Herbs, Supplements & Vitamins: What to Try and What to Buy

The following is an update from an article that ran in the July 2000 issue of Diabetes Interview. Because we received numerous requests for reprints of the article, we have decided to update it and rerun it here.

| Aug 1, 2001

Everyone, including your neighbor, manicurist and racquetball partner, seems to be jumping enthusiastically onto the "supplement bandwagon." Should you and your diabetes climb aboard?

What works? What is worth buying? For years, diabetes treatment only included insulin, oral medications, diet and exercise. Today, we are learning that supplements, herbs and vitamins are an important addition to diabetes treatment choices.

Herbs, vitamins and supplements offer valuable treatment options for diabetes. The research in this field is young, but interest in the mainstream medical community is growing.

Physicians are now beginning to learn about the impact that supplementation has on diabetes. Become a partner with your doctor and work together to find the information needed to safely jump on the supplement bandwagon that leads to good health.

R. Keith Campbell, RPh, CDE, professor at the pharmacy department at Washington State University in Pullman, Washington, says people with diabetes can get most of the vitamins, minerals and trace elements from their diet only if they eat a well-balanced diet and seven to nine vegetables and fruits daily.

"However," he adds, "only nine percent of the U.S. population does this."

Campbell says people with diabetes who do not normalize blood-glucose levels also put more stress on their bodies.

"High blood sugars increase coagulation factors, cause red blood cells to be rigid, have increased capillary basement membrane thickness and have increased advanced glycosylation end products that are a result of oxidation," he says. "In addition, when blood sugars are increased, patients urinate out vitamins, minerals and trace elements."

Campbell says all of this builds a strong case for people with diabetes to add daily supplementation of vitamins and minerals.

The following items have demonstrated benefits in either animal or human studies, and sometimes in both. As interest grows in the mainstream medical community, this list is sure to grow.

Alpha-Lipoic Acid (Lipoic Acid)—For Nerve Pain

A German favorite, alpha-lipoic acid is used to treat nerve damage caused by diabetes. The supplement demonstrated its ability to reduce foot pain, burning and numbness caused by diabetic neuropathy in the September 1997 issue of Diabetes. The February 1999 issue of Diabetes Care reported that alpha-lipoic acid was found to reduce fasting blood glucose concentrations in test subjects. The December 1999 issue of Diabetic Medicine said that taking 1,800 mg of oral alpha-lipoic acid daily for 19 days helped reduce nerve pain for type 2 patients.

Alpha-lipoic acid acts as an antioxidant, helping to protect the cells of the liver and brain. It may also prevent cataracts and improve the effectiveness of other antioxidants, including vitamins E and C.

Natural Health magazine recommends a daily dose of 100 to 600 milligrams. The supplement should be taken in the morning for maximum effect.

Vitamin B6—Prevents Neuropathy Pain

Vitamin B deficiency is known to be a cause of neuropathy, and may aggravate the condition once it has begun.

A study published in the December 1997 issue of the East African Medical Journal suggests that the pain, numbness and discomfort of neuropathy can be improved with supplements of vitamin B6. A 1996 study published in Endocrinology and Diabetes reports that type 1s and insulin-dependent type 2s with diabetic polyneuropathy for at least four months but less than three years, experienced positive changes, including nerve regeneration, after taking vitamins B1, B6 and B12.

However, supplements of higher than 100 milligrams per day can, over time, cause the very symptoms that are being treated: numbness, weakness and loss of function in the extremities.

According to David Edelberg, MD, vitamin B6 is best when taken as part of a vitamin B complex. Daily doses of B6 can go as high as 100 milligrams, but should not be exceeded.

Vitamin C—Prevents Cataracts

A well-established vitamin superstar, vitamin C can lower blood sugar in type 2s, and was found to reduce the risk of coronary disease in women at the 1999 American Diabetes Association scientific sessions. Researchers at the University of Washington in Seattle found that vitamin C helps people with diabetes avoid kidney disease. And vitamin C may also offer a way to prevent diabetic cataracts and aid blood flow in type 1s.

In the January 1999 issue of Diabetes Research in Clinical Practice, researchers found that vitamin C supplements may reduce the presence of certain substances, including sorbitol, which promote the development of this eye problem.

Jeffery Blumberg, PhD, recommends taking between 250 and 1000 milligrams of vitamin C a day.

Capsaicin (cayenne pepper)—For Nerve Pain

When used topically as an ointment, capsaicin can decrease the pain associated with diabetic nerve pain in legs, hands and feet for up to five days.

Capsaicin does so by reducing the perception of pain in these areas, but may take from three days to four weeks to take effect. Its benefits as a treatment for pain are noted in multiple journals, including the March 1991 issue of the New England Journal of Medicine and the June 1997 issue of the International Journal of Dermatology.

Chromium—Reduces BGs

Chromium is naturally found in brewer's yeast or in pill form as either picolinate or polynicotinate/GTF (glucose tolerance factor).

This supplement has repeatedly demonstrated its ability to improve insulin sensitivity and reduce blood sugar levels in both type 1 and type 2 diabetes.

