Beauty Health for Life

The National Institutes of Health (NIH) National Center for Complimentary and Alternative Medicine (NCCAM) reviewed the safety and effectiveness of 6 dietary supplements commonly used by people with diabetes.

You can view their report here:
Research Report: Treating Type 2 Diabetes with Dietary Supplements

Its publication date is June 2005, so it may not lect the most recent findings for these supplements. Nonetheless, it provides a good overview of each supplement along with a summary of research findings.

The 6 supplements reviewed were:

Alpha-Lipoic Acid
Chromium
Coenzyme Q10
Garlic
Magnesium
Omega-3 Fatty Acids

The agencys recommendations, in short:

"The evidence that is available is not sufficiently strong to prove that any of the six supplements discussed in this report have benefits for type 2 diabetes or its complications."

"The six dietary supplements appear to be generally safe at low-to-moderate doses. However, each can interact with various prescription medications, affecting the action of the medications."

"Consult your health care provider before starting a supplement, especially if you are pregnant or nursing, or considering giving a supplement to a child."

Dietary supplements accounted for more than half the Class 1 drugs recalled by the U.S. Food and Drug Administration from 2004-12, meaning they contained substances that could cause serious health problems or even death, a new study from St. Michaels Hospital has found.

The majority of those recalled supplements were bodybuilding, weight loss or sexual enhancement products that contain unapproved medicinal ingredients, including steroids, said the studys lead author, Dr. Ziv Harel.

Almost one-quarter of the substances are manufactured outside of the United States, he said in the study published online in the journal JAMA Internal Medicine.

Unlike pharmaceutical products, dietary supplements do not require FDA approval before they can be sold. The FDA defines a dietary supplement as a product taken by mouth that contains a "dietary ingredient" such as vitamins, minerals, herbs, other botanicals, amino acids or substances such as metabolites. There are about 65,000 dietary supplements on the market consumed by more than 150 million Americans.

Of the 465 drugs subject to a Class 1 recall in the U.S. between Jan. 1, 2004, and Dec. 19, 2012, 237 or 51 per cent were dietary supplements. The majority of recalls occurred after 2008 for reasons unknown, the researchers said.

Supplements marketed as sexual enhancement products were the most commonly recalled dietary supplements (95, or 40 per cent).

Dr. Harel, a nephrologist whose research focus is patient safety, said that when the FDA learns of an adulterated dietary supplement, it is required to contact the manufacturer to trace the source of the product and initiate a recall. However, a recent investigation by the Office of the Inspector general determined that the FDA does not possess accurate contact information for 20 per cent of supplement manufacturers.

The FDA has recently introduced a number of initiatives aimed at mitigating the impact of the most common adulterated supplements, including the creation of multinational enforcement groups and widespread media campaigns focusing on improving awareness.

"Despite these initiatives, products subject to Class I recalls continue to be readily available for sale, which may be due to an increasingly complex distribution network associated with these products, as well as ineffective communication by the FDA to consumers," Dr. Harel said.

"We also found a number of recalled products to be manufactured outside of the U.S. where manufacturing practices may not be subject to the same oversight and regulation required of domestic companies."

Dr. Harel said increased efforts are needed to regulate this industry. "Keeping the status quo may taint the dietary supplement industry as a whole."

It isnt just carbohydrates people with diabetes need to be vigilant about. Its the fat too.

A new study from the Joslin Clinic in Boston found that patients with type 1 diabetes required more insulin coverage for a higher-fat meal compared to a lower-fat meal. The meals were prepared in the Clinics kitchen and had identical carbohydrate and protein, but different fat content - 60 grams vs. 10 grams. The carbohydrates in the meals had similar glycemic indexes.

Dietary Fat Acutely Increases Glucose Concentrations and Insulin Requirements in Patients With Type 1 Diabetes, Diabetes Care, April 2013

It was a small study of crossover design, meaning each participant consumed both the high-fat meal and the low-fat meal.

"RESULTS Seven patients with type 1 diabetes (age, 55 ± 12 years; A1C 7.2 ± 0.8%) successfully completed the protocol. [The high-fat] dinner required more insulin than [the low-fat] dinner (12.6 ± 1.9 units vs. 9.0 ± 1.3 units; P = 0.01) and, despite the additional insulin, caused more hyperglycemia.

CONCLUSIONS This evidence that dietary fat increases glucose levels and insulin requirements highlights the limitations of the current carbohydrate-based approach to bolus dose calculation. These findings point to the need for alternative insulin dosing algorithms for higher-fat meals and suggest that dietary fat intake is an important nutritional consideration for glycemic control in individuals with type 1 diabetes."

Joslin accompanied their study with this short video:

"When people ate a higher fat meal, their blood sugars were higher for longer and required more insulin."

Why does dietary fat lead to higher blood glucose? It is thought that fat contributes to insulin resistance:

"Dietary fat and free fatty acids (FFAs) are known to impair insulin sensitivity and to enhance hepatic glucose production. ... Interventions that lower [free fatty acid] levels in nondiabetic and type 2 diabetic individuals lead to both improved insulin sensitivity and glucose tolerance."

Saturated fat may be more problematic:

"Studies in nondiabetic individuals indicate that saturated fats cause more profound insulin resistance than monounsaturated and polyunsaturated fats. By design, the [high-fat] dinner meal in the current study was predominantly saturated fat."

And:

"Pizza is widely recognized to cause marked late postprandial hyperglycemia in patients with type 1 diabetes."

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Vitamin D supplement potency varies widely, and the amount of vitamin D in over-the-counter and compounded supplements does not necessarily match the amount listed on the label, according to a research letter published in the journal JAMA Internal Medicine.

The analysis showed that the amount of vitamin D in these supplements ranged from 9 percent to 146 percent of the amount listed on the label. Not only was there variation among different brands and manufacturers, but also among different pills from the same bottle.

"We were surprised by the variation in potency among these vitamin D pills," says Erin S. LeBlanc, MD, MPH, lead author and investigator with the Kaiser Permanente Center for Health Research in Portland, Ore. "The biggest worry is for someone who has low levels of vitamin D in their blood. If they are consistently taking a supplement with little vitamin D in it, they could face health risks."

According to a recent editorial in the New England Journal of Medicine, more than 100 million Americans spend a combined $28 billion on vitamins, herbs and supplements each year. The U.S. Food and Drug Administration is considering new safety guidelines for some supplements but, for the most part, the industry remains unregulated.

Some manufacturers participate in a voluntary quality verification program operated by the U.S. Pharmacopeial Convention -- an independent, nonprofit organization that sets public standards for the quality of dietary supplements. In order to receive the USP verification mark, manufacturers facilities undergo annual good manufacturing-practice audits, and their products are tested for quality, potency and purity. Dr. LeBlanc and her colleagues included one supplement from a USP Verified manufacturer in their sample. They found the amount of vitamin D in pills from that bottle was generally more accurate than the other bottles tested.

"The USP verification mark may give consumers some reassurance that the amount of vitamin D in those pills is close to the amount listed on the label," said Dr. LeBlanc. "There are not many manufacturers that have the USP mark, but it may be worth the extra effort to look for it."