Calcium, vitamin C supplements may help protect against diabetes
In an article published online on October 26, 2010 in the journal Diabetes Care, Honglei Chen, MD, PhD from the National Institute of Environmental Health Sciences and colleagues report that individuals who regularly consume individual calcium or vitamin C supplements have a lower risk of developing diabetes than nonusers.
Dr Chen and associates evaluated data from 232,007 participants in the National Institutes of Health-American Association of Retired Persons Diet and Health Study. Dietary questionnaires administered upon enrollment between 1995 and 1996 were analyzed for multivitamin supplement use as well as individual supplements containing iron, zinc, selenium, folate, beta-carotene, calcium, and vitamins A, C or E. Multivitamins were categorized as stress-tab, Theragran or One-a Day types. Follow-up questionnaire responses revealed 14,130 cases of diabetes diagnosed after the year 2000.
Over half of the participants reported using multivitamins, and of these, 78 percent reported daily use. Vitamin C was the most commonly used individual supplement, followed by vitamin E and calcium. A protective effect for multivitamin use against diabetes was observed, however, its significance disappeared after adjusting for the use of individual micronutrient supplements. When individual supplements were examined, participants who used vitamin C daily had a 9 percent lower risk of developing diabetes, and for those who used calcium daily, the risk was 15 percent lower.
In their discussion of the findings, the authors note that vitamin C is a potent antioxidant and may have a role in the energy-dependent release of insulin from the pancreas. Several possible mechanisms were posited for calcium against diabetes, including effects on blood pressure, insulin sensitivity and body weight. Additionally, the effects of calcium could depend upon other nutrients, particularly vitamin D.
"It is likely that multivitamins at their current composition cannot reduce the risk of diabetes," the authors write. "Most multivitamins contain lower amounts of single antioxidants than individual vitamin supplements and thus might not be sufficient to be biologically effective."
"Due to the exploratory and observational nature of our study, potential benefit of vitamin C and calcium use on diabetes prevention should be further evaluated," they recommend.
Glycation and oxidative stress are central to the damage caused by diabetes. Unfortunately, neither of them figures into conventional treatment for diabetes, which is generally concerned only with blood sugar control.
Glycation occurs when glucose reacts with protein, resulting in sugar-damaged proteins called advanced glycation end products (AGEs) (Kohn RR et al 1984; Monnier VM et al 1984). One well-known AGE among diabetics is glycated hemoglobin (HbA1c). HbA1c is created when glucose molecules bind to hemoglobin in the blood. Measuring HbA1c in the blood can help determine the overall exposure of hemoglobin to glucose, which yields a picture of long-term blood glucose levels.
Glycated proteins cause damage to cells in numerous ways, including impairing cellular function, which induces the production of inflammatory cytokines (Wright E Jr. et al 2006) and free radicals (Forbes JM et al 2003; Schmidt AM et al 2000).
High levels of blood glucose and glycation also produce free radicals that further damage cellular proteins (Vincent AM et al 2005) and reduce nitric oxide levels. Nitric oxide is a potent vasodilator that helps keep arteries relaxed and wide open. Oxidative stress in diabetes is also linked to endothelial dysfunction, the process that characterizes atherosclerotic heart disease. According to studies, diabetes encourages white blood cells to stick to the endothelium, or the thin layer of cells that line the inside of arteries. These white blood cells cause the local release of pro-inflammatory chemicals that damage the endothelium, accelerating atherosclerosis (Lum H et al 2001).
Several preclinical studies evaluated vitamin C’s role during mild oxidative stress. The aqueous humor of the eye provides surrounding tissues with a source of vitamin C. Since animal studies have shown that glucose inhibits vitamin C uptake, this protective mechanism may be impaired in diabetes (Corti A et al 2004). Supplementation with antioxidant vitamins C and E plays an important role in improving eye health (Peponis V et al 2004). High vitamin C intake depresses glycation, which has important implications for slowing diabetes progression and aging (Krone CA et al 2004).
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The typical American diet is loaded with foods that contain arachidonic acid (like egg yolk, red meat, poultry, and dairy products) or stimulate the production of excess arachidonic acid in the body (foods rich in high-glycemic carbohydrates, saturated fats, and omega-6 fatty acids).
Scientific studies show that excess arachidonic acid increases levels of the 5-lipoxy-genase (5-LOX) enzyme, which can induce undesirable effects in cells. This may result in the excess accumulation of leukotriene B4, a pro-inflammatory compound that attacks the joints, the arterial wall, and other tissues.
In India, extracts from the Boswellia plant have been used for centuries as fluid-balancing agents. Human studies have confirmed that a specific Boswellia extract known as AKBA (3-O-acetyl-11-keto-ß-boswellic acid) selectively inhibits 5-LOX.