For most of the 21 million Americans diagnosed with type 2 diabetes, the main goal of treatment is simply to control their glucose (blood sugar) levels with diet, exercise and sometimes medication.

But there's much more that should be done to help prevent serious complications, which can shorten the life expectancy of a person with diabetes-by about 7.5 years in men and 8.2 years in women.

Sobering statistics: About 80% of people with diabetes die from cardiovascular complications, such as a heart attack. About half the patients with poor glucose control will eventually suffer from nerve damage (neuropathy). Another 20% to 30% may experience retinopathy or other eye disorders.

Whether or not you're taking medication for diabetes, virtually all of these complications can be avoided-and, in some cases, reversed-with natural approaches.

Important: Be sure to speak to your doctor before following any of the steps in this article-some may affect diabetes drugs and other types of medication.

Best ways for people with diabetes to avoid complications...

Controlling Inflammation

People with diabetes typically have elevated levels of C-reactive protein, a blood protein that indicates chronic low-level inflammation, the underlying cause of most cardiovascular, eye and nerve disorders. Inflammation also exacerbates arthritis, which is more common in diabetics than in those without the disease. Effective options...

Stop eating wheat. Many people with diabetes are allergic or sensitive to gluten, a protein found naturally in wheat, barley and rye-and sometimes in other grains, such as oats, because they become "cross-contaminated" during processing. Even trace amounts of gluten can stimulate the production of cytokines, substances that increase inflammation. (See self-test on the net page to determine whether you are sensitive to gluten.)

Besides increasing inflammation in these patients, exposure to gluten may lead to fatigue and joint problems. Gluten may also impair digestion in these people, making it harder to lose weight-a serious problem because excess body fat increases inflammation even more.

Important: Read food labels. Besides avoiding obvious sources of gluten such as wheat bread and wheat pasta, look for terms such as "amino peptide complex, "filler flour," "hydrolyzed protein" and "vegetable starch"-these indicate that gluten is or may be found in the product. Gluten is also present in unexpected sources, such as soy sauce, malt and graham flour, as well as thousands of nonfood products, including some medications. To determine if a medication contains gluten, call the drug manufacturer. For a list of foods and products that contain gluten, consult the gluten Intolerance Group's website

Give up diary. Oftentimes people who are sensitive to gluten also have problems digesting casein, a dairy protein.

To test for a gluten or dairy sensitivity: Eliminate each food type one at a time for several weeks. If you notice an improvement in energy, or a reduction in joint pain or digestion problems, you're probably sensitive to one or both. To make sure, reintroduce dairy and/or gluten foods one at a time to see if your symptoms return.

Important: Foods that are labeled "lactose-free" or "dairy-free" are not necessarily casein-free. Foods that are both gluten-free and casein-free can be found online at www.trader or

To keep it simple: Remember that all unprocessed meats, vegetables and fruits are gluten-free and dairy-free.

Supplement with omega-3 fatty acids. The American Diabetes Association recommends a diet high in these fatty acids because of their ability to reduce inflammation and other diabetes complications. Unfortunately, many people find it difficult to eat enough omega-3-rich foods, such as salmon, mackerel and herring-two six-ounce servings a week are recommended-so supplements often are a good choice.

My advice: Take a daily supplement with at least 1,500 mg of eicosapentaenoic acid (EPA), the component in fish oil that helps reduce the inflammation that contributes to diabetes related complications. If you're allergic to fish, you can use an omega-3 supplement derived from algae.

Omega-3 fatty acids, also found in flaxseed and walnuts, have the additional benefit of helping to lower triglycerides, blood fats that have been linked to atherosclerosis and cardiovascular disease.

Fight Arterial Calcification

The Rotterdam Heart Study, which looked at the dietary histories of more than 4,800 patients, found that those with low blood levels of vitamin K2 were 57% more likely to develop heart disease, due in part to an increase in calcium in the arteries. Paradoxically, these patients had lower bone levels of calcium, which increases the risk for fractures.

Because diabetic patients have an extremely high risk for heart disease, I routinely recommend a daily supplement (45 mcg) of vitamin K2. You can also get more of this nutrient by eating such foods as liver, eggs and certain cheeses.

Caution: Because there are different forms of vitamin K-some of which interfere with the effects of warfarin (Coumadin) and other blood thinners-always speak to your doctor before taking any vitamin K supplement.

Overcome Fatigue

Both inflammation and elevated blood sugar increase fatigue, making it one of the most common symptoms of diabetes. Helpful...

Coenzyme Q1O (CoQ1O) increases the body's production of adenosine triphosphate (ATP), a molecule that enhances the performance of mitochondria, the energy-producing components of cells. CoQ1O is also an antioxidant that reduces inflammation. Typical dose: 100 mg to 200 mg, twice daily.

Magnesium is involved in glucose and insulin reactions and is typically lower than normal in people with diabetes who experience fatigue. Patients who eat a healthy diet, including magnesium-rich foods such as nuts and oatmeal, and supplement with magnesium often report an increase in energy. They also show improvements in blood pressure and cardiac performance. Talk to your doctor about the appropriate dosage of a magnesium supplement-especially if you have kidney disease or heart disease, both of which can be worsened by too much magnesium.

All forms of supplemental magnesium can be used, but magnesium citrate causes diarrhea in some people. If this happens to you, take a different form, such as magnesium tau-rate or magnesium glycinate.

Avoid Diabetic Neuropathy

Excess blood sugar can damage the tiny blood vessels that carry blood and nutrients to nerves in the fingers, legs and/or feet, causing neuropathy. Neuropathy can eventually lead to tissue damage that requires amputation. What to try...

Alpha-lipoic acid makes the cells more sensitive to insulin and can relieve symptoms of diabetic neuropathy.

Typical dose: 600 mg to 1,200 mg daily for people with diabetes who have neuropathy. To help prevent neuropathy, 100 mg to 300 mg daily is the typical dose.

B-complex supplement may help prevent neuropathy or reduce symptoms in patients who already have it.

Typical dose: Two B-100 complex supplements daily for people with diabetes who have neuropathy... one B-100 complex daily to help prevent neuropathy.

Prevent Eye Damage

High blood sugar can cause diabetic retinopathy, which can lead to blindness. It can also increase eye pressure and lead to glaucoma.

Self-defense: Eat more fresh fruits and vegetables. These foods contain antioxidants such as lutein, zeaxanthin and vitamin C, which strengthen eye capillaries, fight free radicals and reduce the risk for blindness. Frozen fruits and vegetables also can be used.

Best choice: Blueberries or bilberries-both contain anthocyanins, antioxidants that help prevent eye damage and appear to improve glucose levels.

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