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Diabetes Mellitus
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Approach to the Patient | Principal Proposed Natural Therapies | Other Proposed Natural Therapies | Drug
Interactions
Approach to the Patient
The nutrient chromium appears to play a physiological role in glucose metabolism and, when taken as a
supplement, may improve glucose control. Weaker evidence suggests efficacy for ginseng ( Panax spp.).
Numerous other natural agents have weaker supporting evidence.
The supplements lipoic acid, evening primrose oil, and vitamin E may be beneficial in diabetic autonomic and
peripheral neuropathy. Some evidence suggests that use of niacinamide or vitamin D supplements may reduce
risk of childhood onset diabetes.
There are numerous other natural treatments that your patient may be using for diabetes, including
acetyl-L-carnitine, aloe vera, arginine, bilberry leaf, bitter melon, caiapo, cinnamon, Coccinia indica,fenugreek,
garlic, glucomannan, gymnema, holy basil, lipoic acid, magnesium, maitake, nopal cactus, onion, pterocarpus,
salt bush, vanadium,vitamin C, and vitamin E. For potential safety risks with the more common of these
substances, see the full herb/supplement articles.
Concerns have been raised regarding the safety of the supplement glucosamine in patients with diabetes.
However, while a few early case reports and animal studies had suggested that glucosamine might impair glucose
control, subsequent controlled studies in humans have been reassuring. 2–7,133-135 Weak theoretical concerns
remain regarding whether glucosamine supplements might increase risk of diabetic cataracts by enhancing
glycosylation.1
Similarly, despite earlier concerns, current evidence suggests that both fish oil and high dose vitamin B3 are safe
for use in diabetics. 120,121,127
However, while the supplement CLA (conjugated linoleic acid) has shown a bit of promise as a treatment for
diabetes,103 in other studies it has apparently increased insulin resistance both in people with type 2 diabetes and
in non-diabetic obese men. 136-138 128 For this reason, CLA should be used cautiously, if at all, in people who
have type 2 diabetes or are at risk for it.
A caution: if any of the proposed hypoglycemic treatments mentioned below are actually effective, their use
might necessitate dose adjustment of standard treatment to avoid hypoglycemia. Close glucose monitoring at the
onset of adjunctive therapy is therefore advised.
Principal Proposed Natural Therapies
Glycemic Control
Chromium [+3]
Ginseng [+2]
Coenzyme Q10 [+2X]
Vanadium [+1]
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Diabetic Neuropathy
Lipoic Acid (Intravenous) [+3], (Oral) [–2]
Evening Primrose Oil [+3]
Vitamin E [+2]
Nutrient Deficiencies: Prevention
Niacinamide (Vitamin B3) [+2X]
Vitamin D [+1]
(Higher numbers indicate stronger evidence; X modifier indicates contradictory results. See the Introduction for
details of the rating scale.)
Glycemic Control
Chromium +3
A 4-month study reported in 1997 followed 180 Chinese men and women with type 2 diabetes, comparing the
effects of 1,000 mcg chromium daily, 200 mcg chromium, and placebo. 8 HbA1c values improved significantly
in the group receiving 1,000 mcg after 2 months, and in both chromium groups after 4 months. Fasting glucose
was also lower in the higher-dose chromium group.
Another double-blind trial compared placebo against chromium from Brewer’s yeast (23.3 mcg chromium daily)
and chromium chloride (200 mcg chromium daily) in 78 individuals with type 2 diabetes. 9 This rather complex
crossover study consisted of four 8-week intervals of treatment in random order. The results in the 67 completers
showed that both active treatments significantly improved glycemic control. Mixed results have been seen in
other small trials. 139,140 10,11
One placebo-controlled study of 30 women with pregnancy-related diabetes found that supplementation with
chromium at a dosage of 4 or 8 mcg chromium picolinate/kg body weight significantly improved blood sugar
control.12 Some evidence suggests that chromium might be helpful for corticosteroid-induced diabetes. 13,14
Chromium may also be helpful in impaired glucose tolerance short of actual diabetes. 9,15,16,17
For more information, including dosage and safety issues, see the Chromium article.
