updated 9/00

Diabetes is a disorder of carbohydrate metabolism caused by inadequate production or utilization of insulin, the hormone secreted by beta cells in the pancreas. Type I diabetes (Insulin-dependent diabetes mellitus or IDDM) is also called juvenile diabetes, as it appears most often in children under the age of 15. It is an autoimmune disease that affects about 10% of the diabetic population. The more prevalent Type II diabetes (non-insulin dependent diabetes mellitus or NIDDM), is also called adult-onset diabetes, as it appears most frequently in adults over the age of 20. The age-related terms are becoming outdated, however, because NIDDM is now showing up in increasing numbers in children, and IDDM is appearing more frequently in adults. It is very important to differentiate between the two types, partly because the dietary and nutrient requirements vary in some important ways.

Major symptoms of diabetes include excessive thirst, fatigue and frequent urination. The long-term health problems that can result from diabetes are mostly vascular. Fluctuations in blood sugar shock the mural cells in tiny capillaries, gradually weakening and narrowing them. Most diabetic problems result from this breakdown in the vascular system. The resultant damage is usually much more severe in patients with poor blood sugar control and/or poor nutritional status.

Through a process called glycosylation, excess sugar attaches to the hemoglobin in your red blood cells and makes it more difficult for them to deliver necessary oxygen to your tissues. When there is a lack of insulin, the body burns fat instead of sugar, causing an increase in toxic acids called ketones. Diabetics who do not have the necessary discipline to take proper care of their health risk blindness, kidney failure, burning nerve pain and early death. Because of the horrific cost of poorly managed diabetes, and because it is so easy to avoid or slow the onset of problems with simple lifestyle and diet changes, specific programs designed to increase patient awareness and compliance are now rapidly being developed by the insurance health care industry.

It is possible to live a long and healthy life with diabetes. As I mentioned in our introduction, I was diagnosed with Type I diabetes (IDDM) in 1961 at the age of 11. Now, almost 40 years later, I have not suffered any major diabetes-related health problems. I have been able to accomplish this through strict discipline, by adhering pretty much to every guideline explained in the following chapters. The herbs I take vary according to signs and symptoms.

I would like to emphasize here the importance of listening to your body. As a child, when I found out I was diabetic I went to the library and read everything I could. The books available at that time told me I had no options, and that gradual deterioration would inevitably lead to severe complications. I was terrified. I decided to do everything I could to stay healthy. I began by cutting out all dietary sugars except fruit. I spent the next ten years learning, through trial and error, how to manage my disease. For example, I figured out by 1965 that eating blueberries made me feel good, as did exercising daily. When my early doctors gave me insulin, I followed their instructions to the letter and assumed I couldn’t change the dose. I remember one particular day when my sugar level was very high. I called my doctor, who told me I could change my dose by two units. I did just that, and immediately felt better. From that moment on, I took on the responsibility of adjusting my own insulin as needed. Back when the early blood sugar monitors first came out, before they were available in drug stores, I stood in line to get one at a medical supply outlet. I began to adjust my medicines and foods to keep my sugars on an even keel. Remember, this all occurred decades before researchers demonstrated the importance of exercise and good blood sugar control, and the benefits of flavonoids in blueberries. I did these things because instinctively, I "knew" they made me feel better. I listened to my body. You can do the same.

In spite of my efforts, by the time I reached my early 20's, I began to exhibit early signs of diabetic problems. My skin tone was pale and I had some stiffness in my joints. My sugar levels would sometimes fluctuate way too much. When I was 26 I met Dr. Mana, my Ayurvedic teacher, in Kathmandu, Nepal. He started me on herbal medications, and this put me on the road to true control of my disease.

The following steps are crucial to gaining complete control of your disease:

• Thoroughly understand the disease and its relationship to your whole person.

