How to Reverse Prediabetes
What Is Prediabetes?
Prediabetes is defined as a condition of slightly elevated blood glucose levels and is high risk for the development of type 2 diabetes. Usually there are no obvious symptoms, but damage is already occurring from elevated blood sugar. The heart, blood vessels, and kidneys are the organs most affected, but a low level ripple effect occurs throughout the body with this borderline blood sugar dysfunction.
When prediabetes worsens and progresses into diabetes, it may cause symptoms that include darkening of the skin on certain body parts like the neck, elbows, knees, knuckles, and arm pits as well as frequent urination, increased thirst, fatigue and blurred vision. Skin tags are also a sign of impaired glucose tolerance and insulin resistance.
High blood pressure, elevated total cholesterol, LDL, and triglycerides, and low HDL are associated with prediabetes and type 2 diabetes. Waist size is an indication of prediabetes trending toward diabetes. The general rule of thumb that indicates insulin resistance for men is a waist size larger than 40 inches and in women a waist size larger than 35 inches. There are exceptions that can occur as those who are slim and do not have expanding waistlines can also be prediabetic.
Other common risk factors related with prediabetes diagnosis include women and girls who have a history of polycystic ovary syndrome/PCOS or gestational diabetes. Sleep apnea, sedentary lifestyle, poor diet, and diabetic family history are other common risk factors. Prediabetes is more common in those 45 years of age and older, but children and teenagers are now experiencing prediabetes and type 2 diabetes at alarming rate. Certain ethnic backgrounds like African-Americans, Hispanics, Native Americans, Asian-Americans, and Pacific Islanders are more likely to develop prediabetes according to the Mayo Clinic.
Know Your Hemoglobin A1C and Blood Sugar Levels
Prediabetes diagnosis is based on two lab tests – hemoglobin A1C and fasting blood sugar. Hemoglobin A1C measures the percent of blood sugar attached to hemoglobin, a type of protein in your red blood cells. The A1C measurement reflects an average of blood sugar levels for the previous two to three months. When blood sugar levels are elevated, it sticks to hemoglobin making tissues stiff and leading to advanced glycation end products (AGE). As tissues like capillaries, nerve cells, and cell membranes become stiff from AGE, the body has to work harder, and more cellular inflammation and damage occurs. Healthy, optimal hemoglobin A1C test is between 4.8 to 5.5 percent. An A1C level between 5.7 and 6.4 percent is considered prediabetes. Hemoglobine A1C levels at 6.5 percent and higher is considered diabetic.
A1C measurements can be thought of like a Richter scale or earthquake rating system. For each tenth of a point increase in the A1C, it creates a measureable jump in tissue inflammation and stiffness from elevated blood sugar, especially in the brain. In 2013, the New England Journal of Medicine proved that an A1C above 5.5 percent adversely affects brain health with substantial neurodegeneration and dementia risk. An A1C at 5.5 is normal, but dementia changes were seen starting at an A1C of 5.7, which is the low end of the range of prediabetes.
The A1C test is not perfect but it provides helpful information. Individuals with insulin resistance and high blood sugar often experience very low blood sugar. In these situations, the high and low blood sugar levels can affect the interpretation of the A1C. The high and low blood sugar number may fool averages and the actual stress on the body.
Normal fasting blood sugar levels are 80-100. The ideal range is 65-85. Impaired or prediabetic fasting blood glucose values are 100-125 mg/dl. If you take the oral glucose tolerance test and blood sugars are 140-199 at two hours after the start of the test, then you have impaired glucose tolerance. It can be helpful to also know your insulin level. This is a blood test just like fasting glucose and A1C.
Prediabetes Leads to Cell Changes and Increased Disease Risks
Heart disease and some cancers are found with or fueled by prediabetes. These concerns start slow and subtle, in a subclinical manner in prediabetes. Subclinical refers to the beginning of the disease before symptoms occur and common medical tests can identify it. In the case of heart disease and atherosclerosis, sophisticated imaging and lab studies have shown early presence of atherosclerosis within the blood vessel walls in prediabetic adults well before standard labs and symptoms present.
