Diabetes-Associated Staph Infections
You sit down to lunch and take a bite of your sandwich/soup/ Lean Cuisine. If you are a person with a healthy metabolism, that food is broken down into glucose, a form of sugar found in the blood and a main source of fuel in the body. It is during digestion that glucose passes into the bloodstream and, via the presence of the pancreatic hormone insulin, makes its way into the body's cells to be used for growth and energy.
As that sandwich is eaten, the pancreas is supposed to automatically produce the proper amount of insulin to move glucose into the body's cells; when insulin is produced inadequately or not at all, glucose begins to build up in the blood and is excreted through urine. This leaves the body without its main source of fuel. The disorder that primarily affects the metabolism in this way is diabetes, be it Type I or Type II.
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Who's At Risk?
Source: NIDDK |
Type I diabetes, formerly called juvenile-onset diabetes or insulin-dependent diabetes is an autoimmune disease, in which the immune system turns against the body it is supposed to protect. In the case of Type I diabetes, the immune system attacks and destroys insulin-producing beta cells in the pancreas.
According to data from the National Institute of Diabetes, Digestion & Kidney Diseases (NIDDK), scientists are uncertain as to what makes the immune system attack beta cells. They believe autoimmune, genetic and environmental factors, including viruses, may be to blame.
In Type I, a person must take insulin daily. Five percent to 10 percent of diabetic cases are Type I, most often developing in children and young adults. Symptoms for Type I usually develop over a short period of time, but beta cells may have been under attack much earlier. It occurs equally among males and females, and the disease is more common in Caucasians than non-Caucasians.
Type II, on the other hand, is found in about 90 percent to 95 percent of diagnosed diabetes cases. This form usually develops in those age 40 and older, most commonly in adults over 55. Type II, formerly known as adult-onset diabetes, is often part of a metabolic syndrome that includes elevated blood pressure, high levels of blood lipids and the presence of obesity; according to NIDDK, approximately 80 percent of Type II diabetics are overweight. In the United States, the disease is most prevalent among non-Caucasians such as American Indians, blacks and Hispanics.
At the time Type II is diagnosed, the pancreas is usually producing adequate amounts of insulin but, for some unknown reason, the body cannot use the insulin effectively--a condition known as insulin resistance. After several years of having this condition, insulin production then decreases. Symptoms of Type II--such as blurred vision, frequent infections and slow-healing wounds--develop gradually, although some people can have no symptoms. Healthy eating, physical activity and blood glucose testing are good tools for managing Type II; however, there are many with the disease that, like Type I diabetics, depend on insulin.
In addition, pre-diabetes and obesity play a large role in the onset of this condition. People with pre-diabetes are at a higher risk of developing Type II diabetes and even heart disease. Usually, with weight loss and moderate activity, a person can delay or even prevent these conditions.
Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are considered predecessors to diabetes and hallmarks of pre-diabetes. In America, 16 million adults ages 40 to 74 have IGT and 10 million have IFG.
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A diabetic is 1.6 times more likely than a non-diabetic to use CAM therapies. Of that number, those 65 and older were the most likely to use these modalities. Source: Diabetes Care, 25:324-9, 2002. |
According to ADA, pre-diabetes does long-term damage, especially to the heart and circulatory system. However, there is some good news about this condition. "[P]eople with pre-diabetes can prevent the development of Type II diabetes by making changes in their diet and increasing their level of physical activity," ADA stated. "They may even be able to return their blood glucose levels to the normal range."
Diabetes is the sixth leading cause of death and disability in the United States; in 1999, 450,000 died from the disease. An estimated 6.2 percent of the population--or 17 million people--have diabetes; however, 5.9 million with the disease have not been diagnosed. According to NIDDK, 8.9 percent of the U.S. population is predicted to have diabetes by 2025.
What does this information mean for the retailer? According to the Novo Nordisk Diabetes Treatment Pharmacy Satisfaction Report 2002, "Overall, independent pharmacies were ranked highest in addressing the needs of diabetes households." Coupled with the figure that diabetics are 1.6 times more likely to use complementary and alternative medicine (CAM) than nondiabetics,1 it is important to be armed with information that will help you meet the needs of the diabetic consumer.
Protecting Yourself: Controlling Blood Sugar & Weight
Nutritional ingredients and diabetes have come a long way from the 1917 starvation treatment of whiskey mixed with black coffee. Currently, there is a wide expanse of products that have sound science (and not folkloric hearsay) backing them.
