I was asked recently to recommend a regimen for an eleven year-old boy who had been found to have diabetes. While it was not the first time that I had been faced with the challenge of childhood diabetes this boy’s condition was different than those I had previously seen. He did not have the type of diabetes that has classically affected children; he had the type that I would have expected to see in his grandfather.

Twenty-five years ago type 2 diabetes, or non-insulin dependent diabetes, was known as “Late-onset” or “Mature-onset” diabetes. Type 1, or insulin dependent, diabetes was called “Juvenile-onset” diabetes.

This is because non-insulin dependent diabetes was almost always a grandpa or grandma disease. It presented late in life, typically in one’s sixties or seventies. The age of onset has been steadily decreasing, however. In the later half of the 1990s it began to appear in teenagers and today it is presenting in children, like the eleven year-old above.

To understand the reasons for the increasing incidence and decreasing age of onset of type 2 diabetes it is necessary to recognize that the condition does not arise because the body is no longer able to produce insulin, but rather that the body is no longer able to efficiently use insulin.

When cells lose their ability to take up insulin effectively the body is said to be insulin resistant. In nearly all cases of type 2 diabetes too much insulin is circulating in the body; the cells and tissues of the body are simply unable to take it in and utilize it properly.

It is now recognized that type 2 diabetes is not a condition that arises suddenly and without warning, but is rather is an advanced state of insulin resistance that has been present for some time. In most instances, insulin resistance has been present for decades before an individual is found to be diabetic.

When insulin resistance develops, the body attempts to solve the problem by producing more insulin. This strategy is effective in controlling blood sugar levels and preventing the appearance of the symptoms of diabetes, but the rise in circulating insulin creates a challenge that the medical world is now calling the “Metabolic Syndrome” or “Syndrome X”.

Type 2 diabetes has reached epidemic proportions in the United States. Diabetes, however, is like the visible portion of an iceberg. Most insulin resistance goes undetected, yet it is as potentially lethal as the invisible mass that sank the Titanic. It is estimated that one out of every four adults in the United States has the metabolic syndrome, which will ultimately present as full-blown diabetes.

A syndrome is a collection of symptoms or findings in a single individual. The features that characterize the metabolic syndrome appear to stem from a state of insulin resistance.

Excessive fat in and around the abdomen is one of the most visible signs of the metabolic syndrome. This is defined as a waist circumference in excess of 40 inches in a man or 35 inches in a woman. Obesity develops because one of insulin’s chief actions in the body is to facilitate the storage of fat.

As the body becomes less efficient in using insulin fasting levels of sugar rise, typically to 110 mg/dl or greater. Rising glucose levels cause a corresponding rise in triglycerides (a form of fat in the bloodstream), an undesirable situation since the protective HDL cholesterol tends to fall as triglyerides increase. Triglyeride levels of 150 mg/dl and HDL levels below 40 in men or below 50 in women are typical in the metabolic syndrome.

Because higher than normal levels of insulin can cause rapid fluctuations in blood sugar, individuals with the metabolic syndrome are prone to episodes of hypoglycemia. These are characterized by shakiness, light-headedness, irritability, and sweating. They typically occur two to three hours after a meal that is composed primarily of refined carbohydrates and low in fat or protein.

As the metabolic syndrome gains momentum, blood pressure rises to 130/85 or higher, making insulin resistance one of the leading causes of hypertension. Ironically, many of the drugs prescribed to lower blood pressure increase insulin resistance making the blood pressure more difficult to control and speeding the onset of overt diabetes.

Other subtle abnormalities are seen. There is an increased tendency of the blood to form clots, which can trigger heart attacks or strokes. Levels of C-reactive protein, which is associated with inflammation and is linked to an increased risk of heart attack, are also elevated. When one considers that low HDL levels and hypertension are also significant risk factors for atherosclerosis and its complications like heart attack and stroke it is easy to understand why it is important to reverse the metabolic syndrome long before it presents as Type 2 diabetes.

Several factors contribute to the development of insulin resistance. Some people have a genetic make-up that makes them more likely to develop insulin resistance. Type 2 diabetes commonly follows family lines. This is not the only predisposing factor however. Fortunately most people can overcome their genetic predisposition by making wise choices in life.

Insulin resistance and the resulting metabolic syndrome result almost exclusively from physical inactivity and the consumption of refined foods, which generate profound nutritional deficiencies. The challenges posed by refined foods were detailed in the July 2003 issue of this newsletter.

When three or more of the findings associated with insulin resistance are present an individual has met the criteria for the metabolic syndrome. He or she is then advised to increase physical activity and lose weight.

