Type 1 Diabetes (Holistic)

Alpha lipoic acid is an important nutrient for mitochondrial function. It has antioxidant properties and can act as a reducer of oxidized forms of vitamins C and E. A number of placebo-controlled clinical trials have found that supplementing with 600 to 1,200 mg of alpha-lipoic acid per day can improve the symptoms of diabetic nerve damage (neuropathy). Animal studies and early clinical research suggest alpha-lipoic acid may also help prevent diabetes-related damage to the small blood vessels and nerves in the eyes (diabetic retinopathy).

Double-blind trials have shown that topical application of creams containing 0.025 to 0.075% capsaicin (from cayenne [Capsicum frutescens]) can relieve symptoms of diabetic nerve damage (neuropathy). Four or more applications per day may be required to relieve severe pain. This should be done only under a doctor’s supervision.

People with type 1 diabetes often have low magnesium levels, and low magnesium status is correlated with poor glucose control and increased risk of complications. In magnesium-deficient pregnant women with type 1 diabetes, the lack of magnesium may even account for the high rate of miscarriages and birth defects associated with type 1 diabetes. Some studies have found that magnesium replenishment using supplements can improve blood glucose control and may reduce the risks of certain diabetes complications, such as cardiovascular disease and neuropathy, in children and adults with type 1 diabetes. Many doctors recommend that adults with type 1 diabetes and normal kidney function supplement with 200 to 600 mg of magnesium per day to maintain normal magnesium status; children with type 1 diabetes may benefit from a lower dose.

Vitamin B12, or cobalamin, is needed for normal functioning of nerve cells and is also involved in homocysteine metabolism. People with type 1 diabetes have an increased risk of other disorders that can affect their B12 status, such as autoimmune gastritis, celiac disease, and pernicious anemia. Vitamin B12, taken at a dose of 1,500 micrograms per day for 24 weeks, has been found to reduce symptoms and disability due to diabetic nerve damage (neuropathy). In a preliminary trial that included 544 participants with diabetic neuropathy, supplementing with vitamin B12 (in the form of methylcobalamin) along with folic acid (in the form of methylfolate) and vitamin B6 (in the form of pyridoxal-5-phosphate) for 12 weeks was associated with a 35% drop in symptom scores and a 32% drop in pain scores. A comparison trial in 100 subjects with diabetic neuropathy found injections of B12 were more effective than the commonly used pain medication, nortriptyline, for treating symptoms of diabetic neuropathy. A number of other studies have shown B12, alone and in combination with other treatments such as alpha-lipoic acid and prostaglandin E1, can be beneficial in those with diabetic neuropathy. Oral vitamin B12 up to 1,500 micrograms per day is recommended by some practitioners.

People with type 1 diabetes may have impaired vitamin B6 metabolism, resulting in increased susceptibility to deficiency. Vitamin B6, along with other B vitamins, is critical for homocysteine metabolism and may thereby reduce their risk of vascular complications of diabetes, particularly diabetes-related kidney disease. Research in people with type 1 diabetes showed supplementation with B1, B6, and B12 lowered elevated homocysteine levels and improved kidney function. Vitamin B6 alone, at doses of 100 to 500 mg per day, also improved kidney function in a group of people with type 1 diabetes-related kidney impairment. In children with type 1 diabetes, taking 100 mg of B6 per day for eight weeks led to improvements in blood vessel function. The benefits of B6 in people with diabetes may also be related to its apparent ability to prevent the formation of damaging advanced glycation end-products (AGEs).

Vitamin D is needed to regulate immune activity and research has shown it has an important role in preventing autoimmune diseases, including type 1 diabetes. Vitamin D receptors have been found in the pancreas where insulin is made and some, but not all, preliminary evidence suggests that supplementation might reduce the risk of developing type 1 diabetes. Case reports even suggest a combination of high-dose vitamin D and omega-3 fatty acids may completely reverse the onset of type 1 diabetes.

