Ryan Bradley, ND, MPH is a doctor of naturopathic medicine in San Diego, CA. Diabetes is an area of both research and clinical specialization for Dr. Bradley. He practices integrative care for diabetes and heart health as the Director of the Center for Diabetes & Cardiovascular Wellness at the Bastyr University California.
Add Spice and Add Life!
Is it just chance that many cultures have traditional dishes that have been passed down generation after generation and are still eaten today? Have you ever considered whether these foods, or food combinations, may have health benefits?
While dietary research largely overlooks the possible health benefits of traditional foods due to its focus on fat content versus carbohydrate content, clinical research on specific foods and food ingredients demonstrates food as more than fat and carbohydrates, but contains compounds that improve health.
In diabetes, these healthful qualities include improvement in blood sugar, reduction in inflammation, improvement in cholesterol and lipid status, and perhaps reduction in blood pressure.
So far in the medical literature, the herbs and spices from the Indian continent seem to be among the most active for improving blood sugar. Clinical and basic bench, i.e. test tube, research has demonstrated benefit of the spices: cinnamon, fenugreek, ginger, tumeric, and cumin.
Cinnamon and Diabetes
At least three clinical studies have been performed to test the blood sugar lowering and insulin-sensitizing affects of Cinnamon (Cinnamomum cassia). In one of these studies, different doses (1,3, or 6 grams) of cinnamon were given in capsules to people with diabetes for 40 days (Khan et al. 2003); this study demonstrated improvements in both fasting blood sugar and in LDL (“bad”) cholesterol at all doses.
Similar findings were observed when an aqueous (water-based) extract (equivalent to 3 grams of powdered cinnamon) was administered to people with diabetes for four months; these people were not using insulin (Mang et al. 2006).
However, recently published research by Vanschoonbeek et al. contradicts these reports, finding no improvement through supplementation of cinnamon at a dose of 1.5 grams per day. As is always the way with science, conflicting evidence frequently emerges- and ultimately we learn more from these discrepancies.
Is cinnamon effective?
At least three clinical studies have been performed to test the blood sugar lowering and insulin-sensitizing affects of Cinnamon.
And if so, how should I take it? The short answer is, we do not know. Much of the groundbreaking research from the lab of Richard Anderson, PhD at the USDA (research funded by Diabetes Action) suggests the water-soluble phenolic components of cinnamon are the most effective (Broadhurst et al. 2000). Supplements are available containing just these components and these supplements may prove to be more effective that whole cinnamon.
Studies have not been performed comparing cinnamon in food versus whole cinnamon in capsules or versus the water-extract of cinnamon in capsules. Unfortunately we still know very little about the safety of all forms of cinnamon when taken as a supplement, although the data on water-extracts of cinnamon suggests safety when administered to lab animals (Onderoglu et al. 1999). I discourage taking large doses of whole cinnamon until we know more its safety.
Research on the spice fenugreek (Trigonella foenum-graecum) is also promising in diabetes. Clinical research in people with diabetes has been performed on both a fenugreek extract and on soaked fenugreek seeds showing improvements in fasting blood sugar and insulin sensitivity (Gupta et al. 2001 and Madar et al. 1988).
...ginger has demonstrated promising results in basic science and animal research testing its ability to improve insulin sensitivity...
Ginger (Zingiber officianlis) has been used as a staple ingredient in Indian and Asian food for hundreds of years. In western herbalism, it is known for its action as a digestive, an anti-inflammatory, and as an anti-nausea medicine. However, recently ginger has demonstrated promising results in basic science and animal research testing its ability to improve insulin sensitivity, reduce oxidation, and improve cholesterol (Bhandari et al. 2005 and Akhani et al. 2004). We still do not know much about the impact of ginger on these parameters in humans, however the preliminary research is very promising- and ginger tastes quite good!
Turmeric (Curcuma longa) is sold in most grocery stores ground as a yellow-orange powder, or sold in many Asian and specialty markets as a whole orange root. Turmeric has been used in Traditional Chinese and Ayurvedic herbal medicine for thousands of years as a detoxification herb (as it appears to protect the liver) and as a potent anti-inflammatory.
...[Turmeric] improves the action of disrupted insulin-response pathways in diabetes.
