Text of Speech on Nutrition Given to a Diabetic Support Group

Diabetic Support Group-St. Alexander’s Church. 300 S. Cornell, Villa Park, IL 1/22/2002 Healthy Living Through Nutrition – presented by Neil E. Levin, Certified Clinical Nutritionist What is Diabetes? People with diabetes can’t properly process glucose, the main sugar that the body uses for energy. So glucose stays in the blood, making blood glucose rise. Ironically, at the same time the cells of the body can be starved for glucose. Diabetes can lead to wounds not healing, more infections, and problems involving the eyes, kidneys, nerves, and heart. Neuropathy from diabetic complications may lead to amputation of extremities, especially the feet. There are two types of diabetes mellitus. Childhood-onset diabetes is also called type 1 (insulin-dependent) diabetes. In type 1 diabetes, the pancreas can’t make insulin needed to process glucose. This is theorized to be an autoimmune disease, where the pancreatic cells are attacked and destroyed by the immune system. Natural therapies can’t cure type 1 diabetes, but they may help by making the body more receptive to injected insulin. It is critical for people with type 1 diabetes to work carefully with the doctor prescribing insulin before contemplating the use of any herbs, supplements, or dietary changes. Any change that makes the body more receptive to insulin could require critical changes in insulin dosage that must be determined by the treating physician. Adult-onset diabetes is also called type 2, or non-insulin-dependent, diabetes. With type 2 diabetes, the pancreas may make enough insulin, but the body has trouble using the insulin at the cellular level. Type 2 diabetes responds well to natural therapies. Again, medications may need to be adjusted to provide safety if you change your diet or dietary supplement program. People with diabetes have a higher risk for heart disease and atherosclerosis. Diabetics especially have a higher mortality rate if they also have high levels of homocysteine, associated with low intake of certain B vitamins. What causes insulin resistance? It is estimated that 1 in 4 people non-diabetic have genetic predisposition to insulin resistance. Whether or not the insulin resistance develops may depend on your eating and exercise habits. Low physical activity is the main reason why insulin resistance develops. Gaining weight/body fat around the mid-section is a common trigger. With insulin resistance it’s more difficult to lose weight. So, obesity and insulin resistance becomes a viscous cycle--obesity contributes to insulin resistance, and insulin resistance contributes to weight gain! People who maintain a healthy weight and enjoy regular physical activity rarely develop insulin resistance, even if they have an underlying genetic predisposition. NOTE: Some medications (like Depakote, an anti-seizure medication) and some disease states (like PolyCystic Ovarian Syndrome, or PCOS) have also been associated with insulin resistance and weight gain. It’s always important to rule-out these non-diet/non-exercise related problems with your doctor. Syndrome X can increase symptoms of aging, increasing your risk of developing heart disease, diabetes, Alzheimer's, cancer, and other age-related diseases. Many of these diseases have an oxidative or inflammatory component and may be mitigated by antioxidant and anti-inflammatory nutrients or drugs. Syndrome X refers specifically to a group of health problems that can include insulin resistance (the inability to properly deal with dietary carbohydrates and sugars), abnormal blood fats (such as elevated cholesterol and triglycerides), being overweight, and having high blood pressure; leading to nervous system disorders, eye disease, diabetes, cardiovascular disease, cancer, and Alzheimer's disease. In addition to physical symptoms, you may feel exhausted, spacey, depressed, irritable, or angry when you shouldn't be. Doctors have known for years that each of these health problems can increase the risk of other diseases, such as heart disease and diabetes. However, until relatively recently, they failed to see these health problems as part of a syndrome. We now know that eating large amounts of certain dietary carbohydrates can raise cholesterol, triglyceride, and insulin levels. Insulin resistance and Syndrome X are caused primarily by a diet high in refined carbohydrates, which probably include many of your favorite and frequently eaten foods, such as cereals, muffins, breads and rolls, pastas, cookies, donuts, and soft drinks. These refined carbohydrates not only raise glucose and insulin to unhealthy levels, but they also are devoid of the many vitamins, minerals, and vitamin-like nutrients our bodies need to properly utilize these foods. Two of the key players in this life-and-death drama affecting you are substances regarded as absolutely essential for health: glucose (also known as blood sugar) and the hormone insulin. Because of the foods we, as a population, now eat, our bodies' levels of glucose and insulin have gone out of control. Quite simply, we are overdosing on glucose and insulin. Both substances in high doses accelerate the aging of our bodies and encourage the development of disease. We know also that elevated insulin can promote obesity and high blood pressure. Because these problems are related and tend to occur in clusters, they