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How Bariatric Surgery helps to reduce Diabetes?

How Bariatric Surgery helps to reduce Diabetes?

Can bariatric surgery completely take care of diabetes?

Frontier Voice of Nutrition Remarks (February 23, 2013) Nalin Siriwardhana, Ph.D., interviewed Prof. Samuel Klein, M.D., an expert in metabolism and human Nutrition. <<<Print PDF>>>

An overview of Bariatric Surgery - Nutrition Remarks

An overview of Bariatric Surgery – Nutrition Remarks

Bariatric surgery has become an invaluable tool in reducing health complications associated with severe obesity (morbid obesity). Bariatric surgery also called weight loss surgery is a surgical procedure which can ultimately restrict/reduce energy intake by limiting food intake or absorption or both. The type of bariatric surgery is depending upon variety of factors including person’s health status, preference and available options to choose. The most commonly performed surgeries are gastric banding, roux-en-y gastric bypass, and sleeve gsatrectomy.

While obesity is a well-known cause for type 2 diabetes (T2D), reduction of obesity has been similarly known to reduce T2D. This is due to improved insulin release and action.

In order to clarify the effects of bariatric surgery on T2D, we interviewed Prof. Samuel Klein.

Question from Nutrition Remarks: What is bariatric surgery and how it helps to reduce diabetes?

Answer from Dr. Klein: Bariatric surgery represents a series of gastrointestinal surgical procedures that help obese people lose weight and improve their health. The marked weight loss achieved by bariatric surgery make it the most effective available therapy for type 2 diabetes (T2D), because it improves beta-cell function (beta-cell produce and release insulin) and insulin sensitivity, which are the two major factors involved in the development of diabetes.

Question: Who are qualified for bariatric surgery?

Answer: Patients with class III obesity (BMI ³ 40 kg/m2) or those with class II obesity (BMI 35.0-39.9 kg/m2) and one or more severe obesity-related medical complications (e.g., hypertension, type 2 diabetes mellitus, heart failure, or sleep apnea) are eligible for surgery.

Question: What is the average cost of a general bariatric surgery?

Answer: Cost can vary depending on the type surgery and hospital in which the surgery is performed. In general, at present, a bariatric surgery in United States will cost between $15,000 – $25,000.

Question: Are there any side effects/complications associated with bariatric surgery?

Answer: With an experienced surgeon, this is a safe procedure compared with other surgical procedures. However, there are still important risks, including postoperative infections, pulmonary embolism, nutritional deficiencies, and even death.

Question: How patients should eat after the surgery for better outcomes?

Answer: The key to losing weight after surgery is to eat fewer calories than before surgery. Eating behavior after surgery depends on the specific surgical procedure and the patient, but in all cases patients who lose weight after surgery have reduced their food intake. The mechanism(s) responsible for the decrease in food intake after bariatric surgery is not exactly known and is likely to differ among procedures.

This news release was a follow-up based on the following original scientific article published by Prof. Samuel Klein.

Bradley et al Effects of bariatric surgery on glucose homeostasis and type 2 diabetes. in Gastroenterology. 2012;143(4):897-912.

Additional general background information was acquired from PubMed and NIH sources.

Prof. Klein would like to acknowledge that he is a shareholder of Aspire Bariatrics and serves on Scientific Advisory Boards for Vivus, Takeda and Novo Nordisk.

Prof. Samuel Klein M.D. is the William H. Danforth Professor of Medicine, Director of the Center for Human Nutrition, Director of the Center for Applied Research

Dr. Samuel Klein., M.D.

Dr. Samuel Klein., M.D.

Sciences, Chief of the Division of Geriatrics and Nutritional Sciences, and Medical Director of the Weight Management Program at Washington University School of Medicine in St. Louis, Missouri. Dr. Klein received an MD degree from Temple University Medical School in 1979 and an MS Degree in Nutritional Biochemistry and Metabolism from the Massachusetts Institute of Technology in 1984. He completed residency training in Internal Medicine and a Clinical Nutrition fellowship at University Hospital in Boston, a National Institutes of Health Nutrition and Metabolism Research fellowship at Harvard Medical School, and a Gastroenterology fellowship at The Mt.Sinai Hospital in New York. He is board certified in Internal Medicine, Gastroenterology, and Nutrition.

