What is Diabetes mellitus?
Basically, diabetes mellitus is what happens when you have too much sugar in your blood. This happens both because a person eats too much sugar or high GL load foods, and because their insulin isn’t working properly. As soon as your blood sugar goes too high the body pumps insulin into the bloodstream which gets the excess out as fast as possible, converting much of it into fat.
If you don’t make enough insulin, or you are ‘insulin resistant’ your blood sugar (glucose) level stays too high. This is bad news because glucose is highly toxic in large amounts, damaging arteries, brain cells, kidneys and the eyes. Glucose also feeds infections, chronic inflammation and promotes the formation of blood clots; some 80 per cent of people with diabetes die from cardiovascular disease.
Every year, a thousand people with diabetes start kidney dialysis, while others go blind. Half of all diabetics have one or more of these complications. Much of this damage happens because sugar sticks to, and damages protein, producing what are called ‘advanced glycation end-products’, nicknamed AGEs – and that’s what they do – age you rapidly.
Two Kinds of Diabetes
There are two kinds of diabetes: insulin-dependent diabetes (Type 1) and non-insulin dependent diabetes (Type 2). Type 1 diabetes is very rare. It usually develops in children whose immune systems mistakenly attack cells in the pancreas that make insulin. It’s called an ‘auto-immune’ disease and is linked with food allergy, especially to dairy products introduced in early infancy. Without insulin you can’t control blood sugar. These people therefore need to inject insulin.
The next best thing is following my low GL load diet, plus certain supplements, because this decreases the need for insulin. Type 1 diabetes is not, however, completely reversible. By far the most common type of diabetes is Type 2 diabetes. This is a direct consequence of diet and lifestyle, the single greatest being weight gain. Being obese increases diabetes mellitus risk 77 times.
Diagnosing Diabetes mellitus
The diagnosis of diabetes is based on testing your blood sugar level in one of three ways. Firstly, if your ‘fasting’ blood glucose level is too high (above 7.8 mmol/l) that means your insulin isn’t working. Secondly, if you eat something sweet – the equivalent of the sugar in a can of fizzy drink – and 2 hours later your blood glucose is above 11 mmol/l then you’re diagnosed with diabetes.
A more sensitive test is a measure of your ‘long-term’ blood sugar levels. Every time your blood sugar levels goes too high, creating blood sugar ‘spikes’, your red blood cells get a little more sugar coated. This is measured as Glycosylated Haemoglobin, meaning sugar-coated red blood cells. This is also called HbA1c and is an example of an AGE – a messed up molecule that can cause immense damage. If your blood level is above 7% you need to be screened for diabetes. Ideally, your doctor should also test your insulin level to get a full picture of your blood sugar control. You want your ‘fasting’ blood sugar level to be below 6, your ‘after a meal’ blood sugar level to be below 7 and your Glycosylated Haemoglobin to be as low as possible, and certainly below 6.3%.(1)
The healthiest people have a Glycosylated Haemoglobin of between 4% and 5%.
A Tale of Two Diabetics
To make all this real let’s take the case of a recently diagnosed diabetic on standard diabetic medication, and a long-term diabetic, injecting insulin. Kyra, aged 37, was diagnosed with diabetes in January 2007. Kyra’s fasting glucose level was 11 (should be below 6), and a glycosylated haemoglobin level of 7.8 (should be below 6.3). She was overweight, weighing in at 18 stone (252 pounds). She was prescribed the drug Metformin 500mg, twice a day, by her GP who told her she would remain on the drug for the rest of her life.
Metformin improves your sensitivity to insulin and helped lower her blood sugar to an average of 7. She was referred to a dietician who recommended a low fat, low sugar, low calorie diet, limiting fruit to no more than 5 portions of fruit per day. The dietician told her to stop eating pumpkin seeds because they are ‘high in fat’ and to drink diet cola instead of cola. (In animal studies pumpkin extracts help to stabilise insulin levels.)(2) She followed the conventional low fat, low calorie diet, cutting down her sugar intake, and started walking every day. She came to see me in April and had done well, losing one stone in under three months. But she still suffered from low energy, dizziness, mood swings and digestive complaints and had too high blood sugar levels.
