Can a Holistic Approach to Diabetes Reduce Risk?

Written by Dr. Steve Chaney on . Posted in Holistic Approach to Diabetes

The Role of Supplementation In Reducing Diabetes Risk

Author: Dr. Stephen Chaney

 

holistic approach diabetes doctors recommendDoctors usually discuss a holistic approach to diabetes with their patients.  But, that often isn’t the case for other diseases. Why do doctors recommend drugs rather than natural approaches for controlling and treating other diseases? In part, it’s because so many Americans would rather take a pill than change their diet or lifestyle. Many of our doctors have become so conditioned to that expectation from their patients they don’t even suggest diet and lifestyle changes.

That is our fault. We need to take responsibility for our health. Rather than just accepting whatever treatment our doctors suggest, we should partner with our doctors in designing the best treatment plan for us.

The other reason doctors often recommend drugs is that they are trained to base their decisions on evidence-based medicine. The Gold Standard for evidence-based medicine is, of course, a double blind, placebo controlled clinical trial. In those studies, a single component is compared to the placebo. That is easy to do when you are comparing a drug to a placebo. The drug either works better than the placebo, or it doesn’t.

 

Do Natural Remedies for Diabetes Work?

 

Of course, many of you are more interested in knowing whether holistic, natural approaches also work. That is a much more difficult question to answer.

Double blind, placebo controlled clinical studies are much more difficult to perform when you are looking at foods or nutrients. That’s because foods and nutrients are seldom effective by themselves. They interact with each other. It is the whole, rather than the individual components, that reduce the risk of diabetes and other diseases. Even worse, when you want to test the effectiveness of a holistic change in diet and lifestyle, how do you design a placebo?

holistic approach diabetes talkIt reminds me of an international cancer symposium I attended over 30 years ago as a young Assistant Professor. A world-renowned cancer expert gave a talk from main stage and concluded by saying “I can show you, unequivocally, that colon cancer risk is significantly decreased by a lifestyle that includes a high-fiber diet, a low-fat diet, adequate calcium, adequate B vitamins, omega-3 fatty acids, exercise, and weight control. But, I can’t show you that any one of them, by themselves, is effective.”

The question that came to me as I heard him speak was: “What’s the message that a responsible scientist or responsible health professional should be giving to their patients or the people that they are advising?” You’ve heard experts saying: “Don’t worry about the fat.” “Don’t worry about calcium.” “Don’t worry about B vitamins.” “Don’t worry about fiber.” “None of them can be shown to decrease the risk of colon cancer.”

Is that the message we should be giving people? Or should we really be saying what that doctor said many years ago – that a lifestyle that includes all those things significantly decreases the risk of colon cancer?

The problem is the negative studies you hear about, and your doctor hears about, are usually studies done with individual foods or individual nutrients. Those studies leave the impression that natural approaches don’t work. However, when you look at a holistic approach to diabetes, the answers are often much different.

 

Can a Holistic Approach to Diabetes Reduce Risk?

holistic approach diabetes reduceI created the diagram on the left for my book “Slaying the Food Myths” to represent holistic approaches to health. Simply put, diet, weight control, exercise, and supplementation all play a role in improving our health. It is that sweet spot in the middle of the diagram where we receive the optimal benefit. Finally, both diet and supplementation should also be holistic. No one food or nutrient will be effective by itself.

This is perfectly illustrated by a recent study (S.M. Kimball et al, Journal of Clinical & Translational Endocrinology, doi: 10.1016/j.jcte.2017.11.002 eCollection Dec 2017 ). If you just read the headlines, you would conclude the study was just about the effect of supplementation on the risk of developing diabetes. However, when you read the publication, you realized the study involves a lot more than supplementation.

The study was conducted by a non-profit wellness organization called Pure North S’Energy Foundation located in Calgary, Canada. They enrolled 188 middle-aged adults (ages 25-54 years) in the studies. Based on BMI measurements the participants were overweight, but not obese. They were followed for a two-year period.

Each of the participants met regularly with a health care professional who provided them with lifestyle advice. Specifically:

  • They were advised to increase fruit and vegetable intake and reduce processed foods.
  • If they had cardiovascular risk factors such as hypertension or hyperlipidemia, they were advised to go on the DASH diet.
  • They were advised to follow an exercise routine that was appropriate for their health status.

In addition, the subjects were divided into two groups:

  • Group 1 received a liquid vitamin D3 supplement consisting of 1,000 IU of vitamin D/drop. The dosage they received was individualized so that each subject received enough vitamin D to bring their blood levels of 25-hydroxy-vitamin D to an optimal level of >100 nmole/L.
  • Group 2 received the vitamin D plus 600 mg of EPA and EPA, plus a very comprehensive multivitamin. In addition to the nutrients found in most multivitamins, their formulation contained carotenoids such as lutein and lycopene, polyphenols from wine grapes, N-acetyl cysteine, coenzyme Q10 and a host of other phytonutrients.

