Many of my patients who are taking nutritional supplements often do not understand why they take them, or whether there is a true health benefit to their use. In the case of diabetes mellitus, there are several nutritional supplements which may benefit the diabetic patient. Below are some of the nutrients that can provide support for the diabetic patient:
Alpha Lipoic Acid (ALA): a metabolic anti-oxidant that may be helpful in diabetic neuropathy (600-1200 mg daily, taken in divided doses)
Chromium picolinate: trace element required for proper maintenance of carbohydrate and lipid metabolism, it has been shown to improve the glucose/insulin system in diabetics. Doses of 600-1000mcg/d are being studied in the newer clinical trials.
Magnesium: affects many cellular functions including energy metabolism, cell proliferation, the transport of potassium and calcium ions and modulating signal transduction. Magnesium deficiency has a negative impact on glucose homeostasis and insulin sensitivity and is involved in the evolution of complications such as retinopathy, thrombosis and hypertension in type 2 diabetics (Walti 2003). As magnesium is intracellular, RBC magnesium is a more sensitive indicator of deficiency. Hypomagnesemia has been linked to poor glycemic control, coronary artery diseases, hypertension, diabetic retinopathy, nephropathy, neuropathy, and foot ulcerations (Pham 2007). A meta-analysis of 9 randomized, double blind, controlled trials concluded that oral magnesium supplementation might lower fasting plasma glucose levels in diabetics (Song, et al., 2006).Magnesium supplementation may be important when considering the vasoconstrictive effects of hypomagnesemia and the magnitude of vascular disorders seen in those with diabetes (Whang, Sims, 2000). Patients with diabetes, and those with significant risk factors for the disorder, should be encouraged to limit refined grains and acquire their energy from whole grain products rich in magnesium. Metformin can deplete magnesium levels, as well as vitamin B12 and coenzyme Q10. If supplementing, magnesium lactate, aspartate, and glycinate are all gentle on the GI tract and less likely to cause diarrhea. The dose varies but is generally 300-500 mg per day.
One note of caution, the kidney is the principle organ involved in magnesium homeostasis. Magnesium supplementation in patients with renal disease must be done with caution.
Vitamin D: Accumulating evidence suggests that low levels of vitamin D might be involved in the development of type 2 diabetes(Liu 2010, Mathieu et al., 2005, Chiu et al., 2004). Given the overall health benefits of vitamin D it just seems to make sense that 25-hydroxy vitamin D levels be checked and supplementation recommended if levels are lower than 35 ng/mL (many experts would argue a higher serum level).
Thiamine/B1: Thiamine is a water-soluble vitamin essential for normal metabolism of fat, glucose and protein as it is involved in key pathways of cellular energy synthesis. 75% of patients with diabetes were shown to have reduced levels of thiamine and increased urinary excretion of thiamine relative to controls (Thornally,et al 2007). Low thiamine levels correlated with increased levels of vascular adhesion molecules, known markers for vascular disease. It may be advisable for diabetic patients to take a multiple vitamin that provides 25 mg per day of thiamine.