The researchers measured the 25-hydroxy vitamin D levels of the women from blood samples taken late in their pregnancy. Vitamin D levels were more than 10% lower on average in the women whose children became diabetic compared to the control group (65.8 vs 73.1 nmol/L). Furthermore, when the women were divided into quartiles, those in the lowest quartile for 25-hydroxy vitamin D had 2.39 times higher odds of having a child with type-1 diabetes compared to the highest quartile.

This isn’t the first study to suggest a link between a mother’s vitamin D status and diabetes risk. A Norwegian study, published in the journal Diabetologia in 2000, found that mothers who took cod liver oil supplements during pregnancy had offspring with 70% lower odds of developing type-1 diabetes compared to the children of mothers who did not take cod liver oil supplements. The authors of the study concluded that the lower rates of diabetes observed were likely due to either the high levels of vitamin D, or the omega-3 fatty acids EPA and DHA found in the supplements.

Type-1 diabetes makes up a relatively small proportion of total diabetes cases however rates have been steadily increasing by around 3% per year in recent decades. In contrast to type-2 diabetes, type-1 diabetes typically occurs in children and younger adults. Countries with a high incidence of type-1 diabetes include Norway, Finland, the UK, Canada, and New Zealand.

Although moderate daily sun exposure is the easiest way to maintain high vitamin D levels, some foods are also rich in vitamin D including fish oil, dairy products, fortified cereals, eggs, and some varieties of mushrooms.

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The research, led by Ronan Roussel, Professor of Medicine at the Hospital Bichat in Paris, involved 3,615 adults who were followed for 9 years. Over the course of the study there were 565 new cases of hyperglycaemia which was defined as either a fasting glucose level over 6.1 mmol/L or the commencement of treatment for diabetes. After adjustment for a number of factors including age, weight, physical activity, and consumption of sugary drinks, the researchers found that compared to those who consumed less than 0.5 litres of water a day, those who drank between 0.5 and 1 litre of water a day were 32% less likely to develop hyperglycaemia while those who drank more than 1 litre of water a day were 21% less likely to develop the condition.

The researchers were encouraged by the findings however they acknowledge that further research needs to be carried out in order to confirm a link between water intake and high blood sugar.

The research was carried out because of previous observations that vasopressin, a hormone involved in homeostasis, may be linked to high blood sugar. Vasopressin levels are increased when fluid intake is low and some animal studies have found that the injection of vasopressin into the blood leads to a corresponding spike in blood sugar levels. Human studies looking at the risk of diabetes in relation to vasopressin have been rare due to the difficulty of accurately measuring circulating vasopressin levels (it is unstable and has a short half life).

One study, published in the journal Circulation in 2010, looked at the relationship between plasma copeptin, which is a surrogate for vasopressin, and diabetes risk in a group of 4742 Swedish adults. The researchers found that those with copeptin levels in the top 25% were 2.09 times more likely to develop diabetes over the course of the study than those in the bottom 25% for copeptin.

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The first study was conducted by researchers from the Center for Perinatal Studies at the Swedish Medical Center in Washington, USA, and involved the study of 3,158 pregnant women who were followed over the course of their pregnancy. During the study, 158 of the women developed gestational diabetes. The researchers found that women who reported the highest intake of heme iron, more than 1.5mg per day, were 3.3 times more likely to develop gestational diabetes than women who consumed less than 0.48mg per day. The researchers calculated that each 1mg per day increase in heme iron intake increased the risk of gestational diabetes by 51%. For comparison, a serving of porterhouse steak contains around 2mg of heme iron.

Interestingly, intake of non-heme iron, which is found in plants, was negatively correlated with gestational diabetes risk although this was not statistically significant.

The second study was published in the journal Diabetes Care and involved 13,475 from the Nurses Health Study II. Researchers in that study found that women in the highest quintile for heme iron intake (more than 1.6mg per day) were 58% more likely to develop gestational diabetes than women in the lowest quintile (less than 0.66mg per day). Neither dietary non-heme iron nor supplemental iron intake were associated with gestational diabetes risk in the study.

Iron is a potent catalyst for the production of reactive oxygen species which cause damage to cells in the body. Beta cells located in the pancreas, which are responsible for the production and release of insulin, are particularly susceptible to oxidative damage. Furthermore, iron appears to accumulate readily in the pancreas due to high expression of DMT-1, which is a protein involved in the transportation of several metal ions in the body including iron. This suggests a mechanism linking excessive iron intake to diabetes where-by high levels of iron accumulate in the pancreas leading to iron induced oxidative damage of pancreatic beta-cells and a subsequent drop in the ability of the pancreas to secrete insulin.

Heme iron is absorbed more readily than non-heme iron which might explain why only heme iron intake appears to increase the risk of developing gestational diabetes.