[Note: This supplement is not commercially available. However, I would not recommend it if it were. There appears to be little scientific rationale for the amounts of some ingredients.]

In short, all the subjects were put on a holistic diet and lifestyle program ( a holistic approach to diabetes ). Groupe 2 also received what I would consider a holistic supplement. Here were the results of the study.

  • Neither group had significant weight loss or weight gain.
  • Serum 25-hydroxyvitamin D increased significantly in both groups (the vitamin D supplementation was effective).
  • HbA1c levels (a measure of blood sugar control) worsened slightly in Group 1 and improved slightly in Group 2.

However, those were average values. Individual subjects had much more significant changes in HbA1c. In fact, based on changes in HbA1c levels:

  • 16% of Group 1 participants and only 8% of Group 2 participants progressed from normal blood sugar control to either prediabetes or diabetes.
  • 8% of Group1 participants and 44% of Group 2 participants improved from prediabetes or diabetes to normal blood sugar control.

The authors of the study concluded: “The results suggest that nutrient supplementation may provide a safe, economical, and effective means for lowering diabetes risk. Further examination of this potential via randomized controlled trials is warranted.”

 

The Role of Supplementation In Reducing Diabetes Risk

holistic approach to diabetes supplementationThis is a single study and needs to be confirmed by future studies. However, if this study is confirmed, it has some interesting implications:

  • It suggests a holistic approach to supplementation may be effective at decreasing diabetes risk.
  • The holistic approach to supplementation was coupled with a holistic diet and lifestyle change in this study. We cannot assume that supplementation alone would have been effective in reducing diabetes risk.
  • Since both Groups 1 and Group 2 included diet and lifestyle changes, we can conclude that the holistic diet and lifestyle changes in this study were not sufficient to reduce diabetes risk. Holistic supplementation was also required.
  • The reason that diet and lifestyle changes did not affect diabetes risk in this study was most likely the failure to include a weight loss component. Multiple studies have shown that weight loss reduces diabetes risk.

 

The Bottom Line:

 

A recent study looked at the effect of a holistic diet, lifestyle and supplementation intervention on diabetes risk.

All participants in the study met regularly with a health care professional who provided them with lifestyle advice. Specifically:

  • They were advised to increase fruit and vegetable intake and reduce processed foods.
  • If they had cardiovascular risk factors such as hypertension or hyperlipidemia, they were advised to go on the DASH diet.
  • They were advised to follow an exercise routine that was appropriate for their health status.

The subjects were divided into two groups:

  • Group 1 received a liquid vitamin D3 supplement consisting of 1,000 IU of vitamin D.
  • Group 2 received the vitamin D plus 600 mg of EPA and EPA, plus a very comprehensive multivitamin containing carotenoids such as lutein and lycopene, polyphenols from wine grapes, N-acetyl cysteine, coenzyme Q10 and a host of other phytonutrients.

Over a two-year period:

  • 16% of Group 1 participants and only 8% of Group 2 progressed from normal blood sugar control to either prediabetes or diabetes.
  • 8% of Group1 participants and 44% of Group 2 participants improved from prediabetes or diabetes to normal blood sugar control.

This is a single study and needs to be confirmed by future studies. However, if this study is confirmed, it has some interesting implications:

  • It suggests a holistic approach to supplementation may be effective at decreasing diabetes risk.
  • The holistic approach to supplementation was coupled with a holistic diet and lifestyle change in this study. We cannot assume that supplementation alone would have been effective in reducing diabetes risk.
  • Since both Groups 1 and Group 2 included diet and lifestyle changes, we know that the holistic diet and lifestyle changes in this study were not sufficient to reduce diabetes risk. Holistic supplementation was also required.
  • The reason that diet and lifestyle change did not affect diabetes risk was most likely the failure to include a weight loss component. Multiple studies have shown that weight loss reduces diabetes risk.

For more details, read the article above:

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (2)

  • Kathy Brauer

    |

    Group 2 received the vitamin D plus 600 mg of EPA and EPA, plus a very comprehensive multivitamin.

    Should that be EPA and DHA? Not too pick, but checking my assumption.

    Reply

    • Dr. Steve Chaney

      |

      Yes. Thanks for spotting the typo

      Reply

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Latest Article

Do Omega-3s Lower Blood Pressure in Young, Healthy Adults?

Posted August 14, 2018 by Dr. Steve Chaney

What Is The Omega-3 Index And Why Is It Important?

