The World's Healthiest Foods

Type 2 Diabetes Mellitus

Individuals with type 2 diabetes mellitus have difficulty controlling their blood sugar levels because the cells of the body don't absorb sugar from the bloodstream the way they should. This leads to very high blood sugar levels, sugar in the urine, and very high blood insulin levels.

If not treated properly, type 2 diabetes can cause kidney damage, poor circulation, numbness in the feet, dangerous infections and erectile dysfunction. The main consequence of this condition, however, is heart disease, which claims the lives of approximately 80% of all diabetic patients. The good news is that dietary changes can really help with blood sugar control and can also help to prevent the damage caused by type 2 diabetes.

Eat more

  • Organically grown green leafy vegetables, such as Swiss chard, mustard greens, and kale
  • Citrus fruits and red bell pepper
  • Red and purple fruits, such as cherries, blueberries
  • Nuts, especially almonds and walnuts
  • Cold water fish such as salmon, cod, herring, mackerel and halibut
  • Extra virgin olive oil
  • Cinnamon
  • Garlic
  • Legumes and whole grains, especially buckwheat, and barley
  • Soyfoods
  • Tomatoes
  • Chili peppers
Avoid concentrated sugars, dried fruit, fruit juices, saturated fats, trans fats, excessive total fats,
excessive iron, particularly from red meat

Description

What Is Type 2 Diabetes Mellitus?

Type 2 diabetes mellitus affects over 12 million people in the Unites States. Although it usually occurs in adults in their 40s or older, recent reports show that it's becoming more and more common in younger adults and even children.

In 1986, type 2 diabetes caused the deaths of 144,000 people in the United States alone. Diabetic patients are more likely to require kidney dialysis due to kidney failure, and amputations as a result of certain infections.

Approximately 80% of all diabetics die of heart disease, which strikes diabetics at a younger age than the rest of the population. Diabetic patients often require medication and must spend time checking their sugar levels and worrying about whether or not their blood sugar is under control.

Fortunately, a healthy diet containing nutritious, whole foods can go a long way towards helping diabetic patients manage their condition.

Symptoms

People in the early stages of type 2 diabetes may have mild or no symptoms. As the disease progresses and the damage continues, more symptoms may appear.

Some early symptoms of type 2 diabetes include:

Some of the later symptoms or consequences of type 2 diabetes include:

The Disease Process

What is going on in the body to produce both high blood sugar and high insulin levels? There are several things that may cause the problem of type 2 diabetes, and they may start sooner than we think.

Normally, certain cells in the pancreas produce a substance called insulin. The main job of this substance is to bind to insulin receptors, which are made just for insulin. Once the insulin binds to these receptors, cells are able to start absorbing sugar, also known as glucose, from the bloodstream.

The pancreas typically produces insulin at certain times, like after we eat, which is when the many sugar molecules from food have been absorbed and are in the blood. Insulin allows cells to get the glucose that they need for energy and also helps keep the blood sugar levels from getting too high after a meal.

In type 2 diabetes patients, however, something goes wrong. For some, the insulin that the pancreas produces is defective and cannot bind to the receptors properly. This causes the blood sugar levels to rise very high since much of the sugar cannot get out of the bloodstream.

For others, the insulin is normal, but the cells of the body are producing insulin receptors that are defective. Since the insulin cannot bind to these receptors, they cannot absorb glucose as well, and the blood sugar levels rise. The high blood sugar levels then trigger the pancreas to produce even more insulin in an attempt to fix the situation.

Unfortunately, this does little good and results in both high blood sugar and high insulin levels. This situation is referred to as insulin resistance, as the cells are resistant to the normal effects of insulin.

When cells of the body are unable to absorb sugar, they don't get the energy they need for normal function, so the person ends up feeling weak and tired, and also very hungry as the cells call out for more energy. High blood sugar levels put an extra burden on the kidneys, which leads to sugar in the urine and a need to urinate much more than usual. Since there is extra urine being produced, the body feels extra thirsty in an effort to replace all of that lost fluid.

In addition to the above mentioned problems, type 2 diabetes patients have something else to deal with. Studies show that type 2 diabetes patients have higher levels of free radicals in their bodies than non-diabetics. Free radicals are substances produced in the body. Normally, they are used by the immune system to attack and kill invading germs. When there are too many of them, however, they can cause a lot of damage to normal cells and organs.

Free radicals are believed to play a major role in the formation and progression of atherosclerosis, and may be responsible for the kidney damage seen in diabetes. They can also damage blood vessels and nerve cells, leading to poor circulation, numbness, and an increased susceptibility to certain infections.

Researchers are not sure if these excess free radicals are caused solely by high blood sugar levels, as many patients with good blood sugar control also have high levels in their bloodstream. It's believed that high insulin levels may also cause the production of these dangerous free radicals. This means that it may be important to not only keep blood sugar levels under control, but also to prevent blood insulin levels from getting too high. Fortunately, both of these can be achieved through a healthy diet.

A Word About Type 1 Diabetes Mellitus

Type 1 Diabetes or Juvenile Diabetes is a very different condition from type 2 diabetes. Type 1 diabetes is the main type of diabetes found in people under the age of 30 years old and accounts for around 10% of all cases of diabetes in the United States.

In this form of diabetes, special cells in the pancreas that are responsible for producing insulin become damaged by cells of the immune system. It's believed that in people who are genetically prone to developing type 1 diabetes, either a viral infection or exposure to milk proteins at a young age causes the immune system to attack and kill these special cells.

Without insulin, the cells of the body cannot absorb sugar, leading to high levels of blood sugar. Unlike type 2 diabetes, however, these patients have very low or no levels of insulin in their bodies and therefore need to take insulin starting at a young age in order to live. This form of diabetes causes kidney failure, blindness, and diabetic coma much more often than type 2 diabetes does. While some type 2 diabetes patients are given insulin to try to help with blood sugar control, it is still a different condition from type 1 diabetes.

Causes

Although genetics play some role in type 2 diabetes, as it does tend to run in families, the most important causes of type 2 diabetes are diet and lifestyle. Approximately 90% of diabetic patients are obese, making extra pounds a significant risk factor for diabetes development.

It's not known exactly how obesity contributes to poor insulin production or binding, but weight reduction has been shown to have great effects on blood sugar control. Even people who lose a moderate amount of weight find that their blood sugar levels are much lower and easier to maintain.

Another very important risk factor is lack of exercise. Studies have shown that even mild amounts of regular exercising, like walking a few times a week, can make body cells and insulin bind better to reduce blood sugar levels. Exercise is also a vital part of any weight loss program. People who may have atherosclerosis or heart disease should see a doctor before starting an exercise program.

Recent research has suggested that type 2 diabetes development may begin years before it can be diagnosed. Warning signs such as hypoglycemia or mild insulin resistance may be early indications of a problem with blood sugar control. If these signs are ignored, they body may eventually progress to a state of full-blown type 2 diabetes.

This means that the prevention of type 2 diabetes should start early, possibly in childhood as more and more young adults are winding up with this condition every day. Fortunately, it may be much easier to prevent type 2 diabetes than one would think. Maintaining a sensible weight, getting regular amounts of physical activity, and following a healthy diet can really reduce your risk of developing type 2 diabetes in the future.

Dietary Causes

A poor diet is probably the most important cause of type 2 diabetes. Studies of the eating habits of different populations have revealed that diets high in fat (especially animal fat), animal protein, refined sugars, processed carbohydrates, and trans fatty acids, and low in fiber and complex carbohydrates are associated with a greatly increased risk of type 2 diabetes.

This translates to a diet high in meat, dairy, margarine, refined vegetable oils, white flour products, and sugar. Unfortunately, this is the diet commonly consumed by people in the United States, also known as the Standard American Diet (appropriately abbreviated as "SAD").

Refined grains and the foods made from them (e.g., white breads, cookies, pastries, pasta and rice) have been linked not only to weight gain but to increased risk of insulin resistance (the precursor of type 2 diabetes) and the metabolic syndrome (a strong predictor of both type 2 diabetes and cardiovascular disease), while eating more wholegrain foods is being shown to protect against all these ills. Common features of the metabolic syndrome include visceral obesity (the "apple shaped" body), low levels of protective HDL cholesterol, high triglycerides, and high blood pressure.

In a study that appeared in the February 2004 issue of Diabetes Care, researchers who analyzed data on 2,834 participants in the Framingham Offspring Study, found that the prevalence of both insulin resistance and the metabolic syndrome was significantly lower among those eating the most cereal fiber from whole grains compared to those eating the least.

Prevalence of the metabolic syndrome was 38% lower among those with the highest intake of fiber from whole grains. Conversely, study subjects whose diets had the highest glycemic index and glycemic load, both of which are typically low in whole foods and high in processed refined foods, were 141% more likely to have the metabolic syndrome compared to those whose diets had the lowest glycemic index and glycemic load. In other words, compared to those whose diets were primarily composed of whole high fiber foods: whole grains, legumes, vegetables and fruits.

Whole Grains Lower Risk of Metabolic Syndrome, Type 2 Diabetes

Two studies recently published in the American Journal of Clinical Nutrition further support the importance of eating whole grains to lower risk of not only metabolic syndrome and type 2 diabetes, but heart disease.

Older adults who ate 3 daily servings of whole grains were significantly less likely to develop metabolic syndrome or to die from heart disease than those eating refined grains, according to research conducted at the ARS Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts and published in the January 2006 issue of the American Journal of Clinical Nutrition.

