When she finally went to the doctor, three months after she first noticed her symptoms, Allene Harris of Valley Mills, Texas, was surprised to learn she has diabetes. It doesn’t run in her family. “I just didn’t feel right,” she recalls. “I was very tired, and I thought it was because of the stress I’d gone through when my mother died. But I was happy to hear it could be controlled by diet. My doctor said that as long as I was willing to make some changes, I probably wouldn’t need to take insulin.”
Her diet—a careful balance of carbohydrates, protein and fat that’s heavy on fiber and light on saturated fat and sugar, with just enough calories to maintain her weight—perked her up as fast as it dropped her blood sugar. She was feeling better in a matter of days.
“I knew this was something that wouldn’t get better on its own, so I found out as much as I could about taking care of it and started doing it,” she says. Much of her nutrition information comes from a diabetes support group that includes a nutritionist.
This sort of take-charge approach can make the difference between living a long, healthy life despite diabetes and suffering the potential consequences: heart disease, blindness, nerve and kidney damage and poor cir - cu lation in the hands and feet.
“There’s absolutely no doubt that diet is the cornerstone of diabetes care,” says Mary Dan Eades, M.D., medical director of the Arkansas Center for Health and Weight Control in Little Rock. “The change in a person’s condition as a result of proper nutritional guidance can be dramatic.”
Double Trouble with Sugar
Most of us know that people with diabetes have problems with too much sugar in their bodies. But there’s a bit more to be aware of in understanding this complex disease. For one thing, diabetes comes in two different forms.
Type I diabetes, formerly called juvenile diabetes, results from a lack of insulin, the hormone that allows cells to take up glucose circulating in the bloodstream. Glucose is the simple sugar that the body uses for fuel. Type I diabetes is also called insulin-dependent diabetes mellitus. (Mellitus means “honeyed” in Latin.) The lack of insulin comes about because of damage to insulin-secreting cells in the pancreas. The damage may be caused by a virus or by an auto immune reaction, in which the body’s immune system attacks cells in the body.
Type II diabetes, or non-insulin-dependent diabetes mellitus (formerly called adult-onset diabetes), results because sugar can’t get inside cells, a condition called insulin resistance. Most people with Type II diabetes have plenty of insulin, at least in the beginning stages of the condition. But receptor sites, or portals, on the membranes of the cells don’t work properly to allow sugar inside. Exactly why that happens nobody knows, but research indicates that the defect in the receptors probably occurs from damage brought about by chronic exposure to high levels of insulin.
In both types, the end result is too much sugar in the blood. “Excess sugar causes tremendous oxidative stress in the body, which leads to all sorts of problems,” explains Joe Vinson, Ph.D., professor of chemistry and nutrition at the University of Scranton in Pennsylvania. That simply means sugar molecules react with oxygen to form unstable molecules called free radicals, which cause havoc by stealing electrons from your body’s healthy molecules to balance themselves.
This electron pilfering damages cells and sets the stage for heart disease as well as for kidney, eye and nerve damage. “Oxidative damage is thought to be associated with all of the complications of diabetes,” Dr. Vinson says.
Excess sugar also sticks to proteins, causing their structural and functional properties to be significantly changed. “This is another major cause of diabetes complications,” Dr. Vinson explains. “It’s one reason people with diabetes often have a hard time healing from wounds or surgery. They have trouble making quality collagen, the connective tissue that is the major structural protein in the body.”
Nutritional therapy for diabetes covers all the bases. It helps lower blood sugar and blood fats, restores nutrients in people whose diabetes is not well-controlled and protects against oxidative damage.
Changes in eating habits are considered standard treatment for diabetes, especially for Type II. And individual nutrients appear to play important roles. Here’s what research shows may be helpful.
Vitamin C Saves Cells
Diabetes itself doesn’t kill people. But those nasty complications, such as heart disease and blindness, can make things rough. And that’s where vitamin C comes in.
Studies show that vitamin C helps prevent the sugar inside cells from converting to sorbitol, a sugar alcohol that cells can neither burn for energy nor move out. Vitamin C may also be effective in diminishing the damage to proteins caused by free radicals.
“Sorbitol buildup has been implicated in diabetes-related eye, nerve and kidney damage,” says John J. Cunningham, Ph.D., professor of nutrition at the University of Massachusetts at Amherst. “It accumulates in cells and disrupts a large spectrum of biochemical reactions.” In other words, it really gunks up the works.
In a study by researchers at the University of Massachusetts at Amherst, the red blood cell levels of sorbitol in people with Type I diabetes dropped from double the normal amount to normal after they took 100 or 600 milligrams of vitamin C a day for 58 days.
