Herbal Treatments for Diabetes & Syndrome X

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Diabetes affects 16 million people in the U.S. It is the fourth leading cause of death, and is the principle cause of blindness, and the most common cause of kidney failure. Many people have diabetes but don't know it. Type I diabetes, often called juvenile onset diabetes, affects 5 percent of the diabetic population. People with Type I diabetes are dependent on insulin. Type II diabetes, or non-insulin dependent diabetes, usually affects adults and can run in families. In recent years there is a dramatic increase in Type II diabetes, due to hereditary factors, diets rich in processed foods, and lack of regular exercise. What was once referred to as adult onset diabetes (Type II) is now affecting obese children.

Many experts see diabetes as a marker for aging, as diabetics have been known to develop higher cholesterol and typically die of heart disease at younger age than non-diabetics. It is hypothesized that elevated glucose generates a large number of free radicals, which damage cells. When people hear about problems with glucose and insulin, they normally think of diabetes. Diabetes is only one condition that exhibits these symptoms. In 1988, Stanford endocrinologist Gerald Reaven, M.D., coined the term Syndrome X. Syndrome X refers to conditions brought about by excessive refined carbohydrate diets. This includes two or more of the following: insulin resistance, elevated cholesterol or triglycerides, abdominal obesity, and high blood pressure. Having Syndrome X increases one's odds of getting diabetes or heart disease. The easiest way to diagnose insulin resistance is with a glucose tolerance test. In abdominal obesity ("beer gut", "pot belly") glucose is stored as fat, genetically this has helped our species during times of famine. As the number of fat cells increase, the relative percentage of muscle cells decreases, reducing the number of sites for insulin to function. Obesity increases the risk of diabetes, heart disease, and some cancers; obese women are more likely than thin women to develop breast cancer. Cholesterol and triglycerides are associated with an increased risk of heart disease and stroke, however cholesterol is vital to the making of steroid hormones such as testosterone and estrogen. In Syndrome X, there may be a high total cholesterol, low good HDL cholesterol, high LDL to HDL cholesterol ratio, or high triglyceride levels. There may also be oxidized LDL cholesterol.

The body strives to maintain a balance of glucose (blood sugar). After meals, the body responds to the rise in blood glucose by secreting insulin, a hormone produced by the beta cells of the pancreas. Insulin lowers blood glucose by increasing the rate at which cells throughout the body absorb glucose. Declines in blood glucose causes the release of glucagon, a hormone produced by alpha cells of the pancreas. Glucagon stimulates the release of glucose stored in body tissues, especially the liver. If the blood glucose falls rapidly or if a person is angry or fearful, the result causes a release of epinephrine (adrenaline) and coricosteroids by the adrenal glands. These chemicals have the power to break-down stored glucose to provide extra energy to cope with a crisis. Insulin can increase blood pressure in a number of ways. It can increase the retention of sodium, increase the secretion of cortisol, a stress hormone, as well as triggering the sympathetic nervous system to speed up heart rate and blood pressure. Increased blood flow in the arteries can be due to obesity, as the heart has to pump harder through a larger body, or because of arteriosclerosis (hardening of the arteries) which makes the vessels less elastic. (Given equal water pressure, water moves through a narrow hose faster and with greater pressure than it does through a wider hose.) Hypertension can lead to heart disease, stroke and kidney disease, and is also associated with memory loss and Alzheimer's disease.

Sugar overload
Causes of diabetes and Syndrome X include stress, excessive amount of processed foods and lack of exercise. Physical and psychological stress increase cortisol levels, which reduces the ability of glucose to get into the cells, as well as being a risk factor for heart disease and Alzheimer's disease. Fatigue, mental exhaustion, and anger are associated with excess levels of cortisol.

