Diabetes A Nutritional and Functional Medical Approach To Diagnosis and Treatment

Transcription

1 Diabetes A Nutritional and Functional Medical Approach To Diagnosis and Treatment By Ronald J. Grisanti D.C., D.A.B.C.O. Diabetes affects an estimated 17 million Americans, and the number rises each year. Here you'll find in-depth information about the real causes of Diabetes, peer-reviewed medical diagnosis and advanced medical treatment options not found anywhere else. Diabetes mellitus results from the inability of the body to control blood glucose levels adequately due to a lack of insulin or insulin resistance. Diabetes mellitus is a disease in which the body does not produce or does not use insulin effectively. It is the most common endocrine disease, affecting approximately 17 million. Insulin is a hormone produced in the pancreas. Insulin is produced in direct response to your glucose (sugar) levels It is responsible for transporting glucose (from carbohydrates) into the cells to fuel cellular metabolism and energy production. After a meal, when blood sugar increases, insulin levels rise. Between meals, when blood sugar is low, insulin levels remain low. Simply put, insulin reduces blood sugar. Diabetes can affect people of any age. It increases the risk of chronic, debilitating conditions, including cardiovascular disease, retinopathy and blindness, peripheral neuropathies, vascular insufficiency and amputation, immune deficiencies, skin ulceration and wound healing disturbances, and kidney disease. Diabetes is diagnosed when there is a fasting plasma glucose (FPG) of greater than 126mg/dL, or a two-hour plasma glucose (OGTT oral glucose tolerance test) of greater than 200mg/dL. Three physiological abnormalities typically occur in type 2 Diabetes: insulin resistance, increased glucose production in the liver and poor beta cell function. These can occur individually or in combination. Insulin Resistance Insulin resistance appears to be the first stage of the disease. Insulin resistance is defined as an inability of insulin to pull glucose out of the blood and put it into the cells. In a healthy person, insulin will firmly attach itself to the run-away glucose and hold on to it. It will then safely transport the glucose to its destination. Even though the beta cells of the pancreas is able to produce normal amounts of insulin in direct response to the rising glucose, it simply unable to attach itself to the glucose. Unfortunately this causes glucose levels to rise. In response, the pancreas releases more and more insulin.

2 This is likely the result of genetic defects that cause an inadequate number of insulin receptors and/ or an inefficient glucose transport system. Insulin resistance is due to high insulin levels, not high glucose levels. Although blood glucose can be maintained within normal limits if enough insulin is produced, eventually, though, the beta cells "burn out" and insulin resistance may progress to full-blown diabetes. Liver Gluconeogenesis Many people with type 2 diabetes also produce a large amount of glucose in the liver. In biochemistry terms, this is called hepatic gluconeogenesis. This increase in glucose is likely related to fat breakdown. When the body is not efficiently using glucose as an energy source, fat becomes an important source of fuel. The breakdown of fat causes the liver to produce glucose. Because patients with type 2 diabetes are insensitive to the effects of insulin, which normally suppresses the production of glucose in the liver, this gluconeogenesis goes unchecked. Beta Cell Exhaustion In type 2 diabetes, the ability of the beta cells (beta cells make insulin) to release insulin needed after eating a meal deteriorates early on in the disease process. Therefore, blood glucose remains high for one to two hours after a large meal. As the disease progresses, the insulin release that continues following a meal worsens, resulting in pancreatic beta cell exhaustion. Type 2 diabetes appears to be caused by genetic defects that initially result in an inability of insulin to bind or attach itself to glucose. Unfortunately, over time the pancreas s ability to make more insulin via the beta cells completely erodes leading to a run-away glucose problem. However, new evidence has emerged which points to diet and lifestyle as important contributing factors to the development of the disease. A person over the age of 45 and overweight is a prime candidate for developing type 2 diabetes. Approximately percent of Americans are obese, and many more are overweight. Research has shown a strong correlation between upper body obesity ("apple shapes") and the development of type 2 diabetes mellitus. Complications from Untreated Diabetes The long-term complications associated with diabetes are serious, often life threatening, and diagnosed in the late stages of the disease progression. These complications are due to persistently elevated glucose levels from poor glucose control. Coronary heart disease and peripheral vascular disease retinopathy, nephropathy, and neuropathy are some of more common complications Heart disease is the leading cause of diabetes-related deaths, with adults having two to four times higher heart disease death rates than adults without the disease. The risk of stroke is two to four times higher in people with diabetes. Patients with diabetes experience an accelerated rate of arteriosclerosis, and some percent of patients with diabetes have high blood pressure.

