Thursday, June 27, 2013

Conquering Type 2 diabetes: Exercise and Supplements

Over the last 2 blogs we have discussed how you can manipulate diet and lifestyle to help prevent or reverse Type 2 diabetes.  The reason hose two blogs came first is because that is where most of your efforts should lie.  Unfortunately, mot people first look to supplements and exercise to beat Type 2 diabetes and this is a mistake.  It is simply not possible to reverse the damage from an inappropriate diet and lifestyle with exercise and supplements no matter what your condition is, especially Type 2 diabetes.  The sooner people realize this, the sooner they can attain optimal health, wellbeing, and an ideal physique.  However, this does not mean exercise and supplements are of no value.  In fact, once you get the other two factors in line, exercise and supplements can be a good way to have a little more flexibility in your diet and help mitigate the damage you can cause if you go nuts on the weekend.  Let's take a look at the research.

Exercise for Type 2 diabetes

I have written extensively on this blog about the different muscle types and how they help ictate what a person with Type 2 diabetes should do for exercise.  Rather than hash out all of the research again, you can find the article that cite all of the references here and here.  Now, let's just get the crib notes version of all of that.

You have two major types of muscle fibers, Type I and Type II.  Type II fibers can be further broken down in to Type IIa and Type IIx fibers.  See the chart below of the characteristics of each fiber type.  Please note that IIx and IIb are used interchangeably to denote the fastest twitch muscle fibers so on this chart the IIx fibers are referred to as IIb fibers.
Taken from

The important thing to realize about these muscle fiber types is that the IIa and IIx fibers can more or less convert to one another depending on training status.  When a person begins exercising, over time the IIx fibers convert to IIa fibers while Type I fibers just increase their fat storing ability.  When a person stops exercising, eventually the IIa fibers convert back to IIx fibers.  This is important for Type 2 diabetes because people prone to Type 2 diabetes have a higher proportion of Type II muscle fibers.  People with Type 2 diabetes have a very high percentage of IIx fibers.  It is easy to see that the higher proportion of IIx fibers is obviously a result of not partaking in regular exercise.

As a long term adaptation to exercise, muscle fibers begin to store more energy in the form of glucose and fat.  Type I fibers use primarily fat to recharge their energy stores while the Type II fiber types tend to store more glucose, or glycogen.  Type IIx fibers store less glycogen than IIa fibers and as an adaptation to continued exercise, they begin to increase glycogen stores and convert to IIa fibers.  This has a couple of positive benefits with regard to blood glucose control.  First, by actively using the glycogen stored within the muscle, the muscle is able to take in more glucose when you eat carbohydrates and store it as glycogen.  In addition, this increases the amount of glycogen the muscle fiber can store, giving you more leeway when you decide to consume excessive carbohydrates before they begin turning to fat or accumulating in your bloodstream.

In order to get the Type IIx fibers to convert to IIa fibers, you need to activate them.  Type II fiber types are activated during high force movements such as lifting weights or performing the explosive movements common in most sports.  They are not typically activated by activities that are long and slow in duration, these activities recruit primarily Type I muscle fibers.  In addition, you want to use a full range of motion in whatever activity you are doing or you won't activate all of the muscle fibers from the muscle group you are using.  Unfortunately, most people begin jogging or biking in an attempt to help combat Type 2 diabetes.  This is a mistake because most people do not do them at an intensity sufficient to activate the Type II muscle fiber types, few people use a full range of motion when they run, and running and biking do little for the upper body.

The best bang for your buck to beat Type 2 diabetes exercise-wise is to either play a sport or strength train.  Any sport will do provided it is not an endurance event such as high mileage running or biking,  You could even do short sprints which I highly recommend provided you are doing something for your upper body as well.  My personal preference is strength training because you can do it in 30 minutes and you can get away with only doing it twice a week if you lift heavy enough weights.  You will want to work mostly compound movements such as lunges, pull ups, push ups/bench press, shoulder press, rows, and deadlifts.  Technique is important so using an experienced strength coach or personal trainer is a good idea.  In my experience, sticking to 3 sets of 12 reps for the first month to break yourself in and gradually working towards 3 sets or 4-8 reps per exercise is the best exercise option for fighting Type 2 diabetes.

