International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 1-11 http://medscipublisher.com/index.php/ijccr 6 spleen and stomach, play a key role in regulating glucose metabolism. In TCM, the spleen is responsible for transforming food into energy (qi), and its deficiency is linked to diabetes. Incorporating foods like whole grains and sweet vegetables helps to strengthen the spleen and improve insulin sensitivity. Additionally, consuming bitter foods (Fire element) helps to clear excess heat and reduce blood sugar levels, making them particularly useful in managing diabetes (Rennert and Charney, 2003). Research supports the idea that lifestyle modifications, including specific dietary interventions, can reduce the risk of cardiovascular complications in diabetic patients. For instance, diets based on the Five Elements principles, such as low-glycemic and Mediterranean diets, have been shown to lower glucose levels and improve cardiovascular outcomes in diabetes patients. These dietary strategies align with TCM principles by addressing the underlying causes of metabolic imbalance through balanced nutrition (Mazzone, 2005). Figure 2 Schematic of hepatic metabolic regulation induced by a low-carbohydrate diet (Adopted from Volek et al., 2008) Restriction in dietary carbohydrate, even in the presence of high saturated fatty acids, decreases availability of ligands (glucose, fructose, and insulin) that activate lipogenic and inhibit fatty acid oxidative pathways. The relative importance of each transcri ptional pathway is unclear, but the end result-increased fat oxidation, decreased lipogenesis, and decreased secretion of very low-density lipoprotein-is a highly reliable outcome of low carbohydrate diets (PPAR, peroxisome proliferator-activated receptor) (Adopted from Volek et al., 2008) 6.2 Mechanisms of five elements dietary intervention in hypertension Hypertension, another chronic metabolic disorder, can be managed through the Five Elements diet by addressing the root causes of excess pressure in the cardiovascular system. In TCM, hypertension is often associated with an imbalance of the Fire element (Heart) and the Water element (Kidneys). Salty foods, associated with the Water element, can nourish the kidneys, while bitter foods, linked to the Fire element, help clear heat and reduce inflammation, both of which are common in hypertensive patients. This approach not only manages blood pressure but also targets underlying imbalances that exacerbate hypertension (Oettgen, 2009). Clinical evidence suggests that combining dietary modifications with other lifestyle interventions, such as exercise, can significantly lower blood pressure. Dietary approaches to managing hypertension, such as the DASH diet (Dietary Approaches to Stop Hypertension), have parallels with the Five Elements Theory, particularly in their emphasis on reducing sodium intake and increasing consumption of fruits, vegetables, and whole grains. These foods help to balance the elements and maintain healthy blood pressure levels (Zarich, 2003). 6.3 Preventive strategies for hyperlipidemia and cardiovascular diseases using the five elements diet Hyperlipidemia, characterized by high levels of lipids in the blood, is closely linked to Cardiovascular Disease (CVD). The Five Elements diet can help manage hyperlipidemia by focusing on foods that support liver function (Wood element) and balance digestion (Earth element). For example, sour foods, such as citrus fruits and vinegar, help stimulate liver function and improve lipid metabolism, while sweet and bitter foods assist in reducing
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