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Diabetes: Can Diabetes be Reversed? and Natural Remedies for Diabetes

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Introduction:

Can diabetes be reversed? This depends on the type of diabetes, and how long it has been present. This educational program uses the science of Diabetes Mellitus to teach individuals how to avoid, prevent, or even possibly cure this condition with Integrative Medicine. Use this program to address Diabetes Mellitus with research for long term control with the goal for elimination of this condition. Diabetes Mellitus describes a group of diseases in which a patient develops high blood sugar (glucose) levels.

In Diabetes Mellitus, the body either does not produce enough insulin, produces no insulin, or insulin resistance is present. Insulin resistance occurs when the body does not respond properly to the insulin the pancreas produces. Patients with high blood glucose will typically experience frequent urination and will become increasingly thirsty and hungry. Obesity is a widespread health problem in the United States which leads to type 2 Diabetes mellitus frequently. All types of diabetes are treatable, but overweight individuals with recent onset of diabetes mellitus type 2 have the best chance of reversal by losing weight and pursuing the many effective natural remedies for diabetes. If diabetes is left untreated it often causes other health problems including eye, foot, and skin complications, heart disease, hypertension, infection, hearing loss, neuropathy, nephropathy, and stroke.

 

Screening for diabetes:

Individuals are considered at higher risk for diabetes mellitus if they have a history of diabetes in parents or siblings, are overweight (BMI ≥25 kg/m2), are sedentary, are one of the follwing ethnicities ( African-Americans, Hispanic-Americans, Native Americans, Asian-Americans, Pacific Islanders), history of high blood pressure over 135/80 mm Hg, HDL cholesterol ≤35 mg/dl (0.90 mmol/l) and/or a triglyceride level ≥250 mg/dl (2.82 mmol/l), history of gestational diabetes, delivery of a baby weighing over 9 lbs, or a history of Polycystic ovary syndrome.

According to the U.S. Preventive Services Task Force (USPSTF), adults without any symptoms but with sustained blood pressure greater than 135/80 mm Hg (treated or untreated) are recommended to have screening for type 2 diabetes. The American Diabetes Association (ADA) recommends to screen for diabetes at 45 years of age. They also recommend screening for diabetes at any age in those who are overweight (body mass index greater than 25) plus history of high blood pressure, family history of diabetes, high cholesterol, sedentary lifesyle, childbirth weight over 9 pounds, diabetes while pregnant, or polycystic ovaries.

 

Diagnosis of Diabetes Mellitus:

Diagnosis of diabetes mellitus according to the American Diabetes Association (ADA) is accomplished by the following:

Fasting blood glucose of 126 mg/dl or more on 2 separate occasions.

Random blood sugar over 200 mg/dl.

Hemoglobin A1C (glycosylated hemoglobin) of 6.5% or more on 2 separate occasions.

Oral Glucose Tolerance Test: Glucose over 200 mg/dl after 2 hours.

 

Diagnosis of pre-diabetes according to the American Diabetes Association (ADA) is accomplished by the following:

Fasting blood glucose of 100 to 125 mg/dl.

Hemoglobin A1C (glycosylated hemoglobin) of 5.7 to 6.4%

Oral Glucose Tolerance Test: Glucose of 140 to 199 mg/dl after 2 hours.

 

Disease management:

Disease management includes education by the physician, dietary change, medication, exercise, and maintaining a healthy weight. Type I diabetes mellitus generally develops before 30 years of age and results from autoimmune damage to insulin producing cells rendering the pancreas unable to secrete insulin. Diabetes type I patients require long acting basal insulin coverage over the course of 24 hours with short acting insulin before meals which mimics the body’s natural response to food. Diabetes mellitus type II is generally known as non-insulin-dependent diabetes, but this is a misnomer as type II may also require insulin. Type II is the most common form of diabetes mellitus and occurs more often in obese individuals regardless of age. It also occurs more often in older adults, those exposed to steroids for other diseases, and in those with poor diet or with sedentary lifestyle.

 

Treatment of diabetes mellitus:

The ideal treatment of diabetes mellitus is seated in education, medications, insulin if required, dietary change, exercise, attainment of ideal weight, and supplements. Diabetes mellitus type 2 may have been present for years prior to formal diagnosis, but is preventable by maintaining normal weight and healthy lifestyle habits. If new in onset, diabetes mellitus type 2 may be reversible using a combination of the many natural remedies for diabetes.

Patients should be educated about how to provide self-care for diabetes with methods for strict blood glucose control and beneficial lifestyle changes such as glucometer use, insulin sliding scale if required, dietary changes, exercise, attainment of ideal weight, and beneficial supplements.

Strict control of blood glucose will reduce rate of eye, foot, and skin complications, heart disease, hypertension, infection, hearing loss, neuropathy, nephropathy, and stroke associated with diabetes.

 

Diabetes Education

 

Dietary changes and weight loss improves glucose control in diabetes:

Eliminate all concentrated sweets and sugars from the diet. Consume small meals frequently rather than large meals. Avoid large amount of carbohydrates in each meal. Use the following diet guidelines in Medline Plus. Also, please see the section on weight loss.

Review of diets effective for weight loss: According to an article by Peter M. Clifton entitled “Dietary treatment for obesity,” today’s dieter has many options for successful weight loss. He states that there are five basic dietary strategies, which include 1) low-fat diets, 2) low calorie diets, 3) very-low calorie diets, 4) carbohydrate-restricted diets, and 5) low-glycemic-index diets. Clifton explained that long-term weight loss is defined as losing at least 10% of initial body weight and keeping it off for at least a year. The author stated that maintenance can be achieved by eating a low-fat diet, making sure one eats breakfast almost every day, obtain body weight regularly, engage in physical activity for around an hour every day, and maintaining a consistent eating pattern. Clifton mentioned that a final effort in the fight to lose weight may include surgical treatment such as gastric banding, or gastric bypass and after the first year of treatment 19-25% of individuals who chose surgery reduced their mortality. Clifton unfortunately found that after considering all weight loss options, only 20% of obese individuals that used weight-loss measures were able to maintain a weight loss of 10% or more after a 3 year period. (29)

Low fat diets were reviewed by Clifton in a meta-analysis of 13 studies that contained 1,728 individuals. Comparing a low-fat diet to a control diet, the average weight loss is 5.4 kg at 12 months. He stated that a low fat diet has been beneficial in reducing diabetes and high blood presser for up to 3 years in the research reviewed.

