Diabetes II and Natural Blood Sugar Control

                              Dr. Justin Pollack, ND

Unlike type I diabetes where insulin replacement can effectively treat the cause of the problem, the type II diabetic suffers a more complex problem of insulin resistance. In the early stages of the disease, the pancreas produces much more insulin than a normal person, yet overstuffed cells will stop responding to the hormone. Insulin takes blood sugar out of circulation and stores it in muscle and liver cells, making excess into fat and cholesterol, earning it the name hormone of storage. Type II diabetes often starts as metabolic syndrome and its four criteria include: elevated fasting blood sugar (>100mg/dL), high blood pressure (>130/85), large waist circumference (>40” men, >35” women) and low HDL (<40-50 mg/dL) / elevated lipids of other types. This is dangerous because it increases a person’s risk of developing atherosclerosis and a whole host of cardiovascular diseases which continue to be the leading cause of preventable death in most of the developed world. Without a change, this person is headed toward type II diabetes. They probably already have a fatty liver (steatohepatitis) because it is one of the primary factors leading to insulin resistance. 

With the advent of CGMs (Continuous Glucose Monitors), major advancements have been made in our understanding of how blood sugar and insulin affect us. We always knew that drops in blood sugar and energy went hand in hand, but the list of problems associated with blood sugar spikes and crashes is well researched and documented in biochemist Jessie Inchauspe’s book Glucose Revolution:1 PCOS (polycystic ovarian syndrome), infertility, heart disease, cancer risk, depressive episodes, dementia, Alzheimer’s, chronic fatigue, constant hunger and cravings, insulin resistance and type II diabetes. 

Food and Movement Approaches for Lowering Glucose and Insulin
It is well-documented that exercise is good for you, but to find out that it is better than a pill or medication?2-5 Let’s take a look at what happens when someone wearing a continuous glucose monitor goes for a 20-minute walk after eating a big bowl of rice. Incredibly, it cuts the spike in glucose in half. If we stay sedentary as the spike reaches its peak, glucose floods our cells and overwhelms our mitochondria. Free radicals are produced, inflammation increases, and excess glucose is stored away in the liver, muscles and fat.
Two food hacks that Inchauspe’ cites, are changing the order of your food and adding a green starter to all your meals.6-9 She tells the story of Gustavo, a salesman in Mexico who had lost two people close to him to type II diabetes mellitus. At 50 years old, he was seriously overweight and headed toward insulin resistance. He discovered Inchauspe’s Instagram page, and devised a trick that cut his glucose spikes in half. Before going out to dinner, he made himself a big plate of grilled broccoli at home and ate it with salt and hot sauce. When he went out with friends (where starches/breads and sugars were abundant), he had a lower insulin spike, less inflammation, less damage to his cells and less inching toward type II diabetes. 
The effect of vinegar (apple cider vinegar in many studies)10-14, protein (nut butter)15 or some fat (olive or avocado oil) on lowering insulin spikes and glucose levels is well documented. It is well-known that diluted apple cider vinegar before a meal kick-starts the digestive process, but it has been uncovered in recent studies that it can reduce glucose spikes by up to 30% and decrease the amount of insulin released by 20%. 

Targeted Nutrient and Herbal Approaches for Blood Sugar
Chromium picolinate is part of glucose tolerance factor, helps insulin usage at the cellular level and can help raise HDL cholesterol.16,17 Trace minerals such as zinc, copper and vanadium have shown promise in helping cells utilize insulin, while magnesium has been shown to help glucose transport, insulin utilization, lipid metabolism, reduce oxidative stress and ramp up cell antioxidant systems.18,19 Cinnamon has been shown to reduce blood sugar, bad cholesterol, and reduce inflammation.20,21 Gymnema (sugar destroyer) is a powerful herb from India that blocks the taste of sweet on the taste buds, lowers intestinal absorption of glucose, can help with lowering weight and cholesterol.22 Momordica (bitter melon) has shown to have hypoglycemic (blood sugar lowering) and antioxidant effects.23

When you are told to ask your doctor about dosages and interactions for herbs and nutrients, understand that naturopathic doctors go through the few accredited graduate medical schools teaching herbalism and nutrition. We are here to help, test, teach and guide you when you want to treat the cause, not the symptoms.. naturally. 

