Magnesium and Blood Sugar Control

What is Magnesium

Magnesium is a mineral that has many responsibilities in the body. Enzymes that perform important roles use magnesium to help carry out biochemical reactions including the production of proteins, muscle and nerve operations, and blood pressure control(1). A growing body of evidence also suggests that magnesium plays a significant role in the regulation of blood sugar and insulin action (1, 2, 4,5)

Most magnesium is located either in cells or bones, making it a difficult mineral to measure in the human body (1). Magnesium levels are tightly regulated by the kidney, which can make an inadequacy even harder to detect if one may be present. Despite magnesium being difficult to measure, there are individuals known to be at a higher risk of having inadequate levels.


Groups at Risk for Magnesium Deficiency

People with diabetes

  • When there is a large amount of glucose in the body, the kidney compensates by getting rid of the glucose through increasing urinary output. Magnesium is also lost through this increased urinary output, following the glucose (1).  It has even been suggested that altered magnesium levels may promote the development of type 2 diabetes (2).

Older adults

  • It has been found that older adults have decreased intakes of magnesium compared to younger adults (1). The amount of magnesium absorbed in the intestine also decreases with age, while the amount excreted by the kidney increases.

People taking certain medications

  • Certain medications including diuretics, antibiotics, and proton pump inhibitors may also have the potential to decrease the amount of magnesium in the body (1)

People with gastrointestinal issues

  • Crohn’s disease, celiac disease, and individuals who have undergone resection or bypass of the small intestine may not be absorbing magnesium sufficiently (1).

Blood Sugar Control and Magnesium

Low magnesium levels are common in individuals with type two diabetes, especially if blood glucose levels are poorly controlled (2). Magnesium is important in controlling the action of insulin and insulin reliant glucose uptake at the cell. Overall, low magnesium levels can impair the action of insulin and increase insulin resistance (2,5)

How Can I Increase Mangensium In My Diet?

The Recommended Dietary Allowance for magnesium is 320 mg for women and 420 mg for men. To reach this daily try aiming to include a few of the magnesium-rich foods listed below.

  • Green leafy vegetables
  • Legumes
  • Nuts and Seeds
  • Whole-Grains
  • Dark Chocolate
  • Avocados

Do I Need A Supplement?

Oral magnesium supplements are available and may be beneficial for those with type 2 diabetes with a magnesium deficiency and to help decrease insulin resistance (2, 4). Consult your doctor before starting magnesium supplementation magnesium as supplement form may interfere with drug absorption, reducing the effect of some medications.

Taking magnesium in supplement form also increases the risk of producing toxicity symptoms like diarrhea, weakness, blurred vision, and cardiac distress (1). The risk of toxicity is not present when obtaining magnesium through food sources because the kidney regulates excessive amounts through excretion in urine (1).  The Institute Of Medicine has set an Upper Limit for adults taking magnesium supplements at 350 mg daily. This does not include intake from food sources (3).

Take-Home Message

If you have diabetes or another condition that increases your risk for magnesium deficiency take a look at your typical diet and aim to consume foods with a good source of magnesium.  If you still think you might be coming up short talk to your doctor and dietitian about starting a supplement.

Vitamin B12 and Metformin

What is Vitamin B12?

Vitamin B12, also known as cobalamin, plays a crucial role in many important functions in the body. It is essential for nervous system fuction, blood cell formation, metabolism of folic acid, and synthesis of DNA (1)In the diet vitamin B12 is typically obtained through consumption of meat or milk.  The best source of vitamin B12 can be found in clams and liver, with a 3 oz portion of clams providing 1400% of the Daily Value!(1,2).

The digestion and absorption of vitamin B12 relies on certain factors to be present in order to be successful. The high acidity of the stomach is an important part of the digestive process because it allows for proteins surrounding vitamin to break free, continuing digestion (2). Different transporters and chaperones are required for absorbtion by the cells. Because there are many steps in the process of digestion and absorption, there are many areas that can go wrong if not all that is required is present.  


Does Taking Metformin Increase Risk of Vitamin B12 Deficiency?

Metformin is the most commonly prescribed drug to individuals with type 2 diabetes and is also used for insulin resistant conditions like polycystic ovarian syndrome (PCOS) (4). Metformin has many benefits for those with insulin resistance, and is prescribed as a first line of treatment. However in a systematic review of multiple research studies, it was concluded that long term use of metformin had a significant impact on a reduction of vitamin B12 concentrations (3).  Studies show the prevelance of vitamin B12 deficiency to be has high as 30% in patients with type 2 diabetes taking metformin (5).