Vitamin D deficiency is common in people with type 1 diabetes and associated with poor glucose control. Supplementation with cholecalciferol (vitamin D3), in doses ranging from 2,000 IU per day to about 6,000 IU per day, has been shown in randomized controlled trials to slow the decline of pancreatic function in people with newly diagnosed type 1 diabetes who have not yet suffered an extensive loss of pancreatic function. Furthermore, the majority of the research shows vitamin D3, in doses ranging from 2,000–10,000 IU per day, improves short and long term glycemic control in people with type 1 diabetes, particularly in those with low vitamin D status, possibly by preserving beta cell function and increasing insulin production.

In a double-blind study of people with diabetic nerve damage (neuropathy), supplementing with acetyl-L-carnitine was significantly more effective than a placebo in improving subjective symptoms of neuropathy and objective measures of nerve function. People who received 1,000 mg of acetyl-L-carnitine three times per day tended to fare better than those who received 500 mg three times per day.

Animal research suggests bilberry extract may improve glycemic control and lower the risk of some diabetic complications, such as diabetic cataracts and retinopathy. Compounds called anthocyanins, found in bilberry and other dark berries, have strong antioxidant and anti-inflammatory effects that appear to mitigate some of the negative impacts of chronically elevated glucose levels. One preliminary trial found that supplementation with a standardized extract of bilberry improved signs of retinal damage in some people with diabetic retinopathy.

Biotin is a B vitamin needed to process glucose. High doses of biotin have been suggested to reverse some of the negative effects of chronic low insulin levels on glucose metabolism. In a pilot trial, people with type 1 diabetes given 16 mg of biotin per day for one week experienced 50% reductions in fasting glucose levels. In a placebo-controlled trial, people with type 1 diabetes treated with biotin at doses of about 2–4 mg per day, depending on body weight, had improvements in blood glucose regulation and blood lipid levels after three months. Case reports suggest biotin may also reduce pain from diabetic nerve damage (neuropathy). Some doctors recommend a trial of 16 mg of biotin daily for a few weeks to see if blood sugar levels decrease.

Chromium, a trace mineral that appears to increase the effectiveness of insulin, has been reported to improve blood glucose control in people with various forms of diabetes, including type 1 diabetes. Low chromium levels have been correlated with poor glucose control and human case studies and animal research suggest chromium supplementation may improve glycemic control and prevent some diabetic complications. The typical amount of chromium used in studies is 200 micrograms one to three times per day. Supplementation with chromium could potentially enhance the effects of drugs for diabetes (for example, insulin or other blood sugar-lowering agents) and possibly lead to hypoglycemia. Therefore, people with diabetes taking these medications should supplement with chromium only under the supervision of a doctor.

Coenzyme Q10 (CoQ10) is needed for normal blood sugar metabolism. One research team reported that, in study subjects with vascular complications related to type 1 diabetes, adding CoQ10 to standard insulin therapy increased antioxidant status, reduced free radical damage to lipids, and improved blood vessel function. The same research group also reported that CoQ10 supplementation, at the unusually high dose of 1,000 mg per day, improved blood glucose control in those with type 1 diabetes-related kidney dysfunction. However, in a placebo-controlled trial, supplementation with 100 mg of CoQ10 per day for three months neither improved glucose control nor reduced the need for insulin in participants with type 1 diabetes. Although the potential benefits of CoQ10 supplements in treatment of type 1 diabetes remains uncertain, some doctors recommend taking 50–100 mg per day due to its likely ability to protect heart, blood vessel, and kidney health.

Fenugreek seeds are high in soluble fiber, which helps lower blood sugar by slowing down carbohydrate digestion and absorption. Fenugreek extract has also been shown to increase the number and function of insulin-producing cells in the pancreas and improve blood sugar control, lipid levels, and antioxidant capacity in animal models of type 1 diabetes. In a controlled study in people with type 1 diabetes, incorporating powdered fenugreek seed into lunch and dinner meals (50 grams per meal) for ten days improved several measures of blood sugar control compared to a similar ten-day diet without added fenugreek.

Dietary fiber has been found to have a small but notable positive impact on blood glucose control in people with type 1 diabetes. Clinical trials in people with type 1 diabetes suggest fiber supplements, when taken before meals, may reduce the post-meal rise in blood sugar. More research is needed to determine if regular use of fiber supplements benefits long-term blood sugar control in type 1 diabetes.

