Active management of blood glucose levels should be a standard practice of any longevity protocol. Rising glucose levels as we get older can be the harbingers of many age-related chronic diseases. Fortunately, lifestyle factors such as diet, exercise, and good quality sleep are all effective tools in maintaining healthy and stable blood sugar levels. There are also a number of natural supplements that can be helpful in both lowering overall glucose levels as well as attenuating the glycemic responses (spikes) to meals. Here we dive into 5 of these tools and look at the evidence behind their effectiveness.
A Quick Primer on Blood Sugar Regulation
In healthy individuals, blood sugar is regulated by hormones produced in the pancreas—insulin and glucagon. When you consume carbohydrates, they get broken down into sugars that are transported to the bloodstream and on to your cells. The pancreas secretes insulin which acts like a key, providing an access point for sugar to enter the cells. When your blood sugar dips below normal levels, the pancreas secretes glucagon, a hormone that acts in the liver to break down glycogen stores and return blood sugar levels to normal. Maintaining your blood sugar within normal ranges is critical for your brain and organ systems to perform their functions and allow you to participate in exercise and daily activities.
Source: Decoding Diabetes Mellitus
Normal regulation of blood glucose can sometimes go awry. People born with type 1 diabetes carry genetic mutations that prevent the pancreas from producing insulin. The result is chronically high blood sugar levels which, if left untreated, can have severe health consequences, including death. For this reason, type 1 diabetics must take insulin to maintain normal blood sugar levels.
People can also become resistant to the effects of insulin over time, resulting in type 2 diabetes. Although the science on the exact causes that drive diabetes is still evolving, it is clear that lifestyle factors such as poor dietary habits, lack of exercise, heart disease, and obesity are all common risk factors. One popular hypothesis is that the convergence of lifestyle choices, genetic factors, and central obesity (belly fat) disrupt normal processes in the cell that are necessary to metabolize glucose. The cells become resistant to the action of insulin and as a result, blood sugar levels become abnormally high. When high blood sugar is left uncontrolled, it eventually leads to type 2 diabetes.
There are a number of drugs that are used to control blood glucose levels in people diagnosed with diabetes. One that is commonly prescribed is metformin, which has also been shown to have healthspan extension effects. Another class of drugs rising in popularity are called SGL-2 inhibitors. In patients who are either non-compliant or have persistently high blood sugars, additional medications such as glipizide, januvia, trulicity can also be added to the treatment plan to help avoid complications.
However, there is a growing movement outside the traditional medical establishment to not only treat diabetes, but to reverse it through a combination of lifestyle adjustments. At the forefront of this effort are companies such as Virta Health, which recently published the results of a 2-year study showing the remarkable effects of lifestyle interventions in pre-diabetic patients.
This is a refreshing change from simply managing diabetes as a chronic disease, and it should come as no surprise as approximately 75% of chronic disease can be traced back to lifestyle factors like diet, exercise, stress management and smoking.
Go deeper with these studies on using lifestyle interventions to treat and reverse diabetes:
- Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
- Intensive lifestyle changes are necessary to improve insulin sensitivity: A randomized controlled trial
- Self-management education for adults with type 2 diabetes: A meta-analysis of the effect on glycemic control
- XENical in the prevention of diabetes in obese subjects (XENDOS) study: A randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients
- Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance
Natural supplements to help you keep a lid on glucose levels
If you are following the traditional advice of avoiding processed carbs and refined sugars, eating more plant-based food, and avoiding high GI fruits, but you still don’t have your glucose levels where you want them, here are 5 somewhat unconventional alternatives that may help you reach your goals.
1. Apple Cider Vinegar
The studies we found on Apple Cider Vinegar and glycemic control are small but suggest favorable effects. This randomized crossover trial (N=19) found that when compared to placebo, consuming a mixture of 20 mL of apple cider vinegar, 40 mL of water and 1 tsp of saccharine significantly increased insulin sensitivity by 34% in insulin resistant participants and 19% in diabetic participants following meals. Another randomized crossover (N=11) found that consuming 2 tablespoons of apple cider vinegar before bed lowered fasting glucose by 2% the following morning. The most robust study we found was this meta-analysis and review of six studies (N=317) that suggests that apple cider vinegar lowers fasting plasma glucose and HbA1C (a measure of how tightly controlled your glucose levels are over time) in diabetics.