Author: Dr. Stephen Chaney

 

Do omega-3s lower blood pressure in healthy adults?

omega-3s lower blood pressure young adultsThe literature on the potential health benefits of omega-3s is very confusing. That’s because a lot of bad studies have been published. Many of them never determined the omega-3 status of their subjects prior to omega-3 supplementation. Others relied on dietary recalls of fish consumption, which can be inaccurate.

Fortunately, a much more accurate measure of omega-3 status has been developed and validated in recent years. It’s called the Omega-3 Index. Simply put, the Omega-3 Index is the percentage of EPA and DHA compared to 26 other fatty acids found in cellular membranes. Using modern technology, it can be determined from a single finger prick blood sample. It is a very accurate reflection of omega-3 intake relative to other fats in the diet over the past few months. More importantly, it is a measure of the omega-3 content of your cell membranes, which is a direct measure of your omega-3 nutritional status.

A recent extension of the Framingham Heart Study reported that participants with an Omega-3 Index >6.8% had a 39% lower risk of cardiovascular disease than those with an Omega-3 Index <4.2% (WS Harris et al, Journal of Clinical Lipidology, 12: 718-724, 2018 ). Although more work needs to be done, an Omega-3 Index of 4% or less is generally considered indicative of high cardiovascular risk, while 8% or better is considered indicative of low cardiovascular risk. For reference, the average American has an Omega-3 Index in the 4-5% range. In Japan, where fish consumption is much higher and cardiovascular risk much lower, the Omega-3 Index is in the 9-11% range.

Previous studies have suggested that omega-3 fatty acids lower blood pressure to a modest extent. Thus, it is not surprising that more recent studies have shown an inverse correlation between Omega-3 Index and blood pressure. However, those studies have been done with older populations, many of whom had already developed high blood pressure.

From a public health point of view, it is much more interesting to investigate whether it might be possible to prevent high blood pressure in older adults by optimizing omega-3 intake in a young, healthy population, most of whom had not yet developed high blood pressure. Unfortunately, there were no studies looking at that population. The current study was designed to fill that gap.

 

How Was The Study Done?

omega-3s lower blood pressure young healthy adultsThe current study (M.G. Filipovic et al, Journal of Hypertension, 36: 1548-1554, 2018 ) was based on data collected from 2036 healthy adults, aged 25-41, from Liechtenstein. They were participants in the GAPP (Genetic and Phenotypic Determinants of Blood Pressure) study. Participants were excluded from the study if they had been diagnosed with high blood pressure and were taking medication to lower their blood pressure. They were also excluded if they had heart disease, chronic kidney disease, other severe illnesses, obesity, sleep apnea, or daily use of non-steroidal anti-inflammatory medications.

Blood samples were collected at the time of their enrollment in the study and frozen for subsequent determination of Omega-3 Index. Blood pressure was also measured at their time of enrollment in two different ways. The first was a standard blood pressure measurement in a doctor’s office.

For the second measurement they were given a wearable blood pressure monitor that recorded their blood pressure over 24 hours every 15 minutes during the day and every 30 minutes while they were sleeping. This is considered more accurate than a resting blood pressure measurement in a doctor’s office because it records the variation in blood pressure, while you are sleeping, while you are exercising, and while you go about your everyday activities.

 

Do Omega-3s Lower Blood Pressure In Young, Healthy Adults?

omega-3s lower blood pressure young adults equipmentNone of the participants in the study had significantly elevated blood pressure. The mean systolic and diastolic office blood pressures were 120±13 and 78±9 respectively. The average Omega-3 Index in this population was 4.6%, which is similar to the average Omega-3 Index in the United States.

When they compared the group with the highest Omega-3 Index (average = 5.8%) with the group with the lowest Omega-3 Index (average = 4.6%):

  • The office measurement of systolic and diastolic blood pressure was decreased by 3.3% and 2.6% respectively
  • While those numbers appear small, the differences were highly significant.
  • The 24-hour blood pressure measurements showed a similar decrease.
  • Blood pressure measurements decreased linearly with increasing Omega-3 Index. [In studies of this kind, a linear dose-response is considered an internal validation of the differences observed between the group with the highest Omega-3 Index and the group with the lowest Omega-3 Index.]

The authors concluded: “A higher Omega-3 Index is associated with statistically significant, clinically relevant, lower systolic and diastolic blood pressure in normotensive, young and healthy individuals. Diets rich omega-3 fatty acids may be a strategy for primary prevention of hypertension.”

 

What Does This Mean For You?

omega-3s lower blood pressure young adults questionPerhaps I should first comment on the significance of the relatively small decrease in blood pressure observed in this study.

