medical treatments are available to control diabetes and its complications. information on diabetes (with a focus on type 2), summarizes scientific research …
CAM and Diabetes: A Focus on Dietary Supplements
Diabetes is a chronic condition affecting millions of Americans Conventional medical treatments are available to control diabetes and its complications However, some people also try complementary and alternative medicine CAM therapies, including dietary supplements This fact sheet provides basic information on diabetes with a focus on type 2, summarizes scientific research on the effectiveness and safety of selected supplements that people with diabetes sometimes use, and suggests sources for additional information
Key Points
In general, there is not enough scientific evidence to prove that dietary
supplements have substantial benefits for type 2 diabetes or its complications
It is very important not to replace conventional medical therapy for diabetes
with an unproven CAM therapy
Tell your health care providers about any complementary and alternative
practices you use Give them a full picture of what you do to manage your health This will help ensure coordinated and safe care
About Diabetes
Diabetes encompasses a group of diseases Type 2 diabetes accounts for 90 to 95 percent of all diagnosed cases and occurs more frequently
in older people Type 1 diabetes, which accounts for 5 to 10 percent of cases, usually strikes children and young adults A third form, gestational diabetes, develops in some women during pregnancy In all forms of diabetes, the bodys ability to convert food into energy is impaired After a meal, the body breaks down most food into glucose a kind of sugar, the main source of fuel for cells In people with diabetes, the body does not make enough insulin–a hormone that helps glucose enter cells–or the cells do not respond to insulin properly Often, both insulin production and insulin action are impaired Without treatment, glucose builds up in the blood instead of moving into the cells, where it can be converted into energy Over
time, the high blood glucose levels caused by diabetes can damage many parts of the body, including the heart and blood vessels, eyes, kidneys, nerves, feet, and skin Such complications can be prevented or delayed by controlling blood glucose, blood pressure, and cholesterol levels Type 2 diabetes, the focus of this fact sheet, most often is associated with older age although it is increasingly being diagnosed in children, obesity about 80 percent of people with
type 2 diabetes are overweight, a family history of diabetes, and physical inactivity Certain minority population groups are at greater risk, as are women who have had gestational diabetes Type 2 diabetes usually begins as insulin resistance, a disorder in which cells do not use insulin properly Symptoms develop gradually and may include fatigue, frequent urination, excessive thirst and hunger, weight loss, blurred vision, and slow-healing wounds or sores However, it is possible to have type 2 diabetes without experiencing any symptoms People with diabetes should try to keep their blood glucose in a healthy range The basic tools for managing type 2 diabetes are healthy eating, physical activity, and blood glucose monitoring Many people also need to take prescription pills, insulin, or both To find out more about diabetes and related conditions, contact the National Diabetes Information Clearinghouse see For More Information
Dietary Supplements and Type 2 Diabetes
Some people with diabetes use CAM therapies for their health condition For example, they may try acupuncture or biofeedback to help with painful symptoms Some use dietary supplements in efforts to improve their blood
glucose control, manage symptoms, and lessen the risk of developing serious complications such as heart problems This section addresses what is known about a few of the many supplements used for diabetes, with a focus on some that have been studied in clinical trials, such as alpha-lipoic acid, chromium, omega-3 fatty acids, and polyphenols Alpha-lipoic acid ALA, also known as lipoic acid or thioctic acid is an antioxidant–a substance that protects against cell damage ALA is found in certain foods, such as liver, spinach, broccoli, and potatoes Some people with type 2 diabetes take ALA supplements in the hope of lowering blood glucose levels by improving the bodys ability to use insulin; others use ALA to prevent or treat diabetic neuropathy a nerve disorder Supplements are marketed as tablets or capsules
ALA has been researched for its effect on insulin sensitivity, glucose metabolism, and