With weight playing such a large role in Type II diabetes, it is no wonder that the latest figures indicate the growing rate of obesity is directly correlated with the rise in diabetes.2 One study (the Diabetes Prevention Program) indicated that in 3,200 overweight pre-diabetics at high risk for diabetes, it was possible to delay--and possibly prevent--this risk by reducing weight 5 percent to 7 percent.
In terms of prevention, vitamin E was found to prevent the onset of Type II diabetes among habitual users,3 while vitamin D was found to reduce the risk of Type I diabetes by 80 percent in children receiving regular vitamin D supplements during their first year of life.4
Alpha-lipoic acid (ALA), a vitamin-like antioxidant, was found to improve skeletal muscle glucose transport, which increases glucose disposal. Pretreatment with ALA on muscle cells was found to have a protective effect on cells from oxidative stress-induced insulin resistance.5
Minerals are also an important part of diabetes care. The mineral chromium makes glucose tolerance factor in the body, which in turn improves insulin activity. Researchers at the USDA Beltsville Human Nutrition Research Center hypothesized that an elevated intake of supplemental chromium may help control Type II diabetics' insulin levels.6 In a trial involving 180 diabetic subjects, one of three regimens was given: 1) placebo; 2) 100 mcg/d of chromium picolinate (as Chromax®, manufactured by Purchase, N.Y.-based Nutrition 21); or 3) 500 mcg/d of chromium picolinate (as Chromax). Researchers concluded supplemental chromium had significant benefits on not only insulin, but also glucose and cholesterol variables in subjects with Type II diabetes.
Because chromium may mediate insulin resistance, researchers from Hanyang University in Korea reported that chromium is a good aid for improving carbohydrate and lipid metabolism.7 In a laboratory experiment in which rats received chromium picolinate (30 mg/kg/d) or placebo over two weeks, supplementation was found to increase insulin sensitivity.
Chromium tripicolinate, on the other hand, has been shown to have a small but significant, dose-dependent improvement in glucose tolerance in healthy, non-obese animals, according to research from The University of Queensland in Australia.8 Researchers went on to say that healthy animals at risk of glucose intolerance and diabetes because of underlying low insulin sensitivity or genetic factors may benefit from long-term chromium supplementation.
In the aging female population, those who are postmenopausal are at an increased risk for cardiovascular disease and Type II diabetes compared to younger women. Researchers from France reported that chromium levels decline with age, which is not good news considering the mineral works in tandem with glucose and lipid metabolism.9
Chromium nicotinate (as ChromeMate® from Benicia, Calif.-based InterHealth) is another member of the extended chromium family. ChromeMate is bound in a unique way to niacin, a heart-healthy B vitamin making a name for itself in diabetes. Niacin improves the bioavailability and safety of chromium, with doses of 1,000 mcg/d of ChromeMate showing no toxicity.
"It overcomes sugar-induced blood pressure elevation and may even prove useful in preventing Type II diabetes," said Allondra Stevens, marketing services manager at InterHealth. She added that zinc, selenium and vanadium, when supplemented alongside chromium, may help regulate blood sugar levels even more.10 Also, good synergy has been seen between chromium and Maitake mushroom (provided by Ridgefield Park, N.J.-based Maitake Products) by favorably influencing blood pressure and blood glucose levels.11
"Diabetes expresses itself in a variety of symptoms beyond just blood sugar levels, and Maitake holds promise in some of these areas," said Mark Kaylor, Ph.D., an herbalist in private practice and a consultant to Maitake Products. "Maitake's abilities to boost immune responses, act as an antioxidant, protect the liver, aid in weight loss and balance the endocrine system all help to fulfill this role."
On the botanical front, Ayurveda and other Indian literature reports that of the 45,000 plant species in the world today, several thousand are claimed to have medicinal properties. Gymnema is one of these plants, the Gymnema sylvestre species of which is purported to have hypoglycemic and anti-hyperglycemic activity, according to Indian scientists.12 The leaves from Gymnema inodorum have been shown to affect glucose levels in a rat model.13 Researchers from the Nippon Veterinary and Animal Science University in Tokyo found that triterpenoids in the leaves inhibited glucose absorption and suppressed the increase of blood glucose.
"Gymnema" in Hindi literally means "sugar destroyer," which may be due in part to its ability to nip in the bud cravings for sugars and carbs while helping to regulate blood sugar. The herb has also been found to have regenerative effects on pancreatic beta cells. Together with bitter melon, which has been found to function like insulin, gymnema can influence a diabetic's care. "Natural formulations that regulate blood sugar provide a synergistic effect," said Grace Ormstein, M.D., scientific advisor for Houston-based Himalaya USA, maker of GlucoCare®, an herbal formulation that supports healthy blood sugar levels. "The herbs work together to enhance desired effectiveness and counterbalance potential side effects."
