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High blood sugar causes nearly 4 million deaths every year and the International Diabetes Federation (IDF) reports that in 2017,  global healthcare spending on diabetes among adults was 850 billion dollars (3).

Diabetes is often “sneaky”, since individuals can be asymptomatic and become aware of their condition only years after onset. The classic symptoms, in acute cases, are episodes of increased thirst and diuresis (polydipsia and polyuria), weight loss, increased appetite, fatigue, discomfort, acetone breath, and abdominal pain. In severe cases, loss of consciousness and confusion may also occur (4) (5).

Sustained high blood glucose levels can lead to several complications including: renal failure, diabetic ulcers, amputation of the limbs, loss of vision, and nerve damage. In addition, the overall risk of premature death increases: diabetic adults are 2-3 times more likely to be at risk for heart attack and stroke. In fact, about 3% of world blindness is caused by diabetic retinopathy (1) (3) .

If the current trend cannot be reversed, the WHO predicts that by 2045 the sick will reach 629 million. As a result, the WHO has agreed on a global goal to stop the increased rates of diabetes by 2025 (3) (1).

According to the epidemiological data relating to COVID-19, among the pre-existing conditions that make individuals more vulnerable to infection, diabetes is one of the main causes (6). Although the risk of contracting the infection seems to be the same as that of the general population, the data available today show that the prognosis in people with diabetes who contract the virus is worse (7). The probability of complications such as pneumonia and respiratory failure, even with a fatal outcome, is higher than that in non-diabetic individuals (8).

Before March 20, 2020, according to data from the Istituto Superiore di Sanità (ISS), there were 163 coronavirus deaths from diabetes, 33.9% of the total deaths (9). The reason for this increased vulnerability are not yet clear, but according to researchers from the Diabetes Research Institute (DRI) of the San Raffaele Scientific Institute, it seems that the major risk factors in diabetic subjects are old age and other preexisting conditions, like cardiovascular and kidney disease (7). The DRI points out that information regarding this new infection is premature and, in some ways, contradictory. The DRI therefore recommends the utmost caution in offering suggestions, since they cannot be based on solid and rigorous scientific evidence yet (7).

Diabetes is a complex condition that, in fact, can be distinguished and divided into different types:

• Type 1 diabetes: autoimmune disease in which the immune system destroys beta cells in the pancreas that produce insulin. In this case, hyperglycemia is due to lack of insulin production and is therefore referred to as “insulin-dependent” diabetes. Type-1 diabetes is known as “juvenile diabetes”, since its onset is more common in childhood, and hardly occurs beyond the age of 40.

• Type 2 diabetes: characterized by reduced sensitivity to insulin by the target cells and/or by the reduced secretion of insulin. The disease usually occurs in adulthood, in individuals 40 years of age or older. However, the age of onset is becoming lower and lower due to the prevalence of childhood obesity.

• Gestational diabetes: can appear during pregnancy.

• Other forms of diabetes: can be related to genetic defects in the pancreas or insulin response, or to pancreatic diseases caused by taking medications.

Risk Factors

To date, no measures are known for the prevention of type 1 diabetes, but effective approaches are known to prevent type 2 diabetes and all its complications, including premature death (1).

Among the risk factors for type 2 diabetes, several are related to a poor lifestyle and are thus easily modifiable:

• Excess body weight
• Sedentary lifestyle
• Overeating
• Cigarette smoking
• Hypertension (high blood pressure)
• Hypercholesterolemia (high levels of LDL cholesterol)
• High triglyceride levels

Numerous studies show that proper nutrition and regular physical activity are indispensable tools for the prevention of diabetes, and represent a real component of integrated therapy for diabetic patients. It is important to consume foods rich in fiber, such as legumes, seasonal vegetables, whole grains, and nuts. The intake of simple sugars present in sweets and packaged products should be limited. Starchy foods such as pasta, white bread and white rice must also be reduced. Additionally, saturated fats in animal products, which are commonly found in cheeses, meat, and salami, as well as hydrogenated fats used in industrial products like sweet and savory snacks, chips, and crackers, should not be consumed often. Furthermore, regarding sugar intake, only one serving of fruit should be consumed daily.

In diabetic subjects, alcoholic beverages should only be consumed in small quantities, since in addition to providing calories and sugar, they can cause sudden drops in blood glucose (hypoglycemia). In general, if diabetes is under control, the quantities allowed are the same as the general population: 125 ml glass of wine per day for women and two for men, and avoid drinking on an empty stomach. Alcohol is a toxic substance for our nervous system, and in the case of neuropathy, care must be even more rigorous.

In diabetics, smoking must be avoided at all costs. Cigarettes not only expose individuals to all the complications of the disease, but above all, make it difficult to control and manage blood sugar.

Physical activity, suitable for everyone’s ability and age, contributes to weight loss and helps control blood sugar because it enables the muscles to use and consume glucose as an energy source. Exercise increases insulin sensitivity and helps lower blood pressure, as well as improves the body’s lipid profile.

Practical Recommendations

• Monitor weight.
• Stick to the Longevity Diet as much as possible: choose fresh vegetables and fiber-rich foods, consume protein preferably of vegetable or fish origin, and choose good sources of fat such as extra virgin olive oil and nuts.

