Sorting out supplements for diabetes

From cinnamon and magnesium to herbal formulas claiming to calm down high blood sugars, there are a multitude of diabetes friendly supplements and vitamins popping up. Why do people turn to supplements? Many people with diabetes may be looking for something less potent than a medication or looking for something that treats health in the whole body, not just diabetes. The big question is” Should you take supplements for diabetes?”

Dietary supplements are commonly used in the United States, with reports of their use among patients with diabetes ranging from 22% to 67%. Patients with diabetes are even more likely to use dietary supplements than the general population, with a subset of patients preferring “natural” therapies to a medication prescription. Did you know that Metformin, which the first line and most widely used drug globally, was originally developed from natural compounds found in the plant Galega officinalis, known as French lilac or goat’s rue.  Synthetic biguanides were developed in the 1920s in Germany, but their use was limited due to side effects. So it was introduced for use first in France in 1957, and then finally in the United States in 1995 once it was proven safe enough.

So here is a list of some of the most commonly asked about supplements:

Alpha-Lipoic Acid: Commonly referred to as ALA, alpha-lipoic acid is an antioxidant that helps the body convert energy into food. Unlike most dietary supplements used in diabetes, ALA is primarily used for peripheral neuropathy instead of blood glucose or A1C control. ALA does not prevent neuropathy, but  it improves associated symptoms. It is unknown at this time whether it slows progression. While it is not commonly used to lower blood glucose, ALA may lower blood glucose, particularly in patients taking a medication with hypoglycemia as an adverse effect. This is a result of ALA increasing insulin sensitivity by 18% to 20% in patients with type 2 diabetes.

Chromium: Patients with diabetes may be deficient in chromium, a trace element. The theorized benefit in type 2 diabetes is increased insulin sensitivity and improved glucose tolerance. Chromium is also thought to play a role in carbohydrate and lipid metabolism.Patients are also interested in using chromium for weight loss, which is regulated by dopaminergic and serotonergic pathways. There are insulin receptors on these neuronal pathways, and insulin can decrease motivated feeding behavior.

Cinnamon: Cinnamon is widely used by patients for both diabetes and hyperlipidemia. Cassia cinnamon, the variety contained in cinnamon supplements, is the same type of cinnamon as is used for cooking and baking. A meta-analysis found that dosages of 1 to 6 g per day of cassia cinnamon resulted in decreased fasting blood glucose and lipids, but not decreased A1C. However, a real-world study found a decrease of 0.83% in A1C over 3 months for 1 g per day. Another study used 2 g per day found only a reduced A1C of 0.36%, and a Cochrane review found insufficient evidence.  While A1C does not appear to significantly improve with cinnamon use, cinnamon has produced blood glucose lowering of 18% to 29% in dosages of 1 to 6 g daily for 40 days. One g (approximately 1/2 teaspoon) continued to improve blood glucose levels for up to 20 days after discontinuation. The active ingredient in cinnamon is hydroxychalcone, which is thought to enhance the activity of insulin.

Fenugreek: This dietary supplement is commonly used in cultural cooking in other countries. Small studies have shown that fenugreek may have a benefit in lowering blood glucose, likely through stimulation of insulin release. Fenugreek also contains fiber and slows gastric emptying to decrease carbohydrate digestion and absorption.

B Vitamins: Several B vitamins are commonly used in type 2 diabetes, including thiamine (B1), pyridoxine (B6), biotin, folic acid (B9), and cobalamin (B12). Thiamine is commonly used for neuropathy associated with diabetes because many people with neuropathy have a thiamine deficiency. There is also a fat soluble version of Thiamine called Benfotiamine that is supposed to have a higher bioavailability and they say it helps with brain cognition too.  Thiamine has been found to be lower in patients with type 2 diabetes. Although it is typically used for neuropathy, thiamine has been found to decrease glucose and lipid levels in patients with diabetes. Patients with diabetes have also been found to have lower levels of the active form pyridoxine.  A pyridoxine deficiency may negatively affect the progression of complications association with diabetes. Research on biotin in diabetes is limited, and most evidence is in combination with chromium.

