The epidemic of type 2 diabetes and metabolic syndrome, which is striking Western nations and the United States in particular, has elicited somewhat of a muted reaction. “Diabesity” may affect as many as 100 million Americans and nearly a billion people around the world, but compare the public health response to previous epidemics—polio for example. It doesn’t come close. Perhaps this is because it’s a silent, insidious epidemic, developing over years with debilitating symptoms that seriously impact a person’s quality of life.
Yes, we have taken some measures, such as urging people at risk to improve their diet and exercise habits. This approach places the emphasis on the lifestyle choices of the individual, but new research, along with the skyrocketing rates of diabetes, suggests that we’re missing some key pieces of the puzzle.
As a nation, we adhere religiously to the notion of calories in and calories out. Eat less, exercise more and everything will be fine. This is not entirely wrong—but it’s clearly an oversimplification. We cannot pretend that metabolism functions in isolation,sequestered from environmental influences
and the delicate balance of our biological systems.
So it’s not a question of following the same strategies—except more vigorously. We need to look beyond the well-worn tropes that have dominated our approach to these conditions. Fortunately, there’s a growing body of research to help us better understand the complex factors behind metabolic
syndrome and type 2 diabetes. Two factors emerging as key culprits: environmental toxins and poor quality sleep.
The Toxic Load
While what we eat, and how much, certainly affect our weight and susceptibility to diabetes and metabolic syndrome, this oversimplified equation ignores the body’s ability to process these calories. Again, there is a growing body of evidence that overexposure to
environmental toxins can impair our intricate metabolic mechanisms.
Numerous studies demonstrate that many of the chemical compounds pervasive today have an adverse impact on metabolism.
• A study published in The Lancet found a correlation between persistent organic pollutants (POPs) in blood and insulin resistance.1
• Another study described the different ways toxins provoke insulin resistance, such as mitochondrial injury, oxidative stress, inflammation and debilitated thyroid metabolism.2
• Research published in JAMA showed BPA, found in plastics, canned foods and even cash register receipts, increases risk of diabetes.3
• Toxins have been shown to interfere with an entire class of nuclear receptors (called PPARs), causing insulin resistance and other harm.4
• Another study found that weight gain and fat storage in rats exposed to chemical toxins was completely independent of calories and exercise.5
There are dozens of studies with similar findings, and they paint a toxic picture: environmental pollutants appear to scramble our metabolic signals, impairing glucose management and weight control mechanisms.Clearly, genes and genetic expression play a role as well, but as so many have suggested, “Genetics loads the gun, environment pulls the trigger.”
While it’s upsetting to see that common chemicals are having such a profound impact on metabolism—and other areas of health—the fact that research is elucidating some of these complex mechanisms means we may be zeroing in on effective therapeutic targets.
Given the quantity of toxins we face in our everyday lives, detoxification plays an important role in maintaining long-term health on a number of levels. The practice of detox is an ancient one, popularized in recent years with a myriad of products, services and wellness retreats aimed at reducing toxic body burden and restoring vitality.
Aside from the hype, as well as the discrediting of detox by much of conventional medicine, there are a number of foods, ingredients and supplements, which are shown to reduce levels of toxins in the body. But it’s important to do it right so as not to overwhelm your system or deplete essential nutrients. I rarely recommend extreme measures such as rapid detox programs, fasting or colonics. Rather, an emphasis on nutrient-dense whole foods and select botanicals and nutrients offers a gentle yet effective route to eliminating toxins from the body over time. Our bodies are designed
with an elaborate system of detoxification mechanism, incorporating many organ systems and biochemical pathways including the skin, lungs, liver and kidneys. The daily intake of dietary phytochemicals found in common foods, herbs, and nutrients provides ongoing support for the optimal functioning of our inherent detox capacities.
Cruciferous vegetables, such as broccoli, cabbage, kale and bok choy are well-known detoxifiers, and also help promote healthy hormone metabolism. Other effective detoxifiers include green tea, garlic, milk thistle, dandelion leaf and root, onions and turmeric. One clinical study showed that broccoli sprouts helped the body detoxify a number of airborne pollutants, particularly benzene. A half cup a day enhanced excretion of benzene, acrolein and other toxins.
There are also a variety of vitamins, minerals and other nutrients that support detoxification, such as L-methylfolate, zinc, selenium, N-acetyl-cysteine, glutathione and vitamin C. Alginates, derived from kelp, are also effective detoxifiers shown to remove heavy metals, radioactive isotopes and pesticides from the digestive tract. Alginates also support healthy glucose metabolism.
Another clinically proven detoxifier is modified citrus pectin (MCP). Made from the pith of orange peels, MCP has a well deserved reputation for safely binding and removing toxins such as lead, mercury, arsenic and others, while not affecting essential minerals. MCP also binds and blocks galectin-3, an inflammatory protein that’s been linked to cancer, fibrosis, heart disease and other conditions.
