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From the Townsend Letter
April 2014

The Role of Nutritional and Botanical Agents in the Management of Type 2 Diabetes Mellitus
by Mona Morstein, ND
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Genetics and Diabetes
Genetics of type 2 diabetes [online document]. American Medical Association.

Gut Dysbiosis and Diabetes
Karlsson FH, Tremaroli V, Nookaew I, et al. Gut metagenome in European women with normal, impaired and diabetic glucose control. Nature. 2013. doi:10.1038/nature12198.

Musso G, Gambino R, Cassader M. Obesity, diabetes, and gut microbiota: the hygiene hypothesis expanded? Diabetes Care. October 2010;33(10):2277–2284. doi:10.2337/dc10-0556.

Environmental Toxins' Causing Diabetes
Lang IA, Galloway TS, Scarlett A, et al. Association of urinary bisphenol A concentration with medical disorders and laboratory abnormalities in adults. JAMA. 2008;300(11):1303–1310.

Lee DH, Lee IK, Song K, et al. A strong dose-response relation between serum concentrations of persistent organic pollutants and diabetes: results from the National Health and Examination Survey 1999–2002. Diabetes Care. 2006;29(7):1638–1644.

Fujiyoshi PT, Michalek JE, Matsumura F. Molecular epidemiologic evidence for diabetogenic effects of dioxin exposure in U.S. Air force veterans of the Vietnam war. Environ Health Perspect. 2006;114(11):1677–1683.

Sharp D. Environmental toxins, a potential risk factor for diabetes among Canadian Aboriginals. Int J Circumpolar Health. 2009;68(4):316–326.

Turyk M, Anderson H, Knobeloch L, Imm P, Persky V. Organochlorine exposure and incidence of diabetes in a cohort of Great Lakes sport fish consumers. Environ Health Perspect. 2009;117(7):1076–1082.

Turyk M, Anderson HA, Knobeloch L, Imm P, Persky VW. Prevalence of diabetes and body burdens of polychlorinated biphenyls, polybrominated diphenyl ethers, and p,p'-diphenyldichloroethene in Great Lakes sport fish consumers. Chemosphere. 2009;75(5):674–679.

Codru N, Schymura MJ, Negoita S; Akwesasne Task Force on Environment, Rej R, Carpenter DO. Diabetes in relation to serum levels of polychlorinated biphenyls and chlorinated pesticides in adult Native Americans. Environ Health Perspect. 2007;115(10):1442–1447.

Navas-Acien A, Silbergeld EK, Pastor-Barriuso R, Guallar E. Arsenic exposure and prevalence of type 2 diabetes in US adults. JAMA. 2008;300(7):814–822.

Windham B. Diabetes: The Mercury and Vaccine Factor. Scientific Research Collated and Summarized. Tallahassee, FL: Dental Amalgam Mercury Syndrome Inc; 2008.

Diabetes ROS Formation
Singh RP, Sharad S, Kapur S. Free radicals and oxidative stress in neurodegenerative diseases: relevance of dietary antioxidants. J Ind Acad Clin Med. 2004;5(3):218–225.

UKPDS, DCCT, A1C Study and Diabetic Damage, CDC Study, WHO Bulletin

UK Prospective Diabetes Study [Web page].

DCCT and EDIC: The Diabetes Control and Complications Trial and Follow-up Study [Web page]. National Diabetes Information Clearinghouse.

Brownlee M, Hirsch IB. Glycemic variability: a hemoglobin A1c-independent risk factor for diabetic complications. JAMA. 2006;295:1707

Obesity and overweight [Web page]. Centers for Disease Control.

Gakidou E, Mallinger L, Abbott-Klafter J, et al. Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys. Bull World Health Organ. 2011;89:172–183. doi:10.2471/BLT.10.080820.

Kelleher SL, McCormick NH, Velasquez V, Lopez V. Zinc in specialized secretory tissues: roles in the pancreas, prostate, and mammary gland. Adv Nutr. March 2011;2:101–111, 201.

Roussel, AM, Kerkani, A, et al. Antioxidant effects of zinc supplementation in Tunisians with type 2 diabetes mellitus. J Am Coll Nutr. 2003 Aug;22(4):316–321.

Tobias MH, Zadowicz MM, et al. The role of dietary zinc in modifying the onset and severity of spontaneous diabetes in the BB Wistar rat. Mol Genet Metab. 1998;63;205–213.

Salgueiro MJ, Krebs N, et al. Zinc and diabetes mellitus: is there a need for zinc supplementation in diabetes mellitus patients? Biol Trace Elem Res. 2001 Sep;81(3):215–228.

Chausmer AB. Zinc, insulin and diabetes. J Am Coll Nutr. 1998;17(2):109-115. doi:10.1080/07315724.1998.10718735.

Binds to insulin receptor to active insulin: Vincent JB. The biochemistry of chromium. J Nutr. April 1, 2000. 130(4):715–718.

Chromium helps diabetics especially when insulin resistance is worse: Wang ZQ, Qin J, Martin J, et al. Phenotype of subjects with type 2 diabetes mellitus may determine clinical response to chromium supplementation. Metabolism. 2007 Dec;56(12):1652–1655.

Anderson RA. Chromium, glucose intolerance and diabetes. J Am Coll Nutr. 1998;17:548–555 (review).

———. Chromium in the prevention and control of diabetes. Diabetes Metab. 2000;26:22–27 (review).

Anderson RA, Cheng N, Bryden NA, et al. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes. 1997;46:1786–1791.

