During my recent trip to the Indian city of Pune, I was told more than once that twenty years ago it was a slow paced, relaxed place quite distinct from Mumbai, its enormous, frenetic, over-populated neighbor to the north. Unfortunately, that atmosphere appears to have been a casualty of ‘progress’ as the city epitomizes India’s headlong rush into modernity. Once a city of bicycles, the streets are now filled with all varieties of motorized vehicles whose drivers seem to be playing an endless game of chicken with each other and pay little heed to pedestrians whatsoever. The air quality likewise has suffered from the traffic and industrial growth. Many people take on the ‘bandit look’, wrapping their mouths and nose with a scarf or kerchief to filter out the pollution.
Pune has become a major hub of information technology, educational and research institutions as well as diverse industries, many of which are foreign owned. Gleaming office buildings have sprouted up throughout the newer sections of the city, Scandinavian pharmaceutical companies have developed an entire suburb and Mercedes Benz have set up shop to produce drugs and cars for the domestic market.
Entering into the city, one is struck with the number of billboards advertizing luxury apartments and condominiums. The outskirts of the city are expanding as housing developments and high rises are built to meet the needs of the burgeoning population. Along with professionals and skilled labor, the relative affluence has drawn a great number of internal immigrants from throughout the nation. At nearly 3.5 million people, Pune is now the 8th largest urban area in India.
Another unfortunate sign of modernity, not unique to Pune, is the epidemic-like presence of diabetes nationwide. In fact, according to the International Diabetic Federation, the 50.8 million Indians suffering from diabetes represents the highest number in the world. It is estimated that this year 7% of the population suffers from the disease.
Although India may lead the pack, the explosion in diabetes, of course, is a worldwide phenomenon. Within 20 years, it is estimated that nearly one half a billion people will suffer from the disease. Interestingly, in developing nations, dramatic increases in diabetes parallels an increase in the overall standard of living while in developed nations the highest percentage of diabetes cases are found in the economic underclass.
In this country, diabetes is especially rampant amongst inner city African American, Native American living on reservations, as well as poor rural Hispanic Americans communities. This is likely due to a lethal combination of dietary and genetic factors further aggravated by insufficient exercise.
Fundamentally, diabetes is a malfunction of carbohydrate metabolism characterized by high levels of blood sugar. One form of diabetes known as Type 1 or Juvenile Diabetes is caused by the insufficient production of the pancreatic hormone insulin. The second type, Type 2 or Adult Onset diabetes, is characterized by an inability of the body cells to respond properly to insulin. This phenomenon is known as ‘insulin resistance.’ While there is an increase in both types of diabetes, the vast majority of cases – some 90 to 95% of the cases in this country – are Type 2.
In Japan, diabetes was first recognized nearly a millennium ago when the servants of the royal family noticed the unusual odor of their master’s urine. Not coincidentally, it was only this small, idle privileged class that had begun to consume refined carbohydrates in the form of white rice. The disease was unknown amongst the general population that performed manual labor and subsisted on whole grains such as brown rice, barley, and millet.
While there are definitely genetic traits amongst certain ethnic groups and within particular families that predisposes a person toward diabetes, this predisposition is generally triggered by our relatively sedentary lifestyle and diet high in refined carbohydrates. Compared to our hardworking, simple eating forefathers, most of us live like the idle privileged royalty of Japan.
Clearly, effective treatment of diabetes must include changes adequate lifestyle and appropriate dietary changes. But, in addition, there are other modalities that affect the body’s capacity to metabolize carbohydrates. My recent trip to Pune, gave me the opportunity to work with a homeopath who specializes in the treatment of diabetes and to return home with a deeper understanding how to effectively treat the disease.
PART II
The annual cost of treating the nearly 25 million diabetics in this country has exceeded one hundred billion dollars, and the cost is expected to triple over the next two decades as the number of diabetics is expected to soar.
To avert this disaster, there needs to be a sea change in the manner diabetes is treated on both the societal and individual levels. The answer lies in reframing the problem and making the symptomatic pharmaceutical approach to the disease an option of last resort. For the underlying causes of this epidemic and ways to address these causes are not a mystery.
The vast majority of people with diabetes, especially the ‘adult onset’, type II or ‘insulin resistant’ variety, can be helped through a combination of diet, lifestyle modifications and any number of natural therapies.
