High Blood Sugar
By Bruce Scali
By Bruce Scali
Controlling Blood Sugar: An Integrated Approach
Eric Braverman, MD, is an integrative medicine specialist and director of the Place for Achieving Total Health (PATH Medical) in New York City. Dr. Braverman reports tremendous success in working with patients with high blood sugar. By integrating supplements, diet, medication, and lifestyle changes, his patients have achieved better health and relief from the ravages of diabetes and high blood sugar.
Dietary modification is a crucial part of Dr. Braverman’s approach. “Sugar, white flour, and soft drinks today are what tobacco was 50 years ago,” he says. “We’re seeing the result of long-term consumption of junk food, despite warnings about its consequences. This simple rule of thumb for general health is especially important for diabetics: eliminate processed foods such as white sugar, white rice, and white flour from your diet.”
Dr. Braverman is also a strong advocate of diabetes screening. “Considering the looming diabetes epidemic, everyone should insist on a glucose test,” he adds. “Those with risk factors should monitor their blood sugar every three months, and those who enjoy good health should request a hemoglobin A1C (HbA1c) test at their annual physical. It’s as important as a Pap smear, cardiogram, PSA, or breast exam.”
Using his integrative approach, Dr. Braverman has seen significant improvement in the laboratory parameters of his patients. “Diabetics often have HbA1c levels over 12%,” he explains. “Standard therapies typically lower that by one or two points. The Life Extension protocol can cut it in half. I have used Life Extension techniques to lower HbA1c levels of 14% down to 8%, and a level of 13% was returned to normal (below 6%). Diabetics who have triglyceride levels of 1500 mg/dL are frequently reversed to normal, cholesterol levels of 373 mg/dL are reversed to normal, and even signs of kidney failure with a blood creatinine level of 2.1-2.2 mg/dL have been reversed. Diabetics are at a high risk of developing Alzheimer’s and early memory loss 30 years before developing dementia. We’ve been able to reverse this memory problem as well.”
Dr. Braverman’s advice is simple and direct: “Maintain a healthy weight, eat properly, balance your hormones, and take the right supplements.”
Hormone Balance and Diabetes
Hormone balancing is a critical yet often overlooked element in a program of diabetes management, according to Dr. Braverman. He believes that declining hormone levels result in diminished blood sugar control, since hormone deficiencies can decrease the effectiveness of insulin. One theory of aging suggests that we are only as young as our oldest part. If we do not address the diminished hormone levels that accompany normal aging, then therapies will be only marginally effective. High blood sugar may represent only the tip of the iceberg, or the visible manifestation of a greater problem, which is an underlying hormone imbalance.
In order to balance hormone levels, it is first necessary to assess the levels of several hormones in the body. Blood testing provides an accurate way to assess hormone status. Typically, hormone testing for men will assess levels of DHEA, testosterone, and estrogen. Hormone testing for women assesses DHEA, estrogen, progesterone, and testosterone.
Testosterone supplementation for men reduces insulin resistance, raises beneficial HDL, lowers blood pressure and triglycerides, and helps to reduce excess weight while building muscle.50,51 “I’ve had patients reduce their insulin from 100 units to 50 by balancing their testosterone,” says Dr. Braverman.
Women tend to gain weight easily from age 35 on due to decreasing levels of estrogen, progesterone, and testosterone. Data suggest that correcting these hormone imbalances in women improves glucose control and may alleviate the tendency to gain weight.52 Additionally, many women anecdotally report improved mood, energy, and libido following hormone balancing.
A proper level of DHEA (dehydroepiandrosterone) should be maintained in both men and women to support insulin’s action on glucose.53 Women typically need up to 100 mg of DHEA daily, while men typically require up to 200 mg.
Dr. Braverman recommends bioidentical hormones rather than synthetic hormones such as Premarin®. He notes that men and women must be screened thoroughly for cancer before taking any sex hormones. Nutritional and herbal supplements, such as Life Extension’s Super MiraForte and Natural Estrogen, help balance hormone levels in men and women, respectively.
