A major health concern worldwide is the continued increase of people with prediabetes and diabetes. There are estimates of more than 470 million people developing prediabetes by the year 2030, and each year 5-10 percent of people with prediabetes will progress to diabetes mellitus.  With proper detection and treatment of prediabetes the onset of diabetes can be delayed and even prevented.  ​

Prediabetes can be reversed with the proper nutrition, weight loss, exercise and healthy lifestyle as we have discussed in previous posts.  Additional factors in reversing prediabetes are prescription medications, supplements and meditation.  

Metformin
Metformin is the primary prescription medication recommended for treatment of prediabetes.  Metformin was recommended by the American Diabetes Association Standards of Medical Care in 2013 and is still recommended in the latest 2016 edition.  Check out the ADA 2016 recommendations and more information on preventing diabetes: 2016 ADA Recommendations.  
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The ADA suggests metformin therapy for prevention of type 2 diabetes should be considered in those with prediabetes, especially in those with BMI (Body Mass Index) >35, those aged <60 years, and women with prior gestational diabetes mellitus.  Additionally, metformin has been shown to be safe long-term as well as have secondary health benefits such as reductions in body mass index (BMI) and light density lipoprotein cholesterol (LDL) or bad cholesterol.   

Vitamin D
Some studies have suggested that vitamin D helps prevent the progression of prediabetes to diabetes, however, a recent study showed that vitamin D 20,000 IU per week for five years, did not prevent progression from prediabets to diabetes. This study came from the journal of clinical endocrinology.

The reasoning behind the importance of vitamin D supplementation originally came from studies such as those published by the Journal of Endocrinology from 1988.  These studies suggested that vitamin D deficiency in experimental animals leads to reduced insulin secretion which may be restored with vitamin D supplementation.  

​More recently, studies with vitamin D supplementation for improving glucose tolerance or prevention of Type II Diabetes, have not shown very positive results (Journal of Clinical Endocrinology Metabolism 2014).   One reason may be that the effect of vitamin D on glucose metabolism is small, and that the duration of the published studies where short term.

Because type II diabetes develops gradually over many years through a prediabetic stage, it is possible that an effect of vitamin D supplementation on prevention of type II diabetes may take years to become evident.  In short, if you do have a vitamin D deficiency it is important to discuss the best way to increase your level with your primary physician.  Vitamin D deficiency is detected in the blood and your physician can recommend the correct supplemental dosage based on your lab results.  

Vitamin K1

​Those with pre diabetes have blood sugar levels that are higher than normal but not yet high enough to be considered full onset diabetes.  Vitamin K1, also known as phylloquinone, has been shown to provide beneficial effects on blood sugar and insulin health in prediabetics.  

A 4 week study showed that those who took 1000mcg of vitamin K1 significantly increased insulin sensitivity and improved blood sugar control compared to the placebo group. Blood samples were studied to measure osteocalcin, a hormone that is thought to affect blood sugar health.  Osteocalcin is a protein hormone found in bone that depends on vitamin K1 for production.  Basically, by getting enough vitamin K1 in your diet, more osteocalcin can be produced in the body helping to release insulin from the pancreas and prevent diabetes.  Additionally, osteocalcin administration in mice has been shown to decrease fat pad mass and serum triglyceride levels.  

Foods that contain vitamin K1 include kale, spinach, mustard greens, collard greens, swiss chard, broccoli, brussel sprouts and asparagus just to name a few.  There are vitamin K supplements that are available as well.  Many of these include vitamin K1 and K2.  Vitamin K also helps support healthy bones and arteries.  

Meditation

The final section in this three part series on reversing prediabetes is about the benefits of meditation.  I recommend beginning with an easy 10 minutes per day.  There are easy to use meditation apps like Headspace and Stop, Breathe & Think that will help teach and guide you through the basics.  