Almost everyone is capable of increasing the level of physical activity. While walking is one of the best forms of activity for improving insulin resistance, any activity that creates muscular activity is beneficial. Losing weight, however, is not so simple.

Since insulin’s primary function is to convert sugar to fat, high levels of insulin promote weight gain. As body weight rises, insulin resistance increases. In response the body produces more insulin, which converts more sugar to fat, and the vicious cycle continues.

If an individual with the metabolic syndrome is to lose weight successfully and efficiently, he or she must first break that cycle by reducing insulin resistance and lowering insulin levels. Regular physical activity in which muscles are moved continuously for twenty to thirty minutes will lower insulin resistance. A daily walk, swim, bicycle ride or similar activity is important not because a certain number of calories are burned while the activity is being performed, but because the body will continue to burn calories more efficiently for the next 24 hours.

Refined sugars, flours and grains should be avoided, as they promote insulin resistance. The diet should consist of complex carbohydrates (whole grains, fruits and vegetables), proteins, and fats that are liquid at room temperature.

In addition, nutritional supplementation is a critical factor in lowering insulin resistance and reversing the metabolic syndrome.

I recently formulated a supplement, Chromium Plus, that would address the causes of insulin resistance in a comprehensive manner. One of my primary motivations was self-preservation. If you have read the story of my personal odyssey from sickness to wellness, you know that I have faced several health challenges over the course of my life. The metabolic syndrome is one of them. While I was able to moderate its effects with diet, activity and supplementation, my blood pressure remained borderline, my HDL low, and my waistline measurement too high. I knew that the genetic predisposition I had inherited from my grandfather was continuing to develop.

Chromium polynicotinate is a key ingredient. Chromium is an insulin co-factor, and chromium deficiencies, which are widespread in our society, are indistinguishable from what is called type 2 diabetes. The polynicotinate form is the most bioavailable, meaning that it is the form that is best absorbed and utilized by the body.

Chromium alone will reverse some, but not all instances of insulin resistance. The presence of vanadium, a trace mineral, significantly increases chromium’s efficacy. Vanadium has been likened to a key that unlocks the door that allows insulin to enter the cell. Magnesium is also an important mineral in reversing insulin resistance. I did not include it in the formulation, however, because magnesium is typically taken as an individual supplement, often in combination with calcium.

Several herbs have been demonstrated to effectively moderate glucose levels. Momordica charantia (bitter gourd) and gymnema sylvestre have been used for centuries, particular in ayurveda, the traditional herbal medicine of India. Both have been studied extensively. Research has demonstrated their effectiveness in moderating blood sugar levels and their mechanism of action is at least partially understood.

Momordica’s primary mode of action appears to be in increasing the liver’s effectiveness in converting sugar for use as energy. Studies also suggest that it supports the function of the insulin producing islet cells in the pancreas. Other compounds within the whole extract may slow the absorption of sugars from the stomach and intestinal tract.

Gymnema has been used in India for over 2000 years. Its Hindi name is gurmar, which means “destroyer of sugar.” This name may have arisen due to its ability to block the taste of sugar when chewed. It began to be studied scientifically in the 1920s. Research has demonstrated that, like momordica, it supports pancreatic function. It also enhances cellular glucose uptake, and reduces the amount of glucose manufactured in the liver.

A third herb, morinda citrafolia (Noni), has been used for centuries by native Hawaiian healers as a means to control blood sugar and blood pressure. While Noni has not been studied scientifically to the same degree as momordica and gymnema, anecdotal reports of its effectiveness in moderating blood sugar levels are widespread.

As the mechanism of insulin resistance has become better understood, it has been learned that substances known as glycoaminoglycans improve the cellular uptake of insulin. They have also been found to be effective in lowering the incidence of diabetic complications such as retinopathy (eye disease) and nephropathy (kidney disease).

Essential fatty acids are also being shown to lower insulin resistance. Since the extract of New Zealand Green Lipped Mussels is high in glycoaminoglycans and the essential fatty acids EPA, DHA, & ETA, I elected to use it as the source of these important nutrients.

Finally, lipoic acid, which is approved in Germany for the treatment of diabetic neuropathy (numbness, tingling or pain related to nerve damage), was included. Lipoic acid has been shown to have a remarkable ability to reduce insulin resistance and improve blood sugar levels. It also improves blood flow to nerves, and stimulates the regeneration of nerve fibers.

Although Chromium Plus was just released in August, the results have been encouraging. I am confident that many people will be able to reverse the metabolic syndrome through diet, activity, and sound nutritional supplementation.