Dr. Klein is past-president of the North American Association for the Study of Obesity and the American Society for Clinical Nutrition, and inaugral chair of the Integrative Physiology of Obesity and Diabetes NIH study section. He was elected to the American Society for Clinical Investigation in 1996 and to the American Association of Physicians

in 2008. Dr. Klein has had consistent R01 funding from the NIH since 1990, and has published more than 350 papers in nutrition, metabolism, and obesity. He has received numerous awards for his research, including the American Gastroenterological Association (AGA) Miles and Shirley Fiterman Foundation Award in Nutrition and the AGA Masters Award for Outstanding Achievement in Basic or Clinical Research in Digestive Sciences, the Daniel P. Schuster Distinguished Investigator Award in Clinical and Translational Science from Washington University School of Medicine, and The Obesity Society TOPS Research Achievement Award.

Dr. Klein’s research activities are focused on understanding the mechanisms responsible for metabolic dysfunction associated with weight gain and obesity, and the pathophysiology of nonalcoholic fatty liver disease.

More about Dr. Klein


Written by Nalin Siriwardhana, Ph.D.


Copyright © 2013 Nutrition Remarks. All rights reserved


Coffee and Diabetes

Coffee and Diabetes

Can drinking coffee lower your risk for developing diabetes?

Written by Emily Creasy, MS, RD, LD, (Nutrition Remarks writer), Reviewed by Nalin Siriwardhana, Ph.D.

Health News Highlights (June 15, 2012) <<<Print PDF>>>

After water and tea, coffee is one of the most commonly consumed beverages in the world. According to the National Coffee Association, about 64 percent of Americans consume some form of coffee each day. In recent years, many links have been made associating coffee consumption with improved health, living longer, and a decreased risk for developing diseases such as heart disease and infections. A strong connection is also being identified linking coffee intake with a decreased risk for developing type 2 diabetes.

Coffee contains a large number of bioactive compounds including polyphenols, soluble fiber, lipids or fats, sugars known as polysaccharides, and minerals. These compounds work in our bodies to help keep us healthy by removing harmful compounds.

It is also known that coffee contains high amounts of caffeine. In our body, caffeine acts as a nerve stimulant and can help to improve brain functioning, enhance mental alertness and concentration, and decrease feelings of tiredness or fatigue. According to the U.S. Food and Drug Administration (FDA), an average cup of coffee contains anywhere from 60 to 150 mg caffeine.

The thermogenic affect (production of heat within your body) of both coffee and caffeine may help to prevent diabetes. Diet-induced thermogenensis occurs when a food or beverage increases your energy levels by breaking down calories from fat. By promoting thermogenesis, coffee may help to promote fat breakdown, resulting in potential weight loss and an overall decreased risk for developing both diabetes and cardiovascular disease.

Caffeine alone has been shown to negatively affect blood glucose levels and insulin sensitivity, however when it is consumed in coffee, other factors in coffee work to counteract these negative effects. It is postulated that magnesium, a mineral component of coffee, may work to promote glucose metabolism in the blood. Magnesium has long been known to offer many benefits in the body including improved glucose metabolism and insulin sensitivity. On the other hand, coffee is known to reduce magnesium absorption.

Similarly, the high antioxidant content of coffee may help to protect the pancreas by preventing damage to it’s healthy cells.. The pancreas is responsible for producing insulin. In your body, insulin is needed to remove the sugar from your blood and allow it to get into cells where the sugar can then be used for energy. By keeping the pancreas healthy, unwanted stress can be avoided and a steady production of insulin can be maintained.

