Diabetes / Metabolic Syndrome

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

Sections

Diabetes Type 2 and Metabolic Syndrome

Metabolic Syndrome or Syndrome X is another problem that has dominated the concerns of the health community in recent years, and as stated, accounts for roughly 90 percent of patients now diagnosed with diabetes. Previously called a prediabetic state, we now know that a combination of health factors leads to metabolic problems with poor blood sugar and cholesterol regulation that looks like diabetes and may lead to onset of a real diabetic state. For the vast majority of patients with Metabolic Syndrome, though, they will not proceed to an actual diabetic state, and their treatment strategy should reflect this fact. In the last decade we in fact found that standard treatment for Metabolic Syndrome led to the onset of actual diabetes, with the routine prescription of statin drugs to lower LDL-cholesterol increasing the risk of progressing to true diabetes by 46 percent, according to a 2015 Finnish study, and this is unacceptable. In addition, it has been shown that the use of statin drugs may raise the A1C index, which became the benchmark for diagnosis of true diabetes, leading to overdiagnosis and excessive prescription of medications. These newer medications to treat insulin resistance and diabetes have also been shown to actually increase cardiovascular risk, and obesity, in many cases, which is obviously the opposite of the desired outcomes. This Metabolic Syndrome is explored in another section on this website because the patient with metabolic syndrome should take a somewhat different approach to correct this problem, which standard medicine has been slow to acknowledge, creating an enormous iatrogenic harm. Differentiation of Metabolic Syndrome from Diabetic Disease is still a problem due to the complexity of the health factors involved, but the basic difference involves Metabolic Syndrome having a focus of insulin resistance driving higher circulating insulin in response to diet, while diabetes having a focus of insulin deficiency and lowered insulin in response to diet, obviously opposite effects.

Finally, in 2016, the first of sensible studies of treatment and cure for Diabetes Type 2, prediabetic state, or Metabolic Syndrome was completed and the results of a small initial human clinical study at Newcastle University, headed by Dr. Roy Taylor, showed that a dietary approach for 6 months of low calories and avoidance of processed food and starchy food reversed Diabetes Type 2, or Metabolic Syndrome, for 50 percent of patients, with no return of the Syndrome, and no dependence on medication afterward. Professor Taylor stated in a New York Times article of April 19, 2016, entitled Diet Versus Type 2 Diabetes, that: "Yes, this is a reversible disease - that you will have no more diabetes medications, no more sitting in doctors' rooms, no more excess health care charges - that is enormously motivating." While voices in standard medicine touted the weight loss as the key factor, this study showed that most of the cured patients experienced a rather modest weight loss, perhaps 30 pounds from an obese state, yet still achieved a metabolic normalization, merely by sticking to a diet of a 600-700 calorie per day diet consisting of 3 diet milkshakes per day and half a pound of non-starchy vegetables for 8 weeks, and then maintaining a healthy diet and weight loss for the next 6 months. Obviously, the alteration of the metabolic stimulus of excess insulin metabolism and improvement in liver metabolism resulted in a return to a normal healthy metabolism. The study participants stopped all diabetes medications before starting the study, and half of them no longer needed these medications in the future. Immediately, this definitive study that upends the longstanding advice that Metabolic Syndrome is actually diabetes, and has no actual cure, was subject to a strong industry "spin", and many patients were told to enroll in fruitless weight loss programs that have failed them for decades, or to subject themselves to bariatric surgery that artificially starves the body by drastically decreasing the size of the stomach. What this UK study showed, and what subsequent larger studies will show, is that a reversal of the metabolic insulin dysfunction with Complementary and Integrative Medicine, mainly by adopting a diet of low caloric intake, no meat, no sugar, no processed food, and instead eating fresh whole vegetarian fare, will restore the genetically programmed metabolism. Including herbal and nutrient medicine, lifestyle changes, and short courses of acupuncture into this treatment protocol will surely increase the success rate. To see the conservative assessment of this landmark study, and the plan to advance the human clinical trials to a larger Diabetes Remission Clinical Trial (DIRECT), just click here: http://www.ncl.ac.uk/magres/research/diabetes/reversal.htm . Whether we will finally see a truly pragmatic and scientific approach to Metabolic Syndrome, and finally an integrative approach to this devastating health problem, with a thorough holistic approach, is still in question, as this would greatly decrease profits in the lucrative industry of medicine. Patient demand may be the key, and needs to be achieved through greater patient understanding.

