Jule Klotter
Diabetes and Environmental Toxins
Back in August 2016, Joseph Pizzorno, ND, editor-in-chief of Integrative Medicine: A Clinician’s Journal, wrote an editorial about the role of environmental chemicals in the 7-to-10-fold increase in type 2 diabetes over the past 50 years. While he agrees that obesity, lack of exercise, and sugar consumption are also factors, Pizzorno says the increase in sugar consumption, which started about forty years before diabetes began to rise, does not correlate with diabetes incidence. Instead, he says that environmental chemicals found in food, air, and drinking water—sometimes called obesogens or diabetogens—are the main cause.
In researching this topic, Pizzorno found that people with the highest body load of persistent organic pollutants (POPs), such as PCBs, DDE, and hexachlorobenzene, have the greatest risk of diabetes—regardless of body mass. Obese people with low POP levels do not have an increased risk of diabetes while thin people with high POP levels do. These pollutants are among those that impair insulin sensitivity and/or decrease insulin production.
In his article, Pizzorno focuses on seven types of diabetogens: arsenic, bisphenol A (BPA), dioxins, organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), phthalates, and polycyclic aromatic hydrocarbons (PAHs). Arsenic and chemicals in plastics appear to be the most problematic. Arsenic damages pancreatic β cells, decreasing insulin production. In many areas of the US, drinking water has arsenic levels that exceed the EPA limit (10 μg/L). High arsenic levels have also been found in seafood, rice, mushrooms, and poultry.
Chemicals in plastics, including BPA and phthalates, are also major contributors to diabetes risk. BPA is used to make plastic water bottles, the inner linings of food cans, implanted medical devices, and other polycarbonate plastic items. BPA causes insulin resistance by blocking insulin receptors, resulting in visceral fat accumulation as well as increased diabetes risk. Phthalates, also used in food packaging, increase plastics’ flexibility, transparency, and durability. These chemicals readily contaminate foods they contact, particularly foods that contain fats—such as milk, cheese, butter, and meat. Grease-resistant packaging used by fast-food restaurants and to make pizza boxes and microwave popcorn packaging is another source of these chemicals.
In March 2020, Environmental Health published a consensus statement from an international group of scientists stating that chemicals in packaging, kitchen utensils, tableware, and food processing equipment need to be better regulated because these chemicals do leach into food and drinks and only a few have been investigated for health effects.
Dr. Pizzorno says that conventional laboratory tests, particularly GGT (aka GGTP) for measuring γ-glutamyl transferase, can indicate whether chemical load is a factor: “This enzyme recycles glutathione for detoxification of POPs and is induced in proportion to exposure.” He refers to a four-year study in which increased GGT correlated with increased risk of diabetes (Lee et al. Diabetologia. 2003;46(3):359-364). Measuring arsenic content in toenail clippings is the best way to assess body load of this metal: “Blood and urine levels typically only indicate acute exposure.”
Avoidance tops the list of Dr. Pizzorno’s strategies for reducing toxic load. Increasing glutathione production (to facilitate phase 2 detoxification and help protect from oxidation) and increasing dietary fiber that binds to the chemicals so that they can be excreted are also essential. Dr. Michelle Perro presents a case history in this month’s “Pediatric Pearls” column that illustrates the use of these strategies for reversing type 2 diabetes in a teenager.
In a 2019 podcast with Ari Whitten, Dr. Pizzorno says that diabetes is not the only disorder tied to environmental chemicals. Fluorinated hydrocarbons in Teflon-coated pans, GORE-TEX clothing, and Scotchgard carpet and furnishings increase uric acid levels, which leads to gout. PCBs bind to cartilage, which can lead to the autoimmune disorder rheumatoid arthritis: “…what was previously normal tissue in the cartilage, when you bind a chemical [or metal] to it, it is now an abnormal tissue and the body develops an immune reaction to that. We call it autoimmune disease.”
Dr. Pizzorno published The Toxin Solution, which outlines the health effects of environmental toxins and how to reduce body load for the lay reader, in 2017. “There are about a hundred toxins now in our environment at high enough levels to induce disease in humans,” he told Whitten, “and that is why I wrote that book.” He also co-authored a textbook with Walter J. Crinnion called Clinical Environmental Medicine.
Gross L. Scientists say lax regulation of chemicals in food packaging endangers human health. March 2, 2020. https://thefern.org.