Study findings were derived from three-day food records and blood tests done between 1981 and 1984 on 535 healthy men and women, aged 60-98 years, who were then followed for 12-15 years.

When sorted into groups according to the amount of whole-grain foods they ate, those eating the most-an average of about 2.9 servings a day-had significantly fewer metabolic syndrome risk factors and less risk of dying from heart disease than those in the group with the lowest intake of whole grains.

In contrast, eating refined grains was associated with higher fasting blood sugar levels, and a significantly higher prevalence of metabolic syndrome, and increased risk of death from cardiovascular disease.

Metabolic syndrome has become increasingly common in the United States with an estimated more than 50 million Americans affected by this condition, which is characterized by:

  • Abdominal obesity (excessive fat in and around the midsection)
  • Atherogenic dyslipidemia (high levels of blood fats that promote plaque buildup in artery walls- high triglycerides and LDL cholesterol- and low levels of protective HDL cholesterol)
  • High blood pressure
  • Insulin resistance or glucose intolerance (inability of the cells to respond to insulin and absorb blood sugar)
  • Increased susceptibility to blood clot formation (increased blood levels of fibrinogen or plasminogen activator inhibitor-1-compounds involved in blood clot formation)
  • Proinflammatory state (increased blood levels of pro-inflammatory C-reactive protein, another risk factor for cardiovascular disease)

People with metabolic syndrome are at increased risk not only for coronary heart disease and other diseases related to plaque buildup in artery walls (e.g., stroke and peripheral vascular disease), but also type 2 diabetes.

In a second study published in the February 2006 issue of the American Journal of Clinical Nutrition, researchers at the Harvard School of Public Health evaluated 938 healthy men and women and found that those eating the most whole grains had the lowest blood levels of homocysteine (an amino acid that can damage the inner lining of the arteries and is a significant risk factor for cardiovascular disease), as well as better lipid profiles (less triglycerides, total and LDL cholesterol, and more HDL cholesterol), and lower blood levels of compounds whose elevation is associated with poor blood sugar control (fasting insulin, hemoglobin A-1c, C-peptide, and leptin).

Whole grains include whole wheat, breads, pasta, cereals and crackers made from whole wheat flour, brown rice, barley, oats, rye, spelt and quinoa. Refined grains include the wheat flour (also listed as unbleached wheat flour) used in the majority of commercially prepared breads, pasta, crackers, cookies, etc., sold in the United States, white rice and instant oatmeal. While most Americans currently eat less than one daily serving of a whole-grain food, after their study of the effects of whole grains on older adults, the Tufts' researchers urge Americans of all ages to increase the amount of whole grains they eat to at least three servings a day.

Red meat may also contribute to an increased risk of type 2 diabetes. Researchers at the Harvard School of Public Health, Boston, US, have found that a person's intake of heme iron intake from red meat, but not from non-red meat sources, is associated with an increased risk of developing type 2 diabetes.

Why the link? Iron is a transitional metal that can catalyze the formation of free radicals called hydroxyl radicals that are implicated in diabetes. Previous studies have indicated an association between serum ferritin concentrations (a biomarker of the body's iron stores) and insulin resistance. Other studies that have compared serum ferritin levels between meat eaters and vegetarians have shown that vegetarians have lower serum ferritin levels and are more insulin sensitive. However, it has been thought that these differences could be due to other components of diet or lifestyle, and it has also been suggested that donating blood reduces iron stores and might therefore influence diabetes sensitivity.

This study factored in these possibilities and still found that only iron from red meat was associated with an increased risk of type 2 diabetes. For 12 years, researchers followed 38,394 men aged 40 to 75 years, who were participants in the Health Professionals Follow-up Study. All were free of diabetes, cardiovascular disease, and cancer when the study began. All filled in dietary questionnaires, and 33,541 provided a history of blood donation. When all the data was in, results showed that heme iron, which is found in animal products, was associated with a risk of type 2 diabetes, but total iron intake and blood donation were not related. Absorption of heme iron is more complete than non-heme iron, which is found in plants and dietary supplements.

The research team then subdivided the men's heme iron intake into heme iron derived from red meat and that from other sources. Diabetes risk increased with heme iron intake from red meat, but not with heme iron intake from other sources, such as chicken or fish. Their conclusion: Heme-iron intake from red meat sources is positively associated with the risk of type 2 diabetes. Total iron intake, heme-iron intake from non-red meat sources, and blood donations are not related to the risk of type 2 diabetes.

Since the hydroxyl radicals whose formation is catalyzed by heme-iron from red meat have also been linked to cardiovascular disease, enjoying red meat less frequently and choosing chicken, fish or vegetarian sources of protein (e.g., beans, nuts and seeds, eggs, and low fat dairy products) as your dietary staples is recommended.

Red meat not only increases risk of developing type 2 diabetes, but in persons with this condition, may greatly increase risk of developing cardiovascular disease.

Data collected from the Nurses' Health Study by researchers at the Harvard School of Public Health suggests that frequent consumption of red meat may increase risk of coronary heart disease by as much as 50% in women with diabetes(Qi L, van Dam RM, et al. Diabetes Care).

Dr. Lu Qi and colleagues at the Harvard School of Public Health found a significant association between red meat and dietary iron intake and incidence of fatal coronary heart disease, coronary revascularization and total coronary heart disease in the 6,161 women with type 2 diabetes who were enrolled in the study, which ran from 1980 to 2000.

Women with the highest intake of heme iron (the form in which iron is concentrated in red meat) had a 50% increased risk of coronary heart disease compared to women whose diets provided the least heme iron. And the increase in risk was even stronger in post-menopausal than pre-menopausal women-not surprising since a woman's monthly period may help remove excess iron from the body.

Diets high in fruits and vegetables, whole grains, legumes, olive oil, and fish are strongly associated with a reduced risk of developing type 2 diabetes. This diet can also help with blood sugar control for people who already have diabetes. In addition, consumption of foods rich in nutrients, particularly omega-3 fatty acids, vitamin E, vitamin C, magnesium, zinc, chromium, vitamin D, vitamin B12, and folic acid, can help reduce risk of the long-term consequences such as heart disease.

Nutrient Needs

Important Note:

Diabetic patients who are currently taking blood glucose-lowering medications should take note that dietary changes recommended below may significantly lower blood sugar levels. It's very important to adopt these changes slowly while monitoring blood sugar and continuing to see a doctor. Failure to monitor blood sugar and medication levels can result in very low blood sugar levels, which can be dangerous.

Foods That May Help Include:

Chili Peppers

Making chili pepper a frequently enjoyed spice in your Healthiest Way of Eating could help reduce your risk of hyperinsulinemia (high blood levels of insulin)-a disorder associated with type 2 diabetes.

In a study published in the July 2006 issue of the American Journal of Clinical Nutrition, Australian researchers showed that the amount of insulin required to lower blood sugar after a meal is reduced if the meal contains chili pepper. When chili-containing meals are a regular part of the diet, insulin requirements drop even lower.

Plus, chili's beneficial effects on insulin needs get even better as body mass index (BMI, a measure of obesity) increases. In overweight people, not only do chili-containing meals significantly lower the amount of insulin required to lower blood sugar levels after a meal, but chili-containing meals also result in a lower ratio of C-peptide/ insulin, an indication that the rate at which the liver is clearing insulin has increased.

The amount of C-peptide in the blood also shows how much insulin is being produced by the pancreas. The pancreas produces proinsulin, which splits into insulin and C-peptide when secreted into the bloodstream. Each molecule of proinsulin breaks into one molecule of C-peptide and one molecule of insulin, so less C-peptide means less insulin has been secreted into the bloodstream.

In this study, which involved 36 subjects aged 22-70 years, the effects of three interventions were evaluated. Subjects were given a bland meal after a bland diet containing no spices, a chili-containing meal after a bland diet, and finally, a chili-containing meal after a chili-containing diet. A palatable chili flavoring, not pure capsaicin (the active component in chili), was used.

Blood sugar rose similarly after all three interventions, but insulin rose the most after the bland meal after a bland diet and the least after the chili-containing meal after a chili-rich diet.

The maximum increases in insulin after the bland diet followed by a chili-containing meal were 15% lower than after the bland meal following a bland diet, and 24% lower after the chili-containing meal after a chili-rich diet compared to the chili-containing meal after the bland diet.

C-peptide blood levels also increased the most after the bland meal after a bland diet and the least after the chili-containing meal after a chili-rich diet, showing the least insulin was secreted after the chili-rich diet and meal.

In addition, the C-peptide/insulin ratio was highest after the chili-containing meal after a chili-rich diet, indicating an increase in the liver's ability to clear insulin.

Besides capsaicin, chilies contain antioxidants, including vitamin C and carotenoids, which might also help improve insulin regulation. So, spice up your meals with chili peppers. Your body will need to make less insulin and will use it more effectively.

Legumes

Hidden inside the humble, unassuming bean, or lentil, or pea, lies one of the best nutritional treatments available for type 2 diabetes. Packed inside these legumes is just the right blend of fiber, protein, and nutrients to have the profound effect on blood sugar regulation that modern drugs have yet to achieve; and legumes have no harmful side effects.

Study after study has demonstrated that beans can help with blood sugar control better than any other food available. While many meals lead to sharp rises in blood sugar and blood insulin levels, a meal with legumes does not cause this. Instead, the rise in blood sugar is slow and not very high, which leads to a much lesser rise in blood insulin levels.

