Diabetes mellitus is an old and complex disease. It can strike
anyone in any family at any time, though it is most common among
affluent Westerners. The incidence of this autoimmune disease has
tripled over the last eight years and, today, over 100 million people
around the world have the condition. Nearly a third of these are in
Europe. In children, diabetes is one of the fastest growing illnesses,
and contracting it can mean a lifetime on medication and the risk of
kidney disease later in life.
There are two main types of
diabetes. Type I - also known as insulin-dependent diabetes (IDDM) or
juvenile-onset diabetes - is less common than type II diabetes - also
known as non-insulin-dependent diabetes (NIDDM) or mature-onset
diabetes.
There is now strong evidence that environmental
factors may play the largest part in the development of diabetes; these
include obesity, physical inactivity, dietary fat intake, cigarette
smoking and alcohol consumption (BMJ,1995; 310:560-4; BMJ,1995;
310:555-9). NIDDM, in particular, shares a common epidemiology with
coronary heart disease, and may be linked to life in the womb,
particularly intrauterine growth retardation (Diabetologia, 1993; 36:
62-67).
In both types of diabetes, the underlying problem is
that the insulin-producing cells in the pancreas can't produce any or
enough of this vital hormone to meet the body's demands. Insulin clears
sugar from the bloodstream, vital organs and tissues. It is also
necessary to convert food into energy. Individuals with IDDM are unable
to produce any insulin, while those with NIDDM can't produce enough, or
their bodies can't use it effectively.
Over the years, a number
of aggressive medical treatments have emerged in the treatment of both
types of diabetes. The basic treatment for IDDM is injections of
insulin. The amount needed is often dependent on lifestyle factors,
such as how much exercise an individual takes and what foods he or she
eats. In extreme cases, the individual's life can end up being centred
around the timing of insulin injections.
For NIDDM, treatments
are more varied but not always successful. These include
sulphonylureas, which stimulate insulin release from the pancreas.
These are prescribed when diabetes can't be controlled by diet alone.
This type of drug tends to encourage weight gain and has been
associated with sensitivity reactions such as rashes, fever, jaundice
and photosensitivity. Sulphonylureas can also increase the risk of
hypoglycaemia, if blood sugar levels are allowed to get too low.
Other
treatments, such as biguanides, lower blood glucose levels, but are
associated with nausea and diarrhoea. Alpha-glucosidase inhibitors,
which slow down digestion and the absorption of carbohydrates, are
sometimes used instead of insulin.
While it is unlikely that any
alternative treatment will remove the need for insulin in diabetics,
this is one disease which genuinely can be controlled through
conscientious self-management and the careful selection of appropriate
therapy.
In addition to seeking out therapies which act directly
on the pancreas, liver and kidneys, diabetics should also consider the
role which their emotional state can play in reducing glucose
tolerance. Stress reduction is one area which shows promise. Another is
social support.
Trials involving alternatives for diabetes are
small. Many are too small to draw definite conclusions. Because of the
ethics involved in removing individuals from lifesaving insulin or
other medication, studies into alternatives often involve using these
therapies in a more complementary way. Nevertheless, there are
indications that many of these therapies can have a significant effect
in lowering blood glucose levels, reducing 'bad' LDL cholesterol (a
risk factor in diabetics) and relieving some of the other symptoms
which diabetic patients experience.
Herbs
More than 500
traditional plant remedies for diabetes have been recorded, but only a
handful have received scientific and medical evaluation (Diabet Care,
1989; 12: 553-64).
Holy basil leaves (Ocimum sanctum and Ocimum
album) have been shown to dramatically reduce blood glucose levels. In
a single-blind trial involving individuals with NIDDM, holy basil was
tested against other types of leaves. Those using holy basil
experienced a reduction in glucose levels of between 7.3 and 17.6 per
cent. Those using other types of leaves did not experience the same
effect. Holy basil was also associated with a lowering of total
cholesterol levels (Int J Clin Pharm & Ther, 1996; 34:406-9).
In
another trial of holy basil, 27 NIDDM patients were monitored for 30
days while taking the remedy. At the end of the trial, they experienced
a significant lowering of blood glucose levels (20.8 per cent), a
reduction in LDL cholesterol by 14 per cent and a 16.4 per cent lower
triglyceride level ( J Nutr Environ Med, 1997; 7: 113-8).
In
another study, 36 NIDDM patients were treated for eight weeks with
ginseng (either 100 or 200 mg daily) or a placebo. Ginseng was shown to
elevate mood, improve psychological and physical functions, and reduce
fasting blood glucose and body weight. The 200 mg dose was the most
effective. The authors concluded that ginseng may be a useful adjunct
to other therapies (Diabet Care, 1995;18: 1373-5).