Clifton explained that low-calorie diets usually limit intake to 1100-1600 kcal per day. One kcal is equal to 1 calorie as typically discussed in layman’s terms. The author described this diet to have slightly better results to that of a low-fat diet, however the difference in outcome is very small. Clifton expressed that a low-calorie diet combined with moderate fat intake has proven superior results when compared to the low-fat diet. The most common form of this diet is achieved through meal replacements whereby one or two meals per day is replaced with a low-calorie drink and can result in an 8.6% reduction in weight within 12 months. According to Clifton, those on carbohydrate-restricted diets typically feel satisfied longer on this diet because of the increased amount of protein. The success of this diet is attributed to the reduction in appetite. He stated that dieters using this method tend to lose more weight than those on low-fat diets when evaluated after 6 months, but after 12 months the difference is no longer obvious.

According to Clifton, carbohydrate-restricted diet influenced weight loss, but if not combined with protein, then there is also a loss of lean body muscle mass. Clifton mentioned that a protein intake of more than 1.05g/kg of body weight increased retention of lean body muscle mass.

Clifton described low-glycemic index diets as inclusion of all complex carbohydrates with no simple sugars, similar to a diabetic diet. According to this author, low-glycemic-index and low-glycemic load diets lead to both weight loss and the lowering of LDL cholesterol.

According to Anderson JW et al, a very low calorie diet refers to an intake less than 1000 kcal per day. The difference in weight loss between this diet and a low-calorie diet of about 1100-1600 kcal per day becomes small in the long term. Also, those subjects who exercised maintained the weight loss longer. (52)

 

Results of dietary adjustment in diabetes:

Dietary adjustment is just one of the many natural remedies for diabetes. Weickert and Martin performed a study which included a summary of the effect of dietary adjustments on insulin resistance and diabetes risk. Weickert and Martin expressed that (24):

 

Control Blood Sugar by Changing the Order of Food in a Meal

A. Shukla et al found that glucose levels following a meal were decreased by about 29%, 37%, and 17% at 30, 60, and 120 min respectively, when the protein and vegetables within a meal were consumed prior to carbohydrates compared to eating these foods in the opposite order. The authors expressed that this eating method may improve insulin sensitivity and that additional research is needed to evaluate the method for longer term glycemic control. (67)

 

Low carbohydrate diet and glycemic control:

Several previous studies have proven that a low-carbohydrate diet improves glycemic control. In one study reviewed, 84 obese patients with type 2 diabetes were randomly placed on 2 separate diets for 24 weeks. The first diet was a low-carbohydrate diet with under 20 grams of carbohydrates per day expressed as ketogenic (resulting in protein breakdown). The other diet was a low glycemic, reduced calorie diet which included 500 kcal under their weight maintenance kcal. About 58.3% of the test group completed the study. Both groups led to improved glycemic control and medication reduction or elimination. However, within the lower carb group, a greater improvement was evident. Both diets led to reduction in hemoglobin A1C (a blood test that measures long term glucose control).The low carb diet resulted in the best improvement of -1.5% and the reduced calorie improved by -0.5%. Bodyweight improved by -11.1 kg and -6.9 kg respectively. HDL improved by 5.6 points in the low carb diet and did not improve in the other diet. Also, diabetes medications were reduced or eliminated in 95.2% and 62% in each of the diets respectively. (25)

 

Low fat vegan diet vs. American Diabetes Association diet for diabetes:

Barnard, ND et al examined the effects of diet on concentration of glucose in the blood, weight, and plasma lipids among individuals with type 2 diabetes mellitus for 74 weeks. Participants were randomly assigned to a low-fat vegan diet (n=42) or a standard diabetes diet based on the 2003 American Diabetes Association guidelines (n=50). Glycated hemoglobin (HbA1c), plasma lipids, and weight were measured. At the end of the study period, weight significantly decreased by 4.4 kg and 3.9 kg in the vegan and conventional groups, respectively. For participants on the vegan diet, total cholesterol and LDL cholesterol decreased by 20.4 mg/dL and 13.5 mg/dL, respectively. Corresponding values for those on the conventional diet was a decrease of 6.8 mg/dL and 3.4 mg/dL. In conclusion changes in overall lifestyle that include a vegan or nearly-vegan diet may be effective in improving the health of people with diabetes. (26)

 

Vegetarian diet and incidence of diabetes:

In a two-year study of non-diabetic participants, 15,200 men and 26,187 women were followed for 2 years. It was inclusive of 17.3% blacks. During that time period the development of diabetes cases were significantly reduced in vegans, lacto-ovo, and semi vegetarians. It was determined that vegetarian diets are associated with reduction in diabetes incidence. Those with black ethnicity also were found to have lower incidence of diabetes. The vegetarian diets appeared to negate the higher risk of diabetes present in blacks due to their ethnicity. (27)

 

Amount of weight loss required to improve blood glucose levels:

According to a study published by Nature Clinical Practice Gastroenterology & Hepatology in 2008, overweight and obese individuals run the risk of having type 2 diabetes, high cholesterol, and high blood pressure. Individuals suffering from these ailments can reverse the effects by losing 8%-10% of initial body weight. As low as a 5% weight loss maintained long term can have beneficial effects on cholesterol and blood glucose levels in the body. (28)

 

Diet for management of diabetic gastroparesis:

Individuals with long-standing type 1 and 2 typical diabetes (mellitus) are at risk for diabetic gastroparesis (DGP), or slow emptying of the stomach, which leads to complications such as induction of gastrointestinal (GI) symptoms (early satiety, abdominal distension, reflux, stomach spasm, postprandial nausea, vomiting), change in drug absorption, and weakening of glycemic control (levels of glucose in the blood). To lessen and/or improve these symptoms and glycemic control small frequent meals, increasing liquid calories, reducing high fat or high fiber intake, consuming bezoar forming foods (such as apples, berries, broccoli, Brussels sprouts, corn, green beans) and tailoring intake of carbohydrates based on medications or insulin is recommended. (Food that is poorly digested can collect in the stomach and form a mass called a bezoar.) However, every patient responds differently to specific foods/supplements and has different needs. Therefore there is no one-size-fits-all dietary plan for DGP. In cases where patients can’t stabilize weight or gain weight from normal oral consumption tube feeding may be an option. (30)