A meal containing beans can even have a positive effect on the blood sugar response to the next meal eaten, even if the next meal does not contain beans. Beans can be mixed with a number of different types of foods and still maintain their excellent effects on blood glucose levels.

In addition to containing fiber and numerous vital nutrients, legumes are also a great source of high-quality protein. They can very easily be used as a replacement for animal protein, which has been shown to cause problems for diabetic patients. The variety of legumes available, such as black beans, white beans, pinto beans, kidney beans, red beans, chickpeas, green peas, red lentils, French lentils, and soybeans, can keep your diet both interesting and healthy.

Soybeans, in particular, may help protect against diabetes-related kidney and heart disease. A small clinical trial conducted on type 2 diabetes patients with nephropathy (diabetes-related kidney damage) suggests that soy protein can help protect diabetics' hearts and kidneys from damage caused by the disease. The study, a randomized crossover clinical trial, was conducted on 14 type 2 diabetes patients (10 men, 4 women) receiving medical care at an educational university hospital and private kidney disease clinic in Tehran. For the first seven weeks, patients followed a diet typically recommended to control nephropathy, which included 0.8 grams/kilogram of protein, based on 70% animal and 30% vegetable protein. After a washout period during which study subjects ate their pre-study diet, they were readmitted for another 7 week cycle, this time consuming a diet containing 35% soy protein and 30% vegetable protein. Following the soy diet, all patients experienced significant reductions in total cholesterol, triglyceride and LDL-cholesterol, while levels of beneficial HDL cholesterol remained stable and renal function improved. Researchers concluded, "Soy inclusion in the diet can modify the risk factors of heart disease and improve kidney function in these patients."

Another study, this one conducted at the University of Illinois and published in the August 2004 issue of the Journal of Nutrition, provides more evidence that soy protein helps persons with diabetes prevent kidney disease and improve their cholesterol profile. This study, a seven month crossover trial, involved 14 men with type 2 diabetes and kidney disease. After the first month, during which baseline measurements were established for each man, they were divided into two groups, one of which received a daily serving of vanilla flavored protein powder made from soy protein while the other group was given protein powder containing casein (the primary protein in cow's milk). After eight weeks, the men were given no protein powder for four weeks and then switched over to the other protein powder for eight weeks. Serving size of both types of protein was 0.5g/kg/day.

While on the soy protein, the men's urinary albumin concentrations decreased by 9.5% but increased by 11.1% while on the casein diet. Higher amounts of albumin in the urine are a marker for deterioration in kidney function.

In addition, blood levels of beneficial HDL-cholesterol increased by 4.3% after the soy protein diet but tended to be lower after casein consumption.

Why were these beneficial effects seen with soy? The authors suggest that soy's isoflavones may be responsible for the improvement in cholesterol profile, while soy's higher levels of the amino acid arginine, a chemical precursor to a molecule called nitric oxide that dilates arteries, are responsible for improving blood flow in the kidney and thus kidney function. Their conclusion: a simple dietary modification-adding soy protein foods to the diet- could help persons with diabetics prevent kidney disease and improve their cholesterol profile.

Whole Grains

Whole grain foods have come a long way since the days of the hard, flavorless bran muffin. Now you can find whole wheat bread, whole grain crackers, whole grain pastas, brown rice, barley soups, quinoa vegetable salads, amaranth breakfast cereals, numerous flavors of granola, and many other delicious whole-grain products.

Whole grains are very high in fiber, especially insoluble fiber. Certain grains, like oats and barley, are also high in soluble fiber. Since both types of fiber are helpful for people with diabetes, a good mix of whole grains is recommended.

Grains also contain many other vitamins and minerals needed by the body for healthy function. Refined grains, on the other hand, have been stripped of their nutrients and fiber and are very detrimental to diabetic patients. They can cause blood sugar levels to quickly rise to very high levels, which makes insulin levels rise rapidly as well. Alternatively, researchers are now suggesting that whole grains' ability to improve insulin sensitivity may be an important mechanism through which they reduce the risk of type 2 diabetes.

By replacing products made with refined flours and grains with whole grain foods, you can prevent high blood sugar spikes and improve your blood sugar control.

Among the minerals for which whole grains are an excellent source is magnesium, which acts as a co-factor for more than 300 enzymes, including enzymes involved in the body's use of glucose and insulin secretion.

The FDA permits foods that contain at least 51% whole grains by weight (and are also low in fat, saturated fat, and cholesterol) to display a health claim stating consumption is linked to lower risk of heart disease and certain cancers. Now, research suggests regular consumption of whole grains also reduces risk of type 2 diabetes. (van Dam RM, Hu FB, Diabetes Care).

In this 8-year trial, involving 41,186 particpants of the Black Women's Health Study, research data confirmed inverse associations between magnesium, calcium and major food sources in relation to type 2 diabetes that had already been reported in predominantly white populations.

Risk of type 2 diabetes was 31% lower in black women who frequently ate whole grains compared to those eating the least of these magnesium-rich foods. When the women's dietary intake of magnesium intake was considered by itself, a beneficial, but lesser- 19%- reduction in risk of type 2 diabetes was found, indicating that whole grains offer special benefits in promoting healthy blood sugar control. Daily consumption of low-fat dairy foods was also helpful, lowering risk of type 2 diabetes by 13%.

Two recent studies suggest that buckwheat and barley may be particularly good whole grain choices.

Canadian researchers, publishing their findings in the December 2003 issue of the Journal of Agricultural and Food Chemistry have found new evidence that buckwheat may be helpful in the management of diabetes. In a placebo-controlled study, a single dose of buckwheat seed extract lowered blood glucose levels by 12-19% at 90 and 120 minutes after administration when fed to rats with chemically-induced diabetes. No glucose reduction was seen in rats given placebo. The component in buckwheat responsible for its blood glucose-lowering effects appears to be chiro-inositol, a compound that has been shown in other animal and human studies to play a significant role in glucose metabolism and cell signaling. While researchers do not yet know precisely how it works, preliminary evidence suggests chiro-inositol makes cells more sensitive to insulin and may even act as an insulin mimic. Results of the Canadian study were so promising that one of the lead investigators, Roman Przbylski, is currently collaborating with Canadian-based Kade Research to develop new buckwheat varieties with much higher amounts of chiro-inositol. Although the rats used in this study had the equivalent of Type 1 diabetes in humans, the researchers are confident that buckwheat will exert similar glucose-lowering effects when given to rats with Type 2 diabetes, which is the next study on their agenda. Type 2 diabetes, which is by far the most common form in humans (90% of diabetes in humans is Type 2), is characterized by an inability of cells to respond properly to insulin.

In a human study conducted by the Agricultural Research Service at the Diet and Human Performance Laboratory in Beltsville, MD, and published in the June 2005 issue of the Journal of the American College of Nutrition, barley was much more effective in reducing both glucose and insulin responses than oats.

In this study, which involved 10 overweight women (mean age: 50 years, body mass index: 30), subjects ate a controlled diet for 2 days and were then given, in rotation, glucose alone and then 4 test meals in which 2/3 of the carbohydrate came first from oat flour then oatmeal, barley flour or barley flakes.

Glucose responses were reduced after test meals by both oats and barley, although more by barley (29-36% by oats and 59-65% by barley). Insulin responses after test meals were significantly reduced only by barley (44-56%). Interestingly, whether the oats or barley was consumed in the form of meal, flakes or flour had little effect. What seems to have been responsible for barley's significantly greater effectiveness in reducing both glucose and insulin responses is barley's soluble fiber content. The barley used in the study (a cultivar called Prowashonupana) contains more than 4 times the soluble fiber of common oats.

Fruits and Vegetables

The incredible variety of fiber-rich fruits and vegetables currently available at your local grocery store is staggering. Fruits and vegetables contain many other vital nutrients such as antioxidant vitamins like vitamin E, C, and beta-carotene, which are needed to neutralize free radicals.

Fruits and vegetables also contain bioflavonoids, which exert powerful antioxidant effects in the body. Although sweet in flavor, fruits have actually been shown to have stabilizing effects on blood sugar levels when consumed in small amounts at a time. Fructose, the main sugar found in fruits, does not cause blood sugar levels to rise as much as refined sugar when it is eaten in the form of portion-controlled fresh fruit.

Fruits and vegetables are delicious accompaniments to legumes, whole grains, and fish. They can be eaten raw, lightly steamed, simmered in soups and stews, baked, roasted, or even shish kabobbed. Diabetics should try to eat a wide variety of different fruits and vegetables, and to control fruit portion sizes since this will ensure a well-rounded intake of many nutrients and bioflavonoids.

Note: Dried fruits and fruit juices are not good choices for diabetics. In the case of dried fruits, with the watery portion of the whole food removed, the sugar concentration is simply too high. In the case of fruit juices, too much of the whole food fiber and related nutrients have been removed, which concentrates the sugar.

Cherries Fight Diabetes and Feed Your Sweet Tooth

Anthocyanins, plant pigments found in cherries and other red and purple fruits, may help lower blood sugar levels in people with diabetes, suggests laboratory research published in the January 2005 issue of the Journal of Agricultural and Food Chemistry.

When researchers at Michigan State University exposed rodent pancreatic cells to anthocyanins, insulin production increased 50%.

The mechanism of action by which anthocyanins boost insulin production is not yet known, but the Michigan research team is currently feeding anthocyanins to a group of obese, diabetic mice to determine precisely how the plant compounds affect insulin levels in live subjects. Not only are anthocyanins capable of increasing insulin production, they are potent antioxidants that studies are increasingly associated with numerous health benefits, including protection against heart disease and cancer.