“That’s important, because it could mean that over time, people with diabetes who get plenty of vitamin C will have fewer complications,” Dr. Cunningham explains. “Given its ability to permeate all tissues in the body and its low toxicity, we believe vitamin C is a superior choice over drugs that do the same thing.”
Sorbitol, by the way, is used as a sweetener in some dietetic foods. But that doesn’t pose a danger for people with diabetes, says Dr. Cunningham. “Dietary sorbitol is poorly absorbed, for one thing,” he says. “And it’s not transported inside cells, the only place it does harm.”
Doctors who recommend vitamin C for diabetes suggest anywhere from 100 to 8,000 milligrams a day. In his study, Dr. Cunningham found that 100 milligrams of supplemental vitamin C a day works just as well as 600 milligrams a day in people already getting at least the Daily Value (60 milligrams) from foods. Dr. Cunningham suggests that you work with your health care team, including a nutritionist, to determine the right amount for you. For some people, doses exceeding 1,200 milligrams a day can cause diarrhea.
Citrus fruits are tops for vitamin C delivery. Or thrill your taste buds by blending orange juice with a cup of cubed guava or papaya. That tasty concoction packs close to 200 milligrams of vitamin C.
| Food Factors Diet is considered the cornerstone of treatment when it comes to diabetes. But don't count on your doctor to fill you in on all of the details. "I suggest that you ask your doctor for a referral to a dietitian, because I believe dietitians know more about dietary recommendations than most doctors and have more time to explain things," says Kathleen Wishner, M.D., Ph.D., past president of the American Diabetes Association. Here, then, are the top dietary measures. Count down calories. If you're overweight, you'll do best if you lose some girth. But you don't necessarily have to get down to bantam weight to gain the advantage. "For some people, simply losing 10 to 15 pounds can make a big difference," says Dr. Wishner. If your blood sugar is high, it will drop within a day or two of your starting a reduced-calorie diet. (So if you're using insulin, your doctor will need to adjust your dose downward.) In fact, in the days before insulin was available, people were sometimes treated with low-calorie, low-carbohydrate diets or intermittent fasting, after doctors observed that their diabetes patients did better during times of relative famine. Most doctors recommend that their patients with diabetes cut back on fat to lose weight. But for some people with diabetes, trimming carbohydrates works better, says Mary Dan Eades, M.D., medical director of the Arkansas Center for Health and Weight Control in Little Rock. Eat beans and barley. Both are packed with fiber, and most experts recommend that people with diabetes double their fiber intakes to 30 grams a day. Dr. Eades recommends up to 50 grams a day, using psyllium, the kind of gelatinous fiber found in Metamucil. Fiber slows intestinal absorption of sugar and so smooths out blood sugar levels. Many people with diabetes can eliminate the need for insulin with a high-fiber, high-carbohydrate diet, says James W. Anderson, M.D., professor of medicine and clinical nutrition at the University of Kentucky College of Medicine in Lexington and a pioneer in fiber research. In one study, people with diabetes who ate 6.8 grams (about two rounded tablespoons) of psyllium fiber before both breakfast and dinner had 14 to 20 percent drops in postmeal blood sugar. You can get more fiber by eating whole grains, beans, fruits and vegetables. Top fiber sources: dried pears (11.5 grams in five halves), corn bran (7.9 grams in two tablespoons), blackberries (7.2 grams in one cup) and chick-peas (7 grams in a half-cup). Make it mono. Some research suggests that certain people with Type II (non-insulin-dependent) diabetes do better on a diet fairly high in monounsaturated fat, the kind found in olive oil and canola oil, than on the standard high-carbohydrate, low-fat (30 percent) diet. Researchers at the University of Texas Southwestern Medical Center at Dallas found that a diet with 45 percent of calories from fat (a mix of 25 percent monos and 10 percent each of saturated and polyunsaturated fats) produced lower blood levels of triglycerides (a heart diseasepromoting fat), glucose and insulin than a typical high-carbohydrate diet. People with diabetes who benefited most from this dietary switch: those with high triglycerides and low levels of HDL cholesterol, the "good" cholesterol. "It seems apparent that a diet rich in monounsaturated fat improves glucose control in some people, although we don't yet understand exactly why," says Abhimanyu Garg, M.D., the study's main researcher. If you want to try this diet, start by replacing saturated fats (hard at room temperature) and polyunsaturated fats (oils such as corn, soybean, sunflower and safflower) with olive oil or canola oil, Dr. Garg suggests. Avocados and some nuts are also rich sources of monounsaturated fat. It's best to work with a nutritionist to plan a menu that doesn't add extra calories. Go extra-easy on the hard stuff. People with diabetes used to be told not to drink at all, period. After all, alcohol is empty calories that most folks with this disease don't need. But since there is no convincing evidence to show that moderate drinking causes significantly higher blood sugar, and since many people with diabetes are at least occasional social drinkers, the American Diabetes Association offers these guidelines. * Don't drink more than two drinks two times a week. One drink equals 1½ ounces of distilled spirits, 4 ounces of dry wine, 2 ounces of dry sherry or 12 ounces of beer. * Drink only when you're also eating food. * Avoid sugared drinks such as liqueurs, sweet wines and sweet mixes. * Sip slowly. Make your drink last a long time. |
Vitamin E Saves Hearts
Vitamin E gets lots of good press for its role in helping to prevent heart disease. That’s important for people with diabetes, whose risk of heart disease is two to four times normal.
