Stop the Rust: Antioxidant Therapy in Diabetes
Having high blood sugar causes changes to happen all over the body. In many ways the changes are similar to rust forming - a process known chemically as oxidation. As you have probably witnessed, rust gradually erodes metal until it no longer functions properly. The same phenomenon occurs in the human body when our ability to use fuel (sugar) for energy is impaired. It occurs in many different parts of our body including in blood vessels, in the pancreas (the organ that produces insulin), at the receptors that bind insulin, and inside our cells. Blood vessel damage causes the development of complications in diabetes including kidney damage (nephropathy), nerve damage (neuropathy), eye damage (retinopathy), and hardening of the arteries (atherosclerosis). These complications can lead to kidney failure, pain, blindness, heart attack, and stroke.
Medical researchers have recently learned that rusting, or oxidation, may cause diabetes and the process continues once diabetes has been discovered, causing more and more damage (Evans, 2003 and Brownlee, 2005). The damage is triggered by the production of “free radicals”; free radicals can be thought of as very sticky chemicals that like to change the structure and function of the tissues around them. The levels of free radicals rise because of several factors including antioxidants being too low in the body and the abnormal function of enzymes in our body.
What can be done to prevent this rusting from occurring?
The most important factor in stopping the continuation of oxidation in the body is to do everything possible to get blood sugar, cholesterol, and triglycerides under control and stable. Research suggests that the ups and downs in blood sugar level and the average blood sugar are both important in the development of oxidation. Getting blood sugar under control and stable is accomplished by following a comprehensive diet plan under the supervision of a nutritionist, a frequent exercise regimen, following your doctor’s recommendations about when to take medications, and consulting complementary medicine providers about other therapies.
What about antioxidants?
Put simply, antioxidants stop the rust from forming. You can think of them as decoys that attract and neutralize the very sticky free radical compounds. Common antioxidants include vitamin C (ascorbic acid), vitamin E, selenium, and beta-carotene. Examples of less well-known antioxidants include alpha-lipoic acid, N-acetylcysteine, and coenzyme Q10 - all of which have clinical trial research that shows improvement in blood sugar and/or improvement in oxidation in the body.
Complementary Pearl for Diabetes:
Coenzyme Q10 (CoQ10) improved blood sugar control and lowered hemoglobin A1c by 0.4% in people with Type 2 diabetes (Hodgson et al. 2002); although not a large reduction, research shows every drop counts! Also randomized, placebo-controlled research of CoQ10 in high blood pressure resulted in a 17.8 point blood pressure reduction (Burke et al. 2001).
Should everyone with diabetes take antioxidants?
The short answer is we do not yet know- but some research suggests antioxidant supplements can be helpful. The research on some antioxidants has been disappointing. Current research on vitamin E, for example, has failed to show any preventive effect on heart or blood vessel disease with supplementation (Lonn et al. 2005). However it is important, but confusing, to understand that vitamin E is not a single compound. In fact there are many different forms of vitamin E, including alpha-, delta-, and gamma-tocopherols. Interestingly the vitamin E that has been most tested in clinical research is not the most common form of vitamin E found in food! Also, antioxidants do not act alone in the human body - they act together in finely choreographed dances. In short, the jury is still out on antioxidants however research on some of the more promising antioxidants in just beginning. In my opinion, antioxidant research - especially research of antioxidants in combinations - are one of the most exciting areas of clinical research in diabetes.
Don’t I get enough antioxidants from food?
The answer to this question depends on many factors including your level of blood sugar and the foods you have in your diet. I frequently recommend patients have a colorful plate of food rather than just white and brown. Eliminating white, carbohydrate-rich foods and replacing them with a naturally colored rainbow of fruits and vegetables will typically reduce the glycemic index and load of meals and increase the antioxidants in the meal! The more colors (natural colors- not additives) of food on your plate the better! Research suggests that plant-based pigments are very powerful antioxidants; in fact a large study called the Los Angeles Atherosclerosis Study showed that people with higher levels of certain antioxidant pigments from food seemed to have a slower progression of blood vessel disease (Dwyer et al. 2004). Also research shows that organic (produce grown without added pesticides and herbicides) have higher antioxidant content than non-organic foods.
So what should I take?
My typical recommendation includes:
A high-fiber, low glycemic load diet that eliminates white carbohydrate and adds a rainbow of fruits and vegetables
A combination supplement, often a high-potency multivitamin, that contains a mixture of antioxidants, including vitamin C, vitamin E (as mixed-tocopherols), selenium, and mixed-carotenoids including zeaxanthin and lutein (plant-based pigments)
Additional antioxidant supplements depending on the degree of blood sugar control, current medications, and the presence of other complications
So when should I take:
Coenzyme Q10 (CoQ10): If you have high blood pressure, are on certain cholesterol medications, or have congestive heart failure supplementing CoQ10 may help (Hodgson et al. 2002, Bargossi et al. 1994, Oda et al. 1994)
N-Acetylcysteine (NAC): If your blood sugar is poorly controlled and/or you know you have some blood vessel damage or complications, NAC may be beneficial (Orzechowsk et al. 2003)
Alpha-lipoic Acid (ALA): If you have nerve pain (neuropathy)and are not in good blood sugar control, ALA maybe helpful in reducing pain and improving blood sugar levels (Negrisanu et al. 1999 and Ziegler et al. 1997)
Although all of these antioxidants have clinical research trials that suggest they can be beneficial, all treatments should be discussed with your doctors as interactions with medications can occur and all new treatments should be monitored. I recommend developing an individual plan in consultation with your naturopathic physician.
Ryan Bradley, ND, MPH is a naturopathic doctor, clinical researcher and epidemiologist in San Diego, CA. He is Assistant Director of Research at the National College of Natural Medicine in Portland, OR. In addition to his research, he is a practicing clinician specializing in natural and integrative approaches to treating type 2 diabetes, chronic kidney disease and heart disease at Pacific Pearl La Jolla.