Diabetes Melitus - Syndrome X
-By Stephen Holt, M.D

Understanding Diabetes Mellitus
Diabetes mellitus is a common disorder characterized by excessive levels of blood glucose, or sugar. This happens in conditions where there is absence or lack of effective functioning of insulin. This article will discuss the two common types of diabetes: Type 1, or "juvenile onset diabetes," a condition where there is damage to the cells in the pancreas that secrete insulin; this is common in young people; and Type 2, or "maturity onset diabetes," which accounts for more than 90% of all known cases of diabetes. This type of diabetes is often associated in its early phases with a resistance to insulin. Insulin may be present in early forms of Type 2 diabetes, but it is unable to do its job of driving the glucose into cells.

Type 2 diabetes is the type of diabetes that is more relevant to our understanding of the abnormalities of body chemistry, or metabolic disturbances, that cause Syndrome X. The metabolic Syndrome X is the variable combination of obesity, hypertension and hypercholesterolemia, linked by an underlying resistance to insulin. While maturity-onset Type 2 diabetes occurs most often in adults, a striking increase has been noted among children in recent years. This has led to the coinage of a strange label "maturity onset diabetes of the young" or MODY.

Either type of diabetes can cause similar medical complications, such as cardiovascular disease, nerve damage (neuropathy), eye disease (retinopathy) and kidney disorders. One cannot completely separate Type 1 and Type 2 diabetes; some overlap exists between them. There is a third type of diabetes called the Gestational Diabetes that occurs somewhat temporarily in pregnancy. Gestational Diabetes involves insulin resistance. Research has characterized it to have much in common with Syndrome X. Diabetes is a heterogeneous (multifactorial) disease.

Fiber and Diabetes
Diabetes mellitus is the oldest dietary fiber-deficiency disease observed in humans. In 1979, my colleagues and I described the physiological effects of soluble fiber on the absorption of glucose and model compounds in humans (Holt S. et al., Lancet, 1, 639-9, 1979). In our study of acute dosing of soluble fiber, we observed the rate of sugar absorption was slowed and blood glucose tolerance curves tended to flatten. This research forms the basis of an understanding of what is popularly termed "the Glycemic Index." Thus, soluble fiber makes absorption efficient and delays the metabolic incorporation of ingested glucose into the body.

Recent studies have shown the ability of the extracts of soluble oat fiber (beta glucans) to significantly lower blood glucose levels following meals and reduce blood cholesterol levels in a favorable manner (lower LDL, lower triglycerides, with a tendency to raise HDL). Beta glucans function to control body chemistry that is altered by insulin resistance and diabetes mellitus. Diabetes mellitus is often associated with multiple risk factors for cardiovascular disabilities, such as obesity, hypertension and high blood cholesterol. Extracts of soluble oat fiber, or beta glucans, have an important role to play in controlling these risk factors. Enhanced intake of both soluble and insoluble dietary fiber is a grossly underestimated natural option that will considerably improve conditions of patients with both Type 1 and Type 2 diabetes.

Antioxidants and Omega-3's
Antioxidants of many types may benefit an individual with diabetes mellitus because many of the consequences or complications of diabetes are due to oxidative stress on the body, or the generation of free radicals. In diabetes and Syndrome X, cross-linking of sugar and protein causes advanced glycation end products which, in turn, damage vital organs. In this circumstance, antioxidant compounds such as vitamins C, E, beta-carotene, selenium and coenzyme Q-10 and many plant or animal antioxidant compounds (phytonutrients, phytoantioxidants) can exert a major beneficial effect by "mopping up" free radicals. Of particular interest is the dietary supplement alpha-lipoic acid (thioctic acid). This antioxidant plays a specific role in glucose oxidation and is accessible to both water and fat components of the body. Furthermore, alpha-lipoic acid may improve the body's sensitivity to insulin; it has been used in the prevention of complications of diabetes and liver damage.

Much interest has focused on the omega-3 fatty acid EPA (eicosapentaenoic acid) because of its vital role in balancing favorable eicosanoid production in the body and exerting beneficial effects in common cardiovascular diseases. The acid EPA is readily converted to DHA ? which is found in large amounts in cell membranes, especially in the nervous system and is an effective inhibitor of the genesis of "undesirable" forms of eicosanoids from arachidonic acid. For these and other reasons, EPA must be considered the emperor of fatty acids; it has an underestimated role in the management of diabetes mellitus and Syndrome X.

