information on nutrition, diet, lifestyle & research
Diabetes mellitus can be more easily managed through a number of proactive steps that one can take involving proper diet, exercise, lifestyle considerations, and specific nutrients. This is particularly true of adult onset, or type 2 diabetes.
Type 2 diabetes responds well to natural therapies.Lifestyle Changes
- Weight loss: Being overweight increases the need for insulin and can even make healthy people pre-diabetic (weight loss reverses this problem).
- Exercise: Exercise helps decrease body fat and improves insulin sensitivity. Therefore, diabetics should never begin an exercise program without consulting a healthcare professional.
- Alcohol: Moderate drinking by healthy people improves glucose tolerance. However, alcohol has been reported to worsen glucose tolerance in the elderly and in diabetics. People with diabetes should limit alcohol intake to two drinks per day.
- Quit smoking: Diabetics who smoke are at higher risk for diabetes-linked problems. Smokers are more likely to become diabetic than are non-smokers.
- Self-Monitoring issues - self monitoring of glucose
Note: All people with diabetes should seek medical advice before they make any dietary changes.
- Carbohydrates: Eating carbohydrate-containing foods, whether high in sugar or high in starch such as bread, potatoes, pasta, processed breakfast cereals and rice temporarily raises blood sugar and insulin levels. People eating large amounts of foods with high glycemic indices have been reported to be at increased risk of type 2 diabetes.
- Sweet drinks It has been widely recognized that if sugary drinks were eliminated the incidence of many conditions, including diabetes, would decrease markedly.
- Fiber Although the research is inconclusive, most doctors advise people with diabetes to eat a diet high in fiber. Focus should be on fruits, vegetables, seeds, oats and whole-grain products. Note: Diabetics with unrecognized kidney failure could develop serious complications from a high-fiber (and therefore high-potassium) diet.
- Fish: Eating fish may provide some protection from diabetes.
- Vegetarian diet: Vegetarians are reported to have a low risk of type 2 diabetes.
- Protein: Switching to a high- or low-protein diet should be discussed with a doctor.
- Fat: Diets high in fat, especially saturated fat worsen glucose tolerance and increase the risk of type 2 diabetes. In contrast, glucose intolerance has been improved by diets high in monounsaturated fats such as those containing olive oil. However, people who are overweight need to be careful.
- Children & milk Most studies indicate that children with type 1 diabetes drink cow's milk at an earlier age than other children; one hypothesis is that antibodies weaken insulin producing capacity of pancreas.
- Onion: Preliminary trials and at least one double-blind trial have shown that large amounts of onion can lower blood sugar levels in people with diabetes.
- Diet Recommendations
- Lifestyle Recommendations
- Nutrient Discussion
NOTE: Any changes in medication should be discussed with your doctor.
People with diabetes mellitus cannot properly process glucose, a sugar the body uses for energy. As a result, glucose stays in the blood, causing blood glucose levels to rise. At the same time, however, the cells of the body can be starved for glucose. Diabetes can lead to poor wound healing, higher risk of infections, and many other problems involving the eyes, kidneys, nerves, and heart.
A pre-diabetic condition is one in which blood glucose levels are not high enough to warrant a diagnosis of diabetes. It has been found that even though diabetes doesn't yet technically exist, long-term adverse changes are occurring to the circulatory system and heart.
Adult-onset diabetes is also called type 2 or non-insulin-dependent diabetes. With type 2, the pancreas often makes enough insulin, but the body has trouble using the insulin. Type 2 often responds well to natural therapies.
Childhood-onset diabetes is also called type 1 or insulin-dependent diabetes. In type 1 diabetes, the pancreas cannot make the insulin needed to process glucose. Natural therapies cannot cure type 1, but may help by making the body more receptive to insulin supplied by injection. It is critical for people with type 1 diabetes to work carefully with the doctor prescribing insulin before making any lifestyle or dietary changes mentioned in this section.
Symptoms of diabetes can develop suddenly (over days or weeks) in previously healthy children or adolescents, or can develop gradually (over several years) in overweight adults over the age of 40.
The classic symptoms include feeling tired and sick, frequent urination, excessive thirst, excessive hunger, and weight loss.
Ketoacidosis is a condition due to starvation or uncontrolled diabetes, and is common in type 1 diabetes. Ketones are acid compounds which form in the blood when the body breaks down fats and proteins. Symptoms include abdominal pain, vomiting, rapid breathing, extreme tiredness and drowsiness. Patients with ketoacidosis will also have a sweet breath odor. Left untreated, this condition can lead to coma and death.
