Metabolic syndrome: natural solutions for a worldwide health problem

Jack ChallemSymptoms of metabolic syndrome, a form of prediabetes, can be offset with natural compounds. But their effectiveness ultimately may depend on how these ingredients are combined in formulas. Jack Challem investigates

Ten years ago relatively few people appreciated the term 'metabolic syndrome.' Today, doctors around the world routinely diagnose it in patients, and the term is quickly becoming household words. The condition, a form of prediabetes, is also attracting the interest of natural-ingredients suppliers and supplements companies.

Prediabetes, of course, is a stepping stone to full-blown type 2 diabetes. The diagnosis of metabolic syndrome is based on a cluster of familiar symptoms that increase the risk of full-blown type 2 diabetes, coronary artery disease and many other disease processes. Metabolic syndrome is also known as Syndrome X and insulin resistance syndrome.

The official medical definitions of metabolic syndrome vary slightly among medical organisations, such as the US National Institutes of Health, the International Diabetes Federation and the World Health Organization.1,2,3 As a general rule, metabolic syndrome includes at least three of the following symptoms: insulin resistance; elevated blood glucose; abdominal obesity; hypertension; and elevated total cholesterol, low-density lipoprotein (LDL) cholesterol, or triglyceride in combination with decreased high-density lipoprotein (HDL) cholesterol.4

Insulin resistance, indicated by hyperinsulinaemia, forms the central feature of metabolic syndrome. It develops after years of eating high-glycaemic foods, which spike blood glucose levels and stimulate insulin secretion. As fasting and postprandial insulin levels increase, the body's cells become resistant to insulin's normal role in removing glucose from the blood. Glucose levels then climb, while insulin's collateral effects mount.

Because insulin promotes the storage of fat, particularly around the belly, abdominal obesity usually becomes the most visible sign of insulin resistance. Indeed, being overweight is the principal risk factor for developing prediabetes and diabetes. In the United States, two thirds of American adults are now overweight, with one third of Americans being obese (30 or more pounds over their ideal weight). Men fare a little worse than women, with four of every five American men now overweight.5

In England, 39 per cent of people are overweight and 21 per cent are obese. The numbers are rising, and projections indicate that one third of British men will be obese by 2010.6 Regardless of what you might have heard about French women not getting fat, 42 per cent of French citizens tip the scales as overweight or obese, and the per cent goes up to 51 per cent in some parts of the country.7

Hyperinsulinaemia also contributes to hypertension, elevated total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides.8,9,10 Untreated, the diagnosis of type 2 diabetes usually occurs within a few years.11 However, hyperinsulinaemia may be present 15 years before elevated glucose and other symptoms of diabetes or metabolic syndrome become clinically meaningful, providing a window for prevention and treatment.12

Each individual symptom of metabolic syndrome increases the risk of diabetes and coronary artery disease. Combined, the risk amplifies. Even erectile dysfunction,13 Alzheimer's disease,14 polycystic ovary syndrome,15 and some types of cancer (eg, of the breast)16 have been linked to hyperinsulinaemia or metabolic syndrome. In fact, elevated insulin and glucose stimulate inflammation, creating a potential link to every chronic degenerative disease process.

Worldwide problem
The prevalence of metabolic syndrome in the United States has been estimated at somewhere between 39 million17,18 and 10019 million adult cases, the majority of which remain undiagnosed.17,18,19 In England, metabolic syndrome is strongly stratified along income, with more than one fifth of poorer men and women having the condition — two to three times the prevalence among wealthier men and women.20

Worldwide, the prognosis is grim, with diabetes being the eventual outcome. According to a recent report in the New England Journal of Medicine, diabetes cases will probably soar to unprecedented levels by 2030. Although the researchers projected a 72 per cent increase in diabetes in the United States and a 32 per cent increase in Europe, diabetes will jump by 164 per cent in the Middle East, 150 per cent in India, 104 per cent in China and 148 per cent in South America. Currently, an estimated 246 million people worldwide have diabetes. That number is expected to climb to 420 million in less than 20 years.21

Natural ingredients
Individual nutritional ingredients, in supplements or functional foods, can help improve insulin function, glucose control, and other signs and symptoms of metabolic syndrome. They function by providing the natural building blocks for a variety of biochemical pathways. Based on published research, the top-tier ingredients include alpha-lipoic acid and R-lipoic acid, chromium, biotin, Pycnogenol, and silymarin. (See the sidebar below for other important ingredients.)

