COMMENTARY

Common Supplements for Diabetes: Any Benefits?

Anne L. Peters, MD

Disclosures

September 30, 2010

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Hi, I'm Dr. Anne Peters, Director of the Clinical Diabetes Programs at the University of Southern California, and today I'm going to talk about complementary and alternative medicines for treating diabetes and cardiovascular disease.

Now first off, I'm going to tell you that I'm not a big proponent of these kinds of treatments. I think that all treatments of whatever sort are a kind of medication, and they all have risks and benefits. I want to see my patients healthy as much as anyone. My first and foremost approach to treating diabetes is through lifestyle, through a healthy diet and exercise, because I think that helps everybody. It helps everybody without diabetes, too. I just really believe in a healthy way of being. But I also know that my patients want to have choices, and they want to make their own choices and feel like they have some power in treating their diabetes -- and maybe help themselves more than I can help them. Many of my patients -- and in fact, nationwide up to 50% of patients -- will turn to complementary and alternative medications as an adjunct for treating their diabetes. I think we need to know about it and then be aware of what our patients are doing.

Be sure that when your patients come to see you that they bring in all of what they're taking, not just the pills you have prescribed, but the entire batch of it so you can really assess what they're doing. Just to show you what I mean by risks, for instance, vitamin C is a really commonly used vitamin. People love vitamin C. They pop this by the gallon, but if you start consuming large doses -- more than 3, 4, or 5 g a day -- you can actually cause insulin resistance. I've seen some patients on megadose vitamin C therapy who have become very hyperglycemic because of the high doses of vitamin C. Nothing is benign, but some things may be better than others.

One of my favorite supplements -- not necessarily because it works so well, but because my patients really do seem to like it and in some cases it has worked -- is cinnamon. There are a number of studies looking at the benefits of cinnamon on blood glucose levels. Some of those studies have been positive, others negative, but in general I think cinnamon doesn't hurt you. Cinnamon has a potential for a kind of contact dermatitis, but it really doesn't do much else that's bad, except that it actually can prolong the protime in patients who are on Coumadin®, so you actually do want to make sure you check that in patients who start on cinnamon therapy. The dose of cinnamon in those studies is between 1 and 6 g/day. The standard pill is between 300 and 500 mg. Patients should take it either 2 or 3 times a day. If they're going to use cinnamon, they want to get cassia cinnamon. They don't want to get the other forms of cinnamon because the cassia cinnamon has been most effective in treating blood sugars and is the one that's likely to show any benefit, if cinnamon is in fact beneficial.

Now, the next supplement that I want to talk about is chromium picolinate. Where chromium came from as a treatment for diabetes, I believe, is that there were patients long ago on TPN [total parenteral nutrition] who basically weren't given enough chromium in the TPN solution, and over a year or two became truly chromium deficient. When they were given chromium to replete their levels back to normal after getting hyperglycemic, their blood glucose levels would come back down. It was really chromium deficiency causing diabetes, but it's very hard to become chromium deficient while you were actually eating regular food. But that's really where the notion, I think -- that chromium deficiency or chromium was important in diabetes -- came from.

If patients are going to take chromium, they should take the chromium picolinate because that's the form that has been studied. Although often low doses are recommended, in order to get any benefit, you need to take 600 µg/day. In the trials that they have done with chromium, it takes 2-3 months to see an effect on glucose levels. Just like with cinnamon, the trials aren't particularly conclusive. Sometimes it may help a little, sometimes not. But the one group of patients who may be relatively chromium deficient are patients on steroids. Those patients may actually have somewhat better blood glucose levels if you do in fact supplement them with chromium.

Now, the final supplement I'm going to talk about isn't for diabetes, but cardiovascular disease, and it is fish oil. Fish oil is one of the most widely used supplements in the United States. What fish oil is supposed to do, and this is in particular in our patients with diabetes, is to help lower the risk for cardiac arrhythmias, sudden death, and to lower triglycerides. There are lots of studies looking at fish oil, studies that range from its effect on asthma to schizophrenia, to everything else. There may be a significant anti-inflammatory effect of fish oil. But in diabetes, what I can measure is triglyceride levels, and if you give patients about 4 g of fish oil a day, you'll see a really nice reduction in their triglycerides. Additionally, you might see a slight increase in their LDL cholesterol levels. All of your patients are hopefully -- or at least most patients with type 2 diabetes -- will already be on a statin, but just make sure you look at their whole lipid profile when you add in fish oil. A lower dose at 1-2 g/day is associated with a reduction in cardiac arrhythmia in patients who are at high risk, so you don't need the total 4-g dose in everybody, but certainly in patients with higher triglyceride levels, you want to use the higher dose. Fish oil can be bought in any health food store. There are many, many different varieties, and it can also be given to patients as a prescription medication.

Those are just 3 of the supplements that are available that may be, or may not be, helpful for patients with diabetes, but like I said, many of my patients take these supplements. I think it's useful to be knowledgeable about them and just make sure you guide your patients to use the ones that are safer, rather than those that are less safe.

This has been Dr. Anne Peters for Medscape. Thank you.

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