Early heart disease and atherosclerosis changes are seen in adults but also adolescents with prediabetes and type 2 diabetes. Researchers found that obese, insulin resistant teenagers had inflamed inner endothelial blood vessel linings. Higher levels of VLDL cholesterol particles and small dense LDL particles were found which indicates micro-damage to the blood vessels. Large visible changes to larger structure and function of blood vessels were not seen, yet early disease was visibly present.
An analogy to microvascular damage is like the small cracks seen in the infrastructure of roadways and bridges. As time and repetitive traffic flow occurs over the cracks, it creates chronic wear-and-tear that leads to larger visible structural changes like potholes, rough roads, and rusty bridges. Tackling road repair with minor cracks is much easier to do than rebuilding the road. Likewise, dietary, lifestyle, and early inflammation management is much easier to do than quadruple coronary by-pass, heart stints, insulin and multiple meds later in the disease process.
The study above describes a very important finding pertaining to heart disease and LDL. LDL cholesterol health depends not just on the number. What LDL means to the health of the blood vessels depends on the type of LDL particle size, i.e. small and dense or large and fluffy. Small, dense LDL particle size is associated with high inflammation and increased disease. Large and fluffy is healthy, beneficial, and protective. Small, dense LDL particle size is driven by high carbohydrate/ sugar intake. LDL is also impacted by other key factors. LDL particle size can be measured in blood tests available through your provider.
Cancer risk has been found to increase with prediabeties. A recent literature review study identified that a slight increase in fasting blood sugar (prediabetes) particularly in men led to an increase in cancer mortality. Stomach, liver and pancreatic cancer were the most common cancers found linked with prediabetes.
What Causes Prediabetes?
If the viewpoint on prediabetes causing disease is reversed, we find that various disorders can actually lead to prediabetes, in addition to the factors listed above. In these cases, it is important to address the underlying disorder to help the body better manage blood sugar. There are a number of factors to consider including thyroid, gut bacteria, sleep, magnesium deficiency, iron/ferritin deficiency and even bone health and osteoporosis.
Elevated A1C numbers and prediabetes occur for reasons outside of the risk factors listed earlier. Some factors that lead to prediabetes relate to thyroid, gut bacteria, sleep disorders, and even bone health and osteoporosis. Recent research identified that individuals with an elevated thyroid stimulating hormone (TSH) had a 15 percent increase risk of prediabetes compared to those who had a normal TSH.
Other hypothyroid studies found that those with higher FT4 (free thyroxine) levels compared to low FT4 levels have a lower risk of prediabetes and diabetes. Individuals who had low and low-normal thyroid function had a higher likelihood of prediabetes and an increased likelihood of prediabetes progressing into type 2 diabetes.
Gut Bacteria Imbalances
In the last decade, research on the gut flora has identified numerous far-reaching effects throughout the body. Imbalanced gut bacteria can cause development and progression of prediabetes, metabolic syndrome and insulin resistance. Healthy gut bacteria has been shown to prevent and treat prediabetes in some various populations as it can improve insulin sensitivity.
In addition, the composition of gut bacteria is impacted by changes in sleep and circadian rhythm. For example, shift workers are at high risk of diabetes, metabolic syndrome, and prediabetes. Circadian rhythm disruption from shift work negatively impacts the gut bacteria leading to dysbiosis and even changes in intestinal permeability. The change in gut bacteria from circadian rhythm disruption and shift creates a cascade effect which leads to impaired glucose metabolism, insulin resistance, obesity, prediabetes, diabetes, and other disorders.
Sleep disturbances which includes obstructive sleep apnea, insufficient sleep, and poor sleep quality worsens blood sugar management and glucose tolerance. Sleep habits, sleep disorders, and shift work throw a metabolic monkey wrench into hormones and metabolism which can lead to prediabetes and diabetes.
Low Magnesium and Iron Levels Linked with Prediabetes
Inadequate magnesium is associated with prediabetes. Researchers found that even just 0.1 mmol/l decrease in blood magnesium levels was linked with a significant increase in prediabetes and diabetes. Studies like this prove that even little differences can make a significant impact in function. Strive to have your magnesium levels in the upper range of the serum magnesium test.
