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Diabetes incidence has skyrocketed in recent decades due to our dietary and life-style choices - i.e., we are too fat, eat bad foods, and don’t exercise enough. Unfortunately, due to extensive metabolic, hormonal, body-composition shifts that occur after spinal cord injury (SCI), people with SCI are especially prone to develop diabetes. This article discusses various nutritional or botanical approaches that reduce blood-sugar levels in people with this disease.


Diabetes is characterized by the body’s inability to properly use glucose, our body’s metabolic energy currency. Under healthy conditions, the hormone insulin controls blood-glucose levels. Produced by the pancreas, insulin flows through our blood to various tissues where they bind to cell-surface receptors. This binding initiates a complex biochemical cascade that culminates in glucose uptake into cells to fuel metabolic processes. As blood-glucose levels decline due to cellular uptake, the pancreas shuts down insulin production to prevent hypoglycemia (low blood sugar) and, in turn, the liver, the body’s nutrient-processing organ, starts releasing glucose back into the blood.

Although distinctions are more blurred than once thought, in type-1 (“juvenile”) diabetes, the pancreas produces inadequate insulin to promote glucose uptake into cells. In contrast, in type-2 (“adult-onset diabetes”), cells become less responsive to the insulin that is still produced.

Through not clearly defined physiological mechanisms, persistently high blood glucose may eventually lead to complications such as kidney disease, neuropathy (nerve disease), and eye problems.

Diabetes and SCI

Dr. William Bauman and colleagues at the Bronx VA Medical Center have shown that SCI predisposes one to diabetes. For example, their research indicates that 1) only 44% of veterans with SCI have normal glucose metabolism compared to 82% without SCI and 2) higher-level injuries further predispose individuals to diabetes.

Nutrient Density & SCI

Before our sedentary modern age, mankind had high caloric needs due to more intense manual labor. If 4,000 calories/day were needed to fuel such labor, one was much more likely to absorb trace nutrients compared to today’s office worker who gains weight from 1,500 calories/day of nutrient-depleted, processed foods.

This concept is especially relevant to SCI. For example, by comparing identical twins with and without SCI, Bauman has shown that caloric needs are greatly reduced after injury. Such a reduction automatically results in the uptake of fewer trace nutrients in a weight-maintaining diet.

Another factor compromising nutrient uptake is extensive antibiotic use - a life-saving cornerstone of SCI medicine. A Science magazine article (Gilmore & Ferretti, March 28, 2003) noted: "Not only does the highly evolved gut flora community extend the processing of undigested food to the benefit of the host, but it also contributes to host defense by limiting colonization of the gastrointestinal tract by pathogens." More simply stated, there are hundreds of bacterial species within our gut that are essential for proper digestion. Every time you use an antibiotic, assistive bacteria are killed, in turn, lessening the uptake of nutrients already inherently compromised by SCI.

The gist of this discussion is people with SCI need to make every calorie count, because the adverse ramifications of eating nutrient-depleted food will be greatly magnified for them.

Given these considerations, the effectiveness of supplementing your diet with various nutrients to reduce blood-glucose levels depends upon how much of the nutrients you already absorb from your diet. If your diet already contains an abundance of a nutrient, a supplement isn’t going to help; but if it is lacking, it may provide significant benefit.

Many of the foods, supplements, or botanical agents discussed below are supported by scientific studies (including, in some cases, rigorous double-blind clinical studies) and are readily available from nutritional, health-food or ethnic-grocery stores, or Internet sources.

Mineral Supplements

Trace amounts of chromium are essential for proper carbohydrate metabolism. Depending upon dietary intake, studies suggest that chromium supplementation lowers blood-glucose levels by increasing cell-surface insulin receptors and, in turn, glucose transport into cells. Traditional food sources of chromium include beer, brewer’s yeast, brown rice, cheese, meat, and whole grains.

Before insulin, vanadium was a traditional French diabetes remedy. Animal and human studies indicate that vanadium, like chromium, facilitates glucose uptake and metabolism by enhancing insulin-receptor expression. Vanadium is found in fish, vegetable oils, and olives. Excess vanadium supplementation should be avoided.

