Diabetes / Metabolic Syndrome

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

Sections

Insulin-dependent Diabetes Type 1 - IDDM

One form of diabetes, Type 1, eventually results in pancreatic beta cell damage and cell death, probably due to autoimmune disorder, but also now shown to be due to heavy metal toxins in the environment, such as arsenic and mercury from coal fired power plants, and other heavy industries (see links to scientific studies in Additional Information). As studies continue to elucidate the poorly understood etiopathology of Type 1 Diabetes, though, we see that the array of factors destroying the insulin producing beta cells of the pancreas represent a larger cycle of dysfunction. In 2016, experts at the Kumamoto University in Japan showed that the protein hormone oxytocin, linked to dysmetabolic syndromes, obesity and diabetes in recent years, protects the pancreatic beta cells from cytotoxic stress-induced cell death (PMID: 27143105). Oxytocin is a neuropeptide largely produced in the hypothalamus and distributed in circulation by the pituitary, and just a few years ago most scientists just assumed that its hormonal role was largely limited to childbirth mechanisms. Today, we see that oxytocin is highly involved in mood, memory, social instinct, addiction, and inflammatory regulation. We see from such study that the failure to acknowledge the more holistic nature of diabetic cause and pathology, and the stubborn insistence on treating it only be supplying deficient insulin, as well as calling other types of Metabolic Syndrome by the same name, has led to a great failure to prevent and treat this prevalent disease. 

This pancreatic beta cell damage caused by a number of factors results in the inability to produce enough insulin hormone with true diabetes. Synthetic insulin is usually injected daily by these patients with careful monitoring. The vast majority of patients with Diabetes Type 2, though, who are not dependent on insulin injections, may manage their sugar metabolism with a program of sensible dietary and exercise habits, herbal and nutrient medicine, and perhaps acupuncture. This routine can also improve sugar metabolism in the insulin dependent group, though, and lead to a lower dosage need for the synthetic insulin and better proactive management of insulin and glucose fluctuations, resulting in fewer long-term adverse effects. An array of both insulin-dependent and insulin-independent effects may be achieved with Complementary and Integrative Medicine (CIM) that will improve the quality of life and outcomes for diabetic patients of all types. Even patients who take various diabetic medications to help control their disease or syndrome, should consider the sensible integration of Complementary and Integrative Medicine (CIM) to achieve the best results and decrease dependence on medications. Numerous studies and warnings now reveal the inadequacies of standard pharmacological management of diabetes and the need for a more holistic approach in treatment.

While it may be simple to believe that those unlucky enough to end up with insulin-dependent Diabetes Type 1 were just the victims of fate, inheritance and autoimmune disorder, study of this disease is extensive and reveals that it has a multifactorial set of causes, often different from one diabetic to another, and in many cases could have been prevented.

The causes and contributors for insulin dependent Diabetes Mellitus (IDDM or type 1) include genetic propensities (although the genetic risk of inheriting is only 1-10% from parents with IDDM, and even identical twins had concurrent IDDM in only 30-50% of cases studied), 2) post-surgical stress, 3) adverse effects of medications (e.g prednisone or other corticosteroids, some antibiotics, chemotherapy agents, and drugs used to treat HIV, as well as atypical antipsychotics and statin drugs), 4) stressful diseases (e.g. Graves), 5) environmental chemicals (especially poisons, heavy metal toxins, and herbicides), 6) hormonal changes (e.g. pregnancy), 7) autoimmune responses (four antibodies are highly associated), as well as deep chronic viral infections that initiate the autoimmune dysfunction. The array of potential contributors to IDDM are numerous, and with increased public understanding of this subject, many millions of sufferers may be able to avoid the onset of Diabetes Type 1 as well as Metabolic Syndrome and Diabetes Type 2. There is no longer any doubt that even Diabetes Type 1 is a multifactorial disease involving an array of environmental causes and needs a more holistic approach to treatment and prevention. In 2015, the results of a large cohort study at Linkoping University in Sweden, headed by Dr. Johnny Ludvigsson, professor of pediatrics, showed that childhood stress and trauma were highly associated with future risk of developing type 1 diabetes. Data from the ABIS study of 10,495 families from 4 cities, with children born between 1997 and 1999, and monitored until age 14, was used to prove this associative cause. Such information points to the need to treat the whole person to decrease the risk of diabetes. The protocol in standard medicine, to just blame genetic inheritance, and then put the patient on synthetic insulin, and an array of metabolic and cardiovascular pharmaceutical drugs for life, has proven to be misguided. A more thoughtful and holistic approach is sorely needed as the explosive rise in diabetes incidence is occurring.

