Living With Diabetes

Supplements to Make the Job Easier (Part II)

References

There are more than 16 million Americans living with diabetes, whether Type I or Type II. Fortunately, there are a number of dietary ingredients that may help diabetics gain greater control over their blood sugar levels and/or reduce the long-term detrimental effects of high blood sugar levels. Part one of this article (in the November issue of HSR) looked at some of the botanical compounds that may prove beneficial to diabetics managing their blood sugar. This month, we delve into some of the other nutritional compounds that are important in diabetes.

Altered metabolism of inositol, a natural substance associated with the B complex group of vitamins, has been documented in patients with diabetes.¹ In fact, over 20 years ago, researchers found high blood sugar levels in diabetes “may condition a widespread relative intracellular inositol deficiency, and suggest that restoration of normal intracellular inositol concentrations might prove to be of benefit in the prevention and treatment of certain of the complications associated with human diabetes mellitus.”² As it turned out, supplementation with inositol has proven beneficial for diabetics. For example, low levels of inositol have been associated with neuropathy in diabetic patients,³ and inositol supplementation has been demonstrated to be effective in treating diabetic neuropathy.⁴ Another benefit is that supplementation with inositol can help prevent the premature aging of certain cells in the diabetic which is caused by elevated concentrations of blood sugar.⁵ Other research suggests inositol may exert a protective effect on slowly developing diabetic cataracts.⁶

Finally, consider that the incidence of major congenital malformations is approximately 6 to 9 percent in pregnancies complicated by diabetes mellitus. This incidence is almost four-fold higher than in the general population. Congenital malformations are now ranked as the leading cause of death in the offspring of women with diabetes. This particular type of congenital malformation in the offspring of diabetic women is referred to as diabetic embryopathy. Dietary supplementation with inositol has been shown to reduce the incidence of diabetes-related malformations in offspring of diabetic pregnant animals.⁷ Researchers have indicated inositol supplementation offers great promise, in addition to blood sugar control, as a dietary preventive measure against diabetic embryopathy.⁸

Possibly the best known mineral for addressing insulin function and blood glucose control is chromium. Chromium is necessary for proper insulin function and blood glucose regulation because it helps facilitate the uptake of glucose for energy production. It also increases the efficacy of insulin, thereby reducing the amounts the body must produce. In addition, chromium appears to have insulin mimetic activity and further activates cellular insulin receptors, enhancing glucose uptake.

There are a number of chromium forms available in the dietary supplement market. Chromium carnosinate is a water-soluble, bio-available and biologically safe dipeptide-nutrient compound. Carnosine, the natural dipeptide part of the compound, is abundant in human muscles and plays an important role as an antioxidant, buffer and mineral carrier. Research demonstrated chromium carnosinate (as CarnoChrome, from VDF FutureCeuticals) is effective at reducing fasting blood glucose levels in diabetics by as much as 15 percent in mild diabetics and up to 40 percent in severe diabetics.⁹ A reduction in triglycerides was also noted. This indicates chromium carnosinate can transport glucose out of the bloodstream. Another study showed chromium carnosinate (as CarnoChrome) has a profound ability to induce glucose uptake in L6 muscle cells.¹⁰ As a matter of fact, chromium carnosinate induced glucose uptake 90 percent as efficiently as insulin itself.

Chromium picolinate has been extensively studied in animal and human trials. Researchers in India conducted a study using 50 Type II diabetics and 50 matched controls, and found chromium picolinate (as Chromax®, from Nutrition 21) improved glycemic control in the diabetic subjects, which was attributed to an increase in insulin action rather than stimulating insulin secretion.¹¹ Similar studies have found that chromium picolinate (as Chromax) can moderate glucose intolerance,¹² and improve both glycemic control and lipid parameters.¹³

Another form of chromium, chromium polynicotinate, has also been studied for its impact on diabetes. A review from Georgetown University Medical Center noted niacin-bound chromium (as ChromeMate®, from InterHealth Nutraceuticals) appears to improve insulin sensitivity and reduce the signs of disorders such as syndrome X.¹⁴ A rat study conducted at Georgetown found diabetic rats that received niacin-bound chromium (as ChromeMate), zinc and a grape seed extract had significantly greater insulin sensitivity and lower markers of blood glucose.¹⁵

