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Diabetes / Prediabetes

Diabetes and Prediabetes

Rev Diabet Stud. 2014 Summer;11(2):167-74. doi: 10.1900/RDS.2014.11.167. Epub 2014 Aug 10.

The therapeutic potential of milk thistle in diabetes.

Abstract

Milk thistle has been known for more than 2.000 years as a herbal remedy for a variety of disorders. It has mainly been used to treat liver and gallbladder diseases. Silibum marianum, the Latin term for the plant, and its seeds contain a whole family of natural compounds, called flavonolignans. Silimarin is a dry mixture of these compounds; it is extracted after processing with ethanol, methanol, and acetone. Silimarin contains mainly silibin A, silibin B, taxifolin, isosilibin A, isosilibin B, silichristin A, silidianin, and other compounds in smaller concentrations. Apart from its use in liver and gallbladder disorders, milk thistle has recently gained attention due to its hypoglycemic and hypolipidemic properties. Recently, a substance from milk thistle has been shown to possess peroxisome proliferator-activated receptor γ (PPARγ) agonist properties. PPARγ is the molecular target of thiazolidinediones, which are used clinically as insulin sensitizers to lower blood glucose levels in diabetes type 2 patients. The thiazolidinedione type of PPARγ ligands is an agonist with a very high binding affinity. However, this ligand type demonstrates a range of undesirable side effects [weight gain, fluid retention], thus necessitating the search for new effective PPARγ agonists. Interestingly, studies indicate that partial agonism of PPARγ induces promising activity patterns by retaining the positive effects attributed to the full agonists, with reduced side effects. In this review, the therapeutic potential of milk thistle in the management of diabetes and its complications are discussed.

PMID: 25396404   PMCID: PMC4310066
PLoS One. 2014 Apr 9;9(4):e91027. doi: 10.1371/journal.pone.0091027. eCollection 2014.
A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes.
Saslow LR1, Kim S1, Daubenmier JJ1, Moskowitz JT1, Phinney SD2, Goldman V1, Murphy EJ1, Cox RM3, Moran P1, Hecht FM1.Abstract
We compared the effects of two diets on glycated hemoglobin (HbA1c) and other health-related outcomes in overweight or obese adults with type 2 diabetes or prediabetes (HbA1c>6%). We randomized participants to either a medium carbohydrate, low fat, calorie-restricted, carbohydrate counting diet (MCCR) consistent with guidelines from the American Diabetes Association (n = 18) or a very low carbohydrate, high fat, non calorie-restricted diet whose goal was to induce nutritional ketosis (LCK, n = 16). We excluded participants receiving insulin; 74% were taking oral diabetes medications. Groups met for 13 sessions over 3 months and were taught diet information and psychological skills to promote behavior change and maintenance. At 3 months, mean HbA1c level was unchanged from baseline in the MCCR diet group, while it decreased 0.6% in the LCK group; there was a significant between group difference in HbA1c change favoring the LCK group (-0.6%, 95% CI, -1.1% to -0.03%, p = 0.04). Forty-four percent of the LCK group discontinued one or more diabetes medications, compared to 11% of the MCCR group (p = 0.03); 31% discontinued sulfonylureas in the LCK group, compared to 5% in the MCCR group (p = 0.05). The LCK group lost 5.5 kg vs. 2.6 kg lost in MCCR group (p = 0.09). Our results suggest that a very low carbohydrate diet coupled with skills to promote behavior change may improve glycemic control in type 2 diabetes while allowing decreases in diabetes medications. This clinical trial was registered with ClinicalTrials.gov, number NCT01713764.PMID: 24717684 PMCID: PMC3981696Biomed Res Int. 2013;2013:896536. doi: 10.1155/2013/896536. Epub 2013 Jul 25.
Vitamin C intake reduces the cytotoxicity associated with hyperglycemia in prediabetes and type 2 diabetes.Franke SI1, Müller LL, Santos MC, Fishborn A, Hermes L, Molz P, Pereira CS, Wichmann FM, Horta JA, Maluf SW, Prá D.
Abstract
Hyperglycemia leads to the formation of free radicals and advanced glycation end-products (AGEs). Antioxidants can reduce the level of protein glycation and DNA damage. In this study, we compared the levels of vitamin C intake, which is among the most abundant antioxidants obtained from diet, with the levels of fasting plasma glucose (FPG), glycated hemoglobin (A1C), DNA damage, and cytotoxicity in prediabetic subjects and type 2 diabetic subjects. Our results indicated that there was no significant correlation between FPG or A1C and DNA damage parameters (micronuclei, nucleoplasmic bridges, and nuclear buds). FPG and A1C correlated with necrosis (r = 0.294; P = 0.013 and r = 0.401; P = 0.001, resp.). Vitamin C intake correlated negatively with necrosis and apoptosis (r = -0.246; P = 0.040, and r = -0.276; P = 0.021, resp.). The lack of a correlation between the FPG and A1C and DNA damage could be explained, at least in part, by the elimination of cells with DNA damage by either necrosis or apoptosis (cytotoxicity). Vitamin C appeared to improve cell survival by reducing cytotoxicity. Therefore, the present results indicate the need for clinical studies to evaluate the effect of low-dose vitamin C supplementation in type 2 diabetes.
PMID: 23984417 PMCID: PMC3741954

Am J Kidney Dis. 2012 Dec;60(6):896-903. doi: 10.1053/j.ajkd.2012.06.005. Epub 2012 Jul 7.

