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Diabetes

Diabetes

Diabetes

Diabetes mellitus is a chronic disease characterised by high levels of sugar in the blood due to insufficient insulin and/or insulin resistance (where the cells do not respond to insulin normally). Insulin is a hormone produced by the pancreas which is responsible for moving the glucose in the blood following a meal into the fat, liver and muscle cells to be stored for energy.

Aetiology

There are three major types of diabetes with different causes and risk factors:

Type 1 diabetes: an auto-immune disorder characterised by the destruction of the insulin- producing pancreatic beta-cells. Cause of auto-immunity unknown, but may be triggered by viral infection or toxic exposure in a genetically susceptible individual. Can occur at any age, but most commonly diagnosed in children, adolescents and young adults. Type 1 diabetes is insulin- dependent – as no insulin is being produced by the pancreas, patients must have daily insulin injections

Type 2 diabetes: makes up the majority of diabetes cases and is related to diet and lifestyle. Caused by insulin resistance where the pancreas continues to produce insulin, but the insulin receptors on the cells no longer respond normally to it, affecting the uptake of glucose by the liver, fat and muscle cells. Mostly develops in older, overweight adults, but incidence is increasing in younger adulthood and adolescence due to rates of obesity. Type 2 diabetes is usually non- insulin dependent.

Gestational diabetes: high blood sugar that develops at any stage during pregnancy, most commonly the 3rd trimester, in a woman who does not have diabetes. It is caused when the pancreas of the pregnant woman does not secrete the extra insulin required during pregnancy, leading to increased blood glucose levels. More insulin is required in pregnancy because several factors, including pregnancy hormones, increase insulin resistance by affecting the binding of insulin to insulin receptors.

Risk factors

Type 1 diabetes

  • Family history of Type 1 diabetes or other autoimmune disease e.g. Hashimoto‘s thyroiditis,
  • Graves‘ disease, myasthenia gravis, Addison‘s disease or pernicious anaemia
  • Maternal pre-eclampsia
  • Illness during early infancy
  • Child of an older mother
  • Cow‘s milk consumption in infancy
  • Northern European or Mediterranean descent
  • Smoked / cured meats: contains nitrates which can destroy b-cells in susceptible individuals

Type II diabetes

  • Family history of Type II diabetes
    • Age older than 45 years
    • Diet high in sugars, refined carbohydrates and fat
    • Excess body fat, especially abdominal obesity with waist circumference > 90cm in women and > 102cm in men
    • Dyslipidaemias (high triglyceride, high LDL, low HDL)
    • Hypertension
    • History of gestational diabetes or polycystic ovary syndrome
    • African American, Hispanic American and Native American descent
    • Low birth weight and/or malnutrition in pregnancy may cause metabolic abnormalities that later leads to diabetes
    • Prolonged stress

Gestational diabetes

  • Pregnancy at age over 25
    • Family history of diabetes
    • High birth-weight baby (> 9lb)
    • High blood pressure
    • Excessive amniotic fluid
    • Overweight before and/or during pregnancy

Signs & symptoms of Diabetes

Type 1 diabetes: develops rapidly.

  • Frequent Thirst
    • Frequent Hunger
    • Frequent urination
    • Fatigue
    • Blurred vision
    • Tingling in feet
    • Fruity breath odour
    • Weight loss

Type 2 diabetes: develops slowly and may be asymptomatic for years. Early symptoms may include:

  • Frequent infections that take a long time to heal e.g. UTIs, skin infections etc.
    • Fatigue
    • Increased thirst and hunger
    • Increased urination
    • Blurred vision
    • Erectile dysfunction
    • Pain or numbness in hands or feet

Gestational diabetes

  • Usually has few symptoms and is often picked up by screening during pregnancy

Complications

  • Acute complications: arise from blood sugars becoming too high or low. More common in Type 1 diabetes and both can result in coma and death.

Long-term complications:

Retinopathy and cataracts

  • Nephropathy and kidney failure
    • Poor peripheral circulation – diabetic ulcers, gangrene
    • Atherosclerosis and heart disease
    • Peripheral neuropathies – numbness, tingling, pain, dulled sensations

Gestational diabetes:

  • Babies born to mothers with gestational diabetes are at risk:
    • Birth defects and infant mortality
    • Being large for gestational age
    • Low blood sugar
    • Women with gestational diabetes are at increased risk of developing Type 2 diabetes; they also have a higher incidence of pre-eclampsia and Caesarian section

TREATMENT STRATEGY FOR DIABETES

Type 1 diabetes is insulin-dependent and requires life-long insulin therapy.

Good dietary management can reduce the dosage of insulin needed and prevent complications. Dietary changes should always be made in conjunction with carefully monitoring blood glucose levels.

Type 2 Diabetes is reversible in the early stages with dietary and lifestyle intervention

Gestational Diabetes can usually be managed by dietary changes and exercise, although some women may require anti-diabetic drugs or insulin therapy.

The treatment strategy for all types of diabetes is more or less the same, except where indicated.