form a syndrome. Syndrome X is primarily a nutritional disease caused by eating the wrong types of foods. You have the power to easily modify your lifestyle to protect yourself against Syndrome X. It is a disease caused by your body's inability to make the most of the food you eat. Doctors who recognize the underlying cause of this epidemic call it by one of several, often overlapping names: insulin resistance, metabolic syndrome, glucose intolerance, prediabetes, or Syndrome X. But few people have recognized the full scope of this disorder: it affects, to one degree or another, the majority of people in the country. If you are over the age of 35, you may be more familiar with some of the early signs and symptoms than the names of this condition: feeling sluggish, physically and mentally, after you eat and at many other times as well. Gaining a pound here and a pound there-and having increasing difficulty in losing them. Having your blood pressure creep up year and after year. And finding that your cholesterol, triglycerides, and blood sugar levels are doing the same. These are all accepted signs of getting older, but they are all easily reversible. Such symptoms indicate that something is fundamentally wrong with your health, and they have an "additive" effect, meaning that two or three of these symptoms (such as obesity plus high blood pressure) increase your risk of serious disease far more than just one symptom. Reducing Insulin Sensitivity the Natural Way There are many healthy lifestyle choices that you can make to improve your insulin sensitivity. These healthy choices are important whether or not you have diabetes and whether or not you are also taking medication for your condition. 1) Exercise! -- Regular physical activity (both aerobics and strength training) increase your cells' sensitivity to insulin. Aim for 20-60 minutes of aerobic activity (e.g. brisk walking, jogging, swimming, or cycling) 3-5 days per week. In addition, aim for 30 minutes of strength training (with free weights, machines, resistance bands, or your own body’s resistance) 2-3 times per week. Gradually work up to these exercise goals, and discover a variety of different activities that you enjoy and can fit into your busy life. 2) Maintain normal weight -- Even as little as a 10% reduction in weight can help improve your cells' insulin sensitivity. To lose weight safely and effectively, reduce your total calorie intake by about 500 calories each day (that’s equal to about one candy bar and one 16 oz. glass of juice or soda). Aim for a 1-2 pound weight loss per week. NOTE: Restrictive dieting (<> 2 pounds per week) are NOT recommended. Both can contribute to nutrient deficiencies, excessive loss of lean body mass vs. fat, reduced metabolic rate, food preoccupation, depression, fatigue, irritability, binge eating, and rapid weight re-gain. 3) Eat a moderate carbohydrate diet (about 45% of total calories)! -- Carbohydrates (especially low fiber, refined white grains and sugary foods/beverages) stimulate the most insulin secretion after you eat them. Your insulin levels are already high, so eating a diet that further increases insulin is not desirable. • Choose a diet rich in mostly nonstarchy vegetables (leafy greens, broccoli, cabbage, cauliflower, zucchini, etc.). Aim for about 3 cups of chopped veggies per day (6 servings per day). • Choose a diet with whole fruits instead of juices, most of the time. Aim for about 3 small pieces of fruit per day (3 servings per day). • Choose mostly high fiber, whole grains and legumes (brown rice, whole wheat pasta, beans, whole wheat bread, whole grain cereals), and keep portion sizes moderate. Aim for about 5-7 servings per day. One serving equals one slice of bread, one 6” tortilla, ½ cup grains, legumes, or starchy vegetables, or ½ small bagel. • If you enjoy sweet desserts on occasion, just balance them out by eating fewer amounts of other carbohydrate-rich foods (like bread, pasta, and rice) at that meal. 4) Replace excess carbs with more heart healthy monounsaturated fats! (nuts, peanut butter, olive/canola oil, avocados) These fats don't affect your insulin levels, and they are good for your heart! But, like all foods high in fat, they have a lot of calories, so be sensible about your serving sizes. For instance, enjoy 1/4 cup of nuts for a snack instead of "bready" things. Enjoy 1-2 Tbsp. oil/vinegar dressings on your salads. Add a couple slices of avocado to sandwiches/salads. 5) Consume adequate protein with meals! Protein-rich foods (like tofu, fish, chicken, lean meat, low fat cottage cheese, and eggs) will help promote satiety so you don't feel hungry all the time. 6) Manage stress, and get enough sleep! Stress and inadequate sleep increase stress hormones (like cortisol) that increase insulin levels. Again, your goal is to lessen your already high insulin levels, so be sure to practice daily relaxation exercises and get to bed at a reasonable hour. Nutrition is Your Best Medicine One of the problems people face in reversing insulin resistance and Syndrome X is perceptual: the long-held belief that food has relatively little to do with the development and progression of disease and the maintenance of health. We believe-and are supported with overwhelming scientific evidence-that the quality of our foods has a direct and fundamental bearing on the quality of our health, more so even than the