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Chromium and diabetes - benefits and sources

In a previous post I explained my 10 underlying mechanisms of diabetes, and mentioned that chromium is know to assist in the binding of insulin to cell membranes.

The transfer of glucose from the blood is achieved when insulin successfully binds with an insulin receptors on cell membranes which then facilitates the flow of glucose and also the transfer of insulin itself thus dropping the levels of both in the blood.

This is how chromium availability helps to relieve impaired glucose tolerance and type 2 diabetes.

Sources of chromium

So what are the sources of chromium and can it be dangerous if mis-used?

It turns out that not a lot is known because there is a lack of accurate tests, in volume and accuracy, for chromium status - its not usually something tested in blood tests for example.

What's known is that its deficiency may be a contributing factor in impaired glucose tolerance and type 2 diabetes.  It's food sources are also known, although there again data is limited:

• whole grain products;
• broccoli;
• green beans;
• grape juice; and,
• spices.

What do diabetics need to know?

Important things for diabetics to know are these:

• heavy exercise may increase the amount of chromium needed;
• foods high in sucrose and fructose increase chromium loss (which makes you wonder about cause and effect with regard to Type 2 diabetes - since high fructose/sucrose diets often lead to diabetes); and,
• Vitamin C in amounts of 100mg or more can increase the absorption of chromium.

Those are quite important points, because I do exercise quite heavily as part of my diabetic control regime, and also perhaps I should be taking a regular vitamin C tablet in conjunction with any chromium supplements.

With regard to supplements, chromium picolate is the form used in much of the research on the health effects of chromium.  It is said to have high bioavailability, and so does chromium nicotinate, whereas hexavalent chromium is highly toxic.  The former forms of chromium are trivalent forms, but even there people with kidney or liver disease are cautioned to take lower doses.  Certain nutritional yeast products are fortified with chromium and have high bioavailabilty (often known as chromium yeast in which the yeast combines the chromium into its fermenting products as it ferments).

For me the keys are to make broccoli a very regular vegetable choice, to check supplements for chromium since I need to keep up levels due to my exercise regime, and consider a nightly Vitamin C tablet.

On the other hand

On the other hand, a very recent 2007 study published in Diabetes Care found that "there is no evidence that chromium in the form of chromium yeast is effective in improving. glycemic control in western patients with type 2 diabetes" - so don't go to any extremes.

However, chromium is the most widely studied supplement for diabetes and the aggregate study results are inconclusive - neither positive nor negative.

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Sweet news from bitter melon for diabetics

Do we have another answer as to why bitter melon may be good for diabetics? (Studies suggest that bitter melon [ampalaya in Filipino] contains a hypoglycemic polypeptide, a plant insulin responsible for its blood sugar lowering effect.)

It's certainly an acquired taste, and bitter is its trademark. It's now been found that when this bitterness hits the gut bitter-taste receptors in the gut activate the production of glucagon-like peptide 1 (GLP-1), a protein that stimulates insulin secretion in the pancreas which is beneficial for diabetics.

The reaction stems from a defense against toxins in food, first signalled by the tongue. Toxins in food often have a bad, bitter taste that makes people want to spit them out. If toxins are swallowed, bitter-taste receptors in the gut sense them and trigger the production of a hormone called cholecystokinin that both suppresses appetite (presumably to keep them from eating more of the toxic food) and slows the movement of food from the stomach to the small intestine.

That bitterness also slows the digestive process, keeping bad food in the stomach longer and increasing the chances that it will be expelled - a finding from researchers at the University of California at Irvine.

At face value we can imagine that bitter melon stimulates that toxin-repelling reaction from the gut, generating GLP-1 and thus slowing digestion, the movement of food to the gut, and raising insulin secretion.

And since we know now that because bitter-taste receptors are expressed in the gut, a new avenue exists to identify ways to stimulate production of GLP-1 through drugs and also other plants and complementary medicines.

As an aside, the researchers also postulated that a low cholesterol diet, based on higher plant food intake, trained the gut to be more sensitive to toxins and bitterness, and that in this case such a person would be more responsive to say bitter melon than a person on a high-cholesterol (meat-based) diet.  That's an interesting avenue to be explored in relation to a diabetic food plan.