  • These were young adults, all of whom had normal or near normal blood pressure.
  • The difference in Omega-3 Index was rather small (5.8% to 4.6%). None of the participants in the study were at the 8% or above that is considered optimal.
  • Liechtenstein is a small country located between Switzerland and Spain. Fish consumption is low and omega-3 supplement consumption is rare.

Under these conditions, even a small, but statistically significant, decrease in blood pressure is remarkable.

We should think of this study as the start of the investigation of the relationship between omega-3 status and blood pressure. Its weakness is that it only shows an association between high Omega-3 Index and low blood pressure. It does not prove cause and effect.

Its strength is that it is consistent with many other studies showing omega-3 fatty acids lower blood pressure. Furthermore, it suggests that the effect of omega-3s on blood pressure may also be seen in young, healthy adults who have not yet developed high blood pressure.

Finally, the authors suggested that a diet rich in omega-3s might reduce the incidence of high blood pressure by slowing the age-related increase in blood pressure that most Americans experience. This idea is logical, but speculative at present.

However, the GAPP study is designed to provide the answer to that question. It is a long-term study with follow-up examinations scheduled every 3-5 years. It will be interesting to see whether the author’s prediction holds true, and a higher Omega-3 Index is associated with a slower increase in blood pressure as the participants age.

 

Why Is The Omega-3 Index Important?

 

The authors of this study said: “The Omega-3 Index is very robust to short-term intake of omega-3 fatty acids and reliably reflects an individual’s long-term omega-3 status and tissue omega-3 content. Therefore, the Omega-3 Index has the potential to become a cardiovascular risk factor as much as the HbA1c is for people with diabetes…” That is a bit of an overstatement. HbA1c is a measure of disease progression for diabetes because it is a direct measure of blood sugar control.

In contrast, Omega-3 Index is merely a risk factor for cardiovascular disease. However, if it is further validated by future studies, it is likely to be as important for predicting cardiovascular risk as are cholesterol levels and markers of inflammation.

However, to me the most important role of Omega-3 Index is in the design of future clinical studies. If anyone really wants to determine whether omega-3 supplementation reduces cardiovascular risk, high blood pressure, diabetes or any other health outcome they should:

  • Start with a population group with an Omega-3 Index in the deficient (4-5%) range.
  • Supplement with omega-3 fatty acids in a double blind, placebo-controlled manner.
  • Show that supplementation brought participants up to an optimal Omega-3 Index of 8% or greater.
  • Look at health outcomes such as heart attacks, cardiovascular deaths, hypertension, stroke, or depression.
  • Continue the study long enough for the beneficial effects of omega-3 supplementation to be measurable. For cardiovascular outcomes the American Heart Association has stated that at least two years are required to obtain meaningful results.

These are the kind of experiments that will be required to give definitive, reproducible results and resolve the confusion about the health effects of omega-3 fatty acids.

 

The Bottom Line

 

An accurate measure of omega-3 status has been developed and validated in recent years. It’s called the Omega-3 Index. Simply put, the Omega-3 Index is the percentage of EPA and DHA compared to 26 other fatty acids found in cellular membranes.

Although more work needs to be done, an Omega-3 Index of 4% or less is generally considered indicative of high cardiovascular risk while 8% or better is considered indicative of low cardiovascular risk.

Previous studies have shown an inverse correlation between Omega-3 Index and blood pressure. However, these studies have been done with older populations, many of whom had already developed high blood pressure.

From a public health point of view, it is much more interesting to investigate whether it might be possible to prevent high blood pressure in older adults by optimizing omega-3 intake in a young, healthy population, most of whom had not yet developed high blood pressure. Until now, there have been no studies looking at that population.

The study described in this article was designed to fill that gap. The participants in this study were ages 25-41, were healthy, and none of them had elevated blood pressure.

When the group with the highest Omega-3 Index (average = 5.8%) was compared with the group with the lowest Omega-3 Index (average = 4.6%):

  • Both systolic and diastolic blood pressure were decreased
  • Blood pressure measurements decreased linearly with increasing Omega-3 Index.

The authors concluded: “A higher Omega-3 Index is associated with statistically significant, clinically relevant, lower systolic and diastolic blood pressure in normotensive, young and healthy individuals. Diets rich omega-3 fatty acids may be a strategy for primary prevention of hypertension.”

Let me translate that last sentence into plain English for you. The authors were saying that optimizing omega-3 intake in young adults may slow the age-related increase in blood pressure and reduce the risk of them developing high blood pressure as they age. This may begin to answer the question “Do omega-3s lower blood pressure in young, healthy adults?”

Or even more simply put: Aging is inevitable. Becoming unhealthy is not.

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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