What Are the Interactions with Food? The effects of sibutramine are increased by alcohol. Avoid alcohol while using this drug.
Orlistat (Xenical, Alli)
This drug prevents a significant portion of dietary fat from being absorbed into the body. Instead, the fat passes right through. The side-effect profile of this drug is daunting, with potentially embarrassing gastrointestinal problems occurring in up to 27 percent of patients (see the later section on side effects). Other side effects such as rash, headache, depression, and decreased immunity are likely the direct result of decreased absorption of essential fatty acids and fat-soluble vitamins such as A, D, and E. As the long-term consequences of using this drug come to light, gallstones are emerging as a serious side effect.
What Does It Do in the Body? Orlistat is a lipase inhibitor. It inhibits the activity of an enzyme that breaks down fats before they are absorbed through the walls of the intestines. This prevents the absorption of about 30 percent of the fat taken in through the diet.
What Is It Prescribed For? Management of obesity, including weight loss and weight maintenance. It is also prescribed to reduce the risk of regaining weight that has been lost.
What Are the Possible Side Effects? Gallstones are a serious possible side effect. Digestive side effects include oily spotting (in 26.6 percent of patients); flatulence with discharge (in 23.9 percent); urgent need to defecate (in 22.1 percent); fatty, oily stools; increased defecation; and fecal incontinence. Most side effects were dramatically reduced in the second year of treatment, but they still affected between 1.8 and 5.5 percent of patients using orlistat. Side effects include headache, anxiety, depression (starting in the second year of treatment), dizziness, dry skin, rash, abdominal pain or discomfort, gum disease, infectious diarrhea, nausea, rectal pain/discomfort, tooth disorders, vomiting, arthritis, back pain, joint disorders, muscle pain, menstrual irregularities, vaginitis, increased incidence of flu, respiratory tract infections, fatigue, eye irritation, sleep problems, and urinary tract infection.
CAUTION!
• While taking orlistat, it is important to adhere to a low-fat diet (less than 30 percent fat) to avoid fecal incontinence and diarrhea.
• This and other weight loss drugs should not be used by anyone with a history of eating disorders, such as anorexia nervosa or bulimia.
What Are the Interactions with Food? Orlistat should be taken with meals.
What Nutrients Does It Throw out of Balance or Interact With? In patients with normal baseline vitamin levels before using orlistat, after the use of orlistat vitamin A levels were low in 2.2 percent, vitamin D levels were low in 12 percent, vitamin E levels were low in 5.8 percent, and beta-carotene levels were low in 6.1 percent. When fats are flushed through the system without being broken down, fat-soluble vitamins go along with them.
What Else to Take If You Take This Drug. A high-potency multivitamin containing vitamins A, D, and E, and beta-carotene, along with an essential fatty acid supplement. Take them between doses of orlistat.
Natural Alternatives to Diabetes and Weight Control Drugs
There are many safe, natural, and effective ways to help control blood sugar and shed excess weight without drugs. For most diabetics, these two changes go hand-in-hand. If you are overweight but don’t know whether you have diabetes or are at risk for it, make sure you are evaluated by a physician to rule it out; knowing you have diabetes or insulin resistance will help you make the right changes to move back toward health. The Six Core Principles for Optimal Health are your cornerstone for healthy weight and stable blood sugar, with an emphasis on exercise, the reduction of processed foods and sugar, and—yes!—vegetables, preferably fresh and organic and not overcooked.
The high-carbohydrate diet traditionally recommended by the American Diabetes Association is proving not to be the answer for many diabetics. If you are a type 2 diabetic who is overweight and insulin resistant, it may be important for you to cut way back on carbohydrates. When you do eat them, stick to complex carbohydrates with plenty of fiber such as whole grains, vegetables, and legumes (e.g., beans). Sugar and simple carbohydrates (e.g., white flour, pasta, potatoes, corn, and bananas) create spikes in blood sugar and insulin production, and your goal is to keep both insulin and blood sugar on an even keel. Beans are especially good foods for balancing blood sugar.