Omega-3 fatty acids from fish are well known to reduce inflammatory immune activity and have beneficial effects in a range of autoimmune conditions. Observational research suggests higher levels during infancy and early childhood may be linked to lower risk of developing type 1 diabetes. One study done in Norway found that babies given cod liver oil regularly during the first year of life had a 26% lower risk of developing type 1 diabetes in childhood. However, not all studies have noted a connection between omega-3 fatty acids and type 1 diabetes risk, and some researchers have proposed the discrepancies may be explained by genetic factors affecting fatty acid metabolism.

Higher intake of EPA, an omega-3 fatty acids from fish, has been correlated with better preservation of pancreatic cells that produce insulin and long-term blood glucose control in youth with type 1 diabetes. A small pilot trial found that supplementation with 630 mg of EPA and 330 mg of DHA (another omega-3 fatty acid from fish oil) per day improved blood glucose control in subjects with type 1 diabetes. Furthermore, better omega-3 fatty acid status may be helpful in slowing the progression of diabetes-associated complications such as kidney dysfunction and nerve pain.

Although fish oil fatty acids generally have positive effects on triglyceride levels, some studies have found supplemental DHA can increase LDL- and total cholesterol, which may increase cardiac risk. For this reason, some doctors are wary of fish oil supplements for patients with type 1 diabetes and may recommend EPA-only supplements instead.

Test tube and animal studies have found several mechanisms by which gymnema (Gymnema sylvestre) may help normalize blood sugar control in people with diabetes, including reducing glucose absorption in the intestines, and stimulating regeneration and activity of pancreatic cells that release insulin. In a controlled trial with people with type 1 diabetes, 400 mg per day of gymnema extract improved blood glucose control and reduced requirements for insulin. Some practitioners recommend using gymnema extracts standardized for their content of active constituents called gymnemic acids. Gymnema is not a substitute for insulin, but insulin amounts may need to be lowered in order to avoid hypoglycemia while taking gymnema.

Acetyl l-carnitine is an amino acid compound used to treat conditions affecting the brain and peripheral nervous system. Research reviews have concluded acetyl l-carnitine, in doses of at least 2 grams per day, can relieve pain and improve nerve function in those with diabetic nerve damage (neuropathy). A preliminary trial found 500 mg of acetyl l-carnitine three times daily for 24 weeks relieved symptoms of diabetic nerve damage (neuropathy) as effectively as vitamin B12.

Sea buckthorn (Hippophae rhamnoides) is a source of antioxidant polyphenols, and laboratory and animal studies suggest extracts from sea buckthorn have a positive impact on carbohydrate and lipid metabolism. In one study, a sea buckthorn extract was found to lower the rise in blood glucose that occurs after a meal in healthy men. In a preliminary trial, children with type 1 diabetes who consumed a concentrated mixture of sea buckthorn berries and blueberries (concentration and relative proportions not stated) for two months had improved blood measures of glucose control. Double-blind research using sea buckthorn alone is needed to confirm these findings and to determine an effective per day amount of sea buckthorn.

Because oxidative damage is believed to play a role in the development of diabetic complications, such as eye damage (retinopathy), kidney damage (nephropathy), and nerve damage (neuropathy), antioxidant nutrients like selenium might play an important preventive role. In a placebo-controlled trial that included people with type 1 and type 2 diabetes and related nephropathy, those given 200 micrograms of selenium per day for 12 weeks had increased antioxidant capacity but no change in markers of kidney function. One doctor reported administering a per day regimen of antioxidants including 500 micrograms selenium, plus 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C, per day for several years to 20 people with diabetic eye damage (retinopathy). During that time, the doctor observed that 19 of the 20 people showed either improvement or no progression of their retinopathy. In a three-month study, taking supplements providing 100 micrograms selenium, 600 mg alpha-lipoic acid, and 1,200 IU vitamin E per day resulted in improvements in neuropathy symptoms in those with long-standing diabetes. People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner.