Fish

When was the last time you had a big plate of fresh baked pink salmon fillet? It shouldn't have been too long ago if you have type 2 diabetes. Fish be an important ingredient in the diets of diabetic patients, replacing other meats and sources of fats.

Fish are very high in omega-3 fatty acids, which have been shown to be helpful in diabetes. In fact, several studies have shown that type 2 diabetes occurs much less frequently in populations that eat fish regularly compared to populations that don't eat much fish.

Regular fish consumption is especially beneficial for postmenopausal women with diabetes since it significantly reduces the progression of atherosclerosis in this population, shows a Tufts University study published in the September 2004 issue of the American Journal of Clinical Nutrition.

This three year study included 229 women with atherosclerosis, 42% of whom also had diabetes. Although new atherosclerotic lesions were seen in all the women, regardless of fish intake, those who consumed 2 or more servings of fish per week had significantly fewer lesions-especially if at least one serving was chosen from fish high in omega-3 fatty acids, such as salmon, tuna, mackerel or sardines.

Women with diabetes eating less than 2 servings of fish experienced an average 4.54% increase in stenosis (thickening and restriction) in their arteries, compared to an average increase of only 0.06% in women eating 2 servings of any fish per week.

In diabetic women eating less than 1 serving of omega-3-rich fish per week, stenosis increased 5.12% compared to a 0.35% increase in those who ate 1 or more servings of omega-3-rich fish each week.

Eating fish rich in omega-3s is so beneficial because these fats:

  • lower the amount of lipids (fats such as cholesterol and triglycerides) circulating in the bloodstream
  • decrease platelet aggregation, preventing excessive blood clotting
  • inhibit thickening of the arteries by decreasing endothelial cells' production of a platelet-derived growth factor (the lining of the arteries is composed of endothelial cells)
  • increase the activity of another chemical derived from endothelial cells (endothelium-derived nitric oxide), which causes arteries to relax and dilate
  • reduce the production of messenger chemicals called cytokines, which are involved in the inflammatory response associated with atherosclerosis

Omega 3s Help Prevent Obesity and Improve Insulin Response

Research presented in December 2004 at the 6th Congress of the International Society for the Study of Fatty Acids and Lipids suggests that while saturated fats appear to promote weight gain, the omega 3 fats found in cold water fish, such as tuna, reduce the risk of becoming obese and improve the body's ability to respond to insulin. The reason why? The omega 3 fatty acid, eicosapentaenoic acid (EPA) stimulates the secretion of leptin, a hormone that helps regulate food intake, body weight and metabolism, and is expressed primarily by adipocytes (fat cells).

Fish are also high in protein and other essential nutrients. It's important for diabetic patients to replace other animal sources of protein with fish. Simply adding fish to a diet that is already high in animal protein and fat may have harmful effects.

Olive Oil

While fat intake in general should be kept fairly low in diabetes, using some olive oil can be beneficial. Heavy corn oil dressing can drown a fresh green salad, but pure extra virgin olive oil in a lemon or balsamic vinaigrette adds a light yet flavorful touch to any salad.

Studies have shown that meals containing olive oil have better effects on blood sugar than meals low in fat. In addition, olive oil may be able to help raise levels of HDL (the good cholesterol).

Olive oil helps prevent belly fat and improves insulin sensitivity. Belly fat is associated with insulin resistance, which leads to further weight gain and increases risk of type 2 diabetes.

When researchers fed type 2 diabetic patients different diets - a high carbohydrate diet, or a diet rich in either saturated fat or olive oil (Mediterranean diet) - the high carb diet increased abdominal fat compared to the fat-rich diets. Of the three diets, the diet rich in olive oil did best, preventing not only belly fat accumulation, but the insulin resistance and drop in adiponectin seen after the high carbohydrate diet meals. Adiponectin, a hormone produced and secreted by fat cells (adipocytes), regulates sugar and fat metabolism, improves insulin sensitivity, and has antiinflammatory effects on the cells lining the blood vessel walls. Low blood levels of adiponectin are a marker for metabolic syndrome, are common in obesity, and are also associated with increased heart attack risk. Diabetes Care. 2007 Jul;30(7):1717-23. Epub 2007 Mar 23.

However, olive oil, though more stable than some oils, can still be damaged by heat. Heating olive oil to high temperatures can damage it, producing free radicals that have negative health effects. Olive oil should therefore not be used while cooking, but should instead be added to the dish after the cooking is done or should be used in dressings and uncooked sauces.

Olive oil should also not be added to a diet already high in fats. The extra calories can actually make diabetes worse. Instead, use olive oil to replace other oils, like corn, sunflower, or safflower oil, and other sources of fat, such as the saturated fats found in meat and dairy products, or the unhealthy trans fats found in margarines.

Cinnamon

Cinnamon may help people with type 2 diabetes improve their ability to respond to insulin, thus normalizing their blood sugar levels. Both test tube and animal studies have shown that compounds in cinnamon not only stimulate insulin receptors, but also inhibit an enzyme that inactivates them, thus significantly increasing cells' ability to use glucose. Studies to confirm cinnamon's beneficial actions in humans are currently underway.

Additional test tube, animal and human studies have all recently investigated cinnamon's ability to improve insulin activity, and thus our cells' ability to absorb and use glucose from the blood.

On going in vitro or test tube research conducted by Richard Anderson and his colleagues at the USDA Human Nutrition Research Center is providing new understanding of the mechanisms through which cinnamon enhances insulin activity. In their latest paper, published in the Journal of Agricultural and Food Chemistry, Anderson et al. characterize the insulin-enhancing complexes in cinnamon-a collection of catechin/epicatechin oligomers that increase the body's insulin-dependent ability to use glucose roughly 20-fold. Some scientists had been concerned about potentially toxic effects of regularly consuming cinnamon. This new research shows that the potentially toxic compounds in cinnamon bark are found primarily in the lipid (fat) soluble fractions and are present only at very low levels in water soluble cinnamon extracts, which are the ones with the insulin-enhancing compounds.

A recent animal study demonstrating cinnamon's beneficial effects on insulin activity appeared in the December 2003 issue of Diabetes Research and Clinical Practice. In this study, when rats were given a daily dose of cinnamon (300 mg per kilogram of body weight) for a 3 week period, their skeletal muscle was able to absorb 17% more blood sugar per minute compared to that of control rats, which had not received cinnamon, an increase researchers attributed to cinnamon's enhancement of the muscle cells' insulin-signaling pathway. In humans with type 2 diabetes, consuming as little as 1 gram of cinnamon per day was found to reduce blood sugar, triglycerides, LDL (bad) cholesterol, and total cholesterol, in a study published in the December 2003 issue of Diabetes Care. The placebo-controlled study evaluated 60 people with type 2 diabetes (30 men and 30 women ranging in age from 44 to 58 years) who were divided into 6 groups. Groups 1, 2, and 3 were given 1, 3, or 6 grams of cinnamon daily, while groups 4, 5, and 6 received 1, 3 or 6 grams of placebo. After 40 days, all three levels of cinnamon reduced blood sugar levels by 18-29%, triglycerides 23-30%, LDL cholesterol 7-27%, and total cholesterol 12-26%, while no significant changes were seen in those groups receiving placebo. The researchers' conclusion: including cinnamon in the diet of people with type 2 diabetes will reduce risk factors associated with diabetes and cardiovascular diseases.

Seasoning a high carb food with cinnamon can help lessen its impact on blood sugar levels. Cinnamon slows the rate at which the stomach empties after meals, reducing the rise in blood sugar after eating. Researchers measured how quickly the stomach emptied after 14 healthy subjects ate 300 grams (1.2 cups) of rice pudding alone or seasoned with 6 grams (1.2 teaspoons) of cinnamon. Adding cinnamon to the rice pudding lowered the gastric emptying rate from 37% to 34.5% and significantly lessened the rise in blood sugar levels after eating. Am J Clin Nutr. 2 007 Jun;85(6):1552-6.

Garlic

Cardiovascular disease is a well-known side-effect of diabetes, but garlic may provide some protection, according to a study published December 2003. When diabetic rats were given garlic extract for an 8-week period, the hyperreactivity of their blood vessels to noradrenaline (a vasoconstrictive hormone) and acetylcholine (a compound involved in nerve transmission) was significantly lessened. According to the researchers, their results suggest that garlic may help prevent the development of abnormal vascular contraction seen in diabetics.

Tomato Juice

Tomato juice may also be protective. Tomato juice is an effective blood thinner in persons with type 2 diabetes, suggests Australian research published in the August 2004 issue of the prestigious Journal of the American Medical Association. In this study, 20 people with type 2 diabetes were given 250 ml (about 8 ounces) of tomato juice or a tomato-flavored placebo daily. Subjects had no history of clotting problems and were taking no medications that would affect blood clotting ability. After just 3 weeks, platelet aggregation (the clumping together of blood cells) was significantly reduced among those drinking real tomato juice, while no such effect was noted in those receiving placebo. Be sure to choose a low-sodium tomato juice; many "regular" tomato juice products are loaded with artery-unfriendly sodium.

Walnuts

One of the most feared complications of diabetes is the increased risk of cardiovascular disease: 65% of Americans with diabetes die of heart disease.

Fortunately, just enjoying a handful of walnuts each day can help lower a diabetic's heart disease risk.