The studies by Professor Roy Taylor of Newcastle University showed that while systemic insulin resistance, the earliest distinct predictor of advance to what is called Type 2 Diabetes, is mainly thought to originate in the muscles, with fat cells adopting insulin resistance, that his research clearly shows that "early improvement in control of fasting plasma glucose level is associated only with improvement in liver insulin sensitivity." This syndrome of liver metabolic dysfunction is highly associated with triglyceride levels and fatty liver. Improving this liver metabolism and health, decreasing the fat accumulation in the liver, is strongly associated with improvement in insulin suppression of glucose production and the fasting blood glucose level in blood circulation. Overfeeding with sugar has been shown to increase the liver fatty stores quickly and dramatically, and surely it has been demonstrated how high-fructose corn syrup, altered sugars, and transfats contribute heavily to this rapid increase in liver fatty tissues and Metabolic Syndrome. Clearly, the exact diet that is heavily advertised and promoted by the food industry has created this alarming epidemic of Metabolic Syndrome. Other environmental concerns have been shown to contribute to the 50 percent reduction in pancreatic beta cells in many individuals when this liver dysfunction occurs. Free fatty acids and their metabolites, especially ceramides, appear to contribute heavily to pancreatic beta cell apoptosis. Early markers of Metabolic Syndrome include slightly elevated triglycerides and ALT liver enzymes, overlooked because they usually fall just below the range considered clinically in excess. An holistic regimen of diet and daily exercise, as well as other aids to liver health and function, could dramatically prevent or reverse most cases of Metabolic Syndrome.

This complexity in distinguishing Metabolic Syndrome from true diabetes is a good reason for the patient to take a more proactive approach and slowly increase physiological understanding of their metabolism and the various health problems associated with Metabolic Syndrome and Type 2 Diabetes. Depending entirely on standard medicine in this realm has led to an enormous amount of apparent harm. Often, in today's age of time limitations with medical doctors and treatment guidelines controlled by the insurance companies, the proactive approach by the patient is the most secure way to insure optimum treatment, and integration of the medical specialty of Traditional Chinese Medicine (TCM) as well as the Naturopathic Doctor insures that a complete and holistic protocol of care is maintained.

The following section of this paper will help you to understand the disease as a whole and may be too detailed for you at this time, or present information that you already have investigated. If you would like to first look at dietary and lifestyle advice, skip this section for now and come back to it when questions arise about your use of integrative medicine, and go directly to the dietary recommendations.

There are two basic types of diabetes. Diabetes Insipidus is a rare disorder that is generally linked to hypothalamic and pituitary disorders such as a tumor or lesion (i.e cancer and stroke), or to kidney diseases (often associated with hypertension). It involves either the deficiency of arginine vasopressin, an anti-diuretic hormone (ADH) of the pituitary, or to a failure of the kidney to respond to the ADH to properly regulate fluids in the body. When fluid loss exceeds fluid intake, cells and membranes become dehydrated, especially brain cells, causing symptoms such as lethargy, irritability, and weakness, as well as thirst and dry mouth. In a healthy body, when extracellular fluid and/or blood volume is decreased, ADH is released and less fluid is lost in the urine. At the same time thirst is stimulated as a signal to replenish fluids. Hyperglycemia is not present in diabetes insipitus. Very few patients will have this type of diabetes, but if you do, the strategy for management is very different from that of Diabetes Mellitus.

Diabetes Mellitus by contrast, is a disorder where excess sugar in the urine causes an osmotic fluid loss, or dumping of water to rid the body of excess sugar, leading to greater fluid loss than intake. It too involves cell dehydration, and many of the symptoms listed above apply here also, along with severe loss of potassium. This form of diabetes is the prevalent form of the disease, and is divided into two types, type I insulin-dependent diabetes mellitus (IDDM) and type II non-insulin-dependent diabetes mellitus (NIDDM). Type 2 is the form that is occurring with alarming frequency at present because of poor dietary habits in our society. Type 2 is now frequently called metabolic syndrome to emphasize that this disorder involves more than the sugar-insulin dysfunction, and there is a need for a better differentiation between true diabetes and metabolic syndromes in order to customize care and prevent the unnecessary over-prescription of drugs. Read on to gain an understanding of this most common type of diabetes, and go to the web article on this site to further read about Metabolic Syndrome and how it is differentiated from Diabetes Mellitus Type 2.