Sweeteners including sugar, fructose, sucrose, maltose, lactose, corn syrup, and grape concentrate are consumed at alarming rates. The average U.S. consumption of sugar is over 150 pounds per year, as compared with residents in the 1800's who consumed 12 pounds per year. If we go back further, sugar was rarely consumed at all, the main source of sweets being honey and whole fruits. In addition to being damaging on their own, sugars provide empty calories, which replace nutrient dense foods. High carbohydrate diets, smoking, radiation, or pollution, generates free radicals in the body, and thus increases the need for antioxidant vitamins. Sugar increases LDL cholesterol and triglycerides and makes platelet cells aggregate, which tends to contribute to heart disease and stroke. It also reduces levels of calcium and phosphorus, which are needed to maintain healthy bones.

Complications of Diabetes
Chronic health problems associated with diabetes include atherosclerosis, diabetic neuropathy, diabetic retinophathy, diabetic foot ulcers and kidney disease. Hypoglycemia, or low blood sugar, is much more common in Type I diabetes. Taking too much insulin, missing meals or overexerting for one's constitution can cause hypoglycemia. Sweating, nervousness, headache, tremor, hunger, and unpleasant dreams may all be signs of hypoglycemia. Diabetic ketoacidosis also more common in type I diabetes, can result in a build up of ketones or ketoacides, which are produced by the breakdown of fat by-products. Diabetics must measure levels of ketones in the urine to prevent ketoacidosis, which can increase urination and thirst, fatigue, nausea, vomiting and if untreated, a coma. Nonketogenic Hypersmolar Syndrome is caused by severe dehydration caused by lack of fluid intake, burns, stroke, pneumonia, and certain drugs such as diuretics, glucocorticoids, diazoxide, and phenytoin.

Medications in diabetes
Standard medications for diabetes include, Cholorpropamide (Diabinese), glipizide (Glucotrol), glyuride (Micronase), Tolazamide (Tolinase) and tolbutamide (Orinase). They are not typically effective. After three months of continual treatment, they fail to adequately control blood sugar in 40 percent of the cases. Even for the responders, usually the effects wear off. The long-term success at being able to control blood sugar levels is only about 30 percent (Murray, Michael, Diabetes and Hypoglycemia, Roseville, CA: Prima Publishing, 1994, P. 15). As they are sulfa compounds they must not be taken by those who have an allergy to sulfa drugs. Typical side effects include digestive and skin reactions, headache, fatigue and liver damage. In some cases insulin needs to be prescribed with these drugs. Metformin (Glucophage), perhaps the most popular diabetes drug, improves insulin resistance but may increase the risk of heart disease by reducing levels of folic acid, vitamin B12, and increased homocysteine. It can also cause headache, dizziness, fatigue and digestive symptoms. The New England Journal of Medicine reported that moderate exercise (walking an average of 30 minutes a day five days a week) and dietary changes (lowering fat and overall calorie intake) were found to be more effective than metformin (Glucophage) in delaying and possibly preventing type II diabetes in a study of 3,234 overweight people with impaired glucose tolerance (IGT), a precursor of diabetes. Where the diet and exercise regime achieved a 5 to 7% weight loss, it reduced diabetes incidence by 58% compared to 31% in the metformin group, both at 3-year follow-ups. (New England Journal of Medicine, Vol. 346:393-403).

Diet
Caloric restriction leads to greater insulin sensitivity. Therefore eating more nutritious foods and fewer refined carbohydrates, incorporating good fats into the diet, and eliminating unhealthy fats can lower glucose and insulin levels, and reduce glucose damage to the body. Studies at the University of Naples in Italy have shown that those who live past 100 were trimmer, had less body fat, and were less likely to have pot bellies than those in their 40's (Jack Challem, et al, Syndrome X, New York: John Wiley & Sons, 2002, P. 37). Typically they ate 5 times as much vegetables.

Emphasize fresh vegetables and fruits, extra virgin olive oil for cooking, use flax or avocado oil for dressing, avoid soft drinks, fruit juices, alcohol, fried foods (which contain trans-fatty acids), and margarine. Lean protein with every meal can help to stabilize blood glucose levels: particularly helpful are fish including salmon, trout, tuna, sardines, herring, anchovies, and mackerel. Increase exercise by walking, gardening, dancing, swimming, and biking; exercising has numerous health benefits and increases insulin sensitivity.

