Type 2 diabetes mellitus

Conventional therapy for type 2 diabetes mellitus focuses on preserving (or restoring) the patient’s quality of life, freedom from symptoms, establishing near-normal blood glucose levels, controlling cardiovascular risk factors and by these means avoiding acute and late complications. Therapy is based on dietary change, weight reduction and increased physical activity (1). However, metabolic syndrome and type 2 diabetes are more than just isolated disorders of sugar metabolism. Large-scale studies such as the ADVANCE (2) and ACCORD (3) trials have shown that tight control of sugar metabolism (aiming for HbA_1C ≤ 6.5% and < 6% respectively) versus moderate control leads to no reduction in macrosvascular disease and only minimal improvement in microvascular diabetes complications, while findings regarding its influence on mortality have been inconclusive.

Earlier studies (4) had already shown that improvements in prognosis are only to a small degree dependent on the quality of metabolic control (HbA_1C). In cases of particularly ambitious treatment of all cardiovascular risk factors, including recommendations for lifestyle changes (fat consumption, physical exercise, smoking cessation), an absolute reduction in the risk of cardiovascular events by 20 % (NNT = 5) was observed versus treatment according to national guidelines (5).

This underscores the significance of a multifactorial therapeutic approach, but it also shows that around 80 % of patients do not even benefit from such aggressive therapy. Obviously there is a need for a comprehensive therapeutic concept which takes account of and acts upon the many different aspects of type 2 diabetes that manifest themselves in association with the various facets of metabolic syndrome.

In contrast to type 1 diabetes, both metabolic syndrome and type 2 diabetes show a clear genetic predisposition. This “heritability“ can make the disease appear as an act of providence from which there is no escape. On the other hand, metabolic syndrome, and so too, therefore, type 2 diabetes, belong to those disorders whose manifestation is significantly influenced by lifestyle factors. It follows that those at risk are by no means victims of their genetic makeup but can themselves contribute decisively to the prevention or management of the disease.

Type 2 diabetes thus calls not only for a pathogenetically oriented therapeutic approach but, to a decisive degree, also for one oriented to salutogenesis, which aims at strengthening the healing potential that stands available in the face of the disease and incorporating it into an overall therapeutic concept. Such integrative concepts differ from additive ones, which merely rely on an aggregation of various therapeutic options, in that they take their starting point from an underlying anthropology and understanding of the disease from which different therapeutic options are then evolved (6, 7).

If one takes into account the various late sequelae and complications with which it is associated in the areas of the system of the nerves and senses, the rhythmic system and the organisation of the metabolism and movement, the means available today for therapeutically controlling type 2 diabetes cannot be considered anywhere near sufficient, and there is an urgent need for therapeutic options which do more than bring relevant disease parameters relating to the sugar and fat metabolism or other risk factors within their normal ranges.

Constitutional aspects of the disease

Truncal obesity

A differentiated view on the nature of type 2 diabetes can be obtained by studying the disease in terms of the different dimensions (or levels) of human existence. A salient characteristic which can already be seen in the physical appearance of those affected is central truncal obesity. Their pronounced truncal corpulence often stands in contrast to the more slender build of their limbs. It is as if these two spheres of the organisation of the metabolism and limbs belonged to two different individuals, whose slender extremities would lead one to expect a more delicate overall build. The body’s qualities of shape are diminished and its curves are determined by space-filling fatty tissue whose predominance causes contours to fade. In a person with pronounced obesity the body’s physical shape, whose uniqueness reflects the organisation of the ego, appears to have receded, giving way to a shapeless mass.

Needless to say that a variety of typical body shapes can be observed. Nevertheless it remains that central obesity is the foremost characteristic of both metabolic syndrome and type 2 diabetes.

Sclerotic processes

At a functional level sclerotic processes develop at all three of the human organism’s levels of existence. The system of the nerves and senses may be affected by cerebrovascular insufficiency or by neurodegenerative diseases such as Alzheimer’s dementia, a condition observed at elevated frequency in diabetics (8).

A frequent sclerotic disease affecting the middle human being is coronary heart disease. Yet it holds in general that the rhythmic system is increasingly marked by rigidity, induration and sclerosis. For example, metabolic syndrome is associated with an elevated rate of thrombophilia (9). Furthermore, heart rate variability, in which other rhythms of the body, notably the respiratory rate, are reflected, may be impaired and “frozen” (10).