Meditation will help you to relax and deal with stress in a new way.  At times, life stresses us all out! However, for those with prediabetes or diabetes, stress presents additional problems.  Stress can directly effect blood glucose levels.  Also, we are more likely to participate in behaviors that are unhealthy when we are stressed. We may tend to eat more high-carbohydrate foods like chips and cookies, or sit on the couch and watch TV instead of exercising. 
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Research studies suggest that regularly practicing meditation helps people reduce their response to stress by slowing heart rate, lowering blood pressure, reducing oxygen intake, and changing the brain waves to a more relaxed state. Controlling your response to stress is also likely to lower blood glucose levels. Regular meditation will help you think clearly before acting. You will be able to handle stress more easily and make better decisions.  

There are so many ways to get started meditating.  As I mentioned above, meditation apps are an easy and inexpensive way.  Also, youtube has several guided meditation videos.  Take a look at these youtube channels; The Honest Guys and Jason Stephenson.  Take an extra 10 minutes or so out of your day to focus on yourself, it is well worth it!

Cheers to your health!

In this day and age everyone has heard of acupuncture. Because of celebrities like Kim Kardashian posting pictures with needles in her face during her facial rejuvenation sessions, and athlete Kobe Bryant using it for ankle injury, acupuncture has made its way from the dark dungeons of Chinatown into the most prominent offices of Manhattan. Pain is the most common condition treated by acupuncture. However, many people do not know that this medicine has healing abilities that stretch far beyond just pain management.  Mila Mintsis, L.Ac. is a leading certified acupuncturist in New York City. She practices at Dynamic Sports Physical Therapy in Manhattan. She discusses here 5 things that you may not know acupuncture does.  

1.      Acupuncture decreases anxiety. 
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In our fast paced society, with increasing demands of work and family life and the challenges of finding balance between them, it is no wonder that such a high number of people suffer from anxiety. The statistics show an increase in usage of anxiety medications and in my practice, close to 90% of clients report feeling anxious on a near-daily basis. The bad news is that acupuncture will not solve your work or family problems. But the good news is that it will make you more equipped to deal with life’s challenges. Studies show that acupuncture increases production of endorphins, reduces prefrontal cortex activity and blocks production of stress hormones, which results in a relaxation response. Patients report feeling euphoric and experience a deep state of relaxation following treatments. Want to try acupuncture for anxiety but anxious about needles? Don’t be. People are often surprised by how gentle and comfortable of a procedure it is and many fall asleep during treatments.
 
2.      Clears up allergies. 

Allergies are an ever-present epidemic. You, as well as people you know, may be suffering from allergies. There are many theories as to why generations before us did not suffer from allergies as much as we do, but there are few solutions being offered. Recent studies have warned that allergy medications can impair brain function and increase the risk of dementia. Luckily, acupuncture can provide a relief from allergy symptoms without any side effects. There are two main mechanisms behind this effect: First, it modulates cytokines, which are secreted by the cells of the immune system and help to reduce inflammation.  Secondly, it reduces IgE levels, which are the immunoglobulins that react to allergens and produce the “allergic response”.  After treatments, people report reduction in nasal congestion, sneezing and itching and say they can breathe again. For best results, treatments must be done a few weeks before the allergy season begins. In addition, dietary modifications such as elimination of diary and sugar are recommended for longer lasting relief.
 
3.     Acupuncture can get you pregnant. 

Yup, you heard me right. After pain management, fertility is probably the most sought after treatment by acupuncture. Often performed in conjunction with Western medicine treatments, acupuncture has shown to increase the success of pregnancy rates. Acupuncture increases blood flow to the uterus; decreases anxiety and stress (which often come as a result of being unable to conceive), and regulates hormone levels.  Some studies show that receiving acupuncture before and after the embryo transfer in assisted reproduction therapies, greatly increases the odds of implantation, leading to live births. There are occasions where the man’s health impedes a successful pregnancy. Acupuncture has been found to improve sperm quality in cases of male infertility. In any case, it seems that both parties can benefit from treatments, to increase their odds of conception.
 