Success with natural methods
Careful attention to one's symptoms, home glucose monitoring, and careful diet are all important to success with natural therapies. The herbs mentioned below are all bio-active in pill form which is more applicable for Americans in long term treatment. For example, unripe bitter melon has a glucose lowering effect but must be taken as a fresh juice or daily decoction, therefore it is not likely to be successfully used by American diabetics.

Corosolic acid (Queens Crepe Myrtle, Lagerstroemia speciosa)

Corosolic acid is extracted from the Asian tree queen's crepe myrtle (QCM) (Lagerstroemia speciosa). It is one of the more promising blood sugar regulating plants because a low dosage of the extract is still effective. Laboratory studies in Japan have indicated that Corosolic acid is an activator of glucose transport and has a hypoglycemic effect when used orally. In a placebo controlled study in Japan, patients with fasting glucose levels of 110 mg/dl, were given a placebo or standardized queen crepe myrtle tablets equaling 160 mcg of Corosolic acid. A statistically significant drop in blood glucose was seen in most patients. In an American study with ten Type II diabetic patients, average blood glucose dropped 31.9 percent after two weeks of administration of a preparation consisting of 480 mcg of Corosolic acid. When normal volunteers were given the same preparation, they were not affected in one study. In the other study the equivalent of 240 mcg of Corosolic acid produced a hypoglycemic effect, but volunteers recovered to normal blood glucose levels in three hours.

The most recent, a 60 day experiment, was conducted on 9 male and female Type-II diabetics, ranging in ages of 37-72. Each participant was given 16 mg of Queen Crepe Myrtle extract 1% corosolic acid in capsule form, 3 times per day, one after each meal. Blood was drawn from the volunteers under fasting, and serum glucose levels were estimated using enzymatic glucose oxidase/peroxidase method within 60 minutes of blood collection. The results showed an average reduction of 15% in fasting serum glucose levels within 15 days. Within 30 days the average reduction was 19.96% and 22.08% after 60 days. The results are almost identical to the first study, which was only 30 days and comprised 8 volunteers. The first study resulted in an average reduction of 15% after 15 days and 19% after 30. All participants benefited from the use of Queen's Crepe Myrtle with an average reduction of 22% (Challem, pp. 228-29).

Ginseng
Ginseng has been used since ancient times as a treatment for diabetes symptoms. Although all ginseng species have hypoglycemic effects in laboratory models, American Ginseng (Panax quinqefolium) is the preferred species because it is cooling and generates fluids and is traditionally used for thirst, fatigue, and hunger. Empirically, it has been used to treat diabetes. At the University of Toronto, researchers conducted several studies testing the effects of American ginseng on glucose levels. Twelve healthy individuals received either a placebo or 1, 2, or 3 grams of American ginseng at various time intervals before a capillary blood and glucose challenge test was administered. Glycemia was lowest 40 minutes after dosages of American ginseng. According to the researchers, each dosage worked equally as well.

Similar findings were observed in three additional human studies.(American ginseng attenuates postprandial glycemia in a time-dependent but not dose dependent manner in healthy individuals, Vuksan, V., et all, "American Journal of Clinical Nutrition", Vol. 73, No. 4, 753-758, April 2001).

Toronto researchers concluded that American ginseng stimulates insulin secretion and improves nitric oxidemediated uptake of glucose into cells, and this may explain why non-diabetics get the best effect taking American ginseng 40 minutes prior to a glucose challenge. Regulating glycemia is important to people with diabetes and syndrome X, as poor control of postprandial glucose levels increases the risk of developing atherosclerosis and death due to cardiovascular disease. High blood glucose concentration is a risk factor for mortality in middle-aged nondiabetic men. (Diabetes Care, 1998; 21 (3) 360-7.)

Milk Thistle
Milk Thistle has been found to be beneficial in a wide range of liver disorders. Eighty percent silymarin extracts of milk thistle (for example, a 200 mg capsule or tablet of milk thistle will have 160mg of silymarin) have been found to have antioxidant and glucose regulating properties.