For further information about gastroparesis, please see University of Virginia Nutrition Services, Gastroparesis Diet Tips which may be accessed here (59): gastroparesis handout

 

 

Dietary habits to avoid in patients with diabetes:

Caffeine and glucose levels:

A study of 30 healthy nonsmoking individuals found that caffeine consumption can increase glucose concentrations. Participants went without coffee, tea, chocolate or coke for 4 weeks and were then given 200 mg oral caffeine or placebo (decaffeinated coffee) An 75g oral glucose tolerance test (OGTT) found similar blood insulin levels in both groups, but blood glucose levels were found to increase in the caffeine group at the 2nd, 3rd, and 4th hours compared to placebo. (35)

Drinking caffeinated coffee with meals may decrease insulin sensitivity, according researchers. Ten healthy men 5 mg/kg of caffeinated coffee one hour before eating a meal (75-g oral glucose load) with either a high glycemic index (Crispex) — comprised of foods that raise blood sugar levels quickly, such as processed carbohydrates — or a low glycemic index meal (All Bran). Caffeinated coffee before a high glycemic index meal resulted in significant insulin sensitivity reduction of 40% compared to decaffeinated coffee before the same meal. Caffeinated coffee prior to a low glycemic index meal led a 29% decrease in insulin sensitivity than the same meal eaten after consuming decaffeinated coffee. (36)

 

Areca-nut chewing and type 2 diabetes:

Areca-nut chewing has been associated with oral diseases such as oral cancer, oral submucous fibrosis, and periodontal disease.  The areca-nut provides a mild stimulant, causing a warming sensation in the body and slightly heightened alertness.  However, research between 1991 and 2010 shows that chewing areca-nuts is associated with hyperglycemia and type 2 diabetes, metabolic syndrome, obesity, increased body mass, and higher triglyceride levels. (37)

 

Physical activity and diabetes mellitus patients:

When starting exercise in patients with health conditions, or in chronically ill patients, please see aerobic exercise or resistance training sections. According to the World Health Organization, the most benefit from physical activity is achieved with at least 2.5 hours of aerobic exercise of moderate intensity per week. and by performing resistance exercises for muscle strengthening. Increased intensity, frequency and duration of exercise is associated with increased added health benefits. Regular exercise is recommended for not only all healthy individuals, but also those suffering from obesity, diabetes, hypertension, atherosclerotic cardiovascular disease, and cancer. (53)

Aerobic exercise, diabetes, blood pressure, and cholesterol: Aerobic exercise improves long term blood glucose control, insulin sensitivity, blood pressure, cholesterol, and risk of coronary artery disease in patients with and without Diabetes Mellitus.

Individuals with type 2 diabetics can improve multiple health parameters associated with Diabetes Mellitus through regular exercise. A brisk half-an-hour walk every day can significantly reduce (improve) HbA1c (glycated hemoglobin test indicating how well diabetes is being controlled ), blood pressure, blood lipids and coronary heart disease risk. Exercise regimens should be monitored and tailored to the individual to avoid over-exertion. General practitioner should continually encourage their patient to engage in physical activity, with the aim of improving insulin resistance. (16)

Low intensity aerobic exercise of longer duration resulted in more sustained improvement in insulin sensitivity than higher intensity for a shorter time period. Patients with type 2 diabetes mellitus (T2DM) were examined to determine whether exercise programs differing in duration and intensity had different effects on insulin sensitivity (oral glucose tolerance test, ISI) following a 12-week exercise program. Inactive T2DM patients (age 51.2 ± 1.3 years) were assigned to 5 sessions/week and 240 kcal/session of either a low-intensity (50% VO(2peak), n = 27) or a high-intensity exercise group (75% VO(2peak), n = 28). Insulin sensitivity (ISI) increased in both groups 16-24 h after the final exercise session. The interesting fact is that only the low-intensity group had elevated ISI 15 days after the end of training despite each group burning about the same amount of calories per session. The low intensity group spent about 56 minutes per session and the high intensity group about 34 minutes per session. These findings suggest that in T2DM patients, improvements in insulin sensitivity may rely more on exercise duration than exercise intensity. (17)

According to the American College of Sports Medicine and the American Heart Association (AHA), adults with type 2 diabetes may benefit from aerobic activity at moderate-intensity (50-70% of peak heart rate) or vigorous-intensity (above 70% peak heart rate) aerobic activity at least 3 days per week with no more than 2 consecutive days without exercise. Exercise should add up to a minimum of 150 minutes per week of moderate-intensity and/or a minimum of 90 minutes/week of vigorous-intensity exercise. Muscle-strength training exercises should also be performed 3 days each week using a variety of exercises involving the major muscle groups. The exercise regimen should progress to include 3 sets of 8-10 reps with use of a weight that cannot be lifted more than 9 or 10 times. (13)

Regular exercise can be beneficial for patients with Type I (insulin-dependent) and II (non-insulin-dependent) diabetes. Specific advantages for people with diabetes may include reductions in weight, increased insulin sensitivity, although blood sugar control does not always improve and may actually increase risks of hypoglycemia (low blood sugar), especially among Type I diabetics. All patients on an exercise regimen for the management of diabetes should be monitored. To prevent hypoglycemia or hyperglycemia (high blood sugar), some steps may be taken. Eating a meal 1-3 hours before exercise is recommended. If blood sugar is less than 100 mg/dL, a pre-exercise snack is needed. If blood sugar is greater than 250 mg/dL or serum ketones are positive, postpone exercise. If currently taking subcutaneous insulin, it should be given 1 hour prior to exercise in the abdomen. Injections in the fingers, and other extremities, should be avoided. If insulin peaks or hypoglycemia develops while exercising, decrease insulin prior to next workout. Additionally, before exercising, the intensity, duration and energy needed to complete the workout should be known. During long vigorous exercise, carbohydrate feedings (30-40 grams for adults, 15-25 grams for children) are recommended every 30 minutes. Plenty of water or other fluids should be taken while exercising. Blood sugar levels should be monitored during and after a long exercise session. For 12-24 hours after exercising, calorie intake should be increased based on how hard and long the exercise period was. (14)