That high risk results mostly from free radical damage to fats found in the bloodstream, explains Sushil Jain, Ph.D., professor of pediatrics, physiology and biochemistry in the Department of Pediatrics at Louisiana State University Medical Center in Shreveport.
The damage, called lipid peroxidation, leads to clogging in the miles of tiny capillaries found in the body, to the reduced life span of red blood cells and to something called platelet aggregation, in which blood cells tend to stick to each other and to blood vessel walls, causing serious traffic jams.
“People with diabetes may need more antioxidant protection than is available in a normal diet,” Dr. Jain says. In his studies, people with diabetes who took supplements of 100 international units of vitamin E a day had 25 to 30 percent lower blood levels of harmful triglycerides, which are blood fats made of sugar. Vitamin E also reduced the tendency for sugar to stick to proteins in the blood, Dr. Jain says.
Doctors who prescribe vitamin E for their patients with diabetes recommend from 100 to 800 international units a day. “I begin with 100 international units and may go as high as 800 international units,” Dr. Eades says. It’s important to work with your doctor as you increase levels, she adds. “If you’re taking insulin, your doctor may need to drop your insulin dose with each increase in vitamin E. And you should monitor your blood pressure, as there is speculation that vitamin E might increase blood pressure in some people.”
The large amounts of vitamin E used for diabetes are not available from even the best food sources: wheat germ and nut and seed oils. Only supplements can provide these large amounts. Doses exceeding 600 international units a day should be taken only under medical supervision.
| Prescriptions for Healing Doctors agree that good nutrition is important for people with diabetes. What they consider good nutrition varies, however. Doctors who do recommend nutritional supplements suggest these amounts. Nutrient Daily Amount
B-complex 100 milligrams Biotin 15,000 micrograms Calcium 1,000 milligrams Chromium 200 micrograms (niacin-bound chromium or chromium picolinate) Magnesium 500 milligrams Vitamin C 1008,000 milligrams Vitamin E 100800 international units Plus a multivitamin/mineral supplement containing the Daily Values of all essential vitamins and minerals
MEDICAL ALERT: It's best to work with a doctor knowledgeable in nutrition when you're adding nutritional supplements to your diabetes treatment program. Your blood sugar and drug dosage need to be carefully monitored. If you have diabetes and you want to try chromium supplementation, you should do so only under your doctor's supervision. He may need to adjust your insulin dosage as your blood sugar level drops. People who have heart or kidney problems should talk to their doctors before beginning magnesium supplementation. Doses of vitamin C exceeding 1,200 milligrams a day can cause diarrhea in some people. It's a good idea to talk to your doctor before taking more than 600 international units of vitamin E daily. If you are taking anticoagulants, you should not take vitamin E supplements. |
Magnesium: For Eyes and More
It may be the world’s most underappreciated mineral. Magnesium is not a trace mineral but a nutrient necessary for every major biological function in your body. And it offers a long list of potential benefits for diabetes. Low levels have been linked to degeneration of the eye’s retina, high blood sugar, high blood pressure and clotting problems that can lead to heart disease.
Although studies have yet to be done that look at whether supplemental magnesium can prevent diabetic complications such as retinal damage, some research indicates that it could be helpful.
In Italy, for instance, doctors found that people with Type II diabetes who took 450 milligrams of supplemental magnesium a day produced more insulin and cleared sugar from their bloodstreams better than before they started taking magnesium supplements.
People with diabetes, especially those taking insulin or whose blood sugar is not well-controlled, tend to come up short on magnesium, studies show. One in four may have the kind of marginal deficiency that often goes undetected, even when they’re eating enough. “People with diabetes tend to lose magnesium through their urine,” Dr. Eades explains.
“I have people take 1,000 milligrams of magnesium twice a day for four weeks to assess their responses,” Dr. Eades says. (She also has people take 1,500 milligrams of calcium a day during this period.) But she cautions against taking these amounts unless you discuss it with your doctor first. This is especially important if you have heart or kidney problems. During this therapy, most people experience some improvement in blood sugar and blood pressure and have less fatigue. After four weeks, she reduces the dose to 500 milligrams a day (100 milligrams more than the Daily Value), taken along with 1,000 milligrams of calcium.