For those
with IDDM, fenugreek seeds (Trigonella foenum-graecum) may prove
useful. In one study, Type I individuals were divided into two groups:
one given a managed diet and fenugreek seeds, and a control group with
a managed diet only. Those in the diet and herb group received defatted
seed powder, 100 g daily, divided into two doses at lunch and dinner.
The
herb and diet group showed significant improvement in their fasting
blood sugar levels and improved in the glucose tolerance test. They
also experienced a 54 per cent reduction in 24-hour urinary glucose
excretion. In addition, serum total cholesterol, LDL and VLDL (very
low-density lipoprotein) were all significantly reduced. HDL remained
unchanged. These changes were not noted in the diet-only group (Eur J
Clin Nutr,1990; 44: 301-6).
Fenugreek seeds have received a
great deal of study and do not appear to be associated with damaging
side effects (Phytother Res, 1996; 10: 519-20).
Dandelion root,
Jerusalem artichoke and burdock root all contain a substance called
inulin, which assists in blood sugar control (Am J Clin Nutr, 1990; 52:
675-81) and in reducing hyperglycaemia and fatigue after starchy meals
(Am Intern Med, 1931; 5: 274-84).
Finally, Gingko biloba has
been shown to be better than placebo for those experiencing visual
impairment due to diabetes (J Francais d'Opthamal, 1988; 11: 671-4).
Ethnic remedies
The
use of traditional remedies remains contentious (Afr J Med Sci, 1992;
22: 31-7), yet there is evidence that many of these ethnic remedies are
effective.
The stems of prickly pears (of the opuntia cactus or
nopal), commonly eaten in Mexico, have a reputation for treating
diabetes. In an experimental, double-blind study, a group of NIDDM
patients ate 500 g of broiled nopal stems. After three hours, they
experienced an average reduction in glucose levels of 17 per cent and,
in insulin levels, 50 per cent, compared with those taking a control
food (Diabet Care, 1988; 11: 63-6).
Coccinia indica is an
Ayurvedic remedy made from a creeper which grows wild in Bangladesh and
in many parts of the Indian subcontinent. In a double-blind controlled
trial of 32 patients, 16 received Coccinia indica. There was a marked
improvement in their glucose tolerance, while the placebo group showed
no improvement. (Bang Med Res Council Bull, 1979; 5: 60-6).
The
Ayurvedic herbal mixture MA-471 has also shown promising results in
treating patients with NIDDM who have been diagnosed for less than five
years. Its use can result in a significant fall in serum total
cholesterol and postprandial blood glucose levels. In one trial, it
helped patients achieve control over symptoms in 68.3 per cent of cases
(Alt Ther Clin Pract, 1996; 3: 26-31).
Also from the Indian
subcontinent, the bark of sanderswood has a long history in the
treatment of diabetes. The bark contains a flavonoid called epicatechin
and, when combined with the alcoholic extract of Pterocarpus marsupium,
has been proved able to regenerate functional cells of the pancreas
(Lancet, 1981; 2: 759-60; Lancet, 1982; 2: 272).
In traditional
Chinese medicine a simple remedy, guava juice, has been used for years
to prevent and improve the condition of diabetics (Am J Chinese Med,
1983; 11: 74-6). Other TCM remedies include the herbal medicine
Goshajinkigan. Given in doses of 7.5 g per day for three months, it was
shown to relieve symptoms of numbness in nine out of 13 patients.
Numbness returned or worsened when the drug was discontinued (Diabet
Res Clin Pract, 1994, 26:121-8).
Bushenhuoxue can help diabetics
with vascular disease. When 68 patients took either this TCM remedy or
placebo, those taking bushenhuoxue experienced lowered blood sugar
levels, while HDL cholesterol levels increased. There were virtually no
changes in the placebo group (Chung Kuo Chung Hsi i Chieh Ho Tsa Chih,
1995; 15: 661-3).
Two other TCM remedies are of note. In a small
trial involving 40 patients, jin-qi-jiang-tang-pian was tested against
another herb for two months. Twenty patients got the active herb, and
all experienced major improvement in their symptoms (Chung Kuo Chung
Hsi I Chieh Ho Tsa Chih, 1993; 13: 587-90).
When jiang tang san
([TS) was tested in a group of 30 people with NIDDM, results suggested
that JTS lowered blood glucose levels by 86 per cent. It also lowered
blood lipid and blood pressure levels and promoted the elevation of
serum insulin levels one hour after eating. The researchers concluded
that JTS may be helpful for those who do not respond well to
conventional hypoglycaemic medications (Chung Kuo Chung Hsi I Chieh Ho
Tsa Chih,1994; 14:650-2).
