Diabetes

Suikerziekte / Diabetes

Stoornis in koolhydraat- en vetstofwisseling veroorzaakt door een tekort aan insuline in de bloedvaten en de cellen.

Oorzaken

• Pancreasfunctie, aanmaak van insuline in de eilandjes van Langerhans is verstoord, maar de oorzaak daarvan is onduidelijk.

• erfelijke factoren spelen een rol

• vetzucht bevordert de ziekte

• ouderdom, slijtage van de pancreas?

Soorten

• Type I: juveniele diabetes, bij jongeren, de ß-cellen in de eilandjes van Langerhans functioneren niet goed.

• Type II: ouderdomsdiabetes, de meest voorkomende, gaat dikwijls samen met vetzucht. Cellen zijn minder gevoelig voor insuline, insuline wordt slecht gebruikt door het lichaam.

Kruiden, een alfabetisch overzicht

• • Allium cepa / Ui : ook schil met hoog quercetinegehalte gebruiken bvb als soep

  • Allium sativum / Knoflook

  • Arctium lappa / Grote klis*: inuline

  • Atriplex halimus / Saltbush (Maluah): zoutsmakende plant uit Negev-woestijn Israel

  • Cinnamomum / Kaneel

  • Cyamopsis tetragonoloba / Guargom: slijmstoffen

  • Cynara scolymus / Artisjok

  • Eucalyptus globulus / Eucalyptus: blad als thee, niet de etherische olie

  • Eleutherococcus senticosus / Siberische ginseng: adaptogeen

  • Galega officinalis / Galega: obsoleet

  • Geranium robertianum / Robertskruid

  • Gymnema sylvestris: tropische plant uit de wouden van India

  • Helianthus tuberosus / Aardpeer: inuline

  • Juglans regia / Walnootboom

  • Momordica charantia / Bitter melon (Karela): tropische groente, sap, extract onrijpe vrucht

  • Opuntia / Nopal of Vijgcactus: vruchten als voedsel

  • Panax ginseng / Koreaanse ginseng*: adaptogeen

  • Phaseolus vulgaris / Spercieboon

  • Polygonum aviculare / Varkensgras

  • Pterocarpus marsupium (India): flavonoïd epicatechine in schors beschermt beta-cellen

  • Stevia rebaudiana: zoetstofplant, vervanger suiker

  • Tarraxacum officinale / Paardebloem

  • Trigonella foenum-graecum / Fenegriek*: zaad

  • Vaccinium myrtillus / Blauwe bosbes

De bekendste plantenstoffen met bloedsuikerverlagende werking zijn:

• glucoquininen met insuline-achtige werking o.a. in Allium cepa.

• inuline en andere FOS, fructo-oligosacchariden o.a. in grote klis, aardpeer, schorseneren.

• vezelstoffen / slijmstoffen o.a. in guargom, fenegriek, heemst

Aanvullende planten

vooral bedoeld om cardiovasculaire complicaties tegen te gaan, dus vooral de kruiden voor hart en bloedvaten o.a. knoflook en vooral Ginkgo biloba en andere flavonoïdplanten.

Voedingssupplementen / Oligo

• chroom*: in GTF (glucose tolerantie factor), in biergist

• mangaan: co-factor in glucosestofwisseling, diabetici hebben gemiddeld een lagere mangaanspiegel.

• zink*: beschermend effect op ß-cellen

• voedingsvezels: volkoren en fruit of groenten

Voeding en leefstijl

• minder enkelvoudige suikers, minder dierlijke vetten en calorieën

• meer volkoren graanproducten, meer vis, meerdere keren kleinere hoeveelheden eten.

• peulvruchten (soep) en noten, ook aardnoten?

• meer bewegen, vooral stevige, niet-uitputtende wandelingen 3x per week 1 uur: verbetert de efficiëntie van insuline, vermindert totaalcholesterol, verhoogt HDL.

Literatuur

• Auswirkungen eines modifizierten Guar-Gummi-Praparates auf den Glukose- und Lipidspiegel bei Diabetikern und gesunden Freiwilligen. Atherosclerosis 45 (1982).

• Bourret J.C. - Les nouveaux succes de la medecine par les plantes. Le diabete.

• Faulds - Eucalyptus in treatment of diabetes. The Glasgow Med. J. 1920.

• Huibers J. - Suikerziekte (Anckertje 57)

• Lau S. - Insuline slikken in plaats van prikken? Ned. Tdschr. Phytoth. 3 (1994)

• Leclerc H. - La phytothérapie hypoglycémiante. Progres med. 1935

• Leclerc H. - Une plante hypoglycemiante: le Galega. Rev. de Phytoth. 1947.

