Discussion of Diet, Nutrients & Diabetes
Carbohydrates & Glycemic Index
Diets that are high in carbohydrates increase insulin demands for normal blood sugar, but do not necessarily increase diabetes risk.2 Scientists have found, however, that high-sugar diets may lower tolerance for glucose. 3 An example of a human group exhibiting such decreased glucose tolerance were Yemenite Jews migrating from a non-sugar diet region to a region where sugar was included. This group experienced significant weight gain, the likely explanation for increased diabetes in the group.
Foods that are high in either sugar or starch cause a temporary increase in insulin and blood sugar levels. How rapidly the blood sugar level rises is dependent upon the glycemic index - the rate at which the carbohydrate is absorbed. Diets that include many carbohydrates with high glycemic indexes, such as sugar (high) versus agave syrup (low), are more likely to develop type 2 diabetes. Breads and processed grains have a high glycemic index; foods such as peas, beans, oats and fresh fresh have a low glycemic index, partly because of their high fiber levels.
Diets with high levels of sugar for short-durations do not cause blood sugar problems, and some studies report that this is true even of patients with diabetes. 15,216,17 Current medical guidelines do not prohibit moderate sugar consumption, as long as blood levels of triglycerides, cholesterol and glucose are maintained.18 However, we feel that because high levels of sugar in the diet cause so many other health-related problems it is wise to keep to a low-sugar diet, especially avoiding sodas and processed foods.
High Fiber Diet
Diets that are high in fiber - meaning fresh fruits and vegetables, whole grains, oats, seeds and limited use of processed foods such as white flour and manufactured breakfast cereals help diabetes maintenance as well as controlling blood sugar levels using oral drugs. In one study a diet high in leafy greens, granola and fruit, given to study participants in amounts greater than that typically recommended, and without any supplementary fiber. Over a six week period the control group received the American Diabetes Association (ADA) diet with 24 grams of fiber daily and the test group received the high fiber diet with 50 grams of fiber daily. The patients with the high fiber diets had glucose levels 10% lower than the control group, and their insulin levels were 12% lower than the controls. In addition the patients on the high fiber diet had significantly lower levels of total and LDL cholesterol and triglycerides, as well as slightly lower levels of glycosylated hemoglobin - one indicated of chronic high glucose levels in the blood.
Fish in the diet tend to support both weight loss and improved glucose and insulin and cholesterol levels. The omega 3 fatty acids found in fatty fish like salmon and fish low on the food chain like herring and sardines are helpful for all of these issues and have been tied to better heart health, better vision health, and better overall health.
Vegetarian Diet: Low Fat & Protein, High Fiber
The diet of vegetarians is naturally low in fat and high in fiber. So it is no surprise that vegetarians have a lower risk of type 2 diabetes. In fact, when patients with nerve damage due to diabetes change to a vegan diet without meat, dairy, or eggs, nerve pain has been reported to improve with several days. The saturated fats found in meat products contribute to heart disease - a high risk condition for diabetics.
The vegetarian diet also tends to be lower in protein than that of meat eaters. This lowered protein consumption is, in turn, tied to lessened diabetic kidney damage and improved glucose tolerance. Conversely, a low-carb, high-protein diet has been found to be helpful for weight loss and insulin level controls in obese males.
As mentioned above, high fat diets, particularly consumption of saturated fats found in meats, cheese and butter increase risk of developing type 2 diabetes. This increased risk is not due solely to weight gain. Conversely, glucose tolerance high in mono-unsaturated oils such as olive oil have been found to be helpful. While, for patients with type 1 diabetes it is difficult to adjust the calories from fat and carbs, but changing the kind of fat is useful in controling blood sugar and cholesterol levels. Current research suggests limiting saturated fats to 7% of the total daily calories and recommends monounsaturated fats such as olive oil.281
Children & Milk
There is a continuing debates as to whether children should not be given milk, especially if they are genetically more at risk for type 1 diabetes. Globally, it has been found that children who receive calories primarily from milk or meat have a higher risk of developing type 1 diabetes than vegetarian children.49 This has been validated by animal research. Milk contains a protein similar to pancrease lipase-related protein - which digests fats in human milk. It is possible for cow's milk proteins to pass into the bloodstream where antibodies attack it. The antibodies attack not only the milk protein, but the similar pancreatic proteins. Viral infections such as Coxsakie stimulate the antibody release. (Coxsakie virus is also similar to certain cells in the pancreas).
