Early Intervention is Critical to Reverse Diabetes

Cooking, eating, and exercising to protect your cell health
By Steven Joyal, MD

Diabetes is a debilitating disease, and we see the effects on our bodies ranging from obesity and chronic fatigue up to blindness and even amputation. The disease is at epidemic levels now with 25 million diagnosed, another seven million unaware they have the disease, and an estimated 79 million “prediabetics” who will get the disease if they don’t make a course correction soon. The encouraging news is that diabetes can be prevented, reversed, and managed effectively by paying close attention to the small cellular details that influence the insulin-producing cells in our pancreas.

These processes frame the body’s ability for insulin to shuttle glucose into cells and form critical chemical reactions that shape the way sugar molecules bond to proteins. Type 2 diabetes can be loosely defined as beta cell dysfunction and insulin resistance.

With beta cell dysfunction, the insulin-producing beta cells in our pancreas don’t work well, hence the term. This is a problem with the supply side of the insulin equation. The other major problem—insulin resistance—occurs when insulin receptors in the cells are not as receptive as they should be. Cell function is compromised and the bloodstream is flooded with the excess insulin and glucose that the cells should have been taking up. Insulin is what allows glucose to enter cells, and glucose is the fuel cells need to function.

We can greatly reduce the risk of developing type 2 diabetes—or allowing existing type 2 diabetes to progress—by focusing on four areas of cellular health. Two of them we have just talked about: beta cell dysfunction and insulin resistance. The other two are glycation and oxidative stress.

Glycation is an important but poorly appreciated process that damages cells and tissues in people with type 2 diabetes. This biochemical phenomenon between proteins and glucose creates glycotoxins known as advanced glycation end products (AGEs). When blood sugar levels are elevated, sugar molecules react with cellular proteins and form highly  reactive AGEs that lead to a host of problems.

Oxidative stress is a physiological stress caused by the cumulative damage done by free radicals inadequately neutralized by antioxidants. (High blood sugar is strongly associated with increased numbers of free radicals.) Oxidative stress is held to be associated with aging.

Early intervention

In the early stages of type 2 diabetes and prediabetes, when symptoms are mild, a foundational strategy must include an increase in physical exercise and an improvement in diet. Just 30 minutes a day of moderate physical activity—coupled with a 5 to 10 percent reduction in body weight—produces a 58 percent reduction in the incidence of diabetes among people at high risk.

In the context of type 2 diabetes, diet has received much attention, particularly with high glycemic-index foods. While reducing highly processed carbohydrates like refined sugar and fiber-free white flour is important for metabolic health, overreliance on the glycemic index (GI) as a barometer of food “goodness” is flawed. Think balanced, think protein-rich and most of all, think healthy fats when eating to manage blood sugar and diabetes.

Try to get 15 to 20 percent of your calories from protein (unless you have diabetic kidney disease). Fats should make up 25 to 35 percent of your calories, mostly monounsaturated fats from olives and avocados, and omega-3 fats from walnuts (which also contain omega-6 fats), flaxseed, and fatty fish like salmon and tuna. The remaining 45 to 55 percent of your calories should come from complex carbs like leafy green vegetables, whole grains, legumes, and beans.

Carbohydrates can be your friend: the key is to focus on those high in soluble plant fiber, so you get 25 or more grams of fiber per day. This type of dietary fiber helps blunt blood sugar spikes after meals and reduces LDL and triglyceride levels.

Reduce glycation in foods with “low and slow” cooking

Glycation damages cells and tissues in people with type 2 diabetes. AGEs are highly reactive and can set off a chain reaction of oxidation and inflammation. When they accumulate in the coronary arteries and blood vessels in the retina and the kidney they can damage cells, accelerate aging, and cause other complications.

AGEs can also be formed in foods cooked under high heat with methods like grilling, broiling, and frying. To minimize glycotoxin formation in food, switch to “low and slow” cooking with techniques that utilize temperatures below 250 degrees—examples would be poaching, steaming, braising, stewing, and slow cooking in a crockpot. In general, raw fruits, lightly steamed vegetables, unroasted nuts, and seeds have low levels of glycotoxins.

Avoiding foods cooked under high heat for prolonged periods of time is an excellent first step. You can further protect yourself through a number of dietary supplements that serve as antiglycation agents.

Benfotiamine is a variation of vitamin B1 that reduces the nerve and blood-vessel damage caused by glycation. A study showed that 100 mg of benofotiamine given four times daily improved diabetic neuropathy (kidney disease) scores and pain relief.

Carnosine is a glycation inhibitor that protects against diabetic kidney disease and reduces the formation of AGEs. Carnosine has been compared to the anti-aging drug aminoguanidine and showed similar results.

