Type 2 Diabetes and Omega-3s: How they can help you
Type 2 diabetes (T2DM) has been identified as one of the largest global health emergencies of the 21st century, with more and more people worldwide being diagnosed every year (1). Canada follows this trend, showing 1 in 3 Canadians are living with diabetes or prediabetes, with the prevalence ever-increasing right alongside our obesity rates (2). In our “Standard American Diet” culture, our high intake of trans & saturated fats, refined sugars and calorie-rich, nutrient-poor foods, result in increased fat mass, hormonal dysregulation and leave us in a state of chronic inflammation.
It can be daunting to be faced with these stats and a label of “diabetes”, but fortunately, there are many strategies to keep your risk for future complications and blood sugars well managed. Many of the most effective approaches to treat diabetes are lifestyle based, focusing on increasing movement, making healthier dietary swaps and the use of supplementation where indicated, one of these being omega-3 fatty acids!
Diabetes 101: What does my diagnosis mean?
Prediabetes
Although not considered a “disease” in itself, prediabetes is a condition which is often a precursor to being diagnosed with type 2 diabetes (2). In this stage, your blood sugars are still higher than what is considered normal, but not yet high enough to fit the criteria for a diabetes diagnosis.
Very commonly with prediabetes, something called “hyperinsulinemia” is simultaneously occurring. This means that your pancreas is working in overdrive, producing much more insulin than what is typical, yet people with prediabetes are unable to properly use this hormone, resulting in insulin resistance. Although we want our pancreas to produce insulin when we need it, this hormone also doubles as a potent director of fat storage.
Chronic overproduction signals to your body to stash fat cells, specifically around the waistline and major abdominal organs. Extra fat, especially types that accumulate in the belly area, are notorious producers of inflammatory mediators. This constant state of inflammation inhibits your body’s ability to communicate to insulin receptors, further contributing to your body’s state of resistance…and the vicious cycle starts again!
Type 2 Diabetes
Eventually your pancreas can no longer produce enough insulin to effectively manage our blood sugars, and this very often leads to the development of type 2 diabetes (2). This results in your blood sugar being higher than what is considered normal, which over time, can lead to a host of health complications, like kidney disease, nerve damage, and cardiovascular disease, the leading cause of morbidity and mortality in diabetics.
So… what is my risk, and how can I decrease it?
Rather than being a condition that just suddenly “happens”, type two diabetes is something that takes many years to emerge. You can experience decades of symptoms or co-morbid conditions before your blood sugar levels climb high enough to meet the criteria for diabetes. Are you wondering if you’re at risk? Check out the list below.
- Family history of diabetes or being over 40 years old
- Overweight or carrying most of your weight around your abdomen
- High blood pressure
- Hyperlipidemia - Triglycerides, LDL-C, Cholesterol
- Polycystic Ovarian Syndrome or “PCOS”
- Signs of insulin resistance - darkened skin patches in folds of skin (armpits, groin, neck), struggle losing weight, intense sugar cravings, extreme fatigue
- Prediabetes - impaired glucose control & insulin output
Where do Omega-3s fit in?
Resulting from insulin resistance, people with type 2 diabetes often have other areas of metabolic dysfunction beyond that of just glycemic control, including hypertension, hyperlipidemia, increased body fat, or any combination of these.
As omega-3s, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are known to be potent anti-inflammatories and heart health heroes, they are a uniquely useful tool to target multiple systems of dysregulation associated with diabetes.
1) Favourable effects on lipids - Triglycerides & HDL-C (high-density lipoprotein)
As heart disease is one of the major complications arising from diabetes, lowering risk is a critical aspect to consider. The lower your “bad fats” like triglycerides, and the higher your “good” fats, like HDL-C, the lower the overall risk for atherosclerosis and cardiovascular disease (3). It is widely supported that at a dose of 2-4g* of combined EPA + DHA, fish oil can both dramatically lower serum triglycerides and increase serum HDL-C in those with type 2 diabetes (4,5).
2) Reduction in pro-inflammatory cytokines
T2DM is considered to be a pathologic state of amplified inflammation (6), and is associated with high levels of inflammatory mediators that are released from abdominal fat cells - some of the main offenders being MCP-1, TNF-a, IL-6 and IL-1. In those with T2DM, 2,700mg* of combined EPA + DHA (600 + 300mg), has been shown to be beneficial in reducing inflammation markers in the body (7).
3) Insulin sensitizing effects
One of the primary therapeutic goals for those living with type 2 diabetes & prediabetes is blood sugar management, with a specific target of keeping sugars stable after meals. In those labelled as having insulin resistance, 1,800mg* of pure EPA per day showed lower post-meal spikes in blood sugars, and improvement inability to effectively use insulin (8).
In tandem with a healthy diet and regular exercise, supplements like omega-3 can enhance management of your diabetes, and aid you on your way to smooth-sailing blood sugar control.
*As always, please speak to your health care practitioner about what dose of omega-3s would be best for you as an individual.
Sources:
1. Houlder RL. (2018). 2018 Clinical Practice Guidelines Committees. Canadian Journal of Diabetes, 42, 1-5. doi: 10.1016/s1499-2671(17)31026-2
2.The Canadian Diabetes Association. (2020). Type 2 Diabetes. https://www.diabetes.ca/about-diabetes/type-2
3. Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, Deane KH, AlAbdulghafoor FK, Summerbell CD, Worthington HV, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018;11:D3177.
4. Martinez-Fernandez L., Laiglesia LM, Huerta AE, Martinez JA & Moreno-Aliaga MJ. (2015). Omega-3 fatty acids and adipose tissue function in obesity and metabolic syndrome. Prostaglandins and Other Lipid Mediators, 121, 24-41. http://dx.doi.org/10.1016/j.prostaglandins.2015.07.003;
5. Gao et al. (2020). Effects of fish oil supplementation on glucose control and lipid levels among patients with type 2 diabetes mellitus: a Meta-analysis of randomized controlled trials. Lipids in Health and Disease, 19(87). https://doi.org/10.1186/s12944-020-01214-w.
6. O’Mahoney et al. (2018) Omega-3 polyunsaturated fatty acids favourably modulate cardiometabolic biomarkers in type 2 diabetes: a meta-analysis and meta-regression of randomized controlled trials. Cardiovasc Diabetol,17(98). https://doi.org/10.1186/s12933-018-0740-x
7. Mazaherioun et al. (2017) Beneficial Effects of n-3 Fatty Acids on Cardiometabolic and Inflammatory Markers in Type 2 Diabetes Mellitus: A Clinical Trial. Med Princ Pract. 26(6), 535‐541. doi:10.1159/000484089
8. Sawada T, Tsubata H, Hashimoto N, Takabe M, Miyata T, Aoki K, Yamashita S, Oishi S, Osue T, Yokoi K, et al. (2016). Effects of 6-month eicosapentaenoic acid treatment on postprandial hyperglycemia, hyperlipidemia, insulin secretion ability, and concomitant endothelial dysfunction among newly-diagnosed impaired glucose metabolism patients with coronary artery disease. An open-label, single-blinded, prospective randomized controlled trial. Cardiovasc Diabetol, 15 (121). DOI 10.1186/s12933-016-0437-y