While the research on this subject has been controversial, and study results have varied, it may be that different genetic strains of milk protein are a factor, and in addition, homogenized and (nowadays) organic milk may be a factor. It has been noted that children when type 1 diabetes often have other allergies. Therefore an allergic reaction to milk and consequent antibody attack on the allergen may be a factor as well because these antibodies can react to the pancreatic proteins that are similar to the milk proteins.
A research study in Finland found that children who received cow's milk formula before three months of age had an increased risk of type 1 diabetes. There may also be a conntection between infant cow's milk consumption and type 2 diabetes risk. The general recommendation therefore is to encourage breast feeding, or soy milk, especially in cases where there is a history of diabetes in a family.
The sulfer compounds and flavonoids in onions may account for their apparent helpfulness in reducing blood sugar leves. A number of studies, both human and animal suggest that onion consumption can reduce too-high blood sugar levels by as much a 70%. 264 265 266 How the metabolism of raw onion is tied to lower blood sugar is still being studied, but onions may block the breakdown of insulin in the liver, leaving more insulin in the bloodstream.267 Onion is a rich source of chrmium which also has been shown to have some value in stabilizing proper blood sugar levels. A study done in 2013 looked at a particular extract of ripe onion juice and found a sight reduction in blood sugar levels in lab animals over just eight days.277
- Alpha Lipoic Acid: Research trials have reported that supplementing with the antioxidant apha lipoic acid 131-137 daily (600-1,200mg) helps effectiveness of insulin and relieves diabetic eye disease symptoms. More recent research validates that alpha lipoic acid is a recommended supplement for type 2 diabetics.281
- Vitamin E deficiencies are more likely to occur in diabetes, both
type 1145 and type 2.146 Most, but not all double blind studies and trials have also determined that supplementing with Vitamin E
improves glucose tolerance in type 2 diabetics.147-150 It has also been useful for better glucose tolerence in older people with or without diabetes.151, 152
Dosage: The dosage, at least 900 IU of daily vitamin E is needed for at least three or more months in order for noticeable results.
On the few trials where vitamin E was not helpful, it was found that nerve damage was at least partly reversed by such supplementation - for six months.153 Both animal154 and pilot human155 studies suggest that vitamin E may lower the risk of diabetic eye disease, or diabetic retinopathy and diabetic kidney disease, or diabetic nephropathy. Supplementing with vitamin E reduces glycosylation (how much sugar attaches to protein molecules) in most studies.156-163
Furthermore, there is a benefit to supplementing with vitamin E because it reduces the risk of some types of stroke (cerebral infractions) in diabetics who smoke.165
- Vitamin C levels are likely to be very low in patients with type 1 diabetes.166 Vitamin C may reduce the amount of sugar that attaches to protein molecules167, generally
improve glucose tolerance in type 2 diabetics. 169,170 Diabetics experience protein loss through their urine (proteinuria) - supplementation with
Vitamin C (500 mg twice a day for 12 months)172
The recommended dosage for vitamin C is 1-3g daily, although in some people higher amounts may actually increase blood sugar levels.173 One isolated study reported that diabetic retinopathy was more prevalent in people taking both vitamin E and C - but it did not take into account that the more severe one's diabetic eye disease, the more likely one is to take antioxidants in order to help reduce further damage. Most medical practitioners remain relatively assured that the two vitamins are beneficial for diabetics.
- CoEnzyme Q10 (CoQ10) is required for proper blood sugar metabolism and both people and animals low in CoQ10 are more likely to have diabetes compared to healthy individuals.191 Results for supplementation with CoQ10 are mixed - in one pilot study, blood sugar levels significantly improved in 31% of diabetic patients taking 120mg daily of CoQ7 (similar to CoQ10) 192 But in other research supplementing with daily 100mg CoQ10 did not reduce insulin requirements or improve glucose tolerance - this was for type 1 diabetics.193 Although there is no consensus, many medical professionals do recommend 50mg daily to protect against symptoms caused by deficiency
- Quercetin may be helpful for people who are diabetic - it is found in high concentrations in the outer rings of onions. It has the capacity to reduce sorbitol levels. Sorbital is a sugar that accumulates in kidney and nerve cells, and in the eye in diabetic patients and has been connected to related impairment.230 More research is needed to validate whether quercetin is helpful for diabetic patients.
