I recently carried out a survey among physicians working with diabetic patients: I wanted to know how comprehensive their treatments were. To my surprise, all of them focused treatment on strict blood glucose control using either only drug therapy or a combination of drugs and dietary changes. Unfortunately, this simplified approach not only fails to address the damage diabetes causes, but it can actually hasten the progression of diabetes. Keep reading to find out what vitamins are crucial for optimal diabetes management and why people with diabetes need them.
Before I get started, please keep in mind that I am not implying you should run to the nearest health store and buy all the following vitamins. I usually advise my patients to try and get all the nutrients their body needs from REAL foods while ensuring their digestive tract is working optimally.
Why do diabetic patients need more vitamins?
The first reason is that diabetes is a nutritional wasting disease – when blood glucose (sugar) levels are high, they act as a diuretic. This causes excessive urination which washes out loads of nutrients including antioxidants, vitamins and minerals such as magnesium and zinc. Simply drinking more water won’t help replace the water-soluble nutrients that were lost.
Another reason is glycation, a process in which glucose molecules react with proteins in the body – this damages the protein turning them into nonfunctional structures called advanced glycation end products (AGEs). Unfortunately, although glycation is a key-feature of diabetes-related complications such as blindness, heart attack and nerve damage, it does not figure in conventional treatment for diabetes. You’ve probably heard of glycated hemoglobin (HbA1c), a well-known AGE among diabetics. Well, HbA1c is formed when glucose molecules in the blood attach to hemoglobin – measuring your HbA1c will give you a picture of the extent to which your hemoglobin is exposed to glucose (that is, how controlled your blood glucose levels are.)
The third reason is that diabetes causes a lot of oxidative stress – elevated blood glucose levels and glycation produce free radicals that further damage proteins in your body while reducing levels of nitric oxide. Since the arteries are kept relaxed and wide open by nitric oxide, high levels of free radicals adversely affect arteries throughout the body. This can pave the way for numerous complications and is the reason why individuals suffering from diabetes face higher risks of atherosclerosis (the hardening of arteries), heart disease and heart attacks.
[color-box color=”main”]Take home message: Diabetes promotes nutrient losses in the urine and leads to glycation and oxidation which significantly increase the risks of diabetic complication.[/color-box]
So, why won’t strict blood glucose control solve this issue?
Although maintaining optimal blood glucose levels will help reduce urinary losses of micronutrients and decrease the stress induced by diabetes, doing so does not eliminate these issues. You see, individuals suffering from diabetes often face regular periods of high blood glucose levels even if their overall blood glucose control is good. Unfortunately, most conventional physicians miss that point.
In a nutshell, how can vitamins protect against diabetic complications?
A diet naturally rich in vitamins and minerals can help reduce glycation and oxidative stress while toning down inflammation. In fact, a large human trial showed that for each 1 percent reduction in HbA1c, there was:
- A 37 percent reduction in microvascular complications which affect small blood vessels in the eyes, nerves and kidneys.
- A 21 percent decrease in risk for any complication of diabetes.
- A 21 percent decline in deaths linked to diabetes.
- A 14 percent reduction in heart attack.
[color-box color=”main”]Take home message: Correcting urinary micronutrient losses, even after diabetic complications have already happened, can often tone down these complications and avert future occurrences. [/color-box]
The truth about Type 2 diabetes (and why you need to rethink your treatment).
Most of the patients who work with me to manage their diabetes are told that they need to boost their insulin levels. They are even prescribed drugs such as sulfonylureas to boost their insulin levels in the early stages of the disease. The (flawed) assumption is that the extra insulin will help drive the glucose in the blood into the cells – this would then lower blood glucose levels. However, the issue is that, in the early stages of diabetes, insulin levels are already high since the problem is not with insulin production.
Rather, there is an issue with insulin utilization. You see, our cell membranes have insulin receptors – in people with type 2 diabetes, these receptors are less responsive to the insulin. As such, less glucose is absorbed from the bloodstream and glucose levels slowly rise.
Our body responds to this increase in blood glucose by prompting the pancreas (an organ) to produce more insulin in order to regulate glucose levels. While this can help successfully drive blood glucose into cells and reduce blood glucose levels, this short-term fix also speeds up the progression of the disease. That’s because, eventually, the delicate insulin receptors become less sensitive, leading to insulin resistance, a condition which forces the pancreas to produce even more insulin to normalize blood glucose levels. As the disease progresses, the pancreas ‘burn out’ and can no longer produce enough insulin, causing insulin levels to plummet below normal and allowing blood glucose to increase even more and inflict greater damage.
If you want to know more about what’s really causing diabetes and what to do about it, check out the following speech by Dr. Sarah Hallberg.