Walnuts are an especially rich source of polyunsaturated fatty acids, specifically alpha linolenic acid, an omega-3 fatty acid highly protective against heart disease.

In patients with type 2 diabetes, including a daily ounce of walnuts in a diet in which 30% of calories came from fat translated into a significant improvement in subjects' cholesterol profile.

In this study, published in the December 2004 issue of Diabetes Care, 58 men and women with an average age of 59 years, were assigned to one of three diets in which 30% of calories was derived from fat: a low fat diet, a modified low fat diet, and a modified low fat diet including an ounce of walnuts per day.

After 6 months, those on the walnut diet had achieved a significantly greater increase in their HDL-to-total cholesterol ratio than the other groups, plus walnut eaters saw a 10% reduction in their LDL cholesterol. Why such benefit from walnuts? Most likely because walnuts are exceptionally high in their content of monounsaturated fat and the omega-3 fatty acid, alpha-linolenic acid. Plus, walnuts combine these heart healthy fats with a hefty dose of the antioxidants including at least 16 antioxidant phenols, vitamin E, ellagic and gallic acid.

New research continues to show that when walnuts are eaten as part of a modified low-fat diet, the result is a more cardiprotective fat profile in diabetic patients than can be achieved by simply lowering the fat content of the diet. In a study published in the July 2005 issue of the Journal of the American Dietetic Association, all 55 study participants with type 2 diabetes were put on low fat diets, but the only group to achieve a cardioprotective fat profile (less than 10% of calories from saturated fat, 7-10% of calories from polyunsaturated fats, adequate omega-3 fats, and an omega-6:omega-3 ratio of less than 10) were those who ate walnuts (30 grams-about one ounce-per day).

Almonds Provide Double-Barreled Protection against Diabetes and Cardiovascular Disease

Lessening after-meal surges in blood sugar helps protect against diabetes and cardiovascular disease, most likely by lessening the increase in cholesterol-damaging free radicals that accompanies large elevations in blood sugar. This is one reason why low- glycemic index diets result in lower risk of diabetes and heart disease.

Almonds appear to not only decrease after-meal rises in blood sugar, but also provide antioxidants to mop up the smaller amounts of free radicals that still result. (Jenkins DJ, Kendall CW, Journal of Nutrition)

Researchers fed 15 healthy subjects 5 meals providing a comparable amount of carbohydrate, fat and protein: 3 test meals (almonds and bread, parboiled rice, and instant mashed potatoes) and 2 bread control meals. Blood samples, taken before each meal and 4 hours afterwards, showed levels of protective antioxidants increased after the almond meal, but decreased after the other meals. And not only did the almond meal increase antioxidant levels, but unlike the other foods, almonds also lowered the rise in blood sugar and insulin seen after eating.

Further research shows that eating almonds along with a high glycemic index food significantly lowers the glycemic index of the meal and lessens the rise in blood sugar after eating. (Jones AR, Kendall CW, Metabolism)

In this study, after an overnight 10-12 hour fast, 9 healthy volunteers were randomly fed 3 test meals and 2 white bread (high glycemic) control meals on separate days. Each meal contained 50 grams of carbohydrate from white bread eaten either alone or in combination with 1, 2, or 3 ounces of almonds. To check subjects' rise in blood sugar, blood samples were taken for glucose analysis immediately after eating, and at 15, 30, 45, 60, 90 and 120 minutes.

Eating almonds reduced the glycemic index (GI) of the meal and subjects' rise in blood sugar in a dose-dependent manner - the more almonds consumed, the lower the meal's GI and the less the rise in subjects' blood sugar after eating.

When one-ounce of almonds was eaten along with white bread, the GI of the meal (105.8) was comparable to eating white bread alone, but when two ounces of almonds were consumed with the white bread, the GI dropped to 63, and when 3 ounces of almonds were eaten, the GI was only 45.2 - less than half the GI of the white bread only meal.

Subjects' blood sugar rose 2.8 mmol/L after eating only white bread. When one ounce of almonds was eaten with the bread, blood sugar rose 2.2 mmol/L. Eating two ounces of almonds with the bread resulted in a rise in blood sugar of 2.0 mmol/L, and eating three ounces of almonds caused blood sugar to rise only 1.6 mmol/L - less than half the rise seen after eating white bread alone. Practical Tip: So, don't just enjoy almonds as a between-meal snack. Spread a little almond butter on your toast or down the center of a stalk of celery. Add a handful of lightly roasted almonds to your salad or chop and use as a topping for pasta, steamed or healthy sautéed vegetables. When eating foods with a higher glycemic index, including almonds in the meal can help keep your blood sugar under control.

Nutrients in Foods That May Help Include:

Fiber

Many studies have shown that a diet high in fiber has beneficial effects on diabetes. In particular, a fiber-rich meal leads to a much smaller rise in blood sugar and blood insulin levels compared to a meal low in fiber.

One theory suggests fiber slows down the rate at which sugar is absorbed in the gut, so blood sugar rises more slowly, which also results in blood insulin levels rising more slowly. Fiber also seems to help cells absorb glucose more easily. Diets high in fiber are associated with a much lower risk of developing diabetes than the standard low-fiber American diet.

A second role of fiber that appears important is its role in preventing excessive inflammation. The connection between fiber and inflammation is very likely to involve intestinal bacteria. Several types of fiber can be consumed by bacteria in the lower intestine and converted into a short chain fatty acid called butyric acid. Not only can this fatty acid be used by cells in the lower intestine for energy, but it can also block inflammatory responses. Some studies suggest that approximately 20 grams of daily fiber may be required to achieve these anti-inflammatory benefits.

The two main types of fiber are soluble fiber and insoluble fiber. Soluble fiber is the kind of fiber found mostly in fruits and vegetables, legumes, and certain grains like oats and barley. Insoluble fiber is found mainly in other kinds of whole grains.

Because these two types of fiber have slightly different actions in the body, it's important for diabetic patients to get a good mix of both. This can be easily achieved by eating a variety of fruits, vegetables, whole grains, and legumes.

Some excellent food sources of fiber include raspberries, mustard greens, turnip greens, collard greens, broccoli, cauliflower, and Swiss chard.

Omega-3 Fatty Acids

Omega-3 fatty acids are considered essential fats because they're needed by the body for daily activities and cannot be made from other nutrients but must be derived from the diet. In particular, the body uses omega-3 fats for making healthy, appropriately permeable cell membranes and blood vessels. Healthy cell membranes are able to appropriately respond to insulin and therefore absorb glucose better.

In addition, omega-3 fats have been shown to reduce the risk of atherosclerosis and heart disease and prevent poor blood circulation in diabetics. In addition, omega-3 fats can lower high triglyceride levels, another risk factor for heart disease commonly seen in diabetic patients.

Food sources of omega-3 fatty acids should be used to replace other high-fat foods in the diet, such as fatty meats and dairy products. Simply adding omega-3 fats to a diet that is already high in fat will not be helpful.

Food sources of omega-3 fatty acids include flax seeds, walnuts, and cold water fish, like salmon, cod, and halibut.

Vitamin E

Vitamin E is one of the major antioxidants in the body. Its main job is to roam the body searching for free radicals. When it comes into contact with these damaging chemicals, it neutralizes them, so they can't do any more harm.

Vitamin E has been shown to do great things for diabetic patients. First off, it may be able to improve the ability of cells to absorb glucose, thus lowering high blood sugar levels. It can also slow the progression of atherosclerosis and reduce the risk of heart attack and stroke by inhibiting the formation of blood clots. In this way, vitamin E may also work to prevent retinopathy, a condition of blood clots in the vessels of the eyes that can lead to blindness in diabetic patients.

In addition, vitamin E has been shown to reduce the symptoms of poor circulation and nerve damage in patients with advanced diabetes. In general, vitamin E seems to be a very important nutrient for treating blood sugar problems as well as preventing some of the major long-term consequences of type 2 diabetes.

Vitamin E and Beta-Cryptoxanthin

A study published in the February 2004 issue of Diabetes Care suggests that a diet rich in vitamin E and certain carotenoids reduces the risk of type 2 diabetes. To assess diabetes risk in comparison with dietary intake of different kinds of antioxidants, a research team from Finland's National Public Health Institute followed a study population of 2,285 men and 2,019 women between 40-69 years of age, all of whom were free of diabetes when the study began.

From a dietary history interview, researchers calculated study participants' intake of vitamin C, four tocopherols and four tocotrienols (various forms of vitamin E), and six carotenoids during the year before the study began. Study subjects were then followed for the next 23 years, during which 164 men and 219 women developed diabetes.

While vitamin C intake did not appear to affect diabetes risk, eating foods rich in vitamin E and the carotenoid beta-cryptoxanthin were both found to significantly reduce risk of Type 2 diabetes.

Those eating the most vitamin E-rich foods had a 31% lower risk of developing diabetes compared to those eating the least, and those consuming the most beta-cryptoxanthin, which is found in citrus fruits, cut their chances developing type 2 diabetes by 42%.

Unfortunately, many diabetic patients have very low levels of vitamin E because diabetes results in the production of higher than normal amounts of free radicals. It's particularly important, therefore, for persons with diabetes to get plenty of vitamin E in their diets.

Excellent and very good sources of vitamin E include: mustard greens, Swiss chard, sunflower seeds, turnip greens, almonds, kale and spinach.

Concentrated sources of beta-cryptoxanthin include: red bell pepper, papaya, cilantro, oranges, corn, and watermelon.