Diabetes can be basically divided into three main types: Type 1, Type 2, and gestational diabetes. While Type 1 diabetes is typically present from childhood, both Type 2 and gestational diabetes develop as a result of lifestyle changes and choices. Type 2 diabetes is a chronic disease in which higher than normal levels of sugar, or glucose, exist in your blood.

Normally, your body is able to produce enough insulin. For those with Type 1 diabetes, the body does not make enough insulin on it’s own, therefore insulin must be supplemented via medications. In the case of Type 2 diabetes, your body makes enough insulin, however your cells do not respond correctly to it making it more difficult to remove the sugar from your blood. Overtime, the sugar builds up in the blood resulting in hyperglycemia, or high blood sugar levels. If left untreated, hyperglycemia can lead to more serious problems, including nerve damage, eye and foot problems, and a decreased ability to fight off infections.

Factors which may increase your risk for developing diabetes include, but are not limited to, decreased physical activity levels, following a poor diet rich in fats and sugars, having a family history of diabetes, and being overweight or obese.

Gestational diabetes is a condition that develops during pregnancy. An increase in hormones interferes with insulin preventing it from removing sugar from the blood properly. Generally women with gestational diabetes experience normal blood sugar levels after delivery, however they do have an increased risk for developing Type 2 diabetes later in life.

Studies have consistently shown that regular coffee consumption can help to decrease blood glucose levels, regardless of age, race, gender, or geographic location. The maintenance of normal blood glucose levels overtime can help to decrease your risk for developing Type 2 diabetes.

Dr. van Dam and Dr. Hu from the Department of Nutrition and Health, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, the Netherlands, reviewed a total of 15 epidemiological research studies involving over 200,000 participants, and found that consuming higher amounts of coffee (4 or more cups per day) each day consistently resulted in a 35 percent decreased risk for developing Type 2 diabetes.

Similarly, after analyzing 20 additional studies on coffee and diabetes, Dr. Huxley and colleagues, at the George Institute for International Health, The University of Sydney, Australia, found that each cup of coffee you drink per day can decrease your risk for Type 2 diabetes by about 7 percent. Based on this, drinking just two cups of coffee a day can decrease your risk for Type 2 diabetes by 14 percent.

Results were seen using both caffeinated and decaffeinated coffee. The blood sugar lowering affects do not depend on the caffeine content of coffee, but rather the many other natural bioactive compounds found in the beverage.

According to Drs. Natella and Scaccini, a large amount of epidemiological studies consistently associate coffee consumption with a decreased occurrence of impaired glucose tolerance, hyperglycemia, hyperinsulinemia, and insulin sensitivity, all of which are typically associated with Type 2 diabetes.

A study by Dr. Williams and colleagues at the Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, discovered that caffeinated coffee may be especially beneficial for women, as it helps to promote higher levels of adinopectin in the body. Adinopectin is a hormone known to regulate glucose breakdown and insulin sensitivity. In addition, adiponectin is a well known anti-inflammatory cytokine that helps to maintain good health. It is typically found to be low in those with diabetes. Based on their study, consuming at least three cups of caffeinated coffee per day may help to keep adinopectin levels high in women with and without diabetes.

Moderate coffee consumption by women prior to becoming pregnant may also help to decrease the risk for developing gestational diabetes. A study by Dr. Adeney and colleagues at the Department of Epidemiology, University of Washington School of Public Health and Community Medicine, found that these preventative effects were not noted in women who drank coffee during pregnancy. Coffee consumption during pregnancy is often ill advised due to the potential health risks for both the mother and unborn child.

How you prepare your coffee and when you consume it may also play a role in its protective capacity. While Americans typically consume coffee as a breakfast beverage, a study by Dr. Sartorelli and colleagues at the Department of Social Medicine, University of São Paulo, Brazil, found that the optimal time for coffee consumption may be after lunch. Coffee consumption with a mid-day meal was associated with a significantly decreased risk for diabetes. Effects were seen with caffeinated and decaffeinated as well as sweetened and black coffee.