Many people who struggle with their weight have been trying to lose excess pounds with the government-approved high-carbohydrate, low-fat, low-cholesterol diet, and the result has been temporary losses followed by a gain larger than what was lost. We now know that this type of diet can cause or worsen blood sugar ups and downs that lead to carbohydrate cravings. We also know that the average low-fat diet—laden with processed foods that have the fat removed and flavor added back in with sugar and artificial flavorings—are notoriously unsatisfying. Such diets inevitably lead to overconsumption of high-carbohydrate foods, which can pack a lot of empty calories. Those calories are stored as fat, especially in a body that is insulin resistant and has high insulin levels. The book The Zone by Barry Sears (Harper- Collins, 1995) provides good, in-depth coverage of a balanced diet for insulin and weight control.
We’d like to make a point too often missed by the trend-hungry diet industry: the healthfulness of your diet involves much more than its carbohydrate, fat, or protein content. A high-carb diet made up of bread, cake, cookies, sodas, and the occasional piece of fresh fruit is a very different thing from a high-carb diet made up of brown rice, beans, vegetables, and fruits. A high-protein diet made up of processed meats (ham, bologna, bacon), processed cheese, and sugar-laden yogurt is quite different from one made up of lean meats, eggs, tofu, and fish accompanied by plenty of fresh veggies.
As you read about the supplements that can help stabilize your blood sugar, keep in mind that they will affect your blood sugar, so they shouldn’t be used without very close monitoring if you have diabetes. You should be able to find all of these supplements at your health food store. If you are not diabetic, many of the diabetes supplements could be helpful for you. If you are diabetic and obese, the supplements recommended for weight control could assist you in your efforts to keep weight—and, by proxy, insulin levels—within healthy limits. While under a doctor’s care, make sure he or she knows about all of the supplements you’re using.
An Ayurvedic, Chinese, or naturopathic doctor will work very closely with diabetics, prescribing a variety of herbs and supplements depending on the health of the patient. If you have unstable blood sugar or are diabetic, please work closely with one of these types of physicians, or an M.D. or D.O. (doctor of osteopathy) willing to use herbs and nutritional supplements. In the “Resources and Recommended Reading” section of this book, you’ll find an organization that will refer you to an alternative health care professional in your area.
Chromium and niacin: Partners in Blood sugar Control
Chromium is one of your key supplements when you need better blood sugar control. The people who make those awful bottled “natural” fruit drinks and teas aren’t going to like this, but it’s possible that the steep rise in our consumption of high fructose corn syrup has contributed to the rise in diabetes by depleting chromium. (As our consumption of high fructose corn syrup has risen 250 percent in the past 15 years, our rate of diabetes has increased approximately 45 percent in about the same time period.) According to studies done at the Agriculture Department’s Human Nutrition Research Center, fructose consumption causes a drop in chromium, raises LDL “bad” cholesterol and triglycerides, and impairs immune system function—yet another great reason to read labels and avoid processed foods.
According to researchers, giving people with elevated blood sugar a chromium supplement will result in a significant drop in blood sugar in 80 to 90 percent of those people. Please don’t be scared away from chromium by media reports about its potential dangers. Taking chromium picolinate supplements of 200 to 600 mcg daily is not the same as giving rats 5,000 to 6,000 times that
dose every day, nor is it the same as factory workers breathing chromium dust. It is estimated that 90 percent of Americans are actually deficient in chromium, and at the recommended doses it is very safe and very effective in helping stabilize blood sugar as well as helping burn fat during exercise and producing lean muscle tissue.
The other nutrient necessary to help insulin do its job of ushering sugar into cells is niacin (vitamin B3). Niacin works with chromium and should be taken in the form of inositol hexanicotinate with enough to give you 100 mg of niacin daily to start with. For example, one brand of 500 mg tablets of inositol hexanicotinate yields 400 mg of inositol and 100 mg of niacin. You can gradually raise the dose if needed, up to 400 mg of niacin daily.
Other Important Supplements for Stable Blood Sugar
Vanadium, a trace mineral taken in the form of vanadyl sulfate, helps insulin work more efficiently. That may be why it also lowers cholesterol and triglyceride levels. Long-term high doses of vanadium are not recommended, but you can use it to help stabilize your blood sugar and then cut back. Start with 6 mg daily and work your way up to 100 mg daily until you get results. Once you begin having results, stay at that dose for up to three weeks and then taper back gradually to 6 to 10 mg daily.
