Conservative management and prevention of diabetes mellitus
Frank E. Strehl
Diabetes mellitus is a significant chronic health problem in the US as an estimated 18 million Americans are currently living with this disease–one that is primarily a preventable condition. Doctors of chiropractic are the ideal physicians to manage the vast majority of these patients since lifestyle and dietary alterations will effectively control the blood glucose in up to 80% of those afflicted with this condition. Our current Western diet combined with our sessile lifestyle appears to account for approximately 80% of the cases of diabetes which are classified as Type 2 or non-insulin dependent. The complications of uncontrolled blood glucose include an increased risk of cardiovascular disease, stroke, renal disease, retinopathy leading to blindness, and various neuropathies.
Type 1 diabetes, insulin-dependent diabetes mellitus (IDDM), develops secondary to the degeneration of the pancreatic B-cells that produce insulin and is considered to result from a genetic predisposition that is triggered by various environmental factors. Ramel reported in the Annals of Nutrition and Metabolism that there is a definite link between the consumption of cow’s milk and Type 1 diabetes. This form of diabetes is usually diagnosed during childhood or adolescence. Fortunately, only 15-20% of diabetics have this form in which the primary signal for glucose transport into the cells, insulin, is at very low or nonexistent levels.
Type 2 diabetes affects 80-85% of those diagnosed with the condition and it is considered to be non-insulin dependent (NIDDM). These people are usually found to have elevated levels of serum insulin and as a result are insulin resistant. This form of diabetes includes the “metabolic syndrome” or “Syndrome X” that is used to describe those who are at an increased risk of developing Type 2 diabetes secondary to abdominal obesity, elevated triglycerides, low HDL cholesterol levels, hypertension, and elevated serum glucose levels. Our Western diet that involves repetitive consumption of refined carbohydrates results in spikes in the blood glucose. The resultant spike in insulin secretion is probably the leading cause of insulin resistance and thus Type 2 diabetes.
Urinary Glucose: Detecting diabetes is one of the best arguments for performing a routine urinary dipstick test on all new patients and once a year on all existing patients. In patients with diabetes mellitus the glucose is in such an excess that the reabsorption process is unable to absorb this glucose and as a result the glucose is eliminated through the urine.
Urinary pH: The acid/base balance of the body is critical in the regulation of glucose. This is accomplished through testing the first morning urine–the ideal range should be 6.5-7.5. When the pH is below 6.5, the body finds it difficult to buffer the mineral capacity, especially magnesium, and without this mineral the body is unable to remove the acids within the individual cells. This results in the glutamate levels dropping, which makes it even more difficult for the body to regulate the serum glucose. As an example, protein, grains, dairy, sugars, and fried foods are all acid-forming while fruits and vegetables are alkaline-forming.
Fasting Serum Glucose: Although the clinical range for glucose is 65-110, the ideal homeostatic range is closer to 85-100. Numerous studies have identified a serum glucose level of 160 mg/dl on three consecutive tests to be pathognomonic of diabetes. It should be noted that the American Diabetic Association has identified a fasting glucose of 125 as being consistent with diabetes mellitus–the pharmaceutical industry’s influence might be suspected in the selection of this number just as was the case in the numbers designating pre-hypertension. The astute doctor should identify any steady elevation from year to year and implement preemptive measures immediately.
Hemoglobin A1e (Glycohemoglobin): The clinical range for this test is 4.2-7.0, and it is an assessment of a patient’s average glucose level over approximately a 6-week period. It is possible for someone to have a well-regulated serum glucose level but have an elevated long-term average glucose level.
ELISA/ACT delayed food allergy testing: Currently, one of the theories for the etiology of diabetes is an immune system malfunction, and thus, delayed food allergies may play a role in this disease. The ELISA/ACT food and chemical allergy test is easy and noninvasive, and since it is performed in vitro on live lymphocytes, there is no further challenge to the immune system. The significance of such testing lies in the fact that delayed food allergies may cause a reaction anywhere from one hour to four days following ingestion of the offending-substance. In short, a food that is normally considered to be healthy may actually be poison for the patient. The treatment is quite simple, as these foods, preservatives, and flavorings are carefully avoided in the patient’s diet.