3 It can lead to blindness, heart disease, strokes, kidney failure, amputations, and nerve damage. GI problems such as chronic constipation, or diarrhea, loss of sexual function, bladder function are symptoms of untreated Type 2 diabetes Diabetes is the leading cause of nontraumatic amputations in the U.S. Inability to maintain normal glucose control can lead to many metabolic diseases, including obesity, heart disease, hypertension, diabetes, chronic fatigue, accelerated aging, as well as numerous mental and emotional disorders. Unfortunately, without early and accurate preventive testing, the first "sign" that surfaces may be a permanent complication from type-2 diabetes such as nerve loss, impotence, or even blindness. SIGNS & SYMPTOMS Frequent urination Increased thirst Fatigue Irritability Dizziness Lethargy Loss of coordination Perspiration Nausea Fruity odor to the breath Blurred Vision Numbness or burning sensation in hands and feet Traditional Clinical Lab Assessments Blood Glucose Elevations of serum glucose should lead to confirmatory testing such as fasting insulin, serum phosphorus, magnesium, hemoglobin A1c, and/or fructosamine. Urine Glucose Glucose Tolerance Test (GTT) Fructosamine Blood or urine glucose provides information about immediate diabetic control, fructosamine about short-term control (last 20 days), and HbA1c about long-term control (3-month period) Glycohemoglobin (HgbA1c) Elevated HbA1c levels reflect poor diabetic control in the previous three to 12 weeks. HbA1c can provide information missed in spot checks of urine or serum glucose.

4 Functional Medicine Clinical Lab Assessments The following laboratory testing can provide valuable information necessary for diagnosis and treatment. The information obtained from these advanced medical tests can be the "key" to finding the "cause" of diabetes. Organic Acid Test Organic acid testing is one of the most powerful test used to identify specific nutritional and metabolic causes of challenging health problems. Organic acids testing is a urine test. Science has discovered specific chemicals in the urine that pinpoint "glitches" in one's health. These chemicals are referred to as metabolic end products. These end products have fancy names like Xanthurenate, Kynurenate, Methylmalonate.. to name a few. Each of these end products is linked to a specific function in the body. If you have too much of these end products, it can help your doctor determine the probable cause of your health problem. Abnormal high levels of organic acids can be traced to inherited enzyme deficiencies, build-up of toxins, nutrient deficiencies, or drug effects. Every cell is affected when a metabolic pathway is damaged. A single urine specimen can test and scientifically evaluate: Fatty acid metabolism Neurotransmitter metabolism Carbohydrate metabolism Oxidative damage Energy production Detoxification status B-Complex sufficiency Intestinal dysbiosis due to bacteria and yeast Methylation co-factors Inflammatory reactions Organic Acid Testing has been found to not only be beneficial for the clinical evaluation of diabetes but for the following conditions: Cardiovascular Disease Identifying individuals who are deficient in coenzyme Q10 and other cardioprotective nutrients should routinely be part of any comprehensive risk reduction plan. Organic acid testing provides documentation for the use of nutrient therapies to reduce cardiovascular problems. Cholesterol lowering drugs such as Lipitor can interfere with the production of CoQ10. Vitamin B12, folic acid and vitamin B6 can reduce the levels of homocysteine. Organic Acid Testing can help your physician identifying specific biomarkers which are linked to these deficiencies. If your urine reveals high levels of the following: Succinate, Xanthurenate, Kynurenate, Methylmalonate, Formiminoglutamic Acid, then it is quite clear that you are deficient in CoQ10, B12, folate, B6 and are risk of developing heart disease. The reduction of this metabolic end products provide a valuable piece of your heart health.