4.    Acupuncture helps digestion. 

Digestive complaints are another issue that has been plaguing our society. Often, when I ask my patients about their digestion, they will say that it is “good” or “normal”. Unfortunately, frequent bloating and infrequent bowel movements is the new definition of normal. Many are unaware that for good health, bowel movements have to occur daily, and frequent bloating is a sign that your body is not properly digesting the food and assimilating nutrients. Proper digestion starts with proper nutrition and Chinese medicine offers specific dietary plans according to your individual digestive issues. In addition to dietary changes, acupuncture can improve digestion by promoting the parasympathetic state, which is also known as “rest and digest”.  Most of us are constantly on the go and chronically stressed, which results in sympathetic dominance or “fight-or-flight mode”. It is our body’s way of responding to and dealing with stressful situations. This sympathetic dominance physically impedes proper digestion. Creating a favorable parasympathetic state, as acupuncture does, helps to heal digestive complaints.
 
5.     Acupuncture can get rid of your headaches.

Whether you suffer from tension headaches or migraines, acupuncture can help. A study conducted at Duke University, showed that acupuncture was better at treating headaches than aspirin. Other studies have proven acupuncture to be a valuable tool as well. Tension headaches differ from migraines and other headaches in their etiology and therefore acupuncture approaches each with a different strategy.  One of the reasons we get headaches is due to constriction of blood vessels, which reduces circulation, and can induce headache pain. Needle stimulation at specific areas on the body increases circulation and induces blood vessel dilation, which can alleviate pain. Tension or spasming in the upper back and neck muscles due to emotional stress or excessive computer use, can produce a referred pain into the head, causing tension headaches. Placing needles into involved muscle groups induces relaxation in the muscle tissue and eliminates headaches. During treatments, patients often describe a pleasant warming sensation in the back, and they feel immediately better. And most importantly, acupuncture is safe and has no side-effects, unlike some medications.
 
I hope this information was helpful and insightful. And remember life can be painful but suffering is always optional. Give acupuncture a try if you have any conditions discussed above.



 
 
References:
Duke Medicine. “Duke Study: Acupuncture Offers Better Headache Relief over Medication.” MyNC.com. Dec. 1, 2008.
 
Fang J, Wang D, Zhao Q, Hong Y, Jin Y, Liu Z, Zhou K, Jing X, Yu X, Pan R, Chang A, Liu H, Zhu B. “Brain-Gut Axis Modulation of Acupuncture in Functional Dyspepsia: A Preliminary Resting-State fcMRI Study.” Evid Based Complement Alternat Med. 2015;2015:860463. doi: 10.1155/2015/860463. Epub 2015 Nov 8.
 
Feng, Shaoyan, Miaomiao Han, Yunping Fan, Guangwei Yang, Zhenpeng Liao, Wei Liao, and Huabin Li. "Acupuncture for the treatment of allergic rhinitis: A systematic review and meta-analysis." American Journal of Rhinology & Allergy 29, no. 1 (2015): 57-62.
 
Fox, Maggie. “Acupuncture beats aspirin for chronic headache. “ Reuters. Mon Dec 1, 2008
 
He Y, Chen CT, Qian LH, Xia CL, Li J, Li SQ, Liu BP. [Acupuncture treatment of male infertility: a systematic review]. Zhonghua Nan Ke Xue. 2015 Jul;21(7):637-45.
 
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. “Acupuncture for tension-type headache.” Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007587. doi: 10.1002/14651858.CD007587.
 
Melchart D, Weidenhammer W, Streng A, Hoppe A, Pfaffenrath V, Linde K. “Acupuncture for chronic headaches--an epidemiological study.” Headache. 2006 Apr;46(4):632-41.

N.P. "Common allergy medications could damage brain, increase dementia risk study finds." Cox Media Group National Conent Desk.  Updated: April 19, 2016-7:01AM
 
Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. “Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy.” Fertil Steril. 2002 Apr;77(4):721-4.
 
Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J. “Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial.” Fertil Steril. 2006 May;85(5):1341-6. Epub 2006 Apr 5.
 
Xie Y, Wan W, Zhao Y, Ye Z, Chen H, Hong X, Wu L, Wang R, Yang J. “Impacts on the life quality of the patients with allergic rhinitis treated with warming acupuncture in winter and summer.” Zhongguo Zhen Jiu. 2015 Dec;35(12):1215-20.
 
