Diabetes Mellitus - Burton Goldberg's site

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Diabetes Mellitus

Oct 22, 2006 18:51 PDT

 

 

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Signs and Symptoms

Risk Factors

Diagnosis

Preventive Care

Treatment Approach

Nutrition and Dietary Supplements

Herbs

Acupuncture

Mind/Body Medicine

Other Considerations

Pregnancy

Prognosis and Complications

Supporting Research

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Diabetes mellitus is a chronic condition associated with abnormally

high levels of sugar (glucose) in the blood. People with diabetes either do not

produce enough insulin—a hormone that is needed to convert sugar, starches and

other food into energy needed for daily life—or cannot use the insulin that

their bodies produce. As a result, glucose builds up in the bloodstream. If left

untreated, diabetes can lead to blindness, kidney disease, nerve disease, heart

disease, and stroke.

 

According to the National Institute of Diabetes and Digestive and

Kidney Diseases (NIDDK), 15.7 million Americans—nearly 6% of the

population—have diabetes.

 

Although an estimated 10.3 million have been diagnosed, 5.4 million

people are not aware that they have the disease. It is the seventh

leading cause of death in the United States and it affects males and

females of all ages, races, and income levels.

 

There are two major types of diabetes mellitus:

 

Type 1—Also known as insulin-dependent diabetes mellitus (IDDM),

type 1 diabetes is an autoimmune disease (a condition arising from and directed

against a person's own tissues) in which the pancreas produces little or no

insulin.

Individuals with type 1 diabetes must take insulin throughout their lives to

manage their condition. Type 1 diabetes usually occurs most often in children

and young adults and it accounts for 5% to 10% of all diabetes cases.

 

Type 2—The most common form of diabetes (accounting for 90% of all

cases), type 2 diabetes is a metabolic disorder resulting from the

body's inability to make enough, or properly use, insulin. It occurs

most frequently in people who are overweight, inactive, and older

than 40 years of age (although the rates in children are rising).

 

Most people with type 2 diabetes—about 60% to 70%—do not need to take insulin to

manage their condition, however. For this reason, type 2 diabetes is also called

noninsulin-dependent diabetes mellitus (NIDDM).

 

Gestational diabetes is a type of diabetes that can develop when a

woman is pregnant. Towards the end of a pregnancy (usually the third

trimester), a woman may have higher than normal levels of glucose in

her bloodstream. One percent of all pregnant women develop gestational diabetes.

Although it usually disappears after delivery, the mother is at increased risk

of developing type 2 diabetes later in life. Other types of diabetes are

associated with genetic syndromes, surgery, drugs, malnutrition, infections, and

other illnesses.

--

Signs and Symptoms

 

Type 1

 

While production of insulin diminishes gradually over a matter of

years, the signs and symptoms of type 1 diabetes tend to appear abruptly, once

80% to 90% of the pancreatic cells can no longer make insulin. The signs and

symptoms include:

 

Excessive urination

Excessive intake of water and/or food

Loss of bladder control in children after they had already been

trained

Unintended weight loss over several days (people with type 1

diabetes

tend to be thin)

High levels of glucose in the blood and urine

Nausea and vomiting

Abdominal pain or discomfort

Weakness and excessive fatigue

Increased susceptibility to infection, such as vaginitis and other

yeast

infections

Dehydration

Blurred vision

Irritability, restlessness, and/or apathy

Ketoacidosis —a potentially fatal condition marked by an

accumulation of

ketones (chemicals that build up in the bloodstream when the body is

forced to burn fat instead of glucose) and increased acidity of the

blood

Type 2

 

People with type 2 diabetes often have no symptoms, and their

condition is detected only when a routine exam reveals high blood glucose

levels.

 

Occasionally, however, a person with type 2 diabetes may experience

symptoms listed below, which tend to appear slowly over time:

 

Numbness or burning sensation of the feet, ankles, and legs

Blurred or poor vision

Impotence

Fatigue

Poor wound healing

In some cases, symptoms may mimic type 1 diabetes and appear more

abruptly:

 

Excessive urination and thirst

Yeast infections

Whole body itching

Coma—in severe cases, high blood glucose may affect water

distribution in brain cells, causing a state of deep unconsciousness, or coma.

