On the one hand, the organization sponsors a highly respected peer-reviewed diabetes journal called Diabetes Care, and this journal regularly publishes studies on the benefits of supplements, vitamins, minerals, nutraceuticals and botanicals. But here's a direct quote from the ADA describing their position on using supplements:
"There is no clear evidence of benefit from vitamin or mineral supplements for people with diabetes who do not have underlying vitamin or mineral deficiencies. Nor is there evidence to support the use of cinnamon or other herbs or supplements for the treatment of diabetes."
Contrary to this statement, many studies have shown the positive benefits of taking supplements in diabetic patients. Here's why a patient should take supplements as part of an effective diabetes protocol:
Antioxidants. Damage to a diabetic body from years of high glucose levels can cause the development of diabetic complications due to pro-oxidative biochemical pathways. Antioxidant supplementation can help your body stop rampant oxidative damage.
Deficiencies. Many people in the West, including diabetic patients, are nutrient deficient. High serum glucose can cause the loss of many nutrients—such as zinc, chromium and magnesium—from the body through the kidneys, and some medications patients take (for example, metformin and proton pump inhibitors) can cause nutrient deficiencies by reducing absorption from the gut. In addition, the unhealthy diet many type 2 diabetes patients have eaten for years may have been deficient in essential fatty acids, vitamin D3 and other nutrients.
Improved glucose control. Some supplements have good data showing that they can be beneficial for decreasing insulin resistance at the cellular level, enabling glucose to enter into the cell more easily.
Studies have shown that supplements can help lower fasting and after-meal glucose, lower A1C values (the level of hemoglobin proteins on red blood cells covered by glucose, the key monitoring tool for glucose regulation) and lower cholesterol and triglycerides.
Supplements can also help reduce the frequency of hypoglycemic and hyperglycemic events.1-3
Reduced appetite and cravings. Some supplements can be very helpful in reducing cravings for food, especially for carbohydrates.
Improved energy and mood. Nutrients can help elevate energy and mood in several ways. Fluctuating glucose levels all day can cause irritability and other unstable moods, and feeling like a victim to diabetes instead of a victor over it can negatively affect self-esteem.
Nutrients can help increase energy by supplying cells with all they need to work better.
Nutrients such as omega-3 oils and bioavailable folic acid are both associated with helping to reduce depression and anxiety.4,5
If a patient is eating healthier, does not have cravings, has good energy and mood, and has lower glucose levels, he or she will be able to lose weight much more quickly and effectively.
Finland has the highest per capita occurrence of type 1 diabetes in the world. As a result, researchers in Finland, as well as in other countries, have done extensive research focused on which supplements can be used with infants to help reduce the risk of developing type 1 diabetes later in their lives.
Two main nutrients, fish oils and vitamin D3, have been highlighted in these studies.6,7
Probiotics have also been shown to be helpful for glycemic control.8
A good multivitamin and mineral supplement, vitamins D3, probiotics, niacinamide and omega-3 fatty acids with extra magnesium, zinc, vanadium and potassium should be part of every diabetic's toolkit.
But a number of lesser known supplements can also have a major effect in helping you to master your diabetes.
(R-ALA). If I could only prescribe one supplement to a diabetes patient, it would be R-alpha-lipoic acid. This water- and fat-soluble antioxidant has been shown to improve insulin sensitivity and glucose metabolism in type 2 diabetes patients,9,10 and research suggests that it can also prevent diabetes from progressing to complications in the nerves, eyes, and kidneys.11,12
Alpha-lipoic acid is listed either as ALA or R-ALA. When listed as ALA, this means it contains two chemical structures that are mirror images of each other—the S form and the R form, in a 50:50 ratio. However, the R form is the only one that is active in the body, and so it should be the only form used.
If an alpha-lipoic acid product says each capsule contains 300 mg ALA, in actuality only 150 mg is R-ALA that will be active. An R-alpha-lipoic acid product that says each capsule contains 300 mg is all active in the body. So look for a product that says it contains "R-ALA" instead of just "ALA."
