Diabetes Prevention and Management
Multi-micronutrients, Diet, and Lifestyle Recommendations
In spite of current preventive recommendations, the incidence of diabetes is increasing throughout the world including in the United States. This increase implies that the proposed recommendations--primarily changes in diet and lifestyle--are not having optimal results. If there are no significant changes in the current preventive recommendations, it is estimated that by 2034 the number of individuals in the United States with diagnosed and undiagnosed diabetes will increase from about 23.7 million to 44.1 million. During this period, about 65 percent of the population is expected to remain overweight or obese. The annual medical cost of this disease is expected to rise from 113 billion to 336 billion dollars, a threefold increase during the same time period. The projected increase in this disease and its related cost makes it imperative that we develop an additional strategy for prevention. This chapter describes a novel prevention strategy using micronutrients that would complement the current recommendations.
TYPES OF PREVENTION STRATEGIES
Prevention strategies can be divided into two groups: primary prevention and secondary prevention. Primary prevention strategies include ways to avoid exposure to agents that can induce one or more risk factors for developing diabetes. The purpose of primary prevention is to protect non-diabetic individuals or pre-diabetic individuals from actual onset of diabetes.
Secondary prevention focuses on stopping or slowing diabetes progression in high-risk populations. Secondary prevention strategies may involve insulin (in the case of type 1 diabetes) and micronutrients together with changes in diet and lifestyle.
RECOMMENDATIONS FOR PRIMARY PREVENTION
Changes in Diet and Lifestyle
Primary prevention strategies for both type 1 diabetes and type 2 diabetes should be adopted from childhood. Pregnant women who have a family history of type 1 diabetes should also adopt primary prevention strategies. Diet and lifestyle changes are very important in primary prevention. Fat-rich and calorie-rich diets and physical inactivity contribute to obesity and insulin resistance, which are considered major risk factors in the development of diabetes. Increased levels of oxidative stress and chronic inflammation are found in obese individuals and individuals with insulin resistance.
To reduce obesity, oxidative stress, and chronic inflammation, I recommend daily consumption of a low-fat and high-fiber diet with plenty of fruits (especially grapes and berries) and leafy vegetables. It is also recommended to avoid excessive intake of carbohydrates and proteins. Whenever oil is used for cooking, virgin olive oil is preferred because it is rich in alpha-linolenic acid (ALA), which has been shown to have beneficial effects in patients with diabetes. For non-vegetarians, fish (especially salmon) twice a week and chicken is recommended. For vegetarians, I recommend an increased intake of lima beans and soy or soy products. Certain spices and herbs--such as turmeric, cinnamon, garlic, and ginger--can be added to vegetables or meat. These spices and herbs have antioxidant and anti-inflammation properties.
Changes in lifestyle recommendations include maintaining normal weight, reducing obesity, increasing physical activity, stopping tobacco smoking, reducing stress, and exercising moderately four to five times a week. Moderate exercise includes walking twenty to twenty-five minutes per day at least five days per week or using a treadmill and weight lifting for thirty minutes three to four times a week. The level of exercise depends upon the age and condition of the individual.
These changes appear to be easy to implement, but in reality, they are difficult to follow consistently. This is due to the fact that human behavior and habits are difficult to change. This is supported by the phenomenon that despite extensive education programs about maintaining normal weight, the number of overweight and obese individuals is increasing in the United States.
An appropriate preparation of multiple micronutrients is equally important for primary prevention and complements the effect of changes in diet and lifestyle in reducing the risk of diabetes. Micronutrients include dietary antioxidants (vitamin A, beta-carotene, vitamin C, vitamin E, and selenium) and endogenous antioxidants (alpha-lipoic acid, glutathione-elevating agent n-acetylcysteine, coenzyme Q10, and L-carnitine), B vitamins, vitamin D, chromium, and appropriate minerals. The doses of each of these ingredients in a micronutrient formulation would differ depending upon the age of the individual. Micronutrient formulations for various age groups are presented in tables 8.1 to 8.4. These formulations, now referred to as BioArmor, have been patented by the Premier Micronutrient Corporation and are currently marketed to consumers.
These formulations have unique properties that are not found in other multi-vitamin preparations currently sold. For example, the micronutrient formulations have no iron, copper, manganese, or heavy metals (vanadium, zirconium, and molybdenum). Iron and copper are not added because they are known to interact with vitamin C and generate excessive amounts of free radicals. In addition, prolonged consumption of these trace minerals in the presence of antioxidants may increase the free iron or copper stores in the body, because there is no way for men to excrete iron, nor for women after menopause. Increased stores of free iron may increase the risk of some human chronic diseases including heart disease. Heavy metals are not added because prolonged consumption may increase their levels in the body, and because there is no significant mechanism for excretion of these metals from the body. High levels of these metals are considered neurotoxic.
TABLE 8.1 FORMULATION FOR CHILDREN 5-10 YEARS OF AGE WITHOUT A DIABETES RISK FACTOR
Micronutrient / Amount
Vitamin A (palmitate) / 1,500 IU
Natural mixed carotenoids / 5 mg
Vitamin C (as calcium ascorbate) / 100 mg
Vitamin D3 (cholecalciferol) / 400 IU
Vitamin E (two forms: d-alpha-tocopheryl acetate and d-alpha tocopheryl acid succinate, 25 IU each) / 50 IU
Vitamin B1 (Thiamine mononitrate) / 2 mg
Vitamin B2 (Riboflavin) / 2 mg
Niacin (as Niacinamide ascorbate) / 10 mg
Vitamin B6 ( Pyridoxine HCl) / 2 mg
Folate (Folic acid) / 400 mcg
Vitamin B12 (as cyanocobalamin) / 5 mcg
Biotin / 100 mcg
Pantothenic acid (as d-calcium pantothenate) / 5 mg
Calcium citrate / 100 mg
Magnesium citrate / 50 mg
Zinc glycinate / 7.5 mg
Selenium (l-selenomethionine) / 50 mcg
Chromium (as chromium picolinate) / 25 mcg