---

Causes

 

Both types of diabetes are caused by the absence, insufficient

production, or lack of response by cells in the body to the hormone

insulin. Insulin is a key regulator of the body's metabolism. After

meals, food is digested in the stomach and intestines.

 

Sugar (glucose) molecules are absorbed directly into the bloodstream, and blood

glucose levels rise. Under normal circumstances, the rise in blood glucose

levels signals specific cells in the pancreas—called beta cells—to secrete

insulin into the bloodstream. Insulin, in turn, enables glucose to enter cells

in the body to be burned for energy or stored for future use.

 

People with type 1 diabetes produce little or no insulin at all

because their immune systems attack and destroy the insulin-producing beta cells

in the pancreas. Although it is not clear what specifically causes type 1

diabetes, it is believed that exposure to a toxin or viral nfection may trigger

this autoimmune attack in genetically susceptible individuals. In type 1

diabetes, beta cells are destroyed gradually, but symptoms do not appear until

at least 80% of the cells are affected.

 

Type 2 diabetes usually develops in older, overweight individuals

who become resistant to the effects of insulin over time. When type 2 diabetes

is diagnosed, the pancreas is usually producing enough

insulin but, for unknown reasons, the body cannot use the insulin

effectively (a condition called insulin resistance). In people with type 2

diabetes, production of insulin by the pancreas also tends to diminish.

 

As mentioned above, other types of diabetes can occur as a result of

pregnancy (gestational diabetes), genetic disorders, surgery,

medications such as steroids, malnutrition, infections, and other

illnesses. In addition, physical stress can cause a temporary rise

in blood sugar or even uncover " hidden " diabetes.

---

Risk Factors

 

Type 1

 

Family history of type 1 diabetes

Mother who had preeclampsia (a condition characterized by a sharp

increase in blood pressure during the third trimester of pregnancy)

Family history of autoimmune diseases, including Hashimoto's

thyroiditis, Graves' disease, myasthenia gravis, Addison's disease,

or pernicious anemia

 

Viral infections during infancy including mumps, rubella, and

coxsackie

Child of an older mother

Northern European or Mediterranean descent

Consumption of cow's milk during infancy (this idea is controversial

however)

 

Type 2

 

Family history of type 2 diabetes (one-quarter to one-third of all

individuals with type 2 diabetes have a family history of the

condition)

 

Age older than 40 years

Excess body fat, particularly around the waist

Sedentary lifestyle and high-fat, high-calorie diet

Abnormal levels of cholesterol and/or trigylcerides in the blood

High blood pressure

History of gestational diabetes or polycystic ovary syndrome (a

hormonal

disorder that causes women to have irregular or no menstruation)

African American, Hispanic American or Native American (particularly

Pima tribe in Arizona) descent

Low birth weight and/or a mother's malnutrition in pregnancy may

cause

metabolic disturbances in a fetus that lead to diabetes later in the

child's life

---

Diagnosis

 

According to the American Diabetes Association, all pregnant women

should be screened for gestational diabetes during their third

trimester

and people who are 45 years or older should have their blood glucose

levels checked randomly every 3 years. Those who have a high risk of

developing diabetes (such as people with a family history of the

disease) should be tested more often.

 

When a healthcare practitioner suspects that an individual may have

diabetes, he or she will draw blood samples and send them to a

laboratory for analysis.

 

Different types of tests are used to diagnose diabetes—random plasma glucose,

fasting plasma glucose, and oral glucose

tolerance tests. If the blood sugar is elevated (as detected by a

random measurement in the middle of the day), a fasting plasma glucose test will

likely be ordered. This means that, after an individual has fasted overnight (at

least 8 hours), a sample of blood is drawn and sent to the laboratory for

analysis. Normal fasting plasma glucose levels are less than 110 milligrams per

deciliter (mg/dL). People with fasting plasma

glucose levels of more than 140 mg/dL (on two or more tests on

different days) definitely have diabetes. If results from the fasting plasma

glucose test are questionable (meaning glucose levels are between

120 and 140 mg/dL) and diabetes is still suspected, a glucose tolerance test

will be ordered. In this test, three measurements of blood glucose are taken

over 2 hours after a large amount of sugar is ingested. If two of the

measurements (or more) are at least 200 mg/dL, diabetes is diagnosed.

 

Once a diagnosis of type 2 diabetes is made, several follow-up

visits are necessary to establish appropriate medication dosages. In type 1

diabetes, insulin is generally started in the hospital, followed by precise

adjustments at home (often with the aid of a visiting nurse).

People with type 1 diabetes and many of those with type 2 diabetes

are taught how to self-monitor their blood sugars. The doctor is likely to

request physical exams every 3 to 6 months, where he or she will evaluate for

signs of blood vessel, nervous system, eye, and kidney disorders. Blood and

urine tests are generally performed as part of these follow-up appointments.

Dieticians are also an integral part of care from the outset and during

follow-up visits.

---

Preventive Care

 

Type 1

 

Although possible methods for preventing type 1 diabetes are under

investigation, there is currently no proven way to prevent this type

of diabetes. Interestingly, though, a recent study conducted in Finland suggests

that adequate amounts of vitamin D, particularly in the first year of life, may

decrease one's chances of developing type 1 diabetes within the first 30 years

of life.

 

In northern Finland (where the annual exposure to sunlight is very limited)

more than 10,000 infants were followed for up to 30 years. Those given at least

2,000 IU of vitamin D per day (generally from cod liver oil) for the first year

of life were

significantly less likely to develop type 1 diabetes over a 30-year

time course than infants who were given less than that.

 

Type 2

 

Considerable evidence from population-based studies suggests that

type 2 diabetes is highly preventable—particularly through exercise and weight

management. Individuals who are physically inactive and/or overweight are much

more likely to develop type 2 diabetes. Similarly, people who move from a

non-Westernized country to a Westernized country (such as the United States

where individuals tend to be overweight and live sedentary lives), increase

their risk for type 2 diabetes considerably.

 

Studies suggest that vigorous physical activity is not necessary in

order to protect against the development of diabetes; moderate,

regular exercise such as walking for 30 minutes most days of the week, is

enough. In general, lifestyle interventions used to treat diabetes

may help prevent the condition as well.

--

Treatment Approach

 

The goal of diabetes treatment is to achieve and maintain blood

glucose

levels within or near the normal range (90 to 126 milligrams per

deciliter [mg/dL]). A recent major study, called the Diabetes

Control and Complications Trial (DCCT), found that diabetics who kept their

blood glucose levels close to normal reduced their risk of developing major

complications from the condition. Maintaining blood glucose

levels is often very difficult, however. People with diabetes must learn how to

manage their condition on a daily basis to prevent blood glucose levels from

dropping too low (hypoglycemia) or spiking too high (hyperglycemia). Treatment

for type 1 diabetes requires a strict regimen that typically includes a

carefully calculated diet, planned exercise,

daily blood glucose testing at home (even several times per day),

and, most importantly, multiple daily insulin injections. Similarly,

healthy eating habits, physical activity, and daily blood glucose testing are

the basic tools that people with type 2 diabetes need to manage their condition.

 

 

In summary, people with diabetes should use the following therapies

to help manage their blood glucose levels and to prevent complications

associated with the condition:

 

Lifestyle changes, particularly in diet and exercise habits

Medications, particularly insulin for individuals with type 1

diabetes

and some people with type 2 diabetes

Supplements, including fiber and chromium

Relaxation techniques

Acupuncture for pain from nerve damage

---

Lifestyle

 

People with diabetes can improve significantly from lifestyle

changes—particularly diet and exercise. Type 2 diabetics can even

eliminate the need for medications when they make adequate and

appropriate lifestyle changes.

 

Diet

 

The American Diabetes Association (ADA) recommends that individuals

with diabetes consume a healthy, low-fat diet, rich in grains, fruits, and

vegetables.

 

A healthy diet typically includes 10% to 20% of daily

calories from protein (including poultry, fish, dairy, and vegetable

sources). Diabetics who also have kidney disease should work with

their healthcare practitioners to limit protein intake to 10% of daily calories.

A low-fat diet typically includes 30% or less of daily calories from fat—less

than 10% from saturated fats and up to 10% from polyunsaturated fats (such as

fats from fish). In addition, weight loss should be part of the plan for those

with type 2 diabetes. Moderate weight loss (achieved by reducing calories by 250

to 500 per day and exercising regularly) not only controls blood sugars but

blood pressure and cholesterol as well. Diabetics who eat healthy, well-balanced

diets will not need to take extra vitamins or minerals to treat their condition.