Pizzorno J. Is the Diabetes Epidemic Primarily Due to Toxins? Integrative Med. August 2016;15(4):8-17.
The Unknown Link Between Toxins and Disease and How to Detox Your Body with Dr. Joe Pizzorno (transcript). The Energy Blueprint podcast. September 14, 2019.
Exercise for Patients with CHD and Diabetes
Exercise/physical activity is a recommended therapy for people with diabetes and coronary heart disease (CHD); but, is moderate or vigorous activity more beneficial? High intensity exercise (anaerobic) has a stronger beneficial effect on HbA1c, the biomarker that indicates average blood sugar level over the previous two to three months. Consequently, some have thought more vigorous exercise would be better for diabetes patients. A 2019 German study challenges that belief.
In their small pilot study, Bernhard Schwaab et al tested the effect of moderate exercise (aerobic) vs intense exercise (anaerobic) on patients with coronary heart disease who had been newly diagnosed with type 2 diabetes mellitus (T2DM), using the standard 75 g oral glucose tolerance test (OGTT). None of the participants were using any type of hyperglycemia or diabetes dietary intervention or medication, but all were on some type of medication for heart disease.
Out of 16 consecutive patients who met the inclusion criteria, only 10 completed the study; one refused to take part, and five could not complete the cardiopulmonary exercise testing (CPX) on a cycle ergometer because of angina (n=2), dyspnea (n=2), or muscle fatigue (n=1). The remaining participants took part in anaerobic exercise (CPX-1) at 7 am after an overnight fast, within 3-5 days after their diagnostic OGTT (OGTT-0); the goal was to reach a respiratory exchange ratio of 1.20, the point at which metabolic acidosis occurs “at the end of maximum incremental cycle ergometer exercise in sedentary men.” After their heart rate, blood pressure and gases returned to resting values, the participants had another OGTT. The next morning at 7 am, aerobic exercise—which sought to maintain a respiratory exchange ratio between 0.90-0.95—was conducted and a third OGTT ensued when heart rate, blood pressure and gases had returned to resting values.
The researchers found no significant differences in plasma glucose (PG) between the three OGTTs at the 1-hour measurement. At the 2-hour point, however, they found significant differences between the two types of exercise. Anaerobic exercise produced mixed plasma glucose levels among the participants with five showing a further increase in plasma glucose, two showing a decrease, and three having the same levels as at the 1-hour point. “Mean values at 2-h-PG did not differ between OGGT-0 (at rest) and OGTT-1 (anaerobic).” All patients showed a decrease in plasma glucose at the 2-hour point after aerobic exercise: “…the mean value was significantly lower as compared to 2-h-PB in the screening OGTT-0 at rest (9.4 ±2.3 vs. 12.6 ± 2.2 mmol/l; p<0.05).” The researchers noted that patients with T2DM and coronary heart disease have highly individualized glycemic responses to exercise.
“A very low (to at most moderate) exercise intensity might be appropriate in this deconditioned cohort with T2DM and CHD, as shown in this study,” conclude the authors. This study has several limitations: its small size, its short length, and the use of fasting measurements only. Non-fasting results may differ. The authors say, “Long-term response to different exercise intensities should be investigated without disregarding personal preferences for a specific type of exercise in order to increase the adherence to sustainable lifestyle changes in patients with T2DM.”
In a commentary on this study, Stephan Jacob and Andrew J. Krentz relay that the European Society of Cardiology and researchers at Belgium’s University of Hasselt have developed a pilot evidence-based interactive decision-support tool (www.escardio.org) for physicians who want to make exercise prescriptions for patients with cardiovascular risk factors or disease. In lieu of that, they suggest that patients exercise in the ‘comfort zone’ (in which he/she can walk and talk) “to avoid potentially detrimental anaerobic metabolic stress.”
Jacob S, Krentz AJ. Exercise prescription in patients with type 2 diabetes and coronary heart disease: could less be more? Cardiovascular Endocrinology & Metabolism. 2020;9(1).
Schwaab B, et al. Effects of aerobic and anaerobic exercise on glucose tolerance in pateints with coronary heart disease and type 2 diabetes mellitus. Cardiovascular Endocrinology & Metabolism. 2020; 9(1).