For patients with diabetes and heart disease: Intensive cardiac rehabilitation program showed improvement of multiple health parameters. Silberman and colleagues reported the results of an analysis of patients (n=2974) participating in an intensive cardiac rehabilitation program. The authors reported significant improvements in body mass index (BMI), triglycerides, low density lipoprotein cholesterol, total cholesterol, hemoglobin A1c, systolic blood pressure, diastolic blood pressure, depression, hostility, exercise, and functional capacity at 12 weeks and 1 year. (18)

Resistance training may improve the disease state of diabetes mellitus. According to the World Health Organization, resistance exercises are important for muscle strengthening. Exercise is recommended for not only all healthy individuals, but also those suffering from obesity, diabetes, hypertension, atherosclerotic cardiovascular disease, and cancer. (53)

 

Integrative medicine treatments for patients with diabetes mellitus:

Fiber and diabetes mellitus:

Guar gum ( a type of glucomannan):

In individuals with type 2 diabetes (n=16), guar gum (Guarina) significantly improved fasting blood sugar and HbAlc (a measure how well diabetes is being controlled).  Participants were administered either Guarina (G) or placebo for 2 periods of 8-weeks. Compared to placebo, fasting blood sugar levels were significantly reduced to 151.7 mg/dL by G (vs 168.6 mg/dL for placebo). G supplementation also significantly reduced HbAlc (by 6.9%) and fasting insulin levels (by 18.3 U/ml). Total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol, salt, potassium, chloride, magnesium and calcium levels were not affected by either placebo or G. Side-effects were reported in 62.5% of patients receiving Guarina and included abdominal cramps, diarrhea (most common), and skin itching. (1)

Guar may help improve blood sugar (glucose) levels in patients with diabetes. In this study 20 participants (n=12 non-insulin-treated and 8 insulin-treated) received 10 g/d granulated guar for 2 months. After one month, average glycosylated hemoglobin levels (HbA1c%) were significantly reduced by 0.6% and by 1% after 2 months. After guar administration was stopped, HbA1c% rose to its pre-guar level of 11.1%. (2)

Guar gum was shown to improve blood sugar levels, need for insulin, and levels of total cholesterol in patients with type 1 diabetes.  Guar gum or placebo was administered to patients 4 times/day for 4 weeks. After guar administration, following breakfast and lunch, blood sugar levels and insulin needs were significantly reduced compared to placebo. Guar was also associated with a reduction in total cholesterol of 21%. (3)

Fiber-containing nutrition bars containing guar gum viscous fiber were found to decreased hunger and increased fullness in type 2 diabetics in this study (n=99). Participants ate 300-calorie candy bars for lunch and reported a 27.1% increase in fullness, a 15.8% decrease in food intake, and a 14.2% decrease in hunger two to four hours after the fiber-containing nutrition bars. Results indicate that guar gum may be a useful for managing type 2 diabetes by promoting weight loss. (4)

Guar gum, derived from guar beans, is an herbal medicine found to improve long-term control of blood sugar levels (glycemic control), measures of blood glucose after eating (postprandial glucose tolerance), and lipid (fat) concentrations in 15 individuals (aged 45-70 years old, 8 male) with non-insulin-dependent diabetes mellitus. Participants started on placebo for 8-weeks (period 1) followed by 42-weeks of daily guar gum (15 g) treatment and finishing with another 8-week placebo (period 2). Glycosylated HbA1 concentration, measure of blood sugar, significantly decreased from 9.0% during period 1 to 8.5% during guar gum treatment and remained at this level. A decrease of fasting blood sugar, though not significant, was also reported between period 1 and guar gum treatment (9.5 mmol/L and 9.2 mmol/L, respectively). Also, a significant increase to 10.4 mmol/L was reported between guar treatment and period 2. Compared to guar gum treatment, average total cholesterol during period 1 and period 2 were significantly reduce to 5.74 mmol/L and 6.61 mmol/L, respectively. LDL cholesterol fell significantly from 3.90 mmol/L during period 1 to 3.57 mmol/L during guar gum treatment. During period 2 the LDL cholesterol concentration increased to 4.32 mmol/L. Average HDL-cholesterol concentrations showed a steady non-significant increase during the study (period 1, 1.18 mmol/L; guar gum treatment, 1.26 mmol/L; period 2, 1.33). Some minor side-effects reported throughout the study included flatulence, loose stools, and a feeling of stomach discomfort. (5)

A double-blind placebo-controlled, cross-over study of 25 healthy normal weight middle-aged men found that 30 g/d of guar gum derived from guar beans, improved blood pressure, blood glucose, cholesterol, and triglycerides, leading the authors to recommend guar gum for people with insulin resistance, a group of health risk factors that increase the likelihood of heart disease and diabetes. Study participants underwent a regimen of 2-weeks without treatment followed by 6 weeks of placebo or treatment 3 times a day. Compared to placebo, guar treatment was significantly associated with a the following: a 0.3 mmol/L decrease in fasting blood sugar, a 0.6 mmol/L decrease in cholesterol, a 0.2 mmol/L decrease in triglycerides, a 2.9 mU/L decrease in plasminogen activator inhibitor-1 activity (important component of blood clotting), a decrease in systolic and diastolic blood pressure (6 mmHg and 3 mmHg, respectively), and an increase in insulin sensitivity, measured with the euglycemic-clamp technique (the less glucose that’s taken up by tissues during the procedure, the more insulin resistant a patient is), of 1.2 mg . kg lean body mass-1 . min-1. (6)

 

Psyllium, guar gum and insulin levels:

Research into the inclusion of ispaghula husk (also known as psyllium or brand name Metamucil) and guar gum in the diet of 10 healthy women aged 30-48 years old concluded that postprandial glucose and insulin concentrations (sugar and insulin levels after a meal) were reduced. After an overnight fast participants took fiber in the morning. Average insulin levels were lowered from 30 to 90 minutes after administration of both fibers. (7)

 

Psyllium and diabetes:

Psyllium, a soluble fiber used as laxative also known as ispaghula husk or brand Metamucil, was studied in a double-blind placebo-controlled study for its effect on fat and sugar levels in 49 patients with type 2 diabetes.  Participants were given their normal anti-diabetic drugs plus they were randomized to receive either 5.1g psyllium (Plantago ovata Forsk) twice per day (a half hour before breakfast and dinner) or placebo. At the end of the study, participants in the psyllium group showed a significant reduction in fasting blood sugar levels and average level of blood sugar as measured by glycosylated hemoglobin (HbA1c). Both of these results suggest an improvement in blood sugar control. Additionally, HDL cholesterol was reported to increase significantly with psyllium. (8)

