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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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What makes us diabetic - understanding the 10 key mechanisms

Have you read medical explanations of diabetes and found them a little hard to understand, yet you wouldn't mind knowing "what's going on inside" but can't find the right level of explanation?

I've read many explanations, many times, and if you Google around you'll find lots.  But I thought that what's needed is something simple as possible, but no simpler, which includes explanations of some of the fundamentals.

So here is my attempt which is a step-by-step functional flow intermingled with explanatory statements:

1. The body secretes insulin in response to rising levels of blood sugar - after we eat.
2. The purpose of the sugar going into the blood is to be taken to other places, where it can be used.
3. The blood itself does not need sugar and in fact if it is not removed it becomes harmful - which is of course one of the harmful effects of diabetes.
4. The body pumps the insulin into the blood, sensing the rising blood sugar, in order to tell the blood to get rid of that sugar by delivering it to where it is needed.
5. The insulin binds to the surfaces of cell membranes to stimulate the cells to take in more blood sugar and hence to remove it from the blood.
6. So the insulin has a double effect, it helps the cell to pump in more glucose (blood sugar) for its necessary functioning, and as a consequence lowers the level of glucose in the blood.
7. There is other "stuff" which assists insulin in stimulating the cells and pumping the glucose from the blood and these are called glucose tolerance factors - a "factor" here used in a classic sense of the word meaning "an agent" (see Wikipedia GTF).
8. Insulin does other work such as helping shift fatty acids from the blood into cells, which is essential for the functioning of muscles for example.
9. Cell membranes have insulin receptors - these receptors are welcoming committees for insulin and grab the insulin in as it circulates in the blood - think of the sprukers on the footpath in front of some restaurants - waving in the insulin.
10. When the insulin "shakes hands", or binds, with these receptors then the combination of the two creates an active gate for the flow of glucose and other materials into the cell, that is the binding of the insulin "activates" the receptor and gets the transfer process going.

They are the 10 key things that a normally functioning system does.

Here are the basic three things that go wrong for us diabetics:

1. We don't produce insulin - that's a "Type 1" problem which requires insulin replacement and injections on a strict regime.
2. We produce enough insulin but the cell receptors no longer want to shake hands and engage with our insulin to activate the transfer of glucose from the blood - this is "Type 2" insulin resistance.
3. We produce insulin but not enough and also we become resistant - this is also Type 2.

Knowing this allows us to understand the rationale behind various ideas and suggestions and treatment strategies, for example:

1. We might want to try reducing the blood sugar levels so as to not overload any insulin that remains - or slow down the release of glucose through dietary selection - this works when you still have insulin but not enough to clear the blood of harmful quantities.
2. We might want to try treatments which can stimulate or help activate the cell receptors and raise their interest in grabbing hold the existing insulin - think of this as "Viagra" for diabetes - for example chromium binds to the insulin receptor and enhances its activity and this is how chromium availability can help relieve impaired glucose tolerance and Type 2 diabetes. (Chromium sources include whole grain products, broccoli, green beans, and spices).

I think that understanding this basic underlying mechanism is helpful in understanding what various treatments, supplements, and other advice is trying to effect - to get the insulin working again to transport blood glucose out of the blood and into cells.

Knowing this also makes clear where some of the terms come from, such as "glucose intolerance" which is when the action in point 7 above doesn't work and "tolerance" becomes "intolerance".

It gets a lot more complex, because for one thing the walls of the blood vessels themselves get damaged by the excess blood glucose (seen high levels of high-sensitivity C-reactive protein or interleukin-6 - markers of systemic inflammation), which then becomes a vicious closed loop because it makes things even harder for the insulin to work. And then, Vitamin E has been found in mice to reduce these protein markers of inflammation - etc etc etc it gets too complicated; so that's why I've kept the focus on the clear 10 points of what makes us diabetic.

And also bear in mind that some easy comments in my description, such as the help chromium gives, are not yet understood medically, meaning for example that how chromium serves as a "cofactor" for insulin action is yet to be fully understood. That's all for another time.

Given the direct mention of chromium above, I'll discuss more about that in another post.

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Tumeric in diabetic diet shown to protect health of eyes

Indian researchers have done a lot of work on diabetes, and now a team at the Madras Diabetes Research Foundation (MDRF, headed by Viswanathan Mohan, a renowned diabetologist) in Chennai reports that curcumin (in turmeric) also blocks a key biological pathway needed for development of diabetic retinopathy, an eye complication among diabetics that leads to blindness if untreated.

That's good news for diabetics as these eye problems are not uncommon in advanced diabetes, and even in those with other elements of diabetes under control.

A previous study had showed that the prevalence of diabetic retinopathy in Indians is lower than that reported among Europeans which got the researchers thinking about what was in the diet that gave protection to Indians.

"We suspected it was turmeric," says Mohan Rema, chief ophthalmologist and vice-president at MDRF. The hunch turned out to be correct.

The action of turmeric (also spelt "tumeric") against various cancers was a clue which lead the MDRF to think that it might help in preventing diabetic retinopathy since that is related to a process called angiogenesis that involves the growth of new blood vessels in the back of the eye (when the so called "endothelial cells" that line the inside of retinal blood vessels proliferate and migrate away from the parent vessels to form a network of new fragile micro capillaries which bleed).

According to the MDRF this is the first scientifically documented evidence of the molecular action of curcumin against diabetic retinopathy.

Of course it has a long "non-scientific" history. In Chinese medicine, turmeric is known to stimulate circulation, resolve bruises and clots, strengthen the gall bladder, inhibit dangerous blood clotting, reduce liver toxins, act an anti-inflammatory, and help metabolise fats.

It is also revered in India’s Ayurveda as the most natural antibiotic, even surpassing echinacea, and as the most potent of all blood purifiers. It is also recommended as the best herb to regulate womens’ menstrual periods and as a powerful tonic for womens’ reproductive organs.

Tumeric is also said to help joint and bone health, aid in the clearing of skin plagued with acne and even heal the scars of bad acne.

What does it mean for diabetics?

Add turmeric to your supplements - noting a couple of things.  The first is that other turmeric-related experiments have used tumeric-extracts which are much more concentrated than tumeric powder for cooking, but the second is that since the average Indian diet does not include turmeric extract but mere turmeric powders then it must be effective - according to the reasons above for this latest study.

Where can you use turmeric? That's a good question - it can be a bit of an acquired taste.  The obvious place is to add to some of your soups and stews, and the less obvious to sprinkle some on a morning half avocado as I do irregularly.

Turmeric (Curcuma longa) is a member of the ginger family, and perhaps that will get you thinking about the wider possibilities of where to include it in a diabetic food plan.  For example turmeric tea:

• 2 cups water;
• 1/2 teaspoon powdered ginger;
• 1/2 teaspoon powdered turmeric;
• Bring water to a boil, then add powdered herbs, simmer for 10 minutes;
• Strain tea into a mug, add juice of 1/2 lemon.

That sounds a bit potent but I'll give it a go and see !!  Non-diabetics add a good dose of sweetener which makes it more palatable. An option is to add the tea mixture to milk, or soy milk, and add a drop of two of almond oil.

OR, just buy turmeric/curcumin extract capsules and take daily! That's what I do.

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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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