While sugar consumption is often associated with the development of diabetes, Dr. Natella and Dr. Scaccini report that adding it to coffee does not appear to interfere with the protective affects coffee has to offer. However, consuming high amounts of sugar in the diet overtime may affect your body’s insulin sensitivity leading to an increased risk for developing Type 2 diabetes.

Coffee contains many bioactive compounds that may help to promote improved health. A recent study by Dr. Freedman and colleagues at the National Institutes of Health reports that regular coffee consumption may even help you to live longer. Based on scientific research, daily coffee intake can decrease your risk for developing diabetes over time. It is important to monitor your coffee intake, as increased caffeine intake may lead to unwanted symptoms of dehydration, distraction, jitteriness and loss of sleep. Discuss your diet with your doctor or a dietitian to determine a safe amount of coffee for your specific needs.


Natella F, Scaccini C. Role of coffee in modulation of diabetes risk. Nutrition Reviews. April 2012.

National Coffee Association. 2012 National Coffee Drinking Trends. http://www.ncausa.org/i4a/pages/Index.cfm?pageID=731

National Coffee Association. 2008 National Coffee Drinking Trends. http://www.ncausa.org/i4a/pages/index.cfm?pageid=201

U.S. Food and Drug Administration. Medicines in My Home: Caffeine and Your Body. http://www.fda.gov/downloads/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/UCM205286.pdf

Westerterp KR. Diet induced thermogenesis. Nutrition and Metabolism. August 2004.

de Valk HW. Magnesium in diabetes mellitus. The Netherlands Journal of Medicine. April 1999.

PubMed Health. Diabetes. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002194/

van Dam RM, Hu FB. Coffee consumption and risk of type 2 diabetes: a systematic review. The Journal of the American Medical Association. July 2005.

Huxley R, Lee CM, Barzi F, Timmermeister L, Czernichow S, Perkovic V, Grobbee DE, Batty D, Woodward M. Coffee, decaffeinated coffee, and tea consumption in relation to incident type 2 diabetes mellitus: a systematic review with meta-analysis. Archives of Internal Medicine. December 2009.

Williams CJ, Fargnoli JL, Hwang JJ, van Dam RM, Blackburn GL, Hu FB, Mantzoros CS. Coffee consumption is associated with higher plasma adiponectin concentrations in women with or without type 2 diabetes: a prospective cohort study. Diabetes Care. March 2008.

Adeney KL, Williams MA, Schiff MA, Qiu C, Sorensen TK. Coffee consumption and the risk of gestational diabetes mellitus. Acta Obstetricia et Gynecologica Scandinavia. 2007.

Sartorelli DS, Fagherazzi G, Balkau B, Touillaud MS, Boutron-Ruault MC, de Lauzon-Guillain B, Clavel-Chapelon F. Differential effects of coffee on the risk of type 2 diabetes according to meal consumption in a French cohort of women: the E3N/EPIC cohort study. The American Journal of Clinical Nutrition. April 2010.

Freedman ND, Park Y, Abnet CC, Hollenbeck AR, Sinha R. Association of coffee drinking with total and cause-specific mortality. The New England Journal of Medicine. May 2012.

Copyright © 2012 Nutrition Remarks. All rights reserved


Coffee Reduces Diabetes Risk

Coffee Reduces Diabetes Risk

Coffee and type II diabetes (T2D)

Frontier Voice of Nutrition Remarks (June 11, 2012) <<<Print PDF>>>

NalinSiriwardhana, Ph.D., interviewed Dr. Fausta Natella, Ph.D., from the National Research Institute for Food and Nutrition, in Rome.

Now it is clear that coffee can help to reduce the type 2 diabetes (T2D) risk. Dr. Fausta Natella, Ph.D., and Dr. Cristina Scaccini Ph.D., performed an in depth analysis on available scientific information on coffee and its effect on diabetes risk. Their analysis showed that coffee may reduce the T2D risk regardless of race, gender, geographic distribution, or the type of coffee consumed (i.e., caffeinated or decaffeinated). Further, these experts suggest that moderate coffee drinking (3-4 cups a day) will be sufficient to be benefitted against T2D.

