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kathryn's thoughtsKathryn’s Thoughts!

An In depth look at Dietary Supplements for the best Glycemic and Cholesterol Management for people with Type 1 and Type 2 Diabetes

supplements

I recently viewed the webinar “Role of Dietary Supplements in Glycemic and Cholesterol management” which can be found on the AADE website.

There are several reasons a person might want to to use supplements such as med costs being too high, to avoid adverse side effects, suggestion from friends, family, claims made about the supplement, etc. If you find that you’re someone who is interested in using something other than your prescribed medicine here’s some advice from the webinar presented by Lorena Drago, RD, CDE, MS, CDN, LVCYT:

  1. Be aware that dietary supplements do not require FDA approval.
  2. Supplements still contain chemical compound – many want to make the switch with belief its more natural.
  3. Compare the drug to supplement – name, brand name, side effects, cost, effectiveness, precautions.
  4. Make sure you are taking the right doses and are aware of what’s in it and how much.
    *Supplements are not generally needed for those who have a balanced diet, and some can have harmful side effects, so use them with caution.

2 Resources to learn more about dietary supplements:

  1. Natural Medicines Database – Tells everything about what’s in the supplement and has a patient handout.
  2. Consumer Lab (must pay to use) – Tests all the products – lets you know which are best to use/recommend.

The webinar went over a list of popular supplements taken for glycemic control and cholesterol management. Below you can find the claims, possible risks/benefits, dosage, and key ingredients:

What are the popular supplements that help with glycemic control and cholesterol management?

Below is a list of the claims, possible risks/benefits, dosage, and key ingredients:

Alpha-Lipoic Acid (ALA)

  1. Claims
    • Promote healthy blood sugar
    • Reduce the symptoms of peripheral neuropathy
  2. Research and Efficacy
    • Improved insulin sensitivity in T2D patients and saw a slight A1c decrease
    • Most studies used mixed isomer forms of ALA-( R ) form is more expensive and is found in foods like spinach, broccoli, tomatoes, Brussel sprouts
    • Intravenous ALA can improve neuropathy when administered for 3 weeks-oral intake is not as effective
  3. Dosage
    • 600-1200mg (day)
  4. Safety
    • Skin rash, nausea
    • Doses up to 2,000mg a day have been well tolerated
  5. Taken 30 minutes before eating or 2 hours after eating to increase bioavailability

Banaba Leaf (coracle acid)

  • Claims
    • Lower blood glucose
    • Help insulin work efficiently
    • Lower faster and postprandial glucose
    • Maintain healthy bg levels
    • Inhibit gluconeogenesis
    • No adverse effects
  • Active ingredient studied in humans = coprozoic acid and has shown about a 10-15% decrease 2 hours after dosing in fasting and postmedial glucose
    • A 30% decrease in glucose was observed with a 48mg dose

*A Patient interested in taking this supplement for hopes of improved management should ensure that it contains coprozoic acid

Bitter Melon

  • Claims
    • Glycemic support
    • weight loss
    • decreased insulin resistance
    • inhibits glucose reabsorption
    • increases insulin secretion and peripheral cell glucose utilization
    • suppress key enzymes in the gluconeogenic pathways
  • No standard dose, use various forms of the fruit
    • Whole plant recommended for T2D patients
    • Can cause hypoglycemia in children
    • Stomach discomfort

Cinnamon

  • Claims
    • Lower bg in T1 and T2D
    • Inconsistent results, no adverse effects
    • Thought- improves insulin sensitivity
  • Research

Studies have used doses of 1,3, or 6g of cinnamomum cassia

    • in divided dose (pantry cinnamon) 1g=1/2 teaspoon – unclear of how much and what type- if a patient is going to use it suggested to recommend 6g everyday

Chromium

  • Claims
    • Manage glucose and cholesterol
    • Promotes weight loss
    • Essential trace mineral
    • Needed to metabolize glucose
    • Supplementation may benefit deficient population
  • Inconclusive effects on blood glucose
  • Adequate Intake (AI)
    • Women 19-50: 25mg/day
    • >50: 20mg/day
    • Men 19-50: 35mg/day
    • >50: 30mg/day
  • Different Types
    • Food-Chromium chloride-least bio available
    • Most supplements contain nicotinate
  • Typical dose
    • 200mg-1,000mg
    • BMI over 30 should go for a higher dosage

