What is Diabetes?
Diabetes is a condition where the concentration of glucose in the bloodstream is chronically higher than normal. Glucose is a 6-carbon sugar (carbohydrate) that is our body's primary fuel. All sugars and starches (both carbohydrates) we eat are eventually be broken down to glucose, and proteins and fats can be used to make glucose also. When we speak of "blood sugar", we are talking about the concentration of glucose in the bloodstream. It should never be too high or too low, and the body operates normally when glucose concentrations are between 80 and 120 milligrams per deciliter. Blood glucose levels rise after eating, so tests are usually done after someone has fasted for 12 hours. If fasting levels are consistently high, this is an indication of possible diabetes.
Five percent of diabetics have Type I diabetes, also known as "insulin-dependent diabetes mellitus" (IDDM). IDDM is an irreversible autoimmune disease where the pancreas is dysfunctional and does not produce the hormone insulin. Insulin is normally secreted by the pancreas in response to rising blood sugar levels, such as after food is ingested and is beginning to be digested. Insulin escorts nutrients to our cells to fuel them. IDDM typically appears early in life, in childhood or teenage years, so is also called "juvenile onset diabetes". Those with IDDM need to inject insulin daily to remain alive, but they can certainly lower their insulin requirements, and dramatically improve their quality of life by following a nutritional program.
Ninety-five percent of diabetics have Type II diabetes, which is called non-insulin dependent diabetes mellitus (NIDDM) in the research literature, and we'll use NIDDM here. Colloquially, it is known as "adult-onset" diabetes, reflecting the fact that NIDDM usually occurs in people over 40 to 50 years old. Those with NIDDM differ greatly in that they typically have adequate or even too much insulin, but this insulin is not utilized effectively. Insulin receptors on the cells may not "accept" insulin correctly, or perhaps the cells have fewer receptors than they should. In contrast to IDDM, NIDDM is almost completely caused by poor nutritional and lifestyle choices, and as such is often reversible.
A third type of diabetes called gestational diabetes can occur in the last trimester of pregnancy. Gestational diabetes is similar to NIDDM in its origin and treament, and usually disappears soon after childbirth. Treatment with dietary control and vitamin/mineral supplements are of the utmost importance in gestational diabetes, since many drugs and herbs are not safe to use during pregnancy.
In all types of diabetes, the main result is that blood sugar levels are both too high overall and poorly regulated. Since glucose is the primary fuel for the body, its regulation is crucial to our metabolisms. We simply can't function if insulin doesn't do its job. Insulin is primarily known for escorting glucose to our cells, but it also escorts proteins and fats, and helps regulate the storage and release of nutrients in our organs, muscles and fat tissue. This means that a diabetic's metabolic, growth, repair, and detoxification functions are all compromised all the time!
OPTIONAL INSET TEXT
Glucose Tolerance Tests are common tests used to spot individuals who may be diabetic. If you have been pregnant, you have probably had a basic glucose tolerance test. In glucose tolerance tests, a standard glucose dose is administered, and the rise, peak, and fall of blood glucose is monitored over the next few hours. If glucose is normally metabolized or "tolerated", the resulting curve is normal. Both the area under the curve and the peak are of interest. Blood sugar levels should not peak above certain values, and they should drop back to normal values after the test is complete. If glucose tolerance is poor, as is the case for diabetics, both the area under the curve and the peak value are abnormally large. This indicates that the individual has difficulty clearing glucose out of the blood. Tests can also be run in this fashion after a regular meal is consumed instead of just glucose.
Insulin sensitivity indicates how well tissues react to insulin. NIDDM is characterized by poor insulin sensitivity, meaning that tissues aren't responding to the hormone correctly or efficiently. These tissues may be described as being insulin resistant, indicating their cells don't respond to insulin's signaling and take up nutrients from the bloodstream as well as they should. Insulin sensitivity can be estimated by keeping the blood sugar at a constant concentration with a steady glucose intake.
END INSET
NIDDM is a Nutritional Disease
The bad news is that NIDDM is one of the largest health problems in Western countries. The cost of diabetes to Medicare alone (never mind all the other health insurers!) was a staggering 42.5 billion dollars in 1995. NIDDM currently affects some 6 to 12 million people in the US alone, and the incidence is increasing despite continued advances in medical care. It's also estimated that millions more people have the disease and don't yet know it. The good news is that NIDDM is first and foremost a nutritional disease, so is highly amenable to nutritional treatment. NIDDM is but one of many chronic diseases that are fundamentally caused by straying from our Paleolithic diet.
The most important fundamental concept in nutrition is that we have still have the bodies, metabolisms, and physiologies of Paleolithic hunter-gatherers. Our fundamental nutritional needs are unlikely to have changed significantly since the rise of our genus (Homo) 2.5 to 2.3 million years ago, and certainly not since the rise of our species (Homo sapiens)between 300,000 and 100,000 years ago. Modern humans have been widespread for 50,000 years,; however, agriculture has only been around 10,000 years at the most. Most Native North Americans have practiced agriculture less than 500 years, and some still don't practice it. For 99.8% of our time as humans we ate exclusively wild foods. As far as humans are concerned, agriculture is a new experience--we are still in the initial stages of a grand experiment conducted on our ourselves.