Prolonged use of metformin causes cobalamin malabsorption, which generally presents after 12 months of use. Cobalamin has been associated with reduced cognitive function in patients with diabetes, and it is used to correct deficiency versus treatment of diabetes. Folic acid has been shown to help improve glycemic control and insulin resistance. Metformin may be associated with folic acid deficiency, as well.

Vitamin D: There has been some mild research to show the correlation between geographical latitude and incidence of both type 1 and type 2 diabetes, and a seasonal variation in disease-state control has also been found. This suggests an inverse relationship between sunlight and diabetes incidence.  Vitamin D receptors are present in pancreatic beta cells, and vitamin D is thought to decrease insulin resistance and increase insulin secretion.  Deficiency of vitamin D has been associated with type 2 diabetes, likely owing to the deposition of vitamin D into fat, where it becomes less bioavailable.

Vitamin D deficiency leads to decreased insulin sensitivity. Clinical trials of calcium and vitamin D supplementation found that vitamin D may decrease the risk of type 2 diabetes. When taken by patients with impaired glucose tolerance and type 2 diabetes, vitamin D may improve insulin secretion and glucose tolerance, resulting in lowered A1C levels. Although clinical trials are limited in assessing vitamin D as a modifier of type 2 diabetes risk, a 2007 meta-analysis suggested that vitamin D, when administered with calcium, may promote beta-cell function and insulin sensitivity.

Probiotics: In my opinion the use of probiotics is haphazard. There is not enough information. Everyone has a different microbiome, and it is not tested, so how do you know which probiotic to use? In general, Probiotic species that appear to have benefit in multiple trials include Bifidobacterium breve, B longum, Lactobacillus acidophilus, L bulgaricus, L casei, L rhamnosus, and L sporogenes

In the medical arena, the general consensus is that most supplements do not have adequate clinical data to support their use in type 2 diabetes. With that said, A1C was found to be lower in patients who reported some type of supplement use, although which supplements were used was not reported. Generally, supplements are seen as safe because most are not very potent, but there are definitely still safety risks. For example, if you are pregnant, bitter melon can lead to a miscarriage. The most commonly held opinion is that supplements “can’t hurt and might help.”

If you are trying a bunch out, they can hurt your pocketbook if you are not picking the right ones for you. In 2019, millennial consumers in the United States spent an average of 62.73 U.S. dollars per trip on vitamins and supplements. The average spend per trip on vitamins and supplements of consumers who fall under the greatest generation age category was 129.58 U.S. dollars that year.

It is grounded in scientific research that the prescription medications are the most effective for the most amount of people. Cheap medications like Metformin definitely give you the most bang for your buck. Berberine works much the same as Metformin, but it is not as strong and way more expensive, but also has other potential benefits like for the thyroid function. Many people do not want to take Metformin, but they buy very expensive probiotics and metformin also could work by alters the gut microbiota composition by enhancing the growth of some bacteria, such as Akkermansia muciniphila.

All in all, many supplements are not living up to their reputations, like Chromium for example, which also has the potential to interact with certain medications. Cinnamon is another example, I have some patients who swear by it and others that it did not do the job. For me, it did not do the job. Then again, there supplements like examples are Vitamin D or pysllium that have more than one healthy effect in the body and they do not interact with any medications. I personally use supplements for my diabetes. I know what I am picking out, why I am using it, and I fine tune my supplement use to just a few of them that are the biggest bang for my buck and health.

It is best to consult with me at Evolve Diabetes. We can figure out “What are your goals with using this supplement? What is it that you want to achieve?” Maybe you want a product that also lowers cholesterol, lowers weight, decreases bone pain, decreases depression, etc. I can monitor your progress and evaluate for any potential risks.

My resources are:

https://www.uspharmacist.com/article/the-role-of-supplements-in-diabetes-management

https://www.statista.com/statistics/1086289/us-consumers-vitamins-and-supplements-spend-by-generation/#:~:text=In%202019%2C%20millennial%20consumers%20in,129.58%20U.S.%20dollars%20that%20year.