Supplements - A Stepwise Approach

Before being diagnosed with diabetes over 14 years ago, the only supplement I was taking was a multi-vitamin. I added a couple of capsules of fish oil daily and, as I read more, I experimented with more supplements. Usually, I will start with a smaller dose and gradually build to a larger therapeutic dose. By adding new supplements one at a time gradually, I am able to ascertain how the supplements are working for me.

Only once did I have a strongly negative reaction to a supplement. That was the herbal extract ephedra which contains ephedrine, a powerful stimulant that greatly benefits weight loss but with some very negative side effects. I figured out it was not for me ... long before FDA banned it. I cannot think of any other supplement in the last two decades which has been implicated in seriously negative side effects. Supplements do not have a record of serious side effects like pharmaceuticals which have even resulted in death in rare cases. Nonetheless, sensitive people may find they have problems with mega doses of some supplements. Alpha lipoic acid is an example of an excellent supplement for diabetics that I need to be careful with. I used to take 3 x 600mg a day which I regard as the maximum reasonable dose. ALA is very acidic and I found that large 600mg capsules sometimes gave me a little heartburn. Now, I take 4 x 300mg/day with no problems.

I do take many supplements. I do believe that therapeutic doses are often mega doses. I do not think that anybody should add more than one new supplement at a time and it is best to increase dosage gradually.

Will supplements dramatically improve your health? I do hear accounts of significant improvement related to supplements, especially fish oil and Vitamin D3, but most supplements are an act of faith. I take my supplements regularly and I notice nothing. It seems as if nothing has happened -- nothing at all. No heart disease, no neuropathy, no retinopathy, no kidney disease -- nothing at all.

And that's why I take supplements.

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.

Fish Oil to Reduce Inflammation

Almost everybody is already taking fish oil, right? Unfortunately, a couple of regular fish oil capsules a day does not do much. I recommend supplementing with at least four grams a day of EPA & DHA omega-3 to reduce inflammation. This therapeutic dose is consistent with American Heart Association recommendations for reducing high triglycerides. Please note that this is not four grams a day of fish oil, but 4000 mg a day (4g) of the EPA and DHA omega-3 fatty acids contained in the fish oil. These mega doses of omega-3 can dramatically lower CRP. In one six month study, subjects receiving just 1.5 gram a day of EPA & DHA omega-3 lowered their CRP by almost 40%. http://ncp.sagepub.com/cgi/content/abstract/0884533609335376v1

Can you get enough omega-3 from eating fish? It is possible, but very difficult. You would need to eat about 11 oz. a day of salmon (more than $180/month) or eight cans of tuna a day (over $300/month). Regrettably, most fish has traces of mercury, PCB's and other contaminants and may not be a healthy source of omega-3 if over consumed.

Normal fish oil softgels contain just 180mg of EPA and 120mg of DHA per softgel. At this low dosage, you would to take 14 softgels a day for a therapeutic dose!!! An inexpensive bottle of 100 softgels might be as cheap as $3.50 which works out to a cost of about $15.00/month for a therapeutic dose. 420 softgels a month is a whole lot of pill popping!

Higher dose fish oil might contain 300mg of EPA and 200mg of DHA. At this dosage, you would need to take eight softgels per day. A bottle of Swanson Super EPA Fish Oil with 100 softgels costs $6.39 purchased online which works out to just $15.34/month. A little less pill popping, but 240 softgels a month is still formidable.

Now, if you can convince your doctor that omega-3 is a good thing, he/she will probably prescribe the patented prescription omega-3 from fish oil called Lovaza. It only requires four softgels per day, but is very expensive! Doctors generally prescribe it to treat high triglycerides which usually are associated with high CRP. A bottle of 100 softgels is $167.69 at Walgreens which is a cost of $201.23/month!!! Don’t be fooled. This is nothing more than concentrated, very expensive fish oil.

I prefer to take fish oil as a pleasant tasting lemon flavored liquid oil. The champagne of fish oil is Carlson Lemon-Flavored Liquid Fish Oil. You need to take just one tablespoon per day (3 tsp). Remembering how disgusting the cod liver oil of my youth tasted, I was initially hesitant, but, honestly, it really tastes good. A 500 ml (16.9 fl oz) bottle costs $22.19 purchased online from Swanson which works out to $19.97/month.

Taking a therapeutic daily dose, omega-3 has also been shown in studies to lower triglycerides 20-30% and raise healthy HDL cholesterol by about 5% on average. Many diabetics report more dramatic results.

Bibliography of Research on Omega-3 and Inflammation:

http://www.omega-research.com/research.php?catid=5