Protecting beta cells and preventing insulin sensitivity

A very good strategy for reversing type 2 diabetes is to enhance insulin sensitivity in cells and tissues of the body. As mentioned earlier, insulin resistance occurs when cellular receptors become desensitized and the body has to make a steadily increasing amount of insulin to get the same effect. Eventually, when the body is in type 2 diabetes, the overworked pancreas simply wears out.

To enhance insulin sensitivity, focus on eating the foods described earlier, getting 30 minutes or more of exercise per day, and supplementing with those in the following list.

Evidence also strongly supports strategies that target beta cell health—beta cells are critically important, as they are responsible for secreting insulin in response to glucose in the bloodstream. A failure to achieve healthy blood sugar levels despite elevated insulin levels is a sure sign that the beta cells are stressed and organs like the liver are insulin resistant.

Recent science suggests that beta cell dysfunction and insulin resistance may occur even earlier than once thought—far in advance of a diagnosis of type 2 diabetes. That is why addressing beta cell function and insulin resistance early in the process may prevent permanent damage to the pancreas.

Coffee to the rescue

Coffee consumption is associated with improved blood sugar control and lower risk of type 2 diabetes. Most likely this is from the polyphenols contained in coffee, not from caffeine as the stimulant tends to worsen insulin sensitivity. A specific polyphenol, chlorogenic acid, is responsible for reducing intestinal absorption of glucose, inhibiting the gene expression of an enzyme that generates glucose from glycogen, and improving beta-cell function.

Since green coffee beans contain greater levels of chlorogenic acid than roasted beans but are not readily edible, extracts of green coffee bean standardized for chlorogenic acid are an intriguing supplement option. A dose of 200 to 400 mg of green coffee bean extract standardized to 50 percent chlorogenic acid taken before meals can help support healthy blood sugar levels.

Another interesting benefit of chlorogenic acid is weight loss and decreased fat storage. In a small human crossover study, participants who consumed chlorogenic acid experienced significantly lowered body weight of 17.6 pounds (over 10 percent of body weight) without dramatic changes to diet. The study authors noted that all 16 of the subjects were classified as overweight at the beginning of the study and at the end six of the subjects were within a normal weight for their height.

This study also used somewhat higher doses of chlorogenic acid than other studies, ranging from 700 mg to 1,050 mg total daily dose as compared to studies targeting blood sugar where the dose was 200 to 400 mg before meals (600 mg to 800 mg total daily dose). Look for extracts that are standardized to 50 percent chlorogenic acid, with at least a 200 mg dose before meals.

Study authors noted that adherence to weight loss drugs remains poor, largely due to limited effectiveness, but that chlorogenic acid may prove to be a valuable means to reduce body weight and the metabolic risks associated with obesity.

Supplements for beta cell function and insulin sensitivity

There are a number of ways to support beta cell function and enhance insulin sensitivity with food-based dietary supplements. Here are some you may want to consider:

Barley beta-glucan, a fiber derived from barley extract, slows the absorption of glucose and helps optimize blood glucose levels and improve insulin sensitivity. Studies suggest that six grams a day of beta-glucans consumed in a beverage over 12 weeks may improve insulin sensitivity among those with prediabetes.

Chromium, an essential trace mineral, supports insulin sensitivity and normalizes blood sugar levels, and improves metabolism of carbohydrates, proteins, and lipids.

Cinnamon, specifically water-soluble cinnamon extract, may help alleviate glucose intolerance according to a USDA study that isolated insulin-enhancing complexes in cinnamon that prevent or alleviate glucose intolerance and diabetes. The recommended dose is 125 mg of water-soluble cinnamon extract three times daily.

DHEA has been shown in animal studies to increase beta cells in the pancreas. If you want to take DHEA, it is important to be tested before and after supplementation. Men and women with hormone-sensitive cancer—such as prostate or breast—should not take DHEA without consultation with their physician.

Ginkgo biloba is a common botanical that may significantly increase pancreatic beta cell function in response to glucose loading.

L-Carnitine can help support healthy blood sugar levels, increase insulin sensitivity and glucose storage, and optimize fat and carbohydrate metabolism.

Magnesium levels are often low in people with diabetes, as it is depleted by medications and the disease process. Magnesium is critical to support insulin sensitivity and healthy blood sugar levels. A double-blind, placebo-controlled trial showed that 2.5 grams of magnesium chloride significantly improved insulin sensitivity in magnesium-depleted patients. (Note that magnesium chloride is less concentrated than the more commonly found magnesium oxide. An optimal level would be 250 to 500 mg of elemental magnesium daily.)