[color-box color=”main”]Take home message: Preventing or correcting insulin resistance will help protect you against numerous complications of diabetes.[/color-box]
Vitamins that can help protect against diabetes’ devastating effects.
Besides being involved in the utilization of protein, fats and carbohydrates, biotin also improves insulin sensitivity which, as discussed earlier, dwindles as diabetes progresses, leading to increased risks for diabetic complications. Biotin also increases the activity of glucokinase, an enzyme in charge of glucose utilization by the liver – diabetics often have low levels of glucokinase. Moreover, biotin can help reduce pain induced by diabetic nerve damage.
What research indicates:
- Compared to non-diabetic individuals, those suffering from diabetes are more likely to have low serum biotin levels.
- Supplementing biotin can help reduce triglyceride levels in both diabetic and non-diabetic individuals.
- Daily supplementation with biotin showed mixed results in terms of changes in blood glucose concentrations.
Recommended dietary intake: 30µg per day
Supplement: 300µg per day
- 1/2 cup peanuts: 73µg
- 3oz liver, cooked: 27 – 35µg
- 1/2 cup almonds: 34µg
- 2 tablespoons unsweetened, natural peanut butter: 32µg
- 1 large egg, cooked: 13 – 25µg
- 1/2 cup sweet potatoes: 6µg
- 3oz salmon, cooked: 4 – 5µg
- 1 whole avocado: 2 – 6µg
- 1 banana: 3µg
- 3oz tuna, cooked: 3µg
[color-box color=”main”]Cooking advice: Biotin is very sensitive to heat which is why many traditional cultures consumed some of their meats raw or fermented. If you’re not a fan of raw or fermented foods, try cooking your eggs, liver or salmon on low heat.[/color-box]
Factors that decrease biotin levels in the body:
- Raw egg whites contain avidin which can bind to biotin in the intestines preventing it from being absorbed. Eating 2 or more uncooked egg whites per day for several months may cause a serious biotin deficiency.
- Anti-seizure drugs
- Taking antibiotics for an extended period of time (especially if no probiotics are taken concurrently) can reduce the production of biotin by bacteria.
Tips to boost the effect of biotin:
- Consider consuming biotin-rich foods with chromium-rich foods such as meat, chicken, liver, eggs, fresh vegetables, mushrooms, broccoli and herbs.
- Consume fermented foods on a daily basis (about 1 tablespoon of sauerkraut or a few tablespoons of kefir) or take a quality probiotic.
2. Vitamin B6, folate and vitamin B12
These three B-vitamins help lower levels of homocsyteine which, if allowed to accumulate in the body, can increase risks for heart disease, stroke and several other health conditions. Moreover, both vitamin B6 and vitamin B12 support nerve health, which is essential for preventing conditions like diabetic neuropathy (a form of nerve damage). Low levels of vitamin B6 have also been linked to glucose intolerance.
You’ll notice that I mentioned folate and not folic acid – no, these two are not the same: folate is the natural form of vitamin B9 whereas folic acid is its synthetic form. ‘So what?’ you may wonder. Well, because of the way it is processed in the body, a high intake folic acid from fortified food products could lead to increased cancer risks.
Recommended dietary intake: 1.5 – 1.7mg per day (higher levels for individuals aged 51 and above)
Supplement: 50 – 100mg per day
Selected food sources:
- 1 cup chickpeas, cooked: 1.1mg
- 3oz beef liver, pan fried: 0.9mg
- 3oz yellowfin tuna, fresh: 0.9mg
- 3oz sockeye salmon, cooked: 0.6mg
- 3oz chicken breast, roasted: 0.5mg
- 3oz turkey, meat only, roasted: 0.4mg
- 1 medium banana: 0.4mg
- 3oz ground beef, 85% lean: 0.3mg
- 1/2 cup winter squash, baked: 0.2mg
- 1oz mixed nuts, dry-roasted: 0.1mg
- 1/2 cup spinach: 0.1mg
- 1 cup watermelon: 0.1mg
Recommended dietary intake: 400 – 600µg per day (higher levels for pregnant ladies)
Supplement: 1,000µg per day
Selected food sources:
- 3oz beef liver, cooked: 215µg
- 1/2 cup spinach, cooked: 131µg
- 1/2 cup black-eyed peas, cooked: 105µg
- 4 spears asparagus: 89µg
- 1/2 cup Brussels sprouts: 78µg
- 1 cup lettuce: 64µg
- 1/2 cup avocado: 59µg
- 1/2 cup broccoli, cooked: 52µg
- 1/2 cup mustard greens, cooked: 52µg
- 1/2 cup kidney beans: 46µg
- 1oz peanuts, dry roasted: 41µg
- 3oz Dungeness crab: 36µg
- 1/2 cup turnip greens: 32µg
- 1 small orange: 29µg
- 1/2 cup papaya: 27µg
- 1 medium banana: 24µg
- 1 large egg: 22µg
- 3oz halibut, cooked: 12µg
- 3oz ground beef, 85% lean: 7µg
Note: If you intend to take a folate supplement, look for a product that lists “5-methyltetrahydrofolate” or “5-MTHF” on the label and avoid those containing folic acid.
