Each day, approximately 2,700 people are diagnosed with diabetes. About 1 million people aged 20 years or older will be diagnosed this year.
—American Diabetes Association
Harry is now 73, but he was 50 when his blood sugar began creeping up. At each annual physical, it was a bit higher. His doctor would watch the sugar level and tell Harry, “By the way, it wouldn’t hurt to lose some weight.” Finally, after 13 years, Harry’s blood sugar levels exceeded the boundary for diabetes, and Harry was officially diagnosed.
Although Harry had heard the scare stories about diabetes (his uncle had gone blind and lost a foot), Harry felt just fine, so he ignored the warnings. His doctor prescribed a drug to reduce blood sugar, which Harry took haphazardly. His blood sugar continued creeping ever upward.
After a few years, Harry noticed he didn’t have the zip he once had. But then again, he was getting older. His feet tingled a bit sometimes, and cuts and sores didn’t heal very quickly. Perhaps most worrisome, he wasn’t up to the bedroom experience the way he used to be. You’d think Harry would have clued in to these problems, but it seemed easier to ignore them — for a while.
The inevitable day finally came when the doctor suggested insulin. This was the straw that broke the camel’s back. Harry could tolerate anything but the needle. So Harry came to me to see what we could do. After some discussion, we determined the first goal was to push the blood sugar down as fast as possible to avoid the insulin. Harry agreed to dietary revisions and herbal medicines (outlined below) to avoid insulin.
Six weeks later, we embarked on a long-term plan to reverse the disease and keep Harry off insulin. Over the course of a year, Harry lost 50 pounds, made some serious dietary changes and got accustomed to taking daily natural remedies. It’s been 10 years, his blood sugar has stabilized at a normal level and those nagging symptoms are a thing of the past.
Important note: If you have diabetes, you should never suddenly quit using diabetic drugs, especially insulin. Under a physician’s guidance, it may be possible for type 2 diabetics to gradually reduce the dose substantially and successfully, ideally to zero.
Doubling Diabetic Population
A major health epidemic, diabetes is creating a serious burden on the world’s health-care system. It is estimated that 7.2 percent of American adults (about 17 million people) are diabetic. Unfortunately, according to the American Diabetes Association, 5.9 million of those people don’t even know they have it. The prevalence of diabetes is increasing rapidly, at a rate of 7 percent per year. At the current rate, the diabetic population will just about double every decade. Thirty years from now, at least 50 percent of people 50 or older will have the disease.
Diabetes is the fifth deadliest disease in the United States. It is associated with a Western lifestyle and is rarely seen in cultures relying on more traditional diets. As people around the world gradually adjust their diets from native, local foods to commercial, processed diets, their rate of diabetes rises, over time matching the proportion in Western cultures. India, a country with historically low diabetes rates, is now experiencing the highest rate of increase.
Diabetes, or diabetes mellitus, is the most common of the serious metabolic diseases and is characterized by high blood sugar levels in the body. Diabetes is a chronic disorder of carbohydrate, fat and protein metabolism. Its chief complications include arterial plaque (atherosclerosis), heart disease and stroke, kidney disease, nerve degeneration, foot ulcers, gum disease and, occasionally, dementia.
The two major types of diabetes are type 1 and type 2.
Type 1, or insulin-dependent diabetes mellitus, usually is diagnosed in children, teens and young adults (before age 25) and accounts for 5 to 10 percent of American diabetics. This form involves complete destruction of the cells in the pancreas (called beta cells) that produce the hormone insulin. People with type 1 diabetes require lifelong insulin to control blood sugar. Fortunately, the modern development of insulin has allowed these people to survive their illness, but there is no known cure. Natural methods can and do offer hope for improved control of blood sugar, however.
The precise cause of type 1 diabetes has not been discovered, but the disease may be due to injury of the beta cells in combination with a defect in the capacity of the body to heal its tissue. Possible causes of this injury may be autoimmune reactions, free radical (toxicity) damage or viral infection. Because the onset of type 1 diabetes is much greater during October through March, mumps, hepatitis and measles are suspected.
