Pre-Diabetes

Pre-diabetes is much like it sounds, it is when your blood sugar level is elevated beyond normal however still not at the level to be considered type 2 diabetes. If gone untreated, it will most likely develop into type 2 diabetes.  Unfortunately, when receiving a diagnosis of pre-diabetes, there is a strong possibility that the damage of type 2 diabetes, especially to your heart and blood vessels, has already begun. The good news is that there is still time to make lifestyle changes to reverse it and regulate your blood sugar. 

The causes of pre-diabetes is still unclear, but are associated with a combination of genes, diet, and lifestyle factors.  Pre-diabetes is associated with insulin resistance.  Insulin is a hormone that is made by the pancreas that helps get glucose from the blood into the cells to produce energy.  Insulin resistance occurs when there are high levels of glucose in the blood that trigger an increase in insulin, when the levels remain high over time, skeletal muscle cells become overwhelmed and start to become sluggish allowing for glucose levels to remain high in the blood and the body to become more resistant to insulin, alternatively, high blood sugar can result in the pancreas not being able to keep up with the demand of insulin production.  The excess glucose is then turned into fat and results in weight gain.  People who are overweight, especially those with visceral obesity are at higher risk of becoming pre-diabetic. Other risk factors include:

 ·       Age- nearly half of people over 45 years old will develop pre-diabetes (Mercola, 2015).

·       Sedentary lifestyle

·       Race- African-Americans, Hispanics, Native Americans, Asian Americans, and Pacific Islanders are at greater risk for developing pre-diabetes.

·       Family History- If you have a parent or sibling with type 2 diabetes your risk for developing pre-diabetes increases. If you had gestational diabetes when pregnant this will also increase your risk.

·       Diet- A diet high in processed foods and sugars is associated with a risk of pre-diabetes.

·       Polycystic Ovary Syndrome- women who have POS have an increased chance of developing pre-diabetes.

·       High blood pressure- those with a diagnosis of high blood pressure have an elevated risk of developing pre-diabetes.

·       Low HDL cholesterol- High-density lipoprotein also known as “good” cholesterol lower than 35mg/dl.

·       High Triglycerides- above 250mg/dl.

·       Sleep- Sleep disorders such as sleep apnea increase your risk for insulin resistance.

Many who suffer from pre-diabetes will do so without any symptoms.  One sign that you may be at risk of pre-diabetes is a skin condition called acanthosis nigricans, which causes darkened skin on certain parts of your body such as your knees, elbows, armpits, neck, and knuckles.  If symptoms such as increased thirst, frequent urination, blurred vision, and fatigue begin then that may be a sign that you have gone from pre-diabetes to type 2 diabetes.

 Diagnosis of pre-diabetes can be done by a medical practitioner through the following tests:

 ·       Glycated hemoglobin (A1C) test- This test measures the blood sugar attached to the hemoglobin in your blood.  It will report your average glucose for up to 3 months. In general, an A1C level between 5.7 and 6.4 percent is considered pre-diabetes.

·       Fasting blood sugar test- a blood sample is taken after you have fasted for at least 8 hours or overnight. A fasting blood sugar level between 100 to 125 mg/dl is considered pre-diabetes.

 Once you have been diagnosed with pre-diabetes there is much that you can do to make significant changes that will reverse your diagnosis.  

Diet:  A diet free of processed foods, refined sugar, refined carbohydrates is crucial to reverse pre-diabetes.  Consuming organic vegetables and fruits, grass-fed meats, wild-caught fish, while eliminating grains, legumes, gluten, and dairy.  A Paleolithic diet has been shown to be effective in treating Type 2 diabetes and metabolic problems while increasing weight loss.  A diet high in protein, fiber, and good fats and low in carbohydrates is optimal for controlling blood sugar levels.  Limiting carbohydrate consumption can reduce insulin spikes and keep glycemic control.

 Other things to avoid:

·       Trans fats- Trans fats will interfere with your insulin receptors, increasing your risk of diabetes.

·       Artificial Sweeteners- can increase your risk of developing diabetes by disrupting your intestinal microflora. It can induce gut dysbiosis and glucose intolerance.

·       Starchy Carbohydrates- Approximately 60 research studies have shown evidence in support of restricting starchy carbohydrates in regulating blood sugar.

