Dr. Sarah Cimperman, ND
Toxic compounds permeate our environment and they permeate our bodies. Almost 500 different chemicals have been found in human blood and fat tissue1 and studies show that the older we get, the more toxins we contain.2 Several are called “diabetogens” because they increase the risk of developing type two diabetes mellitus (T2DM). During the most recent National Health and Nutrition Examination Survey, researchers detected diabetogens in every single sample from the 2,500 people tested.3 More people are at risk for T2DM than ever before, now that prediabetes affects 79 million people in the United States, or one in three adults and almost one in four adolescents. To treat it successfully, the environmental component must be addressed. Detoxification is an important part of a comprehensive treatment plan to reverse prediabetes.
Toxins associated with an increased risk of T2DM include pesticides, bisphenol A, phthalates, dioxins, perfluorinated chemicals, brominated flame-retardants, volatile organic compounds, and heavy metals.
In the United States, more than five billion pounds of pesticides are applied to our crops every year.4 Pesticides disrupt hormone balance by mimicking the hormones made by our bodies, blocking hormone receptors, triggering high levels of insulin, and promoting insulin resistance.5
Bisphenol A (BPA) is used to make epoxy linings inside food and beverage cans as well as polystyrene and polycarbonate (a hard, clear plastic). These materials are found in water bottles, baby bottles, pizza boxes, Styrofoam cups, egg cartons, takeout containers, plastic wrap, and other plastic items. BPA also has multiple industrial uses. When it escapes from landfills, it can contaminate drinking water, fish, and seafood. BPA also acts as a hormone disruptor and increases the risk of T2DM.5
Phthalates are chemicals that add flexibility to plastics. They’re used to make epoxy-lined cans, plastic food and beverage containers, plastic wrap and other plastic items, as well as personal products, paint, and many other things. Phthalates act as endocrine disruptors and increase the risk of T2DM.
Dioxins include polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans, and polychlorinated dibenzodioxins. They are produced by a variety of industrial processes and once they’re released into the environment, they contaminate soils and waterways and accumulate in our food. The greatest source for most people is contaminated fish and seafood, and the highest concentrations are found in predators at the top of the food chain. Dioxins disrupt blood sugar metabolism and hormone balance, and they increase the risk of T2DM.6
Perfluorinated chemicals (PFCs) make materials stain- and stick-resistant. Several PFCs exist, but the two most common are perfluorooctanoic acid and perfluorooctane sulfonate. They leach into our food from nonstick cookware and food packaging like pizza boxes, microwave popcorn bags, and fast food containers. They’re also found in fabric, furnishings, household cleaners, and personal care products. Increased blood levels of PFCs have been associated with high insulin levels and insulin resistance.
Brominated flame-retardants (BFRs) are added to furniture, electronic equipment, mattresses, and clothing. Because they don’t break down easily, they’ve become persistent and widespread in the environment. BFRs act as hormone disruptors and studies have linked them to obesity, prediabetes, and T2DM.8
Volatile organic compounds (VOCs) are chemicals used in manufacturing. They escape in the form of gases from building materials, furnishings, office equipment, household cleaners, and fragranced products like air fresheners and scented candles. According to the EPA, VOCs are up to ten times more concentrated in indoor air than in outdoor air.9 Studies show that they promote high levels of blood sugar and insulin resistance.10
Heavy metals enter our diet primarily through drinking water, fish and seafood, and produce sprayed with herbicides or grown in contaminated soil. We can also be exposed to heavy metals from many other sources including antiseptics, dental amalgams, and cigarette smoke. Arsenic, cadmium, nickel, and mercury can increase blood sugar levels, damage insulin-producing cells in the pancreas, and interfere with cells’ ability to absorb sugar from the blood.11
Prediabetes Detox Program
Detoxification is the removal of toxins from the body. For people with prediabetes, the benefits don’t end there. The Prediabetes Detox program addresses other underlying factors that may be contributing to the disease process, like inflammation, high levels of stress hormones, or low levels of vitamin D. It also encourages people to make long-term changes to their diet, exercise, and lifestyle that can help reverse prediabetes permanently.
The Prediabetes Detox Program can be broken down into three components: diet, supplements, and lifestyle. Together, they reduce inflammation, lower high blood sugar and insulin levels, prompt the body to burn fat instead of accumulate fat, mobilize toxins stored inside fat cells, optimize liver function, and support the elimination of mobilized toxins. The detox program should be followed at least two weeks and up to eight weeks, until morning fasting glucose levels are consistently 87 mg/dl or lower.12
Some people should not undergo detoxification. They include pregnant women, breastfeeding women, and individuals with any of the following: kidney disease, liver disease, cardiac arrhythmia, unexplained abdominal pain, acute inflammation of any part of the gastrointestinal tract, recent surgery or chemotherapy, or constipation (having less than one bowel movement per day).