Groups At Risk For Vitamin B12 Deficiency

  • older adults
  • vegetarian or vegan diets
  • use of proton pump ihibitors (PPIs)
  • gastrointesntial disorders (Crohns diease and celiac disease)
  • history of gastrointenstial surgery



What Are The Risks Of Vitamin B12 Deficiency?

People with type 2 diabetes are at an increased risk for cardiovascular complications as well as peripheral neuropathy, and having low vitamin B12 levels increases this risk(2). Elevated cardiovascular disease risk is due to the role vitamin B12 plays in metabolism of an amino acid called homocysteine. Without B12, homocysteine levels stay elevated, which can increase your risk of heart disease (2,3). Peripheral neuropathy is a condition in which multiple symptoms can be present including pain, numbness, tingling in hands or feet, and sensory loss (7). With a vitamin B12 deficiency, damage can occur to myelin sheaths that surround nerves. The myelin sheaths protect nerves and without this protection, neuropathy can develop (7).


Bottom Line

If you are at increased risk for vitamin B12 deficiency you should talk to your doctor or dietitian about a supplement. According to the Institute of Medicine vitamin B12 is not known to cause any adverse side effects at high doses, meaning the risks of supplementing are likely low (6). Studies suggest supplements may be beneficial for certain groups but you will want to make sure you are taking the correct dose and from of the vitamin for the greatest result.  (2,3). 

Foods To Lower Your Cholesterol

How Can Foods Lower Cholesterol?

With an estimated 1 out of 3 American adults with high cholesterol levels, it’s no surprise that questions about diet changes to lower cholesterol come up often.  If you have been diagnosed with high cholesterol taking a look at your diet is a great place to start because there are actually a few different ways foods can lower cholesterol levels.

What Is Cholesterol?

Cholesterol is a waxy substance produced in the liver and essential to human health. We often think of cholesterol in a negative light but it has important functions in the body including serving as a structural component of hormones, nerve impulse conductivity, and the endogenous production vitamin D. In addition to what is made in the body, cholesterol can also be absorbed from food sources.

cholesterol from the liver and food sources

What Does It Matter If Cholesterol Is High?

Having high cholesterol increases the risk of atherosclerotic cardiovascular disease (ASCVD) which is when plaque builds up in the blood vessels of the heart, brain, and peripheral arteries.  According to the Center for Disease Control, heart disease and stroke are the first and fifth leading cause of death in the United States.(1) It’s recommended that healthy adults have their cholesterol checked every 4 to 6 years.  For those at greater risk or with a history of heart disease more frequent checks may be needed.

What To Eat If You Want to Lower Your Cholesterol?

1. Increase Soluble Fiber

Soluble fiber works to decrease cholesterol by binding bile salts in the digestive tract. Bile salts are made in the liver using cholesterol and play an important role in digestion and absorption of food.  When they are bound and excreted with the soluble fiber it helps to reduce reabsorption and regulates cholesterol levels in the body.   Aim for a daily goal of at least 10 grams of soluble fiber.  This makes up around one- third of your total daily goal of 25-30 grams. Good sources of soluble fiber with at least 2 grams per serving include oatmeal, mango, figs, black beans, oat bran, and brussels sprouts.

2. Add Plant Sterols

Cholesterol plays several important roles in the human body including cell wall structure, while plants don’t have cholesterol they do have a similar compound known as phytosterols. Phytosterols are so structurally similar to cholesterol that they compete for absorption sites in the intestines and can limit cholesterol absorption from foods.  The Food and Drug Administration has approved a health claim stating that 1.3 grams of plant sterol esters daily may reduce the risk of heart disease. (2) The National Cholesterol Education Program recommends adding 2 grams of phytosterols daily for people with high cholesterol.(3)  Food sources include avocados, nuts, and vegetable oils. It is also possible to use foods fortified with phytosterols such as margarine spreads and juices.

3. Choose Foods Higher in Monounsaturated Fatty Acids More Often

A study published in the American Journal of Clinical Nutrition found that a diet higher in monounsaturated fatty acids (MUFAs) successfully reduced LDL cholesterol by 14% without raising triglycerides or lowering protective HDL cholesterol.(5)  The diet higher in MUFAs was concluded to have greater cardiovascular risk-lowering benefits as compared to a low-fat diet due to these protective effects.  If you are looking to add more MUFAs to your diet avocados, nuts, and olive oil are great sources.