Niacin, also known as vitamin B3, may help restore beta cell function. But because niacin can disrupt blood sugar control in patients with type 2 diabetes, patients taking niacin must closely monitor blood sugar levels and discontinue treatment in the event of worsening of glycemic control.

Omega-3 fatty acids play a multifaceted role in diabetes prevention and treatment, enhancing glucose metabolism, reducing C-reactive protein levels (a biomarker of inflammation), and supporting fat metabolism. In human experiments, omega-3s lowered blood pressure and triglyceride levels and helped prevent diabetic retina disease, thus relieving many of the complications associated with diabetes. For optimal results, 2.5 g of fish oil or krill oil per day is recommended, with a seven-to-one ratio of EPA to DHA.

Antioxidants and anti-inflammatory agents

Antioxidants and anti-inflammatory agents defend against the damage caused by excess glucose through oxidative stress and inflammation, which accelerates aging and contributes to diabetes-related problems like kidney disease, diabetic eye disease, and heart attack.

Coenzyme Q10 (CoQ10) is an antioxidant shown in several clinical reports to support blood sugar control. In a controlled human trial, type 2 diabetics given 100 mg CoQ10 twice daily (200 mg total daily dose) experienced improved glycemic control and reduced blood pressure. In a separate study, CoQ10 improved blood flow in type 2 diabetics, an outcome attributed to CoQ10’s ability to lower vascular oxidative stress. Statin drugs—such as lovastatin, simvastatin, and pravastatin, intended to reduce cholesterol—decrease CoQ10 levels, so supplementation is recommended. The ubiquinol form of CoQ10 appears to offer superior oral bioavailability, so this is preferred over the ubiquinone (oxidized) form. Dosage of ubiquinol will vary based on your physician’s recommendation of 100mg to 300 mg a day.

Curcumin is derived from the Indian spice turmeric. Curcumin is well known for its antioxidant and anti-inflammatory properties and as an aid in glycemic control. In a randomized study of 72 diabetics, the drug atorvastatin was compared with curcumin (150 mg twice daily) or a placebo for eight weeks—the curcumin showed comparable results to that of atorvastatin by reducing oxidative stress. Curcumin also has been shown to inhibit the development of diabetic kidney disease and retina disease.

French melon extract contains superoxide dismutase (SOD), an enzyme and a potent antioxidant that naturally declines in our bodies as we age. Studies suggest oral supplementation of SOD—along with a protein called gliadin to protect from digestion in the gut—may support vascular health and reduce the risk of atherosclerosis associated with diabetes. Studies also show that long-term supplementation with SOD (for two to three years) may protect against age-related carotid artery thickness increases. A reasonable daily dose is 1,000 mg of French melon extract.

Green tea contains epicatechin, catechin, gallocatechin, and epigallocatechin gallate (EGCG), powerful antioxidants that play a role in the health of the pancreas and liver. Animal studies show that epigallocatechins prevent proinflammatory cytokines from damaging beta cells. Experimental tissue studies also show that green tea suppresses factors involved in diet-induced obesity which can lead to diabetes. At least five cups of green tea per day are needed for optimal health benefits, or a supplement containing at least 300 mg of EGCG.

Lipoic acid is an antioxidant that helps with blood sugar control and preventing such long-term complications as heart disease, kidney disease, and small blood-vessel disease. Experimental studies suggest that lipoic acid also helps reduce fat accumulation, lowers triglyceride accumulation in skeletal muscles, and protects pancreatic beta cells. In a large clinical trial, diabetics with nerve damage affecting the heart showed significant improvement without significant side effects from 800 mg oral lipoic acid daily.

Pomegranate is filled with antioxidants and a class of polyphenols called punicalagins, which support optimal blood pressure and decrease the risk of vascular endothelial damage associated with diabetes. Scientists found that diabetics who drank pomegranate juice for three months reduced the thickening of the innermost layers of the arterial wall. Pomegranate may also improve levels of total cholesterol, LDL cholesterol, and the ratio of HDL to LDL.

Whey protein isolate, a purified protein source, helps balance insulin secretion with blood glucose levels. Components in whey protein support healthy blood pressure and boost the immune system by enhancing glutathione levels, an antioxidant responsible for liver detoxification that is often depleted in diabetics. Whey protein also helps facilitate weight management through appetite control and satiety. Dosage is recommended at 20 to 40 mg of high quality whey protein isolate per day from a low-temperature-processed whey protein isolate.

 

Steven V. Joyal, MD, is chief medical officer for Life Extension, the world’s leading organization dedicated to extending the healthy human life span. Before joining Life Extension, Dr. Joyal was employed by Bristol-Myers Squibb Pharmaceutical Research Institute as the group director in global clinical metabolic drug development. His work there influenced the research and development of medications related to obesity, diabetes, and hyperlipidemia.