46 year old obese male presenting with diabetic symptoms. Current symptoms are increased thirst, increased hunger and increased urination. His vision has also been getting increasingly blurry.
Diet is heavy in refined foods and animal products with his favourite foods being pasta and white bread. A couple of beers are consumed most nights and he drinks three to four cups of coffee per day. Afternoon sluggishness and headaches are common, coffee helps alleviate this. He is constantly hungry and snacks on sugary and fatty food such as biscuits and chips.
There are spider nevi on his face, is sweaty and is uncomfortable sitting in the chair. The client mentions that lately he has been moody and losing his temper quite easily at trivial things. His wound healing and recovery from illness has also been slow.
Diabetes type 2 is a progressive condition where the body becomes resistant to insulin and insulin production in the pancreas is reduced. Key symptoms of diabetes type 2 include
- Infections that take a long time to heal
- Increased thirst and hunger
- Blurred vision
- Increased urination
- Pain or numbness in hands or feet
- Erectile dysfunction
There are a number of diet and lifestyle factors that contribute toward the onset of type 2 diabetes, these include
- Excess weight and obesity
- Diet high in refined foods, sugars and fat, particularly trans fat
- Alcohol consumption
- Low levels of physical activity
The client’s diet and lifestyle are clearly contributing majorly towards his current symptom picture, he has most of the key diabetic symptoms and also exhibits most of the dietary and lifestyle risk factors. A total overhaul of the client’s diet and lifestyle would be required.
The client also is showing signs of liver insufficiency. Excess sweating, fatigue and spider nevus are all key indicators of a liver under stress. In addition, excess weight, alcohol consumption, high fat intake, excess coffee consumption and prolonged raised blood glucose levels would all be further stressing the liver. A referral to a GP is recommended to undertake a liver function test as there could be a possibility of non-alcoholic fatty liver disease (NAFLD).
Being uncomfortable sitting and crossing and uncrossing legs constantly may be a sign of poor circulation, another common side effect of diabetes. Diabetes can cause plaque to build up in the blood vessels restricting blood flow. Stress, irritability and emotional outbursts can also be contributed to by an unstable blood sugar level.
Diet and lifestyle is a major focus in this case with a low glycaemic load (GL) diet being a key objective. A low GL diet involves the elimination of sugars, refined carbohydrates, alcohol and fruit juice from the diet. Grains, starchy vegetables, dried fruits and fruit in general should be limited. Dietary intake will focus on whole foods, high in fibre including adequate protein and healthy fats at each meal. Adequate protein needs to be a minimum 0.8g/kg of body weight with studies suggesting a higher level of protein of around 1.5g/kg being beneficial in assisting stabilising blood sugar, promoting weight loss and lowering cardiovascular risk. Healthy Fats such as extra virgin olive oil, oily fish, avocado, nuts and seeds etc. are also encouraged while eliminating trans-fats and minimising saturated fats.
Foods high in chromium, magnesium and Omega 3 fatty acids should be included. High Chromium foods include liver, fish, vegetables and whole grains. Chromium is required for the uptake of insulin into the cells and strengthens the action of insulin. Studies show improved blood glucose and lipid profiles with supplementation of chromium in type 2 diabetic patients.
Magnesium deficiency has also been associated with poor glycaemic control and impaired insulin secretion and function. Magnesium has many actions in the body including energy production, insulin signalling, fatty acid synthesis and glucose utilisation. Foods high in magnesium include leafy green vegetables, whole grains and nuts and seeds.
Omega 3 fatty acids have a beneficial effect on blood lipids and reduce inflammation. High Omega 3 intake assists with energy and glucose regulation and positively assists in fat loss through increasing beta oxidation and glycogen synthesis, therefore reducing fat storage.
Alpha Lipoic Acid
Alpha lipoic acid (ALA) is a water and fat soluble anti-oxidant that protects against diabetes by minimising the detrimental effects diabetes has on the eyes, blood vessels and kidneys. It does this by enhancing the uptake of glucose into the cells via the GLUT4 transport system, similar to the uptake of glucose initiated by insulin.
B complex vitamins are important for all people and are indicated in diabetic cases, B-complex vitamins greatly assists in the metabolism of carbohydrates as well as support a multitude of other functions within the body.
In regards to the liver, S-Adenosylmethionine (SAM-e) and betaine would be of benefit. SAM-e is an important methyl donor and required for the production of CoQ10, carnitine, methyl cobalamin, and phosphatidylcholine. SAM-e is indicated to up-regulate and increase the antioxidant glutathione in the body and reduce inflammation by upregulating interleukin 10. It also inhibits apoptosis of normal liver cells. A deficiency of SAM-e impairs function of the liver and leaves the liver more susceptible to damage. Clients with methylation cycle impairment, such as those with the MTHFR polymorphism, are at a much higher risk here.
Betaine is another major methyl donor and used in the creation cycle of methionine, further assisting to help raise SAM-e levels in the body. A study on betaine supplementation with humans over one year found that the aminotransferase enzymes ALT and AST where significantly improved and liver biopsy showed reduced fatty infiltration and fibrosis.
The client was prescribed the following, this is a high number of supplements with most being only initially for a period of less than 3 months.
Omega 3 EFA’s
Alpha Lipoic Acid
Custom Liquid Herbal Formula
Exercise – 3+ times per week
Insulin signalling, glucose utilisation
Antioxidant, enhances glucose uptake
Blood sugar balancing, circulation and liver support
Liver protection, methyl donor
Liver protection, methyl donor
Stress management, weight loss
After 2 weeks of the modified diet and lifestyle, nutritional supplements and herbal protocol, the diabetic and liver symptoms were reduced considerably. Much greater improvement was made at the 12 week follow-up consultation with the client reporting much more energy, losing 15kg of weight, feeling much happier and stable in his mood and food cravings completely gone. The lifestyle changes will need to be kept up long term to avoid the symptoms reappearing and continue weight loss.
***This case and dosages prescribed were specific to the individual and presenting condition, this protocol may not suit everyone with these symptoms. A consultation with a suitably qualified practitioner should be undertaken before commencing any treatment ***