Patients with diabetes: Nutrition and lifestyle interventions for better glucose control

Many of your patients come to you for reasons related directly to physical health conditions, including pulled muscles, slipped discs, a strained back or misaligned hips. But did you know a number of those same patients also have high blood sugar or diabetes? 

The U.S. Centers for Disease Control and Prevention (CDC) reports more than 38 million Americans have diabetes and about 97 million Americans have prediabetes, which is high blood sugar but not quite full-blown diabetes.¹ The number of those diagnosed with diabetes has more than doubled in the past 20 years, and almost half of the individuals with prediabetes are age 65 or older, and very likely facing other health issues.¹ 

Granted, these are not uplifting statistics, but there is reason for hope. To begin with, the relatively recent rise in type 2 diabetes shows it is not inevitable.  

The very fact that type 2 diabetes was once rare shows diabetes is indeed an option based on lifestyle, nutrient intake, diet and a host of other factors. It means we as practitioners have a choice as to whether it continues unabated or becomes an unpleasant memory. And recommending the right nutrients as part of a way of realigning the body and mind’s relationship with sugar can help make diabetes a thing of the past. But first, let’s better understand the problem. 

Diabetes is a disease of cellular starvation

While health practitioners understand diabetes’ mechanisms, the people we treat may not. Putting the biomechanics of it into simpler terms can help define it more succinctly and simply for our patients. 

The sugar connection to diabetes isn’t necessarily a bug, but a feature. Our bodies use sugar as  fuel for our cells’ energy furnaces, and for most of human history, we have had a high-fiber and high-protein diet. As a result, whatever carbohydrates and sugars we managed to consume were released very slowly and steadily into the bloodstream over many hours. 

These days, by contrast, an average diet includes almost 140 pounds of sugar per person, per year. That’s 18% of our overall calories, and not surprisingly, it causes massive spikes in blood sugar. This forces our bodies to prevent this sugar from entering the cells too quickly – a phenomenon best known as insulin resistance. 

Insulin is an important key that opens our cell furnaces so sugar can get in to be burned for energy. But when the body’s cells become deaf to the insulin and the cells do not allow the sugar transported by the insulin into the cell, the sugar builds up in the bloodstream instead. Since the sugar can’t get into the cell to be burned for fuel, the cells are, as unlikely as it seems, starving. 

As a result, cells send out the message they are energy-starved, causing the body to crave more sugar and make more insulin. These high insulin levels then proceed to turn the sugar into fat, causing people to pack on extra pounds (the often-prevalent “spare tire” around the midsection) and become even more insulin-resistant. The cycle continues until the body can no longer compensate and blood sugar levels rise further. It’s a nasty spiral creating havoc with metabolism and cause a lot of damage to nerves and blood vessels over time. 

Fortunately, we can help break this cycle. Recommend your patients start with their diets first. 

Wholesome foods make a difference

Replacing refined carbs and sugars with fats and proteins is an excellent first step. Initially, they may think it is counterintuitive to add fats if they’ve been concerned about extra pounds contributing to elevated blood sugar levels. But the interesting thing is the opposite seems to hold true. Because a diet higher in fat and protein isn’t adding to the burden of sugar in the bloodstream, it forces the body to use its energy source wisely and more efficiently. 

A few examples of the best foods to recommend include:  

• Eggs – preferably from a cage-free, cruelty-free source. They provide a rich source of protein, carotenoids and other nutrients. 
• Unprocessed beef, lamb, chicken, turkey and duck – avoid meats with nitrates. 
• Cold-water fish, including trout, salmon, cod or tuna, provide essential omega-3s and excellent protein. 
• Vegetables, including broccoli, cabbage, leafy green mixes, spinach, cauliflower, carrots, celery, peppers, cucumbers, sweet potatoes or beets. 
• Natural, non-hydrolyzed fats like butter, coconut oil, olive oil and avocado. 
• Nuts, including almonds, walnuts, macadamias, pecans and sunflower seeds. 

Recommending a sensible exercise regimen is a necessary second step. Suggest patients carve out time for a walk, bike ride or just working in the garden to help them keep weight and blood sugar levels in line and clear their minds. Exercising outside is best, as vitamin D, formed naturally when we spend time in sunlight, is also associated with lowered diabetes risk. 

Effective nutrient interventions

Along with these lifestyle changes, one of the best botanicals for anyone with elevated blood sugar or diabetes is Hintonia latiflora. 

