UNDERSTANDING DIABETIC COMPLICATIONS

BY TENEILLE NEWTON GRAD DIP HPROM, BHSC (COMP MED), ADV DIP NAT, ND

Diabetes and cardiovascular disease are two of the biggest killers both in Australia and around the world. Type 2 diabetes is the fastest growing health problem in Australia and a serious public health issue which costs us all.

All of the complications that may occur in patients with diabetes are in part due to the out of control blood glucose causing protein glycation and cross-linking, as well as increased oxidative stress. Have you ever glazed pork, chicken or duck? The sugar glaze you brush on is what causes the delicious crispiness when you pull the dish out of the oven. Imagine that crisping occurring to your blood vessels and other tissues! The process of glycation causes proliferation of the epithelial layer lining the blood vessels and subsequently impairs circulatory function. The most common complications include nephropathy, retinopathy, neuropathy and diabetic ulcerations.

Diabetic Complications are Serious and Common

A diabetics risk of dying from cardiovascular disease is increased at least two to three times that of non-diabetics After 10 years of living with diabetes, seven out of 10 people will have kidney damage in some form, progressing in some to kidney failure. Others will suffer from retinopathy, visual impairments and eventually blindness. Fortunately, there are some natural solutions available to minimise the likelihood of developing these complications and also to manage them.

Diabetic Nephropathy

As previously mentioned, 70 percent of diabetics will have some form of kidney damage after 10 years. The odds are definitely not in your favour, so it is of vital importance to begin preventative strategies at the earliest time after diabetes diagnosis. Diet alone may be able to significantly influence kidney health in diabetics. Ketogenic diets are often used in the management of both obesity and diabetes and it seems as though it has additional benefits for kidney health’ An animal study found that after two months of following a ketogenic diet, diabetic animals had completely reversed the diabetic nephropathy as indicated by stress-induced gene expression and albumin/creatinine ratios. ln addition, there was partial reversal of the histological kidney changes associated with diabetic nephropathy. Chromium picolinate has also shown it may be beneficial for the diabetic kidney. Diabetic subjects receiving chromium picolinate reduced the excretion of albumin to approximately half that of the untreated diabetic subjects. Those receiving chromium also had reduced interleukin 6 and 17 and increased indolamine 2,3 dioxygenase. This indicates chromium is reducing the production of proinflammatorY cytokines. Zinc, magnesium, vitamin C and vitamin E also show promise in maintaining kidney health in diabetics Type 2 diabetics received 2OOmg magnesium and 30mg zinc (group MgZn), 2O0mg vitamin C anO ldOtU vitamin E (group VitCE), a combination of MgZn and VitCE or placebo for 3 months. ln the VitCE and combination groups there was a significant decrease in urinary albumin secretion and the combination group also had decreased blood pressure, decreased fasting serum glucose and increased HDL cholesterol.3 These results indicate an improvement in glomerular function in type 2 diabetic patients. Zinc has also demonstrated ability to partially prevent pathological changes to the kidney in diabetic animals 4 Zinc supplementation reouJeo renal inflammation, oxidative damage and up-regulation of growth factors.

Diabetic Retinopathy

Diabetes is the leading cause of blindness. At least 28 percent of diabetics over 40 have diabetic retinopathy and almost 5 percent have the vision-threatening form. Excessive blood glucose and the associated increase in oxidative stress inhibit the maturation of pro-nerve growth factor to nerve growth factor which is involved in the protection of the nerves of the retina’ This results in impaired neuronal function in the retina. Diabetic retinopathy can also be considered a marker of systemic microvascular problems as a result of diabetes. A component of Green Tea and well known antioxidant is epicatechin. It has been shown to inhibit a downstream receptor involved in neuronal cell death signalling which is activated by pro-nerve growth factor. Green Tea may be beneficial to protect the integrity of the retinal nerve in diabetic people. Another antioxidant compound, Resveratrol may also be useful due to its ability to prevent the formation of new blood vessels and facilitates the removal of abnormal vessels.

