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Supplementationto ManageDiabetesByYousry Naguib, Ph.D.

D iabetes is a chronic disease

affecting 16 million people inthe U.S., and more than 125

million worldwide. It is the fourth-lead-ing cause of death by disease in theUnited States. About two-thirds of thenearly 16 million people with type II dia-betes in the u.S. are overweight, accord-ing to the American DiabetesAssociation. The pancreas in diabeticpeople produces little or no insulin, thehormone responsible for facilitatinguptake of glucose by cells to give energy.

There are two main types of dia-betes mellitus: adult-onset diabetes,also called Type II or non-insulin-dependent diabetes mellitus(NIDDM); and childhood-onset dia-betes, also called Type I, or insulin-dependent diabetes mellitus (IDDM).

In Type I, the pancreas cannot makethe insulin needed to process glucose.Type I most often occurs in children andyoung adults. Individuals suffering fromType I are totally insulin dependent.Without regular injections of insulin,the sufferer lapses into a coma and dies.

Type II accounts for 90 to 95 per-cent of diabetes, is usually of gradualonset, and occurs mainly in people over40. It is a metabolic disorder resultingfrom the body's inability to makeenough, or properly use, insulin. Type IIdiabetes is nearing epidemic proportionsdue to a greater prevalence of obesity.The combination of dietary measures,weight reduction, and oral medicationcan keep the condition under control fora period of time, but most people withType II ultimately require insulin injec-tions.

Diabetes can bri~g about a variety ofcomplications, usually progressive andirreversible. Diabetes may be controlledwith insulin and in some cases throughcareful diet. Weightloss is consideredthecornerstone of treatment in Type II dia-betics because it allows the body to betteruse insulin and thus lowersblood sugar.

Researchers at Harvard found thatmore than 90 percent of the 3,300women who developed diabetes over a16-year study period were overweight,inactive, and smokers. The researchersfollowed 85,000 female nurses whowere free of heart disease, diabetes,and cancer at the beginning of thestudy. Being overweight or obese wasthe most important diabetes risk pre-dictor, followed by lack of exercise.The study suggests most diabetes canbe prevented through diet and exercise.

It is the

fourth-leading

cause of death bydisease in the

United States.

HERBAL SUPPLEMENTS

Fenugreek

Fenugreek (Trigonella foenumgrae-cum) has been used for hundreds of years,as a spice and as a medicinal supplement.Several studies, including one publishedin 1990 in the European Journal of

Clinical Nutrition, suggest that this herbcan lower blood sugar. Researchers foundthat type I diabetics who took 50 grams offenugreek seed powder twice daily hadsignificantly lower blood sugar levels thanthose taking a placebo.!

In a recent double-blind placebo con-trolled study, 25 newly diagnosed Type IIdiabetics (fasting glucose less than 200mg/dl) were randomly assigned to receive1-g daily hydro-alcoholic extract of fenu-greek seeds or a placebo for two months.The fenugreek group had significantly

f

lower insulin resistence and improved

glycemic controL2Fenugreek seeds are rich in galac-

tomannan, which are soluble fibers.

Research showed that galactomannan infenugreek decreased the hypoglycemiceffect of foods.3 Acatris (Schouten) com-

pany has recently introduced an odorlessfenugreek extract under the trade nameFenuLife. Technical Sourcing also intro-duced a new dietary supplement calledPromilin containing the main bioactiveingredient 4-hydroxyisoleucine, derivedfrom fenugreek. Recent findings supportthe role of 4-hydroxyisoleucine in support-ing blood sugar balance, reducing body fat,and aiding muscle growth and recovery.4

Bitter melon

Bitter melon (Momordica charantia

Linn.), commonly known as Karela, hasbeen reported to have hypoglycemic,antiviral, anti-diabetic, and anti-tumoractivities. In a recent clinical study, Bittermelon was shown to significantly reduceboth fasting and post-prandial (blood-sugar levels after carbohydrate consump-tion) serum glucose levels in non-insulindependent diabetes mellitus patients.s

Panax Ginseng

Ginseng is traditionally considered atonic and has been shown to help lowerblood glucose levels. In a recent random-ized placebo controlled study, researchersin Toronto examined the effects of

American ginseng (Panax quinquefolius)on the blood sugar levels of 19 subjects.Ten non-diabetics took 3 g of Americanginseng or placebo, either 40 minutesbefore or while ingesting a high-sugarsolution. Nine Type II diabetics receivedthe same treatments. Taking the ginsengbefore the sugar dose led to a significantreduction in glucose absorption amongboth diabetics and the non-diabetics.

When the sugar solution was taken simul-taneously with the American ginseng, thediabetics still experienced a reduction,whereas the non-diabetics did not.6

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52 Vitamin Retailer. February 2003

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GarciniaThe South Asian fruit Garcinia

cambogia is about the size of anorange and looks similar to a smallpumpkin. It contains the popularweight-loss ingredient hydroxycitricacid. Hydroxycitric acid derived fromgarcinia works at the cellular level tokeep carbohydrates from turning intofat, and to suppress appetite and toprovide energy.?

