Treating Type II Diabetes Nutritionally
by C. Leigh Broadhurst, Ph.D.

Up to 16 million people in the United States and Canada have a disease that some researchers say is almost entirely caused by poor nutrition and could be prevented or reversed with a whole-foods diet. Type II diabetes, or noninsulin-dependent diabetes mellitus (NIDDM), affects roughly 95 percent of all diabetics and in almost all cases develops after age 40. It is vastly different from Type I, or insulin-dependent diabetes mellitus (IDDM), which primarily affects children and teenagers and is usually caused by autoimmune destruction of insulin-producing pancreatic cells. People with irreversible conditions must inject insulin daily.

In contrast, people with NIDDM typically have enough insulin, but it is not used effectively.1 Insulin receptors on the cells may not accept insulin the way they should, or the cells may have too few receptors. This situation is called insulin resistance, meaning the cells resist the hormonal signaling of insulin. Early symptoms are excessive thirst, frequent urination, weight gain, blurred vision, extreme fatigue, high cholesterol and/or triacylglycerols, carbohydrate cravings yet extreme fatigue after eating them, numbness in extremities, and an inability to tolerate cold.

The incidence of diabetes among seven U.S. ethnic minorities for which there are data is much higher than the incidence in their respective countries of origin.2 When members of any ethnic group move to the United States, their incidence of diabetes increases. This is interesting evidence that suggests NIDDM is caused by diet and lifestyle.

A more subtle point also illustrated in the figure is that the incidence of NIDDM in the United States is greater among minorities than Caucasians, even when diet and lifestyle factors are taken into account. The typical incidence of NIDDM among Caucasians is 2 to 4 percent. Native Americans have the highest NIDDM incidence of any population: for example, 50 percent of the Pima Indians in Arizona have NIDDM, though diabetes was rarely seen in Native American populations prior to 1940.3 In Canada, 728 Ojibwa-Cree Indians on a reserve in subarctic Ontario were studied; across all age groups, 18 percent of females and 16 percent of males had NIDDM. Also, 28 percent of females and 24 percent of males had prediabetic insulin resistance. NIDDM, insulin resistance and obesity were more common in females, and 54 percent of women ages 50 to 59 had NIDDM.4 In contrast, Caucasians (mainly of northern European ancestry) have the lowest incidence of NIDDM--2 percent. So there is also a genetic variation influencing the incidence of diabetes among ethnic groups. This variation may suggest why ethnic groups that were among the first to adopt agriculture-based diets now have the lowest NIDDM incidence.

The Modern Diet Connection
In my research I have found that straying from a hunter-gatherer, whole-foods diet is the ultimate cause of NIDDM. According to natural medicine, most major causes of NIDDM can be related to a processed-food and agriculture-based diet. These include:

* Obesity, or too much body fat compared to lean-tissue weight. Obesity is a major clinical factor of NIDDM.
* Too many calories, especially from refined and processed carbohydrates and fats.
* Lack of certain polyunsaturated fats and unbalanced fat intakes.
* Chromium deficiency.
* Lack of certain phytochemicals.



My research supports an "evolutionary diet" as an ideal NIDDM treatment. The diet is based on lean protein, vegetables, whole fruits and moderate amounts of fat, especially polyunsaturated and monounsaturated fats.5 Fish, nuts and cold-pressed unrefined oils such as flaxseed, olive and sesame are recommended sources of fat. Carbohydrates should not be prominent in the diet, and sugars, any form of wheat but especially white flour,6,7 other refined grains, fried foods and junk foods all need to be minimized.

Supplements that Support Diabetics
By combining an evolutionary-type diet, fat loss, exercise and nutritional supplements, NIDDM can be prevented or reversed and the impact of IDDM minimized.5 People with NIDDM can begin taking supplements directly, but because of the effects on glucose metabolism and insulin levels, those with IDDM and anyone using antidiabetic medications should consult their doctors first. The general recommendation for IDDM patients is to divide the maximum recommended dosage by four, take one-fourth the dose for a week and add a fourth every seven to 10 days, all the while monitoring blood sugar. It is imperative that people monitor their blood sugar and keep thorough records because natural protocols tend to work more slowly than pharmaceuticals. A blood sugar record is the only way doctors can tell if the treatment is working.

The following supplements promise to help prevent or treat diabetes. Not discussed here, but also important, are magnesium, vitamins E and B6, selenium and all antioxidants.