Prediabetes Detox Diet
The Prediabetes Detox diet consists of three satisfying meals each day and a twelve-hour fast overnight. Foods should be organic whenever possible, especially when it comes to the Dirty Dozen Plus most contaminated fruits and vegetables (www.ewg.org/foodnews). Fish and seafood should be low in toxins and high in omega-3 fats (www.seafood.edf.org). Animal products including eggs, meat, and dairy are allowed but optional and must come from pasture-raised, grass-fed, or wild animals.
Certain foods should be eaten every day. These include fermented foods (pickles, sauerkraut, kimchi, vinegar, tamari, tempeh, miso, cacao nibs, certain teas, yogurt, cheese, kefir), liver-supportive foods (at least two cups of cruciferous vegetables, dandelion greens, artichokes, beets, and/or berries), and ground flax or psyllium seeds (two tablespoons). Ground flax seeds reduce the absorption of sugar, help eliminate toxins in the stool, support the growth of healthy bacteria, and improve insulin sensitivity and blood sugar control.13 Psyllium has also been shown to lower high blood sugar and insulin levels.14
During detox, people should drink plenty of filtered water (half their body weight in ounces) including three or more cups of unsweetened tea (green, white, rooibos, dandelion, or ginger). They are also encouraged to incorporate into their diet herbs and spices shown to improve glucose control, reduce inflammation, and support detoxification. These include garlic, onions, cinnamon, ginger, cayenne, fenugreek, cumin, turmeric, black pepper, parsley, cilantro, vinegar, and citrus zest.15
Dairy products are optional. People with a known or suspected sensitivity or intolerance should avoid all dairy products during detox. For people who tolerate dairy well, certain products are allowed (plain whole-milk yogurt, aged and ripened cheeses, butter, and cream) because they can be good sources of amino acids, conjugated linoleic acid, omega-3 fats, beneficial bacteria, and whey, which has been shown to boost levels of glutathione in the liver and lower levels of the stress hormone cortisol.16
During detox, it’s important to avoid all processed foods, sweet foods and sweet drinks (whether naturally or artificially sweetened), and starches including grains, root vegetables (except beets), and fruit (except whole unsweetened berries and some citrus). They should also avoid inflammatory fats (deep-fried foods, butter substitutes, hydrogenated and interesterified oils, trans-fats, and liquid oils that have not been cold-pressed) and foods and beverages in contact with plastic, polystyrene, and nonstick surfaces.
Prediabetes Detox Supplements
Taking supplements during detox ensures that people get the vitamin, mineral, amino acid, and antioxidant support their bodies need for the mobilization and elimination of environmental chemicals. Dozens of different supplements can be used to support our natural detoxification mechanisms, but the Prediabetes Detox Program utilizes the eight most important for people with prediabetes: a multivitamin/mineral formula; extra vitamin C (2,000 mg BID-TID), extra magnesium (400 mg BID), vitamin D (1,000 to 2,000 IU QD), alpha-lipoic acid (600 milligrams BID), omega-3 fats (2,000 mg DHA+EPA QD), probiotics (10 billion QD), and a botanical formula for liver support including herbs like milk thistle, dandelion, and burdock. People who don’t drink enough tea can take green tea in capsule form.
Protein powder is not a standard part of the Prediabetes Detox Program because people are advised to avoid processed foods and grains. However, certain individuals benefit from a protein supplement including those who follow a vegan diet and anyone who doesn’t get enough protein from dietary sources. Whey is one good option and a vegan-friendly alternative is a blend of hemp, pea, and rice proteins.
Anyone with documented heavy metal toxicity will need to talk to their doctors about chelating agents and supportive supplements like vitamin E, selenium, n-acetyl cysteine, and modified citrus pectin.
Prediabetes Detox Lifestyle
The lifestyle component of the Prediabetes Detox Program focuses on reducing or eliminating factors that promote inflammation, raise blood sugar and insulin levels, and increase the risk for T2DM (such as smoking17 and stress) while adding activities that promote elimination, lower blood sugar and insulin levels, and decrease the risk of T2DM (like exercise, stress management, sleep, and sauna therapy).
Detox is a good opportunity for smokers to quit. Nearly 90 percent of those who stop successfully quit abruptly and the cold turkey method has been shown to be twice as effective as medication and nicotine replacement therapy,18 which can increase levels of insulin and promote insulin resistance.1
Stress can be managed in a variety of ways including exercise, yoga, breathing exercises, meditation, self-hypnosis, guided imagery, progressive muscle relaxation, massage, and qigong.