genes that we inherit. from Syndrome X: The Complete Nutritional Program to Preventing and Reversing Insulin Resistance. Copyright © 2000 by Jack Challem, Burt Berkson, and Melissa Diane Smith. Syndrome X: The Complete Nutritional Program to Preventing and Reversing Insulin Resistance ($24.95) is available at all bookstores, online booksellers, and from the Wiley web site at www.wiley.com. To order, call John Wiley & Sons publishers at 1-800-225-5945, or go to www.amazon.com. Syndrome X: The Complete Nutritional Program to Prevent and Reverse Insulin Resistance Jack Challem Burt Berkson, M.D., Ph.D. Melissa Diane Smith Glycemic Index of Foods: Eating carbohydrate-containing foods, whether high in sugar or starch (such as bread, potatoes, processed breakfast cereals, and rice), temporarily raises blood sugar and insulin levels. The blood sugar-raising effect of a food, called its “glycemic index,” depends on how rapidly its carbohydrate is absorbed. Many starchy foods have a glycemic index similar to sucrose (table sugar). People eating large amounts of foods with high glycemic indices (such as those mentioned above), have been reported to be at increased risk of type 2 diabetes. On the other hand, eating a diet high in carbohydrate-rich foods with low glycemic indices is associated with a low risk of type 2 diabetes. Beans, peas, fruit, and oats, have low glycemic indices, despite their high carbohydrate content, due mostly to the health-promoting effects of soluble fiber. Diabetes disrupts the mechanisms by which the body controls blood sugar. Until recently, health professionals have recommended sugar restriction to people with diabetes, even though short-term high-sugar diets have been shown, in some studies, not to cause blood sugar problems in people with diabetes. Currently, the American Diabetic Association (ADA) guidelines do not prohibit the use of moderate amounts of sugar, as long as the goals of normalizing blood levels of glucose, triglycerides, and cholesterol are being achieved. Most doctors recommend that people with diabetes cut intake of sugar from snacks and processed foods, and replace these foods with high-fiber, whole foods. This tends to lower the glycemic index of the overall diet and has the additional benefit of increasing vitamin, mineral, and fiber intake. Other authorities also recommend lowering the glycemic index of the diet to improve the control of diabetes. Other Diets: FIBER: A high-fiber diet has been shown to work better in controlling diabetes than the diet recommended by the ADA, and may control blood sugar levels as well as oral diabetes drugs. In this study, the increase in dietary fiber was accomplished exclusively through the consumption of foods naturally high in fiber—such as leafy green vegetables, granola, and fruit—to a level beyond that recommended by the ADA. No fiber supplements were given. All participants received both the ADA diet (providing 24 grams of fiber per day) and the high-fiber diet (providing 50 grams of fiber per day), for a period of six weeks. After six weeks of following each diet, tests were performed to determine blood glucose, insulin, cholesterol, triglyceride, and other values. When glucose levels were monitored over a 24-hour period, participants eating the high-fiber diet had an average glucose level that was 10% lower than participants eating the ADA diet. Insulin levels were 12% lower in the group eating the high-fiber diet compared to the group eating the ADA diet, indicating a beneficial increase in the body’s sensitivity to insulin. Moreover, people eating the high-fiber diet experienced significant reductions in total cholesterol, triglycerides, and LDL (“bad”) cholesterol compared to those eating the ADA diet. They also had slight decreases in glycosylated hemoglobin, a measure of chronically high blood glucose levels. High-fiber supplements, such as psyllium, guar gum (found in beans), pectin (from fruit), oat bran, and glucomannan have improved glucose tolerance in some studies. Positive results have also been reported with the consumption of 1–3 ounces of powdered fenugreek seeds per day. A review of the research revealed that the extent to which moderate amounts of fiber help people with diabetes in the long term is still unknown, and the lack of many long-term studies has led some researchers to question the importance of fiber in improving diabetes. Still, most doctors advise people with diabetes to eat a diet high in fiber. Focus should be placed on fruits, vegetables, seeds, oats, and whole-grain products. OTHER RESTRICTED DIETS: Eating fish also may afford some protection from diabetes. Incorporating a fish meal into a weight-loss regimen was more effective than either measure alone at improving glucose and insulin metabolism and high cholesterol. Vegetarians have been reported to have a low risk of type 2 diabetes. When people with diabetic nerve damage switch to a vegan diet (no meat, dairy, or eggs), improvements have been reported after several days. In one trial, pain completely disappeared in 17 of 21 people. Fats from meat and dairy also contribute to heart disease, the leading killer of people with diabetes. Some of these benefits may be due to the better food and oils consumed by health-conscious people plus the lack of animal fats in their diet. Vegetarians eat less protein than do meat eaters. The reduction of protein intake