The remaining 90 to 95 percent of diabetics in the United States have non-insulin-dependent diabetes mellitus, or type 2, which usually is diagnosed after 40 years of age. Type 2 diabetes is characterized by a loss of sensitivity to insulin. Typically, insulin levels in the blood are actually increased, but the tissues have lost their ability to respond to the hormone.
Obesity is a serious contributing factor in type 2 diabetes — 90 percent of type 2 diabetics are obese. Even in nondiabetic individuals, large weight gain results in carbohydrate intolerance, higher blood insulin and insulin insensitivity in the tissues of the body. Progressive insulin insensitivity is now thought to be the main factor in the development of this type of diabetes. Most obese diabetics are able to restore normal blood sugar levels by achieving ideal body weight. Even though dietary intervention has a high success rate, it’s often overlooked in favor of insulin or other anti-diabetes drugs.
"Between 1990 and 1998, diabetes rose 33 percent, and 6.5 percent of the population was diagnosed with the disease. The rise was sharpest — about 70 percent — among people ages 30 to 39."
It’s critical for the diabetic to keep his or her blood levels of triglycerides and cholesterol low. As people deviate from a diet low in fats and refined carbohydrates, triglyceride levels rise. Some researchers believe the triglyceride level is the single most accurate prediction of diabetes risk. The previous conventional treatment supported a high-fat diet, which reduces blood sugar in the short run, but now is thought to raise triglycerides, ultimately provoking diabetes more intensively in the future.
Atherosclerosis is a major complication in diabetes. Therefore, lifelong maintenance of proper cholesterol levels is essential. Recent studies have shown that lowering cholesterol levels retards the progression of kidney disease. Not only do dietary measures affect cholesterol levels, but many herbs are quite successful in this area (see more about cholesterol on Page 44).
American ginseng (Panax quinquefolius) is making news in the United States as an aid to controlling blood sugar. A number of studies conducted by scientists at the University of Toronto verified ginseng’s ability to smooth out the after-meal blood sugar spikes that type 2 diabetics experience.
The first paper, published in 2000, explained that a single 3-gram capsule of a prepared ginseng extract reduced these blood sugar rises. In nondiabetic healthy people, ginseng only suppressed postmeal blood glucose if taken 40 minutes before eating carbohydrates, while diabetics got results when they took ginseng either 40 minutes before or with the carbohydrate.
The investigators then wanted to determine which timing and dose would be most beneficial for diabetic patients. They concluded that time did not matter and that doses above 3 grams per meal were no more effective than smaller doses. Next, they compared times and doses in nondiabetics. Again, time did not matter but increasing the dose improved results a bit. Larger doses reduced blood sugar by a slightly higher percentage (3 grams, 26.6 percent; 6 grams, 29.3 percent; 9 grams, 38.5 percent).
Then, in 2001, the researchers administered the herb closer to the meal. Ginseng doses from 1 to 3 grams all worked equally. The best blood sugar lowering effect was from taking the herb 40 minutes before the meal. Based on these studies, the bottom line is that a modest dose of 1 gram taken 40 minutes before each meal would work well for pre-diabetic people (anyone who has abnormal blood sugar levels or mechanisms that would eventually lead to diabetes if left untreated).
Fenugreek (Trigonella foenum-graecum), which is used as a seasoning in foods (especially in Egypt, India and the Middle East), is a well-documented herb for blood sugar control. Studies demonstrate benefits in both types of diabetics.
In one open study of 60 type 2 diabetics, published in Nutrition Research, 25 grams per day of fenugreek led to noteworthy improvements in overall blood sugar
control, blood sugar elevations after a meal and cholesterol levels. A different open study from the European Journal of Clinical Nutrition showed results with only 15 grams of fenugreek daily.
Further, in a small single-blind controlled study, patients with type 1 diabetes were randomly prescribed either fenugreek at a dose of 50 grams twice daily as part of their lunch and dinner, or the same meals without the powder, each for 10 days. Those on the fenugreek diet had significant decreases in their fasting blood sugar.
