Can diabetes supplements be the key to controlling blood glucose levels?
About a year ago I was teaching type 2 diabetes education to a group of patients. One of the attendees swore blind that adding a cinnamon supplement to his diet improved his glucose levels.
This stirred my interest at the time but with a busy schedule it was soon forgotten to the realms of every day practice. Since that day I’ve had more patients tell me how diabetes supplements have helped them improve their glucose levels.
I’ve been meaning to look into this for some time. This week I finally managed to get around to it and see for myself if there is actually any evidence to support these patients claims.
With any claim like this, I must admit I approach it with a certain amount of caution. Often patients will be looking for something that acts as the miracle solution. The path of least resistance. Add a diabetes supplement and everything will be alright.
In nutrition it is very difficult to figure out exactly what is going on. This is because it is hard to control only one variable or nutrient at a time.
For example, my patient in type 2 education also mentioned he’d lost a lot of weight at around the same time as his magic cinnamon supplement improved his glucose levels. Another common scenario I see is patients utterly convinced they have seen an improvement in their glucose levels, only for their HbA1c to have increased. So sometimes what patients say and what is actually happening are two different things.
This is one reason why we always check your HbA1c or ask to see your glucose meter. Not to spy on you or question you but just to make sure everything adds up. To be thorough if you will.
The problem with studying this
Nutrients do not exist individually in food. Every food has many different nutrients making it really difficult to analyse the effect of only one nutrient.
When looking at the published research the most studied nutrients seem to be cinnamon, chromium and magnesium. Admittedly, there appears to be a fair amount of support showing people with low magnesium are more likely to have type 2 diabetes.
People who have high intakes of chromium and magnesium also seem to have better glucose control. Although, this isn’t too surprising when we look at the foods that are rich in both of these. Vegetables, fruit, legumes, protein and wholegrain foods, are where chromium and magnesium are mostly found. You may notice all these foods seem quite healthy. In fact, they are exactly the kind of foods we recommend our patients eat to help manage their type 2 diabetes. So it’s no surprise then that those people eating high levels of chromium and magnesium tend to have better glucose control.
The only way to really study nutrients in isolation is via supplementation. This is likely why most of the evidence out there uses supplementation to see how nutrients may effect the body.
In an ideal world, when we conduct research we use a randomised control study. Here, you take one group of people and give them something they don’t usually have i.e. a supplement or medication. This is called the intervention group. We compare this group against another group we have done nothing with. This is called the control group. We then compare the two groups against the measures we are looking at. In this case, blood glucose levels.
This is the type of research medical companies use when studying the effect of medications. It helps us establish cause and effect and compare between one group doing something and another group continuing as normal.
The problem with nutrition research is it isn’t as big a business as pharmaceuticals. The industry is also mostly unregulated. Therefore, studies tend to be under funded. Why spend money on studies when you can market supplements anyway. This means studies do not have enough participants, have inconsistent study designs using different quantities of the supplement, over different time periods and thus they are highly prone to bias.
So not ideal.
How do we get around this. I won’t lie, it’s difficult.
One method we can use, and one I do use, is to look at review articles. Review articles gather all these small studies and amalgamate the findings to form an overall conclusion.
However, review articles are also prone to flaws. Each review study will have inclusion criteria for the studies they will look at. The less robust their method is, the more likely poor studies will find their way into reviews.
So it’s a bit of a minefield.
The trick then, is to critically review the articles and not to look at only one or two articles. You can prove almost anything if you cherry pick only the articles that support your statement.
Instead, we need to weigh the evidence against each other and evaluate how well conducted the study was we are using.
So with all that in mind, what did I find?
Admittedly when looking at individual studies I found much more evidence for cinnamon, chromium and magnesium improving glucose levels, reducing blood lipids and helping with weight loss, than articles that reported no benefit.
Granted, not all of these articles we’re the best designed but perhaps there is something there.
The problem is when looking at more credible and robust review articles from the Cochrane review and Diabetes UK the landscape changes. Neither of these sources found convincing evidence we should be recommending supplements to help with diabetes control.
The Cochrane reviews found some evidence for chromium helping with weight loss but this research wasn’t enough for them to recommend adding chromium to the diet as a supplement.
Diabetes UK also recognised the potential benefit of chromium and magnesium in helping to improve blood glucose levels. However, they do not go as far as recommending this.
This is because once both sources reviewed the evidence that met their standards for inclusion, evidence was lacking to support the use of supplements.
I hope I’ve been able to convey why it’s difficult to establish a cause and effect relationship in nutrition. This is important when looking at the benefit of individual nutrients in the diet to see if they have specific benefits. Food contains a combination of many nutrients and thus are not eaten in isolation. This is one reason why we don’t tend to focus on individual nutrients in the diet.
As it stands, there is no proven benefit for the use of supplements or diabetes supplements in improving glucose levels in type 2 diabetes.
Even if there was a benefit, remember supplements do not address the underlying cause of type 2 diabetes. The diabetes supplements would be creating a false economy because the reason for the type 2 diabetes manifesting remains. Granted, if there was benefit, perhaps patients where the diabetes is not the result of being overweight or unfit e.g. elderly, there could be a role. More research is needed.
However, the foundation of good diabetes control remains a healthy balanced diet and getting as active as possible for most people. No supplement or medication for type 2 diabetes replaces this or likely ever will.
Therefore, if you want to improve your control, this is the place to start.
Want to find out how to make a lifestyle change? I’ve written about the diet here. https://diabetesdietguy.com/2018/01/13/correct-amount-of-carbohydrate-for-all-types-of-diabetes/