A significant amount of research has been conducted on the natural antioxidant alpha-lipoic acid (ALA) in the treatment of diabetes. In one study, 74 patients with Type II diabetes were given either a placebo or ALA.¹⁶ When compared to the placebo group, those receiving the ALA had significantly greater insulin sensitivity, and improvement in insulin-stimulated glucose disposal. The researchers logically concluded, “The results suggest that oral administration of alpha-lipoic acid can improve insulin sensitivity in patients with Type II diabetes.” ALA may also prevent the development of diabetic neuropathy. In one study in Type II diabetics, ALA treatment was associated with “a favorable effect on neuropathic deficits without causing significant adverse reactions.”¹⁷ In another two-year study, ALA “appeared to have a beneficial effect on several attributes of nerve conduction” in a group of Type II diabetic patients.¹⁸ Additional research on diabetics has shown ALA has been able to improve other aspects of diabetic neuropathy,19,20 including improvements in neuropathy symptoms.^21,22,23

Another important consideration is that oxidative stress caused by free radicals can exacerbate the diabetic condition. Research provides evidence that, in Type II diabetics, treatment with ALA significantly improves antioxidant defense²⁴—even in patients with poor blood sugar control and albuminuria (i.e., too many serum proteins in the urine).²⁵

Finally, one of the most important benefits offered to diabetics by ALA is its proven ability to enhance the disposal of blood sugar in patients with Type II diabetes, which gives it great potential as a blood sugar lowering agent.²⁶ In a related study of lean and obese diabetic patients, ALA prevented increases in metabolites that are typically associated with high blood sugar, and also increased blood sugar effectiveness.²⁷

Research has shown some diabetic patients who use diet to control their blood sugar may have a deficiency of coenzyme Q10 (CoQ10), which may be further exacerbated by certain commonly used antidiabetic drugs. Such a deficiency of CoQ10 in the pancreas could impair aspects of energy metabolism and the biosynthesis of insulin.²⁸

Other research has also demonstrated CoQ10 levels are lower in diabetic patients, which can cause diabetic cardiomyopathy.²⁹ That same research, however, showed that the diabetic cardiomyopathy can be reversed by CoQ10 supplementation. Research has also demonstrated CoQ10 exhibits an antiarrhythmic (i.e., prevents abnormal heart beat) effect in patients with diabetes.³⁰

A newly discovered form of diabetes is referred to as maternally inherited diabetes mellitus and deafness (MIDD). The characteristic clinical features of MIDD are progressive worsening of insulin secretion and, as the name would suggest, neurosensory deafness and maternal inheritance. After three years of treatment with CoQ10 therapy on MIDD patients, progressive hearing loss was prevented and blood sugar metabolites improved after exercise.³¹ Furthermore, there were no side effects during therapy.

The most significant clinical applications for extracts of bilberry— a European relative of the blueberry—are in the field of eye health. The health of the eye depends on a rich supply of nutrients and oxygen. Bilberry appears to support vision by improving the delivery of oxygen and blood, as well as other important pharmacological effects. Among other benefits, bilberry has proven effective in treating or preventing diabetic retinopathy and macular degeneration. Bilberry’s strengthening effect on collagen may explain its benefit in helping to treat diabetic retinopathy. It also effectively regulates blood sugar levels in diabetic subjects.³²

Because antioxidants block the production of advanced glycosylation end products (AGE), most good antioxidants have potential value for use by diabetics. For example, Ginkgo biloba has powerful antioxidant properties, may enhance peripheral circulation and can highly benefit vascular disease. Ginkgo promotes blood flow in both healthy and compromised blood vessels. Many medical experts advise aspirin therapy for diabetics to thin the blood and reduce its stickiness; ginkgo does this naturally. The benefits of ginkgo biloba extract (GBE) are primarily attributed to two groups of active constituents: the ginkgo flavone glycosides and the terpene lactones. Ginkgo flavone glycosides, which typically make up approximately 24 percent of the extract, are primarily responsible for GBE’s antioxidant activity and mildly inhibit platelet aggregation (stickiness). GBE’s antioxidant action may also extend to the brain and retina of the eye.³³ Preliminary trials have suggested potential benefit for people with macular degeneration³⁴ and diabetic retinopathy.³⁵