Studies now link a vitamin D deficiency with diabetes, immune function, and bone loss. It may be that vitamin D deficiency is a factor in the onset of diabetes and that a supplement of vitamin D could help reverse the disease. Take 1,000 to 2,000 IU daily, and spend at least 15 minutes per day in the sun, with skin exposed and without sunblock.
Zinc (10 to 15 mg daily), selenium (100 to 200 mcg daily), and manganese (10 mg daily) all play a role in regulating blood sugar and should be included in your daily multivitamin. Many diabetics are deficient in magnesium, which is key to a healthy heart, so be sure you’re getting 400 to 800 mg daily in a supplement.
Recent studies have shown that both vitamin E and vitamin C significantly improve glucose (sugar) tolerance in type 2 diabetics. In fact, two independent studies have shown that low blood levels of vitamin E are correlated with a four times higher risk of diabetes. In a study published in the Journal of Clinical Investigation, researchers at Harvard who gave diabetic patients intravenous vitamin C found that it significantly improved blood vessel dilation and function. Since impaired blood flow is one of the primary causes of diabetes complications, this is significant information. It’s a good idea for almost everyone to take 1,000 to 2,000 mg of vitamin C daily, but if you are diabetic, you may want to double that amount. (Vitamin C can give false readings on some types of glucose tests, so consult with your physician or pharmacist about which form of glucose testing works best with vitamin C.) Make sure you’re getting your bioflavonoids with the vitamin C. The bioflavonoids in grapeseed extract and ginkgo biloba help strengthen blood vessels and improve blood flow to the extremities.
Calcium, long known to be important for bone health, may also help with weight loss, according to recent research by scientists at the University of Vermont. Women who increased their calcium intake by as little as 130 mg a day showed an increased rate of weight loss compared to women whose calcium intake didn’t increase. In-depth studies of fat-cell function have shown that when calcium intake is too low, a hormone that causes bones to demineralize is released. This same hormone affects fat cells, too, by prompting them to store more fat. Other research has shown that the amount of calcium stored in fat cells plays an important role in regulating how much fat they store or burn. Mice bred to be obese and plumped up on a high-fat, high-sugar diet were then put on a calorie- restricted diet. Some of the mice received calcium supplementation. Those with extra calcium in the diet lost 42 percent of their fat weight, while those receiving no extra calcium only lost 8 percent! One of the study’s authors, Jean Harvey-Berino, Ph.D., advises that taking at least 1,000 mg of supplemental calcium per day is a good way to enhance weight loss.
Essential fatty acids (EFAs) are especially essential for people with unstable blood sugar, making it very important to cut out the EFA-blocking hydrogenated oils found in chips, baked goods, and nearly all processed foods. Research has shown that diabetics given evening primrose oil for a year had improved nerve function, while those on a placebo became worse. Other research has shown that diabetics on a high monounsaturated oil diet (e.g., olive oil, canola oil, avocados) had lower triglycerides and better levels of blood glucose and insulin than those on a primarily high-carbohydrate diet. Eating plenty of fresh, organic vegetables, a variety of whole grains, and fish should give you a good base of EFAs over the long term. Limiting hydrogenated fats and refined carbohydrates will help the essential fats you take in to go down the proper pathway for better health.
Ginseng has been used by the Chinese for centuries to help control diabetes, and recent studies confirm that it can reduce fasting blood glucose as well as improve mood and help in weight reduction. Herbalist Donald Brown recommends a standardized extract with a 5 to 7 percent ginsenoside content. More or less can throw blood sugar off rather than bring it into balance. For this use, ginseng is probably best taken as a liquid extract.
One of the Ayurvedic herbs of choice in India for lowering blood sugar, now available in the United States, is called Gymnema sylvestre. There is also some evidence that Gymnema sylvestre actually reverses damage to certain cells in the pancreas that can be destroyed by diabetes. You can find it at your health food store. Be sure to tell your health care provider that you are taking this herb, because if you are taking diabetes drugs they may need to be adjusted.
