The Role of Nutritional and Botanical Agents in the Management of Type

2 Diabetes Mellitus

by Mona Morstein, ND

Diabetes is reaching an epidemic level not only in the US, but also worldwide. There are 26 million patients diagnosed diabetic in the US, and 87 million who are prediabetic; essentially, one out of every three people in the US are – or are becoming – diabetic. If nothing changes, the Centers for Disease Control (CDC) predicts that by 2050, 50% of Americans will be diabetic. Worldwide, there are 350 million diabetic patients, with a concentration in areas of higher economic status and greater urbanization areas. 90-95% of diabetic patients are type 2, and the number diagnosed in the childhood or teenage years is also increasing. Worldwide occurrence of the autoimmune type 1 diabetes is also increasing.

The etiological factors for developing type 2 diabetes are multifactorial. They include: excess intake of refined sugar; excess intake of saturated fat; overeating; abdominal weight gain; lack of exercise; environmental toxins (mercury lead, arsenic, bisphenol A, persistent organic pollutants); nutrient deficiencies; genetics; gut dysbiosis; and hormone dysregulation. Insulin resistance is the key metabolic abnormality in type 2 diabetic patients, resulting in increased appetite, elevated glucose levels, higher BMIs, higher insulin secretion, and mixed hyperlipidemia.

There are many complications associated with being a prediabetic or diabetic patient, as a result of increased glucose and lack of antioxidants that lead to increased oxidation reactions. Diabetic damage occurs because of increased reactive oxygen species, such as superoxide anion radicals, hydroxyl radicals, peroxynitrite radicals, and lipid peroxidation. Diabetic patients have an increased risk of cardiovascular disease, eye problems (such as retinopathy and cataracts), nephropathy, and neuropathy. Physiologically this is because those body cells do not require insulin, and so cannot screen out excess glucose by becoming insulin resistant, as can fat and liver cells. Therefore, because eye, renal, nerve, and endothelial cells absorb glucose at the level that it is in the serum, a great deal of oxidative damage occurs to the cells and they can suffer devastating complications. Death from diabetes is usually caused by a heart attack or stroke. Diabetic patients have the highest occurrence of adult blindness, and are the highest population developing end-stage renal disease and nontraumatic limb amputations.

Standard conventional care of diabetic patients includes medications, beneficial lifestyle changes, and associated medications. There are the oral hypoglycemic medications: metformin, sulfonylureas, DPP-IV inhibitors, SGLT2 sodium-glucose transporter, and the thiazolidinediones. There are also diabetic injections: GLP-1 drugs and the various forms of basal and bolus insulin. Outside of the focus on medication, standard care encourages patients to stop smoking, lose weight, have good stress management, and eat healthfully, although many patients are not given specific directives or counseling in those regards.

There are three basic treatment goals for US diabetic patients: A1C <7%; blood pressure ≤ 130/80 mm/hg, and cholesterol <200 and LDL <100. These goals are in accord with the UKPDS (United Kingdom Prospective Diabetes Study) and DCCT (Diabetes Control and Complications Trial), which proved that the lower the A1Cs of a patient, the fewer complications developed. A JAMA study showed an A1C over 5.5 indicates that the glucose level in the patient is damaging the body. Diabetic patients can often require 3 to 4 separate hypertensive agents to bring their BPs down to a safe level. On top of that, the CDC shows that 68% of Americans are either overweight or obese, and central, abdominal weight is a key factor in insulin resistance. Even so, standard care is failing to control this disease worldwide. A World Health Organization (WHO) bulletin of 2011 stated that unfortunately 90% of American patients do not meet those three treatment goals.

Approaches using micronutrients and botanical agents have been shown in numerous clinical studies to afford the best chances of obtaining those treatment goals without risking the sometimes problematic side effects of hypoglycemia from overmedication of glucose-lowering agents.

A low-carbohydrate diet is recommended for type 2 patients. The Nutrition and Metabolism Society devotes its entire dietary research to showing that low-carb diets are not just appropriate to type 2 diabetes but also extremely safe and effective at lowering glucose levels, decreasing insulin resistance, enhancing appetite control, and promoting weight loss, as well as normalizing lipid panels. Exercise – including aerobic, resistance, and high-intensity interval training – needs to be offered in ways that self-motivate patients to perform it regularly. Sleep studies to rule out apnea are vital, and sleep needs to be from 6 to 9 hours to promote appropriate regulation of leptin and ghrelin. Diet diaries, nutrient status measurements, hormonal evaluation, gut dysbiosis, and environmental xenobiotic burdens can all serve as extremely meaningful tests to help discern all possible etiologies for type 2 diabetes development. Last, adding in dietary and botanical supplements has been shown in studies to be very effective in helping the body lower glucose levels, lower lipid levels, decrease blood pressure, and prevent and reverse diabetic complications.

