Stop the Rust:
Antioxidant Therapy in Diabetes
Ryan Bradley,
ND
June 2006
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.
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