Holy basil leaf (Ocimum sanctum). This unassuming little garden plant plays a central role in the folk medicine of South Asia. Called tulsi in Sanskrit, this mild medicinal herb and vegetable is cultivated near temples and private homes, where it is believed to purify the air and to sanctify the environs.
Holy basil treats diabetes, normalizing both blood sugar and blood fats, including cholesterol and triglycerides, factors that are integral to diabetes, as well as to other cardiovascular diseases. A significant placebo-controlled, crossover study published in the Journal of Clinical Pharmacy and Therapeutics showed a 17.6 percent reduction in blood sugar and led the scientists to conclude that holy basil was of value in mild to moderate diabetes.
Traditionally, holy basil is given as a tea. Try a dose of 1 teaspoon of dry herb, brewed into 1 cup of water, in a dose of 3 cups per day.
Bitter melon (Momordica charantia). Also known as balsam pear, this vegetable, widely cultivated for food in Asia, Africa and South America, is widely known as a folk remedy in diabetes. This fruit looks like an ugly cucumber, green and covered with gourd-like bumps. Many studies, including a 2003 study published in the American Journal of Health-System Pharmacy, have demonstrated the hypoglycemic effect of this herb.
Bitter melon, commonly available in Chinese restaurants and Asian grocery stores, can be steamed or sautéed and eaten as a food. The fresh juice, dried herb and water decoction (tea) all are effective. Studies showed good results with 2 ounces of juice per day. The juice got its common name for good reason and is difficult to make palatable. So plug your nose and take a 2-ounce shot — down the hatch.
Gurmar leaf (Gymnema sylvestre). This remarkable herb, well known in Ayurvedic medicine, is just beginning to get serious attention in the United States. The plant’s leaves, when chewed, interfere with the ability to taste sweetness, which explains its Hindi name, gurmar, “destroyer of sugar.”
Gymnema certainly could serve as the backbone of a natural diabetes program. It has been used in India for the treatment of diabetes for more than 2,000 years. Used primarily for type 2 diabetes, its benefits extend to type 1, and it continues to be recommended today in India. The leaves raise insulin levels when administered to healthy volunteers. Gurmar tends to be a blood sugar balancer, lowering glucose significantly only in hyperglycemic people. It also significantly improves cholesterol and triglyceride levels.
Traditionally, 6 to 12 grams of the powdered leaf per day is used. Studies recently performed in India have used 400 mg per day of an extract of the leaves. In type 2 diabetics, ongoing use for periods as long as 18 to 24 months has been successful. In type 1 diabetic patients, a similar amount of 400 mg daily has been used as an adjunct to ongoing use of insulin.
In one recent study at the University of Madras, gurmar showed the potential for pancreas repair, raising the output of insulin to normal levels. Another Indian study reported that 25 percent of the participants were able to discontinue all diabetes medication with the use of gurmar alone.
Garlic and onions (Allium sativum, A. cepa). While well known as common foods, the bulbs of onion and garlic are significant hypoglycemics. The active properties are thought to be sulfur-containing compounds, such as allicin. Evidence suggests these compounds lower glucose levels by competing with insulin in the liver. The well-known cardiovascular benefits of these herbs alone (regulating blood pressure, cholesterol and platelet aggregation) justify their use in diabetes. However, even at moderate dietary levels, garlic and onions have potent effects, so diabetics should use them liberally.
The Western diet contributes to high blood sugar, which creates chaos in the body. Refined carbohydrates rapidly pump up glucose levels. To lessen this high blood glucose, the pancreas secretes large amounts of insulin, which helps glucose to be burned for energy.
Eventually, the high insulin levels engulf the body’s insulin receptors and cells become resistant to the hormone, making the body unable to control blood sugar levels effectively. And so it begins — the cycle of diabetes, heart disease and assorted complications. Because uncontrolled diabetes can cause devastating health problems, the American Diabetes Association recommends keeping your blood sugar levels as close to normal as possible (determined by a fasting plasma glucose level range of 60 to 109 mg/dl).