The goal of conventional medicine is to raise insulin and lower blood sugar levels but not to restore the cellular sensitivity to insulin. It is a symptomatic approach that doesn’t correct the mechanism that has broken down in the body. In fact, there is good reason to believe that this approach has deleterious long-term effects because. Amongst other problems, pumping more insulin into a system that is already insulin resistant will increase the resistance.
Instead, effective treatment must on restoring an appropriate level of cellular sensitivity to insulin as well as another hormone called ‘leptin’. Leptin is found in the fat tissues throughout the body and its role is to complete a feedback loop by traveling to the brain and stimulating a sense of satiety as well as signaling the body to burn excess fat. (See http://www.centerforhomeopathy.com/articles.php?showarticle=1&article=100) Fortunately, the methods by which insulin sensitivity is re-established are much the same as for leptin.
So, what are these methods?
1. Exercise: This is one area where everyone agrees. Physical activity has a beneficial effect on insulin sensitivity in non-diabetics as well as insulin resistant diabetics. Interestingly, research has shown that there is a distinction between the immediate effects of exercise and the effects of physical training programs. Up to two hours after exercise, glucose uptake is elevated and one exercise session of exercise can increase insulin sensitivity for at least the next sixteen hours in the same two groups.
Physical training, which can be simply defined as organized instruction in motor activities of the body, enhances the effect of exercise on insulin sensitivity via a number of metabolic changes. This includes changes in the metabolism of fats and control of glucose output in the liver. So, the conclusion is that while exercise, one to two hours per day, is helpful – no, essential – for regaining insulin sensitivity, a regimen of physical training optimal.
2. Diet: Over the years there have been two basic approaches to diet for diabetics. One is a low fat higher carbohydrate and the other a low carbohydrate higher protein diet. My personal experience working with patients is that former is rarely successful and the latter very helpful.
Here are some basic guidelines to follow - Fast for the 11 or 12 hours between supper and breakfast and allow 3 hours between the end of supper and going to sleep. This gives the body the best opportunity to burning off calories and fat from the evening meal for the first 6 to 8 hours after eating it.
- Try 3 squares meals per day with 5-6 hours between them and no snacking. This can be a challenge for people who tend to have episodes of blood sugar fluctuation, but snacking stimulate increased insulin production. If there are drops in blood sugar in-between meals, then begin with 4 meals daily and increase exercise are a good strategy.
- Overeating is the basic cause of insulin and (and leptin) resistance. So, the goal should be to relax, eat slowly, chew well and enjoying the taste of one’s food and the experience of eating in general.
- High-protein breakfast in the morning. This will prevent energy dips in the afternoon. People who take in too many carbohydrates early in the day also tend to overeat.
- In general, eat fewer carbohydrates and eat low glycemic ones. For most insulin resistant people, eating only vegetable carbohydrates and eliminating starchy carbs from grains, potatoes and very sweet root vegetables like beets and squash is optimal.
PART III
There are many effective ways to treat diabetes – especially adult onset or Type 2 diabetes - that can either eliminate the need for or make it possible to reduce the dosage of conventional medications. Chief amongst the many advantages of these treatments is that they can fully or partially restore normal cellular insulin sensitivity. While conventional treatment manages symptoms by lowering blood sugar, it is not curative because a healthy cellular response to insulin is not re-established. In fact, there is evidence that conventional treatment, while eliminating the symptoms and normalizing blood sugar levels, actually exacerbates the underlying causal condition.
In the previous column, we reviewed two fundamental treatment strategies without which successful outcomes are well nigh impossible.
The first is physical exercise, preferably a regimen of physical training. The second is a low carbohydrate diet, preferably eliminating the consumptions of starchy carbohydrates such as grains and white potatoes.
The third strategy is to control inflammation that is associated with diabetes. Researchers in the US and Europe have shown that insulin resistance is correlated with an inflammation of macrophages, which are a type white blood cell. They hypothesize that eliminating or blocking this inflammatory response would result in increase insulin sensitivity.
An interesting take on the diabetes-inflammation connection is given by Doug Kaufmann in the book ‘Infectious Diabetes: A Cutting-Edge Approach to Stopping One of America’s Fastest Growing Epidemics in Its Tracks (Fungus Link Series)’. Kaufmann has researched and written prolifically about the link between chronic fungal infections and a number of diseases, cancer and diabetes included. He sites evidence that untreated systemic fungal conditions are at the root of these ailments.
