secretion of insulin. Excessive secretion of insulin drives blood sugar down and often causes symptoms of hypoglycemia to appear. In response to the rapid fall in blood sugar, the adrenal glands secrete epinephrine (adrenaline), which causes a rapid increase in blood sugar. In time, the adrenal glands become exhausted and can no longer mount an appropriate response. When the body requires this response and the adrenal glands are unable to comply, the result is called reactive hypoglycemia (low blood sugar). Adrenal fatigue results in a host of other health problems.(12)
2) Cardiovascular Disease: There are a few different ways in which diabetes is a risk factor for CVD. a) Glucose in the blood stream is very easily oxidized. Free radicals (a product of the oxidative process) cause damage to arteries, which can lead to hardening of the arteries and heart attack. b) Insulin plays an important role in the proper storage of fats. In the case of insulin resistance, fats cannot be stored properly in fat cells and end up staying in the blood stream. c) Damage to blood vessels can cause a range of problems such as poor circulation to the legs and feet (which can result in poor wound healing, foot ulcers, and amputation), and blindness (if the vascular damage happens in the eyes). These particular problems are known as peripheral vascular disease.
3) Immune Problems such as increased incidence of autoimmune conditions, immune system dysfunction and thyroid disease.
4) Neurologic problems such as depression, cognitive deficits, neuropathy and chronic pain.
5) Problems with eliminative and digestive functions such as hypercholesterolemia, nephropathy, and kidney disease.(5 p1088-1089)
What Can I Do About It?
Treatment
Please note, the suggestions made here are not intended to replace the advice of a qualified professional health practitioner. It is important not to self-diagnose, considering the serious nature of this condition. Dietary and lifestyle changes are easy to accomplish at home, but particularly when considering herbal treatment, expert advice is very important and highly recommended.
Dietary
Having dietary discipline is the key to avoiding and even reversing Type 2 Diabetes. A wise person once said, “We must feed the body, not the mouth” – meaning we must eat for the nourishment of our bodies, not simply because we want something that tastes good. There are some simple techniques to regulating our blood sugar through what we eat, but first we need to understand how this all works. Let’s start with the Glycemic Index and Glycemic Load concept. Glycemic Index (GI) refers to how fast carbohydrates are converted to glucose and enter the bloodstream. Glycemic Load (GL) refers to how much carbohydrate is present in a typical serving of a particular food, which is a more accurate representation of what we are really eating.(5 p 1098) A high GI food that we eat very little of during a meal will not have a big impact on our blood sugar. A food that is high on the Glycemic Index that we eat a lot of (high GL), like that giant bag of popcorn at the movies, will have a profound impact. With this in mind, here are a few simple points to keep in mind.
Try to keep your intake of carbohydrates to a moderate amount. We need some carbs, but we should be eating mostly vegetables, fruits, high quality proteins and healthy fats.
Try to eat foods in their natural state (or as close as possible). The process of refining raises the GI of carbohydrates by removing fibre and other parts which slow the breakdown and conversion of starches to glucose. Chewy, crunchy, fibrous foods take longer to digest. Oats, barley, fruits high in pectin and legumes are all good sources of soluble fibre.
Acid (vinegar, lemon juice, pickles) slows down digestion of starches and slows gastric emptying, which in turn lowers the GI of your meal
Go easy on the salt. Salt increases the rate of starch digestion and the absorption of glucose, which raises the GI of your meal.
High fat foods and proteins slow rate of gastric emptying.
Garlic and onion are both good at keeping blood glucose levels low. Garlic is stronger, but onion is more easily tolerated without causing gastric upset.
When you do need bread, traditional methods of rising bread dough (such as sourdough fermentation) are slower and produce breads with a lower GI than breads made with rapid-rise dough.
Generally, the riper the food the higher the GI of the food would be. For example, ripe or very ripe bananas have a higher GI than unripe bananas.(5 p1096-7)
You can easily refer to an online Glycemic Index that lists various foods and where they rank as far as their GI and GL ratings go. The general rule is to avoid high GI foods (especially those that are also high GL), and eat more foods that have a lower GI rating. Here are a few general suggestions.
