Diabetes mellitus is an inability to metabolize carbohydrates resulting from inadequate production or utilization of insulin. Other forms of diabetes (such as diabetes insipidus) are not included in this discussion.
People with diabetes cannot properly process glucose, a sugar the body uses for energy. As a result, glucose stays in the blood, causing blood glucose to rise. At the same time, however, the cells of the body can be starved for glucose. Diabetes can lead to poor wound healing, higher risk of infections, and many other problems involving the eyes, kidneys, nerves, and heart.
There are two types of diabetes mellitus. Childhood-onset diabetes is also called type 1, or insulin-dependent, diabetes. In type 1 diabetes, the pancreas cannot make the insulin needed to process glucose. Natural therapies cannot cure type 1 diabetes, but they may help by making the body more receptive to insulin supplied by injection. It is particularly 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 mentioned in this article. 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 often makes enough insulin, but the body has trouble using the insulin. Type 2 diabetes frequently responds well to natural therapies.
People with diabetes have a high risk for heart disease and atherosclerosis. In addition, those with diabetes have a higher mortality rate if they also have high homocysteine levels.1
Dietary changes that may be helpful for diabetes
The relationship between eating carbohydrates and type 2 diabetes is a complex issue. While eating carbohydrates increases the need for insulin to keep blood sugar normal, diets high in total carbohydrates do not necessarily increase the risk of type 2 diabetes.2 3 Researchers have found that diets very high in sugar may worsen glucose tolerance in nondiabetic animals4 and humans.5 However, the amount of sugar used in these studies in proportion to other foods is much larger than is typically found in human diets.
Years ago, one researcher reported an increase in diabetes among Yemenite Jews who had migrated from a region where no sugar was eaten to one in which they ate a diet including sugar.6 However, other factors, such as weight gain, may explain the increased risk of diabetes that occurred in this group.7 Other studies have found no independent relationship between sugar intake and the development of glucose intolerance.8
Eating carbohydrate-containing foods, whether high in sugar or high in starch (such as bread, potatoes, processed breakfast cereals, and rice), temporarily raises blood sugar and insulin levels.9 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).10 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.11 12 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.13 14 15 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.16 17 18 Currently, the American Diabetic Association (ADA) guidelines19 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.20
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.21 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,22 23 guar gum (found in beans),24 pectin (from fruit),25 oat bran,26 and glucomannan27 28 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.29 30 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.31 Nonetheless, 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.
Eating fish also may afford some protection from diabetes.32 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.33
Vegetarians have been reported to have a low risk of type 2 diabetes.34 When people with diabetic nerve damage switch to a vegan diet (no meat, dairy, or eggs), improvements have been reported after several days.35 In one trial, pain completely disappeared in 17 of 21 people.36 Fats from meat and dairy also contribute to heart disease, the leading killer of people with diabetes.
Vegetarians also eat less protein than do meat eaters. The reduction of protein intake has lowered kidney damage caused by diabetes37 38 and may also improve glucose tolerance.39 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 resulted in greater weight loss and control of insulin levels, compared with that of a low-carbohydrate diet.40 Switching to either a high- or low-protein diet should be discussed with a doctor.
Diets high in fat, especially saturated fat, worsen glucose tolerance and increase the risk of type 2 diabetes,41 42 43 44 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,45 46 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.48 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.
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.49 Countries with high milk consumption have a high risk of type 1 diabetes.50 Animal research also indicates that avoiding milk affords protection from type 1 diabetes.51 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.52 53 54 55 However, other studies have failed to find such a link.56 57 One study even reported a protective effect of higher intake of dairy products on diabetes risk in children.58 One reason for the conflicting results of the research may be that different genetic strains of cows’ milk protein (casein) are associated with different levels of risk.59 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.60
Immune problems in people with type 1 diabetes have been tied to other allergies as well,61 and the importance of focusing only on the avoidance of dairy products remains unclear.62 Preliminary studies have found that early introduction of cows’ milk formula feeding increases the risk of developing type 1 diabetes, although contradictory results have also been published.63 64 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.65 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.66
Lifestyle changes that may be helpful for diabetes
Most people with type 2 diabetes are overweight.67 Excess abdominal weight does not stop insulin formation,68 but it does make the body less sensitive to insulin.69 Excess weight can even make healthy people pre-diabetic.70 Weight loss reverses this problem.71 In most studies, type 2 diabetes has improved with weight loss.72 73 74
Increased weight gain in infancy has been associated with a one-and-a-half-fold increase in the risk of developing type 1 diabetes in childhood.75 Being overweight also increases the need for insulin. Therefore, people with type 1 diabetes should achieve and maintain appropriate body weight.