Homoeopathy
Homoeopathic studies
are thin on the ground. However, one review article showed that when a
small group of diabetics were treated with individually prescribed
homoeopathic drugs, blood sugar levels fell significantly, especially
in those taking the remedy Tarentula cub (Hahnemann Hom Scand, 1987;
11: 105-13).
In one small study of 78 individuals with NIDDM,
half received the conventional antidiabetic treatment glibenclamide
(Daonil) in combination with an individually chosen homoeopathic remedy
and half received conventional treatment and a placebo. Both groups
received dietary instructions as well. All the patients in the study
group were matched for age, sex and weight, and required doses of
antidiabetic medication.
After nine months of treatment, both
groups were assessed, and it was found that individuals in the
homoeopathic group had significantly lower blood glucose levels. In
addition, the amount of medication used decreased significantly in the
homoeopathic group, but not in the allopathic group - 54 per cent
compared with 0.5 per cent. There were also fewer infections in the
homoeopathic group - 10 per cent compared with 30 per cent (Proceedings
of the 43rd Congress of the International Homoeopathic Medical League,
Athens, May 22-26, 1988).
Yoga
Yoga may be useful as an aid
to conventional therapy, according to a study from London's Royal Free
Hospital. The study group consisted of 21 NIDDM patients, 13 taking
medication, eight on diet control alone. Each patient was randomised
into either a yoga or control group (control consisted of continuing
with whatever treatment they were using).
Those in the yoga
group met once or twice a week, in addition to practising one or more
times a week at home. After 12 weeks, the fasting blood glucose levels
and glycated haemoglobin in the yoga group had improved, and a third of
those on medication were able to reduce their medication. Patients also
reported feeling better, less anxious and more in control of
themselves, and expressed a desire to continue with the yoga after the
trial (Comp Med Res, 1992; 6: 66-8).
Acupuncture
It is
unlikely that acupuncture alone can significantly cure diabetes.
Because diabetics can present with mixed symptoms such as thirst,
excessive appetite, fever, flushing, cold limbs and oedema, acupuncture
can be used to treat these, though its effect on blood glucose levels
is mixed (J Trad Chin Med, 1985; 5: 79-84; J Trad Chinese Med, 1987; 7:
95-100; J Chinese Med, 1984; 15: 3-5). Reviews of acupuncture in the
treatment of diabetes seem to reinforce its complementary nature U Trad
Chin Med 1995; 15: 145-54; Chung His I Chieh Ho Tsa Chich, 1991; 11:
382-4).
Relaxation
Studies are confused as to which group of
diabetics may benefit most from relaxation (Diabet Care, 1993; 16:
1087-94). Some say that those with emotional problems who also have
diabetes may gain genuine benefit from counselling or relaxation
(Diabet Med, 1993; 10: 530-34). Relaxation techniques can also be
useful for diabetic children (Patient Ed Counsel, 1990; 16: 247-53).
But,
in general, relaxation techniques do seem to have an important role to
play in the self-management of both IDDM and NIDDM. In one study, 12
patients with IDDM were tested at baseline with a glucose tolerance
test and intravenous insulin tolerance test.
Half were then
given five days of progressive relaxation training, after which all
patients were re-tested. The treated patients were tested while
practising relaxation, and it was found that this group had
significantly improved glucose tolerance, without affecting insulin
sensitivity or glucose-stimulated insulin secretory activity (Diabet
Care, 1983; 6: 176-9).
Using biofeedback as an aid to relaxation
may also be helpful. In a study of 20 patients - 10 with poorly
controlled IDDM and 10 untreated NIDDM subjects - biofeedback proved to
be not so useful in treating IDDM but more useful in cases of NIDDM
(Diabet Care, 1987; 10: 72-5). For those with IDDM, this method may be
more beneficial as an adjunct to other treatments (Diabet Care, 1991;
14:360-5).
In the same vein, several studies into the level of
social support of diabetes sufferers have turned up interesting
results. In one, 240 diabetics (types I and II) were randomised into
two groups: a training programme on how to manage their condition, or a
training programme with eight support group meetings. At seven-month
follow-up, both groups improved with regard to understanding their
condition and knowledge of how to manage it, but the support group
expressed greater satisfaction with what they had learned (Diabet Ed,
1992; 18: 303-9). In another study, older diabetics were followed for
two years. Those who took part in intensive support groups, followed by
monthly sessions for continuing education and support, experienced
better quality of life and felt better able to control diabetes
themselves U Am Ger Soc, 1992; 40: 147-50).