Recommended dietary intake: 2.4 -2.8µg per day (higher levels for pregnant ladies)
Supplement: 100µg per day
Selected food sources:
- 3oz clams, cooked: 84.1µg
- 3oz beef liver, cooked: 70.7µg
- 3oz wild trout, cooked: 5.4µg
- 3oz sockeye salmon, cooked: 4.8µg
- 3oz tuna: 2.5µg
- 3oz beef, top sirloin: 1.4µg
- 1 whole egg: 0.6µg
- 3oz chicken breast: 0.3µg
[color-box color=”main”]Caution: If you opt to take these B-vitamins in supplement form, be careful to avoid high doses as these could have adverse effects especially in cases of advanced diabetic nephropathy. [/color-box]
3. Vitamin C
Studies indicate that vitamin C can improve eye health by improving the antioxidant capacity of the eye. This vitamin also reduces glycation. As such, vitamin C can help slow down diabetes progression.
As an antioxidant vitamin, vitamin C can considerably decrease inflammation in patients with both diabetes and coronary artery disease. Along with other nutrients, vitamin C is able to enhance blood vessel elasticity and blood flow thus improving blood pressure in people with diabetes.
Recommended dietary intake: 75 – 90mg per day (higher levels for pregnant ladies)
Supplement: 1,000mg per day
Selected food sources:
- 1/2 cup red pepper, raw: 95mg
- 1 medium orange: 70mg
- 1 medium kiwifruit: 64mg
- 1/2 cup green pepper, raw: 60mg
- 1/2 cup broccoli, cooked: 51mg
- 1/2 cup strawberries, fresh: 49mg
- 1/2 cup Brussels sprouts, cooked: 48mg
- 1/2 cup papaya (1” pieces): 44mg
- 1/2 medium grapefruit: 39mg
- 1/2 cup cantaloupe: 29mg
- 1/2 cup cabbage, cooked: 28mg
- 1/2 cup cauliflower, raw: 26mg
- 1 medium tomato, raw: 17mg
- 1/2 cup spinach, cooked: 9mg
4. Vitamin D
Besides promoting bone health, the sunshine vitamin also modulates the immune system in such a way that it can help avert type 1 diabetes. Studies suggest that, early in life, vitamin D is able to limit the expression of certain cytokines (small proteins involved in cell signaling) – this seems to prevent the autoimmune attack on the cells of the pancreas thus protecting against diabetes type 1.
Individuals experiencing a loss of insulin sensitivity may also benefit from vitamin D which appears to preserve our cell’s sensitivity to insulin. This can reduce the progression to full blown diabetes type 2 and may also protect against the metabolic syndrome, a cluster of risk factors that increase the risk of heart disease and stroke.
Recommended dietary intake: 2,000 IUs per day
Supplement: 2,000 – 5,000 IUs per day (as cholecalciferol or D3)
Selected food sources:
- Cod liver oil, 1 tablespoon: 1,360 IUs
- 3oz herring: 667 IUs
- 3oz swordfish, cooked: 566 IUs
- 3oz sockeye salmon, cooked: 447 IUs
- 3oz tuna fish, cooked: 154IUs
- 2 sardines, in oil*: 46 IUs
- 3oz beef liver, cooked: 42 IUs
- 1 large egg, with the yolk: 41 IUs
* When choosing sardines in oil, choose those that come in a jar or a BPA-free can. The product you choose should also contain extra virgin olive oil instead of industrial seed oils which promote inflammation.
Tips to maximize vitamin D absorption
- Eat foods rich in vitamin D with a source of fat since this vitamin is fat-soluble.
- If you choose to supplement with vitamin D, you would benefit from including foods rich in vitamin A and vitamin K2 in your daily diet – these two vitamins protect against vitamin D toxicity.
- If you take vitamin D pills, do so just before taking your largest meal. Research indicates that people who took vitamin D with their largest meal experienced a 50% increase in their blood levels of 25-hydroxyvitamin D (the active form of the vitamin) compared to those who popped the pill on an empty stomach or with a light meal.
You could benefit from a vitamin D supplement if you:
- Take orlistat or cholestyramine – these medications thwart the absorption of 25-hydroxyvitamin D.
- Take anti-seizure drugs, anti-inflammatory medications like prednisone or immunotherapy drugs which are given to patients who have undergone organ transplant or those diagnosed with HIV-AIDS. These medications interfere with the body’s ability to maintain healthy levels of vitamin D.
- Don’t get enough sun exposure or live in cold climates.