Manifestations of the process of sclerosis finally also become impressively visible in the organisation of the limbs (diabetic foot syndrome): The life organisation of the affected individual is no longer sufficiently able to express itself in regenerative, anabolic processes and instead is led into processes of sclerosis and induration. One such process is chronic inflammation (9), a point of great significance in understanding type 2 diabetes and metabolic syndrome at a functional level. Unlike acute inflammation, which takes possession of the organism by warming it through fever, chronic inflammation is associated with sclerosis and induration. There are many examples to illustrate this connection between chronic inflammation and sclerosis. Not the least of these is arteriosclerosis, which is more likely to develop in the presence of chronic inflammation.

Chronobiological alterations

Numerous alterations associated with impairment of the rhythmic system have been described in diabetes mellitus. Deserving first mention here is a reduced HRV associated with elevated cardiovascular and overall mortality (11). Also to be found in diabetics, however, are finer rhythmic alterations such as a reduced coordination between heart rate and respiration (12).

Depression

Decisive characteristics are not only to be found at the level of the body and its altered vital organisation but also at the emotional level. Individuals with metabolic syndrome frequently complain of a depressed mood (13), sometimes associated with restlessness and ready irritability (14). Depression has been identified in its own right as a risk factor for developing type 2 diabetes mellitus (15, 16) and may be associated with sleep disorders of various kinds.

For these reasons it is essential to take psychological aspects into account in patients with metabolic syndrome and type 2 diabetes. Unfortunately this is often completely neglected in consultations with the patient, which will commonly revolve around the control of their blood sugar and how it might be optimised.

Impaired self-efficacy

Finally, persons afflicted with type 2 diabetes also show certain characteristics in their ego organisation. The individuality of a human being can connect itself with the body in varying degrees, using it to this extent as an instrument of the unfolding will. In type 2 diabetes the efficacy of the self in taking possession of the body is impaired. Decisions of the will become impeded in that what the person knows no longer provides the motive for his or her subsequent actions.

Three different qualities can be distinguished in describing human action: It is guided and steered by an image which defines the goal and purpose of the ensuing action. However, the image of an action alone does not have the power to motivate a human being. It needs to grow from being the image of an action to become its motive, allowing the person to internally feel and experience the necessity of performing it. Thus the image of an action becomes associated with a felt necessity which can subsequently motivate the person to perform it. The action that results is an expression of the will, bringing about the goal which before existed only as its image.

In patients with metabolic syndrome and type 2 diabetes there is usually sufficient knowledge in terms of action imagery around what would be the “right thing to do”. However they lack the capacity to generate motivation and willpower. Thus the products of their conscious mind provide no basis for their subsequent actions.

The concept of sense of coherence (SOC), developed by Aaron Antonovsky, describes a person’s capacity to experience the world as comprehensible, manageable and meaningful. The better their sense of coherence is developed, the better they will be able to cope with stressors. A poor sense of coherence is associated with a low degree of “self-efficacy”, which can manifest itself at different levels of the organism. At the psychological level it may be observed in insufficient emotional self-regulation. Even minor events in the outside world can trigger strong emotional responses which leave the person’s ego overwhelmed and helpless. One study has demonstrated an association between a low SOC and type 2 diabetes in women (17), while another has conversely shown SOC to be a risk factor for developing type 2 diabetes (18).

Insulin resistance

Metabolic syndrome and type 2 diabetes are both characterised by insulin resistance. This means that larger quantities of insulin are required in order for it to sustain its effect on the glucose metabolism. However, rather than being an unalterable state, insulin resistance is capable of improvement, for example through physical exercise (19). To this extent the measurable pathophysiological phenomenon of insulin resistance can be linked to a human trait better described in terms of the humanities: If the system of the metabolism and limbs has sufficient ego efficacy, there will also be physiological insulin effectiveness and sensitivity. If the ego organisation within the system of the metabolism and limbs is impaired in its efficacy, then insulin resistance will develop in the tissues (e.g. liver, musculature).

Pathogenesis and salutogenesis

Any anthroposophic approach to treatment of diabetes must of necessity be integrative, meaning that not only pathogenetic but also preventive salutogenic aspects need to be considered.