Taurine is an amino acid that is not used in protein synthesis but serves other functions in the body. Because of its role in cardiovascular and nervous system health, it may be an important nutrient for people with type 1 diabetes. A small crossover trial with nine young men with type 1 diabetes found, compared to placebo, supplementing with 500 mg taurine three times per day for two weeks reduced arterial stiffness and increased the blood vessel dilation response to higher blood flow, indicating taurine improved their vascular function. Findings from animal studies suggest taurine supplementation may improve heart and blood vessel dysfunction associated with type 1 diabetes. Evidence from laboratory studies also suggests taurine may prevent or reverse damage to insulin-producing pancreatic cells. Taurine also reduced diabetes-related penile muscle scarring and erectile dysfunction in a rat model of type 1 diabetes.

Blood levels of vitamin B1 (thiamine) have been found to be low in people with type 1 diabetes, and low levels are correlated with greater risk of diabetes-related anemia and other complications. Supplementing with B1, along with vitamins B6 and B12, was found to reduce high levels of homocysteine in children type 1 diabetes in one placebo-controlled trial. High homocysteine levels are generally correlated with blood vessel dysfunction and reducing high levels may help prevent vascular complications of diabetes. In this trial, improvement in markers of kidney function were also seen.

Several controlled trials have evaluated the effect of benfotiamine, a fat-soluble form of vitamin B1, on diabetic neuropathy in participants with type 1 and type 2 diabetes. In one of these trials, 600 mg per day of benfotiamine was more effective than 300 mg per day or placebo for reducing neuropathic pain after six weeks; in a three-week trial, those receiving 400 mg per day of benfotiamine had greater pain reduction than those receiving placebo. However, 300 mg of benfotiamine daily had no benefits on nerve function relative to placebo in people with type 1 diabetes after 24 months, suggesting this dose may be too low to be helpful.

High doses of niacin (a form of vitamin B3), such as 2 to 3 grams per day, are sometimes recommended to lower high triglyceride and cholesterol levels in people with type 1 diabetes. However, niacin’s ability to reduce cardiovascular risk in the context of type 1 diabetes has not been established. It is important to note that niacin doses this high, particularly in extended release formulations, may cause flushing, stomach upset, and liver toxicity, and should be used by people with diabetes only with medical supervision.

Animal research suggests that niacinamide, a form of vitamin B3 with fewer side effects, may prevent toxic damage to the pancreatic cells that make insulin. Although one intriguing study found niacinamide supplementation was associated with a lower incidence of type 1 diabetes in children at high risk, more recent studies have not confirmed a protective effect.

A controlled clinical trial in subjects with recently diagnosed type 1 diabetes found the addition of niacinamide (25 mg per day per kg of body weight; approximately 2–3 grams per day) to intensive insulin treatment led to greater improvement in HgA1c over two years, but other clinical trials have found no benefit on glucose metabolism in similar subjects.

Vitamin C is important for lowering oxidative stress and preventing oxidative tissue damage linked to high glucose levels in people with diabetes. Vitamin C levels have been found to be lower in people with type 1 diabetes compared to healthy people, and low levels have been correlated with markers of decreased cardiovascular health in those with type 1 diabetes. In addition, because vitamin C uptake by cells is enhanced by insulin and suppressed by high glucose levels, people with type 1 diabetes have more difficulty meeting their cellular and tissue needs for vitamin C. In a placebo-controlled trial, 1,000 mg vitamin C along with 800 IU vitamin E per day for six months improved blood vessel function in participants with type 1 diabetes. Another placebo-controlled trial found the high dose of 6 grams of vitamin C per day for six months improved markers of capillary health. Several studies show vitamin C may protect blood vessels from free radical damage during the vulnerable periods of high blood glucose in subjects with type 1 diabetes. A small one-month study in children with type 1 diabetes found no effect of supplementation with 250 mg per day of vitamin C on vascular health. Another trial in nine type 1 diabetes-affected adolescents investigated doses of vitamin C ranging from 250–750 mg per day, depending on weight, combined with vitamin E for six weeks and saw no change in vascular function. Whether these negative findings reflect study factors such as low dose, short duration, and small number of participants is unclear.

People with low blood levels of vitamin E are more likely to develop type 1 diabetes, but no studies have been done using vitamin E supplements to try to prevent type 1 diabetes. Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic eye damage and nephropathy, serious complications of diabetes involving the eyes and kidneys, respectively, though no long-term trials in humans have confirmed this preliminary evidence. Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. Excessive glycosylation appears to be one of the causes of the organ damage that occurs in diabetes. Vitamin E supplementation has reduced the amount of glycosylation in many,although not all, studies of people with type 1 diabetes.