Some ingredients, such as chromium and biotin, have been tested in combination. However, no individual ingredients have been found helpful in treating all aspects of metabolic syndrome in people. As a general rule, ingredients that reduce the risk of diabetes will likely reduce symptoms of metabolic syndrome. The ideal approach to product formulation would be to address most or all of the symptoms of metabolic syndrome.

Alpha-lipoic acid and R-lipoic acid have long been used as prescription drugs in Germany to treat diabetic nerve disease. Alpha-lipoic (thioctic) acid improves insulin function and is also a potent antioxidant. The latter is important because many of the complications of diabetes involve free radical damage and alterations in gene expression and cell signaling.22 Alpha-lipoic acid also plays co-enzymatic roles in the Krebs cycle, where glucose and fats are burned for energy.

Several large clinical trials have confirmed the benefits of alpha-lipoic acid in improving insulin function and reducing insulin resistance, even when blood glucose levels remain steady.23 That's important because of the health hazards of elevated insulin.

Stabilising insulin and blood glucose levels tends to reduce hunger jags and overeating, a common problem in metabolic syndrome. However, according to an animal study, lipoic acid may have appetite-reducing benefits via a different mechanism. Researchers reported in Nature Medicine that lipoic acid suppressed AMP-activated protein kinase, a hunger-regulating enzyme in the hypothalamus gland. Alpha-lipoic acid supplements reduced appetite, weight and blood glucose levels in laboratory rats. 24

Alpha-lipoic acid contains equal amounts of both S and R isomers, although research suggests that the R form is the more natural and biologically active part of the molecule.25 R-lipoic acid may be an alternative. However, most of the clinical research has used alpha-lipoic acid, and R-lipoic acid is more difficult to produce and more expensive than the alpha form.

Chromium is an essential dietary mineral that potentiates insulin function, leading to the cellular uptake and metabolism of blood glucose. Chromium deficiency results in symptoms similar to those of metabolic syndrome and diabetes, including elevations in blood lipids and decreases in glucose tolerance.26 Chromium supplements can improve insulin function and reduce blood-sugar levels over several months.27

Chromium picolinate, polynicotinate (niacin-bound), and glycinate are the most common forms found in supplements. However, most clinical studies over the past 10 years have used the picolinate and polynicotinate forms. Supplementation studies have found that 1,000mcg daily seems to be the ideal dose for people with diabetes. 28 Smaller amounts may be useful in less severe glucose intolerance.

Recent studies by Harry Preuss, MD, of Georgetown University, have found that chromium polynicotinate (600mcg/day for three months) lowered blood-sugar levels.29 Another study by Preuss found that chromium polynicotinate promoted fat loss but preserved muscle in overweight women.30 Meanwhile, other researchers found that chromium picolinate reduced weight gain from the diabetes drug glipizide.31

Biotin is a B-complex vitamin essential for the manufacture of insulin, and it also has insulinlike activity. Biotin regulates genes involved in the metabolism of glucose, amino acids and fatty acids.32 Clinical trials of biotin have led to reductions in triglyceride levels, but not in other signs of diabetes or metabolic syndrome.33 However, combining chromium picolinate (600mcg daily) with biotin (2,000mcg daily) has yielded more promising results, with reductions in blood glucose and HbA1c (which reflects glucose levels over six weeks), as well as improvements in blood-lipid ratios over periods ranging from one to three months.34,35,36

Pycnogenol is extracted from the bark of French maritime pine trees. This natural antioxidant complex inhibits the activity of alpha-glucosidase, one of the key enzymes that breaks down sugars and carbohydrates during digestion. The mechanism is similar to the diabetes drug acarbose, but a study found Pycnogenol 190 times more potent than acarbose in inhibiting alpha-glucosidase. As a result, some carbs pass through the gut without being broken down into glucose or stored as fat.37