 

Those with prediabetes have blood glucose (blood sugar) levels that are higher than normal but not yet high enough to be diagnosed as diabetes.  Doctors will sometimes refer to prediabetes as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), depending on what test was used when detected.  Many americans that have prediabetes will convert to diabetes within 10 years.  There are an estimated 37,000,000 Americans that have prediabetes of which the majority have no idea that they do.  

Prediabetes is often without clear symptoms.  Some people who have pre-diabetes may experience some of the symptoms of diabetes.  These include frequent urination, fatigue, increased thirst and blurred vision.  People who are overweight (BMI of 25 or above) or have a family history of diabetes are definitely in a higher risk category as well as those of African American and Native American descent.  People with these risk factors or symptoms should definitely ask their doctor to have a blood test called hemoglobin A1c (HbA1C),glycosylated hemoglobin or glycated hemoglobin test.

The HbA1C test shows how well your diabetes is being controlled.  It provides an average of your blood sugar control over a 2-3 month period.  The HbA1C test measures what percentage of your hemoglobin or protein in red blood cells that carries oxygen, is coated with sugar (glycated).  The higher your A1C level, the more uncontrolled your blood sugar is and the higher your risk of diabetes and complications from diabetes.   If your HbA1c is between 5.7%-6.4% you are pre diabetic.  If it is 6.5% or above you are considered diabetic.  Ideally you want yours to be below 5.4%.  Also, you should take into account fasting blood glucose which should be less than 100mg/dl.  Those with pre-diabetes are 100mg/dl-125mg/dl and diabetes 126mg/dl or higher on two separate tests.  

So, you were diagnosed as pre diabetic, now what?  Well, there are several ways in which you can reverse this condition before it progresses.  But, before making any health or lifestyle changes definitely check with your physician first.  A good idea would be to see a doctor that practices functional or integrative medicine.  These physicians can be found all throughout the country.  Integrative or functional medicine is a healing-oriented medicine that takes into account the whole person including all aspects of lifestyle i.e. diet, exercise, family history, stress levels and environment.  It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and complementary.  
You can find local integrative doctors near you here: ACAM.org.  

 Losing about 7% of your body weight or 15 pounds if you weigh 200 pounds, is an easy place to start for those overweight.  However, things are not always so easy.  A recent study from Korea concluded that visceral fat mass, or fat around the organs, acquired using dual-energy X-ray absorptiometry (DXA), has stronger associations with diabetes and pre-diabetes than other measurements.  Therefore, fat around the organs or visceral fat, is a better predictor of pre diabetes than adipose fat or fat under the skin which is the fat we can see when looking at a person (or ourselves in the mirror).  

 Visceral fat is basically excess intra-abdominal tissue accumulation.  It is fat that is actually covering the organs including the liver, pancreas and kidneys.  A sign of excess visceral fat storage is if you have a belly that sicks out and a large waist.  This is most noticeable in overweight and obese people but anyone can have visceral fat and not know it.  Visceral fat cells do more than just make your pants tight, they also cause changes in the way your body functions by producing hormones and inflammatory factors leading to heart disease, inflammation, cancer, dementia, strokes, depression and diabetes.  
Carrying a high amount of visceral fat is known to be associated with insulin resistance, which can lead to glucose intolerance and type 2 diabetes. Researchers have found that visceral secretes a protein called retinol-binding protein 4 (RBP4) which has been shown to increase resistance to insulin.  Storing excess fat around the organs increases production of pro-inflammatory chemicals called cytokines, which leads to inflammation.  It also interferes with hormones that help regulate appetite, weight, mood and brain function.

A relatively good indicator of visceral fat is to take a measurement of your waist. Harvard University notes around 10% of our total fat is likely to be stored as visceral fat, therefore if you are carrying higher amounts of body fat than is recommended, it is therefore more likely that you are also storing more visceral fat than is healthy.  The most certain way to tell if you are carrying excess visceral fat is with an MRI.  MRI's are expensive and do not tell you if you have diabetes so this should be discussed with your physician.  

In order to reverse pre diabetes, you must focus on decreasing body fat and improving your insulin sensitivity.  In part II, I will discuss ways to do this using four categories for lifestyle change;  diet, exercise, vitamins and supplements and stress reduction.  Keep an eye out for this life changing blog post coming soon!