Heart Rate Variability and Solar and Geomagnetic Energy
A 2019 study, conducted by researchers from Saudi Arabia, Lithuania, and the US (HeartMath and NASA Ames Research Center), found evidence that solar activity and geomagnetic activity affect heart rate variability. Every 10.5 to 11.0 years, the magnetic north and south poles on the sun change places (aka the solar cycle). As activity increases, the sun displays more sunspots and coronal flares and emits more ultraviolet and solar radio flux radiations. It has long been recognized that social unrest as well as human innovation and creativity increase as solar activity increases. But solar activity also affects individual physiology, particularly the nervous and cardiovascular systems.
Based on scientific literature, the authors write, “It appears that sharp or sudden variations in geomagnetic and solar activity as well as geomagnetic storms can act as stressors, which alter regulatory processes such as melatonin/serotonin balance, blood pressure, breathing, reproductive, immune, neurological, and cardiac system processes.”
Their study involved 16 women with no known physical or mental health disorders who were employed full-time at the Prince Sultan Cardiac Center in Hofuf, Saudi Arabia: 8 nurses, 6 housekeeping staff, 4 from the research department. The women’s heart rate variability (HRV) was recorded for 72 consecutive hours each week for five months using Bodyguard HRV recorders (Firstbeat Technologies Ltd, Finland). HRV is the measure of beat-to-beat changes in heart rate and indicates autonomic nervous system function.
The women had individualized responses to the geomagnetic and solar activity changes; but when taken as a group, the authors found a correlation between daily autonomic nervous system responses and the solar energy. Specifically, they found “increases in solar radio flux, cosmic rays and Schumann resonance power are all associated with increased HRV and parasympathetic activity [the rest and digest response].” The authors say, “The findings support the hypothesis that energetic environmental phenomena affect psychophysical processes that can affect people in different ways depending on their sensitivity, health status and capacity for self-regulation.”
We have no control over the solar cycle, of course. How and why environmental energy has a physiological effect is still unclear. Figuring out why some people are strongly affected by environmental energy and others are not may lead to new ways to promote health. Perhaps more and larger studies with different populations, new designs, and conducted in other locations will give more clues. Unfortunately, we still seem to be at the stage of downplaying the physiological effects of the electromagnetic energies (natural and man-made) in our environment. What you can’t see, touch, hear, or taste can’t affect you, right?
Alabdulgader A, et al. Long-Term Study of Heart Rate Variability Responses to Changes in the Solar and Geomagnetic Environment. Scientific Reports. 2018;8:2663.
Zinc and Hypertension Drugs
Many drugs used to control high blood pressure produce zinc deficiency, according to a 2018 study from Poland. The researchers recruited 98 patients (61 females; 37 males) who had not received treatment for primary arterial hypertension. For this randomized, prospective study, each patient was prescribed one antihypertension drug for three months. Thirty-six received a diuretic; 18 received a calcium antagonist; another 18 took a β-blocker; 14 took an angiotensin-converting enzyme inhibitor (ACE-I); and, 12 took an angiotensin II receptor antagonist. Participants were instructed to maintain their normal diets and activity levels throughout the study and to avoid taking any dietary supplements. Before treatment and after three months of therapy, the researchers took samples to measure iron (Fe), zinc (Zn), and copper (Cu) levels in serum, erythrocytes, hair, and urine.
While all the drugs produced a significant reduction in blood pressure levels, some also caused a decrease in zinc levels. Diuretics caused a significant drop in serum and erythrocyte zinc concentrations, and they increased the excretion of zinc in urine. Ca-antagonists produced a significant decrease in erythrocyte zinc concentration, and angiotensin-converting enzyme inhibitors caused a significant decrease in serum zinc concentration.
Zinc is a cofactor for over 300 enzymes in the body. It is essential for DNA replication, energy production, glutathione activity, immune response, blood clotting, and more. Although this is a small study with more women than men, it might be prudent to check for zinc deficiency in patients who are taking a diuretic, Ca-antagonist, or angiotensin-converting enzyme inhibitor—and supplement accordingly.
Chasapis CT, et al. Zinc and Human Health: An Update. Archives of Toxicology. November 2011;86(4):521-34.
Suliburska J, et al. Diuretics, Ca-Antagonists, and Angiotensin-Converting Enzyme Inhibitors Affect Zinc Status in Hypertensive Patients on Monotherapy: A Randomized Trial. Nutrients. 2018;10:1284.
The article originally appeared in Townsend Letter (May 2020).
Published May 28, 2024
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