Life Extension Magazine August 2010
Combating the “Diabesity” Epidemic
By Julius Goepp, MD
The combination of diabetes and obesity—now termed “diabesity” by some experts—is the largest epidemic the world has ever faced.1 By some estimates, the total number of individuals with obesity-induced diabetes will escalate to 366 million worldwide by 2030,2 with an 8-10 year3 reduction in their life expectancy.
The harbingers of diabesity can go undetected for years, as conventional medicine persists in late detection by “waiting” for blood markers to reach critical levels, then adopting failed strategies that can worsen the patient’s outlook for survival.4
Aging individuals are told to focus on blood sugar levels without an explanation of the lethal factor linking obesity and diabetes: inflammation.5,6 Fat cells generate inflammatory cytokines. Excess fatty tissue floods the body with these harmful signaling molecules, triggering a pathological cascade across a range of additional bodily tissues, impairing their response to insulin and leptin, and disabling their ability to properly metabolize sugars, fats, and protein.7
This deadly feedback loop may commence long before full-blown diabetes manifests,8 suggesting the need for a multimodal prevention strategy implemented far in advance of early signs and symptoms.
In this article, you will learn how curcumin imposes an anti-inflammatory blockade via multiple physiological pathways—including those associated with diabetes onset. You will also discover how it enhances glucose control and insulin sensitivity, quells inflammation at the cellular level, and restores balance across a range of systems normally ravaged by diabetes. Adding to the extraordinary benefits of curcumin, new studies have shown that carnitine, vitamin E, and magnesium complement curcumin in controlling the many destructive elements of high blood sugar. Together, all these nutrients can make a significant difference in the battle against diabesity.
Curcumin: Glucose Control and Increasing Insulin Sensitivity
Experiments in type 2 diabetic animals reveal that curcumin suppresses spikes in glucose levels via multiple mechanisms.9-12 A curcumin complex was shown to significantly reduce blood glucose and lipid levels in diabetic rats and restore blood pressure and endothelial function to normal.13 PPAR (peroxisome proliferator-activated receptor) is a group of nuclear receptor proteins that modulate metabolism through helping regulate gene expression and facilitating sugar uptake and utilization from the blood. Activation of PPAR is one way that curcumin exerts its glucose-lowering effects.14
Another way curcumin brings blood sugar under control is in the liver, where it decreases activity of enzymes that make new sugar molecules, while increasing activity of enzymes that break down and store sugar.15,16 To do this curcumin activates a liver complex called AMP-activated kinase (AMPK) at a rate that may be higher than metformin, while simultaneously reducing expression of glucose-producing genes.17
Curcumin further contributes to glucose control in diabetes by increasing the number of insulin receptors on cell membranes and improving their insulin-binding capacity, restoring both to near-normal levels.10 Increasing sugar uptake from blood, decreasing new glucose formation, and increasing insulin’s effectiveness are three entirely independent means by which curcumin lowers blood sugar.
Curcumin Fights Oxidation and AGEs: the Inflammation Blockade
Advanced glycation end-products (AGEs) form when glucose cross-links with functional proteins, rendering them dysfunctional and destroying cell membranes and vital enzyme systems.18 The resulting inflammation produces oxidant stress and further tissue injury.19 Curcumin blocks formation of AGEs and prevents many of their oxidant-induced, inflammation-promoting, tissue-damaging effects.20,21
For example, blindness caused by diabetic retinopathy is a direct result of capillary overgrowth from long-term exposure to high glucose levels and resultant inflammation.22 Curcumin was shown to help suppress some of the AGE-induced inflammatory changes that promote diabetic retinopathy. It also lowered levels of growth factors that promote capillary proliferation.23-27
Cataracts, another vision-threatening consequence of diabetes, result from damage to delicate proteins in the eye’s lens, producing cloudiness and eventually opacity. Curcumin delayed progression and maturationof cataracts in diabetic rats, countering the oxidative stress and reversing changes associated with lipid peroxidation.28,29
Curcumin also boosts levels of natural antioxidants that diabetes depletes, including glutathione, superoxide dismutase (SOD), and catalase—restoring them to normal levels.30-32 As a result, curcumin helps reduce the amount of oxidized fat molecules in the circulation, which are major contributors to cardiovascular disease.33 And curcumin’s reduction of AGEs in connective tissue helps reduce the chemical cross-linking that adds unwanted stiffness to blood vessels, skin, and other tissues in diabetics.34
Brain cells in diabetics are especially vulnerable to oxidative stress and lipid peroxidation because of their lipid-rich cell membranes. Curcumin metabolites prevent brain lipid peroxidation in diabetic rats, potentially protecting brain cells from long-term injury.35 Acting by a completely different mechanism, curcumin further protects diabetic brain cells by preventing oxidative damage to mitochondria and boosting levels of the energy compound adenosine triphosphate (ATP) in brain tissue.36
Diabetics undergo acceleration of inflammatory changes in blood vessel walls that produce endothelial dysfunction and ultimately atherosclerosis. Curcumin supplements in animals markedly reduce dangerous markers of inflammation such as interleukin-6 and tumor necrosis factor-alpha (TNF-alpha).11 And curcumin reduces production of inflammatory cytokines in fat tissue itself, helping to lower the overall burden of inflammation and insulin resistance produced by obesity.19,37
Advanced Cardiovascular Defense with Curcumin
The over-oxidized environment in diabetics’ blood and tissues puts a huge strain on vascular health. This hyperoxidation is the root cause of diabetics’ markedly increased risk of stroke, heart attack, and peripheral vascular disease.38 Curcumin combats vascular destruction in diabetics in several ways.39
Curcumin decreased blood sugar and simultaneously reduced vessel-damaging lipid peroxidation to near normal in diabetic rats.12 It also normalizes the out-of-control lipid profiles so common in diabetics.40 Animals fed a high-cholesterol diet that were supplemented with curcumin had a decrease in total cholesterol of 21% and of harmful low-density lipoprotein (LDL) by 43%, but an increase in beneficial high-density lipoprotein (HDL) of 50%!41
Curcumin exerts direct effects on blood vessels, which are vulnerable to oxidant and inflammatory damage. It can help to restore the vital vascular reactivity needed to control blood pressure and flow.42 Curcumin supplements in diabetic rats also have beneficial effects on blood vessel tone in heart muscle, and protect small blood vessels in the eye from endothelial dysfunction.43 In addition, curcumin inhibits platelet aggregation that can contribute to heart attacks and strokes.44
In 2008, researchers in India published a landmark human study showing how curcumin improves endothelial function in type 2 diabetics.45 They tested the supplement head-to-head against the prescription cholesterol-lowering drug atorvastatin (Lipitor®) and a placebo. At the end of the study, significant improvement in endothelial function occurred in both the drug and the curcumin supplemented groups to a similar extent, while placebo recipients had no change. At the same time, the supplemented group and the drug-treated group both showed significant reductions in markers of oxidative stress and inflammatory cytokines. This study alone supports routine curcumin supplementation in diabetics, who are at extreme risk for the consequences of endothelial dysfunction.