• Learn how to manage the disease properly, which will help you detect and treat any problems that may arise while they are still small
• Adopt the necessary nutrition and lifestyle habits, and incorporate herbal supplements that can prevent or repair problems

The pancreas contains groups of beta cells called islets that secrete insulin. Type I diabetes (IDDM) mellitus results from a progressive destruction of these insulin-secreting beta cells by T lymphocytes, a type of white blood cell. This destruction may be triggered by errors in the production of the insulin molecule, or perhaps by viral invasion. These errors stimulate the white blood cells (T cells and macrophages) to attack and destroy the beta cells producing the insulin. Type I diabetics always need insulin, and must maintain excellent control of their insulin levels to avoid serious health problems.

Type I diabetics often require a diet higher in protein, vegetables and healthy fats, which restricts sugars and grain carbohydrates like wheat and corn. This type of diet alone will lower blood sugar, reduce craving for sweets, and lower levels of glycosylated hemoglobin. However, each patient’s nutritional requirements are unique due to our biochemical individuality. Some do better on the HCF (high carbohydrate and fiber) diet usually recommended for Type II diabetics. The HCF diet is high in cereal grains, legumes and root vegetables, and restricts intake of fats and simple sugars. Because many studies do not distinguish between high and low quality fats, it is difficult to interpret the scientific data. This diet will not work if the fats consumed are of low quality or excessive in amount.

Type II diabetes, the more common form, is characterized by onset at a later age, and is often associated with obesity and poor diet. The average American consumes nine percent of his or her daily diet in the form of simple sugars, resulting in a significant reduction in nutrient and mineral intake. This nutritional decline is exacerbated by a modern trend of decreased nutritional value in ordinary foods. The high levels of dietary sugar stresses the pancreas and the liver and overall sugar regulation. This may result in depletion of insulin supplies, or cells may become resistant to the insulin. The incidence of Type II diabetes is much higher in countries where the general population follows the standard American diet (the "SAD diet"). Native populations such as American Indians and aborigines who abandon their traditional diets develop the disease much more frequently than populations that maintain their native diets (reported by Bergner, 1997).

Insulin resistance is a major concern for Type II diabetics. The body produces enough insulin, but for some reason the cells resist using it. Blood sugar control worsens as abnormal fat stores increase and obesity increases insulin resistance. Therefore, weight loss is often all that is needed for Type II diabetics to reduce their medicine requirements. Some successful patients can even come off their prescription medications altogether. Essential fatty acids are also good for this problem.

Prescriptions are not a substitute for healthy living. Various prescription pills for NIDDM can "wear off" and stop working after a few years as the body builds a tolerance. This phenomenon has been known to occur in up to 40% of patients. You must learn to identify and utilize lifestyle alternatives. For example, it appears that garlic bulb (2 cloves per day) and onion (1 medium bulb per day) can lower blood sugar by about the same amount as prescription medicines in some patients (Tjokroprawiro et al., 1983, Sheela et al., 1995, reported in Duke, 1997).

Type II diabetics sometimes do well on the HCF diet, which is high in cereal grains, legumes and root vegetables, with restrictions on fats and simple sugars. Conversely, some patients do better on the higher protein diet usually recommended for Type I diabetics. As I stated earlier, each person’s nutritional requirements are unique, so it is necessary to listen to your body to manage your diet and your disease successfully.

Traditional Ayurvedic Medicine (TAM) doctors were perhaps the first to classify diabetes as a separate disease, calling it madhumeha, which means "honey-like urine." They noticed that patients with this malady had ants attracted to their urine. There were two distinct types of diabetes in Ayurveda since ancient times. We discussed earlier the Ayurvedic body types, and in this disease, the Vata or nerve-natured person is more likely to get type 1 diabetes. The obese person with strong appetite (Pitta-Kapha type) is more likely to get type 2 diabetes.

Although Ayurveda had no idea of insulin, it is certainly clear they understood long ago that the thin and wasting physical condition of typical of young diabetics was related to digestive problems and presence of sugar in the urine. As they described it, the nerve-natured person is by nature thinner, restless and had a weaker digestive system, which accounted for their generally low weight. At the same time, the highly restless nature often displayed a craving for sweets. Putting high levels of sugars into a weak digestive system created dryness and heat, and favored promotion of toxic gasses (Vata dosha). This in turn weakened the major digestive organ called agnyasaya, Sanskrit for pancreas (Bajracharya, 1988). As Ayurvedic physicians began to have access to modern physiological teachings, theybegan to relate these ideas to type one diabetes and hypoglycemia.

