Friday, April 2, 2010

Supplements for Diabetics

I do not know anybody who takes more supplements than me. Frankly, supplements are the realm of charlatans and weak science, so it is not easy to ascertain what really works. The industry is not nearly as profitable as the pharmaceutical industry and rarely is there commercial motivation to fund serious scientific research. I do contract manufacturing of supplements for Chinese companies at a California facility, so there's my bias ... and the source of a little bit of expertise.

My personal philosophy is that if there is convincing research suggesting a supplement may be helpful in meeting my health goals, if the supplement is not toxic or harmful at doses anywhere near what I take and it is not cost prohibitive, I will use it. I do not do this lightly. All my decisions are well researched and I urge friends to do the same. Supplements are certainly not as risky as pharmaceuticals with their many known side effects, but one must still consider the benefits and risks. I have used supplements since being diagnosed with diabetes more than 14 years ago and still have no diabetic complications ... despite some questionable lifestyle choices over the years. Maybe supplements work.

Below are the supplements which are commonly used by diabetics. I list them in priority order based on how effective I believe they are in promoting diabetic health.

Supplements which may prevent Diabetic Complications –

Omega-3 from fish oilAt least 4000mg a day of EPA & DHA omega-3 in divided doses. Reduces high triglycerides and C-reactive protein levels which are associated with the onset of heart disease and neuropathy in diabetics.

Vitamin D3 – Most diabetics are deficient in Vitamin D3 and should be tested. Generally, diabetics need to supplement with 4000-10,000 IU a day to attain optimal serum D3 levels which are known to prevent diabetes, improve insulin sensitivity, reduce heart risk and prevent many other chronic diseases.

Alpha Lipoic Acid – 600-1800mg a day in divided doses. Highly acidic, it may result in heartburn is some people. Known to prevent neuropathy and some claim it relieves symptoms of neuropathy. May lower BGs in some people. Strong inhibitor of of advanced glycation end-products (AGEs).

Biotin – 8-18mg a day in divided doses. Should be taken with Alpha Lipoic Acid as taking either individually may result in a deficiency of the other. May lower BGs in some people.

Vitamin B1 (thiamine) – 300-1200mg a day in divided doses. Mega-doses of B1 have been shown in some clinical studies to prevent diabetic neuropathy and kidney disease. As thiamine is water soluble, it quickly washes out of the body and is not very bio-available. The lipid soluble version of B1, benfotiamine is believed to be more bio-available but is relatively expensive.

Quercetin – About 500mg a day. This common flavonoid reduces levels of sorbitol which may accumulate in diabetics leading to neuropathy, nephropathy or retinopathy.

Vitamin K2 as menaquinone – 45-200mcg a day. Assists the body in effectively utilizing calcium. Prevents arterial calcification which leads to heart disease.

Vitamin B12 – 1000-2000mcg a day. Mega doses taken sublingually under the tongue as a lozenge may relieve symptoms of neuropathy and chronic fatigue. Some doctors administer it intravenously. Methylcobalamin is the form believed to be best absorbed and utilized. Those taking Metformin are more likely to have a deficiency if not supplementing.

Evening Primrose Oil – 1-4 grams a day. EPO is one of the richest sources of GLA which may prevent and/or ease the symptoms of diabetic neuropathy. EPO also lowers BGs in some people.

N-Acetyl Cysteine (NAC) 500-1800mg a day in divided doses. NAC is a very effective inhibiter of AGE formation. Some studies found that NAC protects pancreatic beta-cells from glucotoxicity.

Lycopene – 10-20mg a day of this powerful antioxidant is very cardioprotective and inhibits the formation of AGEs. The main dietary source is cooked tomatoes, but you would need to consume an entire 6 oz. can of tomato paste to get 16mg of lycopene (and 32g of carb including 13g of fructose!), so I go for the 20mg softgels with zero carb.

Carnosine – 100-1000mg a day in 1-3 doses before meals. One of the strongest inhibitors of the advanced glycation end-products (AGEs) which lead to many complications. In the diet, this amino acid is found only in animal protein.

Supplements with may help Lower BGs –

Chromium – 200-1000mg a day may improve glucose tolerance in pre-diabetics and T2 diabetics, especially if they have a chromium deficiency. Improves lipid profile in some people.

Zinc – 15-25mg a day. Many diabetics are deficient in zinc. May improve glucose metabolism, especially in people with a known deficiency.

Magnesium – 500-600mg a day. May improve insulin sensitivity.

Vitamin D3, ALA, Biotin, EPOMentioned above, also may help lower BGs in some diabetics.

Supplements for General Health –

Multi-Vitamin and Mineral – Choose a product that requires at least two tablets or capsules per day to get an adequate dosage. Choose one high in B vitamins but no more than 400mg of folic acid. Vitamin A should be from betacarotene not retinol. Do not get MVMs with iron unless you have a known deficiency.

CoQ10 – 100-200mg a day, 200-300mg a day for people taking statins. Especially important for people who take statins which deplete CoQ10.


  1. Does the recommendation of 4 g of EPA and DHA Omega-3 give the minimum quantities of EPA and DHA individually? What if one takes all the recommended 4 g either entirely as EPA or entirely as DHA?


  2. Rad,

    I have not seen good research on what constitutes the optimal ratio of EPA to DHA in omega-3. Generally, EPA is seen as more cardio-protective and DHA is seen as more supportive of cognitive function, vision and neural development - especially in children.

    Personally, I am comfortable with the 3:2 EPA to DHA ratio found in common fish oil.

    As the conversion of the plant based ALA omega-3 to DHA is not very good in the human body, I assume that vegetarians are likely to have low DHA levels if they do not supplement.

  3. Effect of Vitamin K Supplementation on Insulin Resistance in Older Men and Women

    Dietary vitamin K intake in relation to cancer incidence and mortality

    These papers suggest there may be good reasons for using a combined Vitamin K supplement (not just vitamin K2mk4) or at least ensuring food choices contain somewhat more than the basic RDA.

  4. Hey Denny! I can post now. I set up a gmail account. I really have been enjoying your posts. I would like to see some good uses for the oils you listed from an earlier post. I want to learn how to cook with these oils to improve my health.

  5. Ted,

    Thank you for pointing out that there are two main forms of Vitamin K. Vitamin K1 can be found in many foods including dark green leafy vegetables and has been associated with improved BG control and diabetes prevention in some studies.

    I was recommending K2 which cannot be found in sufficient quantities in the Western diet. Cheese provides just a little. It prevents atherosclerosis and is extremely cardioprotective. You mention K2mk4 which has a much shorter half-life and requires a larger dosage in divided doses. K2mk7 is much more powerful and has a long half-life. It only requires a small amount every day or two.

    Here is an example of a product that contains both K2mk7 and K1. You can take more K1 if your diet is insufficient.

    Thank you for mentioning that K2mk7 is in the news lately for preventing cancer, too. In this blog, I do not speak to cancer prevention. That may be my industry training. FDA jumps all over nutritional supplement companies that use the C word in any health claims.

  6. Glad you found my blog accessible, Larry. Look forward to your future comments.

  7. Denny

    I note you dont mention vitamin C (I know there are sugarless vitamin C versions also) I have read that 2000mg a day can lower CRP any thoughts and that that and vitamin C suplementation?