 

Glucomannan and diabetes, cholesterol control:

A meta-analysis of 14 studies (n=531) found that glucomannan, a water-soluble dietary fiber that is derived from the konjac root, has a beneficial affect on total cholesterol, LDL cholesterol, triglycerides, body weight, and fasting blood glucose (FBG). Dosage used was a range of 1.2 to 15.1 grams per day. However, HDL cholesterol or blood pressure (BP) were unaffected by glucomannan. The average benefit, taking all study results into account, associated with glucomannan include decreases in total cholesterol by -19.28 mg/dL, in LDL cholesterol by -15.99 mg/dL, in triglycerides by -11.08 mg/dL, in body weight by – 0.79 kg (-1.74 lbs), and in FBG by -7.44 mg/dL. No effect on HDL or blood pressure was seen. (9)

Taking glucomannan, a water-soluble dietary fiber that is derived from the konjac root, in combination with plant sterols (naturally occurring compounds with cholesterol-lowering effects) may help diabetes patients keep their cholesterol in check. For the study, 16 diabetes patients and 18 non-diabetic individuals were assigned to one of four treatments for 21 days: supplements containing plant sterols (1.8 g/day), supplements containing glucomannan (10 g/day), supplements containing a combination of glucomannan and plant sterols, or a placebo. Results indicated that the combination of glucomannan and plant sterols was most effective at lowering LDL cholesterol. LDL cholesterol was 3.16 mmol/L after glucomannan, 2.95 mmol/L after glucomannan plus plant sterols, and 3.60 mmol/L after placebo. Total cholesterol was also lower after glucomannan plus sterols (4.72 mmol/L) compared to placebo (5.47 mmol/L). (10)

Four weeks of treatment with glucomannan (3.6 g/day), a water-soluble dietary fiber that is derived from the konjac root, was found to help guard against elevated glucose (sugar) levels and improve cholesterol levels in diabetes patients. The study involved 22 diabetes patients with high cholesterol who were not taking cholesterol medication. Results showed that glucomannan was superior to placebo in significantly reducing LDL cholesterol by 20.7% and fasting glucose levels (a measure of blood sugar after not eating or drinking for at least eight hours) by 23.3%. (11)

Glucomannan, a water-soluble dietary fiber that is derived from the konjac root, may help control diabetes. In a study, 11 type 2 diabetes patients with hyperlipidemia (high lipid levels especially cholesterol) and hypertension ate either glucomannan-enriched biscuits (0.7 g/412 kJ [100 kcal] of glucomannan) or placebo wheat bran fiber biscuits every day for three weeks. Researchers found that compared to placebo, consumption of the glucomannan-enriched significantly improvement blood sugar control ( by 5.7%), decreased cholesterol, and decreased systolic blood pressure (6.9%). (12)

 

Fiber adverse reactions and interactions.

Dry natural powdered fibers are generally safe when mixed with adequate water or another liquid, but these are not without health risks. At least 8 ounces of fluid is recommended when taking dry fibers such as glucomannan, Konjac root, guar gum, Citrucel, and psyllium (Metamucil). Health Canada issued a warning that glucomannan fiber caused choking, obstruction of the throat, esophagus or bowels according to reports when not consumed with adequate amount of fluid (54). The warning also stated that the fiber should not be taken before bed. Fibers may also bind medications and interfere with absorption resulting in a reduction in the desired effect of the medication. Therefore, it may be best to take medications 2 hours before or after the fiber is taken.

 

Vitamin D and diabetes:

Recent guidelines reflect a gradually increasing acceptance of enhanced vitamin D supplementation, which has a wide margin of safety, and the potential for individual health improvement may be substantial. Please see the section on vitamin D for further details.

A study looked at the relationship between vitamin D level and diabetes mellitus type 2. Vitamin D level is most commonly measured by physicians using a blood test for the concentration of the compound 25-hydroxy vitamin D which is also known as 25(OH)D in the body. The study included 276 Korean patients with diabetes mellitus type 2 with 25(OH)D levels which were considered “deficient” and “insufficient”. The authors defined vitamin D deficiency as a 25(OH)D level of less than 20 ng/ml and vitamin D insufficiency as a level of 20-29 ng/ml. Blood and urine tests were performed after at least 9 hours of fasting, and serum 25(OH)D was measured in a central laboratory in Seoul, Korea. To compare their results, 160 non-diabetic Koreans were selected as control subjects. The results of the study found that T2DM patients were significantly more likely than their non-diabetic counterparts to be taller, have higher body weight, higher body mass index, and bigger waist circumference. Compared with control subjects, patients with T2DM had a lower 25(OH)D level (15.4±0.5 vs. 12.9±0.4 ng/ml, p<0.01). Factors directly affecting levels of 25(OH)D in T2DM patients were found to include HbA1C (hemoglobin A1C), triglyceride, and LDL-C (low-density lipoprotein cholesterol). This retrospective analysis showed that patients with T2DM have a very low 25(OH)D level. High levels of TG, LDL, and HbA1C were found to have a consistent association with vitamin D deficiency in diabetes mellitus type 2 patients. (38)

 

Vitamin D and diabetes mellitus type 1:

The incidence of type 1 diabetes in young children was reduced by vitamin D supplementation (39).

A study in Italy compared the levels of vitamin D in newly diagnosed diabetes mellitus type 1 patients to age-matched controls, and found that low 25(OH)D levels appeared to increase the risk of developing the disease with a median 25(OH)D level of 36.2 nmol/l lower than controls and odds ratio of 3.45 for 25(OH)D of 51-74 nmol/l, and odds ratio of 5.56 for 25(OH)D of less than or equal to 50nmol/l. (57)