5 Chronic Fatigue Most patients experiencing chronic fatigue have multiple factors impacting energy production. Low thyroid and adrenal function, psychological stress, toxic overload, poor dietary habits, lack of exercise, sleep cycle disruptions, chronic pain, and inadequate nutritional status can all play a role. The assessment of cell dysfunction may be the key to breaking the energy blockage. If the basic energygenerating system is blocked or sluggish, cells cannot meet their metabolic needs. Over time, this decreased capacity creates organ weakness and a intense fatigue, which is further evidenced by accumulated metabolic end products in the urine. High levels of the following end products have been linked to chronic fatigue: alpha-ketoglutarate, Succinate, Fumarate, Malate. Depression Organic Acid testing helps to identify depressed patients who may benefit from specific nutritional approaches. No other single assessment tool provides simultaneous markers of B vitamin status, methlyation cofactors, neurotransmitter metabolism, and sulfur-containing amino acids. Since unmet needs for vitamins B6 or B12, folic acid, and serotonin or catecholamine precursor amino acids can exacerbate depressive tendencies, identifying any one of these factors may help in the management of your clinically depressed patients. High levels of the following metabolic end products have been linked to depression: Xanthurenate, Methylmalonate, Formiminoglutamic Acid, Kynurenate, Pyroglutamate, Sulfate, Vanilmandelate, Homovanillate, 5- Hydroxyindoleacetate, Orotate Obesity The Organic Acid test reveals numerous metabolic factors other than caloric or fat intakes that have effects on body weight. The most common interventions involve optimal doses of essential amino acids, carnitine, and vitamin-derived cofactors for energy pathways. Such predictive metabolomics allow you to assess metabolic efficiency. Addressing these issues at the functional level is far more efficient than searching for potential influences with predictive genomics testing. Metabolic profiling with the New Organix Profile gives you direct insight into fatty acid, amino acid, and carbohydrate metabolism as well as nutrient deficiencies related to carnitine, chromium, vanadium, B vitamins, and lipoic acid. All have been implicated in obesity. The following metabolic end-products have been linked to obesity: Adipate, Suberate, Ethylmalonate, Pyruvate, Lactate, beta-hydroxybutyrate Organic acids analysis is a useful method for measurement of biochemical intermediates in urine. These intermediates can offer information about key enzyme functions and nutrient competence (amino acids, nutrient cofactors, minerals and fatty acids). Several examples can be cited: Elevations of pyruvate, lactate, á-hydroxybutyrate, and â-hydroxybutyrate indicate impairment in enzyme functions relative to carbohydrate metabolism. Elevation of tricarballylate suggests functional magnesium deficiency, which can impact glycemic response mechanisms due to bacterial pathogens.

6 Elevation of vanilmandelate reflects elevations in epinephrine, an aggressive antagonist of insulin. Detoxication and dysbiosis markers in organic acids suggest the relative competence of the liver and gastrointestinal tract to detoxify insulin, a critical process in carbohydrate metabolism. Red Blood Cell Mineral Test Research suggests that early imbalances of specific minerals may play an important role in upsetting healthy glucose and insulin metabolism. Both high levels of toxic heavy metals and low levels of essential minerals have been linked to the accelerated progression of type-2 diabetes and its related complications. Chromium is a trace mineral that may improve glycemic regulation. Chromium acts as a powerful blood sugar modulator that can help safe-guard against glucose imbalances. It helps to lower glucose response in individuals with elevated levels. Chromium has a beneficial metabolic effect by increasing insulin's ability to bind to cells. Chromium supplementation appears to produce a positive effect on glucose and insulin metabolism only in people with pre-existing deficiencies. Besides chromium, other minerals that have been found to play an important role in glucose regulation and insulin sensitivity include zinc, potassium, magnesium, selenium, and vanadium. Magnesium and potassium deficiencies are often found in patients with diabetes, and may impair cardiac function and carbohydrate metabolism. Low levels of serum magnesium have been found to be a strong, independent predictor of type-2 diabetes in white subjects. shortages "can ameliorate or prevent" cardiovascular complications in diabetes. Zinc plays an important role in the body makes and uses insulin. Lower levels may affect the ability of the pancreas to produce and secrete insulin, particularly in type-2 diabetes. Research has shown that the trace mineral vanadium has strong potential for improving glucose and insulin regulation in diabetics. Besides nutrient imbalances, exposure to toxic heavy metals can also increase the risk of developing type-2 diabetes and related complications. In general, higher levels of heavy metals, such as mercury, are associated with increased oxidative stress and higher risk of degenerative complications such as heart disease. Studies show that individuals who are exposed to higher amounts of arsenic - in their soil and/or drinking water - have a higher independent risk of developing type-2 diabetes. Cadmium, a heavy metal contaminant found in air, soil, and water, can accumulate in the body with chronic exposure. Such accumulations increase the

