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Efficacy of Common Supplements

Acetyl-L-Carnitine

Acetyl-L-Carnitine (ALC) is indicated for the treatment of diabetic neuropathy, which is the most common late complication of diabetes (1). This is usually associated with neuropathic pain (1). The levels of ALC are lower in people that have complications of diabetes (1). In patients with diabetic neuropathy, there is damage to the sensory neuronal membranes, which results in an increase of sodium channels (1). This causes an increase in spontaneous neuronal firing (1). ALC is thought to slow down the neuronal degeneration, help in the regeneration and repair of neurons, and therefore decrease excessive excitability and firing (1). ALC may also improve peripheral neuropathy in addition to autonomic neuropathy (1). There are currently preliminary research that suggests ALC may also improve the utilization of glucose, due to increasing expression of glycolytic and gluconeogenic enzymes (1,2). Clinical studies have shown that ALC is effective in treating painful neuropathies (1,2,3). In one study, taking 1,000 mg ALC three times a day for 52 weeks showed beneficial effects on pain (1,2). Patients that have neuropathy due to type 1 or 2 diabetes improve their symptoms after taking this medication (1). The dose usually taken is 1500 -3000 mg daily in divided doses for a period of a year (1). In patients that reported having neuropathic pain as the most bothersome symptom, taking ALC 1000 mg two to three times daily decrease neuropathy related pain within six months of treatment initiation (1). A higher dose of 1000 mg two to three times daily appears to be more effective in reducing neuropathy related pain (1). ALC is well tolerated orally (1). It may cause minor symptoms such as nausea, vomiting, and gastrointestinal upset. One of the metabolites of ALC may cause fishy odor in the urine, breath and sweat (1). This medication does not interact with any of the medications that GS is taking (1). However, the amount of ALC contained in the supplement (125 mg) is less than the amount that was reported in the studies (4).

Alpha-lipoic acid

Alpha-lipoic acid (ALA) is used for the treatment of diabetes (1). It is taken orally or intravenously and seems to improve insulin sensitivity and glucose disposal in patients with type 2 diabetes (1,5). ALA has been shown to increase GLUT4 translocation to cell membranes, which increases the glucose uptake in adipose and muscle cells (1). Therefore, ALA appears to participate in the insulin signaling pathway, as a result increasing glucose uptake into muscle and fat cells (10). In one study, thirteen patients were given ALA either in 1000 mg/500 mL NaCL (n=7) or vehicle only (500 mL NaCl, n=6). After the acute parenteral administration of ALA, the glucose infusion rate increased 47%, metabolic clearance rate increased 55%, and insulin sensitivity increased 57%, whereas the controlled group showed no significant change (1,5). The benefits of ALA are that it speeds the removal of glucose from the blood stream (enhances glucose uptake in T2DM), partly enhances insulin function, reduces insulin resistance and its antioxidant effects may be useful in slowing the development of diabetic neuropathy (1,6). Clinical studies have reported that iv administration of ALA is able to significantly increase insulin sensitivity in patients with type 2 DM, whereas oral administration only has a marginal effect (1,5,6). This is likely due to the short duration during which a therapeutic level of ALA is maintained in plasma (1,5).

Oxidative stress is proposed to be an early event in the pathology of diabetes and as a result may have a role in the onset and even the progression of late complications (1). One study demonstrated that of the 107 diabetic patients (T1 and T2) that took LA (600 mg per day for more than 3 months) showed decreased oxidative stress compared to those without ALA treatment (1,5,6). Patients that took ALA 600 to 1800 mg orally or 500 to 1000 mg intravenously on a daily basis had noted significant improvement in insulin resistance and glucose effectiveness after four weeks of oral treatment or after 1 to 10 days of intravenous treatment. However, it does not appear that ALA lowers A1C levels in patients that have type 2 DM (1,5,6). ALA is well tolerated (1). Higher doses may cause nausea or gastrointestinal distress along with fatigue, insomnia and overstimulation (1). Since there is some evidence that ALA when used as a supplement can improve insulin mediated glucose utilization, it is therefore quite possible that supplementation can increase the risk of hypoglycemia in diabetic patients that are on insulin or oral hypogylcemic agents (1). Therefore, it is a good idea that the blood glucose levels should be monitored closely when ALA supplementation is used (1). Dosing adjustments for insulin or oral hypoglycemic agents may be needed (1).

