Diabetes. It seems to be all over the place—your own friend or relative has developed it. It’s on the news, there’s diabetic meal plan books right there at the check out counter, celebrities do commercials about how to buy diabetic supplies, and you’re starting to look at that belly of yours with growing worry.
Why is it important to know about Diabetes? Because, quite simply, it is at epidemic levels in the United States. Over the next 24 hours, while you are brushing your teeth, eating lunch, cleaning the dinner dishes, 2200 people will be diagnosed with diabetes, 512 diabetics will die, 66 diabetics will go blind, 77 diabetics will be diagnosed with end-stage renal disease, setting them up for a life dependent on dialysis, and 153 diabetics will have some part of their foot or leg amputated.
That adds up to 21 million Americans with diabetes right now, and 47 million Americans with “pre-diabetes”, also known as Metabolic Syndrome. In fact, the Centers For Disease Control, one of our governmental agencies designed to protect the health of Americans, states right now that if things don’t change, one of out every three babies born today will wind up with diabetes, and one out of every two Hispanic babies. In fact, ethnic groups such as African-Americans, Hispanics, Pacific Islanders, Native Americans, Alaskan Inuit, and Asians all have a higher risk of developing diabetes than Caucasians, although in my practice I see plenty of Caucasian diabetics.
The NY Times has recently written a series of articles about Diabetes which stated that in just that city alone 1 in 8 New Yorkers are diabetic. They also wrote a startling article stating that facilities designed to help patients control their diabetes to prevent complications from occurring were all closed down because insurances paid so poorly to prevent complications. Insurances would only pay ($75) for a patient to see a podiatrist to have good foot care instituted, but were willing to pay $30,000 to have that same foot amputated once the patient’s disease progressed.
This is the state of standard medicine in our country today. In eight-minute office visits, diabetic patients simply do not receive the education or attention they need to learn to control their diabetes, to actually be able to become a fully controlled diabetic. Most patients with diabetes do not regularly take their blood sugars, do not know what their A1C score is, or even what it means, have not had any nutritional education, and only see their doctor 2-4 times a year. Most do not really even understand what diabetes is, and what caused it in them.
So, let’s do a quick educational tour of diabetes. There are four main types of diabetes:
- Gestational Diabetes, which occurs when a non-diabetic woman becomes diabetic during her pregnancy, usually due to excessive weight gain from eating poorly. The risks of this include having the fetus become too large for a vaginal birth, necessitating a C-section. 40% of all women who develop gestational diabetes will be full blown Type 2 diabetes within 12 years after their delivery.
- Type I Diabetes, which is an auto-immune disease whereby a person’s own immune system attacks their pancreas, destroying the cells that produce insulin. This comes on very quickly and usually in the pediatric population. About 5-15% of diabetics have this type of disease and they must be on injectable insulin. Type I is associated with feeding infants dairy and wheat before they are one year old, so it is highly recommended all babies avoid those foods and are breast fed for at least 6 months.
- Type 1.5 Diabetes.This is a little known type of diabetes called LADA—Latent Autoimmune Diabetes of the Adult. This is like Type I, but it comes on later in life, when patients are in their late 30s or 40s.
- Type 2 Diabetes. This type of diabetes is the one causing our present epidemic; 90-95% of all diabetics have this type.
Type 2 diabetes is caused by a number of factors, most of them controllable, one of them genetic. The genetic factor is the “thrifty gene”, which evolved in people to enable them to gain weight easier when food was plentiful; thus, when food was scarce, those with a few extra pounds on them would survive, when the skinny folks died. Until the last century, food was never a guarantee and folks who had the thrifty gene were a great boon to the survival of humankind. However, with food plentiful all the time, that gene works against people, making it easier to pour on the pounds with regular eating.
However, what one eats is a big factor in developing diabetes too. Drs Gross and Li did a study whereby they found that the number one causative food responsible for the rise in obesity in the last 50 years in America was “high fructose corn syrup”. This is found, well, everywhere—all your pops have it, your ketchup, cookies, pastries, your salad dressings, your spaghetti sauce, etc. Other foods associated with causing diabetes are other refined sugars, refined carbohydrates like white flour, white rice, white pasta, and saturated fats, such as those found in fried foods, burgers, steaks, cheese. And of course, eating too many calories in and of itself causes weight gain.
