Diabetes Anhang 2
[Matthias Girke]
On the background of the three-fold
human organism, type 1 and type 2 diabetes mellitus appear as a polarity.
In type 1 diabetes action of the
nerve-sense system is dominant, In terms of the human biography: type 1
diabetes appears linked with insufficient incarnation of the soul and spiritual
being
In type 2 diabetes action of the
will in the metabolic-limb system is restricted. In terms of the human
biography: in type 2 diabetes with premature separation and excarnation.
Conventional therapy focuses on what
can be measured and regulated, i.e. the glucose level. In this way it addresses
the physical plane but fails to address the soul
and spirit aspects of the illness – the
disease process itself.
Through its perspective on disease,
anthroposophical medicine is able to develop therapeutic aims and concepts that
go beyond regulation.
Key Words
Diabetes mellitus type 1 and type 2
Insulin
Insulin resistance
Diabetic nephropathy
Diabetic retinopathy
Autonomic diabetic neuropathy
Polyneuropathy
Diabetic foot syndrome
Rosemary
Mistletoe
Introduction
In diabetology the therapeutic
approach has focused on regulating blood sugar to within normal levels, and
with commendable results: A disease known for over
2.000 years can now be effectively managed
and regulated. The underlying pathology is understood as a disorder of
biochemical and - increasingly - molecular
biological processes.
Yet the deeper question remains as
insistent as ever: How do the objective findings of science relate to the whole
being of man, embracing not only a physical form
but also soul and spiritual
dimensions?
In this sense the approach of causal analysis needs to be broadened. The
life of those suffering from disease is lived on these multiple levels at every
instant; and when
illness so deeply impinges on their lives and biographies, the above
question is alive in them whether or not they express it in words. Medicine
must ask itself whether
pursuing this question is “merely” a service to the patient's subjective
sense of well-being or if it might not lead to new paths in the therapy of
diabetes.
Will our therapeutic task regarding diabetes mellitus be accomplished
when with our growing arsenal of therapeutic tools we succeed in producing
glucose profiles matching
the “healthy norm”? The answer is clearly “no.” The actual disease
process remains untouched by such medication. We have merely gained control
over consequences of the
illness and thus reduced the risk of further injury. Man is a being
oriented towards becoming and developing; and when this is recognized, illness
is never a “mechanical failure.”
Symptoms challenge the sufferer to make illness fruitful on the plane of
inner development. An ideal therapy, in the process of exerting a positive
influence on the disease process, would also mediate related steps in inner
development. Healing, in this sense, goes beyond finding-oriented therapy.
Along with its positive effect of preventing typical diabetic complications,
the regulating approach introduces the risk of arresting the disease and
“freezing” development. For this reason the choice of further therapies to
accompany the regulation process it is of critical importance.
In 1922 for the first time a child was treated with insulin. In 1923
Banting and MacLeod were awarded the Nobel Prize for their discovery of
insulin. Parallel to these developments, in 1920 R.S. began to give indications
on the treatment of diabetes - indications that have remained in their germinal
form, undeveloped, to this day.
Alongside of soul-spiritual aspects they entailed an unusual external
(medicinal) approach. Understanding and developing this will require extensive
work.
Perhaps one day the qualitative measures of a medical art will occupy a
place alongside of the regulating measures of conventional scientific medicine.
A large part of the
task will certainly involve developing appropriate prevention in face of
the obvious influence of the factors that contribute to manifestation. The
prerequisite for this is an understanding of diabetes that recognizes higher
“members” of being in the human organization and develops a therapeutic
approach based on this understanding.
2. How Individuality Acts in the
Organism
On the foundation of the nerve-sense system, the inner being of man
gains awareness of itself and the world. The colorful world of the soul and the
multiplicity of sensory impressions all become conscious. Over against this
thrust towards consciousness, however, the soul has another orientation which
takes hold of the organism in motor and metabolic processes.
picture of the human being on which present-day medicine is based fails
to see beyond the connection of inner experiences to neuronal structures.
To put it positively, it is solely aware of the relationship of
consciousness to the nervous system and conceives of the rest of the organism
as soul-less. The criterion of brain death is based on this kind of picture. In
reality every dynamic process or movement is the continuation of an inward
intention; in it the inner world of the human being engages directly and immediately
in the metabolic and motor organization. Only consciousness and the form-giving
quality are based on the nerve organization. It is the
astral organization which makes a living organism into one that is
wakeful and conscious; in the upper pole of the human organization it is
chiefly a vehicle of consciousness, while in the lower pole it lives chiefly in
metabolic and motor functions. Consciousness and movement manifest its polar
qualities. Consciousness arises through
a metamorphosis of life-forces. These act in the organism’s life
processes of growth and regeneration, but they can also be transformed into
forces of consciousness.
Here, in the domain of waking consciousness carried by thought, the
astral organization has one thrust of its activity. The other, associated
primarily with the lower pole,
leads to metabolic processes in the life-realm which - in the case of
movement, for example
- may have a warming quality akin to inflammation (see below).
I-Organization
and Sugar Metabolism
Each human existence poses the question how the inner being is connected
with the physical body. Rudolf Steiner addresses this question while discussing
the relationship
of the I-organization to sugar: “Wherever sugar is present,
I-organization is present; wherever sugar arises, the I-organization appears in
order to give a human orientation to sub-human (vegetative, animal) corporeality”.
A vast gap seems to separate these
two worlds, and no connection is readily evident. Here we shall explore one of
the possible ways of illuminating this issue.
First of all, it is obvious that the narrowing of our attention to the
ponderable aspects of substance has only made the riddle of this connection
greater. The focus on dimension, number and weight reveals a material world
which occupies space - the conventionally accepted “reality” - yet at the same
time further obscures our view of the spiritual.
This ponderable side of substance has a complement in its imponderable
qualities, which are manifested in their processual action. In this connection
it is revealing to observe how the sugar metabolism - particularly the action
of glucose - affects the metabolic processes of the animate organism. It is the
qualities of consciousness and movement that are most closely connected to
sugar metabolism. Consciousness develops on the foundation of the nerve-sense
system and -as any hypoglycemic knows- manifests a dependence on glucose
metabolism. Movement too, as a phenomenon of the metabolic-limb system, is
realized on the foundation of sugar metabolism.
Thus the essential manifestations of the sentient (astral) organization
in the three-fold human being are connected with the sugar metabolism. In man
as distinct from the animal, however, the two domains of consciousness and
movement undergo a further enhancement through the individuality. In man,
consciousness rises to the possibility
of self-consciousness, and movement is subject to the conscious
intention and control of the I. Thus
the human qualities which have their organic basis in sugar metabolism point
towards the I-organization.
A metabolic pathway that has been known for over a century is that of
glycolysis. In 1897, Eduard Buchner succeeded in demonstrating that a cell-free
extract of yeast can undergo anaerobic fermentation of sugar resulting in
alcohol. In glycolysis, glucose which tends towards mineral crystallization -
i.e., the physical level - is raised through
a metabolic process to the fluid-etheric level. Given sufficient oxygen,
the glycolytic breakdown of glucose does not proceed all the way to the lactate
stage, but only to pyruvate, which can be oxidized to carbon dioxide in a
fundamental reaction sequence. This opens the metabolic pathway of glucose to
the air organism as an instrument of the astral organization. The essential
connection of this metabolic pathway of glucose to the I-organization, however, resides in its serving heat and energy
metabolism.
The human I-organization lives in the warmth that so abundantly results
from this. Substance dissolves into process, developing in its imponderable
qualities towards the human spirit and becoming permeated with its life, soul
and spirit. As R.S. formulated it 1922, “the human being must have the power to
dissolve sugar; his life consists in this”. Impairment of this power points
towards the disease of diabetes. The instrument of the I-organization becomes
inaccessible to its action, thus mineralizing and crystallizing in the
deposited glucose whose toxicity is now so well understood.
Blood Sugar Regulation on the
Background of the Threefold Human Organism
Blood sugar regulation is regarded as a function of the interplay of
various endocrine hormones. It must be recognized that this view is limited to
the metabolic processes in the organism which can be described in biochemical
terms and offers no link to the soul and spirit aspects of the human being.
Accordingly, any therapeutic approach that confines itself to the plane of
blood sugar regulation always risks ignoring the inner being of man. Even a
cursory look at the regulation of glucose levels, which are generally constant
within narrow limits and also nearly age-stable, gives evidence of the soul and
spirit being at work in the threefold organism. Elevations of the glucose
concentration may be associated with endocrine changes in any of the following:
the pancreatic glucagon (belonging to the metabolic system), the cortisol of
the adrenals (more closely connected with the soul process of waking-up), the
thyroid hormones (serving the unfolding of soul-spiritual life), the
catecholamines (intimately linked with the development of consciousness), or
stress-conditioned secretion of STH. The result is an elevation in blood sugar
in connection with a soul-spiritual being oriented towards waking, i.e.
to the upper pole of the human being. On the other hand, a depression of
blood sugar levels is registered with every muscular movement and particularly
with athletic activity. Thus when the soul-spiritual entity realizes its
intentions in limb movement, it leads to a depression in blood sugar
concentration as glucose is drawn into the warmth-linked metabolic processes of
will activity. In summary, when the inner human being is oriented towards the
nerve-sense system, a rise is observed in the glucose concentration in the
blood, whereas when it is active in the metabolic-limbs system, a decrease is
noted.
In the first case - orientation towards the upper pole - blood glucose
is “deposited” (in a relative sense). As it falls away from the higher members,
the crystallizing tendency of the glucose results in a subtle sal quality
permeating the organism. This can even become pathogenic in the sense of
glucose toxicity. Taking HbA1c as a parameter for this depositing quality
linked with the upper pole, it is of interest that HbA1c (study on 4,662 men)
is associated with a death risk whether or not it exists in the context of
diabetes, apparently without any threshold value. According to the study, a 1%
rise in this parameter was associated with a 29% increase in risk of death for
all causes, independent of other known risk factors. In the second case the
glucose is taken up into the warmth and will-activity of the higher members.
Glucose’s sal quality and its sulfuric action_substance is transformed into
process_are now mediated by a rhythmic quality. As early as the 20’s of the
last century, an oscillation of the fasting blood sugar was described. Later, a
temporal correlation between rhythmically spaced insulin secretion and plasma
glucose was mentioned.
In this way the spectrum of glucose metabolism, ranging from crystalline
glucose to its dissolution in the warmth processes of the human organism, finds
its place within the threefold human organism.
Thus our characterization of diabetes is further differentiated as we
chart its relationship to the generation of consciousness and will activity by
man’s soul-spiritual being.
3. Polarity in the Clinical Picture
of Diabetes mellitus
Physiological Foundations
The clinical pictures of type 1 and type 2 diabetes display a striking
polarity, especially when juvenile diabetes is juxtaposed to the type 2
diabetes of the adipose adult (formerly 2b). Although in principle both forms
of diabetes can occur at other periods of life as well, the primary incidence
of insulin-deficiency diabetes is from childhood through early adulthood, while
type 2 tends to fall in the second half of life. Besides this age difference in
the occurrence of the disease, there is another clinical aspect.
A young man of about 17 has been
recently diagnosed with type 1 diabetes. He is presently preparing for his
abitur exams. For some weeks he has appeared pale
and unwell. He complains of
insatiable
thirst, fatigue and weakness, and has lost approximately 15 kg. The
patient is dark-haired and of gracile body type. Following diagnosis, his
primary care physician has sent him to the hospital for primary care and
insulin regulation (ICT).
