Since it has become evident that cases of type 2 diabetes are on a rapid increase, medical professionals and researchers across the globe have been racing to find new ways of treating and/or reversing the condition. While most of this research is taking place within well-established and recognised medical and pharmaceutical institutions, there is also research into diabetes cures taking place within alternative and complementary medical therapies.

At the recent multidisciplinary diabetes study day, themed ‘Shifting sands in diabetes management and care delivery’, naturopath Carina Harkin presented the naturopathic angle on the causes of type 1 and type 2 diabetes as well as a range of naturopathic treatments in terms of diet, lifestyle, herbal medicine and supplements for these conditions. 

Meanwhile, Prof Richard Firth presented the evidence-base for complementary and alternative medicine (CAM) therapies in diabetes and pointed out that while the mere mention of CAM therapies makes some healthcare professionals frown, over 200 current medications are derived from plants, which of course are at the basis of many CAM therapies as well. 

The study day was organised by Diabetes Ireland in conjunction with the Irish Endocrine Society, the Irish Nutrition and Dietetic Institute and the Irish Diabetes Nurse Specialist Association. 

Naturopathic causes of type 1 diabetes

According to Carina Harkin, there are three main lines of thought as to the naturopathic causes of type 1 diabetes: that of the hygiene hypothesis and molecular mimicry (aka major histocompatibility complex dysfunction); the leaky-gut syndrome (meaning increased intestinal hyperpermeability); and that of excess inflammatory mediators, including C-reactive protein. This means that naturopaths believe there is more than just a ‘genetic’ cause of type 1 diabetes.

The hygiene hypothesis and molecular mimicry

The hygiene hypothesis basically refers to a lack of exposure in childhood to infectious agents, micro-organisms (eg. gut flora or probiotics) and parasites. This lack of exposure increases susceptibility to allergic disease by suppressing development of the immune system.

“So when the child comes in contact with bacteria and viruses, this activates a Th1-mediated immune response which down-regulates Th2 responses to keep the immune system in check,” said Ms Harkin.

“So in autoimmune diseases like type 1 diabetes, the Th2 is overactive and it needs to be disciplined.”

According to Ms Harkin, autoimmune diseases like type 1 diabetes and acute lymphoblastic leukaemia in young people in the developed world, and even autism according to some theories, have the hygiene hypothesis as part of their pathogenesis. Why this is particularly so in the developed world is due to the high uptake of vaccinations, the suppression of fevers (with paracetamols, etc), higher number of C-sections and more women not breastfeeding.

“Naturopaths really like fever,’ said Ms Harkin. “A sign of someone who is really healthy is someone who throws a really good fever.”

According to Ms Harkin, there are several benefits of a healthy fever, which in adults would range between 38-40ºC, such as the increased mobility of leukocytes, enhanced leukocytes phagocytosis, decreased endotoxin effect and increased proliferation of T cells.

“Most importantly, when it comes to fevers in relation to type 1 diabetes, it downregulates the immune system to prevent the body from attacking itself.”

Molecular mimicry on the other hand occurs when the body’s immune system is uneducated and cannot recognise one cell from another. This leads to the body attacking its own cells. In type 1 diabetes, naturopaths think this molecular mimicry is linked to bovine protein in milk, which is very similar to the protein in the islets of Langerhans in the pancreatic cells.

“So if the body develops antibodies to the bovine protein, these can also attack the islets of Langerhans, leading to insulin-dependant diabetes,” suggested Ms Harkin.

Leaky gut syndrome

Increased intestinal hyperpermeability, or so-called leaky gut syndrome, occurs in the tight junctions within the gastrointestinal tract. The tight junctions represent the major barrier between intestinal epithelial cells that line the gastrointestinal tract, and are meant to prevent antigens from entering the bloodstream. Damage to the T junctions means that antigens get into the bloodstream and set off an immune reaction creating antibodies meaning more antigen-antibodies will be circulating in the system.

“These antibodies will travel through the body and lodge in different places determined by genetics,” said Ms Harkin. 

“So for example, if they lodge in the lungs, it will lead to asthma, if they lodge in the nose its hayfever, in the stomach it’s inflammatory bowel disease or Crohn’s disease, and in the pancreas it’s type 1 diabetes.” 

According to Ms Harkin, this damage to the T junctions occurs through inflammation (inflammatory cytokines), but can also occur from people not chewing (digesting) their food properly.

“Large molecules can tear a hole in the gut lining, they get into the bloodstream and set off an immune reaction in the stomach that shouldn’t be there.

“As naturopaths, we will try to heal the gut lining in order to prevent this chain of events.”

Excess inflammatory mediators including C-reactive protein

C-reactive protein (CRP) is an inflammatory biomarker found in the blood. The levels of CRP will rise in response to inflammation.