Meditation can also
have a positive effect on the symptoms of diabetes (Diabet Ed, 1984;
10: 22-5). Transcendental meditation has a proven track record in
lessening free radical damage and alleviating stress. In one pilot
study, subjects practising TM experienced reduced serum glucose levels,
as defined by an oral glucose-tolerance test. (Report from the
International Conference on Research on Higher States of Consciousness,
Faculty of Science, Mahidol University, Bangkok, Thailand, 4-6
December, 1980).
Reflexology
Massage of all types has been
established as a stress beater, though studies relating specifically to
diabetes are difficult to find. In one, 32 individuals with NIDDM were
randomly divided into a medication group or medication plus foot
reflexology.
After 30 days, a number of measurements, including
fasting blood glucose levels and serum lipid peroxide, greatly reduced
in the reflexology group, but there was no change in the medicine-only
group (Chung Kuo Chung His I Chieh Ho Tsa Chih,1993; 13:536-8).
Finally,
in one small, double-blind, crossover study of the effect of
non-contact therapeutic touch and prayer on IDDM, small reductions in
insulin dose levels were found. The study was not large enough to draw
sweeping conclusions (J Sci Explor, 1994; 8: 367-77).
Many
people with diabetes don't know it until the symptoms of the disease
become so acute they need urgent medical attention. This is one reason
why finding ways of preventing the disease is so urgent. Another reason
for implementing lifestyle changes before problems occur is that some
individuals with diabetes find that their quality of life diminishes
greatly
in relation to the amount of time they need to spend
focusing on food intake and medication. For those who already have
diabetes, there is no cure but careful self-management. The
appropriate
choice of complementary therapies can mean a reduction in aggressive
medications and a boost to your day-to-day quality of life.
Insulin can be a lifesaver, but its use is also associated with
debilitating side effects. While you may never be able to come off
insulin completely if you are diabetic, lowering the amount you need to
rely on can reap many benefits.
Firstly, it is possible that
some diabetics are taking too much insulin. For example, 'white coat
hyperglycaemia' - in which blood glucose is higher in the clinic than
when measured at home - is a well-documented phenomenon (MD Med J,
1990; 39: 555-9; BMJ, 1992; 305: 1194-96), though doctors are quick to
ascribe this to patient error. Nevertheless, your doctor could be
overprescribing or giving you a just-in-case dose, even though there is
no evidence that prophylactic insulin is either safe or effective
(Lancet, June 20, 1992, 1504).
What is more, reliance on insulin
can cause longer-term problems such as neurological complications, eye
problems, nephropathy, neuropathy and cardiovascular disease. These
side effects are the most common cause of death in IDDM. The jury is
also still out on the safety of human insulin, which is not 'natural'
at all but genetically engineered and more likely to cause death and
debilitating side effects than the porcine variety. Human insulin can
also prevent diabetics from perceiving symptoms of a hypo, thus
increasing the likelihood of severe hypoglycaemia (Lancet, 1987; ii;
382-5).
Instead of not producing enough insulin, your body may
be insulin-resistant, in which case insulin injections may not be the
best way to approach the problem. Certain outside influences can
increase your resistance to insulin. These include cigarette smoking
(Lancet, May 19,1992;1128), obesity (Diabet Care, 1991; 14: 173-94) and
hypertension. Insulin resistance is actually quite common in those who
are not diagnosed as diabetic. As many as 25 per cent of the 'normal'
population are insulin-resistant, as are those diagnosed as
glucose-intolerant or NIDDM (Diabetes, 1988; 37: 1595-607). In these
individuals, the pancreas will compensate by increasing insulin
production. Others will go on to develop IDDM (Lancet, 1994; 344:
521-3).
To protect yourself
Check levels of vitamins and minerals. If
necessary, have a blood test and correct any deficiencies. Chromium
deficiency can be related to reduced glucose tolerance, increased
glucose levels on an empty stomach and reduced number of insulin
receptors. Supplements may help (Erfahrungsheilkunde, 1997; 46: 150-2).
Try taking 200 ug daily (Am J Clin Nutri, 1991; 54: 909-16). Magnesium
deficiency is also common in NIDDM (Diabet Res Clin Pract, 1990; 10:
203-9; Magnesium, 1984; 3: 315-23). Other common deficiencies in those
with glucose intolerance include copper, zinc and manganese. In cases
of insulin resistance, common deficiencies include phosphorous and
potassium.