4. Limit Saturated Fat

We used to think that eating cholesterol in the diet had the greatest impact on serum cholesterol levels however recent research doesn’t support this as the primary contributor.  As it turns out it’s the saturated fat in foods that appears to have a greater influence. If you are watching your cholesterol levels it’s best to limit saturated fat to no more than 7% of total daily calories. For a typical 2000 calorie diet, this would equate to about 15 grams a day.  This may seem like quite a bit but if you choose to have a hamburger with a slice of cheese and modest 1/2 cup serving of Ben and Jerry’s vanilla ice cream that would bring you up to about 19 grams of saturated fat.  Other foods high in saturated fat include whole milk and yogurt, butter, cream, fatty cuts of beef and pork,  sausages, poultry with the skin, coconut and palm oils.

Considerations For People With Diabetes

When managing type 2 diabetes we tend to focus blood sugars however people with diabetes are also at greater risk for dyslipidemia. It’s recommended to have cholesterol levels checked annually and aim to keep LDL cholesterol < 70 mg/dL.(4)  Knowing your personal trends and targets is part of knowing your “ABCs” or A1C, blood pressure and cholesterol goals to reduce the risk of diabetes-related complications.

Spotting Metabolic Syndrome and 3 Ways to Reduce Your Risk

What is Metabolic Syndrome?

You may have heard the name but there is often some confusion about what exactly is metabolic syndrome, in fact,  keyword research shows over 74,000 Google searches for “metabolic syndrome” in just the past 24 hours.  Also called syndrome x, metabolic syndrome is the name for a group of conditions that raise the risk of cardiovascular diseases and diabetes.  When an individual has three of the five conditions a diagnosis of metabolic syndrome can be made. According to data from the National Health and Nutrition Examination Survey (NHANES) the prevalence of metabolic syndrome has been on the rise since the early 1990s and by 2012 it’s estimated that more than one-third of US adults met the diagnostic criteria.    

The World Health Organization (WHO) defines Metabolic Syndrome diagnosis with any three of the following:

  • High blood pressure ( systolic reading of 135 mm Hg over diastolic 85 mm Hg or greater)
  • Impaired glucose tolerance (fasting blood glucose of 100 mg/dL or greater)
  • High waist circumference (greater than 40 inches in men and 35 inches in women)
  • High triglycerides (150 mg/dL or greater)
  • Low HDL cholesterol (less than 40 mg/dL in men and 50 mg/dL in women)


3 Ways to Reduce Your Risk

Metabolic syndrome is treated by addressing the conditions that contribute to the diagnosis. Interventions with diet and lifestyle can often help to reverse the conditions that make up metabolic syndrome.  For example, a weight loss of as little as 3% can lead to improvements in blood lipids and meeting minimum recommendations for daily exercise can help keep blood pressure in check.  If you are looking to reduce your risk, try starting with the three tips below:


1. Know Your Numbers

Being an active participant in your healthcare and knowing where you stand can help you better understand your risk. Blood pressure, fasting glucose and blood lipids are tests that should be done each year at your annual check-up visit.  Knowing where you stand now and watching the trends year after year can help you take action sooner if one area starts to creep up.


2. Don’t Ignore Your Weight

A prospective study published in the American Journal of Medicine in 2000 estimated that the average American gains and then maintains about a pound of weight annually.  This may not seem clinically significant enough to warrant intervention at an annual check-up visit however year after year of gradual gains can become significant and contribute to the development of metabolic syndrome.  Your weight may not fit perfectly within the BMI scale but knowing what’s a healthy range for you and watching your trends is important.

3. Strive For 150

Participating in some form of physical activity is well established in the research to have protective effects against the conditions that contribute to metabolic syndrome including lowering blood pressure, maintaining weight and reducing insulin resistance.  Check in to see how close you are getting to meeting the minimum recommendations of 150 minutes of physical activity per week.  Already there? See if you can reach 300 minutes a week for additional benefits.  For more on the benefits of exercise check out my post on the 2018 Exercise Guidelines from the US Department of Health and Human Services.

New Exercise Guidelines Released

The 2018 Exercise Guidelines: What the Past 10 Years Have Taught Us

The United State Department of Health and Human Services has updated its exercise guidelines! The 2018 guidelines are an update to the first-ever published recommendations in 2008, which included a weekly goal of at least 150 minutes to 300 minutes of moderate-intensity physical activity in bouts of at least 10 minutes at a time. In this second edition of the Physical Activity Guidelines for Americans what they recommend may not surprise you: most of us need to move more! The Department estimates that at present  50% of Americans are not meeting the current exercise recommendations and 30% of Americans report doing no moderate-vigorous intensity physical activity at all. With the release of the new guidelines maybe what changed most significantly is the growing body of evidence behind the reasons why we should care about this. 

