Helpful Supplements for Diabetes

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Helpful Supplements for Diabetes
There are only a handful of supplements promoted as being helpful for people with diabetes that actually work. You can read about the ones that don't and learn about the flawed research and fake online marketing with shills that is used to promote them HERE.

Here we'll look at the few supplements that may be helpful. To be included on this page, the usefulness of a supplement must be supported by peer reviewed research not funded by someone with a financial stake in the supplement. In addition, the supplement should be recommended by people with diabetes with long-term reputations among the online community as objective sources--not shills for supplement companies who suddenly pop up claiming excellent results for some currently popular supplement.

Vitamin D is Low in People Diagnosed with Diabetes But Supplementation Doesn't Help

Evidence is accumulating that suggests that Vitamin D is low in people who develop Type 2 diabetes. Because of this there has been speculation that Vitamin D improves insulin sensitivity. Unfortunately, there is not a scintilla of evidence that supplementing with Vitamin D in any form will reverse diabetes.

I am temporarily leaving Vitamin D in the "helpful" category, because it is possible it has some value in countering heart disease, but the evidence is accumulating that it may be just another overhyped simplistic cure promoted by unscrupulous celebrity doctors looking to earn fortunes selling products to people suffering serious chronic illnesses.

The early enthusiasm for Vitamin D as a treatment for diabetes occurred after a November 2007 a study headed by Dr. Paul Knekt published in Diabetes Care found that over 17 years in a population of roughly 4,000 Finnish men and women, individuals with higher blood levels of vitamin D had a 40 percent lower risk of developing type 2 diabetes than those with lower levels of this vitamin.

Serum 25-Hydroxyvitamin D Concentration and Subsequent Risk of Type 2 Diabetes. Catharina Mattila, Paul Knekt, et al. Diabetes Care 30:2569-2570, 2007

A review of earlier work pointing to the same conclusion can be found in:

The Role of Vitamin D and Calcium in Type 2 Diabetes. A Systematic Review and Meta-Analysis. Anastassios G. Pittas, Joseph Lau, Frank B. Hu and Bess Dawson-Hughes.J Clin Endo & Metab Vol. 92, No. 6 2017-2029.

Vitamin D Has No Effect On Early Type 1 Diabetes

Low levels of Vitamin D have also been linked with increased incidence of autoimmune disease, including both Type 1 diabetes and multiple schlerosis. One meta-study concluded that supplementation with Vitamin D had a preventative effect on the development of Type 1 (autoimmune) diabetes.

Vitamin D supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis.C S Zipitis, A K Akobeng. Archives of Disease in Childhood 2008;93:512-517

Unfortunately, Vitamin D in this context is preventative, but does not reverse the condition.

Giving Vitamin D to people recently diagnosed with Type 1 (autoimmune) diabetes for two years made zero difference in their outcomes.

No Protective Effect of Calcitriol on ß-Cell Function in Recent-Onset Type 1 Diabetes
The IMDIAB XIII trial
Diabetes Care September 2010 vol. 33 no. 9 1962-1963. doi: 10.2337/dc10-0814

Vitamin D Infusion Does NOT Improve Glucose Metabolism

Here's another result that points to the possibility that it may be that something about having diabetes lowers Vitamin D levels, rather than that Vitamin D improves insulin sensitivity.

A study in which people who were deficient in Vitamin D were given glucose tolerance tests and then given a massive dose of Vitamin D which raised their levels to normal after which they were given follow up glucose tolerance tests found no change in blood sugar or insulin sensitivity after Vitamin D was normalized.

Glucose tolerance and vitamin D: Effects of treating vitamin D deficiency Kamilia Tai. Nutrition. Volume 24, Issue 10, Pages 950-956 (October 2008).

