Combating the “Diabesity” EpidemicAugust 2010
By Julius Goepp, MD
Curcumin Provides Kidney and Liver Protection
Diabetes wreaks havoc on vital organs, particularly those with high blood flows such as the kidney and liver. End-stage renal disease (ESRD) is a tremendous cause of suffering and death among diabetics; while non-alcoholic steatohepatitis (also called “fatty liver disease”) begins its damaging effects even in early-stage insulin resistance.46 No drug exists to effectively prevent progression of these diabetic complications, but curcumin’s multi-targeted capabilities offer distinct protection.
Dietary curcumin supplements significantly reduced kidney lesions in diabetic laboratory animals and slowed progression of the illness.47 Treatment with curcumin significantly reduced both kidney dysfunction and oxidative stress in diabetic rats.48,49 A 2009 study revealed one of the ways it works: curcumin’s powerful anti-inflammatory, gene expression-modulating activities were blocking production of growth factors and other proteins that lead to damaged kidney tissue.50
Curcumin prevents dietary-induced fatty liver, prevents activation of the liver inflammatory cells that produce the condition, and can also ameliorate fatty liver caused by alcohol intake in diabetic rats.46 In a laboratory study, diabetic rats displayed abnormal liver function tests. Curcumin supplementation for 45 days reversed these abnormalities to near normal.49 This suggests that curcumin may be helpful for people with diabetes, who have a higher incidence of liver function test abnormalities than people who do not have diabetes.51 In 2009, it was shown that curcumin achieves these effects by suppressing destructive lipid-handling genes, simultaneously stimulating PPAR-gamma activity to improve liver cells’ energy utilization.52
Curcumin Protects Nerve and Brain Cells
Nerve and brain tissue come under direct attack by high sugar levels in diabetic patients, resulting in severe pain called diabetic neuropathy and in cognitive disturbances ranging from memory loss to severe diabetic encephalopathy and dementia. Curcumin has proven effective in preventing or mitigating both.
Neuropathic pain is recognized as one of the most difficult to treat, and frustrates patients and physicians alike. Indian researchers experimentally induced the condition in diabetic rats, then supplemented them with curcumin.53 The treatment significantly attenuated excessive painful response to mild stimuli (hyperalgesia). The effects were even more pronounced when supplementation was combined with insulin.54
Diabetic encephalopathy is a complex and poorly-understood process of accelerated brain aging and cognitive decline related both to high glucose levels and insulin deficiency in brain tissue.55,56 Chronic treatment with curcumin reversed the extreme oxidant damage and inflammation in the brains of diabetic rats, and markedly improved their performance on tasks of memory and cognition.56
Carnitine Improves Blood Sugar and Lipids in Diabetes
Carnitine is a small amino acid-derived molecule used by cells to shuttle fats into mitochondria, where they are burned for energy.57,58 Diabetic tissue, especially cardiac muscle, can accumulate lipids that impair function.59,60 Both aging and obesity reduce carnitine levels, contributing to mitochondrial aging and loss of metabolic control.61 That makes carnitine a very appealing supplement for its ability to promote mitochondrial health and fat/sugar utilization before problems arise.58,62
Human carnitine studies in diabetes are compelling. Given intravenously to insulin-resistant diabetics, L-carnitine or acetyl-L-carnitine improved insulin sensitivity, glucose uptake and effective utilization from the bloodstream, while improving efficiency of energy utilization.58,63 One gram of L-carnitine orally three times daily over 12 weeks significantly lowered fasting blood sugar in middle-aged adults with type 2 diabetes.64
Because of its unique impact on fat utilization, carnitine is also highly effective at improving diabetics’ abnormal lipid profiles, alone or in combination with a statin drug like simvastatin (Zocor®).65-67 That’s big news for diabetics, who must optimize their lipid profiles in order to avoid devastating cardiovascular consequences.