• Mada Z. e.a. - Glucose-lowering effect of fenugreek in non-insulin dependent diabetics. Eur. J. Clin. Nutr. 42 (1988)

• Murray M. - Diabetes and Hypoglycemia (1994)

• Natural Products used for Diabetes. Shapiro en Gong. J. American Pharm. Ass. 2002.

• Pedersen O. e.a. - Increasing insulin receptors after exercise in patients with insulin-dependent diabetes. N. Engl. J. Med. 302 (1980)

• Phytopharmaka als Antidiabetika. Prof.Ammon in Ztschr. f. Phytoth. 15 (1994)

• Piotrowski - Action hypoglycemiante de l’ extrait de Bardane. Soc.de therap. 1935.

• Planten als anti-diabetica: droom en werkelijkheid. Gert Laekeman. Ned. Ver. Geneeskr.

• Sharma K.K. e.a. - Antihyperglycemic effect of onion: Effect on fasting blood sugar and induced hyperglycemia in man. Ind. J. Med. Res. 65 (1977)

• Voeding en diabetes. Doc. en Inf. Centrum Tiense Suikerraffinaderij.

• Weiss R. - Herbal Medicine (1979)

• Welihinda e.a. - Effect of Momordica ch. on the glucose tolerance in maturity onset diabetes. J. Ethnopharmacol. 17 (1986)

• Yamashita K. e.a. - Effects of fructo-oligosacchariden on blood glucose and serumlipides in diabetic subjects. Nutr. Res. 4 (1984).

• Review meer dan 400 wetenschappelijke onderzoeken met planten

©Herboristen Opleiding ‘Dodonaeus’ / Maurice Godefridi

Systematic review of herbs and dietary supplements for glycemic control in diabetes.

Yeh GY, Eisenberg DM, Kaptchuk TJ, Phillips RS.Diabetes Care. 2003 Apr;26(4):1277-94.

Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, Massachusetts, USA. gyeh@caregroup.harvard.edu

OBJECTIVE: To conduct a systematic review of the published literature on the efficacy and safety of herbal therapies and vitamin/mineral supplements for glucose control in patients with diabetes. RESEARCH DESIGN AND METHODS: We conducted an electronic literature search of MEDLINE, OLDMEDLINE, Cochrane Library Database, and HealthSTAR, from database inception to May 2002, in addition to performing hand searches and consulting with experts in the field. Available clinical studies published in the English language that used human participants and examined glycemic control were included. Data were extracted in a standardized manner, and two independent investigators assessed methodological quality of randomized controlled trials using the Jadad scale.

RESULTS: A total of 108 trials examining 36 herbs (single or in combination) and 9 vitamin/mineral supplements, involving 4,565 patients with diabetes or impaired glucose tolerance, met the inclusion criteria and were analyzed. There were 58 controlled clinical trials involving individuals with diabetes or impaired glucose tolerance (42 randomized and 16 nonrandomized trials). Most studies involved patients with type 2 diabetes. Heterogeneity and the small number of studies per supplement precluded formal meta-analyses. Of these 58 trials, the direction of the evidence for improved glucose control was positive in 76% (44 of 58). Very few adverse effects were reported.

CONCLUSIONS: There is still insufficient evidence to draw definitive conclusions about the efficacy of individual herbs and supplements for diabetes; however, they appear to be generally safe. The available data suggest that several supplements may warrant further study. The best evidence for efficacy from adequately designed randomized controlled trials (RCTs) is available for Coccinia indica and American ginseng. Chromium has been the most widely studied supplement. Other supplements with positive preliminary results include Gymnema sylvestre, Aloe vera, vanadium, Momordica charantia, and nopal.

http://care.diabetesjournals.org/content/26/4/1277.long

Effects of Long-Term Treatment with Stevioside on the Type 2 Diabetic Goto-Kakizak GK) Rats – Potential as a New Antidiabetic drug. Per Bendix Jeppesen, Søren Gregersen and Kjeld Hermansen Dept. Of Endocrinology and Metabolism C, Aarhus Amtssygehus,

Extracts from leaves of Stevia rebaudiana Bertoni (SrB), have been used in traditional medicine in Paraguay and Brasil as treatment of diabetes. Recently, we demonstrated a direct insulinotropic effect of stevioside in vivo in isolated mouse islets and in vivo in diabetic rats.