This result was duplicated in a second placebo-controlled study of 61 participants given placebo, 100,000 IU or 200,000 IU of Vitamin D3.
Though the Vitamin D made a very small difference in their blood pressure (which was still too high after supplementation) the study found
here was no significant difference in the primary outcome of endothelial function at 8 weeks (placebo 5.2%, n=22; 100,000 IU 4.3%, n=19; 200,000 IU 4.9%, n=17) or at 16 weeks. Insulin resistance and glycosylated haemoglobin did not improve with either dose of vitamin D3.
The effect of different doses of vitamin D3 on markers of vascular health in patients with type 2 diabetes: a randomised controlled trial.M. D. Witham et al. Diabetologia Volume 53, Number 10, 2112-2119, DOI: 10.1007/s00125-010-1838-1

Vitamin D May Not Be Significant in Loss of Blood Sugar Control

A study of 446 European subjects diagnosed with metabolic syndrome found no relationship between blood concentrations of vitamin D and insulin secretion or sensitivity. In this group 20% had vitamin D levels over 30 ng/ml (75 nmol/L). This may suggest that the low vitamin D levels seen in people with diabetes are a result, not a cause of their blood sugar disorder.

Serum Vitamin D Concentration Does Not Predict Insulin Action or Secretion in European Subjects With the Metabolic Syndrome. Hanne L. Gulseth et al. Diabetes Care April 2010 vol. 33 no. 4 923-925. doi: 10.2337/dc09-1692

Womens Health Study Finds No Effect on Diabetes of Vitamin D and Calcium Supplementation

The Womens Health Study--the people who put an end to the myth that the low fat diet prevents heart disease--came up with the finding that, in 33,951 women, supplementation with 400 IU Vitamin D and 1000 mg Calcium made no difference in the number of people who developed diabetes. The finding was described as "robust."

Calcium Plus Vitamin D Supplementation and the Risk of Incident Diabetes in the Women's Health Initiative. WHI investigators. Diabetes Care 31:701-707, 2008

Those who champion Vitamin D claim that much higher doses are required to see an effect. This may be true as the amount of Vitamin D used in this study was well under the amount that is necessary to raise low levels into the normal range.

High Dose Vitamin D Increased Fractures in Older Women

Adouble-blind, placebo-controlled trial of 2256 community-dwelling women, aged 70 years or older, given Intervention 500,000 IU of cholecalciferol or placebo by injection saw a 26% higher risk of fracture in the group receiving the supplementation. So much for the theory that doses were too low in other studies.
Annual High-Dose Oral Vitamin D and Falls and Fractures in Older WomenKerrie M. Sanders et al. JAMA 2010;303(18):1815-1822.

Vitamin D's Connection with Cardiovascular Disease

Recent research has linked low levels of Vitamin D with higher risk of cardiovascular disease. An analysis of the Framingham data found that "Vitamin D deficiency is associated with incident cardiovascular disease."

Vitamin D Deficiency and Risk of Cardiovascular Disease. Thomas J. Wang et al.Circulation. 2008;117:503-511.

The research that has not yet been done is the well-conducted study that would investigate whether supplementing with Vitamin D would lower the incidence of heart disease. Dr. Davis of The Heart Scan Blog claims to have seen vitamin D supplementation improve cardiac health. He believes that it is a vital part, along with Vitamin K, of the metabolic process that directs dietary calcium where it belongs--on the bones, rather than being deposited in arterial plaque which is part of the process that leads to heart attack.

Vitamin D May Have an Effect on Mood

There is some evidence that Vitamin D reverses the depression many people experience in the dark months of winter.

Vitamin D3 enhances mood in healthy subjects during winter Allen T. G. Lansdowne, S. C. Provost. Psychopharmacology, DOI 10.1007/s002130050517

Because Vitamin D has a positive effect on mood--similar to that burst of good feeling we experience when we step out into the sun, it is possible that the low levels of Vitamin D found in people with Diabetes may be related to the increased incidence of depression associated with Type 2 diabetes.

Vitamin D Improves Outcome in Chronic Kidney Disease

A study published in May of 2008 found that patients with chronic kidney disease given Calcitriol (a form of Vitamin D) had a 26% lower mortality and a 20% lower rate of going onto dialysis over a period of almost two years.

Association of Oral Calcitriol with Improved Survival in Nondialyzed CKD Abigail B. Shoben et. al. Journal of the American Society of Nephrology Published online May 7, 2008. doi: 10.1681/ASN.2007111164

A Danger with Vitamin D: High Blood Calcium Which May Cause Hardened Arteries

If you supplement with the very high Vitamin D levels being promoted by celebrity doctors you run the risk of experiencing very high blood calcium levels if you take calcium supplements. Even blood calcium levels in the high normal level have been associated with increased heart disease so this is a serious concern.