Focusing on supplementation, some of the most studied, most efficacious, and most beneficial supplements include:

1. Zinc: needed to produce, secrete and activate insulin receptors on the cell. Studies have shown that adding zinc to diabetic patients can be helpful. Hyperglycemia can cause pathological losses of zinc in the urine. Zinc also has an antioxidant effect on cells in diabetic patients.

2. Chromium polynicotinate: Chromium has a vital role in binding to the insulin receptor to activate it on body cells, reducing insulin resistance. In many studies chromium as a supplement has been shown to lower glucose levels, lipids, A1C, and insulin in diabetic patients.

3. Gymnema sylvestre: Known as gurmar, or “sugar destroyer” in Ayurvedic medicine, Gymnema has been consistent in showing its benefits in patients with diabetes. Studies on the herb have shown that it may be helpful in lowering glucose levels. It was shown to regenerate pancreatic tissues, allowing more insulin to be produced, and help regulate insulin secretion. It also increases the utilization of glucose at the cell, via reducing insulin resistance, and can help decrease appetite and reduce sugar cravings.

4. Cinnamon: Studies continue on cinnamon and have shown that cinnamon lowers stomach-emptying times and postprandial glucose levels; it reduces glucose in type 2 diabetes patients who had poor diabetic control. It has also shown to be helpful in lowering insulin levels, blood pressure, and the hemoglobin A1C. This is a safe herb. Cinnamonum cassia (a.k.a. Cinnamonum burmanii) is the type of cinnamon with the best effect on patients.

5. Berberine HCL: A leading study on humans showed that berberine HCL equaled the effects of metformin on diabetic patients. In the pilot study, the A1C, fasting and postprandial glucose, plasma triglycerides, cholesterol and LDL, and fasting glucose and HOMAR were reduced, as well as body weight. Berberine is also a liver protectant and activates AMP protein kinase at the cell, which promotes GLUT 4 translocation, allowing more glucose to be absorbed from cells. This is very significant, and berberine is an important component in diabetic supplements due to its efficacy and its safety profile.

6. R-ALA: Alpha-lipoic acid has numerous benefits to the diabetic patient. It is both a water- and fat-soluble antioxidant and has been shown to protect patients with fatty liver from liver disease progression. It can help insulin resistance and has been shown to protect diabetics from developing complications in their nerves, eyes, and kidneys. It is very safe. The R isomer is the only active isomer in the body and, since it can now be stabilized, should be the form recommended to patients, instead of regular lipoic acid wherein half the isomers are the nonhelpful S isomer.

7. Taurine: Taurine is an inexpensive amino acid, underused as a diabetic treatment. It has been found to be a potent hypoglycemic agent, and it can also enhance the effect of insulin. One study showed that giving taurine to diabetic patients for a month required a reduction in their insulin dosing, to avoid taurine-induced hypoglycemia. It was also noted that patients had reductions in cholesterol and triglycerides as well. Taurine is found naturally in the eye tissue and heart tissue and is protective of oxidative damage in both.

8. Benfotiamine: Also known as allithiamine, this fat-soluble form of thiamine has been shown in studies to be very capable at reducing the formation of advanced glycation end products (AGEs), which are well known to lead to the development of diabetic complications. Benfotiamine increases the production of thiamine pyrophosphate, which increases transketolase activity; transketolase blocks glucose-induced damage by preventing AGE formation. Since AGE formation promotes oxidative damage throughout the body, benfotiamine has been shown to treat and improve retinopathy, nephropathy, and neuropathy

9. Bilberry extract: Bilberry extract is rich in bioflavonoids and anthocyanosides, and has a specific affinity for the eyes. In a rat study, it was shown that ingesting bilberry extract reduced hyperglycemia and insulin sensitivity via activation of AMP-activated protein kinase. In several studies, bilberry was analyzed in type 2 diabetes patients with retinopathy, and it was found to induce a clear improvement in their retinopathy, with marked reduction or disappearance of retinal hemorrhages. It may also be beneficial in improving microcirculation and lowering glucose levels. As retinopathy is a leading complication in diabetic patients, and diabetes is the main cause of adult blindness, this study is remarkably important.

