Diabetes
A Nutritional and Functional Medical Approach To
Diagnosis and Treatment
By Ronald J. Grisanti D.C., D.A.B.C.O.
Diabetes affects an estimated 17 million Americans, and the number rises
each year. Here you'll find in-depth information about the real causes of
Diabetes, peer-reviewed medical diagnosis and advanced medical
treatment options not found anywhere else.
Diabetes mellitus results from the inability of the body to control blood glucose
levels adequately due to a lack of insulin or insulin resistance. Diabetes mellitus
is a disease in which the body does not produce or does not use insulin
effectively. It is the most common endocrine disease, affecting approximately 17
million.
Insulin is a hormone produced in the pancreas. Insulin is produced in direct
response to your glucose (sugar) levels It is responsible for transporting glucose
(from carbohydrates) into the cells to fuel cellular metabolism and energy
production. After a meal, when blood sugar increases, insulin levels rise.
Between meals, when blood sugar is low, insulin levels remain low. Simply put,
insulin reduces blood sugar.
Diabetes can affect people of any age. It increases the risk of chronic, debilitating
conditions, including cardiovascular disease, retinopathy and blindness,
peripheral neuropathies, vascular insufficiency and amputation, immune
deficiencies, skin ulceration and wound healing disturbances, and kidney
disease.
Diabetes is diagnosed when there is a fasting plasma glucose (FPG) of greater
than 126mg/dL, or a two-hour plasma glucose (OGTT – oral glucose tolerance
test) of greater than 200mg/dL.
Three physiological abnormalities typically occur in type 2 Diabetes: insulin
resistance, increased glucose production in the liver and poor beta cell function.
These can occur individually or in combination.
Insulin Resistance
Insulin resistance appears to be the first stage of the disease. Insulin resistance
is defined as an inability of insulin to pull glucose out of the blood and put it into
the cells. In a healthy person, insulin will firmly attach itself to the run-away
glucose and hold on to it. It will then safely transport the glucose to its
destination. Even though the beta cells of the pancreas is able to produce normal
amounts of insulin in direct response to the rising glucose, it simply unable to
attach itself to the glucose. Unfortunately this causes glucose levels to rise. In
response, the pancreas releases more and more insulin.
This is likely the result of genetic defects that cause an inadequate number of
insulin receptors and/ or an inefficient glucose transport system. Insulin
resistance is due to high insulin levels, not high glucose levels. Although blood
glucose can be maintained within normal limits if enough insulin is produced,
eventually, though, the beta cells "burn out" and insulin resistance may progress
to full-blown diabetes.
Liver Gluconeogenesis
Many people with type 2 diabetes also produce a large amount of glucose in the
liver. In biochemistry terms, this is called hepatic gluconeogenesis. This increase
in glucose is likely related to fat breakdown. When the body is not efficiently
using glucose as an energy source, fat becomes an important source of fuel. The
breakdown of fat causes the liver to produce glucose. Because patients with type
2 diabetes are insensitive to the effects of insulin, which normally suppresses the
production of glucose in the liver, this gluconeogenesis goes unchecked.
Beta Cell Exhaustion
In type 2 diabetes, the ability of the beta cells (beta cells make insulin) to release
insulin needed after eating a meal deteriorates early on in the disease process.
Therefore, blood glucose remains high for one to two hours after a large meal. As
the disease progresses, the insulin release that continues following a meal
worsens, resulting in pancreatic beta cell exhaustion.
Type 2 diabetes appears to be caused by genetic defects that initially result in an
inability of insulin to bind or attach itself to glucose. Unfortunately, over time the
pancreas’s ability to make more insulin via the beta cells completely erodes
leading to a run-away glucose problem. However, new evidence has emerged
which points to diet and lifestyle as important contributing factors to the
development of the disease.
A person over the age of 45 and overweight is a prime candidate for developing
type 2 diabetes. Approximately 30-39 percent of Americans are obese, and many
more are overweight. Research has shown a strong correlation between upper
body obesity ("apple shapes") and the development of type 2 diabetes mellitus.
