Ampalaya: Nature's Remedy for Type 1 & Type 2 Diabetes

• 1 •

THE DIABETES EPIDEMIC

Around the world, the prevalence of type 2 diabetes is very high and increasing, say a number of researchers, including a team at the University Hospital in Amsterdam, the Netherlands. The World Health Organization, in fact, predicts that between 1995 and 2025 the worldwide prevalence of diabetes among those twenty years of age and older will increase from 4 to 5.4 percent. And, according to the Journal of the American Medical Association (JAMA), the high-risk factors for developing diabetes are related to premature death.

The Dutch researchers believe, therefore, that it is necessary to identify those at high risk and take precautionary measures. Among those identified as having a higher risk for developing diabetes are people with impaired glucose tolerance (IGT) and impaired fasting glucose. In six studies among people with IGT, cumulative evidence ranging from 23 to 62 percent was reported for periods between two and twenty-seven years of follow-up. And, compared to white populations, there was a higher incidence among Hispanics, Mexican-Americans, Nauruans (Nauru is a republic about 2,800 miles southwest of Hawaii) and Pima Indians, who live, for the most part, on reservations in Arizona.¹

Since type 2 diabetes is increasingly prevalent worldwide, it puts added burdens on health and healthcare costs, reports James B. Meigs, M.D., and colleagues at the Harvard Medical School in Boston, Massachusetts, so even though this type of diabetes may be largely preventable, a comprehensive understanding of its cause is still needed. One of the suspected causes is atherosclerotic cardiovascular disease because, although it is the principal complication once a person has type 2 diabetes, it can also precede the development of the disease.

Another precursor could be a dysfunction of the endothelial cells that line the internal body cavities. The Harvard researchers believe that therapies to improve endothelial dysfunction may be important in the treatment of insulin resistance, and in strategies to slow the accelerating worldwide epidemic of type 2 diabetes and its costly, morbid complications.²

Diabetes in the United States increased alarmingly in 1999, causing the government to call the disease an unfolding epidemic. According to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, the number of people with diabetes went up across almost every demographic category, an increase they attributed largely to obesity, which rose an astounding 57 percent from 1991. While cases of type 2 diabetes rose from about 6.5 percent in 1998 to 6.9 percent in 1999, the obesity rate went up to almost one in five Americans, and this was up from 12 percent in 1991.

The CDC found that diabetes increased 33 percent nationally in 2000, and this rise crossed all races and age groups, with the sharpest increase—about 70 percent—among those who were between thirty and thirty-nine.

The dramatic new evidence signals the unfolding of an epidemic in the United States, says Jeffrey P. Koplan, director of the CDC.

While statistics vary, the CDC estimated that the number of Americans with diabetes was expected to rise to 22 million by 2005, up from 16 million in 2001. They also said that diabetes is the fifth leading cause of death in the United States, with almost 800,000 new cases diagnosed annually.³

While there are conflicting theories among scientists, the life expectancy of Americans, which has been increasing for more than two centuries, could soon level off or even decline, reports Rosie Mestel in the Los Angeles Times. In a more detailed account in the New England Journal of Medicine, a research team states that, if there were no adult obesity, the current average lifespan of about seventy-seven and a half years would be increased by four to nine months. Since obesity in childhood has at least doubled in recent decades, however, the extra body weight could reduce life expectancy by two to five years sometime in the first half of this century.

Some experts have insisted that the greatest impact of obesity does not lie in death, but rather in the quality of life—through arthritis, disability, low back pain, and the damaging complications of diabetes.⁴

In the 2000 census, 35.1 million people in the United States, and 3.8 million in the Commonwealth of Puerto Rico identified themselves as Hispanic, Latino, or Spanish. In 2001 in America, Hispanics of all races experienced more age-adjusted years of potential life lost before age seventy-five per 100,000 population than non-Hispanic whites. The leading causes of death were chronic liver disease and cirrhosis (62 percent), diabetes (41 percent), human immunodeficiency (HIV) disease (168 percent), homicide (128 percent), and strokes (up 18 percent).⁵

New York City is facing an epidemic of diabetes, according to The New York Times. It was found that 8 percent of adults in the city have the disease, which is double the rate eight years ago—12.2 percent of them are Hispanics and 10.8 percent are non-Hispanic blacks. Whites who are not Hispanic have the lowest rate—5 percent—and Asians are second to last with 6.8 percent.

