In recent decades, we’ve come to understand that lifestyle plays a huge role in the development of Type 2 diabetes. More recently, a multitude of other factors have been identified that can contribute to increased risk for Type 2 diabetes, such as low intake of some essential nutrients, some medications, environmental pollutants, sustained elevated stress hormones and inadequate sleep.
 
Since no one lives in a bubble, when you combine poor diet with lack of physical exercise and other risk factors, you can quickly see why diabetes is epidemic and continuing to increase. The statistics are frightening. The Center for Disease Control (CDC) predicted that 40% of the U.S. population will have diabetes in the future; and for minorities it is even more desperate, with numbers predicted to reach 50% and higher. 
 
Diabetes is a condition that leads to many significant complications, such as kidney disease and the need for dialysis, heart disease, non-traumatic amputations, and even Alzheimer’s. This is about to break our medical system; people want to avoid getting diabetes if at all possible.
 
Diabetes and its complications can be minimized with the right planning and lifestyle; and the need for better diabetes management and prevention present many opportunities for nutrition and lifestyle businesses, as well as supplement manufacturers. 
 
The first thing people need to do is find out their fasting blood glucose level. Hemoglobin A1C and fasting blood glucose levels are the metrics most commonly used to diagnose diabetes. A normal fasting blood sugar level is 65-99mg/dl glucose.  Under 65 is too low and 100 and above is too high; 100-120 is considered a pre-diabetes level and 120 and up is diagnostic of diabetes.  
 
However, risks for diabetes start increasing significantly once blood glucose reaches 85. Every point above 84 creates a 6% increased risk of developing diabetes over the next decade. So blood sugars of 90-94 lead to 49% increased risk of developing diabetes, and blood glucose levels of 95-99 more than double the risk for diabetes compared to people with blood glucose levels of 84 and under.[i] This knowledge offers the opportunity to get proactive for diabetes prevention, in time to actually be more effective. Truly, the time to be concerned about diabetes is long before you get it!
 
So what can be done to help prevent diabetes? It all comes down to reducing risk factors as much as possible.
 
Typical risk factors for diabetes include:
 
Being overweight or obese
Having a family member with diabetes
Being African American, Pacific Islander, Native American or Hispanic descent
Having a blood pressure 140/90
Elevated LDL and not enough HDL cholesterol
Exercising less than three times a week.   
 
While we can’t control some of these factors, people can make an effort to maintain a normal healthy weight and to exercise. Weight gain can lead to insulin resistance, the first step toward diabetes. Exercising three times a week, even if it is a 30-minute walk five days a week, helps prevent insulin resistance and helps manage weight. 
 
Other Risk Factors
Let’s discuss intake of refined carbs. It’s interesting this is rarely ever mentioned as a risk factor considering correlational data between the two is so strong.[ii] 
 
There are dozens, if not hundreds, of studies now that show elimination of refined flours and sugars is the number one way to reduce inflammatory processes that occur from postprandial hyperglycemia. The biggest factor that contributes to arterial plaque formation is postprandial hyperglycemia. Lower carbohydrate diets are also the best choice for people with Metabolic Syndrome, which is when people have become insulin resistant and their blood glucose starts to elevate along with high blood pressure and cholesterol.[iii] So using a low carb diet is the best way to help address the other two risk factors on the conventional list, high blood pressure and cholesterol.
 
As a clinician, I see that most people still take in too many carbs and sugar. In my clinic, we teach patients to count carbs and cut down on the consumption of refined carbohydrates and sugars, while increasing intake of fiber, but it can still be very difficult to do in social situations and while eating out. So any help people can get with this issue is extremely valuable.
 
Intake of whole grains lowers diabetes risk; a big reason may be because of their resistant starch content, a food component that is being heavily researched today. Resistant starches are forms of starch that do not digest. Because they aren’t digested, they travel to the large intestine, where they feed the beneficial flora of the colon leading to improved signaling of gut hormones that control appetite and help with blood glucose regulation.
 