The mechanism behind vinegar’s beneficial effects on blood sugar may be due to delayed gastric emptying (food exiting the stomach). According to multiple sources (e.g., study 1, study 2, study 3) the acetic acid found in apple cider vinegar slows the rate of gastric emptying, thus delaying absorption of dietary carbs and slowing the rise in blood sugar. Essentially, acetic acid helps to attenuate your glycemic response to a meal and prevent sharp rises in blood sugar levels.
Look for an organic, raw, apple cider vinegar like this one we found on Amazon ($7). Be sure to dilute it to avoid stomach irritation and damage to your teeth. We suggest a 1:8 ratio—that is, 1 teaspoon of apple cider vinegar to 8 ounces of water. The typical recommendation is to take some ACV prior to a meal.
While there is no set dosage for ACV, be aware that consuming too much of it can reduce potassium to dangerous levels. The following groups should use caution and consult with their doctor before using this product:
- People with kidney problems or a history of ulcers
- People taking insulin or furosemide (Lasix)
2. Bitter Melon
Bitter melon is a type of gourd that grows in parts of Asia, South America, the Caribbean, and East Africa in a broad variety of shapes and sizes. This green fruit, which grows in bitterness as it ripens, has been used in alternative medical practices for centuries for a number of purposes including helping to control blood sugar.
Research into the effectiveness of bitter melon suggests a possible benefit in glucose regulation although the studies we found are relatively small and dosages across them vary significantly making direct comparisons difficult. This systematic review and meta-analysis of ten studies (N=1043) suggests that bitter melon has beneficial effects on fasting glucose and HbA1C; however, the authors also note the need for larger, high quality studies to corroborate these findings. Similarly, in this 2021 review of evidence on the use of bitter melon in treatment of diabetics, the authors suggest a beneficial effect, but advocate for additional research on bitter melon’s pharmaceutical applications as current studies are still in the early stages of development. Perhaps the single most robust study we found was this randomized, double-blind trial in which participants were split into 4 groups: group one received 500 mg of bitter melon per day, group two received 1,000 mg of bitter melon per day, group three received 2,000 mg of bitter melon per day, and controls received 1,000 mg of metformin per day. After four weeks, participants consuming 2,000 mg of bitter melon per day had a significant reduction (-10 points) in fructosamine (a measure of blood sugar over the past 2-3 weeks) that was comparable to the metformin controls (-16 points). There was no significant change in groups consuming 500 or 1,000 mg of bitter melon per day.
Mechanistically, bitter melon mimics the properties of insulin and can help cells uptake sugar from the blood and use it as energy. There is no standard dosage of bitter melon available at this time so supplements vary in their concentration. Bitter melon can be purchased as a whole fruit and incorporated into recipes like this one for bitter melon stir-fry.
High consumption of bitter melon may interfere with certain medications and have other unwanted side effects. Consult with your doctor before you begin consuming bitter melon to lower your blood sugar.
Cinnamon is a common spice derived from the bark of Cinnamomum trees. In the US, cinnamon is classified in two types: ceylon cinnamon and cassia cinnamon. Ceylon is more expensive and has more antioxidants per serving; it’s sometimes called “true cinnamon”. Cassia cinnamon is the more common of the two and therefore less expensive. Both types have positive links to health and many research studies suggest that cinnamon can be beneficial for controlling blood sugar.
Studies on cinnamon as an alternative diabetes therapy have shown varying, but mostly favorable results. For example, this double-blind placebo-controlled trial (N=22) of pre-diabetics found that supplementing 500mg of cinnamon per day for 12 weeks reduced measures of oxidative stress by 14%, effectively diminishing one of the risk factors for progression to type 2 diabetes. Cinnamon has also been shown to increase insulin sensitivity. This small study (N=7) found that 5g of cinnamon significantly improved insulin sensitivity for as long as 12 hours and reduced glycemic response by as much as 13% in an oral glucose tolerance test (OGTT). Another small study (N=8) echoed these findings, showing that supplementing 3g of cinnamon per day for 2 weeks reduced both glucose and insulin responses, by as much as 13% and 27%, respectively. Authors of this review and meta-analysis of 10 randomized clinical trials (N=543) conclude that consumption of cinnamon is associated with a statistically significant decrease in levels of fasting plasma glucose by an average of nearly 25 points.