The other type of diabetes presents an almost complete contrast: A
55-year-old female teacher, quite overweight, has for decades been in treatment
for diabetes by her primary care physician, most recently due to loss of
efficacy of sulfonurea medication and the need to begin insulin therapy. In
complete contrast to the first patient, she feels energetic and healthy has
trouble accepting the concerns of the physicians regarding regulation of
diabetes and hypertension. She has a strong constitution and appears healthy, with
red cheeks. While she is essentially a sociable and good-natured person, a
streak of emotional impulsivity and instability are unmistakable.
These two typical patients present a polarity which can also be found in
various other illnesses. Corresponding polar images are known in asthma, for
example, where one sees the slender, asthenic patient alongside of the adipose
one. This contrast also appears in “pale” and “red” hypertension. It is the
disease polarity that reflects a dominance of
the upper or lower pole of the human organization and can be described
as the neurasthenic or hysterical disease type (in clear distinction from
psychiatric terminology).
Lab results on both types of patients reveal pathologically elevated
glucose levels, and in some instances equally pathological HbA1c. Contemplating
the further phenomenology, one views the full span that makes up this polarity.
In the area of the life organization, there is the frailty and cachexia of the
type 1 patient over against the vital appearance of the adipose type 2. In the
feeling life one frequently encounters the contrast between a wakeful psyche
that may be exhausted and overtaxed by consciousness, versus an emotionally
oriented and sometimes impulsive dynamic. In the first case, the individuality
is threatened by a lack of strength for its development,
in the second by an emotional dynamic frequently experienced as
overwhelming.The patho-phenomenology outlined above provides a basis for
venturing a comprehensive picture of diabetes.
On the physical plane, our attention is drawn on the one hand to the
pancreas organization and on the other to the peripheral phenomena of insulin
resistance, which have now been clearly determined, partly in connection with
the musculature. The new classification of diabetes adopted by the American
Diabetes Association (ADA) and by the WHO in 1997, which supplants the
preceding one, recognizes this polarity in that it contrasts ß-cell destruction
(type 1) with insulin resistance (type 2) accompanied by insulin deficiency
(usually relative, less often absolute).
4. Type 1 and Type 2 Diabetes
mellitus
In its various forms, the disease picture of diabetes mellitus points
with particular clarity to the three-fold human organism. Thus, the primary
phenomenology for which the disease was named is situated in the metabolic
realm. On another plane, the rhythmic system is affected in a variety of ways,
ultimately extending to atherosclerotic alterations of the vascular system,
which is particularly informed by rhythmic processuality. Finally, there are
the unmistakable alterations in the nervous system and sensory organization.
The predominant age of manifestation is a clear initial indicator,
falling as it does either in youth or in adulthood. The other forms of the illness
will not be discussed in this connection. Childhood is the age of predominance
of the nerve-sense organization; hence at this age we encounter type 1
diabetes, whose clinical picture clearly reveals the predominance of the upper
pole. In temporal succession to the infantile dominance of the nerve-sense
system comes the development of the metabolic-limb system. As we shall
elaborate below, at this point the essential phenomena of type 2 diabetes
manifests themselves as a disease picture in which the metabolic-limb system
takes center stage.
A cause for concern is the apparently increasing frequency of this
“senile” form of diabetes in young patients, some under 20 years old.
4.1 The Development of the Threefold
Human Organism and Type 1 Diabetes
The development of the threefold
organism provides significant support towards understanding type 1 diabetes.
In childhood the entire organism has the gesture of a sense-organ. It
has not yet developed an independent metabolic organization possessing its own
space: “First of all, one needs to recognize that in human childhood,
specifically in the earliest childhood of the human being, the entire
constellation of the three systems is different than in later stages of life.
In childhood we have a human organization in which the nerve-sense organs
penetrate much more intensively into the two other systems than in later life
in the human being. In a sense the child is really all sense-organ”.
Being a sense-organ also means that
the child’s being still lives completely in its surroundings, in the periphery,
and only gradually masters the inner world of its body.
Much as embryonic development
proceeds from the periphery of the developing embryo, which is only gradually
taken hold of in the various processes of invagination,
a similar gesture prevails on the
functional plane in childhood, moving from the periphery towards increasingly
autonomous existence. “When the child is quite young,
all development proceeds from the head. When the change of teeth is
over..., then all development comes from the chest. ... And only when the human
being has become sexually mature does development proceed from the whole human
being, from the limbs” (11: R.S.’s lecture for the workers at the Goetheanum).
Of course this infantile preponderance of the head organization does not imply
a dominance of the forces of consciousness. At this stage these forces still
must remain asleep, to awaken only much later. What we are speaking of are the
formative life forces, which in the infantile organism unfold primarily in the
head and sensory organization, removed from consciousness, and take hold of the
rest of the body only in the further course of development. It is the path from
a sensory system open to the periphery, to the development of an interior
bodily space. The emanation of development from the head organization is
vividly manifested in the changes of bodily form from childhood to adulthood.
The increasing formation of the limb organization is easily recognized,
and a corresponding gesture can be read in the formative metamorphosis of the
skull: Initially, development of the neurocranium dominates, with a small
facial skull and a narrow limb area of the maxilla and (primarily) the
mandibles. Then there is more intense development of this limb-related
organization, which recedes again in later life, particularly in the phase of
old age. This formative metamorphosis quite visibly reflects
the path of incarnation and
excarnation of the spiritual individuality, becoming the outward gesture of an
inner, spiritual process.
The peak incidence of type 1 diabetes between the ages of 14 and 20
_preceded by a clinically undetected phase of disease prior to
manifestation_falls in the period of
human development during which these critical transformations are taking
place in the threefold human organism. If the metabolic-limb organism is not
completely taken hold of in this process, it remains in a comparatively
“infantile” configuration, creating the disposition to type 1diabetes. A
significant signal in this connection is the increased frequency (by approx.
5%) of celiac sprue among type 1 diabetics, which also points to deficient
action in the metabolic organization. Autoimmune thyroid disease, which
is more frequent in the context of type 1 diabetes, points in the same
direction. Also worthy of note in this context is Mauriac Syndrome, described
by Pierre Mauriac in 1930 as a combination of dwarfism, hepatomegaly and
delayed puberty (followed by hypogonadism) in juvenile diabetes. Today this syndrome
is an absolute rarity and certainly
a tragic expression of poor control of the metabolism. It underscores
how short stature entails delayed puberty as a deficient limb-orientation of
the higher bodies (particularly
the astral organization) and thus supports the picture of diabetes that
we have outlined. This places type 1 diabetes in a context that R.S.
characterized as deficient “engagement of the I in the organism,” which
normally takes place in the period between the change of teeth and puberty,
“culminating between the ninth and tenth years”.
Lymphocytic Insulitis
The pancreas, the organ essential to the action of the I organization in
the metabolic system, is abandoned by the action of the upper bodies. As when
any foreign entity appears in the organism, this can become the cause of
inflammation.in this case an autoimmune response in the form of lymphocytic
insulitis. Rather than healing, the inflammation becomes chronic, ultimately
leading to sclerosis and destroying the endocrine system. Of interest in this
connection is the protective inflammation which is supposed to be the
counterpart of a destructive inflammation leading to chronic inflammatory processes
and ultimately to sclerosis of the organ. From the present approach what is
important is not to see the pathogenesis exclusively in terms of the functional
loss of a physically conceived endocrine organ, but to understand this physical
disease manifestation as an expression and a consequence of pathological action
on the part of the higher constituents of the human organization.
Etiological Considerations
On the background of the higher-body constellation in type 1 diabetes,
as we consider the factors contributing to deficient action of the higher
members in the metabolic-limb system we must also take into account the
influences which transform life forces prematurely into forces of consciousness
and thus promote development of the constitution associated with type 1
diabetes. These are influences which either hinder the necessary incarnation of
the higher members in the metabolic-limb organization or cause them
to disengage again after having achieved efficacy in this region of the
three-fold organism.
Of interest in this connection is a Swedish study comparing 338 children
with diabetes to 528 children of a control population to determine the
influence of highly impacting life events such as death of a close relative,
divorce of parents or change of home. The authors found that among 5- 9-year-old
children with diabetes, loss of one parent prior to manifestation of the
disease was more frequently observed than among healthy children. The
difference, however, was quite small, a factor of approx.
Particularly with early manifestations of diabetes, however, the causes
hindering a normal grasping of the metabolic organization may be related to
destiny, stemming from
a distant past in previous earth lives. At the same time the
comparatively minor role played by genetic factors forces us to seek largely
unknown pathogenic factors that may
be inherent in the conditions of present-day child development. In this
context the growing incidence of type 1 diabetes should certainly be a cause
for grave concern, teaching us to pay greater attention to causes lying in the
soul-spiritual “developmental climate.” Thus, excessive transformation of life
forces into consciousness forces is related to later appearance of diabetes
chiefly in adults with a slender constitution (formerly classed as type 2a), as
we shall discuss below.
Prevention
This picture of type 1-diabetes opens the question of prophylaxis for a
disease whose manifestation appears to be promoted by the most various “environmental
factors,”
a disease that appears in twins with a concordance rate of only 36%
(18). What can hinder the action of the higher members in the metabolic
organization? In terms of the picture we have outlined, over-powerful
engagement of the forces of consciousness may be a factor. This is called forth
by non-age-appropriate intellectual taxing of the
child or by violent and frequently repeated emotional upheavals, which
draw the action of the higher members out of the metabolic organization (where
they are removed from consciousness) into the nervous organization. As a
fundamental consideration, this will surely have a bearing on late disease
manifestation and type 2a patients of the old classification (see below). R.S.
speaks in this connection of the damaging effect of excessive memorization and taxing
of the memory forces in children. He speaks in a similar way of the influence
of emotional upsets, which, and this applies to adults as well, “can be
connected to a high degree with the development of diabetes”. These phenomena
will be discussed below in the context of the metabolic syndrome. How relevant
such factors may be to studies pointing to higher incidence of diabetes in low
social status
residential areas remains to be determined. In any case, the significant
role played by non-genetic factors in the development of type 1 diabetes is
clearly demonstrated by its low concordance rate in monozygous twins.
At the same time we are challenged to investigate the largely unknown
factors contributing to the manifestation of diabetes, and the connection
described here may provide orientation. In this regard we must insert a comment
on type 2a diabetes of the old classification. In many of its phenomena, it
displays a polar quality to the type 2 diabetes
to be described below, yet its pathology is close to that of type 1
diabetes, indicating that it must entail a related constellation of the
physical and higher bodies.
The patients affected by this form of the illness, which manifests
primarily in adulthood, are not adipose but frequently of slender body build.
In contrast to adipose diabetics they are not characterized by abundant
vitality, in fact tending to have a rather gaunt aspect. The metamorphosis of
life forces into mental forces is frequently conducive to
a psychological makeup favoring exactness or even pedantry, the kind of
patient who might keep long annotated lists of carefully recorded daily blood
sugar levels.
Thus on the psychological level we
encounter a striking contrast to the adipose diabetic and to patients with
metabolic syndrome, which will now be described.
The question is whether some type 2a diabetics (old nomenclature) might
not be “hidden” type 1 diabetics. Here, R.S.’s indication on overtaxing of the
memory and intellect gains a broader biographical perspective which he saw with
great clarity: “We must develop the ability to enter into the human being in a
soul-spiritual way. Then we will recognize that in a child, around the ninth or
tenth year of life, let us say, the faculty of memory can be called on too much
or, then again, too little. On the other hand,
such inveighing against overtaxing the memory can just as easily lead to
undertaxing it.
