‘PORTFOLIO’ OF REVERSING PREDIABETES
- Yan Yan
- Feb 13, 2024
- 19 min read
Updated: Nov 20, 2024
The journey to reverse prediabetes and prevent its progression into type 2 diabetes (T2D) resembles scaling a mountain peak-it demands both courage and persistent effort to reach the summit. Success lies in seizing the pivotal reversal window, typically within the first 6 years of prediabetes diagnosis or during the youthful phase, and embracing a healthy lifestyle. Encouraging ourselves from within, and supported by our 'portfolio' for prediabetes reversal, we are propelled to the pinnacle of triumph.
Every cloud has a silver lining.
Early intervention in prediabetes, particularly within the initial 6 years, significantly reduces the risk of progression to diabetes and associated complications compared to those who did not receive early intervention [1-3]. This includes a notable 4-year delay in diabetes onset, a significant 26% decrease in macrovascular lesions (cardiovascular disease and cerebrovascular issues), a remarkable 60% decrease in microvascular issues (retinopathy, nephropathy, and amputations), and a substantial 33% reduction in cardiovascular disease-related deaths. These findings underscore the critical importance of timely intervention within the first 6 years for prediabetics to prevent progression to diabetes and associated complications.
The World Health Organization (WHO) emphasizes that 60% of an individual's life quality is influenced by behavior and lifestyle [4]. This reminds us of the crucial role of healthy behaviors in preventing chronic diseases like prediabetes.
*Participating in the curriculum of CDC’s National Diabetes Prevention Program can provide valuable guidance and support in adopting a healthier lifestyle: Link to CDC’s National Diabetes Prevention Program:
Are you looking to manage prediabetes or prevent its progression to diabetes? Start by consulting the 'Dietary Guidelines for Americans, 2020-2025' (www.dietaryguidelines.gov) and ADA's guidance on 'DIABETES & FOOD Understanding Carbs' (https://diabetes.org/food-nutrition/understanding-carbs). You can also explore free resources at WWW.ENDOTEXT.ORG on 'Nutritional Recommendations for Individuals with Diabetes' (https://www.ncbi.nlm.nih.gov/books/NBK279012/).
For personalized nutrition advice, consider consulting a registered dietitian or your medical doctor. Below, we offer a basic overview of nutritional balance and carbohydrate choices. Keep in mind that individual dietary needs may vary, and personalized recommendations ensure your plan aligns with your health goals.
1. The main principles for diets include:
*Choose nutrient-dense, high-fiber foods.
Allocate 85% of daily calories to nutrient-dense foods based on food group recommendations, reserving the remaining 15% for added sugars and saturated fats (Figure 1) [5]. Prioritize complex carbohydrates like whole grains, quinoa, oats, and beans, while limiting refined grains, sugary treats, and beverages. Also, avoid excess saturated fats, sugar, and sodium.
*Opt for vegetable oil rich in Omega-3, Omega-6, and Omega-9 as alternatives to fats high in saturated fats [5-10].
These fatty acids, primarily derived from fish, vegetable oils, plants, and seeds, are unsaturated and offer various health benefits. Omega-3 and Omega-9 fatty acids provide anti-inflammatory benefits, which are beneficial for conditions like obesity and T2D. Additionally, Omega-6 fatty acids may help reduce the risk of heart disease and stroke. To improve the omega-3 to omega-6 ratio, focus on increasing omega-3 intake rather than reducing omega-6s. You can incorporate supplements like flaxseed oil, fish oil (EPA and DHA), and olive oil into your diet. Alternatively, consider replacing some oils with nuts, seeds (ALA), or avocado. Be mindful of trans fats found in margarines, shortening, and fried foods.
Dr. Yan et al. discovered that pecans induce differentiation in human bone marrow-derived stem cells (Figure 2) [11], suggesting the significance of further investigating their potential to enhance human pancreatic stem cell differentiation into β cells and their function. Moreover pecans and their polyphenols exhibit preventive effects on obesity, hepatic steatosis, and diabetes in mice [12]. Nut consumption, including pecans, is associated with potential prevention and management of T2D [13]. Therefore, incorporating Omega-3-rich pecans into your diet may contribute to reducing pancreatic inflammation and fostering β cell growth based on research findings.
Figure 2. Pecan (096-P) induces differentiation of human bone marrow derived mesenchymal stem cells (BM-MSC) into chondrocytes and expression of glycosaminoglycan (GAG) in vitro.