Nutrition Remarks interviewed Dr. Fausta Natella, Ph.D., who performed this analysis in collaboration with Dr. Cristina Scaccini Ph.D.

Question from Nutrition Remarks: What is the role of coffee in T2D and are there any effect on type I diabetes (T1D) as well?

Answer from Dr. Natella: Several epidemiological evidences indicate that there is an inverse association between coffee consumption and risk of T2D. It means the higher is the consumption the lower is the risk to develop this disease. On the contrary, no effect of coffee consumption on T1D has been observed. It is however worth to mention that the etiology of the T2D and T1D is very different so that the conclusions obtained from studies on T2D cannot be extrapolated to T1D.

Question: In general, how many coffees a day is known to improve diabetes health effects?

Answer: The inverse association between coffee consumption and T2D risk is dose-dependent. The last published scientific analysis (meta-analysis by Huxley in 2009) shows about 7% reduction of the risk per cup of coffee consumed per day. Though it has beneficial effect on T2D, we cannot recommend increasing the coffee consumption as a strategy for the prevention of diabetes as a high consumption of coffee can also have some negative effects on health (e.g. increasing pressure and cholesterol level, causing anxiety and sleeplessness in susceptible individuals). Hence, we suggest a moderate coffee consumption not exceeding 3-4 cups per day.

Question: In general, the effects of coffee are preventive or therapeutic or both?

Answer: The effects of coffee are only preventive. The few and contrasting data on the possible effects of coffee consumption on diabetic patients do not allow us to draw any definitive conclusion; we can only state that a moderate coffee consumption does not seem to be contraindicated in diabetics.

Question: What are the most effective bioactive compounds in the coffee that can prevent T2D?

Answer: Generally, the effects of coffee on health are related to caffeine that owns several “pharmacological” effects on human body, mainly at the level of the central nervous system. However, coffee contains several other bioactive molecules (over 1000 chemicals have been identified in roasted coffee). Among them polyphenolic compounds are the most abundant and may play a significant role in protecting our body from T2D.

Question: What is the role of coffee polyphenols in reducing T2D?

Answer: Many different mechanisms have been proposed to explain how coffee-phenolic compounds exert their action. However, at the moment, there is no conclusive scientific consent about them, and it is not possible to define exact mechanisms.

Question: What is your opinion on proper time gaps between meal and coffee? Should there be a time gap?

Answer: According to a recent epidemiological study published by Sartorelli and colleagues in 2011, the anti-diabetic effect of coffee is not only related to frequency and amount of coffee consumption, but is also related to the modality of the consumption. In particular, one study has shown that the consumption of coffee after lunch further reduces the risk of contracting this disease. It is however important to stress that only one evidence is not sufficient to draw any definitive scientific conclusion. Thus, to give any suggestion, further researches are needed to confirm this hypothesis.

Question: Does decaffeinated coffee have same or different effects compared to regular coffee?

Answer: Epidemiological studies indicate that the association between coffee consumption and T2D is valid also for decaffeinated coffee. That’s why we think that the anti-diabetes role of coffee is not only due to caffeine, but also due to other bioactive compounds in the coffee.

Question: Is there any evidence to suggest that espresso have more pronounced effects than regular coffee? Also, does it make any difference when adding sugar, cream and milk into coffee?

Answer: No, the capacity of coffee to decrease D2T risk seems to be the same whatever is the coffee (brand, blend, amount of powder used for preparation, etc). Also the use of milk, cream, sugar and/or other sweeteners does not seem to drastically reduce the beneficial effect of coffee.

Question: What are the other significant health benefits of coffee other than reducing the diabetes risk?

Answer: Coffee consumption has also been correlated with the reduced risk of colon cancer and neurodegenerative diseases (such as Alzheimer and Parkinson).

