Drugs and nutritional therapies that work in the prevention and treatment of diabetes.

In the clinical management of diabetes—and pre-diabetes, the prevention of diabetes—health education is critical, particularly with respect to drug therapy. Many of the patients I see with diabetes are misinformed and have doctors that are misinformed. Very frequently they have been prescribed old-fashioned types of drugs and are not taking advantage of more modern types of pharmacologic and neutriceutical agents.

Also complicating the drug therapy management of diabetic patients is the fact that we must deal not only with the glucose and insulin levels, but also the ancillary problems, such as hypertension, lipid abnormalities, hormone dysfunction—especially thyroid, adrenal, and sex hormones. Additional conditions, which complicate treatment and which must be addressed in the therapeutic modality, include visceral adiposity, homocysteine, uric acid elevation and progressive nerve and vascular problems, including retinal and renal disorders. These problems must come under an all-out attack that includes drug therapy and natural therapies, plus dedicated lifestyle changes.

The conditions secondary to diabetes and pre-diabetes are chiefly related to cardiovascular problems, because high glucose levels result in what I call the atherogenic and thrombogenic lipid profile. This profile consists in high triglycerides, low HDL, increased small particle size LDL, and changes in blood clotting characteristics. Associated problems that must be considered are postprandial hyperglycemia (elevated glucose after meals) and postprandial hyperlipidemia (elevated lipids after meals). These problems are called postprandial dysmetabolism.

Elevated glucose causes four specific problems that not only inflict damage on nerve tissue and blood vessels, but also dispose one to cardiovascular disease and accelerate the aging process:

1. Glycosylation. High glucose levels adhering to protein molecules causing protein and DNA damage as well as the production of AGEs: advanced glycation end products, detrimental to nerves and blood vessels.
2. Oxidative stress. The by-product damage done to cells in the process of burning nutrients to produce energy, countered by anti-oxidants.
3. Inflammation. The body's response to cell damage, a known risk factor in cardiovascular disease. It is marked by C-reactive protein (CRP) levels, cardio-CRP, fibrinogen, and white blood count.
4. Thrombosis. The formation of blood clots; coronary thrombosis is a cause of heart attacks.

The Drugs

In my practice, although I specialize in holistic cardio-endocrinology, I use a number of drugs that I find essential in diabetes management, especially since the newer drugs are extremely efficient. The classes of drugs are as follows:

1. Sulfonylurea types (Glucotrol, DiaBeta, Micronase, Amaryl).
2. Meglitinides (Prandin).
3. Biguanides (metformin/glucophage).
4. Alpha glucosidase inhibitors (Precose Glyset).
5. TZDs or thiazolidinediones, such as Actos. Note. Avandia, is still on the market although it has been pegged as a drug that can increase heart risk.
6. Incretins, which include the miracle drug Byetta, an injectable.
7. DPP-4 inhibitor Januvia.

What is significant about these modern drugs is that they are effective not only for glucose and insulin management, but many of them have collateral benefits in treating lipids and arteriosclerosis. For example, Actos will slow the progression of arteriosclerosis and possibly reverse arteriosclerosis; glucophage and byetta also reduce weight. But additional drug therapy will be necessary for obesity, hypertension, lipids, fatigue, dysbiosis and low hormone levels.

The Neutriceuticals

With regards to neutriceuticals, as with the drugs, we target those same problems—hypertension, elevated lipids, homocysteine, inflammation, oxidative stress, thrombosis, glycosylation—plus the attendant conditions: obesity, fatigue, and hormonal dysregulation. It is not possible here to discuss in detail each neutriceutical and its effects. Here is a list of those that I have used with success in preventing and treating diabetes: fiber, magnesium, chromium, vanadium, lipoic acid, XS maitake mushroom, Garcinia cambogia, Gymnema sylvestre, fenugreek, cinnamon, Pycnogenol, Asian pumpkin extract, phaseolamin, corosolic acid, biotin and ginseng. These are among the many, many natural substances that can be used therapeutically.

Lately attention has been drawn to hormonal factors in diabetes and obesity (what I call diabesity). Frequently, I see patients with clinical hypothyroidism—that is, early stage hypothyroidism (insufficient thyroid hormone). Recent publications have indicated that a higher range of TSH (thyroid stimulating hormone), even a level within normal range, can be associated with inability to lose weight. Along with hypothyroidism very frequently there occurs adrenal fatigue and adrenal hormone depression. For this condition, DHEA (the body's super hormone) replacement therapy can be very effective in increasing energy and reducing visceral adiposity.

Most diabetic and pre-diabetic men I see have a testosterone deficiency. Administration of the testosterone hormone not only helps the insulin resistance of the diabetes, but also improves their endurance and energy levels, and improves libido and ED. Other problems that are often addressed in the diabetic patient are brain fog and intestinal dysbiosis, by products of the diabetic's high glucose level. For this, I use certain diets that reduce allergens, such as wheat or gluten. These diets are quite effective in reducing weight as well. Also, Candida albicans, often found in diabetic patients, must be treated.

Diet and Exercise

Of priority in the prevention and management of diabetes are a strict disciplined diet and a structured exercise program. I cannot discuss any aspect of this subject without stressing these essential elements. The diet of choice at my centers in New York is a low glycemic, modified low-carbohydrate Mediterranean diet, which is low in grains, fruits, and starches and high in vegetables, salads, lean protein, with some olive oil and some red wine when indicated. The other essential is exercise. It is equally if not more important than all other therapies discussed here in the management and prevention of diabetes. I recommend "cross training"; that is, resistance training, weights and aerobics, and treadmill walking.

My program is obviously extensive and includes all of the above management therapies as well as the help and counsel of the certified medical nutritionists and diabetes educators Maria Santoro and Gia Mazzeo who are a part of my practice. I also perform at my centers a cardio-metabolic evaluation, which includes a complete cardiac evaluation and metabolic evaluation with the use of body composition studies, measurement of basal metabolic rate, measurement of a two-week daily energy expenditure, and most recently added, gastric analysis for hypochlorhydria or lack of stomach acids.

About Dr. Vagnini
Dr. Vagnini is ELDR's chief medical advisor. He is the coauthor, along with ELDR Editor-in-Chief Dave Bunnell, of the book, Count Down Your Age [1] (McGraw-Hill). To learn more about Dr. Vagnini, visit his website » [2]