Pycnogenol can also lead to significant reductions in fasting blood sugar and post-meal increases in blood sugar. In one study, people with diabetes took 50mg of Pycnogenol daily for three weeks and benefited from an average 10 per cent decrease in fasting blood-sugar levels. The benefits increased with larger amounts of Pycnogenol, topping out at 200mg daily with a 13 per cent reduction in fasting blood sugar.38

Silymarin, the antioxidant extract of the herb milk thistle (Silybum marianum) enhances liver function — significant because this organ works in tandem with the pancreas to regulate blood-glucose levels. In a 12-month study, 600mg daily of silymarin reduced blood-sugar levels in seriously ill diabetic patients by 13 per cent to 15 per cent. The patients also benefited from less sugar in the urine, lower HbA1c levels and smaller insulin requirements.39

A more recent study involved 51 diabetic patients, who took either 200mg of silymarin three times daily or placebos for four months. Silymarin supplementation led to striking improvements in almost every indicator of glucose tolerance and cardiovascular disease. Fasting blood sugar decreased from an average of 156mg/dl to 133mg/dl, a decline of almost 15 per cent. Glycated hemoglobin (HbA1c), a marker of average glucose levels, went from 7.8 to 6.8 per cent, a drop of almost 13 per cent, over about six weeks. In addition, insulin levels declined by 25 per cent, and total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels decreased significantly.40

Fibre/starch blockers are intriguing because one of the traits of metabolic syndrome is hypersensitivity to carbohydrates, especially sugars.41 High-fibre, low-glycaemic foods have long been known to reduce blood-glucose, insulin and lipid levels.42,43 Fibre speeds bowel transit time, allowing for less absorption of starches and sugars, while low-glycaemic carbohydrates result in moderate increases in blood-glucose and insulin levels. Several proprietary fibre products (eg, PGX) are sold at the retail level and are not yet available as raw materials. Although starch blockers, such as Phase 2 starch neutralizer, work through a mechanism different from that of fibre, they do seem to have similar benefits.44

Jack Challem is author of Syndrome X (Wiley, 2000), and The Food-Mood Solution (2007). His next book, Stop Prediabetes Now , will be published in November 2007. Respond:

"The prevalence of metabolic syndrome in the United States has been estimated at somewhere between 39 million and 100 million adult cases…."
"As a general rule, ingredients that reduce the risk of diabetes will likely reduce symptoms of metabolic syndrome …"

Ingredients for individual symptoms of metabolic syndrome

  • Elevated glucose: bitter melon, chromium/biotin combination, cinnamon, magnesium, N-acetylcysteine, Pycnogenol, silymarin.
  • Insulin resistance: alpha-lipoic acid, biotin, chromium, silymarin.
  • Hypertension: L-arginine, Maitake mushrooms, omega-3 fatty acids, Pycnogenol
  • Elevated triglyceride: biotin, omega-3 fatty acids.
  • Elevated cholesterol/LDL: cinnamon, Maitake mushrooms, niacin, phytosterols
  • Appetite and weight reduction: alpha-lipoic acid, fibre, starch blockers, vinegar60


Functional Ingredients

  • Alpha-lipoic acid. Improves insulin function and reduces insulin resistance, even when blood-glucose levels remain steady.
  • Biotin. Helps make insulin and has insulinlike activity. Reduces triglycerides. Combined with chromium, reduces blood glucose and improves blood-lipid ratios.
  • Chromium. Improves insulin function and reduces blood-sugar levels.
  • Fibre/Starch blockers. Reduce absorption of starches and sugars.
  • Pycnogenol. Helps break down sugars and carbs. Reduces blood-sugar levels.
  • Silymarin. Helps regulate blood glucose levels by enhancing liver function.
Other potentially helpful natural compounds: Limited research has found that these substances may be helpful in some of the symptoms of metabolic syndrome and diabetes.
  • Bitter melon. Extracts of this green gourd have been shown to reduce blood-glucose levels in cell, animal and human studies.46
  • Cinnamon. Two recent studies found that cinnamon reduced fasting blood glucose, post-prandial glucose increases and blood lipids. A third study found no benefits.47,48
  • Fenugreek. Soluble fibre in fenugreek seeds slows carbohydrate absorption and boosts insulin activity.49
  • Green tea. Primary catechin EGCG improves insulin sensitivity, improves glucose utilisation and metabolism, and acts as an antioxidant.50
  • L-arginine. The precursor to nitric oxide, L-arginine is a vasodilator and can lower blood pressure.45
  • Magnesium. This essential mineral can lower fasting blood sugar and raise the 'good,' high-density lipoprotein form of cholesterol.51
  • Maitake mushrooms. Some evidence indicates that glycoprotein extracts Grifola frondosa may benefit those with diabetes, hypertension, elevated blood lipids and overweight issues.52
  • N-acetylcysteine. This sulfur-containing supplement may help improve glucose tolerance.53
  • Omega-3 fatty acids. These healthy fats reduce insulin resistance and triglyceride levels; their anti-inflammatory effects may also reduce diabetic complications.54
  • Phytosterols. These plant extracts can lower total cholesterol and LDL cholesterol almost as impressively as medications.55
  • Vanadyl sulfate. Regarded as an insulin mimic, this mineral compound may improve insulin resistance.56