Polyunsaturated Fatty Acids (PUFAs): Flexible cell membranes have more and better insulin receptors, which allow for efficient glucose metabolism. PUFAs help make cell membranes flexible, whereas saturated fats make them stiffer. Most important are the n-3 long-chain PUFAs, mainly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), found in high concentrations in fish oils. Rat studies have shown dramatic reversal of diabetes with fish-oil supplementation.8 Human studies have shown that insulin resistance correlates with low levels of long-chain PUFAs.9 Both NIDDM and IDDM are characterized by a significantly reduced ability to convert n-6 PUFA linoleic acid and n-3 PUFA alpha-linolenic acid to their long-chain derivatives, gamma-linolenic and arachidonic acids (n-6), as well as EPA and DHA (n-3).10 PUFA supplementation, including long-chain PUFA, linoleic acid and alpha-linolenic acid, is recommended for diabetics. It is beneficial to supplement in a 1:1 n-6 to n-3 ratio because modern diets contain more n-6 PUFA than an evolutionary diet.11

Chromium: This essential trace element is required for normal insulin functioning. Chromium deficiency produces diabetic symptoms including high blood glucose, decreased insulin binding and number of insulin receptors, decreased high-density lipoprotein cholesterol and increased total cholesterol and triacylglycerols. A diet high in refined grains and sugars exacerbates chromium depletion because metabolizing these foods requires more chromium than they provide. The majority of the U.S. population does not obtain the 50- to 200-mcg daily recommended intake.1 The chromium requirements of our Paleolithic ancestors were almost certainly lower than ours because they didn't eat cereal grains or refined sugars, but they did consume lean protein, balanced PUFAs and plenty of fiber. They also lived in the East African Rift Valley for more than 4 million years, a geologically active area with chromium-rich soils.11

An appropriate diet and 200-400 mcg chromium per day may help prevent NIDDM but may not be sufficient to reverse existing diabetes. A 1997 double-blind study by U.S. Department of Agriculture (USDA), Beltsville, Md., and Beijing Medical University on three groups of 60 Chinese Type II diabetics, found that 500 mcg chromium picolinate twice daily for four months was greatly superior to placebo.12

Currently, chromium picolinate is considered the best-characterized, most stable and most effective form of supplemental chromium.1,13 Research from USDA, Beltsville, found that the chromium in chromium nicotinate or chromium polynicotinate is not bound to nicotinic acid (vitamin B3), but rather to water or hydroxide.14 Chromium oxides and hydroxides are only absorbed at a rate of less than 1 percent. Research has shown the same profile for so-called glucose tolerance factor complexes and the European supplement chromium pidolate,15 so there is still room for improvement in chromium supplements design.

The Promise of Medicinal Plants
Many phytochemicals in fruits and vegetables are bitter or astringent; therefore, agriculturalists have practiced "negative selection" for these compounds. These phytochemicals are systematically bred down to low levels or concentrated in peels that aren't eaten. Modern produce is bred to be larger, milder and sweeter. Consequently, we have lost a lot of phytochemical protection from chronic diseases, NIDDM included.12 However, many of these bitter and astringent compounds are present today in herbal products. Preliminary evidence suggests that the following herbs may be useful in helping some diabetics achieve better blood sugar control:

Bitter melon (Momordica charantia): In 1993 at B.J. Medical College, Ahmadabad, India, six NIDDM patients were given 100 mL of a bitter melon decoction daily. After three weeks their fasting blood glucose dropped 54 percent. By seven weeks all six were at or near the normal glucose level, and sugar was no longer detectable in their urine.16 The effects of bitter melon are gradual and cumulative, and only a juice or decoction has been consistently effective. To use bitter melon, start with 50 mL juice and increase to 200 mL after three weeks. Use 200 mL for four weeks, monitoring progress, then adjust down to an effective maintenance dosage. Use the same procedure for IDDM treatment.

Korean ginseng (Panax ginseng): A 1995 University of Oulu, Finland, study found that 200 mg ginseng per day for eight weeks improved mood and physical activity and lowered fasting blood glucose and body weight compared to placebo.17 This is a small ginseng dosage, and neither I nor any Asian medicine practitioner I know would hesitate to recommend two to four 500-mg capsules per day.

Holy basil (Ocimum sanctum): In a 1997 study at M.S. University of Baroda, India, 17 NIDDM patients were supplemented with 1 g basil leaf per day for 30 days. Ten NIDDM patients served as controls, receiving no supplementation. All subjects were taking antidiabetic medications and did not change their diets. Holy basil lowered fasting blood glucose 20.8 percent, total cholesterol 11.3 percent and triacylglycerols 16.4 percent.18 I recommend 1-4 g of dried leaf daily.