Complications from Untreated Diabetes
The long-term complications associated with diabetes are serious, often life
threatening, and diagnosed in the late stages of the disease progression. These
complications are due to persistently elevated glucose levels from poor glucose
control. Coronary heart disease and peripheral vascular disease retinopathy,
nephropathy, and neuropathy are some of more common complications
Heart disease is the leading cause of diabetes-related deaths, with adults having
two to four times higher heart disease death rates than adults without the
disease. The risk of stroke is two to four times higher in people with diabetes.
Patients with diabetes experience an accelerated rate of arteriosclerosis, and
some 60-65 percent of patients with diabetes have high blood pressure.
It can lead to blindness, heart disease, strokes, kidney failure, amputations, and
nerve damage.
GI problems such as chronic constipation, or diarrhea, loss of sexual function,
bladder function are symptoms of untreated Type 2 diabetes
Diabetes is the leading cause of nontraumatic amputations in the U.S.
Inability to maintain normal glucose control can lead to many metabolic diseases,
including obesity, heart disease, hypertension, diabetes, chronic fatigue,
accelerated aging, as well as numerous mental and emotional disorders.
Unfortunately, without early and accurate preventive testing, the first "sign" that
surfaces may be a permanent complication from type-2 diabetes such as nerve
loss, impotence, or even blindness.
SIGNS & SYMPTOMS
Frequent urination
Increased thirst
Fatigue
Irritability
Dizziness
Lethargy
Loss of coordination
Perspiration
Nausea
Fruity odor to the breath
Blurred Vision
Numbness or burning sensation in hands and feet
Traditional Clinical Lab Assessments
Blood Glucose
Elevations of serum glucose should lead to confirmatory testing such as fasting
insulin, serum phosphorus, magnesium, hemoglobin A1c, and/or fructosamine.
Urine Glucose
Glucose Tolerance Test (GTT)
Fructosamine
Blood or urine glucose provides information about immediate diabetic control,
fructosamine about short-term control (last 20 days), and HbA1c about long-term
control (3-month period)
Glycohemoglobin (HgbA1c)
Elevated HbA1c levels reflect poor diabetic control in the previous three to 12
weeks. HbA1c can provide information missed in spot checks of urine or serum
glucose.
Functional Medicine Clinical Lab Assessments
The following laboratory testing can provide valuable information necessary for
diagnosis and treatment. The information obtained from these advanced medical
tests can be the "key" to finding the "cause" of diabetes.
Organic Acid Test
Organic acid testing is one of the most powerful test used to identify specific
nutritional and metabolic causes of challenging health problems.
Organic acids testing is a urine test. Science has discovered specific chemicals
in the urine that pinpoint "glitches" in one's health. These chemicals are referred
to as metabolic end products. These end products have fancy names like
Xanthurenate, Kynurenate, Methylmalonate.. to name a few. Each of these end
products is linked to a specific function in the body. If you have too much of these
end products, it can help your doctor determine the probable cause of your
health problem. Abnormal high levels of organic acids can be traced to inherited
enzyme deficiencies, build-up of toxins, nutrient deficiencies, or drug effects.
Every cell is affected when a metabolic pathway is damaged.
A single urine specimen can test and scientifically evaluate:
Fatty acid metabolism
Neurotransmitter metabolism
Carbohydrate metabolism
Oxidative damage
Energy production
Detoxification status
B-Complex sufficiency
Intestinal dysbiosis due to bacteria and yeast
Methylation co-factors
Inflammatory reactions
Organic Acid Testing has been found to not only be beneficial for the clinical
evaluation of diabetes but for the following conditions:
Cardiovascular Disease
Identifying individuals who are deficient in coenzyme Q10 and other cardioprotective nutrients should routinely be part of any comprehensive risk reduction
plan. Organic acid testing provides documentation for the use of nutrient
therapies to reduce cardiovascular problems. Cholesterol lowering drugs such as
Lipitor can interfere with the production of CoQ10. Vitamin B12, folic acid and
vitamin B6 can reduce the levels of homocysteine. Organic Acid Testing can help
your physician identifying specific biomarkers which are linked to these
deficiencies. If your urine reveals high levels of the following: Succinate,
Xanthurenate, Kynurenate, Methylmalonate, Formiminoglutamic Acid, then it is
quite clear that you are deficient in CoQ10, B12, folate, B6 and are risk of
developing heart disease. The reduction of this metabolic end products provide a
valuable piece of your heart health.