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Slashing the diabetic supplement list

When I read David Mendosa's post on why he is stopping taking aspirin, while that topic certainly caught my attention, I stopped in my tracks more when I came across his comment about his constant attention to cutting down the size of his diabetic pill box.

"My alternative supplement list keeps shrinking, but it is still too long to make me happy."

That stopped me in my tracks for two reasons, one because I look at my supplement list with the same concern while at the same time I like to try new alternatives. 

The second because I had decided just a week before to actually go cold turkey and get back to basics on the list because I was no longer sure which bits were of value.

The actual kicker was that I was about to go to Japan, and I did not want to carry all the pills.  When the reality of packing them makes you realise that you are going to look like a hypochondriac at Customs then you realise that there are way too many. 

Another kicker was that my morning blood glucose readings had taken an unexpected jump up and were maintaining a new higher level with which I was not happy.  I wanted to get back to the basic needs and then work from there on the problem of the morning glucose levels.

The result was cutting back to three supplements, two of them I take twice a day and the other only in the morning. One is a general broad-spectrum "Over 60 Male" tablet, the other a broad spectrum general diabetes-related formulation, and the third that I kept taking, in the morning, is turmeric which I get from Thailand.

I arrived back home from Japan yesterday evening, and while there, on the cold-turkey supplement withdrawal, my morning blood sugars did return to lower levels, approaching where they were before I noticed the rise over the last month.

There could be a million reasons for this since the whole lifestyle and diet is different - the food difference is obvious, but also sleeping on futons on the tatami-mat floor, and most nights going to the bathhouse and sauna from about 8pm to 9.30pm.  What effects those had I don't know, and I only took enough strips to measure the morning readings.

Oddly enough, on the first morning back home - this morning - my reading was quite high again.  It was up more than 20 mg/dl ( 1.0 mmol/l ) from where I expected and where it had settled back to when away.  So therefore the supplements themselves are probably playing little part since I have not added any since returning.

I guess that the flight and the tiredness and the effect on liquids and water in the body would all play a more dominant role on the first morning home.

I'm going to stick with my reduced plan and think carefully about each addition and also see what effect I can measure - which is where I started some years ago but the supplements had gradually developed a bit of a life of their own, which I have now stemmed.

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When contradictory research can lead diabetics astray

When we read that ginseng can help control blood sugar it looks like good news - easy to understand and easy to go out and buy some ginseng.

Not so simple! The same researchers who were most prominent in publishing the results of the benefits of ginseng for diabetics did further work which surprisingly showed that their results were specific to a species of ginseng.

American ginseng produced the good results, but Asian ginseng actually produced opposite and worse results than no dose.

Reporting this the researchers noted that "practitioners and consumers should be aware of ginseng’s variable effect".  It's a little more than variable, in one case it is positive and in the other negative in that it sent blood sugar levels up "significantly". They had a chemical explanation:

Ginsenoside analyses showed that the Asian ginseng contained up to 96% lower and sevenfold higher quantities of various ginsenosides and their ratios than our previous efficacious batch of American ginseng.

This reminds us diabetics of the "cinnamon issue" whereby Ceylonese cinnamon is the one with recorded beneficial effects, but Chinese cinnamon which is most common on the shelves in the US and many other places has up to 10 times the amount of an undesirable compound which has been found to cause negative health outcomes.

We have to be careful rushing ahead on any research findings, and not just get half the story as it could be the wrong half e.g. just cinnamon instead of Ceylonese cinnamon, or just ginseng instead of American ginseng.

- See my cinnamon at breakfast post.

In fact we need to be even more careful than we think, because the same people who reported the initial success with American ginseng have also reported where whole studies failed to reproduce their previous good results - in fact they've reported zero results on at least one occasion. In the academic world reporting one result and then later publishing a paper saying that you can't reproduce the result gets you two publications - and that's the success measure, its not about looking after diabetic health. 

That's our responsibility. It turns out that the effect of even American ginseng is very batch-dependent.

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ABCD - apple, breakfast, cinnamon and diabetes, how bioactive is this mash-up?

When I posted previously about the potential benefits of apple peels to diabetics it raised the question of how to eat apples and apple peel most enjoyably and effectively?

Along the journey of me learning about the recent research on the bioactive value of apples I also came across the debate about cinnamon and its potential to help diabetics. And apple and cinnamon go quite well together !!