Chromium lowers A1Cs: Anderson RA, Cheng N, Bryden NA, et al. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes. November 1997;46. Available at

Lamson, DS, Plaza, SM. The safety and efficacy of high-dose chromium. Altern Med Rev. 2002 Jun;7(3):218–335.

Improves insulin sensitivity and reduce serum glucose: Zhang H, Wei J, Xue R, et al. Berberine lowers blood glucose in type 2 diabetes mellitus patients through increasing insulin receptor expression. Metabolism. 2010;59:285–292.

Decreased A1C, decreased fasting and postprandial glucose, increase insulin sensitivity: Yeh GY, Eisenberg DM, Kaptchuk TJ, Phillips RS. Systematic review of herbs and dietary supplements for glycemic control in diabetes. Diabetes Care. 2003;26:1277–1294. Available at

Improves glucose and insulin variables: Anderson RA, Cheng N, Bryden NA, et al. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes. November 1997;46(11):1786–1791. doi:10.2337/diab.46.11.1786.

Improves glucose tolerance and lipids in the elderly: Offenbacher EG, Pi-Sunyer FX. Beneficial effect of chromium-rich yeast on glucose tolerance and blood lipids in elderly subjects. Diabetes. November 1980;29(11)919–925. doi:10.2337/diab.29.11.919.

Anderson RA. Chromium, glucose intolerance and diabetes. J Am Coll Nutr. 1998 Dec;17(6):548–555.

Excellent review of Gymnema: Kanetkar P, Singhal R, Kamat M. J Clin Biochem Nutr. 2007 September;41(2):77–81. Epub 2007 August 29. doi:10.3164/jcbn.2007010.

Leach MJ. Gymnema sylvestre for diabetes mellitus: a systematic review. J Altern Complement Med. 2007 Nov;13(9):977–983.

Hypoglycemic activity, appetite control, lipid improvements: Bone K. Gymnema: a key herb in the management of diabetes. Townsend Lett. Dec 2002.

Baskaran K, Kizar Ahamath B, Radha Shanmugasundaram K, Shanmugasundaram ER. Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin-dependent diabetes mellitus patients. J Ethnopharmacol. 1990;30:295–300

Shanmugasundaram ER, Rajeswari G, Baskaran K, Rajesh Kumar BR, Radha Shanmugasundaram K, Kizar Ahmath B. Use of Gymnema sylvestre leaf extract in the control of blood glucose in insulin-dependent diabetes mellitus. J Ethnopharmacol. 1990:30:281–294.

Increase pancreatic insulin production and responsiveness: Zhang et al. Op cit.

Lowers glucose, lowers lipids, increase circulating insulin: Shanmugasundaram KR, Panneerselvam C.Use of Gymnema sylvestre leaf extract in the control of blood glucose in insulin-dependent diabetes mellitus.
Shanmugasundaram ER, Rajeswari G, Baskaran K, Rajesh Kumar BR, Radha Shanmugasundaram K, Kizar Ahmath B. The insulinotropic activity of Gymnema sylvestre, R.Br. an Indian medical herb used in controlling diabetes mellitus. Pharm Res Comm. May 1981;13(5):475–486.

Lower glucose, lowers A1C, increases insulin: Yeh et al. Op cit.

Improves glucose and lipids in type 2 diabetes: Khan A, Safdar M, Ali Khan MM, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003 Dec;26(12):3215–3218.

Reduces fasting plasma glucose: Mang B, Wolters M, Schmitt B, et al. Effects of a cinnamon extract on plasma glucose, HbA1c, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest. May 2006;36(5)340–344. Epub 18 Apr 2006. doi:10.1111/j.1365-2362.2006.01629.x.;jsessionid=DA8630A0D2852109284276B202440B97.d04t03?

Lowers gastric emptying and reduces post-prandial glucose levels: Darwiche G, Björgell G, Almér L-O. Effect of cinnamon on postprandial blood glucose, gastric emptying, and satiety in healthy subjects. Am J Clin Nutr. June 2007;85 (6 6):1552–1556.

Berberine HCL
Similar effects to Metformin: Yin J, Xing H, Ye J. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism. 2008 May;57(5):712–717.

R-Alpha-Lipoic Acid
Stopped progression of urinary albumin concentration: Borcea V, Nourooz-Zadeh J, Wolff SP, et al. Alpha-lipoic acid decreases oxidative stress even in diabetic patients with poor glycemic control and albuminuria. Free Radic Biol Med. 1999 Jun;26(11–12):1495–1500.

Decreased urinary excretion rates: Kahler W, Kuklinski B, Ruhlmann C, Plotz C. Diabetes mellitus – a free radical-associated disease. Results of adjuvant antioxidant supplementation. [In German.] Z Gesamte Inn Med. 1993 May;48(5):223–232

Alpha Lipoic acid reduces blood sugars and prevents/treats neuropathy: Diabetes Care. 2008.

Ruhnau KJ, Meissner HP, et al. Effects of 3-week oral treatment with the antioxidant thioctic acid (alpha-lipoic acid) in symptomatic diabetic polyneuropathy. Diabet Med. 1999;16:1040–1043.

Ziegler D, Schatz H, Conrad R, et al. Effects of treatment with the antioxidant alpha lipoic acid on cardiac autonomic neuropathy in NIDDM. A 4-month randomized controlled multicenter trial (DEKAN Study). Diabetes Care. 1997;20:369–373.

Jacob S, Ruus P, Hermann R, et al. Oral administration of RAC-alpha-lipoic acid modulates insulin sensitivity in patients with type-w diabetes mellitus: a placebo-controlled pilot trial. Free Radic Biol Med. 1999;27:309–314.

Improves insulin sensitivity and prevent complications: Zhang. Op cit.

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