In everything the middle road must be found, calling on the memory not too
much, not too little. Imagine that around the ninth, tenth year of a child’s
life we ask too much memory work, we require too much of the memory in
education, in the classroom. The actual consequences will not become apparent
until this person is thirty, forty years old or perhaps even later. At that
point the person will become either a rheumatic or a diabetic.
It is precisely by overtaxing the memory at the wrong time, let us say
between the 9th and 10th years of life, that this
overtaxing of the memory in childhood will later manifest in excessive
deposition of wrong metabolic products. ... On the other hand, if we put the
memory to work too little, failing to ask the child to commit a sufficient
amount to memory, at a later age we are calling forth all manner ofconditions
with a strong tendency to inflammation. To understand how the bodily conditions
at one age can be the consequences of soul-spiritual conditions of another age
of life - that is what is important, that is what we must know”.
4.2 Type 2 Diabetes mellitus and the
Metabolic Syndrome
In recent years the significance of what is known as the metabolic
syndrome in the development of diabetes has become clearer. The term refers to
a constellation of insulin resistance, hyperinsulinemia, hypertriglyceridemia,
arterial hypertension and abdominal adiposity. Additional findings associated
with this constellation make metabolic syndrome an extremely complex disease
picture. This illness, which already displays insulin resistance, is assumed to
transition through impaired glucose tolerance into
type 2b diabetes mellitus of the old classification.
Metabolic Syndrome
What picture can be developed of metabolic syndrome? To begin with one
can contemplate the phenomenon of insulin resistance. When this is present,
more insulin is needed on target tissue in order to achieve an insulin action
than on non-insulin-resistant tissue. Applied to glucose, insulin resistance
can be interpreted as a glucose absorption disorder. In addition to the liver
and sites such as the fatty tissue, this phenomenon is encountered in the
skeletal musculature of the human being, i.e. in the movement organization.
This in itself makes it possible to link a discussion of metabolic syndrome to
inner aspects of the human being. What are the peculiarities of the will, which
creates an instrument for itself in the movement organization; and what is the
significance of movement in which the will expresses itself? Here it is of
special interest to note that insulin sensitivity can be markedly improved by
movement. In a monitored movement program, a significant decrease in insulin
resistance was evidenced.
Furthermore it could be “very convincingly demonstrated that regular
physical training can in fact prevent later occurrence of type 2 diabetes”. If,
in describing this syndrome, our attention turns to the inner human being, the
following picture of metabolic syndrome may result:
When the human will adequately takes hold of the metabolic and limb
organization, there is no disorder of insulin sensitivity and thus no disorder
in glucose absorption by
the musculature. When its efficacy in the movement organization is
inadequate, insulin resistance develops. In the context of an inadequate limb
impulse, adiposity (primarily abdominal) may develop, since the “consuming power”
of the limbs is too small.
Alongside of primary insulin resistance secondary forms can be
distinguished. Of interest in this connection is insulin resistance in
hyperthyroidism, with its psychological orientation towards consciousness and
tendency to restriction of the limb sphere to the point of possible thyrotoxic
myopathy. The astral body and the I also withdraw from the movement
organization, making their presence felt as restless, tormenting forces of
consciousness. In the case of cirrhosis of the liver, sclerotic disease in the
metabolic system impedes the action of the higher members, resulting in insulin
resistance. A revealing point of comparison in this connection is with
pregnancy: Here too the higher levels of the human organization withdraw to
make room for the development of new life. In this situation, what could be
called a physiological insulin resistance arises.
This casts light on gestational diabetes. In parenteral feeding as well,
the higher bodies dissociate themselves from active engagement in the digestive
tract and insulin resistance is observed. Yet another example of dissociation
of the astral body and I organization is the rising insulin resistance of
advanced age, paralleling the excarnation
of the self.
With the withdrawal of activity from the limbs, associated with
metabolic syndrome we observe the development of a fat metabolism disorder that
is susceptible to movement-dependent influence.
Now that a differentiated phenomenology has been developed for metabolic
syndrome, at first identified merely as group of four factors, it has become
possible to follow the constellation of the higher bodies exactly in regularly
diagnosed changes in fat metabolism. In the process, we recognize a conceptual
sphere embracing the spiritual and physical at once.
Dyslipoproteinemia, < by lack of movement, leads to an
“atherosclerotic” constellation. The higher bodies increasingly withdraw from
the metabolic-limb organization and push towards awakening, i.e. towards the
upper pole. Other phenomena of insulin resistance point in this direction as
well. High insulin levels are associated in certain conditions with increased
activity of the sympathicus, which accompanies awakening. Any orientation
towards consciousness is organically accompanied by a tendency to over-forming
and solidification as a functional sclerotic gesture. Significant in this
connection is the depressed EDRF production that has been linked to insulin
resistance, which may point to restricted vascular dilation, thus making it one
of the most discrete describable signs we have of over-forming and hardening in
the vascular system. Likewise pointing in the direction of sclerosis are the
frequently elevated fibrinogen levels in metabolic syndrome and numerous other hypercoagulation phenomena associated with
them. Thus the withdrawal of the metabolic-movement impulse is accompanied by
an increasingly apparent tendency to sclerosis and hardening.
This is also corroborated by the observation that lack of movement is
linked with an elevation of plasma viscosity and erythrocyte aggregation. The
tendency begins in scarcely detectible phenomena of endothelial dysfunction and
continues more openly in hypercoagulation, finally becoming manifest in changes
in the vascular walls potentially reaching the stage of calcifying
arteriosclerosis.
It is the same disease process whose signature can be read to varying
degrees in the blood and the vascular organization. The sclerotic quality that
we have identified is also found in other areas of the metabolic organization.
For example, the formation of cholesterol gall stones is more frequently
observed in this context.
Changes in Soul Life
The emotional life of patients with metabolic syndrome frequently
exhibits an excitability and impulsivity that may reach the point of emotional
instability. It would seem that the soul dynamic which normally expresses
itself in movement of the limb system, turns_when it leaves it, towards
consciousness, entering the realm of feelings and emotions as a highly
excitable psychic life. RR values showing a rapid rise in moments of emotional
tension and declining significantly moments later belong to this picture as
well. They cast further light on the characteristic hypertension of metabolic
syndrome, which accompanies this disease picture from early on, quite in
contrast to generally normotensive type 1 diabetes. In a study by Sung et al.
(29), mental stress caused a greater increase in systolic and diastolic blood
pressure in insulin-resistant women than in a non-insulin-resistant control
group. One is left with the impression that as astral activity lifts out of the
metabolic-limb organization and moves toward the upper pole, manifested in an
excitable emotional life, it does not encounter commensurate forces of peace,
level-headedness and structuring as qualities of the human I. This inherent
will power of the individuality appears incapable of adequate efficacy. The
I-organization engages insufficiently in the metabolic-limb system. Recent
studies of metabolic syndrome have found visceral obesity associated with
hypersensitivity of the hypothalamus-pituitary-adrenal-axis; increased cortisol
secretion was observed within the daily rhythm. The adrenal glands are thought
to secrete increased amounts of cortisol following ACTH stimulation.
Furthermore, increased cortisol secretion was found in physical and
psychological stress tests on patients with metabolic syndrome. Acute stress
situations and poor stress management are associated with an activation of this
endocrine axis. Chronic stress is thought to lead to a marked activation.
Patients with metabolic syndrome often answer “yes” to the question after the
stress test, complaining of states of anxiety, depression, sleeplessness and
nightmares.
Body shape, soul life and the
guiding power of the I
Adiposity can be described in terms of various aspects of fat
distribution and body shape and has been categorized accordingly (increased
total body fat, increased abdominal fat, increased deposits of visceral fat and
increased gluteal-femoral fat tissue (30)). An essential relationship to soul
life becomes evident here. In the study conducted by von Lapidus et al. (31), central
adiposity (waist/hip ratio or WHR) in women revealed a positive correlation
with the feeling of stress, sleeplessness and use of tranquilizers and
antidepressants. In contrast, no corresponding connection to BMI (body mass
index) could be determined. In fact, a negative correlation to the feeling of
stress, sleeplessness and pill use was found. In central adiposity we are
dealing with a wakeful orientation of the psyche described as chronic arousal.
The psyche tends less inwards than outwards, less towards introversion than
towards extroversion. In generalized adiposity the astral body remains
connected with the organism and does not yet dissociate from it.
In central adiposity, however, the dissociation is evident: The rather
slender extremities along with the changes associated with metabolic syndrome
and type 2 diabetes point towards withdrawal of the limb quality. The astral
body separates out of the lower pole of the organization and its dynamic pushes
towards a state of psychic awakeness, i.e. towards the mid and upper human
organization. The more frequent appearance of “hectic spots” on the upper
thorax, neck and face may be a bodily manifestation of this; similarly,
quickness to tears at emotional moments and difficulty controlling them point to
glandular activity of the metabolic system in the domain of the sense
organization. Another phenomenon variously described in this context (32) is
that of inadequate coping skills in stressful situations and the feeling of
“losing control.” The I manifestly lacks the power to direct the overwhelming
astral dynamic. Following the lead of Björntorp, Moyer et al. come to the
conclusion that “WHR might be a somatic indicator of uncontrollable
psychosocial handicaps and poor coping skills” (33). There is inadequate
forming power on the part of the I; the mind imposes too little structure on
the feeling and will life. Comparatively speaking, too little structuring power
is evident in the soul life. This type of inner constitution was described as
early as 1920 by R.S. whose description
is quoted below. In the physical body, deficient inner structuring power is
associated with a constitution conducive to the rounded forms that appear both
in the form of central adiposity and also in the face_once again, an
illustration of a diminishing formative and structuring quality in the human
body. It was in this context_specifically, in discussing a constitutional
tendency to obesity associated with an inflammatory symptom complex, that
Rudolf Steiner spoke of a “disintegration”
of the structural framework in-formed in the body by the I. As this
framework bears an inner relation to the process of sight (34), this casts
further light on the involvement of the eyes in diabetes mellitus (see below).
Waking and Sleeping in Type 2
Diabetes mellitus
As the excited astral organization is freed from the lower pole and
pushes towards the mid and upper organization, it is accompanied by an
activation of the sympathetic nervous system. In the early stages of diabetes,
with the onset of sleep the astral body may be freed of the restless
wakefulness of its day-life and enter into a night-time constellation. The
observations of patients with metabolic syndrome mentioned above, however,
point towards possible sleep disorders even at this stage of the illness.
With the release of the astral body there is a decrease in blood
pressure, which is dependant on the waking state; activity of the sympathetic
nervous system diminishes and hemoconcentration also decreases slightly. In
their study of type 2 patients with diabetic nephropathy, Nielsen et al. (35)
describe some patients with sympathetic activation that persists -
comparatively - in the sleeping prone position relative to the waking prone
position; this is associated with little or no drop in blood pressure, rising
noradrenalin and hematocrit, and unchanged adrenalin. and melatonin. levels.
In patients with essential
hypertension, Pedulla et al. describe severe impairment of sleep architecture
with absence of the night-time dip in pressure (non-dippers).
The sleeping soul-spiritual being evidently does not reach the deep
levels of NREM sleep to nearly the same extent as in healthy sleep. This
“flattened” sleep pattern is characterized by many short episodes of arousal
reactions, which can be understood as abrupt transitions from deeper levels of
NREM sleep to shallower ones or as a transition from REM sleep to waking. The
length of these “arousal reactions,” which are associated with EMG changes
and/or increases in heart and respiratory rate, determines their classification
as arousal (≥1Min.) or microarousal (>3 sec., <1 min.). The study
found that these microarousals were significantly more frequent in all stages
of sleep among hypertensive patients who lacked the nocturnal blood pressure
dip. Taken together, these phenomena point to deficient nocturnal release of
the astral organization. A higher-body configuration retaining a resemblance to
wakefulness persists in sleep and may be associated with sclerotic processes.