Green, oolong and black teas are all made from the leaves of the same plant species. Green, unfermented tea is the world’s second most popular beverage, after water. It is the polyphenols in green tea, specifically the catechin polyphenols, which gives it biological and medicinal qualities. Catechins, particularly epigallocatechin gallate (EGCG), are what give green tea its antioxidant, antimicrobial, blood thinning and cholesterol lowering activities,⁵⁴ all of which should be of interest to diabetics.

Remember, if you are speaking with customers who are diabetic and controlled on medication, it is critical that they make their health care providers aware of any changes they might make in their lifestyle. Diet, exercise and supplements may affect blood sugar levels. By making the health care provider a participant in any lifestyle changes, these customers will ensure their health is properly monitored.

December 2005 Health Supplement Retailer
"Living With Diabetes: Supplements To Make the Job Easier (Part II)" References

1. Holub BJ. "The nutritional significance, metabolism, and function of myo-inositol and phosphatidylinositol in health and disease." Adv Nutr Res. 4:107-41. 1982.

2. Clements RS Jr, Reynertson R. "Myoinositol metabolism in diabetes mellitus. Effect of insulin treatment." Diabetes. 26, 3:215-21, 1977. http://diabetes.diabetesjournals.org/

3. Servo C, Bergstrom L, Fogelholm R. "Cerebrospinal fluid sorbitol and myoinositol in diabetic polyneuropathy." Acta Med Scand. 202, 4:301-4, 1977.

4. Pfeifer MA, Schumer MP. "Clinical trials of diabetic neuropathy: past, present, and future." Diabetes. 44, 12:1355-61, 1995. http://diabetes.diabetesjournals.org/

5. Sibbitt WL Jr et al. "Glucose inhibition of human fibroblast proliferation and response to growth factors is prevented by inhibitors of aldose reductase." Mech Ageing Dev. 47, 3:265-79, 1989. www.elsevier.com/locate/mechagedev

6. Beyer-Mears A et al. "Dietary myo-inositol effect on sugar cataractogenesis." Pharmacology. 39, 1:59-68, 1989.

7. Reece EA et al. "The role of free radicals and membrane lipids in diabetes-induced congenital malformations." J Soc Gynecol Investig. 5, 4:178-87, 1998.

8. Reece EA, Homko CJ, Wu YK. "Multifactorial basis of the syndrome of diabetic embryopathy." Teratology. 54, 4:171-82, 1996.

9. Dragojevic R. "Clinical trial on efficacy of carnochrome as mono-therapy nutritional supplementation 10-selected diabetes type 2 patients." Unpublished research from Department of Endocrinology, Military Medical Institute, Belgrade, Yugoslavia. 2002.

10. Unpublished research obtained in personal communication on Jan. 9, 2002, with Dusan Milkovic, FutureCeuticals, San Diego.

11. Ghosh D et al. "Role of chromium supplementation in Indians with type 2 diabetes mellitus." J Nutr Biochem. 13, 11:690-697, 2002. www.elsevier.com/locate/jnutbio

12. Rabinovitz H et al. "Effect of chromium supplementation on blood glucose and lipid levels in type 2 diabetes mellitus elderly patients." Int J Vitam Nutr Res. 74, 3:178-82, 2004.

13. Houweling ST et al. "Effects of chromium treatment in patients with poorly controlled, insulin-treated type 2 diabetes mellitus. A randomized, double blind, placebo-controlled trial." 18th International Diabetes Federation Congress, Aug. 24-29, 2003, Abstract 756.