During detoxification and until fasting glucose levels are consistently normal, patients should exercise five hours each week and incorporate aerobic exercise, strengthening exercise, interval training, and stretching. Studies show that the combination of aerobic and strengthening exercises are much more effective at lowering hemoglobin A1C levels than either type of exercise alone.20 Strengthening exercises also improve the sensitivity of insulin receptors on cells, allowing them to absorb sugar from the blood more efficiently, and significantly reduce the risk of developing T2DM. Interval training is the practice of alternating short bursts of higher intensity physical activity with longer periods of lower intensity activity. It stimulates the body to burn more fat,21 increases exercise capacity,22 and can be done with almost any activity. People can start by adding one high-intensity interval of 30 seconds to their exercise routine and gradually work their way up to three high-intensity intervals of one to four minutes each (spaced at least four minutes apart), three times per week.
Anyone who isn’t already physically active and individuals who want to intensify their current routine should first get permission from their doctor. It’s also a good idea to meet at least once with a personal trainer who can put together an appropriate routine and make sure the exercises are being done correctly.
People should get at least nine hours of sleep each night during detox. Short sleep cycles raise blood sugar, cause cells to lose sensitivity to insulin, and increase the risk for T2DM.23 Research studies show that when people sleep seven hours or less overnight, our bodies are prompted to store fat, but when people sleep nine hours or more, these influences are suppressed.24
People are encouraged to do five to seven treatments per week of either infrared sauna (one 20-minute session) or traditional sauna (one to four 15-minute sessions). They should drink eight ounces of filtered water, ginger tea, or coconut water before and after each session; follow each session with a 30-second cold shower, washing their bodies well to remove toxins secreted by the skin; and relax for 20 minutes or more after each treatment. To replace lost electrolytes, they should consume at least two cups of foods rich in electrolytes at their next meal (celery, broccoli, artichokes, mustard greens, spinach, sardines, haddock, wild Alaskan salmon).
As part of the Prediabetes Detox Program, people are also encouraged to “detox” their home environment and minimize unnecessary exposure to common chemicals. A full Home Detox Checklist is available at http://adifferentkindofdoctor.blogspot.com/2011/12/home-detox-checklist.html.
After detox, people should continue eating the detox diet while they systematically reintroduce the whole foods they have been avoiding (like fruit, starchy vegetables, and whole grains) and monitor effects on blood sugar levels (upon waking and two hours after each meal). They should continue to avoid processed foods and any foods causing elevations in blood sugar above 120 mg/dl two hours after eating. People can also test foods they have been avoiding because of suspected sensitivity, like gluten or dairy products.
To permanently prevent T2DM and ensure optimal health, after detox and long-term, it’s important to eat a diet low in sweets and starches, exercise at least three hours every week, get at least eight hours of sleep each night, manage stress effectively, take supplements tailored to meet individual needs, and undertake a detox program once or twice each year.
- EWG (Environmental Working Group). Pollution in Minority Newborns: BPA and Other Cord Blood Pollutants. [Web page]. EWG website. http://www.ewg.org/research/minority-cord-blood-report/bpa-and-other-cord-blood-pollutants. Accessed September 10, 2013.
- Hue O, Marcotte J, Berrigan F, et al. Plasma concentration of organochlorine compounds is associated with age and not obesity. Chemosphere. 2007;67(7):1463-7.
- CDC (Centers for Disease Control and Prevention). Fourth National Report on Human Exposure to Environmental Chemicals, Updated Tables. [Web page]. CDC website. http://www.cdc.gov/exposurereport/. Accessed September 10, 2013.
- EPA (Environmental Protection Agency. 2000-2001 Pesticide Market Estimates: Usage. [Web page]. EPA website. http://www.epa.gov/pesticides/pestsales/01pestsales/usage2001.htm. Accessed September 12, 2013.
- Alonso-Magdalena P, Quesada I, and Nadal A. Endocrine disruptors in the etiology of type 2 diabetes mellitus. Nature Reviews, Endocrinology. 2011;7(6):346-53.
- Wang, SL, PC Tsai, CY Yang, et al. Increased Risk of Diabetes and Polychlorinated Biphenyls and Dioxins: A 24-Year Follow-Up Study of the Yucheng Cohort. Diabetes Care. 2008; 31(8): 1574–1579.
- Lin CY, Chen PC, Lin YC, et al. Association among serum perfluoroalkyl chemicals, glucose homeostasis, and metabolic syndrome in adolescents and adults. Diabetes Care. 2009;32(4):702-7.
- Casals-Casas C and Desvergne B. Endocrine disruptors: from endocrine to metabolic disruption. Annual Review of Physiology. 2011;73:135-62.
- Environmental Protection Agency. An Introduction to Indoor Air Quality. [Web page]. EPA website http://www.epa.gov/iaq/voc.html. Accessed September 10 2013.
- Hong YC, Park EY, Park MS, et al. Community level exposure to chemicals and oxidative stress in adult population. Toxicology Letters. 2009;184(2):139-44.