Beneficial Effects of Fiber
In addition to recommending abundant dietary fiber to his patients, Dr. Braverman advocates the use of fiber supplements. Supplemental sources of fiber include psyllium husk, guar gum, and a dietary fiber blend called PGX™. Psyllium husk can be used in capsule or powder form, and has been reported to decrease glucose absorption and reduce total cholesterol and LDL in type II diabetics.54 Guar gum is another beneficial fiber for controlling blood sugar because it slows gastric emptying and thus the absorption of glucose.55 PGX™ is a fiber supplement that binds to many times its weight in water, helping to slow carbohydrate absorption and promote a feeling of fullness. Clinical trials support its application in improving glycemic control in diabetes and in enhancing lipid profiles.56,57 (See “Novel Fiber Limits Sugar Absorption, Life Extension, September 2004.)
The Importance of Supplements
Nutritional supplements are powerful tools in supporting healthy metabolism and normalizing blood sugar. High blood sugar is marked by many complications, including increased risk for heart disease, kidney and nerve damage, visual deterioration, and vascular problems.
As shown in Tables 3 and 4, proper supplementation can help reduce blood glucose levels, improve insulin action, increase cellular metabolism, and correct the damage of glycation.
Chromium is a trace mineral with numerous beneficial actions for supporting healthy blood sugar. Chromium appears to promote insulin sensitivity and improve glycemic control in many individuals.58 Additionally, chromium has been found to lower blood glucose levels, both at fasting and at two hours following a glucose challenge.59 Chromium also has been demonstrated to lower triglyceride levels and boost levels of HDL in patients with type II diabetes.59 Chromium thus helps to optimize both blood sugar levels and blood lipid profiles.
Essential fatty acids such as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are crucial nutrients for people with high blood sugar. In mammal studies, EPA supplementation helps to prevent insulin resistance and improve glucose tolerance test parameters.60 Human studies have demonstrated that EPA and DHA together help lower serum triglycerides and raise HDL in non-insulin-dependent diabetic patients.61 Additionally, EPA and DHA supplements decreased rates of lipid peroxidation and raised levels of glutathione peroxidase, an antioxidant enzyme.61 Omega-3 fatty acids therefore may help to improve the dyslipidemia that often occurs with hyperglycemia and may decrease the rate of vascular complications.
Lipoic acid, a potent antioxidant and coenzyme, is one of the most critical nutrients for people with high blood sugar. Clinical and animal studies have shown that lipoic acid stimulates insulin-mediated glucose uptake.62 In rats fed a high-sugar diet, lipoic acid improved insulin sensitivity and glucose tolerance.62 In a study of type II diabetics, three months of supplementation with lipoic acid helped to improve painful neuropathy symptoms in 77% and eliminated symptoms in 19% of participants.63 Lipoic acid also improved nerve-conduction velocity, which is often compromised in diabetic patients suffering from neuropathy.63 Lipoic acid therefore acts by several mechanisms to improve insulin sensitivity as well as help support healthy nerve function.
Bilberry, a close relative of the blueberry, has been eaten and used medicinally for centuries because of its high nutritive value. Bilberry leaf decoctions administered orally have been shown to lower blood glucose levels.64 Bilberry exhibits an affinity for the tissues of the eye, improving the delivery of oxygen and blood to the eye tissues and scavenging free radicals that can contribute to conditions such as cataracts and macular degeneration.64 Anthocyanosides present in bilberry have been found to retard the development of cataracts in animals and humans.64 European studies have shown that bilberry anthocyanosides are highly effective in preventing diabetic retinopathy.64 Additionally, bilberry extracts improve microcirculation, enhance collagen integrity, and exert anti-inflammatory properties.64 Bilberry is thus a powerful tool in protecting the eyes against the secondary effects of high blood sugar.
A multi-vitamin/mineral helps form the foundation of a healthy lifestyle for all adults, and is especially important for those with hyperglycemia. Diabetic patients are susceptible to infections and delayed wound healing. An important study showed that diabetics who supplemented with a multi-vitamin/mineral formula for one year experienced a decreased rate of illness, infection, and missed time from work compared to study subjects who took a placebo.65 Thus, a multi-vitamin/mineral supplement may help patients with high blood sugar to optimize health and prevent illness.
1. Killilea T. Long-term consequences of type 2 diabetes mellitus: economic impact on society and managed care. Am J Manag Care. 2002 Oct;8(16 Suppl):S441-9.