Eat More
- organic fruits and vegetables (low GI/GL types)
- complex carbohydrates when necessary
- protein with each meal
- Fibre
Eat Less
-High GI/GL foods
- alcohol, refined foods, caffeine, sugar, soft drinks, salt
- trans fats, deep fried foods, oxidized fats (stale nuts and seeds, rancid oils, smoked oils)
Exercise
The benefits of regular exercise are well known to most people. However, when considered in the case of diabetes, they become even clearer. Muscle cells play a major role in the storage and use (breakdown) of glucose – their main source of fuel. Logically, as muscle mass increases, the uptake of glucose from the bloodstream increases. More muscle means less glucose in the blood. Just 30 minutes per day of aerobic exercise, strength training, weight lifting, and/or stretching makes a big difference in a number of areas. Exercise directly improves insulin sensitivity, improves glucose control, helps regulate healthy weight, reduces blood pressure, reduces the risk of cardiovascular disease, improves levels of blood lipids, and helps to manage stress.(7)
Herbs
Unlike Type 1 diabetes, people with Type 2 normally have a pancreas that still produces some insulin. Because of this, type 2 people can respond well to herbal therapies. With the help of a qualified herbalist, type 2 diabetes can be prevented and even reversed. The following is a list of some of the herbs that can help and the actions that they provide. It is important to seek the advice of a professional before taking any of the following herbs.
Gymnema sylvestre Also known as the ‘sugar destroyer’ due to the fact that it numbs the tongue’s ability to taste sweet, an effect that can last for an hour or more. Aside from its actions on blood glucose levels, this sweet-blocking feature alone is great for those with a particularly strong sweet tooth. This herb needs to be taken for at least 120 days to achieve optimal benefit. Its actions are:
Hypoglycemic: reduces absorption of glucose and inhibits glucose transport in the small intestine.
It is a pancreatic trophorestorative (heals through nourishment): increases the number of, and helps to regenerate pancreatic beta cells.
Suppresses appetite for up to 90 minutes (5 p1104)
Trigonella fenum-graecum Also called fenugreek seed, this herbs is an important ingredient in curry and is well taken as a food..
Fibre and gum contained in the seed delay gastric emptying
Stimulates glucose-induced insulin secretion
Improves peripheral glucose secretion
Has shown antidiabetic action at insulin receptor and GI level vs. placebo.(5 p1104)
Cinnamomum zeylanicum – Cinnamon bark.
Reduces blood glucose levels(13)
Lowers triglyceride and serum cholesterol levels vs. placebo.(14)
Galega officinalis – Goat’s Rue
Hypoglycemic
Increases activity of insulin
Increases insulin sensitivity
Momordica charantia – Bitter Melon
Lowers blood glucose.
Contains insulin-like compound, which could eventually be a replacement injection for insulin, and would potentially have fewer side effects.(5 p1105)
Panax quinquefolium – Canadian Ginseng.
Hypoglycemic
Stimulates pancreatic beta cells to increase insulin production
Less stimulating than Panax ginseng.(5 p1105)
Panax ginseng – Red Korean Ginseng
Hypoglycemic
Improves mood, energy and psychomotor performance (15 p429)
Improves glucose and insulin regulation.(16)
Codonopsis pilosula – Codonopsis (Dang shen)
Hypoglycemic
Antioxidant with an affinity for pancreatic beta cells
Combination of Codonopsis, Astragalus and Lycium decreases glucose and protects beta cells
Glycyrrhiza glabra – Licorice Root
Improves disordered glucose tolerance
Enhances insulin sensitivity
What’s The Bottom Line?