Eating 3 balanced meals and snacks when necessary can help keep blood sugar levels consistent.  It is also important to make sure that all meals and snacks contain a combination of, protein, fat, and good carbohydrates.  Eat within the first hour of waking, making sure you have a good protein to help you start your day and sustain you until your next meal.  Good high-quality fats such as avocados, nuts seeds, coconut oil, extra virgin olive oil, grass-fed meats, and eggs should be consumed without restriction. Eating before becoming hungry ensures that you haven’t waited until your blood sugar levels have dropped, and your body is under stress.  Overeating can also add stress to the body and increase blood sugar too much leading to weight gain, so eating to your 80 % full can help while combating pre-diabetes. There has been new research that shows intermittent fasting as a good approach for those with diabetes, so it is safe to assume that this would also be a great tool for those with pre-diabetes. I will do a separate post on intermittent fasting, as this is something that is not a once size fits all approach.

Exercise: Exercise is a vital component to combatting pre-diabetes and managing insulin resistance. Exercise will burn excess glucose a well as increase insulin sensitivity. For those who are obese and just starting to exercise low intensity walking until health improves is beneficial until you are able to increase your workout.  Interval training, which includes bursts of cardio, is most effective for its effects on insulin signaling and reducing blood glucose and lipogenesis.  Including weight training in your routine can also activate type 2 muscle fibers which can help reverse insulin resistance.

Stress: Managing stress is an important factor for reversing pre-diabetes.  Living in constant flight or fight mode will cause blood sugar dysregulation, as your body prepares for “fight,” it will raise your blood sugar levels for a fight that isn’t truly there.  Developing a practice of meditation or other stress management techniques is beneficial for also managing blood sugar.

Sleep: 8-9 hours of good, restful sleep is optimal for most adults. Studies have shown that sleep disturbances and issues such as sleep apnea increases your risk for insulin resistance. People who work night shifts and who wake frequently throughout the night also have an increased risk of developing pre-diabetes.

Key Nutrients to combat Pre-diabetes

Biotin- Biotin is a B vitamin.  It helps metabolize carbohydrates and amino acids and helps the utilization of fatty acids into energy.  Biotin also increases the production of the enzyme glucokinase, which is typically low in diabetics, which helps the liver utilize glucose.  Biotin deficiencies can impair the metabolism of sugar.

Foods rich in Biotin include organ meats, walnuts, pecans, black-eyed peas, split peas, almonds, cauliflower, eggs, and mushrooms.  Raw egg whites contain a protein that binds to biotin and will prevent its absorption, therefore is not recommended. Supplementation can be beneficial, a dose of 9-16mg daily is optimal. 

Magnesium- Magnesium is a mineral in our body that is involved in almost every body process and almost 400 enzyme systems.  It is critical for energy production and an important part of muscle and nerve function and glucose control, it improves insulin response, therefore this mineral plays an important part in combating pre-diabetes.  It will also help relax your body and aid in sleep.

Food sources of magnesium include kelp, spinach, swiss chard, pumpkin seeds, sesame seeds, almonds, avocado, dried figs, flax seeds, summer squash, blackstrap molasses, and broccoli.  A green smoothie/juice would be a great way to add magnesium to your diet.  Additional supplementation is helpful as a deficiency is common. Supplementation of 400-800mg per day divided throughout the day can be beneficial.  Magnesium glycinate is a well-absorbed form for many. If dealing with constipation issues, Magnesium citrate may be a better choice.

Niacin- Also known as B3, is important in energy production, and the metabolism of fat, cholesterol, and carbohydrates. It is an essential part of the glucose tolerance factor. In supplement form, niacinamide can lower insulin levels and improve metabolic control and increase beta-cell function.  It can also help control blood sugar in people with type 2 Diabetes that are unresponsive to oral anti-hyperglycemic medication. Niacin can be made in the body through the conversion of tryptophan.

Food sources of niacin include liver and other organ meats, fish, eggs, sesame and sunflower seeds, pine nuts, almonds, and red chili peppers.   An additional dose of 25 mg/kg daily can be beneficial when combating pre-diabetes. 

Additional Nutrient & Herb Recommendations:

Chromium- A part of the glucose tolerance factor, which helps glucose get into the cells is essential in blood sugar regulation. Chromium levels have a major impact on insulin sensitivity. If chromium levels are low it can cause blood sugar levels to remain high, as there will be a lack of sensitivity to insulin. Chromium levels can be depleted by the consumption of refined sugars, white flour products, and by lack of exercise.