has lowered kidney damage caused by diabetes and may also improve glucose tolerance. However, in a group of 13 obese males with high blood-insulin levels (as is often seen in diabetes), a high-protein, low-carbohydrate diet (like the Atkins Diet) resulted in greater weight loss and control of insulin levels, compared with that of a low-carbohydrate diet. Switching to either a high- or low-protein diet should be discussed with a doctor. The high protein diets seem to be better suited to people with Type O Blood types than for others. Diets high in fat, especially saturated fat, worsen glucose tolerance and increase the risk of type 2 diabetes, an effect that is not simply the result of weight gain caused by eating high-fat foods. Saturated fat is found primarily in meat, dairy fat, and the dark meat and skins of poultry. In contrast, glucose intolerance has been improved by diets high in monounsaturated oils, which may be good for people with diabetes.47 There is often difficulty in changing the overall percentage of calories from fat and carbohydrates in the diets of people with type 1 diabetes. However, modifying the quality of the dietary fat is achievable. In adolescents with type 1 diabetes, increasing monounsaturated fats relative to other fats in the diet is associated with better control over blood sugar and cholesterol levels. The easiest way to incorporate monounsaturates into the diet is to use oils containing olive oil. However, those who are overweight need to be aware—olive oil is high in calories. Glucose tolerance improves in healthy people taking omega-3 fatty acid supplements. Some studies have found that fish oil supplementation improves glucose tolerance, high triglycerides, and cholesterol levels in people with diabetes. In one trial, people with diabetic neuropathy and diabetic nephropathy experienced significant improvement when given 600 mg three times per day of purified EPA—one of the two major omega-3 fatty acids found in fish oil supplements—for 48 weeks. Another consideration regards the inflammatory nature of certain oils. Inflammations are associated with animal fats and most vegetable oils, especially the refined and hydrogenated types. The Omega-3 oils are actually anti-inflammatory. These are mostly from cold water fish and from flaxseed oil. Those with inflammatory conditions, including arthritis, Parkinson’s, cancer and other chronic ailments, should seriously consider getting the vast bulk of their oil intake from only quality Omega-3 oils as a means to stop conditions that promote inflammation in the body. Should children avoid milk to prevent type 1 diabetes? Worldwide, children whose dietary energy comes primarily from dairy (or meat) products have a significantly higher chance of developing type 1 diabetes than do children whose dietary energy comes primarily from vegetable sources. Countries with high milk consumption have a high risk of type 1 (insulin-dependent) diabetes. Animal research also indicates that avoiding milk affords protection from type 1 diabetes. Milk contains a protein related to a protein in the pancreas, the organ where insulin is made. Some researchers believe that children who are allergic to milk may develop antibodies that attack the pancreas, causing type 1 diabetes. Several studies have linked cows’ milk consumption to the occurrence of type 1 diabetes in children. Different genetic strains of cows’ milk protein (casein) are associated with different levels of risk. Some children who drink cows’ milk produce antibodies to the milk, and it has been hypothesized that these antibodies can cross-react with and damage the insulin-producing cells of the pancreas. Immune problems in people with type 1 diabetes have been tied to other allergies as well, and it’s important to not focus only on avoiding dairy products. Preliminary studies have found that early introduction of cows’ milk formula feeding increases the risk of developing type 1 diabetes. A study of Finnish children (including full-term children with diabetes) showed that early introduction of cows’ milk formula feeding before three months of age (vs. after three months of age) was associated with increased risk of type 1 diabetes. This research supports abstaining from dairy products in infancy and early childhood, particularly for children with a family history of type 1 diabetes. Recent research also suggests a possible link between milk consumption in infancy and an increased risk of type 2 (non-insulin-dependent) diabetes. The risk seems to be associated with milk proteins rather than sugars. Eye Problems (Retinopathy): Some sugars are actually potentially harmful to the eyes, especially for those with diabetic neuropathies that may affect vision. Animal studies suggest that dietary fructose may contribute to the development of retinopathy. Although such an association has not been demonstrated in humans, some doctors advise their diabetic patients to avoid foods containing added fructose or high-fructose corn syrup. Fructose that occurs naturally in fruit has not been found to be harmful. The accumulation of another sugar alcohol called sorbitol is another risk factor. In a study of people with diabetes, cigarette smoking was found to be a risk factor for the development of retinopathy. In a study of people with type 1 (insulin-dependent) diabetes, those who maintained their blood sugar levels close