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Diabetes Mellitus Type 2
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Diabetes mellitus has become one of the most widespread diseases in existence. Over the past thirty-five years, the industrialized world has seen the number of diabetes cases multiply fivefold. In the United States alone, an estimated $150 billion is spent annually on treating diabetes and related complications. An estimated 16 million people in America are known to have diabetes, but the most amazing fact is that approximately half of our nation doesn't even know they have it yet. More than 24 million Americans suffer from pre-clinical diabetes and over 80 million have insulin resistance.

Diabetes is now the leading cause of new cases of blindness in the United States as a result of diabetic retinopathy. It is also responsible for over one third of the new cases of end-stage renal disease in this country. These complications along with diabetic neuropathy are the result of damage to the microvasculature (the smallest arteries).

Diabetic treatment is aimed at decreasing these complications. However, 80% of diabetic patients will end up dying from a cardiovascular event like a heart attack, stroke, ruptured aneurysm, or peripheral vascular disease (loss of a limb). These complications are the result of accelerated aging of the large arteries in the body. All the diabetic treatment patients are receiving has not decreased this risk during the past 40 years. This is partly due to the fact that by the time a patient is actually diagnosed with diabetes-60% already have major cardiovascular disease. They have had insulin resistance and accelerated damage to their arteries for the past 15 to 20 years before they became diabetic. Physicians are simply not treating this insulin resistance and by the time they become diabetic it is too late.

Why are we seeing such an increase in the number of people who are becoming diabetic in the United States? Americans believe a high-carbohydrate, low-fat diet is the healthiest way to eat. Dietitians believe a carbohydrate is a carbohydrate, with absolutely no distinction of how fast we absorb the sugar from that carbohydrate. However, carbohydrates are simply long chains of sugars that are released at various rates in the body. This has been documented in the medical literature as glycemic index (the rate that sugars are absorbed and increase the blood sugar). Carbohydrates such as white bread, white flour, pasta, white rice, and potatoes release their sugars rapidly (high-glycemic foods) and increase the blood sugars faster than if you were slapping table sugar on your tongue. Foods such as green beans, rye bread, whole apples, and cauliflower release their sugars slowly (low-glycemic foods). This rapid rise in blood sugar after a high glycemic meal stimulates the release of insulin from the pancreas, which is needed to control the blood sugar level. The blood sugar drops and our body's crave more calories and more high-glycemic foods. We simply keep repeating this pattern over and over-day after day. Medical studies are now showing us that this type of diet causes us to become less and less sensitive to our own insulin (insulin resistance). It is a lot like crying "wolf" all of the time-we are simply stimulating the release of insulin time after time.

An estimated 24% of the adults in the U.S. have insulin resistance, also known as Syndrome X or more recently the Metabolic Syndrome. In my clinical practice, I have observed a troubling pattern. Many patients beginning in their late 30s or early 40s begin gaining a significant amount of weight around their middle (central obesity). They then begin to develop increased levels of total cholesterol and triglycerides along with very low levels of HDL or "good" cholesterol. Shortly thereafter, they develop hypertension, which needs to be treated. By their late forties, they've become diabetic.

This epidemic pattern of insulin resistance develops over a 15 to 20 year period. People aren't as sensitive to their own insulin as they once were. I see this over and over in my practice. The sad thing is that once insulin resistance develops, one's arteries are aging a third faster than they should. In other words, for those people in this category, for every third birthday they can add an additional year.

Insulin resistance is the beginning event of a complicated metabolic change that occurs one's body. Our bodies still wants and needs to control blood sugars. Therefore, the beta cells of the pancreas simply put out more insulin and our blood insulin levels rise. This elevated insulin in our blood stream is called hyperinsulinemia and leads to a constellation of metabolic changes in our body called Syndrome X.

When a person develops full-blown Syndrome X, he or she has a 20-fold increase risk of developing cardiovascular disease. After 15 to 20 years in this state, the beta cells of the pancreas finally wear out and your insulin levels begin to fall and your blood sugars begin to rise. First, you develop pre-clinical diabetes (blood sugars are elevated, but not high enough for you to be called diabetic). Then a few years later you actually become diabetic. However, it is important to realize that your arteries begin to age at an accelerated rate as soon as you first develop this insulin resistance. This is why 60% of the patients already have major cardiovascular disease the day they are first diagnosed with diabetes.