In my research, I have found that the major causes for NIDDM can all be related to a processed food agriculture-based diet:
[1] Obesity, or too much body fat with respect to the weight of lean tissue.
[2] Too many calories, especially from refined and processed carbohydrates and fats.
[3] Lack of certain polyunsaturated (essential) fatty acids (PUFA), and unbalanced fat intakes.
[4] Chromium deficiency.
[5] Lack of certain phytochemicals.
The diet we evolved eating consisted of lean wild game meat (including game, reptiles, amphibians, and insects!), fish, shellfish, raw fruits and vegetables, occasional nuts and seeds. No cereal grains, refined sugar, soybeans, dairy products, alcohol, hydrogenated fats, or large amounts of animal fat and dried legumes. Nothing processed, preserved, or artificial. The calories from fat were usually below 30%. With the rare exception of honey, these diets never contained concentrated carbohydrate sources such as sugar, corn syrup, flour, rice, and pasta. Hunter-gatherers also consumed a seasonal variety of vegetables, fruits, seeds, and nuts. These foods contain plenty of fiber and beneficial phytochemicals.
The Agricultural Revolution changed this dramatically. Cereal grains became the basis for both human and livestock nutrition. Modern agriculture and food processing have led to over 30% of calories from fat in our diets--with a lot more saturated and hydrogenated fats, and unbalanced and/or reduced intakes of PUFA. Fats and carbohydrates are now separated from whole foods, refined, processed, and readded. This readdition usually increases the amount of fat and sugar in foods, while decreasing the amount of fiber and vitamins, minerals, and phytochemicals (and often protein) which were obligatory for our ancestors. Cereal grains are unnatural foods for livestock too, and cause excessive fat accumulation.
NIDDM and Obesity
Obesity is unquestionably the major cause of NIDDM. If you are a diabetic and are overweight, then you have almost certainly already been told by your doctor to drop some pounds. In many cases, weight loss on the order of 20 to 50 pounds is all it takes to control or significantly improve NIDDM. Obesity itself interferes with normal glucose metabolism, and decreases insulin sensitivity. In addition, insulin receptors on the cells which store fat don't seem to work as well when the cells are "stuffed" with storage fat. Conversely, chronically elevated levels of insulin can make fat loss more difficult and may increase appetite.
Overweight Means Overfat
It's very important to realize that the weight you need to lose to help control your diabetes is FAT. 300 pound body builders don't have NIDDM, because their weight comes from extra muscle, not extra fat. Muscles are active tissue, and burn calories 24 hours a day. Your skeletal muscles are those which support your body, such as those found in legs, back, arms etc. Skeletal muscles are by far the biggest users of glucose in your body. This means the more muscles you have, and the more you use them, the lower your risk for developing NIDDM.
What's really important is having high ratio of lean to fat tissue in your total body weight. A high ratio of lean to fat tissue is associated with a strongly decreased risk for NIDDM. Lean tissue includes muscles, bones, tendons, ligaments, cartilage, and essential organs. Our 300 pound body builder is an extreme example, but serves the purpose well. On his body you You can see every muscle on his body, because his body fat level is only about 5-7% of his total body weight. He also has large, strong bones. He is not concerned about too much except gaining and maintaining muscle mass (mass Mass is a scientific term but is more or less equivalent to pounds here.) without gaining fat. Instead of being concerned about diabetes, he is concerned about having low blood sugar during intense workouts.
The ratio of lean to fat tissue is important even if you don't appear to be overweight. There is a big, big difference between being lean and being skinny. Lean means simply having a high ratio of lean to fat tissue. Skinny means you may not have too much body fat, but you don't have too much muscle either! Skinny people have a lean to fat ratio that is either average, or in some cases below average. Being skinny may be preferable to being clearly overfat or obese, but does not protect you from NIDDM as much as being lean does.
Chromium
Chromium (Cr) is an essential trace element required for normal insulin functioning. Cr deficiency produces diabetic symptoms including high blood sugar, impaired glucose metabolism, decreased insulin binding and receptor number, decreased HDL cholesterol, and increased total cholesterol and and triglycerides. A diet high in refined grains and sugars exacerbates Cr depletion. Firstly, these foods contain low amounts of Cr, yet Cr is necessary to metabolize them. Secondly, a high consumption of sugars and refined starches foods increases Cr excreted in the urine by 10 to 300%. Typical North American and European diets require more Cr than they provide, thus leading to long-term depletion of Cr from our bodies. The majority of the US population does not obtain the recommended intake of 50 to 200 micrograms per day. Brewer's yeast, beer, whole grains, cheese, liver, and meat can be good dietary sources of Cr; however, Cr contents of foods vary widely. Much of the Cr in foods may be unabsorbable metal contamination from stainless steel food processing equipment. Refining of grains and sugars, and processing of foods removes most of the absorbable Cr.
