Article ID # 20060703
Trouble from Head to Toe
by Karyn Maier
Energy Times, July 3, 2006

A big part of dealing successfully with diabetes involves keeping a step ahead of its complications, which include blurred vision, foot problems and everything in between. Fortunately, there are natural ways to overcome the obstacles excess blood sugar can place in your path.

I used to taunt my older sibling about being a "Super Sister," one that even Marcia Brady would envy. She was an honor roll student, master of numerous musical instruments, had a leading role in nearly every school play and served on every committee and club. If that wasn't enough, she was also a teenage model. Nothing, it seemed, could slow that young lady down-until a simple shopping trip would prove to be a life-changing speed bump. "I was walking down the middle of the mall one day and suddenly I wasn't able to see," my sister recalls. "Everything was so blurry, I could barely get back to the car. In hindsight, my symptoms were classic. Weight loss, feeling hungry, fatigue, frequent nightly visits to the bathroom-they were all there."

At first, we wondered if a lingering upper respiratory infection might be to blame. But blood tests revealed that my sister's blood-sugar level was in the low 800s, a measurement nearly seven times above normal range. Not surprisingly, she was immediately admitted to the hospital where, at the age of 24, she was diagnosed with the sixth leading cause of death in the US-diabetes (in her case, it was type 1). Now in her 40s, with a successful career in marketing, this mother of two still does it all and enjoys a full life-but not one free of challenges. While most moms might be hustling the kids out the door on a busy morning, my sister sticks her daughter's finger to determine the daily routine. Like her mother, my 10-year-old niece is also diabetic, and every day is a juggling duet to balance insulin, glucose readings and dietary carbohydrates several times a day among school, sports and client meetings.

The Diabetic Downfall
Diabetes is a metabolic disorder in which blood-sugar (glucose) levels are above normal-either the body doesn't produce enough of the hormone insulin, which breaks down sugar in the blood, or cannot utilize its own insulin as it should. Diabetes can cause serious health complications including heart disease, blindness, kidney failure and even limb loss. The good news is that if you are one of the 20.8 million Americans struggling with diabetes (type 1 and type 2 combined) there are natural approaches to help avoid these life-threatening conditions. It's important to understand how high levels of glucose in the bloodstream cause damage and lead to serious complications. The most significant problem is glycation, the same process that causes food to brown in the oven. Glycation occurs when simple sugar molecules (such as glucose) attach to proteins to create sugar-damaged proteins called advanced glycation endproducts (AGEs). Some AGEs are benign, but others interfere with molecular functioning and can lead to serious nerve and organ damage. Oxidative stress also plays a key role in the development of diabetes-related complications. Harmful AGEs can promote high levels of free radicals that can further damage cellular proteins and reduce nitric oxide levels, leading to compromised arteries throughout the body. In fact, an adult diabetic is at two to four times higher risk for stroke and heart disease. One reason for this is glycation: When glucose molecules bind to cholesterol-transporting low-density lipoprotein (LDL) molecules, it prevents the LDL from binding to liver receptor sites that normally trigger the production of cholesterol to cease. As a result, the liver is tricked into thinking there's a cholesterol shortage and keeps producing and delivering more to the bloodstream.
According to the American Diabetes Association (ADA), diabetic retinopathy is the leading cause of new blindness in adults aged 20 to 74 years, with 12,000 to 24,000 cases each year. Because tiny blood vessels in the eye are especially vulnerable to high blood glucose, they can hemorrhage and blur vision. In an advanced stage, blood vessels leak lipids (fats) into the macular portion of the retina and newly formed vessels grow along the retina and in the vitreous gel that fills the inside of the eye. Without treatment, these rogue vessels can destroy the retina completely and lead to permanent blindness. Diabetes has also become the most common single cause of kidney disease and renal failure in the United States, due in part to the increased occurrence of type 2 diabetes. This condition, medically known as nephropathy, is caused by blood vessel damage that disrupts the kidney's filtering system; it is first detected when a urinalysis reveals too much albumin (protein) in the urine. Unfortunately, obvious symptoms don't develop until nephropathy's later stages. However, increased blood pressure, along with raised cholesterol and triglyceride levels, are common indicators. Impaired sexual function, in both men and women, is another consideration since it involves both the nervous and vascular systems. Women with type 1 diabetes are twice as likely to experience sexual dysfunction compared with non-diabetic women, and up to 80% of men with diabetes may experience erectile dysfunction. Again, nerve damage and faulty blood supply are to blame.
More than half of those with diabetes will experience neuropathy, or nerve damage affecting virtually any nerve or groups of nerves due to poor blood supply. Peripheral neuropathy is the most common type; it usually affects the lower extremities and is characterized by a tingling or burning sensation-or a lack of any feeling at all. The latter can lead to serious trouble. If a foot ulcer (a common occurrence among diabetics) should go unnoticed and untreated, it can infect the bone and put the sufferer at risk for amputation. Since my sister's long-ago shaky episode at the mall, she's been able to thwart most serious complications through sheer discipline in managing her disease. "The only damage I've really had to contend with is peripheral neuropathy," she reports, while musing that it's funny how nerves that don't work anymore can cause pain and the destruction of her feet. As a result, she now has a condition called Charcot's joint, to which my sister likens her legs and feet to being "a suspension bridge without any suspension." Nerve damage to a weight-bearing joint, usually the knee, leads to the degeneration of cartilage and muscles that can no longer support the bones, which can cause fractures and, eventually, severe foot deformities. Since surgery or medication is of little benefit, my sister opted for her "funny shoes" and leg braces instead. "I can walk without them," she says, "but I pay for it for days, so I usually just keep them on."