Evidence has accumulated that the active omega-3 fatty acid EPA can favorably affect the PPAR (receptor complex), which is involved in insulin action, carbohydrate metabolism and lipid chemistry. Thus, EPA has emerged as a very important way of combating insulin resistance by regulating certain components of the PPAR receptor. EPA (found in fish oil) appears to be a natural and powerful antidote to insulin resistance, and is emerging as a first-line option for Syndrome X, with its cardinal components of glucose intolerance, hypertension, hyperlipidemia and obesity.   I am particularly impressed by the use of coenzyme Q-10 combined with relatively high doses of EPA in the management of diabetes-complicated cardiovascular disease (a very common combination of disabilities).

Many Natural Substances of Diabetes
The word diabetes means "siphon," and water-soluble vitamins and several minerals are excreted in abundance by diabetic individuals. An adequate intake of vitamins and minerals is mandatory in the management of diabetes. While elements such as chromium and vanadium are known to assist the function of insulin, emerging research shows that the adequate dietary intake of calcium and magnesium is important for control of blood glucose and insulin receptor function. The role of adequate mineral intake in diabetes is underexplored. Soy foods are very valuable in the management of diabetes mellitus, but their value has been wrongly impugned by the "meat and dairy lobby." Soy has a low glycemic index, soy protein lowers blood cholesterol and isoflavones are powerful antioxidants. Soy protein is handled efficiently by the kidneys, which are a common target of attack in diabetes mellitus.

Several herbs or botanicals have been proposed as potential "treatments" for diabetes mellitus. There is no doubt that some plant compounds have a significant effect on lowering blood sugar, but their mechanism of action remains poorly understood. Popular botanicals used to induce a hypoglycemic effect include bitter melon (Momordica charantia), fenugreek (Trigonella foenum-graecum), garlic (Allium sativum), corosolic acid (Lagerstroemia speciosa or Punica granatum), stevia (Stevia rebaudiana) and Gymnema sylvestre. I believe that the more potent botanical extracts should only be used under the supervision of a health care practitioner, because of potential serious drug interactions with medication.

Of particular interest is the use of fermented barley extracts (GlycoX), which have been shown to reduce blood sugar by up to 63% and blood cholesterol by about 21% in individuals with Type 2 diabetes mellitus. Several other botanicals have been proposed as potential treatments for glucose intolerance, with some of them having the added advantage of promoting cholesterol control. Examples of these other botanicals include: Tinospora cordifolia, Pterocarpus marsupium, Azadirachta indica, Ficus racemosa, Aegle marmelose, syzygium cumini, Cinnamonum tamala, Atriplex halimu, Vaccinium myrtillus, Korean ginseng, Opunta ficus, Ocimum sanctum and Silybum marianum.

Diabetes Prevention
In recent times, the American Diabetes Association has revised its guidelines on the management of Type 2 diabetes by stressing the role of diet and exercise in management as first-line options. Drug therapy for Type 2 diabetes, including oral hypoglycemic drugs and insulin-sensitizing drugs, is regarded increasingly as a "back-up plan." Syndrome X, or the metabolic syndrome, is amenable to dietary interventions and lifestyle adjustments.

Complex dietary supplements can provide Syndrome X nutritional factors and can promote healthy blood glucose, healthy blood cholesterol, healthy immune function, healthy digestive function, antioxidant effects, inhibition of carbohydrate absorption and a useful adjunctive role in the control of calorie intake. They can do this by inducing a feeling of satiety (the feel-full/weight-loss trick) in an individual. Dietary and lifestyle changes can help keep diabetes under control or prevent it altogether. Public education is a key initiative in the fight against the constellation of disorders that are associated with the development and progression of Syndrome X, a forerunner of the Type 2 diabetes mellitus that affects about 70 million Americans. The cluster of disorders associated with Syndrome X — obesity, insulin resistance, high blood cholesterol and high blood pressure — underlies the number one cause of death and disability in Western society, which is cardiovascular disease, including stroke and heart attack.

Conclusion
Diabetes mellitus is part of the killer combination of diseases that account for most premature deaths or disability. To combat these problems, one would need a multi-pronged approach beginning with simple lifestyle modifications, particularly proper nutrition, rather than the instant prescription of drugs that are costly and have questionable benefits. Syndrome X and its consequences are the most important public health issues for the new millennium.