It can be difficult to establish whether in diabetes fungal overgrowth is a fundamental cause, one amongst several factors or simply a coexisting expression of overall disrupted health. But my clinical experience is that, in fact, there is a correlation between the two. For instance, I recall treating a case of Type II diabetes early in my practice where the patient reported after a few months that not only were his blood sugar levels returning to normal but a decades long, very stubborn toenail fungal infection miraculously disappeared.
The fungal connection also possibly sheds light on two other therapies that have been used quite successfully with diabetics. One is the use of ionized water (sometimes called ‘Kangen Water’). A product of electrolysis, this water has many beneficial properties, chief amongst them being alkalinity and a high negative oxidation-reduction potential (ORP). Practically speaking, pathogenic organisms – bacteria, viruses and fungi, for instance – do not thrive in the presence of this water.
The other therapy is the oral consumption of chlorine dioxide (ClO2). This substance, long known to be an extremely potent disinfectant quite toxic to disease causing micro-organisms, has only in the last decade or so been used in humans. Most often referred to as ‘MMS’ (Miracle Mineral Solution), there are thousands of documented cases of malaria being cured in a matter of hours after one dose.
The full scope of this therapy – and the story that lies behind it – are a subject for another day, but suffice it to say that based on the initial successes with malaria, MMS has been successfully used to treat people with a wide variety of diseases including diabetes.
Ionized water and chlorine dioxide aside, a primary way to reduce the inflammation associated with diabetes comes back diet. Fortunately, and surely not coincidentally, an anti-inflammatory diet is nearly identical with the low carbohydrate diet discussed previously. To review, this means: - eating vegetables, fruits, highly quality oils (virgin coconut and olive) - reduction or elimination of starchy carbohydrates such as grains (grains – whole or refined ones such as bread and pasta) and potatoes. - elimination of fried foods, simple sugars and oils high in omega 6 essential fatty acids such as corn, safflower, sunflower, peanut oils and a great many vegetable oils.
PART IV
We have already seen that amongst the strategies to deal with diabetes, exercise, diet and controlling inflammation are essential. Another component concerns is stress management.
Cortisol is an adrenal hormone that is released to help the body fight the effects of inflammation, injury, toxins and sometimes aberrant digestive reactions. It is also released when a person experiences chronic stress. Increased cortisol slows the metabolism of glucose and therefore is a factor in increased blood glucose levels. It has been found that when cortisol levels in the blood are excessive, insulin cannot lower the blood sugar. This is another avenue by which insulin resistance develops.
Unlike diet and exercise, controlling the amount of stress one is under is not always possible. Relationships, jobs, family, finances and the vagaries of life are often things that a person cannot dictate. But what can be managed to a lesser or greater degree the response to those outward stresses.
It is the inner, individual experience of stress that determines the physiological response and thus the amount of cortisol being released. And we can influence our inward stress reaction by any number of ways. Whether by spiritual pursuits ranging from prayer to meditation, exercise ranging from yoga or tai chi to working out or running, biofeedback, therapy or bodywork – these are all effective methods. Homeopathy, too, of which I will have much to say later on, is a very powerful way for a person to ‘de-stress’.
Nutritional supplements as well as botanical medicines can also be an integral part of an overall strategy to treat diabetes. There are basically two types of effect one is looking for with herbs and supplements. One is to reduce inflammation and the other is to directly regulate blood sugar levels.
Here are just a few out the multitude of vitamins, minerals and herbs that can be used to treat diabetes:
Perhaps the best-known supplement for treating diabetes is the trace mineral chromium. Often identified as ‘GTF chromium’ (meaning glucose tolerance factor). It acts to promote glucose transport to the cells.
Alpha-lipoic acid is an anti-oxidant, which also has been shown to increase cellular uptake of glucose. It is used in high doses to prevent the common symptom of diabetic neuropathy.
Vitamin D and magnesium are also known to stimulate the production of insulin. In addition, the essential fatty acids, found in fish and flax seed oil, are very powerful anti-inflammatories.