  • Reduce and stabilise blood glucose level
  • Improve insulin sensitivity
  • Support glucose metabolism
  • Investigate and correct gut dysbiosis
  • Ensure methylation and gall bladder are functioning correctly
  • Reduce inflammation and oxidative stress (caused by high blood glucose)
  • Reduce weight / support fat metabolism (mainly in Type 2 diabetes)
  • Prevent complications:
    • Support microcirculation
    • Support cardiovascular health
    • Support nervous system

Diet plan guidelines for Diabetes

  • A low-glycaemic load diet is one of the primary treatment strategies for all types of diabetes:
    • Sugars and refined carbohydrate intake should be eliminated, and intake of high-glycaemic foods such as grains, starchy vegetables, dried fruits, sweet fruits and fruit juices should be limited.
    • Small, frequent meals throughout the day, rather than 3 large meals, may help with blood sugar control
    • Avoid overeating in any one sitting

Low carbohydrate ketogenic diet:

  • Some studies have shown that a low-carbohydrate ketogenic diet (< 50 g carbohydrate per day) may be even more useful than the low-glycaemic index diet in controlling blood glucose in type 2 diabetes, especially in obese subjects (Hussain et al, 2012; Westman et al, 2008; Dashti et al, 2007)
    • The low-carbohydrate diet reduces insulin requirements and there is evidence that some animal fats may have a protective effect on obesity, diabetes and heart disease.
    • Diabetics put on a ketogenic diet may be able to reduce or stop their medication (Yancy et al, 2005)
    • Diabetics should consult their doctor before going on a ketogenic diet and be carefully monitored as excessive ketones in the blood can lead to ketoacidosis, in which the blood becomes acidic, leading to serious illness. Type 1 diabetics are particularly at risk of ketoacidosis and must be monitored carefully by their GP
    • There is not enough evidence to support the safety of ketogenic diets in pregnancy; therefore, pregnant women should not be put on a low-carbohydrate ketogenic diet and rather should focus more on a low GI diet.
  • Reduce overall caloric intake (in type 2 diabetes): 250-500 calories less than the average daily intake
  • Diets should be high in fibre to support blood glucose control:
    • Fibre should come from legumes, whole grains and vegetables. Legumes, in particular, have been shown  to improve glycaemic control and reduce cardiovascular risk (Jenkins et al, 2012)
    • Soluble fibre should be included to slow absorption of glucose: oats, oat bran, oat milk, psyllium, chia bran, linseeds.
    • Psyllium hulls and ground linseeds are associated with reductions in fasting glucose, cholesterol, LDL and trigylcerides.
  • Adequate protein, especially from grass fed meats, poultry, fish, legumes, nuts, seeds and spirulina, should be included in meals to help stabilise blood sugars
    • Diabetes WA recommends a maximum of 20% protein. However, other studies have found that a moderate increase of protein to 20-30% (1.5-2 g/kg) of caloric intake in diabetic patients without renal disease results in better glucose control, weight reduction and improvement in cardiovascular risk factors (Hamdy & Horton, 2011)  Clinically we find 1.8g/kg – 2.5g/kg effective in blood glucose management.

Fats

  • Include healthy fats in each meal to slow absorption of glucose: oily fish, olive oil, avocado, nuts and seeds, coconut oil.
    • It is recommended to increase mono-unsaturated and polyunsaturated fats, especially omega-3 fatty acids and reduce saturated fats, trans fats and refined vegetable oils.
    • At least 2-3 servings of fish should be consumed per week; alternatively, non-animal sources of omega 3, such as hempseed oil, flaxseed oil and nut oils such as pecan and walnut, may be recommended. Chia seeds are an excellent source of alpha-linolenic acid as well as protein, fibre and minerals
    • Olive oil is high in mono unsaturated fatty acids (MUFA‘s), which research has found to be associated with significant improvements in abnormal glucose markers
  • Care must be taken with low fat products as they are often loaded with sugar. Patients must be educated to look for fat and carbohydrate content on labels.  Low fat products in general we advise to avoid.

Dairy foods:

  • Studies have shown a positive association between the consumption of beta-casein A1 and type I diabetes (Elliott et al, 1999). Therefore, milk containing beta-casein A1 may be best avoided in Type I diabetes.
    • Conversely, other studies have found in inverse relationship between low-fat dairy consumption and the risk of developing Type II diabetes (Tong et al, 2011). 
    • Clinically we advise to avoid milk.

Sweeteners

  • Sugar consumption, including all nutritive sweeteners and simple sugars, should be avoided.
    • Artificial sweeteners are often recommended as an alternative to replace sugar; however the use of fructose and sorbitol, for example, are known to be involved in diabetic complications and should be discouraged.
    • Xylitol or stevia are recommended as sugar alternatives as they have no effect on blood sugars and are safer to use.  Ideally no sweeteners should be used.

Alcohol

  • Excessive alcohol consumption should be discouraged and alcohol should never be consumed on an empty stomach.  Ideally avoided in diabetic patients.

