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      Dietary and nutraceutical approach to type 2 diabetes

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          Abstract

          Nutritional medical treatment is the first step to achieve adequate glycemic control and prevent diabetic complications. Lifestyle changes include moderate weight loss (7%) and regular physical activity (150 min/week). The appropriate diet composition is < 30% total fat, < 10% saturated fats, > 15 g/1000 kcal fiber, half soluble, 45–60% of carbohydrates with amoderate intake of sugar (50 g/day) and protein intake of 15–20% of the total calories a day. Patients need to limit the intake of saturated fats to < 7% of the daily calorie intake. Monounsaturated fatty acids such as olive oil and other vegetable oils are recommended. L-carnitine, α-lipoic acid, berberine and ω-3 fatty acids can be useful supplements.

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          Human epicardial adipose tissue is a source of inflammatory mediators.

          Tomasz Mazurek, LiFeng Zhang, Andrew Zalewski … (2003)
          Inflammatory mediators that originate in vascular and extravascular tissues promote coronary lesion formation. Adipose tissue may function as an endocrine organ that contributes to an inflammatory burden in patients at risk of cardiovascular complications. In this study, we sought to compare expression of inflammatory mediators in epicardial and subcutaneous adipose stores in patients with critical CAD. Paired samples of epicardial and subcutaneous adipose tissues were harvested at the outset of elective CABG surgery (n=42; age 65+/-10 years). Local expression of chemokine (monocyte chemotactic protein [MCP]-1) and inflammatory cytokines (interleukin [IL]-1beta, IL-6, and tumor necrosis factor [TNF]-alpha) was analyzed by TaqMan real-time reverse transcription-polymerase chain reaction (mRNA) and by ELISA (protein release over 3 hours). Significantly higher levels of IL-1beta, IL-6, MCP-1, and TNF-alpha mRNA and protein were observed in epicardial adipose stores. Proinflammatory properties of epicardial adipose tissue were noted irrespective of clinical variables (diabetes, body mass index, and chronic use of statins or ACE inhibitors/angiotensin II receptor blockers) or plasma concentrations of circulating biomarkers. In a subset of samples (n=11), global gene expression was explored by DNA microarray hybridization and confirmed the presence of a broad inflammatory reaction in epicardial adipose tissue in patients with coronary artery disease. The above findings were paralleled by the presence of inflammatory cell infiltrates in epicardial adipose stores. Epicardial adipose tissue is a source of several inflammatory mediators in high-risk cardiac patients. Plasma inflammatory biomarkers may not adequately reflect local tissue inflammation. Current therapies do not appear to eliminate local inflammatory signals in epicardial adipose tissue.
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            Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association.

            John Bantle, Judith Wylie-Rosett, Ann Albright … (2008)
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              Efficacy of berberine in patients with type 2 diabetes mellitus.

              Jun Yin, Huili Xing, Jianping Ye (2008)
              Berberine has been shown to regulate glucose and lipid metabolism in vitro and in vivo. This pilot study was to determine the efficacy and safety of berberine in the treatment of type 2 diabetes mellitus patients. In study A, 36 adults with newly diagnosed type 2 diabetes mellitus were randomly assigned to treatment with berberine or metformin (0.5 g 3 times a day) in a 3-month trial. The hypoglycemic effect of berberine was similar to that of metformin. Significant decreases in hemoglobin A1c (from 9.5%+/-0.5% to 7.5%+/-0.4%, P<.01), fasting blood glucose (from 10.6+/-0.9 mmol/L to 6.9+/-0.5 mmol/L, P<.01), postprandial blood glucose (from 19.8+/-1.7 to 11.1+/-0.9 mmol/L, P<.01), and plasma triglycerides (from 1.13+/-0.13 to 0.89+/-0.03 mmol/L, P<.05) were observed in the berberine group. In study B, 48 adults with poorly controlled type 2 diabetes mellitus were treated supplemented with berberine in a 3-month trial. Berberine acted by lowering fasting blood glucose and postprandial blood glucose from 1 week to the end of the trial. Hemoglobin A1c decreased from 8.1%+/-0.2% to 7.3%+/-0.3% (P<.001). Fasting plasma insulin and homeostasis model assessment of insulin resistance index were reduced by 28.1% and 44.7% (P<.001), respectively. Total cholesterol and low-density lipoprotein cholesterol were decreased significantly as well. During the trial, 20 (34.5%) patients experienced transient gastrointestinal adverse effects. Functional liver or kidney damages were not observed for all patients. In conclusion, this pilot study indicates that berberine is a potent oral hypoglycemic agent with beneficial effects on lipid metabolism.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Med Sci
                Journal ID (iso-abbrev): Arch Med Sci
                Journal ID (publisher-id): AMS
                Title: Archives of Medical Science : AMS
                Publisher: Termedia Publishing House
                ISSN (Print): 1734-1922
                ISSN (Electronic): 1896-9151
                Publication date (Electronic): 13 May 2014
                Publication date (Print): 12 May 2014
                Volume: 10
                Issue: 2
                Pages: 336-344
                Affiliations
                [1 ]Department of Internal Medicine and Therapeutics, University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
                [2 ]Center for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research, University of Pavia, Pavia, Italy
                [3 ]Cardiology Department of the School of Medicine, Universidad Autonoma de Guadalajara, Jalisco, México
                Author notes
                Corresponding author: Celina Preciado Limas, Cardiology Department, School of Medicine, Universidad Autonoma, de Guadalajara, Jalisco, México. E-mail: PCeballos@ 123456gruporimsa.com.mx
                Article
                Publisher ID: 22716
                DOI: 10.5114/aoms.2014.42587
                PMC ID: 4042055
                PubMed ID: 24904670
                SO-VID: c00d4eb1-e670-4560-8e90-e5b76d219e30
                Copyright © Copyright © 2014 Termedia & Banach
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 05 September 2012
                Date revision received : 13 November 2012
                Date accepted : 31 January 2013
                Categories
                Subject: State of the Art Papers

                ScienceOpen disciplines: Medicine
                Keywords: berberine,diabetes,diet,l-carnitine,ω-3
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: berberine, diabetes, diet, l-carnitine, ω-3

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