Suggested daily dose: 300 to 1,200 mg a day of R-ALA, the equivalent of 600 to 2,400 mg a day of a product labeled as only ALA
This fat-soluble form of thiamine (also known as allithiamine) has been shown to reduce the formation of advanced glycation end products, which are linked to the development of diabetic complications.13
Better absorbed than water-soluble thiamine, benfotiamine increases the production of thiamine pyrophosphate, which blocks glucose-induced damage. It's been shown to improve retinopathy, nephropathy and neuropathy.14-17
Suggested daily dosage: 150 to 450 mg
N-acetyl cysteine (NAC)
NAC, another valuable and inexpensive nutraceutical, can reduce insulin resistance by acting as an antioxidant to prevent oxidative glucose damage.18 It's been shown specifically to help protect the eyes from diabetic retinal degeneration,19 and to spare kidney and skin cells from diabetes-related damage.20
Suggested daily dosage: 600 to 2,400 mg
This nutraceutical has been shown to improve pain, nerve degeneration, and vibratory perception in patients with chronic diabetic neuropathy.21
I give acetyl-l-carnitine to every diabetic patient who has any type of neuropathy.
Suggested daily dose is 1,500 to 3,000 mg
Taurine is an inexpensive amino acid that is underused as a diabetic supplement. Taurine prevents the glycosylation of proteins. It's the main amino acid in the heart and helps the gallbladder work better to digest fats. Taurine has been found to be a potent hypoglycemic agent, and it can also enhance the effect of insulin. One study showed giving taurine to diabetic patients for a month necessitated a reduction in their insulin dosing to avoid taurine-induced hypoglycemia. Patients also had reductions in their cholesterol and triglyceride levels after taking taurine.22,23
Suggested daily dose: 500 to 1,500 mg
This antioxidant is found in cruciferous vegetables like broccoli. In addition to its well-documented anti-cancer effects, sulforaphane was found to reduce fasting blood glucose and A1c in obese patients with type 2 diabetes.24 It can protect against blood vessel damage caused by oxidative stress, helping to prevent diabetic complications.25
Suggested daily dosage: 30 to 200 mg
This product has shown potential benefits in improving insulin resistance and reducing the risk of diabetic complications.26
Suggested daily dosage: 1,000 mg
Known as gurmar, or 'sugar destroyer,' in Aryuvedic medicine, Gymnema has consistently shown benefits in patients with diabetes. The most active part of Gymnema seems to be 'gymnemic acids.' Analyses of the herb have shown it may be helpful in lowering glucose levels and blocking glucose absorption from the intestine. It's also been shown to prevent the accumulation of fats in the liver and blood, and to decrease body weight.27
I usually use it in capsules, or in liquid form in some patients.
Suggested daily dosage: in capsule form, doses of 400 to 2,400 mg a day.
Cinnamonium cassia and its relative C. burmanii are the types of cinnamon that have the best effect on patients. Numerous studies on cinnamon show that it can slow stomach emptying and lower postprandial glucose levels.
It reduces glucose levels in type 2 patients who have had poor diabetic control. It may also be helpful in lowering insulin levels, blood pressure and A1C, and reduce the formation of advanced glycation end products, which have been implicated in chronic inflammatory diseases.28
Suggested daily dosage: 1 to 2 g or 200 mg or more of a concentrated extract
A leading study on humans showed that berberine HCL matched the effects of metformin on diabetic patients.
In the pilot study, berberine promoted cellular uptake of glucose from the blood, lowered blood glucose and reduced insulin resistance.
An antioxidant, berberine may help strengthen pancreatic beta cells and help prevent the liver from overproducing glucose.29,30
Dosage can be problematic, however, as higher doses can upset the small intestine. I recommend patients slowly increase their dosage and to take the pill right after a meal, when food is already in the stomach.
