Extended-Release Niacin Effective in Low Doses for Diabetics

DALLAS July 2002 Niacin, a medication once discouraged for the treatment of lipid abnormalities in patients with diabetes, has the potential ability, when given in low doses, to be well-tolerated and effective, according to UT Southwestern Medical Center at Dallas researchers, who led the multicenter trial.

Source: University of Texas Southwestern

How to keep damage from diabetes at bay (Filed: 21/06/2002) Dr Sarah Brewer on supplements that help to combat diabetes, how to lower triglyceride levels and foods that aggravate polymyalgia rheumatica

DEAR DOCTOR - I have been diagnosed with mild diabetes which is currently controlled by diet. Are there any supplements I should consider taking?

A vitamin and mineral supplement that includes magnesium, chromium, zinc and vitamin B3 (niacin) is useful, as these nutrients are involved in glucose metabolism. Chromium and vitamin B3 combine with amino acids in the body to form an organic complex known as Glucose Tolerance Factor (GTF), which interacts with insulin to regulate the uptake of glucose by cells. Supplements that present chromium in the form of GTF (derived from yeast or bacterial cultures such as NDS Chromium Plus) appear to be most biologically active. In one study, almost half of those with diabetes who took supplements providing 200mcg chromium per day needed less insulin or oral medication. The effects were twice as good in those with non-insulin dependent diabetes such as yourself, than in those with insulin dependent diabetes.

High dose antioxidants (vitamins C, E, carotenoids and selenium) help to mop up the excess harmful free radicals produced during diabetes and also seem to improve glucose metabolism, especially high dose vitamin E (eg 800 i.u. daily). In a group of 40 people with diabetes, those taking 150mg pycnogenol (pine bark extracts) daily showed significant improvements in retinal changes after just two months treatment, compared with no benefit in those taking placebos. Bilberry extracts also help to protect the eyes from some of the long-term retinal damage associated with diabetes. An ayurvedic herb, gymnema sylvestre, and pfaffia (Brazilian ginseng) are also used to improve insulin output and normalise blood sugar levels. Garlic and omega-3 fish oils will help to reduce the risk of coronary heart disease. As fish oils and herbal remedies may affect insulin production, monitor blood glucose levels carefully if you are taking prescribed medication for diabetes, as it is important to avoid hypoglycaemic attacks.

DEAR DOCTOR - I have raised triglyceride levels and have reacted to the medication the doctor tried. Are there any alternative options to try?

Triglycerides act as an important source of energy - especially when fasting and during prolonged exercise. Some are derived from the diet while others are made in the body. Raised levels can occur through abnormalities of lipid metabolism, from drinking excess alcohol (because the liver stops processing dietary fats so it can detoxify alcohol) or as a side effect of certain drugs such as isotretinoin, thiazide diuretics and beta-blockers.

Clinical trials have shown that taking garlic tablets can lower triglycerides by eight per cent to 27 per cent. Vitamin B3 (niacin) is important for the processing of fatty acids released from body fat stores, it is used medicinally to lower abnormally high cholesterol and triglyceride levels, while increasing beneficial HDL-cholesterol. Supplements containing choline or lecithin are also used, and in one study of 32 people with high blood lipids, taking 10.5g lecithin for 30 days reduced total cholesterol and triglycerides by about one third, while beneficial HDL-cholesterol increased by 46 per cent.

Follow a diet that is low in fat (especially saturated fat) and sugar, and take aerobic exercise for at least 30 minutes, five times per week. Antioxidants (eg vitamins C, E, selenium, grapeseed, alpha-lipoic acid) and folic acid will help to reduce your risk of coronary heart disease by protecting circulating fats from oxidation.

That's the word from Florida researchers who followed 18 previously sedentary, overweight subjects for six months. They presented their findings recently at the American Diabetes Association's scientific session in San Francisco.

Glen E. Duncan, a postdoctoral research fellow at the University of Florida who led the study, says risk factors declined just by adding the exercise and not improving the diet.

"Even though they did not lose weight, their insulin sensitivity improved nearly twofold from when they started," Duncan says.

The better a person's insulin sensitivity, the lower the risk of getting Type II diabetes, which now affects about 8 percent of U.S. adults. The more insulin-resistant a person is, the higher the risk.

The Florida research follows a much larger study released last year in the New England Journal of Medicine, in which more than 3,000 subjects in the Diabetes Prevention Program reduced their risk of Type II diabetes by 58 percent if they adopted intensive lifestyle changes, including a low-fat diet and daily exercise.

The more recent study suggests, however, that exercise alone may be a good start.

The subjects in the Florida study were, on average, 52 years old and had body mass indexes (BMIs) of nearly 29. A person who is 5-foot-10 and weighs 200 pounds has a BMI of 29, as does someone who is 5-foot-2 and weighs 160 pounds.

