Highly Recommended Nutraceuticals

Nutritional supplements are very important for diabetics, for several reasons. Many of our foods are now grown in nutrient depleted soils because of current intensive farming practices. Even organic foods are not as nutrient-rich as they were years ago. In addition, our modern high-sugar diet strips our food of vital nutrients during processing. The digestive system of diabetics is also compromised, making it difficult to absorb nutrients even if they are eaten in adequate amounts.
     To compensate, diabetics need to supplement their diets with key micronutrients. The better nourished our bodies, the greater possibility of avoiding the harmful cascading effects from long-term diabetes that show up as cardiovascular disease, heart disease, kidney damage, nerve damage, and other chronic conditions. Taking nutritional supplements may be seen as a form of additional insurance against these devastating diseases.

Highly Recommended Nutraceuticals

Based on the most current research, the following medicinal nutrients, or nutraceuticals, are highly recommended for diabetics. Chromium and vanadium, for example, are crucial in any attempt at controlling blood sugar levels. In these cases, the research is quite extensive. However, these supplements alone will not attain the goals of controlling blood sugar and avoiding further tissue damage and complications without dietary and lifestyle modifications aimed at controlling blood sugar levels.

Chromium 

Background
Chromium exists in three forms: metallic chromium or chromium ‘0’, which has no activity nutritionally; chromium VI, which is used in the chemical and welding industries; and chromium III, which is found in foods and supplements. Chromium III is an essential trace element in human nutrition. It was discovered in 1929 that brewer’s yeast (which is high in chromium) increased the blood sugar lowering effects of insulin therapy. Deficiency of chromium has since been linked to a number of disorders, including decreased glucose tolerance and Type II diabetes. In fact, chromium has been found to be a component of a molecule known as GTF (glucose tolerance factor), which promotes insulin sensitivity.
     A number of human cases have now been documented in which parenteral nutrition (feeding with a tube) has resulted in low chromium levels, high blood sugar levels, and even diabetic complications. Research has shown that chromium supplementation at 250 ug/day reversed these problems.

Clinical Studies
Blood Sugar and Insulin Control

A number of studies have demonstrated that chromium is effective in treating both types of diabetes. One controlled study of 180 Type II diabetics involved random supplementation of placebo 200 mcg or 1000 mcg of chromium as picolinate every day or a period of 4 months. Fasting and 2-hour glucose levels (after glucose challenge) were measured. At 2 months and 4 months, these levels decreased significantly in the 1000 mcg group, while the 200 mcg group had no significant drop. As well, after 4 months, nearly all of the diabetes patients in the higher dose group no longer had traditional signs and symptoms of diabetes. Their blood sugar and insulin levels dropped to near normal -- something that pharmaceutical medications rarely achieve. The 1000 mcg dosage also led to a significant decrease in average blood sugar levels to normal or near normal levels (as measured by the gold standard test known as HbA1c) and cholesterol levels after the 2 months of treatment, which was not seen in the group receiving the lower dose.
     In another study, 162 diabetics (48 type 1 diabetes, 114 type 2) were given 200 mcg/day of chromium picolinate daily. Seventy-one percent of the Type I patients responded positively, allowing an overall 30% decrease of their insulin dose. This study shows that even those diabetics who inject insulin and/or are in the later stages of diabetes respond positively to chromium supplementation. Many diabetics have trouble with good blood sugar control; in this study, blood sugar control also responded positively, improving as soon as quickly as 10 days after the beginning of treatment.
     The chronic use of corticosteroids can result in high blood sugar levels and insulin imbalances. Chromium supplementation was investigated in patients with diabetes caused by the therapeutic use of these medications. At a dose of 600 mcg/day, chromium picolinate was effective in lowering blood glucose from an average of 13.9 mM/L to 8.3 mM/L in 47 of 50 patients. Patients were also able to reduce insulin and/or hypoglycemic medications by half within 1 week of beginning chromium supplementation.