Diabetes Type 1 is now considered a syndrome of diseases that are related to immune responses. A number of associations and triggers in early childhood, such as Vitamin D hormone deficiency, immune responses to proteins in cow milk, a lack of early immune memory from insufficient breast feeding and lack of colostrum, fatty acid imbalances, and exposure to more complex solid foods at too early of an age, have been noted in studies. Other associations to IDDM in adult life have been identified as well, as mentioned above. This long list of causes and contributors does not make it easy for the patient or physician to assess the individual with diabetes and arrive at a course of therapy to reverse the disease, and almost all patients have been told that there is no hope of cure or reversal of the pathology, and that they all must simply rely on synthetic insulin to manage their blood sugars. There is hope of such a reversal, or cure, though. The assumption that pancreatic beta cells that produce insulin which were destroyed by the disease could not regrow has been finally shown to be a false notion. While the search for specific allopathic chemicals to stimulate regrowth is being heavily researched, it is more likely that a thorough holistic approach with Complementary and Integrative Medicine will be necessary to achieve healthy pancreatic regrowth and functional restoration, perhaps combined with specific allopathic chemicals in the future. IDDM patients may start to understand and adopt some of these healthy protocols of pancreatic beta cell restoration now, though, as they are healthy protocols without risk of adverse effects. Utilizing a knowledgeable Complementary Medicine physician, such as a Licensed Acupuncturist and herbalist, or a Naturopathic Doctor, will help achieve this goal, and provide a better overall health and quality of life.

The persistent lack of differentiation of these diabetic types and conditions by medical doctors has not helped diabetic patients deal with their disease on an individualized basis. Although true diabetes is classified as either insipidus or mellitus, when the doctor uses the term diabetes, he or she generally is referring to the more common Diabetes Mellitus, or even more commonly, to the condition that is now classified as Metabolic Syndrome. Mellitus was a term coined in 1675 and taken from the Greek work meaning honeyed, referring to the phenomena of the sickly sweet smell of the diabetic's urine. Primary, or essential diabetes, refers to a disease of the pancreas, and perhaps has a relatively high degree of genetic propensity, although this is still unclear. Secondary diabetes, which occurs secondary to another cause, may occur with (A) pancreatitis or other pancreatic destruction, (B) with endocrine disorders, and (C) with drug-induced diabetic states from prescription of synthetic corticoid or thyroid hormones, atypical antipsychotics, and other drugs, among other causes. As stated, over 90% of diagnoses of diabetes, though, are actually referring to Metabolic Syndrome, which usually involves a combination of dysfunctions, including insulin resistance at the fat cell receptors linked to chronic inflammation, liver dysfunction, and endocrine imbalance, and this Metabolic Syndrome may progress to true diabetes if not treated with a holistic approach. Treatment and management of insulin-dependent Diabetes type 1 differs from the protocol needed to address this more prevalent type 2 and Metabolic Syndrome, though, and the more the patient understands these differentiations, the more successful an individualized therapeutic protocol will be.