10. Green tea leaf extract: Green tea contains the catechin EGCG, which has been shown in numerous studies to be a safe and effective antioxidant. It has been shown to improve glucose tolerance in patients. In a study in Japan, green tea was shown to reduce the risk for type 2 diabetes onset. Green tea was shown to decrease hepatic glucose production, and oversecretion of glucose from the liver is a continual problem, causing hyperglycemia in type 2 diabetes patients. Green tea has also been shown to be an effective antiangiogenesis factor, which may have a significant effect on preventing retinopathy. It has also shown to promote fat oxidation and thermogenesis.

11. Curcumin extract: Curcumin seems to have multiple benefits in diabetes. It has been shown to be a marked inhibitor of reactive oxygen species, which interferes with protein kinase C, thus providing a benefit in diabetes protection and the prevention of complications. It was shown to reduce progression in NAFLD (nonalcoholic fatty liver disease) patients, reduce renal lesions, reduce broad oxidative damage, and reduce cytokine expression. Curcumin prevented retinopathy in streptozotocin-induced rats.

12. Gingko biloba: This plant has been associated with reducing the risk of dementia and cognitive decline, but it has also been shown in human studies to reduce fibrinogen levels, and improved retinal capillary blood rate in type 2 diabetes patients with retinopathy. It was shown to protect diabetic kidneys in animal studies. Gingko has also been shown to inhibit or reduce functional and morphological retina impairments. It was shown to reduce platelet aggregation in type 2 diabetes patients, too.

13. Vanadium: This mineral has been shown to be an insulin mimetic, reducing insulin resistance. In numerous studies of the diabetic rat, vanadium has been shown to reduce elevated glucose and lipids. The best absorbed form of vanadium is bis(maltolato)oxovanadium(IV) – it is 2 to 3 times more potent than vanadyl sulfate and has shown less toxicity.

14. Resveratrol: a bioflavonoid that has been shown in diabetic studies to protect pancreatic cells, reduce inflammatory cytokines, and increase antioxidants. It may also help improve insulin’s actions and lower levels of glucose, A1C, and insulin. It was also shown to help decrease body weight, systolic BP, cholesterol, and triglycerides.

Using a comprehensive alternative-medicine treatment protocol, many diabetic patients can avoid using medications and even reverse their diabetic condition so that they have well-controlled A1C levels, and also lower lipids, lose weight, and have better energy and well regulated serum glucose readings. Diabetes is a condition that does not have to lead to progressive complications and early death from cardiovascular disease. It is preventable, treatable, and reversible when treated by astute physicians addressing all the obstacles to cures and setting up a winning treatment plan with their patients.

References

Diabetic Numbers

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Future Diabetics

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Obesity

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Diabetes ROS Formation

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Chromium

Binds to insulin receptor to active insulin: Vincent JB. The biochemistry of chromium. J Nutr. April 1, 2000. 130(4):715–718. http://jn.nutrition.org/cgi/content/full/130/4/715.

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.

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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 http://nutrapure.sg/wp-content/uploads/2013/04/Chromium-improves-insulin-and-glucose-levels-in-Type-2-Diabetics.pdf.

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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 http://integrativehealthconnection.com/wp-content/uploads/2011/11/Systematic-Review-of-Herbs-and-Dietary-Supplements-for-Glycemic-Control-in-Diabetes.pdf

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. http://diabetes.diabetesjournals.org/content/46/11/1786.short

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. http://diabetes.diabetesjournals.org/content/29/11/919.short

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Gymnema

Excellent review of Gymnema: Kanetkar P, Singhal R, Kamat M. Gymnema sylvestre: a memoir.J Clin Biochem Nutr. 2007 September;41(2):77–81. Epub 2007 August 29. doi:10.3164/jcbn.2007010. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2170951

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. Beneficial effect of chromium-rich yeast on glucose tolerance and blood lipids in elderly subjects

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Published online 2007 August 29. doi:  10.3164/jcbn.200701Antidiabetic 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. http://dx.doi.org/10.1016/S0031-6989(81)80074-4.