We don’t use the word epidemic lightly, said Thomas R. Frieden, M.D., the city’s health commissioner. This data gives us a remarkable sense of the diversity and disparity between rich and poor in the city. Of all diseases New Yorkers suffer, diabetes and HIV have the greatest disparities of race and class.⁶

The double-column lead article in The New York Times on January 9, 2006 screamed out, Diabetes and Its Awful Toll Quietly Emerge as a Crisis. Subtitled The Stealth Epidemic, this was the first in a series of four articles outlining the devastating growth of this disease in the city. It is estimated that 800,000 adult New Yorkers, more than one in eight, now have diabetes, and the number for the Latino population is forecast to become one in every two people. (The article says that one-third of the people believed to have diabetes do not even know they have the disease.) City officials are quoted as saying it is the only disease that is growing, and growing quickly, and they worry that it could completely overwhelm the public health system in the future.⁷

METABOLIC SYNDROME

Regardless what the causes of diabetes are in various countries, the current buzz phrase regarding type 2 diabetes and cardiovascular disease is metabolic syndrome, previously called syndrome X (see Chapter 4 for additional information). Researchers report that an epidemic of metabolic syndrome is sweeping the United States, and that about one-third of the United States population has the syndrome and faces increased risk for developing diabetes and heart problems.

Again, the researchers blame obesity for the growing epidemic. As abdominal obesity becomes more common, so does metabolic syndrome and its companion conditions—glucose intolerance, high blood pressure, and high cholesterol and triglyceride levels. Also contributing to the statistics are aging, genetic predisposition, and lack of exercise, according to JAMA.

In the same article, Mike Mitka says, Some researchers say the United States is in the midst of an epidemic of metabolic syndrome, but is the syndrome really new? Or is it a repackaging of familiar risk factors into a more sober-sounding entity that hopefully spurs physicians to vigorously treat patients who present themselves with these elevated risk factors for heart disease and diabetes?

Mitka quotes Scott M. Grundy, M.D., of the University of Texas Southwestern Medical Center in Dallas, as saying that the term metabolic syndrome came about to remind physicians not to dismiss their patients with only vague suggestions to exercise more and weigh less. He said this syndrome was initially described in the late 1980s by Gerald M. Reaven, M.D., who noticed that a cluster of conditions—cholesterol and triglyceride levels, high blood pressure, and hyperglycemia (high blood-sugar levels)—tended to be found in his patients with cardiovascular disease, and he called the condition syndrome X. It has also been referred to as Reaven’s syndrome, dysmetabolic syndrome, and insulin-resistance syndrome.

The National Institutes of Health and other organizations have expanded the definition of metabolic syndrome. People have this condition if they have three of five characteristics, including abdominal obesity (waist circumference), elevated fasting glucose, elevated triglycerides, low level of HDL cholesterol (the beneficial kind), and high systolic (beating) and diastolic (resting) blood pressure. As reported by JAMA, clinical identification of the metabolic syndrome is diagnosed when any three of these potential risk factors are out of line.

1. Abdominal obesity. Measurement should be less than 40 inches for men; less than 35 inches for women.

2. Blood pressure. Systolic should be less than 130 mmHg, and diastolic should be less than 85 mmHg.

3. Triglycerides. These should be less than 150 mg/dl.

4. Fasting glucose. This should be less than 100 mg/dl.

5. High-density lipoprotein cholesterol (HDL). This should be less than 40 mg/dl in men, and less than 50 mg/dl in women.

Lifestyle modifications which result in weight loss and increased physical activity represent the first-line treatment following diagnosis of metabolic syndrome, JAMA continues. The goal for weight loss is around 7 to 10 percent over a six- to twelve-month period. Also, a minimum of thirty minutes of moderate-intensity physical activity is recommended.

