Southwest Acupuncture College Chinese Medical Theory I:II
November 25, 2020
“Alzheimer’s disease (AD) is an age-related metabolic neurodegenerative disease (Jack et al., 2010). Diabetes and impaired insulin signaling in the brain are linked to the pathogenesis of Alzheimer’s disease.” (Mayo Clinic, 2018) Informally, Alzheimer’s Disease is known as Diabetes Type 3. According to C. Ronald Kahn, MD, chief academic officer of the Joslin Diabetes Center at Harvard University in Boston, “the brain has insulin-sensitive tissue”. Therefore, understanding vascular dementia (not just AD) requires an understanding of insulin resistance, insulin production, and insulin absorption by brain cells in order to make the connection to vascular dementias, including Alzheimer’s. Clinical manifestations of Alzheimer’s Disease include non-memory aspects of cognition as the first signs of cognitive impairment related to AD. Examples include problem recollecting words, vision/spatial issues, and impaired reasoning or judgment. (NIH/NIA, 2018). The connection between Alzheimer’s Disease and Diabetes stems from the research on the brain's cells inability to process insulin over extended periods of time. Diabetes Type 1 and Diabetes Type 2 involve the insufficient production and processing of insulin by cells. AD or Diabetes Type 3, evolves after brain cells decay and die from lack of nutrients (necrosis). Whether it be because of a lack in ability to produce insulin (Type 1), or because insulin processing by the cells in the body is impaired (Type 2), either way Diabetes Type 1 and Type 2 is involved in vascular dementia. Diabetes Type 1 is diagnosed when the pancreatic endocrine Islets of Langerhans are impaired, resulting in the lack of production of insulin. Type 2 Diabetes is more complex and takes more time to develop. Type 2 Diabetes used to be called adult-onset Diabetes, to differentiate from the genetic Type 1. This label is no longer applicable since children are also developing Type 2 Diabetes. Type 2 Diabetes is due to either the insufficient insulin production or the onset of insulin resistance. When cells do not respond to insulin appropriately, the liver releases glucose into the bloodstream to compensate. Increased levels of water retention by the kidneys is also a manifestation of Type 2. High blood sugar levels in Diabetes is due to insulin not being produced well enough or because not enough of it reaches the cells for energy production. (Basu 2017) Blood glucose is the main source of energy. Insulin facilitates glucose absorption. Without proper levels of insulin, the glucose cannot enter the cells thereby flooding the bloodstream. Without glucose in the cells, the cells starve without access to food (glucose) and die. In human muscle cells, this creates the loss of body tissue. In brain cells, this can lead to vascular dementia like Alzheimer’s Disease. Even though insulin is produced in the pancreas, Diabetes has a direct connection to the Spleen, the Stomach, the Liver, the GallBladder, the Kidney, the Small Intestine, the Blood Vessels, the tongue (ageusia-loss of taste), the muscles, and more. In Western medicine the pancreas is an organ that is part of the digestive and endocrine systems in vertebrates. In humans, the pancreas is classified as a gland. This gland has a direct connection to the Spleen by means of the greater
pancreatic artery (great pancreatic artery or arteria pancreatica magna), is the largest artery that supplies the pancreas. It arises from the splenic artery. The splenic artery or the lienal artery is the blood vessel that supplies oxygenated blood to the Spleen. The pancreas and the Spleen are physically connected through the same arterial blood supply. The pancreas is roughly 12-15 cm or 4.7 to 5.9 in in length and is divided into a head, neck, body, and a tail. (Wikipedia, Pancreas). The majority of the pancreas is located behind the Stomach with the tail ending adjacent to the Spleen. By following the blood flow we can clearly determine the impact that each Zang-Fu Organ has on the pancreas. The Celiac artery, also known as the coeliac artery, the coeliac trunk, or truncus coeliacus, is the first major branch of the abdominal aorta. “Branching from the aorta at thoracic vertebra 12 (T12) in humans, it is one of three anterior/ midline branches of the abdominal aorta (the others are the superior and inferior mesenteric arteries). The celiac artery supplies oxygenated blood to the liver, stomach, abdominal esophagus, spleen and the superior half of both the duodenum and the pancreas. The celiac artery is the only major artery that nourishes the abdominal digestive organs.” (Wikipedia, Celiac artery) The connection between these organs is clear through their shared blood supply. The left gastroepiploic artery (or left gastro-omental artery), the largest branch of the splenic artery, connects the Spleen, the Stomach and the pancreas. The next connection is through the duodenum. “The duodenum is the first section of the small intestine and is the shortest part of the small intestine. It is a hollow jointed tube about 25–38 cm (10–15 inches) long connecting the stomach. The first part of the duodenum is mobile, and connected to the liver by the hepatoduodenal ligament of the lesser omentum.” (Wikipedia, Duodenum) The duodenum is where the GallBladder, Liver, head of pancreas, neck of GallBladder, and neck of pancreas all come together to join the Small Intestine. Blood flow connections with the Small Intestine are through the inferior pancreaticoduodenal artery which branches from the superior mesenteric artery or from its first intestinal branch, opposite the upper border of the inferior part of the duodenum. The Liver and the GallBladder also have a direct relationship with the pancreas and Stomach and not just physically through the duodenum. The liver produces bile, which is stored in the GallBladder and is part of the digestive process. Bile helps with the digestion of fats. The release of bile from the GallBladder is made directly into the Small Intestine. The GallBladder also regulates fluid retention. “This is through the active transport of sodium and chloride ions[ 17] across the epithelium of the gallbladder, which creates an osmotic pressure that also causes water and other electrolytes to be reabsorbed.” (Wikipedia, Gallbladder) When the GallBladder is compromised, bile is not released, fats are not properly digested, sodium and chloride ions are not properly managed, which can lead to the retention of fluids, inflammation, and in severe cases may lead to the formation of edema.