Low iron and low serum ferritin levels can also lead to elevated hemoglobin A1C and prediabetes. This can be easily overlooked. Low serum ferritin is the first stage of iron deficiency. Low ferritin levels stress the pancreas, thyroid, mitochondria, and normal metabolism. If prediabetes does not makes sense for your medical history, i.e. it is occurring without diet and lifestyle challenges, evaluate your ferritin levels. Once these levels are corrected, hemoglobin A1C may improve.
Bones Affect Blood Sugar
Emerging research is painting a fascinating link with bone health and blood sugar. Bones are now being described as an endocrine organ and involved with blood sugar regulation. A recent study showed that osteoclasts (cells that break down bones) actively regulate blood sugar homeostasis. When osteoclasts were too overactive as seen with bone loss and osteoporosis, it led to impaired blood sugar regulation.
One of the hormones with this relationship is osteprotegerin or OPG. This hormone is being considered as a screening tool to evaluate postmenopausal women for prediabetes and increased osteoporosis risk. Even though this research is new, it gives us a new picture that bones play a role in blood sugar management. If your bones aren't healthy, it is likely they are contributing in some way to insulin resistance, prediabetes, and even diabetes.
You can think of prediabetes as a warning light indicating that you have a tire with low pressure. You don't have a flat tire yet and the vehicle is still drivable. However, you don't know how long you can drive on it before it will blow out or run flat. You can put off getting the tire repaired or replaced until there is a crisis and you are forced to do it. This is akin to ignoring the prediabetes with the damage escalating. Then all of a sudden, you have the disease of type 2 diabetes and are now on several medications and perhaps even insulin and face real risks with heart disease, stroke, kidney failure, blindness, and dementia.
If you have concerns with thyroid (Hashimoto's, Grave's disease, etc.), gut issues (SIBO/SIFO, dysbiosis, Crohn's, Ulcerative Colitis, etc.), sleep disorders and lack of sleep, osteopenia/osteoporosis, or low magnesium or iron levels, then you are at risk of becoming one of the 54 million with prediabetes. Address the underlying health concern.
Great information can be found in our Health Topics. Support for blood sugar should also be considered to help relieve prediabetic stress. Start following The Leptin Diet for high protein, good fats and low carbohydrate intake for optimal dietary management. Top nutrients include chromium, B vitamins, r-alpha lipoic acid, carnosine, cinnamon extract, omega-3 fish oils, and fiber. Are you going to fix the bad tire before it fails or are you putting it off until you absolutely have to do something?
Cinnamon – This popular spice has been used for centuries as it has exemplary track-record for blood sugar support and insulin function. Cinnamon also supports healthy cholesterol. It is considered the “king of antioxidants spices” providing a wealth of uses for the protection against AGEs/Advanced Glycation End products, immune system, brain, blood pressure, fatty liver and more. We offer a standardized extract that provides potent quality with other blood sugar supportive nutrients.
Chromium – Chromium is a trace mineral essential for blood sugar metabolism. Diets high in carbohydrates, processed foods, and conventional agricultural methods leads to diminished chromium levels that the body needs for blood sugar management. Together with exercise, chromium helps the body burn sugar for energy.
Probiotics – Beneficial bacteria for the gut or probiotics are vital for health. Imbalanced gut bacteria are known to contribute to poor blood sugar metabolism, metabolic syndrome, prediabetes, and diabetes. Non-beneficial bacteria also contributes to weight gain. Beneficial bacteria like Lactobacillus and Bifido bacterium help support healthy gut flora.
Ashwagandha – This adaptogenic herb has been used for thousands of years for thyroid support, stress tolerance, and to rejuvenate the body. It also helps provide antioxidant and cholesterol support. Ashwagandha research shows that it supports healthy blood sugar management and reduces cortisol stress.
Magnesium – Magnesium is involved with several hundred processes in the body making it a much needed daily nutrient. Inadequate magnesium is prevalent in diets and rapidly depleted with stress. Lack of magnesium has been found as a reason for blood sugar stress. Avoid low quality forms of magnesium oxide or carbonate. Easy to absorb magnesium forms includes magnesium glycinate, magnesium malate, and magnesium from coral minerals.