Supplements for Type 2 diabetes

There are a few supplements that are beneficial for people with Type 2 diabetes.  These include:


Magnesium is critically important for proper blood glucose control.  Not only is it necessary for insulin secretion, it's also necessary for glucose to move from your blood in to cells once insulin has attached to the cell to let glucose in.  For a thorough discussion on magnesium, click here.  The problem with supplementing magnesium is that you want a type of magnesium that is time released so that it doesn't cause loose stool.  Magnesium oxide, the form of magnesium most typically found in supplements is poorly absorbed and normally causes loose stool.  I personally use Jigsaw Magnesium w/SRT but you can also use any brand of magnesium glycinate or citrate.

You want approximately 420mg or elemental magnesium a day as a maintenance dose.  If you are deficient in magnesium, as most people are(Especially people with Type 2 diabetes), you may need much more to become sufficient in magnesium.  You can request an RBC magnesium test from an integrative medicine doctor to determine if you have adequate magnesium levels.  In addition, if you have low stomach acid, gut dysbiosis, or leaky gut you may want to try transdermal magnesium in the form of magnesium oil or epsom salt baths as you will have problems absorbing it.  Since magnesium is water soluble, excess magnesium is simply excreted in the urine.  If you have kidney issues you should speak with your doctor before beginning magnesium supplementation.  I do not have kidney problems and have gone as high as 1500mg per day between oral (800mg) and transdermal(700mg) for a month with no issue.  However, the oil burns and you may need to dilute it with distilled water before applying.  If you have problems sleeping, this is your go to supplement.


There is some epidemiological evidence that Type 2 diabetics take in too little iodine(1) and people with Type 2 diabetes are at an increased risk for hypothyroidism(2).  This data is certainly not a scorching endorsement for iodine in Type 2 diabetes, but in my opinion most people who don't eat sea vegetables, or ample amounts of fish are probably deficient in iodine.  In addition, high consumption of goitrogenic foods such as the cruciferous vegetables(Broccoli, spinach, cauliflower, kale) and using refined sea salt instead of iodized salt also make you more likely to be deficient in iodine.  In the body, iodine is used to make thyroid hormones which regulate metabolism in every cell.  If you are not sure if you are deficient in iodine, there is a test called the 24 hour iodine loading test which can show you whether or not you need to supplement with iodine.  For more information on supplementing with iodine, click here.

Resistant starch

Resistant starch is a hot topic in the Paleo community.  Like soluble fiber, resistant starch is fermented in to short chain fatty acids in your large intestine which are used to heal gut damage.  Studies have shown resistant starch to lower blood glucose and impove insulin sensitivity in healthy subjects (3,4,5,6) and subjects with Type 2 diabetes(7,8).  The structure of resistant starch prevents it from being digested in the small intestine, allowing it to make it to the large intestine where it can feed good bacteria that help improve blood glucose regulation(For more on how this works click here).  There are supplements that contain resistant starch such as Hi-maize corn starch, but the most readily available form of resistant starch is unmodified potato starch which contains 7.8g of resistant starch per tbsp.  You can use it as a thickener in shakes or put it in water and drink it.  Just be sure not to heat it as heating it changes the starch in to a more digestible form.  Two tbsp per day seems to be a sufficient dose, but once you improve your gut function and blood glucose control you only really need to use it as damage control when you decide to go nuts and eat crazy.  It is best to start with a lower dose and spread it out throughout the day to prevent gas.  I have a future blog post planned on resistant starch that will go in to more detail as there is a ton of research on it.


So there you have it.  Over the last 3 blogs we've gone over everything you need to know about diet, lifestyle, exercise, and supplements to prevent or reverse Type 2 diabetes.  For the vast majority of people with insulin resistance or full blown Type 2 diabetes, this is more than enough to fix blood glucose control and prevent the damage caused by elevated glucose levels.  If you have done sufficient damage to your pancreas you may be dependent on some level of insulin injections for life, but this protocol will allow you to minimize the amount of insulin you need to inject and live a happier, healthier life.