They discribed another scenario with regards to type two diabetes. When someone is obese and has strong digestive energy (Pitta-Kapha personality), constantly eating heavy and/or sugary foods, the pancreas can becomes over-active. There is an increase in bile flow to the intestine to digest the fats, and weight gain ensues. In this condition, secretions are increased, and the mucous membranes and arteries are "working overtime." These increased secretions cause blockages in the vessels and ducts, as well as obesity. The secretions and blockages irritate the nervous system and change the physical properties of the blood. The altered sugars (called "greaseless sugar") cannot be absorbed, so they exit through the urinary system as honey-urine (Bajracharya, 1988). Although Ayurveda has no concept of "insulin resistance," it is obvious they were describing type two diabetes in another way. Because we now know the duct and membrane blockages tends to slow blood flow and metabolism, that excess fats change cell receptor sites, and high levels of sugars stimulate insulin release, it is easy to speculate that the physical conditions described in the traditional literature could by causative of insulin resistance. This would also make it more clear why Type 2 diabetes often recedes or disappears when patients lose weight. Adding their understanding to modern understanding, we see that type two diabetes is a disease of obesity and insulin resistance (Western understanding) and poor fat digestion and resultant excess mucus exudation and duct blockage (Eastern understanding). This broadens our therapeutic options.

• Regular daily exercise is essential for diabetics. A sedentary period will elevate your blood sugars within half a day. A few hours of exercise will bring sugars down. Regular (and frequent) exercise is helpful for burning fat and improving cardiovascular health. This consequently improves circulation and metabolism, which will help your body fight off other diabetes-related symptoms. In one study that followed a group of nurses for eight years, the ones who exercised the most had a 54% lower incidence of diabetes than the sedentary subjects (Christensen, 1999). Diabetics must keep moving. One of the Ayurvedic treatments for diabetes is to walk 2-3 hours per day while taking shilajatu and garlic pills, and following a careful diet.

• The appropriate amount of insulin is the one that causes the least fluctuation in your blood sugar levels, and keeps you at a healthy weight. You may have to experiment under a doctor's supervision to find your proper insulin dosage and the best times of day for you to take insulin. Some patients also need to use more than one type of insulin. There are both long and short-acting forms.

• Check your blood sugars several times per day, and act accordingly. If your sugars are above 150, it is a good idea to delay meals. Otherwise, food will cause them to rise above 200, leading to the production of toxic ketones. You might want to consider using Humalog, the fast-acting insulin, to bring down levels quickly. Check your levels two hours after eating, when sugars are usually highest, and take a few units of Humalog right then and there (I learned this trick from another diabetic). Other strategies that will help stabilize sugar levels include increasing exercise on the spot, or reducing food intake on your next meal. Consciously figure out how to keep your levels from getting too high.

• Relaxation and stress reduction techniques have also been shown to reduce insulin needs in some patients. Learn T’ai Chi, meditation or Yoga. Studies have shown that such stress reduction tactics can reduce medication need and reduce sugar levels (McGrady and Horner, 1999, Jain et al., 1993).

• Check your glycosylated hemoglobin (HgbA1c) every 3-4 months, to find out how well you are controlling your blood sugars. This test requires a doctor's prescription.

• Get a yearly eye examination by a good ophthalmologist. Diabetics are more prone to retinopathy, glaucoma and cataracts. The earlier treatment is initiated, the greater the success. If you develop retinopathy, there are herbs that can resolve the problem even in cases where bleeding has started (refer to our discussion of all three diseases in Chapter 16 for more information).

• Avoid artificial sweeteners. There is concern they are toxic to nerves, and diabetics are more susceptible to this reaction. Try stevia leaf or d-xylose, available in most health food stores. These natural sweeteners will not increase your blood sugar.