And the bottom-line question really is, “Does eating a lot of sugar cause diabetes?” Time after time, previous studies have found little relationship between total carbohydrate intake and diabetes risk. Using total carbohydrate intake, however, does not take into account the blood sugar effect or insulin demand of various forms of carbohydrates.
A study in the Journal of the American Medical Association looked at this issue. The report was part of a long-term study of diet and lifestyle factors in relation to chronic diseases (the Nurses’ Health Study) that involved more than 65,000 women ages 40 to 65 in 1986. All were free of cardiovascular disease, cancer and diabetes at the beginning of the study. The patients were followed for six years to chart the number that developed diabetes.
Of the 65,000 women, more than 900 developed diabetes. The women eating foods with the highest glycemic index (the carbohydrates that provoked the highest insulin demand) had the highest incidence of diabetes. Cola beverages, white bread, white rice and potatoes were risk factors. High-fiber whole grains reduced the chance of developing the disease. The scientists concluded that diets with high refined carbohydrates and low fiber content lead to a chronic high demand for insulin and increased the occurrence of diabetes, independent of other dietary factors and currently known risk factors. Their final advice is that grains should be consumed in a minimally refined form to reduce diabetes.
Dietary modification is absolutely essential for successful diabetes treatment. The disease is highly correlated with the “civilized” diet of refined carbohydrates and fiber-depleted food. Well-known naturopathic physicians Joseph Pizzorno and Michael Murray of Bastyr University in Kenmore, Washington, state, “the epidemiological evidence indicting the Western diet and lifestyle as the ultimate etiological factor in diabetes mellitus is overwhelming.”
The diet of choice in diabetes treatment is a program of high carbohydrate and high plant fiber (the HCHF diet), developed by James W. Anderson, M.D., and his team at the University of Kentucky at Lexington. This preferred routine includes cereal grains, legumes and root vegetables at high levels and limits simple sugars (white sugar), refined grains and fat. Anderson states that the ideal diabetic diet could include as much as 70 grams of dietary fiber per day. This diet has been shown to be considerably more successful than the conventional mainstream diabetic diet.
The HCHF diet results in reduced blood sugar after meals and later in the day, increases insulin sensitivity, reduces cholesterol and triglycerides, increases HDL cholesterol (“good” cholesterol) and promotes progressive weight reduction, all of which reduce the need for insulin. Diabetics who have adopted the HCHF diet and reaped the benefits, but who then resumed the conventional diabetic treatment diet, saw their insulin requirements return to prior levels.
Let’s Get Moving
Every authority in diabetes stresses the role of exercise in effective treatment. Every factor of diabetes is benefited by exercise. Obese diabetics are encouraged to build up the intensity of their exercise program gradually, then to go for the maximum they can possibly do. Thin types (usually type 1) may have to be a bit more moderate, with the focus on brisk walking. Exercise also reduces insulin resistance. The fitter a person is, the more muscle and other tissues respond to insulin. Several studies of strength training in older people have recently proved they can change their insulin levels with exercise alone.
A combination of diet and exercise can dramatically delay type 2 diabetes. The Diabetes Prevention Program is a major clinical trial in conjunction with the National Institutes of Health, comparing diet and exercise to drug treatment in 3,234 people with impaired glucose tolerance, a condition that often precedes diabetes. The trial was so successful that it was ended a year early because the data had clearly answered the main research questions. Subjects were randomly assigned to intensive lifestyle intervention groups. They reduced their risk of getting type 2 diabetes by 58 percent. All they did was maintain their physical activity at 30 minutes per day (usually with walking or similar mild exercise) and lost 5 to 7 percent of their body weight (about 15 pounds, on average).
Karta Purkh Singh Khalsa, a frequent contributor to Herbs for Health, is an adjunct faculty member in the botanical medicine department of Bastyr University. He is currently writing a book on Ayurvedic herbalism.
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