Gymnema (Gurmer) aka sugar destroyer

  • Claims
    • Treat blood glucose in T1 and T2D
    • Decrease fasting bg and insulin dose in T1D
    • Decrease A1c and lipids in T2D
  • Dosage
    • 400mg/day (with 24% glycemic acids)
  • No adverse effects reported
  • Intravenous 15% decease 6 hours after administration- mist people haven’t used
  • Dose must correlate with what the studies have shown (likely under-dosing)

Nopol

  • Claims
    • Supports healthy blood glucose levels
  • Contains Fiber
  • Dose
    • 100-500g/daily of boiled stems
  • Side effects
    • Nausea, abdominal fullness, mild diarrhea
  • Studies
    • About 18%reduction with about 18oz (the more the better) – inject that daily
    • Ingest less ex 3oz – still effective but unknown how much

Nopol

  • Claims
    • Supports healthy blood glucose levels
  • Contains Fiber
  • Dose
    • 100-500g/daily of boiled stems
  • Side effects
    • Nausea, abdominal fullness, mild diarrhea
  • Studies
    • About 18%reduction with about 18oz (the more the better) – inject that daily
    • Ingest less ex 3oz – still effective but unknown how much

Functional Foods

Apple Cider Vinegar (ACV)

  • Claims
    • Improved diabetes management
    • Weight loss
    • Less leg cramps
    • Improved gastroparesis
  • Study/dosage
    • 20g in diabetes study and 15ml 2x daily for 12 weeks improved insulin sensitivity
    • 20g ACV with meals increased insulin sensitivity in individuals with insulin resistance
    • ACV and low cal diet reduced BMI and hip circumference compared to low cal alone and increased HDL and lowered LDL
  • *Needs 4-8% acidity

Oats

  • Claims
    • Improve cardiovascular effects
    • Decrease cholesterol and LDL total
  • How much
    • 56-150g of whole oat with 3.6-10g
  • *Whole oats or steel cut with no additives

Olive Oil

  • Claims
    • Decreases risk heart disease
    • Decrease hypertension
    • Decrease Cholesterol
    • Helps Obesity and diabetes
  • Study
    • Replacing saturated fat with olive oil can reduce risk for cardiovascular disease
  • *Should by in dark container rather than clear and glass over plastic
  • Extra Virgin has more polythelias- want this

Stanols and Sterols (in plants)

  • Claims
    • Lowers LDL and total cholesterol about 10-15%
  • Doses
    • 2.7 to 5.1g per day
    • May take up to 3 months to improve
    • Appears safe in doses shown, high levels may interfere with the absorption of fat-soluble vitamins

Omega 3 (fish oil)

  • Claims
    • Decrease cholesterol
    • Decrease triglycerides
  • Found that fish oil (EPA, DHA) does not reduce heart attack or stroke risk
  • Generally safe, doses vary 2g may suppress the immune system. Mercury concerns if consumption exceeds 6 ounces per week
  • Fish oil is best absorbed with fats
  • RX fish oils are better – EPA and no DHA- reduce TG by 21-33% over 3 months without increasing LDL-C
  • Total amount EPA and DHA is more important than total amount of oil for triglyceride effects

Functional Beverages (meal replacers)

  • Claims
    • Weight loss
    • Improved T2D management
    • Increased muscle mass
  • Meal replacement with a calorie restricted diet reverse T2D in 40% of participants for at least 6 months
  • Drinking whey protein prior to high glycemic meal improved insulin compared to individuals who did not- glucose levels were 28% lower over a 3-hour period
  • The most weight loss was seen with soy-based meal replacements
  • Recommendations
    • 3 fortified meal replacement shakes per day
    • Whey protein (50g) in 250ml water 

If you have any follow-up questions or want some more guidance on using supplements, please go ahead and give the office a call and set up time to speak with one of our dietitians.

Back to November 2019 Newsletter