In a 6-year Nurses Health study of 65,000 women whose diets were high in carbohydrates from white bread, potatoes, white rice, and pasta (high-glycemic diet), participants had two and one-half times the risk of developing type II diabetes (adult onset diabetes) than those who ate a low-glycemic diet. The researchers excluded other risk factors such as weight, exercise level, and family history. This increased risk was related strictly to their diet.

Walter Willett, a professor of epidemiology and nutrition at the Harvard School of Public Health and a co-author of this study, found the results of this study along with other studies so convincing that he has recommended the government change the Food Guide Pyramid. The Food Guide Pyramid recommends 6 to 11 servings of carbohydrates a day but does not make any distinction whether these are high-glycemic or low-glycemic carbohydrates. He believes white flour, white bread, potatoes, white rice, and pasta should actual be moved up the Food Guide Pyramid and considered in the sweets category because metabolically they are the same. I couldn't agree more.

Clinical trials have demonstrated patients with pre-clinical diabetes or impaired glucose tolerance have significantly lower levels of antioxidants. There was evidence of significantly increased levels of oxidative stress, which led to a depletion of our antioxidant defense system. In other trials, this oxidative stress was more significant in those who had secondary complications of their diabetes like retinopathy or cardiovascular disease. These authors felt that antioxidant supplementation should be added to the traditional insulin treatment as a means to help arrest these complications. The neurology department at Mayo Clinic reported a study where they experimentally created diabetic peripheral neuropathy. They concluded this complication was indeed caused by oxidative stress. They were able to reverse this nerve damage by giving alpha lipoic acid, which is both a fat-soluble and water-soluble antioxidant. They also noted if the subjects had good levels of alpha-lipoic acid because of supplementation before they induced the oxidative stress, there was no nerve damage.

Many micronutrients have been found to be deficient in patients with Syndrome X, pre-clinical diabetes and actual diabetes. One of the most crucial is chromium. Chromium is critical in the metabolism of glucose and the action of insulin and has been shown to greatly improve insulin sensitivity, especially in those who are deficient. Studies indicate that almost 90 % of the American population is deficient in chromium.

Vitamin E not only improves the antioxidant defenses but also has been shown to improve insulin resistance. In other studies, a low vitamin E level has been found to be an independent and strong predictor for the development of adult onset diabetes mellitus. There was a five-fold increase in the risk of developing diabetes in those individuals who had low levels of vitamin E.

Magnesium deficiency has been associated with both types 1 and 2 diabetes. This low level of magnesium has further been associated with an increased risk of diabetic patients developing diabetic retinopathy as well and when corrected in the elderly a significant improvement in the function of insulin results. Diagnosing magnesium deficiency is quite difficult. Serum magnesium levels must be used where only 0.3 percent of the body's total magnesium is located. Cellular levels of magnesium are much more sensitive and accurate. Magnesium deficiency may be the most under diagnosed electrolyte abnormality today.

Clinical Applications

For patients who have type-2 diabetes mellitus, physicians are often treating blood sugars instead of the underlying problem, which is insulin resistance in over 95% of the type-2 diabetic patients. In fact, when insulin resistance is corrected early, it is easily reversible with just basic healthy lifestyle changes. This not only allows the patient to avoid the accelerated aging of their arteries but allows them to avoid becoming diabetic altogether.

With the principles that follow, almost all of my patients with insulin resistance have reversed their conditions and 17 documented patients who've had full-blown diabetes have totally reversed their disease.

How do I know if I have developed Insulin Resistance?

You can know if you have developed insulin resistance when obtaining the results of your last lipid profile from your physician. Simply divide your triglyceride level by your HDL or "good" cholesterol. If this number is greater than 2, you are starting to develop insulin resistance. With Syndrome X your triglyceride level begins to increase and your HDL cholesterol will decrease. Therefore, this ratio is an indirect measure of your blood insulin levels. The greater this number-the higher your insulin levels and the more serious your problem has become. For example, if your triglyceride level is 350 and your HDL level is 35-you have a ratio of 10 and are well into this serious metabolic disorder.

Why Don't Physicians Treat Insulin Resistance?

Physicians have been content treating the complications or the results of insulin resistance such as high blood pressure, elevated cholesterol and triglycerides, and even diabetes itself without treating the underlying cause-insulin resistance. In my personal opinion, the main reason physicians don't treat insulin resistance is there's no drug for it. Physicians are drug- and disease-oriented. Insulin resistance is treated-as you will see-by making some basic lifestyle changes.

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