Another botanical that shows promise in both controlling blood sugar and weight is Panax ginseng berry extract. In research from Chicago, obese, diabetic mice were given the extract, which aided in weight loss, reduced plasma cholesterol levels and increased the rate of insulin-stimulated glucose disposal.14
Conjugated linoleic acid (CLA), a naturally occurring group of dienoic derivatives of linoleic acid, was found to have an inverse relationship with body weight in Type II diabetics.15 Researchers from schools including Purdue University in West Lafayette, Ind., gave 21 subjects either 8 g/d of mixed CLA isomers (37-percent c9,tll and 39-percent t10,c12) or a placebo for eight weeks. Glucose and body weight were significantly decreased in those taking CLA. (The CLA used in the study was CLA One® from Lake Bluff, Ill.-based PharmaNutrients.)
Duane Fimreite, technical director at Vernon Hills, Ill.-based Natural Inc., maker of Tonalin® CLA, said that one theory behind CLA's benefits for diabetics is tied to its ability to reduce body fat, enabling the pancreas to function properly in secreting insulin. In support of this theory, research has shown CLA to be quite effective in lowering plasma glucose and adipose (fat) tissue while increasing insulin sensitivity.16 However, results from one study did not indicate the same effect. The study, out of Tokyo, showed that CLA decreased the fat hormone leptin, which may have led to the development of insulin resistance in the animal model being used.17 Different outcomes in this instance could have been the result of the specific isomer composition and/or concentration of CLA used.
"Another theory for how it works is that CLA may bind to the same receptors (PPARs) that are also targeted by some of the drugs used to treat Type II diabetes, thus leading to an improvement in serum insulin levels," said Marianne O'Shea, Ph.D., manager of nutrition and technical services at Channahon, Ill.-based Loders Croklaan Lipid Nutrition, maker of Clarinol™ CLA.
"Peer-reviewed articles on CLA are almost a monthly occurrence," said William Smart, managing director of PharmaNutrients. "The only obstacle in not seeing this ingredient as a tool in diabetes care is the existing mindset of many natural product manufacturers, and subsequently the consumer, that CLA is solely for body composition and lean body mass development."
According to Fimreite, CLA should be sold as a health promoter. "Specifically, for those at risk for Type II diabetes, the retailer can promote the positive results seen in animal and cell culture studies," he said.
Fenugreek (Trigonella foenum graecum L.) may benefit both Type I and Type II diabetics, according to researchers from the Republic of Yemen, due to its ability to inhibit glucose uptake.18 In a study out of the University of Manitoba, Canada, researchers reported fenugreek seed powder stabilized glucose homeostasis in the liver of Type I diabetic rats.19 And in research from the Jaipur Diabetes and Research Centre, India, the seeds from this plant have also been shown to improve glycemic control and decrease insulin resistance in patients with newly diagnosed Type II diabetes.20
The seeds from the fenugreek plant have been shown to have an effect on the free radicals that researchers say are responsible for the severity and complications of diabetes.21 According to research out of India, fenugreek administered to diabetic animals reversed peroxidative damage. Other research from India indicated fenugreek seed powder supplementation (for 30 days at a dose of 2 g/kg) decreased lipid peroxidation and helped restore the antioxidants in the liver of a rat model.22
Paul Flowerman, president of Morristown, N.J.-based PL Thomas, distributor of FenuPure™, reported that the patented and GRAS (generally recognized as safe) fenugreek fiber extract is good for glucose control when used in either foods or nutraceuticals. "It is the unique galactomannan structure that allows the gum to surround fats and sugars that slows down the rate at which they are absorbed," he explained, adding that in a 2000 study, FenuPure delayed the onset of diabetes in an animal model.
Researchers from Shanxi Medical University in China reported fiber given to Type II diabetic rats for eight weeks increased insulin sensitivity, decreased high blood lipid levels and prevented impaired glucose tolerance.23 The researchers concluded that because high levels of triglycerides and impaired glucose tolerance are big factors in diabetes, fiber may help negate the effects of Type II diabetes.
Nor does all fiber hold the same benefits. Researchers from Simmons College, Boston, reported that in studying whole-grain versus refined-grain intake and the risk of Type II diabetes, refined grains were found to not be significantly associated with risk prevention.24 However, a diet high in whole grains was seen to reduce the risk.