Concerning cinnamon there IS quite a debate. It seems that cinnamon had quite a reputation in the ancient and Eastern world as a medicine related to improved heart and blood conditions.

Indeed in the journal Diabetes Care in 2003 (by Khan and colleagues) a study evaluated 60 people with type 2 diabetes around the age of 50. They were divided into six groups of 10 patients each. In the cinnamon-treated groups reductions in fasting glucose (down 18 percent to 29 percent), triglycerides (down 23 percent to 30 percent), LDL cholesterol (down 7 percent to 27 percent) and total cholesterol (down 12 percent to 26 percent) were reported.

But other studies have contradicted this study, or not been able to replicate the positive findings.

Cinnamon who?

It seems that large part of the lack of consistency is because of different cinnamon extracts and confusion about what is cinnamon. According to an anonymous comment posted on a Diabetes Health article about cinnamon and diabetes:

First, much of the benefit from cinnamon comes from real cinnamon, not that which is purchased in the supermarket and labeled "cinnamon"....Secondly, what is sold in most supermarkets (cassia) has a compound in it (courmarin) that can inflame and damage kidneys. It is the aqueous extract of cinnamon that has been shown to be of benefit to diabetics. The particular extract is known as Cinnulin PF, a trademarked compound.

Indeed Chinese cinnamon which is the "supermarket" type of cinnamon has about 7% courmarin, whereas Ceylon cinnamon (Cinnamomum zeylanicum) has less than 1/10th that amount. Apparently in England and Australia it's illegal to sell “cinnamon” that is actually cassia.

Recent advancements in phytochemistry have shown that it is a "proanthocyanidin", cinnamtannin B1, isolated from C. zeylanicum which is of theraputic effect on type 2 diabetes. Recent (2007) results also suggest that cinnamon exhibits the potential to increase the amount of proteins involved in insulin signaling, glucose transport, and anti-inflammatory/anti-angiogenesis response - which all means good news for type 2 diabetics.

A - B = Breakfast - C - D

So how do we turn all that into something useful for us diabetics - how about B for Breakfast.

• A = apples, grated through the intact skin - try a Fuji;
• B = breakfast, something like organic or cold rolled oats soaked overnight;
• C = real cinnamon sprinkled on top, Ceylon cinnamon of course;
• D - diabetic benefits - its up to your personal metabolism but possibly as good as the 2003 results above.

I'm going to give this a go, since I'm always willing to try and measure myself and see how I think that it is working for me.  I'm kind of optimistic about this one.  I add a few extra things as part of my usual breakfast routine, such as soy protein isolate (plenty of controversy here!), konbu (burdock) root powder, 4 prunes, and a good yogurt usually full cream.  I have plenty of measurements about those combinations so I can tell the difference with new supplements.

I'm looking forward to trying out the cinnamon.

You'll find some other cooking suggestions here, along with preparation advice. For example how about this (my variation):

Crush cinnamon sticks, steep in scalded milk overnight, then strain and use the milk to make ice cream, custards, and pastry cream.

That sounds great if instead we add that milk to the breakfast, along with the actual ground cinnamon. Or if you are adventurous try Pongal Style Oats along with ground cinnamon.

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Blood glucose levels reduced by drinking chamomile tea, reduced diabetic damage

It was reported recently that drinking chamomile tea daily with meals may help prevent the complications of diabetes (which include loss of vision, nerve damage, and kidney damage), which was found by researchers in Japan and the United Kingdom.

The researchers fed chamomile extract to a group of diabetic rats for 21 days and compared the results to a group of control animals on a normal diet. The chamomile-supplemented animals showed a significant decrease in blood glucose levels compared with the controls, they say.

In the study, Atsushi Kato and colleagues point out that chamomile, also known as manzanilla, has been used for years as a medicinal cure-all to treat a variety of medical problems including stress, colds, and menstrual cramps. This was the first "scientific test" of some of the claims made for chamomile in relation to benefits for diabetics.

The article didn't mention this, but is it thought that chamazulene carboxylic acid may be the main cause of the "anti-inflammatory" activity which is of benefit to diabetics, and to be noted is that this also occurs in Yarrow (Achillea millefolium).  Yarrow has a long history as a medicinal herb, famously for soldiers to treat battle wounds and hence an old folk name "soldier's woundwort".