Perhaps more than any other disease, Diabetes Mellitus is associated with diet, both in relation to cause and to control of the disease. There is rarely a cure for Diabetes Mellitus, but the mechanisms of the disorder may be controlled successfully by a change in habits, especially dietary and exercise routines, and consequently, the disease state presents little danger as long as these healthy habits are maintained. If the pancreatic beta cells are destroyed, as in the autoimmune type 1, a patient may be insulin dependent, but the need for insulin will decrease with increased control of the blood sugar metabolism by the patient. The vast majority of diabetes patients are not insulin dependent, diagnosed with type 2 diabetes, though, and these patients also should gain an understanding of the sugar metabolism and take healthy steps to control it with dietary habits, exercise, nutrient therapy, herbs and acupuncture. Diabetes and Metabolic Syndrome, more than any other set of diseases, requires a strong proactive approach on the part of the patient, and understanding is the key to developing a successful approach.

As for the cause of true diabetes, although genetics may predispose one to the disease, and viral infections, particularly mumps, are often linked to the disease onset by triggering of an autoimmune response, such dietary factors as overeating and obesity, and a diet low in fibrous, natural, whole foods and high in processed foods, are believed to be behind most cases of the disease. Destruction of the pancreatic beta cells from glucose toxicity, advanced glycation endproducts (AGEs), and oxidative stress, combined with lipotoxicity (high triglycerides and free fatty acids), presents the most plausible explanation for the key metabolic dysfunctions that lead to beta cell death. The modern diet with processed palmitic acids (hydrolyzed palm and coconut oils), high fructose corn syrup, AGEs, fatty acid imbalance, and a gross excess of sugars and high glycemic index carbohydrates, contributes to a variety of metabolic and genetic dysfunctions, with many individuals genetically predisposed to higher risk. The modern diet appears to be the main culprit, although a combination of factors contributes. For instance, prescription drugs are sometimes the culprit as well. Eli Lilly, by September of 2008, was settling over 8000 claims of diabetes acquired by taking the anti-psychotic drug Zyprexa, which caused massive weight gain and very high blood sugars in many patients, and U.S. FDA warnings for Abilify (Aripiprazole) and all other antipsychotics were issued in 2004, describing the increased risks for hyperglycemia and diabetes from chronic use of these drugs. Eli Lilly was found to have hidden this information from doctors to boost sales, and promoted the drug for many patients with mild problems of anxiety and depression, and other off-label uses (not FDA approved), incurring a large liability. The American Diabetes Association has warned of this problem in this class of drugs for many years, yet most Medical Doctors did not inform their patients of this diabetic, hyperglycemic and metabolic risk when they prescribed these drugs. Despite FDA warnings and lawsuits, Abilify became the highest selling prescription drug in the United States by 2015, mainly driven by TV and online marketing, and of course, the cute sounding names given to these antipsychotic medications. This may be one of the reasons that new case of diabetes have increased so dramatically.

Understanding the array of factors that cause diabetes will help patients to educate their children, friends and coworkers that may be at risk, and perhaps some day start lowering the dramatic rise in new case of diabetes. For patients with diabetes, especially IDDM or insulin-dependent Diabetes Type 1, the main consideration of how to stop the disease and pancreatic damage from progressing, and how to avoid the eventual severe consequences with comordid diseases, such as peripheral neuropathy, diabetic retinopathy, cardiovascular disease, and dementia. To control this disease, and it's progression, you must first understand what it is, what type you have, why your symptoms arise, and what your doctor is doing to control the disease, and a lack of patient teaching is a big problem. Patient education and understanding are very important, and have long been ignored. Keep in mind that the progression of the disorder to a clinical state, or state where symptoms are noticed, is usually gradual, and further progression to a state where serious health problems arise, such as cardiovascular disease, eye disease, neuropathy, skin problems, and kidney damage is also usually a gradual process. Once you are diagnosed with the disease, there is usually ample time to develop a lifestyle of controlled diet and exercise, and to utilize, or integrate, Complementary Medicine to prevent progression of the disease and symptoms. Most of the diabetic syndromes are slow and chronic, and sudden crises, such as diabetic ketoacidosis (DKA) or hyperosmolar nonketonic syndrome (HNKS), are rare in the beginning stages of clinical diabetes, and will be explained later in this paper. If Medical Doctors would start encouraging their diabetic patients to integrate safe and effective Complementary Medicine, outcomes in diabetes would improve dramatically, and with current research and evidence, it appears that only the monetary incentive and ideas of competition are holding us back from achieving a better future for patients with a devastating set of disease syndromes.