Diabetics often have low levels of magnesium, a mineral required for many physiological functions. Individuals with the least amount of magnesium in their blood have twice the diabetes incidence as those with the highest levels. Scientists have shown that when magnesium-deficient patients were given supplements, their responsiveness to insulin and glucose metabolism improved. Fish, meat, seafood and nuts are rich magnesium sources.

Other Supplements

The antioxidant alpha-lipoic acid is a common German treatment for diabetic neuropathy (antioxidants protect our bodies from cell-damaging, free radicals). Basically, with such neuropathy, persistent high blood glucose generates oxidative stress that compromises blood flow to nerves, damaging signal-conducting axons. Over time, this damage may lead to, for example, foot problems requiring amputation. Through its antioxidant properties, alpha-lipoic acid enhances nerve health, lessening neuropathy. Red meat is a good source of alpha-lipoic acid.

The amino acid carnitine plays a key role in fat and glucose metabolism. Evidence suggests it lowers glucose levels through increasing glucose metabolism (i.e., burning it off) and creating glucose polymers called glycogen (i.e., putting it in storage). Double-blind clinical studies indicate that carnitine helps diabetic neuropathy by enhancing neuronal conduction and reducing pain. Beef is the richest source of carnitine.

The vitamin nicotinamide (a biochemical derivative of niacin) lowers blood-glucose levels by enhancing the pancreas’ insulin-producing ability. For example, blood-glucose metabolism was improved in type-2 diabetics who had lost responsiveness to commonly prescribed sulfonylurea drugs (sulfonylureas make the pancreas release more insulin) after consuming nicotinamide for six months. Meat, fish and poultry are good sources of this vitamin.

Foods and Botanical Medicines

Before insulin was developed, diabetes was treated throughout the world with a multitude of traditional plant remedies:

Ginseng is a traditional cure-all that restores a more health-promoting balance or homeostasis to the body. Studies show that diabetics who consume ginseng (American species) before an oral glucose challenge had lower blood-glucose levels. With such a challenge, fasting patients consume glucose, and then its elimination from the blood is followed over time. The results suggest that consuming ginseng before a meal could lower blood-sugar levels after the meal (i.e., postprandial).

Unripe bitter melon, a cucumber-shaped fruit, is a traditional Asian diabetes remedy. In one study, diabetics who drank juiced bitter-melon had lower fasting and postprandial blood-glucose levels. Bitter melon includes physiologically active agents that affect glucose metabolism, including an insulin-resembling molecule.

Related to milkweed, gymnema is an Ayurvedic (India’s ancient medicine) remedy for diabetes. Diabetics who consumed gymnema for 18-20 months had lower blood-sugar levels, and a significant number were able to discontinue conventional oral medications. In rats, gymnema doubled pancreatic, insulin-producing beta cells.

Fenugreek, a common Indian and Middle-Eastern spice, possesses anti-diabetic properties. In one study, diabetics who consumed fenugreek seed powder at lunch and dinner for six months had substantially lower fasting blood glucose and demonstrated improved glucose-tolerance test results. Because fenugreek is somewhat bitter, it can also be taken in capsules available at health-food stores.

The pads and fruits of the prickly pear cactus or nopal are Hispanic foods that are also traditional anti-diabetic remedies. Several studies demonstrate the ability of nopal, which contains substances that increase insulin sensitivity, to reduce blood-glucose levels in diabetics. Nopal can be consumed raw, cooked or juiced.  

Another desert plant with anti-diabetic properties is aloe vera. Best known as a topical remedy for burns and wounds, it is also a traditional Arabian Peninsula diabetes remedy. Studies suggest that diabetics who consume aloe gel daily over time can substantially lower blood-glucose levels.

Eating nuts and nut butters reduces diabetes risk, probably due to their fiber, healthy fats and magnesium. In a nutshell, Harvard investigators followed 83,000 women and found that those who ate an ounce of nuts or a tablespoon of peanut butter five times a week or more reduced their risk of diabetes by nearly 30%.

Other potential anti-diabetes foods include 1) noni juice (Morinda citrifolia), a traditional Polynesian cure-all for many disorders; 2) cinnamon; 3) jambul, a plant related to cloves and another Ayurvedic remedy; and 4) stevia, a popular sugar substitute isolated from a South-American shrub.


