Vicious circles: Diabetes, and vitamin and mineral deficiencies

This started out as an endnote to another post I’m working on, and kept growing. It’s important enough stuff to move over to a post of its own, anyway.

Diabetes can lead to lots of nutritional deficiencies, through obvious mechanisms such as peeing out lots of vitamins and minerals. Very few doctors seem to even think about how frequently this happens. I had to figure out and correct these deficiencies on my own.

Polyuria will pretty obviously mess up your electrolyte balance–a lot like a stomach virus, or sweating really heavily–and you also pee out an awful lot of water-soluble vitamins. The more you drink to make up for losing fluid, the more vitamins and minerals you end up losing in urine. Apparently, “thiamine concentration in blood plasma was decreased 76% in type 1 diabetic patients and 75% in type 2 diabetic patients”, regardless of blood glucose management. Diabetic kidneys are a little too good at filtering it out. I would be amazed if other B vitamins were not similarly affected. Being low on B vitamins will also make you depressed and tired all the time.

I got symptoms of more than one B vitamin deficiency (there’s a lot of overlap in symptoms, and they work togther a lot), including signs of full-blown “dry” beriberi: “However, because doctors may not consider beriberi in non-alcoholics, this diagnosis is often missed.” As another overview points out: “Probably the best diagnostic test is a good clinical response to administration of thiamine.” I feel confident saying that this was the problem, because my system did respond quickly to thiamine supplementation.

Like with potassium and especially magnesium, getting low on B vitamins can make your blood glucose control much worse, setting up a vicious cycle. Lack of all these nutrients will also cause muscle spasms/pain/weakness, besides hypertension and any number of cardiovascular and neurological problems generally written off as diabetic complications. Making sure you have enough thiamine can fend off all kinds of cellular damage from high blood glucose. Low magnesium and potassium levels are risk | factors for developing Type 2 diabetes and high blood pressure in the first place, and are also implicated in any number of “diabetic complications”. Besides hideous muscle cramps, I started getting disturbing heart arrhythmias which went away within an hour when I took in enough combined potassium and magnesium.

Here’s one interesting article I ran across, illustrating some connections: Hypertension, Hypokalemia, and Thiazide-Induced Diabetes: A 3-Way Connection:

Hypertension treated with thiazides [diuretics], especially in higher doses, can cause hypokalemia. Hypokalemia, in turn, can aggravate hypertension and also lead to diabetes mellitus via mechanisms discussed in the text. Diabetes, in turn, can cause hypertension, and people with hypertension are more likely to get diabetes mellitus. Correcting potassium stores may, therefore, be beneficial for both diabetes mellitus and hypertension.

From another article, “38% of diabetic outpatient clinic visits involve hypomagnesemia”. “Also hypomagnesemia is related to thiamine deficiency because magnesium is needed for transforming thiamine into thiamine pyrophosphate.” It’s all connected. You can substitute magnesium in that above study, just as easily (there has been similar research). Also, if you are low on magnesium, you can’t use your potassium properly; this happens with other nutrients, too, like a chain missing links. Being low on potassium will also make you insatiably thirsty, which will make you pee out more nutrients; it’s also easy to blame on the diabetes itself, and took me a while to figure out.

This is one of the reasons the renewed all-or-nothing sodium hating here in the UK appalls me; it’s all about balance between electrolytes, and the ones trying to scare people away from sodium bloody well ought to know this by now. My mom almost killed herself ca. 1980, when they were still pushing this approach back in the US: she was told “cut out the salt, or DIE!” and wound up in the hospital over it. She took the ill-considered advice seriously and stayed away from things like tomatoes (high in both sodium and potassium!), and baked her own salt-free bread; high doses of diuretics probably helped, as well. ´Most of the seriously impairing “side effects” she experienced later, for many years, can easily be attributed to serious dehydration and electrolyte imbalances–no doubt lack of some vitamins, as well–from the combo of diuretics and increasingly-difficult-to-manage diabetes.

That includes the same near-constant feverish feeling and flu-like symptoms I also experienced for nigh on 15 years. I assumed I just had a lousy immune system (like my mom’s) and kept catching colds and flu, until I replaced some minerals. So far this winter, I have had one cold.

Even without diabetes to make people excrete more magnesium and reduce their stores, a lot of people are low on it. Intensive farming practices without proper replacement have led to serious soil depletion of a lot of minerals, so we get much less in foods than was the case even 50 years ago. Note how over this same time period, a number of chronic illnesses, including diabetes, cardiovascular problems, and osteoporosis have gone “epidemic”. In the US, “According to recent USDA surveys, the average intake of magnesium by women 19 to 50 years of age was about 74 percent of the RDA. Men of the same age got about 94 percent of the recommended amount. About 50 percent of women had intakes below 70 percent of their RDA.”