In this way the documented pathological relevance of “non-dipping” is
illuminated by spiritual science.
The Activity of the Higher Bodies in
Metabolic Syndrome and Type 2 Diabetes mellitus
In view of what was presented above,
the following characterization of diabetes by Rudolf Steiner appears to apply
to the “prediabetic” metabolic syndrome as well:
“Then again it simply cannot be ignored that with diabetes, to a greater
or lesser extent we are dealing with essentially psychic causes and that
emotional upheavals that
a person goes through, if easily excitable, may be strongly linked to
the arising of diabetes. The I is actually weak, and because it is weak it
tends to restrict its activity to
the periphery of the organism, to the brain through which it develops a
strong intellectualism. But the I is not capable of moving deeper into the
organism, where the actual processing of protein occurs. In its place, the
activity of the astral body enters all the more into those areas that the I
fails to reach.
“Now it so happens that these internal processes, specifically internal
secretory processes, are themselves powerfully linked with the generation of
feeling, with the emotional life. While the I is chiefly occupied with brain
activity, it leaves unattended all activity that is of a secretory nature,
which is essentially an oscillating, circulating activity.
And it is in these circumstances that the human being loses mastery over
certain psychic influences that express themselves as feeling influences.
“When we are active in an one-sidedly intellectual way, out of the
brain, then the inner world makes its own movement. At such moments we are
especially susceptible to inner upheavals, and as a consequence these upheavals
evoke organic processes when they really should be doing something else.
Properly they should not directly evoke organic processes as upheavals acting
on the feeling life; rather, they should be penetrated by the intellect,
mitigated by the understanding before affecting the human being internally.
“For the activity of the astral body is at its most vital where … the
process of the middle organization takes place: between digestion, blood
formation and respiration.
Due to the weakness of the I, this middle organization process is left
to its own resources. It begins to develop all manner of self-willed processes,
not out of the whole human being but out of the middle realm. And one may say
that the disposition towards diabetes is present precisely when the I excludes
itself from the inner processes”.
In summary, we arrive at the following picture of metabolic syndrome as
an illness closely associated with type 2b diabetes mellitus (old
classification): I-organization and astral organization fail to achieve
adequate efficacy in the metabolic-movement system. The astral dynamic in this
area of the threefold organism turns increasingly towards the middle realm of
the human being and may be observed in such phenomena as an excitable emotional
life. Being active peripherally, the I organization does not make its presence
felt sufficiently in the metabolic-limb system and is unable to exert adequate
control over this astral quality.
In this connection there is yet another viewpoint from which to look at
the symptom complex now known as metabolic syndrome. It is the discussion offered
by Rudolf Steiner in the middle chapters of his book Fundamentals of Therapy,
which touches, as early as 1925, on the symptomatology of metabolic syndrome.
In chapter 8 the higher-body constellation of diabetes mellitus is described.
After a section devoted to the connection of the I-organization with sugar, we
read the following formulation: “Everything that pulls the I-organization out
of effective engagement in bodily activity promotes diabetes: upheavals
occurring not singly but in repetition; intellectual overtaxing; hereditary
conditions that hinder normal engagement of the I-organization in the organism
as a whole...”.
It is a telling fact that will-activity in the limb system is capable
not only of lowering insulin resistance but also of preventing later occurrence
of diabetes. Activation of the opposite pole of soul life from consciousness
has a positive impact on pathogenesis and thus points to the link described by
Rudolf Steiner.
Chapter 9 the role of protein is examined and albuminuria is mentioned
as a disease symptom. It too appears in connection with the action of the
I-organization in the metabolic system (pancreas).
Chapter 10 comes to the role of fat
in relation to warmth processes and the I-organization.
Chapter 11, finally, examines the role of uric acid, which also
accompanies metabolic syndrome in the form of hyperuricemia.
Thus in 4 chapters of the fundamental book on anthroposophical medicine,
alongside of a discussion of diabetes mellitus, mention is made of associated
symptomatologies which today are regarded as elements of metabolic syndrome.
This interconnectedness was already recognized in 1925 in a
spiritual-scientific exploration of the action of the
I-organization.
Sensory Function in the Metabolic
System
The characteristics of muscular insulin resistance are consistent with
the withdrawal of the astral body and I-organization from the limb system. A
complementary picture
is found in hepatic insulin resistance and the deficient inhibition of
gluconeogensis/glycogenolysis associated with it. When glucose is introduced
through food intake or released when the digestive tract breaks down food to
overcome its foreign qualities, in healthy individuals there is a decrease in
hepatic glucose release in response to insulin as well as in response to the
elevated glucose concentration itself. In an oral glucose tolerance test, a
reduction of glucose production to approximately one half of the initial value
is observed. The reduction reaches its maximum after 90 – 120 minutes and
affects equally gluconeogenesis and glycolysis (39). The organism reacts with a
sensory perception on a level far below the threshold of waking consciousness,
and with the metabolic readjustment described it “makes room” for the glucose
to be assimilated.
In diabetes this perceptual capacity dwindles. At this point the
I-organization is not only inadequately effective in the limb region, but one
of the sensory processes maintained by it in the metabolic system has also
become “blind.”
5. Diabetes mellitus – Pathological
Manifestations in the Threefold Organism
5.1 Metabolic and Movement
Organization
In advanced diabetes the pathological manifestations bear the same
signature, but now they have shifted from the functional to the organic plane.
Peripheral arterial occlusive disease, which develops at this stage of
diabetes, affects the limb system by restricting the capacity for movement.
Further aggravation of this condition can result from the various diabetic
neuropathies. In addition there are the skeletal alterations, the limited joint
mobility, and of course the comprehensive picture of the diabetic foot. In
place of a movement organization, what develops are phenomena of sclerosis_a
visible sign of deficient efficacy of the will.
Diabetic Foot Syndrome
A characteristic result of diabetes in the limb system is the diabetic
foot syndrome. In the current view, its etiopathogenesis entails neuropathic or
ischemic factors, or a combination of the two, making it a pathological entity
of blood and nerve.
The reductions of sensory functioning that may accompany the diabetic
foot point to dwindling efficacy of the I-organization. Similarly, the
reduction of pain perception
and sensitivity, as aspects of awareness, points to the progressive
withdrawal of the astral organization. Accordingly, part of the syndrome of
diabetic foot is believed to
be a muscular dysfunction characterized by an imbalance in the muscular
equilibrium between agonists and antagonists in the lower leg and foot,
followed by muscular atrophy. It is a physical image of the atrophy of the
astrally-controlled movement organization. Commonly observed and consistent
with this image are loss of elasticity and increased stiffness of the joints of
the hands and feet, a cheiroarthropathy which affects more than 40% of patients
with a long history of diabetes.
The neurotrophic lesions, the poor healing of rhagades or fissures
resulting from skin dryness due to decreased perspiration, as well as the
susceptibility to infections all point to a weakened etheric organization.
On the physical level, callus formation and in some cases thickening of
the nail plate are examples of sclerotic phenomena. Foot statics succumb to
gravity (with possible collapse of the entire arch, Charcot deformity),
resulting in pressure sores with subsequent corns, under which ulcers finally
form.
The osteoarthropathy characteristic
of diabetes mellitus has various causes: In addition to mechanical factors
causing the foot to succumb to gravity, a role is also played
by nutritional aspects related to restricted circulation and by
neuropathic factors associated with the dysbalance described above in the
movement organization of the foot. Infections, as inflammatory processes,
further aggravate the complex process. If the disease progresses, the resulting
flat-footedness can ultimately develop into a “rocker foot” with the middle of
the sole bearing the maximal weight. At this point the three-foldness of the
human gait has been lost, yielding to the forces of gravity. Tactile sense perception
in walking is associated with the front part of the foot; here the nerve-sense
system has created an organ of its function. Thus children frequently go on
tiptoe when they are learning to walk, as their bodily form is largely
determined by the nerve-sense system. The heel, in contrast, bears the will
quality inherent in setting down the foot. These two areas are mediated by the
arch of the foot, which, at advanced stages of diabetic foot syndrome,
collapses: In the form-language of the altered foot skeleton, this reveals an
unimpeded action of the forces of gravity.
Diabetes and the Metabolic
Organization
The withdrawal of limb activity in diabetes is linked with corresponding
restrictions in the metabolic area as well. Much like the insulin resistance of
the skeletal muscles, there is a hepatic insulin resistance that shows a clear
correspondence to the fasting blood sugar level. An incipient sclerosis of the
liver_cirrhosis_is frequently associated with the diabetic metabolism. In this
connection the term “hepatogenic diabetes” was coined quite early on, and an
insulin resistance was doubtless also later described. Action of the higher
bodies in the metabolic system is inadequate.
Action of the sentient organization
is expressed in the intestinal movement system. The fact that it is dependent
on waking and sleeping and that muscular contraction
(e.g. in the gall bladder) is triggered by the dimly-sensed food
stimulus is clear evidence of astral activity. A phenomenon associated with
steatosis hepatis (fatty liver) is reduced gall bladder contractility, an
expression of inadequate action of the higher bodies in the movement
organization. In diabetes too, corroborating the picture developed here, one
finds diminished contraction of the gall bladder after stimulation. This
contraction and emptying disorder is considered characteristic of the diabetic
gall bladder. Steatosis hepatis is a fairly regular finding, distinguished
sonographically as “white” liver. It develops in the context of the higher body
constellation described above, in which there is inadequate action of the
higher bodies in the metabolic organization. As R.S. put it in a lecture to the
workers at the Goetheanum, “...if ... the astral body
always remained outside as it does in sleep, then our organs would very
soon become fatty”. In response to this unphysiological activity of the higher
bodies there is an inflammatory reaction. The acronym NASH (nonalcoholic
steatohepatitis) describes this quality, which arises in the form of chronic
inflammation and then, under excessive forming by the nerve-sense system, leads
to a disease process in the form of sclerosis (fibrosis). Numerous alterations
of a similar quality in the gastrointestinal movement organization have been
described. Interestingly, the symptom picture of bloating, nausea, heartburn
and constipation or diarrhea, in comparison with a control group, was found
more frequently in type 2 diabetes than in type1 diabetes (earlier
nomenclature). In the esophagus, a decrease in contraction amplitude, increased
(tertiary) contractions, multi-peaked peristaltic contractions and decreased
pressure in the lower esophageal sphincter are found. Scintigraphic assessment
reveals a delay in esophageal transit time in 40% – 80% of diabetics. Gastric
motility disorders frequently entail antral hypomotility and periods of
frequent tonic-phasic contractions of the pylorus. In contrast to the
air-filled fundus cupola, which remains unmoving in peristalsis and bears a
relationship to the nerve-sense system, the antrum with motility “mill”
represents the movement system of the stomach: Its rhythmical action is that of
a rhythmic system mediating between polarities. When the sentient organization
withdraws from this movement system, it leaves behind antral hypomotility and
awakens in such complaints as nausea and postprandial bloating. As the
intensity of movement recedes, “consciousness” arises at the wrong place.
Independent of any diabetic alterations, simply an elevated blood sugar level
is believed to delay gastric emptying. A comparable higher-body constellation
is found in the small intestine. Here one observes hypomotility with reduced
phasic contraction and nonpropagated, long-duration groups of contractions. In
regard to the colon no significant diabetes-specific alterations have been
described.