2. Narayan KM, Gregg EW, Fagot-Campagna A, Engelgau MM, Vinicor F. Diabetes—a common, growing, serious, costly, and potentially preventable public health problem. Diabetes Res Clin Pract. 2000 Oct;50 Suppl 2S77-84.
3. Osei K. Global epidemic of type 2 diabetes: implications for developing countries. Ethn Dis. 2003;13(2 Suppl 2):S102-6.
4. Gu K, Cowie CC, Harris MI. Mortality in adults with and without diabetes in a national cohort of the US population, 1971-1993. Diabetes Care. 1998 Jul;21(7):1138-45.
5. Ahmed N. Advanced glycation endproducts—role in pathology of diabetic complications. Diabetes Res Clin Pract. 2005 Jan;67(1):3-21.
6. Bonnefont-Rousselot D, Beaudeux JL, Therond P, Peynet J, Legrand A, Delattre J. Diabetes mellitus, oxidative stress and advanced glycation endproducts. Ann Pharm Fr. 2004 May;62(3):147-57.
7. Leslie DL, Rosenheck RA. Incidence of newly diagnosed diabetes attributable to atypical antipsychotic medications. Am J Psychiatry. 2004 Sep;161(9):1709-11.
8. Kropp S, Grohmann R, Hauser U, Ruther E, Degner D. Hyperglycemia associated with antipsychotic treatment in a multicenter drug safety project. Pharmacopsychiatry. 2004 Mar;37 Suppl 1S79-83.
9. Fletcher B, Gulanick M, Lamendola C. Risk factors for type 2 diabetes mellitus. J Cardiovasc Nurs. 2002 Jan;16(2):17-23.
10. Trevisan R, Vedovato M, Tiengo A. The epidemiology of diabetes mellitus. Nephrol Dial Transplant. 1998;13 Suppl 82-5.
11. Meigs JB. Epidemiology of the insulin resistance syndrome. Curr Diab Rep. 2003 Feb;3(1):73-9.
12. Laaksonen DE, Niskanen L, Punnonen K, et al. Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes Care. 2004 May;27(5):1036-41.
13. Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA. 2001 Sep 12;286(10):1218-27.
14. Kelly JM, Marrero DG, Gallivan J, Leontos C, Perry S. Diabetes prevention. A GAMEPLAN for success. Geriatrics. 2004 Jul;59(7):26-31.
15. Scheen AJ. Clinical study of the month. Prevention of type 2 diabetes in overweight patients with impaired glucose tolerance: efficiency of lifestyle changes. Rev Med Liege. 2001 Jun;56(6):463-5.
16. Kanaya AM, Narayan KM. Prevention of type 2 diabetes: data from recent trials. Prim Care. 2003 Sep;30(3):511-26.
17. Goldstein BJ. Insulin resistance as the core defect in type 2 diabetes mellitus. Am J Cardiol. 2002 Sep 5;90(5A):3G-10G.
18. Chisholm DJ, Campbell LV, Kraegen EW. Pathogenesis of the insulin resistance syndrome (syndrome X). Clin Exp Pharmacol Physiol. 1997 Sep;24(9-10):782-4.
19. Lorenzo C, Okoloise M, Williams K, Stern MP, Haffner SM. The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study. Diabetes Care. 2003 Nov;26(11):3153-9.
20. Scheen AJ. From obesity to diabetes: why, when and who? Acta Clin Belg. 2000 Jan;55(1):9-15.
21. Resnick HE, Valsania P, Halter JB, Lin X. Relation of weight gain and weight loss on subsequent diabetes risk in overweight adults. J Epidemiol Community Health. 2000 Aug;54(8):596-602.
22. Wannamethee SG, Shaper AG. Weight change and duration of overweight and obesity in the incidence of type 2 diabetes. Diabetes Care. 1999 Aug;22(8):1266-72.
23. Moore LL, Visioni AJ, Wilson PW, et al. Can sustained weight loss in overweight individuals reduce the risk of diabetes mellitus? Epidemiology. 2000 May;11(3):269-73.
24. Ryan DH. Diet and exercise in the prevention of diabetes. Int J Clin Pract Suppl. 2003 Mar;(134):28-35.
25. Ivy JL. Role of exercise training in the prevention and treatment of insulin resistance and non-insulin-dependent diabetes mellitus. Sports Med. 1997 Nov;24(5):321-36.
