Antioxidants in Diabetes

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Antioxidants in Diabetes
Posted by Jasenka Piljac Zegarac on Tue, Sep 09, 2014 @ 12:39 PM
Diabetes, caused by the body's inability to produce enough insulin or utilize
the insulin produced by the pancreas, is a chronic disease that affects millions
of people worldwide. Diabetes leads to increased healthcare expenses,
severely diminished quality of life, multiple health complications and a
shortened life expectancy. It is estimated that about 347 million people
worldwide have diabetes. 1 In certain countries, diabetes incidence has reached
alarming proportions. Low- and middle-income countries are affected the
most, accounting for more than 80% of diabetes deaths.2 According to
predictions of the World Health Organization (WHO), diabetes will be the
seventh leading cause of death in 2030.3
It is well-known that avoiding tobacco use, maintaining proper nutrition and a healthy body weight, and
exercising regularly can delay or prevent type 2, adult-onset diabetes. Recently, the scientific community
has taken a closer look at the role of oxidative stress and dietary antioxidants in diabetes. What is the
connection here? Abnormally large levels of free radicals are formed in diabetes by glucose oxidation,
nonenzymatic glycation of proteins, as well as oxidative degradation of glycated proteins. 4 Generated free
radicals cause damage to cellular structures and macromolecules such as proteins and nucleic acids,
increase lipid peroxidation, and lead to the development of insulin resistance. In addition, diabetic
hyperglycemia induces oxidative stress via several mechanisms which ultimately lead to decreased
bioavailability of the vasodilator nitric oxide and endothelial dysfunction.5 Insulin resistance and endothelial
dysfunction co-exist in diabetes, and facilitate the development of a series of complications including both
microvascular and major cardiovascular ones such as hypertension, atherosclerosis and coronary artery
disease.
Since the connection between oxidative stress and major complications of diabetes has been established,
research efforts have been aimed at reducing reactive oxygen species, decreasing endothelial dysfunction
and preventing diabetic vascular complications by administration of antioxidants. Studies were conducted
in both animals and humans while those performed in humans mostly focused on supplementation with
antioxidant vitamins B, C and E. The findings of several short-term, acute phase studies suggested that
treatment with vitamin C infusion improved endothelial function in both type I and type II diabetes
patients, 6,7 however, long-term studies yielded inconsistent results. A large clinical trial conducted in the
US involving daily supplementation with 400 IU of vitamin E followed up 9,500 subjects of whom 3654 had
diabetes and showed no effect on cardiovascular outcomes in all subgroups, including those with diabetes,
over a follow-up period of 4.5 years. 8 Because of inconsistent findings between studies, and potentially
serious side effects involved with the intake of high doses of certain vitamins, scientists have not
recommended supplementation for battling oxidative stress in diabetes.5
So, back to the plate we go. In their natural sources, fruits and vegetables, antioxidants never exist as
isolated compounds and their effects are always a product of synergistic interactions with other
antioxidants, as well as the action of various enzymes involved in metabolism. While it is possible, and
often necessary, to reduce the deficiency of certain nutrients via supplementation it is virtually impossible to
exactly reproduce the complex reactions involved in natural food metabolism and nutrient uptake. Studies
over the past decades have repeatedly associated Mediterranean-type diet, relying on fish as the primary
protein source and rich in fruits, vegetables, and olive oil, with a decreased incidence of cardiovascular
diseases. Mediterranean-style diets are naturally rich in antioxidants and have anti-inflammatory properties

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Antioxidants in Diabetes

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http://www.brunswicklabs.com/blog/bid/354571/Antioxidants-in-Diabetes

due to large quantities of plant foods consumed. A clinical trial conducted in 2004 on 180 patients with
metabolic syndrome resulted in improved endothelial function and insulin sensitivity after the two-year
intervention in patients following the Mediterranean-style diet. 9
With the available biological assays it is now possible to determine the level of oxidative stress and assess
the damage done to macromolecules with an array of assays conducted on blood plasma. With the
Cellular Insulin Receptor Assay (CIR) it is also possible to determine the impact of a test material on insulin
receptor activity in human cell lines. Finally, antioxidant activity, as well as the concentration of individual
antioxidant constituents in food samples, may be determined as a step toward optimizing the dietary habits
of diabetes patients. On the quest for effective disease prevention measures and those aimed at alleviating
existing chronic conditions, making informed choices about the food we put on our plates has become a
necessity.

1. Danaei G, Finucane MM, Lu Y, et al. National, regional, and global trends in fasting plasma glucose
and diabetes prevalence since 1980: systematic analysis of health examination surveys and
epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011;
378(9785):3140.
2. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to
2030. PLoS Med. 2006; 3(11):e442.
3. Global status report on noncommunicable diseases 2010. Geneva, World Health Organization, 2011.
4. Maritim AC, Sanders RA, Watkins JB. Diabetes, oxidative stress, and antioxidants: A review. J
Biochem Mol Toxicol. 2003; 17(1):24-38.
5. Doupis J, Veves A. Antioxidants, diabetes and endothelial dysfunction. US Endocrinology. 2007;
(2):61-5.
6. Timimi FK, Ting HH, Haley EA, et al. Vitamin C improves endothelium-dependent vasodilation in
patients with insulin dependent diabetes mellitus. J Am Coll Cardiol. 1998; 31:5527.
7. Ting HH, Timimi FK, Boles KS, et al. Vitamin C improves endothelium-dependent vasodilation in
patients with noninsulin dependent diabetes mellitus. J Clin Invest. 1996; 97:228.
8. Yusuf S, Dagenais G, Pogue J, et al. Vitamin E supplementation and cardiovascular events in
high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. The N Engl J Med.
2000; 342(3):15460.
9. Esposito K, Marfella R, Ciotola M, et al. Effect of a Mediterranean-style diet on endothelial
dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial.
JAMA. 2004; 292(12):144046.

Jasenka Piljac Zegarac is a scientist and freelance writer. She may be contacted with inquiries and
collaboration requests.
Tags: antioxidant, testing, nutrition, WHO, biological assay, oxidative stress, functional foods,
diabetes, anti-diabetes
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