• Eat more beans. Your body metabolizes beans slowly, which slows down the absorption of sugars from the intestinal tract, aiding your body’s regulation of sugar levels. A diet high in fiber is very helpful for diabetics due to this beneficial action.

• Eat lots of berries, especially blueberries. Blueberries (or bilberries) contain anthocyanins, plant chemicals that help repair tiny blood vessels especially in the eyes. Consume about one quart of fresh or one bag of frozen blueberries per week. Blueberries, blackberries and raspberries are also low in sugar.

• Take your vitamins. Diabetics can benefit greatly from vitamin supplements (Kahler et al., 1993), and I recommend taking a multivitamin twice each day, as well as the following:

• Vitamin C (2000 mg), which makes collagen and keeps capillaries strong.

• The B vitamins, including niacin, zinc and other minerals, which are important for sugar metabolism.
• Vitamin E and essential fatty acids (EFAs), which are important for cell membrane stability.
• Alpha-lipoic acid, which protects nerves, decreases insulin resistance and can reverse neuropathy (Reljanovic et al., 1999).
• Quercetin (1,000 mg per day), one of the most powerful bioflavonoids that prevents capillary leakage.
• Always take a multi-mineral if you have diabetes. Three minerals that are known to lower blood sugars are: GTF chromium (200 mcg per day), manganese (5-15 mg per day) and vanadium (20 mg per day for two weeks, and then 2 mg per day). Interestingly, one study showed that herbs traditionally used to treat diabetes contained higher-than-normal levels of chromium (Castro 1998). Barley also contains high levels of chromium.

Numerous herbs can affect blood sugar levels and overall diabetic status. For a complete list of the herbs that can affect blood sugar, refer to Appendix A. However, be aware that there have been reports of other herbs in many parts of the world that act on blood sugar levels, so this is a fertile field for continued research.

• Turmeric root, black atractylodes rhizome, fenugreek seeds, bitter melon (which contains an insulin-like molecule), prickly pear cactus (Opuntia fuliginosa- used by Native Americans), ganoderma mushroom, gymnema, Malabar kino (Pterocarpus marsupium), green tea, maitake mushroom, devil's club root bark (Oplopanax horridum), jambul seed (Syzygium jambolanum), fig leaf (Ficus carica), Siberian ginseng root bark, and bay leaves can help regulate and lower elevated blood sugars. Pterocarpus marsupium may help beta-cells to regenerate (reported in Murray and Pizzorno, 2000).
• Ayurvedic doctors use a complex mineral formula called trivanga bhasma to lower blood sugars, not available in Western world due to its heavy metal content, albeit purified. This is prescribed side-by-side with digestive medicines such as garlic and trikatu for both by types of diabetes until the urine is free of sugar, and then discontinued in favor of the medicines listed below.
• Long-term use of shilajatu and triphala is excellent for improving energy in Type I diabetics and reducing long-term complications. This is the combination Dr. Mana gave me in 1976, and I still take these herbs frequently. Herbs that promote digestion, such as garlic or trikatu are also important, as well as high quality oils to maintain membrane moisture and health. If the patient is emaciated, ashwaghanda root is used. For Type Two diabetes, in addition to trivanga bhasma and digestive medicine, weight-loss medicines and those that open blockage are useful, especially shilajatu mixed with agnimantha root & bark (Premna integrifolia).

• Some studies indicate that the use of niacinamide (a form of niacin, also called nicotinamide) very early in the disease process can sometimes prevent the destruction of beta cells. Some patients have had complete reversal (Cleary, 1990). The reason it works is that it inhibits monocyte/macrophage function in the peripheral blood preventing production of the beta-cell destructive cytokines interleukin-12 and tumor necrosis factor-alpha (Kretowski et. al., 2000).
• Herbs from the vessel-strengthening group, especially tien chi root, act directly on capillary vessel weakness, thus preventing diabetic complications. Tien chi root is one of my herbal mainstays. I take it several months each year to prevent vessel and eye damage.

