Diabetes

Suikerziekte

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

Herbal Supplements May Improve Glycemic Control in Diabetes Mellitus

Suksomboon N, Poolsup N, Boonkaew S, Suthisisang CC. Meta-analysis of the effect of herbal supplement on glycemic control in type 2 diabetes. J Ethnopharmacol. 2011 Oct 11;137(3):1328-1333.

More than 400 herbs are used to treat diabetes mellitus. Reviews of these herbs suggest a positive effect in improving glycemic control with a good safety profile. Noting the lack of a meta-analysis of the use of single herbs for glycemic control in type 2 diabetes, the authors performed a systematic review and meta-analysis to evaluate the effect of herbs on glycemic control in type 2 diabetes to establish its therapeutic benefit in these patients.

The authors searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from their inceptions to February 2011. To be included in the meta-analysis, a study had to be a randomized, placebo-controlled trial of a single herb that assessed glycemic control in type 2 diabetes, that was of at least 8 weeks duration, and that reported glycated hemoglobin (HbA1c) levels.

From the studies, the authors recorded year of publication, country, study design, patient characteristics, sample size, outcome measures, and dropout rate. The methodological quality of each study was assessed by using the Jadad scale, with a score of at least 3 out of 5 denoting high quality. The primary and secondary outcomes were HbA1c and fasting blood glucose (FBG) levels.

The authors identified 60 randomized, controlled trials of single herbs in patients with type 2 diabetes. Of those, 23 trials of 19 individual herbs met the inclusion criteria.

Of those 23 trials, 14 were further excluded because they used totally different kinds of herbs, and the results were not poolable. The remaining nine trials (including 487 subjects) assessing the effect of cassia (Chinese cinnamon; Cinnamomum aromaticum syn. C. cassia; 3 studies), sweet potato (Ipomoea batatas; 2 studies), milk thistle (Silybum marianum; 2 studies), and fenugreek (Trigonella foenum-graecum; 2 studies) were included in the meta-analysis.

In the 3 studies of Chinese cinnamon used in 182 patients, the effect of cinnamon was no better than that of placebo. The pooled mean differences were 0.10% (95% confidence interval [CI]: -0.15% to 0.35%) for HbA1c and -1.06 mg/dL (95% CI: -9.5 mg/dL to 7.38 mg/dL) for FBG. Sweet potato improved glycemic control significantly better than placebo in 2 studies. The pooled mean differences were -0.30% (95% CI: -0.57% to -0.04%; P=0.02) for HbA1c and -10.20 mg/dL (95% CI: -15.08 mg/dL to -5.32 mg/dL; P<0.0001) for FBG. Both HbA1c and FBG were reduced significantly with milk thistle compared with placebo in 2 studies. The pooled mean differences were -1.92% (95% CI: -3.32% to -0.51%; P=0.008) for HbA1c and -38.05 mg/dL (95% CI: -66.57 mg/dL to -9.54 mg/dL; P<0.009) for FBG. With fenugreek, HbA1c decreased significantly compared with placebo. In the 2 studies, the pooled mean difference was -1.13% (95% CI: -2.14% to -0.11%; P=0.03). No effect on FBG was observed, however.

Most of the trials considered the single herb as an adjunct to antidiabetic medications except in the sweet potato trials, which included type 2 diabetes patients treated with diet only. Heterogeneity was observed in the results of the milk thistle and fenugreek studies. The methodological quality scores of the studies varied from 2 to 5 points on the Jadad scale. Of the 9 trials, 5 were rated as high quality. Most of the studies did not describe a randomization method, and most did not mention whether placebo and the single herb were indistinguishable.

In this meta-analysis, sweet potato and milk thistle significantly improved HbA1c and FBG compared with placebo, whereas fenugreek significantly improved HbA1c only. An extract of sweet potato has been shown to enhance glucose uptake and delay carbohydrate absorption. Milk thistle contains silymarin, which is known to improve insulin resistance.

Although cassia had no effect on HbA1c and FBG in this meta-analysis, it was shown to enhance glucose uptake and glycogen synthesis in earlier studies. In this meta-analysis, the "nonsignificant effect of [cassia] on glycemic control may be attributable to low baseline HbA1c value and the influence of concurrent prescribed antidiabetic drugs," state the authors.

The authors suggest that the use of sweet potato, milk thistle, and fenugreek with dietary control or medications may offer an alternative for patients who cannot achieve glycemic control. "However, given the poor quality of the available evidence and high heterogeneity of the study results for milk thistle and fenugreek, further high-quality, large trials using standardized preparation are warranted to better elucidate the effects of these herbs on glycemic control," conclude the authors.

http://www.holisticonline.com/remedies/diabetes/diabetes_herbs.htm

http://www.diabetes-diabetic-diet.com/herbs_for_diabetes.htm

http://www.itmonline.org/arts/diabherb.htm

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

http://www.liebertonline.com/doi/pdfplus/10.1089/act.2009.15605?cookieSet=1

Clinical Management Series: Natural Medicines Comprehensive Database

Uittreksel uit Les conseils au comptoir pour le diabète non insulino-dépendant

Eric BECKER Préparateur en pharmacie Octobre 2008

GYMNEMA sylvestre Asclepiadaceae:

Dans les forets tropicales de l’Inde, on trouve une plante grimpante ligneuse dont la médecine ayurvédique utilise ses propriétés thérapeutiques depuis plus de 2500 ans. Au cours des années 1920, les chercheurs indiens ont confirmés les propriétés hypoglycémiantes des feuilles de Gymnema.