In a study at Monfalcone Hospital in Groiza, Italy, 60 insulin dependant diabetics took either 600 mg of silymarin or a placebo for 12 months. After the first month, in which fasting glucose levels were elevated, fasting glucose declined by 9.5 percent and average daily glucose dropped 14.9 percent among the treated group. In addition, glucosuria (sugar in the urine), and glycosylated hemoglobin, and insulin requirements declined significantly (Challem, P. 220).

Stevia
Stevia, a South American herb, has glucose lowering properties taken in large dosages and is considered a natural sweetener. It is sold in health food stores in dry leaf form, powder, and alcohol tincture. The author has found stevia very useful in helping clients wean off of sugar and sugar substitutes.

TCM formulas
Although Traditional Chinese formulas are very helpful at treating constitutional factors and various symptoms, they have not been widely studied for their glucose lowering effects. Formulas such as Drain Dampness (Wu Ling San) may be used to reduce water weight. Formulas such as Astra Essence may be used to reduce night time urination and has a mild hypoglycemic effect. Lily Bulb (Bai He Gu Jin Tang) or Tremella & American Ginseng can be used for chronic thirst and dryness.

Cautions, Contraindications, and Conclusions
Before trying herbs, it is essential that diabetics be under the care of a knowledgeable health professional. In addition to glucose monitoring, it is imperative to emphasize exercise, stress reduction and the importance of diet emphasizing fresh vegetable, fruits, lean protein, nuts and seeds and eliminating refined foods. Be very cautious about products sold in Chinatown as they may be adulterated with pharmaceuticals. Products sold in health food stores may contain the proverbial "kitchen sink" of glucose nutrients, yet not enough of any one ingredient to get a therapeutic effect.

The author has developed Myrtle Seng™, a formula with therapeutic amounts of Queens Crepe Myrtle containing one percent Corosolic acid and American Ginseng. As this formula may lessen the need for diabetes medication, it is essential that clients and their practitioners monitor patients carefully. Myrtle Seng may be combined with Milk Thistle 80, TCM formulas, or vitamins as desired.

Diabetes II: Complications of Diabetes
This is the second of a two-part article on diabetes. For part one, please refer to the newsletter Herbal Treatments for Diabetes and Sundrome X, Vol. 12 No. 1.

Over time, elevated glucose levels damage the nervous system, blood vessels, and organs. A sugar based substance builds up in the walls of the blood vessels, causing them to thicken and leak. There is less blood available to the skin and nerves. Uncontrolled or poorly controlled glucose levels cause the buildup of plaque in the blood vessels known as atherosclerosis. Atherosclerosis, heart attacks and strokes are more common in diabetics. Poor circulation through large and small blood vessels may harm the heart, brain, legs, eyes, kidneys, nerves and skin, and may slow the healing process. Damage to the blood vessels of the eye can cause diabetic retinopathy. Kidney damage may result in kidney failure that requires dialysis. Nerve damage may cause weakness, tingling, or burning pain to the hands, legs, and feet. Damage to the nerves makes injury more likely as a person cannot sense changes in temperature or pressure. Poor blood flow also leads to poor wound healing, and leg and foot ulcers, which may become infected and necessitate amputation. Controlling blood glucose levels can prevent or delay these complications.

Hypoglycemia
Hypoglycemia or low blood sugar, can result in severe hunger, headache, anxiety, irritability, sweating without exercise, confusion, tremor, or in severe case, coma. In diabetics, hypoglycemia is caused by overdose of insulin or medication, lack of eating, or intense exercise without eating. There are two main types of hypoglycemia — reactive and fasting. Reactive hypoglycemia is characterized by symptoms that occur 2 to 4 hours after a meal, or the use of certain drugs. Fasting hypoglycemia is very rare and usually accompanies various cancers, liver damage, or prolonged malnutrition.

Low blood sugar causes harm to many organs, especially the brain. To protect the brain, the body manufactures glycogen from the liver and makes glucose. This process causes adrenaline (epinephrine) levels to rise which tends to cause the above mentioned symptoms. It is important to treat low blood sugar levels quickly, which is why diabetics are often instructed to carry glucose tablets, candy, or fruit to treat episodes of hypoglycemia. Type I diabetics are instructed to have glycogen with them at all times, a hormone which raises blood sugar.

