Author: Paul Hollinrake, Researcher & Trainer in Public Health/27 September 2018
Type 2 diabetes (T2DM) is a growing public health concern and is becoming an increasing burden on the NHS with treatments costing around £10 billion a year which is nearly 10% of the health service budget. It is estimated that 1 in 15 adults have diabetes and this is expected to rise to 1 in 10 by 2030 unless education programmes such as those delivered by XPERT health and the National Diabetes Prevention Programme (NDPP) are successful.
T2DM is a metabolic disorder, if an individual has three or more of the following risk factors (Metabolic Syndrome) they are likely to be insulin resistant:
1. Increased waist size: Greater than 94 cm in Caucasian men and greater than 80 cm in Caucasian women, or greater than 90 cm in South Asian men and greater than 80 cm South Asian women
2. Raised triglycerides: Greater than 1·7 mmol/l (or on medication to reduce triglycerides)
3. Reduced HDL-cholesterol: Less than 1·03 mmol/l in men; less than 1·29 mmol/l in women
4. Raised blood pressure: Systolic greater than 130 mmHg; Diastolic greater than 85 mmHg (or on medication to reduce blood pressure)
5. Raised fasting glucose: Fasting plasma glucose greater than 5·6 mmol/l
Insulin is a hormone produced in the pancreas which regulates the amount of glucose in the blood. This hormone acts like a key, unlocking the door into the body cells so that the glucose can pass from the blood into the body cell where it is either used for energy, stored as a carbohydrate reserve (glycogen) or converted to fat.
Unfortunately, we have changed from a nation consuming three meals per day with no snacks to grazing throughout the day. Increased frequency of eating and consumption of a large amount of quick-releasing carbohydrate can cause repeated surges in blood glucose. This results in continuous high levels of insulin (hyperinsulinemia). Ideally, insulin levels should be able to return to a fasting state between meals. Over a period of time, continuous high levels of insulin can cause insulin resistance, therefore glucose cannot enter the cell.
Although the pathophysiology is very complex there is no doubt that lifestyle factors such as diet, exercise, stress reduction, and sleep are fundamental considerations to address low-grade inflammation, hyperlipidaemia and hyperglycaemia for those who have metabolic syndrome/T2DM. As such natural interventions that address the cause may play a role in both the prevention and progression of these dysmetabolic states. There are some claims which suggest that certain nutritional support supplements can have a therapeutic effect on blood glucose control. This blog will discuss the key vitamins and minerals that have important functions in the metabolism of carbohydrate, fat, and protein and which foods to include in the diet to avoid any deficiencies in these key nutrients and therefore better regulate blood glucose.
Vitamin B6 works as a co-enzyme which is needed for more than 100 enzymes involved in protein metabolism. It also assists in the breakdown of carbohydrate (glycogen) and helps with red cell metabolism. Deficiency symptoms can be seen in nervous system disorders, sleeplessness, confusion, depression, irritability, and anemia. Good sources of B6 are found in potatoes, bananas, beans, oats, seeds, spinach, trout, avocado, tuna, salmon, peanut butter, walnuts, and hazelnuts.
Biotin has an important role in carbohydrate and fat metabolism and helps to regulate both insulin secretion from the pancreas and post-meal liver glucose uptake and output. There is some evidence that supplementing biotin with chromium significantly increases glycogen storage and decreases plasma glucose and fats compared to each taken alone. However, deficiency is rare in humans who have good gut bacteria as these can produce enough biotin. However, dietary sources of biotin can be found in green leafy vegetables, whole grains, salmon, avocado, lettuce, tomatoes, carrots, almonds, eggs, cabbage, onions, cucumber, cauliflower, berries, halibut, oats, and walnuts.
Chromium is a mineral that is involved in carbohydrate and fat metabolism and being deficient may predispose you to carbohydrate intolerance. However, chromium is highly available in many foods such as eggs, whole-grain products, coffee, nuts, green beans, broccoli, garlic, seeds, and meat. Therefore, if you are consuming a varied diet, it is very unlikely that you will be deficient.
Magnesium assists in carbohydrate and fat metabolism as well as DNA and protein synthesis. Magnesium is found mainly in the bones, but it can also be found in muscle. Nearly 300 essential metabolic reactions rely on magnesium. However, deficiency is very rare due to the abundance of magnesium in foods. These include whole grains, almonds, hazelnuts, peanuts, green leafy vegetables, soy beans, avocado, bananas, apricots, apples, cashews, lima beans, pumpkin and sesame seeds, salmon, halibut, navy and black beans.
Zinc can also have positive effects on glucose metabolism. It is an essential nutrient for the normal processing and storage of insulin, and receptor/post-receptor insulin function. It is also an important anti-inflammatory and anti-oxidant. A recent systematic review and meta-analysis of 14 human clinical trials found zinc supplementation significantly reduced fasting blood glucose in healthy and insulin resistant individuals. However, zinc is found in many natural whole foods such as sesame and pumpkin seeds, wild game, crab, poultry, beans, cashews, chickpeas, almonds, peas, yoghurt, mushrooms, oysters and shrimp.
Cinnamon is a spice that has been used as an ingredient throughout history and is made from the inner bark of trees. It is loaded with antioxidants and has anti-inflammatory properties. Some studies have shown it to have health benefits such as reducing insulin resistance, blood glucose levels and risk factors for heart disease. However, others have shown no benefit and clearly, more research is required. In the meantime, if you like cinnamon, add it to your cooking.
Pro and prebiotics
There is more and more evidence pointing towards an association between obesity, T2DM and gut dysbiosis (bacteria imbalance). A diet composed of mainly processed foods high in fat and sugar encourages gut dysbiosis. There are as many bacteria (microbiome) in your body as there are body cells. But, believe it or not, most of these bacteria are good for you and help to keep you healthy! Getting the right balance of bacteria, especially in your gut, has been shown to help with weight loss, improved digestion, an enhanced immune system, better skin and a reduced risk of many diseases. This is where probiotics and prebiotics come in. Probiotics are foods or supplements that contain these friendly bacteria and are supposed to help populate our guts with health-boosting bacteria. Examples of probiotic foods include yoghurt, kefir, sauerkraut, tempeh, and kimchi. Prebiotics are types of dietary fibre that feed the friendly bacteria in your gut. This helps the gut bacteria produce nutrients for your colon cells and leads to a healthier digestive system. Examples include garlic, leeks, onions, asparagus, apples, cocoa, flaxseed and seaweed (marine algae).
Take home message
You may need to consider the long-term effects of eating a processed diet high in fat and sugar, and the negative impact of this on the microbiome and intestinal health.
Studies looking at the health benefits from supplementation show mixed results and currently, there appears to be no advantage from taking supplements. Save the expense and consume real foods, especially those mentioned above to help regulate blood glucose levels.
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