Mini directory

Fibersol-2 digestion-resistant maltodextrin is a highly soluble fibre that is stable, has low viscosity, is transparent in solution and adds virtually no flavor to the finished product.

VitaSugar food ingredient is a prebiotic fibre and low-caloric nutritive sweetener suitable for baked goods, confectionaries, milk products, sweets and sweets-related products. It is stable above 320 degrees F.

Corowise brand plant sterols are taking the mainstream beverage world by storm, from Minute Maid orange juice to Rice Dream rice milk, as well as incorporation into breads, bars, cheeses and more.

Fish oil-derived oils and powders are taste- and odour-free, and suitable for the range of foods, supplements and pet products.

FenuLife brand fenugreek is an odourless and tasteless fenugreek extract for dietary supplements, foods and cosmetics.

Integrity Nutraceuticals
Cinnulin PF is a patented, concentrated cinnamon (Cinnamomi cassia) extract. The 100 per cent water-soluble product undergoes a specialised extraction process that maintains the natural content of cinnamon's polyphenol polymers.

ChromeMate (generically called chromium nicotinate, chromium polynicotinate or niacin-bound chromium) is a patented oxygen-co-ordinated niacin-bound chromium complex that plays an important role in proper insulin function, maintenance of healthy blood sugar and cholesterol levels, normal energy production, and promotion of healthy body weight.

Maitake Products
SX-Fraction is available in a standardised extract form as a raw material lableled "PSX-Fraction" to qualified manufacturers. The ingredient has been awarded a US patent as a blycoprotein with antidiabetic, antihypertensive antiobesity and antihyperlipidemic effects Grifola frondosa.

Martek Biosciences
life'sDHA is algae-derived DHA suitable for supplements, foods, beverages and infant formula.

Natural Health Science
Pycnogenol French maritime pine bark extract is exclusively distributed in North America by NHS. German company Horphag Research is the original supplier.

Next Pharmaceuticals
Chromulin is a new patented form of chromium that is stable, water soluble, and with superior absorption. It is a natural combination of the essential mineral chromium III with the essential amino acid histidine.

Ocean Nutrition Canada
meg-3 brand omega-3 fish oil has a patented Powder-loc micro-encapsulation technology making it state of the art for food and beverage integration without off-flavours or odours.

Pharmachem Labs
Phase 2 starch neutralizer and its food-friendly counterpart, Starchlite, are extracts of white kidney beans and both are GRAS.