26. Schulze MB, Hu FB. Primary prevention of diabetes: what can be done and how much can be prevented? Annu Rev Public Health. 2004 Oct 26.
27. Eyre H, Kahn R, Robertson RM, et al. Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Stroke. 2004 Aug;35(8):1999-2010.
28. Manson JE, Ajani UA, Liu S, Nathan DM, Hennekens CH. A prospective study of cigarette smoking and the incidence of diabetes mellitus among US male physicians. Am J Med. 2000 Nov;109(7):538-42.
29. Jenkins AJ, Rowley KG, Lyons TJ, et al. Lipoproteins and diabetic microvascular complications. Curr Pharm Des. 2004;10(27):3395-418.
30. Greenfield JR, Samaras K, Hayward CS, Chisholm DJ, Campbell LV. Beneficial postprandial effect of a small amount of alcohol on diabetes and cardiovascular risk factor. Modification by insulin resistance. J Clin Endocrinol Metab. 2005 Feb;90(2):661-72.
31. Avogaro A, Watanabe RM, Dall’Arche A, et al. Acute alcohol consumption improves insulin action without affecting insulin secretion in type 2 diabetic subjects. Diabetes Care. 2004 Jun;27(6):1369-74.
32. Shai I, Rimm EB, Schulze MB, et al. Moderate alcohol intake and markers of inflammation and endothelial dysfunction among diabetic men. Diabetologia. 2004 Oct;47(10):1760-7.
33. Riazi A, Pickup J, Bradley C. Daily stress and glycaemic control in Type 1 diabetes: individual differences in magnitude, direction, and timing of stress-reactivity. Diabetes Res Clin Pract. 2004 Dec;66(3):237-44.
34. Foster-Powell K, Holt SHA, Brand-Miller JC. International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr. 2002 July;76(1):5-56.
35. Reaven GM. Diet and Syndrome X. Curr Atheroscler Rep. 2000 Nov;2(6):503-7.
36. Gannon MC, Nuttall FQ, Saeed A, Jordan K, Hoover H. An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Am J Clin Nutr. 2003 Oct;78(4):734-41.
37. Nuttall FQ, Gannon MC, Saeed A, Jordan K, Hoover H. The metabolic response of subjects with type 2 diabetes to a high-protein, weight-maintenance diet. J Clin Endocrinol Metab. 2003 Aug;88(8):3577-83.
38. Brinkworth GD, Noakes M, Parker B, Foster P, Clifton PM. Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with type 2 diabetes: one-year follow-up of a randomised trial. Diabetologia. 2004 Oct;47(10):1677-86.
39. Nuttall FQ, Gannon MC. Metabolic response of people with type 2 diabetes to a high protein diet. Nutr Metab (Lond). 2004 Sep 13;1(1):6.
40. Salmeron J, Hu FB, Manson JE, et al. Dietary fat intake and risk of type 2 diabetes in women. Am J Clin Nutr. 2001 Jun;73(6):1019-26.
41. McKeown NM. Whole grain intake and insulin sensitivity: evidence from observational studies. Nutr Rev. 2004 Jul;62(7 Pt 1):286-91.
42. Schulze MB, Liu S, Rimm EB, et al. Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr. 2004 Aug;80(2):348-56.
43. Hodge AM, English DR, O’Dea K, Giles GG. Glycemic index and dietary fiber and the risk of type 2 diabetes. Diabetes Care. 2004 Nov;27(11):2701-6.
44. Chandalia M, Garg A, Lutjohann D, et al. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. N Engl J Med. 2000 May 11;342(19):1392-8.
45. Campos KE, Diniz YS, Cataneo AC, et al. Hypoglycaemic and antioxidant effects of onion, Allium cepa: dietary onion addition, antioxidant activity and hypoglycaemic effects on diabetic rats. Int J Food Sci Nutr. 2003 May;54(3):241-6.
46. Kumar GR, Reddy KP. Reduced nociceptive responses in mice with alloxan induced hyperglycemia after garlic (Allium sativum Linn.) treatment. Indian J Exp Biol. 1999 Jul;37(7):662-6.
47. Khan A, Safdar M, Ali Khan MM, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003 Dec;26(12):3215-8.
48. Guerci B, Drouin P, Grange V, et al. Self-monitoring of blood glucose significantly improves metabolic control in patients with type 2 diabetes mellitus: the Auto-Surveillance Intervention Active (ASIA) study. Diabetes Metab. 2003 Dec;29(6):587-94.