 

Exercise

 

Exercise plays an important role in controlling diabetes because it

lowers blood sugar and helps insulin to work more efficiently in the

body. Exercise also enhances cardiovascular fitness by improving

blood flow and increasing the heart's pumping power. It also promotes weight

loss and lowers blood pressure. Exercise only has value, however, when it is

done regularly—at least three to four sessions per week for 30 to 60 minutes per

session. People with type 2 diabetes who exercise regularly have been shown to

lose weight and gain better control

over their blood pressure, thereby reducing their risk for cardiovascular

disease (a major complication of diabetes). Studies have also shown

that people with type 1 diabetes who regularly exercise reduce their need for

insulin injections.

 

Despite the benefits of exercise, however, many people have

difficulty sticking with an exercise program for a long period of time.

Healthcare practitioners can help develop suitable routines as well as

strategies that may improve adherence to such routines. Anyone with long-

standing diabetes should undergo a thorough screening before beginning an

exercise program and should be monitored carefully by his or her physician.

---

Nutrition and Dietary Supplements

 

In addition to the basic dietary guidelines mentioned in the

Lifestyle section, further dietary options may be available for people with

diabetes. Considerable research has been conducted on the relationship between

diabetes and specific nutrients and dietary supplements.

Whenever considering the use of supplements or making dietary

changes, be sure to discuss these with your healthcare provider to ensure safety

and appropriateness.

---

Supplements with Glucose-Lowering Effects

 

Chromium

 

Found in a variety of foods and supplements, including liver,

brewer's

yeast, cheese, meats, fish, fruits, vegetables, and whole grains,

chromium appears to enhance the body's sensitivity to insulin.

Chromium

is believed to help insulin pull glucose from the bloodstream into

the

cells for energy. The benefit of chromium supplements for diabetes

has

been studied and debated for a number of years. While some studies

have

shown no beneficial effects of chromium use for people with

diabetes,

other studies have shown that chromium supplements may reduce blood

glucose levels in individuals with type 2 diabetes and reduce the

need

for insulin in those with type 1 diabetes. Most Americans obtain at

least 50 mcg of chromium in their diets each day. The National

Research

Council estimates that intakes of 50 to 200 mcg per day are safe and

effective. Studies showing improved blood sugar control for those

with

diabetes have used doses of chromium picolinate ranging from 200 to

1,000 mcg per day. Until studies of long-term safety have been

conducted

with the higher doses, however, it is best to use no more than 200

mcg

per day.

 

Magnesium

 

While several studies have demonstrated a strong association between

low

levels of magnesium in the blood and type 2 diabetes, researchers

have

yet to determine which is the cause and which is the effect. In

other

words, researchers are investigating whether low magnesium levels

worsen

blood sugar control in type 2 diabetics or whether diabetes causes

magnesium deficiencies. Some experts believe that low magnesium

levels

worsen blood sugar control and that foods rich in magnesium (such as

whole grains, green leafy vegetables, bananas, legumes, nuts, and

seeds)

or magnesium supplements may promote healthy blood glucose levels.

At

least one small study suggests that taking magnesium supplements may

improve the action of insulin and decrease blood sugar levels,

particularly in the elderly. People with severe heart disease or

kidney

disease should not take magnesium supplements. Whether or not it is

safe

and appropriateness to take magnesium supplements should be

discussed

with a healthcare provider.

 

Fiber

Studies suggest that a high-fiber diet may help:

 

Prevent development of type 2 diabetes

Lower average glucose and insulin levels in people who already have

type

2 diabetes

Improve cholesterol and triglyceride levels in those with diabetes

In a large-scale study of nurses in the United States, women who

consumed the most whole grain foods in their diets were nearly 40%

less

likely to develop diabetes than women who consumed the least.

 

Studies have also shown that cholesterol levels improved in people

with

type 2 diabetes after they took supplements of a soluble fiber known

as

psyllium (Plantago psyllium).