Rampant Vitamin D supplementation is causing a revival in what used to be a rare condition, Milk Alkali syndrome, which can be fatal.

Got Calcium? Welcome to the Calcium-Alkali Syndrome Ami M. Patel and Stanley Goldfarb. J Am Soc Nephrol 21: 1440-1443, 2010

I personally experienced a serious problem with a high blood calcium level after supplementing with 2000 IU of Vitamin D for about 9 months in my doctor's suggestion. I was NOT taking any calcium supplements, but I was eating several servings of cheese each day as part of my lower carbohydrate diet. My Vitamin D level tested well above the low end of normal but at a level that the lab considered normal, but the lab high is the level at which Vitamin D toxicity occurs.

If you do supplement with more than 1000 IU a day of calcium you must get your blood calcium levels checked from time to time and if they are at the high end, you should back off both Vitamin D and foods high in calcium until they come down.

As is always the case, our metabolisms are too complex to be "cured" with any supplement. It is possible that supplementation with Vitamin D in those with measured low levels is helpful for heart disease, but it is foolish to supplement with massive doses of Vitamin D when you don't know your levels and are not tracking your blood calcium.

In addition, I have see a healthy person experience a hormonal reaction similar to "roid rage" when they supplemented with high doses of Vitamin D. Dr. William Davis confirmed to me, via email that Vitamin D can raise Testosterone levels.

Recommended Dose:

1000 IU per day. The oil based versions of Vitamin D are better absorbed than those found in hard calcium-based pills. There is no need to buy overpriced special versions of Vitamin D, such as Vitamin D2,as they may actually be less effective than the regular ones.

There is some controversy about what level constitutes an overdose but if you are not getting a lot of sun, adults should be fine taking 1000 IU. If you are taking Vitamin D, ask your doctor to test your Vitamin D level when you get your other blood tests just to be safe.
Doses higher than 1000 IU may cause problems if you already have normal levels of Vitamin D and may unbalance your blood calcium levels.

Benfotiamine and Vitamin B1

Vitamin B1 and Benfotiamine which is a lipid soluble form of Vitamin B1 are supplements for which there is growing amount of research suggesting that they might be helpful for people with diabetes.

Vitamin B1 has been shown to lower the amount of albumen secreted into urine.

High-dose thiamine therapy for patients with type 2 diabetes and microalbuminuria: a randomised, double-blind placebo-controlled pilot study. N. Rabbani et al. Diabetologia10.1007/s00125-008-1224-4, Dec 05, 2008.

Benfotiamine appears to help neuropathic pain and may reduce the incidence of microvascular complications.

.A study reported by the BBC on August 8, 2007 found that the blood of people with diabetes is very deficient in vitamin B-1 (thiamine) and explained that this had been missed in previous testing for technical reasons.

BBD: Diabetes problems 'vitamin link'

Here's the published study:

High prevalence of low plasma thiamine concentration in diabetes linked to a marker of vascular disease. Thornalley PJ et al, Diabetologia. 2007 Oct;50(10):2164-70.



A study conducted at Albert Einstein Medical School published in Sept, 2008, found that the combination of benfotiamine and alpha-lipoic acid, while having no effect on blood sugar level, normalized AGE overproduction associated with high blood sugars as well as several other pathways known to lead to complications.

Oral benfotiamine plus a-lipoic acid normalises complication-causing pathways in type 1 diabetes. X. Du et. at. Diabetologia Volume 51, Number 10 / October, 2008, pp. 1930-1932.

Other research suggests that thiamine can block the processes that lead to microvascular complications which include neuropathy, retinopathy and kidney disease.


Benfotiamine Prevents Macro- and Microvascular Endothelial Dysfunction and Oxidative Stress Following a Meal Rich in Advanced Glycation End Products in Individuals With Type 2 Diabetes.Alin Stirban et al.,Diabetes Care 29:2064-2071, 2006.

Benfotiamine blocks three major pathways of hyperglycemic damage and prevents experimental diabetic retinopathyHans-Peter Hammes, et al., Nature Medicine 9, 294 - 299 (2003)

Benfotiamine in the treatment of diabetic polyneuropathy--a three-week randomized, controlled pilot study (BEDIP study). Haupt E, Ledermann H, Kopcke W. Int J Clin Pharmacol Ther. 2005 Feb;43(2):71-7.