CCA also occurs in other Asteraceae species (besides chamomile) which is said to be "the largest family of flowering plants, with more than 25 000 species world-wide" and includes the daisy family, sunflower family, and thistle family (and dandelions). The most well known food product of the family is certainly sunflower oil and kernels. Other well-known foods are Jerusalem and French artichokes, lettuce, chicory and medicinally wild rosemary and wild camphor bush.

I'm fascinated that it includes thistles because I think that there is another story in thistles and their value for diabetics, as well as the value of dandelion roots.

The main consitutuent of chamomile is apigenin 7-O-glucoside and it is this which is thought to be responsible for its anti-cancer activities, which are believed to be facilitated in the gut (small intestine), and even have benefit for such cancers as prostate cancer.

It may be that chamomile can reduce blood pressure, which would be generally helpful for diabetics since they often have a range of associated conditions such as elevated cholesterol and blood pressure.  UK scientists (2005) found very positive effects of drinking chamomile tea for 2 week, including "increased urinary excretion of hippurate". In 2008 Nature published a paper wherein researchers from the UK, USA, Belgium, Japan, and China found an inverse relationship between the concentration of hippurate in the urine and blood pressure. 

Is there any downside with chamomile?

Well probably nothing yet as the research reported was the first "scientific test"  But we do know that the essential oil of chamomile contains considerable content of couramin which has been linked to cancer and liver damage in animals (download PDF). This is the undesirable product within Chinese cinnamon, whereas cinnamon is often recommended for diabetics but it should be the Ceylonese cinnamon which has one-tenth the couramin.  For example in bilberries, black rasperries and Angelica roots couramin is below "detectable levels" - that's important because bilberries are an important diabetic supplement to reduce neuropathy.

There are also various forms of chamomile, and many called "wild chamomile". For example Athemis Cotula is called "wild chamomile" but testing its extracts showed no "antibacterial activity"; German chamomile is also called wild chamomile and it has a long history of medicinal usages - so some care is needed in understanding which extracts and species are being used.

The orginal true medicinal chamomile, at least as know to the West, is the German chamomile "Matricaria recutita".

In terms of anti-oxidant activity, research has shown the following order: thyme > basil > rosemary > chamomile > lavender and cinnamon, with thyme and basil standing out.  Does this mean that you should be drinking thyme tea instead? I don't know ! And whether they have the same positive impact on lowering blood sugar I don't know.

So where are we?

There seem to be benefits and no harm in a regular cup of chamomile tea, and potentially specific positive benefits for diabetics.  You might like to also consider, for variety, as I do:

• Bilberry tea and extracts - for capilliary improvement and to ameliorate neuropathy;
• Green tea - for well know benefits;
• Dandeline root tea - not really sure here but I suspect benefits for diabetics.

Check your chinese grocery store for a good range at the right price - "yellow spring crysantemum" 黃春菊 although I can't say that this would be German Chamomile although I'm sure that the Chinese know what they're doing.

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Peeling away the benefits of apples for diabetics

Don't peel that apple just yet, read some of the benefits of apple peel for diabetics first !

I know from my analysis of visitors to this website that many people search on aspects of apples.  That's a little surprising but true - "apples and diabetics", "green or read apple better for diabetic", "granny smith glycemic index", "pink lady versus granny smith for diabetics" - those are typical search phrases.

Actually, I don't know why I see so many searches related to apples compared to other foods, but they dominate in the searches arriving here.  Now there may just be a good reason, and it is that those people searching know more than I do about the benefits of apples for diabetics and are searching about to confirm their ideas?

Don't peel that apple !

What I really had no idea about before is that apple peels contain a majority of the antioxidants as compared to the flesh. Recent work has shown that apple peels contain anywhere from two to six times (depending on the variety) more phenolic compounds than in the flesh, and two to three times more flavonoids in the peels when compared to the flesh.

I "stumbled upon" research from research from Cornell University, dated 28 August 2008, in which peel of Red Delicious apples was tested and found to contain potent anti-oxidant and anti-proliferative activities.

Red Delicious peel contains flavonoids, the major flavonoids in apple peels are quercetin-3-O-β-D-glucopyranoside and other related quercetins. Quercetin is also a strong antioxidant, and is thought to have potential protective effects against both cancer and heart disease.