She went on my low GL load diet, and started supplementing chromium 600mcg together with a cinnamon extract called Cinnulin, vitamin C and a high-potency multivitamin. Within days her blood sugar was normal and, three weeks later she didn’t need medication. Six weeks after starting my low GL load diet her blood sugar level was normal (averaging 5.5), and glycosylated haemoglobin was normal (6.2%), without medication, and she had lost another stone (14 lbs) in weight. Kyra was delighted. “My doctor told me I’d be on medication for the rest of my life. I am really thrilled to have been able to come off medication and still have a stable blood sugar. My energy is much better. My skin is clearer, mood more stable and I’ve lost 14lbs. I feel in control of food instead of it being in control of me.” One year later she’s lost another 14 pounds, three stone in all since her diagnosis. Her glycosylated haemoglobin is 5.2%, which is perfect, and blood glucose now averages 5. She still has no sugar cravings, good energy and mood. She’s cut back on the chromium and now takes 200mcg. Her doctor is delighted. But what if you’ve suffered from diabetes for years, and need insulin to control it? Can a low GL diet still reverse it?
A nurse in Norway is a case in point. She started gaining weight in her 30s. She followed official nutritional recommendations and did not overeat but, year on year, continued to gain weight. In 1992, at the age of 61, she was diagnosed with type-2 diabetes, hypertension and low thyroid, and weighed 120 kg, close to 19 stone. Her blood sugar was out of control and her glycosylated haemoglobin was 8.9%. She was treated with a cocktail of drugs and ended up injecting 150 units of insulin a day. But, despite all this, her weight continued to increase so she decided she had to do something different. She sought the advice of diabetes expert Dr Fedon Lindberg in Norway, who put her on a strict low GL diet and exercise regime. To cut a long story short today, she needs no insulin, takes no medication, has a normal blood sugar and glycosylated haemoglobin and her weight has stabilized below 80 kgs (12 and a half stone). Her story was recently published in the Norwegian Journal of Medicine.(3)
The Dangers of Insulin
Having too much insulin actually promotes weight gain because its job is to store excess sugar in the blood as fat. The antidote is a low GL diet. The higher your insulin the more effective a low-GL load diet is.(4) By following my low-GL load diet your blood sugar level is naturally more even, so your body doesn’t have to produce so much insulin. There’s another problem with making, or injecting too much insulin - it increases cholesterol production in the liver, it constricts blood vessels making your blood pressure go up and stimulates the release of dangerous fats called triglycerides. So it’s bad news for heart disease. Eating a low-GL load diet lowers both insulin levels and cholesterol in diabetics.(5)
Some diabetes drugs, called sulfonylureas (brands include Amaryl, Euglucon and Diamicron), are designed to stimulate the beta cells in the pancreas to produce more insulin. Most type 2 diabetics produce too much insulin already – the problem is that the insulin that’s produced just does not function properly. These drugs also increase the risk of death from cardiovascular disease, according to a five-year study of 5,500 diabetics, published in 2006 in the Canadian Medical Association Journal. The higher the drug dose and the more consistently the patients took the drugs, the greater the risk of cardiovascular death.(6) The same is true with a newer class of drug called glitazones. In fact, a major government funded study in the US, testing the effects of aggressive drug strategies to lower blood sugar levels in more than 10,000 diabetics had to be abandoned due to much higher cardiovascular deaths.(7)
A recent issue of the British Medical Journal stated that ‘taking prescription drugs (glitazones) to prevent diabetes cannot be justified’(8), favouring a diet and lifestyle approach. When you get your diet right, these drugs often become unnecessary.
Instead of trying to cheat the system by stimulating more insulin release, the solution for both weight gain, diabetes and heart disease, is to eat a low GL Load diet that means you need to make less insulin to keep your blood sugar level stable, and to naturally improve your sensitivity to insulin so you need less insulin to get the job done (more on how to do this in a minute). Hundreds of studies now prove that a low GL Load diet helps to improve blood sugar balance, and makes you less insulin-resistant, and hence reduces the need for medication. These are well summarised in a review article in the Journal of the American Medical Association for those who want the science.(9)
Exercise Plays a Key Role
Exercise is also a vital piece of the prevention equation. A review of fourteen good quality trials found that, while exercise alone didn’t decrease weight, it did lower glycosylated haemoglobin by the kind of amount one might expect from a drug.(10) As your energy goes up on my low-GL load diet you’ll find that so too does your desire to exercise.