Exercise helps decrease body fat76 and improve insulin sensitivity.77 People who exercise are less likely to develop type 2 diabetes than those who do not.78 People with type 1 diabetes who exercise require less insulin.79 However, exercise can induce low blood sugar or even occasionally increased blood sugar.80 Moreover, a preliminary study has shown that long-term physical activity was not associated with control of blood glucose in people with type 1 diabetes.81 Therefore, people with diabetes should never begin an intensive exercise program without consulting a healthcare professional.
Moderate drinking in healthy people improves glucose tolerance.82 83 84 85 However, alcohol has been reported to worsen glucose tolerance in the elderly86 and in people with diabetes87 in some studies. People with diabetes who drink have also been reported to have a high risk for eye88 and nerve damage.89
Questions remain about where the line should be drawn regarding alcohol intake. For healthy people, light drinking will not increase the risk of diabetes, and may even reduce the risk of developing type 2 diabetes;90 however, heavy drinking does increase the risk of developing diabetes and should be avoided.91 People with diabetes should limit alcohol intake to two drinks per day. Total avoidance of alcohol in people with diabetes who are not suffering from alcoholism, liver disease (e.g., cirrhosis), gastritis, ulcers, and other conditions made worse by alcohol might actually be counterproductive. In one report, older people with type 2 diabetes who drank daily, but moderately, had a dramatically lower incidence of deaths from heart disease compared with nondrinkers.92 This outcome is not surprising since moderate alcohol intake is associated with protection from heart disease in most other reports. This finding may be of particular importance because heart disease is the leading killer of people with diabetes. In another study, nondrinkers had a higher incidence of type 2 diabetes than did moderate drinkers.93
People with diabetes who smoke are at higher risk for kidney damage,94 heart disease,95 and other diabetes-linked problems. Smokers are also more likely to develop diabetes;96 therefore, it is important to quit smoking.
Although most healthcare providers agree on the necessity of self-monitoring of blood glucose (SMBG) by people with type 1 diabetes, disagreement exists within the medical community regarding the efficacy and necessity of SMBG by people with type 2 diabetes. A controlled clinical trial found that home glucose monitoring strips did not affect the management of type 2 diabetes.97 Moreover, a review of available literature concluded that the efficacy of SMBG in people with type 2 diabetes is questionable and should be tested in a rigorous high-quality trial.98 Advocates of SMBG, such as the ADA, have observed that SMBG by people with diabetes has revolutionized management of the disease, enabling them to achieve and maintain specific goals.99 These observations are well-supported in the medical literature.100 Detractors point out that indiscriminate use of self-monitoring is of questionable value and adds enormously to healthcare costs.101 The ADA acknowledges that accuracy of SMBG is instrument- and technique-dependent. Errors in technique and inadequate use of control procedures have been shown to lead to inaccurate test results.102 Nevertheless, it is likely that self-monitoring of blood glucose, if used properly, can have a positive effect by increasing patient involvement in overall diabetes care.103 Pharmacists and healthcare practitioners can teach people with diabetes certain skills that will enhance their ability to properly self-manage blood glucose.
Nutritional supplements that may be helpful for diabetes
A variety of vitamins, minerals, amino acids, and other supplements may help with symptoms and deficiencies associated with diabetes.
Multiple Vitamin–Mineral Supplement
A few trials have reported no beneficial effects from chromium supplementation.117 118 119 All of these trials used 200 mcg or less of supplemental chromium, which is often not adequate for people with diabetes, especially if it is in a form that is poorly absorbed. 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.120 Many doctors recommend up to 1,000 mcg per day for people with diabetes.121
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.