Hintonia grows in the Sonoran Desert in Mexico in a very harsh climate, which actually helps create the powerful defensive compounds in the plant that help reduce high blood sugar. It is so well-regarded that hintonia has been clinically studied in Europe for more than 60 years and approved for use in people with type 2 diabetes. From the beginning, research showed the botanical could help people reduce their medications or avoid the need for prescription medications completely.² 

More recently, a clinical study published in the German journal Naturopathic Practice with Natural Medicine, the same dry concentrated bark extract of hintonia, combined with additional nutrients (biotin and vitamins B1, B6, B12, folate, chromium, zinc and vitamins C and E) significantly lowered hemoglobin A1C test values, fasting glucose levels and postprandial blood sugar levels. Factoring in all of the diabetic symptoms, the scores improved from 4.8 points to 1.3 points at the end of the eight-month study. 

Clinical results show

Hintonia latiflora combined with key nutrients for blood sugar control can: 

• Lower A1C levels by 10% 
• Improve fasting blood sugar by 23% 
• Balance total cholesterol and reduce triglyceride levels 
• Prevent reactive hypoglycemia — undesirable drops in blood sugar after eating 
• Reduce or eliminate the need for medication in nearly half of patients 

The details are impressive. A1C levels improved by an average of 10.4%. Participants’ fasting glucose was lowered by an average of 23.3%, and postprandial glucose by an average of 24.9%. They also saw positive changes in blood pressure, lipids and liver values.³ 

Fasting blood sugar levels greatly improved during study

Improvement in symptoms associated with diabetes

Those already taking anti-diabetic prescription drugs stayed on their medication throughout the duration of the study — the hintonia and nutrient combination was simply added on. By the end of the study, of those still using medication, 39% could reduce their medication levels. Some were able to stop taking their prescription drugs entirely.³ 

In another clinical study, adult participants with type 2 diabetes were provided with the same hintonia and trace nutrient combination for six months. Once again, it significantly reduced fasting and postprandial blood glucose numbers and A1C levels, in addition to normalizing cholesterol and triglyceride levels.⁴ 

The reason hintonia works is related to a compound in the bark, coutareagenin, which inhibits alpha glucosidase, an enzyme that releases sugar from carbohydrates.⁵ Overall, it’s an excellent choice for patients struggling with high blood sugar or diabetes and can be used with existing medications. 

In addition to hintonia, bioactive B vitamins plus magnesium can help reset the body’s glucose tolerance and to protect blood vessels and nerves throughout the body to prevent or reverse symptoms of neuropathy. There’s a good chance many of your patients may be deficient in these nutrients — if so, it puts them at greater risk of diabetes, so adding them to a daily regimen may be imperative. 

For instance, a study published in the journal Clinical Nutrition examined patients with hyperglycemia; 14 of 34 patients were found to be deficient in vitamin B6. Fortunately, those in the group who were given pyridoxal-5-phosphate (P-5-P), the active form of vitamin B6, showed reduced blood glucose levels after only seven days.⁶  

But of all the B vitamins, B12 is the one your patients over 60 years of age are most likely to be deficient in.⁷ 

This may be due to lack of intrinsic factor, a protein that helps absorb vitamin B12 in the intestines. Also, long-term use of the diabetes medicine metformin (a good medication) routinely causes B12 deficiency over time. Plus, common cyanocobalamin forms of B12 require conversion by the liver and some people are simply poor converters. However, recommending supplemental methylcobalamin, the active form of vitamin B12, is one way of overcoming that issue. 

Research published in the journal Reviews in Neurological Diseases evaluated a combination of L-methylfolate (the active form of folate versus folic acid), methylcobalamin and P-5-P in patients with diabetes. The nutrients improved epidermal nerve fiber density (ENFD) in 73% of the treated participants in just six months. Additionally, 82% reported reduced frequency and intensity of the “pins and needles” feeling or of the painful sensation (or lack of sensation) brought about by simple touch and contact.⁸ 

Berberine improves blood sugar too

Berberine is very powerful at restoring insulin sensitivity. Because of this, it not only brings down blood sugar in patients with diabetes, but also helps treat cholesterol and reduce high blood pressure, conditions associated with metabolic syndrome.  