A multi-faceted approach to protect cardiovascular health of the cardiovascular system caused by chronic elevated blood diabetes is essential for diabetics, as the deterioration glucose is the key factor of complications.
Diabetic Neuropathy

Diabetic neuropathy is a painful condition affecting up to 30 percent of those living with diabetes. Diabetic neuropathy is not often reported to healthcare practitioners and it is estimated that at least two out of every five cases are not being treated.. Neuropathy is also not as simple as just some nerve pain. lt can be debilitating affecting sleep, overall quality of life and also emotional and mental health. Generally, neuropathy starts from the ground up, affecting the feet first, then travelling up the legs. Interestingly, being taller makes you more likely to suffer from neuropathies. Recent research suggests that there may be mitochondrial involvement in the development of neuropathies. It is already established that diabetes is a condition of mitochondrial dysfunction and this may be a factor in diabetic neuropathy. The mitochondria present in nerve cells have a significantly longer life than those in other cells of the body and are therefore at greater risk of dysfunction quite simply due to their age. It has been theorised that supporting mitochondrial function may reduce pain and improve the function of nerve cells. Alpha-lipoic acid may be of particular benefit to patients with diabetic neuropathies as it has shown to significantly reduce the symptoms of pain, parathaesia, numbness and the burning sensation associated with diabetic neuropathy.600 mg of alpha-lipoic acid administered orally for five weeks significantly reduced the symptoms of neuropathic pain in people with diabetic neuropathy.ll Other studies have found additional benefits of alpha-lipoic acid such as increased insulin receptor sensitivity and function and increased cellular uptake of glucose by adipocytes and myocytes.l2i3 A placebo controlled clinical trial using 600 mg daily of alpha-lipoic acid improved insulin sensitivity in type 2 diabetics by 25 percent after four weeks. The management of diabetic neuropathy benefits from additional nutritional supplementation. A combination of 20 mg zinc, 250 mg magnesium, 200 mg of vitamin C and 100 mg of vitamin E were given to people with diabetic neuropathy either with or without additional vitamin B complex or placebo. After four months of treatment, both nutrient groups experienced significantly greater symptomatic relief from their neuropathies than those receiving placebo. There is also evidence for the efficacy of vitamin E, zinc, and chromium supplemented individually to reduce the symptoms of diabetic neuropathy. In addition to its direct cardiovascular benefits, omega 3 fatty acids decrease the symptoms and signs of diabetic neuropathy.1800 mg of EPA daily for a period of 48 weeks improved measured arterial circulation, blood lipid profiles as well as decreased the feelings of numbness and coldness in affected limbs.

Diabelic CVD

Diabetics are at significantly increased risk of cardiovascular disease and cardiomyopathy which involves inflammation and deterioration of cardiac muscle. As impaired cardiovascular function and increased oxidative stress are both underlying factors involved in the aforementioned diabetic complications, by improving cardiovascular function the additional complications also improve. To support cardiovascular health we can use all of our tried and trusted treatments, including Omega 3 fish oils, coenzyme Q10, magnesium, vitamin C with bioflavonoids and garlic io name but a few. ln diabetics, coenzyme Q10 with mixed tocopherols and beta-carotene improved the function of the left ventricle and decreased the activity of lactate.dehydrogenase.20 ln addition, this antioxidant combination also decreased plasma lipid peroxide levels, indicating reduced oxidative stress. A multi{aceted approach to protect cardiovascular health is essential for diabetics, as it is the deterioration of the cardiovascular system caused by chronic elevated blood glucose that is the key underlying factor of diabetic complications. This may serve to protect against damage to the nerves, kidneys and eyes.

Summary of Treatments in Diabetic Complications

For the management and prevention of diabetic complications there are key nutritional and herbal treatments to include. Of course blood sugar metabolism must be improved as this is the root cause of these complications. Then the focus must be on the inclusion of potent antioxidants to protect cells, the cardiovascular and nervous systems from damage. A combination of Resveratrol, Grapeseed, Green Tea, Turmeric, vitamins A, C, E, zinc and alpha-lipoic acid will provide a full spectrum of antioxidant defence Additional coenzyme Q10 and Omega 3 fish oil concentrates will provide protect cellular integrity and function.

References

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