It’s well known that elevated fasting blood sugar is a precursor to diabetes. Less well known, but increasingly recognized, is that elevated fasting serum glucose and/or insulin levels are also risk factors for cancer, and the risk grows as fasting blood sugar and insulin levels rise. With the escalation of obesity and diabetes worldwide, it is important to recognize these diseases as causative factors for cancer development, especially for older individuals.
The insulin-like growth factor (IGF) system is a complex network essential for normal embryonic and postnatal growth, and plays an important role in the function of healthy immune function and bone growth, among other physiological functions. However, deregulation of the IGF system leads to stimulation of cancer cell growth and survival, as well as cancer invasion and resistance to many targeted drug therapies and chemotherapy agents.
When insulin-like growth factor-I receptor (IGF-IR) is over-expressed, there is an effect on the relationship of the receptor to other biological factors involved in cancer, including estrogen receptors, the HER II neu receptor, and phosphoinositide 3-kinase (PI3-K). Awareness of these relationships could help in our understanding of breast and other cancer biology, and the importance of the IGF-IR in cancer progression and in the effective management of cancer.
Insulin Resistance and Chronic Stress
Insulin resistance (IR) is a condition in which cells fail to respond efficiently to the normal actions of the hormone insulin. Because of this dysfunction, insulin resistant cells are not able to take in glucose, amino acids, and fatty acids normally, resulting in elevated levels of glucose and insulin in the blood. There are a host of metabolic-endocrine factors and dysfunctions that contribute to or relate to IR. Chronic stress of any kind contributes to insulin resistance in cancer because it alters the internal environment of the host.
Unhealthy dietary choices, particularly foods rich in refined sugars and carbohydrates, as well as refined saturated and polyunsaturated fats, are the primary dietary factors that impair glucose and insulin homeostasis. Other lifestyle stressors that lead to IR include a sedentary lifestyle, lack of adequate sleep, exposure to environmental toxins, and emotional stress.
Poor thyroid function can also cause insulin resistance; when we address the health of the entire endocrine system (hypothalamic/pituitary/adrenal/thyroid axis), we support the body in coming back into a healthy balance. To do this, we use nourishing botanical compounds and appropriate nutritional supplements in conjunction with a supportive diet and lifestyle. When the body is provided with the building blocks it needs for health, balance is naturally restored.
In working with insulin resistance, diabetes, or cancer, we always begin with diet, lifestyle, and adaptogens—plants and nutrients that support the endocrine system and help the body recover from stress. We then add specifics as needed to address the needs of the individual. Plant compounds are unique in that they have a pleotrophic effect, which means they have a positive influence on multiple physiological pathways. Although the effects are much weaker than those of pharmaceutical drugs, this gives the body an opportunity to adjust and align itself with the changes in cellular metabolism promoted by plant compounds.
When putting together a botanical protocol, I first consider the primary, secondary, and companion adaptogens that are appropriate for the patient, and I then layer those with targeted endocrine system regulators or insulintrophic acting agents (for more in-depth information on my approach, see my recent book, Adaptogens in Medical Herbalism: Elite Herbs and Natural Compounds for Mastering Stress, Aging and Chronic Disease, Healing Arts Press, 2013).
Some of my favorite primary foundational adaptogens include:
• Panax ginseng: I recommend ginseng to all of my patients, as well as Eleutherococcus senticosus. Eleutheroside B is a very potent insulintrophic compound, it improves oxygen uptake by the cells, glucose uptake, fatty acid uptake, and it is an anabolic nutrient, meaning that it activates protein synthesis.
• Oplopanax horridus: A native northwest botanical (commonly called Devil’s club), opolopanax is an excellent adaptogen with significant insulin trophic actions and cancer suppressing actions.
• Aralia manchurica: Also called spikenard, the plant contains araliasides, which are profoundly insulin trophic, insulin-sensitizing compounds. It lowers blood sugar, has anti-diabetic effects, is immune enhancing and has anti-cancer effects.
Additional botanicals and botanical compounds that are beneficial for insulin resistance and diabetes include:
• Berberine: Extracted from Coptis spp., it is a very potent suppressor of cancer, and is also an insulin sensitizer.
• Forskolin: Extracted from Coleus forskolii, it re-sensitizes cell receptors by activating the enzyme adenylyl cyclase and increasing the intracellular levels of cAMP. cAMP is an important signal carrier necessary for the proper biological response of cells to hormones and other extracellular signals.
• Fucoxanthin: A carotenoid found in the seaweed wakame; improves lipid metabolism, lowers blood glucose and insulin levels and has cancer preventive effects.
• Ursolic acid: A compound found in sage, basil, rosemary, and Holy basil (Tulsi); comparable to metformin as an insulin sensitizer, and has a pleotrophic effect that suppresses cancer and is a very potent down-regulator of aromatase.
• Nigella sativa: Commonly known as black cumin seed; has profound insulintrophic and cancer suppressing activity and anti-obesity effects.
• Camellia sinensis: Green tea contains a compound called epigallocatechin gallate (EGCG) that helps to stabilize blood sugar levels. I recommend an extract containing 95% phenolic compounds, 60% catechins with 40% EGCG.
• Salacia reticulata: An Ayurvedic herb used for diabetes; salacia contains mangiferin, a polyphenol that enhances the body’s sensitivity to insulin. It also contains inhibitors of sugar digestion and absorption. Salacia’s polyphenols inhibit fat metabolizing enzymes and enhance lipolysis (the breakdown of fat stored in fat cells).
• Cinnamomum aromaticum: A familiar kitchen spice, cinnamon has well-known insulintrophic effects and re-dox antioxidant effects. I recommend cinnamon medicinally in formulas and also in medicinal smoothies.
• Trigonella foenum-graecum: More commonly known as fenugreek, this East Indian herb contains saponin compounds with anabolic properties. It also has cancer suppressing and glucose and insulin regulating properties.
I am not opposed to using metformin, and in severe cases of IR (especially if cancer is involved) I recommend it to stabilize a patient. But I usually recommend only one per day, not 2 to 4 a day, which is the amount commonly prescribed. When the patient is stabilized, I wean them off of the medication because of the downsides. Metformin is a potent inducer of lactic acidosis, and can interfere with utilization of B-12 and folate. There are benefits and drawbacks to most pharmaceuticals. Our goal is to maximize the benefits while minimizing potential negative side effects, and this is where the wholistic approach of the Eclectic Triphasic Medical System excels.