Gurmar (Gymnema sylvestre): This herb appears to stimulate insulin secretion while lowering cholesterol and triacylglycerols. In a 1990 open study in Calcutta, India, gurmar was tested on 22 patients who were not insulin dependent but were taking oral antidiabetic medications. The patients were given 400 mg standardized gurmar extract per day for 18 to 20 months. All were able to reduce their medication dosages, and five discontinued medication. The extract was judged superior to the medications for long-term blood-sugar stabilization, lowering of triacylglycerols and overall patient well-being.19

In another controlled study, 400 mg of the extract was given to 27 IDDM patients. Insulin requirements dropped nearly 50 percent, and fasting blood sugar levels decreased. Triacylglycerols dropped to near normal levels, and the subjects reported improved mood and physical performance.19 Since gurmar may increase insulin levels, it is more appropriate for IDDM patients than for NIDDM patients. It is not effective for all patients, but the beneficial effects on triacylglycerols and cholesterol make it worth a try. The dose is one 100-mg capsule of a standardized product three to four times per day.

Beyond Fiber
High-fiber diets are uniformly recommended for diabetics. Particularly important is soluble fiber, including gums, mucilages, pectins and polysaccharides, all of which can slow the absorption of glucose in the intestines. However, some plant foods provide
synergistic benefits beyond just inhibiting glucose absorption. A few examples follow.

Flaxseed (Linum usitatissimum): In a 1993 study at the University of Toronto, five nondiabetic subjects were given a glucose solution along with plain water or water containing mucilage extracted from flaxseed. The flaxseed mucilage dose improved glucose metabolism by 27 percent compared to water. Two other groups were given either plain white bread or bread with 25 percent flaxseed meal. The flaxseed bread improved glucose metabolism by 28 percent compared to plain bread.20 Because the mucilage content of flaxseed meal is only a few percent, the effect appears to go beyond the simple inhibition of glucose absorption to the synergistic actions of phytochemicals throughout the body. Flaxseed, the richest food source of lignins, also has protein, PUFAs and trace elements, all of which are beneficial. The daily dose is two tablespoons flaxseed meal powder mixed in water.

Fenugreek (Trigonella foenum graecum): The seeds of this plant are about 50 percent fiber, 20 percent of which is mucilage. In a 1990 double-blind study by the Indian National Institute of Nutrition, Hyderabad, India, 10 IDDM patients were given meals with 100 g defatted powdered fenugreek per day or regular meals. After 10 days, fasting glucose levels decreased 30 percent in patients receiving meals with fenugreek; urinary sugar excretion dropped 54 percent, but there was no increase in insulin levels.21 Because fasting glucose levels were affected, simple inhibition of glucose absorption can't be the only explanation. Fenugreek also contains protein, saponins and the phytochemicals coumarin, fenugreekine, nicotinic acid, phytic acid, scopoletin and trigonelline, all of which lower blood sugar. 5,11

In other double-blind studies by the Indian National Institute of Nutrition, 15-25 g of fenugreek powder were similarly effective for NIDDM patients and also lowered low-density lipoprotein cholesterol and triacylglycerols.11 In a 1997 joint study, researchers from R.N.T. Medical College, Udaipur, India, and Odense University, Denmark, gave 20 NIDDM patients 5 g fenugreek daily for one month. Ten patients had severe diabetes, and 10 had mild diabetes. Two groups of 10 severe and 10 mild NIDDM patients served as controls. Fenugreek lowered fasting and post-meal blood glucose in the mild NIDDM group only. This indicates that 5 g may be a preventive dose, while larger doses are needed for active NIDDM treatment.22 Bulk fenugreek is inexpensive, but doses higher than 10 g per day cause flatulence. Standardized fenugreek fiber products are now available that are said to be effective at 5-10 g per day.

Nopal (Opuntia spp.): In a 1990 La Raza, Mexico, hospital study, eight diabetics were given 500 g of nopal, also known as prickly pear cactus, on an empty stomach. Five tests were performed on each subject, four with different cooked or raw cactus preparations and one with water. After 180 minutes, fasting glucose was lowered 22 to 25 percent by all nopal preparations compared to 6 percent for water.23 Nopal is rich in pectin, but again, fasting glucose was affected, so the effect is more than inhibition of glucose absorption. Animal studies corroborate this, showing small amounts of an active fraction isolated from nopal can partially reverse diabetes.24 To use nopal, purchase fresh or canned cactus and eat at least one cup cooked or raw daily. Dried nopal has not been shown conclusively to be effective, but encapsulated products are becoming available.

Although some genetic factors undeniably play a role, NIDDM is first and foremost a nutritional disease. I'm convinced that the treatment and prevention of NIDDM is best achieved through diet and supplementation.

If we don't act now with education and further research, the incidence of NIDDM will skyrocket as more of the world's population adopts the Western diet.