Chronic Fatigue
Most patients experiencing chronic fatigue have multiple factors impacting
energy production. Low thyroid and adrenal function, psychological stress, toxic
overload, poor dietary habits, lack of exercise, sleep cycle disruptions, chronic
pain, and inadequate nutritional status can all play a role. The assessment of cell
dysfunction may be the key to breaking the energy blockage. If the basic energygenerating system is blocked or sluggish, cells cannot meet their metabolic
needs. Over time, this decreased capacity creates organ weakness and a
intense fatigue, which is further evidenced by accumulated metabolic end
products in the urine. High levels of the following end products have been linked
to chronic fatigue: alpha-Ketoglutarate, Succinate, Fumarate, Malate.
Depression
Organic Acid testing helps to identify depressed patients who may benefit from
specific nutritional approaches. No other single assessment tool provides
simultaneous markers of B vitamin status, methlyation cofactors,
neurotransmitter metabolism, and sulfur-containing amino acids. Since unmet
needs for vitamins B6 or B12, folic acid, and serotonin or catecholamine
precursor amino acids can exacerbate depressive tendencies, identifying any
one of these factors may help in the management of your clinically depressed
patients. High levels of the following metabolic end products have been linked to
depression: Xanthurenate, Methylmalonate, Formiminoglutamic Acid,
Kynurenate, Pyroglutamate, Sulfate, Vanilmandelate, Homovanillate, 5Hydroxyindoleacetate, Orotate
Obesity
The Organic Acid test reveals numerous metabolic factors other than caloric or
fat intakes that have effects on body weight. The most common interventions
involve optimal doses of essential amino acids, carnitine, and vitamin-derived
cofactors for energy pathways. Such predictive metabolomics allow you to
assess metabolic efficiency. Addressing these issues at the functional level is far
more efficient than searching for potential influences with predictive genomics
testing. Metabolic profiling with the New Organix Profile gives you direct insight
into fatty acid, amino acid, and carbohydrate metabolism as well as nutrient
deficiencies related to carnitine, chromium, vanadium, B vitamins, and lipoic acid.
All have been implicated in obesity. The following metabolic end-products have
been linked to obesity: Adipate, Suberate, Ethylmalonate, Pyruvate, Lactate,
beta-Hydroxybutyrate
Organic acids analysis is a useful method for measurement of biochemical
intermediates in urine. These intermediates can offer information about key
enzyme functions and nutrient competence (amino acids, nutrient cofactors,
minerals and fatty acids). Several examples can be cited:
Elevations of pyruvate, lactate, á-hydroxybutyrate, and â-hydroxybutyrate
indicate impairment in enzyme functions relative to carbohydrate metabolism.
Elevation of tricarballylate suggests functional magnesium deficiency, which can
impact glycemic response mechanisms due to bacterial pathogens.
Elevation of vanilmandelate reflects elevations in epinephrine, an aggressive
antagonist of insulin.
Detoxication and dysbiosis markers in organic acids suggest the relative
competence of the liver and gastrointestinal tract to detoxify insulin, a critical
process in carbohydrate metabolism.
Red Blood Cell Mineral Test
Research suggests that early imbalances of specific minerals may play an
important role in upsetting healthy glucose and insulin metabolism.
Both high levels of toxic heavy metals and low levels of essential minerals have
been linked to the accelerated progression of type-2 diabetes and its related
complications.
Chromium is a trace mineral that may improve glycemic regulation. Chromium
acts as a powerful blood sugar modulator that can help safe-guard against
glucose imbalances. It helps to lower glucose response in individuals with
elevated levels.
Chromium has a beneficial metabolic effect by increasing insulin's ability to bind
to cells. Chromium supplementation appears to produce a positive effect on
glucose and insulin metabolism only in people with pre-existing deficiencies.