7 likelihood of kidney damage/ failure, spur free radical activity, and exacerbate neuromuscular complications of type-2 diabetes. Treatment Options: Disease-Specific Treatments simply refer to the fact that treatment is directed to suppress symptoms with little consideration to the reasons why a person is sick in the place. Almost all conditions are treated "exactly" the same. Instead of the treating the individual patient with the disease, the disease is treated instead. Remember this type of treatment DOES NOT take in consideration, the unique makeup of each individual. Oral drug therapy for the management of type 2 diabetes now includes more choices of agents in several drug classes, most of which work by different mechanisms of action. Sulfonylureas cause release of insulin from the pancreas and increase the sensitivity of insulin receptors; biguanides work in the liver; thiazolidinediones work in muscle tissue; glucosidase inhibitors work in the small intestine; and meglitinide causes release of insulin from the pancreas. Patient-Specific Treatment Options * The following treatment options have been researched and found to be effective in the management of depression. It is highly discouraged to assume that any of the below natural products are going to cure your health condition. Unfortunately, many people attempt to self diagnose or believe that a specific supplement or natural treatment will cure their problem. The purpose of this site is to provide medically sound answers to many of the most chronic health challenges. You first MUST be evaluated to determine EXACTLY what natural treatments will help. Once you are properly tested, your physician will then be in a position to pinpoint the probable causes of your health problem and make the appropriate recommendations. For instances, if your physician finds that the cause of your depression is due to amino acid deficiencies than he/she can then personalize your treatment. On the other hand, if your Organic acid test shows that your levels of B6, B12 and folate are well within normal ranges, then you can see why taking B6, B12 or folate would not be effective in improving depressive disorders. Remember, instead of treating a "disease" we are treating the "person with the disease". No two people are alike. For one person, the cause of their * Disease-Specific Treatments simply refer to the fact that treatment is directed to suppress symptoms with little consideration to the reasons why a person is sick in the place. Almost all conditions are treated "exactly" the same. Instead of the treating the individual patient with the disease, the disease is treated instead. Remember this type of treatment DOES NOT take in consideration, the unique makeup of each individual.

8 Patient-Specific Treatment Options are the future of medicine. Identifying the cause of your health problem then personalizing the treatment will soon be the accepted norm for people who are sick and tired of simply treating symptoms but instead want to get well. Natural Herbal and Supplement Remedies: Gymnema Bitter Melon Evening Primrose Coenzyme Q10 (CO-Q10) A deficiency of coenzyme Q10 could damage how the body processes insulin. CoQ10 supplementation may improve the functioning of beta cells and the production of insulin. Biotin Biotin reportedly stimulates glucokinase enzyme activity. This is an enzyme that plays an important role in regulating a range of glucose-related metabolic processes. It appears that biotin may be a safe nutritional product to aid in the management of type 2 diabetes. Chromium Various studies support that chromium has a positive effect on blood glucose levels, and recent studies report that chromium may positively impact hemoglobin A1c as well. The glucose tolerance factor (GTF), which is comprised of trivalent chromium, niacin, glycine, glutamic acid, and cysteine has been found to be an excellent source of chromium Dr. Walter Mertz of the United States Department of Agriculture researched GTF chromium. He found that chromium was a crucial part of the binding complex that allowed insulin to attach to cells. Organically bound GTF chromium is thought to be safe and well tolerated. Chromium picolinate is another popular form of chromium that has clinical support for blood sugar regulation.. For diabetics, adding chromium to the diet should be done gradually, especially if they are currently controlled on medication. Recent studies report 600mcg to 1,000mcg a day may be needed to control the type 2 diabetic. Magnesium Magnesium is involved in glucose metabolism and insulin secretion. It is well documented that low magnesium may aggravate diabetic conditions.