Effect of addition of silymarin to renin-angiotensin system inhibitors on proteinuria in type 2 diabetic patients with overt nephropathy: a randomized, double-blind, placebo-controlled trial.

Abstract

BACKGROUND:

A large proportion of patients with type 2 diabetes mellitus have diabetic nephropathy. Despite current therapies including renin-angiotensin system inhibitors, diabetic nephropathy progresses to end-stage renal disease in most of these patients. Therefore, there is an urgent need to find new treatments for such patients. The aim of this study was to evaluate the efficacy of silymarin, an herbal drug with antioxidant and anti-inflammatory properties, in preventing the progression of diabetic nephropathy.

STUDY DESIGN:

Randomized, double-blind, placebo-controlled, 2-arm parallel trial.

SETTING & PARTICIPANTS:

60 patients with type 2 diabetes with macroalbuminuria (urinary albumin excretion >300 mg/24 h) despite treatment with the maximum dose of a renin-angiotensin system inhibitor for more than 6 months and estimated glomerular filtration rate >30 mL/min/1.73 m(2).

INTERVENTION:

Patients were randomly assigned to 2 equal groups to receive three 140-mg tablets of silymarin or 3 tablets of placebo daily for 3 months.

OUTCOMES:

The primary outcome was absolute change in urinary albumin-creatinine ratio (UACR) from baseline to the end of the treatment phase.

MEASUREMENTS:

UACR and urinary and serum levels of TNF-α (tumor necrosis factor α; an inflammatory marker), malondialdehyde (MDA; an oxidative stress marker), and TGFβ (transforming growth factor β; a marker of fibrosis) at baseline and the end of the treatment phase.

RESULTS:

Although UACR decreased in both groups, this decrement was significantly higher in the silymarin compared with the placebo group; mean difference in change in UACR between the 2 groups was -347 (95% CI, -690 to -4) mg/g. Urinary levels of TNF-α and urinary and serum levels of MDA also decreased significantly in the silymarin compared with the placebo group.

LIMITATIONS:

Small sample size and short duration of the treatment phase.

CONCLUSIONS:

Silymarin reduces urinary excretion of albumin, TNF-α, and MDA in patients with diabetic nephropathy and may be considered as a novel addition to the anti-diabetic nephropathy armamentarium.

TRIAL REGISTRATION: ClinicalTrials.gov NCT01003236.

Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

PMID: 22770926

 

Arsenic is a toxin which can lead to diabetes, and even high blood pressure and different cancers.

Where is our arsenic coming from?  There are two forms of arsenic, inorganic (most harmful) and organic arsenic (not very harmful, mostly in fish).  Some areas of Canada have elevated inorganic arsenic in the tap water…make sure your home water levels are below 0.01 mg/L (or 10 parts per billion).  We also find an increased amount of arsenic in particular food items, including rice, mushrooms, and poultry.  Often, this is from contamination of the feed or fertilizer that is used, although arsenic is also naturally found in certain rock and soils.  There is also a significant amount of arsenic in pressure-treated wood (called CCA-treated wood) and through the mining and smelting industries.  Find out your level of arsenic.  In our centre, we test arsenic from different sites of the body, the hair, blood, and urine, to understand how recent your exposures were/are, and if your body is able to eliminate it.

Chromium and polyphenols from cinnamon improve insulin sensitivity.

One of the increasing  challenges in health care today, is the slow yet progressive development of prediabetes into diabetes.  The lack of sensitivity to the hormone insulin, is an important step necessary to promote the development of diabetes.  The research study (below) shows that chromium and cinnamon play a role in improving the way our body responds to insulin.  To find out your risk of diabetes, and whether you have prediabetes, come to our centre for a screen.  We can also check if you have enough (or too much) chromium.

Anderson, RA. Chromium and polyphenols from cinnamon improve insulin sensitivity. The Proceedings of the Nutritional Society.  2008 Feb;67(1):48-53.

Otles S, Cagindi O.  Health importance of arsenic in drinking water and food.  Environmental Geochemistry and Health.  April 13, 2010 [Epub ahead of print].

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