The Western school of thought prescribes medications to regulate insulin and glucose levels in the bloodstream. For the 10% of Type 1 Diabetics, this medication is lifesaving. For the 90% of Diabetics who are Type 2, Western medicine has no other explanation beyond stating that the necrosis of the beta cells in the Islets of Langerhans have caused the malfunction insulin production or that a malfunction was developed through an unhealthy lifestyle. Type 2 Diabetes is a world wide health concern that has been labeled a pandemic. (Diabetes 2017). While the pancreas and genetics provide answers to the Type 1 Diabetics, Type 2 Diabetics are left without resources or answers. TCM considers all of the connections between the Organs as important in order to formulate a TCM Dx. According to TCM Simple, Diabetes is known as Xiao Ke in Chinese and is “caused by yin deficiency, dryness and heat in internal organs. In most cases, affected organs are lungs, stomach and kidneys. In TCM theory, common symptoms of Xiao Ke include frequent urination, thirst, hunger, weight loss and urine with sugar in it.” (TCM Simple) The site goes on to explain that Diabetes could be due to three possible sources: Diabetes due to Lung Heat, Diabetes due to Stomach Fire, and Diabetes due to Kidney Yin Deficiency. All three of these Dx are internal in nature and could be traced to Middle Jiao heat malfunction. Diabetes can also be caused by Internal Pathogenic Factors due to emotions and lifestyle. Finally, Miscellaneous Pathogenic Factors of Diet are also clearly present. With the current emphasis on the COVID pandemic resulting in house arrest-type of situations and with world-wide populations being stripped of all legal rights to worship and see their family and friends, remembering that those with Diabetes are at an even higher risk for complications of this dangerous virus is imperative. As agreed by health organizations, Diabetes is also a global pandemic. By conducting more research and investigation into Diabetes Type 2, we can hopefully gain more understanding on how to better control cell necrosis. The world population is aging. The global birth rates continue to decline. In our immediate future we are looking at a large portion of the human population facing vascular related dementia in their later years, with very limited human capital resources to medically care for them all. It is our responsibility to be a source of solutions for our patients in our communities.
Basu, Rita. MD. (May 2017). What is Diabetes? Type 2 Diabetes. National Institute of Diabetes and Digestive and Kidney Disease. U.S. Department of Health & Human Services. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2 -diabetes.
Celiac Artery. November 24, 2020. https://en.wikipedia.org/wiki/Celiac_artery
Diabetes. November 24, 2020. https://en.wikipedia.org/wiki/Type_2_diabetes
Duodenum. November 24, 2020. https://en.wikipedia.org/wiki/Duodenum
Gallbladder. November 24, 2020. https://en.wikipedia.org/wiki/Gallbladder
Greater Pancreatic Artery . November 24, 2020. https://en.wikipedia.org/wiki/Greater_pancreatic_artery
Huggins Salomon, Sheryl., Church, Kacy. (August 3, 2018). Why Some Researchers are Calling Alzheimer’s Disease a ‘Type 3 Diabetes’. Everyday Health. https://www.everydayhealth.com/diabetes/alzheimers-disease-actually-type-diabetes/.
Inferior Pancreaticoduodenal Artery. November 24, 2020. https://en.wikipedia.org/wiki/Inferior_pancreaticoduodenal_artery
Left Gastroepiploic Artery. November 24, 2020. https://en.wikipedia.org/wiki/Left_gastroepiploic_artery
Mayo Clinic. (August 23, 2018) Diabetes 3,2,1. Mayo Clinic Center for Regenerative Medicine. [Centerforregmedmc] https://regenerativemedicineblog.mayoclinic.org/2018/08/23/diabetes-3-2-1/
Na Zhao,Chia-Chen Liu,Alexandra J. Van Ingelgom,Yuka A. Martens,Cynthia Linares,Joshua A. Knight,Meghan M. Painter,Patrick M. Sullivan,Guojun Bu. (2017) Apolipoprotein E4 Impairs Neuronal Insulin Signaling by Trapping Insulin Receptor in the Endosomes. Neuron Magazine, Elsevier. https://doi.org/10.1016/j.neuron.2017.09.003
Pancreas. November 24, 2020. https://en.wikipedia.org/wiki/Pancreas
Superior Mesenteric Artery. November 24, 2020. https://en.wikipedia.org/wiki/Superior_mesenteric_artery
TCM Simple. (2020). Chinese Medicine Treatment for Diabetes. https://www.tcmsimple.com/diabetes.php
University of Minnesota. (2016). Diabetes. What is Diabetes? Earl E. Bakken Center for Spirituality and Healing. https://www.takingcharge.csh.umn.edu/diabetes
Unnikrishnan, Ranjit1 , Pradeepa, Rajendra1 , Joshi, Shashank R. 2 Mohan, Viswanathan. (June 2017). Type 2 Diabetes: Demystifying the World Epidemic. American Diabetes Association. Diabetes 2017 Jun; 66(6): 1432-1442. https://doi.org/10.2337/db16-0766
U.S. Department of Health & Human Services. (May 2017). What Are the Signs of Alzheimer’s Disease- Symptoms and Diagnosis of Alzheimer’s Disease. National Institute of Health. National Institute on Aging. https://www.nia.nih.gov/health/what-are-signs-alzheimers-disease
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