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

Cinnamon

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. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2362.2006.01629.x/abstract;jsessionid=DA8630A0D2852109284276B202440B97.d04t03?userIsAuthenticated=false&deniedAccessCustomisedMessage=

Lowers gastric emptying and reduces post-prandial glucose levels: Hlebowicz J,, Safd Man MM, Kttrson RA.Cinnamon improves glucose and lipids of people with type 2 diabetes. Darwiche G, Björgell G, Almér L-O. Effect of cinnamon on postprandial blood glucose, gastric emptying, and satiety in healthy subjects.

Joanna Hlebowicz, 

Gassan Darwiche, 

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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.

Curcumin

Curcumin and retinal stress: Kowluru RA, Kanwar M. Effects of curcumin on retinal oxidative stress and inflammation in diabetes. Nutr Metab. 16 April 2007;4:8. Available at http://www.biomedcentral.com/content/pdf/1743-7075-4-8.pdf.

Curcumin inhibits ROS species generation: Balasubramanyam M, Koteswari AA, Kumar RS, Monickaraj SF, Maheswari JU, Mohan V. Curcumin-induced inhibition of cellular reactive oxygen species generation: Novel therapeutic implications J Biosci. December 2003;28(6):715–721. http://mdrf-eprints.in/148/1/curcumin_induce_inhibition.pdf

Lessens nephropathy: Tirkey N, Kaur G, Vij G, Chopra K. Curcumin, a diferuloylmethane, attenuates cyclosporine-induced renal dysfunction and oxidative stress in rat kidneys. BMC Pharmacol. 2005 Oct 15;5:15.

Reversal of inflammatory and metabolic derangements associated with diabetes and glycemic control: Endocrinology. April 2008.

Arun N, Nalini N. Efficacy of turmeric on blood sugar and polyol pathway in diabetic albino rats. Plant Foods Hum Nutr. 2002 Winter;57(1):41–52.

Rungseesantivanon S, Thenchaisri N, Ruangvejvorachai P, Patumraj S. Curcumin supplementation could improve diabetes-induced endothelial dysfunction associated with decreased vascular superoxide production and PKC inhibition. BMC Complement Altern Med. 2010;10:57. Available at http://www.biomedcentral.com/1472-6882/10/57.

Protecting rat kidney from diabetic damage: Welt K, Weiss J, Martin R, Hermsdorf T, Drews S, Fitzl G. Ginkgo biloba extract protects rat kidney from diabetic and hypoxic damage. Phytomedicine. 2007 Feb;14(2–3):196–203. Epub 2006 Jun 16. http://www.ncbi.nlm.nih.gov/pubmed/16781853.

Prevents diabetic nephropathy: Lu Q, Yin XX, Wang JY, Gao YY, Pan YM. Effects of Ginkgo biloba on prevention of development of experimental diabetic nephropathy in rats. Acta Pharmacol Sin. 2007 Jun;28(6):818–828. http://www.ncbi.nlm.nih.gov/pubmed/17506941

Retina impairment: Droy-Lefaix MT, Cluzel J, Menerath JM, Bonhomme B, Doly M. Antioxidant effect of a Ginkgo biloba extract (EGb 761) on the retina. Int J Tissue React. 1995;17(3):93–100. http://www.ncbi.nlm.nih.gov/pubmed/8867648

Improved hemorrheological properties by gingko extract: Huang S-Y, Jeng C, Kao S-C, Yu J J-H, Liu D-Z. Improved haemorrheological properties by Ginkgo biloba extract (Egb 761) in type 2 diabetes mellitus complicated with retinopathy. Clin Nutr. August 2004;23(4):615–621. http://www.sciencedirect.com/science/article/pii/S0261561403002334

Gingko and platelet aggregation: Kudolo GB, Dorsey S, Blodgett J. Effect of the ingestion of Ginkgo biloba extract on platelet aggregation and urinary prostanoid excretion in healthy and Type 2 diabetic subjects. Thromb Res. 1 November 2002. 108(2–3):151–160. http://www.sciencedirect.com/science/article/pii/S0049384802003948

Taurine

Odetti P, Pesce C, Traverso N, Menini S, Maineri EP. Comparative trial of N-acetyl-cysteine, taurine, and oxerutin on skin and kidney damage in long-term experimental diabetes. Diabetes. 2003 Feb;52(2):499–505.

Verzola D, Bertolotto MB. Taurine prevents apoptosis induced by high ambient glucose in human tubule renal cells. J Investig Med. 2002 Nov;50(6):443–451.