• Diabetics suffering from neuropathy may benefit from acupuncture, alpha-lipoic acid supplements, and ginkgo leaf (Reljanovic et al., 1999, Chung et al., 1999).
• Coenzyme Q10 (CoQ10) can help with heart problems and blood sugar control in diabetics. In one study as many as 59% of patients responded to supplementation (reported in Murray, 1996).

• Evening primrose oil was shown in a double-blind clinical trial of 22 diabetics with neuropathy to reduce pain and improve motor function after six months of supplementation (Jamal, 1987).

• Chinese research shows that herbs from the moving blood group help prevent diabetic complications (Huang et al., 1997). I use herbs from this group several months per year for preventive purposes—I recommend you do the same.

Bajracharya, MB. Diabetes: How, Why and What to Do About It., Kathmandu: Piyusavarsi Ausadhalaya publishers, 1988. (Pamphlet).

Bergner P. The Healing Power of Minerals, Rocklin: Prima Publishing, 1997.

Castro VR Chromium in a series of Portuguese plants used in the herbal treatment of diabetes. Biol Trace Elem Res 1998 Apr-May;62(1-2):101-6 Escola Superior Agraria (IPCB), Castelo Branco, Portugal.

Christensen D, Brisk steps can reduce diabetes risk Science News vol 156, October 23, 1000 p. 260, 1999.

Chung HS, Harris A, Kristinsson JK, Ciulla TA, Kagemann C, Ritch R. Ginkgo biloba extract increases ocular blood flow velocity. J Ocul Pharmacol Ther. 1999 Jun;15(3):233-40.

Cleary JP. Vitamin B-3 in the treatment of diabetes mellitus: Case reports and review of the literature. J Nutr Med 1:217-225, 1990.

Duke, J. The Green Pharmacy, Emmaus: Rodale press, 1997.

Huang SM, Liao XY, Wu LF. [Clinical report of 60 cases of diabetic cardio-vascular autonomous neuropathy by stasis removing treatment of combined traditional and Western medicine]. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih. 1997 Oct;17(10):594-6. Chinese.

Jain SC, Uppal A, Bhatnagar SO, Talukdar B. A study of response pattern of non-insulin dependent diabetics to yoga therapy. Diabetes Res Clin Pract. 1993 Jan;19(1):69-74.

Jamal GA. et al., Treatment of diabetic neuropathy with famma-linolenic acid (GLA) as evening primrose oil (Efamol). J Am Coll Nutr 6:86, 1987.

Jamal GA. et al., Treatment of diabetic neuropathy with famma-linolenic acid (GLA) as evening primrose oil (Efamol). J Am Coll Nutr 6:86, 1987.

McGrady A, Horner J. Role of mood in outcome of biofeedback assisted relaxation therapy in insulin dependent diabetes mellitus. Appl Psychophysiol Biofeedback. 1999 Mar;24(1):79-88.

Murray, MT. , An Encyclopedia of Nutritional Supplements. Rocklin: Prima Publishing, 1996.

Murray, MT and Pizzorno J. , Textbook of Natural Medicine. London: Prima Churchill Livingstone, 2000.

Reljanovic M, Reichel G, Rett K, Lobisch M, Schuette K, Moller W, Tritschler HJ, Mehnert H. Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two year multicenter randomized double-blind placebo-controlled trial (ALADIN II). Alpha Lipoic Acid in Diabetic Neuropathy. Free Radic Res. 1999 Sep;31(3):171-9.

Resnick HE, Valsania P, Phillips CL. Diabetes mellitus and nontraumatic lower extremity amputation in black and white Americans: the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, 1971-1992. Arch Intern Med. 1999 Nov 8;159(20):2470-5.

Sheela CG, Kumud K, Augusti KT. Anti-diabetic effects of onion and garlic sulfoxide amino acids in rats. Planta Med. 1995 Aug;61(4):356-7.

Tjokroprawiro A, Pikir BS, Budhiarta AA, Pranawa, Soewondo H, Donosepoetro M, Budhianto FX, Wibowo JA, Tanuwidjaja SJ, Pangemanan M, et al. Metabolic effects of onion and green beans on diabetic patients. Tohoku J Exp Med. 1983 Dec;141 Suppl:671-6.