9 Vanadium Supplementation with vanadyl sulfate and other vanadium compounds has been reported to markedly improve a number of clinical measures of diabetes. It appears that vanadium mimics the effects of insulin, resulting in decreased gluconeogenesis and an increase in glycogen production. Animal studies have demonstrated that vanadium administered to diabetic rats restores elevated blood glucose to normal ranges. Human studies have shown that Type 2 diabetics given oral vanadyl sulfate (50mg twice daily for four weeks) in a single-blind, placebo-controlled study had a nearly 20 percent drop in fasting blood glucose in one study. Vanadium pentoxide and vanadyl sulfate are active, absorbable forms of vanadium. Alpha-Lipoic Acid (ALA) Alpha-lipoic acid (ALA) is an antioxidant substance produced by the body. ALA is also known as alpha-lipoate or thiotic acid. Alpha-lipoic acid has also demonstrated a positive effect on insulin and blood sugar metabolism for type 2 diabetics. Zinc Zinc deficiency is associated with a number of metabolic disorders, including impaired glucose tolerance, insulin degradation, decreased insulin potency, and reduced pancreatic insulin content. Zinc plays a role in the regulation of insulin production by the pancreas and glucose utilization by muscle and fat cells. Zinc also serves as a component in glucose transport and in gene expression of insulin receptors. Cyclo (His-Pro) Cyclo hispro, a thyrotropin releasing hormone metabolite, is thought to be a useful agent in improving blood sugar regulation. Cyclo hispro has potential for individuals with hypoglycemia, diabetes, and impaired glucose tolerance (IGT). It has been documented that individuals with diabetes have impaired intestinal zinc absorption and low plasma zinc levels. Studies suggest that Cyclo hispro extract influences intestinal zinc absorption mechanisms. This extract not only contains high levels of zinc, but also several cofactors reported to stimulate intestinal zinc absorption. In a recent controlled clinical trial, cyclo hispro was administered to 22 male subjects with type 2 diabetes. After three months, the treatment group reportedly exhibited significantly diminished fasting blood glucose levels and fasting plasma insulin levels. Improving zinc utilization is important because it plays a role in over 300 different enzymatic functions. Most importantly for the diabetic, it is involved in wound healing, immune function, and skin integrity.

10 Lifestyle and Nutritional Advice: Diabetes and obesity has reached epidemic proportions in the last few years. People simply don't eat enough fresh foods, and there are fewer micronutrients in the soil (like chromium and vanadium) where food is grown. Carbohydrates alone are not the culprit, because humans were eating carbohydrates long before these problems arose. It is true, however, that people are eating excessive amounts of carbohydrates, and it would be better to moderate that intake. There are several ways to improve insulin regulation with natural agents, but the real key is to adjust the dietary selection of foods. In general, the American diet consists of way too many carbohydrates, especially refined carbohydrates. People do not eat enough fresh vegetables and fruits, and quality sources of protein and legumes. In addition most people do not take in adequate sources of essential fats. With the average American eating approximately 150 pounds of sugar a year, it is apparent that there is a continual demand for more insulin production. The average person drinking two "big gulp" drinks a day is receiving approximately 54 teaspoons of sugar. The apparent first step is to eat foods that will least aggravate insulin response. The first concept to understand is the glycemic index. It is a known fact that certain foods actually cause a sharper rise in insulin release than others. Foods that do not cause a rapid rise in blood sugar will not aggravate the insulin response. For example, in the past, it was thought that all complex carbohydrates were equal. It is now known that different grains have varying glycemic responses. It is valuable to consider the glycemic index when looking at foods that contain varying amounts of carbohydrates. Proteins and fats have virtually no glycemic factor. Legumes: Virtually all legumes have a moderate glycemic index. Vegetables: Some vegetables have a high glycemic index and should be used in moderation if one is trying to actively control blood sugar. The most prominent of these are white potatoes (baked), carrots, beets, and turnips. Dairy products: Most dairy products have a low glycemic index. However, some people do not tolerate dairy well. Fruits: Fruits are generally in the middle of the road in terms of glycemic index, but dried fruits, which are concentrated, rank higher. Drinking fruit juices will definitely aggravate blood sugar response and is known to contribute to triglyceride response. Therefore, fruit juices should be limited Most sweeteners such as honey, molasses, sugar, and white grape juice concentrate tend to have a high glycemic index. Rice syrup and granulated rice sweeteners are also acceptable alternatives. There is some evidence that aspartame may aggravate insulin resistance over time. Grains: Many of the grain sources such as rice, wheat, and corn tend to have a high glycemic index, but grains such as buckwheat, millet, barley, rye, and bulgur are actually quite low. For successful weight loss and blood sugar control, this group of foods should be used in moderation. Also, the addition of fats such as olive oil or butter (in moderation) can slow the glycemic index.