Adrenal Stress Test: Test kits can be ordered from a number of quality laboratories, and the test is performed in the privacy of the patient’s home. The value of this test is that the physical and emotional stress of diabetes demands that the adrenal glands work at full capacity releasing cortisol. This release stimulates the release of glucose from the liver to cause the serum glucose to increase triggering release of insulin and eventually the serum glucose will drop. The Adrenal Stress Test assesses the levels of cortisol throughout the day and the average level of DHEA. Once these levels are known, the cortisol and DHEA can be balanced with one of the phytochemicals structured like the body’s cortisol or DHEA.
Having assessed the diabetic patient, treatment may commence with lifestyle and dietary changes, in addition to nutritional supplementation. Some basic guidelines for a diabetic patient include:
* Avoid most processed foods.
* Avoid trans-fatty acids.
* Increase dietary fiber.
* Avoid known food allergens (it may prove beneficial to test for gliadin antibodies and anti-tissue glutamase to rule out the possibility of celiac disease and thus, the elimination of gliadin and gluten respectively).
* Avoid artificial sweeteners, especially aspartame and Splenda; stevia and xylitol are acceptable alternatives.
Nutritional Supplement Considerations
Dietary Fiber: Both types of diabetes respond favorably to an increased consumption of fiber, which reduces the speed at which carbohydrates are absorbed and increases tissue sensitivity to insulin. Psyllium husk powder (also available in capsules) has been demonstrated to reduce both fasting and postprandial blood glucose levels, as well as improve the lipid profiles in Type 2 diabetics. (Dosage: 5 g taken 20-30 minutes prior to meals)
Essential Fatty Acids: Diabetic patients have a decreased conversion of the Linoleic acid into gamma-linolenic acid, so increasing the consumption of the latter is prudent. This can be accomplished by prescribing evening primrose oil or the less expensive borage oil. The consumption of the long chain EPA and DHA found in fish oils will be protective to the retina of diabetic patients. (Dosage: 1,000 mg twice a day)
Chromium: Chromium works in conjunction with insulin to increase the access of insulin into the cells. One milligram a day has been found to improve the HbAlc and fasting glucose when compared to placebo. (Dosage: 1-2 mg/day)
Vanadium: Vanadium has been found to enhance the action of insulin in numerous studies. (Dosage: 100 mg/day)
Alpha Lipoic Acid (Thioctic Acid): Alpha lipoic acid modulates glucose and insulin sensitivities, as well as preventing much of the free radical damage secondary to prolonged hyperglycemia. (Dosage: 600 mg three times a day)
Vaccinium Myrtillus (Bilberry, Blueberry): Research has demonstrated that oral administration reduces hyperglycemia in normal and depancreatized dogs, even when glucose is concurrently injected intravenously. Upon injection, it is somewhat weaker than insulin, but it is also less toxic–a single dose can yield beneficial results for several weeks. The anthocyanosides inhibit sorbitol accumulation and thus provide protection from the vascular and neurological sequelae of diabetes. (Dosage: 160 mg (25% extract) taken three times a day)
Bitter Melon (Momordica Charantia): Bitter melon, rumored to be on the hit list of the Codex Alimentarious and thus targeted for being banned, was demonstrated in one study to cause a hypoglycemic response when taken as an aqueous suspension in 86% of NIDDM patients. In a similar study, 73% of Type 2 diabetics responded favorably to the consumption of 1 oz. of bitter melon juice. Unfortunately, these were not controlled trials. (Dosage: 1,000 mg/day)
Gymnema Sylvestre: One extract of Gymnema sylvestre (GS4) has been used in clinical trials on both Type 1 and 2 diabetics. In one study, IDDM patients given 400 mg/day of GS4 had insulin requirements reduced, and their fasting blood glucose levels were lowered. This same extract has been found to double the number of pancreatic beta cells of diabetic rats. All of these actions appear to result from increasing beta cell membrane permeability. (Dosage: 400 mg/day)
Both Type 1 and 2 diabetes respond quite favorably to natural treatments and fall within the domain of chiropractic management. It should be noted that Type 1 diabetics will most likely still require insulin, but the dosage may be markedly reduced. This is desirable as many researchers have speculated that synthetic insulin itself may be responsible for many of the harmful vascular effects of diabetes mellitus.
About the Author
Dr. Frank Strehl is a graduate of National College of Chiropractic and a Diplomate of the American Board of Chiropractic Internists. Dr. Strehl hosts a radio show, “Doctor on Call” which can be heard in the Chicago metro area, as well as parts of Indiana and Wisconsin. His private practice is located in Wheaton, Illinois.
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by Frank E. Strehl, DC, DABCI
COPYRIGHT 2006 Original Internist, Inc.
COPYRIGHT 2007 Gale Group