diabetic neuropathy Some studies have found benefits, but more research is needed There are some studies, reported from outside the United States, of ALA delivered intravenously; however, this research is outside the scope of this fact sheet
Because ALA might lower blood sugar too much,
people with diabetes who take it must
monitor their blood sugar levels very carefully
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Chromium is an essential trace mineral–that is, the body requires small amounts of it to function properly Some people with diabetes take chromium in an effort to improve their blood glucose control Chromium is found in many foods, but usually only in small amounts; relatively good sources include meat, whole grain products, and some fruits, vegetables, and spices In supplement form capsules and tablets, it is sold as chromium picolinate, chromium chloride, and chromium nicotinate
Chromium supplementation has been researched for its effect on glucose control in people
with diabetes Study results have been mixed Some researchers have found benefits, but many of the studies have not been well designed Additional, high-quality research is needed
At low doses, short-term use of chromium appears to be safe for most adults However,
people with diabetes should be aware that chromium might cause blood sugar levels to go too low High doses can cause serious side effects, including kidney problems–an issue of special concern to people with diabetes Omega-3 fatty acids are polyunsaturated
fatty acids that come from foods such as fish, fish oil, vegetable oil primarily canola and soybean, walnuts, and wheat germ Omega-3 supplements are available as capsules or oils such as fish oil Omega-3s are important in a number of bodily functions, including the movement of calcium and other substances in and out of cells, the relaxation and contraction of muscles, blood clotting, digestion, fertility, cell division, and growth In addition, omega-3s are thought to protect against heart disease, reduce inflammation, and lower triglyceride levels
Omega-3 fatty acids have been researched for their effect on controlling glucose and
reducing heart disease risk in people with type 2 diabetes Studies show that omega-3 fatty acids lower triglycerides, but do not affect blood glucose control, total cholesterol, or HDL good cholesterol in people with diabetes In some studies, omega-3 fatty acids also raised LDL bad cholesterol Additional research, particularly long-term studies that look specifically at heart disease in people with diabetes, is needed
Omega-3s appear to be safe for most adults at low-to-moderate doses Safety questions
have been raised about fish oil supplements,
because some species of fish can be contaminated by substances such as mercury, pesticides, or PCBs In high doses, fish oil can interact with certain medications, including blood thinners and drugs used for high blood pressure Polyphenols–antioxidants found in tea and dark chocolate, among other dietary sources–are being studied for possible effects on vascular health including blood pressure and on the bodys ability to use insulin
Laboratory studies suggest that EGCG, a polyphenol found in green tea, may protect against
cardiovascular disease and have a beneficial effect on insulin activity and glucose control However, a few small clinical trials studying EGCG and green tea in people with diabetes have not shown such effects
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No adverse effects of EGCG or green tea were discussed in these studies Green tea is safe
for most adults when used in moderate amounts However, green tea contains caffeine, which can cause, in some people, insomnia, anxiety, or irritability, among other effects Green tea also has small amounts of vitamin K, which can make anticoagulant drugs, such as warfarin, less effective Other supplements are also being studied for diabetes-related effects
For example:
Preliminary research has explored the use of garlic for lowering blood glucose levels, but
findings have not been consistent
Studies of the effects of magnesium supplementation on blood glucose control have had
mixed results, although researchers have found that eating a diet high in magnesium may lower the risk of diabetes
There is not enough evidence to evaluate the effectiveness of coenzyme Q10
supplementation as a CAM therapy for diabetes; studies of its ability to affect glucose control have had conflicting findings
Researchers are studying whether the herb ginseng and the trace mineral vanadium might
help control glucose levels
Some people with diabetes may also try botanicals such as prickly pear cactus, gurmar,
Coccinia indica, aloe vera, fenugreek, and bitter melon to control their glucose levels However, there is limited research on the effectiveness of these botanicals for diabetes