to the normal range had less severe retinopathy, compared with those whose blood sugar levels were higher. Tighter control of blood-sugar levels can be achieved with a medically supervised program of diet, exercise, and, when appropriate, medication. Nutritional supplements that may be helpful: Free radicals have been implicated in the development and progression of several forms of retinopathy. Retrolental fibroplasia, a retinopathy that occurs in some premature infants who have been exposed to high levels of oxygen, is an example of free radical-induced damage to the retina. In an analysis of the best published trials, large amounts of vitamin E were found to reduce the incidence of severe retinopathy in premature infants by over 50%. Some of the evidence supporting the use of vitamin E in the prevention of retrolental fibroplasia comes from trials that have used 100 IU of vitamin E per 2.2 pounds of body weight in the form of oral supplementation. Use of large amounts of vitamin E in the prevention of retrolental fibroplasia requires the supervision of a pediatrician. Vitamin E has also been found to prevent retinopathy in people with a rare genetic disease known as abetalipoproteinemia. People with this disorder lack a protein that transports fat-soluble nutrients, and can therefore develop deficiencies of vitamin E and other nutrients. In one trial, vitamin E failed to improve vision in people with diabetic retinopathy, although in a double-blind trial, people with type 1 diabetes given very high amounts of vitamin E were reported to show a normalization of blood flow to the retina. This finding has made researchers hopeful that vitamin E might help prevent diabetic retinopathy. However, no long-term trials have yet been conducted with vitamin E in the actual prevention of diabetic retinopathy. Because oxidation damage is believed to play a role in the development of retinopathy, antioxidant nutrients might be protective. One doctor has administered a daily regimen of 500 mcg selenium, 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C for several years to 20 people with diabetic retinopathy. During that time, 19 of the 20 people showed either improvement or no progression of their retinopathy. People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner. Low blood levels of magnesium have been found to be a risk factor for retinopathy for some people with diabetes. One study investigated the effect of adding 100 mcg per day of vitamin B12 to the insulin injections of 15 children with diabetic retinopathy. After one year, signs of retinopathy disappeared in 7 of 15 cases; after two years, 8 of 15 were free of retinopathy. Adults with diabetic retinopathy did not benefit from vitamin B12 injections. Consultation with a physician is necessary before adding injectable vitamin B12 to insulin. Quercetin (a flavonoid) has been shown to inhibit the enzyme, aldose reductase. This enzyme appears to contribute to worsening of diabetic retinopathy.. Although human studies have not been done using quercetin to treat retinopathy, some doctors prescribe 400 mg of quercetin three times per day. Another flavonoid, rutin, has been used with success to treat retinopathy in preliminary research. Proanthocyanidins (OPCs), a group of flavonoids found in pine bark, grape seed, and other plant sources have been reported in preliminary French trials to help limit the progression of retinopathy. Nutritional supplements that may be helpful: Medical reports dating back to 1853, as well as modern research, indicate that chromium-rich brewer’s yeast (9 grams per day) can be useful in treating diabetes. In recent years, chromium has been shown to improve glucose and related variables in people with glucose intolerance and type 1, type 2, gestational, and steroid-induced diabetes. Improved glucose tolerance with lower or similar levels of insulin have been reported in more than ten trials of chromium supplementation in people with varying degrees of glucose intolerance. Chromium supplements improve glucose tolerance in people with both type 2 and type 1 diabetes, apparently by increasing sensitivity to insulin. Chromium improves the processing of glucose in people with prediabetic glucose intolerance and in women with diabetes associated with pregnancy. Chromium even helps healthy people, although one such report found chromium useful only when accompanied by 100 mg of niacin. Chromium may also lower total cholesterol, LDL cholesterol, and triglycerides (risk factors in heart disease). A few trials that reported no beneficial effects from chromium supplementation. used 200 mcg or less of supplemental chromium, which is often not adequate for people with diabetes, especially if it is in a poorly absorbed form. The typical amount of chromium used in research trials is 200 mcg per day, although as much as 1,000 mcg per day has been used. Many doctors recommend up to 1,000 mcg per day for people with diabetes. Supplementation with chromium or brewer’s yeast could potentially enhance the effects of drugs for diabetes (e.g., insulin or other blood sugar-lowering agents) and possibly lead to hypoglycemia. Therefore, people with diabetes taking these medications should supplement chromium or brewer’s yeast only under the supervision of a doctor. People with diabetes tend to have low magnesium levels. Double-blind research indicates that supplementing