Complementary and Integrative Medicine (CIM) may help the patient with Type 1 Diabetes in a number of ways. Control of the sugar and lipid metabolism with improved diet and exercise habits, as well as nutrient medicine, and potentially acupuncture (see study links below), may reduce the need for injected insulin as a control, and help to maintain better natural homeostatic controls, and reduce harmful fluxuations in glucose and energy metabolism. Restoration and regrowth of insulin secreting beta cells in the pancreas is now confirmed as a possibility as well, and a comprehensive step-by-step treatment protocol is needed to achieve this task over time. In the long term, the reduction of dosage of injected insulin will prevent side effects and harm from chronic use of injected synthetic insulin, and support of the natural hormonal metabolism will provide health benefits that synthetic insulins are unable to provide.

If patients begin to understand that there is actually a way to eventually restore pancreatic function and to regrow pancreatic beta cells, they must also understand that this restoration will require a systematic approach. To achieve a restoration of pancreatic insulin production, the less the body depends upon synthetic insulin replacement, the better. Better self-initiated control of blood sugar and fatty metabolism will also insure an optimal static health and prevent the ill effects of a fluctuating sugar and lipid metabolism. The time spent with the patient to help with establishing these individualized dietary and exercise regimes by the Licensed Acupuncturist and herbalist, or Naturopathic Doctor, will be an important part of the integrated treatment plan. The combination of individualized advice for the proactive patient added to acupuncture stimulation and herbal nutrient medicine may be particularly beneficial. In addition, a number of herbal medicines are proving potentially beneficial for various systems and tissues involved in the disease, directly and indirectly. Autoimmune effects may be reduced, pancreatic beta cell regeneration achieved, liver function improved, and even the hypothalamic function may be improved and positively affect blood glucose control. The hypothalamus is the nerve center control of the hormonal system in our bodies, and stimulates various central hormonal releases via the pituitary gland, the control center in the adrenal-hypothalamus-pituitary axis, and Cortin (adrenal cortex chemistry) effects are found to be central to this control. As early as 1940, scientific studies identified bioidentical extracts from the adrenal cortex of beef that affected both the blood sugar levels and electrolyte balance in study animals (Science 21 June 1940; Vol 9 (2373): 600-602). In recent years, study in China has identified specific acupuncture stimulations that affect these Cortin-effects, helping to modulate blood sugar control centrally. The combination of adrenal cortex extracts, herbs and nutrients, combined with these acupuncture stimulations, provides one part of a healthy holistic protocol of treatment to help the diabetic patient achieve a healthier proactive control of their metabolism, even when beta-cell damage has occurred.

Much scientific evidence has been accumulated to guide the professional use of herbal medicines to treat the array of health problems seen in diabetic states, and some of this scientific study is available in the section of this article entitled Additional Information and Links to Scientific Studies. For example, vasopressin is just one of a set of neurohypophysial hormones in this adrenal axis, and is associated with diabetic neuropathy. Studies in Korea in 2007 (see the study link below in additional information) revealed that a Chinese herbal medicine from the silkworm significantly reduced blood sugars in laboratory animals with induced diabetes by affecting the expression of vasopressin. Vasopressin, or arginine vasopressin (argipressin), is an antidiuretic hormone that regulates a variety of physiological effects, including blood sugars, water retention, and blood vessel constriction (blood pressure). Neurohypophysial hormones are protein hormones that are stored and secreted from the pituitary gland, a part of the hypothalamus complex in the brain which reacts to feedback regulations initiated by the adrenal glands of the kidneys. This adds an important therapeutic tool for the professional herbalist in helping the patient afflicted with Diabetes type 1. A protocol combining various adjunct treatments such as this would benefit the patient tremendously over time. By combining an array of herbal and nutrient chemicals in a step-by-step manner, and adding specific acupuncture stimulations to affect these same systems, a gradual restoration of a healthier adrenal axis and glucose metabolism can be achieved.