1. Inchauspe’, J. (2022) Glucose Revolution: The life-changing power of balancing your blood sugar. Simon & Schuster.
2. Richter, E. A., & Hargreaves, M. (2013). Exercise, GLUT4, and skeletal muscle glucose uptake. Physiological reviews, 93(3), 993–1017. https://doi.org/10.1152/physrev.00038.2012
3. Baker, J. S., McCormick, M. C., & Robergs, R. A. (2010). Interaction among Skeletal Muscle Metabolic Energy Systems during Intense Exercise. Journal of nutrition and metabolism, 2010, 905612. https://doi.org/10.1155/2010/905612
4. Borror, A., Zieff, G., Battaglini, C., & Stoner, L. (2018). The Effects of Postprandial Exercise on Glucose Control in Individuals with Type 2 Diabetes: A Systematic Review. Sports medicine (Auckland, N.Z.), 48(6), 1479–1491. https://doi.org/10.1007/s40279-018-0864-x
5. Colberg, S. R., Zarrabi, L., Bennington, L., Nakave, A., Thomas Somma, C., Swain, D. P., & Sechrist, S. R. (2009). Postprandial walking is better for lowering the glycemic effect of dinner than pre-dinner exercise in type 2 diabetic individuals. Journal of the American Medical Directors Association, 10(6), 394–397. https://doi.org/10.1016/j.jamda.2009.03.015
6. Shukla, A. P., Iliescu, R. G., Thomas, C. E., & Aronne, L. J. (2015). Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels. Diabetes care, 38(7), e98–e99. https://doi.org/10.2337/dc15-0429
7. Nishino, K., Sakurai, M., Takeshita, Y., & Takamura, T. (2018). Consuming Carbohydrates after Meat or Vegetables Lowers Postprandial Excursions of Glucose and Insulin in Nondiabetic Subjects. Journal of nutritional science and vitaminology, 64(5), 316–320. https://doi.org/10.3177/jnsv.64.316
8. Barber, T. M., Kabisch, S., Pfeiffer, A. F. H., & Weickert, M. O. (2020). The Health Benefits of Dietary Fibre. Nutrients, 12(10), 3209. https://doi.org/10.3390/nu12103209
9. Nesti, L., Mengozzi, A., & Tricò, D. (2019). Impact of Nutrient Type and Sequence on Glucose Tolerance: Physiological Insights and Therapeutic Implications. Frontiers in endocrinology, 10, 144. https://doi.org/10.3389/fendo.2019.00144
10. Kondo, T., Kishi, M., Fushimi, T., Ugajin, S., & Kaga, T. (2009). Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects. Bioscience, biotechnology, and biochemistry, 73(8), 1837–1843. https://doi.org/10.1271/bbb.90231
11. Santos, H. O., de Moraes, W. M. A. M., da Silva, G. A. R., Prestes, J., & Schoenfeld, B. J. (2019). Vinegar (acetic acid) intake on glucose metabolism: A narrative review. Clinical nutrition ESPEN, 32, 1–7. https://doi.org/10.1016/j.clnesp.2019.05.008
12. Shishehbor, F., Mansoori, A., & Shirani, F. (2017). Vinegar consumption can attenuate postprandial glucose and insulin responses; a systematic review and meta-analysis of clinical trials. Diabetes research and clinical practice, 127, 1–9. https://doi.org/10.1016/j.diabres.2017.01.021
13. Wu, D., Kimura, F., Takashima, A., Shimizu, Y., Takebayashi, A., Kita, N., Zhang, G., & Murakami, T. (2013). Intake of vinegar beverage is associated with restoration of ovulatory function in women with polycystic ovary syndrome. The Tohoku journal of experimental medicine, 230(1), 17–23. https://doi.org/10.1620/tjem.230.17
14. Ostman, E., Granfeldt, Y., Persson, L., & Björck, I. (2005). Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects. European journal of clinical nutrition, 59(9), 983–988. https://doi.org/10.1038/sj.ejcn.1602197
15. Lilly, L. N., Heiss, C. J., Maragoudakis, S. F., Braden, K. L., & Smith, S. E. (2019). The Effect of Added Peanut Butter on the Glycemic Response to a High-Glycemic Index Meal: A Pilot Study. Journal of the American College of Nutrition, 38(4), 351–357. https://doi.org/10.1080/07315724.2018.1519404
16. Xia, J., Yu, J., Xu, H., Zhou, Y., Li, H., Yin, S., Xu, D., Wang, Y., Xia, H., Liao, W., Wang, S., & Sun, G. (2023). Comparative effects of vitamin and mineral supplements in the management of type 2 diabetes in primary care: A systematic review and network meta-analysis of randomized controlled trials. Pharmacological research, 188, 106647. https://doi.org/10.1016/j.phrs.2023.106647 
17. Asbaghi, O., Fatemeh, N., Mahnaz, R. K., Ehsan, G., Elham, E., Behzad, N., Damoon, A. L., & Amirmansour, A. N. (2020). Effects of chromium supplementation on glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Pharmacological research, 161, 105098. https://doi.org/10.1016/j.phrs.2020.105098 
18. Bjørklund, G., Dadar, M., Pivina, L., Doşa, M. D., Semenova, Y., & Aaseth, J. (2020). The Role of Zinc and Copper in Insulin Resistance and Diabetes Mellitus. Current medicinal chemistry, 27(39), 6643–6657. https://doi.org/10.2174/0929867326666190902122155 
19. Feng, J., Wang, H., Jing, Z., Wang, Y., Cheng, Y., Wang, W., & Sun, W. (2020). Role of Magnesium in Type 2 Diabetes Mellitus. Biological trace element research, 196(1), 74–85. https://doi.org/10.1007/s12011-019-01922-0
20. Silva, M. L., Bernardo, M. A., Singh, J., & de Mesquita, M. F. (2022). Cinnamon as a Complementary Therapeutic Approach for Dysglycemia and Dyslipidemia Control in Type 2 Diabetes Mellitus and Its Molecular Mechanism of Action: A Review. Nutrients, 14(13), 2773. https://doi.org/10.3390/nu14132773
21. Zare, R., Nadjarzadeh, A., Zarshenas, M. M., Shams, M., & Heydari, M. (2019). Efficacy of cinnamon in patients with type II diabetes mellitus: A randomized controlled clinical trial. Clinical nutrition (Edinburgh, Scotland), 38(2), 549–556. https://doi.org/10.1016/j.clnu.2018.03.003
22. Pothuraju, R., Sharma, R. K., Chagalamarri, J., Jangra, S., & Kumar Kavadi, P. (2014). A systematic review of Gymnema sylvestre in obesity and diabetes management. Journal of the science of food and agriculture, 94(5), 834–840. https://doi.org/10.1002/jsfa.6458
23. Richter, E., Geetha, T., Burnett, D., Broderick, T. L., & Babu, J. R. (2023). The Effects of Momordica charantia on Type 2 Diabetes Mellitus and Alzheimer's Disease. International journal of molecular sciences, 24(5), 4643. https://doi.org/10.3390/ijms24054643