Diabetes and the Heart
There are certain health conditions that go hand in hand with diabetes. Most often, diabetes leads to blindness, heart and blood vessel disease, strokes, kidney failure, amputations, and nerve damage. In fact, those with Type I or Type II diabetes have an increased risk for developing cardiovascular disease, with men having a greater risk than women. Heart disease, as a result, is the leading cause of diabetes-related deaths.
Researchers from Rome reported that reduced oxidative activity and increased oxidative stress occur early after the onset of Type I diabetes.25 This reasoning may explain why heart disease is so prevalent in diabetics. Scientists from London also reported that oxidation may render LDL cholesterol more atherogenic, explaining the finding that total antioxidant status is directly linked to coronary artery calcification in Type I diabetics.26
Dyslipidemia in Type II diabetics is characterized by elevated plasma triglycerides and very-low-density lipoproteins (VLDL), in addition to reduced HDL cholesterol levels. Niacin has been used effectively to improve plasma lipid profiles in patients with diabetes. However, the use of niacin in diabetics has been discouraged because high doses may worsen glycemic control.
But, in hopes of finding a natural aid for diabetes and heart health, researchers are still staying busy. In research out of the University of Texas, Dallas, the efficacy and safety of once-daily, extended-release niacin in diabetic dyslipidemia patients was evaluated.27 During a 16-week trial, patients received placebo, 1,000 mg/d or 1,500 mg/d of niacin. Although four patients (out of 146) dropped out due to flushing (a potential side effect of niacin), HDL levels increased and triglyceride levels decreased in the niacin groups.
In other matters of the heart as they relate to the B vitamins, researchers from Belgium found that there was a negative correlation between folic acid levels and increased homocysteine levels, a factor in heart disease, in Type I diabetics.28 And in research involving children with Type I, it was found that folate may protect against the early onset of endothelial dysfunction, another factor in heart disease.29
Phytoestrogens may also play a role in reducing the risk of heart disease. Researchers from England investigated the effects of a combination of 30 g/d of soy protein and 132 mg/d of isoflavones on 32 postmenopausal women with diet-controlled Type II diabetes.30 In the placebo-controlled study, it was found that the phytoestrogen regimen lowered mean values of fasting insulin and insulin resistance, in addition to reducing LDL and total cholesterol levels.
According to Brooksville, Fla.-based PKI Nutrition, maker of Cholest-Aid Complete, high blood glucose levels associated with diabetes interfere with efficient blood flow, thereby leading to vascular problems. Ingredients such as chromium and coenzyme Q10 (CoQ10)--both found in Cholest-Aid Complete--may combat the cardio side effects of diabetes. For example, chromium supplementation was found by researchers in Saudi Arabia to exercise better control of blood lipid variables in Type II diabetics,31 and other research out of Australia indicated CoQ10 supplementation improved endothelial function in dyslipidemic patients with Type II diabetes.32
Fiber may also be a good combatant against the heart problems brought on by diabetes. The ADA recommends intakes for fiber be between 20 g/d and 35 g/d for adults, since consumption of dietary fibers lowers blood cholesterol levels, normalizes blood glucose levels and maintains insulin levels--and may ultimately treat Type II diabetes by both helping with the heart disease and obesity usually linked to the disease.33
Some kinds of fiber--such as inulin and oligofructose--have been shown to have lipid-lowering effects in animals.34 However, human research has shown contradictory evidence regarding these fibers and heart health. In a review of nine studies conducted at The University of Reading, England, researchers reported that three showed no effects of inulin or oligofructose on cholesterol or triacylglycerol blood levels, three showed significant reductions in triacylglyceryl and four showed modest reductions in total and LDL cholesterol levels.
Fibersol-2™, a water-soluble dietary fiber from Decatur, Ill.-based Matsutani America, and the fermentation byproducts created by this fiber in the colon indirectly influence both the absorption and metabolism of sugar. "This fiber moderates serum lipids and serum glucose in significant ways, without causing severe gastric or colon distress," said Steve Young, Ph.D., technical advisor to Matsutani America. "This cannot be said about other water-soluble dietary fibers."