The Cr requirements of our Paleolithic ancestors were almost certainly lower than ours, since they consumed no cereal grains or refined sugars, but did consume lean protein, balanced PUFA, and plenty of soublesoluble fiber. They also lived in the geologically active East African Rift Valley for over for 4 million years. During this time, volcanoes erupted often, covering the area with trace-element rich lava and ash. Further, traditional hunting societies make a point to consume the internal organs of game, which are rich sources of absorbable trace elements, Cr included. We have no reason to think this behavior differed in the past. Therefore it is considered that this relative lack of Cr in Western diets is a major factor in the increasing incidence of NIDDM.
Appropriate dietary choices and chromium supplementation of 200-400 micrograms per day may help prevent NIDDM, but may not be sufficient to reverse existing diabetes. A recent double-blind placebo-controlled study on 3 groups of 60 Chinese NIDDM found that 500 micrograms chromium picolinate given twice per day for 4 months was greatly superior to placebo, lowering fasting blood glucose (129 mg/dL vs 160 mg/dL), post-meal blood glucose, (190 mg/dL vs 223 mg/dL) and nearly normalizing "glycated hemoglobin" (6.6±0.1% vs 8.5±0.2%). Glycated hemoglobin is another test used to measure the extent of diabetes. When blood glucose is too high, glucose can chemically bond to hemoglobin in the blood, which reduces its ability to bind and carry oxygen. Total cholesterol and insulin levels also dropped. A third group given 100 micrograms twice per day showed lesser but significant improvements in glycated hemoglobin and insulin levels, but not blood glucose levels
If you are taking any medication to control your blood sugar, start with 200 micrograms per day for a week, and monitor your glucose closely. Increase by 200 micrograms per week until you reach 1,000, and then have medication adjusted accordingly. For IDDM, use the same approach. Add Cr in 100 to 200 microgram increments per week. Monitor glucose closely, because you should experience a decrease in your insulin requirements. If you have trouble adjusting the insulin dose you take just before going to bed, do not take Cr supplements within 3 hours of retiring. Work up to the level of Cr that allows you to consistently reduce your daytime insulin, and stabilize your requirements. Then work on the night dosage.
Plants and Phytochemicals for Diabetes
We've spoken briefly about the some of the major nutritional factors involved in diabetes, but this is a newsletter about herbs, so let's dig deeper into the roles that medicinal and food plants play. We noted that our ancestors ate a variety of fresh, wild vegetables, fruits, nuts, and seeds. This is a far cry from today's heavy reliance on but a handful of major agricultural crops. It's staggering to realize that the overwhelming majority of plant foods in our diet come from only wheat, white rice, sugar, and corn syrup. These foods, as well as many other cereal grain and legume foods, are concentrated sources of carbohydrates but dilute sources of protein and trace nutrients. This is especially true if they are refined and processed.
Recently there has been an explosion of research concerning the health benefits of phytochemicals in food and medicinal plants. The explosion began when research study after research study came to the same conclusion: the higher the consumption of fruits and vegetables in the diet, the lower the risk for ANY chronic disease, from cancer to NIDDM. Conversely, those who ate few fruits and vegetables were more prone to disease, and more likely to die prematurely. Many plant foods today are much poorer sources of potentially beneficial phytochemicals than the plant foods our Paleolithic hunter-gatherer ancestors consumed. In fact, out ancestors' diets were exceedingly rich in phytochemicals compared to our diets today, and we have come to realize that humans literally evolved bathed in these phytochemicals. It is likely that we are adapted to having these compounds in our diet, and our good health depends in part on their presence.
Many phytochemicals which are biochemically active are belong to the groups known as flavonoids, saponins, alkaloids, lignans, and tannins. These compounds are usually bitter or astringent, ; therefore, horticulturists have practiced "negative selection" for these compounds over the years. Bitter and astringent phytochemicals are bred down to low levels, or concentrated in peels which are not eaten. Produce is consistently bred to be larger, sweeter, and milder. The fruits and vegetables our Paleolithic ancestors ate were more akin to chickweed, choke cherries, and kumquats than iceberg lettuce, bing cherries, and navel oranges! As humans evolved, they did not have big juicy red or golden delicious apples, but maybe a crabapple if they were exceedingly lucky. Consequently, we have lost a good deal of phytochemical protection from many diseases, NIDDM included. The more bland and processed the diet, the greater the loss. The strong-tasting vegetable kale, for example, had the highest antioxidant capacity of 21 vegetables tested in a research study. This is not surprising since wild kale is the precursor to all Brassica species, from kolrhabi to cabbage to cauliflower. Kale bears the most similarity to the Brassicas (cruciferous vegetables) we evolved eating.