Type I or IDDM has been termed juvenile onset, but we now know that it can occur at any age, although crises (DKA/diabetic ketoacidosis) generally occur before the age of 40. Clinical manifestation of symptoms occur after a gradual process of immune destruction of insulin producing beta cells of the pancreas, when 90% of these cells are destroyed. In the past, it was assumed that these destroyed beta cells of the pancreas could not regenerate, but in recent years, research has proven this assumption wrong. Patients with IDDM (insulin-dependent diabetes mellitus) are prescribed insulin, which is monitored daily. Insulin dosage may be reduced when a holistic protocol is integrated into the treatment scheme, and this may prevent some long-term consequences that are devastating in this type of disorder. As always, insulin dosage is determined by daily testing and monitoring, no matter what overall treatment protocol is utilized. Many patients with this disorder now utilize an installed insulin pump that is controlled with digital software and eliminates the need to constantly inject with a needle. Other means of providing insulin dosage, such as aerosol delivery, are currently being worked out and tested for safety. Control of sugar metabolism with dietary habits is an important part of this holistic strategy. Simple habits, such as a short period of excercise after eating simple carbohydrates, greatly aids health sugar metabolism. The patient that assumes that all they need to do is inject insulin to achieve the best health will be sorry that they did not adopt a more holistic regimen in the future. A great number of insulin-dependent diabetics end up with serious cardiovascular problems and kidney dysfunction and end up in the hospital for these problems later in life. This can be avoided.

Type II or NIDDM is characterized by less severe defects in insulin secretion, but also involves defects in insulin binding and sensitivity, especially to fat and muscle cells, and utilization of insulin by all cells of the body, especially in the liver. This often leads to high levels of both glucose and insulin. It is considered an adult onset disease, with crises (HNKS) usually occurring after the age of 60, but in recent years, an alarming percentage of children are acquiring Type II Diabetes, which often should be correctly referred to as Metabolic Syndrome. Insulin resistance is often acquired due to chronic overstimulation of the insulin response along with chronic inflammatory dysfunction affecting the fat cells. This problem is so widespread presently, that drastic measures are being adopted in public health restricting access to simple carbohydrates and transfats in public schools. The best way to adopt healthier dietary habits in both children and adults is to educate the public concerning human physiology and the consequences of unhealthy dietary habits. Commercial food producers must also take some better moral and ethical stand on the effects of food on public health. Like the tobacco industry, people who work in this industry need to consider more than profit when they do their job.

Complications of Metabolic Syndrome include ill health of the inner membranes of arteries, a decrease in healthy kidney and liver function, with poor metabolic control of sodium and triglycerides leading to a rise in blood pressure and cardiovascular disease, decreased control of inflammatory mechanisms and mineral regulation leading to blood clot and thrombus formation, insulin resistance and the inability of the pancreas and liver to respond to higher glucose levels when eating simple carbohydrates and processed food, and related health problems with retinopathy and peripheral neuropathy. A 2013 study at the University of Melbourne Royal Victorian Eye and Ear Hospital also showed that the degree of diabetic retinopathy in type 2 diabetes was highly associated with erectile dysfunction as well, showing that metabolic disorder creates a wide array of health problems and dysfunctions that need a more holistic and thorough approach to treatment (PMID: 23448500). A large retrospective study in the United States, called the National Health and Nutrition Examination Survey from 2001 to 2004 found that for men between the age of 40 and 59 who stated that they only sometime or never were able to maintain an erection, that 1 in 10 had undiagnosed diabetes type 2, or Metabolic Syndrome, while in men of this age that did not have erectile dysfunction, the incidence of undiagnosed diabetes type 2, or Metabolic Syndrome, was 1 in 50. It is now estimated that up to 75 percent of men with Diabetes Type 2 will eventually experience some degree of erectile dysfunction. Simply taking Viagra or a similar medication will not correct the underlying causes of this erectile dysfunction, though, and thus it will worsen. By addressing Metabolic Syndrome and Diabetes Type 2 early in the course and treating it with a restorative medical approach, rather than just controlling the blood sugar with medications, these complications can be avoided. By utilizing Complementary and Integrative Medicine, and Traditional Chinese Medicine (CIM/TCM), these health issues can be prevented. An array of therapeutic tools, combining diet, lifestyle, herbal and nutrient medicine, and acupuncture, will provide the holistic approach that works, and the only side effect is better overall health and quality of life.

As stated, over 90 percent of what is termed Type II diabetes is actually a syndrome called Metabolic Syndrome. To better understand this health problem, the reader is advised to go to the separate article on this website entitled Metabolic Syndrome and Prediabetic State. The progression of the Metabolic Syndrome and prediabetic state to a true diabetic state occurs in only a small percentage of these patients. The confusing stress of the "prediabetic state" or Metabolic Syndrome is proven to contribute to a rise in A1C and contribute to the progression of the disease, and Complementary and Integrative Medicine can help these patients adopt a more sensible and proactive program to prevent the progression of a Metabolic Syndrome to actual diabetes.