In one clinical study, berberine lowered fasting and postprandial glucose from the beginning of the trial to the end of the three-month study. It lowered A1C levels from 8.1% to 7.3% and reduced fasting plasma insulin by 28% and the insulin resistance index by 44%. Not surprisingly, given how all of these conditions are related, triglyceride levels dropped as well. The results were similar to the group treated with metformin, a commonly used drug for type 2 diabetes that can cause side effects.⁹ 

One of the ways berberine can help reduce overall blood sugar levels is by stimulating glycolysis — the process of releasing the energy from sugars. These sugars being used up by the mitochondria as fuel is far better than overloading the bloodstream or being converted into triglycerides. Some research also shows berberine may inhibit alpha glucosidase — much like hintonia.⁹ 

Plus, research indicates berberine inhibits glucose absorption in the first place, so it works in multiple ways to bring blood sugar under control.¹⁰ 

The only downside to berberine is that it can be difficult to absorb, and that has made the standard effective dosing generally recommended at 500mg three times daily. However, this can cause stomach upset. Fortunately, combining berberine with absorption-enhancing gamma cyclodextrin may help overcome that problem and even allow smaller doses of 250 mg twice daily. I routinely recommend hintonia, bioavailable vitamins and minerals, and readily absorbed berberine for my patients with type 2 diabetes. 

Final thoughts

If you have patients who struggle with prediabetic blood sugar levels or have type 2 diabetes and want to control their glucose levels with lifestyle and nutrition interventions first, you can help. A combination of a sensible diet with exercise, along with clinically validated supplements, can help break the sugar spiral and set them on a path to optimal health. 

JACOB TEITELBAUM, MD, is one of the most frequently quoted integrative, energy, pain and fibromyalgia medical authorities in the world. He is the author of 10 books, including the best-selling From Fatigued to Fantastic! (Penguin/Avery 2021) and the popular free Smartphone app Cures A-Z. He is the lead author of eight studies on effective treatment for fibromyalgia and chronic fatigue syndrome. Teitelbaum appears often as a guest on news and talk shows nationwide, including Good Morning America, The Dr. Oz Show, Oprah and Friends, CNN and FoxNewsHealth. Learn more at vitality101.com. 

References

1. National Diabetes Statistics Report. U.S. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/diabetes/data/statistics-report/index.html. Accessed Jan. 28, 2024. 
2. Kuhr R. Oral Diabetes Therapy with an Euphorbiacean Extract. Der Landarzt.1953;29(23):1-8. 
3. Schmidt M, Hladikova M. Hintonia concentrate – for the dietary treatment of increased blood sugar values: Results of a multicentric, prospective, non-interventional study with a defined dry concentrate of hintonia latiflora. Naturheilpraxis. Feb. 2014. [Translated article]. Semantic Scholar. https://api.semanticscholar.org/CorpusID:236880590. Accessed Jan. 28, 2024. 
4. Korecova M, Hladikova M. Treatment of mild and moderate type-2 diabetes: open prospective trial with Hintonia latiflora extract. Eur J Med Res. 2014;19:16. PubMed. https://pubmed.ncbi.nlm.nih.gov/24678614/. Accessed Jan. 28, 2024. 
5. Mata R, et al. Mexican antidiabetic herbs: valuable sources of inhibitors of α-glucosidases. J Nat Prod. 2013;76(3):468-483. PubMed. https://pubmed.ncbi.nlm.nih.gov/23398496/. Accessed Jan. 28, 2024. 
6. Hou CT, et al. Higher plasma pyridoxal 5′-phosphate is associated with better blood glucose responses in critically ill surgical patients with inadequate vitamin B-6 status. Clin Nutr. 2011;30(4):478-483. PubMed. https://pubmed.ncbi.nlm.nih.gov/21349613/. Accessed Jan. 28, 2024. 
7. Baik HW, Russell RM. Vitamin B12 deficiency in the elderly. Annu Rev Nutr. 1999;19:357-377. PubMed. https://pubmed.ncbi.nlm.nih.gov/10448529/. Accessed Jan. 28, 2024. ]
8. Jacobs AM, Cheng D. Management of diabetic small-fiber neuropathy with combination L-methylfolate, methylcobalamin, and pyridoxal 5-phosphate. Rev Neurol Dis. 2011;8(1-2):39-47. PubMed. https://pubmed.ncbi.nlm.nih.gov/21769070/. Accessed Jan. 28, 2024. 
9. Yin J, et al. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism. 2008;57(5):712–717. PubMed. https://pubmed.ncbi.nlm.nih.gov/18442638/. Accessed Jan. 28, 2024. 
10. Pan GY, et al. The antihyperglycaemic activity of berberine arises from a decrease of glucose absorption. Planta Med. 2003;69(7):632-636. PubMed. https://pubmed.ncbi.nlm.nih.gov/12898419/. Accessed Jan. 28, 2024.