with magnesium overcomes this problem. Magnesium supplementation has improved insulin production in elderly people with type 2 diabetes. Elders without diabetes can also produce more insulin as a result of magnesium supplements, according to some trials. Insulin requirements are often lower in people with type 1 diabetes who supplement with magnesium. Diabetes-induced damage to the eyes is more likely to occur in magnesium-deficient people with type 1 diabetes. In magnesium-deficient pregnant women with type 1 diabetes, the lack of magnesium may even account for the high rate of spontaneous abortion and birth defects associated with type 1 diabetes. The American Diabetes Association admits “strong associations...between magnesium deficiency and insulin resistance”. Many doctors recommend that people with diabetes and normal kidney function supplement with 200–600 mg of magnesium per day. Alpha lipoic acid is a powerful natural antioxidant. Preliminary and double-blind trials have found that supplementing 600–1,200 mg of lipoic acid per day improves insulin sensitivity and the symptoms of diabetic neuropathy. Supplementing with 4 grams of evening primrose oil per day for six months has been found in double-blind research to improve nerve function and to relieve pain symptoms of diabetic neuropathy. Glucomannan is a water-soluble dietary fiber that is derived from konjac root (Amorphophallus konjac). Glucomannan delays stomach emptying, leading to a more gradual absorption of dietary sugar. This effect can reduce the elevation of blood sugar levels that is typical after a meal. After-meal blood sugar levels are lower in people with diabetes given glucomannan in their food, and overall diabetic control is improved with glucomannan-enriched diets, according to preliminary and controlled clinical trials. One preliminary report suggested that glucomannan may also be helpful in pregnancy-related diabetes. For controlling blood sugar, 500–700 mg of glucomannan per 100 calories in the diet has been used successfully in controlled research. People with low blood levels of vitamin E are more likely to develop type 1 and type 2 diabetes. Vitamin E supplementation has improved glucose tolerance in people with type 2 diabetes in most, but not all, double-blind trials. Vitamin E has also improved glucose tolerance in elderly people without diabetes. Three months or more of supplementation may be required for benefits to become apparent. The amount used is at least 900 IU of vitamin E per day. In one of the few trials to find vitamin E supplementation ineffective for glucose intolerance in people with type 2 diabetes, damage to nerves caused by the diabetes was nonetheless partially reversed by supplementing with vitamin E for six months. Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic retinopathy and nephropathy, serious complications of diabetes involving the eyes and kidneys. Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. Vitamin E supplementation reduces this problem in many, although not all, studies. Vitamin E appears to lower the risk of cerebral infarction, a type of stroke, in people with diabetes who smoke. A review of a large Finnish study of smokers concluded that smokers with diabetes (or hypertension) represent a subset population that can benefit from small amounts of vitamin E (50 IU per day) without experiencing an increased risk of bleeding. People with type 1 diabetes appear to have low vitamin C levels. As with vitamin E, vitamin C may reduce glycosylation. Vitamin C also lowers sorbitol in people with diabetes. Sorbitol is a sugar that can accumulate and damage the eyes, nerves, and kidneys of people with diabetes. Vitamin C may improve glucose tolerance in type 2 diabetes, although not every study confirms this benefit. Vitamin C supplementation (500 mg twice daily for one year) has significantly reduced urinary protein loss in people with diabetes. Urinary protein loss (also called proteinuria) is associated with poor prognosis in diabetes. Many doctors suggest that people with diabetes supplement with 1–3 grams per day of vitamin C. Higher amounts could be problematic, however. In one person, 4.5 grams per day was reported to increase blood sugar levels. Many people with diabetes have low blood levels of vitamin B6. Levels are even lower in people with diabetes who also have nerve damage (neuropathy). Vitamin B6 supplementation has improved glucose tolerance in women with diabetes caused by pregnancy. Vitamin B6 supplementation is also effective for glucose intolerance induced by birth control pills. For other people with diabetes, 1,800 mg per day of a special form of vitamin B6—pyridoxine alpha-ketoglutarate—has improved glucose tolerance dramatically in some research. Standard vitamin B6 has helped in some, but not all, trials. Biotin is a B vitamin needed to process glucose. When people with type 1 diabetes were given 16 mg of biotin per day for one week, their fasting glucose levels dropped by 50%. Similar results have been reported using 9 mg per day for two months in people with type 2 diabetes.186 Biotin may also reduce pain from diabetic nerve damage. Some doctors try 16 mg of biotin for a few weeks to see if blood sugar levels will fall. Blood levels of vitamin B1 (thiamine) have been found to be low in people with type 1 diabetes. In the 1930s, a trial using 10 mg of vitamin B1 per day