People with low blood levels of vitamin E are more likely to develop type 1 diabetes, but no studies have been done using vitamin E supplements to try to prevent type 1 diabetes. Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic eye damage and nephropathy, serious complications of diabetes involving the eyes and kidneys, respectively, though no long-term trials in humans have confirmed this preliminary evidence. Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. Excessive glycosylation appears to be one of the causes of the organ damage that occurs in diabetes. Vitamin E supplementation has reduced the amount of glycosylation in many,although not all, studies of people with type 1 diabetes.

Açaí is reported to be a traditional remedy for diabetes. Oxidative stress may contribute to diabetes onset and its complications, and açaí is rich in antioxidant polyphenols such as anthocyanins. Studies in people without diabetes show açaí consumption can raise antioxidant status in the body and improve lipid levels and blood vessel function. In animal research, açaí extract reduced diabetes-related kidney damage and dysfunction; however, direct evidence for açaí’s benefits in people with type 1 diabetes is lacking.

Substances that inhibit amylase, the digestive enzyme required to break down dietary starches into absorbable glucose units, can reduce the usual post-meal rise in blood sugar levels in both healthy people and people with diabetes. Amylase inhibitors occur naturally in foods such as whole grains and legumes, as well as in many culinary herbs and spices and medicinal herbs, possibly contributing to their anti-diabetic effects. While some food and herbal extracts with amylase-inhibiting effects have shown promise in animal research, their benefits for type 1 diabetes await confirmation in clinical trials.

Asian ginseng (Panax ginseng) is commonly used in Traditional Chinese Medicine to treat diabetes. It has been shown in test tube and animal studies to enhance the release of insulin from the pancreas and increase the number of insulin receptors. Asian ginseng and its active constituents have also been found to improve blood glucose control and reduce complications in animal models of type 1 diabetes. Clinical trials in people with type 1 diabetes are needed to confirm these findings.

Supplementing with evening primrose oil providing 360–480 mg of gamma-linolenic acid per day for six months has been found in double-blind research to improve nerve function and relieve pain in people with diabetic nerve damage (neuropathy). However, one of the investigators involved in these clinical trials was subsequently found by the professional conduct committee of the General Medical Council (United Kingdom) to have falsified the results of his research. In the absence of more recent clinical trials, it is not clear whether evening primrose oil or GLA is of any value for patients with diabetic neuropathy.

Ginkgo (Ginkgo biloba) extract may be useful to people with type 1 diabetes because of its abilities to raise antioxidant capacity and reduce inflammatory signaling. A standardized ginkgo extract was found to improve insulin production and glucose metabolism and decrease triglyceride levels in an animal model of type 1 diabetes. Preliminary evidence from a trial in subjects with long-standing type 1 diabetes suggests it may have a role in protecting vision. Other animal research and a single small, uncontrolled, pilot trial indicate ginkgo may protect nerve function and prove useful for prevention and treatment of diabetic nerve damage (neuropathy).

Glucomannan is a water-soluble dietary fiber derived from konjac root (Amorphophallus konjac). Glucomannan delays stomach emptying, leading to a more gradual rise in glucose levels after eating carbohydrates. This could result in reduced need for insulin after meals in people with type 1 diabetes. In addition, glucomannan has positive effects on carbohydrate and fat metabolism, as well as the gut microbiota. These properties could lead to benefits in people with type 1 diabetes, but no research has been done to test this possibility.

Hibiscus is a traditional remedy in India for diabetes. Animal research suggests hibiscus extract may stimulate regeneration of pancreatic cells that produce insulin, reduce high glucose and lipid levels, and protect against damage to the heart and kidneys induced by type 1 diabetes. Hibiscus is usually taken as tea, 1 to 2 teaspoons (3 to 6 grams) of dried flower infused into 1 cup (250 ml) of water, three times per day.

