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This article
first appeared in the by Dr. Emmanuel Opara Click Here
to Read Part II Type 2 diabetes constitutes more than
90% of all cases of diabetes mellitus. As many as 80% of individuals with
type 2 diabetes are overweight or obese and obesity often precedes the
development of diabetes. The development of obesity and insulin resistance
depends on a complex interaction between genetic background and diet. Studies
have shown that dietary fat is the primary nutritional stimulus for the
development of obesity and the associated type 2 diabetes. Despite these
findings, consumers are ambivalent towards fat in their foods. To help
prevent the deleterious effects of fat consumption, people suffering from
diabetes, those who are at risk such as persons with family history, and aged
individuals who are deficient in antioxidants, would derive benefits by using
appropriate doses of such supplements as vitamins C and E, L-glutamine,
taurine, chromium and possibly ubiquinone and gymnema sylvestre. The
mechanism of action and the effective doses of these supplements will be
discussed in part II of this article. Diabetes Diabetes mellitus is a chronic and
potentially disabling disease which represents a major public health and
clinical concern.(2) Individuals suffering from diabetes are at an increased
risk of developing chronic complications related to ophthalmic, renal,
neurological, cerebrovascular, cardiovascular, and peripheral vascular
diseases. Consequently, people with diabetes are more likely than those
without the disease to have heart attacks, strokes, amputations, kidney
failure and blindness.(2) Furthermore, as a result of diabetes and its
complications, persons with diabetes have more frequent and intensive
encounters with the health-care system. In 1987, the economic costs of
diabetes was estimated at $20.4 billion, of which 47% were direct medical
expenditures. This estimate included some costs associated with chronic
complications of diabetes but excluded the costs of surgical procedures, home
health care, emergency rooms, ambulance services, services provided by
licensed dietitians, physical therapy and costs associated with the late
complications of diabetes. (2) Prevention & Treatment In a carefully designed study, the
differential effects of fat and sucrose (carbohydrate) on the development of
obesity and diabetes have been examined. (3) In the study, diabetes-prone
C57BL/6J (B/6J) mice and diabetes-resistant A/J mice were fed one of four
different diets, namely: a) high-fat, high-sucrose diet, b) high-fat,
low-sucrose diet, c) low-fat, high-sucrose diet, d) low-fat, low-sucrose
diet. After four months on these diets, it was found that B/6J mice gained
more weight on both high-fat diets without consuming more calories than A/J
mice. In the absence of fat, sucrose caused a decrease in body weight gain in
both strains. Furthermore, whereas fat induced the development of insulin
resistance characterized by hyperglycemia and hyperinsulinemia, sucrose had
no effect on blood glucose and insulin levels.(3) These data clearly show that
the development of obesity and insulin resistance depends on a complex
interaction between genetic background and diet. In other studies performed
in both humans and animal models, it has also been shown that fat is a
primary nutritional stimulus for the development of obesity and the
associated type 2 diabetes. Thus, the high content of fat in most Western
diets accounts for the increased incidence of both obesity and diabetes in
these populations. Any diet whose fat content equals or exceeds 30% of total calories
should be considered high. However, consumers have an ambivalent attitude
towards fat in their foods. The reason for this is, although high-fat
consumption is associated with increased risk for obesity, diabetes and other
diseases such as heart disease, fatty foods are known to make meals more
palatable. The stability over years in fat intake suggests that consumers are
unwilling to sacrifice the pleasure of eating fatty foods for health
reasons.(4) A sensible compromise could be achieved under these circumstances
if consumers are aware of nutritional supplements that would help to prevent
the development of deleterious metabolic effects of dietary fat. Oxidative stress & diabetic
complications Dietary factors The study by Surwit and colleagues
showed that diet did not affect plasma glucose and insulin levels in A/J mice
but high-fat diets induced significant gains in body weight in this
diabetes-resistant mouse strain. This observation may explain why some
individuals gain significant body weight without developing diabetes. Type 2
diabetes is known to have a familial aggregation and studies of twins and
offsprings of diabetic patients have provided a strong evidence for a role of
the genetic component in the development of this disease.6 Although there is
good evidence that type 2 diabetes may be determined by major genes in high
-risk individuals, a polygenic mode of inheritance may not be responsible for
glucose intolerance. In spite of increased search, no single specific marker
for type 2 diabetes has yet been found but linkage in some families has been
discovered.(6) The incidence of diabetes increases
with age. Impaired glucose tolerance (IGT) is clearly the first recognized
stage in the development of type 2 diabetes and it has been reported that the
prevalence of IGT reaches 23% at ages 65-74 years in the US population.(6)
The are several reasons to explain the increased incidence of type 2 diabetes
with age. First, aging appears to induce a specific defect in
glucose-stimulated insulin secretion. This defect is an aspect of the global
defect in glucose metabolism that generally occurs with aging and this has
been attributed to multiple postbinding defects (including glucose transport)
after insulin binding to its receptor. Second, abnormalities in insulin
regulation of FFA /lipid metabolism secondary to increased fat mass and
substrate competition between fat and glucose are present and appear to play
a role in insulin resistance of human aging. Third, antioxidant defense
systems are reduced with age. To prevent these changes that occur with aging,
the need for supplements is apparent. Among the beneficial supplements for
disease prevention are: antioxidants such as ubiquinone, vitamins C and E;
supplements that enhance tissue antioxidant levels such as L-glutamine; other
supplements that inhibit fatty acid oxidation such as L-glutamine and
taurine, as well as those such as L-glutamine and chromium which promote
blood glucose regulation through the reduction of body weight. In addition,
the use of antioxidant supplements may also prevent the development of other
age-associated diseases. Summary Dr. Emmanuel C. Opara is a research
professor in the Departments of Surgery and Cell Biology and is a member of
the Sara W. Stedman Center for Nutritional Studies at Duke University Medical
Center in Durham North Carolina. |
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