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.

Omega-6 to Omega-3 Ratio and Chronic Inflammation

The omega-6 to omega-3 ratio is one of the best predictors of your tissue status and the development of chronic inflammation. The typical American diet is 20:1 and less than 2:1 is optimal.

Health Risk Assessment (HRA) which looks at the omega-6 to omega-3 ratio of the highly unsaturated fatty acids (HUFA) contained in blood serum has found that average middle age American males have 72-82 percent of their tissue HUFA in omega-6. Japanese, on the other hand, have about 30 percent. More than 50 percent omega-6 predicts a high heart disease mortality rate.

http://omega-6-omega-3-balance.omegaoptimize.com/files/8/9/8/7/3/147167-137898/Lands_Omega_6_Handout.pdf

There is an abundance of research pointing to the cardio-protective effects of omega-3, which is certainly important to diabetics, but there is very little information about how the omega-6 to omega-3 ratio predicts the progression of diabetes and diabetic complications. Based on the close correlation of omega-6 to omega-3 ratio and the CRP measure of inflammation, one can assume that this measure would also correlate closely with diabetic progression.

The above chart is from the Gene Smart Omega-3 Index Test website. The company works with Dr. Floyd Chilton author of Inflammation Nation to promote home tests for Omega-3 Index and Omega-6 to Omega-3 Ratio which they argue are better predictors of heart disease risk than other standard tests. Two observations: (1) The above graph does not include the Triglycerides/HDL Ratio which is generally believed to be the best predictor of heart disease. (2) The Omega-3 Index correlates very closely to CRP suggesting that the amount of omega-3 in the body tissue may be a key determinant of the body’s inflammation status. http://www.genesmart.com/

The above online test is being marketed for $150 which is still a little pricey even with the $30 discount, but other companies are also entering the market, which will hopefully bring the price down. I am not aware of any mainstream laboratories that are currently offering omega-6 to omega-3 ratio testing. Your doctor may not be aware of this testing.

Don’t expect to dramatically improve your omega-6 to omega-3 ratio overnight by chugging a bottle of fish oil. All indications are that changing the composition of your body tissue is a slow process. If you start conscientiously reducing inflammatory omega-6 in your diet and try to raise your omega-3 intake through healthy eating and supplementing with fish oil, it might be six months before you see a significant change and maybe a couple of years to achieve your optimal numbers. You are rebuilding your body one cell at a time.

Composition of Common Fats and Oils

The omega-6 polyunsaturated fatty acids (n-6 PUFA) and omega-3 (n-3 PUFA) are very imbalanced in the contemporary diet, with the typical American diet having an n-6:n-3 ratio of about 20:1, when a healthy and non-inflammatory n-6:n:3 ratio would be less than 2:1. The chart below lists common sources of fats and oils with their composition of the main fatty acids.

Generally speaking, the best fats and oils are those with the least amount of the inflammatory omega-6 and the most anti-inflammatory omega-3. Highly inflammatory arachidonic acid (AA or ARA), which is found in many animal protein sources, should be avoided unless the source is also rich in omega-3.