Predominance of sclerotic processes

One of the fundamental preventive approaches is physical exercise. When engaged in physical exercise the human organism takes possession of the system of the metabolism and limbs. Activities of the will unfold through the agency of the system of the metabolism and limbs. They are associated not with sclerosis and induration but on the contrary with inflammation-like warmth-generating processes. While sclerotic diseases are functionally related to the system of the nerves and senses, the inflammatory, warmth-generating processes that act against the sclerosis of the organism are linked to the system of the metabolism and limbs. Thus all diseases characterised by sclerotic processes can be favourably influenced by physical exercise.

One path through which sclerosis can develop is when the upper human being, the bearer of consciousness, is functionally excessive, resulting in a predominance of the system of the nerves and senses within the threefold organism. However a predominance of the system of the nerves and senses may also result from functional impairment in the system of the metabolism and limbs.

Seen in this perspective, all factors which act counter to the organism’s dynamic metabolic processes (which are also what nutritional approaches in diabetology are concerned with) or which diminish the use of the limbs and motor function in general, such as a predominantly sedentary lifestyle, will directly or indirectly promote a predominance of the system of the nerves and senses and the sclerotic processes associated with it. Functionally speaking type 2 diabetes and metabolic syndrome are thus manifestations within the system of the metabolism and limbs of an insufficient effectiveness of the affected individual’s will.

Factors underlying low self-efficacy

For these reasons consideration should be given to factors that are potentially responsible for a low effectiveness of the ego organisation within the system of the metabolism and limbs and may have a decisive impact on the early phases of an individual’s life. It has been shown that stress and adversity experienced in early childhood which overtax the child’s coping capacity (toxic stress) lead to a higher incidence of diabetes at adult age, amongst other consequences (20). Steiner speaks in this connection of memories overburdening an individual’s realm of consciousness (21).

Our present-day civilisation is characterised on the one hand by maximal uptake and storage of information, beginning already in childhood, and on the other by a surprisingly low level of creative activity. This leads to information being “dumped” without having first been processed sufficiently. There is therefore a need to support and foster the creative potential in people’s thinking as their consciousness evolves. In this way human will and activity is carried into the abstract world of information that pervades their thinking, and an element of dynamism is introduced into their realm of consciousness.

Apart from a disproportionate predominance of the conscious pole, psychological factors may also gain significance, impairing the organism’s self-efficacy. Depression certainly has a place in this context. In many cases depression represents a kind of withdrawal from what could be a life of purpose and action. Declining self-efficacy also manifests itself in obsessional ruminations and the various phenomena of psychomotor inhibition. There are many events in life that can throw a person into a state of emotional and spiritual shock which later manifests as type 2 diabetes (22, 23). Withdrawal may also result from failure to find meaning in life or from lack of perspectives for the future.

Besides emotional factors we must finally also mention those of a physical nature which are attributable to a predominantly sedentary lifestyle with lack of exercise. For this reason one should seek to cultivate a liking for exercise in those affected by type 2 diabetes. Physical exercise is more than just a calorie consuming process, and it offers far more than the one-dimensional quality of ergometer training. We perform movements with our limbs, but movement also takes place in our thinking and senses and we can also be moved emotionally. In one-dimensional activities such as ergometer training the motor function of the limbs is isolated from the other aspects of the human organism, for example in that the movement of the limbs is no longer experienced through the senses as movement from one place to another.

In 1920 Rudolf Steiner formulated what one might refer to as case-taking questions through which the interviewer was to be able to gain an impression of the intensity of the ego organisation and astral body acting on the organism’s physical and functional aspects. (24, p. 96–116). These questions served as a basis in developing the Havelhöhe constitutional questionnaire on “autonomic regulation (aR)” and validating it according to established test criteria (25). In several studies diabetics were consistently found to obtain a diminished score with this questionnaire.

Prevention and treatment of metabolic syndrome and type 2 diabetes hinge on improving the organism’s ego efficacy within the system of the metabolism and limbs.

Therapeutic approaches

In conventional therapy the primary focus is on regulating blood sugar and controlling risk factors through medication.