Paleolithic perspectives aside, most of us are not going to return to a diet of the bitter, fibrous, "edible weeds" that are the wild precursors to modern cultivated produce. While most of us could improve our diets, even a hard-core Paleolithic Diet fan like me is loathe to return to a diet of purslane, kale, and inner tree bark when I can have a nice coleslaw or sliced tomatoes instead. Rather than broadly criticizing horticulture, we're instead considering that in the modern world, we may need to look to medicinal plants to help return us to the diet our bodies are expecting to be fed. Many of these bitter and astringent phytochemicals are with us today in the form of herbal products. The use of medicinal plants for diabetes is not just a search for safer alternatives to pharmaceutical drugs. Rather, we gain insight into the validity of traditional medicinal, tonic, and adaptogenic herbs. Such herbs can return valuable components to our diet, thereby making it more similar to our evolutionary diet with a minimum of effort (or bad taste--does anyone other than Dr. Duke really like to eat stewed nettles?).
According to Marles and Farnsworth (1994), 1,123 plants have been used to treat diabetes. Of 295 traditionally used plants screened in cell cultures, 81% were potentially antidiabetic. Over 200 pure phytochemicals are known to be hypoglycemic. However, Marles and Farnsworth caution that one-third to two-thirds of these 1,123 plants may be dangerous, and many of the phytochemicals are hypoglycemic because they are toxic to our metabolisms or liver. Conversely, there are hypoglycemic plants which are very safe and effective precisely because they help return us to our Paleolithic diet. These are the plants that we will focus on here.
Effective Herbs for Diabetes
Here's a few examples of antidiabetic herbs which have been proven effective in controlled human studies. In all cases, these herbal products cannot be expected to control or reverse diabetes alone, but are to be used as adjuncts to diet, exercise and nutritional supplementation. You definitely need to experiment on yourself with different herbs to see which work for you.
Bitter melon: (Momordica charantia) Unripe bitter melon is used traditionally in India, Africa, and Asia as diabetic remedy and as a "bitter tonic" food. It is available in most Asian groceries. Bitter melon contains a mix of hypoglycemic compounds called "charatin", plus an insulin-like protein. The effects of bitter melon are gradual and cumulative, . and aA juice or decoction has been shown to effective, but the powdered dried crude herb has not. A decoction is made by pouring boiling water over chopped fresh fruit, steeping, and straining. In a study in at an Indian medical college, 6 NIDDM patients were given 100 milliliters (ml) of a bitter melon decoction once per day. After 3 weeks, their fasting blood glucose dropped by 54%. After 7 weeks, all 6 were at or near the normal glucose limit, and sugar was no longer detectable in their urine.
To use bitter melon, eat cooked sliced bitter melon with 1 to 2 meals per day, or drink the decocted juice as described above. You may need to start with only a few slices or 50 ml juice and work up to 200 ml after 3 weeks. Use 200 ml for 4 weeks or so, and monitor your progress. Then adjust your dosage down to an effective maintenance dosage. This gradual procedure is the approach to take for IDDM treament also. Standardized encapsulated bitter melon extract is just now coming on the market, and may provide a more convenient alterative.
Gurmar: (Gymnena sylvestre) The leaves of this climbing vine are an ancient Ayurvedic treatment for diabetes. Gurmar appears to stimulate insulin secretion, and lower cholesterol and triacyglycerols without side effects. It has been shown to rejuvenate dysfunctional pancreatic cells in diabetic rats. In an open study in India, gurmar was tested on 22 patients who were not insulin dependent but taking oral antidiabetic medications. The patients were given 400 mg of a standardized gurmar extract per day for 18 to 20 months. They were all able to reduce their medication dosages, and 5 were able to discontinue their medications. The extract was judged superior to the medications for long-term blood sugar stabilization, lowering of triacyglycerols, and the overall well-being of the patients. In a sister controlled study, 400 mg of the extract was given to 27 insulin-dependent diabetics. Insulin requirements dropped by nearly 50%, and fasting blood sugar dropped also. Triacyglycerols dropped to near normal levels, and the subjects reported that their mood and physical performance improved.
Since gurmar acts primarily to increase insulin secretion, it may not be appropriate for individuals with chronically high levels of circulating insulin. This would include most people with NIDDM, but nobody with IDDM. In fact, gurmar is an herb which is probably targeted more towards those with IDDM than those with NIDDM. Gurmar does not seem to lower blood sugar levels in all people, and does take time to become effective, but the beneficial effects on triacyglycerols and cholesterol may make it worth trying no matter what. One capsule of a standardized extract can be taken 1 to 4 times per day. Those with IDDM or on diabetic medications should start with 1 capsule per day and increase by 1 capsule per week, monitoring blood sugar closely.
Korean Ginseng: (Panax ginseng) Traditional Chinese medicine recognized that ginseng helped diabetes centuries ago. On the Western side of the globe, a landmark 1995 Finnish study found that only 200 mg ginseng per day for 8 weeks improved mood and physical activity, and lowered fasting blood glucose and body weight compared to placebo.
This is only a very small ginseng dosage, and I'm frankly surprised it has this much effect. A dosage considered safe and perhaps more appropriate would be 200 mg ginseng extract or 500 mg capsules, 2 to 4 per day. Those with IDDM or on diabetic medications should start with 1 capsule and increase by 1 capsule per week, monitoring blood sugar closely, however dramatic changes in glucose should not be expected. Excessive amounts of Korean ginseng may cause elevated blood pressure, so you should check your blood pressure periodically while increasing your dosage.
