Antioxidants May Reduce Harmful Complications Of Diabetes

SAN FRANCISCO, CA -- April 20, 1998 -- Duke University Medical Center researchers have found that the depletion of body chemicals called antioxidants may increase the risk of complications from the most common form of diabetes.

The scientists recommend that diabetics take antioxidant supplements, such as vitamin C or E, to help stave off or even forestall the hallmark complications of diabetes, including blindness, kidney failure, amputation and even death.

Antioxidants neutralise oxygen free radicals, highly-reactive chemicals that are the potentially-destructive by-products of the body's process of turning food into energy. Normally, the body produces enough antioxidants of its own to keep the reactive oxygen from causing damage.

"We were able to show that patients with poor control of their diabetes who were beginning to show signs of complications had depleted their store of antioxidants," said Duke researcher Dr. Emmanuel Opara. "Further, we found a significant correlation between high blood-sugar levels and depletion of antioxidants. It appears that this depletion is a major risk factor for developing complications and that antioxidant supplements could lower this risk."

Opara presented his studies yesterday at Experimental Biology `98, the annual scientific meeting of the Federation of American Societies for Experimental Biology (FASEB).

The researchers studied 50 similar people with Type II diabetes -- also known as non-insulin-dependent or adult-onset diabetes. In this form of the disease, insulin produced in the body is unable to trigger the lowering of high blood sugar. Type II diabetes afflicts about 90 percent of the estimated 10.7 million Americans diagnosed with the disease and the 5.4 million believed to have undiagnosed cases, according to the Centers for Disease Control and Prevention.

Insulin is the hormone that normally regulates the level of sugar (glucose) in the blood and is produced by cells in the pancreas. Insulin is secreted when the level of blood glucose rises -- as after a meal.

All diabetic patients in the study were taking only drugs referred to as sulfonylureas, which increase the sensitivity of receptors to insulin throughout the body. Half the patients exhibited microalbuminuria, the excretion of tiny amounts of protein in the urine that is considered a precursor of kidney disease, while the other half did not. The researchers took blood samples from all 50 patients, as well as a control group of 20 similar people without diabetes and determined levels of antioxidants in their blood.

"We found that the non-diabetics' ability to defend against damage from the oxygen free radicals was almost twice that of those patients exhibiting microalbuminuria," Opara explained. "And while the difference between the two diabetic groups was not as pronounced, the difference was still statistically significant. Also, antioxidant depletion correlated with high blood sugar after meals only in the group with microalbuminuria."

The researchers determined antioxidant levels by a new chemical assay developed at King's College in England that enabled them to measure all known antioxidants in the blood and to obtain a more global picture of the body's total antioxidant capacity, Opara said. Other assays are only specific for individual antioxidants.

Using the newly-developed assay, the scientists rated the ability of the non-diabetics to defend against free radical damage at 2.7, compared with 1.4 for those with microalbuminuria and 1.7 for the diabetics without microalbuminuria.

Though the exact mechanism of action of the oxygen free radicals is not yet clear, these findings confirm in humans earlier animal studies of the chemicals' role in damage in diabetes, Opara said. Previous Duke studies by Opara have shown that vitamin E can delay the development of diabetes in obese rats with Type II diabetes and that the depletion of the antioxidant glutathione caused diabetes in another rat model.

"The results we've been seeing in our animal studies are now being borne out in humans,” Opara said. "I recommend that since the body has many antioxidants, diabetics should take a number of these agents, including vitamins C and E and N-acetylcysteine."

The diabetic patients involved in the current study come from Egypt, and their samples were brought to Duke by E. Abdel-Rahman, one of Opara's collaborators.

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In a landmark decision on Friday, Jan. 15, 1999, the US Court of Appeals for the District of Columbia ruled that the health claim rules imposed by the FDA unconstitutional and in violation of the Administrative Procedure Act. The court instructed the FDA to define "significant scientific agreement" for health claims on dietary supplement labels, and instructed the FDA to allow the use of disclaimers on labels rather than to suppress these claims outright. The court further held that four FDA Final rules (prohibiting certain nutrient disease relationship claims) invalid under the first Amendment to the Constitution.