Diabetes is an area where a retailer can positively make a difference in the health and well-being of those afflicted by the disease. In the NCPA-Pharmacia 2002 Digest's Survey of Independent Pharmacy Operations in America, the diabetes market is said to be expanding. So should your offerings. Stock a selection of sugar-free candy, nutritional drinks and bars formulated for diabetics, supplements targeted for the disease, and foot and skin care products that help with the side effects of diabetes. But, retailers need to be cautious when dealing with consumers who have this disease, especially those who are on insulin and other prescription drugs. "When selling a glucose regulator, retailers should always preface the sale by encouraging the buyer to consult a doctor before combining a natural product with prescription medication," Ormstein said.
Protein and Diabetes
Among one of the most popular dietary methods used to regulate diabetes is the Atkins diet.37 This high-protein, very low-carb diet has many Americans--be they diabetics or dieters--as fans. Reportedly, it is not dietary fat intake that promotes the development of obesity and diabetes, but rather calories from carbohydrates. Therefore, it seems to make sense to take part in a diet that emphasizes protein over carbs.
However, protein can bring with it fat, especially in food such as cheese and red meat. And, research out of Harvard indicated that fats could have an inverse association with diabetes risk.38 In a cohort study of approximately 36,000 women, diabetes incidence was negatively associated with dietary polyunsaturated fatty acids, vegetable fat and trans fatty acids; however, there was a positive association with omega-3 fatty acids. In fact, 4 g/d of fish oil partially corrected the dyslipidemia (high triglyceride levels specific to diabetics) found in Type II diabetics by lowering triacylglycerol levels.39 Another good source of protein--nuts--was found to significantly lower the risk of developing Type II diabetes. Harvard researchers extrapolated from data gathered from approximately 84,000 women, eating the equivalent of a handful of nuts or a tablespoon of peanut butter five times per week, reduced their risk by more than 20 percent compared to those women who did not.40
In an article appearing in Diabetes Care written by Zachary Bloomgarden, M.D., with the Diabetes Center at Mont Sinai School of Medicine, New York, those diabetics at goal weight may want to incorporate monounsaturated fats into their diet.41 "Another option is the use of plant stanols, which have fewer calories than fat," he said, adding that 2 g/d to 3 g/d reduced LDL cholesterol by approximately 10 percent.
Diabetes and Eye Problems
Diabetes is also the leading cause of new cases of blindness in 20- to 74-year-olds, with diabetic retinopathy leading to 12,000 to 24,000 new cases each year. However, most diabetics only experience minor eye disorders. That said, diabetics are 40-percent more likely to develop glaucoma than non-diabetics and 60-percent more likely to suffer from cataracts. Also, people with the disease are prone to diabetic retinopathy, a potentially blinding complication that damages the eye's retina.
French maritime pine bark extract (Pinus pinaster) may help with the ravages of diabetic retinopathy. In a study conducted in Italy, 40 patients were randomly treated with either placebo or pine bark extract (as Natural Health Science's Pycnogenol®) in doses of 150 mg/d over two months.34 The volunteers were suffering from retinopathy induced by diabetes, atherosclerosis or other vascular diseases. In the placebo group, retinopathy progressively worsened during the trial and visual acuity significantly decreased. The Pycnogenol-treated patients showed no deterioration of retinal function and had a significant recovery of visual acuity.
In study review out of Germany, researchers explained Pycnogenol's effects on eye health was due to an improvement in capillary resistance and a reduction of leakages into the retina.35 Tolerance was generally very good and side effects--mostly referring to gastric discomfort--were rare.
Diabetes-Associated Staph Infections
One-third of diabetics will have a skin disorder caused by diabetes at some point. One of the most common infections is caused by Staphylococcus bacteria, otherwise known as staph. Research out of Georgetown in Washington found oregano oil to work as well as antibiotics on staph.36 In a test tube assay, the oil inhibited the growth of staph as effectively as penicillin and other antibiotics. (This research was sponsored by Waukegan, Ill.-based North American Herb and Spice.) Additionally, researchers from the University of Sydney, Australia, reported eucalyptus and tea tree oils cleared up all 22 cases of staph seen in the investigation: 19 with the oils alone and three with the combination of oils and antibiotics.37
Fighting the Talons of Diabetes References
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34. Williams CM, Jackson KG. "Inulin and oligofructose: effects on lipid metabolism from human studies." Br J Nutr. 87 Suppl 2:S261-4, 2002.
35. Spadea L, Balestrazzi E. "Treatment of vascular retinopathies with Pycnogenol." Phytother Res. 15, 3:219-23, 2001.
36. Schonlau F, Rohdewald P. "Pycnogenol for diabetic retinopathy. A review." Int Ophthalmol. 24, 3:161-71, 2001.