Onions and Garlic: (Allium cepa, Allium sativum) Onions and garlic both contain two chemicals with sulfur-sulfur bonds. Insulin has a similar bond, and the compounds in onions and garlic are thought to bind to enzymes which serve to inactivate insulin, thereby prolonging the "life" of an insulin molecule. A review by Bailey and Day (1989) reported that 10 grams per kilogram body weight of onion or garlic extract lowered fasting blood glucose and improved glucose tolerance by 7 to 18%. This is quite a lot: a kilo of onion or garlic extract per day for a 100 kilo man! Garlic is also an antioxidant, and has been shown to lower cholesterol significantly, so may provide other benefits for diabetics.
An extensive review by Koch and Lawson (1996) found that somewhat lower doses of garlic are effective, ; however, most of the studies cited are studies are old, uncontrolled research. Newer studies indicate that the sulfur-containing phytochemical s-allycysteine sulfoxide (alliin) may indeed be important for garlic to be effective. Fresh cold pressed garlic and onion oils contain the majority of this phytochemical. A single dose of 125 mg per kilogram body weight onion oil lowered fasting glucose in 6 subjects from 75 to 59 mg/dl, while those receiving placebo went from 72 to 66.5 mg/dl. Evidently the placebo effect was still quite large, and this still translates to 12.5 grams onion oil for a 100 kilogram man, so might be considered an excessive dosage. Only a few percent of a fresh garlic clove or fresh onion is oil.
In a double blind study on 10 subjects, 800 mg per day of standardized garlic was given for 4 weeks. The garlic tablets were standardized for their alliin content. Those receiving the garlic significantly lowered their fasting blood glucose from 90.6 to 77.8 mg/dl, while the 10 receiving placebo went from 88.6 to 85.8 mg/dl, a nonsignificant change. In another study, spray dried garlic powder (which does not contain alliin) was given at 700 mg per day for a month, and had no effect.
The bottom line is that onions and garlic have been used as treatments for diabetes for years, and are probably helpful, but do not approach the effectiveness of other antidiabetic herbs and foods. They should be used as adjuncts to other herbal and nutritional treatments. If it suits you, it's good practice to eat onions, garlic, leeks, shallots, or chives on a daily basis. Like Dr. Duke I agree Rraw would be your first preferred choice, then very lightly cooked. Otherwise you might want to take up to 8 standardized garlic capsules per day.
Beyond Fiber: Diabetes Treatment and Prevention
High fiber diets are uniformly recommended for treatment of both NIDDM and IDDM. Particularly important is soluble fiber, found mainly in fruits, vegetables, and some seeds. Insoluble fiber is more characteristic of brans and husks of whole grains (i.e. wheat bran, bran cereal, brown rice). Soluble fibers include pectins, gums, and mucilages, all of which tend to increase the viscosity of food in the intestine, thus slowing or reducing the absorption of glucose. If you think of how pectin gels a fruit syrup into jelly, which is still soft but definitely not liquid, you can imagine how soluble fiber might act in your intestines.
In this respect, any diet featuring large quantities of raw or lightly cooked vegetables is beneficial for diabetics. Not surprisingly, our evolutionary diet was extremely high in vegetables and soluble fiber; however, people today often shun vegetables rich in soluble fiber such as okra, turnips, and parsnips. Many herbs and foods with a good deal of pectin or mucilage have been used successfully for diabetes, and the soluble fiber is certainly effective. A diet high in fiber is also thought to help prevent or slow the development of NIDDM. Epidemiological studies have shown that diets rich in whole grains, fruits, and vegetables result in a decreased incidence of NIDDM in a given age group as opposed to diets rich in white flour, white rice, other refined grains, and sugars. However, there's more to certain herbs than a simple inhibition of glucose absorption. The following herbs go "beyond fiber", lowering blood sugar far beyond what can be accounted for by the physical effect of inhibiting glucose absorption. As above, these herbs have been shown to be effective in human studies and in clinical treatment.
Flaxseed: (Linum usitatissimum) Flaxseed meal (what's left after the flax oil is pressed out) is one of the richest sources of fiber. In a University of Toronto study, five nondiabetic subjects were given a glucose solution along with plain water, or water containing mucilage extracted from flaxseed. The flaxseed mucilage dose improved glucose tolerance by 27% compared to the water. Two other groups were given either plain white bread or bread with 25% flaxseed meal. The flaxseed bread improved glucose tolerance by 28% compared to plain bread. Since the mucilage content of flaxseed meal is only a few percent, there must be more going on than simple inhibition of glucose absorption. Flaxseed is the world's richest source of edible lignans and also has protein, PUFA, and trace minerals, all of which are evidently beneficial.
Properly used, flaxseed meal is easy and inexpensive. 3 to 9 teaspoons of flax meal can be used per day with no gastrointestinal discomfort. For both IDDM and NIDDM, start with 1 teaspoon flaxmeal twice per day and increase to 3 teaspoons twice per day. Make sure you mix the flax seed meal with water or another liquid, or cook with it--do not consume it dry.
