Type-2 Diabetes

The Type-2 Diabetes Epidemic… And Nutritional Ways to Stop It In Its Tracks

The numbers are as alarming as they are depressing. Two of every three American adults are now overweight or obese. Upwards of 100 million have some form of prediabetes, also called glucose intolerance and metabolic syndrome. Twenty-five million Americans have type-2 diabetes, and one million graduate from prediabetes to full-blown type-2 diabetes each year.

Overweight and blood sugar disorders dramatically increase the risk of coronary heart disease, Alzheimer’s, and even cancer. Whatever kind of health care system you might envision, the future spells disaster. That is, unless we start focusing on “self care,” says Ron Hunninghake, M.D., medical director of the nutritionally oriented Riordan Clinic in Wichita, Kansas.

Why are we faced with so many people with weight and blood sugar problems? We’re a nation that eats far too many refined sugars (sucrose and high-fructose corn syrup) and other types of refined, simple carbohydrates, contends Robert Lustig, M.D., of the University of California, San Francisco.

Here’s how the problem starts: Sugary foods (e.g., ice cream, desserts, soft drinks) and simple carbs (e.g., white bread, pasta, pizza) are rapidly digested, leading to a sharp spike in blood sugar levels. Your pancreas responds with a surge of insulin, which lowers blood sugar levels. Sometimes, however, the insulin response is so strong that it reduces blood sugar below its original level, triggering hunger pangs. The fastest solution is to eat more sugary foods, but doing so is anything but the healthiest solution. The result is up-and-down blood-sugar cycle throughout the day, and the steady outpouring of insulin leads to overeating, “insulin resistance,” and eventually, type-2 diabetes.

Clues to Prediabetes and Type-2 Diabetes

Are you at risk for prediabetes and type-2 diabetes? Here are some clues.

  • Fat around the belly. Insulin is the fat-storage hormone, and abnormally high levels promote fat deposits around the belly.
  • Carb cravings, such as for sweets or pizza. Such cravings may be related to food addictions, but they might also reflect drops in blood sugar levels.
  • Lack of hunger in the morning. A healthy person should be hungry after not eating overnight. If you’re not hungry at breakfast time, it may be because your blood sugar is still elevated from a big meal or snacks the night before.
  • Skipping breakfast. Not eating breakfast increases the risk of insulin resistance, the cornerstone of prediabetes and full-blown diabetes.
  • Coffee and a sweet for breakfast. Eating a high-carb breakfast leads to more calorie consumption for the next day and a half. [1] In contrast, eating an egg or other type of protein with breakfast leads to a greater feeling of fullness, a smaller lunch, and consuming fewer calories over the next day and a half.[2]
  • Feeling tired or sleepy after lunch or dinner. If you eat too much, or eat a meal that contains too many sugars and refined carbs, your blood sugar may climb very high. High levels of blood sugar lead to poor concentration and drowsiness.

If you suspect prediabetes or type-2 diabetes, your physician can order blood tests. However, your physician may misinterpret the results.

Most physicians diagnosis prediabetes when a person’s fasting blood-sugar (glucose) level falls between 100 and 125 mg/dl, and diabetes when a fasting blood-sugar level is 126 mg/dl or higher. Although the normal range for blood sugar falls between 65 and 99 mg/dl, the ideal blood-sugar level is actually 80 mg/dl.

A fasting blood sugar level is in the upper 80s or 90s is a red flag, and may be a “false normal.” In these cases, the pancreas works extra hard to secrete large amounts of insulin, which can maintain a normal blood sugar level for many years. But the excess insulin, known as hyperinsulinemia, is a sign of insulin resistance, and elevated insulin levels can presage blood-sugar problems 10 to 15 years before the actual diagnosis of diabetes.[3] An ideal fasting insulin level is less than 7 mcIU/ml; higher levels portend problems. Insist that your doctor measure both your fasting blood sugar and insulin levels.

Tips for Better Eating Habits

Prediabetes and overweight are nutritional disorders, and for most people they are best prevented and controlled through healthy eating habits. I recommend that people emphasize fresh, nutrient-dense foods to obtain the most quality nutrition in each bite. For example, there’s a world of nutritional difference between 1,000 calories of salmon and vegetables and 1,000 calories of ice cream.

My top two food groups consist of quality proteins and high-fiber vegetables.

