Diabetes epidemic threatens cardiovascular disease gains

The March, 2006 issue of the journal Diabetes published the finding of researchers at the Albert Einstein College of Medicine of Yeshiva University of a large increase in the number of diabetes-related deaths and illnesses in New York City, including a significant rise in heart attacks among diabetics. This trend could threaten the decrease in cardiovascular disease and related deaths this country has experienced over the past few decades.

Drs Jing Fang and colleagues examined New York hospitalization and death records for individuals age 35 and older for the periods of 1989 through 1991, and 1999 through 2001. They found that during the intervening decade, mortality from stroke, cancer and all other diseases except diabetes declined, and that mortality from diabetes increased by 61 percent. The percentage of heart attacks among diabetic patients rose from 21 percent to 36 percent with the number of diabetics who suffered heart attacks doubling during this time period. This resulted in the number of heart attacks documented in New York City remaining stable over the period examined in the study. Additionally, days spent in the hospital following a heart attack declined for all but diabetic patients, for which time spent increased by 51 percent.

Senior author Dr Michael Alderman, who is a Medicine professor of epidemiology and population health at Albert Einstein College of Medicine, commented, “Diabetes has reached epidemic proportions in the U.S., and the leading cause of death among people with diabetes is coronary heart disease. We expected to see an increase in hospitalizations due to heart attacks among diabetics, but we were surprised by the magnitude of the increase and the sharply rising trend indicated by these findings.”

Dr Fang, who is currently with the Centers for Disease Control and Prevention in Atlanta, observed, “Over the past 30 years, the U.S. has achieved dramatic reductions in illnesses and deaths from coronary heart disease. But if this upsurge in diabetes-associated deaths and illnesses continues, it may put an end to the progress we've made in combating illness and death from coronary heart disease."

Protocol

Diabetes

* Lipoic acid protects LDL against oxidation and is beneficial in preventing and treating Syndrome X and diabetic complications such as neuropathy. As little as 150-300 mg daily of lipoic acid may be sufficient in healthy individuals. Diabetics usually take 150-300 mg of alpha-lipoic acid 3 times daily. For the last 30 years, German practitioners have used high doses of lipoic acid to improve insulin sensitivity and diabetic conditions.
* Carnosine interferes with the toxic glycation process, thereby preventing the formation of nonfunctioning structures in the body known as AGEs. Diabetics have greatly accelerated rates of glycation compared to nondiabetics. A suggested dosage is 1000 mg daily.
* Essential fatty acids protect the plasma membrane insulin receptors and reduce CRP. Type II diabetics should supplement with high quality fish oil which includes at least 400 mg of EPA and 1000 mg of DHA from fish oil.
* Carnitine improves blood glucose management and increases insulin sensitivity and glucose storage, essential for fat and carbohydrate metabolism. Deficiencies correlate with diabetic neuropathy. A suggested acetyl-L-carnitine dosage is between 300-1000 mg daily.
* Chromium regulates blood glucose levels, fights insulin resistance, lowers HbA1c, aids in weight loss, and inhibits glycation. A suggested dosage is 500-1000 mcg daily.
* DHEA deficiency is associated with a higher rate of insulin resistance and diabetes. A suggested dosage is 15-75 mg, taken early in the day (50 mg represents a typical daily dose). For a discussion relating to caveats surrounding DHEA supplementation and proper dosing based upon individual blood tests, refer to the Therapeutic Section of this protocol.
* CLA aids weight loss and may improve insulin sensitivity. A suggested CLA daily dose is three or four softgels per day of 1000-mg (78%) CLA capsules.
* Magnesium lowers blood glucose levels, increases insulin sensitivity, and calms the SNS. Use at least 500 mg of elemental magnesium daily.
* Silymarin improves hepatic glucose control and reduces free-radical activity. A suggested dosage for Syndrome X patients (those not yet diagnosed with diabetes) is a supplement that provides 250 mg a day of silibinin and 60 mg of silymarin. Diabetic patients often take 2-3 of these silibinin/silymarin capsules each day.
* N-acetyl-L-cysteine (NAC) protects beta cells against free-radical destruction. A suggested dosage is 600 mg daily.
* CoQ10 enhances beta cell function and glycemic control and protects against heart disease. A suggested dosage is 100-300 mg a day.
* Vitamin C lowers blood glucose levels, inhibits glycation, prevents accumulation of sorbitol, strengthens capillaries, aids wound healing, and protects against free radicals. A suggested dosage is 1-3 grams daily in divided doses.
* Vitamin E reduces oxidative stress, enhances insulin sensitivity and glucose transport, and prevents complications arising from inflammation. Antidiabetic value has been observed using from 400-1200 IU of alpha tocopherol vitamin E daily along with a supplement that provides at least 200 mg of gamma tocopherol.
* Bilberry reduces blood glucose levels. A suggested dosage is 100-200 mg 3 times daily. (The bilberry extract should be standardized to contain 25% anthocyanidins.)
* Biotin aids in metabolism of macronutrients, enhances glucose utilization, and is beneficial in diabetic neuropathy. A suggested antidiabetic dosage is 8000-16,000 mcg daily.
* Vitamin K appears to play a role in insulin's response to glucose. Vitamin K is nontoxic at the recommended 10-mg daily dose.

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