Fenugreek: (Trigonella foenum-graecum) Fenugreek is another traditional Ayurvedic remedy for diabetes and cardiovascular disease which has performed well in modern scientific studies. Whole fenugreek seeds are about 50% fiber, with 20% of that mucilage. In a double blind study by the Indian National Institute of Nutrition, 10 IDDM patients were given meals with 100 grams of fenugreek powder (ground defatted, debitterized seeds) per day or regular meals. After 10 days, fasting glucose decreased by 30%, and glucose tolerance improved in those that had fenugreek. The amount of sugar excreted in their urine dropped an astonishing 54%, yet there was no increase in insulin levels. Since fasting glucose was strongly affected, simple inhibition can't be the only explanation. In addition to mucilage, fenugreek also contains protein, saponins, and the hypoglycemic phytochemicals coumarin, fenugreekine, nicotinic acid, phytic acid, scopoletin, and trigonelline. In other double blind studies, 15 to 25 grams fenugreek powder were similarly effective for NIDDM patients. In all studies, fenugreek was very effective at lowering LDL cholesterol and triacylglycerols.
Fenugreek at only 5 grams daily was also given to 20 patients with NIDDM but no coronary artery disease for 1 month. 10 patients had severe diabetes and 10 had mild diabetes. Two groups of 10 mild/severe NIDDM patients served as controls. Fenugreek lowered fasting and post-meal blood sugar, but changes were only significant in the mild NIDDM group. This indicates that 5 grams may be a preventive dose, while larger daily doses are needed to treat or reverse NIDDM.
Fenugreek powder is available in bulk in Indian groceries, or from a bulk spice supplier. You can also buy whole seeds in bulk and grind them yourself in a spice mill or coffee grinder. Fenugreek can also be purchased encapsulated, but you will need to take quite a few capsules per day. Start with 1/4 teaspoon stirred in a glass of water 3 times per day, and increase to a heaping teaspoon 3 times per day. This heaping teaspoon would equate to 10 to 12 500 mg capsules at once. Fenugreek at these levels will almost certainly cause flatulence. If this bothers you, lower your dosage, and combine fenugreek with other herbs. Alternatively, a standardized fenugreek fiber product is just becoming available on the market currently being developed, which is designed to be effective at 5 gram doses.
Nopal (prickly pear) cactus: (Opuntia spp.) Widely used as a food throughout Latin America, nopal is rich in pectin. In a Mexican hospital study, 8 diabetics were given 500 grams of nopal on an empty stomach. Five tests were performed on each subject, 4 with different cooked or raw cactus preparations and 1 with water. After 180 minutes, fasting glucose was lowered by 22 to 25% by all of the nopal preparations, as compared to 6% for water. In a study on rabbits, nopal improved tolerance of injected glucose by 33% (180 minute value is also given for comparison) as compared to water. In both these cases there was no glucose in the intestines so it's apparent that there's more to nopal, too.
To use nopal, purchase the fresh cactus from a grocery with a Latin American produce section and eat a cup cooked or raw every day. Canned nopal is also widely available. Dried nopal preparations have not been shown conclusively to be effective, but encapsulated products are now available, and may soon be standardized and mainstream.
Promising Herbs for Diabetes
Many plants traditionally used for diabetes have a good deal of anecdotal evidence supporting their efficacy, so they have been investigated in laboratory animals and in cell cultures. Table 1 gives some of the more promising, safer herbs which have not been formally studied in humans, but have given good results in other types of studies.
In the laboratory where I work at the US Department of Agriculture, we have investigated over 60 plant extracts in a special cell culture test that determines how much a particular compound stimulates the uptake and utilization of glucose. While these tests are no substitute for human or animal studies, they are important because they identify safe compounds that act directly on the metabolism of cells. As we mentioned above, plenty of plants and individual phytochemicals can lower blood sugar, but many accomplish this by imposing toxic effects on the body. Cinnamon was by far the most active compound in our assay, so we focused on it. After cinnamon, the next most effective plants were witch hazel, green and black tea, and shiitake and white mushrooms--nothing else was particularly remarkable.
From an extract of commercial cinnamon, we have identified novel phytochemicals called chalcone polymers that increases glucose metabolism in the cells 20-fold or more. Chalcone polymers are also antioxidant; we have shown that they strongly inhibit the formation of reactive oxygen species in activated blood platelets, which adds to the already respectable list of antioxidant phytochemicals identified in cinnamon.
Since Khan et al. (1990) first published results identifying cinnamon as a spice which could potentially help diabetes, we have heard from hundreds of people who have tried using it and found that it works. Since cinnamon is very safe, there is little harm in trying it youself. To use cinnamon to help lower blood sugar and broadly improve NIDDM and IDDM, put 3 rounded tablespoons ground cinnamon and 1 to 2 tsp. baking soda (use lesser amount if sodium is a problem for you) in a 32 oz. (quart) canning jar. Fill the jar with boiling water, and let steep at room temperature until cool. Strain or decant liquid and discard "grounds", then put lid on jar and refrigerate. Drink 1 cup (8 oz.) of the tea 4 times per day. After 1-3 weeks, drop to 1 to 2 cups per day, or use as needed. For those with IDDM, start with only 1-2 cups per day, and increase by 1 cup per week, monitoring blood sugar closely. Buying cinnamon is cost-effective and highly recommended.