Looking at the UK, “Dietary intakes of magnesium in the United States have been declining over the last 100 years from about 500mg/day to 175–225mg/day (10) and a recent national survey suggested that the average magnesium intake for women is as low as 228mgs per day (11). But since this figure is derived using a one-day diet recall method, it may actually be an overestimate of actual magnesium intakes (12). Meanwhile, the UK’s Food Standards Agency estimates that the average daily intake of magnesium in Britain for both men and women is just 227mgs – only two thirds of the US recommended daily amount (RDA).” The picture looks similar elsewhere, from quick glances while looking for those figures.

Diabetes is associated with a disturbingly long list of complications. That’s what will reduce your lifespan. Having seen how this played out with relatives and other people she knew suffering a lot, and then dying early, was what made my mom’s diabetes diagnosis more frightening than the later cancer one; she was suicidal for weeks after hers got diagnosed. (If you think you’re inevitably going to get serious neuropathic pain, lose your feet, and die of a heart attack if you’re lucky, why not?!) Most people–including medical professionals, who should know better by now–just think of these complications as the unavoidable wages of diabetes. (This is also related to the atmosphere of blame around Type 2 diabetes, but that is a different story.) From the research I have done, it looks as though pretty much all of this suffering is preventable, and I can’t help but get frustrated and sad about how little attention this gets in the trenches.

Throw in malabsorption from Glucophage/metformin, and you can quickly have a real mess. It can also interfere with thiamine, and given that a lot of the malabsorption is caused by chronic | explosive diarrhea, fat-soluble vitamins are also affected. Metformin carries warnings about B12 and folic acid deficiency–and the rest ought to be obvious!–but not many doctors even seem to be considering this when people come in with blatant deficiency symptoms. I know this firsthand. Not only was I sick the whole time I took the stuff, to the point that I almost stopped leaving the house, my glucose control got really horrible–and the GP kept telling me the “side effects” would subside with time.

Right now, I’m making sure to eat enough salt (got headaches, nausea, and strange dreams before thinking of this!), drinking a lot of tomato juice with a pinch of Epsom salts and KCl salt substitute added, and taking a lot of supplements. Benfotiamine (“a fat-soluble composition and is better absorbed and utilized”) seems to be the way to go if you think you’re low on thiamine–which you probably are if you’re diabetic. I also take a mutivitamin and high-potency B complex, just in case.

Not surprisingly, I’m feeling a lot better in general these days. It’s only been about a month since I recognized the need to get more potassium and (even more) magnesium, and that greatly improved the hideous leg/hip muscle spasms I’d been getting again (much like what Kaninchen ZERO describes as “turning to stone”). The difference was clear: drink some doctored tomato juice, be able to go lie down and go to sleep within an hour! I remembered to order in more benfotiamine last week–having stopped taking it because things had improved so much before–and by the next day after taking it again, a lot of the residual leg/hip cramping was gone. My mood started improving, too, and I’m experiencing much less fatigue and brain fog.

Also see The Role of Magnesium in Fibromyalgia, and Association between magnesium intake and depression and anxiety in community-dwelling adults: the Hordaland Health Study. I also wonder about how much muscle wasting–especially involving limbs–among diabetics is really coming from nutrient deficiencies known to cause this. I am hoping to be able to get back some of the muscle mass I’ve lost, now that I’m not seriously malnourished.

At this point, I am wondering whether I ever had “mild” generalized tardive dystonia, or whether the problems with muscle tone and spasm–which started when I was on medications known for doing that–have mostly been coming from drug-induced diabetes. Time and continued improvement of my nutritional status will tell.

ETA 13 July 2011: I forgot to update this earlier, but noticed that it had gotten a number of hits today. The pain and spasms did improve for a while with the supplements I talked about in this post, but never got totally better and came back worse than before. I kept wondering what I was doing wrong, and got very discouraged. Besides the factors mentioned here–which still play in–it turns out that I have had a confirmed underlying vitamin D deficiency and osteomalacia from it, causing low blood levels of calcium and magnesium. The effects of hypocalcemia and hypomagnesemia look very similar, which is probably how I missed the low calcium symptoms before.

For an overview of how calcium, magnesium, and vitamin D interact in the body, see Magnesium: A Key to Calcium Absorption, Taking Calcium with Magnesium Is CRUCIAL to Absorb that Calcium and Take Magnesium AND Vitamin D To Avoid Vitamin D Side Effects, also Magnesium is more than a co-factor for vitamin D. They all work together (along with trace minerals and some vitamins), and if you are not getting enough magnesium you won’t be able to absorb and use the vitamin D or calcium properly–and so forth. The minerals are electrolytes, and being low on them or otherwise having them out of balance will send your whole neuromuscular system haywire from improper electrical conduction.

