Supplements that Can Help in Diabetes and Prediabetes

By Jack Challem

PRODUCTS: Many supplements are capable of improving insulin function and lowering blood-sugar (glucose) levels. These supplements are far safer than glucose-lowering or insulin-sensitizing medications, and they also correct some of the disease's biochemical underpinnings, instead of merely suppressing symptoms. The most compelling evidence supports the use of chromium, alpha-lipoic acid, biotin, silymarin, cinnamon, and ginseng. Many companies sell supplements that combine these or other supplements for normalizing glucose and insulin activity.

BACKGROUND: Type 2, or diet-related, diabetes is reaching epidemic proportions in the United States. The latest estimates are that some 21 million Americans have this form of diabetes and that as many as 70 million Americans have some degree of prediabetes. The major predisposing risk factor is being overweight, and with two-thirds of Americans overweight, the scale of the problem is nothing less than frightening. In a recent study, researchers calculated that one-third of babies born in 2000 will eventually develop diabetes.

COMMON SUPPLEMENTS AND DOSAGES: Each of the listed supplements has been shown to reduce glucose levels, improve insulin function, or accomplish both. Use the lower end of the dosage range when dealing with prediabetes and the higher end of the range with diabetes. These supplements can be combined. Try each one for 30 days to see if it helps, before you add the next one.

• Chromium picolinate supplements can reduce glucose levels and improve insulin function. Try 400 to 1,000 mcg daily (in divided dosages).

• Alpha-lipoic acid is used in Germany to treat diabetic nerve disease (diabetic neuropathy). Some evidence suggests that the R-lipoic form of alpha-lipoic acid may be more effective, but it is also more expensive. Try 100 to 200 mg three times daily.

• Biotin, a B vitamin, enhances the effects of chromium and alpha-lipoic acid in improving glucose tolerance. Add 750 mcg to 2,000 mcg (2 mg) with either chromium or alpha-lipoic acid.

• Silymarin can significantly improve glucose and insulin levels in serious cases of diabetes. Try 100 to 200 mg three times daily.

• Cinnamon can lower glucose levels. Try 1 to 6 grams a daily, either in capsules or sprinkled on fruit. One gram equals about ¼ teaspoon of ground cinnamon.

• American ginseng can lower glucose levels in both diabetics and healthy people by 20 to 38 percent, depending on the dosage. Try 3 to 9 grams of Panax ginseng with meals.

• Other herbs, including bitter melon, fenugreek, garlic, green tea, nopal, holy basil, and Gymnema sylvestre, has also been found helpful in diabetes. Follow label directions for use.

HOW THE SUPPLEMENTS WORK: These supplements generally work by improving the efficiency of insulin, a hormone needed to transport glucose from the blood into muscle cells. Lower insulin levels are healthier and indicate more efficient use of the hormone. With better insulin activity, glucose is more likely to be burned for energy instead of stored as fat. Some of the supplements, such as chromium picolinate and alpha-lipoic acid, also seem to reduce appetite, which reduces insulin requirements.

WHAT TO LOOK FOR IN QUALITY PRODUCTS: As always, stick with brands you trust. I recommend that you try nutritional supplements before herbal ones. Some supplements combine biotin with either chromium or alpha-lipoic acid.

OTHER CONSIDERATIONS: Type 2 diabetes is a nutritional disease, and it is best treated with nutrition. Supplements will have greater benefits if they are taken in association with better eating habits and weight loss. Increase your protein and high-fiber vegetables, while reducing your intake of sugars and refined carbohydrates.

The best indicator of diabetes risk is fasting insulin, not fasting glucose. Insulin levels start to increase years before glucose levels rise, yet doctors rarely measure insulin. A fasting insulin higher than 15 mcIU/ml is a sign of problems, and levels higher than 25 probably indicate prediabetes or diabetes. Fasting insulin levels under 7 are ideal.

LATEST RESEARCH: Men with diabetes often experience erectile dysfunction, which is related to low blood levels of nitric oxide, a neurotransmitter and cell-signaling molecule that regulates blood-vessel flexibility. Some research suggests that L-arginine (1 gram, three times daily) may be helpful. A recent animal study found that alpha-lipoic acid might help as well.

CAVEATS: Glucose- and insulin-regulating supplements typically have a noticeable effect over several weeks. If you are taking any glucose-lowering or insulin-sensitizing medications (e.g., metformin or insulin), you may start to feel over-medicated. Work with your doctor to reduce your medication levels.

Scientific References

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Anderson RA, Chen N, Bryden NA, et al., "Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes," Diabetes, 1997;46:1786-1791.

Ziegler D. Thioctic acid for patients with symptomatic diabetic polyneuropathy: a critical review. Treatments in Endocrinology, 2004;3:173-189.

Lee WJ, Song KH, Koh EH, et al. Alpha-lipoic acid increases insulin sensitivity by activating AMPK in skeletal muscle. Biochemical and Biophysical Research Communications, 2005;332:885-891.

Velussi M, Cernigoi AM, De Monte AD, et al., "Long-term (12 months) treatment with an antioxidant drug (silymarin) is effective on hyperinsulinemia, exogenous insulin need and malondialdehyde levels in cirrhotic diabetic patients," Journal of Hepatology, 1997;26:871-879.

Khan A, Safdar M, Khan MMA, et al. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care, 2003;26:3215-3218.

Vuksan V, Sievenpiper JL, Koo VYY, et al. American ginseng (panax quinquefolius L) reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus. Archives of Internal Medicine, 2000;160:1009-1013.

Vuksan V, Stavro MP, Sievenpiper JL, et al. American ginseng improves glycemia in individuals with normal glucose tolerance: effect of dose and time escalation. Journal of the American College of Nutrition, 2000;19:738-744.

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Kim MS, Park JY, Namkoong C, et al. Anti-obesity effects of a-lipoic acid mediated by suppression of hypothalamic AMP-activated protein kinase. Nature Medicine, 2004;10:727-733.

Hurdag C, Ozkara H, Citci S, et al. The effects of alpha-lipoic acid on nitric oxide synthetase dispersion in penile function in streptozotocin-induced diabetic rats. International Journal of Tissue Reactions, 2005;27:145-50.