Diagnosis and Possible Reversal of Pre-Diabetes #3

Chronic Inflammation With Two Key Dietary Supplements

Many of my colleagues no longer support a pre-diabetes diagnoses, believing instead that any consistent fasting blood sugar (FBS) over 100 should be considered type 2 diabetes (albeit a milder form) and must be treated. Diabetes is most reversible in the earliest stages, when FBS is less than 125, which is the general range of the term “pre-diabetes.” Effective early identification of underlying causes is critical to the successful treatment of this condition.

While the etiology of pre-diabetes is multifactorial, one consistent hallmark is chronic inflammation. This potential underlying cause is often not considered as fully as it should be in clinical practice. In a self-perpetuating, destructive cycle, hyperglycemia and insulin resistance beget inflammatory changes. According to one recent study, “insulin receptor substrates serine phosphorylation is a time-controlled physi­ological feedback mechanism in insulin signaling that is hijacked by metabolic and inflammatory stresses to promote insulin resistance.”1 FBS consistently above normal and not contributable to non-diabetic factors is evidence of this process in action. In simpler terms, inflam­mation promotes insulin resistance, insulin resistance promotes hyper­glycemia, and hyperglycemia promotes inflammation.

It is important that this cycle be interrupted or pre-diabetes will evolve to diabetes in the majority of patients thus diagnosed. Two scientifically substantiated potent anti-inflammatories to consider clinically are curcumin and omega 3 fatty acids.

Curcumin has been examined for its ability to prevent oxidative stress, modulate the immune system, and reduce inflammation—all of which has a positive impact on pre-diabetes. However, one area of particular interest is curcumin’s ability to inhibit and modulate specific kinases called c-Jun N-terminal kinases (JNKs, also called “stress-acti­vated kinases” or SAPKs). JNKs modify the activity of certain proteins that are especially important in the development of insulin resistance, which is clinically the earliest stage in the development of type 2 diabetes.2 Curcumin is a known inhibitor of JNKs and therefore could be a powerful tool in reversing the metabolic processes that lead to insulin resistance and subsequent prediabetes.3

Biochemistry aside, from a treatment perspective, curcumin has been shown quite efficacious in the prevention of cardiovascular disease, one of the unfortunate potential sequela of diabetes as well as diabetic retin­opathy, a leading cause of blindness.4,5 Preliminary research indicates that curcumin may help prevent diabetic neuropathy.6

Omega 3 fatty acids also have proven anti-inflammatory properties. In a recent study, 148 men with impaired glucose tolerance and/or impaired fasting blood glucose were followed for 12 months after counseling in dietary fat quality. At the end of the study, 92 subjects reverted to normal glucose levels and 56 remained in prediabetic status. None of the partici­pants progressed to full diabetes. Additionally, it was noted that subjects in the highest tertile of omega-3:omega-6 fatty acid ratio showed the highest chance of improving glucose disturbances (2.51, 1.01-6.37).7 Therefore, incorporating more fatty fish into the diet and/or supplementing with omega 3 fatty acids can have a profound impact on ameliorating blood sugar changes associated with type 2 diabetes, and studies indicate a higher omega 3:omega 6 ratio is protective against progression to diabetes.

Given the strong correlation between inflammation and pre-diabetes, I feel it is imperative that clinicians address this issue in this patient population. The scientific literature provides us with enough substantiation to incorporate curcumin and omega 3 fatty acids into the dietary supplement program of the pre-diabetic patient, along with applicable dietary and lifestyle counsel.

References

1 Tanti JF, Jager J. Cellular mechanisms of insulin resistance: role of stress-regulated serine kinases and insulin receptor substrates (IRS) serine phos­phorylation. Curr Opin Pharmacol. 2009 Aug 13.)
2 Kaneto H. The JNK pathway as a therapeutic target for diabetes. Expert Opin Ther Targets. 2005;9(3):581-92.
3 Moon DO, Jin CY, Lee JD, et al. Curcumin decreases binding of Shiga-like toxin-1B on human intestinal epithelial cell line HT29 stimulated with TNF-alpha and IL-1beta: suppression of p38, JNK and NF-kappaB p65 as potential targets. Biol Pharm Bull. 2006;29(7):1470-5.
4 Wongcharoen W, Phrommintikul A. The protective role of curcumin in cardiovascular diseases. Int J Cardiol. 2009;133(2):145-51.
5 Kowluru RA, Kanwar M. Effects of curcumin on retinal oxidative stress and inflammation in diabetes. Nutr Metab (Lond). 2007;4:8.
6 Osawa T. Nephroprotective and hepatoprotective effects of curcuminoids. Adv Exp Med Biol. 2007;595:407-23.
7 Sartorelli DS, Damião R, Chaim R, Hirai A, Gimeno SG, Ferreira SR. Dietary omega-3 fatty acid and omega-3: omega-6 fatty acid ratio predict improve­ment in glucose disturbances in Japanese Brazilians. Nutrition. 2009 Jul 30.
Cheryl Myers, RN, is recognized as an expert in the health and dietary supplement field. She writes, gives public appearances, and is in charge of scientific affairs and education for EuroPharma, Inc. Cheryl graduated from Purdue University, and also has clin­ical certifications in oncology and gerontology, and has a second degree in psychology. Cheryl’s nationally published articles have addressed a variety of health applications for natural products, and Cheryl has been a featured guest on radio shows, and is frequently interviewed by a variety of periodi­cals, including the New York Times, Wall Street Journal, Prevention Magazine, and Healthy Living.

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