11 Fiber: Fiber is an important part of the diet for a number of reasons. It is well known that fiber helps prevent constipation. However, fiber also controls sugar and cholesterol levels and aids in the prevention of colon cancer and diverticulitis. Most individuals with diabetes/insulin resistance do not realize that they run a 75 percent risk of developing arteriosclerosis. Reducing cholesterol levels through the use of fiber is one way to combat this problem. Exercise: Along with dietary responsibility, exercise is the most important step diabetics can take toward tighter blood sugar control. At a minimum, diabetics should get 30 minutes of some form of exercise at least four days a week, but more would be beneficial. Anyone who is over 40, or a brittle diabetic, and has not been exercising, should seek medical advice and supervision before initiation of any exercise program. Closing Comments: As you can see from this paper on Nutritional and Functional Medical Approaches to the Evaluation and Treatment of Diabetes, there is a new direction medicine is taking to uncover the possible cause(s) of a variety of health challenges. There is a wealth of medical research supporting the information presented in this paper. If you or someone you know is suffering from the deliberating effects of diabetes, I encourage you to carefully give serious consideration to this important paper. I would suggest that you discuss this information with your physician. If you are interested in finding a doctor who practices functional and nutritional medicine, please feel free to send me an to drgrisanti@charter.net I will simply need your town and state and I will see who is available to help you. The following labs offer the above mentioned lab tests Great Smokies Diagnostic Labs: (800) MetaMetrix Labs: I would like to invite to take a look at my site Here you will find a wealth of information to help you and your physician uncover the possible cause(s) of a variety of diseases. If you enjoyed reading this paper, I am confident you will thoroughly enjoy my site Contact Information; Ronald J. Grisanti D.C., D.A.B.C.O East North Street Greenville, South Carolina Phone: FAX: drgrisanti@charter.net Website:

12 References: McCarty MF. Can correction of sub-optimal coenzyme Q status improve beta-cell function in type II diabetics? Med Hypotheses. May1999;52(5): McCarty MF. High-dose biotin, an inducer of glucokinase expression, may synergize with chromium picolinate to enable a definitive nutritional therapy for type II diabetes. Med Hypotheses. May1999;52(5): Ghosh D, Bhattacharya B, Mukherjee B, et al. Role of chromium supplementation in Indians with type 2 diabetes mellitus. J Nutr Biochem. Nov2002;13(11): Elamin A, et al. Magnesium and insulin-dependent diabetes mellitus. Diabetes Res Clin Pract. 1990;10(3): Lal J, Vasudev K, Kela AK, Jain SK. Effect of oral magnesium supplementation on the lipid profile and blood glucose of patients with type 2 diabetes mellitus. J Assoc Physicians India. Jan2003;51: Brichard SM, et al. The role of vanadium in the management of diabetes. Trends Pharmacol Sci. 1995;16(8): Boden F, et al. Effects of vanadyl sulfate on carbohydrate and lipid metabolism in patients with non-insulin dependent diabetes mellitus. Metabolism. 1996;45(9): Konrad T, et al. Alpha-lipoic acid treatment decreases serum lactate and pyruvate concentrations and improves glucose effectiveness in lean and obese patients with type II diabetes. Diabetes Care. 1999;22(2): Evans JL, Goldfine ID. Alpha-lipoic acid: a multifunctional antioxidant that improves insulin sensitivity in patients with type 2 diabetes. Diabetes Technol Ther. Sep2000;2(3): Song MK, et al. Animal Prostate Extract Ameliorates Diabetic Symptoms by Stimulating Intestinal Zinc Absorption in Rats. Diabetes Research. 1996;31: Baskaran K, et al. Antidiabetic Effect of a Leaf Extract from Gymnema Sylvestre in Non-insulindependent Diabetes Mellitus Patients. J Ethnopharmacol. Oct1990;30(3): Shanmugasundaram ER, et al. Possible Regeneration of the Islets of Langerhans in Streptozotocin-Diabetic Rats Given Gymnema sylvestre Leaf Extracts. J Ethnopharmacol. Oct1990;30(3): Platel K, et al. Plant Foods in the Management of Diabetes Mellitus: Vegetables as Potential Hypoglycaemic Agents. Nahrung. Apr1997;41(2): Platel K, et al. Effect of Dietary Intake of Freeze Dried Bitter Gourd (Momordica charantia) in Streptozotocin Induced Diabetic Rats. Nahrung. 1995;39(4): Takahashi R, et al. Evening Primrose Oil and Fish Oil in Non-Insulin-Dependent-Diabetes. Prostaglandins Leukot Essent Fatty Acids. 1993;49(2): The following is an Organic Test Lab Test

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