The Disease of the Century

Diabetes will be one of the most challenging health problems in the 21st century. Currently, 8.8% of Canadians live with diabetes and six million Canadians have prediabetes.¹ One in three Canadians is living with diabetes or prediabetes.²  Since 2000, the rate has increased by an average of 3.3% per year.³ Estimates suggest that, unless we intervene, one in three children born in 2000 will eventually develop diabetes.⁴  The consequences are dire: Diabetes shortens lives; it is a leading cause of heart disease, blindness, and kidney failure; and it is a significant contributor to the current rise in dementia.^5,6 Without the action of insulin, cells are incapable of using glucose. This leads to elevated blood glucose levels while intracellular glucose becomes depleted. The consequences of diabetes stem from this shift in the distribution of glucose. Cells starve even in the overabundance of glucose, forcing the body into starvation mode. Chronic hyperglycemia damages tissues and increases the likelihood of diabetic complications. The good news is that type 2 diabetes is preventable, and prediabetes is usually considered reversible.⁷ Diabetes is largely related to weight and lifestyle. Insulin resistance, as seen in type 2 diabetes, is a lifestyle-related disorder, for the most part. It is largely believed that a Western diet in conjunction with a sedentary lifestyle is the primary cause of type 2 diabetes.⁸ Unfortunately, because it is related to lifestyle, diabetics often report experiencing diabetes-related stigma. This “blame the victim” mentality can take a severe toll on the mental health of diabetics. The perceived blame for self-inflicting diabetes leads to feelings of shame, exclusion, and prejudice for sufferers and their families. ⁹ Feeling emotionally safe usually helps patients manage health problems and their glycemia more effectively.¹⁰

Nutrition is one of the important topics for the prevention and control of diabetes. The glycemic load associated with specific foods is one of the key factors to consider. Several studies have documented that a diet producing a high glycemic load is strongly associated with the development of type 2 diabetes.¹¹  In general, plant food is associated with lower type 2 diabetes risk versus meat. Low-energy food is considered more beneficial than high-energy food. Fermented dairy products may be better than nonfermented dairy.^12,13,14 Refined grains and sugar-sweetened beverages consistently appear to promote obesity and diabetes risk.¹⁵ Consumption of a handful of nuts daily may also provide some protection from type 2 diabetes.^16,17

Mediterranean-Style Diet

• High consumption of olive oil, vegetables, legumes, whole grains, fruits, and nuts
• Moderate consumption of poultry and fish
• Low consumption of full-fat dairy products and red meat
• Low-to-moderate consumption of wine as the main source of alcohol accompanying meals.17

The Mediterranean diet is often recommended or considered ideal to reduce the risk of diabetes. Studies demonstrate the beneficial role of the Mediterranean diet in the prevention and management of diabetes.¹⁸Patients following a Mediterranean diet usually see greater improvements in glycemic control and cardiovascular risk factors compared with those on a control diet. Epidemiological studies show that the Mediterranean diet is inversely associated with type 2 diabetes risk. There is also evidence to support an inverse association between the Mediterranean diet and obesity.¹⁹ In the PREDIMED study, the incidence of diabetes in patients with cardiovascular disease was reduced by 52% through the Mediterranean diet.²⁰ Available studies show an overall risk reduction ranging from 12% to 83% for subjects adhering to the Mediterranean diet.²¹ The Mediterranean diet can help improve glycemic control in type 2 diabetics.²²  According to the results of a meta-analysis, the low-carbohydrate, the low glycemic index, the high-protein, and the Mediterranean diets all improve glycemic control (HbA1c reductions of −0.12% [p = 0.04], −0.14% [p = 0.008], −0.28% [p < 0.001], and −0.41% [p < 0.001], respectively).²³

Exercising is essential

Exercise is essential when it comes to diabetes. Exercise improves glucose metabolism and insulin sensitivity, thereby reducing the risk of diabetes and heart disease. The US Diabetes Prevention Program study demonstrated that 30 minutes of daily physical activity and a 5–10% body weight loss resulted in a 58% reduction in the risk of developing diabetes.²⁴ Population studies also show that being physically active reduces the risk of diabetes by approximately 30%.²⁵ Thirty minutes of moderate to vigorous physical activity was associated with a 15% difference in HOMA-defined insulin sensitivity.²⁶ Trials looking at the overall lifestyle have also shown a significant reduction in diabetes risk. These trials usually combine moderate weight loss via lifestyle changes including dietary change and increased physical activity. After three to four years of following this lifestyle program, there was a decrease in the incidence of diabetes by 58% in both landmark trials, namely the Diabetes Prevention Program and the Diabetes Prevention Study.^27,28