49. Schwedes U, Siebolds M, Mertes G. Meal-related structured self-monitoring of blood glucose: effect on diabetes control in non-insulin-treated type 2 diabetic patients. Diabetes Care. 2002 Nov;25(11):1928-32.
50. Mayes JS, Watson GH. Direct effects of sex steroid hormones on adipose tissues and obesity. Obes Rev. 2004 Nov;5(4):197-216.
51. Tsai EC, Matsumoto AM, Fujimoto WY, Boyko EJ. Association of bioavailable, free, and total testosterone with insulin resistance: influence of sex hormone-binding globulin and body fat. Diabetes Care. 2004 Apr;27(4):861-8.
52. Ferrara A, Karter AJ, Ackerson LM, Liu JY, Selby JV. Hormone replacement therapy is associated with better glycemic control in women with type 2 diabetes: The Northern California Kaiser Permanente Diabetes Registry. Diabetes Care. 2001 Jul;24(7):1144-50.
53. Ishizuka T, Kajita K, Miura A, et al. DHEA improves glucose uptake via activations of protein kinase C and phosphatidylinositol 3-kinase. Am J Physiol. 1999 Jan;276(1 Pt 1):E196-204.
54. Sierra M, Garcia JJ, Fernandez N, Diez MJ, Calle AP. Therapeutic effects of psyllium in type 2 diabetic patients. Eur J Clin Nutr. 2002 Sep;56(9):830-42.
55. Russo A, Stevens JE, Wilson T, et al. Guar attenuates fall in postprandial blood pressure and slows gastric emptying of oral glucose in type 2 diabetes. Dig Dis Sci. 2003 Jul;48(7):1221-9.
56. Vuksan V, Sievenpiper JL, Owen R, et al. Beneficial effects of viscous dietary fiber from Konjac-mannan in subjects with the insulin resistance syndrome: results of a controlled metabolic trial. Diabetes Care. 2000 Jan;23(1):9-14.
57. Vuksan V, Jenkins DJ, Spadafora P, et al. Konjac-mannan (glucomannan) improves glycemia and other associated risk factors for coronary heart disease in type 2 diabetes. A randomized controlled metabolic trial. Diabetes Care. 1999 Jun;22(6):913-9.
58. McCarty MF. Nutraceutical resources for diabetes prevention—an update. Med Hypotheses. 2005;64(1):151-8.
59. Bahijiri SM, Mira SA, Mufti AM, Ajabnoor MA. The effects of inorganic chromium and brewer's yeast supplementation on glucose tolerance, serum lipids and drug dosage in individuals with type 2 diabetes. Saudi Med J. 2000 Sep;21(9):831-7.
60. Minami A, Ishimura N, Sakamoto S, et al. Effect of eicosapentaenoic acid ethyl ester v. oleic acid-rich safflower oil on insulin resistance in type 2 diabetic model rats with hypertriacylglycerolaemia. Br J Nutr. 2002 Feb;87(2):157-62.
61. Kesavulu MM, Kameswararao B, Apparao C, Kumar EG, Harinarayan CV. Effect of omega-3 fatty acids on lipid peroxidation and antioxidant enzyme status in type 2 diabetic patients. Diabetes Metab. 2002 Feb;28(1):20-6.
62. Thirunavukkarasu V, Anitha Nandhini AT, Anuradha CV. Lipoic acid attenuates hypertension and improves insulin sensitivity, kallikrein activity and nitrite levels in high fructose-fed rats. J Comp Physiol [B]. 2004 Nov;174(8):587-92.
63. Negrisanu G, Rosu M, Bolte B, Lefter D, Dabelea D. Effects of 3-month treatment with the antioxidant alpha-lipoic acid in diabetic peripheral neuropathy. Rom J Intern Med. 1999 Jul;37(3):297-306.
64. Anon. Monograph. Vaccinium myrtillus (bilberry). Altern Med Rev. 2001 Oct;6(5):500-4.
65. Barringer TA, Kirk JK, Santaniello AC, Foley KL, Michielutte R. Effect of a multivitamin and mineral supplement on infection and quality of life. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2003 Mar 4;138(5):365-71.