Diabetes-induced damage to the eyes is more likely to occur in magnesium-deficient people with type 1 diabetes.130 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.131 The American Diabetes Association admits “strong associations...between magnesium deficiency and insulin resistance” but will not say magnesium deficiency is a risk factor.132 Many doctors, however, recommend that people with diabetes and normal kidney function supplement with 200–600 mg of magnesium per day.
Alpha lipoic acid
Evening primrose oil
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.156 Animal157 and preliminary human158 data indicate that vitamin E supplementation may protect against diabetic retinopathy and nephropathy, serious complications of diabetes involving the eyes and kidneys, respectively, though no long-term trials in humans have confirmed this preliminary evidence.
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,159 160 161 162 163 although not all,164 165 166 studies.
In one report, vitamin E was found to impair glucose tolerance in obese patients with diabetes.167 The reason for the discrepancy between reports is not known.
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.168
One study examined antioxidant supplement intake, including both vitamins E and C, and the incidence of diabetic retinopathy (damage to the eyes caused by diabetes).177 Surprisingly, people with extensive retinopathy had a greater likelihood of having taken vitamin C and vitamin E supplements. The outcome of this trial, however, does not fit with most other published data and might simply reflect the fact that sicker people are more likely to take supplements in hopes of getting better. For the present, most doctors remain relatively unconcerned about the unexpected outcome of this isolated report.
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%.187 Similar results have been reported using 9 mg per day for two months in people with type 2 diabetes.188 Biotin may also reduce pain from diabetic nerve damage.189 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.190 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.191 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.192 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.193 As a result, some doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the optimal level of intake remains unknown.
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.199 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.200 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.201 202 Smaller amounts (500–750 mg per day for one month followed by 250 mg per day) may help some people with type 2 diabetes,203 though this research remains preliminary.
Preliminary trials have shown that niacinamide (another form of vitamin B3) supplementation might be useful in the very early stages of type 1 diabetes,204 though not all trials support this claim.205 206 207 Although an analysis of research shows that niacinamide does help preserve some function of insulin-secreting cells in people recently diagnosed with type 1 diabetes, the amount of insulin required for those given niacinamide has remained essentially as high as for those given placebo.208 A controlled trial found no beneficial effect of niacinamide supplementation (700 mg three times per day in addition to intensive insulin therapy) on pancreatic function and glucose tolerance in people newly diagnosed with type 1 diabetes.209
Some,210 but not all,211 reports suggest that healthy children at high risk for type 1 diabetes (such as the healthy siblings of children with type 1 diabetes) may be protected from the disease by supplementing with niacinamide. Parents of children with type 1 diabetes should consult their doctor regarding niacinamide supplementation as a way to prevent diabetes in their other children. Although the optimal amount of niacinamide is not known, recent evidence suggests that 25 mg per 2.2 pounds of body weight per day may be as effective as higher amounts.212
Some doctors are concerned about having people with type 1 diabetes supplement with zinc because of a report that zinc supplementation increased glycosylation,218 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.
Until this issue is resolved, people with diabetes should feel free to increase their fish intake, but they should consult a doctor before taking fish oil supplements. Sometimes, such supplementation may be considered. 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.232
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.233 Clinical trials have yet to explore whether quercetin actually protects people with diabetes from neuropathy, nephropathy, or retinopathy.
Medium chain triglycerides
Are there any side effects or interactions with diabetes?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful for diabetes
olesterol by 13%, compared to a placebo.255
Are there any side effects or interactions with diabetes?
Refer to the individual herb for information about any side effects or interactions.
Holistic approaches that may be helpful for diabetes
Acupuncture may be helpful in the treatment of diabetes, or complications associated with diabetes. Preliminary trials have suggested that acupuncture can lower blood sugar282 283 284 and improve insulin production285 in people with type 2 diabetes, but trials on long-term effects have not been concluded. In a preliminary trial, 77% of people suffering from diabetic neuropathy experienced significant reduction in pain following up to six acupuncture treatments over a ten-week period. Many were also able to reduce pain medications, but no long-term change in blood-sugar control was observed.286 Bladder control problems, a complication of long-term diabetes, responded to acupuncture treatment with a significant reduction in symptoms in both controlled287 and uncontrolled288 trials.