Can't I Just Take A Pill (Part 2)
Some medication options to lower risk of complications
Last month, I wrote about a question asked by one of my patients (see Part 1). He wanted to know if rather than changing his diet and lifestyle to reduce the risk of diabetes complications, including eye disease, could he just simply ‘take a pill.' After scribbling for him a (third-grade level) drawing (see below), showing the basic recipe for diabetes complications, and after explaining the anti-inflammatory and blood sugar benefits of the so-called "Mediterranean Diet" in combination with regular exercise and prescribed diabetes medications, he politely asked me again: "Doc, can't I just take a pill?"
This month, I'd like to share with you a few ‘pills' that may, in fact lower the risk of developing diabetes-related complications in the eye and, perhaps, elsewhere. Each of these is now available as a non-prescription dietary supplement and, when used in tandem with prescribed medicines, healthy diet and regular exercise, may give those of us with diabetes a bigger, tougher, more effective mop to clean up the ‘toxic biochemicals' (water on the floor) generated by hyperglycemia (running faucet) to cause complications (ruined bathroom floor).
R-Alpha Lipoic Acid: R-alpha lipoic acid (R-ALA) is a sort of super-antioxidant that neutralizes injurious proteins (‘toxic biochemicals') produced by free radicals when the cell nucleus is exposed to high levels of glucose. Unlike the vast majority of anti-oxidants (e.g. Vitamins C, E, and beta carotene), which are inactivated (used up) once they neutralize individual free radical molecules, R-alpha lipoic acid ‘recycles' itself to provide a more constant level of antioxidant defense; in an animal model of diabetic retinopathy, it significantly reduced retinal damage by up to 88%. Moreover, because it is both water and fat soluble, R-ALA is able to reach parts of the body and parts of individual cells that most antioxidants cannot. A number of short term human and animal trials demonstrate that R-ALA reduces markers of inflammation in the blood, heart, nerves and eyes , , but, unfortunately, there are no long term randomized, controlled clinical trials (RCCT) proving its efficacy in human beings with diabetes.
Benfotiamine: Benfotiamine (ben-fo-tee-a-meen) is a lipid (fat) soluble form of Vitamin B1 (thiamine). Once inside of cells, thiamine boosts levels of an enzyme called transketolase, which facilitates the removal of many of the toxic biochemicals produced by high blood sugar. Thiamine is water soluble and is, in fact, difficult to get inside of cells because the cell membrane (outer covering) is composed of fat; benfotiamine, however, can easily cross the cell membrane and boosts levels of transketolase by three to four times. In a study of rats with diabetes, benfotiamine totally prevented the development of diabetic retinopathy in all animals, whereas all other animals developed severe retinopathy. In a recent study of humans without diabetes, benfotiamine dramatically reduced toxic biochemicals (so-called ‘advanced glycation endproducts') generated by a single, high glucose meal, suggesting that the same beneficial effects seen in laboratory animals might very well occur in humans (see www.benfotiamine.net for more information).
Genestein: Genestein is a protein found in soy beans that appears to block the effects of tyrosine kinase, another toxic biochemical that is believed to cause leaky blood vessels in the eyes of patients with diabetic macular edema. In a study of rats with diabetes, genestein resulted in significantly less retinal blood vessel leakage. In a study of Korean women with type 2 diabetes, genestein improved blood levels of a potent antioxidant called glutathione peroxidase over 12 weeks, but no long term studies or benefits in humans have been demonstrated as of yet. Genestein is now commercially available in a supplement made by Bausch and Lomb, called Ocuvite DFTM.
Curcumin: Curcumin is an antioxidant found in the spice, turmeric, which is used extensively in Indian cuisine. It has been shown to reduce many of the major toxic biochemicals responsible for eye and others diseases in lab animals with diabetes, and has proven effective in treating chronic conditions like diabetes, cancer, arteriosclerosis and gastro-intestinal diseases in animal models, as well as several inflammatory eye diseases unrelated to diabetes.
In summary, there is no single ‘magic pill' for preventing the complications of diabetes as of yet. There may, however, be a very effective ‘buffet' of complementary strategies: (1) tight control of blood glucose, blood pressure and blood lipids with proven medications combined with regular physical activity (to turn off the faucet); (2) a low glycemic index, anti-inflammatory diet (to turn off the faucet and mop up the floor); (3) specific, scientifically based nutritional supplements (to give us a bigger, stronger, more effective mop). With perseverance and knowledge, our bathroom floor may look beautiful for a long time to come.
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For more information on diabetic eye disease, consult Dr. Chous' book Diabetic Eye Disease: Lessons From a Diabetic Eye Doctor, Fairwood Press, Seattle, 2003.
Read more about Dr. Chous here.
Visit Dr. Chous' website here.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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