With type 2 diabetes, the condition may not become evident until the patient presents for medical treatment for some other condition. A patient may have heart disease, chronic infections of the gums or urinary tract, blurred vision, numbness in the feet and legs, or slow-healing wounds. Women may experience genital itching.
Causes of Diabetes
Diabetes mellitus may arise from both hereditary and environmental factors. It has been established that some patients with diabetes have common genetic markers.
Type I Diabetes
In type 1 diabetes, the immune system may be triggered by a virus or another microorganism that makes it attack the pancreas beta cells which produce insulin.
Type 2 Diabetes
Age, family history and obesity play a role in type 2 diabetes.
Although in this type of diabetes the pancreas may produce enough insulin, resistance may have developed and the insulin is not as effective. type 2 diabetes symptoms can start very gradually and go unnoticed. Early indicators can include extreme thirst, tiredness and frequent urination. In addition, symptoms may include slow wound healing, sudden weight loss, urinary tract infections, blurred vision or gum disease. Such patients may discover the diabetes when they visit their doctor for other conditions.
Individuals who are at high risk of developing type 2 diabetes mellitus include people who:
- Have a relative with diabetes mellitus
- Are overweight (more than 20% above their ideal body weight)
- Belong to a high risk ethnic population (African-American, Native American, Hispanic, or Native Hawaiian)
- Have delivered a baby weighing more than 9 lbs or have been diagnosed with gestational diabetes.
- Have had impaired glucose tolerance or impaired fasting glucose on previous testing.
- Have high blood pressure (140/90 mmHg or above)
- Have a high density lipoprotein cholesterol level less than or equal to 35 mg/dL and/or a triglyceride level greater than or equal to 250 mg/dL
A number of medications can damage the body's ability to use insulin causing secondary diabetes. These medications include treatments for high blood pressure, drugs with hormonal activity (oral contraceptives, thyroid hormone, progestin, and glucocorticoids), and the anti-inflammation drug indomethacin. Several drugs that are used to treat mood disorders (such as anxiety and depression) can also impair glucose absorption. There are other medications that can cause diabetes symptoms as well.
Type 1 diabetes is usually treated with a combination of diet and insulin.
For type 2 diabetes, proper diet and medication, often taken orally, is prescribed.
Dietary changes that may be helpful
Note: All people with diabetes should seek medical advice before they make any dietary changes.
- Carbohydrates: Eating carbohydrate-containing foods, whether high in sugar or high in starch such as bread, potatoes, pasta, processed breakfast cereals and rice temporarily raises blood sugar and insulin levels. The blood sugar-raising effect of a food, called its "glycemic index," depends on how rapidly its carbohydrate contents are absorbed and converted to sugar. People eating large amounts of foods with high glycemic indices have been reported to be at increased risk of type 2 diabetes.
However, diets high in total carbohydrates do not necessarily increase the risk of type 2 diabetes and some studies have found no independent relationship between sugar intake and the development of glucose intolerance.
Most doctors recommend that diabetics reduce their intake of sugar from snacks and processed foods, and replace these foods with high-fiber, whole foods. more details ...
- Sweet drinks It has been widely recognized that if sugary drinks were eliminated the incidence of many conditions, including diabetes, would decrease markedly. Many diabetics have already been told by their doctors that fresh fruit is preferred to fruit juices - since the high level of fructose in fruit juices raises blood sugar. A study of nearly 7,000 people found that diet soda consumption also significantly increases the risk of type 2 diabetes.9
- Fiber High-fiber supplements such as psyllium, guar gum (found in beans), pectin (from fruit), oat bran and glucomannan (from Amorphophallus konjac) have improved glucose tolerance in some studies. Good results have also been reported with 1-3 ounces of powdered fenugreek seeds per day. Although the research is inconclusive, most doctors advise people with diabetes to eat a diet high in fiber. Focus should be on fruits, vegetables, seeds, oats and whole-grain products.
Note: Diabetics with unrecognized kidney failure could develop serious complications from a high-fiber (and therefore high-potassium) diet.
- Fish: Eating fish may provide some protection from diabetes.
- Vegetarian diet: Vegetarians are reported to have a low risk of type 2 diabetes. People with diabetic nerve damage who switch to a vegan diet (no meat, dairy or eggs) have reported improvement after several days. Fats from meat and dairy may also promote heart disease, the leading killer of people with diabetes.
