What are natural ways to decrease Hemoglobin A1c (HbA1c) and lipid levels in adults with diabetes or prediabetes?

Natural Strategies to Decrease A1c and Lipids

Implement a structured program combining at least 150 minutes weekly of moderate-intensity aerobic exercise with resistance training twice weekly, adopt a low-carbohydrate eating pattern (<40% of calories from carbohydrates) or Mediterranean-style diet, and reduce saturated fat to 7% of total calories—this combination provides the strongest evidence for reducing both A1c and lipid levels naturally. 1

Exercise Prescription for A1c and Lipid Reduction

Aerobic Activity:

• Perform 150 minutes per week of moderate-to-vigorous aerobic activity, spread over at least 3 days with no more than 2 consecutive days without exercise 1
• Structured exercise interventions of at least 8 weeks lower A1C by an average of 0.66% even without weight loss 1
• Daily exercise is recommended to decrease insulin resistance, regardless of diabetes type 1
• Higher frequency of regular physical activity is more effective in reducing A1C levels 1

Resistance Training:

• Complete at least 2 sessions per week of resistance exercise on nonconsecutive days 1
• Each session should include at least one set of five or more different exercises involving large muscle groups 1
• Resistance training provides strong A1C-lowering benefits and improves lipid profiles including triglycerides, LDL cholesterol, and waist circumference 1

Additional Benefits:

• Exercise training improves triglyceride levels, LDL cholesterol, waist circumference, and body mass 1
• Regular physical activity reduces cardiovascular mortality risk in both type 1 and type 2 diabetes 1

Dietary Interventions for A1c Reduction

Low-Carbohydrate Approaches:

• Reducing overall carbohydrate intake demonstrates strong evidence for improving glycemia 2
• Low-carbohydrate diets (<40% of calories from carbohydrates) decrease A1c by 6.4 kg weight equivalent and improve glucose, insulin resistance, and triglycerides 1
• Very-low-carbohydrate eating patterns (<26% total energy from carbohydrates) can reduce A1c by 0.5% in the short term (<6 months) 2
• Caution: Use very-low-carbohydrate plans cautiously with SGLT2 inhibitors due to ketoacidosis risk, and avoid in pregnancy, lactation, children, kidney disease, or disordered eating risk 2, 3

Mediterranean Diet Pattern:

• Focus on dark green vegetables, fruits, nuts, and legumes with moderate to high fish intake 1
• Use extra virgin olive oil as the main dietary fat source 1
• This pattern decreases blood pressure, LDL cholesterol, hemoglobin A1c, and triglycerides while increasing HDL cholesterol 1
• Mediterranean-style, monounsaturated fat-rich eating patterns benefit glycemic control and cardiovascular risk factors 1

Carbohydrate Quality:

• Emphasize high-quality, minimally processed, nutrient-dense carbohydrate sources high in fiber 2
• Focus on non-starchy vegetables, minimize added sugars and refined grains, and choose whole foods over highly processed foods 2
• Consume a minimum of 14g of fiber per 1,000 kcal, with at least half of grain consumption being whole, intact grains 2

Dietary Interventions for Lipid Reduction

Saturated Fat and Cholesterol Management:

• Limit saturated fatty acids to 7% of energy intake for elevated LDL cholesterol 1
• Reduce dietary cholesterol to 200 mg/day 1
• Limit trans fatty acid intake 1

Beneficial Fat Substitutions:

• Replace saturated fat with either carbohydrates or monounsaturated fats 1
• Monounsaturated fat substitution for saturated fat improves lipid profiles 1

Enhanced LDL Lowering:

• Add plant stanols/sterols (2 g/day) to enhance plasma LDL cholesterol lowering 1
• Increase viscous (soluble) fiber intake to 10-25 g/day 1
• Individuals with diabetes and dyslipidemia can modestly reduce total and LDL cholesterol by consuming 1.6-3 g/day of plant stanols or sterols typically found in enriched foods 1

Triglyceride Management:

• Dietary fat restriction and modest weight loss lead to decreased plasma triglycerides 1
• Regular physical activity reduces plasma triglycerides and improves insulin sensitivity 1
• For persistently elevated triglycerides despite lifestyle changes, fish oil supplementation with n-3 fatty acids may be considered, though monitoring is required as it may increase LDL cholesterol 1

Weight Loss for Combined A1c and Lipid Benefits

Structured Programs:

• The Diabetes Prevention Program (16-session curriculum over 6 months) decreases incidence of type 2 diabetes, blood pressure, lipids, and markers of inflammation 1
• Modest weight loss beneficially affects both blood glucose and lipid parameters 1
• A multidomain lifestyle intervention over 12 months achieved mean weight loss of 4.9 kg and A1C reduction of 0.6%, with 20% of prediabetes participants reaching remission 4

Sodium Reduction for Blood Pressure and Overall Health

• Reduce sodium intake to less than 2,300 mg/day (100 mmol) or sodium chloride to 6,000 mg/day 1
• Decreasing sodium intake reduces blood pressure in those with diabetes 1
• For individuals with both diabetes and hypertension, further sodium reduction should be individualized 1

Common Pitfalls to Avoid

Exercise-Related:

• Do not allow more than 2 consecutive days without physical activity, as insulin resistance increases 1
• Prolonged sitting should be minimized even on exercise days 1

Diet-Related:

• Very-low-carbohydrate benefits may diminish over time (>12 months), requiring long-term adherence monitoring 2
• Increasing dietary fat (when substituting for saturated fat) can lead to increased energy intake and weight gain if not monitored 1
• Fish oil supplements may increase LDL cholesterol, requiring lipid monitoring 1

Medication Interactions:

• When implementing low-carbohydrate diets, insulin doses and other diabetes medications often need reduction to prevent hypoglycemia 3
• Very-low-carbohydrate ketogenic diets require caution with SGLT2 inhibitors due to ketoacidosis risk 3

Implementation Strategy

Initial Phase (Weeks 1-4):

• Begin aerobic exercise at 30 minutes, 5 days per week, building toward 150 minutes weekly 1
• Initiate dietary changes by reducing saturated fat to 7% of calories and increasing fiber intake 1
• Start resistance training twice weekly on nonconsecutive days 1

Intermediate Phase (Months 2-3):

• Achieve full exercise prescription of 150 minutes aerobic plus 2 resistance sessions weekly 1
• Implement chosen dietary pattern (low-carbohydrate or Mediterranean) consistently 1, 2
• Add plant stanols/sterols (2 g/day) if LDL remains elevated 1

Long-Term Maintenance (Beyond 3 Months):

• Continue exercise without allowing more than 2 consecutive days of inactivity 1
• Monitor A1c every 3 months until at goal, then every 6 months 5
• Reassess dietary adherence and adjust as needed for sustained benefits 2