Table 1. Promising botanical treatments for NIDDM, based on in vitro or in vivo animal studies.
Common Name Latin Binomial
Cloves Syzygium aromaticum
Cinnamon Cinnamomum spp.
Turmeric Curcuma longaa
Bay leaf Laurus nobilis
Black walnut Juglans regia
Juniper berries Juniperus communis
Izui Polygonatum officinale
Syrian Christ thorn Zizyphus spina-christi
Guduchi Tinospora cordifolia, T. crispa
Cumin Cuminum cyminum
Black cumin Nigella sativa
Cucumber Cucumis sativus
Bottle gourd Curcubita ficifolia
Goat's rue Galega officinalisb
Ganoderma mushroom Ganoderma lucidum
Java plum Syzygium jambolanum
Siberian ginseng Eleutherococcus senticosus
Coriander Coriandrum sativum
Sage Salvia spp.
Lucerne Medicago sativa
Bilberry Vaccinium myrtillus
Tea green and black Camellia sinensis
aThe potential effectiveness of turmeric is related to its strong antioxidant effects, and is more applicable to diabetic complications. Data on insulin potentiation from (Khan et al., 1990) has subsequently not been reproduced in our laboratory at the USDA.
bG. officinalis has been tested in humans and can be effective, but is not considered generally safe. It contains the guanidine derivative galegin, which is similar to synthetic pharmaceutical hypoglycemic biguanide medications. Do not use unless given under the treatement of a medical professional.
A Few Herbs for Diabetic Complications
Both NIDDM and IDDM are associated with a number of potentially serious health conditions known as diabetic complications. Complications worsen with decreasing blood sugar control, and increasing age and obesity. Diabetics who are nutrient deficient, and who use tobacco or drink alcohol have an increased risk for complications. Complications include increased risk for cardiovascular disease and stroke, poor circulation, difficulty walking or exercising, visual deterioration, and permanent, painful nerve damage.
If you have IDDM, the irreversible nature of your condition means that you need to pay extra attention to preventing or minimizing complications. In almost all cases, complications will eventually arise in IDDM patients, but you can defer their onset for many years, and minimize their impact on your health by controlling your blood sugar, eating right, exercising, and starting on a supplement program as early in life as you can. This advice is especially relevant for parents with diabetic children. As a parent, you need to consider that your child may be facing a lifetime of insulin injections, and will never have the fine control of glucose metabolism that a nondiabetic child has. In order to ensure that your child can grow to adulthood as healthily as possible, you need to start preventing/deferring complications now.
A full discussion of diabetic complications would require an entire newsletter, so I'll just highlight some of the herbs and approaches that have been demonstrated to be beneficial in humans. It has been repeatedly observed that diabetics have higher levels of oxidative stress than nondiabetics. This is particularly true if blood sugar control is poor, but even if this is not the case, the abnormal oxidative stress is still present to a significant degree. It's important to recognize that increased oxidative stress is a major factor in all diabetic complications. A first approach might be to supplement vitamin, mineral and botanical antioxidants. Keeping your fruit and vegetable intake helps add antioxidants to your diet as well.
Suggested Botanical Antioxidant Products
Any "green drink"; many specifically state that they contain numerous botanical antioxidants
curcumin
grape seed extract
pine bark extract ( i.e. PycnogenolÆ)
licorice
rosemary extract
oregano, thyme, peppermint, spearmint, or other mint family plants, preferably as teas
garlic
cayenne
Siberian ginseng
green tea beverage or extract
mixed bioflavonoids (i. e. rutin, quercetin, citrus peel extract)
mixed natural carotenoids
schizandra
Neuropathy (painful nerve degeneration; loss of feeling, mobility, and sensitivity to cold, heat and pain)
Primary: evening primrose oil; alpha lipoic acid
Also helpful topically for pain: cayenne pepper ointment
Retinopathy (detereration) of the retina; loss of vision
Primary: buckwheat; butcher's broom; bilberry
Any one or all of these may also be helpful:
ginkgo biloba
bee pollen (a rich source of rutin)
rutin (sometimes available as the individual bioflavonoid)
proanthocyanidins (i.e. grape seed, pine bark extracts)
Cataracts
Primary: mixed natural carotenoid supplement including lutein, lycopene and zeaxanthin; curcumin
Any one or all of these may also be helpful:
alpha lipoic acid
mixed bioflavonoids (i. e. rutin, quercetin, citrus peel extract)
ginkgo
bilberry
schizandra
rosemary and many mints
Microangiopathy, Peripheral Vascular Disease, Intermittent Claudication (Poor circulation, stiffness, and blockage of small blood vessels. May result in pain, loss of mobility, decreased resistance to infection, fluid retention, and cold extremeties.)