The most important thing to take from all of this is that there is hope. If we can overcome our cravings, our habits, our impulses and our tendency to search for comfort from our food, we can avoid type 2 diabetes. While prevention is most important, there is also hope for those of us who have developed this condition. It requires changes that may seem overwhelming at first glance, but the more steps towards healthy living that we can take, as outlined above, the sooner we’ll find our way back to health. Discipline doesn’t come easy but takes practice and patience. Not only can we avoid type 2 diabetes by taking good care of ourselves but we can avoid a great number of other health problems as well. Your health is in your hands.
References
1) Canadian Diabetes Association, “Diabetes: Canada At The Tipping Point. Charting A New Path”; 2010
https://www.diabetes.ca/CDA/media/documents/publications-and-newsletters/advocacy-reports/canada-at-the-tipping-point-english.pdf
2) Juvenile Diabetes Research Foundation. JDRF: News and Media Fact Sheets: About Type 1 and Type 2 Diabetes. www.jdrf.ca/news-and-media/fact-sheets/about-type-1-and-type-2-diabetes/ (Accessed October 15th, 2015).
3) Martini, F. Fundamentals of Anatomy & Physiology, Seventh Edition. San Francisco: Pearson Education Inc (Benjamin Cummings); 2006
4) Hoffman D. Medical Herbalism: The Science and Practice of Herbal
Medicine. Rochester, Vermont: Healing Arts Press; 2003.
5) Hechtman, L. Clinical Naturopathic Medicine: Australia. Churchill Livingstone/Elsevier; 2011
6) Canadian Diabetes Association. Types of Diabetes. http://www.diabetes.ca/about-diabetes/types-of-diabetes (Accessed Oct 22nd, 2015)
7) Diabetes Care. 2010 Dec; 33(12): e147–e167. doi: 10.2337/dc10-9990
8) Canadian Diabetes Association. 2015 Pre-Budget Submission to the Ontario Standing Committee on Finance and Economic Affairs, January 2015. https://www.diabetes.ca/getmedia/7c4e2fbb-16f0-4fd9-9e1b-c494c38f9547/Canadian-Diabetes-Association-2015-Ontario-Pre-Budget-Submission.pdf.aspx (Accessed Oct 21st, 2015).
9) Mayo Clinic News Network. Losing Weight Can Have Big Impact On Those With Diabetes. Dec. 14, 2012. http://newsnetwork.mayoclinic.org/discussion/losing-weight-can-have-big-impact-on-those-with-diabetes/ (Accessed on Oct. 23rd, 2015)
10) Diabetes.co.uk. Diabetes and Obesity. http://www.diabetes.co.uk/diabetes-and-obesity.html (Accessed Oct 22nd, 2015)
11) Mayo Clinic. Diabetic Hypoglycemia. http://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/basics/complications/con-20034680 (Accessed October 15th, 2015).
12) Pizzorno JE Jr, Murray MT, eds. Textbook of Natural Medicine, 2nd edn. Edinburgh: Churchill Livingstone, 1999
13) Mang B, Wolters M, Schmitt B, Kelb K, Lichtinghagen R, Stichtenoth DO, Hahn A. Effects of a cinnamon extract on plasma glucose, HbA, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest. 2006 May;36(5):340-4. PubMed PMID: 16634838
14) Alam Khan, Mahpara Safdar, Mohammad Muzaffar Ali Khan, Khan Nawaz Khattak, and Richard A. Anderson Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes Diabetes Care December 2003 26:12 3215-3218; doi:10.2337/diacare.26.12.3215
15) Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. London: Churchill Livingstone; 2000
16) Vladimir Vuksan, Mi-Kyung Sung, John L. Sievenpiper, P. Mark Stavro, Alexandra L. Jenkins, Marco Di Buono, Kwang-Seung Lee, Lawrence A. Leiter, Ki Yeul Nam, John T. Arnason, Melody Choi, Asima Naeem. Korean red ginseng (Panax ginseng) improves glucose and insulin regulation in well-controlled, type 2 diabetes: Results of a randomized, double-blind, placebo-controlled study of efficacy and safety; Nutrition, Metabolism and Cardiovascular Diseases: Elsevier. January 2008Volume 18, Issue 1, Pages 46–56