5.2 Rhythmic System
In the middle realm of the human being and rhythmic system, sclerotic
phenomena are found as well. It has long been known that diabetics develop
arteriosclerotic vascular alterations earlier and more frequently than
non-diabetics. Even at the time of diagnosis a high percentage of diabetics
show vascular alterations. As was mentioned above,
in diabetes the sclerosis of the vascular system is localized at the
extremities, i.e. peripherally. It affects chiefly the lower limbs and, in
contrast to non-diabetic arteriosclerosis, it is distributed not segmentally
but diffusely over the peripheral vascular segments of the limbs, coronaries
and cerebral arteries. The histological picture incl. formation of intima
plaques, in certain circumstances diffuse intimal fibrosis and the Mönckeberg’s
medial sclerosis typical of diabetes. The blood displays a corresponding
quality of functional sclerosis: the phenomena of hypercoagulability. Elevated
fibrinogen levels are observed, and along with them increased blood viscosity.
Diabetics are also said
to have higher concentrations of factor 5/8 and reduced levels of
proteins C and S in comparison to non-diabetics. Fibrinolytic activity is
decreased due to high levels of plasminogen activator inhibitor. In addition,
elevated thrombocyte aggregability and increased platelet adhesion have been
described. Possibly connected with this is the higher number of large and
activated thrombocyte forms found in diabetics.
Also in regard to the endothelial dysfunction favored by diabetes, we
note a shift in the interplay between forming/hardening and dissolving/dynamic
processes, still almost on the functional plane, to reflect a dominance of the
nerve-sense system. Here primarily constrictive qualities (endothelin,
angiotensin II, noradrenaline) are encountered alongside of reduced dilative
qualities (esp. NO). The spiritual-scientific significance of nitrogen has been
discussed at another place. The collective action of antimonizing and
albuminizing forces described by Rudolf Steiner has shifted in favor of the
antimonizing principle. From the macroscopically describable plaques and
procoagulatory state to the endothelial dysfunction, we encounter gradations of
the same sclerosing principle. These phenomena exemplify perfectly how the
human power of “judgment through intuitive perception” is capable of
recognizing what is acting spiritually in the phenomena described by science.
Another indicator of the impairment of the rhythmic organization as
mediator between the polarities of the nerve-sense system and the
metabolic-limb system is the limitation of pulsatile insulin secretion. Thus,
healthy individuals receiving intermittent doses of glucose show insulin oscillations
of larger amplitude than patients with type 2 diabetes. Here, the capacity for
rhythmic oscillation appears to become restricted.
This background casts a particular light on insulin therapy, whose
implementation can only be crude and rigid when compared with natural insulin
oscillations. For all that
is positive and necessary about regulation of the glucose metabolism in
the diabetic, its manner of application introduces a therapeutic principle that
is rigid and incapable
of rhythmic oscillation.
In the heart too a sclerotic illness is described which may be distinct
from macroangiopathy and is in some cases designated as diabetic
cardiomyopathy. A disorder of diastolic relaxation and compliance is found, and
frequently also an aggravated left-ventricular hypertrophy connected with the
associated hypertension. The rate rigidity of the rhythmic system of the heart
is significant as a phenomenon of sclerosis in the middle organization. At
elevated heart rates, the respiratory sinus arrhythmia is limited or
eliminated. This phenomenon is characteristic of a number of other sclerotic
diseases of the blood vascular system such as coronary heart disease and
hypertension, and is associated with a clustered incidence of sudden heart
death. Essentially, one may say that the middle organization becomes
excessively informed by the sclerotic qualities of the nerve-sense system.
Precisely with type 2-diabetes, arterial hypertension is an essential
factor for prognosis and once again points towards the sclerotic and hardening
quality. At the same time, arterial hypertension manifests a polar picture. The
slender hypertensive contrasts with the adipose patient in terms of the
polarity of the neurasthenic and hysterical constitutions. Formerly these two
disease pictures were contrasted as “pale” and “red” hypertension. The
neurasthenic form of the disease is characterized by the excessively forming
action of the astral body that is characteristic of the upper pole, while the
“hysterical” form is dominated by the type of astral dynamic found in metabolic
syndrome.
5.3 Nerve-Sense System
The Eye and Diabetes – The Kidney
and Diabetes
In the sensory sphere of the upper pole, the sense of sight is primarily
affected. This includes all three areas of the eye organ's threefold structure:
In the anterior section we find the cataract associated with diabetes. The iris
may be affected by neovascularization (rubeosis iridis), ultimately leading to
neovascular glaucoma. Finally, there is the critical phenomenon of diabetic
retinopathy.
A glance at the sensory organization will provide an essential picture
of its background. In contrast to the spherically encased central nervous
system, the bony cavity of the orbita opens outward in an encompassing gesture.
If it can be said that the skull cap envelops the nervous organization, then
the orbita embraces a paired sensory organ whose twelve ocular muscles make
obvious its connection to the movement organization. The sense organs are sites
of a perceiving will-activity which - here - meets itself in the experience of
sight. Will-quality in the sense organization and thought-quality in the
nervous system are juxtaposed here. Compared with the sleeping will of the
limbs, in the upper pole will-activity is closer to consciousness. When the will
organization withdraws - ocular muscle paresis is more common among diabetics
than among non-diabetics - sensory perception wanes and sclerotic processes
develop in an organ which, in its essential nature, is close to an inflammatory
process.
Diabetic Nephropathy
The kidney organization is mentioned at this point for two reasons: On
the one hand numerous phenomena, such as its symmetrical formative principle,
manifest its connection to the upper organization; and on the other hand, in
diabetes the kidneys and eyes are frequently involved at the same time.
Involvement of the kidneys in diabetes is associated with various disease
processes. Among a number of other manifestations of renal disease, the
glomerular area of the kidney is particularly affected. In terms of threefold
organization, this bears a metamorphic relationship to the nerve-sense system.
Rudolf Steiner points towards a connection between the kidneys and the eye
organization. During sleep, structuring processes flow out of the eye
organization and the entire head into the organism. “Let us take the example of
the eye. In it we have
not only the organization that mediates vision, but at the same time we
have in the eye an image of the cosmos, an image of the spiritual forces of the
cosmos. In the period between death and birth, the human being has lived in the
soul-spiritual cosmos. The eye organization is modeled on this life in the
soul-spiritual cosmos. The eye, like all organs of the head, has a dual
function: The first is to mediate a correspondence with the external world
through vision, and this takes place during our waking life.
During our sleep life the eye, along with its environment - its nerve
and blood environment particularly - acts back on the physical organism,
specifically the metabolic-limb organism. For example, during sleep the forces
of the closed eye act on the human kidney system and imprint it with the cosmic
image. Other organs of the head imprint other aspects of the cosmos into the
metabolic-limb system. Thus from the point view of the physical body we have
our period of sleep primarily so that the head forces can exert their
structuring action on the metabolic-limb organization”.
Diabetic nephropathy occurs in both
type 1 and type 2 diabetes.
In the early phase of diabetic nephropathy there is increased blood flow
and - with increased intraglomerular pressure - considerable increase in
glomerular filtration.
In patients with type 2 diabetes there is said to be an initial
hyperfiltration that is less manifest. At this stage the organ is frequently
enlarged. As the disease progresses we observe the development of
glomerulosclerosis: The astral organization, with its characteristic dependency
on waking and sleep, changes the way it acts in the excretory and filtration
processes, reaching a “head-like” constellation typical of the upper pole and
associated with sclerosis. In the context of nephropathy it is possible for
arterial hypertension to develop, revealing a further peculiarity of the two
polar forms of diabetes: Type 1 diabetes gives rise to a hypertensive disorder
only late in its course, in part due to an excessively formative quality of the
upper pole, while type 2 diabetes, with its long history, develops hypertension
quite early as a result of an astral dynamic belonging to the lower pole.
Autonomic Neuropathy
From among the manifestations of the
disease in the nervous system we shall focus on autonomic neuropathy.
The sympathetic nervous system is associated with a predominantly
catabolic dynamic which is oriented towards awakening, i.e. towards the upper
pole. Analogous to the threefold human organism, an activation of the
sympathetic nervous system is associated with a threefold phenomenology: In the
gastrointestinal tract we see sphincter contraction and reduced secretion; in
the middle region, bronchodilatation with tachycardia; and in upper pole,
mydriasis and awakening of consciousness. It is a picture of
the astral organization
progressively withdrawing from the metabolic system and pushing towards the
upper pole.
The parasympathetic quality, in contrast, is dominant in sleep. In the
upper pole it is associated with miosis, in the middle region with
bronchoconstriction and bradycardic heart rate, and in the gastrointestinal
tract with the generation of gastrointestinal motility and secretion. In the
first case, the inner being shifts its orientation from the metabolic system to
the awakening of consciousness. In the second, the upper pole of the human
being falls asleep. Now the orientation is towards the metabolic system with
increased gastrointestinal glandular secretion and motility. Rhythmic phenomena
accompany the interplay of these two orientations of the inner being. We
encounter this breathing rhythm once again in the respiratory sinus arrhythmia.
With each in-breath the higher bodies adopt their orientation towards
consciousness, accompanied by sympathicotonic dominance. With each out-breath a
parasympathicotonic dominance arises with the nocturnal metabolic orientation
of the inner being. In the entire span of the day, this breathing rhythm recurs
in the alternation of waking consciousness and sleep.
In the context of diabetic autonomic
neuropathy, what we find is restricted intestinal motility (see above), which
points towards a deficient parasympathetic quality.
In the rhythmic system we observe restriction of the respiratory sinus
arrhythmia, which - in the context of the cardiac autonomic neuropathy - is
followed or accompanied
by tachycardic heart rate. There are indications that the
parasympathetic fibers are first affected by the neuropathy. Thus here too, the
higher-body orientation associated with the parasympathetic nervous system
withdraws far from consciousness into the night realm, while there is a
relative dominance of the sympathetic quality which tends towards an awakening
of consciousness.
Diabetic Polyneuropathy
Patients with diabetic
polyneuropathy frequently complain of paresthesia and pain in the feet.
Alongside of these “positive” symptoms indicative of an awakening of
consciousness qualities in the “wrong place,” there are also the negative
symptoms - sometimes more frequent - of reduced sensitivity and reduced
perception of pain and warmth. The astral body, normally active in movement of
the limb system, withdraws from its physiological activity in this
will-organization and may awaken in pathological awareness qualities. Deficient
activity on its part can ultimately lead to the flaccid paresis of diabetic
polyneuropathy. Here, pain and paralysis manifest their special connection. It
becomes evident that the primary phenomenon is the inadequate astral action,
while its manifestation in the peripheral nervous system is a “consequence.”
Thus when all the phenomena
described above are taken together one arrives at a picture of diabetes in
which the higher bodies withdraw from the metabolic-limb system and orient
themselves towards the upper, consciousness-bearing pole of the human
organization. The balance in the soul’s breathing rhythm of waking and sleep is
shifted towards the consciousness pole.
6. The Sclerosis Process in Type 1
and Type 2 Diabetes
Diabetes mellitus type 1 and type 2
both develop a sclerosis that affects the entire threefold organism, but the
two have differing etiologies: In type 1 diabetes it is the dominance of the
upper pole. The picture in the adipose type 2 diabetic must be distinguished
from this: Here we find inadequate will-activity of the I-organization in the
movement organization. Movement is coupled with an essentially related quality:
that of inflammation.
Sclerosis and Inflammation
The course of an inflammation
entails phases of heat generation, increased blood flow (vascular phase),
secretion (exudation), cellular movement (migration) and catabolic metabolism
occurring in an acidic milieu. The metabolism of movement displays similar
characteristics in its generation of warmth, increased blood flood, dominance
of movement phenomena and catabolic metabolism - again in an acidic milieu.