Aims: To explore if stevioside exerts anti-hyperglycemic, glucagonostatic or anti-hypertensive effects during longterm feeding with stevioside in diabetic rats.

Methods: For 6 weeks period Goto-Kakizaki (GK) rats were given 0.025 g/kg BW/day of the glycoside stevioside (purity > 99 %) via the drinking water. The same amount of glucose as contained in the stevioside was given to the control group. The tail-blood pressure was measured every week. At week 5 an intraarterial catheter was inserted

in rats of both groups. After 6 days recovery the animals were exposed to an i.v. glucose tolerance test (2.0 g/kg BW) and blood samples were drawn througout a 180 min period.

Results: Stevioside caused a suppression of plasma glucose (incremental area under the curve (IAUC)): 985±20 (stevioside) vs 1575±21 (control) mM x 180 min, p<0.05. Corresponding to this the stevioside fed animals had an enhanced first phase insulin response compared to the control group (IAUC: 343±33 (stevioside) vs 136±24 (control) mU insulin x 30 min, p<0.05. The second phase insulin response, in both groups occurred to be increasing

during the entire observation period. The control group tended to have higher insulin output, however, not attaining statistical significance (IAUC: 4798±34 (control) vs 3776± (stevioside) mU x 150 min, p=0.38). Interestingly, stevioside concomitantly caused a suppression of the glucagon level corresponding to the first phase of the insulin response (IAUC: 2026±234 (stevioside) vs 3535±282 (control) pg/ml x 180 min, p<0.05. From week one and onwards a 7-9 % decrease in both the systolic (p<0.01) and diastolic (p<0.05) blood pressure was elucited by stevioside.

Conclusion: Stevioside normalizes first phase insulin response in diabetic rats during i.v glucose tolerance test, and possess anti-hyperglycemic, insulinotropic and glucagonostatic effects. In addition, stevioside exerted blood pressure suppression. Stevioside appears to be usefull in the treatment of type 2 diabetes and the metabolic syndrome.

Clinical Evaluation of Japanese Phytotherapy (Gosha-jinki-gan) in Diabetic Neuropathy: A Prospective Open Pilot Study

H. Reißenweber, S. Schaefer, W. Mueller-Felber*, and R. Landgraf Research Unit for Japanese Phytotherapy;

Medizinische Klinik - Innenstadt, University of Munich, Germany

Objective: Diabetic neuropathy is one of the severest and most common complications of diabetes mellitus. Direct therapeutic options are still limited. In Japan, a traditional prescription of ten East Asian medicinal herbs, Gosha-jinki-gan, has shown empirical efficacy for this indication which was confirmed in clinical trials. Pharmacological research using animal models revealed that Gosha-jinki-gan influences the metabolic situation as an

aldose reductase inhibitor, works analgetic and improves the microcirculation of peripheral nerves. We here present data of the first clinical trial conducted with a standardized phytoproduct (TJ-107) of this regimen in Europe according to ICH-GCP guidelines.

Materials and Methods: 25 diabetic patients (DM type 1 and 2, HbA1c £ 9, mean age 60.5 (±9)) complaining about a symptomatic stage of diabetic neuropathy with the leading symptoms paresthesia, numbness, or pain were enrolled in a prospective open treatment trial. Total observation period was 36 weeks with a treatment phase of 24 weeks and a follow-up phase of 8 weeks. Primary endpoints were changes in neuropathic symptoms and nerve conduction velocity (NCV). Secondary endpoints were changes in neuropathic deficits, quantitative sensory and autonomic testing, evaluation of microcirculation, Quality of Life and metabolic parameters.

Results: Descriptive statistics were applied for simple data, ANOVA for continous variables. A significant improvement of clinical symptoms by 52.5% was found applying a validated symptom score. There were no such changes for NCV. Evaluation of temperature and vibration sensation resulted in noteworthy, in part significant improvement. No clear change was observed for cardial and gastric autonomic neuropathy, and microcirculatory

testing. Quality of Life showed a trend towards improvement. After stopping the treatment, the symptoms aggravated again which was reflected in most test results after the follow-up phase.

Conclusions: In this pilot study with a limited Western study population and relatively short time range, noteworthy evidence was obtained that Gosha-jinki-gan (TJ-107) is a safe, tolerable and efficacious treatment for symptomatic stages of diabetic neuropathy. In five out of eight endpoints a remarkable or even significant improvement was demonstrated. Future results of a controlled clinical study will confirm if this herbal medication opens up anew therapeutic option for diabetic neuropathy within an international context.

The European Phytojournal Issue 2 draft www.escop.com