Vitamin C

Vitamin E and vitamin C are allies in the war against free radicals. Vitamin C also roams the body, eliminating damaging free radicals before they can do more harm. In addition, vitamin C helps revitalize vitamin E that has gotten worn out by destroying free radicals.

However, diabetic patients also tend to have low levels of vitamin C in their bodies. If you increase your intake of vitamin E, it's very important that you also get more vitamin C, so the vitamin E can do a better job.

Excellent food sources of vitamin C include broccoli, parsley, bell peppers, strawberries, cauliflower, lemons, mustard greens, Brussels sprouts, papaya, kale, cabbage, spinach, kiwifruit, cantaloupe, oranges, grapefruit, tomatoes, chard, collard greens, raspberries, peppermint leaves, asparagus, celery, fennel bulb, pineapple, and watermelon.

Vitamin D

Vitamin D is a nutrient used by the body for many purposes, especially the production of strong, healthy bones. Although it's unclear why, low vitamin D levels are strongly associated with insulin resistance.

Studies have shown that people with diets low in vitamin D are at higher risk for type 2 diabetes than people who get plenty of this vitamin. Low vitamin D also seems to be linked to many of the negative consequences of diabetes. Getting enough vitamin D may therefore important for preventing the development and progression of type 2 diabetes. Shrimp and fortified milk are two very good sources of vitamin D.

Magnesium

Magnesium levels tend to be low in diabetic patients, especially those with kidney problems. Kidney damage causes magnesium to be flushed out in the urine, which can reduce the amount available for the many uses of magnesium in the body.

Unfortunately, low levels of magnesium are associated with an increased risk for heart disease, heart attack, high blood pressure, and stroke. The good news is that increasing the intake of magnesium can help to correct these low levels, as well as increase the ability of cells to absorb and use glucose.

Two new Harvard studies published in the January 2004 issue of the journal Diabetes Carehave confirmed the association between a diet high in magnesium-rich foods and significantly lower risk of developing type 2 diabetes, especially in people who are overweight. The first, with a study population of 85,060 women followed for 18 years, and 42,872 men followed for 12 years, documented a 34% reduction in risk among women, and a 33% risk reduction in men eating the most magnesium-rich foods. And these substantial risk reduction statistics remained significant even after adjustments were made for dietary variables including glycemic load, polyunsaturated fat, trans fat, cereal fiber, and processed meat consumption. The second study reviewed data on 39,345 women, 45 years old or older, who were in the Women's Health Study and were followed for an average of 6 years. Again, a significant inverse relationship was found between consumption of magnesium-rich foods and risk of type 2 diabetes. Fasting insulin levels were found to be significantly higher in overweight women consuming the least magnesium compared to those eating the most magnesium-rich foods (53.5 versus 41.5 pmol/l). (A high fasting insulin level is a sign that the cells' sensitivity to insulin and thus ability to absorb blood sugar is becoming impaired). While overweight women with the lowest intake of magnesium were found to be almost certain to develop type 2 diabetes (their relative risk was 100%), those consuming the most magnesium-rich foods lowered their risk by 22%.

Two studies published in the January 2004 issue of Diabetes Care involving more than 170,000 people found a strong correlation between diets high in magnesium from green leafy vegetables, nuts and whole grains and a low risk of developing type 2 diabetes. In one of the studies, a research team from the Harvard School of Public Health followed 85,060 women for 18 years and 42,872 men for 12 years. None of the study participants had diabetes, cardiovascular disease or cancer when the study began. After adjustments were made to account for age, body mass index, smoking, alcohol consumption and other lifestyle factors, the data revealed that those individuals whose diets were richest in magnesium from leafy greens, nuts and whole grains, were least likely to develop type 2 diabetes. The second study, which evaluated data on 39,345 women participating in the Women's Health Study at Brigham and Women's Hospital and the Harvard Medical School, found that eating foods rich in magnesium improved the body's ability to maintain consistently healthy blood sugar levels and significantly reduced risk of developing type 2 diabetes, especially in overweight women.
Swiss chard and spinach are excellent sources of magnesium. Nuts and whole grains are also good to very good sources of this essential mineral.

Chromium

Several studies have shown that insulin resistance can be caused by chromium deficiency. Chromium is a vital part of glucose tolerance factor, a substance needed by cells in order to take in glucose. Increasing chromium intake has helped some diabetic patients better control their blood sugar levels. Romaine lettuce is an excellent source of chromium and tomatoes and onions are very good sources.

Zinc

One of zinc's main uses is regulating the immune system, which is responsible for fighting off harmful viruses and bacteria. Problems with the circulatory and immune systems can lead to poor wound healing and dangerous infections in diabetics. Sometimes these infections are severe enough to require amputations or even cause death.

Zinc has been shown to increase the number and activity of certain types of immune system cells that are especially important for fighting infections. In addition, zinc can help with blood sugar control. Since diabetic patients also tend to have low zinc levels, it's important that they get plenty of zinc in their diets. Calf liver, crimini mushrooms and spinach are three very good sources of zinc.

Beta-carotene

Beta-carotene, another antioxidant like vitamin C and vitamin E, is found in foods such as fruits and vegetables. It's also able to eliminate harmful free radicals in the body.

Fruits and vegetables rich in beta-carotene are easy to spot since it provides their bright orange and yellow color.

Excellent food sources of beta-carotene include sweet potatoes, carrots, kale, winter squash, collard greens, chard, cantaloupe, mustard greens, romaine lettuce, spinach, parsley, cayenne pepper, peppermint leaves, Brussels sprouts, tomatoes, broccoli, asparagus, and apricots.

Folic Acid and Vitamin B12

Folic acid and vitamin B12 are two nutrients that are associated with reduced risk of heart disease and therefore may be important to those with type 2 diabetes. People who have high blood levels of a substance called homocysteine are at a much greater risk of heart disease than others.

Homocysteine is an intermediate compound produced in the body during a process called methylation. During methylation, the amino acid methionine is first changed into homocysteine, and then converted to cysteine with the help of folic acid and vitamin B12.

If a person does not have adequate amounts of folic acid and vitamin B12, levels of homocysteine build up, a situation to avoid since homocysteine is directly damaging to arteries, reduces the integrity of blood vessel walls, and interferes with the formation of collagen (the main protein in connective tissue).

High levels of homocysteine therefore contribute to the development and progression of atherosclerosis. Foods rich in folic acid and vitamin B12 should be staples in a healthy diet.

Excellent sources of folic acid include: spinach, parsley, broccoli, beets,turnip greens, asparagus, romaine lettuce, lentils, and calf's liver.

Excellent food sources of vitamin B12 include calf liver and snapper.

Nutrient Excesses

Substances to Avoid

Fats

High-fat diets are associated with an increased risk for diabetes. High-fat diets have also been linked to an increase in heart disease, which is a major concern for diabetic patients.

While certain fats, such as omega-3 fatty acids and the monounsaturated fats found in olive oil, have been shown to be beneficial in diabetes, other types of fats, notably saturated fats, should be avoided.

Diabetics should greatly reduce their intake of saturated fats found in meat and dairy products; excess omega-6 fats, highest in meat, dairy products, and corn, safflower and sunflower oils; and trans fats, which are found in margarine, non-dairy creamers, and processed foods.

Saturated Fats

Saturated fats can have several harmful effects in diabetic patients. Meals high in saturated fats have been shown to greatly raise blood insulin levels. Saturated fats can also raise blood triglyceride levels, which have been associated with heart disease.

Eating a diet high in saturated fats can lead to high cholesterol levels, which can cause the progression of atherosclerosis. Saturated fats are found mainly in animal products, such as meats, milk and cheese; therefore, these should be avoided or kept to a minimum (with low fat dairy products consumed instead of whole milk products), replaced with low fat sources of protein such as legumes.

Trans Fats

Trans fats can occur naturally in food, but are never found in such large amounts as occur in a process called hydrogenation. This process is used to turn liquid vegetable oil into more solid margarine. Trans fats can also be formed in oil that is heated for long periods of time, like the oil used and reused for frying french fries, onion rings, burgers and fish patties at your local fast food restaurant.

Trans fats are directly linked to an increased risk for insulin resistance as well as to an increased risk for blood clots, which can lead to heart attack or stroke. Avoiding hydrogenated oils and deep fried food is a must for diabetics.

Omega-6 Fatty Acids

Omega-6 fatty acids are mostly found in refined vegetable oils, such as sunflower, safflower, and corn oils. Several studies have shown a link between excessive intake of omega-6 fats and the development of type 2 diabetes. This link is strongest in populations whose diets are low in omega-3 fats, indicating that it may be the ratio of omega-6 fats to omega-3 fats that is most important.

Experts suggest that this ratio should be no higher than 4:1 of omega-6:omega-3 fats. In those consuming the Standard American Diet, the ratio of omega-6:omega-3 fats is 20:1 or even higher - a ratio that may promote the progression of diabetes. Consumption of animal products and the use of refined vegetable oils should be minimized and replaced with health-promoting fats. These include the omega-3 fats found in cold-water wild-caught fish and flaxseed oil, and the monounsaturated fats found in olive oil.

Omega-3 Fatty Acids

Some studies have shown that a high intake of beneficial omega-3 fatty acids can be harmful in diabetes. Some patients, in an attempt to get plenty of omega-3 fats without eating fish have turned to omega-3 fat supplements.