Alcohol is not recommended at all for pregnant women

  • Include foods high in chromium to support glucose metabolism: liver, brewer‘s yeast, grass fed meats, fish, fruits, vegetables
  • Include foods high in magnesium: green leafy vegetables, nuts and seeds
  • Include anti-inflammatory and antioxidant foods to protect against diabetic complications: berries, cherries, fresh vegetables juices, turmeric, ginger, green tea
  • Include foods to support circulation: onion, garlic, ginger
  • Include cinnamon in the diet: assists with blood glucose control

Supplements that support Diabetes

A thorough assessment of all diabetic patients should be undertaken prior to supplementation to support diabetes.  The below are broad spectrum supplements that assist in the management of diabetes.

  • Chromium – improves insulin sensitivity and facilitates uptake of glucose into cells
  • Magnesium – strong association between low magnesium and Type II diabetes)
  • B-complex – essential for glucose and fat metabolism
  • Vanadium –  facilitates insulin to move glucose into cells
  • Taurine –  stimulates insulin release
  • Omega-3 EFAs – anti-inflammatory, improves blood lipid parameters, protects nervous and cardiovascular systems
  • B3& B6 – protects islet cells from attack and may help restore function in Type 1 diabetes
  • Broad spectrum antioxidants:
    • Vitamin C – stimulates insulin release and protects against oxidative stress
    • Zinc – supports pancreatic function and insulin metabolism, and protects against oxidative stress
    • Selenium – antioxidant
    • Alpha-lipoic acid – also helps prevent peripheral neuropathy
    • Quercetin 100 mg tid: helps protect eye health
    • Biotin 250 mcg/day: helps prevent peripheral neuropathy
  • Probiotics: supports immune health, especially in Type 1 diabetes
  • Vitamin D3 (depending on status) – supports immune health, especially in Type 1 diabetes. Vitamin D deficiency is associated with a higher risk of Type 1 diabetes, as well as the development of peripheral neuropathy and retinopathy
  • B12 –  B12 deficiency linked to development of peripheral neuropathy

Herbal Medicine treatment that supports Diabetes

  • Blood sugar stability – fenugreek, goat‘s rue, gymnema, cinnamon, aloe vera, bitter melon
  • Immune modulating – echinacea, astragalus, Korean ginseng, withania
  • Pancreatic – goat‘s rue (regenerative effect on beta-cells); fringe tree, gymnema, barberry
  • Anti-inflammatory – turmeric, ginger, boswellia
  • Anti-oxidant – turmeric, St Mary‘s thistle, bilberry, green tea, gingko, rosemary
  • Circulatory stimulants – gingko, ginger, prickly ash
  • Adaptogenic – (may reduce blood sugars via reducing stress response): Korean ginseng, withania

Lifestyle / Physical measures

  • With careful attention to diet and exercise, diabetes patients can maintain their blood glucose levels at near normal levels while minimising their insulin dose
  • Regular exercise is important. 30 minutes of aerobic activity most days of the week lowers blood sugar, improves insulin sensitivity, lowers blood pressure, improves circulation, decreases stress, increases energy
    • If blood sugar is poorly controlled (fasting blood glucose > 14 mmol/L), it is best to avoid exercise until blood sugar stabilises.
  • Stress management – need to determine ways to deal with chronic stress and stressful life events as they can potentially exacerbate diabetes
  • Massage to improve circulation and manage stress

FUNCTIONAL MEDICINE NATURAL TREATMENT OF DIABETES

Diabetes is a condition that requires a multifaceted approach in balancing various systems of the body.  Correcting digestion, the absorption of food, intestinal permeability, immune reactions to intolerant foods, gut dysbiosis, gall bladder insufficiency, methylation blocks and nutrient imbalances are all key areas that need assessing and correcting to be able to manage and reverse diabetes.

At our Perth clinic of Advanced Functional Medicine we undertake extensive functional testing on our diabetic patients to explore the above dysfunctions and correct the body system functions and biochemical pathways.  Our approach commonly results in reversal of the disease and a marked reduction in insulin required by type 1 diabetics.  Giving more energy, better cognition, improved sleep, reduced pain and an overall improvement in health.

If you of a family member are suffering from diabetes we would love to hear from you.  Have you reversed type 2 diabetes, what were you best interventions?  Have you had your gut assessed?  How did you change your diet to improve your diabetes?  Please leave a comment below.

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Jarrod Cooper – ND

Jarrod Cooper – ND

Jarrod Cooper - ND is the founder of Advanced Functional Medicine Australia. He is a Naturopathic Doctor with extensive functional medicine training from leading practitioners in the USA and worldwide.

He is leading the way with advancements of functional medicine, clinically implementing worldwide best practices in Functional Medicine throughout Australia.

Jarrod consults in person from Perth, Western Australia and also online via Telehealth throughout Australia and worldwide.

If you are looking for personalised treatment, we highly recommend contacting Jarrod Cooper’s Advanced Functional Medicine clinic in Australia.

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