Some of the best-known botanical medicines used in the treatment of diabetes are the following:
Gymnema Sylvestre, nicknamed ‘Gurmar’ or ‘the sugar destroyer’ in India, is an Ayurvedic herb that helps normalize blood sugar levels. Interestingly, it has been noted that after chewing on the leaves of Gymnema sweet food no longer taste sweet. In Europe, Gymnema is used in Gemmotherapy, which is a type of herbal medicine that uses buds, shoots and other reproductive parts of plants. It is thought that these parts have greater medicinal action than other more mature parts of the plant.
Cinnamon has long been used to stimulate healthy digestion and is one of the most common herbs in Chinese medicine. Studies have shown that it has insulin like properties and also reduces insulin resistance. Additionally, for diabetics, it can lower triglyceride and LDL cholesterol (‘the bad stuff’) in type 2 diabetics. Studies suggest that cinnamon makes cells responsive to insulin, which leads to better glucose control.
Fenugreek is also an Ayurvedic herb that also is a common item in Indian cuisine as a spice in cooking, a tea and as a vegetable. Medicinally, the seeds have traditionally been used. They contain an amino acid that stimulates insulin secretion from the pancreas. Fenigreekine is a compound in the sees that slows down the carbohydrate absorption into the blood and thus lowers sugar levels. Studies with type 1 and type 2diabetics have shown that fenugreek lowers glucose levels, total and LDL cholesterol, as well as triglycerides.
PART V
Earlier this year, I again had the opportunity to work with a senior homeopathic physician from the Institute of Clinic Research in Pune, India.
The ICR is an organization whose roots stretch back to the 1930’s to a physician named L.D. Dhawale who had become enamored with both the efficacy and cost efficiency of homeopathic treatment. A generation later, his son, M.L. Dhawale, expanded on the father’s endeavors by forming the ICR to promote clinical research in homeopathy, as well as standardization of homeopathic education and methodology.
Today, in the geographical area centered on Indian state of Maharashtra, there are 6 hospitals, a homeopathic college and post-graduate teaching facilities, numerous rural clinics and mobile vans in both rural and urban slum areas all run under the auspices of the ICR. Most importantly, there is also a dedicated corps of homeopathic physicians who are carrying out the vision of the organization, oftentimes without great remuneration.
Dr. Shirish Phansalkar (pronounced ‘she-reesh fon-sal-kar’), my host and mentor, is unassuming in demeanor as well as seemingly imperturbable no matter what chaos might be swirling around him. His remarkably genteel manner, fair complexion and neatly trimmed Van Dyke style goatee all combine to give the impression of both indeterminate age and ethnicity.
Dr. Phansalkar is one of the few physicians of the ICR still practicing to have apprenticed directly with M.L. Dhawale, a legendarily stern taskmaster who thoroughly prepared his charges to be excellent clinicians. This was at a time when homeopathy was not that prevalent in India and considered to be a risky career choice. It took the personal intervention and guarantee of Dr. Dhawale to persuade Dr. Phansalkar’s doubtful parents to allow their son to become a homeopath.
And become a homeopath he did. Today, Dr. Phansalkar is engaged in homeopathic activities fairly well non-stop, teaching post-graduates in several facilities, engaging in research projects, overseeing the creation of a new homeopathic hospital, all the while running an extraordinarily busy private clinical practice.
I felt extremely fortunate – almost to the point of embarrassment – to have the opportunity to observe his clinic and discuss various aspects of practice with him during my stay. He was unfailingly gracious and generous with his time.
A chief focus of Dr. Phansalkar’s clinical and research endeavors is the treatment of diabetes, especially the adult onset, Type 2 form of the disease. As mentioned earlier, there is an epidemic-like explosion of diabetes in India and it has the dubious distinction of having more diabetics than any nation in the world.
In a certain sense, true specialists do not exist in the world of homeopathy as compared to conventional medicine. There are no homeopathic cardiologists or gastroenterologists, per se. This is because, when practiced according to the true principles established by Hahnemann and the generations who followed him, homeopathic treatment, by its very nature, necessarily takes into account the physical and mental attributes of the whole person.
A succinct way of putting it is that homeopaths do not treat diseases, but people with diseases. A cardiologist with a working knowledge of homeopathy could just as well treat a person with a liver disorder or migraines as a person with heart disease. But, having said this, for any number of reasons such as location, qualifications, personal interest and degree of success, it is not uncommon for practitioners to treat a relatively high percentage of a certain type of person or certain type of condition. For this reason, there have been and continue to be homeopathic clinics around the world that predominantly treat children, or eczema, or infectious disease.