If You Have Diabetes and Are Thinking About Using a Dietary Supplement
Tell your health care providers about 
any complementary and alternative practices you
use Give them a full picture of what you do to manage your health This will help ensure coordinated and safe
care Medicines for diabetes and other health conditions may need to be adjusted if a person is also using a dietary supplement
Women who are pregnant or nursing, or people who are thinking of using supplements to
treat a child, should consult their health care provider before using any dietary supplement
Do not replace scientifically proven treatments for diabetes with CAM treatments that are
unproven The consequences of not following ones prescribed medical regimen for diabetes can be very serious
Be aware that the label on a dietary supplement bottle may not accurately reflect what
is inside For example, some tests of dietary supplements have found that the contents did not match the dose on the label, and some herbal supplements have been found to be contaminated
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NCCAM-Funded Research
NCCAM-supported research includes projects studying the effects of:
Chromium on glucose control and vascular function Yoga in people at risk for diabetes Ginkgo biloba extract on diabetes medicines EGCG on the bodys response to insulin Reiki on diabetic neuropathy and heart function
Also, researchers in the Diabetes Unit of NCCAMs Division of Intramural Research DIR are
studying many aspects of diabetes, including what happens when the body does not properly react to insulin DIR-sponsored clinical trials include studies of the effects of vitamin C, glucosamine, and dark chocolate on the bodys response to insulin
Selected Sources
About Diabetes
National Institute of Diabetes and Digestive and Kidney Diseases Diabetes Overview National Diabetes Information Clearinghouse Web site Accessed at http://wwwdiabetesniddknihgov/dm/pubs/overview/indexhtm on January 21, 2008
Dietary Supplements: Natural Medicines Comprehensive Database
Natural Medicines Comprehensive Database Product monographs Accessed at http://wwwnaturaldatabasecom on January 21, 2008
Dietary Supplements: Articles From Scientific Journals
Halat KM, Dennehy CE Botanicals and dietary supplements in diabetic peripheral neuropathy Journal of the American Board of Family Practice 2003;161:47-57 Yeh GY, Eisenberg DM, Kaptchuk TJ, et al Systematic review of herbs and dietary supplements for glycemic control in diabetes Diabetes Care 2003;264:1277-1294
Chromium
Althuis MD, Jordan NE, Ludington EA, et al Glucose and insulin responses to dietary chromium supplements: a meta analysis American
Journal of Clinical Nutrition 2002;761:148-155 Balk EM, Tatsioni A, Lichtenstein AH, et al Effect of chromium supplementation on glucose metabolism and lipids: A systematic review of randomized controlled trials Diabetes Care 2007; 308: 2154-2163 Office of Dietary Supplements Chromium Office of Dietary Supplements Web site Accessed at http://wwwodsodnihgov/factsheets/chromiumasp on January 21, 2008
Coenzyme Q10
Bonadkdar RA, Guarneri, E Coenzyme Q10 American Family Physician 2005;726: 1065-1069
Garlic
Agency for Healthcare Research and Quality Garlic: Effects on Cardiovascular Risks and Disease, Protective Effects Against Cancer, and Clinical Adverse Effects Evidence Report/Technology Assessment no 20 Rockville, MD: Agency for Healthcare Research and Quality; 2000 AHRQ publication no 01-E023 Banerjee SK, Maulik SK Effect of garlic on cardiovascular disorders: a review Nutrition Journal 2002;11:4
Magnesium
Larsson SC, Wolk A Magnesium intake and risk of type 2 diabetes: a meta analysis Journal of Internal Medicine 2007;2622:208-214 Office of Dietary Supplements Magnesium Office of Dietary Supplements Web site Accessed at http://wwwodsnihgov/factsheets/magnesiumasp on January 21,
2008
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Schulze MB, Schulz M, Heidemann C, et al Fiber and magnesium intake and incidence of type 2 diabetes: a prospective study and meta-analysis Archives of Internal Medicine 2007;1679:956-965 Song Y, He K, Levitan EB, et al Effects of oral magnesium supplementation on glycaemic control in type 2 diabetes: a meta-analysis of randomized double-blind controlled trials Diabetic Medicine 2006;2310:1050-1056
Omega-3 Fatty Acids