Promoting Healthy Regrowth of the Pancreatic Beta Cells that produce insulin and glucagon with the help of Complementary and Integrative Medicine (CIM)

A short time ago all patients were told that once pancreatic beta cells were destroyed they could not regrow. We now know that this was based on "scientific" assumption and not scientific fact. Experts now agree that a combination of immunotherapy that downregulates autoimmune responses with stimulation of beta-cell regrowth and restoration of cellular function may restore the patient with type 1 diabetes to restoration of euglycemia, or normal homeostatic control of blood sugars (Nature Reviews Drug Discovery 10, 439-452; June, 2011: Frank Waldron-Lynch and Kevan C Herold).

Unfortunately, many experts believe that we are 20-25 years away from implementing a pharmaceutical strategy to regrow or replace pancreatic islet beta cells. This timeline was shortened, though, when in 2013, researchers at the Harvard Stem Cell Institute, Douglas Melton and Peng Yi, discovered that a peptide hormone produced by the liver in mice, betatrophin (meaning growing of beta cells in the pancreas), stimulated the growth of pancreatic beta cells 30-fold. These researchers confirmed that betatrophin is also produced in human liver cells, has been found in human blood plasma, and that the human gene the produces the protein has been cloned. Researchers discovered that the metabolism of the pregnant woman produces increased growth of pancreatic beta cells to handle the increased insulin demand and carbohydrate load, and that human betatrophin hormone is the trigger for this increased pancreatic cell growth. The search for a human homolog to this protein hormone (synthetic pharmaceutical), and then the process of three stages of human clinical trials, may take years, but promises to provide us with a potential medication that may be used to help restore pancreatic function and eliminate the need for synthetic insulin and the numerous chronic adverse effects of diabetic pathology. These researchers have noted that betatrophin is produced both by liver and fat cells, and the search for the trigger of this hormonal production may also reveal other ways to stimulate natural pancreatic beta cell growth. In response to this discovery, Henrik Semb, director of the Danish Stem Cell Center, was quoted in the April 17, 2013 issue of Scientific American, stating that this discovery is very important because "it provides the starting point for further studies to elucidate the underlying mechanism of beta-cell replication." The discovery absolutely confirms what has already been discovered, that stimulation of the human homeostatic physiology has the potential to actually restore healthy beta cells and normal insulin production in the pancreas.

The notion that we could stimulate regrowth and functional restoration of the pancreatic beta cells is not new. A 2009 study by A. Granger and JA Kushner at the University of Pennsylvania School of Medicine (Journal of Internal Medicine. 2009 Oct;266(4):325-38) found that observations and theories made over 100 years ago revealed the regenerative potential of the pancreas. Three theories of regeneration were proposed. One, that acinar cells could differentiate into islet cells; two, that islet cell neogenesis that was similar to formation during embryonic stem cell development occurred; and three, that the pancreas could simply replicate existing islet cells. These three theories are still being debated today.

In recent years, evidence indicates that the neogenesis theory is sound, and that pancreatic duct cells may act as progenitors after injury to the beta islet cells, as well as progenitor cells existing within the islet tissues that are capable of differentiating into insulin producing cells. The pancreatic duct joins the pancreas to the common bile and hepatic ducts to supply the small intestinal duodenum with digestive enzymes and bile as needed. Some individuals have a second, or accessory, pancreatic duct. The pancreatic duct runs the length of the pancreas. Researchers at the Joslin Diabetes Center and Harvard Medical School in Boston, Massachusetts found in 2008 that "carbonic-anhydrase II expressing pancreatic cells act as progenitors that give rise to both new islets and acini after birth and after injury (ductal ligation). This identification of a differentiated pancreatic cell type as an in vivo progenitor for all differentiated pancreatic cell types has implications for a potential expandable source for new islets for replenishing therapy for diabetes in vivo or ex vivo." (Biochem Soc Trans. 2008 Jun;36(Pt 3):353-6; Bonner-Weir S et al). This conclusion indicates that not only stem cell derived therapies, but also restorative therapies in vivo, or in the living pancreas, could improve the mass of hormone-producing islet beta cells in the pancreas. A follow-up study in 2009 by these researchers proved that within the exocrine pancreas (ductal and acinar tissues) there are cells that can give rise to insulin producing beta cells in vitro (see studies cited below). In 2001, ground-breaking research at Massachusetts General Hospital, affiliated with Harvard Medical School, in Boston, Massachusetts, U.S.A. showed that laboratory animals with Type 1 Diabetes showed reversal of beta cell damage with injection of the immune stimulating Freund's Complete Adjuvant (CFA) when spleen cells reacted to stimulate regeneration in the pancreas, which is part of the spleen. Once again, developing the technology to safely introduce altered donor spleen cells into the patient with CFA may take many years to safely develop, but introducing immune stimulating and modulating herbal chemicals and specific acupuncture and electroacupuncture stimulation to achieve these effects is safely available today.