Foods rich in magnesium include whole grains, almonds, cashews, spi n ach, beans and halibut.
Chromium Helps Insulin Work Better
Chromium is a trace mineral. The very same mineral used to put a shine on car bumpers, it is a key player in the body’s use of sugar. It hooks up with insulin to help escort sugar through the cell membrane and into the cell. Deficiencies of chromium make cells resistant to insulin and lead to high blood sugar levels. Of 15 studies that have looked at the effects of chromium supplementation on the body’s ability to use sugar, 12 show positive results.
In one study, people with diabetes who took 200 micrograms of chro mium or nine grams of high-chromium brewer’s yeast a day had lower blood levels of sugar, insulin, triglycerides and total cholesterol and higher levels of heart-healthy HDL cholesterol than before they started taking chromium.
“Deficiency of chromium not only worsens sugar metabolism but also may contribute to development of the numbness, pain and tingling in your feet, legs and hands that diabetes causes,” Dr. Eades says. She recommends daily doses of 200 micrograms of either niacin-bound chromium or chro mium picolinate, an easily absorbed form of the mineral, or nine grams (two teaspoons) of chromium-rich brewer’s yeast.
It’s true that chromium improves glucose tolerance, which is the body’s ability to maintain normal levels of blood sugar after eating, only in people who are low in this trace mineral. But plenty of people fit that category, says Richard Anderson, Ph.D., lead scientist in the nutrient requirements and functions laboratory at the U.S. Department of Agriculture Beltsville Human Nutrition Research Center in Maryland and a leading chromium researcher. He found that most people get only 25 to 30 micrograms a day, which is much less than the Daily Value of 120 micrograms. You’d need to eat at least 3,000 calories a day to get 50 micrograms of chromium and 7,200 calories a day to get 120 micrograms, Dr. Anderson figures.
“No one knows how many people with diabetes are low in chromium, and there’s no good way to assess chromium status,” admits Kathleen Wishner, M.D., Ph.D., past president of the American Diabetes Association. Foods high in chromium include broccoli, bran cereals, whole-grain cereals and breads, green beans and various fruits. Eating sugar uses up the body’s chromium supply.
If you have diabetes and you want to try chromium supplementation, you should do so only under your doctor’s supervision. He may need to adjust your insulin dosage as your blood sugar level drops.
B-Complex May Help Nerves
It’s old news that the B-complex vitamins—niacin, thiamin, folic acid, vitamin B6 and others—are essential for your body to convert sugar and starches to energy. These vitamins are involved in many of the chemical reactions necessary for this process, which is known as carbohydrate metabolism.
A shortage of any one of the B-complex vitamins can cause problems. Vitamin B6 deficiency, for instance, has been linked to something called glucose intolerance, which is an abnormally high rise in blood sugar after eating. This deficiency has also been linked to impaired secretion of insulin and glucagon. Both of these hormones are essential in regulating blood sugar levels.
Shortages of B vitamins can also lead to nerve damage in the hands and feet. Some studies indicate that people with diabetes experience less of the numbness and tingling of diabetes-caused nerve damage if they get supplemental amounts of B vitamins such as B6 and B12.
People with diabetes tend to be low in B vitamins, perhaps in part because the diabetes itself uses up B vitamins and because poorly controlled diabetes causes these nutrients to be excreted in the urine.
“In general, my recommendation is 100 milligrams of a B-complex vitamin daily,” Dr. Eades says. “Then I’ll determine whether someone may need bigger doses of particular B vitamins, such as thiamin, B6 and B12 if there are symptoms of diabetic nerve damage.”
In such cases, she may prescribe up to several hundred milligrams a day, or injections in the case of vitamin B12, until symptoms wane, then cut back.
For vitamin B12, she prescribes injections of 300 to 500 micrograms weekly until symptoms respond, then monthly doses of 500 micrograms indefinitely. (If you can’t get B12 injections, she suggests 500 to 1,000 micrograms taken under the tongue. These supplements are available over the counter.)
Check with your doctor before taking an amount above the Daily Value of any B vitamin, since high dosages may lead to side effects. Doses of 200 milligrams or more of vitamin B6 a day, for example, have caused nerve damage.
Some people may also benefit from taking biotin, another B vitamin, in amounts of up to 15 milligrams (15,000 micrograms) a day, Dr. Eades adds. A study by Japanese researchers found that this vitamin helps cells in muscle tissue use sugar more effectively.
Covering All the Bases
In addition to these particular vitamins, doctors may also recommend that people with diabetes take a multivitamin/mineral supplement that contains the Daily Value of every essential nutrient. That might not be such a bad idea. Research suggests that a multitude of nutrients—zinc, copper, manganese, selenium, calcium, vitamin D and vitamin A—may be in short supply in people with diabetes.