Animal studies with hydroxycitricacid have demonstrated that inhibitionof adenosine triphosphate (ATP) cit-rate lyase enzyme, an enzyme requiredfor converting carbohydrates into fat,leads to a decrease in the synthesis ofboth cholesterol and fatty acids.8

Hi

Gymnema sylvestreGymnema sylvestre is a tropical

plant of the milkweed family native toIndia. The leaf is the primary part usedin medicinal purposes. The plant hasbeen used traditionally for stomachproblems, constipation, and controlling

~~ -~-~---~--~

Diabetes

Type II diabetes. Gymnema sylvestreextract suppresses the craving forsweets and regulates blood sugar levels.

The active ingredient of gymnema isgymnemic acid, which was found to havethe ability to fill the receptor sites on thetaste buds, thereby preventing the sweettaste of sugar molecules. Gymnemic acidalso occupies the receptor sites in theabsorptive layers of the intestine, therebyblocking the absorption of sugar mole-cules from the intestine.9

In one study, extracts from gymnenaleaves (400 mg/day) were administeredfor 18 to 20 months to 22 Type II dia-betics taking conventional medication.All patients showed a significant reduc-tion in blood glucose levels. Five of the22 maintained their blood glucose levelswithout conventional drugs and the dosewas reduced in the others.lO

In another study,extractsof gymnemawere able to double the islet number(clumps of pancreatic cells) and beta cellnumber (insulin-producing cells) in dia-betic rat pancreas. The study suggested

that gymnema may improve health of thepancreas thereby providing a secondmechanism for its action in diabetes.II

GlucosolGlucosol is a standardized extract

from Lagerstroemia speciosa L. leaves.Lagerstroemia speciosa is commonlyknown as crepe myrtle, and is widelydistributed in tropical countries, such asthe Philippines, India, and China. In thePhilippines a tea from the leaves hasbeen used as a beverage as well as fortreating diabetes mellitus. The leavescontain significant amounts of corosolicacid, which has previously been shownto possess anti-diabetic properties andsignificant amounts of tannins, of whichLagerstoemin, flosin B, and reginin Awere identified.

The anti-diabetic activity of anextract from the leaves of

Lagerstroemia speciosa standardizedto 1 percent corosolic acid (Glucosol)has been demonstrated in a clinicaltrial, sponsored by Soft Gel

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Technologies, involving Type II dia-betics, who received a daily oral doseof Glucosol in either a soft gel capsuleor powder formulation.

Gotu kola

In a recent clinical trial, gotu kola(Centella asiatica) was found to improveexisting nerve disease in diabetics. Atotal of 340 participants were dividedinto three groups: group A, 50 diabeticswith peripheral neuropathy (a distortednerve function); group B, 250 diabeticswithout signs of neuropathy; and groupC, 40 healthy non-diabetics. Groups Aand B were randomly assigned to takeeither 60 mg of gotu kola twice a day ora placebo, while all in group C tookplacebo. After 12 months, theresearchers noted that diabetics bothwith and without neuropathy hadimproved blood flow to the feet and lessankle swelling, suggesting that the herbcan help treat and prevent neuropathycomplications.12

Stevia

The plant Stevia rebaudiana Bertonihas been used as a tea for many years inthe treatment of diabetes among Indiansin Paraguay and Brazil. Stevia has nocalories. It stimulates the release of

insulin via a direct action on the pancre-atic beta cells and normalizes the

response to glucose, especially in TypeII diabetes.13

Maitake MushroomVal ued in both Chinese and

Japanese herbology for 3,000 years, themaitake mushroom was shown in trials

conducted with genetically diabeticmice to improve blood sugar levels,triglycerides, and insulin response.Following these animal studies, casestudies were conducted at New YorkMedical College with five volunteersdiagnosed with Type II diabetes; allshowed declines of more than 30 per-cent in their fasting blood glucose levelsunder a maitake regimen.14

VITAMINS/MINERALSUPPLEMENTS

Vitamins B-12 (cyanocobalamine)and B-6 (pyridoxine) work togetherwith the amino acid, tryptophan, to helpmetabolize glucose in the cells. IS Onemilligram of B12 and 10 mg of B6 are

recommended. Diabetics also haveincreased free radical oxidation soadding 100-800 IU of vitamin E givesantioxidant protection. Vitamin E alsoreduces glycosylation (the process ofadding sugar units to proteins) of glyco-hemoglobin.

Mineral supplements are also rec-ommended to support glucose metabo-lism, but they are poorly absorbed bythe body; their absorption can beincreased by chelating (binding) themineral to an organic substance, in par-ticular amino acids.16 Vanadium hasbeen shown to have an insulin-mimick-ing effect in rats. Artificially induceddiabetes in rats can be reversed with

vanadium. Black pepper and dill seedare the richest sources of vanadium.Vanadium can be harmful if it is over-dosed so it is not recommended inpatients unless they are strictly moni-tored. The beneficial dose is 250 mcgthree times daily.17

Magnesium modulates glucosetransport and is a cofactor involved inglucose oxidation. Patients with mag-nesium deficiencies can have insulinresistance. Ketoacidosis (the accumu-lation of ketone molecules, such asacetone, in body tissues and fluids)promotes increased urinary loss ofmagnesium.IS

Chromium is an essential nutrient

required for proper sugar and fat metab-olism. Chromium deficiency is relative-ly common in Type II diabetics.Chromium is poorly absorbed, only 2 to10 percent of dietary intake beingabsorbed. Organic chromium, such aschromium picolinate (Chromax manu-factured by Nutrition 21), and niacin-bound chromium (ChromeMate madeby InterHealth) is absorbed more effi-ciently than inorganic chromium such aschromium chloride.