Vitamin D is important for bone health but also for reducing the risk of autoimmune diseases, type-2 diabetes, heart disease, many cancers and infectious diseases. A report by the Institute of Medicine (IOM) and the Endocrine Society’s Clinical Practice Guidelines tripled the amount of vitamin D required for most children and adults. The Endocrine Society’s Clinical Guidelines for vitamin D concluded that vitamin D deficiency be defined as a 25(OH)D < 20 ng/ml, insufficiency as a 25(OH)D of 21–29 ng/ml and sufficiency as a 25(OH)D of 30–100 ng/ml. For preventing and treating vitamin D deficiency the Guidelines recommended vitamin D intake should be: children < 1 y 400-1,000 IU/d, children 1-18 y 600-1,000 IU/d and adults 1,500-2,000 IU/d to maintain 25(OH)D concentrations of 40–60 ng/ml.  Upper limits of vitamin D intake were also set as follows: 2000 IU/day for children up to age 1 year; 4000 IU/day for children aged 1 – 18 years, and up to 10,000 IU/day for adults aged 19 years and older. The IOM report concluded that dietary and supplemental vitamin D intake is adequate to satisfy both children and adult, but their study suffered from serious flaws. A study (Moore et al) suggests that neither children nor adults in the US are obtaining the new RDA for vitamin D. Among women vitamin D intake from food was 156–208 IU/d and with supplements 244–324 IU/d. For men, corresponding values were 208–320 IU/d and 308–392 IU/d. There is no evidence that there is a downside to increasing vitamin D intake in children and adults, with the exception of those with chronic granuloma forming disorder or lymphoma in which high vitamin D levels may occur resulting in high calcium levels. (40)

 

Cinnamon and diabetes mellitus:

There are 2 types of cinnamon available (56), Cassia cinnamon (Cinnamomum cassia), and Ceylon cinnamon (51). Cinnamomum aromaticum is the name for Cassia cinnamon from Saigon, Vietnam. Cassia cinnamon is produced in China, Vietnam or Indonesia, is less expensive, has a stronger in flavor, and is more readily available. Ceylon cinnamon (Cinnamomum verum or Cinnamomum zeylanicum-the old scientific name) is produced in Sri Lanka, and has a mild flavor compared to Cassia cinnamon. There are no trials performed as of December of 2013 performed for diabetes in humans specifically stating that Ceylon cinnamon was used, although at least 2 trials did not specify the type of cinnamon used (55). However, animal studies have noted that both species of cinnamon have similar hypoglycemic action in animal studies (56).

Cinnamon may improve glucose control in diabetes mellitus. Allen, Robert W et al performed a meta-analysis and systematic review on clinical trials which included use of cinnamon for diabetes mellitus. The study examined 10 randomized controlled trials with 543 subjects at doses of cinnamon between a range of 120 mg and 6000 mg per day taken for 5-18 weeks. The following statistically significant results were found by the authors with a 95% confidence interval. Reduction of fasting blood glucose levels by 8.67-40.52 mg/dL (average 24,59 mg/dL), lower total cholesterol by 1.44-29.76 mg/dL, lower LDL 1.63-17.21 mg/dL, lower triglycerides by 10.91-48.27 mg/dL, and increase in HDL 1.09-2.24 mg/dL. A large variation of dosing was used and substantial variation of results was seen. 2 of the trials reviewed by the author showed 1-1.2 grams of cinnamon per day resulted in an increase in fasting blood glucose, increase in glycosylated hemoglobin (HbAIC), and a few trials even showed some worsening of lipid parameters. A dose of cinnamon of 1-6 grams per day reported a decrease of fasting blood glucose in 6 trials, and most showed improvements of lipid parameters. In the meta-analysis, there was no significant change in HbA1C. (55)

In a comparison between cinnamon, cardamom, saffron, and ginger supplementation for diabetes control, cinnamon was the only one in this group which improved fasting blood glucose (66).

 

Cinnamon adverse reactions and interactions:

According to the authors of the meta-analysis by Allen, Robert W et al, none of the 10 trials reviewed reported any significant adverse effects. The authors also reported that animal studies showed liver toxicity, lowering of platelet counts, increase risk of bleeding, and allergic reactions. Potential interactions with cinnamon include medications which affect platelets and anticoagulants. Caution in patients with compromised liver function. (55)

Researchers examined the tolerably daily intake (TDI) of coumarin, a naturally occurring substance found in a wide variety of plants (tonka bean, vanilla) with hepatotoxic (causing damage to the liver) and carcinogenic (cancer causing) properties. An analysis of clinical data on hepatoxicity from patients treated with coumarin as a medicinal drug was analyzed and resulted in a derived TDI of 0.1mg/kg. Authors suggest that dietary exposure to coumarin is considerable and may be attributable to the popular spice used for cookies and sweet dishes known as cassia cinnamon. Data in this study suggests that Cassia (Chinese) cinnamon may cause hepatotoxicity therefore it may be better to consume Ceylon cinnamon for supplementation. (50)

Sixty samples of ground cinnamon (12 brands) bought in the Czech Republic were analyzed for their courmarin content. Coumarin is a naturally occurring substance found in a wide variety of plants, but the main source of coumarin in the human diet is cinnamon. As a control and for comparison researchers analyzed a sample imported directly from Sri Lanka. In samples from the Czech Republic, mean level of coumarin was found to range from 2,650 to 7,017 mg per kg, indicating the samples were from cassia cinnamon. The coumarin content of a sample from Sri Lanka was below the limit of detection confirming its origin from Cinnamomum verum or the Ceylon variety. Ceylon cinnamon is native to Sri Lankan which exports 85% of the world’s Ceylon cinnamon (according to Druera, http://www.srilankacinnamon.com/ ). (51)

 

Flavonoids and diabetes mellitus type 2:

Flavonoids are powerful antioxidants. The relationship between dietary intake of flavonoids (which includes flavonols, flavones, flavanones, flavan-3-ols, and anthocyanins) on the risk of type 2 diabetes was examined. Wedick and colleagues found that higher intakes of anthocyanins (flavonoid pigments found in red/purplish fruits and vegetables, including purple cabbage, beets, blueberries, cherries) were significantly associated with a lower risk of type 2 diabetes. Specifically, eating ≥2 servings per week of blueberries was associated with a 23% reduction in the risk of type 2 diabetes compared to eating <1 servings per month. Consumption of apples/pears at ≥5 servings per week, compared to <1 servings per month, was also associate with a 23% reduction in the risk of type 2 diabetes. Results suggest that a higher consumption of anthocyanins and anthocyanin-rich fruit is linked with a lower risk of type 2 diabetes. (34)

 

Alpha-lipoic acid and diabetes:

Alpha-lipoic acid and insulin sensitivity: A small trial of oral alpha lipoic acid (ALA) was found to increase insulin sensitivity in patients with type 2 diabetes. Researchers treated 24 patients over four weeks with either 600 mg twice daily of ALA (n=12) or placebo (n=12). At the end of the study, the insulin sensitivity of the diabetics was significantly improved (M from 3.202 to 5.95 mg/kg/min, insulin sensitivity from 4.706 to 7.673 mg/kg/min per mIU/l x 100). The difference was not statistically significant between the treated patients and the placebo group after the end of the period. (19)

 

Broccoli sprouts and diabetes mellitus type 2:

Broccoli sprouts and hyperlipidemia: Broccoli sprouts appear to have numerous potential health benefits and are an inexpensive way to add nutrition to the diet. Research is currently being conducted in a variety of potential treatments but is in early stages. Please see the broccoli sprouts section for further information.