Unfortunately, studies have shown that more than 3 grams of omega-3 fats per day may lead to increased blood sugar, cholesterol, and LDL levels and may worsen insulin resistance. Researchers believe that these negative effects are due to the extra calories in the supplements.

The good news is that people who get their omega-3 fatty acids from fish and not as supplements are not at risk for these negative effects. It's important for diabetics to use food sources of omega-3 fatty acids to replace other sources of fat in their diets rather than adding more fat, even healthy fat, to an already high-fat diet.

Animal Protein

Diets with excessive protein, especially animal protein, are associated with the development of type 2 diabetes and with the progression of diabetic kidney disease. Too much protein in the diet puts extra stress on the kidneys and can lead to further damage. This effect is greatest when the main sources of protein are animal products such as meats and dairy.

Although animal protein in meals may help to blunt the high blood sugar spikes seen in diabetes, it has the tendency to cause great rises in blood insulin levels. Researchers believe that some of the proteins found in animal products may stimulate the pancreas to produce even more excessive amounts of insulin.

Since excessive insulin may be damaging to the body, it might be best for diabetic patients to cut back on the amount of protein they get from animal sources. Meat and dairy products can be easily replaced with non-animal protein sources such as legumes, which do not cause blood insulin levels to rise so much, and which contain fiber and a variety of other important nutrients needed by diabetic patients.

Niacin or Nicotinic Acid

Niacin is a B-vitamin often used in people with atherosclerosis to lower high cholesterol levels. Unfortunately, high intakes of this nutrient can cause high blood sugar levels in people with diabetes. These effects are only seen in people taking very high doses of niacin in supplement form and not from food sources or the amounts found in most multivitamins. Diabetic patients should therefore avoid taking high-dose niacin supplements.

Iron

High levels of free iron in the body may increase the amount of free radicals and the damage they cause. Diabetic patients tend to have very high levels of iron in their bodies, which may be contributing to their problem with free radicals.

Iron is found in high quantities in red meat, but the most important source is vitamin supplements. Diabetics should not take iron supplements, even iron in multivitamins, unless they have been told by their doctor that they need extra iron.

Recommended Diet

The best diet for people with diabetes is a diet, such as the Mediterranean diet, that provides a rich selection of whole, healthy foods research has linked to good blood sugar control. When it comes to prevention of type 2 diabetes, a Mediterranean diet is also effective, not only because of its rich selection of whole, healthy foods but also because it is plant-based. In research studies, plant-based diets have repeatedly provided the best protection against development of type 2 diabetes. In fact, it's not only prevention of type 2 diabetes, but also treatment of type 2 diabetes that seems to be improved with the use of a Mediterranean diet. In a study from Naples, Italy, individuals recently diagnosed with type 2 diabetes and following a Mediterranean diet were much better able to delay their need for prescription drugs than individuals following a standard low-fat diet. Blood sugar control and weight loss were also better in the Mediterranean diet group, despite the fact that both groups had similar calorie intake and similar weekly physical activity levels.

A Review of the Research Finds Many Reasons Why a Mediterranean Diet Protects against Weight Gain and Type 2 Diabetes

Weight gain significant enough to qualify as obesity has become a worldwide epidemic affecting more than 300 million people, including nearly one-third of American adults. And as obesity has increased, so has type 2 diabetes.

Considered a disease of minor significance in the 20th century, type 2 diabetes is now a major threat to human health, afflicting 150 million people worldwide, and its incidence is projected to double by 2025.

So close is the relationship between obesity and type 2 diabetes that researchers have coined a new term to describe it: diabesity.

The fact that both obesity and type 2 diabetes have so recently and drastically increased suggests that both result from changes in our lifestyle that serve us a recipe for ill health:

  • Our diet has shifted to emphasize foods with low nutrient density (supplying excessive calories in comparison to the nutrients they provide)
  • Larger portion sizes
  • Less physical activity

Fortunately, both diet and exercise are within our control, making obesity and type 2 diabetes largely preventable.

Several epidemiological (population) studies have now shown that a Mediterranean diet offers significant protection against weight gain, particularly abdominal weight gain, which has been shown to promote type 2 diabetes. A recent review of the research, published in The Journal of Nutritional Biochemistry, (Schröder H.) explains many of the reasons why. Fiber: the Mediterranean diet is rich in plant foods providing a variety of both soluble and insoluble dietary fiber.

Not only do fiber-rich foods require more chewing, thus slowing the rate at which food is consumed, they produce a feeling of fullness with fewer calories.

When fiber is present in a meal, the small intestine secretes peptides, such as cholecystokinin, that signal satiety to the brain. Legumes and nuts, two fiber-rich staples in the Mediterranean diet, have been shown to greatly increase the secretion of cholechystokinin. Healthy Fats: A Mediterranean diet is rich in healthy unsaturated fats from olive oil, cold water fish, nuts and seeds.

Olive oil, a hallmark of the Mediterranean diet, is used for cooking and to add flavor to legumes, salads and vegetable dishes. Some evidence suggests that oleic acid, the predominant fatty acid of olive oil, is associated with lower insulin resistance.

Research has shown that replacing saturated fat with olive oil in the diet of obese men produces significant loss of both weight and body fat after just 4 weeks. In abdominally obese women, olive oil has been shown to increase the rate at which fat is oxidized (burned) after meals.

Plus, in the Mediterranean diet, olive oil is used to dress vegetables and legumes, which are rich in nutrients and fiber, but very low in calories.

The type of fat in the diet affects the composition of cell membranes. Saturated fats make cell membranes less permeable and receptive to signals from messenger molecules such as insulin, while the omega-3-fatty acids supplied by cold water fish, walnuts and flaxseed render cell membranes more flexible and receptive. Nutrient-density: A Mediterranean meal typically begins with salad as a first-course-a meal plan that has been shown to increase feelings of fullness and, consequently, reduce calorie intake by 12% in comparison to meals without salad as a first course. Moderate red-wine consumption: A glass of red wine often accompanies lunch or dinner in the Mediterranean.

In animal research, voluntary red wine consumption resulted in reduced calorie intake and prevented weight gain in rats on a high-fat diet, but whether a specific component in red wine causes these effects is not yet known.

In human population studies, moderate alcohol consumption has been shown to enhance insulin sensitivity and increase levels of adiponectin, a signaling molecule that stimulates cells' burning of both fatty acids and glucose (sugar). Antioxidants: A Mediterranean diet provides an abundance of antioxidant-rich fruits and vegetables.

Not only has consumption of fruits and vegetables been shown to reduce risk of type 2 diabetes in several population studies, but blood levels of antioxidants have been found to be higher in persons following a Mediterranean diet.

In addition to vitamin antioxidants such as beta-carotene, E and C, the characteristic foods of the Mediterranean diet provide a wide variety of polyphenols with potent, synergistic antioxidant activity.

Since oxidative stress (damage by free radicals) plays a crucial role in the development of insulin resistance and beta cell dysfunction, a Mediterranean diet is highly protective against type 2 diabetes. (Beta cells are responsible for the production of insulin.)

Following an antioxidant-rich Mediterranean diet has been shown to significantly decrease insulin resistance in patients with the metabolic syndrome, and even short-term administration of virgin olive oil has been found to decrease several markers of oxidative stress. Magnesium: Vegetables, legumes and nuts-key components of the Mediterranean diet-are rich sources of magnesium, which is an essential co-factor in enzymes required for cellular energy production.

Studies have linked insufficient magnesium with increased incidence of type 2 diabetes. Whole grains: High consumption of whole grains, which are rich in both fiber and magnesium, is another characteristic of the traditional Mediterranean diet.

Population studies consistently show a protective effect of cereal fiber on insulin sensitivity and risk of type 2 diabetes. Furthermore, the fiber provided by whole grains delays the emptying of stomach, slowing the digestion and absorption of food, which in turn slows the rate at which glucose (sugar) passes into the bloodstream and reduces insulin levels.

By simply enjoying the healthy Mediterranean way of eating espoused by The World's Healthiest Foods, you will naturally receive high amounts of dietary fiber, antioxidants, magnesium and health-promoting monounsaturated and omega-3 fats. And because, this diet is characterized by nutrient-dense foods, which supply fewer calories overall, it automatically promotes a healthy weight, preventing weight gain and lessening your risk of obesity and type 2 diabetes. Researchers have compared the Mediterranean way of eating with a traditional type 2 diabetes diet that is high in carbohydrates (about 60% of total calories) and low in total fat (about 25% of total calories). What they've found is an ability of the Mediterranean way of eating to regulate blood sugar, blood insulin levels, protect the heart, and help improve weight management in a way that is equally as effective as a low-fat, high-carb diet. They concluded that the Mediterranean way of eating represented an attractive and reliable option for individuals already diagnosed with type 2 diabetes.

An increasing number of research studies have started to examine the advantages of a lower-carb approach to blood sugar control that is consistent with the amount of carbs provided in a Mediterranean way of eating. It's not uncommon to see studies in which the percentage of carbs recommended for type 2 diabetics ranges from 30-45%. Some studies also show potential metabolic advantages for a lower carb approach with respect to blood triglyceride levels, and insulin regulation.

A prospective study published in the American Journal of Clinical Nutrition (Mantzoros CS, Williams CJ, et al.), has revealed yet another way in which a Mediterranean diet protects individuals with diabetes. This research showed that following a Mediterranean diet is linked to significantly higher blood levels of adiponectin.

