Alternative methods to control blood sugar (+Week 5)
The takeaway
Week 5 posed some challenges with birthday and Easter celebrations that involved lots of sweets and non-compliant foods, which highlight the need for mindfulness.
To help with blood sugar control, I am using a variety of natural approaches, including apple cider vinegar, inositol supplements, green tea, and cinnamon.
Read on for more details!
I finished the Whole 30 challenge portion of my Microbiome Diet adventures just in time for some momentous occasions: Izak’s birthday and Easter. This meant celebrating with special cupcakes and ice cream, homemade pizzas and an Easter dinner with family-recipe potato and macaroni salads and even more sweets. Since Phase 2 of the Microbiome Diet allows for 90% compliance, I decided to indulge a bit. Although it was all enjoyable, I unfortunately overdid it and subsequently experienced stomach cramps, bloating, dehydration, constipation and elevated blood sugar. It’s fun to treat myself, eat some different foods, and participate in celebrations, but I am learning that I need to exercise better portion control when indulging.
This week, I want to share a few natural approaches I’ve employed over the past few weeks to help with insulin resistance and blood sugar control to try to prevent gestational diabetes. In addition to a (generally) healthy diet and exercise, which are by far the two best ways to control blood sugar, I use apple cider vinegar, myo-inositol and D-chiro inositol, green tea and cinnamon. These foods and supplements can in no way offset or replace a poor diet and lack of exercise. But they may support an overall healthy approach to maintaining proper blood sugar levels. Below I describe the research supporting their use in blood sugar control and diabetes prevention/treatment.
Disclaimer: I am not qualified to prescribe any remedies to treat or prevent illness or conditions. While the foods and supplements I'm taking seem safe, they may interact with other medications or other conditions may make them unsuitable for you. I am happy to share what is in the literature, but please consult your doctor to determine if these are safe options for you.
Vinegar. Vinegar is a dilute form of acetic acid. Several studies have shown that consuming vinegar immediately before a meal, especially one that is high in carbohydrates, can reduce post-prandial (after meal) blood sugar levels [1,2]. Also, if taken before bedtime, vinegar can help reduce fasting blood sugar levels [1,2]. Both of these effects may be more pronounced in people with normal blood sugar than individuals with glucose intolerance or Type 2 diabetes [2]. The exact way vinegar effects blood sugar remains unknown, but several proposed mechanisms follow:
Decreases glucose production in the liver
Increases glucose uptake and utilization in skeletal muscle
Increases blood flow to tissues, which increases glucose uptake
Reduces lipids in blood, leading to improved insulin sensitivity
Slows gastric emptying and increases satiety
Stimulates insulin secretion or improves the action of insulin
Suppresses activity of enzymes that break down sugars, which means fewer sugars are metabolized
Taking 2 Tbs or 30 mL of vinegar (commercial vinegar is about 4-8% acidity) daily is generally regarded as safe [1]. I take about 1 Tbs Bragg’s Apple Cider Vinegar in a cup of warm water twice a day; always before breakfast and usually before bedtime, or sometimes before dinner. There are many claims of apple cider vinegar having various other potential health benefits of taking apple cider vinegar, but this is the only one I’ve actually researched and confirmed.
Myo-inositol and D-chiro inositol. Inositols are a group of compounds that function as messengers inside cells. Two variants of inositol, myo-inositol (MI) and D-chiro inositol (DCI) are important for metabolic regulation. MI is the most abundant and is found in a variety of foods, including fruits (especially oranges and cantaloupe), grains (especially oats and bran), beans, and nuts. DCI is less abundant and found primarily in buckwheat, soy lecithin, fig leaf melon, and legumes (lentils, chickpeas). (MI) was once considered part of the Vitamin B family (Vitamin B8), but was later found to be non-essential since human cells and gut bacteria synthesize it. (Side note: folic acid is also a B vitamin, called Vitamin B9).
MI and DCI can both help improve insulin sensitivity and regulate blood sugar levels [3,4]. I initially heard about myo-inositol it as a way to treat insulin resistance in women with poly-cystic ovary syndrome, and wondered if it would help prevent gestational diabetes. I read a few meta-analyses of several medium-sized trials including over 550 women. The results showed that both MI (4 g daily) and DCI (250 mg daily) are safe during pregnancy and can reduce the incidence of gestational diabetes in high risk pregnant women (high risk meaning overweight, obese, or having a parent with Type 2 diabetes) [5-7].