Low Fat Diets Don’t Work as Well as Low GL Diets for Diabetes
According to diabetes expert Professor Charles Clark, author of the Diabetes Revolution (Vermillion) “There is a simple cure for the obesity and diabetes epidemic but everyone is looking in the wrong place. We blame overeating or fat consumption, but the real villain in both diabetes and obesity is the large amount of refined carbohydrates we eat.
It's this that pushes up our blood sugar levels and leads to diabetes. Meanwhile our bodies store the extra blood sugar as fat and so we put on weight.” Not only does this make sense, it’s supported by so much science that it’s time to bury the low-fat, low-calorie diet myth once and for all. For example, two recent prospective studies found that following a low-fat diet didn’t decrease risk for diabetes, but having a high intake of sugar increased risk.(11) Another, from China, involving over 64,000 people, found that the higher the GL of a person’s diet, the higher was their risk of diabetes.(12) In Japan, a similar study found that the higher the GL the higher were markers for diabetes risk, such as glucose and glycosylated haemoglobin levels.(13)
An Australian study reports that eating more vegetables and low-GL foods cuts diabetes risk by a quarter.(14) Another study of 85,059 women found that low carbohydrate diets are better than low-fat diets in preventing diabetes. The women who ate less carbohydrate and got most of their fat and protein from vegetable sources were at less risk of developing diabetes.(15) A 2008 study in the New England Journal of Medicine put volunteers onto one of three diets: a conventional low-calorie, low-fat diet; a Mediterranean diet, restricted for calories and high in fibre and monounsaturated fats; and a high-protein, high-fat, low-carb diet, similar to the Atkins diet, but emphasising vegetarian sources of protein rather than meat and dairy products.(16) The low-fat diet was the least effective for weight loss and raised glucose levels. The Mediterranean diet was the most effective for diabetes, significantly lowered glucose levels in diabetics. My low GL load diet is the best of all worlds, because it gives you a simple way to control the total GL of your diet, by limiting the amount of carbohydrates you eat and making sure you eat the kind of foods that contain slow-releasing carbohydrates, incorporating all the key principles that help you stabilise your blood sugar, lose sugar cravings and increase your energy, with none of the downsides of high animal protein diets.
Chromium Helps Stabilise Your Blood Sugar
Dozens of top quality studies now confirm that supplementing 400mcg to 600mcg of chromium a day, which is more than ten times the average intake in the British diet, helps stabilize blood sugar. In some trial participants this non-toxic mineral has normalised blood sugar completely. Chromium works by improving your sensitivity to insulin. A 2007 review of over 40 randomised controlled trials found that giving Type-2 diabetics chromium improves their fasting blood sugar levels and also decreases glycosylated haemoglobin levels. The study, published in Diabetes Care, found that the best effects were seen with chromium in doses of 400-1000mcg per day.(17)
For example, a landmark study in 1997, looked at 120 Chinese patients with type 2 diabetes - 60 were given 200ug chromium per day and the other 60 were given 1000ug/day. After just 2 months, significant improvements were seen in glucose control, in both groups. After 4 months, there was almost a 30% reduction in glucose levels in the higher dosage group.(18) In another over 800 diabetics who were taking insulin or anti-hyperglycemic drugs were given 500mcg chromium per day for 9 months. (19) After just 1 month, fasting and post-meal glucose levels had significantly fallen. At the end of the 9 months, 90% of patients reported a decrease in fatigue, thirst and the need for frequent urination which are classic symptoms of diabetes.
In fact chromium has been shown to dramatically decrease the need for medication in many diabetics and in some cases eliminate the need for drugs completely(20). Despite being about ten times higher than you’ll get from a so-called well balanced diet there are no known adverse effects of supplementation below 10,000mcg a day, according the UK’s Committee on Toxicity.(21) Most available chromium supplements are 200mcg, but in relation to diabetes, a daily intake of 400 to 600mcg is most likely to be effective. I’ve not found it necessary to have more than this. I recommend taking chromium picolinate, or chromium polynicotinate (chromium polynicotinate contains vitamin B3 which is works in synergy with chromium).
