This month, we feature a three-part series on diabetes to observe American Diabetes Month.
This article reviews the role nutritional supplements play if you’ve already been diagnosed with diabetes.
Because diabetes is a disease inherently tied to nutrition, nutrition is an important factor in managing diabetes.
While it may not be replacement for traditional treatment in all cases, nutritional supplements provide key nutrients, antioxidants, minerals, and herbs that can help manage blood glucose levels, enhance insulin sensitivity, minimize neuropathy (nerve damage disorders) and provide cardiovascular support.
To be supplement-smart, learn about the potential benefits of the following:
Alpha Lipoic Acid (ALA)
ALA is a powerful antioxidant that neutralizes free-radicals in nearly all areas of the cell. High blood glucose can cause free-radical buildup due to oxidative stress, resulting in nerve damage and other issues, but ALA can help combat this process. ALA has also been shown to improve insulin sensitivity, improve circulation, and may help muscle cells take up blood sugar.
The recommended dosage level is 200-600 mg/day, but because it may affect glucose and minerals in the blood, levels should be monitored carefully. It is also used as a treatment for nerve regeneration against diabetic neuropathy in Germany.
A relative of the blueberry, its fruit and leaves provide powerful antioxidants called anthocyanidins which can help prevent damage to blood vessels, a cause of nerve pain. Anthocyanidins can also prevent damage to the retina and prevent and reduce the severity of diabetic cataracts. The potential for lowering blood glucose has also been demonstrated in animal studies.
One of the B-vitamins, biotin works in conjunction with chromium to increase the effectiveness of insulin, aids in pancreatic function, and lowers blood sugar levels. The recommended dosage level is 9 mg/day, and it has been shown to improve the activity of glucokinase, an enzyme that spurs glucose usage in the liver and is often deficient in diabetics. Biotin can also aid in the treatment of neuropathy. VitaMedica’s Multi-Vitamin is formulated with 375 mcg of biotin.
This tropical fruiting vine helps the liver work more efficiently and lowers blood sugar levels. Studies have shown bitter melon juice to improve glucose tolerance by 73% in some individuals. The recommended daily dosage is 50 to 100 ml of juice, and those taking glucose lowering medications should monitor blood glucose carefully to prevent hypoglycemia. Excessive amounts may cause gastrointestinal upset, and pregnant women should avoid taking bitter melon, as it may contribute to complications.
A metal and essential trace mineral found in meats, animal fats, fish, brown sugar, coffee, tea, some spices, whole-wheat and rye breads, and brewer’s yeast. Supplements can come in many forms including chromium picolinate, chromium chloride, and chromium nicotinate. It works in conjunction with biotin to improve insulin function, helping reverse insulin resistance. It also aids in pancreatic function, lowers blood sugar levels, and aids in transporting glucose into cells.
The recommended dosage level is 100-500 mcg/day, and this has been shown to lower blood glucose, insulin, and cholesterol. Chromium levels decline with age, which may be linked to the high occurrence of Type 2 diabetes in older individuals. Many American diets provide less than 50 mcg of this mineral daily. While chromium is generally safe for adults, because of its effect on insulin function, blood sugar levels should be monitored carefully. VitaMedica’s Multi-Vitamin is formulated with 210 mcg of chromium.
Hydroxychalcone, a substance found in cinnamon, is thought to enhance insulin action. Just 500 mg/day of cinnamon may enhance insulin-signaling pathways and help with blood sugar metabolization. Studies have linked it to improved blood glucose control and reductions of 18 – 29% in fasting blood glucose levels in individuals with type-II diabetes. It has also shown a reductive effect on triglyceride, LDL cholesterol, and total cholesterol levels. However, the dosages used in studies have been inconsistent, and other studies have shown no difference in glycosylated hemoglobin (HbA1C) levels, a measure of how well blood glucose has been controlled during the past 3-4 months.
This essential metal helps protect pancreatic cells that produce insulin, helps prevent diabetes-related damage to blood vessels and nerves, and lowers blood sugar levels. It is advised that copper be taken with zinc to prevent an imbalance of nutrients. VitaMedica’s Multi-Vitamin is formulated with 1.5 mg of copper.