Systemically there is a comparable picture. The stress leukocytosis and the
temperature increase have long been known, as has the fact that movement
entails an acute-phase reaction comparable to that of inflammation. From this
point of view all movement leads to a warming process in the organism akin to
inflammation, while in return all inflammation in the human metabolic system
entails movement phenomena (e.g. migration of inflammatory cells). Due to the
inefficacy of the I-organization in the movement and metabolic system in
diabetes mellitus type 2, we observe a waning of the inflammation-related
quality, resulting in a favorable environment for development of the hardening
disease entity, sclerosis.
Thus one can contemplate
characteristic manifestations of the sclerotic process in terms of the
threefold human organism. In the upper pole with its dominance of the
nerve-sense system, cerebro-vascular insufficiency is observed, with its
possible consequence of cerebral insult. In the middle region the manifestation
is coronary heart disease, while in the lower man it is peripheral arterial
occlusive disease. The decisive element in sclerotic pathology of the upper
pole appears to be the hyper-formative action of the nervous system, while in
the limb organization the inefficacy of warming will-activity appears more
significant (Fig. 3). On the soul plane, an excessively structured mental life
that is insufficiently warmed by will activity in the thinking may be
associated with cerebral vascular sclerosis, while in the limbs the tendency to
vascular sclerosis is favored by inadequate engagement of the will. Coronary
heart disease may be associated with an excessively structured and in some
cases congested emotional life as well as with a restless, excessively aroused
and wakeful soul life.
Regarding the various risk factor
constellations, this differentiated picture based on the threefold organization
casts a significant light on what might otherwise appear to be a uniform
disease picture of arteriosclerosis. Thus, a large meta-analysis of 420,000
patients conclusively demonstrated the relationship between the height of the
diastolic blood pressure and the frequency of stroke. Isolated systolic
hypertension also represents a risk factor. This sclerosing vascular disease
appears to contrast with arteriosclerosis of the limb system. According to
Salonen et al., the severity and extent of autoptically determined
arteriosclerotic lesions is very similar in the coronary arteries and the
extracranial vascular system, while correlation with the arterial periphery is
weak. Like elevated LDL cholesterol levels, arterial (systolic) hypertension,
though a highly significant risk factor in cerebrovascular disease, appears to
play “a rather minor role” (see above) in peripheral arterial occlusive
disease. On the other hand, diabetes mellitus as a disease of the will
organization plays a critical role in its clinical manifestation. It leads to
macroangiopathy of the limbs, which manifests strikingly in the peripheral
sections of the leg arteries.
Mönckeberg's Arteriosclerosis
As a contrasting phenomenon,
atherosclerosis affects primarily the intima of the arteries. This is the area
of the vascular wall in direct proximity to the blood, the site of metabolic
processes which make possible the awakening of a (largely unconscious) tactile
sense and perception of the shear forces of the vascular wall. Mönckeberg's
arteriosclerosis, on the other hand, affects the muscular organization of the
media which borders on the adventitia, whose encapsulation of the artery
suggests comparison with the skull capsule. Mediating between the vascular
realm (akin to the blood and sensitive to its movement quality) and the
adventitia (tending towards structure-forming and composed of connective
tissue) is the media. This disease, first described in 1903 by Mönckeberg, is
characterized by focal to confluent calcifications of the extracellular matrix
of the media. The muscle cells decrease in number and some of them calcify. In
the further course of the disease, formation of typical bone trabeculae is
observed, in
the sense of ectopic ossification. In contrast to atherosclerosis, lipid
deposition and macrophages are absent. A disease frequently associated with
diabetic polyneuropathy,
it offers an archetypal example of the essential character of
pathological processes as described by R.S.: A process that is physiologic in
the human organism (in this case bone formation) becomes pathological when it
occurs at the wrong place. Osseous encapsulation, a physiological process for the
head organization, appears as a “second skeleton” in the vascular realm. In
this disease process the ideal, balanced metamorphosis between muscle and bone
(Rudolf Steiner, see above) shifts towards bone formation. Contrastingly, in
intimal atherosclerosis the sclerosis is not directly caused by the bone
forming process, but by the chronic inflammation. Thus in the case of
atherosclerosis of the intima - a vascular area closely connected to the
metabolic system - the shifting of the balance towards the nerve-sense system
is answered with chronic inflammation - i.e. a reaction form of the
metabolic-limb system - which ultimately leads to sclerosis. In Mönckeberg's
sclerosis, on the other hand, a hardening quality belonging to the nerve-sense
system - the upper pole of the organization - directly causes the medial
sclerosis in the form of ectopic ossification.
The anthroposophical perspective reveals significant meaning in the
sclerotic pathology associated with diabetes: In this condition the individual
is engaged in a struggle with hardening, ahrimanic qualities; and the effect of
the disease
Manifestations of the sclerotic
process in the threefold organism.
Upper Pole - Hardening and Excessive
Structuring
Nerve-Sense - e.g. cholesterol,
hypertension
Organization - cerebro-vascular
insufficiency
Thinking
Middle Sphere
Rhythmic Organization - Coronary
Heart Disease
Feeling
Lower Pole - Peripheral arterial
occlusive Metabolic-Movement - disease
Organization - Reduced will efficacy
Willing - e.g. diabetes mellitus
is to prevent these from gaining
greater power over the human being. Disease, here, appears to be sent by good
powers (52). From this point of view, the rising number of diabetic patients
casts light on the dominant mentality of a civilization that appears to be in
need of this and other diseases as remedies.
7. The Daily Incarnation/Excarnation
Rhythm
An archetypal manifestation of the fluctuating connection of the higher
bodies to the living organism can be observed in the daily phases of waking and
sleep.
A polarity is evident between the morning and evening constellations.
Normally morning is associated with the qualities of refreshment, renewed vigor
and the impulse to be active.
This is one side of it - a very significant side, which points towards
the awakening of the soul out of sleep consciousness. “In sleep the astral body
returns to its home, and upon awakening brings reinvigorated forces to life.
The outward expression of what the astral body brings with it upon awakening is
the refreshment offered by a healthy night's sleep”.
There is, however, another morning quality described by Rudolf Steiner:
sclerosis. Thus, the morning hours are also characterized by the maximum heart
attack frequency
in coronary patients, and the morning stiffness of rheumatics. Impaired
engagement of the astral body may also cause a range of symptoms from morning
exhaustion to the paralyzing morning “low” of the depressive patient.
Similarly, even before waking the vascular system is subject to excessive
forming action with heightened blood pressure. As further indicators of this
hardening quality, fibrinogen and plasminogen activator inhibitor levels rise
(54) and reduced erythrocyte deformability is noted alongside of elevated
hematocrit. In short, the procoagulatory, solidifying qualities predominate in
the morning hours in the phase of incipient awakening. This sclerotic phase is
associated with the minimum core body temperature in man. The process of
morning awakening may be compared to the arsenic process in nature: “What takes
place within the human being may even be called by the name of an external
process that bears what one might call an ‘elective affinity’ to the human
process. For example, if one wishes to express this affinity of the astral body
for the etheric body - and thus also for the physical body - one may quite
rightly speak of it as “arsenization.” In the human being a subtle arsenizing
process is continuously taking place, and it is particularly strong at the
moment of awakening”. Slightly later in the same lecture, Rudolf Steiner offers
a macrocosmic image for the arsenic process: that of the “earth becoming
rock-like.” On a number of occasions Rudolf Steiner mentions the other aspect
of sleep: its mineralizing, sometimes pathogenic quality. Applied to the
sclerotic tendency, this suggests a positive meaning for sleeplessness as a
preventative of sclerotic disease.
On this background, medicinal
induction of sleep also assumes a problematic aspect.
The critical factor for this other
effect of sleep is the duration of the separation of the astral body and I from
the etheric-physical organism. If it lasts too long, the organism grows distant
from its archetypal human form, developing extra-human processes of plant life and
mineral sclerosing. The “persisting capacity” - the capacity to maintain the
signature of the higher bodies in oneself - is the precondition for refreshing
sleep and timely awakening. Sleeping too long - beyond “persisting capacity” -
leads to the processes of sclerosis. In many instances the feelings of malaise
that follow prolonged sleep can be interpreted in this way from a
spiritual-scientific point of view.
In the evening, the polar picture to
this morning sclerotic tendency is observed. In late afternoon the core
temperature reaches its maximum: generation of warmth as opposed to the cool
morning constellation. The procoagulatory quality of morning, with its
increased cardiovascular risk, dwindles as the day progresses towards evening
(e.g. decreasing plasminogen activator inhibitor levels). Thus the sclerotic
morning tendency appears to be balanced against an evening quality more akin to
inflammation in its generation of warmth. Thus in the course of each day a
human being runs through the essential disease spectrum of his earthly
existence. On the soul-spiritual plane, the thought forces are dominant in the
morning, while later in the day the inflammatory constellation is accompanied
by an unfolding of will forces. “The person who has been through esoteric
development will soon discover that such an affinity does exist between his own
etheric body and that which occurs in the external ether, and that he stands
in a different relationship, so to
speak, to the spirits of the morning than to the spirits of the noontime and
those of the evening. The spirits of the morning stimulate us in
such a way that in our etheric body
we feel more stimulated to an activity tending towards the intellect, towards
the reason - more able to think over what has been experienced, more able to
process with the judgment what has been observed in memory. As midday draws on,
these forces of judgment gradually flag and the human being feels the impulses
of the will at work within him. Even if towards noon the ability to perform,
the energy for outer work, begins to grow less than in the morning, inwardly
the will forces are more active. And as evening approaches, this is when the
productive forces enter in - those more connected with imagination”.
In this sense the adipose type
2-diabetes, with its inadequate engagement of the will in the metabolic-limb
system, can be seen as an “impaired” evening constellation.
Type 1-diabetes resembles an
exaggerated morning constellation that persists on awakening and leaves the
metabolic-limb system inadequately engaged.
Interestingly, when the “warmth” of
the evening is contrasted with the “cooler” morning constellation, a number of
phenomena change - if only in their outward exposition. Thus, in warm
environments reduced blood sugar levels are more frequent in type 1 diabetics;
indeed, insulin requirements generally show pronounced temperature-sensitivity.
Temperature dependency has also been described for other sclerotic diseases;
hyperthermia, for example, can produce prolonged reductions in blood pressure.
Diabetes 2b (old classification) is
characterized by inadequate efficacy of the higher members in the
metabolic-limb system, a signature that corresponds to an “impaired” evening
constellation. From this point of view, the course of human life reflects the
polarity of diabetic pathology in its chronological manifestation of juvenile
and senile diabetes. At the same time the course of the day presents a
miniature image of this polarity in the pathological tendencies of the
exaggerated morning constellation and the “impaired,” deficient evening
constellation.
This characterization illuminates
the spectrum of diabetic pathology in the context of the incarnation and
excarnation process, in which the human being enters earthly life
at birth and returns to the
spiritual world at death. Before the insulin era, type 1 diabetes regularly
resulted in early death; left untreated, it hinders incarnation.