Food sources of chromium include calf’s liver, potatoes, green pepper, apple, butter, parsnips, banana, spinach, carrots, oranges, and blueberries.  There is no RDA for chromium however at least 200 mcg each day is needed.  When combating pre-diabetes and type 2 diabetes, supplementing with chromium picolinate 200 mcg, 3 times per day with meals can help regulate blood sugar levels.

Cinnamon- Cinnamon comes from the inner bark of evergreen trees that are native to Sri Lanka, southwest India, and Asia. It is one of the oldest spices known, and it was used in ancient Egypt as a medicinal herb and embalming agent (Murray et al, 2005). Cinnamon is a blood sugar-stabilizing spice, it is anti-diabetic and can lower blood lipids. It is also a potent antioxidant and has been shown to increase glucose metabolism.

Using Ceylon cinnamon as a spice in cooking and including it in your daily diet can be beneficial.  Cinnamon can be used as a natural sweetener, added to your morning coffee, and also works well with poultries and in curries, and with fruits such as apples and pears.

Probiotics- Studies have shown that obese people have a different gut microbiome than lean people. Adding good bacteria to your gut can help strengthen your immune system and overall health. Consuming good bacteria can also help in weight loss. 

Fermented foods are a great way of adding multi strains of good bacteria to your system.  Foods such as sauerkraut, kimchi, fermented vegetables, and Kiefer, consumed daily are a great way to increase good bacteria in your gut.  If you are not eating fermented foods supplementation of 10-50 billion organisms daily can be beneficial.

Omega-3 fatty acids- Omega 3 fatty acids from fish, and fish oils, help protect against heart disease. Fish consumption has also been shown to lower your risk of many chronic diseases including diabetes.  Many people with diabetes often have high triglycerides and low HDL levels.  Omega 3 fatty acids can help lower triglycerides and apoproteins, which are markers for diabetes as well as raise HDL levels.

Omega 3 fat can be found in cold-water fish such as salmon and halibut and fish oil. Including these wild-caught fish in your diet is a great way to increase your Omega 3 intake.  Intake of 600-1200 mg daily optimal when combatting pre-diabetes.  Supplementation from a reputable company that uses wild-caught non-GMO sources is optimal.  

Vitamin D- Vitamin D is produced in our bodies through our skin’s exposure to sunlight.  It is best known for stimulating the absorption of calcium, however, it plays an important role in regulating pancreatic beta cells which make insulin. For prediabetics with levels under 22ng/ml Vitamin D can help improve insulin sensitivity. Vitamin D deficiency is also common in those with Type 2 diabetes.

Natural sources of Vitamin D include cod-liver oil, cold-water fish, butter, and egg yolks. Although vegetables are low in Vitamin D the best source is dark leafy greens.  Supplementation is often necessary as in today’s culture we are not spending as much time outside in the sun, supplementing (anywhere from 2000 iu’s to 5000 iu’s) to achieve a goal of 40-60 ng/ml is optimal.

Ginseng- Panax Ginseng/ American Ginseng is an herb that has been used in Asia and North America for centuries to help a variety of ailments ranging from headaches to infertility.  It is also the most evidence-based herbal therapy for type 2 diabetes.  It is a natural appetite suppressant and can help boost your metabolism, helping your body burn fat at a faster rate.  A study conducted in the UK found that when taken with glucose, there was a reduction in blood glucose levels one hour after consumption.

Consuming 3 grams of whole powdered American ginseng root before each meal will help reduce postprandial glucose.  Consuming Panax ginseng at 200mg can help reduce fasting glucose and body weight.

Environmental considerations: Toxins found in your environment, household cleaning products, and beauty products should be eliminated as much as possible as they can lead to blocked metabolic pathways, and stress on your system.  Research published in the journal Obesity found that a chemical contained in nonstick cookware, Perfluorooctanoic acid (PFOA), may also alter metabolism and lead to weight gain, which in turn can increase your chances of pre-diabetes. Therefore choosing your household products wisely and making healthier, safer choices, can help while combating pre-diabetes.

With 37% of people in the United States over 20 and 51% of those over 65 showing pre-diabetes symptoms, it is a condition that so many are dealing with (Axe, n.d.).  Our nation’s obesity epidemic, as well as the standard American diet, are contributing factors to these percentages. The good news is that with the right changes to your diet and lifestyle, it is reversible and can never develop into Type 2 diabetes.

 ** Disclaimer: the information contained in this post is for educational purposes only. It is not intended to substitute professional medical advice. Always consult a medical professional before beginning any supplementation. **