Coenzyme Q10 (CoQ10)
CoQ10 is a vitamin-like substance and an antioxidant that helps cells make energy. Small amounts are found in meats and seafood. Supplements are found in tablet and capsule form, and while few studies have been conducted on its effect on type-II diabetes, it may be effective to protect against heart disease in diabetics.
Many diabetics manage cholesterol levels by taking statin medications like Crestor or Lipitor. One of the side-effects of taking these drugs is that they deplete CoQ10 levels. Taking a CoQ10 supplement can address this deficiency.
While it is safe for most adults, individuals taking warfarin (a blood thinner), high blood pressure medication, or cancer chemotherapy medicines should check with their doctor before taking CoQ10 for possible drug interactions.
The yellow pigment found in turmeric, animal studies have shown it may relieve neuropathy, a common symptom of diabetes, and act as a neuroprotective agent in central nervous system diseases.
A seed often used in Indian cuisine, studies have shown it can help lower blood sugar, aid in blood sugar metabolism in the liver and kidneys, increase insulin sensitivity, and reduce high cholesterol. Fenugreek also contains fiber and an amino acid that seems to boost the release of insulin. The recommended dosage level 15 to 90 g/day.
In combination with vitamin B12, folic acid helps prevent strokes and loss of limbs due to diabetic complications. Folic acid deficiency has also been linked to various neuropathies. VitaMedica’s Multi-Vitamin is formulated with 600 mcg of folic acid.
A familiar herb to the health-conscious, garlic contains allicin (the chemical that gives it its distinctive odor and taste) and Allyl Propyl Disulphide (APDS), both of which have been linked to blood glucose level reduction. Garlic has also shown to reduce cholesterol and blood pressure. However, study findings about its effect on type-II diabetics have been mixed, so further research is needed. The recommended daily intake level of allicin would be 4,000 mcgs/day, and while it can be consumed as food instead of a supplement, its odorous quality might make for an unpleasant side-effect.
An extract from an Indian plant, it may be helpful for both Type 1 and Type 2 diabetes. It helps to balance blood sugars, reduces fasting blood glucose levels, increases the efficacy of insulin, and may protect us from gaining weight. Other research has shown that it may stimulate regeneration of the pancreas in type-I diabetics. The recommended dosage level (24% gymnemic acid) is 200 mg twice daily.
A carotenoid antioxidant, lutein is found in green leafy vegetables such as kale and spinach. It is found in high concentrations in the retina, and it protects the eye from oxidative stress. Lutein has also been shown to prevent diabetes-related changes in the retina, restore retina thickness, and prevent cataracts (a common complication of diabetes) when used in conjunction with insulin. Studies have shown that lutein may help prevent oxidative stress on the brain as well as diabetic encephalopathy, a condition that involves brain swelling, and a diet high in carotenoid-rich foods may protect against hyperglycemia and the risk of developing diabetes. VitaMedica’s Multi-Vitamin is formulated with 5,100 IUs of Betatene®, a natural mixed blend of carotenoids which includes lutein.
Found in dark, leafy greens, it helps prevent damage to blood vessels and nerves, enhances the production of cellular energy in the mitochondria, and supports heart health. VitaMedica’s Multi-Vitamin is formulated with 4.5 mg of manganese.
Found in leafy green vegetables, nuts, seeds, and some whole grains, most Type 2 diabetics are deficient in magnesium due to diet. Deficiency has been linked to diabetic retinopathy. Supplementation can contribute to lower fasting blood sugar levels, improved insulin function, and relief of neuropathic pain. Magnesium also helps lower blood pressure and the risk of heart attack and stroke by relaxing smooth muscle tissue.
For diabetic individuals or those with heart disease, it is recommended to take magnesium in conjunction with calcium; for each 1,000 mg of calcium, 500-1,000 mg of magnesium should be taken daily (a 2:1 or more ratio). At low doses, magnesium is safe for most adults, but those taking osteoporosis or high blood pressure medications, muscle relaxants, or diuretics should check for drug interactions. At high doses, it may cause side effects such as nausea, diarrhea, muscle weakness, low blood pressure, or irregular heart rate. VitaMedica’s Multi-Vitamin is formulated with 450 mg of magnesium and 750 mg of calcium.