The I-organization is unable to
develop adequate engagement in the metabolic organism. Type 2 diabetes shows
the opposite picture: premature withdrawal from the limb
and metabolic organization leading
to hardening and sclerosis - characteristic qualities of the upper pole. Thus sclerosis
offers a particularly striking example of “head development” at an
inappropriate place. To put this connection into a broader context, it is
helpful to contemplate an image which can be developed in connection with
cancer and has been presented by such researchers as B. von Laue. The tendency
to misplaced sense organ formation - the essential picture of cancer - is a
premature manifestation of an archetypal formative gesture described by R.S.: a
physiological metamorphosis of the metabolic organization of one earth life
into the head organization of the following life. A related thought sees the
diabetic’s withdrawing limb organization, with its traits of the upper pole in
the sense of unphysiological head-formation, also as
a premature manifestation of this
great transformation that links one earth life to the next. Thus each disease,
in its spiritual significance, bears a relation to the threshold of the
spiritual world and poses an unmistakable inner task - one which either is
lived out in the destiny of the disease itself or can be taken up by the
patient consciously on the soul-spiritual level. Out of the sclerotic disease
of diabetes an opportunity arises for the developing human being. Every
therapeutic measure must be examined against this background: Will it help or
hinder the patient’s inner being on its next steps of development?
8. Therapeutic Considerations
Diet
Normally, dietetic approaches to
diabetes treatment take calorie intake into consideration, but further
“restrictions” such as flexible insulin management in the framework of an ICT
(intensified conventional insulin therapy) are considered “a thing of the
past.” Quite apart from the points to be presented below, it is interesting to
note that a dietary approach long known to nephrology has been gaining
importance in diabetes treatment:
Protein restriction has long been
practiced in the nutrition of renal insufficiency patients. In his book
Fundamentals of Therapy, Rudolf Steiner develops a particular view of
albuminuria. The condition stems from deficient breakdown of food protein by
the pancreatic organization, leaving untransformed foreign protein which then
undergoes excretion by the astral organization through the kidneys. Dietary
restriction of protein can evidently result in reduced excretion of foreign
protein. A relevant study was conducted in the framework of the
“Prosit-Projekt”2, a program for diabetes patients entailing smoking cessation,
optimized glucose and blood pressure regulation and protein restriction (60 –
80g/day). After a mean period of 14 months, one third of the patients showed an
improved risk profile with normalization of microalbuminuria.
In this way the metabolic efficacy
of the I-organization, restricted in
connection with the pancreatic function in diabetes, receives due consideration
and dietary activation. The vegetable diet, being less closely related to the
human being than animal substance, demands increased metabolic activity.
An astral organization which presses out of the metabolic limb system into
the upper pole of the human organization is connected with a sympathicotonic
functional state.
In this context a vegetable diet will have the effect of calming and
drawing back the over-powerful astral organization. In addition, by favoring
those parts of the plant which are related to the metabolic-limb system (in
terms of the threefold plant), one can strengthen the efficacy of the will in
the body; foods taken from the blossom sphere of the plant are particularly
important for this purpose (see Kühne, Diabetes und Ernährung, p. 54).
Medicinal Therapy
Each illness can be understood as a
task challenging the developing human being and as a reflection of the
individual's particular situation in regard to threshold to the spiritual
world. In this sense a spiritual reality is expressed in it, and encountering
it is quite comparable to encountering an inner task on the path of spiritual
development. When we compare the spiritual reality of a disease in the way that
R.S. was able to describe for smallpox with the level of understanding of
disease which our present-day consciousness is able to attain, it becomes
obvious that the picture we have presented of diabetes - a disease affecting a
great portion of humanity - can be no more than a preliminary sketch.
A great deal will depend on
achieving a deeper understanding of the disease - and this must not be seen as
an exclusively scientific issue. It must be born out of the will to heal. The
more exactly the disease can be described, the more precisely it will be
possible to formulate the question as to the requirements for healing. Out of
the effort to understand, the physician develops insight into the therapeutic
goal and forms a cognitive organ for the curative qualities that match the
question posed by each illness.
The therapeutic goal is to draw the
I-organization from peripheral activity to central engagement in human
organism, i.e. in the metabolic-limb system. We must set about
a task posed by Rudolf Steiner: to
study the therapeutic efficacy of peripherally applied etheric oils, such as
rosemary therapy, which could gain a significance in diabetes treatment
comparable to that of mistletoe in cancer.
Given the inadequate record of
therapy documentation and the dearth of relevant studies to date, if we are now
to present therapeutic approaches outside the scope of regulatory medication
(e.g., insulin substitution), it will be necessary to make a preliminary
methodological remark. Any therapy presupposes a complete understanding of
the disease to be treated. If the
understanding is restricted to the physical level, the therapeutic goal will
consist in correcting a pathology that has been described in biochemical terms
- e.g., insulin substitution. If, on the other hand, the understanding embraces
the essential nature of the disease, the spiritual entity which ultimately
leads to pathology of the sugar metabolism on the physical plane, then the
scope of the task broadens: The therapeutic goals now formulated may point
towards healing forces in the kingdoms of nature as a source of appropriate
remedies. This must be followed by clinical verification. As an example, after
describing the essential character of diabetes Rudolf Steiner pointed to the
resulting therapeutic goal and finally to the oil-forming process. Based on the
essential picture of diabetes, the attempt will be made to formulate resulting
therapeutic aims and relate these to the remedies that have been found
effective in practice. It need hardly be said that this represents only the
initial concept for a project with much development ahead of it.
The problem in diabetes is that the I-organization is “peripherally” active
and inadequately engaged in the metabolism. Hence the task is to draw it in.
This is where the rosemary oil dispersion bath - based on an indication by R.S.
- gains significance.
The rosemary leaf presents two polar
qualities. On the one hand there is the oil forming process, a
sulfuric-phosphoric process extending into the central region of the plant
organization. In the etheric oil, cosmic warmth forms an initial, comparatively
delicate corporeality. In this case the process extends into the leaf region,
which is dominant in these labiates. The form of the leaf, in contrast, speaks
a different language. It is needle-like, pointed and narrow, revealing powerful
forces of form and structure with a thrust towards hardening. As the rosemary
bush ages, the hardening quality becomes evident in its woody stems. One has
the impression that the leaf's life-forces are drawn completely into the oil
forming process, so that they withdraw from their organic vegetative action in
the leaf forming process. Hence the pointed, needle-like shape resulting from
forces of form and hardening. Here we see a direct confrontation of sal and
sulfur processes in the leaf region.
Through the sulfuric-phosphoric
quality of its etheric oil, rosemary draws the
peripherally active I-organization into will-ful engagement in the
metabolic-limb system.
In his notes to first medical
course, Rudolf Steiner also speaks of the function of foot baths and compresses
on the limbs in uniting the lower organization with the I and astral body. This is the background for rosemary therapy in
polyneuropathy.
A variety of corroborating
observations connected with the action of this ancient medicinal plant have
since been described. A significant study in this connection describes the
action of rosemary (and lavender) by the olfactory route - an application
closely connected with the sensory organization. When applied in bath form and
in contact with the skin's sensory sphere, it also provides for the olfactory
perception essential to its therapeutic action. Rosemary increases wakefulness
and reduces drowsiness. The study corroborated this, finding a reduction of
frontal alpha power, an electrophysiological parameter of the nerve-sense
organization.
In the feeling realm, a reduction of
anxiety and emotional tension was observed: a positive change in psychological
phenomena whose description precisely matches those occurring in diabetics.
Many phenomena, supported to various
degrees by studies, point to increased efficacy of the will in the metabolic
and limb organization with use of rosemary.
A number of reports refer to relaxation of the bronchial and intestinal
musculature. By its warming, will-natured action, rosemary supports the higher
members and relaxes muscular hardening caused by excessive engagement of the
nerve-sense system. Its choleretic action points in the same direction. Used
over extended periods it is found to have an ulcer protective action stemming
from its support of mucoprotective factors, not from changes in acid secretion
(62). Excessive action of the nerve-sense system in the gastric organization is
harmonized by rosemary. In addition, a hair growth promoting effect described
by Rudolf Steiner is supported by a study which employed rosemary as well as
lavender, thymus vulgaris and cedrus atlantica.
In another study of patients with “peripheral circulation disorders,”
Rulffs found that a four-week treatment with twice-weekly rosemary oil baths
had a circulation-promoting action exceeding that of baths using only warm
water. Here too, rosemary supports increased will-related engagement of the
I-organization in its instrument, the blood.
Regarding glucose metabolism only a small number of observations are
presently available. While an older study using animals documented a glucose
raising effect of rosemary, a later study based on animal experiments described
a glucose lowering effect.
In summary, rosemary therapy brings
the higher bodies into a strengthened, will-filled and warming engagement of
the kind required in the therapy of diabetes mellitus. As a curative plant,
rosemary condenses the imponderable qualities of light and warmth in its
oil-forming process and absorbs them into its organization. In the human
organism its action is the same: I-organization and astral organization are
strengthened in their organic activity and guided to take hold of the
metabolism and the limbs.
R.S. introduced mistletoe into
cancer therapy. In its essence this illness represents a “misplaced attempt at
sense-organ formation” and thus it is characterized by a specific predominance
of the nerve-sense system. Human sclerotic pathologies also show a predominance
of the nerve-sense system, but instead of causing the sense-organ forming
tendency manifested in cancer, it leads to “head formation” in the form of
sclerotic processes. It is a predominance of the nervous system, in contrast to
one of the sensory system, which characterizes sclerotic disease.
R.S. saw it as an essential
typological quality of mistletoe that its developmental phases are out of
accord with the annual cycle, blossoming and fruiting at the “wrong time.” This
quality can also become significant in the therapy of sclerotic diseases, as
the following image may help illustrate: First, let one imagine the situation
in winter, with nature rigidifying in the cold. Over the surface of the earth -
hardened and covered with geometrically formed snow crystals - the light of the
sun may become glaring and blinding to the eye. This winter situation may be
seen as nature's image for the nerve-sense system, whose organization too
strives towards form and hardening, and is shone upon by the light of
consciousness. In this winter situation, mistletoe forms its berries in a
sulfuric process. At the “wrong time,” this curative plant develops a warmth
quality directly polar to the cold of the season.
From this nature-image a remedy
picture follows: Mistletoe is able to generate a warmth quality in the
sclerotic organism, thus stimulating the capacity for inflammation.
It helps connect the processual,
will-natured action of the higher members with the organism. Rudolf Steiner
describes this action as a powerful “engagement” of the higher bodies,
supported by phosphoric processes which are also inherent in mistletoe. It is
the realization of a salutogenic principle that is polar to the higher-body
constellation found in sclerotic diseases and diabetes in particular.
While viscum-therapy for cancer is
generally given in the form of injections, its use in diabetes, as practiced
for example in traditional African medicine (Nigeria), is by the oral route. In
an animal study of the antidiabetic action of viscum album, Swanston-Flatt et
al. found no glucose lowering action but a positive effect on associated
symptoms (hyperphagia, polydypsia, weight loss). Obatomi et al. demonstrated a
glucose lowering action for mistletoe grown on lemon and guava trees. The authors
surmise an improvement in peripheral glucose utilization. Finally, Gray and
Flatt studied the effect of a mistletoe extract on a clonal insulin-secreting
cell line and found a dose-dependent increase in insulin secretion.
Diabetes is associated with a
restriction of the sensory functions. The involvement of the eyes in diabetes
is an instructive example. It provides a bridge to understanding other
restrictions of sensory activity, such as those of the sense of touch in
polyneuropathy or, in the metabolic organism, the “blindness” to subconscious
mutual perception of the organs (see above). Thus these restrictions affect a
range of sensory functioning from conscious perception in the nervous and
sensory organization to the unconscious sensory perceptions of the metabolic
organization. The therapeutic goal here is to provide support for the sensory
function.