Based on what we found, cinnamon appears to act as an insulin mimetic. In fact, this in vitro comparative study found that cinnamon increases glucose uptake by the cells in the same way that insulin does. Doses of cinnamon In these clinical studies vary significantly (between 1-6g per day), although we did not find any evidence showing a dose-dependent response of blood glucose levels to cinnamon consumption.
Cassia cinnamon is particularly high in a potentially dangerous plant compound called coumarin. For this reason, the resources we found suggest small doses of cassia cinnamon not exceeding 0.5-1g per day. Ceylon cinnamon has lower levels of coumarin, but should not exceed 6g per day or about 1 teaspoon.
Berberine is a plant compound used in Ayurvedic and traditional Chinese medicine to treat different types of infections due to its antimicrobial properties. It’s not commonly used in Western medicine, but research suggests that it can be a useful tool in lowering blood sugar. According to this randomized clinical trial (N=116), when compared to placebo, patients with type 2 diabetes who took 1g of berberine daily for 3 months lowered their fasting and postload plasma glucose by nearly 2.5 points and their HbA1C by 1. These might not seem like significant values, but a drop in A1C of 1 point can spell the difference between a normal score and an elevated one.
Berberine is also a useful tool when combined with more traditional therapies. This meta-analysis of 27 randomized trials (N= 2,569) concluded that diabetic patients taking berberine plus adopting a lifestyle change had lower fasting plasma glucose, postprandial glucose, and HbA1C than lifestyle change alone or placebo. Furthermore, this review of 14 trials (N=1,068) suggests that when combined with traditional diabetes drugs like metformin and glipizide, berberine produces better glycemic control than medication alone.
Sources (here, here) suggest that berberine may lower blood sugar in a number ways such as increasing insulin sensitivity and insulin production, increasing the breakdown of sugar by the body, and slowing the rate of carb breakdown and absorption from the gut. There is no standard dosage of berberine, although most supplements, like this Amazon best seller ($22), appear to cap their dosage at 1,200mg/day.
Berberine is generally considered safe and is well tolerated by most people. Some may experience digestive side effects (e.g., diarrhea, constipation, stomachache). As with any supplement, consult with your doctor before you begin taking berberine to lower your blood sugar.
5. Ketone esters
Ketones esters are water-soluble exogenous ketone bodies used in nutritional supplements. Under normal conditions, ketones are produced by the body when it’s in a fasted (i.e., starved) state through the breakdown of fat for energy once glycogen stores have been depleted. Recently, ketone esters have garnered interest in the scientific community based on the results of this recently published study. In this randomized crossover trial (N=20), participants were randomized to consume a ketone monoester supplement or water following a 10 hour fast. Thirty minutes later, participants were given a drink with 75g of glucose for an oral glucose tolerance test. Analysis of the results suggested that when compared to placebo, ketone ester supplements lowered the glycemic response and improve insulin sensitivity by 11%.
Other sources of information are purely anecdotal. One of our favorite longevity experts, Peter Attia, covered his experience with ketone ester supplements in this blog post on his website. According to the results of his own self-experimentation, the supplements did produce a hypoglycemic response, though Dr. Attia doesn’t appear keen to try them again any time soon because of the taste and digestive side effects he experienced.
Research into ketone esters is relatively new and additional safety studies need to be completed as well as studies into their mechanism. However, based on the aforementioned study and Dr. Attia’s anecdotal account, there likely is merit to the effect of ketone esters on blood sugar. If you decide to purchase a ketone ester supplement, be sure you aren’t purchasing raspberry ketones or ketone salts; neither have been shown in the research to have an effect on blood sugar. The most interesting ketone ester product we found is this supplement from the folks at HVMN ($99). Consult your doctor before adding this to your supplement regime.
Which one of the 5 natural glucose management tools will work best for you? There is one easy way to find out and that is experimenting for yourself using a continuous glucose monitor or systematically measuring your levels with a glucose meter. We still think this is one of the best longevity hacks you can try. To complement these tools, check out 10 of the worst foods for blood sugar—according to CGM data.
Share your experiences with glucose control with us or anything we may have left out: firstname.lastname@example.org
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