Type 2 diabetes patients who received placebo, broccoli sprouts powder, 5 grams daily or 10 grams daily,  for 4 weeks showed the following results. Total cholesterol was decreased 6.9%, 13.6%, and 10.1% respectively. LDL was lowered by 3%, 14.9% and 10.5% respectively. HDL was decreased by 13.9%, 13%, and 4.6% respectively. Triglycerides were lowered by 6.9%, 7.2% and 18.7% respectively. Fasting blood sugar was reduced by 1%, 13.1% and 19.3% respectively. (32)

The effects of broccoli sprouts powder containing high concentration of sulphoraphane (a compound that exhibits anti-cancer, and antimicrobial properties) on insulin resistance in type 2 diabetic patients was examined in 81 patients who were randomly assigned to receive 10 grams per day of broccoli sprouts powder (n = 27), 5 grams per day broccoli sprouts powder (n = 29) and placebo (n = 25) for 4 weeks. Glucose and insulin concentration, glucose to insulin ratio and homeostasis model assessment of insulin resistance (HOMA-IR) index were measured. HOMA-IR is a formula used to measure insulin resistance estimated from fasting glucose and insulin levels. After 4 weeks, consumption of 10 grams per day broccoli sprouts powder resulted in a significant decrease in insulin levels and HOMA-IR index. These results indicate that broccoli sprouts may improve insulin resistance in type 2 diabetic patients. (32)

 

Diabetic peripheral neuropathy:

Alpha-lipoic acid and diabetic peripheral neuropathy:

There is evidence to suggest that alpha-lipoic acid (ALA), an antioxidant, reduces neuropathic pain in patients with diabetes. Participants in a study were randomized to IV administration of either ALA (600 mg) (n = 60) or placebo (n = 60) for 5 days/week for a total of 14 treatments. At the end of the study, the total symptom score in patients taking ALA had improved by an average of 4.8 points, compared to an improvement of only 1.8 points in the placebo group. Compared to the placebo group, the treatment group had evidence of significant improvement in pain, numbness while asleep, prickling, neuropathy signs, and overall measure of effectiveness. (20)

In a double-blind, placebo-controlled trial,181 patients with diabetic peripheral neuropathy were given either placebo or one of 3 doses of lipoic acid: 600, 1200 or 1800 mg daily. Over the five week study period, benefits were seen in all three lipoic acid groups as compared to the placebo group. Average total symptom score (TSS) (including stabbing pain, burning pain, paresthesia, and asleep numbness of the feet) improved by 51% in ALA600, 48% in ALA1200, and 52% in ALA1800 compared with just 32% in the placebo group. Rates for those experiencing a 50% or more reduction in TSS was 62% (ALA600), 50% (ALA1200), 56% (ALA1800), and 26% (placebo). Participants experienced increased symptoms of nausea, vomiting, and vertigo as the dose of ALA increased. (21)

A review of studies found that among diabetes patients with peripheral neuropathy, a problem with the nerves that can produce pain, loss of sensation, and an inability to control muscles, alpha lipoic acid was found to significantly reduce neuropathic pain. Alpha lipoic acid, a fatty acid, is also an antioxidant found naturally inside every cell in the body. It’s needed by the body to produce the energy for the body’s normal functions. Researchers found that alpha lipoic acid was associated with an average total symptom scores reduction of 2.26. Specifically, when given orally the reduction was 1.78 and when administered by IV the reduction increased to 2.81. There is also evidence that alpha lipoic acid decreases neuropathic pain when given for a period of 3 weeks at a dose of 600 mg/day (grade of recommendation A). However, it is unclear whether the benefits seen after the oral administration of alpha lipoic acid over 3-5 weeks at a dose of  >600 mg/day are clinically relevant. (22)

A meta-analysis of 15 randomized controlled trials found that IV administration of 300-600 mg/day α-lipoic acid (ALA) for 2-4 weeks for treatment of diabetic peripheral neuropathy (DPN), a problem with the nerves that can produce pain, loss of sensation, and an inability to control muscles, was associated with a significant improvement in nerve conduction velocity and neuropathic symptoms. ALA was associated with an average benefit for median motor nerve conduction velocity (MNCV) of 4.63, median sensory nerve conduction velocity (SNCV) of 3.17, for peroneal MNCV, 4.25, and 3.65 for peroneal SNCV. (23)

 

Capsaicin and peripheral neuropathy:

In a study by Anand et al, a topical skin patch with 8% capsaicin placed for 1 hour was successful at producing pain relief at the site of peripheral neuropathy for up to 12 weeks. The mechanism of action was proposed to be defunctionalized peripheral nerve function. There was determined to be a low risk of both adverse systemic reaction and drug interactions. (46)

A review of studies on the use of capsaicin cream for pain relief was conducted. Six studies (n=389) were identified examining low dose (0.075%) capsaicin cream versus placebo. Low dose topical capsaicin was ineffective for pain without significant effect beyond placebo. Studies showed skin reactions could result in withdrawal and were more common with capsaicin than placebo though this became better with time. Adverse effects were rare systemically. (47)

The high dose, 8% capsaicin patch was studied in a similar fashion on postherpetic neuralgia by Irving et al. The patch was also found to be effective at pain relief for 12 weeks. (48)

 

Diabetic peripheral arterial disease in patients with diabetes:

Carnitine is a supplement available in over the counter in health food stores and pharmacies as propionyl- L-carnitine, acetyl-L-carnitine, and L-carnitine. Propionyl-L-carnitine has been studied for use in peripheral arterial disease at a dose of 500-1000 mg oral 3 times daily with most trials showing a benefit in severe disease with improvement in walking distance of over 40%, but has been less effective for mild peripheral arterial disease. Minimal adverse effects have been reported (60).