Weight gain is a risk factor for diabetes. Extra weight in the abdominal area interferes with the insulin processes in the body. The pancreas, a long slim organ behind your stomach, produces insulin and releases that hormone into the blood. Insulin lands on receptors on cells, particularly our fat cells, but also our liver and muscle cells, and tells those cells, “Take in blood sugar”. As the blood sugar levels drop, the pancreas stops making insulin. Insulin has an infinity for fat cells however, and also tells the body to store food as energy and not to burn it metabolically. This is fine if insulin levels are normal. In-between meals in a non-diabetic, the lower levels of blood glucose and insulin allow the body to burn energy just fine and normal weight can be maintained. But as we gain weight, our cells do not listen to insulin that well—that is called “insulin resistance”; thus blood sugar levels stay high, the pancreas continues to put out more and more insulin, we eventually keep gaining more and more fat, and cannot lose it. This becomes a vicious circle: higher insulin means more insulin resistance, which means higher blood sugar levers, which means more insulin output, which means bigger fat cells, which means more insulin resistance, etc. At some point the blood sugar levels get high enough that we diagnose that person as being a diabetic.
Another factor in developing diabetes is lack of exercise. In fact, studies show that the lack of exercise is a bigger risk factor for weight gain than over-eating. That is, if one exercises regularly, they can overeat now and then and not gain weight—it’s that healthy to the body exercise. Of course, those who exercise regularly tend to get rid of their cravings so they don’t overeat.
The World Health Organization has mentioned that the environmental toxin arsenic can cause diabetes—that is commonly found in areas of mining and is in many pesticides we spray on our farm fields. We need to focus on eating organic foods as much as possible. Also, lead toxicity is associated with diabetes. A cleaner world promotes health!
Certain other hormone imbalances can lead to a higher risk of diabetes—high or low testosterone levels, high or low cortisol levels.
At Southwest Naturopathic Medical Center we spend a great deal of time with patients so we can specifically analyze what are the factors most pertinent to them, thus we can best help them fully control their diabetes.
In the next article, I’ll explain how we diagnose diabetes and the differences between MD standard of care and the oftentimes better treatment diabetics get with naturopathic medicine.
Diabetes, Part II
by Dr. Mona Morstein
- Type II Diabetes is diagnosed by finding elevated blood sugars both when the patient is fasting and after they eat. If morning fasting blood sugars are above 126 mg/dl and after eating the blood sugars rise above 200 mg/dl, then a diagnosis of Diabetes can be made. Other labwork that follows that diagnosis include:
- Hemoglobin A1C—This tells us what the patient’s blood sugars have been on average 24 hours a day for the past three months. This is the standard medical indice for following how well a diabetic patient is doing.
- Lipid panels—Includes total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides. We want patients with Diabetes to have healthy levels of these numbers.
- C-peptide or insulin—This tells us how much insulin a patient’s pancreas puts out and helps us know when we definitely need to put them on insulin.
- Diabetic antibodies—These can help us discern whether the patient has Type 1, Type 2 or Type 1.5 diabetes.
- Microalbuminuria, BUN, Creatinine—These tell us how healthy are the kidneys.
- Testosterone—Many diabetic men can be low in testosterone which will keep them from being able to get their blood sugars down as quickly or efficiently.
- Vitamin D—Many patients may be low in Vitamin D, which is needed to reduce insulin resistance.
- Liver enzymes—Sometimes, when people are overweight, they gain weight in their livers which can cause inflammation and potentially harm their livers. That would cause elevated liver enzymes.
- Salivary cortisol—Cortisol is an adrenal hormone. If it is too high or too low it can keep patients from being able to be energetic and lose weight.
There are many other measurements we can do, but that’s enough to discuss right now!
MDs treat Diabetes in several beneficial ways. They encourage weight loss, smoking cessation, and, sometimes, stress management. They are, unfortunately, often remiss in working with a patient’s diet, or they might refer patients to nutritionists who suggest patients follow the American Diabetes Association diet recommendations, which, being so high in carbohydrates, are TERRIBLE for a diabetic to follow.
Typically, when a patient is diagnosed with Diabetes and is being treated by an MD he or she is put on several types of medicines:
- Oral hypoglycemic agents (OHA)—These help lower the blood sugar in several different ways.
- ACE inhibitors—These protect the kidneys, at least temporarily, from damage from uncontrolled Diabetes. They can also lower the blood pressure.
- Statin drugs—Many, if not most, patients with Type II Diabetes have elevated lipid panels. MDs use statin drugs to lower them.
- Injectable insulin—Many MDs start patients on insulin very quickly to try to get their blood sugars down.
- New drugs such as Byetta and Amylin—These are both injectable hormones which help lower the blood sugars.
Unfortunately, the MD protocol struggles to get blood sugars under control. Statistics show that most patients working with MDs do not get their A1Cs down low enough to be considered safe for the patient. Also, statistics show that typically a patient is put on one OHA, and then within 3 or so years needs a second OHA, and then within 3 or so years needs to be on insulin. It’s simply a downward spiral with more and more complications developing in diabetics as they wind up taking more and more drugs.
