BANKS CHIROPRACTIC & NUTRITION

 

Diabetes is on the verge of replacing heart disease as the leading cause of death in the United States. Death rates from diabetes complications doubled between 1971 and 2000. There are two reasons for this sobering statistic; the percentage of the population with diabetes has been increasing dramatically and treatment approaches have been less successful than they have been for other diseases such as heart disease.

 

Perhaps more than any other chronic metabolic disease, diabetes is largely related to poor diet. As would be expected, diabetes is also generally responsive to diet with an adequate and focused intervention. This is particularly true of the earlier stages of disease in the diabetic spectrum. Long before blood glucose is sustained at a high level consistent with the diagnosis of diabetes, other earlier stages of the disease occur. The chart below shows the evolution of diabetes.

 

The first phase of abnormality of sugar metabolism is a state where insulin functions less optimally. When blood sugar levels rise, insulin secreted by the pancreas signals cells to take blood sugar in to use for energy by stimulating signaling receptors on the surface of the cell. In the initial phase of a blood sugar problem, these receptors become “insensitive” and respond less to insulin. This is compensated by a higher than normal level of insulin release to finally stimulate these receptors and lower blood sugar levels.

 

Insulin resistance is the most correctable phase of the spectrum of diabetes. Several factors contribute to insulin resistance and need to be addressed. These may include inflammation related to imbalances in fatty acids in the diet called “omega” fatty acids. Another factor may be mineral imbalances in the diet such as inadequate chromium, vanadium and magnesium. Perhaps the greatest factor in insulin resistance is the amount of dietary carbohydrate “stress”. Insulin is the workhorse of carbohydrate management. If the workhorse is just too over-worked, things begin to fail.

 

The best indicator of dietary carbohydrate “stress” is the dietary glycemic load. This is a combination of both the amount and type of carbohydrate eaten. Glycemic load should not be confused with glycemic index which does not incorporate both amount and type of carbohydrate.

 

All of the factors in insulin resistance can be delineated by a computerized dietary chemical breakdown and a few lab tests. The basis of correcting it is to first understand the combination of factors driving it in each patient.

 

Insulin resistance is not diagnosed with a standard glucose blood test. It is indicated by a measurement called the HOMA index which is a formula calculated from fasting blood glucose and insulin levels. Basically, when cells “resist” insulin, the blood sugar will be controlled but will require high levels of insulin to do so.

 

Other indications of insulin resistance may include a high ratio of triglycerides to HDL (good cholesterol). Insulin resistance causes an increased disposal of blood glucose by the conversion to triglycerides in the liver. This is thought to generate much of the link between diabetes and secondary heart disease.

 

The third indicator of possible insulin resistance is difficulty losing weight with dietary measures. Lab tests and dietary analysis to direct specific dietary recommendations based on poor insulin function may often result in effective weight loss. Ironically, greater weight loss helps with progressive improvement in insulin function further lowering the risk of actually slipping into full diabetes.

 

 

Impaired glucose tolerance is the next step along the path to full diabetes. The fasting blood glucose level may be normal or intermittently elevated a little. As with early heart disease, diagnosis is aided by a “stress test”. The stress that challenges the sugar handling ability is a blood sugar test done after ingesting a known amount of sugar solution. Even if the fasting blood sugar is normal, levels may rise above that expected 2 hours after the test meal. This is the first indicator that the insulin resistance is now not as effectively overcome by excessive insulin output. This stage again is highly manageable with targeting diet and supplementation.

 

 

At some point, insulin production cannot be raised enough to overcome progressive insulin resistance, and the fasting and after meal blood glucose levels remain high enough to be called outright diabetes. In the early stages, oral medications can be used to try to improve insulin sensitivity along with diet and lifestyle modifications. There is a tendency however, for the medication to have diminished effectiveness over time and insulin production eventual begins to fail. This phase requires insulin replacement therapy.