Natural supplement may improve peripheral arterial disease in patients with diabetes. Propionyl-L-carnitine: Propionyl-L-carnitine in treatment of peripheral arterial disease in diabetes: Diabetic patients may benefit from use of propionyl-L-carnitine (PLC, important for energy production in cells). A total of 20 type II diabetic patients with peripheral angiopathy (problem with blood vessels causing poor blood flow) were randomized to receive PLC or placebo. Results indicate that the PLC group had a much improved walking distance and symptoms. (42)

Individuals suffering from disorders of the blood vessels that limit blood flow may benefit from propionyl-L-carnitine (PLC, important for energy production in cells) supplementation and Vascupump therapy (pressure pump for increasing blood circulation). Participants (n=42) with arterial disease (blocked blood flow) were randomized to one of 3 treatments: IV PLC (1200 mg) for 5 sessions/week for 4 weeks (group 1) or PLC plus Vascupump 5 days/week for 4 weeks (group 2) or Vascupump only (group 3) then given a treadmill test. At the end of the study patients in the first group had an average walking distance increase of 102%-118%, group 2: 94%-193%, and group 3: 33%-67%. Participants also experienced a decrease in calf pain in addition to increased blood flow (measured using the Winsor index). (43)

Various pneumatic arterial compression devices have shown evidence that patients with PAD which are not candidates for re-vascularization (arterial bypass) or arterial stent procedures may benefit from treatment with these devices (especially those intolerant to exercise). Research with these devices have reported benefits such as walking distance, leg pain, improved arterial circulation on imaging, and reductions in requirements for amputation. (43,61,62,63)

An example of a pneumatic arterial compression device: http://acimedical.com/artassist/ and  http://www.slideshare.net/ACIMedical/preventing-amputation-with-an-arterial-compression-pump

 

 

Andrographis paniculata and diabetes:

Andrographis paniculata and diabetes: A water solution of plant extract Andrographis paniculata (AP) was examined for blood sugar lowering effect in rats with normal and high blood sugar levels. Researchers found AP at a dose of 50 mg/kg significantly reduced blood sugar by 52.9%. No significant benefits were reported from use of any extracts in rats with normal blood sugar levels. (44)

 

Diabetes mellitus type 2, metformin, and vitamin B12:

The findings of a multicenter randomized controlled trial suggest that patients treated long-term with metformin, the most commonly prescribed oral drug for patients with type 2 diabetes, are at risk of developing vitamin B12 (vitB12) deficiency, and is likely to get progressively worse over time. 390 patients with type 2 diabetes received metformin (850 mg) or placebo three times daily for 4.3 years. Compared with placebo, metformin was associated with a significant 19% decrease in baseline vitamin B12 concentration. The absolute risks for vitamin B12 deficiency and low vitamin B12 level were significantly higher in the metformin group than in the placebo group: 7% and 11% higher, with numbers needed to harm of 14 and 9 per 4.3 years, respectively. Blood homocysteine levels were also significantly elevated. (45)

 

Coenzyme Q10 and endothelial function:

Endothelial dysfunction occurs after a substance acts upon the endothelium (inner lining) of blood vessels to cause and imbalance of contraction and dilation. Endothelial dysfunction is associated with atherosclerosis, diabetes, hypertension, and cardiovascular disease. A meta-analysis examining the results of five randomized controlled trials, including 194 subjects, found that supplemental coenzyme Q10 (CoQ10) resulted in a clinically significant, 1.7% increase in flow-dependent endothelial-mediated dilation. These findings suggest CoQ10 supplementation is associated with significant endothelial function improvement and provides evidence for use in patients with endothelial dysfunction. (49)

 

Diabetic retinopathy:

A number of studies have shown that Pycnogenol, French maritime pine bark extract, may be beneficial for individuals suffering from diabetic retinopathy, a complication of diabetes that affects the eyes (caused by damage to the blood vessels in the retina) and can lead to blindness. Pycnogenol improved blood vessel resistance, reduced leakages into the retina, and was shown to be at least as effective as calcium dobesilate, which is commonly taken for diabetic retinopathy. Pycnogenol was well tolerated with gastric discomfort being the most common side-effect. (41)

 

Gooseberry, fenugreek and blood sugar levels:

Human clinical studies with data on emblica officinalis (gooseberry), fenugreek (herb), green tea, momordica charantia (bitter melon) and cinnamon supplementation were reviewed to determine their effects on hypoglycemic (low blood sugar) patients. Researchers found that fenugreek and emblica officinalis showed the most consistency in lowering fasting blood sugar (FBS) or glycated hemoglobin a.k.a. HbA1c, a lab test that shows the long term control of blood sugar levels in diabetic patients. Most trials showed cinnamon and bitter melon had hypoglycemic effects, but this was not conclusive. Additionally, green tea had very limited effects in reducing FBS or HbA1c levels and is therefore not recommended for managing hyperglycemia. (33)

 

Insulin resistance and nonalcoholic fatty liver disease (NAFLD):

Sixty patients (75% male, mean age 40.0) with nonalcoholic fatty liver disease (NAFLD) participated in a study looking at the link between regular aerobic exercise and insulin resistance, aminotransferase level (high levels signal liver damage or disease) and liver histology after 6 months. All patients were advised to exercise regularly for 30 min/d at least 5 days per week and trained to achieve around 70% of maximal heart rate. In 45 exercise compliant patients insulin resistance decreased from 6.4 to 1.3, body mass index (BMI) from 26.7 kg/m(2) to 25.0 kg/m^2, waist circumference (WC) from 95.7 cm to 90.8 cm and alanine aminotransferase (ALT) from 84.8 U/L to 41.3 U/L (P < 0.01). No significant change in insulin resistance, BMI, WC and ALT were report at 6-month follow-up in the 15 noncompliant participants. Six of 8 patients in compliant group on repeat liver biopsy showed significant change in steatosis (abnormal retention of lipids within a cell) and necroinflammation. Nonalcoholic steatohepatitis scores improved form 5.3 to 3.35. This study showed that regular aerobic exercise by promoting weight loss resulted in improvement in insulin resistance, aminotransferase level and liver histology after 6 mo. (15)

 

 

Assessment and Plan: Diabetes Mellitus

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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