Integrative Diabetes Management: A Case History
By Eric Braverman, MDJuly 2005
By Bruce Scali
Edgar was a 51-year-old diabetic with multiple complaints when I first saw him five years ago. He had been using injectable insulin for several years to manage his blood sugar, but this married computer analyst and father of three could not remember when he was not 40 pounds overweight and suffering from fatigue and hypertension. His latest problem, periodic erectile dysfunction, led him to my office.
Edgar was taking blood pressure and cholesterol medications, but had not seen much improvement in his health with conventional care. He wanted to know whether an integrative medical approach might help him. I assured him that many well-researched strategies were available, and that he would feel much better soon.
Elevated blood sugar (hyperglycemia) starts a cascade of health problems. I suspected that his examination would confirm that Edgar had a metabolic disorder with vascular and diabetic complications. Left unchecked, Edgar’s condition could deteriorate into heart attack, stroke, blindness, amputations, or dementia. Although there was little likelihood of getting him off insulin, much could be done to improve his condition and enhance the quality and span of his life.
I explained that we would formulate a comprehensive lifestyle, diet, supplement, and hormone program to revive Edgar’s metabolism, help him lose weight permanently, restore his sexual function, and avoid the dire consequences of diabetes. Before any specific treatment recommendations were made, the PATH Medical staff would administer a head-to-toe examination under my direction, including a physical examination, standard blood testing and blood sugar assessment, testing for hormone levels, prostate cancer screening, and multiple ultrasound reviews. With this wealth of information, we would get to the source of his complaints, and go beneath the iceberg, so to speak, to avoid Edgar’s impending “shipwreck.”
His test results, shown above along with desirable ranges, had implications for all of his complaints.
In addition, Edgar’s creatinine was 2.3 mg/dL (normal range is 0.4-1.2 mg/dL), indicating impaired kidney function, and his liver enzymes and platelets were elevated, indicating liver disease and blood flow restriction.
Although he was on insulin, Edgar’s blood sugar was not sufficiently under control. His fasting glucose indicated that his body was not able to fully metabolize food in the short term, and his HbA1c level was exceptionally high. Most diabetics present with HbA1c levels between 7% and 8.5%. While HbA1c represents average glucose level in the hemoglobin over three months, Edgar’s metabolism was functioning poorly over an extended period. When an HbA1c level consistently exceeds 10%, patients are at high risk for blindness and amputations.
To constructively address all of his complaints, it was imperative for Edgar to lose weight and lower his blood glucose. To accomplish this, we formulated an aggressive plan to dramatically alter his metabolism.
Edgar’s diet contained too high a percentage of refined carbohydrates and not enough fiber and other beneficial nutrients. We recommended the rainbow diet plan, a program that includes vegetables and fruits from the entire color spectrum, substitutes protein for some carbohydrates, emphasizes unsaturated fats, and ensures adequate fiber. This diet promotes weight loss and provides powerful antioxidants to offset the damage caused by elevated blood sugar.
Edgar was given information about the best protein sources, the best fats (walnuts and oily fish), and making “colorful” food choices: tomatoes, pink grapefruit, cherries, and watermelon for a touch of red; spinach, kale, broccoli, and zucchini for green; carrots, squash, oranges, and cantaloupe for yellow and orange; blueberries, plums, and blackberries for purple and blue; and onions, white beans, garlic, and leeks for white.
To complement his diet, Edgar was instructed to exercise moderately every day, which has been found to help control glucose. He agreed to walk in the park near his home daily for at least 30 minutes.
Supplements lower blood sugar by slowing the digestive process or by increasing cellular use of glucose. We recommended guar gum (1.5 grams daily) and PGX™ (9 grams daily) to Edgar for additional fiber, and added chromium (1000 mcg daily) to enhance his metabolism of glucose.
Additional supplements that may help slow the rise in blood sugar were added to Edgar’s program. These included bilberry leaf (600 mg daily), lipoic acid (600 mg daily), EPA (2400 mg daily), and DHA (1800 mg daily).
Hormone deficiencies can play a role in excess weight, metabolic imbalance, and erectile dysfunction. Edgar’s lab results were low-normal for DHEA and below normal for both testosterone tests. Ranges are established and used by conventional doctors because they represent the levels of hormones found in the general aging population. Life Extension practitioners like myself believe that “normal” ranges are actually well below what should be maintained for optimal health and quality of life. By any measure, however, Edgar required hormone supplementation. Because his PSA test was normal, we could include this therapy in his protocol.
DHEA (200 mg daily) and testosterone gel (1%) were included to boost Edgar’s metabolism. Testosterone injections using a bioidentical rather than a very potent synthetic formulation may have helped Edgar lose weight. Testosterone can also help alleviate erectile dysfunction.
As is often the case, Edgar’s diabetes was co-morbid with his Syndrome X/metabolic syndrome, and his fatigue and sexual dysfunction were also related. It is no coincidence that parts of his program for controlling blood sugar—including diet, exercise, and fish oil supplements—would also benefit his lipid and vascular profiles. In addition, the supplemental testosterone, exercise, chromium, fish oils, and lipoic acid for improved insulin action would also improve his energy level and libido. While Edgar’s treatment included many components, all were necessary in order to address his overall health. Edgar said he would do anything to feel better.
Edgar’s compliance with treatment was exceptional, and he looked and felt incrementally better each time I saw him. As he lost weight, he gained physical and mental energy, and his confidence in his program grew. After six months, he no longer experienced erectile dysfunction, and at 18 months, he had lost 36 pounds.
His cholesterol at 18 months had dropped to 177 mg/dL, while his HDL had risen to 55 mg/dL and his LDL had fallen to 117 mg/dL. His triglycerides had been lowered dramatically to 115 mg/dL, and his hormone levels were in the high-normal range. Ultrasound re-tests did not show marked improvement, which was expected. It would take more time to reverse damage that had developed over years.
Edgar’s improvement in blood sugar parameters was remarkable. His fasting glucose was down to 154 mg/dL, and his HbA1c was lowered from 14.4% to 8.2% (still high, but out of the critical zone). Edgar still needed his insulin, but if he stayed on his path, the likelihood of heart attack, stroke, dementia, or severe diabetic complications would be reduced tremendously. His creatinine level had dropped to 1.6 mg/dL, indicating that reducing blood glucose had improved Edgar’s kidney function.
Edgar’s case illustrates the complex effects of diabetes on the body and the need for a comprehensive treatment strategy. When Edgar came to my office, his diabetes was poorly controlled, his energy level was poor, and his aberrant laboratory measures placed him at risk for further disease and accelerated aging. A comprehensive treatment strategy using dietary and lifestyle interventions, nutritional remedies, hormone balancing, and doctor-patient collaboration helped Edgar to improve his health and energy level dramatically, while reducing his risk for diabetic complications and other age-related diseases.
Integrative care for patients with diabetes and high blood sugar requires a thorough and multifaceted approach. While the results may not appear overnight, dramatic and life-enhancing improvements will reward the proactive patient.