Besides chromium, other minerals that have been found to play an important role
in glucose regulation and insulin sensitivity include zinc, potassium, magnesium,
selenium, and vanadium.
Magnesium and potassium deficiencies are often found in patients with diabetes,
and may impair cardiac function and carbohydrate metabolism. Low levels of
serum magnesium have been found to be a strong, independent predictor of
type-2 diabetes in white subjects. shortages "can ameliorate or prevent"
cardiovascular complications in diabetes.
Zinc plays an important role in the body makes and uses insulin. Lower levels
may affect the ability of the pancreas to produce and secrete insulin, particularly
in type-2 diabetes.
Research has shown that the trace mineral vanadium has strong potential for
improving glucose and insulin regulation in diabetics.
Besides nutrient imbalances, exposure to toxic heavy metals can also increase
the risk of developing type-2 diabetes and related complications.
In general, higher levels of heavy metals, such as mercury, are associated with
increased oxidative stress and higher risk of degenerative complications such as
heart disease. Studies show that individuals who are exposed to higher amounts
of arsenic - in their soil and/or drinking water - have a higher independent risk of
developing type-2 diabetes.
Cadmium, a heavy metal contaminant found in air, soil, and water, can
accumulate in the body with chronic exposure. Such accumulations increase the
likelihood of kidney damage/ failure, spur free radical activity, and exacerbate
neuromuscular complications of type-2 diabetes.
Treatment Options:
Disease-Specific Treatments simply refer to the fact that treatment is directed
to suppress symptoms with little consideration to the reasons why a person is
sick in the place. Almost all conditions are treated "exactly" the same. Instead of
the treating the individual patient with the disease, the disease is treated instead.
Remember this type of treatment DOES NOT take in consideration, the unique
makeup of each individual.
Oral drug therapy for the management of type 2 diabetes now includes more
choices of agents in several drug classes, most of which work by different
mechanisms of action. Sulfonylureas cause release of insulin from the pancreas
and increase the sensitivity of insulin receptors; biguanides work in the liver;
thiazolidinediones work in muscle tissue; glucosidase inhibitors work in the small
intestine; and meglitinide causes release of insulin from the pancreas.
Patient-Specific Treatment Options
* The following treatment options have been researched and found to be
effective in the management of depression. It is highly discouraged to assume
that any of the below natural products are going to cure your health condition.
Unfortunately, many people attempt to self diagnose or believe that a specific
supplement or natural treatment will cure their problem. The purpose of this site
is to provide medically sound answers to many of the most chronic health
challenges.
You first MUST be evaluated to determine EXACTLY what natural treatments will
help. Once you are properly tested, your physician will then be in a position to
pinpoint the probable causes of your health problem and make the appropriate
recommendations. For instances, if your physician finds that the cause of your
depression is due to amino acid deficiencies than he/she can then personalize
your treatment. On the other hand, if your Organic acid test shows that your
levels of B6, B12 and folate are well within normal ranges, then you can see why
taking B6, B12 or folate would not be effective in improving depressive disorders.
Remember, instead of treating a "disease" we are treating the "person with the
disease". No two people are alike. For one person, the cause of their *
Disease-Specific Treatments simply refer to the fact that treatment is directed
to suppress symptoms with little consideration to the reasons why a person is
sick in the place. Almost all conditions are treated "exactly" the same. Instead of
the treating the individual patient with the disease, the disease is treated instead.
Remember this type of treatment DOES NOT take in consideration, the unique
makeup of each individual.
Patient-Specific Treatment Options are the future of medicine. Identifying the
cause of your health problem then personalizing the treatment will soon be the
accepted norm for people who are sick and tired of simply treating symptoms but
instead want to get well.
Natural Herbal and Supplement Remedies:
Gymnema
Bitter Melon
Evening Primrose
Coenzyme Q10 (CO-Q10)
A deficiency of coenzyme Q10 could damage how the body processes insulin.
CoQ10 supplementation may improve the functioning of beta cells and the
production of insulin.
Biotin
Biotin reportedly stimulates glucokinase enzyme activity. This is an enzyme that
plays an important role in regulating a range of glucose-related metabolic
processes. It appears that biotin may be a safe nutritional product to aid in the
management of type 2 diabetes.