High Vitamin C More Than Halves Diabetes Risk
Another important vitamin for diabetics is vitamin C. Having a high level of vitamin C in your blood, consistent with that achieved by supplementation and eating a high fruit and vegetable diet, reduces your risk of diabetes by 62%. That’s the conclusion of a study of over 21,000 people over a twelve year period, published in the Archives of Internal Medicine.(22) Those in the top fifth of plasma vitamin C were 62% less likely to develop diabetes, compared to those in the bottom fifth. The optimal blood level for diabetes reduction is achieved by supplementing 1,000mg a day and eating lots of fruit and vegetables. One study in India gave diabetics either 500mg or 1,000mg of vitamin C. Only those taking 1,000mg of vitamin C a day had a significant decrease in both their blood sugar levels, and glycosylated haemoglobin.(23)
A Spoonful of Cinnamon
Cinnamon has been used for many years in traditional herbal medicine for treatment of type-2 diabetes.
The active ingredient in cinnamon, MCHP, mimics the action of the hormone insulin, which removes excess sugar from the bloodstream. Animal studies have found that there is a positive effect on blood sugar levels when treated with cinnamon. There have also been positive findings in human studies. For example, a research group found that when pre-diabetics were given a cinnamon extract called Cinnulin® for 12 weeks, there were improvements in blood sugar levels, as well as body fat percentage.(24) Another study gave diabetics 1, 3 or 6 grams of cinnamon per day.(25) One gram is about half a teaspoon. All responded to the cinnamon within weeks, with blood sugar levels 20 per cent lower on average than those of a control group. Not all studies, however, have shown a positive result. Based on these results you might want to add half a teaspoon of cinnamon, which is also an excellent antioxidant, to your diet.
Alternatively, supplement a cinnamon extract such as Cinnulin® which has a high concentration of MHCP, the active ingredient. In this case 500mg is sufficient.
In summary, whether you have type-1 (insulin-dependent) or type-2 diabetes, by following a low GL diet you minimise your body’s need to produce insulin. This strategy is also perfect for preventing diabetes:
• Follow my low GL load diet strictly (see The Holford Low GL Diet Bible or Holford Low GL Diet Made Easy)
• Exercise daily
• Supplement 400 to 600mcg of chromium daily. Cut back to 200mcg when you achieve normal blood sugar levels.
• Supplement 1-2 gram of vitamin C daily
• Have the equivalent of half a teaspoon of cinnamon
Bear in mind that your need for medication may decrease so it is important to monitor your blood sugar levels and inform your primary care practitioner accordingly. If you have Type-2 diabetes there’s a good chance you’ll end up not needing any medication. If you have Type-1 (insulin-dependent) diabetes the same recommendations apply but you’ll still need insulin, although possibly less of it. I recommend you start the diet first, together with 1 gram of vitamin C, a good multivitamin. Then, three days later add in a supplement of 200mcg of chromium. Then, 3 days later, increase to 400mcg and three days later, increase to 600mcg while monitoring your blood sugar levels.
1. C L Rohlfing et al, ‘Use of GHb (HbA1c) in screening for undiagnosed diabetes in the U.S. population’, Diabetes Care, 2000, vol 23 (2), pp 187–191; also see D Edelman et al, ‘Utility of Hemoglobin A1c in Predicting Diabetes Risk’, Journal of General Internal Medicine, 2004, vol 19 (12), pp 1175-80.
2. X Tao, ‘Hypoglycaemic role of Cucurbita ficifolia (Cucurbitaceae) fruit extract in streptozotocin-induced diabetic rats’, Journal of the Science of Food and Agriculture, 2007, vol 87 (9), pp 1753-7.
3. S Hexeberg & F Lindberg, ‘Insulin using woman with type 2 diabetes and weight problems’, Tidsskrift for Den norske legeforening, 2008, vol 128, pp 443-5.
4. C B Ebbeling et al, ‘Effect of a Low-Glycemic Load vs Low-Fat Diet in Obese Young Adults: a randomized trial’, Journal of the American Medical Association, 2007, vol 297 (19), pp 2092-102.
5. S W Rizkalla et al, ‘Improved plasma glucose control, whole-body glucose utilization, and lipid profile on a low-glycemic index diet in type 2 diabetic men: a randomized controlled trial’, Diabetes Care, 2004, vol 27 (8), pp 1866-72.
6. D. Bell et al, ‘Do sulfonylurea drugs increase the risk of cardiac events?’ Canadian Medical Association Journal, 2006, vol 174 (2), pp 185-6.