- Fat: Diets high in fat, especially saturated fat worsen glucose tolerance and increase the risk of type 2 diabetes. Saturated fat is found primarily in meat, dairy fat, poultry skins and dark meat. In contrast, glucose intolerance has been improved by diets high in monounsaturated fats such as those containing olive oil. However, people who are overweight need to be careful. For example, olive oil is high in calories. Avoid vegetable oil for both cooking and salad dressing and fried food. Most commercial salad dressings should be avoided for their high sugar content and poor quality oils.
- Children & milk Most studies indicate that children with type 1 diabetes drink cow's milk at an earlier age than do other children. Some children who drink cow's milk produce antibodies to the milk; it has been hypothesized that these antibodies can cross-react with and damage the insulin-producing cells of the pancreas. more detail.
Key nutritional supplements
- Alpha lipoic acid (600 mg, one to three times per day): This powerful natural antioxidant has been shown to improve diabetic neuropathy and to improve insulin sensitivity.
- Brewer's yeast (9 grams per day): Medical reports indicate that chromium-rich brewer's yeast can be useful in treating diabetes.
- Chromium (200-1,000 mcg per day): Chromium has been shown to improve glucose tolerance in people with both type 2 and type 1 diabetes, apparently by increasing sensitivity to insulin.
- Evening primrose oil (EPO) (4 grams per day for six months): EPO has been found in double-blind research to improve nerve function and relieve pain symptoms of diabetic neuropathy.
- Glucomannan: For controlling the elevation of blood sugar, 500-700 mg of glucomannan per 100 calories in the diet has been used successfully in controlled research.
- Turmeric Double-blind research demonstrates that curcumin extract (turmeric) is very effective in preventing the onset of type 2 diabetes.
- Magnesium (300-1,000 mg per day): Diabetes patients tend to have low magnesium levels. Double-blind research indicates that supplementing with magnesium overcomes this problem. Magnesium supplementation may also help improve insulin production in elderly people with type 2 diabetes.
Other nutritional supplements
- Biotin: 9 mg per day for two months or 16 mg per day for three weeks.
- Coenzyme Q10 (CoQ10): 50-120 mg per day.
- L-carnitine: 0.5 mg per 2.2 pounds (1 kilogram) of body weight per day.
- Vitamin B1 (thiamine): 10-25 mg per day.
- Vitamin B6 for gestational diabetes only
- Vitamin C: 1-3 grams per day.
- Vitamin E: 900 IU of vitamin E per day.
- Zinc for deficiency
- See discussion of research on other nutrients
- Cayenne (Capsicum frutescens) (topical cream containing capsaicin for neuropathy): May be applied four times per day for severe pain. Use under a doctor's supervision.
- Fenugreek (Trigonella foenum-graecum): Powdered fenugreek seeds (1-3 ounces of powdered seeds per day) may improve glucose tolerance.
- Psyllium (Plantago ovata): Supplementing with psyllium (5 grams per day for 8 weeks) has been shown to be a safe and well-tolerated way to improve control of blood glucose and cholesterol.
Other herbs that may be helpful
- Aloe (Aloe vera): 1 tablespoon (15 grams) of aloe juice twice daily.
- American ginseng (Panax quinquefolius): 3 grams of American ginseng was found to lower the rise in blood sugar when given up to 40 minutes before the consumption of a drink high in glucose by persons with type 2 diabetes.
- Asian ginseng (Panax ginseng): 200 mg of ginseng extract per day.
- Bilberry (Vaccinium myrtillus) leaf (for control of blood sugar) or berry (for capillary fragility): An herbal extract of the berry in capsules or tablets standardized to provide 25% anthocyanosides can be taken in the amount of 240-600 mg per day.
- Bitter melon (Momordica charantia): One small melon can be eaten, or up to 100 ml of a decoction or 2 ounces of fresh juice can be drunk per day. Tinctures of bitter melon (5 ml two to three times per day) can also be used.
- Gymnema (Gymnema sylvestre): 400 mg per day.
- Hairy Basil (seed) and Holy Basil (leaf): Preliminary trials of holy basil (Ocimum sanctum) leaves and hairy basil (Ocimum canum) seeds have shown that these herbs may help people with type 2 diabetes control their blood sugar levels.