 

Vanadium

 

Vanadium is an essential trace mineral present in the soil and in

many

foods. It appears to mimic the action of insulin and, in a number of

human studies, vanadyl sulfate (a form of vanadium) has increased

insulin sensitivity in those with Type 2 diabetes. Animal studies

and

some small human studies also suggest that vanadium may lower blood

glucose to normal levels (reducing the need for insulin) in

diabetics.

One preliminary study found that people with diabetes using insulin

who

were given vanadium were able to lower their dose of insulin.

However,

because the long-term safety of vanadium has not been established,

this

is not a recommended therapy at this time.

 

Antioxidants

 

Antioxidants such as beta-carotene and vitamin C are scavengers of

free

radicals—unstable and potentially damaging molecules generated by

normal

chemical reactions in the body. Free radicals are unstable because

they

lack one electron. In an attempt to replace this missing electron,

the

free radical molecules react with neighboring molecules in a process

called oxidation. Some studies suggest that people with diabetes

have

elevated levels of free radicals and lower levels of antioxidants.

Preliminary studies suggest that the following antioxidants may

improve

symptoms of diabetes (by returning blood glucose levels to the

normal

range) and reduce the risk of associated complications:

 

Vitamin E

Selenium

Zinc

 

Two additional substances that show preliminary evidence to possibly

help control blood sugar include:

 

Biotin (a B-complex vitamin)—helpful for type 2 diabetes; brewer's

yeast

is a good source of biotin

Vitamin B6—helpful for both type 1 and type 2 diabetes

Supplements with Cardiovascular Effects

 

Because insulin resistance is often associated with cardiovascular

disease, people with diabetes may benefit from nutrients that help

manage elevated blood lipid levels, high blood pressure, or

congestive

heart failure.

The following supplements have been shown to improve cardiovascular

health.

 

Coenzyme Q10 (CoQ10)

Niacinamide

Omega-3 Fatty acids

 

In addition, the following antioxidants have been shown to improve

cholesterol levels in people with type 2 diabetes:

 

Beta-carotene

Vitamin C (1000 mg per day)

Vitamin E (800 IU per day)

At least one study has also found that elevated manganese levels may

help protect against LDL oxidation (a process that contributes to

the

development of plaque in the arteries).

--

 

Supplements that May Reduce Complications of Diabetes

 

More than one-third of all people with diabetes develop a painful

condition known as diabetic neuropathy (nerve damage). Some

researchers

speculate that this condition may be caused by elevated levels of

free

radicals which can cause damage to nerves and blood vessels.

 

Studies suggest that the following antioxidant supplements may

improve

nerve communication in damaged areas and reduce the symptoms of

diabetic

neuropathy:

 

Alpha-lipoic acid

Gamma-linolenic acid (evening primrose oil (Oenothera biennis) is a

rich source)

-

Herbs

 

Plant-based medicines have long been used in the treatment of

diabetes.

For instance, the plant extract guanidine, which lowers blood

glucose,

prompted the development and use of biguanides, a commonly used oral

medication for diabetes. Other herbs may have a role in the

management

or prevention of diabetes. These include:

 

Aloe (Aloe vera)

 

Studies suggest that aloe vera taken orally might help reduce blood

glucose in individuals who have type 2 diabetes. In a few studies,

diabetic women who received aloe vera juice experienced significant

reductions in blood glucose levels compared to women who received

placebo. Although further studies are need to determine the safety

and

effectiveness of aloe in the treatment of diabetes, it seems

possible

that the herb may prove to be a useful addition to the diet,

exercise,

and medication program for type 2 diabetics.

 

Fenugreek seeds (Trigonella foenum graecum)

 

Fenugreek seeds, a spice found in many curry preparations, are high

in

fiber and have been shown to regulate glucose and improve lipid

levels

in both animals and humans. In two small studies of individuals with

either type 1 or type 2 diabetes, fenugreek seed powder lowered

blood

glucose and improved levels of blood cholesterol and trigylcerides,

among other beneficial effects.

 

American ginseng (Panax quinquefolium)

 

Although both Asian (Panax ginseng) and American (Panax

quinquefolium)

appear to lower blood glucose levels, only American ginseng has been

studied in scientific trials. One study found that people with type

2

diabetes who take American ginseng before or together with a glucose

meal experience a reduction in glucose levels after they consume the

meal.