Coenzyme Q 10 +2X
In a 12-week, double-blind, placebo-controlled trial of 74 individuals with diabetes above, use of CoQ 10 at a
dose of 100 mg twice daily significantly improved glucose control as compared to placebo. 130 Similar benefits
were seen in an 8-week, double-blind, placebo-controlled study of 59 men. 131 However, a smaller (n=23)
double-blind, placebo-controlled study failed to find any change in glucose control. 132
Ginseng +2
The possible anti-diabetic effect of American ginseng (Panax quinquefolius) has been evaluated in two
double-blind trials. The first, a double-blind, placebo-controlled crossover study of 9 subjects with type 2
diabetes, found that a single ginseng dose of 3 g significantly reduced postprandial glycemia. 19 The other study
looked at longer-term control of glycemia. 20 In this 8-week trial, American ginseng decreased fasting plasma
glucose 9.4% more than placebo. A third study failed to find benefit with a form of American ginseng that had a
low content of ginsenosides (the presumed active ingredients). 141
Evidence has been mixed regarding the possible anti-diabetic effect of Panax ginseng. Two studies failed to find
hypoglycemic effects with a standard Panax product.142, 18 However, one study did find benefit with a specially
processed ("red" ginseng) product. 143
For more information, including dosage and safety issues, see the Ginseng article.
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Vanadium +1
Studies in rats with and without diabetes suggest that vanadium may have an insulin-like effect, reducing blood
glucose levels.22–32 Most studies involve vanadium (IV)—that is, oxidation state IV vanadium—but vanadium
(V) has also been found effective in at least one animal trial. 33
Based on these findings, preliminary studies involving human subjects have been conducted, with mostly positive
results.34–39 However, the doses of vanadium used, 100 to 125 mg/day, may present significant toxic risk. There
may be some benefit in use of nutritional doses of vanadium, 10 to 30 mcg daily.
For more information, including dosage and safety issues, see the Vanadium article.
Diabetic Neuropathy
Lipoic Acid (Intravenous) +3, (Oral) –2
Oral lipoic acid may be beneficial for cardiac autonomic neuropathy. The DEKAN (Deutsche Kardiale
Autonome Neuropathie) study followed 73 diabetics with symptoms of cardiac autonomic neuropathy for a
period of 4 months. Treatment with 800 mg/day of oral alpha-lipoic acid yielded statistically significant but
modest improvement compared to placebo. 40
There is some evidence that intravenous lipoic acid can reduce symptoms of diabetic peripheral neuropathy in the
short term. However, a large study of oral lipoic acid found it ineffective. 41 The positive evidence for oral lipoic
acid is limited to open trials or trials with inadequate sample size. 40,42–45
For more information, including dosage and safety issues, see the Lipoic Acid article.
Evening Primrose Oil +3
Evening primrose oil, a source of GLA, may be helpful for diabetic peripheral neuropathy. A multicenter
double-blind trial enrolling 111 diabetics found that treatment with evening primrose oil for 1 year improved pain
and numbness as well as objective signs of nerve injury. 46 This study is in agreement with an earlier
double-blind study.47
For more information, including dosage and safety issues, see the Gamma-Linolenic Acid article.
Vitamin E +2
A 4-month, double-blind, placebo-controlled trial found that vitamin E at a dose of 600 mg daily improves the
ratio of cardiac sympathetic to parasympathetic tone. 48
For more information, including dosage and safety issues, see the Vitamin E article.
Nutrient Deficiencies
Certain nutrient deficiencies may be associated with diabetes. Supplementation may be warranted on general
principles, especially for nutrients (such as magnesium and zinc) where marginal nutriture is common in the
population at large.
Magnesium deficiency appears to be common in diabetes. 49,50 Supplementation may therefore be indicated.
However, magnesium appears to increase absorption of oral hypoglycemics, potentially causing a risk of
hypoglycemia.51,52 Individuals with either type 1 or type 2 diabetes may also be deficient in zinc.53,54,55 Vitamin
C levels have been found to be low in many diabetics taking insulin, even though they were consuming
seemingly adequate amounts in their diets. 56,57,58 Some individuals with type 1 diabetes appear to be deficient in
taurine.59 Manganese deficiency reportedly can also occur. 60 Finally, metformin and phenformin may cause
61
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vitamin B12 malabsorption; interestingly, this appears to be correctable through calcium supplementation.
One small double-blind, placebo-controlled study suggests that use of multivitamin/multimineral supplements
may reduce incidence of infectious illness in diabetics. 144 Another failed to find that general nutritional
supplementation accelerated healing of diabetic foot ulcers. 145
Prevention
Niacinamide (Vitamin B 3) +2X
Two studies found that niacinamide (vitamin B 3) may delay or prevent the onset of type 1 diabetes. In a
population-based study of more than 20,000 children, treatment of ICA-positive children with niacinamide for 7
years reduced the incidence of diabetes. 62 Niacinamide might also prolong the “honeymoon period” in type 1
diabetes.63 However, the German portion of the ongoing European Nicotinamide Diabetes Intervention Trial has
failed to demonstrate prevention of diabetes with regular use of niacinamide. 64
In addition, a small, double-blind, controlled trial evaluated niacinamide plus antioxidant vitamins and minerals
given at onset of childhood diabetes. 65 No effects on the course of the disease were seen.