Protein offers a number of benefits. First, fish, chicken, turkey, and lean meats do not raise blood sugar levels. Instead, they stabilize and gradually lower blood sugar levels. [4] [5] By maintaining a relatively level blood sugar, hunger jags stop. Second, protein increases the activity of glucagon, a hormone that counteracts insulin’s negative effects. Third, the body uses protein to make and replace muscle, the principal tissue that burns blood sugar. [6] [7]

High-fiber veggies (most anything except potatoes) also lower and stabilize blood-sugar levels. [8] [9] They are rich in antioxidants and have the added benefit of providing a nutritionally balanced diet. If you’re sedentary, you’ll be able to obtain your carbs from vegetables and fruits. If you’re physically active, you can add nutritious complex carbs in the form of sweet potatoes and fruit.

Eating a protein-rich breakfast (including one or two eggs) helps control blood sugar and weight. Breakfast skippers often end up with higher levels of adrenaline, cortisol, and insulin – a hormone combination that promotes belly fat and increases the long-term risk of prediabetes.

If eggs don’t appeal to you, consider a small amount of chicken or turkey and cheese with a side of high-fiber fruit (e.g., raspberries, blueberries, or kiwifruit) in sugar-free yogurt. Unsweetened steel-cut oatmeal also stabilizes blood sugar. (Other types of oatmeal aren’t as good in this respect.) You can sprinkle some cinnamon onto the fruit or oatmeal – studies have found that cinnamon helps promote healthy blood sugar levels.

For lunch, consider a green salad (sans croutons) with concentrated protein, such as chicken or tuna. Top with vinaigrette because vinegar can contribute to weight loss. [10] [11] [12] [13] For a relatively quick dinner, consider pan-fried salmon or rotisserie chicken with a hefty serving of steamed vegetables.

I generally don’t recommend any heavy starches, such as breads (even whole wheat), pastas, bagels, muffins, and potatoes, because these foods have low nutrient density and provide little nutritional value beyond calories. One notable exception is sourdough bread, which in moderate amounts has been shown to improve blood sugar.[14] If you engage in strenuous exercise, however, you will need some extra carbs.

Supplements Helpful in Maintaining Normal Blood Sugar

Many supplements help maintain normal blood sugar levels. I’ve ranked them in importance based on my interpretation of supportive scientific studies.

Vitamin D and Calcium

Both of these nutrients are required for normal insulin function. In one study, people who took 700 IU of vitamin D and 500 mg of calcium daily had virtually no increase in blood sugar levels over three years, while blood-sugar levels increased more than 6 mg/dl among people taking placebos.[15] The dose of vitamin D in this study was low, so try 2,000 to 5,000 IU of vitamin D, plus 500 mg of calcium citrate.

Silymarin

Three studies of people with diabetes found that silymarin, the potent extract of the herb milk thistle, can reduce blood sugar, insulin, HbA1c, and sugar in the urine. It also lowers cholesterol and triglyceride levels.[16] [17] Try 100-200 mg with each meal.

Chromium

Supplemental chromium can lead to the gradual normalization of insulin and blood sugar levels. [18] Some research has found that chromium supplements are particularly helpful for people who are depressed and overweight. Try 500 mcg twice daily.

Biotin

The body needs this B-complex vitamin to make insulin. Biotin regulates genes involved in the metabolism of glucose, amino acids, and fatty acids. Try 1,000 mcg three times daily with meals.[19]

Alpha-lipoic acid

This antioxidant has been used for years in Europe to treat diabetes and related nerve problems. It is sold without a prescription throughout the United States and many other countries. Alpha-lipoic acid improves insulin function and can gradually lower blood sugar levels.[20] Take 100-200 mg before each meal.

Pycnogenol®

This natural antioxidant complex blocks the activity of alpha-glucosidase, a carb-digesting enzyme. The mechanism is similar to the diabetes drug acarbose, but a study found Pycnogenol® 190 times more potent than acarbose in inhibiting alpha-glucosidase.[21] Try 100-200 mg of Pycnogenol® daily.

Fiber

Some types of fiber supplements can enhance the benefits of dietary fiber in regulating blood sugar, insulin, appetite, and weight control. One such product, PolyGlycopleX, or PGX, is derived from natural plant sources.