Nandhini TA, Anuradha CV. Inhibition of lipid peroxidation, protein glycation and elevation of membrane ion pump activity by taurine in RBC exposed to high glucose. Clin Chim Acta. 2003 Oct;336(1-2):129–135.

Very good lecture on benefits of Taurine by physician: Chauncey K. Is there a role for taurine supplementation in the management of diabetes? [online document]. Office of Dietary Supplements. http://ods.od.nih.gov/pubs/conferences/taurine_supplementation.pdf

Taurine supplementation and diabetes mellitus: Franconi F, Loizzo A, Ghirlanda G, Seghieri G. Taurine supplementation and diabetes mellitus. Curr Opin Clin Nutr Metab Care. 2006 Jan;9(1):32–36. http://www.ncbi.nlm.nih.gov/pubmed/16444816.

Benfotiamine

Normalizes T1 DM pathways (with R-ALA): D Du X, Edelstein D, Brownlee M. Oral benfotiamine plus alpha-lipoic acid normalises complication-causing pathways in type 1 diabetes. Diabetologia. 2008 Oct;51(10):1930–1932. doi:10.1007/s00125-008-1100-2. Epub 2008 Jul 29.

Prevention of incipient diabetic nephropathy: Babaei-Jadidi R, Karachalias N, Ahmed N, Battah S, Thornalley PJ. Prevention of incipient diabetic nephropathy by high-dose thiamine and benfotiamine. diabetes.diabetesjournals.org/content/52/8/2110.full.pdf+html

Babaei-Jadidi R, Karachalias N, Ahmed N, Battah S, Thornalley PJ. Prevention of incipient diabetic nephropathy by high-dose thiamine and benfotiamine. Diabetes. August 2003;52:2110–2120.

Bilberry

Reduce glucose and insulin resistance: Takikawa M, Inoue S, Horio F, Tsuda T. Dietary anthocyanin-rich bilberry extract ameliorates hyperglycemia and insulin sensitivity via activation of AMP-activated protein kinase in diabetic mice. J Nutr. 2010 Mar;140(3):527–533. doi:10.3945/jn.109.118216. Epub 2010 Jan 20. http://www.ncbi.nlm.nih.gov/pubmed/20089785 J Nutr. 2010 Mar;140(3):527–533. Epub 2010 Jan 20.

Bao L, Yao XS, Tsi D, Yau CC, Chia CS, Nagai H, Kurihara H. Protective effects of bilberry (Vaccinium myrtillus L.) extract on KBr03-induced kidney damage in mice. J Agric Food Chem. 2008;56(2):420–425.

Cignarella A, Nastasi M, Cavalli E, et al. Novel lipid-lowering properties of Vaccinium myrtillus L. leaves, a traditional antidiabetic treatment, in several models of rat dyslipidaemia: a comparison with ciprofibrate. Thromb Res. 1996;84(5):311–322.

Cataracts and retinopathy: Head KA. Natural therapies for ocular disorders, part two: cataracts and glaucoma. Altern Med Rev. 2001;6(2):141–166.

Dietary anthocyanidin-rich bilberry extract ameliorates hyperglycemia and insulin sensitivity via activation of amp-activated protein kinase in diabetic mice: Takikawa M, Inoue S, Horio F, Tsuda T. Dietary anthocyanin-rich bilberry extract ameliorates hyperglycemia and insulin sensitivity via activation of AMP-activated protein kinase in diabetic mice. J Nutr. March 2010;140(3)527–533. http://jn.nutrition.org/content/140/3/527.full.

Bilberry and ocular conditions: Microcirculation of the retina [Web page]. Mirtoselect. http://www.mirtoselect.info/public/retina.asp.

Vaccinium myrtillus (bilberry) [monograph online]. Altern Med Rev. 2001;6(5). http://www.thorne.com/altmedrev/.fulltext/6/5/500.pdf.

Green Tea

The effects of green tea consumption on cardiometabolic alterations induced by experimental diabetes: Fiorino P, Evangelista FS, Santos F, et al. Exp Diabetes Res. 2012;2012:309231. Epub 2012 Feb 29.

Yan J, Zhao Y, Suo S, Liu Y, Zhao B. Green Tea catechins ameliorate adipose insulin resistance by improving oxidative stress. Free Radic Biol Med. 2012 May 1;52(9):1648–1657. Epub 2012 Feb 11.