Primary: Padma 28, a patented blends of herbs from traditional Tibetan medicine; gingko biloba; horse chestnut; proanthocyanidins
Any one or all of these may also be helpful:
bilberry
gotu kola (Centella asiatica)
butcher's broom
bee pollen
Note: horse chestnut and butcher's broom are especially helpful for varicose veins and hemorrhoids.
Hyperlipidemia (high levels of blood lipids; high "triglycerides')
Primary: gugulipid; fenugreek; garlic
Any one or all of these may also be helpful:
gurmar
curcumin
basil
flaxseed meal
INSET "INTERVIEW"
Dr. James Duke, Ph. D., Economic Botanist, US Dept. of Agriculture, Beltsville, MD retired.
President, Herbal Vineyard, Inc., Fulton, MD, Author of The Green Pharmacy
I asked Dr. Duke to tell me about some of the herbs that he has seen used successfully for diabetes while out in the field around the world. Jim replies: "Few herbs have attracted as much interest as the food plant known as balsam pear or bitter melon (Momordica charantia). Research on the hypoglycemic properties of Momordica was first published in India in the 1960s, and in a recent trial a fall of 54% in blood sugar was achieved. Bitter melon juice, dried fruits, and seeds have proven oral hypoglycemic activity, due to several identified compounds. Authors recommend 2 oz. fresh juice or 100 ml decoction (Chop 100 grams fresh fruit and boil in 200 ml water down to 100 ml). In another study, consumption of 50 ml extract of bitter gourd reduced hyperglycemia by some 20%. Bitter melon was shown to delay the development of cataracts and other diabetic complications in rats. Dr. H. F. Dankmeijer of Bilthoven uses bitter melon as an insulin substitute in insulin-dependent diabetics. In NIDDM, where insulin resistance is the problem, treatment uses liver-cleansing agents such as Chelidonium (celadine), and Taraxacum (dandelion), all of which have been cited as food plants elsewhere. I'd be reluctant to eat much Chelidonium. Better yet, just eat it as a side dish like the Asians and Indians do."
I asked Dr. Duke about herbs that haven't gotten near the mainstream yet. He replies: "Here's one of my other favorite emerging cures, or remedies from emerging countries. Central American herbal expert Dr. Rosita Arvigo and I have listed a whole host of ailments treatable with the jackass bitters (Neurolaena lobata): ameobas, beef worm, candida, other fungi, giardia, headlice, intestinal parasites, ringworm, and screw worm. As a matter of fact, Rosita peddles jackass bitters as the primary ingredient of her ëTraveler's Tonic' for tourists suffering Montezuma's revenge or malaria. Surrounded by a group of local female healers, some Maya, some African-American, Rosita stressed the power of jackass bitters for vaginal yeast infections at the first Rain Forest Pharmacy Workshop held in Belize (May 20-28, 1995)."
"But none of this folklore anticipates what may be the more promising activity of the jackass bitters, its antidiabetic activity. In my files at the USDA is a copy of a 1989 letter from a Florida physician to the then-director of the USDA Beltsville Human Nutrition Research Center, Dr. Walter Mertz: ëEnclosed is a sample of ëweed' provided to me by a diabetic patient. This is a rather interesting adult-onset diabetic who had been insulin-requiring until beginning this ëweed'. The patient brought back this ëweed' from the Island of Trinidad. I am hoping you will be able to identify the plant and to determine its effective ingredient.' The patient reports that she mixes a small portion of the ëweed' with vermouth and takes small sips of this about twice a day. This has resulted in normalization of her blood sugar over the past approximately six months. Knowing of my interest in folk medicine, Dr. Mertz sent me the letter and specimen, which I tentatively identified as Neurolaena lobata, having found a report that the leaf tea of Neurolaena, under the creole name ëzeb a pic', was taken for diabetes; and in vermouth, for biliousness, colds, dysmenorrhea, fever, and malaria. I responded to the physician for Dr. Mertz, tentatively identifying the plant (only leaves had been submitted)."
"Research has confirmed the antidiabetic activity of jackass bitters. A 100% ethanol extract (a bit stronger than vermouth!) is antihyperglycemic (prevents high blood sugar) in mice orally at doses of 250 mg per kilogram. If I were a 110 kilogram mouse, that would mean I'd have to drink 27.5 grams of nearly 200 proof jackass vermouth. For those of you who don't think metrically, that's less than a single ounce shot. At aA double-shot dose (500 mg/kg orally in the mouse) certainly lowers blood sugar. I could probably even handle a double shot with a little lemonade for chaser (But I would prefer that my lemonade be sweetened with the sweet leaf of Paraguay, Stevia rebaudiana (stevia), rather than demon sugar!). Personally I'd feel a bit safer with the jackass bitters than with the rosy or madagascar periwinkle, known to Belizeans as ram goat (Catharanthus) or the bitter gourd, known to Belizeans as sorosi (Momordica). I'm convinced that all three of these can lower blood sugar, though. Clearly the Jamaican sorosi, or Momordica, is the most promising of the tropical answers to diabetes overall."
END INTERVIEW