Essential fatty acids (EFAs) are important and even a
modest intake, obtainable by consuming fish regularly, is enough to
lower plasma triglyceride levels (Diabetologia, 1997; 40: 45-52). If
you do take supplements, try linseed oil (1-2 tablespoons per day),
fish oil capsules (200-500 mg of EPA) or combination preparations like
Efamol Marine (which contain omega 3 and omega 6 EFAs-four to eight
capsules a day).
In a double-blind, placebo-controlled trial of
patients with diabetic nerve damage, 12 received 360 mg gamma-linolenic
acid (GLA) daily, and 10 placebo, over a six-month period. Those taking
GLA experienced improvement in neuropathic symptom scores, muscle use,
and heat and cold thresholds (Diabet Med, 1990; 7: 319-23).
Free
radical damage has a major role in diabetes. Raised blood glucose
levels produce more free radicals. Also, diabetics are often low in
vitamin E, which helps to minimise free radical damage (Diabet Care,
1991; 14: 68-72). Taking at least 900 mg daily will improve symptoms
(Am J Clin Nutr,1993; 57: 650-56; Am J Clin Nutri, 1993; 58: 412-16).
Vitamin E also improves circulation (Diabetes, 1982; 31: 947-51;
Metabolism, 1992; 41: 613-21).
Also try 500 mg twice daily of
vitamin C. In a placebo-controlled trial of 40 elderly patients with
NIDDM, those taking vitamin C improved whole-body glucose disposal,
lowered cholesterol and decreased free radical damage. The authors
concluded that vitamin C has an important role to play in management of
NIDDM (J AM Coll Nutr, 1995; 14: 387-92).
Try antioxidant
treatment to prevent nerve dysfunction. In a trial of alpha-lipoic acid
ALA in 328 NIDDM patients, intravenous treatment of 600 mg daily over
three weeks proved superior to placebo in reducing symptoms without
causing serious side effects (Diabetologia 1995; 38: 1425-33).
Try
a different diet. In a study of eight patients with IDDM, a largely
vegetarian diet produced marked improvement in symptoms (Diabet
Med,1991; 8:949-53).
A diet high in complex carbohydrates and
plant fibres may be the most effective one. This diet would include
lots of cereal grains, legumes and root vegetables, while restricting
simple sugars and fat. In one report, it led to the discontinuation of
insulin therapy in 60 per cent of IDDM patients and significantly
reduced insulin use in the other 40 per cent (Am J Nutr, 1979; 32:
2312-21).
Fresh food is always best. Special diabetic foods such
as jams, cereal bars and chocolate probably have no special nutritional
advantages and they are expensive.
In addition, you should:
*
Cut out caffeine. Finnish scientists believe excessive coffee
consumption can be an early trigger for IDDM (BMJ, 1990; 300: 642-3).
*
Lose weight. According to a study by the Harvard School of Public
Health, there is a strong link between NIDDM and obesity (BMJ, 1995;
310: 555-9; 560-4).
* Eat lots of onions and garlic. They have a
significant ability to lower blood sugar (Ind J Med Res,1977, 65:
422-29; Quart J Crude Drug Res, 1979; 17: 139-96).
* Cut out
sugar. A high-sugar diet raises your risk of developing NIDDM by one
and a half times. When combined with a low intake of fibre, your risk
doubles (JAMA, 1997; 277: 472-7).
For your pancreas, try papaya (in
capsule form with meals), which contains papain, to help digest
protein. Digestion begins in the mouth, so chew your food care-fully.
Try also having several small meals instead of a few big ones each day,
to take the pressure off the pancreas.
To protect your children:
*
Get them moving. Exercise can prevent NIDDM (Lancet, 1991; 338: 774-8),
and it can minimise the risk in the insulin-resistant children of
diabetic parents who usually have a 40 per cent risk of developing
diabetes themselves (N Eng J Med, 1996; 335: 1357-62).
*
Breastfeed them. This can also help protect children of diabetics.
Early exposure to cow's milk can trigger an immune response, which in
turn can cause an allergy. The risk for a baby exposed to cow's milk in
the first three months of life is one and a half times greater (Lancet,
1996; 348: 926-8; BMJ, 1994; 308: 534-5). Exclusive breastfeeding for
the first two months of life can protect against NIDDM (Lancet, 1997;
350:166-8).
* Early nutrition is important (BMJ, 1993; 306:
283-4). Childhood diabetes doubled in the 12 years to 1994, suggesting
that childhood diabetes is a lifestyle condition, not just a genetic
one. In one study of childhood NIDDM, 92 per cent were obese. The same
researchers also say that watching your child's exposure to harmful
chemicals via plant and animal substances should also be a vital part
of preventing diabetes in children (Lancet, May 25, 1996).