- Vitamin B6 levels found to be low in many diabetics175 176 and even lower in those diabetics with neuropathy.177 Supplementing with vitamin B6 has been found to support glucose tolerance in female diabetics during pregnancy178 179 and for women taking birth control pills.180 Dosage: 1,800 mg daily of the pyridoxine alpha-ketoglutarate form of B6 significantly improved glucose tolerance181 while the standard version of B6 sometimes helps. 182, 183
- Biotin is a B vitamin that is essential for metabolism of glucose in the body. Fasting glucose blood levels in type 1 diabetics droped by 50% (dosage 16 mg of biotin daily) after a week184 Similarly, taking 9 mg daily for 60 days also improved glucose levels.185 Scientists have found that this important B vitamin is useful in reducing diabetic nerve damage pain.186
- Vitamin B1, also known as thiamine is another B vitamin that displays very low levels in type 1 diabetics.187 The earliest small trial in the '30s, testing 10mg thiamine for 4 weeks reduced blood sugar in 6 out of 11 diabetics. 188 In a country where people are often deficient in this important nutrient, providing patients with 25mg daily B1 along with 50 mg daily B6 for four weeks returned noted improvements in diabetic neuropathy symptoms.189 Yet another pilot study reported that the combination of a fat-soluble form of B1, B6 and 12, for 12 weeks, resulted a variety of symptomatic improvements.190
- Vitamin B12 is essential for normal nerve cell activity and functioning and deficiencies lead to a variety of serious and sometimes permanent nerve damage. For diabetics nerve damage is a serious side effect that is preventable by adequate B12 intake, either orally, intravenously, or by way of B12 injections for those patients who are unable to absorb B12 normally.202 Nerve damage due to diabetic kidney disease was significantly reduced by three-times-daily IV injections of 500 mcg methycobalamin over a six month period. 203 Oral vitamin B12 up to 500 three times a day is the dosage suggested by some medical professionals.
- Vitamin B3 - Niacin & Niacinamide - the evidence is limited as to whether this B vitamin is helpful. Dosages in the range of 500-750 mg daily for 30 days, and then 250 mg daily may be helpful for some people206 but the intake of large amounts of niacin (a form of vitamin B3), such as 2-3 grams per day, worsen glucose tolerance and should be taken by diabetics only under a doctor's recommendation.204 205 a few pilot studies suggest that niacinamide may be helpful in early stages of type 1 diabetes Preliminary trials have shown that niacinamide (another form of vitamin, but the evidence is mixed.207, 208 Again, the evidence is mixed as to whether niacinamide does have the effect of protecting insulin-secreting cells in patients newly diagnosed with type 1 diabetes.211, 212. Likewise, some, but not all research suggested that heathy children who are at risk for type 1 diabetes (ie family connections) may be protected by supplementing with B3.213, 214
- Inositol, part of the B vitamin family, is essential for normal functioning of the nervous system. Diabetics often suffer from nerve damage, and this nutrient has been found in some, but not all trials to be helpful.218
- Vitamin D is used by the body to regulate insulin levels in blood216 There are receptors for vitamin D in the pancrease and supplementing with D may raise insulin levels in some type 2 diabetics. Extended vitamin D supplementation may also act to lower blood sugar levels.217 Research published in June, 2014 concluded that supplementing with vitamin D for type 2 diabetics was connected to statistically significant decreases in body mass index (BMI), alanine aminotransferase levels (used in liver screening), and clinically significant reduction in blood sugar levels.275.
The digestive system uses L-carnitine, an amino acid, to convert fat to substances that cells use for energy. Researchers found that diabetics who were given 1mg per kilogram of body weight of L-carnitine, that high levels of fats in the blood (triglycerides and cholesterol) were reduced by 25% to 39% within ten days.194 When L-carnitine has been given in larger quantities, via injection, researchers report that pain symptoms from nerve damage resulting from diabetes were also reduced.195 More current research also validates that L-carnitine may be helpful.281
Protein-rich foods contain the amino acid taurine and it is available as a supplement as well. Type 1 diabetics reportedly have low levels of taurine in their blood, which increase their risk of heart disease. Supplementing with taurine (1.5 grams per day) for three months has been found to bring blood taurine to normal levels and improve the problem of blood viscosity.219 But other double-blind research found that 2 g of taurine daily did not improve impaired kidney functions which are often found in type 2 diabetics.220
Diabetic patients often have low levels of magnesium120 which may be corrected with magnesium supplementation121. It's supplementation has improved insulin production in diabetic seniors122, 124 although not in all trials125. One double-blind study did not find benefit from 500mg daily magnesium for type 2 diabetics, but 1000mg did help123. Results have been mixed - additional research has found both benefit and no benefit from magnesium supplementation.126, 127
Research has, however found that diabetic eye disease is more likely in type 1 diabetes patients who are low in magnesium128 and some researchers feel that magnesium deficiency during pregnancy for diabetic women may contribute to the high level of birth defects and spontaneous abortions.129 Although the ADA does not consider magenesium deficiency to be a risk factor, but does agree that there is a strong association between the two.130. Many medical professionals recommend that patients with diabetes and normal kidney function supplement with 200-600 mg daily.