The questions of the patient should include how Complementary and Integrative Medicine can contribute to this process. Complementary Medicine, and particularly the integrative specialty of Traditional Chinese Medicine (TCM), may supply safe and effective treatment strategies that help decrease the autoimmune dysfunctions and promote healthy restoration of cellular regrowth, two processes that need to go hand in hand to achieve success. This could be accomplished with very minimal side effects, if any. Of course, careful monitoring and adjusting of the therapy, and a sound proactive participation in the process by the patient is essential. An integration of therapies and monitoring by the diabetic specialist, or MD, is also essential. As the pancreas function is restored, standard therapy will have to adjust. This requires knowledge and understanding on the part of the patient, who is the only person involved 24 hours per day, 7 days per week. While stem cell therapy holds promise, the potential for stem cell therapy in pancreatic restoration is still far off, and may involve potential adverse effects that could be mitigated with Complementary and Integrative Medicine. In addition, studies in the last few years have shown that acupuncture and electroacupuncture stimulation may both stimulate marrow-derived stem cells as well as promote their differentiation and activation. Integrating specific acupuncture stimulations into future stem cell therapy in pancreatic regrowth, or just as an adjunct treatment in Type 1 Diabetes holds much promise. As stated, if the autoimmune dysfunction is not mitigated as well, this stem cell therapy may not work in the long run, though. While immune suppressing drugs are available, the harsh adverse effects of these drugs need to be considered, and the use of a more conservative approach with Complementary Medicine considered as well. Initial trials in the laboratory showed that standard immunosuppressive drugs (Rapamycin and Tacrolimus) suppressed the autoimmune responses but also inhibited beta cell regrowth. Immune modulating herbal therapy may present a safe and effective adjunct therapy for the autoimmune aspect as well.

The physiological mechanisms that regulate pancreatic beta cell mass, or regenerative capacity, are being heavily researched in recent years, and this research provides the Licensed Acupuncturist and herbalist with much objective data to guide therapy. Adult beta cell mass does fluctuate in response to physiological cues, including pregnancy and insulin resistance, indicating that a holistic approach to homeostatic restoration could accomplish a regenerative capacity. In addition, insulin-dependent mechanisms of glucose control appear to be dependent on the function of the adrenal glands and their production of beta-endorphins. By exploring a holistic protocol, greater success is expected with restoration of the mass of insulin-producing pancreatic tissues. Specific herbal chemicals have shown great promise in the regeneration of beta cells in the pancreas, and have been used for some time to successfully treat diabetes in China and India. Research is showing that herbal chemicals in Ku gua (Momordica charantia, or Bitter Melon), Xue jie (Sanguina Draconis, or Dragon's blood tree resin), and other Chinese herbs, exert significant effects on pancreatic beta cell regrowth, or have a protective effect, in laboratory in vitro studies. As this research continues, more herbal chemicals are expected to be found that have a proven effect and may play an important role in pancreatic restoration after beta cell damage. A thorough holistic treatment strategy that is individualized will have the greatest chance of success in this regard. Expectations of a cure with a single herb, drug, or therapy are not realistic.