“In healthy amounts, CRP binds – to the surface of antigens – dead or dying cells and some bacteria, to activate the complement system and encourage phagocytosis by macrophages.

“But if you have too much of it, because it also binds autoantigens, this can contribute to autoimmune disease.”

These three main naturopathic hypotheses for the causes of autoimmune disease, including type 1 diabetes, leads to the naturopathic treatment principle of the four Rs:

• Reduce the food antigens

• Repair the gut lining

• Replace the digestive enzymes

• Reinoculate the bowel flora.

“We would also recommend a re-training of the immune system, for example by allowing fevers.”

Naturopathic causes of type 2 diabetes

When it comes to type 2 diabetes, the naturopathic perspective is that insulin resistance causes type 2 diabetes, but it is of course what is called the ‘causative factors’ towards insulin resistance that is of interest. 

These include: excess sugar; excessive refined high glycaemic index (GI) carbohydrate intake; excess inflammatory mediators (interleukin-6 and tumour necrosis factor-alpha [TNF-alpha]); central obesity and non-alcoholic fatty liver disease; magnesium or vitamin D deficiency; essential fatty acid deficiency; and improper ratio of dietary fats.

“Insulin resistance (IR) reduces the muscle’s and fat cell’s glucose uptake and storage of glucose as glycogen and triglycerides,” said Ms Harkin.

“This means there is more sugar flowing around and you get hyperglycaemia.”

“Obviously IR also affects liver cells resulting in reduced glycogen synthesis and storage, and in the fat cells IR reduces the normal effects of insulin on lipids, resulting in reduced uptake of circulating lipids and increased hydrolysis of stored triglycerides,” suggested Ms Harkin.

Sugar

“Sugar leads to heart disease, above all else,” said Ms Harkin.

According to Ms Harkin, this is because fructose alters blood lipids because it affects the liver.

“When you have excess sugar, this results in excess advanced glycation endproducts, called AGEs, and these block glycolysis and affect glucose metabolism negatively. Macrophages exposed to these AGEs become dysfunctional, enter the artery wall and contribute to plaque formation and thrombosis,’ she explained.

“However, I’d still prefer to use sugar to artificial sweeteners. A little bit of brown sugar is alright, at least it contains some nutrients as well.”

Carbohydrate intake

The excessive intake of refined high GI carbohydrate intake is not only on the naturopaths’ sin list. Wholemeal, wholegrain and brown varieties of bread, cereal, pasta and rice have long been promoted as the healthier option of carbohydrates. According to the naturopathic view, intake of white breads, white rice and potatoes should be very limited or not eaten at all.

“If someone asked me how to lose weight, I’d say give up the spuds, give up the bread and you will lose weight. If everyone ate fish and vegetables, and ditched the spuds, they’d lose weight.

“If you have lots of high GI foods, you get hyperglycaemia, you get hyperinsulinaemia and when this happens for a prolonged time with repeated elevated periods, you get insulin resistance via downregulation of insulin receptors.

“This happens because of the GLUT-4 receptors that are special receptors of insulin cells. The more insulin that is around, the less receptive the cells are and then the body has to make more insulin.”

Inflammation and insulin resistance

“It has been shown that insulin resistance does not develop under dietary conditions that would normally produce it in the absence of inflammatory mediators such as TNF-alpha and interleukin-6,” said Ms Harkin. 

“As naturopaths we would try to reduce inflammation by an anti-inflammatory diet, which includes natural cox-inhibitors, natural lox inhibitors, like omega-3, garlic and other foods. But basically, some diets are pro-inflammatory and others are anti-inflammatory.”

Vitamin D deficiency

According to naturopaths, vitamin D deficiency is also linked to the prevalence of type 2 diabetes.

“So the sun is good for you and we don’t need a trial to prove that.”

Excess insulin

Excess insulin goes back to the same problem seen with excess sugar.

“Excess sugar produces excess insulin and every time the cell is exposed to insulin, the production of GLUT-4 on the cells’ membrane is reduced and the body needs to produce more insulin again, which becomes a bad cycle.

“However, this is where exercise comes into the picture. Exercise improves insulin sensitivity. It has been shown that one minute on the bicycle going flat three times a week will improve insulin sensitivity, if not cardiovascular fitness.” 

So exercise, exercise, exercise was Ms Harkin’s message.

Central obesity and fatty liver disease

Central obesity as a risk factor for type 2 diabetes is not news to anyone. 

“Central obesity is linked to visceral adipose cells, and these fat cells again produce significant amounts of proinflammatory cytokines such as TNF-alpha and interleukins as well.”

According to Ms Harkin, these proinflammatory cytokines disrupt normal insulin action in fat and muscle and are believed to be a major factor in insulin resistance.

