Kim A. Carmichael, M.D., FACP Associate Professor of Medicine, often sends his patients to the OTC or vitamin aisles of stores for help with diabetes. He has decided to share the info, so we can tell our patients Click here to read Diabetes: What Can Your Local OTC And Health Store Do For You?
Diabetes: What Can Your Local OTC And Health Store Do For You?
Kim A. Carmichael, M.D., FACP Associate Professor of Medicine
Division of Endocirnology, Metabolism and Lipid Research
Washington University, St. Louis, Missouri
Today, diabetics have numerous types of treatment options including multiple classes of oral agents, injectables, infusion pumps and inhaled insulin. Whereas all of these have a valuable role in the management (and sometimes prevention) of diabetes, the benefits, as well as the myths, of many items found in the neighborhood store should not be overlooked.
While the American Diabetes Association recommends aspirin (75-162 mg/day) for those 21 years of age or older for both primary and secondary prevention of cardiovascular disease, it is of even greater importance for those more than 40 years old or those with additional risk factors such as hypertension, obesity, dyslipidemia, smoking or proteinuria. (1) However, mixing aspirin with ibuprofen may counteract much of the cardiovascular benefit of aspirin therapy (2).
Management of hyperlipidemia in diabetics requires diet, exercise and often medication therapy. However, several easily obtainable OTC items assist with lipid management. Psyllium fiber helps to reduce both total cholesterol and LDL-cholesterol (3). Fish oil supplements, containing very long-chain n-3 polyunsaturated fatty acids, may lower plasma triglyceride levels and reduce adverse cardiovascular events. In addition, two or more servings of fish per week (excluding fried fish fillets) will likely provide even greater benefit if substituted for high-saturated fat-containing foods.
Vitamin D deficiency occurs in approximately 61% of those with type 2 diabetes, 43% of those with type 1, and has a strong inverse correlation with cardiovascular disease (4). Low vitamin D levels (20 ng/mL) are associated with insulin resistance and beta-cell dysfunction (5). Vitamin D replacement therapy may necessitate a prescription and should be discussed with a physician. However, maintenance therapy of 800-1200 IU is generally safe and may be obtained with a multiple vitamins, calcium with D preparations or a Vitamin D supplement daily. It is important to check the supplement/multivitamin
preparation used to ensure that it contains the recommended dose.
Alpha-lipoic acid (ALA) is readily available in most stores and is often beneficial in the management of symptoms of diabetic neuropathy. In a large, randomized multi-center trial those taking ALA 600 mg daily had a 51% decrease in total symptom scores after 5 weeks, compared to only a 32% reduction in the placebo groups (6). No additional benefits were noted at higher doses.
General multiple vitamin supplements may be necessary for pregnant or lactating women, the elderly, strict vegetarians and individuals on calorie-restricted diets. Therapy with either vitamin C or E, although commonly used, has no proven efficacy and there are concerns regarding long-term safety. For example, vitamin C could cause problems for persons with urate (gout) kidney stones and vitamin E could counteract the beneficial effects of statins used to treat high cholesterol. Although chromium and zinc deficiencies are associated with carbohydrate intolerance, nutritional supplementation has not been shown to be effective when these deficiencies do not exist (7). ugar alcohols and nonnutritive sweeteners are considered to be acceptable as long as they are consumed
within quantity limits established by the Food and Drug Administration
Ginseng may reduce postprandial glucose levels in persons with diabetes, but there is no consistent efficacy and there is wide variation in the types and concentrations available (8). This lack of uniformity could cause erratic, and potentially dangerous, fluctuations in blood glucose levels. Without solid scientific documentation of consistent benefit, it should be avoided.
Finally, remember that there are many ways to improve diabetic control without spending a great deal of money. On a nice day walk to the store rather than driving. When driving, park farther away and get the benefit of a little extra exercise. Eating healthy food, drinking plenty of water and integrating exercise into the daily routine will improve blood glucose control as well as the lives of diabetics.
- American Diabetes Association. Standards of Medical Care in Diabetes – 2007. Diabetes Care 2007;30(Suppl 1):S4-41.
- Farkouh ME. Cardiovascular outcomes in high-risk patients with osteoarthritis treated with Ibuprofen, Naproxen or Lumiracoxib. Ann Rheum Dis 2007; 000:1-7.
- Shrestha S.et al. A combination therapy including psyllium and plant sterols lowers LDL cholesterol by modifying lipoprotein metabolism in hypercholesterolemic individuals. J Nutr 2006;136:2492-7.
- Cigolini M et al. Serum 25-hydroxyvitamin D3 concentrations and prevalence of cardiovascular disease among type 2 diabetic patients. Diab Care 2006;29:722-4.
- Chiu KC et al. Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr 2004;79:820-25.
- Ziegler D et al. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy. Diabetes Care 2006;29:2365-70.
- American Diabetes Association. Nutrition Recommendations and interventions for diabetes. Diabetes Care 2007;30(Suppl 1):S48-65.
- Vuksan V et al. Herbal remedies in the management of diabetes: Lessons learned from the study of ginseng. Nutr Metabol Cardiovasc Dis 2005;15:149-60.