for four weeks reported reduced blood sugar levels in six of eleven people with diabetes. More recently, administration of both vitamin B1 (25 mg per day) and vitamin B6 (50 mg per day) led to significant improvement of symptoms of diabetic neuropathy after four weeks. However, this was a trial conducted among people in a vitamin B1-deficient developing country. Therefore, these improvements might not occur in other people with diabetes. Another trial found that combining vitamin B1 (in a special fat-soluble form) and vitamin B6 plus vitamin B12 in high but variable amounts, led to improvement in some aspects of diabetic neuropathy in 12 weeks. As a result, some doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the optimal level of intake remains unknown. Coenzyme Q10 (CoQ10) is needed for normal blood sugar metabolism. Animals with diabetes have been reported to be CoQ10 deficient. People with type 2 diabetes have been found to have significantly lower blood levels of CoQ10 compared with healthy people. CoQ10 is lowered by all “statin” drugs to control cholesterol. L-carnitine is an amino acid needed to properly utilize fat for energy. When people with diabetes were given L-carnitine (1 mg per 2.2 pounds of body weight), high blood levels of fats—both cholesterol and triglycerides—dropped 25–39% in just ten days in one trial. In higher amounts (1 gram per day by injection), L-carnitine has been reported to reduce pain from diabetic nerve damage as well. Zinc supplements have lowered blood sugar levels in people with type 1 diabetes, though some evidence indicates that zinc supplementation in people with type 2 diabetes does not improve their ability to process sugar. Nonetheless, people with type 2 diabetes also have low zinc levels, caused by excess loss of zinc in their urine. Many doctors recommend that people with type 2 diabetes supplement with moderate amounts of zinc (15–25 mg per day) as a way to correct for the deficit. Some doctors are concerned about having people with type 1 diabetes supplement with zinc because of a report that zinc supplementation increased glycosylation, generally a sign of deterioration of the condition. This trial is hard to evaluate because zinc supplementation increases the life of blood cells and such an effect artificially increases the lab test results for glycosylation. Until this issue is resolved, those with type 1 diabetes should consult a doctor before considering supplementation with zinc. Vitamin B12 is needed for normal functioning of nerve cells. Vitamin B12 taken orally, intravenously, or by injection has reduced nerve damage caused by diabetes in most people studied. In a preliminary trial, people with nerve damage due to kidney disease or to diabetes plus kidney disease received intravenous injections of 500 mcg of methylcobalamin (the main form of vitamin B12 found in the blood) three times a day for six months in addition to kidney dialysis. Nerve pain was significantly reduced and nerve function significantly improved in those who received the injections. Oral vitamin B12 up to 500 mcg three times per day is recommended by some practitioners. The intake of large amounts of niacin (a form of vitamin B3), such as 2–3 grams per day, may impair glucose tolerance and should be used by people with diabetes only with medical supervision. Smaller amounts (500–750 mg per day for one month followed by 250 mg per day) may help some people with type 2 diabetes, though this research remains preliminary. Vitamin D is needed to maintain adequate blood levels of insulin. Vitamin D receptors have been found in the pancreas where insulin is made and preliminary evidence suggests that supplementation can increase insulin levels in some people with type 2 diabetes; prolonged supplementation might also help reduce blood sugar levels. Not enough is known about optimal amounts of vitamin D for people with diabetes, and high amounts of vitamin D may be somewhat toxic. However, newer studies indicate that our use of large doses of naturally-occurring Vitamin D from sunlight is much higher than previously thought. Statin drugs also may lower body levels of other substances made from cholesterol, such as Vitamin D and hormones that help our bodies deal with sex, repair and stress. Diabetics considering vitamin D supplementation should talk with, and have vitamin D status assessed by, a doctor. Inositol is needed for normal nerve function. Diabetes can cause a type of nerve damage known as diabetic neuropathy. This condition has been reported in some, but not all, trials to improve with inositol supplementation (500 mg taken twice per day). Taurine is an amino acid found in protein-rich food. People with type 1 diabetes have been reported to have low blood taurine levels, a condition that increases the risk of heart disease by altering blood viscosity. Supplementing with taurine (1.5 grams per day) has restored blood taurine to normal levels and corrected the problem of blood viscosity within three months. Taurine supplementation (2 grams per day for 12 months) failed to improve kidney complications associated with type 2 diabetes. Doctors have suggested that quercetin might help people with diabetes because of its ability to reduce levels of sorbitol—a sugar that accumulates in nerve cells, kidney cells, and cells within the eyes of people with diabetes—and has been linked to damage to those