In 2014, scientists at Johns Hopkins University School of Medicine identified what may be the missing link in explaining how Metabolic Syndrome may advance to actual diabetes affecting the pancreas. Up until this time, the imbalance between the two primary hormones that define the states of dysfunctional regulation of blood sugars, storage and conversion of metabolites such as proteins and fats to sugars, insulin and glucagon, provided an unclear, or indirect cause of eventual type 2 pancreatic diabetes developing from Metabolic Syndrome. In this study at the Johns Hopkins Children's Center, a liver hormone called kisspeptin 1, or K1, until now studied in relation to regulation of puberty and fertility, and suppression of metastasis of cancer, was found to respond to relative excesses of glucagon in the liver by releasing an excess of K1 into the bloodstream, which in turn triggered the pancreatic beta cells to lower the secretion of insulin. Even when insulin resistance at the fat cells and liver leads to excess insulin and lowered insulin effects, the levels of glucagon secretion in the liver remain high in insulin resistance, even abnormally high. In response to this, it appears that the liver adapts by increasing the K1 secretion that then lowers the insulin secretion. By treating the problem of Metabolic Syndrome holistically, addressing chronic imbalance of inflammatory immune mediators, insulin resistance, neurohormonal balance, pancreatic health and function, and most importantly, liver health and function, this syndrome will not advance to a true diabetic state.

Current research will try to portray kisspeptin as as single protein peptide molecule expressed by kisspeptin genes in the liver that can be blocked by a pharmaceutical chemical to obtain a simple treatment of type 2 diabetes. Kisspeptin is more than a diabetic peptide hormone, though. Discovered only in 1996 in cancer research, in 2003 kisspeptin was discovered to stimulate neurons in the hypothalamus-pituitary gland that were involved in the release of gonadotropin-releasing hormone (GnRH), and possibly the regulation of luetinizing hormone and follicle stimulating hormone (LH and FSH). Drugs that are created to block kisspeptin may create an array of adverse health effects on a variety of systems. Kisspeptin is described as a liver hormone, but is most notably expressed in the hypothalamus and hippocampus, and much is left to be discovered about the large family of peptides, or protein fragments, that are called kisspeptin, as well as the variety of kisspeptin receptors. Kisspeptin is a neurohormone, or class of neurohormones. Kisspeptin was also found to stimulate various processes in the adrenal glands. Neurons in various parts of the brain are found to express kisspeptin, and kisspeptin is found to be very sensitive to steroid hormones. Such research indicates that the pathogenesis of Metabolic Syndrome and progression to diabetes type 2 is part of a more complex neurohormonal imbalance, and the characterization of kisspeptin as the single link in the pathogenesis of type 2 diabetes only benefits the pharmaceutical research and the search for a single drug molecule that could block kisspeptin-1. The whole picture of this disease progression is more complex, and will require a more holistic approach to regain healthy metabolic homeostasis. There is no real harm in using various pharmaceuticals to block various metabolic functions to decrease symptoms in diabetes, as long as the patient and their medical team is also trying to restore health, and hopefully stop the dependence on these drugs in the future.

When new drugs are developed to treat the progression of Metabolic Syndrome to true Diabetes Type 2, and these new drugs simply block kisspeptin-1, or K1, this will cause problems. For instance, in 2015, experts at the Children's Health Research Institute, in London, Ontario, Canada, found that K1 acted on the human hypothalamus-pituitary, and also in the ovaries and uterus, and that "a disruption in local KISS1 (kisspeptin 1) in the ovary and uterus is sufficient to trigger infertility". While some researchers will imply that kisspeptin 2 and 3 are the forms of the neurohormone that disrupt the endocrine axis and fertility, as well as other hormonal effects, especially regulation of puberty and early sexual development, this study shows that that is no really true, and K1 will have the same effects. To see this study, click here: http://www.ncbi.nlm.nih.gov/pubmed/26183891 . Other important effects of kisspeptin are also being shown, with a study in Hungary showing that kisspeptin alters vascular tone via regulation of eicosanoid production (essential fatty acids) that also regulate platelet counts. The implications here may be that drugs that block or alter K1 could contribute to cardiovascular disease, hypertension or hypotension, and blood clots or bleeding. To see more of such studies, go to Additional Information on this article. The benefit of taking a more holistic approach and integrating Complementary Medicine may be to avoid these drugs and adverse effects and risks, or to alleviated them.