Masterjohn C, Bruno RS. Therapeutic potential of green tea in nonalcoholic fatty liver disease. Nutr Rev. 2012 Jan;70(1):41–56. doi:10.1111/j.1753-4887.2011.00440.x.

Boschmann M, Thielecke F. The effects of epigallocatechin-3-gallate on thermogenesis and fat oxidation in obese men: a pilot study. J Am Coll Nutr. 2007;26(4):389S–395S.

Hsu CH, Liao YL, Lin SC, Tsai TH, Huang CJ, Chou P. Does supplementation with green tea extract improve insulin resistance in obese type 2 diabetics? A randomized, double-blind, and placebo-controlled clinical trial. Altern Med Rev. 2011 Jun;16(2):157–163.

Tsunek

i H, Ishizuka M, Terasawa M, Wu J-B, Sasaoka T, Kimura I. Effect of green tea on blood glucose levels and serum proteomic patterns in diabetic (db/db) mice and on glucose metabolism in healthy humans. Hiroshi Tsuneki1^*, Mitsuyo Ishizuka12, Miki Terasawa1, Jin-Bin Wu3, Toshiyasu Sasaoka1 and Ikuko Kimura1

BMC Pharmacol.ogy 2004;, 4:18. Effects of green tea on blood glucose levels: http://www.biomedcentral.co Reduce diabeteisk wi green ; JACC Study Group. The relationship between green tea and total caffeine intake and risk for self-reported type 2 diabetes among Japanese adults. Ann Int Med. 18 April 2006;144(8). http://www.annals.org/content/144/8/554.short

Decrease hepatic glucose production: Waltner-Law ME, Wang XL, Law BK, Hall RK, Nawano M, Granner DK. Epigallocatechin gallate, a constituent of green tea, represses hepatic glucose production. J Biol Chem. September 20, 2002. 

First Published on July 12, 2002, doi:10.1074/jbc.M204672200September 20, 2002 The Journal of Biological Chemistry, 277, 34933–34940. http://www.jbc.org/content/277/38/34933.short.

Improves fat oxidation and thermogenesis: Dulloo AG, Duret C, Rohrer D. Efficacy of a green tea extract rich in catechin polyphenols and caffeine in increasing 24-h energy expenditure and fat oxidation in humans. Am J Clin Nutr. December 1999;70(6)1040–1045. http://www.ajcn.org/content/70/6/1040.short

Reduces growth factors: Cao Y, Cao R. Angiogenesis inhibited by drinking tea. Nature. 1 April 1999;398. Available at http://lamtreatmentalliance.org/lta_summits/cao_1999_angiogenesis.pdf.

Vanadium

Sakurai H. A new concept: the use of vanadium complexes in the treatment of diabetes mellitus. Chem Rec. 2002;2(4):237–248.

Yeh GY, Kaptchuk TJ, Eidsenberg DM, Phillips RS. Systematic review of herbs and dietary supplements of glycemic control in diabetes. Diabetes Care. 2003;26:1277 (review).

Cusi K, Cukier S, et al. Vanadyl sulfate improves hepatic and muscle insulin sensitivity in type 2 diabetes. J Clin Endocrinol Metab. 2001 Mar;86(3):1410–1417.

Rat studies and BMOV: Poucheret P, Verma S, Grynpas MD, McNeill JH. Vanadium and diabetes. Mol Cell Biochem. November 1998;188(1–2):73–80. http://www.springerlink.com/content/w3g22k7002lk3r72.

Vanadium salts as insulin substitutes: Sekar N, Li J, Shechter Y. Vanadium salts as insulin substitutes: mechanisms of action, a scientific and therapeutic tool in diabetes mellitus research

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Crit Rev Biochem Mol Biol.1996;31(5–6):339–359 doi:10.3109/10409239609108721

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http://informahealthcare.com/doi/abs/10.3109/10409239609108721.

Resveratrol

Szkudelski T, Szkudelska K. Anti-diabetic effects of resveratrol. Ann N Y Acad Sci. 2011 Jan;1215:34-9. doi:10.1111/j.1749-6632.2010.05844.x. http://www.ncbi.nlm.nih.gov/pubmed/21261639

Resveratrol studies show significant diabetes benefits [blog post]. Natural Products Insider.

September 25, 2013. http://www.naturalproductsinsider.com/news/2013/09/resveratrol-studies-show-significant-diabetes-ben.aspx.