In non-diabetics, hypoglycemia can be caused by the excessive intake of refined carbohydrates. Refined carbohydrates tend to cause blood glucose levels to temporarily rise, and then fall rapidly, straining the body's coping mechanisms. Hypoglycemia may also be caused by abnormalities of the adrenal and pituitary glands, or when non diabetics abuse diabetic medication. Hypoglycemia is associated with aggressive behavior, PMS, migraines and psychological disorders. When subjects restrict their use of sugar and other processed carbohydrates, improvement is often seen.

The treatment of hypoglycemia involves eating less refined carbohydrates and eating lean protein sources with each meal. Many diabetics as well as non diabetics will do better eating 4-6 small meals per day rather than 2-3 large meals. Tonic herbs seem to have a controlling effect on blood sugar levels. The author has had success using Astra Essence [astragalus root and seed (huang qi and sha yuan ji zi), ligustrum (nu zhen zi), ho-shou-wu (he shou wu), lycium fruit (gou qi zi), rehmannia (shu di huang), eucommia (du zhong), cuscuta (tu si zi), ginseng (ren shen), tang-kuei (dang gui), cornus (shan zhu yu)] to help balance blood sugar levels, as well as Adrenosen, a compound that contains adrenal extract which can help replenish stressed adrenals, and PAK, a nutrient shown to promote blood sugar regulation. Another tonic that may be useful include Astra 8, which may be considered because it contains a number of adaptogens which helps the body adapt to stress.

Circulatory Disorders
Both diabetics and people who eat excessive amount of refined carbohydrates tend to suffer from circulatory disorders. In the U.S. and many western countries, atherosclerosis is the leading cause of death. Commonly known as "hardening of the arteries", atherosclerosis occurs when the wall of the arteries become thicker and less flexible. For most people, it may be controlled by increasing exercise, reducing refined foods and increasing fruit and vegetable intake, as well as eliminating smoking. Hypertension, high cholesterol, peripheral arterial disease, stroke, and other heart diseases are more common in diabetics than the general population. In addition to the dietary and lifestyle measures mentioned above, herbs which increase circulation, and/or reduce cholesterol are often helpful. Flavonex is a modern herbal formula that contains gingko leaf extract, which is used to promote heart blood circulation and is safe for long term use. Cir-Q contains herbal extracts to alleviate cramps and increase circulation. Flavonex is often combined with Cir-Q for poor circulation with cramps or with Polilipid for high cholesterol levels.

Diabetic Eye Conditions
People with diabetes are more likely to develop cataracts, glaucoma and retinopathy then other people. Capillary repair and maintenance is particularly important to people with diabetic eye complications. Diabetic retinopathy is caused by a breakdown of tiny capillaries and blood vessels under the retina. It is a leading cause of vision loss for people between twenty-five and seventy-four years of age. The damage is a result of elevated blood glucose levels, which causes a chemical reaction between sugars and the blood vessel wall. Over time, the capillaries swell and become brittle, allowing blood to leak into the retina. Unfortunately there are no markers other than vision distortion. At this point there are currently no medical methods for reversing this damage. In uncontrolled trials, a bilberry extract equivalent to 3-9 tablets of Bil Lutein' (80-260mg of anthocyanins) per day improved diabetic retinopathy with a marked reduction in the disappearance of retinic hemorrhages (Orsussi, P., Rossi, M., Sabbatini, G., et al. Clin Ocul 1983; 4:377-381). In a placebo-controlled trial, bilberry extract equivalent to four tablets per day (115.2 mg of anthocyanins) of Bil Lutein 'showed significant improvements in agiographic and ophthalmoscopic perimeters in 77 percent of patients diagnosed with diabetic or hypertensive retinopathy in one month (Perossini, M. Ann Ottolmol Clin Ocul 1987; 113(12): 1173-1190). Bil Lutein can also be used by diabetics to prevent cataracts, glaucoma and macular degeneration.