However, it is really important to keep in mind that we can not recommend a high consumption of coffee as it has some negative effect on our health (e.g. increasing pressure and cholesterol level, causing anxiety and sleeplessness in susceptible individuals).

Question: What other important information we did not discuss here?

Answer: We should never forget that foods/beverages are not drugs, and that foods/beverages are not good or bad in themselves; it is only the diet as a whole (and lifestyle) that may be good or bad. The influence of coffee consumption on diabetes should always be set into healthy eating and lifestyle practices. We have to remember that coffee may help, but diabetes has to be prevented in first place by controlling overweight and obesity and by increasing physical activity.

This news release was based on the original scientific article published by Drs. Natella and Scaccini in the Nutrition Reviews journal. Additional general background information was acquired from PubMed and NIH sources.

Original work; Natella et al., (2012) Role of coffee in modulation of diabetes risk . Nutrition Reviews 70:4 207-217

Dr. Fausta Natella, Ph.D., is a researcher at the National Research Institute for Food and Nutrition, Rome (Italy). Her research activities focus on the study of the effects of diet, foods, isolated nutrients, non-nutrients, and their metabolites on human health.

Dr. Cristina Scaccini, Ph.D., is a senior scientist at the National Research Institute for Food and Nutrition (INRAN),Rome, and is Principal Investigator of the research team “Bioavailability, metabolism and biological effects of dietary bioactive molecules”.

More about Dr. Natella work


Written by Nalin Siriwardhana, Ph.D. and Shambhunath Choudhary, DVM Ph.D

Copyright © 2012 Nutrition Remarks. All rights reserved

Daily Cinnamon Use for Diabetes Control

Daily Cinnamon Use for Diabetes Control

Can cinnamon help manage type II diabetes?

Written by Emily Creasy, MS, RD, LD, (Nutrition Remarks writer), Reviewed by Dr. Paul Crawford M.D., and Nalin Siriwardhana, Ph.D.

Health News Highlights (March 05, 2012) <<< Print PDF>>>

When used in conjunction with regular diabetes treatment therapy, daily cinnamon supplementation may help to lower blood glucose and hemoglobin A1C (HbA1C) levels in those with type II diabetes.

Type II diabetes is a lifelong disease characterized by high levels of glucose in the blood due to low levels of insulin secretion from pancreas and/or inefficient insulin action (Insulin Resistance). Glucose is a form of sugar that is used by the cells in the body to produce energy we need for functioning. Type II diabetes may also be referred to as adult-onset diabetes or non-insulin dependent diabetes. In the body, insulin works to move and deposit glucose into cells so that it can be used for energy. For those with type II diabetes, cells (especially fat, liver, and muscle cells) do not respond correctly to insulin and do not let glucose in. This causes glucose to build up in the blood, also known as hyperglycemia/high blood glucose. If not controlled, over time this can lead to unwanted health complications including nerve damage, infections (specifically bladder, kidney and skin infections) and an increased risk for heart disease. According to the American Heart Association, heart disease and stroke are the number one causes of death and disability among people with type II diabetes.

A study by Dr. Alam Khan and colleagues at the Department of Human Nutrition, NWFP Agricultural University, Pakistan, showed that daily cinnamon supplementation helped to lower blood glucose levels up to 29 percent, regardless of the amount of cinnamon consumed each day. Cinnamon supplementation was also shown to decrease triglyceride levels in the blood 23 to 30 percent and cholesterol levels up to 26 percent, with greater decreases noted in those consuming higher amounts of cinnamon each day. In comparison, no changes in blood glucose or triglyceride levels were seen in placebo/control groups.

It is important to note that results may vary based on age, weight, and level of compliance to both the supplementation regimen and overall diabetes treatment. The effects of cinnamon supplementation are not permanent and can be reversed once supplementation is stopped. A study by Dr. Solomon and Dr. Blannin at the University of Birmingham, Birmingham, West Midlands, UK, found that, after two weeks of cinnamon supplementation, glucose tolerance and insulin sensitivity was improved. However, once supplementation was stopped, results were quickly reversed.