Evidence suggests that diabetes risk can be lowered by consuming dietary fibers that slow carbohydrate absorption, including glucomannan, a traditional Japanese food isolated from the konjac root (related to yams); and psyllium, the laxative Metamucil’s active ingredient.

Dietary Vices

Coffee addicts rejoice! Validating previous studies, Harvard investigators followed over 126,000 subjects up to 18 years and found that men who drank over six cups (i.e., 48 oz.) of coffee daily reduced their diabetes risk by over 50% (30% for women). The effect faded away with less than three cups per day. Recent research suggests that coffee contains chemicals that attenuate intestinal glucose absorption.

In addition, moderate alcohol consumption lowers diabetes risk, as it does for heart disease. For example, one study evaluated diabetes incidence in 23,000 Finnish twins. Results indicated that the twin who drank moderately but not heavily had half the diabetes risk as the twin who abstained or drank low amounts of alcohol. Among other mechanisms, moderate alcohol consumption may enhance insulin sensitivity.

It goes without saying, however, that these diabetes-related benefits could be offset by other adverse effects.

Native-American Herbs

Native-American medicine emphasizes healing herbs (see October 2004 PN), including many that target diabetes. According to American Indian Healing Arts (1999), anti-diabetic herbs include devil’s club, barberry, uva ursi, Cananda and daisy fleabane, alum root, joe-pye weed, red trillium, wild ginger, clintonia, bugleweed, and flowering spurge. Extensive information on each of these herbs can be obtained through a Google Internet search (www.google.com).


Fat and carbohydrate metabolism are intimately connected, explaining why there are fat vegetarians and why people lose body fat on low-carbohydrate diets. As such, issues involving fat consumption and metabolism are of paramount importance in diabetes.

One fat that is especially important is linolenic acid, an essential fatty acid that we must consume from our diet. Once consumed, we convert it to gamma-linolenic acid, an important precursor to prostaglandin hormones that regulate blood flow. This conversion is compromised in diabetics, which, as a result, promotes diabetic neuropathy. Studies suggest that gamma-linolenic acid supplementation reduces such neuropathy. Primrose, borage, and black current oils are rich sources of this fatty acid.

One intriguing theory attributes diabetes development to the chronic consumption of bad fats and, in turn, suggests that it can be cured by consuming good fats (see e.g., www.healingmatters.com). This theory suggests that diabetes was relatively rare until the introduction of engineered fats into our food supply. Over time, these fats became a pervasive component of our diet and increasingly replaced the more natural fats that our bodies had physiological evolved to use over eons.

If sufficient amounts of unnatural fats intercalate into the cell membrane, membrane viscosity increases, in turn, compromising the ability of embedded insulin receptors to promote glucose uptake. It’s like starting your car when it is minus 25o F and your engine still contains last summer’s heavyweight oil. Turnover (i.e., glucose uptake) won’t be that efficient.

Conversely, if a diet is shifted to one that emphasizes more physiologically-compatible fats, the bad fats will be eventually displaced from the membrane, once again enhancing receptor function.

Fat and carbohydrate metabolism are connected through the Krebs or citric acid cycle elucidated by Sir Hans Krebs. Because this was perhaps the most important discovery in the history of biochemistry, Krebs was awarded the 1953 Nobel Prize and knighted in 1958.

As a fledging biochemist, I met Krebs. He showed a slide of a virtual form letter he had received from the prestigious journal Nature rejecting his seminal work for publication due to insufficient scientific merit.

Today, as I write about therapies that frequently challenge today’s status quo perspectives, I often reflect on Krebs’ rejection letter. If the father of modern biochemistry could be rejected by prestigious scientific authorities, I wonder what paradigm-expanding, function-restoring therapies we are rejecting today.


With over 200,000 Americans dying annually from a disease whose incidence continues to skyrocket, diabetes has become one of society’s foremost health problems. Diabetes is the result of our long-term dietary and lifestyle choices; as a result, its management will depend on the shifts we make in these choices.  Because individuals with SCI are predisposed to diabetes, they need to be especially disciplined with their choices. This article provides some nutritional and botanical options that may assist them in their efforts.

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