Dear Health Conscious Friends:
Insulin/blood glucose regulation is at the core of a number of bodily processes (energy production at the cellular level, hormones, including thyroid, estrogens, testosterone, adrenals, pituitary, hypothalamus, brain function, liver function--essentially every major organ or system in the body, because every cell depends on glucose to some extent) which when imbalanced bring on many symptoms and eventual disease conditions, ultimately leading to death if not controlled. There is an adage that states that "if we lived long enough we would all become diabetics." Well, we don't have to become diabetic. Diet and lifestyle can control this key regulation, but I admit that it can be a challenge to make the necessary changes once on the path to dysinsulinism.
This is a very important health topic and my goal with this particular report is to simply review what research has shown to help this very common issue. I want to use the new Nutritional Medicine, by Dr. Alan Gaby, M.D. only (pp 1081-1099). This is an amazing 1300 page book which compiles nutritional research for hundreds of health conditions. This topic can become very confusing when you introduce various dietary considerations (Vegan, Vegetarian (ovo, lacto), Paleolithic, Mediterranean, SAD (Standard American Diet), and many others), digestive complications, culture, and food quality and availability. I thought by keeping it simple it may be more useful for the majority of my readers and patients.
The simple matter is that to control diabetes (type 2, Insulin resistance) or pre-diabetes with its various blood sugar control issues, you need to drastically reduce the amount of sugars in your diet. Sugars mean any food which not only contains sugars, such as glucose, sucrose, fructose, etc, but any carbohydrate such as starches which are quickly broken down to sugars. And for most people there is the rub--carbohydrate restriction after a lifetime of freely indulging is difficult or near impossible.
There are many tricks even beyond what will be in this article which I hope to cover in future reports. To start, know this, you do not absolutely need carbohydrates, but you do need protein and fats. You can craft a diet which uses these two, protein and fats, as your predominate source of calories and thus side-step the insulin/glucose pathways from carbohydrate ingestion altogether.
Not everyone can do this, so now let's look at what seems to work based on research.
1. Bisphenol A: chronic exposure leads to much greater incidence of insulin/glucose imbalances.
2. Persistent organic pollutants (POP): pesticides and their metabolic products, PCBs (polychlorinated biphenyls), and many others. People with higher POP exposure have 38 times higher likelyhood of becoming diabetic. Interestingly, obesity was not a factor in this group.
Detoxification programs can help with people who have toxins that have contributed to their poor insulin/glucose imbalance.
1. Obesity predisposes one to diabetes. By reducing weight by only 10%, there was a marked improvement in glycemic control. Often if already diabetic this was enough to reduce or even eliminate their medications.
2. Eating smaller more frequent meals seems to improve glycemic control.
(Controversy Alert!: I can tell you there are a number of studies and researchers that show that such a diet does not help weight loss and may not be the best diet long term, because of the effect on leptin levels and consequently insulin levels/insulin resistance. But this is something to keep in mind, especially as one starts modifying their diet and experimenting with changes that may be more steps toward an ideal diet.)
3. Cooking methods that tend to use high heat and create as a consequence advanced glycation end productss (AGEs) increase insulin resistance. AGEs increase pancreatic inflammation and decreased survival in animal studies. Emphasizing boiling, poaching and stewing over frying, broiling and roasting can reduce AGEs in the diet by as much as 50%.
4. Glycemic Index and Glycemic Load. Glycemic Index indicates the relative increase in glucose in the blood 2 hours after consumption times 100. Glycemic load is the Glycemic Index times the carbohydrate content of the food eaten. Refined, starchy foods have a high glycemic index and vegetables, fruit and legumes have a low index. Some foods slow down the digestion, thus releasing the glucose longer than the 2 hour window used to determine the glycemic index. Fiber, protein, phytate, tannins slow down starch/carbohydrate digestion. Legumes eaten with starches can slow down carbohydrate digestion.
Lentils eaten at breakfast not only flattened the blood glucose curve, but reduced the glucose spike of lunch, 4 hours later.