Sleep and Metabolism
In addition to overexposure to toxins, there’s another potential culprit in the diabetes and metabolic syndrome epidemic— lack of sleep. Like industrial pollutants, sleep deprivation has become a common feature of modern life. It’s well known that poor sleep can lead to a host of health problems,
including problems with immunity, cellular health, digestion and cognitive well being— including the ability to flush toxins from the brain. Now we can add metabolism to the list.
This is not really news. There have been studies as far back as 1969 showing that sleep deprivation, even for just a few days, decreases insulin sensitivity and increases glucose levels.
• One study found that people who slept only four hours each night for six nights reduced their glucose tolerance by 40 percent,prematurely aging their metabolism. The issue reversed after normal sleep was restored.6
• Another study found similar results even with less severe sleep deprivation—5.5 hours per night over 14 nights.7
• Other studies have shown that loss of sleep contributes to increases in certain growth hormones, associated with increased glucose and cortisol.8-10
• Lack of sleep has also been shown to increase the release of inflammatory cytokines, which can also increase insulin resistance, as well as causing other problems.11
The Sleep Solution
The first step toward fixing sleep deprivation is recognizing the problem. This may mean convincing patients that the competitive advantages they may gain from sleeping less are more than offset by the damage they are
doing to their health.
Routine plays a critical role in good sleep, and also helps balance circadian rhythms, which in turn can benefit metabolic function. It’s best to go to bed at the same time each night and embrace relaxation routines before bedtime. That means avoiding televisions, smart phones and computers at least two hours before bed, as well as other electronic devices that emit blue light since this disrupts melatonin production. Melatonin naturally increases in a dark environment, so make sure your bedroom is free of glowing electronics, and external light sources such as streetlights.
There are many herbs and nutrients that can also support relaxation and good sleep. One extract emerging as a multi-purpose ingredient is honokiol, derived from magnolia bark. Honokiol supports restful sleep and healthy mood, is a powerful antioxidant, and has been shown to support metabolism, cellular function, neurological health and offer other important benefits.
There are a number of other natural ingredients that support sleep, including lemon balm and passionflower extracts and the amino acid L-tryptophan. I also recommend calcium and magnesium. A small amount of supplemental melatonin can also promote relaxation and more restful sleep, and offer powerful protective benefits.
In addition to detoxification and better sleep, we can also support healthy metabolism more directly. There are a number of botanicals that help balance glucose, improve insulin function and support overall metabolic function. I recommend gymnema leaf, fenugreek, holy basil, as well as berberine-containing botanicals such as extracts of Indian kino bark and golden thread rhizome. Minerals, such as zinc and chromium, the amino acid taurine, as well as the organosulfur compound alpha lipoic acid, also work to benefit metabolic function.
Like so many other chronic health conditions, metabolic syndrome and type 2 diabetes are rooted in complex biological interactions requiring precise balance. By taking a comprehensive, holistic approach, we can help our patients address the multiple underlying causes of the diabesity epidemic while improving other key areas of health in the process.
1 Jones OA, Maguire ML, Griffin n JL. Environmental pollution and diabetes: a neglected association. Lancet. 2008;371(9609):287-288.
2 Hyman M. Systems biology, toxins, obesity, and functional medicine. Altern Ther Health Med. 2007;13(2):S134-S139.
3 Lang IA, Galloway TS, Scarlett A, et al.Association of urinary bisphenol A concentration with medical disorders and laboratory abnormalities in adults. JAMA. 2008;300(11):1303-1310.
4 Griffi n JL, Scott J, Nicholson JK. The influence of pharmacogenetics on fatty liver disease in the wistar and kyoto rats: a combined transcriptomic and metabonomic study. J Proteome Res. 2007;6(1):54-61.
5 Chen JQ, Brown TR, Russo J. Regulation of energy metabolism pathways by estrogens and estrogenic chemicals and potential implications in obesity associated with increased exposure to endocrine disruptors. Biochim Biophys Acta. 2009;1793(7):1128-1143.
6 Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet 1999; 354:1435–1439.
7 Nedeltcheva AV, Kessler L, Imperial J, Penev PD. Exposure to recurrent sleep restriction in the setting of high caloric intake and physical inactivity results in increased insulin resistance and reduced glucose tolerance. J Clin Endocrinol Metab 2009; 94:3242–3250.
8 Spiegel K, Leproult R, Colecchia EF, et al. Adaptation of the 24-h growth hormone profile to a state of sleep debt. Am J Physiol Regul Integr Comp Physiol 2000; 279:R874–R883.
9 Van Cauter E, Polonsky KS, Scheen AJ. Roles of circadian rhythmicity and sleep in human glucose regulation. Endocr Rev 1997; 18:716– 738.
10 Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Circadian interleukin- 6 secretion and quantity and depth of sleep. J Clin Endocrinol Metab 1999; 84:2603–2607.
11 Vgontzas AN, Zoumakis E, Bixler EO, et al. Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J Clin Endocrinol Metab 2004; 89:2119–2126.