More recent research points out that there may be a connection between low antioxidant levels and both magnesium and zinc deficiencies, as well as increased levels of copper type 1 diabetics. Such reduced antioxidant status may be tied to family genetics.280
Patients who suffer from type 1 diabetes (juvenile) are often deficient in the mineral zinc196 which reportedly damages nerve functioning.197 It has been found that supplementing with zinc has reduced blood sugar levels198 although the evidence is mixed.199 It has also been found that patients with type 2 diabetes (adult-onset) also frequently are deficient in zinc and this is evidenced by and perhaps due to loss of zinc through their urine. 200 While many doctors suggest that type 2 diabetics should supplement with 15-25 mg daily zinc, it has also been reported that type 1 diabetic patients who supplemented with zine found excess sugar attaching to protein molecules (glycosylation),201 which is considered to be an indication of worsening of diabetes. But zinc improves vitality of blood cells which artifically increases glycosylation lab results. A 2014 study looked at supplementing with zinc in lab animal who were diabetic and found that nerve deterioration was lessened due to reducing stress incurred by oxidation and regulating metallothionein in the lab animals' peripheral nerves.276 In any case patients with type 1 diabetes should check with their doctor before supplementing with zinc or any other nutrient.
Brewer's Yeast & Chromium
Brewer's yeast is a rich source of chromium. A number of researchers have indicated that 9 grams daily brewer's yeast can be helpful in regulating blood sugar because it improves glucose tolerance in type 1 and 2, as well as gestational and steriod-induced diabetes.105, 106 It has been found that supplementing with chromium can improve glucose tolerance107 because it improves the body's sensitivity to insulin.108 Furthermore, it has been found that chromium assists with glucose metabolism in patients who are prediabetic109, pregnant110. Some trials showed no such connection, however those studies were using lower levels of chromium (up to 200mcg) which is not enough for diabetic. 118. Many medical providers recommend up to 1000 mcg daily for diabetics119.
People who are taking other medications for diabetes should consult with their doctor before taking either brewer's yeast or supplemental chromium. One 2014 study concludes that chromium supplementation should not be part of diabetes treatment278 due to lack of evidence, while another study, looking at Chinese medicine that contains chromium, found that the particular preparation was helpful.
Vanadyl Sulfate (Vanadium)
It has been suggested that vanadyl sulfate, which is a form of the mineral vanadium, may help stabilize blood sugar levels in type 2 diabetics231 232 233 but not those with type 1 diabetes.234 In a small study type 2 diabetics received 75-300 mg vanadyl sulfate daily. Researchers found that patients who received higher levels (150 or 300 mg) had improved glucose metabolism and fasting blood sugar levels.235 Additionall, at the 300 mg dosage total cholesterol was reduced, but HDL was also reduced. Insulin sensitivity did not change. The only side effects were gastrointestinal in nature by the patients taking the higher levels. Long term safety is unknown and the higher levels may be unsafe for long term use.
Diabetic patients often have low levels of manganese in their blood. 240 Research with lab animals indicates that such deficiency may aggrevate glucose intolerance and therefore supplementation may be helpful.241 In one case a type 1 diabetic who received oral manganese chloride (3-5 mg per day) reported a marked fall in blood sugar levels, sometimes to a dangerously low degree. In four other instances such supplementation had no effect.242 Diabetic patients should only supplement with a doctor's recommendation and supervision.