(a, b) Safranin O staining of human BM-MSC after being treated separately with Basal medium (Control), Differentiation Tool medium (Diff Tool) and Differentiation Tool medium added with pecans (096-P) (Diff Tool+096-P) for 1 and 3 weeks. Safranin is used as an indicator of cell chondrogenesis which binds to glycosaminoglycan and shows an orange-red color. The strong-red stained areas (white arrows) under microscopy were identified in the group with 096-P which showed high efficiency of chondrogenic differentiation for human BM-MSC. Scale bars, 1mm(n=3). (c, d) The corresponding quantitative analysis was performed by counting the number of Safranin O-positive cells in each red cluster under the field of view. All data presented as the S.D. from the mean values. *P< 0.05, (Student’s t-test). (e) Under electron micrographs, rounded cells, typical pattern of chondrocytes, were observed in 096-P group. Scale bars of 10x and 40x: 150 μm and 350 μm, respectively. On induction to chondrocytic lineage, the cells hypertrophy assumes the round or cuboidal shapes typical of chondrocytes.
*Choose high-quality proteins. Choose high-quality proteins such as eggs, salmon, shrimp, beef, milk, and tofu, while relatively lowering consumption of red and processed meats. Ensure you meet recommendations for specific protein subgroups like seafood, nuts, seeds, beans, peas, lentils, and soy products [5]. Aim for at least two servings of fish per week. If cholesterol levels and low-density lipoprotein(LDL) are high, limit egg intake to 4-5 eggs weekly [14].
*Ensure sufficient dietary fiber intake from vegetables, beans, and fruits.
Fruits and vegetables are rich in fiber, flavonoids, and antioxidants, which reduce the risk of T2D and supports heart health [15,16]. Aim for a daily intake of 25 to 30 grams of fiber [16]. The WHO recommends consuming 400 grams of combined fruits and vegetables daily to prevent chronic diseases [17]. Include vegetables and fruits such as apples, berries, oranges, etc., in your daily diet. For T2D prevention, it has been recommended to consume approximately 200 grams of fruit per day [18]. Be cautious with sweetened fruit juices, as they may potentially increase the risk of T2D [18].
*Balance your gut microbiota. Balance your gut microbiota by incorporating vegetable foods, probiotics, inulin, and fermentable foods into your diet. These may include sugar-free yogurt, kefir, sauerkraut, Chinese fermented bean curd [19], Japanese natto [20], and more. Please refer to Tip 6 for factors associated with variations in the gut microbiome.
*Please refer to Figure 3, the Nutrition PlaceMat for Diabetes [21].
2. Starchy vegetables: Dietary carbohydrates are primarily found in foods like bread, cereals, noodles, and starchy vegetables. Notably, some vegetables, such as potatoes, can contribute around 15 grams of carbohydrates per 70–90 grams. For accurate carbohydrate estimation, prediabetics should distinguish between non-starchy and starchy vegetables, considering the glycemic index (GI) and its impact on blood glucose levels [22].
Here are some common examples for starchy vegetables: •Beans (kidney, navy, pinto, black, peas , cannellini) •Butternut squash
•Sweet potatoes •Chickpeas
•Yams
•Potatoes •Corn
•Lentils
•Taro
3. Low, Medium and High Carbohydrate Diets:
Carbohydrates are naturally present in various foods. The Institute of Medicine and the Dietary Guidelines for Americans recommend that 45% to 65% of daily calories come from carbohydrates [5,23]. Diets are categorized by the percentage of energy obtained from carbohydrates [24]:
Low-carbohydrate (< 26% carbohydrates).
Moderate-carbohydrate (26% to 44%).
High-carbohydrate (45% or greater).
For a 2,000-calorie diet with 45% to 65% from carbohydrate, this suggests consuming 225 to 325 grams. However, this is a general recommendation for healthy adults. Those with prediabetes may wonder, 'How many carbohydrates should I eat?'
4. Choose Your Carbohydrates Wisely.
Low-carbohydrate diets (LCDs) and very-low-carbohydrate ketogenic diets (VLCKDs) show promise in managing diabetes and obesity, potentially leading to weight loss and reduced medication reliance, according to an ADA website review. However, long-term effects require further research [25].
Currently, the ADA refrains from providing specific carbohydrate recommendations for prediabetes and diabetes, emphasizing personalized approaches. Consulting professionals (RDN/RD or CDCES) and receiving support through Diabetes self-management education (DSME) are crucial for tailored guidance, considering factors like body size and activity level. Consistent monitoring of carbohydrate intake and blood sugar levels is also essential [26].