As a naturopathic physician, I do use some of the prescription medications my medico colleagues do, at times, but only when necessary. There are OHA I use, like Metformin, which is a pretty good drug, pretty safe, and can help patients. Be aware though that Metformin blocks B12 absorption, so if you are on it, you must have a B12 shot AT LEAST once a month. I also like those new hormone injections, Byetta and Amylin, and feel they are safe and effective to use, when necessary, with patients. And, I do prescribe insulin, as well, when patients need it.
However, Naturopathic Medicine has so much else to offer diabetic patients! Our protocols are rational, pragmatic and have science behind them. We focus on a low carbohydrate diet, since Diabetes, by its very definition, means that a person has lost the capacity to properly metabolize the sugars in their body. We have patients come in weekly until we are sure they understand the diet changes and can implement them. That’s very helpful to patients! We put the patient on special nutrients and oils that replenish vitamins and minerals we know diabetics are low in, and that help control their disease. We use other supplements such as Alpha Lipoic Acid, Biotin, and NAC which protect the body from damage from high blood sugars and also help diabetes under good control. We use botanical medicine because herbs are magnificent at reducing blood sugars, slowing down the appetite and reducing cravings, keeping the eyes and kidneys healthy, protecting and even rejuvenating cells in the pancreas (but they cannot heal Type I Diabetes). We work closely with patients to help them exercise safely, and successfully. We also make sure we address any hormone imbalances, such as low testosterone, or high cortisol.
All in all, naturopathic protocols for Diabetes do wonders for patients by focusing on their unique needs in comprehensive protocols. I have patients who have gotten their blood sugars under magnificent control—so much so, that if they saw another doctor they’d never have been diagnosed with Diabetes! All without drugs. While this is not the case with all patients, it happens quite regularly in our clinic.
In the practice of Naturopathic Medicine, patients are given the time they need to understand their disease and what they have to do to keep themselves healthy and their blood sugars controlled. It’s not uncommon that Type II patients might be able to get off their OHA or even their injected insulin, by following their diet plan, by losing weight, exercising regularly, and taking their natural medicines.
Of course, the best thing is to prevent Diabetes in the first place, by eating lightly, exercising regularly, avoiding sugar, high fructose corn syrup, excess grains and taking a good multiple and fish oils every day. But, if you or a loved one develops Diabetes, seeing a naturopathic physician is the best advice you can give them
Something is Happening Here…
by Paul Mittman, ND, DHANP
In fact, it’s happening just about everywhere. Diabetes rates have exploded in the United States and developed countries. Here in the U.S., our government spends billions of dollars treating patients and researching treatments, yet the answer is right under our noses.
Over the last 30 years, Americans ate more junk food in ever-increasing portions (can anyone remember being served an 8 ounce cup of soda pop lately?), consumed more and more calories from carbohydrates, became less and less active, and grew and grew in girth. While new delivery modes for Insulin will certainly make it more convenient and less painful, hence more reliable, for patients who are Insulin dependent, Naturopathic Medicine actually holds the solution for more than 18 million Americans.
At SCNM, we have Dr. Mona Morstein. When she joined our community, she brought more than a decade of experience successfully treating patients suffering from Type II Diabetes. For the past two years, Dr. Morstein has been teaching our students and resident physicians how to help Diabetics achieve lower blood sugars and lose weight, requiring decreased amounts of insulin. In some Type II cases, she has even been able to safely eliminate patient medication. Working with the Southwest College Research Institute, she is also tracking outcomes and will soon publish our first case series on the Naturopathic Treatment of Diabetes.
In addition to her work at our Medical Center in Scottsdale, Dr. Morstein is a research advisor for the San Carlos Apache Tribes new Diabetes Prevention and Treatment Center. She also set up an off-site clinic shift at the Native American Community Health Clinic in downtown Phoenix, where Native Americans and Hispanics receive Naturopathic care for the their diabetes. She has also spoken to the Gila River tribe about including Naturopathic Medicine in their treatment of obesity and diabetes.
Southwest College is committed to increasing our expertise, helping more patients and conducting research on the safe and effective Naturopathic treatment of Diabetes. Together we will make great strides helping people return to health and turn back the tide on this growing health crisis.
Toward great health,
Paul Mittman, ND, DHANP
Diabetes & healthesolutions.com
Dan & Sally Roman are the proud parents of 2 type 1 diabetic children who have successfully managed their disease entirely by lifestyle changes. Dan & Sally offer consultations, workshops and support to people with types 1 and 2 diabetes. They collaborate with health care professionals and educate people on the practical application of lifestyle solutions to help minimize or eliminate the need for insulin and other medications.
Dr. Mona Morstein is associated with this couple and helping them manage patients with Type 1 diabetes.