Inositols are secondary messengers in the insulin signaling pathway. MI activates glucose transporters and glucose utilization [3,8] and DCI regulates glycogen synthesis [3]. When insulin binds its receptor on the cell surface, two distinct inositol compounds that incorporate either MI or DCI are released into the cell. The inositol compounds activate enzymes that metabolize glucose [3,9]. Furthermore, the binding of insulin stimulates the release of inositol compounds, which can further activate insulin-sensitive cells. Both DCI-IPG and MI-IPG significantly reduce insulin resistance and promote proper glucose metabolism [3,10].
My midwife and I talked about it and I decided that the potential benefit outweighed any of the unknown, but unlikely, risks. The studies with MI used 2 grams twice daily (4000 mg total), so I’m doing that as well. The physiological ratio of MI to DCI is 40:1 [3] so I’m also taking 50 mg twice daily (100 g total). Both MI and DCI are heat stable, so I dissolve the slightly sweet-tasting powder in my morning coffee/tea and evening tea.
Green tea. Green tea contains a flavonoid compound called epigallocatechin-3-gallate (EGCG) that has a variety of potential health benefits. EGCG has anti-inflammatory and antioxidant effects. It is considered a mimic of insulin and can reduce the risk of metabolic disease, improve insulin sensitivity and lower blood sugar [11, 12]. Compounds in green tea may stimulate pancreatic β-cells to produce more insulin after meals [11] or protect pancreatic cells from damage [13]. Green tea compounds may also increase the uptake of glucose by skeletal muscle or prevent proliferation of fat cells [11]. Also, EGCG has been shown to inhibit glucose production in the kidney [14].
A meta-analysis of 1133 subjects showed that green tea extract can have decrease fasting blood sugar levels and hemoglobin A1C levels (which reflects a 3 month average of blood sugar levels) [12]. Although the results were statistically significant, they were rather modest and the effects appear to be inconsistent across many studies. Larger meta-analyses showed that consumption of at least 4 cups per day of green tea was associated with a 15% reduced risk of Type 2 diabetes 15,16]. and that higher levels of green tea consumption was associated with lower risk of diabetes [16].
Although I drink multiple cups of tea each day, I only really want one cup of green tea. So I may not get all of the benefits, but combined with everything else, hopefully there’s some benefit. Since I am limiting my caffeine consumption during pregnancy, I often choose decaf tea. However, standard decaffeinating processes also remove much of the beneficial EGCG. Many organic green teas are decaffeinated using only carbon dioxide, which is a gentler process and should preserve more of the EGCG. I aim for a cup each day.
Cinnamon. Cinnamon, made from the inner bark of the Cinnamomum tree, is recognized as a mimic of insulin and can help lower blood sugar levels. A meta-analysis evaluated 10 small studies involving 464 Type 2 diabetic individuals who took between 120 mg and 6 g (1.7 g on average) of cinnamon daily for 4-18 weeks. The results showed statistically significant and fairly substantial reductions in fasting blood sugar (-24 mg/dL on average) [17]. However, the effect appeared to be short-lived as no significant effect in hemoglobin A1C was observed [17,18]. Thus, it can be used in conjunction with hyperglycemia medications and diet and lifestyle changes to manage insulin resistance or Type 2 diabetes.
I use normal amounts of cinnamon on granola, chia seed pudding, and fruit and in tea or coffee. I don’t typically measure, but I’d estimate I use ⅛-¼ tsp each time. Each teaspoon of powder contains about 2.6 g of cinnamon; said another way there is about 1 g of cinnamon in every 0.38 tsp of powder (check out this quantity converter. So 1.7 g (the average quantity of the above-mentioned studies) would be about 2/3 tsp cinnamon.
A concern of using more is the relatively high amount of coumarin in Cassia cinnamon (from the tree Cinnamomum cassia). Coumarin is a blood thinning agent that can damage the liver and cause cancer [19]. A study by the German Federal Institute for Risk Assessment measured levels between 0.09 – 12.2 mg/g coumarin in cassia cinnamon, but most of the samples contained 2-4 mg/g [20]. The European Food Safety Authority states that the tolerable daily limit for coumarin is 0.1 mg/kg (0.045 mg/lb) of body weight [19]. So for me, this means limiting cinnamon to ½-1 tsp each day which seems fairly reasonable.