Damage Control
The best way to avoid long-term complications of diabetes is to take a proactive stance toward prevention by keeping your weight in check, by watching what you eat and by diligently monitoring your glucose levels. Certain supplements may help to control blood-sugar levels naturally. However, it's critical that you consult with your healthcare practitioner before undertaking any supplement use. You should also become familiar with your family history. According to Ruchi Mathur, MD, assistant professor of medicine at the Keck School of Medicine, University of Southern California, monitoring pre-diabetes is a new concept in avoiding serious problems later. "We think of it as a disease in itself now," she says. "A strong family history, particularly within a certain ethnic background, can be quite a hurdle to overcome. Anyone with a family history of diabetes, or who has had gestational diabetes during pregnancy, should be screened by age 35 with annual glucose checkups after that."

Being overweight is another key issue, for children as well as adults. In fact, the incidence of diabetes in children has increased tenfold in the last decade, setting the stage for serious health problems down the road. Pat Kringas, RN, research coordinator at the Naomi Berrie Diabetes Center at Columbia University Medical Center of New York, says that "family history and sedentary activity puts these kids in a high-risk group," and reminds parents to set an example for better eating habits at home and encourage healthy activities, especially those less "screen-related." Incorporate exercise into family time; set up a mini-basketball court in your backyard and shoot hoops or buy bicycles for everyone in the family and ride as a pack. Of particular concern to diabetics is the ravage of vascular disease. In addition to glycation of proteins and antioxidant damage, dysfunction of the endothelial cells-the ones that line the insides of your blood vessels-greatly increases this risk. Since the body needs insulin to remove triglycerides from the blood, elevated levels and endothelial cell damage from oxidized LDL cholesterol especially affect diabetics. Damaged endothelial cells can't properly regulate blood flow and can lead to excessive blood clot formation, a key risk factor in the development of circulatory problems. "Homocysteine may be more dangerous than cholesterol in contributing to cardiovascular disease and stroke," says Frank Murray, author of Natural Supplements for Diabetes (Hampton Roads). "This normally benign amino acid can accumulate as a harmful compound if there is a deficiency in folic acid and vitamins B-6 or B-12. Since excess homocysteine directly damages arterial walls, it has been linked to atherosclerosis (hardening of the arteries), increasing the risk of heart attack, stroke and blood clots, independent of cholesterol levels." Several studies suggest that homocysteine levels are best reduced when vitamins B-6 and B-12 are taken in supplemental form together with folic acid.