While it would be overstating the case to imply that Dr. Phansalkar predominantly treats diabetics, but approximately 1 in every 3 persons he consulted in my presence was a diabetic. He has also researched the homeopathic treatment of diabetes, conducting a 7-year study of 150 patients seen at ICR facilities.
Based on his extensive experience of the disease as well as the general methodology of the ICR, he has developed an effective homeopathic approach toward treating diabetes.
PART VI
The homeopathic treatment of diabetes is based on an analysis of three distinctive traits present in any individual case: the inherited disposition of the patient, the characteristics of the individual’s constitution and the identifying characteristics of the presenting symptoms.
This is, in fact, not dissimilar to the treatment of any disease. A homeopathic diagnosis, while taking into account the changes in the structure and function of tissues categorized as various diseases, places greater emphasis on what is ‘characteristic’ of a person on a genetic, personal and pathological level. ‘Characteristic’ is a favorite term of homeopaths because the choice of an effective remedy is based on the unique nature of the case on any one or combination of these three levels.
That is, while two people may have the exact same ‘disease’, say diabetes, the inherited ‘soil’ from which the disease grew, the nature of the person that defines the way he/she experiences life as well as the symptoms that define the way that person experiences the disease may differ dramatically. Homeopathic diagnosis and treatment rests on a thorough investigation of these attributes.
About two centuries ago, well before the discovery of genes and DNA, and the modern understanding that genetic characteristics can predispose people toward illness, Samuel Hahnemann, the founder of homeopathy had conducted a great deal of research and written a monumental work entitled “Chronic Disease” about the connection between familial history and the disposition toward disease.
He recognized distinctive patterns of symptoms that he called "miasms" associated with particular familial histories. The word ‘miasm’ is derived from the Greek miasma meaning “taint, stain, pollution”, and its contemporary meaning is “any noxious atmosphere or influence.”
Each miasm correlated to the presence of certain diseases in previous generations, and that manifested in the patient not by the presence of that disease, but by a particular configuration of symptoms.
As an example, the ‘tubercular miasm’ that is the result of a history of tuberculosis in the family does not produce TB in a person with that miasm, but he or she will typically tend toward respiratory weakness in the form of allergies, repeated bronchitis or asthma. In addition, this person will display more peculiar, seemingly unrelated symptoms such irregular or crowded teeth, night sweats, diarrhea, irritability and desire to travel.
The presence of these signs and symptoms will indicate to the homeopath that a successful treatment of the presenting illness must take into account the tubercular disposition and prescribe remedies effective for the miasm. Otherwise a thorough cure would not be possible because the miasmatic roots of the disease have not been pulled out. Even if the symptoms are eliminated, whether by homeopathic remedies or conventional drugs, those roots will sprout again.
Therefore, one aspect of treating diabetes is to identify and treat the miasm present in each case.
The second aspect of analysis and treatment is the to identification of the constitution of the patient and a corresponding prescription. Succinctly put, what homeopaths mean by a constitution is a configuration of characteristic traits, be they mental, emotional or physical, which identify the unique nature of that person.
It is through these constitutional traits that the underlying energy patterns of a person, what homeopaths refer to as the ‘vital force,’ make themselves known. Remedies chosen to match these patterns are termed ‘constitutional’, and their mode of action is to vitalize the entire organism, which in turn facilitates a return to health.
Depending on the case, the miasmatic and the constitutional remedies may be one in the same or separate. If it is the former, this one remedy will suffice as the core of treatment. If it is the latter, most likely both remedies will be prescribed sequentially.
Finally, there are instances when it is necessary to employ homeopathic medicines that are neither constitutional nor miasmatic during the course of treatment. This is the case when a constitutional has not been correctly identified or has not acted effectively. Generally known as ‘organ remedies’, this last group has a special affinity for and action on particular tissues or organs in the body.
Their selection is based on characteristics of the pathology – as opposed to the overall constitution - manifesting in that particular case. These characteristic symptoms are either unusual or idiosyncratic symptoms or else exceptionally intense common symptoms of that pathology.
My own personal clinical experience as well as that working with and reviewing the research of the Indian homeopath Dr. Shirish Phansalkar, to whom I am greatly indebted, underscores the fact that the relative significance of these factors will vary from case to case, but that a comprehensive integrated understanding of all three is essential to positive clinical outcomes.