Medscape: Clinical Manifestations and Treatment Options for Diabetic Neuropathies

REVIEW: The role of advanced glycation end products in progression and complications of diabetes.Su-Yen Goh, Mark E Cooper. J Clin Endocrin Metab. doi:10.1210/jc.2007-1817.

More recent research is casting doubt on whether benfortiamine is, actually, oil soluble and whether it has any value compared to much less expensive thiamine.

Benfotiamine, a synthetic S-acyl thiamine derivative, has different mechanisms of action and a different pharmacological profile than lipid-soluble thiamine disulfide derivatives Marie-Laure Volvert et al. BMC Pharmacology 2008, 8:10doi:10.1186/1471-2210-8-10

Recommended Dose:

The dose of Vitamin B1 associated with improved kidney function was 100 mg taken three times a day.

The dose of Benfotiamine used in the above experiments with humans varies. As reported they were "two 50 mg benfotiamine tablets four times daily" (400 mg/day), 200 mg/day, or "a combination of benfotiamine (100 mg) and pyridoxine hydrochloride (100 mg)" once a day.

Given the questions raised about the true value of benfotiamine and its expense, it probably makes sense to use the cheaper thiamine supplements.

Alpha Lipoic Acid

This expensive supplement has been used in intravenous form to treat neuropathy in Germany. It, like cinnamon, is an insulin mimic. A German study where doctors from Buhl and City Hospital in Baden Baden administered different dosages of ALA and placebo to 74 patients for four weeks and then tested their insulin levels to study insulin sensitivity found that glucose disposal in all the ALA-treated subjects improved by an average of 27% though all dosages appeared equally effective. The lowest dose used was 600 mg taken once a day.

Oral administration of RAC-alpha-lipoic acid modulates insulin sensitivity in patients with type-2 diabetes mellitus: a placebo-controlled pilot trial.Free Radic Biol Med, Aug 1999, 27(3-4) p309-14.Jacob S, Ruus P, Hermann R, Tritschler HJ, Maerker E, Renn W, Augustin HJ, Dietze GJ, Rett K.

However,a review of other studies shows less conclusive results for ALA taken orally rather than intravenously.

Alpha-lipoic acid: a multifunctional antioxidant that improves insulin sensitivity in patients with type 2 diabetes.Evans JL, Goldfine. Diabetes Technol Ther, Autumn 2000, 2(3) p401-13.


Dr. Bernstein writes that he has his patients take it in combination with Evening Primrose oil to potentiate the action of insulin whether "homemade" by the body or injected.

Unfortunately, scanning Internet newsgroups for discussions of this supplement does not turn up much encouraging news. Many people report that the combination caused them intolerable gastric distress. EPO was reported to cause mood swings by others, and almost no one reports seeing significant changes in blood sugar after taking this expensive supplement pair.


Better results are reported with R-ALA which is a specific form marketed in the U.S. under the brand name "Insulow." Dr. Bernstein recommends using the R-ALA form on page 238 of the 3rd edition of Dr. Bernstein's Diabetes Solution.

Recommended Dose:

The Jacobs study cited above used 600 mg orally once a day. Dr. Bernstein's Diabetes Solution, 3rd Ed. currently recommends 2 100 mg tablets every 8 hours to be taken along with one 500 mg capsule of Evening Primrose oil

Some people with Type 2 do report that ALA does help with neuropathic pain and that it does not seem to matter whether they use the time release or regular form.

One caution about ALA:

An editorial in the Japanese Journal 'Internal Medicine'" warns that for people with a specific genetic makeup that makes them extremely likely to develop autoimmune (Type 1) diabetes, ALA may provoke an antibody attack. The explanation for why this happens is that "a-lipoic acid (ALA) is reduced in the body to a sulfhydryl compound" and that sulfur rich compounds stimulate the immune attack. This does not appear to be a concern for people who do not have a strong history of autoimmune diabetes.

