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 oil – At 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, EPO – Mentioned 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.

Limiting AGEs, Limiting Complications

Imagine a juicy piece of barbecued meat, marinated in a sweet BBQ sauce and grilled over flaming charcoal until it is a nice brown color with crispy pieces on the outside. Sounds good? Imagine your internal organs processed in the same way and you have a picture of the formation of advanced glycation end-products (AGEs), one of the most harmful processes associated with chronic inflammation. AGEs are the products of sugars and proteins binding together and, in the human cells, it is damage that cannot be undone. While all human tissue is subject to damage by AGEs, the lining of blood vessels in diabetics is especially sensitive leading to heart disease, long-lived nerve cells rapidly accumulate damage resulting in neuropathy, microvascular destruction leads to retinopathy and nephropathy, and AGEs are implicated in the destruction of beta cells in the pancreas. Where do these AGEs come from?

Exogenous AGEs come from your food and drink. Basically, any food preparation with high heat that involves browning is creating AGEs … browned meats, bread crust, caramel coloring in processed foods, and even my beloved dark roast coffee beans. Raw foods and foods cooked in the presence of water contain far less AGEs. Water prevents the proteins and sugars from binding. An example would be a raw chicken breast which contains a moderate amount of AGEs with 7686 units. If you boil it, you will increase the AGEs about 50%, microwaving increases AGEs two-fold, broiling increases AGEs eight-fold, and frying will multiply AGEs ten-fold. It’s not just about meat. Roasted nuts are one of the highest sources of AGEs. Healthy fresh butter has four times as much AGEs by weight as roasted meat. In general, processed meat and other processed foods are much higher in AGEs. See list of AGEs in common foods here.

Advocates of raw vegan diets point out that this way of eating has far less AGEs because raw fruits and vegetables have very little AGEs and cooked meat is never consumed. Makes sense in theory, but studies of long-term vegetarians have shown that they actually have similar or higher levels of plasma AGEs than people eating normal American diets. How can this be? It seems that vegans eat a relatively high carb diet with lots of fructose from fruits and zero carnisone or taurine from meat. This brings us to the other source of AGEs.

Endogenous AGEs are produced in the human body when sugars bind with proteins. Diabetics are especially susceptible to this process which is believed to be the source of most diabetic complications. The best way for diabetics to lower their plasma AGEs level is to lower their A1c which correlates highly with AGEs. As AGEs are a product of inflammation, they also correlate highly with CRP. Limiting carbohydrate in the diet is one of the best ways to minimize the production of AGEs. One sugar is especially deadly – fructose, which is far too abundant in the modern diet. According to Wikipedia:

Endogenous glycations occur mainly in the bloodstream to a small proportion of the absorbed simple sugars: glucose, fructose, and galactose. It appears that fructose and galactose have approximately ten times the glycation activity of glucose, the primary body fuel.

Meat, as I have explained, can be cooked into a high-AGEs food, but it is also a source of two substances that inhibit the production of AGEs in the human body. The amino acids carnosine and taurine are only available in animal protein. For this reason, a low carb diet with little fructose and abundant animal protein may be the best diet for diabetics trying to limit damaging AGEs. Ironic, as cooked meat is one of the highest sources of exogenous AGEs.

Besides carnosine and taurine, there are several nutritional supplements which reduce the production of AGEs. The vitamins benfotiamine (lipid soluble thiamine), alpha lipoic acid (ALA) and lycopene (found in tomatoes) are well known as beneficial in preventing diabetic complications. Some phytonutrients are helpful including quercetin, EGCG (green tea extract), curcumin (turmeric extract), resveratrol (found in red wine) and others.

How to reduce AGEs? Keep your blood sugar low, eat low-carb, enjoy fresh raw veggies, cook with water, limit browned foods, avoid fructose like the plague, restrict processed foods, get enough animal protein, and consider supplements to inhibit the production of AGEs.

Fructose – The Stealth Carb

Fructose is a very useful substance if you need lab rats with inflammation. All you do is give them a 10 percent solution of fructose in their drinking water for 32 weeks, and, like magic, you have laboratory perfect models of vascular inflammation. I wonder what happens to humans who consume Coke for 32 years? http://www.ncbi.nlm.nih.gov/pubmed/18718174

There is no doubt that high levels of carbohydrate in the diet result in tissue inflammation in humans. No carbohydrate is more insidious than the sugar fructose. Table sugar is 50% fructose, high fructose corn syrup (HFCS) used in many processed foods is 55-95% fructose, and most fruit juices are very high in fructose. Even healthy whole fruit has moderate amounts of fructose, and our favorite low carb veggies usual have small amounts of fructose. You cannot completely avoid fructose, but as it is not an essential nutrient, it is wise to consciously minimize your fructose consumption.