Getting reduced hours of sleep (less than 7) is associated with higher blood glucose levels and increased risk of high blood pressure. Inappropriate cortisol response will lead to higher baseline glucose, as well. These two factors are linked because the number one reason for not being able to sleep is something called hyper-arousal, from elevated evening cortisol levels. So another factor for helping preventing risk for diabetes is addressing chronic stress and sleep issues.
 
There are no good drugs developed for the prevention of diabetes, only the treatment of diabetes once you get it. So when you look at all this, there are several important dietary supplements, food ingredients and lifestyle support products that could help create very robust nutrition and lifestyle plans for reducing diabetic risk or making inroads to better blood sugar control.
 
Essential Nutrients
Magnesium and chromium are two essential nutrients that are needed to help glucose handling in the body. While these are not new in the nutrition community, I mention them again because of their pivotal roles.
 
Magnesium. Studies continue to find low magnesium intake in Americans. When magnesium levels are inadequate, the ability to make energy at a cellular level comes to a halt.  When cells do not make energy efficiently, the demand for fuel (glucose) goes up. Appetite for carbohydrates and sugar will increase to get available fuel ready, but it comes at the cost of pending insulin resistance. This is one of the reasons people with diabetes have a hard time managing their diet. At the cellular level, the message is being sent to the brain to take in more fuel. Research has reported that 500 mg of elemental magnesium per day given to overweight individuals can alter expression of some 60 different genes that control inflammation and glucose related metabolism.
 
Chromium. This trace mineral is essential to the function of insulin receptors. There have been numerous studies that have shown improved parameters related to glucose regulation in dosages of 1-2 mg per day. Most of the time products do not contain nearly the amount needed to improve glucose regulation. Modern diets are poor in chromium content and if someone is beginning to exercise, the loss of chromium is accelerated. 
 
Carb Control & Fiber
Phase 2 White Kidney Bean Extract. Blocking the break down of starch has turned out to be a significant and forward thinking strategy for weight management as well as reducing the absorbable glycemic load of food. Researchers found that a proprietary white bean extract known as Phase 2 can reduce carbohydrate absorption by as much as 60% without affecting the absorption of other nutrients, vitamins or minerals.
 
The other value of this supplement in my opinion is that when starch absorption is inhibited, it will deliver more starch intact to the large intestine, resulting in fueling the probiotic flora, much like resistant starch. This has a significant impact on appetite signaling. FDA has allowed claims regarding starch reduction and weight control, which make this supplement the only product on the market with this type of claim. The reality is, people are going to eat starch in this eat-on-the-go society. Giving consumers tools to partially counteract the effect of the starch they take in is an essential strategy for both short- and long-term responsible weight management.  
 
Conclusion
Currently, brand marketing for diabetes products is directed primarily at people who are already diabetic, but there is a tidal wave of newly diagnosed Type 2 diabetics coming. The “quantified self” movement with all of its technology is paving opportunities for lifestyle brands. 
 
Communicating the early signs and lab values can help target people who may be motivated to change lifestyle and dietary habits. It will be important to employ measures for reduced carb intake like Phase 2, blood sugar support nutrients like magnesium and chromium, and stress and sleep support supplements, as well as technology products that can help drive better adherence to dietary choices and encourage exercise—both of which are foundational for preventing and reducing diabetic risk.  

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Jim LaValle, RPh, CCN is a clinical pharmacist, certified clinical nutritionist, with more than 30 years of clinical experience in natural therapeutics. He is best known for his expertise in metabolic and integrative medicine, with extensive background in natural products, lifestyle, drug/nutrient depletion, and uncovering the underlying metabolic issues that keep people from feeling healthy and vital. He has developed health programs for the fitness industry, professional sports teams and healthcare companies. Dr. LaValle is an appointed faculty member and course director for the Integrative Medicine postgraduate program at George Washington University School of Health Sciences. He has trained thousands of healthcare professionals on the value of predictive health and modeling healthcare practices to incorporate lifestyle, diet and natural therapies as part of the health equation for Americans. He is author of more than 20 books including, “Cracking the Metabolic Code,” “Nutritional Cost of Drugs,” and his latest book, “Your Blood Never Lies.” He was named one of the “50 Most Influential Pharmacists” by American Druggist magazine and in 2011 was named National Clinician of The Year by the Natural Products Association.