Inositol, particularly in the forms myo-inositol and D-chiro-inositol, has many functions in the body, including assisting in normal cellular responsiveness to insulin. A gene alteration that affects inositol metabolism may be associated with risk of type 1 diabetes and its complications, and people with type 1 and type 2 diabetes have been found to lose more myo-inositol in their urine compared to those without diabetes. In one small pilot trial in seven people with type 1 diabetes, inositol supplementation (500 mg taken twice per day for two weeks) led to improved nerve function; however, two placebo-controlled trials failed to find a benefit.

Manganese is involved in the activity of an important antioxidant enzyme system in the body. A genetic variant linked to reduced activity of this enzymes system has been implicated as a factor in the development of type 1 diabetes and its complications. Low blood levels of manganese have been reported in people with type 1 and type 2 diabetes. Animal research suggests that manganese supplementation can improve the functioning of this enzyme system, increase insulin secretion, and improve glucose metabolism. One team of researchers reported on a case of a young adult with insulin-dependent diabetes who received oral manganese (3 to 5 mg per day as manganese chloride) and experienced a significant fall in blood glucose, sometimes to dangerously low levels; however, three other people with type 1 diabetes they treated with manganese supplementation had no change in blood glucose levels. People with type 1 diabetes wishing to supplement with manganese should do so only with a doctor’s close supervision.

Mistletoe extract has been shown to stimulate insulin release from pancreas cells. Research in type 1 diabetic animals found that treatment with mistletoe extract reduced metabolic disturbances and improved general health. No research in humans has yet been published; however, given mistletoe’s worldwide reputation as a traditional remedy for diabetes, clinical trials are warranted to validate these promising preliminary findings. Traditionally, mistletoe is prepared by soaking 2 to 4 teaspoons (5 to 12 grams) of chopped mistletoe in 2 cups (500 ml) of water overnight. The mixture is drunk first thing in the morning and sweetened with honey if desired. Another batch may be left to steep during the day and drunk at bedtime.

Olive leaf extract has been shown to reduce oxidative stress, inflammatory signaling, and autoimmune activity, and to improve glucose metabolism and protect pancreatic cells in animal models of type 1 diabetes. These results have not yet been reproduced in human clinical trials.

Research in laboratory animals suggests onion and its active constituents may lower blood glucose levels, raise insulin levels, reduce advanced glycation end-product (AGE) formation, and possibly prevent diabetes complications. In one preliminary trial, people with type 1 diabetes had lower blood glucose levels four hours after eating about three ounces of raw onion than after receiving water.

Quercetin has demonstrated multiple actions that may benefit people with type 1 diabetes, including reducing glucose absorption, increasing insulin release, and promoting glucose uptake by cells. Despite a wealth of animal studies indicating its potential in prevention and treatment of diabetes and its complications, clinical trials have not yet been performed to explore whether quercetin actually benefits people with diabetes.

Animal studies suggest reishi extract may improve immune function and wound healing in the context of type 1 diabetes. Furthermore, reishi has demonstrated anti-diabetic actions, such as lowering high glucose levels and increasing insulin levels, in animal studies. Clinical trials are needed to confirm these effects in humans.

Because oxidation damage is believed to play a role in the development of diabetic eye damage (retinopathy), antioxidant nutrients might be protective. One doctor has administered a daily regimen of 500 mcg selenium, 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C for several years to 20 people with diabetic eye damage (retinopathy). During that time, 19 of the 20 people showed either improvement or no progression of their retinopathy. People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner.

People with type 1 diabetes may be more likely to be zinc-deficient than their healthy counterparts. Low zinc status leads to impaired immune function and increased oxidative stress and has been linked to poorer glucose control. Zinc supplements have been found to increase antioxidant capacity and reduce lipid peroxidation in people with type 1 diabetes.

Despite evidence that zinc may be beneficial in people with type 1 diabetes, some doctors remain skeptical of high doses due to one 1994 study in which zinc supplementation, at a dose of 50 mg per day for 28 days, increased glycosylation (glucose-induced protein damage). This trial is hard to evaluate because zinc supplementation increases the life of blood cells and such an effect artificially increases the lab test results for glycosylation. In fact, laboratory studies suggest zinc can inhibit glycation. Until this issue is resolved, those with type 1 diabetes should consult a doctor before considering high-dose supplementation with zinc.