Gestational diabetes typically occurs during the third trimester of pregnancy. Although the condition usually resolves itself following birth, women who have suffered gestational diabetes have a greater risk of developing type-2 diabetes in later life. One study found that mothers who had gestational diabetes were 7.43 times more likely to subsequently develop type-2 diabetes than mothers who had normal blood sugar levels during pregnancy. Both pre-term delivery and complications during birth are also marginally more common in mothers with gestational diabetes. The prevalence of gestational diabetes is estimated to be around 5% in the United States however the true figure may be higher as asymptomatic women often go undiagnosed. Symptoms of gestational diabetes are similar to those of regular diabetes and include excessive thirst and urination, fatigue, and nausea.

The results above suggest that women should exercise caution before beginning iron supplementation during pregnancy. While anaemia is a risk during, and immediately after pregnancy due to increased blood loss, it is not typically a life threatening condition and the risks of iron supplementation may well outweigh any benefits.

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An American study, published in The American Journal of Clinical Nutrition in 1988, involved supplementing the diets of 12 type-2 diabetics with 20g per day of apple pectin. The researchers found that pectin supplementation improved glucose tolerance, as measured by 3 hour incremental glucose changes following a test meal, by 19.8%.

A 1977 study, published in the Annals of Internal Medicine by researchers at the Medical Research Council Gastroenterology Unit in London, England, looked at the effects of pectin and guar gum (another soluble fibre) on post-meal glucose levels in 4 healthy volunteers. The researchers found that both substances resulted in significant reductions in glucose levels. The average glucose levels of the 4 participants, 15 minutes after a control meal, was 6.18mmol/L while 10g of pectin added to the same meal resulted in average glucose levels 15 minutes after the meal of 5.64mmol/L, a reduction of 8.7%.

In 2010 the European Food Safety Authority (EFSA), after reviewing the scientific literature, approved the health claim that “Consumption of pectins contributes to the reduction of the blood glucose rise after meals”. The claim applies to products that contain at least 10g of pectin.

The positive effects of pectin on post-meal glucose levels are due primarily to its ability to reduce gastric emptying rates which in turn slows down the release of glucose into the blood-stream. Pectin also appears to increase the thickness of the mucosal layer of the intestines, directly reducing the intestinal absorption of glucose.

Pectin is relatively inexpensive to buy, with good quality powdered fruit pectins typically retailing for $10 to $20 per pound at various health food shops and jam-making supply stores. An alternative to straight powdered pectin is a low sugar marmalade, as these usually contain a significant percentage of pectin (low sugar marmalades require additional pectin to aid setting). Other significant dietary sources of pectin include apples, apricots, peaches, oranges, carrots, beans, and grapefruit. Citrus peels have the highest pectin levels with 25-30% pectin by weight.

Individuals looking to improve their glycemic control through pectin supplementation should begin by taking 5g of pectin (approx 1 tsp) at meal times. If post-meal glucose levels aren’t significantly reduced, this can be increased to 10-15g. Care should be taken not to take excessive amounts of pectin because large amounts of soluble fibre may cause bowel obstruction in some people. In general, as long as pectin supplementation is kept below 30g per day, side effects are unlikely.

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The study, which appeared online last month in the journal Diabetes Research and Clinical Practice, was conducted by researchers at the Institute of Clinical Medicine at the University of Tsukuba. The study involved 172 initially healthy Japanese men and women who were followed over 3 years. Participants were asked to report on various eating habits such as whether they were “fast eaters”, “snacked frequently”, “ate late at night”, “skipped meals”, or “ate out frequently”. Over the course of the study, 39 people developed impaired glucose tolerance (IGT) including 2 who went on to develop diabetes. The only self reported eating habit significantly associated with IGT was fast eating.

Self reported fast eating was associated with 2.47 times increased odds of developing IGT. Adjusting the results for various confounders including age, weight, smoking status, alcohol intake, and family history of diabetes, only marginally reduced the odds ratio to 2.43.

The study comes hot on the heels of a recent New Zealand study that found an increased risk of obesity in women who were fast eaters. Obesity is known to increase insulin resistance and the subsequent risk of developing diabetes however given the link between fast eating and IGT persisted even after adjusting for weight, it is likely that other mechanisms are at play.

One possible mechanism is that eating fast may lead to much higher blood glucose levels following meals. Continual spikes in blood glucose may, over time, reduce the effectiveness of insulin in controlling these spikes leading to poorer glycemic control.

Impaired glucose tolerance, which is also considered a type of pre-diabetes, occurs when blood glucose levels are higher than normal following a 2-hour oral glucose tolerance test (OGTT) but below the levels required for a diagnosis of diabetes to be made. A level less than 140 mg/dL after a 2-hour OGTT is considered normal, a level of between 141 mg/dL and 200 mg/dL is indicative of IGT or pre-diabetes, while a level above 200 mg/dL would suggest a diagnosis of full blown diabetes.

Around 15% of adult Americans have impaired glucose tolerance while a further 12% have diabetes.

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The study, which was published in the journal Archives of Internal Medicine, was conducted by British researchers based at the University of Cambridge. This was a large prospective study that involved more than 21,000 men and women from the European Prospective Investigation of Cancer–Norfolk study. The participants, who were initially free of diabetes, had their blood vitamin C levels measured at a beginning of the study and were then followed over a 12 year period.

Over the course of the study, 735 new cases of diabetes were diagnosed. The researchers found that in the unadjusted model, men and women in the top 20% for vitamin C levels were a massive 77% less likely to develop diabetes than those in the bottom 20% for vitamin C levels. Vitamin C levels in the top 20% represented levels above 1.1 mg/dL and 1.29 mg/dL in men and women respectively while the bottom 20% had levels below 0.56 mg/dL and 0.77 mg/dL.

After adjusting the results for several confounders including age, sex, family history of diabetes, alcohol and smoking levels, physical activity, and BMI, the link between diabetes and vitamin C was reduced, but those in the top 20% for vitamin C still showed an impressive 62% reduction in risk.

The odds ratios for the unadjusted and fully adjusted models are shown on the graph to the right.

The researchers also looked at the effect of fruit and vegetable intake on the risk of diabetes, however vitamin C levels were found to be a better predictor of diabetes risk than fruit and vegetable consumption. Those in the top 20% for fruit and vegetable intake were 23% and 32% less likely to develop diabetes in the unadjusted and adjusted models respectively compared to those in the bottom 20%.

Vitamin C has also demonstrated the ability to improve glucose metabolism in both diabetic and non-diabetic subjects. A study, published in the journal Endocrinology and Metabolism in 1994, looked at the effects of vitamin C infusion on 10 healthy and 10 diabetic individuals. Although Vitamin C did not improve insulin response to glucose, it did improve glucose disposal in both groups of subjects through improvements in non-oxidative glucose metabolism. Glucose metabolism refers to the mechanism by which glucose is converted into glycogen by the liver for longer term energy storage. Impaired glucose metabolism is often found in type-2 diabetics.

Most studies find that diabetics have lower average levels of vitamin C in their blood compared to non-diabetics. A study published in the journal Diabetic Medicine in 2009 found significantly lower levels of vitamin C in the blood of diabetics vs non-diabetics despite similar intakes of vitamin C. This suggests that vitamin C requirements may be higher in diabetics than non-diabetics. There is good evidence that vitamin C may reduce the high levels of sorbitol found in diabetics. Sorbitol accumulation in retinal cells causes retinopathy which can lead to impaired vision which is a common problem for diabetics.

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One of the largest studies on the impact of diabetes on life expectancy was published in the Archives of Internal Medicine, in 2007. The researchers used data from the Framingham Heart Study to determine the impact of diabetes on life expectancy at the age of 50. After adjusting the results for potential confounders such as BMI, smoking status, and physical activity, the researchers found that at 50, diabetic men could expect to live a further 21.3 years compared to 28.8 years for non-diabetic men. Diabetic women could expect to live a further 26.5 years compared to 34.7 years for non-diabetic women.

The biggest health issues faced by diabetics are an increased risk of cardiovascular diseases such as heart disease and strokes, an increased risk of certain forms of cancer, and a dramatically increased risk of kidney failure.

Cardiovascular disease

Diabetics have around a 40% increased risk of dying from cardiovascular disease compared to non-diabetics. Data from the INTERHEART study which involved almost 30,000 individuals from 52 countries calculated that diabetic men and women over 55 years of age were 1.93 and 2.59 times more likely to have a heart attack than non-diabetics. In diabetics aged 55 and under, the risks were even greater with women 3.53 and men 2.66 times more likely to have a heart attack than their non diabetic counterparts.

A study, conducted in 2006 and published in the British Medical Journal, reviewed the results of 37 previous studies and calculated the risk of fatal coronary heart disease to be 3.5 and 2.7 times greater in diabetic women and men respectively compared to non-diabetics.

Finally, data from the Nurses Health Study (NHS) suggests that the risk of stroke is increased by around 80% in diabetics. The risk appears to be elevated for ischemic stroke but not haemorrhagic stroke.

Cancer

Diabetics are around 5% more likely to develop cancer at a given age than non-diabetics. A large study of diabetes and cancer risk was published in the American Journal of Epidemiology in 2004. The main results of the study are presented in the graph below.

Diabetes was associated with a significant increase in the risk of liver, bladder, gallbladder, colon, endometrial, and pancreatic cancer. Interestingly, prostate cancer, kidney cancer, and leukaemia were all less likely in diabetics although none of these achieved statistical significance. Some other studies have suggested a link between diabetes and a decreased risk of prostate cancer, possibly as a result of decreased testosterone production in diabetics.

Kidney Failure

Kidney failure as a result of diabetes is known as diabetic nephropathy. Diabetics are four times more likely to die from kidney diseases than non-diabetics with between 8 and 10% of all diabetic deaths attributable to kidney failure. Diabetes can be incredibly taxing on the kidneys, particularly if blood glucose levels go uncontrolled for many years. Keeping both blood glucose and blood pressure levels in a normal range can dramatically reduce a diabetics risk of having kidney problems later in life.

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Blood Glucose Levels

When taken in conjunction with food, guar gum prevents the rapid spikes in blood glucose levels that can occur when eating foods with a high glycemic index. This is because guar gum adds bulk to the food in the stomach, reducing the rate of gastric emptying into the small intestine and therefore increasing the time it takes for a meal to be digested.

Some studies have also found a link between long term guar gum consumption and reduced fasting glucose levels. A study, published in The American Journal of Clinical Nutrition in 1992, looked at the effects of 20g of guar gum per day on 16 diabetic patients over a six week period. The researchers found that the guar gum diet lowered fasting plasma glucose levels from an average of 8.7mmol/L at the beginning of the study to 7.0mmol/L, a reduction of almost 20%.

Cholesterol Levels

A 1979 study, also published in The American Journal of Clinical Nutrition, found a 10.6% reduction in total cholesterol levels in 10 patients who received 15g of guar gum per day for two weeks. Soluble fibres such as guar gum increase the faecal elimination of bile acids from the body. In response, the body increases bile acid production and because cholesterol is required to produce bile acids, levels of circulating cholesterol are reduced.

Maintaining low cholesterol levels is essential for diabetics because diabetics are naturally at a higher risk of heart disease than the general population. Diabetics should aim to keep LDL cholesterol below 70mg/dL and their HDL to LDL ratio above 0.4.

Weight Loss

Diabetics are more likely to be overweight than the general population and can benefit greatly from weight loss. Insulin sensitivity can be improved, and the risk of heart disease significantly reduced by even small reductions in body weight.

Because guar gum is indigestible, it increases the bulk of a meal without adding calories. The result is that less calories are required to produce a feeling of satiety. Fibre also slows the rate of gastric emptying meaning it takes longer before the person feels hungry again. Studies in rats suggest that guar gum may stimulate metabolism resulting in increased resting energy expenditure which also aids in weight loss.

Care should be taken when consuming high amounts of guar gum because excessive intakes of soluble fibre can cause problems in some individuals. Flatulence is a common side effect however much more serious is the risk of a gastro-intestinal tract blockage. Once consumed, guar gum tends to draw water into it, expanding in size and producing a gooey, gel like substance that can block the oesophagus or small intestine. For this reason, only a tablespoon of guar gum should be consumed at once, preferably at meal times.

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Obesity is the primary reason for the high diabetes rates in Nauru with more than 95% of the population classified as either overweight or obese making Nauru the fattest nation on the planet. This is due mainly to a shift away from traditional foods such as fish and coconuts to diets high in refined carbohydrates and cheap, high fat beef and lamb offcuts which are typically exported to South Pacific nations from New Zealand and Australia because they are unfit for either local consumption or export to the more lucrative European markets.

The incidence of diabetes in other countries varies dramatically from as high as 12-18% in the Middle East to as low as 2-3% in some African countries.

A study, published in the journal Diabetes Research and Clinical Practice last year, estimated the prevalence of diabetes for adults aged 20-79 for every country in the world.

The following table lists the 10 countries that were calculated to have the highest prevalence of diabetes in 2010. The prevalence estimates are age standardised to allow better cross-country comparisons.

Country	Diabetes Prevalence
Nauru	30.9%
Untied Arab Emirates	18.7%
Saudi Arabia	16.8%
Mauritius	16.2%
Bahrain	15.4%
Reunion	15.3%
Kuwait	14.6%
Oman	13.4%
Tonga	13.4%
Malaysia	11.6%

The prevalence of diabetes in the United States is estimated to be 10.3% which is relatively high. By comparison, diabetes rates are 3.6% in the United Kingdom, 9.2% in Canada, and 5.7% in Australia. Worldwide, it is estimated that 6.4% of adults are living with diabetes and this figure is predicted to increase to 7.7% by 2030.

Because type-2 diabetes incidence is so strongly related to obesity and a sedentary lifestyle, it is no surprise that the African and poorer Asian countries tend to have the lowest rates of diabetes. Rwanda (1.6%), Mongolia (1.6%), Iceland (1.6%), and Burundi (1.8%) have the lowest rates of diabetes.

Iceland is an interesting case because it has an exceedingly low rate of diabetes for a developed country. Genetic factors, and a higher percentage of A2 milk consumption are possible explanations for the low rate in Iceland. A1 and A2 milk refer to whether A1 beta-casein or A2 beta-casein is the dominant form of casein protein found in a cows milk. There is some, albeit limited, evidence that A1 milk may promote the development of diabetes and heart disease.

A complete list of diabetes incidence rates can be found at Diabetes Atlas, which is run by the International Diabetes Federation.

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The main reason diabetics are cautious when it comes to potatoes is their very high glycemic index (GI) value. The glycemic index is important for diabetics because it is a measure of the impact a particular food has on blood glucose levels once it has been digested. Eating large amounts of foods with high GI values results in a large increase in blood sugar levels which would normally result in a corresponding rise in insulin to bring blood sugar levels back to a normal level within a few hours. Because diabetics have an impaired insulin response, blood sugar levels can remain very high for quite some time leading to the typical symptoms of diabetes such as excessive thirst, frequent urination, tiredness, and nerve problems.

Potatoes have a GI value that ranges from 65 to 80 which is considered high. By comparison table sugar (sucrose) has a GI of 63, white bread has a GI of 71, wholemeal bread a GI of 60, and brown rice a GI of 55.

Interestingly the method of cooking and variety of potato can affect the GI value of potatoes greatly. Newer potatoes tend to have lower GI values than older potatoes. Waxy potato varieties such as Red Norland, Yellow Finn, and Red Pontiac have lower GI values than floury potato varieties such as Russet Burbank and Norgold Russet. A 2005 study published in The Journal of the American Dietetic Association looked at the effect of cooking method on the GI index of potatoes. The researchers found that mashed and boiled potatoes had the highest GI values (85-90). Baked, roasted, or microwaved potatoes had moderate GI values (70-80), while boiling red potatoes, refrigerating overnight, and eating them cold the following day resulted in a GI value of just 56.

Diabetics may also benefit from eating potatoes with the skin on. Potatoes with skin have almost twice the amount of fibre as the flesh by itself. Fiber is important for diabetics because it helps slow the digestion of food, preventing large spikes in blood sugar. Furthermore, although not a significant source of nutrients itself, the potato skin can help prevent the leeching of nutrients into the water when potatoes are boiled.

To sum up, diabetics should be able to incorporate small servings of potatoes into their meals (up to 150g or 1 medium potato) without any adverse health affects. When possible, potatoes should be cooked the night before, then reheated the next day (or eaten cold) with the skin still on. New potatoes should be selected when available while waxy varieties are preferable to floury ones.

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The report, which compared type 1 diabetes incidence in the UK between 1991 and 2008 showed some dramatic increases, particularly among boys aged 0-14 years where the rate more than doubled from 11 cases per 100,000 person-years to 24 cases per 100,000 person-years. The rate for girls aged 0-14 years increased from 15 to 20 cases per 100,000 person-years (a 33% increase). For young adults aged 15-34 rates increased from 13 to 20 per 100,000 for men (a 54% increase) and 7 to 10 per 100,000 in women (a 43% increase).

Despite the increasing rates if type-1 diabetes the causes are still unknown. One theory is that a low intake of vitamin D increases the likelihood of developing autoimmune diseases such as type-1 diabetes. A study, published in the journal The Lancet in 2001, found that infants who regularly received 2000 IU of vitamin D during the first year of their life were 78% less likely to develop type 1 diabetes compared to other infants.

Further evidence of a link between vitamin D and type 1 diabetes comes from the observation that countries close to the equator tend to have lower type-1 diabetes rates than countries further away from the equator. Other autoimmune conditions such as multiple sclerosis also tend to be more common in countries far from the equator.

Other studies have found that advanced maternal age is a strong risk factor for type 1 diabetes. A study published in the British Medical Journal found that a 5 year increase in a mothers age at birth increased their child’s chances of developing type-1 diabetes by 25%. A child born to a 45 year old mother was found to be at a 211% greater risk of developing type-1 diabetes compared with a child born to a 20 year old mother. This finding may explain part of the increasing trend in worldwide diabetes rates because women, particularly in developed countries, tend to have children much later in life than was the norm in the past. In 2009, women aged 35+ accounted for 14.3% of live births in the United States compared to just 4.6% of live births in 1975.

Finland currently has the highest rate of childhood type-1 diabetes in the world with a rate of 37 per 100,000 people per year while Venezuela has the lowest rate in the world with just 0.15 cases per 100,000 people per year. The childhood rate in the USA is currently 15 per 100,000 people which is slightly above the worldwide average. Other countries with high childhood rates of type-1 diabetes include Sweden, Norway, Canada, New Zealand, and the United Kingdom.

The incidence of type-1 diabetes worldwide is estimated to be increasing by 3.9% annually however type-2 diabetes still accounts for almost 90% of total cases. The CDC estimates that if current diabetes trends continue, as many as 1 in 3 Americans will be living with either form of diabetes by the year 2050.

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The study was published by researchers from the Suzuka University of Medical Science in Japan and involved the oral administration of the vanadium-allixin compound to a group of 7 diabetic mice over a 9 day period. The blood glucose levels of the mice were then compared with a group of un-treated diabetic mice, a group of insulin treated diabetic mice, and a control group of non diabetic mice.

Initial blood sugar levels were around 30mmol/L for the diabetic mice and 8mmol/L for the non-diabetic mice. Five days into the vanadium-allixin treatment, blood sugar levels of the diabetic mice began to drop dramatically and by the end of the 9 day treatment had reached 12mmol/L, a similar blood sugar level to the insulin treated diabetic mice.

The vanadium-allixin treated mice also showed a small reduction in weight whereas the insulin treated mice increased in weight slightly over the treatment period.

The researchers believe the compound works by activating the insulin signalling cascade which plays an important role in the regulation of glucose metabolism. The compound also appears to stimulate the function of an enzyme known as AMP-activated protein kinase (AMPK) which helps cells to absorb glucose.

The research raises hope for alternative treatments for both type-1 and type-2 diabetes. Current treatments normally involve daily insulin injections which can be inconvenient to administer whereas the vanadium-allixin compound can be taken orally and unlike insulin, doesn’t appear to cause weight gain, a common side effect of insulin treatment.

The researchers intend to conduct further studies to determine whether the anti-diabetic effects of the compound translate from mice into humans.

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The study, conducted by Pakistani researchers, involved 30 diabetic men and 30 diabetic women who were divided into six groups. The first three groups consumed 1, 3 or 6 grams of cinnamon per day in the form of a cinnamon supplement while the final three groups received placebos.

The cinnamon and placebo tablets were consumed for 40 days and the fasting blood glucose, cholesterol, and triglyceride levels of the patients were recorded on days 0, 20, 40, and 60 of the study.

After 40 days, the researchers found a significant reduction in fasting blood sugar, LDL cholesterol, and triglyceride levels in the cinnamon groups. Fasting blood glucose levels were reduced by 25% for the 1 g per day group, 18% in the 3 g per day group, and 29% in the 6 g per day group. After 60 days (20 days after cinnamon supplementation had finished), fasting blood glucose levels were still significantly lower than they were prior to the cinnamon supplementation.

Cinnamon also lowered LDL cholesterol by up to 27%, and triglyceride levels by as much as 30%.

It is believed that a compound in cinnamon, known as methylhydroxy-chalcone polymer (MHCP), is responsible for the ability of cinnamon to lower blood sugar levels. MHCP appears to increase the metabolism of glucose by fat cells. One study found that MHCP added to fat cells in a test tube resulted in as much as a 20 fold increase in glucose uptake.

MHCP is water soluble and is therefore not present in cinnamon oil, a product often sold as a gourmet food. The water soluble components of cinnamon tend to be less toxic in high doses than the fat soluble portion because excess amounts of the water soluble compounds can be easily eliminated through urine.

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The study involved 20 individuals aged under 30 who were classified as obese (BMI greater than 30). The participants were divided into two groups; the first group received 4g of salsalate each day for a month while the second group received an identical placebo.

The researchers found that the fasting glucose levels of the salsalate group decreased by 13% over the study period relative to the placebo group. Glycemic albumin (another measure of glycemic control) decreased by 17%, and glycemic control improved by 20% relative to the placebo following an oral glucose tolerance test.

Despite these improvements, insulin levels were unchanged in the salsalate group suggesting the improvements in glycemic control were due to an improvement in insulin sensitivity rather than an increase in insulin secretion.

Higher than normal fasting glucose levels is a known risk factor for type-2 diabetes suggesting that salsalate could be used both as a treatment for type-2 diabetes and a preventative measure in high risk individuals.

Salsalate belongs to a family of compounds known as the salicylates which includes acetylsalicylic acid (aspirin). Aspirin is also known to reduce blood sugar levels however the dosage required to achieve this reduction is around 4 to 7g of aspirin a day. Long term aspirin use at this level results in adverse effects such as gastrointestinal bleeding and ulcers. Salsalate, on the other hand is better tolerated by the body and has a much more favorable side-effect profile.

A three year trial, funded by the National Institutes of Health, is currently underway to determine the effectiveness of salsalate over a longer duration.

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Gastric bypass surgery belongs to a class of operations known as bariatric surgeries which are designed to help morbidly obese individuals lose weight. The gastric bypass procedure is carried out by closing off a small stomach pouch from the rest of the stomach. The intestines are then detached from the stomach and connected directly to the pouch so that the remainder of the stomach is “bypassed”. The treatment reduces the volume of food the stomach can hold leading to a reduction in hunger cravings and a feeling of fullness after only a small amount of food is consumed.

The procedure not only leads to weight loss, but also leads to the remission of type-2 diabetes in the overwhelming majority of patients. One study, published in the New England Journal of Medicine in December, 2004, compared the health outcomes of 2,000 obese individuals who underwent gastric bypass surgery with 2,000 control subjects who did not undergo surgery.

The researchers found that the incidence of type-2 diabetes was over seven times lower in the surgery group compared to the control group two years after the surgery and four times lower in the surgery group ten years after the surgery. Furthermore, 72% of diabetic patients who underwent the surgery no longer had diabetes two years after the surgery however this figure dropped to 36% ten years after the surgery.

Another study, published by the Journal of the American Medical Association in 2004 reviewed the results of 136 previous studies and found that gastric bypass surgery led to complete remission of type-2 diabetes 83.7% of the time and improved or resolved type-2 diabetes in 93.2% of cases.

Finally a report published in the Annals of Surgery found that just 30 out of 288 diabetic patients did not achieve remission following gastric bypass surgery.

It was initially believed that the beneficial effects of gastric bypass surgery on diabetes were due solely to the loss of excess weight however recent evidence has suggested that this is not the case. First, in diabetics who lose weight without surgery, modest improvements in glycemic control are observed but complete remission of type-2 diabetes is quite rare. Second, diabetes remission often occurs just days after surgery, long before significant weight loss has occurred.

Scientists have proposed several possible mechanisms that might further explain the ability of gastric bypass surgery to achieve remission of diabetes.

One explanation is that the dramatic reductions in caloric intake lead to a reduction in glucose levels, an improvement in insulin response, and a remission of type-2 diabetes in many cases. One study, published in the Archives of Internal Medicine looked at the effects of a very low calorie diet of 420 calories a day on six obese, diabetic women. The diet led to a reduction in fasting blood glucose levels from an average of 293mg/dL to 126mg/dL. A second study found that a 300 calorie a day liquid diet reduced fasting blood glucose levels from an average of 291mg/dL to 95mg/dL. An individual is considered to be diabetic if they have a fasting blood glucose level above 125mg/dL.

Although both these studies involved extremely low calorie intakes (average daily calorie intake is around 1600 calories after gastric bypass surgery), it is clear that calorie restriction can lead to a significant reduction in blood sugar levels.

A second possible mechanism is that gastric bypass surgery might interfere with the secretion of some unknown chemical from the upper intestine that is responsible for insulin resistance however to date, no such chemical has been isolated.

Those who undergo gastric bypass surgery need to be aware of the risks of the surgery. The surgery carries a mortality rate of between 0.2 and 1.0% depending on the age and weight of the patient, and the experience of the surgeon. Around 10% of patients have post-operative complications such as hemorrhaging, infection, leakages from the pouch into the stomach, or the development of a hernia.

It is also possible for type-2 diabetes to redevelop in those who had previously achieved remission, however this is rare in those who exercise regularly and follow a healthy eating plan. Remission of diabetes following surgery is less common in the elderly, and those with either severe diabetes or who have had the disease for a long period of time.

Current recommendations for gastric bypass surgery require the patient to have a BMI over 40, or a BMI of over 35 and at least one obesity related medical condition such as type-2 diabetes, hypertension, or sleep apnea.

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The study, conducted by Finnish researchers at the National Public Health Institute in Helsinki, Finland, involved the analysis of 2,285 men and 2,019 women aged between 40 and 69 who were initially free of diabetes. During the 23 year study period, 164 males and 219 females developed type-2 diabetes.

The researchers found that those individuals who consumed diets rich in vitamin E and the carotenoid cryptoxanthin were less likely to develop type-2 diabetes. Vitamin C, beta-carotene, and lycopene on the other hand did not appear to reduce the risk of type-2 diabetes. Consumption of the carotenoids lutein and zeaxantin were associated with a modest reduction in type-2 diabetes risk however this was only marginally statistically significant.

After adjusting the results for potential confounding factors such as age, BMI, and a family history of diabetes, those in the highest quartile for Vitamin E intake were found to be 31% less likely to develop type-2 diabetes compared to those in the lowest quartile. For cryptoxanthin intake, those in the highest quartile were 42% less likely to develop type-2 diabetes than those in the lowest quartile.

Cryptoxanthin belongs to a group of chemicals known as carotenoids. Carotenoids are flavonoids that are responsible for the pigmentation of many fruits and vegetables. Cryptoxanthin is also an antioxidant and therefore may prevent oxidative damage to the body due to free radicals. Rich sources of cryptoxanthin include papaya (pawpaw), egg yolk, apples, oranges, peaches, watermelon, and corn.

Zeaxanthin and lutein are commonly found in yellow and orange fruits and vegetables such as peaches, mangoes, prunes, papaya, tangerines, and oranges. Egg yolk is also a rich source of both lutein and zeaxanthin.

Vitamin E rich foods include almonds, spinach, olives, peanuts, avocado, blueberries, tomatoes, kiwifruit, and broccoli.

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One of the largest studies on the impact of exercise on type-2 diabetes risk was conducted in 1992 by researchers from the Department of Medicine at the Harvard Medical School in Boston, USA. The researchers used data from the Physicians’ Health Study which involved 21,2171 male physicians from the United States aged between 40 and 84 who were followed for five years.

Over the course of the study, 285 of the participants were diagnosed with type-2 diabetes. The researchers found that those who exercised more than once a week were 36% less likely to develop type-2 diabetes than those who exercised less than once a week. Furthermore, the incidence of type-2 diabetes continued to decrease with increasing levels of exercise. Compared to those who exercised less than once a week, there was a 23% reduction in type-2 diabetes in those who exercised one to two times a week, a 38% reduction for those exercising between two and four times a week, and a 42% reduction for those who exercised at least five times each week.

It is believed that exercise helps reduce diabetes risk in two ways. First exercise is known to reduce body weight and in particular body fat levels. High body levels of body fat, especially around the abdominal area, is an established risk factor for type-2 diabetes. Secondly, sustained physical activity leads to improvements in insulin sensitivity meaning the body needs less insulin in order to control blood sugar levels.

The study appears in the appears in the July 1, 1992 issue of The Journal of the American Medical Association.