Omega-3 Fatty Acids
Because glucose tolerance improves in heathy people who include omega-3 fatty acids in their diet221 some studies have investigated the relationship and reported that supplementing with fish oil improves glucose tolerance,222 high triglycerides,223 and cholesterol levels in diabetic patients.224 But the evidence is mixed. Other research finds that cholesterol increases225 and diabetes worsens with fish oil supplementation.226 227 228 Research reported in 2014 indicates that omega-3 fatty acids are, in fact, helpful,281 but you should check with your doctor before taking fish oil supplements. In addition, reductions in nerve damage have been reported with fatty acid supplementation when they include EPA taken for 48 weeks.229
Omega-6: Evening Primrose:
Some double-blind research has indicated that evening primrose oil daily for at least six months improves functioning of nerves and relieves pain from diabetic nerve damage.138
Medium Chain Triglycerides
One short pilot study found that medium chain triglycerides could lower blood glucose levels in type 2 diabetics,243 but other research contradicted these results.244
- Turmeric (Curcumin: A randomized, double-blind study of 240 pre-diabetic patients given either a placebo or curcumin extract over a nine month period demonstrated the efficacy of the treatment. After 9 months, 16.4% of the placebo group developed type 2 diabetes, none of the curcumin group developed diabetes. The treatment not only prevented diabetes but strengthened a number of indicators of the health of the pancreas and its ability to regulate blood glucose levels.274 A more recent 6 month, double-blind, placebo controlled and randomized study of type 2 diabetic patients given curcumin reported improvements in pulse wave velocity (artery stiffness, indicating atheriosclerosis), serum adiponectin and leptin levels (associated with overall fat levels in the blood). These factors are tied to a number of better heath indicators for diabetic patients.279
- Cayenne Double-blind research has indicated that creams that include .025 to .075% capsaicin (the active ingredient of cayenne pepper) has the capacity to reduce pain and numbness symptoms in patients suffering from diabetic nerve damage.245 246 This should be done only with a medical professional's supervision.
- Glucomannan, coming from konjac root, is a fiberous herbal preparation that slows digestion in the stomach, which in turn slows the absorption of sugars in the food. The net result is that blood sugar levels don't tend to spike after a meal as much. 139 Research substantiates that blood sugar levels in diabetes after they've consumed a meal are lower if they receive glucomannan in or with their meal140 and additional research supports the fact that diets that include glucomannan help control diabetes.141-143 A pilot study indicated that it may also be useful for diabetes that occurs during pregnancy.144 The dosage in controlled research that has been effective in controlling blood sugar is 500 to 700 mg glucomannan for each 100 calories.
- Asian Ginseng Asian ginseng is frequently used by Chinese medicine practitioners for diabetes treatment because in lab and animal research it supports insulin release and increased insulin receptor numbers.248 - 249 It also reduced blood sugar levels in animal research250 and in type 2 diabetic patients.251
- American Ginseng One small trial reported that included 3g of American ginseng lessened blood sugar spikes following consumption of a high glucose drink in type 2 diabetics252 The herb could be taken 40 minutes before consuming the sweet drink or at the same time. Increasing the amount of ginseng to 6g or 9g made no difference in the outcome, and the ginseng could also be taken up to 2 hours prior to drink consumption.253
- Holy Basil. Two types of holy basil (Ocimum sanctum and Ocimum canum) seeds have been found to help type 2 diabetes patients manage levels of blood sugar.254 255 256 Ocimum sanctum may so act by taking the place of dietary sugars that normally quickly raise blood sugar levels with dietary fiber.
- Gymnema. This herb may be able to stimulate insulin production in patients who have type 2 diabetes. Additionally, it increases the effectiveness of insulin in both type 1 and type 2 diabetics. One early trial found that 400mg daily could lessen need for oral diabetes drugs in some patients257. Other early research supported the idea that Gymnema could permit less insulin in type 1 diabetics, but it is not an insulin substitute. A 2014 review of the research summarizes the research.282
- Aloe Vera. Two trials suggested that 80% aloe gel aloe vera juice can assist in lowering blood sugar in type 2 diabetics. In one trial 15g twice a day reduced the need for the drug glibenclamide259 and the other found that this concentration of aloe vera juice was itself effective.260 Other forms of aloe vera such as fried slices261 and extracts262 may be helpful but are not confirmed by research.
- Bilberry Some complications of diabetes such as cataracts and retina damage may be improved by bilberry extract.268
- Ginkgo Extract of ginkgo biloba may be helpful for early stage diabetic nerve damage. Recent research has confirmed these findings for cataracts in lab animals283, retinal damage284 in additional to current research supporting use of ginkgo in improving hypertenion and blood sugar control in diabetes.
- Olive Leaf has been determined in lab animals to reduce high blood sugar levels272 The only human trial appear to involve only Salacia reticulata root extract or leaf extract and it was found the reduce high blood sugar and LDL cholesterol. The root extract was more effective, showing results after 3 weeks, compared to results after 6 weeks for the leaves.285 This is an ayurvedic preparation.
- Reishi mushroom has been found in animal trials273 and preliminary human trials to have some beneficial effects for diabetics.274 More recent research with lab animals has confirmed this finding.286
- Fruto-Oligosaccharides (FOS). some trials have found that some artificial sweetners, called fructo-oligosaccarides, can markedly reduce fasting blood sugar levels and total cholesteral in type 2 diabetics. 236 However, other trials found contradictory results.237-239.
- Psyllium. Researchers have indicated that psyllium supplements are a safe way to help control blood sugar levels and cholesterol in type 2 diabetics. In a one double-blind trial such patients who received 5.1g daily psyllium for 8 weeks found reduced blood sugar levels between 11 and 19.2%, reduced total cholesterol by 8.9%, and reduced LDL cholesterol by 13% compared to placebo.247
- Mistletoe extract has been found to improve release of insulin from the pancreas270 and reduces diabetic symptoms in animal research.271 More current research in lab animals for at least African mistle (Viscum album) supports this information, but there still is no published research in humans.
274. Curcumin Extract for Prevention of Type 2 Diabetes, Somlak Chuengsamarn, MD and associates, Diabetes Care July 6, 2012
275. The Effects of Vitamin D Supplementation on Hepatic Dysfunction, Vitamin D Status, and Glycemic Control in Children and Adolescents with Vitamin D Deficiency and Either Type 1 or Type 2 Diabetes Mellitus., Nwosu, BU, et al, PLoS One, June, 2014.
276. Zinc supplementation alleviates diabetic peripheral neuropathy by inhibiting oxidative stress and upregulating metallothionein in peripheral nerves of diabetic rats, Biological Trace Elements Research, Liu F., et al, May, 2014, 158(2):211-8.
277. In vivo Investigation of Anti-diabetic Properties of Ripe Onion Juice in Normal and Streptozotocin-induced Diabetic Rats, Lee, C.W. et al, Preventative Nutrition and Food Science, Sept. 2013, 18(3), 169-74.
278. Chromium does not belong in the diabetes treatment arsenal: Current evidence and future perspectives, Landman, G.W., et al, World Journal of Diabetes, April, 2014, 15,5(2), 160-164
279. Reduction of atherogenic risk in patients with type 2 diabetes by curcuminoid extract: a randomized controlled trial., Journal of Nutritional Biochemistry, Chuengsamarn, S., et al, Feb. 2014, 25(2), 144:50
280. Trace elements, magnesium, and the efficacy of antioxidant systems in children with type 1 diabetes mellitus and in their siblings, Salmonowicz, B., et al, Advances in Clinical and Experimental Medicine, March, 2014, 23(2), 259-68.
281. Dietary and nutraceutical approach to type 2 diabetes, Archives of Medica Scienc, Derosa, G, May 2014, 12:10(2), 336-44
282. A systematic review of Gymnema sylvestre in obesity and diabetes management, Journal of Food Science and Agriculture, Pothuraju R., et al, March, 2014, 30; 94(5), 834-840.
283. Preventative effects of Ginkgo biloba extract (EGb761) on high glucose-cultured opacity of rat lens, Phytotherapy Research, Lu Q., at al, May 2014, 28(5), 767-773.
284. Some pathogenic features of diabetic retinopathy in type II diabetes mellitus and the role of antioxidants and ginkgo biloba, Vestinik Oftalmologi, Alekseev IB, et al, May 2013, 129(3), 89-93.
285. Salacia reticulata improves serum lipid profiles and glycemic control in patients with prediabetes and mild to moderate hyperlipidemia: a double-blind, placebo-controlled, randomized trial, Journal of Medicinal Food, Shivaprasad, HN, et al, June 2013, 16(6), page 564-568.
286. Antidiabetic, antihyperlipidemic and antioxidant activities of a novel proteoglycan from ganoderma lucidum fruiting bodies on db/db mice and the possible mechanism, PLoS One, July 2013, 8(7).