organs. Vanadyl sulfate, a form of vanadium, may improve glucose control in people with type 2 diabetes, though it may not help people with type 1 diabetes. Groups receiving 150 mg or 300 mg had glucose metabolism improve, fasting blood sugar decrease, and another marker for chronic high blood sugar reduced. At the 300 mg level, total cholesterol decreased, although not without an accompanying reduction in the protective HDL cholesterol. Vanadium doe not improve insulin sensitivity. Gastrointestinal side effects were experienced by some of the participants taking 150 mg per day and by all of the participants taking 300 mg per day. People with diabetes may have low blood levels of manganese. Animal research suggests that manganese deficiency can contribute to glucose intolerance and may be reversed by supplementation. Herbs that may be helpful: Double-blind trials have shown that topical application of creams containing 0.025–0.075% capsaicin (from cayenne [Capsicum frutescens]) can relieve symptoms of diabetic neuropathy (numbness and tingling in the extremities caused by diabetes). Four or more applications per day may be required to relieve severe pain. This should be done only under a doctor’s supervision. Supplementing with psyllium has been shown to be a safe and well-tolerated way to improve control of blood glucose and cholesterol. In a double-blind trial, men with type 2 diabetes who took 5.1 grams of psyllium per day for eight weeks lowered their blood glucose levels by 11% to 19.2%, their total cholesterol by 8.9%, and their LDL (bad) cholesterol by 13%, compared to a placebo. Asian ginseng is commonly used in Traditional Chinese Medicine to treat diabetes. It has been shown in test tube and animal studies to enhance the release of insulin from the pancreas and to increase the number of insulin receptors. Animal research has also revealed a direct blood sugar-lowering effect of ginseng. A double-blind trial found that 200 mg of ginseng extract per day improved blood sugar control, as well as energy levels in people with type 2 diabetes. In a small preliminary trial, 3 grams of American ginseng was found to lower the rise in blood sugar following the consumption of a drink high in glucose by people with type 2 diabetes. The study found no difference in blood sugar-lowering effect if the herb was taken either 40 minutes before the drink or at the same time. A follow-up to this study found that increasing the amount of American ginseng to either 6 or 9 grams did not increase the effect on blood sugar following the high-glucose drink in people with type 2 diabetes. This study also found that American ginseng was equally effective in controlling the rise in blood sugar whether it was given together with the drink or up to two hours before. Gymnema may stimulate the pancreas to produce insulin in people with type 2 diabetes. Gymnema also improves the ability of insulin to lower blood sugar in people with both type 1 and type 2 diabetes. One preliminary trial found that 400 mg of gymnema extract per day could reduce or eliminate the need for oral blood sugar-lowering drugs in some people with type 2 diabetes. Another preliminary trial suggested the same amount of the extract could allow for use of less insulin in people with type 1 diabetes. Gymnema is not a substitute for insulin. Two preliminary trials found that aloe vera juice (containing 80% aloe gel) helps lower blood sugar levels in people with type 2 diabetes. One trial found that 1 Tbsp (15 grams) twice daily reduced the amount of the blood sugar-lowering drug glibenclamide required to manage blood sugar levels.260 The other trial found the juice by itself was effective. Whole, fried slices, water extracts, and juice of bitter melon may improve blood-sugar control in people with type 2 diabetes, according to preliminary trials. However, double-blind trials are needed to confirm this potential benefit. Preliminary trials and at least one double-blind trial have shown that large amounts of onions can lower blood sugar levels in people with diabetes. The mechanism of onion’s blood sugar-lowering action is not precisely known, though there is evidence that constituents in onions block the breakdown of insulin in the liver. This would lead to higher levels of insulin in the body. Bilberry may lower the risk of some diabetic complications, such as diabetic cataracts and retinopathy. One preliminary trial found that supplementation with a standardized extract of bilberry improved signs of retinal damage in some people with diabetic retinopathy. Ginkgo biloba extract may prove useful for prevention and treatment of early-stage diabetic neuropathy, though research is at best very preliminary in this area. Other herbs that may help are fenugreek seeds and eleuthero (Siberian ginseng). Mistletoe extract has been shown to stimulate insulin release from pancreas cells, and animal research found that it reduces symptoms of diabetes. No research in humans has yet been published; however, given mistletoe’s worldwide reputation as a traditional remedy for diabetes, clinical trials are warranted to validate these promising preliminary findings. Olive leaf extracts have been used experimentally to lower elevated blood-sugar levels in diabetic animals. Animal studies and some very preliminary trials in humans suggest reishi may have some beneficial action in people with diabetes.