Acetyl-L-carnitine supplements (2 grams daily) safely reduced arterial hypertension, insulin resistance, and impaired glucose tolerance, while boosting levels of the protective fat-produced cytokine adiponectin in non-diabetic patients at risk for developing diabetes.68 Daily supplementation with 2 grams of L-carnitine reduced levels of dangerous lipoprotein(a) and oxidized LDL in patients with type 2 diabetes.69,70
Carnitine’s energy-boosting effects are especially important in heart tissue. Long-term oral supplementation with acetyl-L-carnitine preserved vital cardiac nerve function in diabetic patients, whereas placebo-treated subjects suffered significant loss of function.71 Propionyl-L-carnitine improved cardiovascular function in diabetics undergoing coronary bypass surgery.72
Diabetics frequently suffer painful peripheral vascular disease, the narrowing and hardening of blood vessels in the extremities that makes walking difficult and painful. Supplementation with 2-3 grams/day of propionyl-L-carnitine improves symptoms and performance, increasing mean walking distance, measures of blood perfusion, and pain scores.73,74 One study even showed that patients supplemented with 1,200 mg propionyl-L-carnitine intravenously each day could also reduce doses of their prescription glucose-lowering medications.75 Erectile dysfunction is a very specific form of peripheral vascular disease common in diabetics, and propionyl-L-carnitine added to drug treatment improved performance in men unresponsive to drug treatment alone.76-78
With additional evidence that 1-2 grams acetyl-L-carnitine supplementation daily can mitigate painful diabetic neuropathy, it’s clear that carnitine belongs in a responsible anti-diabetic supplement regimen.79,80
Vitamin E and Magnesium Reduce Inflammation, Improve Insulin Sensitivity
Consistent vitamin E supplementation (500-600 mg daily) helps improve vascular function and increases magnesium levels inside cells in type 2 diabetic patients while reducing elevated oxidative stress markers.81,82 Vitamin E supplementation with gamma-tocopherol also quenches biomarkers of oxidation and inflammation in patients with metabolic syndrome, potentially preventing progression to full-blown diabetes.83
Vitamins E and C together lowered inflammation and improved insulin action in pre-diabetic patients.84 Even more dramatically, an antioxidant vitamin combination rich in vitamin E (800 mg vitamin E, 500 mg vitamin C, 10 mg beta-carotene) improved insulin sensitivity, reduced dangerous endothelial adhesion molecules, and increased protective adiponectin levels in obese young adults.85 This late-breaking news is impressive evidence that we can break the cycle of diabesity.
Oral magnesium supplements improve insulin sensitivity and lower hemoglobin A1c levels in type 2 diabetics and in non-diabetic adults.86,87 A large review of previous studies in 2006 established that oral magnesium supplementation (360 mg/day) can reduce fasting glucose levels and raise beneficial HDL in type 2 diabetic patients.88 And a 2009 study showed that daily oral magnesium supplementation (450 mg) significantly lowered both systolic and diastolic blood pressure in hypertensive type 2 diabetics who were also taking the ACE inhibitor captopril.89
Long term magnesium supplementation (300 mg/day) slowed the development of peripheral neuropathy in type 1 diabetics.90 A clinically important study in 2008 revealed that depressed elderly diabetic patients with low magnesium levels responded to oral magnesium supplements (450 mg/day) as well as they did to the powerful prescription antidepressant imipramine.91
A daily combination supplement including 100-150 mg vitamin E and 200 mg magnesium along with vitamin C and zinc significantly increased HDL in a group of type 2 diabetics.92,93 And very recently we learned that the combination of vitamin E and magnesium also works together to decrease plasma lipids and blood viscosity (thickness) in diabetic rats, heralding even greater cardiovascular benefits of these essential nutrients.94
Antioxidant vitamins and minerals such as vitamin E and magnesium are depleted in diabetes,95,96 while both nutrients have been shown to improve insulin action.97,98 At the same time, common lipid-lowering drugs used by diabetics further deplete magnesium levels.99 Experts are therefore deeply interested in these nutrients as beneficial supplements for diabetics and obese pre-diabetics.100
The combination of diabetes and obesity—now termed “diabesity” by some experts—is the largest epidemic in human history, estimated to escalate to 380 million victims worldwide by 2025. The harbingers of diabesity can go undetected for years, as conventional medicine focuses on antiquated blood references ranges while ignoring the key factor that links obesity and diabetes: inflammation.
Curcumin has been shown to impose an anti-inflammatory blockade across multiple systems ravaged by “diabesity.” Curcumin increases glucose metabolism in the liver, while simultaneously reducing expression of glucose-producing genes. It intervenes at nearly every stage in the process of diabetic progress, enhancing the endothelial and multi-organ function, providing optimal cardiac defense, and boosting levels of primary antioxidants while suppressing pro-inflammatory cytokines generated by fatty tissue.
Carnitine helps promote healthy blood sugar and blood lipid levels, while vitamin E and magnesium improve insulin sensitivity, reduce oxidative stress, and support healthy blood pressure. Together, these nutrients synergize to provide powerful defense against the epidemic of diabesity.
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