For most people, using normal amounts of cinnamon probably poses no threat. But I want to be extra cautious while pregnant. An alternative would be to use Ceylon cinnamon (from the tree C. verum) which has much lower levels of coumarin. It also tends to be slightly more expensive. Almost all cinnamon sold in supermarkets is the Cassia variety.
Do you use any of these supplements to control blood sugar or support your health? I’d love to hear about your experiences with these or any others!
References
Petsiou, E.I., et al., Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight. Nutr Rev, 2014. 72(10): p. 651-61.
Lim, J., C.J. Henry, and S. Haldar, Vinegar as a functional ingredient to improve postprandial glycemic control-human intervention findings and molecular mechanisms. Mol Nutr Food Res, 2016. 60(8): p. 1837-49.
Monastra, G., et al., Combining treatment with myo-inositol and D-chiro-inositol (40:1) is effective in restoring ovary function and metabolic balance in PCOS patients. Gynecol Endocrinol, 2017. 33(1): p. 1-9.
Croze, M.L. and C.O. Soulage, Potential role and therapeutic interests of myo-inositol in metabolic diseases. Biochimie, 2013. 95(10): p. 1811-27.
Crawford, T.J., et al., Antenatal dietary supplementation with myo-inositol in women during pregnancy for preventing gestational diabetes. Cochrane Database Syst Rev, 2015(12): p. CD011507.
Guo, X., et al., Myo-inositol lowers the risk of developing gestational diabetic mellitus in pregnancies: A systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. J Diabetes Complications, 2018. 32(3): p. 342-348.
Dell'Edera, D., et al., The influence of D-chiro-inositol and D-myo-inositol in pregnant women with glucose intolerance. Biomed Rep, 2017. 7(2): p. 169-172.
Sun, T.H., et al., Both myo-inositol to chiro-inositol epimerase activities and chiro-inositol to myo-inositol ratios are decreased in tissues of GK type 2 diabetic rats compared to Wistar controls. Biochem Biophys Res Commun, 2002. 293(3): p. 1092-8.
Larner, J., D-chiro-inositol--its functional role in insulin action and its deficit in insulin resistance. Int J Exp Diabetes Res, 2002. 3(1): p. 47-60.
Ortmeyer, H.K., Dietary myoinositol results in lower urine glucose and in lower postprandial plasma glucose in obese insulin resistant rhesus monkeys. Obes Res, 1996. 4(6): p. 569-75.
Ferreira, M.A., et al., Therapeutic potential of green tea on risk factors for type 2 diabetes in obese adults - a review. Obes Rev, 2016. 17(12): p. 1316-1328.
Gu, W.J., et al., The effects of probiotics in early enteral nutrition on the outcomes of trauma: a meta-analysis of randomized controlled trials. JPEN J Parenter Enteral Nutr, 2013. 37(3): p. 310-7.
Huxley, R., et al., Coffee, decaffeinated coffee, and tea consumption in relation to incident type 2 diabetes mellitus: a systematic review with meta-analysis. Arch Intern Med, 2009. 169(22): p. 2053-63.
Waltner-Law, M.E., et al., Epigallocatechin gallate, a constituent of green tea, represses hepatic glucose production. J Biol Chem, 2002. 277(38): p. 34933-40.
Jing, Y., et al., Tea consumption and risk of type 2 diabetes: a meta-analysis of cohort studies. J Gen Intern Med, 2009. 24(5): p. 557-62.
Yang, W.S., et al., Tea consumption and risk of type 2 diabetes: a dose-response meta-analysis of cohort studies. Br J Nutr, 2014. 111(8): p. 1329-39.
Allen, R.W., et al., Cinnamon use in type 2 diabetes: an updated systematic review and meta-analysis. Ann Fam Med, 2013. 11(5): p. 452-9.
Costello, R.B., et al., Do Cinnamon Supplements Have a Role in Glycemic Control in Type 2 Diabetes? A Narrative Review. J Acad Nutr Diet, 2016. 116(11): p. 1794-1802.
Abraham, K., et al., Toxicology and risk assessment of coumarin: focus on human data. Mol Nutr Food Res, 2010. 54(2): p. 228-39.
Assessment), B.F.I.f.R., Consumers, who eat a lot of cinnamon, currently have n overly high exposure to coumarin. BfR Health Assessment, 2006. No. 043.
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