1. Grundy SM, et al. Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109:433-8.
2. International Diabetes Federation. The IDF Consensus worldwide definition of the metabolic syndrome. Brussels, Belgium: International Diabetes Federation; 2004.
3. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO Consultation. Part 1: diagnosis and classification of diabetes mellitus. Geneva, Switzerland: World Health Organization; 1999.
4. Deen D. Metabolic syndrome: time for action. Am Fam Physician 2004;69:2875-2882.
5. Ogden CL, et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA 2006;295:1549-55.
6. Castle T. England facing obesity crisis. Reuters Health. August 25, 2006.
7. Scilino E. France battles a problem that grows and grows: fat. New York Times, January 25, 2006:A4.
8. Lev-Ran A. Mitogenic factors accelerate later-age diseases: insulin as a paradigm. Mech Aging Develop 1998;102:95-113.
9. Insulin resistance, hyperinsulinaemia, dyslipidemia, hypertension and accelerated atherosclerosis. J Clin Pharmacol 1992;32:529-35.
10. Kashyap SR, Defronzo RA. The insulin resistance syndrome: physiological considerations. Diabetes Vascular Dis Res 2007;4:13-19.
11. Tirosh A, et al. Normal fasting plasma glucose levels and type 2 diabetes in young men. New Engl J Med 2005;353:1454-62.
12. Cleland SJ, et al. Insulin as a vascular hormone: implications for the pathophysiology of cardiovascular disease. Clin Exper Pharmacol Physiol 1998;25:175-184.
13. Kupelian V, Shabsigh R, et al. Erectile dysfunction as a predictor of the metabolic syndrome in aging men: results from the Massachusetts Male Aging Study. J Urol 2006;176:222-6.
14. Razay G, et al. The metabolic syndrome and Alzheimer disease. Arch Neurol 2007;64:93-6.
15. Vignesh JP, Mohan V. Polycystic ovary syndrome: A component of metabolic syndrome? J Postgrad Med 2007;53:128-34.
16. Pasanisi P, et al. Metabolic syndrome as a prognostic factor for breast cancer recurrences. Int J Cancer 2006;119:236-8.
17. Ford ES. Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the US. Diabetes Care 2006;29:752.
18. Ford ES, et al. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002;287:356-9.
19. Stop Prediabetes Now. Challem J and Hunninghake R. New York: John Wiley and Sons. In press, 2007.
20. Perel P, et al. Household wealth and the metabolic syndrome in the Whitehall II study. Diabetes Care 2006 Dec;29(12):2694-700.
21. Hossain P, et al. Obesity and diabetes in the developing world?a growing challenge. New Engl J Med 2007;356:213-5.
22. Packer L, et al. Molecular aspects of lipoic acid in the prevention of diabetes complications. Nutrition 2001;17:888-95.
23. Jacob S, et al. Oral administration of rac-a-lipoic acid modulates insulin sensitivity in patients with type-2 diabetes mellitus: a placebo-controlled pilot trial. Free Rad Biol Med 1999;27:309-14.
24. Kim MS, et al. Anti-obesity effects of a-lipoic acid mediated by suppression of hypothalamic AMP-activated protein kinase. Nature Med 2004;10:727-33.
25. Packer L, et al. Molecular aspects of lipoic acid in the prevention of diabetes complications. Nutrition 2001;17:888-95.
26. Jeejeebhoy KN. The role of chromium in nutrition and therapeutics and as a potential toxin. Nutrition Rev 1999;57:329-35.
27. Anderson RA, et al. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes 1997;46:1786-91.
28. Anderson RA, et al. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes 1997;46:1786-1791.
29. Yasmin T, et al. Toxicological assessment of a novel niacin-bound chromium, known to ameliorate the symptoms of metabolic syndromes. J Am College Nutr 45th Annual Meeting, abs 77, October 2004.
30. Crawford V, et al. Effects of niacin-bound chromium supplementation on body composition in overweight African-American women. Diabetes Obes Metab 1999;1:331-7.
31. Martin J, et al. Chromium picolinate supplementation attenuates body weight gain and increases insulin sensitivity in subjects with type 2 diabetes. Diabetes Care 2006;29:1826-32.
32. Rodriguez-Melendez R. Regulation of gene expression by biotin. J Nutr Biochem 2003;14:680-90.
33. Revilla-Monsalve C, et al. Biotin supplementation reduces plasma triacylglycerol and VLDL in type 2 diabetic patients and in nondiabetic subjects with hypertriglyceridemia. Biomed Pharmacother 2006;60:182-5.