“So if you asked who you were to screen, anyone with ‘fat around the middle’ should be sent for screening, and as herbalists, we’re good at moving around that fat around the middle,” said Ms Harkin

Central obesity is also linked to non-alcoholic fatty liver disease. This condition results in excessive release of free fatty acids into the bloodstream and an increase in hepatic glucose production, both of which can exacerbate insulin resistance and increase the risk of type 2 diabetes.

Magnesium deficiency

“Magnesium is involved in insulin production as well ,and poor intracellular magnesium concentrations have been found in type 2 patients and in hypertensive patients as well,’’ said Ms Harkin.

“Magnesium causes vasodilation so it’s good for preventing hypertension, and magnesium administration improves insulin sensitivity.”

Improper ratio of dietary fats

While trans fats and saturated fats promote insulin resistance and heart disease, polyunsaturated and monounsaturated fats increase insulin sensitivity and decrease risk of heart disease. So it’s important to get the ratio between fats right, explained Ms Harkin.

“Man-made, manufactured fats (trans fats) should be avoided at all costs as they are associated with heart disease. Saturated fats we all know about, but we all forget about them as they are in red meat, full-fat dairy products, chocolate, etc. These are still good in certain amounts, but the intake should be limited. Palm oil is an ingredient in lots of processed foods (such as oat cakes/biscuits, normally considered ‘healthy’) and as this is a saturated fat, intake should be limited.

“While fish oils and flax oils which are polyunsaturated or monounsaturated can decrease insulin sensitivity and are good for you.”

Naturopathic treatment

The naturopathic treatment of diabetes includes the use of diet, herbs and supplements, and naturopaths also encourage lifestyle change (such as increased exercise). However, according to Carina Harkin, as much as possible should be achieved with herbs and diet rather than supplements.

“I don’t really like prescribing supplements and making people wrestle with them, so I try to do all I can by prescribing herbs and giving dietary advice.”

Ms Harkin uses herbs to prevent and treat type 2 diabetes, and they are also useful in managing sugar levels in type 1 diabetes. However, while herbs may potentiate the effect of prescribed insulin so that less insulin is required under medical supervision, Ms Harkin pointed out that most of her patients would have type 2 diabetes and that what naturopaths are good at is preventive medicine.

“I always explain to people the causative factors behind their condition so that they can understand why they have what they have.

“Herbal medicine can potentiate the effects of prescribed insulin, so while I see people on drugs, I would never take people off drugs, but I do work with people to reduce medication eventually, so patients do need to be under medical supervision.”

The most commonly used herbs, their effects and possible cautions are listed in Table 1,while the most commonly used nutritional supplements and their effects are listed in Table 2.

“I would never prescribe all the supplements (listed in Table 2). However, I would prescribe chromium as the most important supplement and this needs to be prescribed at 200µg per day. The other main supplement I would prescribe is vitamin E, it prevents oxidating damage to the pancreatic islets and impaired insulin secretion caused by oxidised frying oil ingestion.”

The main naturopathic dietary advice for people with diabetes include to:

• Eat low GI foods 

• Eat foods high in soluble fibre, which lower cholesterol, such as: oat bran, oatmeal, wholegrain breads and cereals, dried grains and legumes (quinoa, millet, buckwheat, kidney beans, etc.) and fruits and vegetables

• Reduce saturated fat intake (found in meats, poultry skin, butter, chocolate, dairy products with fat, lard and palm oil)

• Eat maitake mushrooms (for their hypoglycaemic effects and because they act as a natural alpha-glucosidase inhibitor)

• Eat bitter melon (because it is antimicrobial, antifungal, acts as a digestive stimulant, is hypocholesterolaemic, hypoglycaemic ,and purgative. It is indicated for high cholesterol and triglycerides. A traditional South American remedy for diabetes is to juice one to two fresh bitter melon fruits and drink twice daily

• Eat globe artichoke because it is an anticholesterolaemic, antirheumatic and acts as a digestive, and also lowers postprandial glycaemia. It is used in the treatment of chronic liver and gall bladder disease, jaundice hepatitis and late-onset diabetes

• Fry in coconut oil, because it contains medium-chain triglycerides and when these are digested they go straight to the liver and are transformed into energy, not fat. Coconut oil is also cholesterol free

• Eat oily fish, because of its good omega-3 fatty acids

• Follow an anti-inflammatory diet by decreasing meat and dairy; improving the ratio of omega 3:6:9; and increasing anti-inflammatory EFAs (ALA/GLA and EPA).

Finally, Ms Harkin would also encourage exercise, as exercise increases insulin sensitivity by causing an increase in GLUT-4 on the cell membrane, reversing the decreases in GLUT-4 receptors caused by excess insulin.