14. Preuss HG, Bagchi D, Bagchi M. "Protective effects of a novel niacin-bound chromium complex and a grape seed proanthocyanidin extract on advancing age and various aspects of syndrome X." Ann NY Acad Sci. 957:250-9, 2002. www.nyas.org/publications/annals/

15. Preuss HG et al. "Long-term effects of chromium, grape seed extract and zinc on various metabolic parameters of rats." Mol Cell Biochem. 223, 1-2:95-102, 2001. www.wkap.nl

16. Jacob S et al. "Oral administration of RAC-alpha-lipoic acid modulates insulin sensitivity in patients with type-2 diabetes mellitus: a placebo-controlled pilot trial." Free Radic Biol Med. 27, 3-4:309-14, 1999. www.elsevier.com/locate/freeradbiomed

17. Ziegler D et al. "Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study). ALADIN III Study Group. Alpha-Lipoic Acid in Diabetic Neuropathy." Diabetes Care. 22, 8:1296-301, 1999. http://care.diabetesjournals.org

18. Reljanovic M et al. "Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two year multicenter randomized double-blind placebo-controlled trial (ALADIN II). Alpha Lipoic Acid in Diabetic Neuropathy." Free Radic Res. 31, 3:171-9, 1999. www.tandf.co.uk/journals

19. Haak ES et al. "The effect of alpha-lipoic acid on the neurovascular reflex arc in patients with diabetic neuropathy assessed by capillary microscopy." Microvasc Res. 58, 1:28-34, 1999.

20. Ziegler D et al. "Effects of treatment with the antioxidant alpha-lipoic acid on cardiac autonomic neuropathy in NIDDM patients. A 4-month randomized controlled multicenter trial (DEKAN Study). Deutsche Kardiale Autonome Neuropathie." Diabetes Care. 20, 3:369-73, 1997. http://care.diabetesjournals.org

21. Strokov IA et al. "[The efficacy of the intravenous administration of the trometamol salt of thioctic (alpha-lipoic) acid in diabetic neuropathy]." Zh Nevrol Psikhiatr Im S S Korsakova. 99, 6:18-22, 1999.

22. Ziegler D et al. "Alpha-lipoic acid in the treatment of diabetic peripheral and cardiac autonomic neuropathy." Diabetes. 46 Suppl 2:S62-6, 1997. http://diabetes.diabetesjournals.org/

23. Ziegler D et al. "Treatment of symptomatic diabetic peripheral neuropathy with the anti-oxidant alpha-lipoic acid. A 3-week multicentre randomized controlled trial (ALADIN Study)." Diabetologia. 38, 12:1425-33, 1995. http://link.springer.de/link/service/journals/00125/

24. Roy S et al. "Modulation of cellular reducing equivalent homeostasis by alpha-lipoic acid. Mechanisms and implications for diabetes and ischemic injury." Biochem Pharmacol. 53, 3:393-9, 1997. www.sciencedirect.com/science/journal/00062952

25. Borcea V et al. "alpha-Lipoic acid decreases oxidative stress even in diabetic patients with poor glycemic control and albuminuria." Free Radic Biol Med. 26, 11-12:1495-500, 1999. www.elsevier.com/locate/freeradbiomed

26. Jacob S et al. "Enhancement of glucose disposal in patients with type 2 diabetes by alpha-lipoic acid." Arzneimittelforschung. 45, 8:872-4, 1995.

27. Konrad T et al. "alpha-Lipoic acid treatment decreases serum lactate and pyruvate concentrations and improves glucose effectiveness in lean and obese patients with type 2 diabetes." Diabetes Care. 22, 2:280-7, 1999. http://care.diabetesjournals.org

28. Kishi T et al. "Bioenergetics in clinical medicine. XI. Studies on coenzyme Q and diabetes mellitus." J Med. 7, 3-4:307-21, 1976. www.medical-library.org/j_med.htm

29. Miyake Y et al. "Effect of treatment with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors on serum coenzyme Q10 in diabetic patients." Arzneimittelforschung. 49, 4:324-9, 1999.

30. Fujioka T, Sakamoto Y, Mimura G. "Clinical study of cardiac arrhythmias using a 24-hour continuous electrocardiographic recorder (5th report)--antiarrhythmic action of coenzyme Q10 in diabetics." Tohoku J Exp Med. 141 Suppl:453-63, 1983.