A simple test celled hemoglobin A1c (HbA1C) can be used to help determine an individual’s compliance to diabetes treatment, effectiveness of diabetes treatment, and overall blood glucose management over a 2-3 month period. An exciting study from Dr Paul Crawford and colleagues showed that daily cinnamon supplementation can help to decrease HbA1C levels. It is recommended that HbA1C levels be checked two to three times per year and it is NOT to be used as a replacement for daily blood glucose monitoring. The American Diabetes Association recommends that those with diabetes should try to keep their HbA1C level at or below 7%. In his study, Dr. Crawford randomly divided 109 individuals with type II diabetes into two groups. One group was instructed to consume one gram of cinnamon every day for 90 days in addition to their usual diabetes regimen. The other group continued their usual diabetes management routine with no changes. After 90 days, those taking cinnamon capsules experienced a decrease in HbA1C of 0.83%. The average starting HbA1C of 8.47% was decreased to 7.64% simply by consuming cinnamon each day. In comparison, the control group, which received no cinnamon, showed an HbA1C decrease of only 0.37%.

Diabetes treatment and management requires a lifelong commitment to a healthy lifestyle including a balanced diet, regular physical activity, adherence to medication treatments as applicable and continued blood glucose monitoring. Daily consumption of cinnamon may help to boost diabetes treatment efforts over time. Successful control of diabetes can also help to reduce your risk of obesity, heart disease, and diabetes related complications including kidney disease, eye, skin, and foot problems. Because excessive intake of cinnamon may lead to skin irritation, blood thinning, liver and kidney injury, consult a physician prior to adding cinnamon to your diet to help determine a dose that is appropriate for you and your specific needs.


Khan A, Safdar M, Ali Khan MM, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. December 2003.

Roussel AM, Hininger I, Benaraba R, Ziegenfuss TN, Anderson RA. Antioxidant effects of a cinnamon extract in people with impaired fasting glucose that are overweight or obese. Journal of the American College of Nutrition. February 2009.

Crawford P. Effectiveness of cinnamon for lowering hemoglobin A1C in patients with type 2 diabetes: a randomized, controlled trial. Journal of the American Board of Family Medicine. September 2009.

Solomon TP, Blannin AK. Changes in glucose tolerance and insulin sensitivity following 2 weeks of daily cinnamon ingestion in healthy humans. European Journal of Applied Physiology. April 2009.

American Diabetes Association. Living with Diabetes: A1C. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/

American Diabetes Association. American Diabetes Association’s New Clinical Practice Recommendations Promote A1C as Diagnostic Test for Diabetes. December 2009. http://www.diabetes.org/for-media/2009/cpr-2010-a1c-diagnostic-tool.html

U.S. National Library of Medicine. PubMed Health. A.D.A.M. Medical Encyclopedia: Type 2 Diabetes. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001356/

American Heart Association. Why Diabetes Matters. http://www.heart.org/HEARTORG/Conditions/Diabetes/Diabetes_UCM_001091_SubHomePage.jsp

Copyright © 2012 Nutrition Remarks. All rights reserved

Craving Sweet Foods and its link to Diabetes in Pregnancy

Craving Sweet Foods and its link to Diabetes in Pregnancy

Written by, Suhanki Rajapaksa, MBBS (Nutrition Remarks writer), Reviewed by Professor Beverly J. Tepper, Ph.D. and Nalin Siriwardhana, Ph.D.

Health News Highlights (February 26, 2012)

Food cravings during pregnancy are so common. It is reported that 50-90% of all pregnant women experience some kind of intense desire to consume specific foods at some point during their pregnancies. However, sweet food cravings should be carefully handled for the sake of good health of both mother and the baby.

Women who never had diabetes can experience high blood glucose levels, due to Glucose intolerance (an inability to metabolize glucose properly by the body) during pregnancy. This condition is known as Gestational Diabetes Mellitus (GDM) and it is said to affect about 18% of pregnancies.