Putting It Into Practice

It might seem difficult to reverse diseases – overweight, prediabetes, and type-2 diabetes – that now affect the majority of Americans. As with any other social effort, gains are made with one step at a time. You can reduce your risk of disease through improved eating habits and smart supplementation… and you can help your family and friends do the same.


 

References

[1] Farshchi HR, Taylor MA, Macdonald IA. Deleterious effects of omitting breakfast on insulin sensivitiy and fasting lipid profiles in health lean women. American Journal of Clinical Nutrition, 2005;81:388-396.

[2] Vander Wal JS, Marth JM, Khosla P, et al. Short-term effect of eggs on satiety in overweight and obese subjects. Journal of the American College of Nutrition, 2005;24:510-515.

[3] Zavaroni I, Bonini L, Gasparini P, et al. Hyperinsulinemia in a normal population as a predictor of non-insulin-dependent diabetes mellitus, hypertension, and coronary heart disease: the Barilla factor revisited. Metabolism, 1999;48:989-994.

[4] Gannon MC, Nutthall JA, Damberg G, et al. Effect of protein ingestion on the glucose appearance rate in people with type 2 diabetes. Journal of Clinical Endocrinology & Metabolism. 2001;96:1040-1047.

[5] Layman DK, Baum JI. Dietary protein impact on glycemic control during weight loss. Journal of Nutrition, 2004;134:968S-973S.

[6] Layman DK, Baum JI. Dietary protein impact on glycemic control during weight loss. Journal of Nutrition, 2004;134:968S-973S.

[7] Manninen AH. Very-low-carbohydrate diets and preservation of muscle mass. Nutrition and Metabolism, 2006;3:9-12.

[8] Behall KM, Scholfield DJ, Hallfrisch JG, et al. Consumption of both resistant starch and beta-glucan improves postprandial plasma glucose and insulin in women. Diabetes Care, 2006;29:976-981.

[9] Chandalia M, Garg A, Lutjohann D, et al. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. New England Journal of Medicine, 2000;342:1392-8.

[10] White AM, Johnston CS. 2007. Vinegar ingestion at bedtime moderates waking glucose concentrations in adults with well-controlled type 2 diabetes. Diabetes Care 11: 2814-2815.

[11] Johnston CS, Kim CM, Buller AJ. 2004. Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care 27:281-282.

[12] Ostman E, Granfeldt Y, Persson L, et al. 2005. Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects. European Journal of Clinical Nutrition 59;983-988.

[13] Leeman M, Ostman E, Bjorck I. 2005. Vinegar dressing and cold storage of potatoes lowers postprandial glycaemic andinsulinaemic responses in healthy subjects. European Journal of Clinical Nutrition 59:1266-71.

[14] Liljeberg HG, Björck IM. Delayed gastric emptying rate as a potential

mechanism for lowered glycemia after eating sourdough bread: studies in humans

and rats using test products with added organic acids or an organic salt. American Journal of Clinical Nutrition, 1996;64:886-893.

[15] Pittas AG, Harris SS, Stark PC, et al. The effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in nondiabetic adults.

Diabetes Care, 2007;30:980-986..

[16] Velussi M, Cernigoi AM, De Monte AD, et al., Long-term (12 months) treatment with an antioxidant drug (silymarin) is effective on hyperinsulinemia, exogenous insulin need and malondialdehyde levels in cirrhotic diabetic patients. Journal of Hepatology, 1997;26:871-879.

[17] Huseini HF, Larijani B, Heshmat R, et al. The efficacy of Silybum marianum (L.) Gaertn. (Silymarin) in the treatment of type II diabetes: a randomized, double-blind, placebo-controlled, clinical trial. Phytotherapy Research, 2006;20:1036-1039.

[18] Anderson RA, Chen N, Bryden NA, et al. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes, 1997;46:1786-1791.

[19] Rodriguez-Melendez R, Zempleni. Regulation of gene expression by biotin. Journal of Nutritional Biochemistry, 2003;14:680-690.

[20] Jacob S, Ruus R, Hermann H, et al. Oral administration of RAC-alpha-lipoic acid modulates insulin sensitivity in patients with type-2 diabetes mellitus: a placebo-controlled pilot trial. Free Radical Biological & Medicine, 1999;27:300-314.

[21] Schafer A, Hogger P. Oligomeric procyanidins of French maritime pine bark extract (Pycnogenol) effectively inhibit alpha-glucosidase. Diabetes Research and Clinical Practice, 2007;77:41-46.