The therapeutic goal of anthroposophic medicine in metabolic syndrome and type 2 diabetes goes beyond this in that it also includes strengthening the patient’s ego efficacy within the system of metabolism and limbs.

Medication for blood sugar control (conventional therapy)

Oral antidiabetics (OAD) intervene in the organism’s regulation of blood sugar in a variety of ways. Sulfonylureas and glinides stimulate beta cell insulin secretion, thus lowering the blood sugar level. This therapeutic approach makes it possible to improve glucose control, but it has no effect on the pathological process itself or on the influences underlying type 2 diabetes at different levels of the human organism.

Metformin on the other hand, a substance belonging to the biguanides and thus related to the blood-sugar-lowering guanides that originate from plants such as French lilac (Galega officinalis), has the effect of improving insulin sensitivity. Another group of substances which alleviate insulin resistance though insulin sensitisation, even though they have very much receded into the background today, are the thiazolidindiones, also known as glitazones. Some of the newer substances (such as the incretins) originate from the animal kingdom (the exenatides from lizards, for example). These are able to stimulate insulin secretion specifically at mealtimes, amongst other properties.

DPP4 inhibitors act in a similar direction by inhibiting incretin degradation.

Insulin, finally, can be given to control the glucose metabolism from outside. This almost always leads to hyperinsulinaemia, a condition which differs markedly from the normal state in a number of aspects, including insulin concentration, secretion profile and rhythmic order.

Insulin steers and shapes anabolic processes in the human organism. The role of insulin in controlling anabolic activity is also revealed by what happens when insulin is lacking, namely catabolic processes leading ultimately to ketoacidosis.

Conversely hyperinsulinaemia can lead to an excess of anabolic processes and weight increase.

Anthroposophic medicinal preparations

Rosemary is mostly applied externally as a bath preparation. Beyond this it can also be given internally as Rosmarinus recens D3 (3 x 20 drops). Rosemary fosters presence of mind, strengthening a person’s self-efficacy in the emotional realm in states of dynamism and change. Moreover, it enhances the patient’s ego efficacy at the bodily level as manifest in metabolic processes. Patients taking rosemary medications have reported a greater presence of mind as well as a calming influence of such preparations in association with an improved ego efficacy at the emotional level (an effect different from that of lavender, which calms a person on account of its association with states of sleep).

Bryophyllum (Bryophyllum Weleda 50 % Trit. 3 x 1 pinch.) is a further important medicinal agent which provides relief in states of emotional unrest und irritability. Bryophyllum strengthens the connection between the organism’s emotional organisation and its metabolic processes. It resolves the tendency of the emotional self towards irritability and depression, which is experienced as rising like heat into the upper human being, causing outwardly visible reddening and plethoric patches on the neck and head, by dissociating it from the realm consciousness and allowing it to return into the bodily organism. Many patients report a calming effect of Bryophyllum. While rosemary strengthens the patient’s ego efficacy at the emotional and bodily level, Bryophyllum directs the organism's emotional (astral) organisation back into the vegetative realm.

Aurum/Stibium/Hyoscyamus (WALA) and Aurum/Hyoscyamus comp. (Weleda) (2-3 x 20 drops) are both well suited for histrionic patients, a constitution often associated with type 2 diabetes as well as metabolic syndrome. Hyoscyamus accommodates restless emotional states pressing to break into consciousness, while Stibium strengthens the creative, formative forces and Aurum improves the individual’s ego efficacy by mediating between the weightiness of the body and the light-like nature of the organism’s spiritual and emotional dimensions, allowing them to come to terms with one another.

Phosphorus: If there is not as much a state of emotional unrest but more a paralysis of the will with concomitant fatigue and inactivity, this speaks in favour medication with Phosphorus D6 (Weleda, 20 drops in the morning). Phosphorus strengthens the ego organisation in the dynamics of the metabolism. However, symptoms of this kind should also prompt one to take note of any sleep-related breathing disorder in the manner of obstructive sleep apnoea syndrome (OSAS). In patients who complain not only of daytime fatigue but also of daytime somnolence as well as nycturia this even becomes a probability, indicating further diagnostic measures.

Hypericum , administered as Hypericum auro cultum D2 (3 x 20 drops), can be given to diabetic patients with predominant symptoms of depression. Subsequent adaptations or changes in medication will then depend on their further clinical progress.