(Controversy Alert!: Legumes, including lentils and beans, are a mixed bag. For vegetarians or people transitioning to a newer, long term diet of fewer carbohydrates, legumes may be used temporarily or in moderation, but keep in mind that they can be hard to digest and have lectins which add to digestive inflammation. I present them here for their advantage of insulin/glucose control.)
5. Stay away from Sucrose and Fructose. Sucrose is a disaccharide of one molecule of glucose and one of fructose. Here's a great interview on the topic at Mercola.com. Bottom line is that fructose is actually a liver toxin which is metabolized directly (about 30% immediately to fat) and more than any other substance contributes to insulin resistance. I can tell you, you can over do eating fruit, and especially fruit juices, even fresh squeezed. I did and I caught this when my blood pressure went up. For months I had been buying cases of fruit at Costco and eating many servings a day. I was not drinking fruit juices and certainly not soda pop. On checking, my glucose was at 100, my uric acid was high at 5.8. I cut out all the "healthy" fruit eating and everything returned to normal in 3 months.
6. Dietary fiber slows the glycemic response. A diet with about 50g of fiber (25 g of soluble fiber and 25g of insoluble fiber) significantly improved glycemic control and reduced blood lipids. Supplements appear to help. The best are: unprocessed wheat bran (20g/day), apple fiber (5g, 3x/day with meals) and apple pectin (20g/day). Make sure to mix thoroughly with your food. If you are already eating high fiber diet, do not supplement. All it does is cause GI disturbances.
7. Coffee and Caffeine: consumption is associated with a reduced risk of developing Type 2 diabetes. This is problematic, since coffee/caffeine short term decreases insulin sensitivity and impairs glucose tolerance. Dr. Gaby feels that this is not causal but secondary in that people sensitive to caffeine, and thus avoid it, may be more likely to develop type 2 diabetes. In my own experience with Metabolic Typing I find that to be the case. People who cannot tolerate caffeine well, tend to be fast oxidizers and these people burn glucose quickly which leads to insulin sensitivity issues. So, simply drinking coffee does not mean you are protecting yourself! It may in fact as stated above, make things worse.
These are the ones that research shows definitely help.
1. Chromium. Taken with the other nutrients below create GTF, glucose tolerance factor. 200-1000 mcg/day with Niacin (50-100mg/day)
2. Biotin: 3-16 mg/day.
3. D-chiro-Inositol 600-1200 mg/day (for some people)
4. Vitamin E: 400IU/day as mixed tocopherols; for people with haptoglobin 2-2 genotype. If you do not have this particular genotype, then you should not take higher than 400IU.
5. Vitamin C: 500-1500mg/day
6. Niacinamide: 500mg, 3x/day, especially if sulfonylureas medications are not working (Metformin is not a sulfonylurea)
7. Vitamin D: bring your levels up to a measurable level of about 50 ng/ml. This may require supplementation of anywhere from 1000 IU to 10,000 IU per day. I recommend getting a blood level baseline and then working with me to achieve a optimal level. Regular short term, i.e. about 15-20 minutes, sun bathing is the best way to get your Vitamin D.
8. A basic, easy to absorb multi-vitamin and multi-mineral can help, especially with some of the side effects of glucose control issues, such as immune response to infections.
9. Vanadium: Dr. Gaby does not recommend this, because the studies that show it is effective requires a very high dose and these doses are toxic. A typical diet get about 20mcg/day, while the studies used 50 mg, 2x/day.
10. Cinnamon: 1 g/meal helps some people. Further studies are needed to show which type of people are helped with this spice.
Okay, so these are just some of the things that can help. I did not even get into what kind of exercise best helps, nor did I really delve into the various herbs that can help. But the above is very conservative and can get you started on controlling insulin and blood glucose.
I sincerely hope that this report can help. Please post any comments or questions. I will do my best to answer them.
In good health,
Chuck Belanger, L.Ac.