Fructose goes directly to your liver where it is turned into triglycerides. It does not register on your glucometer right after you eat it, so diabetics often have the false impression that high fructose foods are relatively diabetic friendly. Remember, it’s a glucometer not a fructometer and you won’t catch it with your meter. Because it is so difficult to catch, I call it the Stealth Carb.

So, how do you know if you are consuming too much fructose? There are several tell-tale signs.

1. Triglycerides will be elevated
2. Liver will be inflamed and Non-Alcoholic Fatty Liver Disease (NAFLD) will develop
3. More visceral fat on the upper body and difficulty in losing weight
4. Inflammation of the vascular system (atherosclerosis)
5. Higher insulin resistance
6. Higher C-reactive protein number evidencing inflammation
7. Fructose produces ten times as many Advanced Glycation End-Products (AGEs) as glucose

Simply avoiding sugar, HFCS and fruit juice in all its forms may be enough for most diabetics, but if you have high CRP and/or high triglycerides, you may want to look harder at the sources of fructose in your diet. Here is a list of common foods with the amount of fructose per serving. I list a can of Coke as a reference point.

FOOD	Serving	Fructose (grams)	Calories	Fructose (grams)
All food fresh unless stated	size	per serving	per serving	per 200 calories
Coke (Canned)	12 oz. can	22.5	151	29.8
Raisins (Dried)	1 small box (43g)	12.8	129	19.9
Grapes	1 cup	12.3	104	23.6
Watermelon	1 wedge (286g)	10.5	86	24.4
Tomato Paste (canned)	1 can (6 oz.)	9.9	139	14.3
Apple	1 medium-sized apple	9.7	77	25.1
Kiwi	1 cup (abt 2 kiwis)	7.7	108	14.3
Sweet Cherries	1 cup w/pits (138g)	7.4	87	17.1
Blueberries	1 cup (148g)	7.3	84	17.4
Sweet Onions	1 onion (331g)	6.7	106	12.6
Orange Juice, fresh squeezed	1 cup	5.8	112	10.3
Bananas	1 medium-sized banana	5.7	105	10.9
Plums	1 cup, sliced (abt 2 plums)	5.1	76	13.3
Honeydew Melon	1 wedge (160g)	4.8	58	16.5
Strawberries	1 cup, sliced (166g)	4.0	53	15.2
Tomato Juice (canned)	1 cup	3.7	41	18.1
Blackberries	1 cup (144g)	3.5	62	11.2
Pineapple	1 cup, chunks (165g)	3.5	82	8.5
Sweet Red Pepper	1 cup, chpped (149g)	3.4	46	14.6
Navel Oranges	1 fruit (140g)	3.2	69	9.2
Raspberries	1 cup (123g)	2.9	64	9.0
Tomatoes	1 cup, chopped (180)	2.4	32	15.2
Balsamic Vinegar (Bottled)	1 oz. (2 Tbsp)	2.4	28	16.8
Peaches	1 medium-sized peach	2.3	59	7.8
Grapefruit	1/2 fruit (123g)	2.2	52	8.4
Onions	1 cup, chopped (160g)	2.1	64	6.5
Nectarines	1 medium-sized nectarine	2.0	62	6.3
Green Pepper	1 cup, chopped (149g)	1.7	30	11.5
Green Beans	1 cup (111g)	1.5	44	6.8
Apricots	1 cup, halves (4 apricots)	1.4	74	3.9
Asparagus	1 cup (134g)	1.4	27	10.0
Summer Squash	1 cup, sliced (113g)	1.1	18	11.9
Cucumber	1 cup (1 small cucumber)	1.0	16	12.5
Cabbage	1 cup, shredded (70g)	1.0	17	11.6
Sweet Corn	1 cup (154g)	0.8	132	1.2
Brussel Sprouts	1 cup (88g)	0.8	38	4.3
Radishes	1 cup, sliced (116g)	0.8	19	8.9
Baby Carrots	5 carrots (75g)	0.7	25	5.7
Carrots	1 cup, chopped (128g)	0.7	52	2.7
Carrots	1 cup, chopped (128g)	0.7	52	2.7
Green Peas	1 cup (145g)	0.6	117	1.0
Dill Pickles (Bottled)	1 large (4")	0.6	16	7.3
Broccoli	1 cup, chopped (91)	0.6	31	4.0
Celery	1 cup, chopped (101g)	0.5	16	6.4
Lime Juice	1 oz. (2 Tbsp)	0.2	7	4.9
Okra	1 cup, chopped (100g)	0.2	31	1.4
Green Leaf Lettuce	1 cup, shredded (36g)	0.1	5	5.7
Cider Vinegar (bottled)	1 oz. (2 Tbsp)	0.1	6	2.9
Spinach	1 cup (30g)	0.0	7	1.3