Research supporting chromium's benefits in diabetes is found in several journals, including the October 1998 issue of Nutrition Review, the 1998 issue of the Journal of Family Practice and the November 1997 issue of Diabetes.

R. Keith Campbell, RPh, CDE recommends 400 micrograms of chromium daily.

Vitamin E—Prevents Heart Problems and Retinopathy

The "E" in vitamin E could very well stand for "everything." In addition to being a powerful antioxidant, vitamin E is heart-healthy, may improve diabetic control, helps arrest the development and progression of retinopathy and may even prevent type 2 diabetes.

The November 1993 issue of Diabetes Care reported that vitamin E lowered glucose, triglyceride and cholesterol levels in people with type 2 diabetes. A 1995 study published in the British Medical Journal concluded that below-average vitamin E levels can cause a 390 percent increase in the chance of developing type 2 diabetes.

Vitamin E's beneficial effects with regards to cardiovascular activity are also well documented. Studies in the March 1996 issue of Lancet and the May 1993 issue of The New England Journal of Medicine both found that vitamin E significantly lowered the risks of coronary disease in subjects.

In yet another study examining the benefits of vitamin E supplementation, researchers have proclaimed that routine vitamin E use may have a beneficial effect on the hearts of people with type 1 diabetes. They add that vitamin E should be considered a life-long part of a type 1's vitamin regimen.

In a study published in the November 2000 issue of the American Journal of Clinical Nutrition, patients who took moderately high doses of vitamin E were less likely to have oxidative changes in LDL (bad) cholesterol than patients who took a placebo. Because people with type 1 have high blood-sugar episodes, they are at greater risk for the oxidation of LDL.

The Joslin Diabetes Center in Boston conducted research in 1995 that suggests that supplementation with vitamin E may alter the development of retinopathy.

Campbell recommends a daily dose of 800 IU of vitamin E.

Evening Primrose Oil—Protects Nerves and Arteries; Improves Blood Lipids

When Native American women first chewed on evening primrose seeds to treat premenstrual distress, little did they know this herb would offer so much to so many.

The gamma-linolenic acid contained in evening primrose oil is a popular treatment for multiple ailments in addition to diabetic neuropathy, including PMS, acne, joint pain, eczema, aging and infertility. It also reduces nerve damage in type 1s and type 2s and improves blood lipid levels. Research supporting its diabetic benefits comes from Japan and is found in the August 1993 and July 1991 issues of Prostaglandins Leukotrienes and Essential Fatty Acids.

According to Natural Health magazine, evening primrose oil's effectiveness is maximized by daily doses of between 200 and 500 milligrams.

Fenugreek—Improves Blood Sugar Control

Fenugreek seed's rich fiber slows the rate of gastric emptying, inhibits the absorption of glucose in the intestine, and lowers cholesterol levels.

Clinical studies published in the European Journal of Clinical Nutrition (April 1990 and January 1988 issues) support the use of fenugreek seeds to improve blood sugar control in people with both type 1 and type 2 diabetes. Products lacking either the whole seed or its powder (fenugreek seed extracts and fenugreek tea) do not provide this benefit.

Edelberg recommends taking between five and thirty grams of fenugreek three times a day for maximum effectiveness. He cautions that in some people, fenugreek may cause stomach upset.

Fish Oil—Improves Blood Lipids

Fish oil always seems to be in the news. It is known for reducing the risk of heart attack or stroke. A study published in the April 1998 issue of Diabetes Care offers good news. Fish oil, a source of omega-3 fatty acids, appears to lower triglyceride (blood fat) levels in individuals with diabetes.

Ginseng (American and Asian)—Lowers BGs

Its powers as an ancient Chinese aphrodisiac might be overrated, but studies now show that ginseng's ability to lower blood sugar in type 2 diabetes is quite real.

The benefits of American ginseng (panax ginseng) are noted in the April 2000 issue of Archives of Internal Medicine. Research on Asian ginseng (panax quinquefolium) is presented in the October 1995 issue of Diabetes Care. Both types appear to enhance the release of insulin from the pancreas and increase the number of insulin receptors.

Studies are increasingly proving the benefits of keeping your after-meal BG levels down. Along with these results comes an interest among many with diabetes to help lower their glucose levels using natural substances.

In a more-recent study, published in the September 2000 issue of Diabetes Care, researchers discovered that after-meal BG levels can be lowered using a minimum of three grams of American ginseng.

Nervousness, headache, insomnia and diarrhea may occur with overuse. Buy with caution, as many commercial products contain little or no actual ginseng.

According to Steven Bratman, MD, ginseng is safe and effective in a daily dose of 200 milligrams. It should not be used by people with high blood pressure; and two to three weeks of use should always be followed by a one to two week break.

Gingko Biloba—Improves Circulation

The leaves of the gingko tree may be the key to improving circulation and treating Alzheimer's disease, according to several European studies. Fortunately, Ginko appears to help circulation for people with diabetes as well. One study, which highlights gingko's ability to improve blood circulation of the eye, was published in the June 1999 issue of the Journal of Ocular Pharmacology.