Chromium supplements have beensuccessfully used to treat diabetes.Super CitriMax (developed byInterHealth) is a unique formula ofchromium polynicotinate and extracts ofGarcinia cambogia and Gymnemasylvestre.

In one study, chromium picolinatewas found to improve glucose tolerancein Chinese people with NIDDM. Onehundred and eighty Chinese subjectswith Type II diabetes were divided intothree groups of 60 and supplemented

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1 (800) 477-0031Circle reader service #45

February 2003 .Vitamin Retailer 55

I

, SCIENCE &. NATURE

[4] Broca C et al. 4-Hydroxyisoleucine:experimental evidence of its insulino-tropicand anti-diabetic properties. Am J Physiol1999; 277 (4 Pt 1): E617

[5] Ahmad N et al. Effect of Momordica cha-

rantia extracts on fasting and post-prandialserum glucose levels in NIDDM patients.Bangladesh Med Res Coun Bull 1999; 25:11

[6] Vuksan V et al. American ginseng (Panaxquinquefolius L) reduces post-prandialglycemia in non-diabetic subjects and subjectswith type 2 diabetes mellitus. Archives ofInternal Medicine 2000; 160:1013

[7] Sergio W. A natural food, malabartamarind, may be effective in the treatment ofobesity. Medical Hypothesis 1988; 27:40

[8] Sullivan AC et al. Lipids 1977; 12:1;Triscari J and Sullivan AC. Comparativeeffects of hydroxycitrate on acetyl CoA car-boxylase and fatty acid and cholesterol syn-thesis in vivo. Lipids 1977; 12:357

[9] Shimizu K et al. J VetMed Sci 1997; 59:245

[10] Baskaran K et al. Antidiabetic effect of a

leaf extract from Gymnema sylvestre in non-insulin-dependent diabetes mellitus patients. JEthnopharmacoll990; 30:295

-,--, --

PUR E

HealthAND

BeautyFROM

Japan

Diabetes (continued from page 56)

[11] Shanmugasundaram ER. et al. Use of

Gynrnema sylvestre leaf extract in the control

of blood glucose in insulin-dependent diabetes

mellitus. J Ethnopharmacoll990; 30:281

[12] Angiology 2001:52 (SuppI2): S27-S31

[13] Jeppesen PB et al. Stevioside acts direct-

ly on pancreatic beta cells to secrete insulin.

Metabolism 2000; 49:208

[14] Konno, S. Maitake SX-fraction: Possible

hypoglycemic effect on diabetes mellitus.

Alternative & Complementary Therapies Dec.2001;7:366-370.

[15] Mooradian,A.D.,et ill. Selected vitamins andminerals in diabetes.Diabetes Care 17(5)464-476

[16] Ashnead,H.D. The Roles of Amino Acid

Chelates in Animal Nutrition Noyes Press,New Jersey: 1993

[17] LaValle JB. The nutritional solution tohyperinsulinemia and diabetes. NaturalPharmacy 2(3): 20-21,1998

[18] Anderson RA et al. Elevated intakes of

supplemental chromium improve glucose andinsulin variables in individuals with type IIdiabetes. Diabetes 1997; 46:1786

[19] Thomas VL et al. effect of chromium

nicotinic acid supplementation on selected

cardiovascular disease risk factors. Boil Trace

Elem Res 1996; 55:297

[20] Ruhnau KJ, Ziegler D et al. DiabeticMedicine 1999; 16:1040

[21] Jiang R et al. Nut and peanut butter con-

sumption and risk of Type 2 diabetes in

women. JAm Med Assoc 2002; 288:2554

[22] LaValle JB. The nutritional solution to

hyperinsulinemia and diabetes. Natural

Pharmacy 1998; 2:20

[23] Vinik A. Dietary fiber in management of

diabetes. Diabetes Care 11(2):160

[24] Chandalia M et al. Beneficial effects of

high dietary fiber intake in patients with type

2 diabetes mellitus. New England Journal ofMedicine. 2000; 342

[25] Anderson RA et al. Tea enhances insulin

activity. J Agric Food Chem 2002; 50:7182

Yousry Naguib, Ph.D., is manager of

technical services at Soft Gel Technologies

Inc., a Los Angeles-based contract manu-

facturer. Naguib is an author and former

professor at Suez Canal University in

Egypt. He holds fwo u.s. patents.

- -- --- ,----

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Detoxification I FactorSqualene plays a part in the bodiesdetoxifying process, protecting usagainst oxidants which can causedamage to our defensive systems.

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February 2003 .Vitamin Retailer 59