Among the compounds isolated, quercetin (18) and quercetin-3-O-β-D-glucopyranoside (20) showed potent antiproliferative activities against certain (liver and breast cancer) cells. Six flavonoids and three phenolic compounds showed potent antioxidant activities with caffeic acid, quercetin showing the highest antioxidant activity.

The researchers concluded, that most tested flavonoids and phenolic compounds had high antioxidant activity when compared to ascorbic acid and might be responsible for the antioxidant activities of apples. These results showed apple peel phytochemicals have potent antioxidant and antiproliferative activities.

Said in shorthand, these apple peels had highly bioactive constituents, and therefore I wondered what might carry across to diabetics as there is usually a connection when we see highly bioactive antioxidants.

Does any of this count for diabetics?

To my surprise, I found that the apple-diabetic connection is quite well know, at least in those informed circles which I don't normally inhabit. In 2004, in the Nutrition Journal, researchers from Cornell including a common researcher Rui Hai Liu, published a note called Apple phytochemicals and their health benefits.

...phytochemicals including phenolics, flavonoids and carotenoids from fruits and vegetables may play a key role in reducing chronic disease risk. Apples are a widely consumed, rich source of phytochemicals, and epidemiological studies have linked the consumption of apples with reduced risk of some cancers, cardiovascular disease, asthma, and diabetes.

Not only may apples help decrease the risk of heart disease, cancer, and asthma, but apple consumption may also be associated with a lower risk for diabetes.

In a Finnish study of 10,000 people, a reduced risk of Type II diabetes was associated with apple consumption. Higher quercetin intake, a major component of apple peels as mentioned above, was also associated with a decreased risk in type II diabetes.

Myrecetin and berry intake were also associated with a decreased risk in type II diabetes (but onion, orange, grapefruit and white cabbage intake were not associated with a lowered risk). Apple and pear intake has also been associated with weight loss in middle aged overweight women in Brazil. Approximately 400 hypercholestemic, but nonsmoking, women were randomized to one of three supplement groups: oat cookies, apples or pears, and each subject consumed one of each supplement three times per day for twelve weeks. The participants who consumed either of the fruits had a significant weight loss after 12 weeks of 1.21 kg, whereas those consuming the oat cookies did not have a significant weight loss. Those consuming fruit also had a significantly lower blood glucose level when compared to those consuming the oat cookies.

So based on these epidemiological studies, it appears that apples may play a large role in reducing the risk of a wide variety of chronic disease and maintaining a healthy lifestyle in general.

Of the papers reviewed, apples were most consistently associated with reduced risk of cancer, heart disease, asthma, and type II diabetes when compared to other fruits and vegetables and other sources of flavonoids. Apple consumption was also positively associated with increased lung function and increased weight loss.

Because of these types of findings there is now much more activity in human studies of apples and their bioactive properties.

Surprisingly, considering all the "power foods" being promoted, when compared to many other commonly consumed fruits in the United States, apples had the second highest level of antioxidant activity. Apples also ranked the second for total concentration of phenolic compounds, and perhaps more importantly, apples had the highest portion of free phenolics when compared to other fruits. (This means that these compounds are not bound to other compounds in the fruits, and the phenolics may be more available for eventual absorption into the bloodstream.)

How about different types of apples, and storage?

According to the Cornell report, the phytochemical composition of apples varies greatly between different varieties of apples, and there are also small changes in phytochemicals during the maturation and ripening of the fruit. Storage has little to no effect on apple phytochemicals, but processing can greatly affect apple phytochemicals.

Of Rome Beauty, Idared, Cortland, and Golden Delicious, Rome Beauty had the highest phenolic content while Cortland apples had the lowest. Rome Beauty apples also had the highest flavonoid content while Cortland apples had the lowest.

Out of 10 varieties commonly consumed in the US, Fuji apples had the highest total phenolic and total flavonoid compounds. Red Delicious apples were also quite high. Antioxidant activity of apples also differs between different varieties, and was positively associated with the level of total phenolic content. The apple varieties with the higher phenolics tended to have higher antioxidant activity.

So perhaps an apple a day really can keep the diabetic doctor away!?

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