By William C. Haas III, MD, MBA, Integrative Medicine Fellow, Department of Family and Community Medicine, University of Arizona, Tucson
Type 2 diabetes mellitus (T2DM), typified by resistance to insulin and malfunction of pancreatic cells, remains a global health concern, with over 400 million people predicted to be impacted by the disease by 2030.In spite of progression in treatment options for T2DM, reaching ideal glycemic control remains a goal that necessitates novel breakthroughs in the management and prevention of type 2 diabetes mellitus in order to improve the provisions of patient-oriented care
Patients with diabetes typically experiment with supplementary and integrated treatments, often independent of their medical providers’ knowledge. Some studies have found that type-2 diabetic patients are more than 60% more likely to turn to alternative or complementary treatment regimens when compared with the normal population. Among the many alternative methods reported, micronutrient and botanic supplements tend to place as the most commonly chosen.
Zeroing in on the roles micronutrients play in the management of type 2 diabetes, the first half of this two-part review aims to establish which micronutrient treatments may prove effective and which consumers should avoid. Micronutrients like minerals and vitamins are essential parts of many bodily functions—glucose metabolism and insulin production being especially notable. Chronic hyperglycemia has unfortunately been proven to disrupt glucose metabolism by substantially lowering the body’s count of several micronutrients. Researchers have observed the results of these supplementary micronutrient treatments to analyze each supplement’s efficacy. Abbreviated appraisals of commonly encountered supplementary treatments are provided below.
Alpha Lipoic Acid (ALA) is a naturally occurring compound found in trace amounts in both vegetables and organ meats. As opposed to other supplements studied, ALA is primarily used during the treatment of painful diabetic neuropathy. ALA has withstood significant scrutiny in both its oral and IV forms, and the positive findings of the initial ALADIN and SYDNEY studies have been supported by more recent studies like the SYNDEY2 and the ALADIN 4 year-double blind study. Though unconfirmed, ALA’s mechanism for relieving neuropathic pain is likely related to the reduction of oxidative stress and improvement of nerve blood flow ALA may contribute to. Taking ALA orally is the most accessible and convenient method of treatment, and the optimal dose appears to be around 600 mg per day. At doses more than double the reported optimal dose, patients noted experiencing nausea, vomiting and vertigo, and most commonly heart rate abnormalities. With the cost of a 1-month supply of 600 mg between $25-40, proper and moderated use of ALA may be an effective supplement to reduce diabetic pain.
Chromium was initially discovered in baker’s yeast and is most commonly found in trace amounts of its trivalent form. There are reports that drastic deficiencies in chromium can lead to reversible insulin resistance and even T2DM. Under further review, these reports may hold less merit than once thought. Though chromium is widely hailed for its capability to improve glycemic control, the evidence supporting its tangible benefits for the treatment of diabetes is scant at best. The initial study and its subsequent meta-analysis that both seemed to support chromium’s positive effects have since been lambasted for poor methodology. Other recent meta-analyses have further obfuscated medical understanding of chromium’s effects on T2DM by reaching an array of differing conclusions. At present, the prudent recommendation would be to dissuade T2DM patients from purchasing chromium supplements as their benefits are suspect. If patients are insistent on chromium usage, they are urged to not take doses higher than 1200 mcg per day, as doses in this level have returned reports of abdominal discomfort, bloating and of greater concern, renal failure.
As the average person tends not to take in adequate amounts of magnesium, proper magnesium intake is likely a protective factor against developing T2DM. Inadequate dietary intake of magnesium has even been correlated with increased risk for diabetes mellitus, with a 15-year prospective cohorts study finding that healthy magnesium levels offered significant protection against T2DM. Currently, however, there simply is no substantial evidence to suggest that magnesium supplementation is beneficial to the treatment of diabetes. Perhaps the most effective regimen entails forgoing supplement use altogether, instead focusing on a diet that comprises many magnesium rich foods like green vegetable, fish, and nuts—all foods with other, holistic health benefits. If patients truly wish to supplement magnesium beyond sources from food, a regimen starting at approximately 100 mg daily that works gradually towards 300-600 mg daily is common. Patients should be wary of higher doses as they may cause diarrhea.
Vitamin D is a fat-soluble vitamin that occasionally functions as a hormone in certain areas of the body. Best known for its involvement with calcium metabolism and osseous growth, vitamin D has also been shown to negatively associate with certain extra-skeletal diseases including T2DM. Despite the belief that vitamin D regulates insulin receptor expression and even stimulates insulin release from pancreatic B-cells, evidence, again, does not support supplementation as an effective method for combating or preventing the disease. This recommendation could change as certain variables become clearer, but presently diabetics are advised to not supplement with vitamin D for the sole purpose of enhancing glycemic control. For non-diabetics and diabetics taking vitamin D for other reasons, supplementation should avoid exceedingly high doses as those have led to in rare instances hypercalcemia.
Zinc is an essential mineral responsible for a multitude of cellular and enzymatic processes and functions also as an antioxidant and anti-inflammatory. Moreover, zinc is integral to the synthesis, storage and release of insulin. Studies have shown that the common zinc deficiency in diabetic patients is likely part of a symptomatic and causal relationship: zinc deficiency increases risk for diabetes while diabetes hinders zinc metabolism.
Though isolated studies have examined zinc’s effects on diabetic peripheral neuropathy, the majority of research into the mineral has centered on glucose control. Separate meta-analyses have demonstrated that zinc therapy not only has significant glycemic benefits for current diabetics but also can relieve peripheral neuropathy; however, a 2015 Cochrane review determined that zinc supplementation was not an effective preventative measure for type 2 diabetes. Therefore, zinc can to some extent be seen as a reasonable supplement to alieve certain aspects of diabetic patients’ burden. The most common dosage for zinc therapy was 30 mg of zinc sulphate per day, and though zinc is typically well tolerated, reported side-effects included metallic taste, nausea and vomiting.
Although there is increasing evidence that patients with T2DM are likely to have multiple vitamin and mineral deficiencies, these deficits’ effect on the progression of the disease is rarely concrete. A growing interest among type two diabetics in micronutrient supplements has necessitates expanded research into the field. Current evidence most significantly supports usage of zinc in regulating glycemic levels, while chromium supplements have produced less steady results. Magnesium and vitamin D may play roles in the prevention of T2DM but neither is likely to play strong roles in the active management of the disease. The magnitude of their direct effects on diabetes, however, does not in any way lessen the importance of adequately taking in these nutrients as a byproduct of a healthy diet. Lastly, alpha-lipoic acid offers a promising alternative to suffering through peripheral neuropathy. These general conclusions should be considered, but clinicians should also strongly consider that the existing body of evidence in this field remains limited due to the relative novelty of the field and the significant heterogeneity amongst the patient population. As patients with diabetes continue to explore additional and supplementary treatment options, monitoring the evolving research landscape will remain vital to ensuring the safety and health of T2DM patients.