Supplements play an important role in many people’s lives today as their health benefits can be advantageous. However, for people with diabetes, supplements should be approached cautiously as they can interact with medications and affect blood sugar levels. Although some of these therapies may have the potential to be effective, many of them have not been studied sufficiently to know for sure. It is important to be aware of this, as some supplements can be ineffective or even harmful, especially if taken incorrectly.
The most common supplements include:
- Vitamins (for example, multivitamins or individual vitamins like vitamins C and D)
- Minerals (for example, calcium, magnesium and iron)
- Botanicals or herbs (for example, echinacea and feverfew)
- Botanical compounds (for example, caffeine and curcumin)
- Amino acids (for example, tryptophan and glutamine)
- Probiotics
Supplements should not replace prescribed diabetes medications or lifestyle interventions (for example, diet and exercise). They may be used as part of a comprehensive diabetes management plan under the guidance of a healthcare professional. Additionally, always choose supplements from reputable brands and follow the recommended dosages to minimize the risk of side effects.
Below is a summary of supplements that may affect a person with diabetes.
Supplements that may be considered for individuals with diabetes
1. Omega-3 fatty acids: These can be found on their own or in fish oil supplements. Omega-3 fatty acids may help reduce inflammation and improve cardiovascular health, which is crucial for diabetes management. However, doses should be monitored, especially if you are taking blood thinners. If you eat fish or nuts regularly, you may get adequate omega-3 fatty acids from your diet alone. Supplements may cause mild gastrointestinal effects such as bad breath, heartburn, nausea or diarrhea.
2. Vitamin D: Taking 1000 IU of vitamin D daily for a year or more can lower the risk of developing type 2 diabetes. Many Canadians have insufficient vitamin D levels due to limited sunlight exposure, which may exacerbate diabetes complications. Some factors that make getting enough vitamin D from sunlight challenging are the fall and winter months (for people who live in colder climates), having darker skin and living at higher altitudes. Supplementation can help maintain optimal vitamin D levels, but doses over 1000 IU should be personalized based on blood tests.
2. Chromium: Some studies suggest that chromium supplementation can improve insulin sensitivity and blood sugar control. However, the evidence from clinical studies is mixed and doses should be moderate to avoid toxicity. The adequate intake (or chromium in adults is 25 micrograms per day for females and 35 micrograms for males. Taking this with insulin may cause hypoglycemia. Other side effects may include weight loss, liver dysfunction, skin rash or kidney failure.
3. Magnesium: Magnesium deficiency is common in diabetes and can worsen insulin resistance. Supplementation may improve insulin sensitivity and cardiovascular health, but doses should be tailored to individual needs. For most people, doses should be limited to a maximum of 350 milligrams daily. Magnesium is available in many different formulations, but magnesium oxide has been studied the most in clinical trials for diabetes. At higher doses, side effects may include diarrhea, nausea and stomach cramps.
4. Alpha-lipoic acid: This antioxidant may help reduce neuropathy symptoms and improve insulin sensitivity in people with diabetes. However, it can lower blood sugar levels so close monitoring is essential, especially for those on insulin or oral diabetes medications. Side effects may include headaches, nausea or vomiting.
5. Probiotics: The findings indicated that taking probiotics for improving gut health in type 2 diabetes patients is not associated with any adverse reactions. In patients undergoing metformin treatment, it also can improve glycemic control. Additional clinical trials and studies are required to understand specific factors, such as the impact of different microbial strains and optimal dosage of probiotic interventions to improve outcomes in type 2 diabetes patients.
Supplements to be cautious about for individuals with diabetes
1. Chromium in high doses: While chromium supplementation may benefit some diabetes patients, high doses can lead to adverse effects such as kidney damage and liver toxicity. It is important to stick to the recommended doses.
2. Fenugreek: While fenugreek seeds are traditionally used to lower blood sugar levels, supplements may interact with diabetes medications and cause hypoglycemia. People with diabetes should use caution when taking fenugreek and monitor their blood sugar closely.
3. Bitter melon: Similar to fenugreek, bitter melon may lower blood sugar levels and interact with diabetes medications, leading to hypoglycemia. Its use should be supervised by healthcare professionals.
4. Cinnamon: Despite some evidence suggesting that cinnamon may improve blood sugar control, the results are inconsistent and high doses can be toxic. It is safe for most people at doses below 6 grams (1.2 teaspoons) daily. Patients should be wary of cinnamon supplements as there have been reports of high coumarin levels, which can cause liver toxicity or cancer over time. Therefore, it is safer to opt for culinary use of cinnamon in moderation.
5. John’s wort: This herb is commonly used for depression. It can interact with diabetes and cholesterol medications, reducing their effectiveness and leading to unstable blood sugar levels. People with diabetes should avoid St. John’s wort or use it under medical supervision.
Special situations
1. Vitamin B12: Metformin can interfere with the absorption of vitamin B12 in the body over time, potentially leading to deficiency. This is because metformin can affect the absorption of B12 in the intestines. A deficiency in vitamin B12 can cause symptoms such as fatigue, weakness, constipation, loss of appetite and even nerve problems in severe cases. Therefore, if you’re on metformin for an extended period, it’s a good idea to discuss with your healthcare provider whether you should supplement with vitamin B12.
2. Folic Acid: Women with type 1 or type 2 diabetes should supplement their diet with multivitamins containing 1 milligram of folic acid at least 3 months preconception and continue until at least 12 weeks of pregnancy to prevent birth defects.
Before incorporating any supplement into your diabetes management plan, it is essential to consult with your diabetes healthcare team, who are knowledgeable about both conventional and alternative treatments for diabetes. They can help you evaluate the potential risks and benefits of using supplements and ensure they won’t interfere with any medications you’re taking.
Additionally, it’s important to monitor your blood sugar levels closely if you decide to use supplements, as they may affect your blood sugar levels. Always follow your healthcare provider’s advice and treatment plan for managing diabetes effectively and safely.