There's a bittersweet story behind sorbitol, an agent found in many sugar-free or "dietetic" foods. Sorbitol is formed naturally from glucose in the body and quickly converted to fructose, allowing excess sorbitol to be excreted. However, if there isn't enough cellular glucose available, this conversion is stunted and the sorbitol, once formed, cannot exit the cells. Instead, cells will leak small molecules, such as amino acids, niacin and vitamin C-all compounds needed to protect cells from damage. Accumulation of sorbitol is a major contributor to diabetes-related complications, evidenced by the high concentrations found in the nerve, eye and kidney cells of people with diabetes. However, studies indicate that vitamin C supplementation may inhibit aldose reductase, the enzyme that converts glucose to sorbitol. Since the delivery of vitamin C to cells is insulin-driven, diabetics may be deficient in this important antioxidant. Supplementation may not only improve cellular functioning but prevent the accumulation of sorbitol as well.

Michael Murray, ND, author of How to Prevent and Treat Diabetes with Natural Medicine (Riverhead Books), believes that flavonoids, pigments that lend plants their color, are beneficial in treating diabetes in addition to preventing long-term complications. "Flavonoids such as quercetin," he writes, "promote insulin secretion and are potent inhibitors of glycation and sorbitol accumulation, while flavonoid-rich extracts such as bilberry and hawthorn have been shown to be helpful in diabetic retinopathy and microvascular abnormalities." Alpha lipoic acid (ALA), also known as thiotic acid, is found in every cell of the body and plays a key role in glucose metabolism. Its main action is to increase glucose uptake in skeletal muscles, as well as improve insulin-stimulated glucose disposal. It's also a unique antioxidant in that it's both fat- and water-soluble, making it available to all parts of nerve cells to fight damage caused by free radicals. Another interesting finding is that ALA increases levels of glutathione (an important antioxidant created by the body itself) and may regenerate other antioxidants, such as vitamins C and E. A collaborative study between the Mayo Clinic and Russian researchers found that ALA can considerably reduce the frequency and severity of pain associated with neuropathy. In fact, ALA has been a standard treatment for diabetic neuropathy in Europe for 30 years. Furthermore, a preliminary study showed that daily supplementation with ALA for 18 months slowed the progression of kidney damage in patients with both type 1 and type 2 diabetes.

Pycnogenol, a powerful antioxidant derived from French maritime pine tree bark and the subject of more than 180 studies over 35 years, has been shown to reduce high blood pressure, LDL cholesterol and blood glucose without affecting insulin levels. Of particular note is its ability to reduce leakage into the retina by repairing capillaries in the eyes. While still largely unknown to American doctors, Pycnogenol is the leading prescription for diabetic retinopathy in France.

Botanical Boosters
A number of plant-based therapies that may help fight diabetic complications:

• Coffee berries contain caffeic and chlorogenic acids, which inhibit the action of the glucose-6-phospatase enzyme to reduce excess glucose production from liver-stored glycogen. Caffeic acid also increases cellular glucose uptake.
• Ginkgo biloba extract protects vascular lining and improves blood flow to the extremities, making it beneficial to treat and prevent neuropathy and foot ulcers.
• Grapeseed extract is a systemic antioxidant that can help guard against retinopathy and high blood pressure.
• American ginseng is making news recently as an aid in controlling blood sugar. A number of studies conducted at the University of Toronto verified ginseng's ability to smooth out the after-meal blood-sugar spike that type 2 diabetics experience.
• Holy basil normalizes both blood sugar and fats, according to a study published in the Journal of Clinical Pharmacy and Therapeutics, including cholesterol and triglycerides, factors that are vital in preventing cardiovascular complications.

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