The Novel Agent, Alpha Lipoic Acid, can Cause the Development of
Insulin Autoimmune Syndrome
Yasuko Uchigata.Internal Medicine (Japan).Vol. 46 (2007) , No. 17 pp.1321-1322

Fish Oil Fights Inflammation - But Fish Is A Dangerous Source

There is quite a lot of evidence suggesting that fish oil, a mixture of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has strong anti-inflammatory properties and may also improve lipid profiles and heart attack risk.

You can read an excellent summary of a review that looked at this data here:

Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Disease Protection (American College of Cardiology CME)

One small area of concern about the research cited is that quite a lot of it was done with a prescription (i.e. expensive, proprietary) form of fish oil called Lovaza made by drug kingpin GlaxoSmithKline. You can read the official Prescribing Information about Lovaza HERE.

Lovaza costs around $100 for 60 1 gm capsules and in the studies cited 4 gram daily doses were used. The fish oil you buy at the pharmacy is about $15 for 200 capsules and you can often find "buy one get one free" offers.

This issue is important because the above review notes that re a major Lovaza study "Other studies, including a recent underpowered OMEGA trial, have not demonstrated such benefits." The explanation could be that Lovaza is worth the obscene price or that GSK used the usual big pharma study design dodges and statistical tricks to skew the results. My guess is the latter.

Subtract the drug company studies, though, and there is still a lot of evidence pointing to fish oil as being helpful in inflammatory contexts. You can read a older full-text review that cites many observational studies HERE.

A very recent study examined the impact of fish oil on gene expression, comparing the effects on genes in human subjects of six month supplementation with fish oil against supplementation with sunflower oil.

Fish-oil supplementation induces antiinflammatory gene expression profiles in human blood mononuclear cells. Bouwens M et al. Am J Clin Nutr 2009 Aug;90(2):415-24. Epub 2009 Jun 10.

The finding of the gene study was that
A+DHA intake resulted in a decreased expression of genes involved in inflammatory- and atherogenic-related pathways, such as nuclear transcription factor kappaB signaling, eicosanoid synthesis, scavenger receptor activity, adipogenesis, and hypoxia signaling.
The dose in the above study was 1.8 g a day of fish oil. It is not mentioned if the study used a branded version.

This suggests that fish oil would be a worthwhile supplement for people with diabetes because heart disease is now known to be an inflammatory condition. Some people with Type 2 also turn out to have autoimmune factors at work in attacking their beta cells.

But as good as fish oil might be for you there is one huge caveat. Thanks to the heedless pollution of our environment by coal burning plants releasing mercury in the air, fish has become an extremely toxic way to get your fish oil.

The data commonly cited about the amount of mercury in fish is between twenty and thirty years old and what little evidence we have the current levels of mercury in fish is far, far higher.

Here is the FDA listing of mercury levels in fish:

FDA Mercury Levels in Commercial Fish and Seafood

Note that the date of most of the mercury concentration data cited for many of the fish is "1990-1994" and for some, like shrimp and mackerel, it is 1978.

I personally know two people who consumed fish several times a week believing in its health benefits who were diagnosed with toxic blood mercury levels by mainstream doctors and given chelation therapy.

In a recent book, Experimental Man, by David Ewing Duncan, one that is otherwise not worth reading, the author ate a fish and then went to the lab and had his blood analyzed for mercury. The reading reported was far higher than what the FDA lists of mercury in that particular fish would suggest.

So this suggests that eating fish is not a good way to get the benefits of fish oil.

Capsules are better, though they may, in fact, contain very small amounts of mercury, the amounts are dramatically lower than that found in fish.

Here is a study that gives you some idea of how much mercury might really be in fish oil capsules. Many are free of it, some of it do have small amounts:

Measurement of Mercury Levels in Concentrated Over-the-Counter Fish Oil Preparations: Is Fish Oil Healthier Than Fish? Stacy E. Foran et al. Archives of Pathology and Laboratory Medicine, Vol. 127, No. 12, pp. 1603–1605.

One VERY important warning. Over the year that I have been buying fish oil capsules, I have found the ingredients of the capsules changing from bottle to bottle within the same brand. So does the origin of the fish oil which may be listed as "sardines" in one bottle and not mentioned in another, suggesting it comes from larger, more mercury-polluted fish. I found this true for several different brands. So when a manufacturer cites test values those values may have been done months before and may be entirely different from results you'd see if the tests were performed now.