Adiponectin is a hormone that helps the body maintain healthy blood sugar levels and burn fats, thus playing a protective role against type 2 diabetes, obesity and atherosclerosis. Adiponectin is secreted from adipose (fat tissue) into the bloodstream. Levels of the hormone are inversely correlated with body mass index (BMI): the more fat a person carries in comparison to lean tissue, the lower his or her blood levels of adiponectin.

In this research, involving 987 diabetic women from the Nurses' Health Study, those who scored highest on a 9-point scale measuring adherence to a Mediterranean-type dietary pattern had lower BMIs and smaller waists-despite having higher total calorie intakes-than women with the lowest Mediterranean diet scores.

Average blood levels of adiponectin were 23% higher in women who most closely followed a Mediterranean-type diet compared to low adherers. Of the various foods that make up the Mediterranean dietary pattern, data from this study found that eating nuts and whole grains had the strongest association with increased blood levels of adiponectin.

For men with diabetes as well, a Mediterrean-style diet offers special benefits. One well recognized, if not publicly discussed ramification of diabetes, is erectile dysfunction. Metabolic syndrome, an early pre-diabetes indication that the body is having problems handling sugar, also greatly increases a man's risk of erectile dysfunction for the same reasons as diabetes. Fortunately, following a Mediterranean diet may greatly help heal both health concerns.

A study in the International Journal of Impotence Research (Esposito K, Ciotola M, et al.) involving 65 men diagnosed with erectile dysfunction (ED) associated with metabolic syndrome shows that adherence to a Mediterranean-style diet (increased consumption of fruits, vegetables, nuts, whole grains, and olive oil) not only greatly reduced or eliminated erectile dysfunction, but improved blood vessel health throughout the body (endothelial function) and reduced levels of C-reactive protein, a marker of inflammation associated with risk of cardiovascular disease.

The men were divided into 2 groups with 35 following a Mediterranean-style diet and the remaining 30 serving as controls. The Mediterranean diet guidelines included increasing consumption of vegetables, fruits, whole grains, legumes, nuts, fish and olive oil, limiting consumption of red meat and processed meat.

Subjects in both groups were recommended to walk for at least 30 minutes/day, and encouraged to increase their physical activity level in general.

When the study began, no significant differences in nutrient intake or erectile function scores were found between the groups, but after the 2 year intervention period, remarkable differences were seen between the groups.

Men in the Mediterranean-style diet group had significant improvements in erectile function compared to subjects in the control group. Scores on the International Index of Erectile Function (IIEF) increased from on average 14.4 at baseline to 18.1 compared with a non-significant increase in score in the control group (from 14.9 to 15.2).

Moreover, 13 subjects in the intervention group achieved IIEF scores of 22 or higher after the intervention-scores that indicate a restoration of normal sexual function-compared with only 2 subjects in the control group.

Additional improvements seen in the Mediterranean-diet group included: reductions in blood sugar, insulin, LDL (bad) cholesterol, triglycerides, blood pressure, and C-reactive protein levels, and increases in HDL (good) cholesterol and blood vessel (endothelial) function score. No such changes were found in the control group. The results of this study strongly suggest that following a Mediterranean-style diet can do much to improve erectile function and cardiovascular function overall in men with the metabolic syndrome.

Legumes, another staple component of the Mediterranean diet, are also an ideal food for a person with diabetes. And legumes are a perfect nutritional match with whole grains, providing a hearty blend of protein as well as soluble and insoluble fiber.

A bowl full of steaming buckwheat seasoned with cinnamon and creamy soy milk makes a hearty breakfast that will keep you energized throughout a long morning. Try brown rice with black bean chili, whole grain pasta with a red lentil curry sauce, whole wheat burritos with refried beans and fresh salsa, barley and lentil stew, a lemon-flavored white bean and quinoa salad, and much, much more. Legumes and whole grains provide the basis for dozens of easy-to-prepare meals that are flavorful, satisying, and exceptionally good for blood sugar control.

Skip the tasteless refined vegetable oils and reach for some pure, extra virgin olive oil to add a delicate flavor to sauces and salads, while at the same time helping to improve your health. However, don't just pour it on already fatty foods. Olive oil can only help if you use it to replace other, less healthy oils.

To dress up a meal centered around legumes and whole grains, try a first course of butternut squash soup. Add a side dish of freshly steamed vegetables, drizzled with lemon juice and olive oil, or some steamed sweet potatoes spiced with cinnamon or minced ginger.

Sauté onions to accompany black beans topped with salsa and served with nutty brown rice. Stir-fry garlic, then add broccoli, carrots, onions and sweet red pepper; toss with whole-grain pasta and garnish with walnuts.

Try roasted red peppers stuffed with French lentils and quinoa. Add some chard, a true nutritional superstar, to your barley lentil stew. Top a cool spinach salad with toasted chickpeas. Your imagination is the only limit to the possible combinations.

Tired of flavorless sugar-free candy? Grab a sweet crisp apple, a handful of deep purple grapes, a slice of fresh pineapple or mango. Fresh fruit, which, along with delicious flavor, supplies fiber, flavonoids, vitamins and minerals, provides your taste buds with a welcome replacement for artificially sweetened desserts.

To top off your new, healthy foods diet - try some grilled or baked fish filets. Cold-water, wild-caught fish such as salmon or halibut is an excellent source of good quality protein as well as the right kind of fat - a perfect choice not just for persons with diabetes, but for everyone in the family. The aroma and taste of teriyaki grilled salmon or lemon-pepper baked halibut is elegant enough for any dinner party.

Use cinnamon to spice up your meals while helping to lower your blood sugar. Researchers from the US Agricultural Research Service have shown that less than half a teaspoon per day of cinnamon reduces blood sugar levels in persons with type 2 diabetes in Pakistan. Their study included 60 Pakistani volunteers with type 2 diabetes who were not taking insulin. Subjects were divided into six groups. For 40 days, groups 1, 2 and 3 were given 1, 3, or 6 grams per day of cinnamon while groups 4, 5 and 6 received placebo capsules. Even the lowest amount of cinnamon, 1 gram per day (approximately ¼ to ½ teaspoon), produced an approximately 20% drop in blood sugar; cholesterol and triglycerides were lowered as well. When daily cinnamon was stopped, blood sugar levels began to increase. (December 30, 2003)

One thing all the meals suggested here have in common is that they would qualify as part of a low glycemic index (GI) diet. A study published in the July 2003 issue of Diabetes Care has now demonstrated that a low GI diet, even one containing Mexican-style foods such as corn tortillas, can be used to improve blood sugar control in obese type 2 diabetic patients. Despite the fact that the same amount of carbohydrates were consumed on a Mexican-style diet with a lower glycemic index (GI), this diet resulted in a significant drop in hemoglobin A1c-glycosylated hemoglobin, a measure that reflects average blood sugar levels over the prior month. In this study, 36 obese subjects with type 2 diabetes ate a higher GI Mexican style diet for 6 weeks, then followed no dietary regimen for 6 weeks, and finally consumed a low GI Mexican style diet for the final 6 weeks. During the low-GI diet, the same amount of carbohydrates were consumed, such as corn tortillas and dairy products, but participants ate significantly fewer high GI-carbohydrates, such as white-wheat bread, white long-grain rice, potatoes, high-GI fruits, and carrots, and more lower GI carbohydrates, such as pinto beans, whole-meal wheat bread, and low-GI fruits. This study clearly indicates that not all carbohydrates cause problems with blood sugar control and weight gain-just the simple carbohydrates found in high GI foods, most all of which are foods that like white bread, have been highly refined.

If you would like a piece of bread, choose whole grain rye bread rather than bread made from wheat. A study published in the November 2003 issue of the American Journal of Clinical Nutrition found that bread made from wheat triggers a greater insulin response than rye bread does. Finnish researchers at the University of Kupio compared the effects of eating refined wheat bread with endosperm rye bread, traditional rye bread and high fiber rye bread on several markers of blood sugar control including plasma glucose, insulin, glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP1), and serum C-peptide in 19 healthy post-menopausal women. (GIP and GLP1 are incretin hormones secreted within the gastrointestinal tract during meals that boost the effects of insulin; c-peptide is a marker of insulin secretion) All of these markers were evaluated in blood samples taken both before and after the women ate each of the breads. Results showed that after the women had eaten any of the rye breads, their insulin, GIP and C-peptide responses were significantly lower than after they ate wheat bread. Among the different rye breads, however, no significant differences were seen in insulin and C-peptide response despite their varying levels of fiber. Researchers felt this lower after-meal insulin response could, therefore, not be attributed only to the fiber content of the rye breads, but was also due to the fact that the starch granules in rye bread form a less porous and mechanically firmer matrix than in wheat bread. This would translate into a much greater particle size being swallowed when rye bread is eaten compared to wheat, which would slow the rate at which the starch could be digested into sugar. (December 30, 2003)

Give your mouth a treat, your diet a boost, your blood sugar some much needed down-time, and your body exactly what it needs to be healthy and strong for a long time to come. Eat a diet full of healthy whole foods and see how much better you can feel. Remember that over the long run, placing unnatural restrictions on your diet is very unlikely to keep you healthy. Research has shown that very low-carb diets and low-fat diets may work in the first few months of a type 2 diabetes treatment protocol, but not over the long run. Over the long run, it is important to find a diet approach that is enjoyable and feels natural to you. And within this diet approach, you will most likely have to give yourself room in terms of fats and carbohydrates to enjoy the flavors and textures of whole, natural foods.

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