VITAMIN C

Vitamin C (Ascorbic Acid) is a molecule produced from sugar (glucose) in various plants and also in the liver of many animals. However, not everyone is able to synthesize it, among which primates and, thus, human beings. For us, vitamin C is an essential vitamin, which means it must be obtained through diet.

Are supplements necessary? No: consuming fresh vegetables provides sufficient amounts of vitamin C (for main sources of vitamin C see the article VITAMINS AND MINERALS TO SUPPORT THE IMMUNE SYSTEM).

According to the Italian Society of Human Nutrition (SINU), the recommended daily intake of vitamin C is 105 mg for men and 85 mg for women.

VITAMIN C FUNCTIONS

This vitamin has several functions: it strengthens the immune system and serves as an antioxidant. It’s important to note that vitamin C is involved in the synthesis (production) of collagen, neurotransmitters, and hormones, as well as in the metabolism of cholesterol, and the absorption of iron.

It also has anti-cancer properties, as it protects our body from the aggression of nitrosamines, carcinogenic products that are formed in the stomach from nitrites (nitrogen substances added as preservatives) that are found in some foods, such as processed meats, alcoholic beverages, and cigarettes. Vitamin C, for example, has proven effective in preventing some forms of cancer, like stomach and esophageal cancer, and laryngeal cancer in heavy drinkers and smokers.

The function of vitamin C on the immune system, which is of great interest in this moment of serious health emergency, consists mainly in promoting:

• production of Interferon (IFN-γ), a protein of the cytokine family, released by host cells in response to viruses and bacteria.
• formation and activity of white blood cells (leukocytes), the blood cells responsible for the immune response, as well as the production of antibodies (proteins) produced by some white blood cells, which specifically counteract some pathogens (specific immunity);
• reduction of stress hormones (cortisol),
• production of collagen, a structural protein that forms a supporting scaffold and builds adhesion between cells, thus forming a barrier function against foreign antigens (such as viruses and bacteria);
• anti-oxidative effects, which counteracts cellular damage caused by free radicals (highly reactive molecules that damage others) and regulates the activity of certain immune cells (phagocytes) that destroy pathogens.

VITAMIN C DEFICIENCY

Low levels of vitamin C (hypovitaminosis) causes constant weight loss, fatigue, muscle pain, and gingival bleeding. The following groups are most at risk: elderly, smokers, obese individuals, and diabetics. Prolonged vitamin C deficiency causes scurvy, characterized by tissue damage due to alterations in collagen, hematoma, hemorrhages, gingivitis and loss of teeth, and slow wound healing.

Increased vitamin C consumption is recommended if adequate levels are not being met: 1 gram per day is enough to strengthen the immune system without causing side effects.

Consuming higher doses or supplements is therefore not recommended, and should always be done under medical supervision. Furthermore, there was no direct correlation between the vitamin C doses and protection against infections. That is, lack of vitamin C can weaken the immune system, but beyond the recommended dose, there are no further protective effects. Conversely, consuming vitamin C in excess can cause damage, especially if its use is prolonged.

EXCESS OF VITAMIN C

It is unlikely to consume too much Vitamin C from food alone. Our body absorbs only part s of it: between 50 and 80%. Absorption is inversely proportional to dosage (i.e. the more we take and the less we absorb); and the kidneys filter out excess vitamin C  through the urine.

Excess vitamin C is most likely obtained through the inadequate consumption of supplements, which can cause headaches, heartburn, vomiting, diarrhea, abdominal cramps, and in some cases, kidney stones.

PRACTICAL ADVICE

It is important to vary your diet as much as possible, by consuming daily fresh and seasonal fruits and vegetables (organic if possible). This provides the body with all the necessary nutrients without the need to resort to supplements. For example, an average orange provides about 70 mg of vitamin C, while a kiwi provides about 64 mg.

To obtain adequate amounts of vitamin C, it is important to alternate cooked and raw vegetables in our weekly diet, since this vitamin is highly sensitive to heat (cooking) and light. It is also important to avoid consuming vitamin C rich foods with caffeine, as it can limit its absorption. For this reason, avoid drinking coffee or tea with orange juice in the same meal. Finally, try to consume fruit and vegetables within a few minutes of cutting them, since vitamin C oxidizes easily when in contact with air, losing its beneficial properties.

If any doubts or questions arise about the need to take a vitamin C supplement, contact our doctor or nutritionist, and follow their directions.

It is true that taking in an adequate amount of vitamin C contributes to good health and immune defenses. The “fake news” lies in suggesting that vitamin C should be consumed in high doses (generally ineffective and results in negative side effects), as well as in claiming that these quantities provide absolute protection from Coronavirus infection.

Even in this difficult moment, it is essential to evaluate the reliability of the information circulating online and on social networks, relying only on the indications of competent professionals (general practitioners and specialists, nutritionists and other health professionals), and avoiding the use of “do it yourself” solutions”. The innovative approach proposed by the Valter Longo Onlus Foundation remains valid because it provided the necessary tools to live a long and healthy life, which our team promotes with passion and dedication.

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