Starting in the embryo, the
relationship of quartz to the sensory organization is apparent in the high
silicon-content of the amniotic fluid which surrounds the ectoderm - the tissue
from which the sensory organs derive. With its essential kinship to light,
quartz has the capacity to exert a formative and differentiating action on the
ectodermal structures which later develop sensory functions, from the tactile
sensitivity of the skin to the neuroectodermal organs proper. As a remedy,
quartz supports the activity of the senses. The areas of the human organism
which develop a particular relationship to silica are peripheral structures
determining form and structure. Besides its property of supporting the sensory
function, silica serves the shaping power of the I-organization, making it
possible for the human form to arise. For a 35-year-old diabetic patient,
R.S. and Ita Wegman recommended
“silicic acid in the 10th potency” along with rosemary therapy.
In this connection the substance
polarity of silica and calcium is critical. When the organism is first taking
form, silica accompanies the forces of structure and form; in advanced age, it is
calcium that is dominant in the context of sclerosis.
Inherent in the human sensory
process is a second quality. As the rosemary polarity opposes formation and
fire process, this dynamic phosphorus power stands in opposition to structuring
quartz. The quartz qualities are found in the sensory process, taking in the
light that is active in all sensory modalities. Opposed to them is the
will-related I-activity of
perception, which in the language of substance is related to phosphorus. Quartz
and phosphorus are among the essential functions in the sensory process.
In contrast to the sal process,
phosphorus bears imponderables in its dynamic action:
“The substances that stand in polar opposition
to salt are those that internalize the imponderable - light in particular, but
also other imponderables such as warmth and kindred ones... This is the basis
for the curative efficacy of everything contained in phosphorus or related in
any way to phosphorus as a healing process. For this reason phosphorus, an
internalizer of imponderables, becomes most particularly suited to pushing the
astral body and the I back in when they are disinclined to associate with the
human being”.
Thus phosphorus is able to guide the
will-related action of the I into
the organism, in this way acting much like the etheric oils of rosemary.
Considering also the impaired withdrawal of the higher members as they
transition from a day-time to a night-time configuration, we see that the low
potency morning dose of phosphorus can be complemented by a higher potency
evening dose.
Other Remedies in the Treatment of
Diabetes
Another remedy which takes on
importance in the picture of diabetes we have sketched is iron. One of its
essential qualities is an incarnating thrust that draws the higher members into
the organization. In the form of ferrum sidereum, in the present context it can
also be applied in combination with the pancreas organ preparation.
The formative forces of the
pancreas, which in type 1 diabetes is subject to progressive sclerosis, can be
supported by its organ-building action. Many patients experience a beneficent
action from the preparation pancreas/meteoric iron in this context. In some
cases its indication is guided solely by indefinite sensations reported by
the patient. Occasionally
differentiated perceptions are also reported in connection with this
medication, apparently related to subtle actions of the higher members.
A 33-year-old prospective nurse has suffered from diabetes mellitus type
1 since about the age of 2. Intensified conventional insulin therapy has long
since been abandoned
in favor of an insulin pump. She comes seeking complementary treatment
options in anthroposophical medicine. Following is her description of her
experience with the subcutaneous injections of pancreas/meteoric iron which she
was prescribed:
“The condition prior to receiving
the remedy is the feeling of an unwarmed space - a space not cold or dead, but
deeply passive and cool. When the remedy is brought in a “swimming tube”
develops and in spite of the solid physical boundaries wraps itself around and
inside of the abdomen. A warming, active zone comes into being whose activity
feels like glowing embers or fire. ... Little by little, this active zone makes
it possible for me to begin to inhabit the formerly passive space.”
Stibium too manifests a structuring
activity. It supports the forming forces of the I-organization in their organic
activity. Positive experiences with it have also been reported on the
ophthamological arena.
Drawing will activity into the limb
and metabolic organism in the way described is the therapeutic task for the
adipose type 2 diabetic. Initially one often encounters an excited astral
organization that penetrates into the middle realm. This can be calmed and
drawn back to the lower pole using Bryophyllum, a plant with a vegetative
dominance. This is nicely complemented by Conchae, which has the capacity to
“drive out” excessive and inadequately controlled astral activity. In its shell
formation, the oyster displays an analogy to the formation of the skull cap. In
the oyster, however, the soul-spiritual that is freed cannot awaken to
consciousness through a neural organization, but remains on a level of sleep.
This quality of the oyster shell can have a soothing action on the restless
astrality of the type 2 diabetic.
The motility disorders of the
metabolic organization point to yet another therapeutic need: that of
supporting the I-organization indwelling the intestinal sensory processes and
the astral organization at work in movement processes. To begin with, the
sensory function in the intestinal tract can be stimulated with caraway. In its
substance polarity of resins and etheric oils, caraway contains both of the
qualities that accompany the sensory process in the form of phosphorus and
quartz. In combination with Carbo, it appears to offer a particularly
beneficial medication for such conditions as diarrhea due to autonomic
neuropathy.
Support for the movement
organization in the gastrointestinal tract can be supplied by bitters (Gentiana
lutea, Geum urbanum, both in low potency). Steatosis hepatis, commonly
encountered sonographically as “white liver,” points to the inadequate
engagement of the higher members. As a supportive remedy, Taraxacum in low
potency is effective here as part of a comprehensive liver therapy.
9. The Meaning of Diabetes for the
Individual and as a Symptom of our Times
Each of the two forms of this
disease points in a different way to man's connection to the spiritual world.
In the context of the three-fold human organism, waking day-consciousness
develops on the foundation of the nerve-sense organization. It is the quality
of consciousness which develops on “this side” of the threshold to the
spiritual world. It is transcended each time the human being falls asleep and
waking consciousness is extinguished. Will activity, in contrast, has a
continuous dwelling place in the “night realm” of sleep consciousness: the
spiritual world. The threshold with its guardian quality, mediating between
“this side” and the “beyond,” has its seat in the rhythmic system.
Early development of the forces of
intellect and memory can prematurely sever the growing child’s close connection
to its spiritual home and produce an earthly quality of consciousness_awake and
focused on “this side.” This may contribute towards a condition in which the
upper members of the human organization fail to unite in a physiological way
with the metabolic-limb organism, thus promoting later manifestation of
diabetes. In the adipose type 2 diabetic, in contrast, restricted will activity
causes inadequate engagement in those areas of the organization which remain
continuously asleep during day-consciousness.
The pronounced thrust towards
earthly consciousness, developing out of opposite circumstances, is associated
with sclerotic phenomena. This poses the patient with a different inner task
than that posed, for example, by inflammatory illnesses, whose consciousness
gesture is that of falling asleep. In sclerosis, the task posed by the illness
is that of confronting a hardening ahrimanic reality.
The task is to warm and enliven the
thinking, as the diabetic tends too be too wakeful, too mind-oriented and often
excessively formed and slender_the kind of patient who might come to the
doctor’s office carrying detailed documentation of his glucose profile.
Diabetics need support and training for this enlivening of the mind, not an
emphasis on abstract calculations which so easily become a hindrance. Given an
excitable emotional life, poorly controlled and balanced by forces of thought,
the patient’s task is to become “the measure and master of the floods of
feeling” (Christian Morgenstern). Finally, schooling the will becomes the inner
task posed by the illness. The light of thinking can illuminate the domain of
the will. To liberate thinking from its abstractness and enliven it becomes the
particular inner task in the destiny of these patients.
With transformation of thinking and
enhancement of will capacity as its aims, the entire life of the diabetic
appears as a great school for the will. How much renunciation and
self-overcoming goes into the mastering of daily existence! Particularly in the
case of type 2 diabetes, where patients do not experience themselves as acutely
ill, it is necessary to learn to act out of insight without the pressure of
direct suffering. Thus the illness itself clearly points towards the path of
inner schooling. The destiny inherent in this illness contains motifs also
found in the tasks that an individual on a path of inner development must
freely take on_those of the “six qualities” or the eightfold path, for example.
Of the six qualities, we have spoken
of the need to achieve control of thought processes and will impulses; a
further challenge is posed by the feelings. The documented peculiarities in the
diabetic’s emotional life, such as the heightened anxiety, unrest and
underlying depressive condition in type 2 diabetes, pose long-term challenges
in themselves. Yet the practice of positivity too, attending to that which can
be genuinely recognized as positive - easily succumbs to the patient’s sense of
a dim prognosis. It is difficult, and requires focused attention, to orient
oneself inwardly to the positive fruits of the illness, to the “light side”
that casts the shadow of disease. It is a daily struggle to maintain a
perspective of openness to the future, one which recognizes new possibilities
in spite of, or perhaps because of, the disease. A woman patient with type 2
diabetes gave the author a reproduction of the charioteer, remarking that the
figure’s uprightness and control was a perfect representation of the inner goal
and challenge of diabetes.
Medicinal therapy of diabetes (the
Raphaelic approach) acts at a great remove from the patient’s consciousness.
When it is complemented by a Michaelic impulse, the patient is challenged to
assume inner tasks as a developing individual. Here we see the real meaning of
diabetic training. It should never be confined to the intellectual level
of diabetes-specific information.
“Calculating units of insulin in reference to a normal value, a correction
factor and calorie requirements is precisely the kind of thing that has always
come naturally to me,” said one type 1 diabetic who had been admitted for
intensified insulin therapy. She had a great longing to move from living in her
thinking to living in the will. Thus the central focus of diabetic training,
beyond providing necessary knowledge of the illness and training in
glucose-regulating therapy, is to provide assistance with questions regarding
the path of individual development as it applies to all three faculties of the
soul: thinking, feeling and the will. In the souls of some diabetics these
questions are intensely alive and appear as the central task posed by the
disease; in others, they remain unconscious as an unformulated question and
arise in the “school of life” in the day-to-day process of coping with the
disease.
In the disease cases on which R.S.
was consulted, there is a case in which a diabetic patient is given a
meditation created to draw will forces into the thinking. This provided an
effective inner complement to the external therapy of hot rosemary baths.
At this point we shift our attention
from questions of individual destiny to the significance of diabetes for our
times. Our culture is characterized by an increasing abstraction and
mechanization of thinking, and these qualities are now fostered at a tender age
by early computer use.
Impotence of the mind leads to
paralysis of the will, which is mirrored in an array of products of our
civilization that replace limb activity with button pushing and provide
for no compensating activity. In
this sense our age creates a predisposition to such illnesses as diabetes,
which are frequently seen in conjunction with our high standard of living. In
confronting the challenge of this pathology, we begin to recognize a
developmental necessity not just in the destiny of individuals but of our age
itself. In this sense illness, recognized as a task or challenge, is a source
of healing impulses for humanity as a whole. Beyond its meaning for the
individual human being, diabetes can begin to be seen as a disease which has
been taken on by human beings for the healing of humanity as a whole. As with
other diseases, meaning appears threefold in its individual, its community, and
its era-related aspects. Current therapeutic practice pursues the goal of
regulating various indicative parameters to within normal values (glucose,
blood pressure, lipids). This approach has produced documented improvements in
prognosis.
In regard to the disease process
itself, however, this therapeutic approach represents nothing more than
arresting the disease at a particular stage or regressing it to an earlier
degree of severity. It is not a disease-overcoming principle, but more a
“mummification” of a disease manifestation which results in an improved
prognoses. From the perspective of the insight that disease poses a task and
has a meaning, the exclusively regulatory approach to therapy appears totally
inadequate and illusory as a medical response.
The attempt to answer such questions
has resulted in the development of germinal therapeutic concepts which merit a
place alongside of the conventional approach. It has also greatly clarified the
nature of the inner task posed by diabetes, offering the patient an opportunity
to take steps in inner development.
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