The following examples illustrate the application of low-carbohydrate and moderate-carbohydrate approaches:
*Low-carbohydrate diets are typically employed for weight loss, with potential health benefits extending to reducing the risk of T2D and metabolic syndrome [27]. However, it may also lead to decreased metabolism and energy levels [28].
*Moderate-carbohydrate diets (26-44% carbohydrates) are suitable for weight maintenance, muscle growth through exercise, and effective blood sugar control, especially for those with diabetes engaged in regular resistance training [28].
5. How to Calculate Daily Carbohydrate Intake in Grams from Total Daily Calories [29]?
To calculate your daily carbohydrate intake at 25%, use the following formula: multiply your caloric goal by 0.25 and then divide by four (since one gram of carbohydrates contains four calories).
For instance, if your daily caloric target is 1,500 calories:
1,500 x 0.25 = 375; 375÷4 = 93.75
Therefore, your recommended daily carbohydrate intake would be 93.75 grams.
Skeletal muscles, constituting 80% of postprandial glucose uptake, play a crucial role in glucose homeostasis alongside pancreatic β cells. Skeletal muscle insulin resistance is a key factor in T2D[30]. Both prediabetes and T2D are associated with a higher risk of appendicular skeletal muscle mass loss and sarcopenia [31,32], suggesting that these factors contribute to the disease onset.
During exercise, skeletal muscles act as an endocrine organ, releasing myokines that positively impact islet β cell function, enhance insulin sensitivity, improve glucose oxidation, and increase muscle mass (Figure 4)[33,34]. Regular exercise can alleviate the workload on pancreatic β cells, potentially reversing prediabetes with consistent, long-term adherence.
Figure 4. Myokine-mediated systemic regulation. Skeletal muscle-secreted myokines are involved in cross-talk with other internal organs to regulate cognitive function, stimulate osteoblast differentiation, enhance islet β-cell function, promote insulin secretion, regulate mitochondrial function, increase lipolysis and promote glucose oxidation. Through their role in organ cross-talk and systemic regulation of energy metabolism, myokines hold substantial promise for reducing inflammation and reducing the risk of insulin resistance and type 2 diabetes. This figure was created with Biorender.com.
ADA recommends 150 minutes of moderate-intensity exercise weekly for diabetes management [35]. Notably, research on older adults with prediabetes revealed that engaging in a 15-minute session of moderate postmeal walking after each meal can significantly enhance 24-hour glycemic control [36].
Consider these exercise recommendations: Consult your doctor for personalized guidance and tailor your plan for blood sugar control. Diversify your exercises, for example, incorporating racquet sports, which are associated with a 59% lower heart disease risk and a 47% decrease in overall mortality [37].According to a study reported in JAMA [38], walking 8,000 steps per day was linked to significantly lower all-cause mortality compared to 4,000 steps per day (Mortality: 7.1 vs. 14.4 per 1000 adults per year; Hazard Ratio: 0.49), as was walking 12,000 steps per day (Mortality: 5.1 vs. 14.4 per 1000 adults per year; Hazard Ratio: 0.35)(Figure 5). However, there was no significant association found between step intensity and mortality. Additionally, gradually increase exercise duration while monitoring blood glucose levels regularly.
Figure 5. Steps per Day and All-Cause Mortality in a Study of the Association of Daily Step Count and Step
Intensity With Mortality Among US Adults Aged at Least 40 Years
Mortality rates were adjusted for age; diet quality; sex; race/ethnicity; body mass index; education; alcohol
consumption; smoking status; diagnoses of diabetes, stroke, coronary heart disease, heart failure, cancer, chronic bronchitis, and emphysema; mobility limitation; and self-reported general health. Rates were computed using the 2003 mortality rate for US adults (11.4 deaths per 1000 adults per year). Models included US population and study design weights to account for the complex survey design and models were replicated 5 times to account for imputed steos data. Error bars indicate 95% CIs.
Below, we provide a reference example:
Breakfast: Begin your day with 30 minutes of fasted morning exercise, such as jogging, planking, or swimming. This routine improves skeletal muscle insulin sensitivity, stabilizes postprandial blood sugar[39], reduces the peak blood sugar one hour after meals (Figure 6)[40], and maintains post-2-hour blood sugar within normal standards (<140mg/dl), even without additional exercise. Monitor the carbohydrate content of your breakfast for optimal results.
Figure 6. Fasting Exercise at Different Times in the Morning. After completing a 10, 15, 20, or 30-minute fasted morning exercise, the participant consumed a balanced meal containing 150 g of cooked carbohydrates and essential nutrients. Blood glucose levels were measured one hour after the meal, showing a gradual decrease corresponding to the duration of exercise, ranging from 10 to 30 minutes.