 

Other Herbs

 

Numerous other herbs have been used traditionally to regulate

glucose

levels in the body. Although preliminary research is promising, more

research is needed to determine whether the following herbs are safe

and

effective for the treatment of diabetes:

 

Onion (Allium cepa)

Garlic (Allium sativum)

Andrographis (Andrographis paniculata)

Green tea (Camellia sinensis)

Indian cluster bean (Cyamopsis tetgonolobus)

Gurmar (Gymnema sylvestre)

Bitter melon or karela (Momordica charantia)

Tinospora gulancha (Tinospora cordifolia)

Bilberry (Vaccinium myrtillus)

 

 

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Acupuncture

 

Some researchers speculate that acupuncture may trigger the release

of

natural painkillers and reduce the debilitating symptoms of a

complication of diabetes known as neuropathy (nerve damage). In one

study of diabetics suffering from chronic, painful neuropathy,

acupuncture reduced pain and improved sleep in 77% of the

participants

and eliminated the need for pain medications in 32% of the

participants.

Given these findings, acupuncture may be a reasonable option for

diabetics with neuropathy who either find no symptom relief or

develop side effects from conventional drug treatment.

---

Mind/Body Medicine

 

Stressful life events can worsen diabetes in several ways. For

example,

stress stimulates the nervous and endocrine systems in ways that

increase blood glucose levels and disrupts healthful behaviors

(increasing the chances that an individual may consume a high level

of

calories and limit his or her physical activity—a pattern that leads

to

elevated blood glucose).

 

It makes sense, then, to consider stress management as part of the

treatment and prevention of diabetes. Studies have shown that

diabetics

who participate in biofeedback sessions (a technique that increases

awareness of and control of the body's response to stress) are more

likely to reach target blood glucose levels than diabetics who do

not

receive biofeedback. Although other studies have produced results

that

contradict this, researchers and clinicians generally agree that

long-term stress is likely to worsen diabetes and that biofeedback,

tai

chi, yoga, and other forms of relaxation may help motivate people

with

diabetes to change their habits in order to manage their condition.

---

Other Considerations

 

 

Pregnancy

 

Diabetic women of child-bearing age should consult an endocrine

specialist about the benefits of managing glucose levels before

trying

to conceive.

 

Approximately 7% of all pregnant women in the United States are

diagnosed as having gestational diabetes. Risk factors for

developing

diabetes while pregnant include:

 

Modest weight gain prior to pregnancy (11 to 22 pounds or more)

Family history of diabetes

Tobacco use

African, Hispanic-American, or Asian ancestry

Age older than 50 at conception

 

Normalizing glucose levels in women with gestational diabetes

reduces

their risk of complications, such as having an overweight baby,

birth

trauma, or the need for cesarean section. If the mother's glucose

levels

are uncontrolled, an infant can be stillborn or suffer from any of a

number of complications, including defects of the brain or central

nervous system, an abnormally large body or organs, heart or kidney

abnormalities, asphyxia, respiratory distress, and congestive heart

failure.

 

If dietary restrictions fail to improve glucose levels, a woman with

gestational diabetes may need insulin. Oral diabetes medications

should

not be used during pregnancy. Women who develop gestational diabetes

may

experience the condition again in subsequent pregnancies.

Gestational

diabetes also increases the risk for developing type 2 diabetes.

--

Prognosis and Complications

 

People who maintain tight control over their blood glucose levels

can

prevent or delay the development of long-term complications from

diabetes. Generally, type 1 diabetes is associated with more

complications than type 2 diabetes.

 

Long-term complications of diabetes may include:

 

Heart disease and stroke

Vision loss and blindness

Kidney disease

Neuropathy (nerve damage)

Foot ulcers and infections

Skin problems, including bruising, dryness, itching, hair loss,

warts,

gangrene (tissue death), and skin ulcers

According to the National Institute of Diabetes and Digestive and

Kidney

Diseases, 798,000 Americans are diagnosed with diabetes each year.

Before the discovery of insulin in 1921, most people with diabetes

(particularly those with type 1 diabetes) died soon after they were

diagnosed. Although insulin is not a cure for diabetes, its

discovery

was the first major breakthrough in diabetes treatment. Today, it is

also understood that for people with diabetes, healthy eating and

exercise habits, daily glucose monitoring, and appropriate

medication

are key elements for a long, healthy life.