31. Suzuki S et al. "The effects of coenzyme Q10 treatment on maternally inherited diabetes mellitus and deafness, and mitochondrial DNA 3243 (A to G) mutation." Diabetologia. 41, 5:584-8, 1998. http://link.springer.de/link/service/journals/00125/

32. Murray M. Am J Nat Med. 4, 1:18-22, 1997.

33. Ferrandini C, Droy-Lefaix MT, Christen Y, eds. Ginkgo biloba Extract (EGb 761) as a Free Radical Scavenger. Elsevier, Paris, 1993.

34. Lebuisson DA, Leroy L, Rigal G. "Treatment of senile macular degeneration with Ginkgo biloba extract. A preliminary double-blind, drug versus placebo study." Presse Med. 15:1556-8, 1986.

35. Lanthony P, Cosson JP. "Evolution of color vision in diabetic retinopathy treated by extract of Ginkgo biloba." J Fr Ophthalmol. 11:671-4, 1988.

36. Chandra D, Gupta S. "Anti-inflammatory and anti-arthritic activity of volatile oil of Curcuma longa (Haldi)." Ind J Med Res. 60:138-142, 1972.

37. Arora R et al. "Anti-inflammatory studies on Curcuma longa (turmeric)." Ind J Med Res. 59:1289-1295, 1971.

38. Mukhopadhyay A et al. "Anti-inflammatory and irritant activities of curcumin analogues in rats." Agents Actions. 12:508-515, 1982.

39. Toda S et al. "Natural antioxidants. Antioxidative compounds isolated from rhizome of Curcuma longa L." Chem Pharmacol Bull. 33:1725-1728, 1985.

40. Mortellini R et al. "Curcumin, an antioxidant and anti-inflammatory agent, induces heme oxygenase-1 and protects endothelial cells against oxidative stress." Free Radic Biol Med. 28:1303-1312, 2000. www.elsevier.com/locate/freeradbiomed

41. Pizzorno JE, Murray MT. Textbook of Natural Medicine, 2nd Ed. London: Churchill Livingstone; 1999; 689-693.

42. Mitcheva M et al. "Biochemical and morphological studies on the effects of anthocyans and vitamin E on carbon tetrachloride induced liver injury." Cell Mol Bio. 3 9:443-8, 1993.

43. Maffei F et al. "Free radical scavenging action and anti-enzyme activities of procyanidines from Vitis vinifera. A mechanism for their capillary protective action." Arzneimittelforschung. 44:592-601, 1994.

44. Dartenuc JY, Marache P, Choussat H. "Resistance Capillaire en Geriatrie Etude d’un Microangioprotecteur." Bordeaux Médical. 13:903-7, 1980.

45. Delacroix P. "Etude en Double Avengle de l’Endotelon dans l’Insuffisance Veineuse Chronique." Therapeutique, la Revue de Medicine. 27-28 Sept:1793-802, 1981.

46. Corbe C, Boissin JP, Siou A. "Light vision and chorioretinal circulation. Study of the effect of procyanidalic oligomers." J Fr Ophtalmol. 11:453-60,1988.

47. Boissin JP, Corbe C, Siou A. "Chorioretinal circulation and dazzling; use of procyanidolic oligomers." Bull Soc Ophtalmol Fr. 88:173-4, 177-9, 1988.

48. Kuhn MA, Winston D. Herbal Therapy & Supplements: A Scientific & Traditional Approach. Philadelphia:Lippincott; 2000.

49. Upton R (ed). Schizandra: analytical, quality control and therapeutic monograph. American Herbal Pharmacopoeia 1999;1:1-25.

50. Ip SP et al. "Effect of schisandrin B on hepatic glutathione antioxidant system in mice: Protection against carbon tetrachloride toxicity." Planta Med. 61:398-401, 1995.

51. Bone K. Clinical Applications of Ayurvedic and Chinese Herbs. Warwick, Queensland:Phytotherapy Press; 1996:69-74.

52. Foster S, Yue CX. Herbal Emissaries: Bringing Chinese Herbs to the West. Rochester, VT: Healing Arts Press; 1992:146-52.

53. Fulder S. The Root of Being. London: Hutchinson and Co; 1980.

54. Graham HN. "Green tea composition, consumption, and polyphenol chemistry." Prev Med. 21:334-50, 1992. www.elsevier.com/locate/issn/0091-7435

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