Agency for Healthcare Research and Quality Effects of Omega-3 Fatty Acids on Lipids and Glycemic Control in Type II Diabetes and the Metabolic Syndrome and on Inflammatory Bowel Disease, Rheumatoid Arthritis, Renal Disease, Systemic Lupus Erythematosus, and Osteoporosis Evidence Report/Technology Assessment no 89 Rockville, MD: Agency for Healthcare Research and Quality; 2004 AHRQ publication no 04-E012-2 Hartweg J, Farmer AJ, Perera R, et al Meta-analysis of the effects of n-3 polyunsaturated fatty acids on lipoproteins and other emerging lipid cardiovascular risk markers in patients with type 2 diabetes Diabetologia 2007;508:1593-1602 Hartweg J, Perera R, Montori V, et al Omega-3 polyunsaturated fatty acids PUFA for type 2 diabetes mellitus: review
The Cochrane Database of Systematic Reviews 2008; 1:CD003205 Accessed at http://cochraneorg/reviews on January 28, 2008 Letter regarding dietary supplement health claim for omega-3 fatty acids and coronary heart disease US Food and Drug Administration Web site Accessed at http://wwwfdagov on January 21, 2008 US Food and Drug Administration What You Need to Know About Mercury in Fish and Shellfish US Food and Drug Administration Web site Accessed at http://wwwfdagov/oc/opacom/hottopics/mercury/backgrounderhtml on January 21, 2008
Polyphenols
Collins QF, Liu HY, Pi J, et al Epigallocatechin-3-gallate EGCG, a green tea polyphenol, suppresses hepatic gluconeogenesis through 5-AMP activated protein kinase Journal of Biological Chemistry 2007;28241:30143-30149 Fukino Y, Shimbo M, Aoki N, et al Randomized controlled trial for an effect of green tea consumption on insulin resistance and inflammation markers Journal of Nutritional Science and Vitaminology 2005;515:335-342 Kim J, Formoso G, Li Y, et al Epigallocatechin gallate, a green tea polyphenol, mediates NO-dependent vasodilation using signaling pathways in vascular endothelium requiring reactive oxygen species and Fyn Journal of
Biological Chemistry 2007;28218:13736-13745 Mackenzie T, Leary L, Brooks WB The effect of an extract of green and black tea on glucose control in adults with type 2 diabetes mellitus: double-blind randomized study Metabolism 2007;5610:1340-1344 Potenza MA, Marasciulo FL, Tarquinio M, et al EGCG, a green tea polyphenol, improves endothelial function and insulin sensitivity, reduces blood pressure, and protects against myocardial I/R injury in SHR American Journal of Physiology, Endocrinology, and Metabolism 2007;2925:E1378-E1387 Ryu OH, Lee J, Lee KW, et al Effects of green tea consumption on inflammation, insulin resistance and pulse wave velocity in type 2 diabetes patients Diabetes Research and Clinical Practice 2006;713:356-358
For More Information
NCCAM Clearinghouse
The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature Examples of publications include Whats in the Bottle? An Introduction to Dietary Supplements, and Are You Considering Using CAM? The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners Toll-free in the US:
1-888-644-6226 TTY for deaf and hard-of-hearing callers: 1-866-464-3615 Web site: nccamnihgov E-mail: info@nccamnihgov
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National Diabetes Information Clearinghouse
A service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health NIH, the clearinghouse responds to inquiries, offers diabetes publications, and makes referrals For an alphabetical list of publication topics, go to wwwdiabetesniddknihgov/dm/a-zasp Toll-free in the US: 1-800-860-8747 Web site: wwwdiabetesniddknihgov
National Diabetes Education Program
The National Diabetes Education Program is sponsored by NIH and the Centers for Disease Control and Prevention, with many Federal, state, and local partners Its services include information and publications on diabetes Telephone: 301-496-3583 Web site: wwwndepnihgov
PubMed
A service of the National Library of Medicine NLM, PubMed contains publication information and in most cases brief summaries of articles from scientific and medical journals CAM on PubMed, developed jointly by NCCAM and NLM, is a subset of the PubMed system and focuses on the topic of CAM Web site: wwwncbinlmnihgov/sites/entrez CAM on PubMed:
nccamnihgov/camonpubmed/
Acknowledgments
NCCAM thanks the following people for their technical expertise and review of this publication: Derek LeRoith, MD, PhD, Mount Sinai School of Medicine; Gloria Yeh, MD, MPH, Harvard Medical School; and Michael Quon, MD, PhD, NCCAM This publication is not copyrighted and is in the public domain
Duplication is encouraged
NCCAM has provided this material for your information It is not intended to substitute for the medical expertise and advice of your primary health care provider We encourage you to discuss any decisions about treatment or care with your health care provider The mention of any product, service, or therapy is not an endorsement by NCCAM National Institutes of Health US Department of Health and Human Services
D416 Created June 2008
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