 

 

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Supporting Research

 

Ackermann RT, Mulrow CD, Ramirez G, Gardner CD, Morbidoni L,

Lawrence

VA. Garlic shows promise for improving some cardiovascular risk

factors.

Arch Intern Med. 2001;161:813-824.

 

Al-Habori M, Raman A. Antidiabetic and hypocholesterolemic effects

of

fenugreek. Phyto Res. 1998;12:233-242.

 

Anderson JW, Davidson MH, Blonde L, et al. Long-term

cholesterol-lowering effects on Psyllium as an adjunct to diet

therapy

in the treatment of hypercholesterolemia. Am J Clin Nutr.

2000a;71:1433-1438.

 

Anderson JW, Allgood LD, Lawrence A, et al. Cholesterol-lowering

effects

of psyllium intake adjunctive to diet therapy in men and women with

hypercholesterolemia: meta-analysis of 8 controlled trials. Am J

Clin

Nutr. 2000b;71:472-479.

 

Anderson JW, Johnstone BM, Cook-Newell ME. Meta-analysis of the

effects

of soy protein intake on serum lipids. New Engl J Med. 1995;

333:5:276-282.

 

Anderson RA, Roussel AM, Zouari N, Mahjoub S, Matheau JM, Kerkeni

A.Potential antioxidant effects of zinc and chromium supplementation

in

people with type 2 diabetes mellitus. J Am Coll Nutr.

2001;20(3):212-218.

 

Arsenian, MA. Carnitine and its derivatives in cardiovascular

disease.

Progr in Cardiovasc Dis. 1997;40:3:265-286.

 

Baber R, Bligh PC, Fulcher G, Lieberman D, Nery L, Moreton T. The

effect

of an Isoflavone dietary supplement (P-081) on serum lipids, forearm

bone density & endometrial thickness in post menopausal women

[abstract]. Menopause. 1999;6:326.

 

Binaghi P, Cellina G, Lo Cicero G, et al. Evaluation of the

cholesterol-lowering effectiveness of pantethine in women in

perimenopausal age [in Italian]. Minerva Med. 1990;81:475-479.

 

Birketvedt GS, Aaseth J, Florholmen JR, Ryttig K. Long-term effect

of

fibre supplement and reduced energy intake on body weight and blood

lipids in overweight subjects. Acta Medica. 2000;43(4):129-132.

 

Bonovich K, Colfer H, Davidson M, et al. A multi-center, self-

controlled

study of cholestin in subjects with elevated cholesterol. Paper

presented at: American Heart Association 39th Annual Conference on

Cardiovascular Disease Epidemiology and Prevention; March 1999;

Orlando,

Fla:Abstract.

 

Bordia A, Verma SK, Srivastava KC. Effect of ginger (Zingiber

officinal)

and fenugreek (Trigonella foenumgraecum) on blood lipids, blood

sugar

and platelet aggregation in patients with coronary artery disease.

Prostaglandins, Leukotrienes and Essential Fatty Acids.

1997;56(5):379-384.

 

Bostick RM, Fosdick L, Grandits GA, Grambsch P, Gross M, Louis TA.

Effect of calcium supplementation on serum cholesterol and blood

pressure. Arch Fam Med. 2000;9:31-39.

 

Calderon Jr. R, Schneider RH, Alexander CN, Myers HF, Nidich SI,

Haney

C. Stress, stress reduction and hypercholesterolemia in African

Americans: a review. Ethn Dis. 1999;9:451-462.

 

Castillo-Richmond A, Schneider RH, Alexander CN, et al. Effects of

stress reduction on carotid atherosclerosis in hypertensive African

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Review June 2001

Reviewed By: Participants in the review process include: Robert A.

Anderson, MD, President , American Board of Holistic Medicine, East

Wenatchee, WA; Ruth Debusk, RD, PhD, Editor, Nutrition in

Complementary

Care, Tallahassee, FL; R. Lynn Shumake, PD, Director, Alternative

Medicine Apothecary, Blue Mountain Apothecary & Healing Arts,

University

of Maryland Medical Center, Glenwood, MD.

 

 

2004 A.D.A.M., Inc

 

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