7. J D Williamson et al, ‘The Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes Study (ACCORD-MIND): rationale, design, and methods’, The American Journal of Cardiology, 2007, vol 99 (12A), pp 112i-122i; see National Institutes of Health (NIH) Press Release, 2008, ‘For Safety, NHLBI Changes Intensive Blood Sugar Treatment Strategy in Clinical Trial of Diabetes and Cardiovascular Disease’ [http://www.nih.gov/news/health/feb2008/nhlbi-06.htm]. See also ‘The University Group Diabetes Program. A study of the effects of hypoglycemic agents on vascular complications in patients with adult-onset diabetes. V. Evaluation of pheniformin therapy’, Diabetes, vol. 24 (suppl 1), 1975, pp.65-184.
8. V M Montori, ‘Waking up from the DREAM of preventing diabetes with drugs’, British Medical Journal, 2007, vol. 33, pp. 882-884.
9. D S Ludwig, ‘The Glycemic Index’, Journal of the American Medical Association, 2002, vol 287 (18), pp 2414–23.
10. D E Thomas et al, ‘Exercise for Type 2 Diabetes Mellitus’, The Cochrane Database of Systematic Reviews (online), vol (3), July 2006: CD002968
11. J R Palmer et al, ‘Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women’, Archives of Internal Medicine, 2008, vol 168 (14), pp 1487-1492; L F Tinkler et al, ‘Low-fat dietary pattern and risk of treated diabetes mellitus in postmenopausal women: the Women's Health Initiative randomized controlled dietary modification trial’, Archives of Internal Medicine, 2008, vol 168 (14), pp 1500-1511.
12. R Villegas et al, ‘Prospective study of dietary carbohydrates, glycemic index, glycemic load, and incidence of type 2 diabetes mellitus in middle-aged Chinese women’, Archives of Internal Medicine, 2007, vol 167 (21), pp 2310-2316.
13. K Murakami et al, ‘Dietary Glycemic Index and Load in Relation to Metabolic Risk Factors in Japanese Female Farmers with Traditional Dietary Habits’, American Journal of Clinical Nutrition, 2006, vol 83 (5), pp 1161–9.
14. A W Barclay et al, ‘‘Glycemic index, dietary fiber, and risk of type 2 diabetes in a cohort of older Australians’, Diabetes Care, 2007, vol 30 (11), pp 2811-3.
15. T Halton et al, ‘‘Low-carbohydrate-diet score and risk of type 2 diabetes in women’, American Journal of Clinical Nutrition, 2008, vol 87 (2), pp 339-46.
16. I Shai et al, ‘Dietary Intervention Randomized Controlled Trial’, New England Journal of Medicine, 2008, vol 359 (3), pp 229-241.
17. E Balk et al, ‘Effect of Chromium Supplementation on Glucose Metabolism and Lipids: A Systematic Review of Randomized Controlled Trials’, Diabetes Care, 2007, vol 30 (8), pp 2154-63.
18. R A Anderson et al, , ‘Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes’, Diabetes, 1997, vol 46 (11), pp 1786–1791.
19. N Cheng et al, ‘Follow-up survey of people in China with type 2 diabetes mellitus consuming supplemental chromium’, Journal of Trace Elements in Experimental Medicine, 1999, vol 12 (2), pp 55-60.
20. H Rabinovitz et al, ‘Effect of chromium supplementation on blood glucose and lipid levels in type 2 diabetes mellitus elderly patients’, International Journal for Vitamin and Nutrition Research, 2004, vol 74 (3), pp 178–182.
21. Food Standards Agency, ‘Agency revises chromium picolinate advice’, 2004, [See http://www.food.gov.uk/news/newsarchive/2004/dec/chromiumupdate].
22. A H Harding et al, ‘Plasma Vitamin C Level, Fruit and Vegetable Consumption, and the Risk of New-Onset Type 2 Diabetes Mellitus -The European Prospective Investigation of Cancer - Norfolk Prospective Study’, Archives of Internal Medicine, 2008, vol 168 (14), pp 1493-1499.
23. M Afkhami-Ardekani & A Shojaoddiny-Ardekani, ‘Effect of vitamin C on blood glucose, serum lipids & serum insulin in type 2 diabetes patients’, Indian Journal of Medical Research, 2007, vol 126 (5), pp 471-4.
24. T N Ziegenfuss et al, ‘Effects of a Water-Soluble Cinnamon Extract on Body Composition and Features of the Metabolic Syndrome in Pre-Diabetic Men and Women’, Journal of the International Society of Sports Nutrition, 2006, vol 3 (2), pp 45-53.
25. A Khan et al, ‘Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes’, Diabetes Care, 2003, vol 26 (12), pp 3215-3218.