Cardiodoron ® (Weleda 2-3 x 20 drops or as 3 x 2 RH tablets) is an important medicinal preparation for supporting the rhythmic system which suggests itself particularly in cases of impaired heart rate variability. It can also be given as Aurum Cardiodoron comp. (Weleda, 3 x 20 drops).

Sclerotic processes

Other anthroposophic medicinal preparations address the sclerotic processes associated with diabetes. Unnoticed by the patient these set in at an early stage, causing symptoms such as endothelial dysfunction or thrombophilia.

It is only at a later stage that the process of sclerosis, evolving as it does below the threshold of awareness, surfaces into the patient’s consciousness as a manifestation of disease. In terms of noteworthy clinical symptoms it can affect the system of the nerves and senses as cerebrovascular insufficiency, the rhythmic system as coronary heart disease and the system of the metabolism and limbs as peripheral artery occlusive disease.

The process of sclerosis reflects a predominance of the system of the nerves and senses. Counteracting this in a salutogenic response the organism initiates an inflammatory process. If the inflammatory response is unable to neutralise the sclerotic quality, it develops into chronic inflammation, an accompaniment of various sclerotic diseases.

Two optional therapeutic approaches present themselves here: One is to give a medicinal preparation that accommodates the disease process, while the other is to support the salutogenic inflammation.

Accommodation of the disease process by the medicinal preparation: Plumbum has a kinship with the sclerotic process, as is reflected in its metal qualities, including densification and dissociation, as well as in its toxicological effects in the human organism. Medicinal preparations such as Plumbum mellitum (Scleron, 2 tablets in the morning) or Plumbum aceticum cum mel (special preparation by Weleda, 20 drops in the morning) can serve to accommodate the process of sclerosis.

Support of salutogenic inflammatory processes: This is the single most significant field of application of mistletoe outside oncology. Mistletoe therapy may be initiated in patients whose warmth organism is seen to be disturbed and whose circadian temperature variation lacks a late-afternoon rise in core temperature.

Suitable preparations include Viscum Crataegus s.c., especially if there is concomitant coronary heart disease, Viscum Mali 2 % s.c. or naturally any of the other mistletoe preparations commonly used in oncology. The usual recommendation is to apply 3 s.c. injections per week while clinically monitoring the patient’s temperature curve (measured sublingually or rectally) and inner wellbeing.

If there is improvement in an objective sense or in terms of the patient’s sense of wellbeing, this should only be taken as evidence of medicinal effectiveness in that particular case. Stereotyped medication should be avoided; any evidence of effectiveness and any conclusions drawn from this as to the appropriateness of therapeutic measures taken must be derived from the clinical progress of that particular patient.

Dietary aspects

Four aspects of nutrition

Four aspects need to be considered in relation to the diabetic patient’s diet. One is the calorimetric aspect, which is necessary for assessing the patient’s energy balance.

However, the diet also has influence on metabolic processes, which it can either stimulate or slow down.

Moreover, the ingestion of food bears emotional significance, hence the expression “emotional eating” (26). It can nurse and pacify individuals in a state of emotional unrest, allowing them to relax by redirecting their emotional, spiritual self away from the world of consciousness and into the realm of the metabolism. Thus food intake often not only serves to sustain the organism’s bodily organisation but also occurs for emotional reasons.

Finally, ingestion of food is associated with rich sensory experience. There is an increasing tendency in today’s “fast food society“ to blind oneself to the sensory quality of eating, making it more difficult, if not impossible, to experience food substances and their specific properties with fine sensory differentiation.

Diabetology should thus not only be concerned with selecting the right kinds of food but also with the emotional aspect of nutrition as well as the rich sensory experience which patients need if they are to spiritually encounter the specific character of different foods. From a therapeutic viewpoint it is therefore important to encourage an adequate sensory experience during the act of food ingestion.

Dietary stimulation of the metabolism

A high-fibre, low-meat diet promotes the metabolic efficacy of the upper levels of human existence within the digestive tract. This can be further supported by foods of sulphuric, warming quality. In this connection it is worth noting the effectiveness of antioxidative polyphenols from certain plant seeds and flowers as prophylactics against Alzheimer’s disease (27). The much quoted effectiveness of wine in preventing Alzheimer, a disease frequently associated with diabetes mellitus, appears to be not as much attributable to the alcohol than to substances of the above-named kind which occur especially in the skin of grapes.