Gymnema Sylvestre—Stimulates Insulin Release

Known as the infamous "sugar destroyer" in India, gymnema sylvestre was used for generations as an Indian folk remedy for both type 1 and type 2 diabetes.

Several studies, including one published in the October 1990 Journal of Enthnopharmacology, support using gymnema sylvestre to reduce blood glucose. Gymnema sylvestre stimulates the release of the body's insulin, which may allow users to reduce insulin or oral medication use. Such steps must not be taken, however, without the supervision of a doctor or other healthcare professional.

Gymnema sylvestre is most effective with two daily doses of 200 milligrams each, according to Edelberg.

Magnesium—Prevents Heart and Vision Problems

Magnesium assists with energy metabolism in the muscles and nerves and individuals with diabetes tend to have low magnesium levels.

Supplemental magnesium may prevent heart and vision problems often seen with type 2 diabetes. Several studies, including one published in the May 1998 issue of Diabetes Care, demonstrate the benefit of magnesium supplements. The August 1999 issue of The American Journal of Hypertension reported that researchers discovered that a magnesium-poor diet increases insulin resistance in African-Americans and can lead to glucose intolerance.

Campbell recommends taking magnesium in two daily doses of 800 milligrams each.

Pine Bark Extract (Pycnogenol)—Improves Blood Vessel and Retinal Health

In 1534, a French explorer and his crew became trapped by ice in the Saint Lawrence River. To avoid contracting scurvy, they brewed a tea from the needles and bark of local pine trees. Over 400 years later, a French researcher, intrigued by this story, found that maritime pine bark extract duplicated many of the actions of vitamin C.

Pycnogenol, a patented form of pine bark extract, is used to improve circulation, protect small blood vessels and may combat or even reverse retinopathy.

An Italian study in the January/February 1999 issue of Minerva Cardioangiologica documents Pycnogenol's circulatory benefits. Animal research in Ophthalmic Research in 1996 demonstrates Pycnogenol's protection of the retina. The University of California, Berkeley ran several studies on the effect Pycnogenol has on cells, published in the May 1998 Free Radical Biology and Medicine and the April 1999 Redox Report, which document Pycnogenol's antioxidant abilities. In a more recent study published in Phytotherapy Research (15; 291-223; 2001) Italian researchers discovered that 50mg of Pycnogenol taken three times per day for two months, "demonstrated a beneficial effect.on the progression of diabetic retinopathy."

Psyllium—Slows Glucose Absorption

Like fenugreek, psyllium seeds (not husks) help slow gastric emptying and reduce intestinal glucose absorption rate, as noted in the 1998 summer issue of Archives of Medical Research and the 1998 issue of the Journal of Diabetes Complications.

Adding psyllium to meals may also reduce the glycemic index of carbohydrate foods. This is the same fiber found in Metamucil and other fiber-containing laxative supplements. Avoid products containing sugar and take with plenty of water. They may alter the absorption of other prescription drugs.

Excessive use of psyllium can cause diarrhea and bowel irritation.

Other Fiber Products

Several other herbal products use fiber to improve diabetes and have no known dangerous side effects. These include apple, barley, flaxseed, guar gum, nopal (prickly pear cactus) and pectin. These supplements appear in the winter 1999 issue of On the Cutting Edge, a newsletter of the American Dietetic Association's Diabetes Care and Education practice group.

Quercetin—Antioxidant Protection

We have the lowly onion to thank for introducing quercetin into our flavonoid arsenal of antioxidants.

In a study published in the January 1999 issue of Diabetes, quercetin actively protected cells from oxidative damage. Many people with diabetes have reduced antioxidant defenses that create a greater risk of developing medical problems such as coronary heart disease. Taking quercetin can help reduce this risk. Stomach acid destroys its active components, so look for tablets that are enteric-coated.

James F. Balch, MD, recommends taking 100 milligrams of Quercetin three times daily.


Campbell says that cinnamon has recently been show to reduce blood glucose levels. According to the August 12, 2000 issue of New Scientist, researchers at the U.S. Agricultural Research Service's nutrition labs in Beltsville, Maryland, discovered that taking a quarter to one full teaspoon of cinnamon per day—perhaps in orange juice, coffee or oatmeal—may aid the bodies of type 2s to "recognize and respond to insulin, increasing their glucose metabolism twenty-fold." The ingredient in cinnamon, known as methylhydroxy chalcone polymer, makes fat cells more responsive to insulin, ensuring that the "remove-glucose" message resisters inside the fat cell.

Not-Ready-for-Prime-Time Herbs

The following herbs, shown to have promise in the treatment of diabetes, have no known dangerous side effects, but lack scientific evidence: aloe vera (topical use only), artichokes, carrot oil, coriander, fo ti, java plum, kidney bean pods, lucerne, neem seed oil, peppermint, raspberry, sumac and tarragon. Ref: On The Cutting Edge, Winter 1999.

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