	n-6 PUFA	n-3 PUFA	AA (ARA)	MUFA	SFA
Macadamia Oil	1.7%	0.3%	0%	78%	16%
Coconut Oil	1.8%	0%	0%	6%	87%
Cod Liver Oil	1.8%	21%	0.94%	47%	23%
Butter Fat	2.2%	1.4%	0%	29%	62%
Beef Tallow	3%	0.6%	0%	42%	50%
Cocoa Butter	3%	0.1%	0%	33%	60%
Fish Oil (Salmon)	5%	35%	0.68%	29%	20%
Fish Oil (Sardine)	8%	24%	1.76%	34%	33%
Palm Oil	9%	0.2%	0%	37%	49%
Lard	10%	1.0%	0%	45%	39%
Olive Oil	10%	0.8%	0%	73%	14%
Chicken Liver	10%	0.2%	6.75%	26%	32%
Hazelnut Oil	10%	0%	0%	78%	7%
Flax Seed Oil	13%	53%	0%	20%	9%
Avocado Oil	13%	1.0%	0%	71%	12%
Beef Liver	13%	0.2%	3.88%	13%	34%
Chicken Egg Yolk	13%	0.9%	1.65%	12%	36%
Almond Oil	17%	0%	0%	70%	8%
Chia Oil	19%	57%	0%	7%	10%
Canola Oil	19%	9%	0%	63%	7%
Chicken Fat	20%	1.0%	0.10%	45%	30%
Tea Seed Oil	22%	0.7%	0%	52%	21%
Pork Liver	22%	2%	12.05%	14%	32%
Sunflower Oil	29%	0%	0%	57%	9%
Peanut Oil	32%	0%	0%	46%	17%
Sesame Oil	42%	0%	0%	40%	14%
Pumpkin Seed Oil	42%	0%	0%	33%	18%
Soy Oil	51%	7%	0%	23%	16%
Walnut Oil	53%	10%	0%	23%	9%
Corn Oil	54%	1.2%	0%	28%	13%
Hemp Oil	60%	20%	0%	?	?
Grape Seed Oil	70%	0%	0%	16%	10%
Safflower Oil	75%	0%	0%	14%	6%

Source: USDA National Nutrient Database http://www.nal.usda.gov/fnic/foodcomp/search/

Omega-6: n-6 PUFA is more potent than n-3 PUFA in competing for metabolic events and storage space in human tissue. If it is too plentiful in one’s diet, it will displace omega-3 in the membrane phospholipids. Many chronic diseases (like diabetes) are mediated by excess omega-6. Most tissue receptors favor n-6 over n-3, so too much n-6 in diet will seriously impair the body’s ability to utilize n-3.

Different Omega-3: The EPA and DHA omega-3 contained in fish, other marine products, and some wild or grass-fed meats are the most bio-available. The ALA form of omega-3 which is found in plant foods is much less bio-available. The body must convert it to EPA or DHA before it has the beneficial properties of omega-3. Most people can only convert about 10 percent of ALA into EPA and less than 1 percent into DHA.

Arachidonic Acid: AA is the most inflammatory fatty acid in human tissue. The body needs some AA and can produce AA from n-6 PUFA, but too much may be deleterious to health. When n-6 and n-3 are in balance in the body, dietary AA is probably not a big problem. Some experts, however, recommend that people suffering inflammatory conditions avoid dietary AA. AA is only found in animal fats. The worst source is organ meats, followed by egg yolk. Poultry, while only having moderate amounts of AA, has more than other meats. Fish has AA, but it is not considered inflammatory as in has many more times healthy omega-3.

Monounsaturated Fat: After demonizing saturated fat, the food industry was hard put to discover a substitute for its “healthy” polyunsaturated fat when it became increasingly clear that PUFA was highly inflammatory and associated with many chronic diseases. MUFA appeared to be the obvious choice. Oleic acid, the most common MUFA, is abundant in olive oil and some nut oils which unfortunately have little or no omega-3. Another MUFA is erucic acid which is toxic in large amounts. Rapeseed has 30-60 percent erucic acid, but canola oil is a special form of rapeseed that has only 0.3-1.2 percent of this dangerous fatty acid and reduced amounts of glucosinolates, another dangerous compound in rapeseed.

Saturated Fat: SFA is still assumed to promote heart disease by most mainstream medicine and dietitians, but this theory is being increasing questioned by science and a growing number of low carbers. Frankly, the research is mixed. There are eight fatty acids called saturated. The SFAs found in most animal foods are long-chain fatty acids (14-18 carbons). Many plant foods have Medium Chain Triglycerides (MCT) with 6-12 carbons. These MCTs are the healthiest SFA. Lauric acid is an MCT which is the principal fat in coconut oil. It can also be found in human mother’s milk. MCTs promote immunity, better metabolism, can improve blood glucose and may reduce inflammation.