34. Albarracin CA, et al. Chromium picolinate and biotin combination improves glucose metabolism in treated, uncontrolled overweight to obese patients with type 2 diabetes. Diabetes Metab Res Rev 2007 May 16; [Epub ahead of print].
35. Singer GM, Geohas J. The effect of chromium picolinate and biotin supplementation on glycaemic control in poorly controlled patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized trial. Diabetes Technol Therapeutics 2006;8:636-43.
36. Geohas J, et al. Chromium picolinate and biotin combination reduces atherogenic index of plasma in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial. Am J Med Sci 2007;333:145-53.
37. Schafer A, Hogger P. Oligomeric procyanidins of French maritime pine bark extract (Pycnogenol) effectively inhibit alpha-glucosidase. Diabetes Res Clin Prac 2007;77:41-6.
38. Liu X, et al. French maritime pine bark extract Pycnogenol dose-dependently lowers glucose in type 2 diabetic patients. Diabetes Care 2004;27:839.
39. Velussi M, et al. Long-term (12 months) treatment with an antioxidant drug (silymarin) is effective on hyperinsulinaemia, exogenous insulin need and malondialdehyde levels in cirrhotic diabetic patients. J Hepatol 1997;26:871-9.
40. Huseini HF, et al. The efficacy of Silybum marianum (L.) Gaertn. (Silymarin) in the treatment of type II diabetes: a randomized, double-blind, placebo-controlled, clinical trial. Phytotherapy Res 2006;20:1036-9.
41. Volek JS, Feinman RD. Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond); 2005 Nov, 162:31.
42. Riccardi G, Rivellese AA. Dietary treatment of the metabolic syndrome — the optimal diet. Br J Nutr 2000;83 Suppl 1:S143-8.
43. Riccardi G, Rivellese AA. Effects of dietary fibre and carbohydrate on glucose and lipoprotein metabolism in diabetic patients. Diabetes Care 1991;14:1115-25.
45. Boger RH. The pharmacodynamics of L-arginine. J Nutr 2007;137:1650S-1655S.
46. Krawinkel MB, Keding GB. Bitter gourd (Momordica charantia): a dietary approach to hyperglycemia. Nutr Rev 2006;64(7 Pt 1):331-7.
47. Khan A, et al. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care 2003;26:3215-8.
48. Hlebowicz J, et al. Effect of cinnamon on postprandial blood glucose, gastric emptying, and satiety in healthy subjects. Am J Clin Nutr 2007;85:1552-6.
49. Hannan JM, et al. Soluble dietary fibre fraction of Trigonella foenum-graecum (fenugreek) seed improves glucose homeostasis in animal models of type 1 and type 2 diabetes by delaying carbohydrate digestion and absorption, and enhancing insulin action. Br J Nutr 2007;97:514-21.
50. Houston MC. The metabolic syndrome. Pathophysiology, diagnosis, clinical aspects, prevention and nonpharmacologic treatment: emphasis on lifestyle modifications, nutrition, nutritional supplements, vitamins, minerals, antioxidants, weight management and exercise. J Am Nutraceutical Assoc 2005;8(2):3-83.
51. Song Y, et al. Effects of oral magnesium supplementation on glycaemic control in type 2 diabetes: a meta-analysis of randomized double-blind controlled trials. Diabetic Med 2006;23:1050-6.
52. United States Patent # 7214778
53. Kilic-Okman T, Kucuk M. N-acetylcysteine treatment for polycystic ovary syndrome. Int J Gynecol Obstetrics 2004;85:296-7.
54. Rasic-Milutinovic Z, et al. Effects of n-3 PUFAs supplementation on insulin resistance and inflammatory biomarkers in hemodialysis patients. Renal Failure 2007;29:321-9.
55. Acuff RV, et al. The lipid lowering effect of plant sterol ester capsules in hypercholesterolemic subjects. Lipids Health Dis 2007;96:11.
56. Tas S, et al. Vanadyl sulfate, taurine, and combined vanadyl sulfate and taurine treatments in diabetic rats: effects on the oxidative and antioxidative systems. Arch Med Res 2007;38:276-83.
57. Pittas AG, et al. Vitamin D and calcium intake in relation to type 2 diabetes in women. Diabetes Care 2006;29:650-6.
58. Pittas AG, et al. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metabol 2007;92:2017-29.
59. Adachi Y, et al. Oral administration of a zinc complex improves type 2 diabetes and metabolic syndromes. Biochem Biophys Res Comm 2006;351:165-70.
60. Johnston CS. Strategies for healthy weight loss: from vitamin C to the glycaemic response. J Am Coll Nutr 2005;24:158-65.


Hide comments


  • Allowed HTML tags: <em> <strong> <blockquote> <br> <p>

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.