Good nutrition, exercise and a healthy lifestyle are first-line preventative measures, while natural treatments and nutritional supplements can also help prevent and address insulin resistance. Nutrients such as alpha-lipoic acid, inositol, curcumin, cinnamon, and resveratrol can improve insulin sensitivity, lower blood-sugar levels, assist in weight loss, and reduce the percentage of prediabetic patients who will eventually develop type 2 diabetes.

Alpha-Lipoic Acid

This antioxidant is involved in carbohydrate metabolism and in the mitochondrial citric-acid cycle.²⁹ In human research, alpha-lipoic acid has been shown to improve insulin sensitivity..³⁰ Research also shows that alpha-lipoic acid can help to prevent diabetic endothelial damage and helps to improve glucose transport into the cell.³¹ Supplementation has also been shown to improve weight loss.³² Clinical research shows that taking alpha-lipoic acid reduces levels of leptin in patients with excess adiposity. ³³Supplementation also seems to reduce symptoms of peripheral neuropathy in patients with diabetes.³⁴

Myo-Inositol

Inositol is a sugar alcohol found in foods such as cereals, corn, meat, citrus fruits, and legumes. Studies show that inositol has an insulin-sensitizing effect.³⁵ Defects in the metabolism of inositol are thought to lead to insulin resistance, notably in patients with polycystic ovarian syndrome. Researchers think that inositol helps to induce ovulation in these patients by improving insulin sensitivity.³⁶ Research also shows that inositol supplementation is particularly helpful at preventing the progression from metabolic syndrome to type 2 diabetes. In postmenopausal women with metabolic syndrome following a low-calorie diet while taking myo-inositol for one-year, reductions in total cholesterol, triglycerides, and blood pressure were noted, while high-density-lipoprotein cholesterol and insulin resistance improved.³⁷

Curcumin

Curcumin has a long history of use in traditional Asian and Indian medicine. Research in patients with diabetes shows that taking curcumin daily for 12 weeks reduces fasting blood glucose.³⁸ One meta-analysis of studies in patients with type 2 diabetes shows that taking curcumin for 8–24 weeks improves HbA1c by 0.7% when compared with a placebo or conventional treatment.³⁹ Research also shows that curcumin can significantly help prevent the progression from metabolic syndrome to diabetes. In overweight or obese individuals with prediabetes, research shows that taking curcumin for 90 days improves insulin sensitivity and results in a reduction in fasting glucose and HbA1c when compared with a placebo.⁴⁰ Also, research shows that taking a curcumin supplement for nine months reduces the percentage of prediabetics who eventually develop type 2 diabetes.⁴¹

Cinnamon

Some lab and animal research shows that cinnamon has antidiabetic effects. Animal research shows that cinnamon can help improve weight loss, blood glucose, HbA1c, insulin levels, and blood lipids in patients with diabetes.⁴² One small study in adults with poorly controlled type 2 diabetes showed a trend toward improvement in fasting blood glucose with cinnamon supplementation.⁴³

Resveratrol

Resveratrol is a naturally occurring polyphenol. It is primarily found in red wine, red-grape skins, purple-grape juice, and mulberries. Resveratrol is beneficial for weight loss in overweight or obese individuals. A meta-analysis showed that taking resveratrol decreases body weight by 0.5 kg, BMI by 0.17 kg/m², and waist circumference by 0.8 cm when compared with a placebo or no intervention.⁴⁴ Studies also show that in type 2 diabetics, resveratrol can lower fasting blood glucose levels, fasting insulin, and HbA1c.^45,46

Conclusion

Simple interventions can make a remarkable difference when it comes to preventing the progression from prediabetes to diabetes. More than 15% of the Canadian population is currently at risk for the development of diabetes, with almost 9% having already developed the disease. It is time to start exercising more; improve our diets; and consider supplementation with nutrients and herbs such as alpha-lipoic acid, curcumin, cinnamon, resveratrol, and myo-inositol.