Gestational Diabetes
Gestational diabetes is the most common problem complicating pregnancy today, affecting an estimated 135,000 women. This condition poses a risk to both the mother and the infant, as high levels of blood sugar in the pregnant woman cross the placenta, triggering the beginnings of insulin resistance in the womb. The child is then predisposed to be overweight and develop insulin resistance later in life. If the child is female, she is more likely to develop gestational diabetes during her own pregnancy. Pregnancy is a state of chromium wasting, so it seems logical that intake should be increased during pregnancy. Most prenatal vitamins, unfortunately, contain no or little chromium.
     In a trial of 20 women with gestational diabetes mellitus, the effect of chromium supplementation was investigated. The women were given either 4 mcg/kg body weight or 8 mcg/kg body weight of chromium picolinate supplement or placebo. After 8 weeks, those who were given chromium supplements had significantly lower fasting glucose and insulin levels compared with their own baseline levels and with the placebo group. The 8 mcg/kg/day group had significantly lower postprandial (after meal) glucose levels than the 4 mcg/kg group.
     It has been postulated that nutritional chromium levels may be depleted in women who develop GDM. In one study, hair chromium concentrations were measured in normal and diabetic pregnant women by atomic-absorption spectroscopy. Fifty-two women had a second hair sample taken later during pregnancy that showed a significant decrease in hair chromium levels. However, this decrease was confirmed only for the diabetic pregnant group. It was suggested that impaired utilization of chromium may be a possible cause of gestational diabetes mellitus.
     The utility of chromium therapy in the treatment of gestation diabetes has also been studied. A dose of 8 mcg/kg/day (or 600ug/day for a 75kg woman), 4 mcg/kg/day, or placebo was given to gestational diabetic women. At baseline, the three groups did not differ for insulin, C-peptide, or glucose levels at the fasting and 1-hour time point after the 100 g oral glucose challenge test. After 8 weeks, the two chromium-supplemented groups had significantly lower glucose and insulin levels compared to their baseline levels and to those of the placebo group. The 8 mcg chromium group had significantly lower postprandial glucose levels than the 4 mcg chromium group. The authors concluded that chromium supplementation for gestational diabetic women improves glucose intolerance and lowers hyperinsulinemia.

Doseage
Chromium helps insulin work more efficiently to allow blood glucose to move from the blood into the cells. The Recommended Daily Allowance (RDA) for chromium is 50 to 200 mcg of chromium per day. This may be reasonable for the average healthy person with no personal or family history of diabetes, but higher amounts are likely needed for people with conditions involving insulin resistance and control problems, such as Type II diabetes or Type I diabetes.
     Type II diabetes patients who have taken 200 mcg per day of chromium have had some improvement in their condition in the longer term, but not the faster and more pronounced results in those who have taken 1000 mcg per day. Add to this is the fact that the majority of North Americans do not get the minimum RDI of chromium from their diets and it becomes apparent that lack of chromium may be contributing to the epidemic of diabetes. The amount of chromium people need varies depending on the types of food eaten and their state of health. Patients with Type II diabetes and insulin resistance/syndrome X have greater excretion of chromium, lower tissue levels of chromium, and less of an ability to utilize it in the body.
The U.S. Environmental Protection Agency (EPA) has calculated an RfD for chromium (III) at 70 mg per day (note this is “mg,” 1000X more than “mcg”). The RfD is “an estimate of a daily oral exposure to the human population (including sensitive subgroups) that is likely to be without an appreciable risk of deleterious effects during a lifetime.” This RfD reflects a staggering 350 times the RDI of 50 to 200 mcg. The ratio of RfD to ESADDI is less than 2 for zinc, about 2 for manganese, and about 6 for selenium, as compared to 350 for chromium. This suggests dietary supplementation of chromium may be greatly underdosed. Based on the fact that short-term chromium supplementation of 1000mcg/day was found safe and effective in a number of scientific studies, this seems like a reasonable starting dose for diabetics and those with insulin resistance. Chromium therapy should only be undertaken with the guidance of a healthcare practitioner familiar with its use.


Safety and Side Effects
Toxicity of chromium has been almost exclusively linked to the chromium VI (hexavalent) form. Nutritional chromium (III) is found naturally in many foods, including meats, fish, whole grains, nuts, seeds, romaine lettuce, tomatoes, onions, and brewer’s yeast. Nutritional supplements are available in various complexed forms, such as picolinate, polynicotinate, and citrate. The use of 1000 mcg/day chromium as picolinate in 180 Type II diabetic patients for a period of 4 months showed no toxic reactions in any of the patients. Furthermore, no toxicity has been reported clinically in doses up to 5000 mcg/day of chromium nicotinate.