Similar effects appear to be conferred by certain herbal plants such as curcuma, whose warming, fiery quality can be introduced into the organism with the food. (28). Curcuma is characterised by the fact that the qualities residing in its flowers come within close proximity of its rhizomic organisation. In this way it carries its warming, fiery quality into a plant region whose organisation shows a tendency towards hardening. When used as a food spice curcuma can support the dynamic, warmth-like qualities residing at different levels of the human organism.

Similar qualities can be observed in the blood-pressure lowering effects of cinnamon (29) and rosemary, the latter of which was recommended by Rudolf Steiner for external bath applications (30).

The above examples thus illustrate two important dietary aspects in the treatment of diabetes: From a nutritional viewpoint the goal must be to raise the activity of the organism’s upper levels of existence in its ego organisation within the digestive tract. These can be stimulated with a high-fibre in place of a low-fibre diet, while foods of sulphuric quality, by virtue of their warming character and invigorating effect on the metabolism, can serve to support the ego organisation in terms of its metabolic efficacy.

Oat

Oat is capable of conferring a lasting improvement in insulin sensitivity (31). One to two “oatmeal days” per month (with main meals consisting of approx. 3 carbohydrate units of oatmeal porridge, with fresh vegetables as an option but no other side-dishes) can improve a patient’s metabolism, significantly reducing their need for insulin.

Oat is a grass species with pronounced nurturing properties. It loves moisture and, unlike other cereals, it can be fed to animals as green fodder. It possesses a marked anabolic, etheric quality. At the same time, due to its high silica content (quartz), oat has a close relationship with light (a quality best illustrated by rock crystal with its translucent and refractive properties). Thus the vitality of the life organisation of oat is pervaded with light qualities.

Therefore oats can be used dietetically to strengthen the connection between the spiritual and emotional levels of the organism’s existence on the one side and its metabolic organisation on the other (32).

External heat applications

Medicinal preparations and therapeutic methods associated with heat have a prominent place in diabetes therapy. Heat belongs to the traits of the human ego organisation that relate to the organism’s metabolic processes. People with cold hands experience their hands as alien, rigid and cut off from their inner self, while warm hands reflect the connection that exists between an individual’s emotional, spiritual nature and their motor functions.

Rosemary oil dispersion baths

Rudolf Steiner’s observations in 1920 on the great value of conferring heat through rosemary oil baths mark the inception of this form of treatment in anthroposophic regimens for diabetes mellitus (30). Rosemary oil dispersion baths are distinguished by the allied effects of warm or hot water and rosemary’s warmth-related qualities. Etheric oils are heat-associated substances rich in energy which have absorbed the light and heat of their environment in the process of their formation. When applied externally they can intensify the relationship that exists between the human organism’s emotional and spiritual nature and its metabolic processes.

It is worth emphasising at this point that when used for treating patients with diabetes, oil dispersion baths should not be applied at 37 °C, as might be appropriate in other cases, but as warm or as hot as possible.

In a case report on the first use of rosemary baths in anthroposophic medicine we find instructions by Steiner to raise the temperature until the patient begins to perspire.

Rosemary oil dispersion baths should therefore be prepared from Oleum aethereum Rosmarini 1 % (Weleda) and/or Rosmarinus Oleum aethereum 10 % (WALA) using a stirring device (Junge company) in the ideal case and brought to the indicated temperature level.

Rosemary baths can be applied once or several times a week. A number of studies have been published in recent years on the use of external heat applications. These deal not so much with humid heat but more with dry heat. They report of improvements in glucose metabolism (33) and blood pressure (34) as well as of weight reduction as a result of serial heat applications. Remarkably, the weight loss apparently did not lead to elevated levels of ghrelin. This “hunger hormone”, as it is referred to, is associated with elevated appetite and food intake (34).

Serial heat applications can also alleviate symptoms of cardiac insufficiency or endothelial dysfunction (35, 36). Heat activates the higher levels of human existence, causing them to pervade the system of the metabolism and limbs. It thus has the capacity to accelerate and intensify a sluggish metabolism.