For more information, including dosage and safety issues, see the Vitamin B3 article.
Vitamin D +1
A Finnish observational trial of 12,231 children suggests that use of vitamin D supplements reduces risk of type
1 diabetes.122 Similar results were seen in other observational trials. 123,124
Other Proposed Natural Therapies
Preliminary controlled trials suggest that the herbs aloe vera,69–74 caiapo ( Ipomoea batatas),146,147 cinnamon,148
fenugreek,75,76,77 and gymnema66,67,68 may improve glycemic control. Weaker clinical evidence 81, 109,110
suggests possible benefit with the herbs bilberry leaf,91 bitter melon ( Momordica charantia),88-90,149 Coccinia
indica,87 guggul,78 holy basil ( Ocimum sanctum),95,96 maitake, 125 nopal cactus ( Opuntia streptacantha),97-102
onion,82 OPCs from maritime pine bark, 150 pterocarpus,83 and salt bush ( Atriplex halimus)79,85,86,92-94,
79–102,125,
Other herbs traditionally used for diabetes include alfalfa, Anemarrhena asphodeloides,Catharanthus roseus,
cucumber, Cucurbita ficifolia, cumin, damiana, Euphorbia prostrata,Guaiacum coulteri, Guazuma ulmifolia,
Lepechinia caulescens, neem, Psacalium peltatum, red mangrove, spinach, string bean, and Tournefortia
hirsutissima.109–117
There are a number of non-herb supplements that have also shown a bit of promise for enhancing glucose control,
including arginine,107 carnitine,119 coenzyme Q 10,130,131 glucomannan,104,105,151 lipoic acid,152 magnesium,153
and vitamin E.154-156
Preliminary evidence of benefit has also been seen with combination herbal formulas used in Traditional
Chinese Herbal Medicine157 and those used in Ayurvedic medicine. 158-160
One double-blind, placebo-controlled study evaluated the potential benefits of the Asian anti-diabetic herb
Tinospora crispa for enhancing the hypoglycemic actions of oral medications, but failed to find benefits. 161
Furthermore, some evidence was found in this human trial to support concerns derived from animal studies
regarding the possible hepatotoxicity of this herb.
118,119
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The supplement acetyl-L-carnitine has shown some promise for diabetic cardiac autonomic neuropathy,
and high-dose zinc might offer benefits for diabetic peripheral neuropathy. 108
A meta-analysis of published studies suggests that fish oil can improve hypertriglyceridemia in diabetics without
altering glycemic control.120 Similarly, even when taken in hypolipidemic doses, niacin does not appear to raise
serum glucose in diabetics. 121,129
In a double-blind, crossover trial of 30 type 2 diabetics with micro- or macro-albuminuria, use of vitamin C
(1250 mg) and vitamin E (680 IU) over a period of 4 weeks signficantly reduced urinary albumin excretion rate.
126
Drug Interactions
See the article on each individual supplement for a full description of the interactions summarized here.
Principal Natural Therapies for Diabetes: Interactions with Pharmaceuticals
Natural Therapy Pharmaceutical
Interaction
Chromium,
ginseng
Hypoglycemic agents and any other agent noted above
that may improve glycemic control
Possible risk of hypoglycemia
Niacinamide
Anticonvulsants
Possible increase in serum levels
of drug
Vitamin E
Anticoagulant and antiplatelet agents
Possible increased risk of
bleeding complications
Pharmaceuticals Used for Diabetes: Possible Harmful Interactions with Natural Therapies
Pharmaceutical
Natural Therapy
Interaction
Oral
hypoglycemics
Chromium, ginseng, other herbs and supplements with
putative hypoglycemic effects
Possible increased risk of
hypoglycemia
Dong quai, St. John’s wort
Possible increased risk of
photosensitivity
Ipriflavone, magnesium
Possible increased serum levels
of drug
Potassium citrate, ginkgo
Possible decreased serum levels
of drug
Pharmaceuticals Used for Diabetes: Natural Therapies with Potential Supportive Interactions
Pharmaceutical
Natural Therapy Interaction
Oral hypoglycemics Coenzyme Q10
Possible correction of drug-induced relative deficiency
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Last reviewed March 2005 by EBSCO CAM Review Board
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