Chromium
Various studies support that chromium has a positive effect on blood glucose
levels, and recent studies report that chromium may positively impact
hemoglobin A1c as well.
The glucose tolerance factor (GTF), which is comprised of trivalent chromium,
niacin, glycine, glutamic acid, and cysteine has been found to be an excellent
source of chromium Dr. Walter Mertz of the United States Department of
Agriculture researched GTF chromium. He found that chromium was a crucial
part of the binding complex that allowed insulin to attach to cells. Organically
bound GTF chromium is thought to be safe and well tolerated.
Chromium picolinate is another popular form of chromium that has clinical
support for blood sugar regulation..
For diabetics, adding chromium to the diet should be done gradually, especially if
they are currently controlled on medication. Recent studies report 600mcg to
1,000mcg a day may be needed to control the type 2 diabetic.
Magnesium
Magnesium is involved in glucose metabolism and insulin secretion. It is well
documented that low magnesium may aggravate diabetic conditions.
Vanadium
Supplementation with vanadyl sulfate and other vanadium compounds has been
reported to markedly improve a number of clinical measures of diabetes. It
appears that vanadium mimics the effects of insulin, resulting in decreased
gluconeogenesis and an increase in glycogen production.
Animal studies have demonstrated that vanadium administered to diabetic rats
restores elevated blood glucose to normal ranges. Human studies have shown
that Type 2 diabetics given oral vanadyl sulfate (50mg twice daily for four weeks)
in a single-blind, placebo-controlled study had a nearly 20 percent drop in fasting
blood glucose in one study.
Vanadium pentoxide and vanadyl sulfate are active, absorbable forms of
vanadium.
Alpha-Lipoic Acid (ALA)
Alpha-lipoic acid (ALA) is an antioxidant substance produced by the body. ALA is
also known as alpha-lipoate or thiotic acid. Alpha-lipoic acid has also
demonstrated a positive effect on insulin and blood sugar metabolism for type 2
diabetics.
Zinc
Zinc deficiency is associated with a number of metabolic disorders, including
impaired glucose tolerance, insulin degradation, decreased insulin potency, and
reduced pancreatic insulin content. Zinc plays a role in the regulation of insulin
production by the pancreas and glucose utilization by muscle and fat cells. Zinc
also serves as a component in glucose transport and in gene expression of
insulin receptors.
Cyclo (His-Pro)
Cyclo hispro, a thyrotropin releasing hormone metabolite, is thought to be a
useful agent in improving blood sugar regulation. Cyclo hispro has potential for
individuals with hypoglycemia, diabetes, and impaired glucose tolerance (IGT). It
has been documented that individuals with diabetes have impaired intestinal zinc
absorption and low plasma zinc levels. Studies suggest that Cyclo hispro extract
influences intestinal zinc absorption mechanisms. This extract not only contains
high levels of zinc, but also several cofactors reported to stimulate intestinal zinc
absorption.
In a recent controlled clinical trial, cyclo hispro was administered to 22 male
subjects with type 2 diabetes. After three months, the treatment group reportedly
exhibited significantly diminished fasting blood glucose levels and fasting plasma
insulin levels.
Improving zinc utilization is important because it plays a role in over 300 different
enzymatic functions. Most importantly for the diabetic, it is involved in wound
healing, immune function, and skin integrity.
Lifestyle and Nutritional Advice:
Diabetes and obesity has reached epidemic proportions in the last few years.
People simply don't eat enough fresh foods, and there are fewer micronutrients in
the soil (like chromium and vanadium) where food is grown. Carbohydrates alone
are not the culprit, because humans were eating carbohydrates long before these
problems arose. It is true, however, that people are eating excessive amounts of
carbohydrates, and it would be better to moderate that intake.
There are several ways to improve insulin regulation with natural agents, but the
real key is to adjust the dietary selection of foods. In general, the American diet
consists of way too many carbohydrates, especially refined carbohydrates.