Modern science has been applied to the use of turmeric, and has shown its reputation is based on solid science- turmeric is a potent anti-inflammatory! Although no long-term studies have been done specifically in people with diabetes, the bench research shows that turmeric does reduce many of the inflammatory signals known to be overactive in diabetes (i.e. cytokines IL-6, IL-1, and TNF) and improves the action of disrupted insulin-response pathways in diabetes (i.e. PPAR-gamma) (Shishodia et al. 2005)!
Other herbs and spices that exhibit anti-diabetic action include: cumin (Le at al. 2004 and Rchid et al. 2004), garlic (Ashraf et al. 2005 and Ahmad et al. 2006), and red chili pepper (Tolan et al. 2001 and 2004)!
Food or Supplement?
I see many people with diabetes in my clinical practice already burdened by the numerous bottles of medications and supplements they take daily. I am challenged to refine their treatment plan into a manageable number of bottles and pills that effectively treats their current health concerns and is preventive of future complications. Because this process is already so challenging, my approach is to always bring healthful foods, herbs, and spices into the diet rather than taking as a supplement whenever possible. However, as I mentioned with cinnamon above, there are still many unanswered questions about using these herbs and spices in food versus taking them as a supplement.
...my approach is to always bring healthful foods, herbs, and spices into the diet rather than taking as a supplement whenever possible.
As it may not be possible to bring each of these herbs and spices into your diet every day, a combined approach of supplementation and diet is reasonable. If you were going to use cinnamon as a food, one gram of cinnamon is approximately one-half teaspoon and can be easily sprinkled on whole-grain toast, steel-cut oatmeal, or brewed into a mild tea (add ginger for even more benefit and aid digestion!).
If you were going to take cinnamon as a supplement, I would recommend a supplement that contains the water-extracted components. Consider trying both ways for three months, self-monitor your blood sugar, and ask your doctor to recheck your fasting blood glucose and hemoglobin A1c to see if cinnamon helps you!
What’s the bottom line?
Although definitive statements are difficult to make regarding the exact action and effective “dose” of each of these herbs and spices, in my opinion there is enough research available to suggest these long-standing traditional herbs and spices have health benefits for people with diabetes and eating these foods should be encouraged by physicians and nutritionists.
...there is enough research available to suggest these long-standing traditional herbs and spices have health benefits for people with diabetes...
While these flavors may take some getting used to, many people enjoy them and even crave them once they try a few dishes. If you cook at home, look around for an Indian, Asian, or Middle-eastern cookbook that includes recipes with these ingredients. Ask the employees of local ethnic groceries about the herbs and spices in their shops and how to use them. Many specialty groceries now offer cooking classes in ethnic cooking. If you eat outside of home, try Indian or Thai fare next time instead of American-style family restaurants. (After all the classic American cheeseburger and fries is used in research as a standard way to induce inflammation!!) If you do try eating Indian fare or Asian fare outside of the home, consider skipping the white rice and rice noodles with your meal to further improve its health benefits!
Add spice by learning and enjoying new foods and recipes and you may be adding life!!
For those readers interested in learning more about the technical aspects of the anti-diabetic and anti-inflammatory actions of these herbs and spices, I recommend finding the following excellent review articles at a local medical library:
Aggarwal BB, Shishodia S. Suppression of the nuclear factor-kappaB activation pathway by spice-derived phytochemicals: reasoning for seasoning. Ann N Y Acad Sci. 2004 Dec;1030:434-41.
Srinivasan K. Plant foods in the management of diabetes mellitus: spices as beneficial antidiabetic food adjuncts. Int J Food Sci Nutr. 2005 Sep;56(6):399-414. Review.
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Complementary Pearl for Diabetes:
My favorite breakfast to recommend to patients is spiced-up steel-cut oatmeal. Skip the milk and butter and instead try:
1/4 cup steel-cuts oats, cooked (low glycemic index and improves LDL cholesterol)
15 chopped almonds, raw or cooked (improves LDL cholesterol)
1/2 tsp. cinnamon (improves insulin sensitivity)
1/2 cup frozen blueberries, thawed (high in antioxidants)
1 Tbsp. coconut milk (does contain saturated fat but appears to lower LDL cholesterol and cholesterol oxidation)