Found in fish, fish oil, some vegetable oils (canola and soybean) and walnuts, they are known to reduce the risk of cardiovascular disease, atherosclerosis (artery hardening), inflammation, and lowering triglyceride levels – all concerns for diabetics. They promote fluidity and flexibility in cell walls, which help glucose get into the cells and provide energy.
Some studies have shown that the EPA (Eicosapentaenoic Acid) and DHA (Docosahexaenoic Acid) in omega-3 fatty acids may reduce demyelination in nerves, which reduces neuropathic pain. Additional studies are needed to analyze their effect on blood glucose or long-term heart disease risk in Type 2 diabetics.
Supplementation is available in capsules or fish oil, and the daily recommended dosage level is 600-1200 mg with a 2:1 ratio of EPA to DHA.
Each capsule of VitaMedica’s Super EPA/DHA Fish is formulated with 600 mg of Omega-3s (400 EPA/200 DHA). Importantly, this supplement exceeds international standards for pesticides, mercury or PCB contamination.
Pregnant women and individuals taking blood thinners or high-blood pressure medications should consult their physician before use.
Called an “insulin mimic,” selenium helps transport glucose into cells, a process beneficial to both Type 1 and Type 2 diabetics. Selenium also protects against blood vessel and nerve damage from elevated blood sugars. VitaMedica’s Multi-Vitamin is formulated with 120 mcg of selenium.
Also known as vanadyl sulfate, this mineral is also an “insulin mimic.” It helps liver and muscle cells use insulin more effectively. Dosages ranging from 45-150 mg/day have been shown to improve fasting glucose levels, but during the first week of use or at higher dosage levels (400 mg/day), some individuals may experience mild gastrointestinal distress.
Vitamin B6 (pyridoxine)
B6 works to prevent protein glycosylation which can elevate levels of free radicals and cause complications in the eyes, kidneys, and circulatory system. In conjunction with folic acid and B12, it helps prevent heart attacks, nerve damage, vision loss, and diabetic blindness. Diabetics with neuropathy have exhibited B6 deficiency, and supplementation has been shown to be beneficial. VitaMedica’s Multi-Vitamin is formulated with 75 mg of vitamin B6.
B12 may help moderate long-term diabetic complications such as diabetic retinopathy by lowering levels of homocysteine and by minimizing neuropathic pain, numbness, and tingling which often affects diabetics’ legs and feet. Supplementation may also aid in replenishing B12 levels diminished by usage of diabetes medications such as metformin. Good sources of vitamin B12 include beef liver, clams, trout, salmon, sirloin steak, haddock, tuna, cheese and chicken. VitaMedica’s Multi-Vitamin is formulated with 405 mcg of vitamin B12.
Diabetes reduces intracellular vitamin C and diminishes its protective functions. With vitamin E, vitamin C helps get sugar out of the blood stream and into the cells. It also prevents protein glycosylation, which can elevate levels of free-radicals and cause complications in the eyes, kidneys, and circulatory system. Vitamin C is one of the safest supplements, even at high levels, but at dosage levels near 2,000 mg/day, gastrointestinal distress may occur. VitaMedica’s Multi-Vitamin is formulated with 300 mg of vitamin C and 105 mg of bioflavonoids.
A potent antioxidant that reduces oxidative stress and reduces free-radicals, vitamin E works with B-vitamins to keep the pancreas healthy and helps prevent nerve damage, kidney damage, blindness and heart attacks. With vitamin C, it helps keep blood vessels healthy. VitaMedica’s Multi-Vitamin is formulated with 105 IUs of natural mixed tocopherols and 9 mg of natural mixed tocotrienols.
Found in oysters, ginger, lamb, split peas, egg yolks, beef liver, and nuts, zinc aids in the production and storage of insulin. It helps blood sugar get into the cells and increases the efficacy of insulin. Research shows that Type 2 diabetics have suboptimal zinc levels due to decreased absorption and increased excretion. VitaMedica’s Multi-Vitamin is formulated with 15 mg of zinc.
In addition to diet and lifestyle, nutritional supplements can play a role in managing diabetes and its related conditions. However, if you’re already taking a drug to manage your diabetes, you should consult your healthcare provider before taking a nutritional supplement. In addition, after starting supplement use, monitor your blood glucose carefully and alert your physician to any changes to see if medication adjustments are needed.
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.