The CDC reports that 96 million Americans, or nearly one in three, have prediabetes—and most of them don’t know it.
How do you know if you have prediabetes? Does it mean you’re on the verge of developing type 2 diabetes? What can you do to reverse it.
What Is Prediabetes?
Prediabetes is diagnosed when your blood sugar is higher than normal, but lower than the diabetes range. It is usually diagnosed based on these blood tests:
- Fasting blood sugar: 100–125 mg/dl. Normal fasting blood sugar is less than 100; 126 and higher is suggestive of diabetes.
- Hemoglobin A1C: 5.7% to 6.4%. Normal A1C, which is a measure of the average blood sugar over the previous three months, is below 5.7%; above 6.4% is indicative of diabetes.
Diabetes is a serious condition that affects more than 11% of our population. Uncontrolled blood sugar damages your heart, nerves, kidneys, eyes, and other organs, and I’m all for anything that helps put the brakes on diabetes.
Yet, I am not convinced that labeling 96 million people with a new “disease” is helpful. If a diagnosis of prediabetes is treated as a wake-up call that encourages you to exercise, eat better, and lose weight, great.
My beef with prediabetes is that, by design or by chance, it leads to more medications. Lifestyle changes and weight loss are hard, and when half-hearted efforts fail, the next step is a prescription drug.
Should You Take Metformin for Prediabetes?
The most common drug prescribed for prediabetes is metformin. Metformin is the safest diabetes drug and one of the few that does not cause weight gain. Yet I do not recommend metformin for prediabetes. Side effects include nausea, stomach upset, vomiting, diarrhea, vitamin B12 deficiency, and, in rare cases, hypoglycemia or lactic acidosis.
The main reason I don’t recommend metformin for prediabetes, however, is because it doesn’t hold a candle to lifestyle changes.
The Diabetes Prevention Program Outcomes Study is a long-term, placebo-controlled clinical trial comparing the effects of metformin and lifestyle changes in patients with prediabetes who were considered to be at high risk of developing type 2 diabetes. In a 10-year follow-up, researchers found that when compared with a placebo:
- Metformin reduced the risk of developing diabetes by 18%. Plus, in those who did develop it, the diagnosis was delayed by two years. There were also improvements in A1C and fasting blood sugar.
- Lifestyle interventions reduced diabetes risk by 34%. Study participants who were assigned to this group, which included diet changes and exercise aimed at weight loss, were 34% less likely to develop diabetes over 10 years, and if they did, it was delayed by four years. In addition to lower A1C and blood sugar, they also had reductions in cardiovascular risk factors.
As you can see, lifestyle changes are the clear winner.
Prediabetes Lifestyle Changes
If you want to focus on just one thing to prevent or treat prediabetes and diabetes, make it weight loss. You don’t have to get down to your fighting weight or fit into your wedding dress to reap benefits. Losing just 5%–7% of your initial weight, say 10–15 pounds, makes a difference.
The best way to accomplish this is to get serious about the following lifestyle changes:
- Diet: Avoid sugars and processed carbohydrates and eat lots of nutrient-rich whole foods. A low-glycemic Mediterranean diet works best for most people. It includes high-fiber vegetables, lean protein, eggs, dairy, olive oil, nuts, seeds, legumes, and modest amounts of fruit and whole grains.
- Intermittent fasting: Eating less often does more than reduce your calorie intake. Intermittent fasting also stimulates fat-burning, which makes weight loss easier and has positive effects on other markers of health.
- Exercise: A combination of aerobic exercise and strength training to increase muscle mass is ideal for improving weight, blood sugar, and insulin sensitivity.
- Coffee: People who drink three or more cups of coffee per day are significantly less likely to develop diabetes.
- Alcohol: Studies suggest that modest alcohol intake, such as a glass of wine with meals three or four days a week, may reduce the risk of developing diabetes. Do not exceed this recommendation; heavy drinking is damaging on many levels. And if you do not drink, don’t start.
Best Supplements for Prediabetes
Although lifestyle changes are paramount, a solid nutritional supplement program also helps stave off diabetes and supports overall health. The best supplements for prediabetes include:
- Multivitamins: Make sure your daily multi contains above-RDA doses of magnesium, which has been shown to improve glucose control in prediabetes; antioxidants to protect against oxidative stress caused by elevated blood sugar; and vitamin D since deficiencies are linked with an increased risk of diabetes.
- Berberine: This botanical, which targets the same molecular pathways as metformin, helps lower blood sugar and improves insulin sensitivity. In a handful of clinical trials, berberine was shown to work as well as metformin. The recommended dosage is 1,500 mg per day, taken in divided doses.
- Chromium: Initially called glucose tolerance factor, chromium is a mineral that increases insulin sensitivity, which is the main problem in prediabetes and type 2 diabetes. The suggested daily dosage is 400–600 mcg.
- Botanicals: Several botanicals with deep roots in traditional medicine have been studied for their effects on blood sugar and prediabetes. They include banaba leaf, cinnamon, gymnema, and purslane. Use as directed.
Research suggests that these natural ingredients may work even better when taken together.
For example, in a 12-week placebo-controlled clinical trial, individuals with prediabetes were randomly divided into two groups and assigned to take a supplement containing berberine, chromium, and cinnamon or a placebo pill. When they were retested, the supplement group had significant improvements in oral disposition index, which is a predictor of the likelihood of developing diabetes over a 10-year period.
A diagnosis of prediabetes doesn’t mean you are destined to develop type 2 diabetes—but it does mean you may be heading down that path.
If your doctor diagnoses you with prediabetes, don’t despair—get motivated! Vow once and for all to lose weight and stick with a healthy diet and exercise program. Start taking a basic nutritional supplement program and, for extra support, consider berberine, chromium, cinnamon, and other natural compounds that support healthy blood sugar levels.
Nipping prediabetes in the bud before it progresses to type 2 diabetes can add years to your life and life to your years!