Nutrition Intervention for Prediabetes: Let’s Talk Prevention

The bad news is that there is an epidemic of diabetes across the globe today. The good news is that identifying the signs and intervening early on can prevent the progression from prediabetes to diabetes. Or, even better, stop the progression to prediabetes!

Signs of prediabetes and increased diabetes risk include impaired fasting glucose, impaired glucose tolerance, and elevated hemoglobin A1C.

Impaired fasting glucose
- Fasting plasma glucose of 110 – 125 mg/dL (6.1 – 6.9 mmol/L)
Impaired glucose tolerance
- Fasting plasma glucose below 7.0 mmol/L with a 2-hour post-load plasma
- glucose of 140 – 198 mg/dL (7.8 – 11.0 mmol/L)
Hemoglobin A1C 5.7 – 6.4%

Additional factors associated with diabetes risk that may be improved with nutrition and lifestyle intervention:

Endothelial function measurements
- Brachial artery flow-mediated dilatation
- Carotid arterial stiffness
- Muscle blood flow
Inflammatory markers, chronic low-grade inflammation
- C-reactive protein, hs-CRP
- IL-6, IL-8, TNFa
Hormones
- Adiponectin, leptin, ghrelin, GLP-1, GIP
Lipids
- Total cholesterol, LDL-C, HDL-C, triglycerides
- Free fatty acids, apolipoproteins
- Oxidized LDL
Additional blood glucose parameters
- Fasting insulin
- C-peptide
- Homeostatic model assessment of insulin resistance (HOMA-IR)
- Quantitative insulin sensitivity check index (QUICKI)

Overt diabetes is associated with

Fasting plasma glucose above 125 mg/dL (6.9 mmol/L)
Hemoglobin A1C above 6.4%
Macrovascular complications, including coronary artery disease, peripheral artery disease, and stroke
Microvascular complications, including diabetic retinopathy, nephropathy, and neuropathy

Nutrition Intervention

Individualized nutrition intervention, considered the gold standard for diabetes prevention, improves body weight and blood levels of glucose, insulin, and lipids and can reduce the risk of prediabetes and diabetes. Such intervention also reduces the skyrocketing costs of diabetes care which were estimated at $245 billion in 2012 in the United States alone.

A 2010-2020 scoping review of 95 studies using basic nutritional strategies for individuals with prediabetes included:

Intervention	Details
Dietary Carbohydrate	Restrict simple sugars, refined carbohydrates, and isolated high-glycemic foods. Focus on including vegetables, fresh fruits, dietary fiber, resistant starch (e.g., cooked potatoes and beans), and whole vs refined grains.
Dietary Fiber	Above 15 grams per 1000 Calories
Dietary Protein	Higher protein diets were associated with better glycemic control, i.e., 25-30% versus 15% of total Calories. Focus on chicken, dairy, and nuts versus red meat. Incorporate almonds, pistachios, and [non-GMO] soy protein
Dietary Fat	Below 30% Focus on including monounsaturated fats and extra virgin olive oil.
Low Calorie Diets	8-12 weeks of intervention ranging from 415-1700 Calories with 41-65% carbohydrate 12-43.7% protein 13-30% fat
Physical Activity	20-40 minutes per day
Plant-Based Foods	Include viscous vegetables, berries, kiwi, pistachios, almonds soy [non-GMO], natto, and kimchi.
Vinegar	Consuming vinegar (acetic acid) before meals improved insulin sensitivity, glucose metabolism, lipid profile, and muscle blood flow. Vinegar at bedtime may reduce morning glucose levels.
Weight	Goal BMI below 23 Initial weight loss of at least 5% with sustained weight loss of 7-10% for maintenance of a healthy weight.

Reference

Yau, Jun Wern et al. “Nutritional Strategies in Prediabetes: A Scoping Review of Recent Evidence.” Nutrients vol. 12,10 2990. 29 Sep. 2020, doi:10.3390/nu12102990

Optimal Takeaways

It is important to remember that naturopathic approaches to health have always focused on improving nutrition, lifestyle, and stress management factors to prevent chronic dysfunction and disease.

It is rewarding to see conventional medicine adopt a similar approach and hopefully see the “patient” as a whole person, and not a “disease.”

Additional tips for achieving optimal health include: