The results are controversial however because most countries that consume large amounts of rice actually have a very low diabetes incidence, suggesting that if white rice consumption is a risk factor for diabetes, it is much less important than other established risk factors such as a sedentary lifestyle and obesity.

Brown rice consumption on the other hand generally shows an inverse association with diabetes risk. For example, a Harvard study, published in 2010, found that two servings of brown rice a week cut the risk of developing type-2 diabetes by about 11%. The differing results between brown and white rice are likely due to the lower GI, and more favourable nutrient profile of brown rice.

When compared to potatoes, white rice has a similar GI, but lower amounts of magnesium and fiber, two components that are beneficial for diabetic patients. 100 grams of cooked white rice has no dietary fiber and only 8mg of magnesium compared to 1.8g of fiber and 20mg of magnesium in the same amount of boiled potatoes. In contrast, brown rice has 1.8g of fiber and an impressive 43mg of magnesium.

This doesn’t necessarily mean that white rice should be avoided altogether however regular eaters of white rice should ensure that they get adequate amounts of magnesium and dietary fiber from other sources.

The GI of rice normally fals between 55 and 75 making it a high GI food. Diabetics should therefore be aware that consuming a large amount of rice will have a significant effect on blood sugar levels. The impact on blood sugar levels can be reduced by combining rice with high fiber, low GI foods such as beans, green vegetables, avocados, or nuts,

The GI of rice varies depending on the degree of processing, grain size, cooking time amd amylose content. The average GI values for selected rices are shown below.

• Jasmine: 109
• White (Short Grain):74
• White (Long Grain):60
• Brown (Short Grain): 64
• Brown (Long Grain): 55
• Wild: 56
• Basmati: 56

Brown rice generally has a lower GI than white rice because the high fiber bran and germ components of the rice grain are still intact. Long grain rice has a lower GI than short grain rice because long grain rice has a smaller surface area relative to volume for digestive enzymes to work on, which results in a slower digestion speed. Cooking time also influences the GI of rice, in general overcooked rice has a higher GI than slightly undercooked rice.

Wild rice is generally sold as a whole grain and has more protein and less carbohydrate than regular brown rice however it is more expensive than regular rice due to lower yields and harvesting difficulties.

The GI of a rice variety depends on the relative proportions of the two components of starch, amylose and amylopectin. Amylose is a more densely packed structure that amylopectin and therefore takes longer to digest. Rice generally has anywhere from 0-25% amylose. Diabetics should generally stick to high-amylose varieties of rice as they will have a reduced effect on blood sugar levels. Any rice labelled glutinous, sticky, waxy, mochi, or sweet, is likely to contain very low amounts of amylose and will therefore have a higher GI than rice varieties with a higher amylose content. Basmati rice has one of the highest amylose contents of any variety of rice and is a great option from diabetics. Basmati rice is generally eaten as a white rice, although brown basmati rice can be found in some speciality stores.

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The research, led by Dr. Katherine Samaras, Associate Professor of Medicine at the University of New South Wales in Australia, focussed on 312 adults aged between 70 and 90 who were followed up over 2 years. MRI scans were taken of the participants at the beginning and end of the study to determine total brain volume.

The participants were divided into 4 groups: normal glucose levels at both the beginning and end of the study, impaired fasting glucose (prediabetes) at beginning and end of study, worsening glucose levels during the study (progression from normal glucose to IFG or diabetes, or progression from IFG to diabetes), and full blown diabetes at beginning of the study.

While every group experienced brain shrinkage over the course of the study, decreases in brain volume occurred at a slower rate in the group that maintained normal glucose levels throughout the study. Brain shrinkage in this group was measured at 18.4cm³, compared to 26.6cm³ in the stable pre-diabetic group, 41.7cm³ in the group that experienced a decline in glucose control, and 42.3cm³ in the diabetic group.

A decrease in brain volume is a normal feature of old age and not necessarily an indicator of dementia however substantial reductions in brain size can result in memory loss, mood swings, an inability to pick up new information, and a general decline in cognitive ability.

The researchers believe that the results are likely due to either a direct toxic effect of high blood sugar on the brain similar to the damage high blood sugar does to the peripheral nervous system, or from other factors that are associated with diabetes such as chronic inflammation and high body fat levels.

Furthermore, insulin promotes the development of atherosclerosis, which can impair the flow of blood to the brain, leading to multiple micro-strokes in the brain and the development of vascular dementia. Insulin resistance is a common finding in diabetics and is characterized by chronic high insulin levels.

Previous studies have linked diabetes with a substantially higher risk of developing dementia, particularly vascular dementia. A Dutch study, conducted in 1999 found that individuals with diabetes had 1.9 times greater risk of developing dementia compared to non-diabetics. The risk was greatest for diabetics who were receiving insulin to treat their condition, this group had a 4.3 fold increased incidence of dementia.

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Being overweight or obese risk the strongest risk factor for type-2 diabetes with an estimated PAR (population attributable risk) of 70%. This means that 70% of diabetics have developed the disease as a result of their excess weight. Other risk factors for diabetes include a sedentary lifestyle, a diet high in saturated fat, and a low intake of fiber. Although many studies have looked at patterns of sugar intake and the risk of diabetes, the majority of these studies have found no link between sugar and diabetes, independent of BMI.

One of the largest studies on the issue of sugar intake and diabetes risk was published in the journal Diabetes Care in 2003 and involved 38,480 women aged 45 and older who were followed up for an average of 5.8 years. Participants filed out a food frequency questionnaire at the beginning of the study so that sugar intake could be estimated. Over the course of the study, 918 cases of diabetes occurred. The researchers found no link between diabetes and fructose, sucrose, glucose, lactose, or total sugar intake. In fact, in the fully adjusted model, which controlled for BMI, smoking, alcohol intake, exercise, and a number of other potential confounders, sucrose intake actually showed a weak negative association with diabetes risk although the link was not statistically significant.

Another interesting finding from the study was that those in the highest quintile for sucrose intake, who averaged 57.2g per day, actually had a slightly lower BMI than those in the lowest quintile who averaged 25.8g of sucrose per day.

One of the limitations of the study is that the authors did not discriminate between sugars that were naturally present in foods, and sugar that was added to processed foods.

A second study, published in the journal Diabetes in 2006, looked at the effects of a low sucrose (10% of total energy), and high sucrose (25% of total energy) diet on a group of 14 healthy men who consumed each diet for 6 weeks. The researchers found to significant differences in insulin sensitivity, fasting plasma glucose, serum insulin, and interstitial glucose levels between the high and low sucrose diets although a slight increase in LDL and total cholesterol was observed following the high sucrose diet. The researchers concluded that: “These results suggest that important pathogenic processes that precede diabetes and vascular disease are not significantly worsened by sucrose itself”.

On the other hand, a 2004 study looked at how intake of sugar sweetened beverages influenced weight gain and diabetes risk in a cohort of young and middle aged women. The researchers found that women who increased their soft drink consumption over the study period showed increased weight gain compared to women who had decreased their soft drink consumption. Sugar sweetened soft drink consumption was also linked to diabetes with those consuming more than 1 drink a day 83% more likely to develop diabetes than those averaging less than 1 sugar-sweetened soft drink a month. Adjusting the results for BMI reduced the risk to 39% meaning that much of the excess risk of diabetes was due to higher BMI levels in regular consumers of soft drinks. Interestingly, consumption of fruit juice was not associated with an increased risk of diabetes.

The researchers noted that because of the low satiety of sugar sweetened beverages, people don’t fully compensate for the calories they consume through sugary soft drinks by reducing their subsequent intake of solid foods. This results in an overall increase in energy intake which can lead to weight gain and therefore the development of diabetes.

There is also some evidence that a diet consisting predominantly of foods with a high glycemic index can lead to impaired glucose tolerance and an increased risk of diabetes. Even in this regard, sucrose actually has a relatively moderate glyecmic index compared to many carbohydrate rich foods such as white bread, white rice, and potatoes. White bread for example has a GI of 72 and mashed potatoes a GI of 80 compared to 65 for sucrose. This means that substitution of sucrose with processed, starchy carbohydrates could actually cause much more significant fluctuations in blood sugar levels, potentially raising the risk of developing impaired glucose tolerance and eventually diabetes.

To sum up, consumption of sucrose and other sugars do not appear to be a significant contributor to diabetes risk, providing that a healthy weight is being maintained. Sucrose that is found naturally in whole foods is obviously more desirable than sugar that is added to processed foods because it tends to come with fibre and a variety of vitamins and minerals. Processed foods containing sugar tend to be calorie dense, but deficient in beneficial nutrients. Individuals who struggle to maintain a healthy weight should avoid sugar sweetened beverages in particular because they are linked with excess energy intake and subsequent weight gain.

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The study, led by Professor Martin Gibala of the Department of Kinesiology, McMaster University, Canada, involved seven adults with type-2 diabetes who underwent a session of high intensity physical exercise involving 10 sixty second cycling sprints with a target heart rate of 90% maximum alternating with 1 minute rest periods. The researchers compared the 24-hour glucose levels of the participants with their levels on a control day that involving no physical exercise.

The authors found significant decreased in overall blood glucose levels as well as post-prandial glucose levels (glucose levels immediately following a meal). The amount of time spent with glucose levels above 10 mmol/l decreased from an average of 15.2% on the control day to 4.5% on the exercise day. Post-prandial glucose levels, as measured by the area under the 3-hour glucose response curve following meal times, decreased by 36%.

Professor Gibala has previously conducted studies on high intensity exercise that have produced similar results. A 2011 study published in the Journal of Applied Physiology, found that 6 30-minute high intensity sessions performed over two weeks decreased glucose levels by 13% and improved skeletal muscle mitochondrial capacity – a measure of metabolic health.

Skeletal muscle is the major contributor to post-prandial glucose clearance however it is generally impaired in type-2 diabetics. Insulin and physical exertion both increase glucose uptake by the skeletal muscle. Studies have also shown that repeat physical exercise increases the glucose transport capacity of skeletal muscle.

Most type-1 diabetics, and some type-2 diabetics who require insulin may actually experience slight increases in blood sugar levels immediately after high intensity exercise due to an increase in the levels of counter-regulatory glucose hormones which are released to prevent hypoglycaemia (low blood sugar). This increase in blood sugar levels usually lasts just 1-2 hours while the benefits of high intensity exercise, in terms of improved glucose control, last 24-48 hours.

High intensity physical exercise is not normally recommended for patients with pre-existing heart disease, a BMI greater than 35, or a history of exercise induced syncope.

The American Diabetes Association recommends that diabetics spend 150 minutes a week performing moderate to vigorous aerobic exercise.

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The idea of complementary foods is a relatively new concept in diabetes management and it refers to certain foods, that when consumed in conjunction with a traditionally high GL meal, help reduce the exaggerated glucose response that would normally occur. Some of these complementary foods are discussed in detail below.

Cinnamon

A 2007 study, published in the American Journal of Clinical Nutrition looked at the effects of the addition of 6g of cinnamon to 300g of rice pudding in 14 healthy volunteers. The researchers found that the addition of cinnamon significantly reduced the blood glucose response to the meal as measured by the 2 hour area under the curve (AUC). The one hour and two hour blood glucose responses were 51.3% and 46.1% lower respectively in the cinnamon supplemented meal. Some of the improvement in glycemic response was due to a slight reduction in gastric emptying rate (37% in the control group vs 34.5% in the cinnamon group).

A second study found similar benefits from regular cinnamon supplementation. The 2003 study, which appears in Diabetes Care, a journal published by the American Diabetes Association, found that the addition of 1, 3, or 6 grams of cinnamon every day for 40 days resulted in significant fasting blood glucose and lipid profile improvements in a group of 60 type-2 diabetics. The researchers concluded that: “Because cinnamon would not contribute to caloric intake, those who have type 2 diabetes or those who have elevated glucose, triglyceride, LDL cholesterol, or total cholesterol levels may benefit from the regular inclusion of cinnamon in their daily diet.”

The mechanisms by which cinnamon improves glycemic control are not fully understood however cinnamon is believed to improve the function of the insulin receptor, which plays a keep role in the regulation of glucose levels. Cinnamon also contains MHCP, a phytochemical that in one laboratory study was shown to increase the metabolism of glucose by fat cells 20-fold.

Pectin And Vegetable Gums

Pectin, vegetable gums, and other forms of dietary fiber are indigestible and are therefore a great way to add bulk to a meal without increasing the amount of calories. This helps promote satiety (the feeling of fullness after a meal) and delays gastric emptying. Pectin and vegetable gums easily dissolve in water and leave no after taste. A few teaspoons of powdered pectin or gum is a great way to thicken casseroles, sauces, and dressings without increasing the caloric content.

A study, conducted in 1977 by researchers from the Medical Research Council Gastroenterology Unit, Central Middlesex Hospital, London, found that the addition of both guar gum and pectin to meals significantly reduced postprandial insulin and glucose levels. The additon of guar gum to a liquid test meal reduced blood glucose levels 30 minutes after the meal from an average of 114 mg/dL to 86 mg/dL. A second test, involving a breakfast of butter and marmalade on bread, produced glucose levels 15 minutes after the meal of 111 mg/dL however this was reduced to 102 mg/dL on the addition of 10g of pectin to the marmalade.

Vinegar

Numerous studies have found improvements in postprandial glycemia following vinegar supplementation. A Swedish study, published in the European Journal of Clinical Nutrition in 1998, looked at the effects of vinegar supplementation on postprandial glucose levels following a meal consisting of 122g of white bread, 23g of cheese and 8g of olive oil. The researchers found that the addition of 20g of white vinegar to the meal reduced the postprandial glucose response by 36%.

A second study, also published in the European Journal of Clinical Nutrition, found that pre-boiled potatoes, cooled overnight and served with a vinaigrette sauce containing 28g of vinegar, had a 43% lower glycemic index compared to freshly boiled potatoes not served with vinegar.

Finally, a study conducted by researchers at the Department of Nutrition at Arizona State University, found that the addition of either vinegar or a small amount of peanuts halved the 60-minute glucose response to both a high GL and medium GL test meal. Furthermore, after consumption of the high GL meal, energy consumption throughout the remainder of the day was around 200 to 275 kcal lower when the meal was consumed with either peanuts or vinegar suggesting that the two products increased satiety levels.

Almonds And Other Nuts

A 2007 study, published in the journal Metabolism found that the addition of 30g, 60g, or 90g of almonds to a high GI meal of white bread reduced postprandial glycemia in a dose dependant manner. The addition of 90g of almonds reduced the post meal glycemic response by 58% compared to white bread by itself.

A second study looked at the effects of a single serving of almonds (28g) added to a breakfast meal of bagel, juice, and butter in a group of 19 adults, including 7 type-2 diabetics. Although the almonds didn’t significantly affect the glucose response in healthy individuals, the diabetic group achieved a 30% reduction in postprandial glucose levels.

Frequent nut consumption (including peanuts), has also been shown to substantially reduce the risk of developing diabetes. A 2002 study, published in the Journal of the American Medical Association, found that consumption of 5 servings of nuts (including peanuts) a week reduced the risk of type-2 diabetes in women by 27% while 5 servings or more of peanut butter a week reduced diabetes risk by 21% compared to women who rarly or never consumed peanut butter.

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Root Vegetables & Tubers

Root vegetables and tubers are relatively concentrated sources of sugars and starches and tend to contain only small amounts of fiber. This can be problematic for diabetics because they can produce a large glycemic response in situations when they are not combined with high fiber foods. The glycemic index of root vegetables and tubers range from moderate (40-60) to very high (80+). The lowest GI vegetables are yams, carrots and sweet potatoes with GI values of 38, 47 and 55 respectively. High GI root vegetables include potatoes (GI of 60-90), parsnip (97), rutabaga (71), and beets (65). If you like these vegetables, try and limit your intake to one serving (approx. 200g) a day.

Cooking method also has a significant impact on the GI value of the vegetable. In general, boiling rather than baking or mashing a root vegetable will result in a lower GI. Boiled potatoes for example have a GI of around 70 compared to 80-90 for mashing or baking.

Cooking root vegetables converts some of the starch into simple sugars which are more readily absorbed by the body, increasing their GI values. A raw carrot for example has a GI of just 15, while over-cooking a carrot until it turns to mush can result in a GI as high as 75. The best method of cooking carrots is to lightly steam them as most of the nutritional value will be retained and they will not have a significant impact on your blood sugar levels.

Green And Red Vegetables

Green leafy vegetables such as lettuce, chard, spinach, and the brassicas: broccoli, brussel sprouts, cabbage, cauliflower, bok choy, and kale, are all excellent choices for diabetics and can be consumed in any amounts. These vegetables tend to consist largely of water and fiber and contain very little of the starches and sugars that affect blood sugar levels. 100g of raw cabbage for example contains 92g of water, 2.5g of fiber, and just 3g of sugars.

Red vegetables are also helpful for diabetics because they contain lycopene, a red coloured carotenoid that has been linked to lower rates of prostate cancer and improved cardiovascular health. A 1999 study, published in the American Journal of Epidemiology, found that in both diabetics and individuals with impaired glucose tolerance, lycopene levels were significantly lower than in the general population. The authors also found a negative correlation between fasting insulin levels and levels of lycopene in the blood. High fasting insulin levels are an indicator of insulin resistance suggesting a potential link between high lycopene levels and improved insulin sensitivity.

Lycopene is found in high amounts in red vegetables such as tomatoes, red peppers, and red cabbage. Although not a red vegetable, asparagus also contains a significant amount of lycopene. Cooking tomatoes greatly increases the bioavailability of lycopene, as does consuming the food with a small amount of oil.

Magnesium Rich Vegetables

A high intake of magnesium has been linked to a lower risk of developing type-2 diabetes as well as increased insulin sensitivity. Magnesium deficiency has also been linked to a faster decline of renal function in type-2 diabetics. Diabetics are at a higher risk of magnesium deficiency than the general population because they lose more magnesium through their urine. It has been estimated that as many as 60% of type-2 diabetics are deficient in magnesium.

Magnesium rich vegetables include black beans, spinach, okra, broccoli, artichokes, peas, and Swiss chard.

Other Vegetables

In general, most other vegetables have low to moderate GI values and will not cause diabetics significant problems with glycemic control. In-fact most studies find that a diet high in vegetables reduces an individuals risk of developing diabetes.

Although not vegetables, legumes (peas, beans, and lentils) have GI values ranging from 25-50 and can therefore be eaten safely by diabetics. Legumes are relatively high in amylose, which along with amylopectin, are the two components of starch. Amylose is more slowly digested than amylopectin and thus is less likely to spike blood sugar and insulin levels.

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In general, I am of the belief that better management of diabetes comes not from eating a single food or focusing on a particular food group, but instead from the combined effect of numerous lifestyle and dietary changes such as weight-loss, a higher intake of fruits, vegetables, and whole grains, and increased physical exercise. Having said that, their is certainly a case to be made that substituting table sugar for honey can lead to better glycemic control and an improvement in some cardiovascular risk factors. We will discuss these more in detail below.

Short term effects of honey on blood sugar levels

The easiest way to compare the likely impact on blood sugar levels is to compare the glycemic index values of table sugar and honey. Table sugar (sucrose) has a glycemic index of 62 compared to an average of 54 for honey. This means that compared to table sugar, an equivalent amount of carbohydrates from honey will result, on average, in a 13% lower increase in blood glucose levels. Furthermore, most people find honey to be slightly sweeter than sucrose and therefore can use less of it to sweeten foods (however keep in mind that a teaspoon of honey weighs more than a teaspoon of table sugar because it is denser).

Honey consists of approximately 80% carbohydrate (in the form of various sugars) and 20% water. Like many fruits, honey contains a significant amount of fructose. Although the sugar content varies widely depending on the region the honey was sourced from, fructose and glucose occur in around a 1:1.5 ratio and make up the majority of the sugar content of honey while small amounts of maltose, galactose, sucrose, and around 20 other sugars are also present.

The presence of fructose and glucose together is important because the two seem to work synergistically to improve glucose control. Fructose increases the activity of the enzymes glucokinase and glycogen synthase. Glucokinase is involved in the uptake of glucose by the liver while glycogen synthase is involved in the conversion of glucose to glycogen, which is the long term storage molecule for glucose. Therefore, foods containing fructose help improve glucose uptake and storage, resulting in lower blood glucose levels.

A 2000 study, published in the Journal of Clinical Endocrinology & Metabolism, compared the glycemic response of 11 healthy adults to 75g of glucose, with or without the addition of a small amount of fructose (7.5g). The researchers found that the glucose response, as measured by the area under the 3-hour blood glucose curve, decreased by an average of 19% with the addition of fructose.

Longer term effects of honey

Several studies have looked at the longer term effects of honey consumption on overall health. In general, honey appears to decrease fasting glucose levels and improve various markers of cardiovascular disease. Cardiovascular disease is a big issue for diabetics as the risk of developing heart disease or suffering a stroke is around three times higher than in non-diabetics. Heart attacks and other cardiovascular diseases are responsible for two-thirds of all deaths in the diabetic population.

A 2008 study by researchers at the Heart and Vascular Research Center in Mashhad, Iran, compared the effects of sucrose and honey in a group of 55 overweight volunteers. The participants were randomized to receive either 70 g of sucrose or honey daily for the 30 day study period. The researchers found significant reductions in fasting blood glucose (4.2%), total cholesterol (3%), LDL cholesterol (5.8%), triglycerides (11%), and C-reactive protein (3.2%). In contrast, the above measurements remained unchanged or even worsened slightly in the sucrose group. Furthermore, the body-weight of the volunteers in the honey group actually reduced slightly despite the additional calories from honey and the fact that no other diet or lifestyle changes were made.

The researchers concluded that: “Consumption of natural honey in overweight and obese subjects reduced cardiovascular risk factors, particularly in subjects with elevated risk factors, and it did not increase body weight in overweight or obese subjects.”

Honey exhibits mild anti-inflammatory and anti-oxidant properties which might explain some of the improvements in cardiovascular health observed in the study. Honey also contains trace amounts of the minerals: calcium, iron, magnesium, phosphorus, potassium, zinc, copper, manganese and selenium, many of which play a role in glucose and insulin metabolism as well as the health of the pancreas.

Overall, it appears that substituting honey for table sugar may result in some modest benefits for diabetics however keep in mind that honey still contains a large amount of calories – a tablespoon of honey actually contains more calories than a tablespoon of table sugar due to its higher density. The majority of type-2 diabetics are overweight or obese and in these people weight-loss is generally the best way to improve glycemic control. With that in mind, if you want to try honey rather than sucrose as a sweetening agent, try and limit your consumption of honey to less than a serving a day (approx 20g or 60 calories).

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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.

If you’re feeling adventurous, try adding a small amount of avocado to mashed potato instead of margarine or butter. The avocado will impart a slight greenish tinge to the mashed potato but will not alter taste significantly. The avocado is a rich source of fibre with an impressive 13g of fibre per avocado. In addition to this, avocados are a rich source of oleic acid which has been linked to increased insulin sensitivity in some studies.

French fries are one form of potatoes that should definitely be eaten sparingly. One study, published in the American Journal of Clinical Nutrition in 2006, looked at the effects of potato and french fry consumption on the risk of diabetes in women. The study found that while consumption of both french fries and other forms of potato increased diabetes risk, french fries had a larger effect. Women in the top vs bottom quintile for consumption of french fries had a 21% increased risk of developing diabetes compared to a 14% increased risk for other forms of potato. The researchers suggested that the trans-fat often present in the frying oil might be responsible for the additional diabetes risks associated with french fries.

Fortunately most restaurants and fast food chains are moving towards using trans-fat free oils to fry with. If you choose to eat fries, stick with thick cut fries or wedges as these have a lower ratio of oil to potato (almost half the calories in shoestring fries come from the oil they are fried in).

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 and American 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 7-27%, total cholesterol by 12-26% 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.

Care should be taken not to consume excessive amounts of cinnamon because one variety, known as cassia, contains significant amounts of the chemical coumarin which can cause liver and kidney toxicity in high doses. Generally, levels around 1 teaspoon (3-4 grams) of cinnamon a day are unlikely to cause problems, however cinnamon supplementation should be stopped if any indications of toxicity occur such as tiredness, nuasea, jaundice, weight-loss, or pain in the upper-right abdomen. Those with a history of liver or kidney problems should seek doctors advice before beginning a supplementation regime.

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