Other recommendations include a low intake of cholesterol, saturated fats, and trans-fatty acids, a reduced intake of simple sugars, an increased intakes of fruits, vegetables, and whole grains, and the avoidance of too many refined carbohydrates and fats.⁸

Trans-Fatty Acids

Trans-fatty acids are byproducts of the processing of polyunsaturated vegetable oils, such as corn, safflower, soybean, and sunflower oils, and semi-solidified fats, such as margarine and shortening, according to Robert A. Ronzio, Ph.D. Canola and olive oil do not contain this substance.

The trans-fatty-acid content of partially hydrogenated vegetable oil ranges between 5 and 16 percent. Butter has about 5 percent trans-fatty acids naturally, while margarine contains about 10–27 percent. French fries may contain up to 38 percent of these acids.

Trans-fatty acids do not substitute for essential fatty acids, and they may worsen symptoms of essential-fatty-acid deficiency, Ronzio adds. They seem to antagonize the conversion of essential fatty acids to prostaglandins, hormonelike lipids that regulate pain, affect smooth muscle contraction, raise or lower blood pressure, and perform many other functions. Diets that incorporate high levels of trans-fatty acids are associated with an increased risk of heart disease. Trans-fatty acids may raise blood cholesterol as LDL, while reducing the beneficial HDL.⁹

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THE HISTORY AND SCOPE OF DIABETES

DIABETES THROUGH THE AGES

Diabetes mellitus has plagued humankind since the earliest writings from Asia Minor, China, Egypt, and India, which refer to boils and infections, excessive thirst, loss of weight, and the passing of large amounts of a honeysweet urine, which often attracted ants and flies, according to the Foods and Nutrition Encyclopedia.

The term diabetes originates from the Greek word meaning siphon, or the passing through water, and mellitus comes from the Latin for honeysweet. The Papyrus Ebers, an Egyptian document from about 1550 B.C., recommended that those with the condition should go on a diet of beer, fruits, grains, and honey, which would help to stifle the excessive urination. (It would be centuries before researchers determined that beer contains B-complex vitamins.)

Indian writings from the same era suggested the disease was caused by an overindulgence in food and drink. Reports from the fifteenth through seventeenth centuries described meals for more prosperous citizens that consisted of many courses of roast meats dripping with fat, plenty of butter and cream, and rich, sugary pastries, but little coarse bread or green, leafy vegetables, the encyclopedia says. Consequently, it is not surprising that many cases of diabetes were recorded during that time. To detect the disease, doctors tasted the sweetness of their patient’s urine.

There were two schools of thought concerning diabetes then. One school suggested replacing the sugar lost in the urine, while another theory believed in restricting carbohydrates in order to reduce the effects, which were attributed to an excess of sugar.

The first school was promoted by a British physician Thomas Willis (1621–1675), who recommended a diet limited to barley, bread, milk, and water, which was high in carbohydrates, but low in calories.

More than a century later, a British surgeon named Rollo began a long-lasting trend towards high-fat, high-protein, and low-carbohydrate diets by prescribing mainly meat and fat. (Sound familiar?) While the physicians were still unable to put a handle on the cause of diabetes, the diets apparently helped some people—the encyclopedia says there was evidence of reduced amounts of sugar spilled in the urine.

Restricting calories was apparently an effective therapy. A French physician, Charles Jacques Bouchard, reported that the limited availability of food in Paris during the Franco-Prussian War of 1870–1871 diminished the amount of sugar spilled in the urine of his patients with diabetes.

In 1869, Paul Langerhans, a German anatomist, made a major breakthrough in understanding the pathology of diabetes. While examining a piece of pancreas under a microscope, he discovered tiny cells that differed from the rest of the pancreatic tissue. Later experimentation with animals revealed that these cells, eventually named Islets of Langerhans, were spared when the rest of the pancreas was destroyed, and this prevented diabetes.

In 1889, it was accidentally found that surgically removing the pancreas from dogs led to their early death from diabetes. Pathologist Oskar Minkowski and his German colleagues were studying the role of the pancreas in the digestion of fats, when it was noted that the depancreatized dogs were passing copious amounts of urine, which was attracting flies, due, they discovered, to sugar in the urine, thus connecting the pancreatic function to diabetes.

A significant development came in 1921, when physiologists Sir Frederick Banting and Charles H. Best, working at the University of Toronto in Canada, discovered they could obtain insulin from the pancreases of dogs, providing they tied off the pancreatic duct so as to cause a degeneration of the cells that secreted digestive juices, or used embryonic pancreases from fetal pups, since the insulin-secreting cells develop before the digestive cells. The insulin they received cured the diabetes in animals that had been depancreatized.

After many tests on dogs, the hormone insulin was given to a man with diabetes and he experienced a remarkable recovery. While Banting received the Nobel prize in 1923 for discovering insulin, Best was not entitled to the prize, since he only had an undergraduate degree. However, Banting shared the prize money with his associate.

Ten years before the initial use of insulin, researchers at the Rockefeller Institute in New York had begun treating diabetes by using a starvation diet, which contained few carbohydrates and only about one-half of the energy requirement. Naturally, they became very emaciated, but some of them were later restored to health with insulin.

While the insulin initially brought a dramatic drop in the deaths due to diabetes, the first insulin produced brought too sharp a drop in blood sugar (hypoglycemia), which resulted in distressing symptoms. New forms were later developed by chemically modifying the insulin to slow down its action. In 1936, a Danish physician developed a form of insulin by adding protamine, a proteinlike substance. This, along with other modifications meant only one daily injection was needed, instead of the three or four originally required.

Insulin is crucial because, if you have diabetes, your body is unable to either produce or respond to insulin, the hormone that allows blood glucose (blood sugar) to enter cells and be used for energy.¹

INCIDENCE OF DIABETES IN THE UNITED STATES

As of 2002, there were 18.2 million people in the United States—6.3 percent of the population—with diabetes. Thirteen million of these people have been diagnosed with the disease, and 5.2 million of them have diabetes and don’t know it, according to the American Diabetes Association—an estimated one-third of those in the general population who have diabetes are undiagnosed.

With the disease approaching epidemic proportions, especially in the United States, the Association offers these grim statistics:

1. Approximately 210,000 people under the age of twenty have diabetes, representing 0.26 percent of those in that age group.

2. About one in every 400–500 children and adolescents have type 1 diabetes.

3. Regional studies have found that type 2 diabetes is increasing among African Americans; Hispanic adults, children, and adolescents; and Native Americans.

4. Eighteen million people over the age of twenty, 8.7 percent of the population, have diabetes.

5. Almost eight and a half million people age sixty and older, 18.3 percent of the population, have the disease.

6. More than eight and a half million men over the age of twenty, 8.7 percent of the population, have diabetes.

7. More than nine million women over age twenty, 8.7 percent of the population, have the disease.

8. Twelve and a half million non-Hispanic whites over the age of twenty, 8.4 percent of the population, have diabetes.

9. More than two and a half million non-Hispanic blacks over the age of twenty, 11.4 percent of the population, have the disease. On average, non-Hispanic blacks are one and a half times more likely to develop diabetes than non-Hispanic whites of a similar age.

10. Two million Hispanic Americans twenty years of age and older, 8.2 percent of that age group, have diabetes. Also, Hispanic Americans are one and a half times more likely to have the disease than non-Hispanic whites of a similar age. Mexican Americans, who represent the largest Hispanic subgroup, are over twice as likely to have diabetes than non-Hispanic whites of the same ages. Residents of Puerto Rico are 1.8 times more likely to have diabetes than non-Hispanic whites in the United States.

11. Among American Indians and Alaska Natives ages twenty and over, who receive care from the Indian Health Services, 107,775 (14.5 percent) have diabetes. Researchers report that diabetes is least common among Alaska Natives (8.8 percent), and most common among American Indians in the southeastern United States (27 percent).

12. In Hawaii in 2002, Native Hawaiians, Japanese, and Filipino residents were approximately two times more likely to have diabetes than white residents of a similar age.