Duncan and his colleagues assigned the men and women to different exercise groups. Everyone walked for 30 minutes a session, but some walked at higher frequencies -- almost five to seven days a week compared to three to four -- and higher intensities -- 65 percent to 75 percent of their aerobic capacity versus 45 percent to 55 percent.

The researchers told the subjects not to try to lose weight, just to focus on the exercise. After six months, the researchers took tests such as glucose tolerance tests and noted BMIs. While the BMIs did not change, the subjects' insulin sensitivity improved greatly. Levels of an enzyme that helps in fat metabolism improved, too, Duncan says.

While those at risk for Type II diabetes should also eventually try to lose weight, Duncan says exercise may be the best and easiest place to start. "People have a hard time doing two things, diet and exercise. And even modest amounts of exercise in the absence of weight loss reduces the risk factors for Type II diabetes," he says.

The study makes sense to another expert who often cares for those with Type II diabetes and counsels others on how to avoid it.

"It's an important study because any time you can document something [of benefit] we can relay that into clinical practice," says Dr. Katja Van Herle, chief of endocrinology at Santa Monica-UCLA Medical Center.

"When you use skeletal muscle [during workouts] it allows insulin to be more effective at opening the cell door to get the sugar in [from the bloodstream]," she says. "As we gain more fat cells and don't exercise our skeletal muscles, the doors to the cells get 'stuck.' The pancreas makes more insulin. Sugar levels rise. This study underscores the importance of exercise at reversing this insulin resistance."

Another expert, Cathy Mullooly, a certified diabetes educator at the Joslin Clinic in Boston, praises the length of the study. "This study reinforces the preventive aspects of exercise," she says.

Ginseng Berry

May 24, 2002 -- An extract from the ginseng berry may one day help diabetics with their two greatest challenges: blood sugar control and weight control.

"Since this berry contains agents that are effective against both obesity and diabetes, the ginseng fruit has enormous promise as a source of new drugs," says study director Chun-Su Yuan, MD, PhD, of the University of Chicago's Tang Center for Herbal Medicine Research, in a news release.

For years, doctors have been looking for newer and better treatments for obesity and diabetes. Often, the two conditions occur together. Diabetes is the seventh leading cause of death in the U.S. Type 2 diabetes, characterized by an inability to use the hormone insulin effectively (a phenomenon called insulin resistance), is the most common form, affecting nearly 6% of the population. And those numbers are rising, possibly due to rising obesity in the U.S.

In recent years, scientists have identified a substance in the popular supplement made from ginseng root that can help stabilize blood sugar levels in diabetics. Now, doctors have found that an extract from the berry of the ginseng plant is even more potent -- at least in animals.

The study is published in the June issue of Diabetes, a journal from the American Diabetes Association.

In the study, diabetic mice that were injected daily with ginseng berry extract had complete normalization of blood sugar levels, improved sensitivity to insulin, and lowered cholesterol levels.

The treatment also prompted dramatic weight loss in the animals, which were also obese. The mice lost more than 10% of their body weight in 12 days, while the diabetic mice who didn't get ginseng berry extract gained 5% more weight. The treated mice ate 15% less food and were 35% more active than the mice not receiving the ginseng berry extract.

The extract had no detectable effect on normal mice.

"We were stunned by how different the berry is from the root and by how effective it is in correcting the multiple ... abnormalities associated with diabetes," says Yuan.

Yuan tells WebMD that a particular component of ginseng, known as ginsenoside Re, may be responsible for its potent antidiabetic effect. The substance is concentrated in the berry and is scarce in the root. He is also working to isolate an unidentified component of the extract that he believes is linked to the dramatic weight loss.

"What we can say at this point is that the research is promising," he tells WebMD. "But we don't yet know if this will work in humans. That is the next step."

Many diabetes treatments showing promise in animals have proven disappointing in humans, says ginseng researcher Vladimir Vuksan, PhD. He is associate director of the Risk Factor Modification Center at St. Michael's Hospital in Toronto.

In a study reported two years ago, Vuksan and colleagues found that diabetic patients who took a ginseng supplement made from American-grown root had moderate reductions in blood glucose following meals.

He is still studying ginseng, but he does not recommend that diabetics take currently available ginseng root supplements. That is because there is no way of knowing the composition of the ginseng from product to product, or where it was grown.

"Standardization from product to product is a huge problem, and manufacturers don't list where the ginseng comes from," he tells WebMD. "Ginseng is grown all over the world, but our studies showed this benefit [only with] American ginseng. Some of the ginsengs we have looked at actually raise blood sugar levels, and that would obviously not be good for a diabetic."