- See discussion of other herbs
Acupuncture may be helpful. Although preliminary trials indicate that acupuncture can lower blood sugar1, 2, 3 and improve production of insulin4 in patients with type 2 diabetes, trials on long-term effects have not been concluded. (There has been a long-term study of the use of acupuncture to treat peripheral diabetic neuropathy.8 In a preliminary trial, 77% of people suffering from diabetic neuropathy experienced significant reduction in pain following up to six acupuncture treatments over a ten-week period. Many were also able to reduce pain medications, but no long-term change in blood-sugar control was observed.5Bladder control problems, a complication of long-term diabetes, responded to acupuncture treatment with a significant reduction in symptoms in both controlled6 and uncontrolled7 trials.
Most people with type 2 diabetes are obese or overweight. Excess abdominal weight makes the body less sensitive to insulin. Excess weight makes the body less sensitive to insulin, increases the need for insulin and can even make healthy people pre-diabetic. Losing weight reverses this situation. In most studies, type 2 diabetes has improved with weight loss.
Increased weight gain in infancy makes individuals one and a half times as likely to develop type 1 diabetes in childhood. Being overweight also increases the need for insulin. Therefore, people with type 1 diabetes should achieve and maintain appropriate body weight.
Exercise helps decrease body fat and improve insulin sensitivity. People who exercise are less likely to develop type 2 diabetes than those who do not and exercisers with type 1 require less insulin. Even moderate exercise reduces the risk of type 2 diabetes significantly.
People with type 1 diabetes who exercise require less insulin. However, exercise can induce low blood sugar or even occasionally increased blood sugar. Moreover, a preliminary study has shown that long-term physical activity was not associated with control of blood glucose in people with type 1 diabetes. Therefore, people with diabetes should never begin an intensive exercise program without consulting a healthcare professional.
Moderate drinking in healthy people improves tolerance of glucose. However, drinking had the opposite effect in the elderly and in people with diabetes in some studies. People with diabetes who drink have also been reported to have a high risk for eye and nerve damage.
People with diabetes who smoke are at higher risk for kidney damage, cardiovascular disease and other diabetes-linked problems. Smokers are also more likely to develop diabetes. Therefore, it is important to quit smoking.
Self Monitoring of Blood Glucose
Most medical providers concur that self-monitoring of blood glucose is a good idea for people with type 1 diabetes, but there is disagreement as to whether this is effective or necessary for those with type 2.
Advocates observe that self-monitoring has revolutionized management of type 2 diabetes, allowing patients to maintain goals. These observations are well-supported in the medical literature.
Detractors point out that the value of indiscriminate use of self-monitoring is questionable and adds to medical costs because it is dependent on the accuracy of the instruments and the technique of the user giving rise to inaccurate results. Nonetheless, it is reasonable that self-monitoring of blood glucose, used properly, can have a helpful effect by increasing patient involvement in overall diabetes care. Pharmacists and medical practitioners can teach patients with diabetes skills that will assist their ability to correctly self-manage blood glucose.
1. Feng M, Li Y, Pang B, et al. Acupuncture combined with application of xiaoke plaster for treatment of 309 cases of diabetes mellitus. J Tradit Chin Med 1997;17:247-9.
2. Chen JF. A hemorheological study on the effect of acupuncture in treating diabetes mellitus. J Tradit Chin Med 1987;7:95-100.
3. Chen D, Gong D, Zhai Y. Clinical and experimental studies in treating diabetes mellitus by acupuncture. J Tradit Chin Med 1994;14:163-6.
4. Chen JF, Wei J. Changes of plasma insulin level in diabetics treated with acupuncture. J Tradit Chin Med 1985;5:79-84.
5. Abuaisha BB, Costanzi JB, Boulton AJ. Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study. Diabetes Res Clin Pract 1998;39:115-21.
6. Zheg HT, Huang XM, Sun JH. Treatment of diabetic cystopathy by acupuncture and moxibustion. J Tradit Chin Med 1986;6:243-8.
7. Zhang W. Acupuncture for treatment of diabetic urinary bladder neural dysfunction's report of 36 cases. J Tradit Chin Med 1997;17:211-3.
8. Abuaisha BB, Costanzi JB, Boulton AJ., Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study, Diabetes Res Clin Pract. 1998 Feb;39(2):115-21.
9. Nettleton JA, Lutsey PL, Wang Y, Lima JA, Michos ED, Jacobs DR. Diet soda intake and risk of incident metabolic syndrome and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2009 Apr;32(4):688-94. Epub 2009 Jan 16