In 2002, diabetes was listed as the sixth leading cause of death on U.S. death certificates, and 213,062 of these deaths were a consequence of the disease. And statistics after 2002 indicate that diabetes may have moved up to being the fifth leading cause of death in the United States. The risk of death for those with diabetes is approximately double that of people without the disease.

In 2002, the cost of diabetes in the United States was $132 billion. This broke down to $92 billion in direct medical costs, and $40 billion in indirect costs, such as disability, work loss, and premature death.²

TYPES OF DIABETES

There are three principal types of diabetes: type 1, previously called insulin-dependent diabetes mellitus; type 2, previously called non-insulin-dependent diabetes mellitus; and gestational diabetes, which affects women during pregnancy.

Type 1 Diabetes

Type 1 diabetes was previously called insulin-dependent diabetes mellitus or juvenile-onset diabetes. Type 1 develops when the body’s immune system destroys pancreatic beta cells, which produce insulin to regulate blood glucose. Type 1 diabetes usually strikes children and young adults, but its onset can occur at any age. This type of the disease may account for 5 to 10 percent of all diagnosed cases, and the main risks factors are autoimmune, environmental, and genetic.³

The risk of developing type 1 diabetes in childhood is higher than almost all other severe chronic diseases that can affect children. The peak incidence is reported during puberty, around ten to twelve years of age for girls, and twelve to fourteen years of age for boys.

Type 1 diabetes tends to run in families. For example, brothers and sisters of children with type 1 diabetes have about a 10 percent chance of developing the disease by age fifty. The identical twin of a person with type 1 diabetes has a 25 to 50 percent higher chance of developing type 1 than a child in an unaffected family. There is a higher incidence of type 1 diabetes among Caucasians than other racial groups. Since the symptoms of type 1 diabetes can mimic flu in children, doctors and parents need to be vigilant.

Thousands of people experience the malaise and nagging thirst that is characteristic of type 1 diabetes. Since the disease is usually caused by the death of beta cells in the pancreas, it is a person’s own immune cells that are responsible for the killing, reports Science News.

Japanese scientists have confirmed that some people have this peculiar kind of diabetes that doesn’t fit the type 1 profile. Instead of immune cells, an unknown agent—perhaps a chemical in the environment or a virus—may be responsible for destroying the beta cells.

We all have patients where we often wonder what happened, says David C.W. Lau, M.D., of the University of Calgary in Alberta, Canada. This study suggests an important subtype of type 1 diabetes that is different from the conventional type. Diabetes is more complex than we originally thought.

Doctors can usually confirm diabetes by testing for diabetes-related antibodies in the blood, a sure sign of an immune attack on the pancreas, the Japanese researchers add. But out of fifty-six newly diagnosed Japanese patients, eleven had no trace of such autoimmune antibodies, yet they still exhibited high sugar concentrations in the blood, along with other pancreatic abnormalities.

People with this subtype of diabetes showed signs that the pancreas as a whole was affected, not simply the beta cells. That evidence suggests a viral infection, says Akihisa Imagawa, an endocrinologist at Osaka University.

The pancreas damage might also be related to environmental factors, suggests Ake Lernmark, Ph.D., of the University of Washington in Seattle. Chemicals called nitrosamines, which are derived from nitrates in smoked meats and other cured foods, have been weakly associated with increased diabetes incidence, he said.⁴

A Theory on the Origin of Type 1 Diabetes

Sandra Blakeslee of The New York Times reported on a provocative theory concerning the origin of type 1 diabetes, which suggests that the disease may have started as a way to stay warm. The theory is that juvenile diabetes may have developed in people who lived in Northern Europe about 12,000 years ago when the temperature fell by 10°F within a few decades and the ice age arrived almost overnight.

There is archaeological evidence that many people froze to death, while others fled south, but Sharon Moalem, M.D., of Mount Sinai School of Medicine in New York theorizes that some people may have adapted to the extreme cold. High levels of blood glucose prevent cells and tissues from forming ice crystals, he says, so developing type 1 diabetes would have prevented many people from freezing to death.

Clive Gamble, M.D., of the University of London agreed that this theory