- Chen YW, Yang CY, Huang CF, et al. Heavy metals, islet function and diabetes development. Islets. 2009;1(3):169-76.
- Tirosh A, Shai I, Tekes-Manova D, et al. Normal fasting plasma glucose levels and type 2 diabetes in young men. New England Journal of Medicine. 2005;353(14):1454-62.
- Mani UV, Mani I, Biswas M, et al. An Open-Label Study on the Effect of Flax Seed Powder (Linum usitatissimum) Supplementation in the Management of Diabetes Mellitus. Journal of Dietary Supplements. 2011;8(3):257-65.
- Pastors JG, Blaisdell PW, Balm TK, et al. Psyllium fiber reduces rise in postprandial glucose and insulin concentrations in patients with non-insulin-dependent diabetes. American Journal of Clinical Nutrition 1991;53(6):1431-5.
- Rani MP, Padmakumari KP, Sankarikutty B, et al. Inhibitory potential of ginger extracts against enzymes linked to type 2 diabetes, inflammation and induced oxidative stress. International Journal of Food Sciences and Nutrition. 2011;62(2):106-10.
- Ballali S and Lanciai F. Functional food and diabetes: A natural way in diabetes prevention? International Journal of Food Sciences and Nutrition. 2012;63 Suppl 1:51-61.
- Madkor HR, Mansour SW, and Ramadan G. Modulatory effects of garlic, ginger, turmeric and their mixture on hyperglycaemia, dyslipidaemia and oxidative stress in streptozotocin-nicotinamide diabetic rats. British Journal of Nutrition. 2011;105(8):1210-7.
- Sreelatha S and Inbavalli R. Antioxidant, Antihyperglycemic, and Antihyperlipidemic Effects of Coriandrum sativum Leaf and Stem in Alloxan-Induced Diabetic Rats. Journal of Food Science. 2012;77(7):T119-23
- Bolkent S, Yanardag R, Ozsoy-Sacan O, et al. Effects of parsley (Petroselinum crispum) on the liver of diabetic rats: a morphological and biochemical study. Phytotherapy Research. 2004;18(12):996-9
- Johnston CS, Steplewska I, Long CA, et al. Examination of the antiglycemic properties of vinegar in healthy adults. Annals of Nutrition and Metabolism. 2010;56(1):74-9
- Victor Antony Santiago J, Jayachitra J, Shenbagam M, et al. Dietary D-Limonene Alleviates Insulin Resistance and Oxidative Stress-Induced Liver Injury in High-Fat Diet and L-NAME-Treated Rats. European Journal of Nutrition. 2012;51(1):57-68.
- Markus CR, Olivier B, Panhuysen GE, et al. The Bovine Protein Alpha-Lactalbumin Increases the Plasma Ratio of Tryptophan to the Other Large Neutral Amino Acids, and in Vulnerable Subjects Raises Brain Serotonin Activity, Reduces Cortisol Concentration, and Improves Mood Under Stress. American Journal of Clinical Nutrition. 2000;71(6):1536-44.
- Rafalson L, Donahue RP, Dmochowski J, et al. Cigarette smoking i associated with conversion from normoglycemia to impaired fasting glucose: The Western New York Health Study. Annals of Epidemiology. 2009; 19(6): 365–371.
- Dorana CM, Valenti L, Robinson M, et al. Smoking status of Australian general practice patients and their attempts to quit. Addictive Behaviors. 2006;31(5):758-66.
- Eliasson B, Taskinen MR, and Smith U. Long-term use of nicotine gum is associated with hyperinsulinemia and insulin resistance. Circulation. 1996;94(5):878-81.
- Church TS, Blair SN, Cocreham S, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. Journal of the American Medical Association. 2010;304(20):2253-62.
- Talanian JL, Galloway SD, Heigenhauser GJ, et al. Two weeks of high-intensity aerobic interval training increases the capacity for fat oxidation during exercise in women. Journal of Applied Psychology. 2007;102(4):1439-47.
- Burgomaster KA, Hughes SC, Heigenhauser J, et al. Six sessions of sprint interval training increases muscle oxidative potential and cycle endurance capacity in humans. Journal of Applied Physiology. 2005;98(6):1985-90.
- Knutson K.L. and Van Cauter E. Associations between sleep loss and increased risk of obesity and diabetes. Annals of the New York Academy of Sciences. 2008;1129:287-304.
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Sarah Cimperman, ND is the author of the new book, The Prediabetes Detox: A Whole-Body Program to Balance Your Blood Sugar, Increase Energy, and Reduce Sugar Cravings. She graduated from NCNM in 2002 and has a private practice in New York City. Her expertise has been featured on Fox News and Huffington Post and in Natural Health magazine, Whole Living magazine, and the Well Being Journal, among other publications. Dr. Cimperman also writes two blogs, A Different Kind Of Doctor and The Naturopathic Gourmet.