- Have excess weight – the vitamin gets ‘trapped’ in fat cells and are unavailable for use.
- Suffer from kidney diseases – the kidney activates vitamin D.
- Suffer from gut issues or had part or all of your stomach removed.
- Have an eating disorder.
- Are breastfeeding.
- Suffer from liver failure or primary biliary cirrhosis.
Whether you’re taking a vitamin D supplement or not, try to get some sunlight as well. As a rule of thumb, individuals with light skin need about 15 minutes of direct (not through your windscreen) sun exposure whereas those with darker skin need about 30 minutes of direct sunlight.
5. Vitamin E
Did you know that low levels of this vitamin have been associated with an increased incidence of diabetes? So, whether you’re pre-diabetic or not, you would benefit from including foods rich in vitamin E in your daily diet.
Vitamin E becomes even more important for individuals diagnosed with diabetes since, as mentioned earlier, high blood glucose levels increase free radical production. As an antioxidant vitamin, vitamin E can help the body get rid of excess free radicals.
As such, vitamin E can hamper the progression of diabetes and its associated complications by decreasing glycation, oxidation of fats and by preventing platelets from sticking together. When platelets adhere to one another, the risk of heart disease increases.
In some studies, researchers report decreased insulin resistance and improved blood glucose control in subjects taking vitamin E supplements. However, results are mixed and more research is needed.
Recommended dietary intake: 15mg per day
Supplement: 200 IUs per day
Selected food sources:
- 1oz sunflower seeds, dry roasted: 7.4mg
- 1oz almonds, dry roasted: 6.8mg
- 1oz hazelnuts, dry roasted: 4.3mg
- 2 tablespoons unsweetened, natural peanut butter: 2.9mg
- 1oz peanuts, dry roasted: 2.2mg
- 1/2 cup spinach, cooked: 1.9mg
- 1/2 cup broccoli, cooked: 1.2mg
- 1 medium kiwifruit: 1.1mg
- 1/2 cup mango, sliced: 0.7mg
- 1 medium tomato, raw: 0.7mg
- 1 cup spinach, raw: 0.6mg
You may have heard that industrial oils are rich in vitamin E but what marketers fail to mention is that these oils can increase inflammation in your body.
Tips when choosing a vitamin E supplement
- If you choose to supplement with vitamin E, make sure to take only the natural form which will be listed as d-alpha-tocopherol or d-alpha-tocopheryl. Synthetic forms of the vitamin come as dl-alpha-tocopherol or dl-alpha-tocopheryl.
- Vitamin E supplements containing d-alpha tocopherol are more bioavailable.
- Avoid mega-doses of the vitamin especially if you are taking medications such as warfarin, aspirin or herbal supplements like gingko biloba and garlic – doses greater than 800 IUs may alter blood clotting.
- If you smoke, please make sure to consult your doctor before taking a vitamin E supplement since supplementation has been linked to an increased risk of hemorrhagic stroke in smokers.
- If you are taking medications like orlistat, talk to your healthcare professional regarding the need for a vitamin E supplement since these drugs decrease vitamin E absorption.
When choosing seeds and nuts, select products that do not contain any other ingredient such as oil, flour, sugar, honey or any type of coating.
Recommended supplement intake vs. the advised dietary intake
You’ve probably noticed that the recommended supplement intake is much higher than the corresponding recommended dietary intake for the same nutrient. No, that’s not a typo: vitamin supplements are synthetic, isolated molecules which the body does not metabolize as effectively as vitamins from natural foods. You see, to be optimally absorbed and utilized by the body, most nutrients require substances such as enzymes, synergistic co-factors and organic mineral-activators. All these substances are naturally present in foods but are, most of the time, not included in synthetic vitamins with isolated nutrients.
This is why synthetic vitamins are not as bio-available (available for the body’s use) as natural vitamins. As such, you need a larger dose to benefit from them. This being said, it is absolutely useless to take mega-doses of these water-soluble vitamins unless you don’t mind producing expensive urine and stools. For instance, if you take 5000µg of biotin when your body only needs 300µg, your body will get rid of the extra 4700µg of biotin via your urine or stools.
[color-box color=”main”]Take home message: Except for vitamin D, you can meet your daily vitamin requirements by eating a colorful diet revolving around REAL foods, that is, foods that don’t come in a box, can or jar and which don’t contain ingredients you can’t begin to pronounce.[/color-box]
Now, before you start taking any supplement, I highly advise that you talk to your doctor about replenishing these vital nutrients. You could say something like ‘Doctor, I understand that diabetes causes glycation and can promote the loss of numerous micronutrients in the urine. What active steps would you advise I take to interrupt these processes?’
If your doctor shrugs off this concern, that’s a huge red flag – save yourself a whole lot of needless suffering down the road by running to a physician who will understand your concerns.