Professor Beverly and colleagues at the Department of Food Science in the School of Environmental & Biological Sciences of Rutgers University, has conducted a comprehensive study to investigate sweet cravings in pregnant women with GDM.

A group of pregnant women were enrolled into the study at 16-20 weeks of their pregnancy and monitored during three sessions over the course of their pregnancy and once 6-10 weeks after delivery. Non-pregnant controls were also tested at similar intervals. All pregnant women were routinely screened for GDM at 24-28 weeks of pregnancy. Women who were diagnosed with GDM were referred to nutritional counseling and received diet therapy until the end of their pregnancies. At the same time, the food cravings of these women were noted by questionnaires.

The sweet craving frequency among pregnant women with GDM was on average found to be higher than the women with pregnancies not complicated by GDM (normal glucose tolerant – NGT) or the control group at 34-38 weeks of pregnancy. The number of sweet food cravings per week was twice that of the NGT group. Interestingly these sweet craving frequencies in women with GDM fell significantly lower than the other two groups after delivery. The period when these sweet food cravings occurred was also different among the two pregnant groups. The pregnant women with GDM craved sweet foods most frequently at 34-38 weeks. With the NGT group the maximum frequency was at 24-28 weeks gestation and their cravings had lessened by 34-38 weeks. The women with GDM had these sweet-food cravings even before their diet therapy began.

When asked about how much they liked certain moderately sweetened dairy drinks the women with GDM showed that they liked it more than did the NGT group. Also, it was an interesting finding that even within the GDM group, those with a higher level of glucose intolerance liked glucose solutions better than those with a lower level of Glucose intolerance.

A definite reason for the increase in sweet food cravings by pregnant women with GDM is still unclear. However, researchers believe that insulin resistance (natural hormone insulin becoming less effective at lowering blood sugars) and glucose intolerance, which are associated with GDM, may play a role in the increased preference and cravings for sweet foods in pregnant women with the disease. Studies show that only in women with GDM, fasting insulin was correlated with liking of glucose solutions. And fasting leptin (A hormone which plays a key role in regulating appetite and metabolism) was correlated with sweetness liking of 10% sucrose milk. This correlation was not seen in pregnant women without GDM. This has led researchers to believe that there are hormonal factors involved in changes in food preferences, cravings and taste in pregnancy.

Untreated or poorly controlled GDM can hurt the unborn baby. Fetal Macrosomia (large babies), difficult delivery due to big baby, low blood glucose after birth & breathing problems are all complications which could occur due to GDM. Also these babies are at a higher risk for obesity and type 2 diabetes as they grow into adults.

The above studies show a significant connection between GDM and increased cravings for sweet food. This is important because this increased desire for sweet taste could influence dietary interventions to control this disease. Therefore food cravings should be taken into consideration by healthcare providers when managing GDM. And pregnant women should act with caution when handling their cravings.

This information is primarily based on the following article published in Appetite Journal. Some general background information was acquired from PubMed, NIH and ADA sources.

Lisa M. Belzer, John C. Smulian, Shou-En Lu, Beverly J. Tepper. Food cravings and intake of sweet foods in healthy pregnancy and mild gestational diabetes mellitus. A prospective study. Appetite. Dec 2010; 55(3): 609-615


Lisa M. Belzer, John C. Smulian, Shou-En Lu, Beverly J. Tepper., Food cravings and intake of sweet foods in healthy pregnancy and mild gestational diabetes mellitus. A prospective study. Appetite. Dec 2010; 55(3): 609-615

Lisa M. Belzer, John C. Smulian, Shou-En Lu, Beverly J. Tepper., Changes in Sweet Taste Across Pregnancy in Mild Gestational Diabetes Mellitus: Relationship to Endocrine Factors. Chemical Senses. 2009; 34 (7): 595-605.

What is Gestational Diabetes. American Diabetic Association (ADA) http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html

Copyright © 2012 Nutrition Remarks. All rights reserved