A Growing List of Benefits

While some benefits were known and highlighted in the 2008 guidelines the 2018 report continues to add to the list of conditions which benefit from regular physical activity, including:

  • Reduced risk of developing or progression of certain chronic conditions including type 2 diabetes, hypertension, and osteoarthritis
  • Improvements in brain health including reduced incidence of dementia and improved mood
  • Prevention of weight gain
  • Improved sleep including a reduction in time to fall asleep and improvements in sleep quality
  • Reduced risk of developing gestational diabetes during pregnancy
  • Reduction in the incidence of postpartum depression
  • Reduced risk of falls and related injuries, in older adults
  • Reduced risk of certain cancers including breast, colon, endometrial, esophagus, kidney, lung, stomach and bladder

The report also released new findings that show for individuals who perform little or no moderate-vigorous activity, replacing their sedentary time with light-intensity activity reduces the risk of all-cause mortality, incidence of type 2 diabetes and cardiovascular disease.  The evidence in this area was previously lacking.

What’s Else is New?

  • Removal of the 10-minute bouts minimum- all movement now counts toward the daily goal
  • New recommendations to include preschool-aged children (ages 3-5 years old) and the benefits seen in bone health and reduced risk of excessive weight gain
  • A new Move Your Way campaign to help promote and inspire regular exercise

Bottom Line

Individuals who move more tend to feel better, sleep better and have reduced risks of certain diseases!  For the most benefit, Americans are encouraged to participate in some form of moderate to vigorous physical activity for 150 minutes to 300 minutes per week, plus 2 days of strength exercises. If that is not possible exercise appears to provide benefit in a dose-dependent manner, even including light-intensity movement, so any amount of movement is better than none.  If you are looking for support to start, check out the interactive Activity Planner on Move Your Way, set a goal on your wearable fitness tracker or schedule it into your calendar.  If you set a goal, rather than leaving it to chance, you’re more likely to follow through. 

The MIND Diet: 10 Foods You Should Eat

Mediterranean-DASH Intervention for Neurodegenerative Delay

Are there choices that you could be making in your diet now that could slow cognitive decline and even reduce your risk of developing Alzheimer’s disease? A growing body of evidence is showing that this might be the case. Researchers from Rush University in Chicago created a hybrid of the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet resulting in the MIND diet or Mediterranean-DASH Intervention for Neurodegenerative Delay.  

The study followed over 900 participants ages 58-98 for a period of 4.5 years and in that time researches saw a reduced risk of Alzheimer’s in 53% in those strictly following the diet.  Not ready to commit?  Even in those participants following the diet only moderately well had a 35% risk reduction.

What’s Included in the Diet?

The MIND diet identifies 15 main components: 10 brain-healthy foods to include and 5 foods to avoid.  As you would expect being rooted in the Mediterranean and DASH diets, the MIND diet emphasizes plenty of vegetables, whole grains, and heart-healthy fats.  It limits added sugars, refined flours, and saturated fats.

10 Brain-Healthy Foods:

  • Leafy greens – 6 servings a week- With at least one additional serving of vegetables a day
  • Berries-  2 servings a week
  • Beans – 4 servings a week
  • Nuts – 5 servings per week
  • Whole grains – 3 servings a day
  • Fish – once a week
  • Poultry -twice a week
  • Red wine- one glass a day


5 Foods to Avoid While Following the MIND Diet:

  • Red meat – no more than 4 servings a week
  • Butter – no more than 1 ½ teaspoons a day
  • Pastries and sweets – no more than 5 servings a week
  • Fried and fast foods – less than 1 serving a week
  • Cheese – less than 1 serving a week

What Can You Do?

My take home from this? Next time you are working on putting together your weekly shopping list think about these 15 foods.  How often are you incorporating the “foods to avoid” and how often do you come close to meeting the recommendations for the “food to include”? If your ready to make some changes, start slow and focus on  1-2 things that you could add. Maybe picking up some frozen berries that you can work on adding to yogurt or oatmeal a couple mornings a week. Or try my 3 bean turkey chili recipe for a serving of both beans and poultry. Starting slow and picking one or two things to focus on at a time can help ensure you keep up the habit long term and that is likely what is going to make the largest difference.