Because mercury levels in fish roughly correspond to the size of the fish, you'd do best with fish oil made from very small fish, like sardines. However, small fish taken from highly polluted waters may be more toxic than you'd expect. I also see soy oil increasingly making its way into capsules, a concern for those who have problems with soy proteins. So when you buy your fish oil, examine the label carefully each time.

Recommended Dose

1 to 4 grams a day.

If you have a tendency to bleed, stick with a lower dose as there is some data suggesting fish oil may promote bleeding. Talk to your doctor before starting fish oil if you are taking a blood thinner.. Do not take fish oil if you are allergic to fish.

Another very important point: To avoid the disgusting fish-flavored burps fish oil can cause, buy only "Enteric coated" fish oil. This is the single most common disturbing side effect caused by fish oil and the enteric coating does eliminate it.

Vinegar Lowers Blood Sugar A Tiny Bit


There is tremendous hype in the alternative medical community claiming that vinegar, particularly apple cider vinegar, can cure all human ills, so not surprisingly vinegar has been touted as a treatment for insulin resistance and high blood sugars.

A published study claims that ingesting 2 tablespoons of vinegar lowers fasting blood sugar. Unfortunately, as usual, the actual finding is not all that impressive. In a small group of people with fasting blood sugars were above 137 mg/dl (7.6 mmol/L) taking two tablespoons of vinegar before bed lowered blood sugar by a whopping 5 to 8 mg/dl (.43 mmol/L). This left the study participants with fasting blood sugars that were still dangerously high.

The study only lasted 3 days, so we don't know whether this effect faded out when the regimen was continued, as is often the case with these kinds of minor changes in blood sugar.

As the full text of this study is not available, you can read the details in this dLife report:

dLife: A Spoonful of Vinegar Makes the Blood Sugar Go Down?

The study is available here:
Vinegar Ingestion at Bedtime Moderates Waking Glucose Concentrations in Adults With Well-Controlled Type 2 Diabetes. Andrea M. White et al. Diabetes Care November 2007 vol. 30 no. 11 2814-2815. doi: 10.2337/dc07-1062

An earlier study made with only 12 normal people given three different concentrations of vinegar with a large serving of bread found lower insulin and glucose at 30 and 45 minutes after the meal but no difference at 2 hours. Since the blood sugar of a normal person performs very differently than that of someone with diabetes it is unknown if this study has any relevance.

Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects. E Östman.European Journal of Clinical Nutrition 59, 983–988. published online 29 June 2005

Yet another study with 10 diabetic subjects demonstrated that adding vinegar to an extremely high carb meal--84 grams, made a small difference in the very large rise in the blood glucose of the people with diabetes. The vinegar dropped their blood sugar about 18 mg/dl but this study is worth very little since the blood sugar rise in these people with diabetes was only measured for one hour after eating. This study did test a placebo which gives it a bit more credibility, but the small sample size and the fact that blood sugar was not observed over the 3 hours that the high carbohydrate meal would have raised blood sugar makes it less than compelling.

Vinegar Improves Insulin Sensitivity to a High-Carbohydrate Meal in Subjects With Insulin Resistance or Type 2 Diabetes Carol S. Johnston, et. al. Diabetes Care 27:281-282, 2004

Fortunately, vinegar is something you can safely test on your own. Add no more than two tablespoons of vinegar to a meal whose blood sugar performance you are familiar with and see whether you notice any difference in your blood sugar response.

Some people, myself included, report that repeated dosing with apple cider vinegar leads to stomach uneasiness. If you experience this side effect, stop the vinegar.

There are exaggerated claims made for the unpasteurized apple cider vinegars which are unlikely to be true. The studies that found blood sugar effects were done with pure acetic acid or pasteurized apple cider vinegar. Given that unpasteurized apple cider has been taken off the market in many places because it has caused severe salmonella and E coli infections, claims that the bacteria growing in unpasteurized apple cider vinegar have magical properties are unlikely.

I can find no scientific papers to support any health claim of unpasteurized vinegar. The cost of this unpasteurized vinegar--five times that of any other vinegar, may have something to do with why it is so heavily promoted.

 

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