Sidebars:
Cinnamon Research is Promising



References
1 Anderson RA. Nutritional factors influencing the glucose/insulin system: Chromium. J Am Coll Nutr 1997;16:404-10.

2 Carter JS, et al. Non-insulin dependent diabetes mellitus in minorities in the United States. Ann Intern Med 1996;125:221-32.

3 Szathmary EJE. Non-insulin dependent diabetes mellitus among aboriginal North Americans. Ann Rev Anth 1994;23:457-82.

4 Harris SB, et al. The prevalence of NIDDM and associated risk factors in Native Canadians. Diabetes Care 1997;20:185-7.

5 Campbell LV, et al. The high-monounsaturated-fat diet as a practical alternative for NIDDM. Diabetes Care 1994;17:177-82.

6 Salmeron J, et al. Dietary fiber, glycemic load and risk of non-insulin dependent diabetes mellitus in women. JAMA 1997;77:472-7.

7 Salmeron J, et al. Dietary fiber, glycemic load and risk of NIDDM in men. Diabetes Care 1997;20:545-50.

8 Storlien LH, et al. Influence of dietary fat composition on development of insulin resistance in rats. Diabetes 1991;40:280-9.

9 Borkman M, et al. The relation between insulin sensitivity and the fatty acid composition of phospholipids in skeletal muscle. N Engl J Med 1993;328:238-44.

10 Dutta-Roy AK. Insulin mediated processes in platelets, erythrocytes and monocytes/macrophages: Effects of essential fatty acid metabolism. Prostaglandins Leukot Essent Fatty Acids 1994;51:385-99.

11 Broadhurst CL. Lipids, chromium and phytochemicals: A synergistic approach to non insulin dependent diabetes mellitus [Invited Papers from the Fourth International Conference on Essential Fatty Acids and Eicosanoids, Edinburgh, U.K., July 1997]. Prostaglandins Leukot Essent Fatty Acids 1997;57:202.

12 Anderson RA, et al. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with Type II diabetes. Diabetes 1997;46:1786-91.

13 Anderson RA, et al. Dietary chromium effects on tissue chromium concentrations and absorption in rats. J Trace Elem Exp Med 1996;9:11-25.

14 Broadhurst CL, et al. Characterization by NMR and FTIR spectroscopy, and molecular modeling of chromium(III) picolinate and nicotinate complexes used for nutritional supplementation. Inorg Biochem 1997;66:119-30.

15 Broadhurst CL. Characterization by NMR and FTIR spectroscopy, and molecular modeling of four chromium(III) complexes used for nutritional supplementation. International Symposium on the Health Effects of Dietary Chromium; May 1998; Dedham, MA.

16 Srivastava Y, et al. Antidiabetic and adaptogenic properties of Momordica charantia extract: An experimental and clinical evaluation. Phytotherapy Res 1993;7:285-9.

17 Sotaniemi EA, et al. Ginseng therapy in non-insulin-dependent diabetic patients. Diabetes Care 1995;18:1373-5.

18 Rai V, et al. Effect of Ocimum sanctum leaf powder on blood lipoproteins, glycated proteins, and total amino acids in patients with non-insulin-dependent diabetes mellitus. J Nutr Environ Med 1997;7:113-8.

19 Baskaran K, et al. Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin-dependent diabetes mellitus patients. J Ethnopharm 1990;30:295-305.

20 Cunnane SC, et al. High a-linoleic flaxseed (Linum usitatissimum): Some nutritional properties. Br J Nutr 1993;69:443-53.

21 Sharma RD, et al. Effect of fenugreek seeds on blood glucose and serum lipids in Type I diabetes. Eur J Clin Nutr 1990;44:301-6.

22 Bordia A, et al. Effect of ginger (Zingiber officinale Rosc.) and fenugreek (Trigonella foenum-graecum L.) on blood lipids, blood sugar, and platelet aggregation in patients with coronary artery disease. Prostaglandins Leukot Essent Fatty Acids 1997;56:379-84.

23 Frati AC, et al. Hypoglycemic effect of Opuntia ficus indica in non insulin-dependent diabetes mellitus patients. Phytother Res 1990;4:195-7.

24 Trejo-Gonzales A, et al. A purified extract from prickly pear cactus (Opuntia fulignosa) controls experimentally induced diabetes in rats. J Ethnopharm 1996;55:27-33.

C. Leigh Broadhurst, Ph.D., is a geochemist with experience in the design and operation of analytical laboratories. She works as a visiting scientist for a government nutrition research laboratory and heads 22nd Century Nutrition, a nutrition/scientific consulting company.