An extract of a cucumber-like vegetable called bitter melon (Momordica charantia) has potent blood-glucose-lowering action. Bitter melon is eaten as a medicinal food in many parts of the world.
Banaba (Lagerstroemia speciosa) is a plant that grows wild all over the Philippines, and it is commonly used there as a folk remedy for diabetes. Scientists all over the world are studying its active component, corosolic acid, to better understand why it balances blood sugars so well. In one study, diabetic rats were fed the yolks of eggs from chickens that had been fed banaba, and their high blood sugar was normalized. Research has found that banaba also significantly decreases the amount of lipid (fat) accumulated in the liver. In one study, banaba was found to increase glucose transport into cells just like insulin, but at the same time, it had a suppressive effect on the creation of more fat cells. Banaba may be a very useful plant for the prevention and treatment of high blood sugar and obesity in type 2 diabetics.
Turmeric, a spice often used in the East, and the more familiar spice cinnamon have both shown tremendous potential in helping regulate blood sugar. Richard Anderson, Ph.D., tested these spices in a test tube and found that they tripled insulin’s ability to metabolize sugar. Studies indicate that fenugreek is another spice that can aid you in controlling your sugar levels. In addition, maitake mushrooms have been found to help maintain correct sugar levels. Green tea, berries, and the herb rosemary can all improve insulin sensitivity.
Supplements for Weight Loss
The following supplements aren’t specifically for diabetics, but they can be helpful for those who wish to lose weight. They are almost all derived from plants, and many have a long history of safe medicinal use.
Phaseolus vulgaris is derived from the common white kidney bean. It contains a substance that inhibits the activity of the alpha-amylase enzyme. Alpha-amylase is responsible for breaking down carbohydrates in the digestive tract, and inhibiting it helps slow or decrease the absorption of carbohydrates through the intestinal wall.
Foods That Raise Blood Sugar
Carrots
Oatmeal
Oranges
Potatoes
Processed cereals
Raisins
Refined grains (white bread, pasta)
Sugar, molasses
Sweet corn
Yams
It’s believed that the neurotransmitter serotonin plays a powerful role in appetite control. SSRIs and other neurotran
smitter-affecting drugs dampen appetite due to increases in serotonin availability in the brain.
Garcinia cambogia contains hydroxycitric acid, which has been found to increase the availability of serotonin in the brain almost as much as SSRI drugs do. It has also been found to decrease body fat synthesis. Unlike SSRIs, this plant extract is nontoxic, with side effects occurring only at doses far exceeding recommended dosages (5,000 mg [5 g] per kilogram—that would be equivalent to 350 grams for a 155-pound [70 kg] man). Interestingly, Garcinia cambogia also appears to protect against NSAID-induced ulcers, increasing the stomach lining’s defenses against erosion and slightly decreasing the volume and acidity of digestive juices. Dosages will vary by brand; follow the instructions on the container.
Coenzyme Q10 (CoQ10) is made in the body and is needed within each cell to spark tiny cellular “engines” called mitochondria. Within the mitochondria, fuel—carbs, fats, and sometimes proteins—are metabolized into energy. Research is showing that low CoQ10 levels are correlated with obesity and that boosting these low levels could also boost metabolism and weight loss. Try between 50 and 100 mg per day.
Good Foods for Stable Blood Sugar
Making the Shift to Naturally stable Blood sugar
If you are struggling with unstable blood sugar and coping with a physician who just wants to put you on drugs, perhaps you can take some inspiration from a woman named Susan. During an annual checkup with her physician, Susan was told she had high blood sugar and was given a prescription for an oral diabetes drug. She took the drug until she went on a lengthy vacation and ran out. Remembering the advice she had read in one of Dr. Mindell’s books to cut out sugars, processed foods, and get plenty of exercise, she did just that while on vacation. She felt so great that she continued this regimen when she got back home and never renewed her prescription for the drug. A few months later, she went back to her physician, and her blood sugar was perfectly normal. A year later, her blood sugar was still normal, and she was in great health. Congratulations to Susan and to all of you who have taken charge of your health and are feeling better for it!
Prescription Alternatives Page 46