Eurythmy therapy and therapeutic art in diabetology

Eurythmy therapy has a central place in the treatment of diabetic patients. It employs movement as a means of connecting the emotional and spiritual levels of an individual with their bodily organisation in a differentiated manner. Eurythmy therapy can be applied in all stages of diabetic disease.

The content of eurythmy therapy sessions should always be determined by the currently predominant disease manifestation. For example, in patients with metabolic syndrome or type 2 diabetes who are affected by a malorganised metabolism (steatosis hepatis, cholecystolithiasis) or impaired intestinal motility as a result of autonomic diabetic polyneuropathy it is important to employ voicing as a means of fostering the quality of movement in the intestinal tract.

Eurythmy should also be practised by patients who have had to be immobilised on account of diabetic foot syndrome and have thus been thrown into a passive lifestyle which hampers the healing process.

Among the art therapies plastic modelling has proven beneficial. Plastic modelling engenders creative processes which ultimately lead to the physical act of shaping the modelling mass. In this way it can help the patient reconnect their emotional and spiritual self with their body with renewed intensity.

Anthroposophic therapeutic speech can support the upper levels of human existence (ego and astral body) in connecting more to the organism’s vital functional levels, especially the metabolism (37).

(This text is based on an article entitled Diabetologie (38) which was published in a 2009 issue of Merkurstab as a preprint of a chapter with the same title published by Salumed Verlag in the book Geriatrie (7).)

The therapeutic concepts described above are mostly derived directly from the anthroposophic understanding of diabetes. Their routine use in practice has led to promising experiences in many individual cases. A task for the future will be to evaluate and further develop these concepts in prospective studies. Studies on individual aspects of the therapies described above have already yielded some interesting results, a selection of which is presented in the following.

Rosemary

In a review article on the current state of research on rosemary oil dispersion baths Büssing et al. came to the conclusion that the data record was not sufficient to demonstrate specific effects from this form of treatment (39).

Potential effect factors of rosemary baths are those bath constituents which are absorbed through the skin or by inhalation and the heat (baths given to diabetes patients should be sufficiently hot as to cause perspiration).

A considerable number of in vitro and in vivo studies have been conducted on the phytotherapeutic effects and action mechanisms of Rosmarinus officinalis plant extract in diabetes mellitus. One finding from this research was that carnosol and carnosic acid, two phenolic diterpenes contained in rosemary, selectively activate the PPARγ receptor as a function of their concentration (40). The PPARγ receptor is responsible for the regulation of enzymes controlling the glucose and fat metabolism. It was also found that there is a specific antagonist to the PPARγ receptor which is capable of inhibiting the stimulatory effect of rosemary on glucose uptake by the liver cells (41).

There is also evidence that the blood sugar lowering effect of rosemary comes about not only through its antioxidative effects but also, similarly to metformin, through its inhibiting effect (via the cAMP/PKA/CREB pathway) on gluconeogenesis-promoting gene expression (41, 42). In vitro experiments have also shown rosemary to have an inhibiting effect on  -glucosidase, which is possibly associated with reduced glucose resorption via the small intestine (43, 44). In mice fed on a high-caloric diet rosemary interestingly showed ACE-inhibiting (44), LDL-lowering and weight stabilising effects (45).

Aroma therapy with rosemary has been found to bring about a state of relaxed alertness, enabling test subjects to solve maths problems more quickly than otherwise (46).

Studies on heat treatment have found improved haemodynamic parameters (47) as well as endothelial function (36) in cardiac insufficiency, improved blood flow and symptom scores in severe peripheral artery occlusive disease (48), higher quality of life in type 2 diabetes mellitus (49) and a probable reduction in oxidative stress (50).

Oat

The effects of oat on insulin resistance in diabetes mellitus were investigated in publications cited in (31, 32, 51).

Bryophyllum

An animal experimental study in the context of diabetes mellitus found bryophyllum to have anti-inflammatory and hypoglycaemia-inducing effects in diabetic rats (52). In another study anti-depressive and analgesic effects were observed in rats and mice (53).

Cardiodoron

A large number of studies, including a review, are available on Cardiodoron. They show a normalisation of cardiorespiratory coordination and beneficial effects in functional cardiovascular disorders and/or sleep disorders (54, 55, 56).

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