Des études sur les animaux ont ensuite été effectués et ont prouvé que la plante diminuait l’absorption intestinale du glucose, stimulait la production d’insuline et sensibilisait les cellules à l’action de l’insuline. La recherche moderne a isolé l’acide gymnémique ou « gymnémine » qui semble etre responsable de l’activité hypoglycémiante de la plante.

Les chercheurs indiens ont mis au point l’extrait GS4 et ont mené deux éssais cliniques sans groupe placebo. Au cours de l’un deux, ils ont comparé l’évolution d’un groupe témoin de 22 sujets souffrant de diabète de type 2 et sous médications hypoglycémiante et 25 sujets contrôles. Ils ont

reçu 400mg d’éxtraits de gymnéma par jour pendant 18 à 20mois. La majorité des sujets ont pu a la fin de cette période réduire leur médication classique et cinq ont pu l’interrompre et s’en tenir seulement à l’extrait pour réguler leur glycémie.

Plutot que les feuilles séchées, on utilise de nos jours un extrait normalisé à 24% d’acide gymnique souvent désigné sous le nom de GS4.

ANACARDIUM occidentalis, Anacardiaceae

Arbre a cime évasée d’environ 10 métres de hauteur. Les feuilles sont pérsistantes, alternes, ovales et coriaces. Les fleurs sont blanches teintées de rose, parfumées et réunies en inflorescences terminales. Les fruits possédent une coque acre et toxique abritant une amande blanche, comestible « la noix de cajou ». Ils se forment sous un pédoncule gonflé, charnu et juteux nommé « pomme de cajou »( faux fruit). Aujourd’hui largement cultivé en Afrique, aux Antilles, en Asie du sud-est, au nord-est du Brésil et en Inde. La noix de cajou est la première exportation de la Guinée-Bisseau.

L’anacardier ou « pommier cajou » est utilisé principalement pour ses vertus hypoglycémiantes.

Les macérations et décoction de feuilles et d’écorces permettent de faire diminuer la glycémie chez les diabétiques. Les propriétés ont été vérifiées scientifiquement. 80 grammes de feuilles pour 1 litre d’eau pendant 15 minutes. Filtrer après refroidissement et boire dans la journée.

IRVINGIA gabonensis,

Le manguier sauvage possède un fruit à la pulpe charnue et à noyau dur renfermant une seule graine très oléagineuse. En Afrique, les femmes s’en servent pour préparer le pain d’ODIKA. Expérimentalement, les chercheurs ont mis en évidence le pouvoir hypoglycémiant de la graine d’Irvingia en donnant 4 grammes par jour de mucilage de graine pendant quatre semaines à des diabétiques de type 2.

FICUS bengalensis,

Les racines aériennes contiennent plusieurs molécules de la famille des glucosides et des flavonoides présentant des propriétés hypoglycémiantes. L’activité du glucoside « leucopélargonidine » montre un effet hypoglycémiant et hypolipidémiant, avec une augmentation significative de la libération d’insuline. Les tanins de l’écorce vont conforter l’action du glucoside en freinant l’activité enzymatique de la dégradation des polysaccharides..

Ginseng gunstig bij diabetes via hormonale interacties

Ginseng is een van de populairste kruiden in Aziatische landen en wordt onder meer genomen door diabetici. Koreaanse onderzoekers zetten een onderzoek bij gezonde, menopauzale vrouwen op touw om de werkingsmechanismen te ontrafelen. Zij namen aan dat ginseng via hormonale effecten invloed uitoefent op het glucose- en insulinemetabolisme. Inderdaad zagen de onderzoekers na twee weken effecten op aldosteron, groeihormoon en DHEAS, naast een daling van nuchtere glucosespiegel en insulineresistentie.

De daling van aldosteron was het sterkst en kan al gedeeltelijk de effecten op glucose en insuline verklaren. Activatie van aldosteron (samen met renine en angiotensine) is een van de vele factoren in de ontwikkeling van insulineresistentie.

Verder namen groeihormoon, DHEAS en oestradiol toe bij de vrouwen die ginseng namen. Volgens een meer diepgaande analyse van de gegevens zouden toename van DHEAS en oestradiol veeleer gevolg zijn van de toename van groeihormoon. DHEAS daalt van nature tijdens veroudering tot een fractie van het oorspronkelijke niveau. Een toename is dus zeker een gunstig teken.

Het metabool syndroom treft westerse landen hard, in het bijzonder bepaalde bevolkingsgroepen zoals vrouwen na de menopauze. Minstens een derde van Amerikaanse postmenopauzale vrouwen heeft symptomen van het metabool syndroom. Verhoging van bloedglucose, bloedvetten en insulineresistentie zijn niet te enige symptomen, ook hormonale veranderingen grijpen plaats.

Lage oestradiol is bijvoorbeeld een belangrijke risicofactor. Dat toonden ook studies met hormoonsubstitutie aan, welke het risico op metabool syndroom met 36 % konden verlagen. Hormoonsubstitutie is niet meer de geschikte behandeling van menopauzale problemen wegens bijwerkingen, verhoogd optreden van kanker en afwezigheid van cardiovasculaire bescherming.

Referenties

Lee KJ, Lee SY et al. Diabetes-ameliorating effects of fermented red ginseng and causal effects on hormonal interactions: testing the hypothesis by multiple group path analysis. J Med Food. 2013 May;16(5):383-95

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