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The study, conducted by Spanish researchers and published in the British Medical Journal, followed 13,380 Spanish university graduates for an average of 4.4 years. The graduates adherence to a Mediterranean diet was calculated by giving each participant a score of zero or one for their consumption of nine components of a Mediterranean diet. These components were high intake of fish, low intake of meat and meat products, high intake of legumes, high intake of nuts, high intake of grains, high intake of fruits, moderate alcohol consumption, moderate intake of dairy products, and a high ratio of mono-unsaturated to saturated fat in their diets. The scores were added together to give a total between zero and nine with high scores indicating closer adherence to a Mediterranean diet.

During the study 103 of the participants developed type-2 diabetes. The researchers found that those who closely followed the Mediterranean diet (scores between 7 and 9) were 83% less likely to develop type-2 diabetes compared to those with low adherence to a Mediterranean diet (scores between 0 and 2). Moderate adherence to a Mediterranean diet (scores between 3 and 6) was associated with a 59% reduction in diabetes risk compared to low adherence.

Interestingly those who followed the Mediterranean diet were heavier, more likely to smoke, were older, and had a higher prevalence of diabetes in the family compared to those who did not follow a Mediterranean diet. Despite having many diabetes risk factors, these individuals were still much less likely to develop type-2 diabetes suggesting diet is a very important risk factor in determining diabetes likelihood.

It is believed that the high levels of mono-unsaturated fats found in Mediterranean diets may improve insulin sensitivity and reduce blood lipid levels which in turn reduces the probability of a person developing type-2 diabetes. Mediterranean diets also tend to have lower amounts of red and processed meats than western diets. Previous studies have found a link between red and processed meat consumption and higher rates of type-2 diabetes.

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One of the largest studies on the link between a vegetarian diet and diabetes came from a study of 25,698 seventh day adventists in 1960 over a 21 year study period. The study was published in the American Journal of Public Health in 1985.

Seventh day adventists are discouraged from consuming meat, eggs, drinking alcohol, and smoking cigarettes and as a result the number of vegetarians in the study was quite high with slightly over half the group considered to be vegetarians.

When compared to vegetarians, the risk of diabetes for meat eaters was found to be 70% higher for men and 40% higher for women. In particular, those men who consumed large amounts of meat (6 or more servings a week) were 2.7 times more likely to develop diabetes. Women who consumed 6 or more servings of meat a week were 2.3 times more likely to develop diabetes compared to vegetarians.

The study also found that the incidence of heart disease was much lower in the vegetarian group than for meat eaters.

It is thought that red meat is the type of meat most strongly linked to diabetes due to the large amounts of saturated fat contained in it. Poultry and fish on the other hand are not thought to increase diabetes risk. Saturated fat is known to stimulate the secretion of insulin and may eventually lead to insulin insensitivity. Certain compounds such as nitrosamide which are particularly prevalent in processed and cured meats have also been shown to induce diabetes in animal studies.

Vegetarian diets also tend to be higher in fiber than non-vegetarian diets. A high fiber intake is associated with a reduction in diabetes risk. Vegetarian diets are also generally lower in calories and studies suggest that BMI levels, another diabetes risk fator,  are lower for vegetarians compared to the general population.

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The study was published in The Journal of the American Medical Association in November 2002 by American researchers at the Department of Nutrition at the Harvard School of Public Health. The authors analyzed data on 83,818 women which was collected from the Nurses Health Study (NHS) over a 16 year period from 1980 to 1996.

Around 35% of the study participants reported to consume nuts rarely or never, 36% consumed nuts less than once a week, 24% consumed them between 1 and 4 times a week, and the remaining 5% consumed nuts 5 or more times a week. Nut consumption was defined as one 28g serving of nuts and included peanuts and peanut butter (peanuts are technically classified as a legume).

The researchers found that those who consumed nuts regularly tended to have a lower body mass index (BMI), were more likely to smoke, consumed more fiber, magnesium, and polyunsaturated fat and had a higher daily energy intake.

Frequent nut consumption was associated with a much lower risk of type-2 diabetes. When compared to those who consumed nuts rarely or never, those who consumed nuts 5 or more times a week were 45% less likely to develop diabetes and those who consumed nuts between 1 and 4 times a week were 31% less likely to develop type-2 diabetes. Even after the results were adjusted for BMI, consuming nuts 5 or more times a week still reduced the risk of type-2 diabetes by 26%.

Researchers believe that it is the type of fats contained in nuts that may explain the beneficial effects on diabetes. Nuts tend to be high in monounsaturated and polyunsaturated fats but contain relatively low amounts of saturated fats. Several studies have linked diets high in saturated fats with an increased likelihood of developing type-2 diabetes.

Many people avoid nuts because they are concerned that the high energy and fat content of nuts may lead to weight gain and an increased risk of heart disease and other weight related problems. This particular study found that the opposite is the case and in fact nut consumption may actually reduce BMI.

Nuts may also reduce the risk of heart disease according to some studies. This study found that people who consumed nuts more than 4 times a week had a 48% reduction in fatal CHD events compared to those who consumed nuts less than once a week. Reducing heart disease risk is important for diabetics because diabetes and heart disease are so strongly related.

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