Lunch: Aim to engage in 10-15 minutes of movement after lunch for best results.
Dinner: Incorporate 30 minutes of moderate-intensity exercise or strength training, such as using dumbbells, approximately 1 hour after beginning your meal. Adjust carbohydrate intake based on post-2-hour blood sugar levels and assess the appropriateness of exercise and carbohydrate consumption.
Conclusion: Despite the challenges, move forward confidently, trusting your perseverance. Increased muscle mass and improved muscle and pancreatic function can restore health and reverse prediabetes. Keep pressing on with determination.
In the initial stage, regularly test for prediabetes with fasting and 2-hour postprandial blood glucose checks to determine carbohydrate tolerance. Consider conducting 1-hour and 3-hour postprandial tests at intervals. Aim to maintain blood sugar within normal ranges, especially for younger individuals, and acquire a glucose monitor for convenient self-testing.
*Stress significantly affects metabolic function, potentially triggering prediabetes and T2D [41,42]. Therefore, young individuals, especially those in school, need to practice vigilance, effective stress management strategies, and find a balance between work and life. Explore other posts in this blog on stress mechanisms and control for additional insights and methods.
*Ensure you get 7-8 hours of sleep each night to maintain optimal energy levels and support your body and mind. Inadequate sleep can impact glucose processing and reduce insulin sensitivity [43,44].
*Spend at least 30 minutes outdoors on sunny days for serotonin release, which fosters improved mood and focus[45]. Sun exposure also supports Vitamin D production, crucial for converting tryptophan into serotonin, influencing over 200 genes, and contributing to the prevention and treatment of diabetes and metabolic syndrome [46,47].
*Lower blood oxygen saturation in prediabetes highlights the importance of outdoor activities for oxygen intake, potentially aiding in pancreatic function recovery. A healthy pancreas maintains consistent oxygen levels through a dense capillary network within the islets, emphasizing the role of sunlight and oxygen in enhancing pancreatic function and mood for prediabetes recovery [48-50].
The gut microbiome significantly impacts human health, influencing the development of various chronic diseases, including prediabetes, diabetes, metabolic disorders, and colorectal cancer[51].
Key components of the gut symbiotic flora, including Bifidobacterium, Lactobacillus, Bacteroides, and Clostridium, constitute over 99% of the intestinal flora, supporting digestion and protecting the intestinal tract(Figure 7)[52,53].
Probiotics have been found to reduce HbA1c and LDL levels in individuals with prediabetes[54], optimizing gut health and promoting the secretion of glucagon-like peptide 1 (GLP-1). When combined with prebiotics, probiotics produce metabolites such as short-chain fatty acids (SCFA), which lower blood glucose levels, mitigate insulin resistance, and reduce inflammation. This contributes to the remission of metabolic diseases (Figure 8)[55].
Figure 8. An overview of the improvement in the health of obese/T2D patients treated by modulating their GM using prebiotics supplementation in a regular diet. Administration of prebiotics has the potential to modulate GM composition in patients suffering from T2D and obesity and can be used as a therapeutic approach to cure the adverse effects of metabolic diseases. The daily intake of prebiotics in a designed diet has a major influence on GM by decreasing gut permeability, bacterial translocation, and reducing LPS-induced inflammation. However, this diet increases SCFAs and bifidogenecity in the gut, leading to lower TC levels, lipogenesis, LDL triglycerides, and adiposity, eventually resulting in lower risk of cardiovascular diseases.
Excessive antibiotic use, high consumption of sugary foods, and prolonged use of non-steroidal anti-inflammatory drugs (NSAIDs) have been found to negatively impact gut bacteria and microbiota(Table 1)[56-57]. These changes are characterized by reduced levels of butyrate-producing bacteria in individuals with prediabetes and T2D. Butyrate, a crucial short-chain fatty acid, plays a role in alleviating oxidative stress, reinforcing the epithelial barrier, and protecting against colorectal cancer [58,59].
Moreover, disruptions in the physiological role of incretin, including gastric inhibitory polypeptide (GIP) and GLP-1, contribute to decreased insulin secretion and hyperglycemia in prediabetics and diabetics [60,61].
Table 1. Summary of diet- microbiota interactions in both health and disease[62].
Annotations
1*.Ecologically, alpha diversity refers to the local mean species diversity as introduced by R. H. Whittaker [63].
2*.Prevotella, a Gram-negative bacteria genus, is prevalent in the human gut, with dietary patterns influencing its abundance. Protein and animal fats correlate with Bacteroides dominance, while higher carbohydrate and fiber intake is linked to Prevotella prevalence[64].
3* Akkermansia muciniphila, a mucin-degrading bacterium in the genus Akkermansia, is linked to intestinal health and immunity. Ongoing research explores its connection to obesity, T2D, and inflammation [65].
4*-5*. The gut-brain axis (GBA) enables bidirectional communication between the central and enteric nervous systems, connecting emotional and cognitive brain centers with intestinal functions. Gut microbiota plays a crucial role in this interaction, influencing signaling pathways through neural, endocrine, immune, and humoral links [66,67].
6* White adipose tissue (WAT) stores energy, while brown adipose tissue (BAT) generates body heat. 'Beiging' occurs when WAT adipocytes acquire BAT characteristics [68].
7*.Every-other-day fasting (EODF) selectively stimulates beige fat in white adipose tissue, notably improving obesity, insulin resistance, and hepatic steatosis[69].
8*.Contrary to low core diversity, high microbiota diversity is associated with improved metabolic health. Industrialization has led to reduced gut microbiota biodiversity, impacting health. Reinforcing diverse complex carbohydrates may restore functional microbiota, influencing factors like SCFA production and addressing modern health issues, including obesity [70].
9*.A healthy gut microbiome enhances metabolism, inflammation resistance, and brain function. Core bacteria like Bacteroides and specific species such as Akkermansia spp. may protect against weight gain and enriched in individuals with a high gene count (HGC) [71].
10*. Ruminococcus, an anaerobic, Gram-positive gut microbe in the Clostridia class, is abundant in the human gut microbiota.
In summary, prioritize a balanced gut microbiota by incorporating dietary fibers, diverse complex carbohydrates, probiotics, and prebiotics, while avoiding detrimental dietary factors.
Body mass index (BMI) is calculated by dividing a person's mass (weight) by the square of their height and is expressed in kg/m². The normal BMI range is 18.5-24.9. However, research indicates that Asian Americans may face an elevated risk of insulin resistance even with a BMI within this range [72].
Example:
Weight = 150 lbs x 0.45 = 68 kg
Height = 165 cm (1.65 m)
Calculation: BMI = 68 ÷ (1.65)² = 24.98
Research on dietary supplements for prediabetes and T2D highlights the pivotal role of oxidative stress in their pathogenesis. This stress arises from an imbalance between prooxidants and the body's antioxidant system, primarily driven by an excess of reactive oxygen species(ROS) [73].
Chronic hyperglycemia increases ROS levels, leading to non-enzymatic protein glycation (e.g., HbA1c), glucose oxidation (e.g., increased ROS production during abnormal glucose metabolism), and lipid peroxidation (causing cell membrane damage). This cascade induces oxidative stress, adversely impacting insulin signaling, causing cytotoxicity in pancreatic β cells, and contributing to insulin resistance and diabetes development [74-76].
Antioxidants play an important role in neutralizing excess ROS and bolstering the body's defense system. Exogenous antioxidants, including vitamins C and E, carotenoids, polyphenols, and minerals such as copper, manganese, zinc, selenium, and iron, are essential for combating oxidative stress. However, caution is warranted as high doses of isolated compounds may pose toxicity risks [77].
Studies on the ADA website indicate that dietary antioxidants may reduce the risk of T2D[78]. Additionally, the Bialystok PLUS study links higher dietary total antioxidant capacity (DTAC) to lower prediabetes prevalence, highlighting the significance of recommending a high DTAC in diabetes prevention and treatment [79].
While natural dietary antioxidants are well recognized, the role of dietary supplements in prediabetes and diabetes remains inconclusive, with some studies questioning their effectiveness [80]. For further information, refer to the National Center for Complementary and Integrative Health (NCCIH) resource 'Diabetes and Dietary Supplements: What You Need To Know.' as below:
Be mindful of Endocrine Disrupting Chemicals (EDCs) in your surroundings, found in the environment (air, soil, or water supply), food sources (can linings), personal care products (sunscreen, perfume, cosmetics), and manufactured items (plastic, nonstick cookware, pesticides). EDCs interfere with the normal function of the body’s endocrine system [81], disrupting various hormones and being associated with adverse health outcomes such as altered fertility, nervous and immune system function, certain cancers, metabolic issues, diabetes, obesity, cardiovascular diseases, and more [82].
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In our 'PORTFOLIO' OF REVERSING PREDIABETES, we have compiled nine essential tips for your health journey. Maintain a consistent healthy lifestyle, persevere, and remember: Action is better than waiting.
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