Suggested daily dosage: 1,000 to 1,500 mg
Rich in anthocyanoside bioflavonoids, bilberry has been studied in type 2 diabetic patients and found to induce a clear improvement in glycemic response, with reduction of both glucose and insulin levels after eating.31 It may also be beneficial for improving cholesterol and triglyceride levels, based on evidence from animal studies.32
Suggested daily dosage: 100 to 350 mg
Green tea leaf extract
Green tea contains the bioflavonoid epigallocatechin gallate (EGCG), which has been shown to be a safe and effective antioxidant.
In clinical studies, green tea has been shown to reduce the risk of type 2 diabetes onset. In type 2 diabetes patients, it can improve glucose tolerance, decrease glucose production and over-secretion by the liver, and improve glucose absorption.
Green tea has also been reported to have a protective effect against diabetic retinopathy and to play a role in the prevention of atherosclerosis.33
Suggested daily dosage: 200 to 400 mg. It's also beneficial to drink organic green tea
This bright yellow chemical found in the spice turmeric has been shown to be a marked inhibitor of reactive oxygen species that promote oxidation damage in cells. In laboratory studies, curcumin lowered levels of molecules involved in inflammation, like tumor necrosis factor-alpha, which causes insulin resistance, and NF-KB, a protein that promotes the expression of inflammatory signaling molecules.34,35
Curcumin has also been shown to enhance pancreatic beta cell functioning, and it reduces glucose, A1C, and insulin resistance.36,37
Used in food, it is difficult to absorb, but mixing in black pepper can aid absorption, and most curcumin supplements have added pepper.
Suggested daily dosage: 200 to 3,000 mg
This plant has been associated with reducing the risk of dementia and cognitive decline, but it has also been shown to reduce blood clotting and to improve retinal and kidney function in type 2 diabetic patients with retinopathy.38
This botanical is a valuable addition to a diabetic supplement protocol, but it should not be taken by patients on blood-thinning medications or patients with the rare bleeding condition of hemophilia.
Suggested daily dose: 160 to 240 mg
Garlic has been shown to improve fasting glucose, fructosamine, cholesterol and triglyceride levels in patients with type 2 diabetes.39
I encourage patients to regularly include garlic powder and cloves in their cooking.
American and Asian ginseng
Ginseng has been shown in studies to reduce fasting blood glucose and body weight, and to improve A1C and mood.40-42
Suggested daily dosage: 200 mg. Some people over time might have hormonal side reactions to taking ginseng, so if something changes in your body in this way, alert your physician
Momordica charantia (bitter melon)
This melon, largely found at Asian markets, has a reputation for helping patients with diabetes by improving glucose tolerance and lowering A1C levels.43 It is best taken as a liquid or as an extract.
Suggested daily dosage of the extract: 200 to 800 mg
This herb has been shown to reduce fasting and after-meal glucose levels.44
Suggested daily dosage: 200 mg
Extending a type 1 diabetes honeymoon
A type 1 diabetes honeymoon occurs when a newly diagnosed type 1 diabetes patient suddenly sees his glucose completely under control, and the need for insulin drastically decreases or is even eradicated. It seems the pancreas begins to work again, and this honeymoon period can last for weeks, months or even years.
Some supplements have been studied for their potential to extend the type 1 diabetes honeymoon period. Of course, they work best when a good diet and other aspects of a healthy lifestyle are in place. Niacinamide, for example, alone or with vitamin E, has been shown to extend the honeymoon period.1
Although we generally recommend niacinamide at 1,500 mg per day, in one study the dose used was 25 mg per kg body weight per day, and vitamin E dosing was 15 mg per kg body weight. So, if a child weighed 60 pounds and we used the mg/kg body weight dosing method, she would take only 680 mg niacinamide and 400 mg vitamin E (560 IU) a day, half the standard dose. Check with an integrative physician about the best dosage for you, and do not use niacin, another form of vitamin B3.
Adapted from Dr Mona Morstein's book Master Your Diabetes: A Comprehensive, Integrative Approach for Both Type 1 and Type 2 Diabetes (Chelsea Green Publishing, 2017) and reprinted with permission from the publisher