All this can cause severe muscle spasms, cramps, twitches, passing-out level menstrual cramps and flooding from that, migraines and cluster headaches, even seizures, and pain which is often dismissed and misdiagnosed–since vitamin D deficiency is frequently considered a much rarer problem than it really is, so they don’t even check for that. That is also very dangerous, because your heart is a muscle too, besides all the research showing that these deficiencies contribute to/cause a lot of chronic illnesses and cancers. (I will try to add a link here when I finish a post on vitamin D deficiency and chronic pain, but I did talk about that some in the earlier post linked above.) This reached a crisis point, to the point of a pelvic fracture from getting kicked by the dog (!), after years of living in the UK and not getting nearly as much sun exposure as my burn-resistant “Mediterranean” skin type needs. I thought I was getting enough vitamin D from a 100% RDA cod liver oil capsule, and also had a seriously false sense of security because my skin is as light as most native British people’s when I have been out of the sun for a long time. (In reality, UV treatment for both skin problems and vitamin D synthesis is calculated to the point of a very mild burn, so if you tan easily and do not burn easily, you will need a lot more exposure than someone who does burn more quickly.) Also, it seems that the majority of the White British population is low on vitamin D year round–and no wonder!

But now that I know the symptoms and more about how vitamin D works, I suspect this has been going on, to one degree or another, for about 15 years, since I got put on medications that made me photosensitive and prone to overheating in the sun. So, if you’re on any that will do that, please watch out! There are also not that many food sources, and requirements are turning out to be higher than most doctors still think, as I went into some in the vitamin D post linked above.

My blood sugar control also seems to have improved a lot. I was very frustrated and more than a little scared before, since nothing I did (besides taking Januvia/sitagliptin when I was back in the US) made much difference to my blood sugar levels. None of the things that are supposed to help, did, including a very low carb diet. Vitamin D deficiency is also linked to insulin resistance (through causing magnesium deficiency, at least partly, no doubt) and poor glucose control in diabetics. For more info, please have a look at  Vitamin D and Diabetes: Let the Sunshine In. Their summary:

Vitamin D is an important nutrient for all persons, particularly for those with diabetes. Epidemiologic evidence suggests that an adequate intake of vitamin D may prevent or delay the onset of diabetes. There is also evidence to indicate that it may help to reduce some of the complications associated with diabetes (cardiovascular disease, renal insufficiency, and peripheral neuropathies). Small clinical studies have demonstrated that vitamin D may help with metabolic control, particularly as it relates to beta cell function. The information regarding vitamin D receptor activity as well as the genetic variations that may predispose individuals to problems with vitamin D synthesis and utilization will be important areas of clinical research.

It appears that diet alone will not provide sufficient amounts of vitamin D, and that treatment with supplements is probably necessary for most individuals with diabetes. However, given the possible benefit, it may be an easy and cost-effective therapy which could improve their long-term health outcomes as well as their quality of life.

(Earlier) Edit: A very relevant link I ran across a while after posting this: Diabetes on rise in young aboriginal women:

“Diabetes is a disease of young First Nations adults with a marked predilection for women; in contrast, diabetes is a disease of aging non-First Nations adults that is more common in men,” Dr. Roland Dyck of Royal University Hospital in Saskatoon and his coauthors wrote…

A tuberculosis survey of 1,500 First Nations people in 1937, for example, did not detect diabetes. By 1990, almost 10 per cent of the province’s native people had diabetes, and by 2006, 20 per cent did…

“What is clear is that the rapid appearance of Type 2 diabetes particularly among First Nations people and other indigenous and developing populations has been precipitated by environmental rather than genetic factors,” the researchers said.

Eating a more traditional diet seems to help. The Tohono O’odham on the U.S. side of the border are well known as the group with the world’s highest rate of Type 2 diabetes–estimated at 80%–while their relatives on the other side have a fifth the rate. A lot in the U.S. are also fatter than they used to be. The apparent difference? Living more traditional lifestyles, with access to more traditional foods. I can’t find the reference right now, but I saw one study admitting that “you’re fat and diabetic because you’re lazy and don’t go to the gym” was a very bad (and lazy) assumption; someone working at the health clinic bothered to find out what people were actually doing, and most were pretty physically active in their everyday lives–doing heavy gardening work, walking some distance to go fishing, etc. If there had been a gym readily available there at that point, they’d have been too busy working their asses off to go there! (In other words, about what I would expect.) The kneejerk blaming is persistent, though, as ideology-based approaches to the world usually are.

As far as I can tell, the current “more saturated fat leading to obesity and heart problems” dogma (not necessarily based in reality, when people were eating a lot of fatty foods before!) is far less applicable here than the fact that traditional foods are much richer in all kinds of nutrients. There’s also the slow-release carbohydrate factor from whole grains and tubers to take into account. Tying back in well, beans, nuts, sunflower seeds, pumpkin seeds, fruits, and assorted green leafy stuff will give you an awful lot of magnesium and potassium–among other good things!–and I have been eating more of all of them. They’re also delicious. 🙂

There’s an amazing variety of nuts back home –even after the chestnuts got blight, and many kinds of nut trees plundered for timber–and they used to be a staple. Now they are very expensive if you can’t gather them yourself, so people eat other things which are not nearly as nutritious. Nuts are just one example.

And, in another example of truly wrong-headed advice, the NHS diabetic nutrition sheet I was given (which did not even distinguish between Type 1 and Type 2) warned people to eat things like nuts and salmon maybe once a week if they must eat them at all, because of the (rich in omega-3) fat content. Thank goodness I knew better, in general; it made me feel sorry for the majority who wouldn’t.