Kidney Failure
In diabetics, blood vessels in the kidney thicken and prevent blood from filtering normally. Nephritic syndrome results in loss of protein into the urine, decreased levels of albumin, increased lipids, and retention of sodium and water. Symptoms may include loss of appetite, fluid retention, muscle wasting, frothy urine, and shortness of breath. Chronic kidney failure may cause itching, muscle weakness and cramps, neuropathy, digestive disorders, and weight loss. The skin may turn yellow-brown due to the build up of waste products. Kidney function can be assessed by measuring serum creatinine and blood urea nitrogen (BUN). Imaging procedures such as ultrasound or CT scans can also be used, as well as tissue biopsy. Biomedical treatments may include diuretics, steroids (corticosteroids), and enzyme inhibitors to decrease protein excretion in the urine and lipid concentrations in the blood. Finally dialysis may be administered. One of the most useful formulas for kidney failure is Rehmannia 8 [rehmannia root (shu di huang), poria sclerotium (fu ling), moutan root bark (mu dan pi), dioscorea rhizome (shan yao), cornus fruit (shan zhu yu), alisma rhizome (ze xie), eucommia bark (du zhong), cinnamon bark (rou gui)]. This formula is mostly used for clients who are yang deficient. For yin deficient symptoms consider Nine Flavor Tea. Cordyceps PS has also been found to improve kidney function in modern Chinese experiments.

Neuropathy
Nerve damage occurs when glucose is not metabolized normally and there is an inadequate blood supply. This leads to muscle weakness, loss of sensation, tingling and pain to the hands and feet. An example of this is carpal tunnel syndrome, which is more common in diabetics. Carpal tunnel syndrome results from a compressed median nerve that travels through the wrist on the thumb side of the hand, producing pain, tingling and numbness that can affect the hand, arm, and shoulder.

In the event of weakness or loss of sensation, the administration of herbs with qi and blood tonifying properties such as Marrow Plus are often recommended long term. In the event of tingling or pain, it is often best to move blood using Channel Flow. In the event of spasming type pain, SPZM can be considered. Topical remedies such as Resinall K, Po Sum On oil, and White Flower can be very helpful if applied several times per day.

Diabetic ulcers
Sores and infection may result when there is impaired blood flow to the skin. In addition to using circulatory strategies such as Flavonex, topical treatments may be used to promote the healing response. If it is determined through the four diagnostic methods that the client is weak and deficient, it is also helpful to use tonics such as Marrow Plus or Astra Essence to speed the overall healing process. Examples of topical treatments include Resinall K which can be applied to wounds after the area is cleaned first with soap and water followed by hydrogen peroxide. AC-Q wash is another remedy that can be used as a soak if there is pain or ulcerations.

Case Study:
Dennis was a 67 year old diabetic who has a leg sore the size of a quarter, as well as discoloration of skin of a quarter, as well as discoloration of skin throughout his feet and legs. After a six month treatment with Flavonex, and a topical application with AC-Q wash followed by Resinall K, Dennis' sore healed, and normal color was restored to most of his feet and legs. In addition he had less tingling and cramping of the legs.

Conclusion
Diabetes has achieved epidemic proportions in the U.S. It is important that diabetics regularly monitor their blood glucose and have regular medical check ups. Reducing refined carbohydrates, exercise and stress reduction can prevent and even cure pre-diabetes (often called Syndrome X) and diabetes type II. Herbs help promote healthy habits. As it provides a natural boost, Adrenosen and other formulas with spleen tonics can be used to counter cravings so there is less desire to binge on sweets and other refined carbohydrates. It may be possible to intervene so that medication, often with side effects which contribute to the worsening of the diabetes, is not needed. If a client is already on medication it may be possible to reduce medication through the use of Myrtle Seng™ and other preparations mentioned in the text. If a client is showing some of the complication of diabetes, herbal intervention may help treat these symptoms, and prevent surgeries or other medical procedures. As herbs may interact with diabetic medication, it is essential that patients self monitor their condition with the help of knowledgeable health professionals.

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By Andrew Gaeddert

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