People do not eat enough fresh vegetables and fruits, and quality sources of
protein and legumes. In addition most people do not take in adequate sources of
essential fats. With the average American eating approximately 150 pounds of
sugar a year, it is apparent that there is a continual demand for more insulin
production. The average person drinking two "big gulp" drinks a day is receiving
approximately 54 teaspoons of sugar.
The apparent first step is to eat foods that will least aggravate insulin response.
The first concept to understand is the glycemic index. It is a known fact that
certain foods actually cause a sharper rise in insulin release than others. Foods
that do not cause a rapid rise in blood sugar will not aggravate the insulin
response. For example, in the past, it was thought that all complex carbohydrates
were equal. It is now known that different grains have varying glycemic
responses. It is valuable to consider the glycemic index when looking at foods
that contain varying amounts of carbohydrates. Proteins and fats have virtually
no glycemic factor.
Legumes: Virtually all legumes have a moderate glycemic index.
Vegetables: Some vegetables have a high glycemic index and should be used in
moderation if one is trying to actively control blood sugar. The most prominent of
these are white potatoes (baked), carrots, beets, and turnips.
Dairy products: Most dairy products have a low glycemic index. However, some
people do not tolerate dairy well.
Fruits: Fruits are generally in the middle of the road in terms of glycemic index,
but dried fruits, which are concentrated, rank higher. Drinking fruit juices will
definitely aggravate blood sugar response and is known to contribute to
triglyceride response. Therefore, fruit juices should be limited Most sweeteners
such as honey, molasses, sugar, and white grape juice concentrate tend to have
a high glycemic index. Rice syrup and granulated rice sweeteners are also
acceptable alternatives. There is some evidence that aspartame may aggravate
insulin resistance over time.
Grains: Many of the grain sources such as rice, wheat, and corn tend to have a
high glycemic index, but grains such as buckwheat, millet, barley, rye, and bulgur
are actually quite low. For successful weight loss and blood sugar control, this
group of foods should be used in moderation. Also, the addition of fats such as
olive oil or butter (in moderation) can slow the glycemic index.
Fiber: Fiber is an important part of the diet for a number of reasons. It is well
known that fiber helps prevent constipation. However, fiber also controls sugar
and cholesterol levels and aids in the prevention of colon cancer and
diverticulitis. Most individuals with diabetes/insulin resistance do not realize that
they run a 75 percent risk of developing arteriosclerosis. Reducing cholesterol
levels through the use of fiber is one way to combat this problem.
Exercise: Along with dietary responsibility, exercise is the most important step
diabetics can take toward tighter blood sugar control. At a minimum, diabetics
should get 30 minutes of some form of exercise at least four days a week, but
more would be beneficial. Anyone who is over 40, or a brittle diabetic, and has
not been exercising, should seek medical advice and supervision before initiation
of any exercise program.
Closing Comments: As you can see from this paper on Nutritional and
Functional Medical Approaches to the Evaluation and Treatment of Diabetes,
there is a new direction medicine is taking to uncover the possible cause(s) of a
variety of health challenges. There is a wealth of medical research supporting the
information presented in this paper.
If you or someone you know is suffering from the deliberating effects of diabetes,
I encourage you to carefully give serious consideration to this important paper. I
would suggest that you discuss this information with your physician. If you are
interested in finding a doctor who practices functional and nutritional medicine,
please feel free to send me an e-mail to drgrisanti@charter.net I will simply need
your town and state and I will see who is available to help you.
The following labs offer the above mentioned lab tests
Great Smokies Diagnostic Labs: (800)522-4762
MetaMetrix Labs: 800-221-4640
I would like to invite to take a look at my site www.YourMedicalDetective.com.
Here you will find a wealth of information to help you and your physician uncover
the possible cause(s) of a variety of diseases. If you enjoyed reading this paper, I
am confident you will thoroughly enjoy my site www.YourMedicalDetective.com
Contact Information;
Ronald J. Grisanti D.C., D.A.B.C.O.
4200 East North Street
Greenville, South Carolina 29615
Phone: 1-864-292-0226
FAX: 1-864-268-7022
E-mail: drgrisanti@charter.net
Website: www.YourMedicalDetective.com
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The following is an Organic Test Lab Test