Bilberry

The bilberry is a plant that is in the same family as the American blueberry (1,7). The leaf part of the bilberry has been used to treat diabetes (1,7). However, more research is needed into the beneficial properties of the bilberry in diabetes (1,7). Based on a study on rat models, the bilberry lowered the blood glucose (1). There is potential benefit in diabetes, but at this time, it is not recommended to help manage diabetes based on little evidence (1,7). Bilberry is really well tolerated and has little adverse effects (1,7). Some people may experience mind digestive distress, skin rashes and drowsiness however (1,7). Preliminary research in rate models suggest that the leaf extract from the bilberry may lower blood glucose (1,7). On a theoretical basis, concomitant use of bilberry leaf may require dosing adjustment of anti-diabetes drugs (1). Monitoring is required (1).

Ginseng

There are 11 species of ginseng that are available commercially, but most of the studies have evaluated the Asian (Panax ginseng) or American (Panax quinquefolius L.) ginseng (1,7,8). The physiological effects of ginseng are due to its triterpene β-glycosides, known as ginsenosides (1). It is proposed these ginsenosides are thought to reduce postprandial glucose levels, which may be attributed to insulin sensitization or direct stimulation of insulin release or both of these mechanisms (1). The exact mechanism of how ginseng lowers blood glucose is not known (8). One proposal is that ginseng may modulate digestion (8). An inhibition of the neuronal discharge frequency from section of the brainstem that is responsible for gastric actions as been noted when rats were given American ginseng (8). Studies in animal models and cell culture systems illustrated that ginseng extracts do have beneficial effects on insulin action and metabolism (1). Most human studies have only evaluated the effect of a single oral dose of ginseng (8). Some studies have illustrated that a single dose lowered blood glucose area under the curve during an oral glucose test (8). There are two studies that tested the effect of prolonged daily treatment with ginseng extracts on glycemic control in subjects with type 2 DM (8). However, the interpretation of the data is uncertain as there were confounding factors present that may have influenced the outcome (8). Body weight changes and changes in diabetic medications occurred in these studies (8). It is suggested that taking American ginseng 3 grams orally, up to two hours before a meal can significantly lower the postprandial glucose levels experienced in patients that have type 2 DM (1). Doses that exceeded the 3 grams appear not prove to be more beneficial (1). Depending on the variations in the concentration of ginsenosides, the glucose lowering effect may be variable (1). However, a recent study in 2011, in which a randomized, double blind, placebo controlled β-cell function or insulin sensitivity in subjects with impaired glucose tolerance or newly diagnosed type 2 DM (8). The data suggested minimal bioavailability after oral ingestion, which limited the efficacy in people compared to animal studies. (8) The data from the study concludes that ginseng does not improve β –cell function or insulin sensitivity in patients with diabetes (8). This suggests that more evidence is required before ginseng can be recommended for use in diabetes (8). Ginseng is mostly well tolerated. Adverse reactions can include insomnia, tachycardia, Stevens-John syndrome, and amenorrhea (1). This medication does not interact with any of the medications GS is taking (1).

References

  1. Natural Medicines Comprehensive Database [cited 2011 Sep 19]. Jellin JM, editor. Stockton: Therapeutic Research Facility. Subscription required.
  2. Onofrj M, Fulgente T, Melchionda D, et al. L-acetylcarnitine as a new therapeutic approach for peripheral neuropathies with pain. Int J Clin Pharmacol Res. 1995;15:9-15.
  3. De Grandis D, Minardi C. Acetyl-L-carnitine (levacecarnine) in the treatment of diabetic neuropathy. A long-term, randomised, double-blind, placebo-controlled study. Drugs R D 2002;3:223-3.
  4. Diabetes Health™ Nutritional Support Formula [Internet]. 2011 [cited 2011 Sep 19]. Available from: http://www.wholehealth.com/vitamins-supplements/diabetes-health
  5. Konrad T, Vicini P, Kusterer K, et al. Alpha-lipoic acid treatment decreases serum lactate and pyruvate concentrations and improves glucose effectiveness in lean and obese patients with Type 2 diabetes. Diabetes Care. 1999;22:280-7.
  6. Jacob S, Henriksen EJ, Tritschler HJ, et al. Improvement of insuli-stimulated glucose-disposal in type 2 diabetes after repeated parenteral administration of thioctic acid. Exp Clin Endocrinol Diabet. 1996;104:284-8.
  7. Shane-McWhorter L. Biological Complementary Thereapies: A Focus on Botanical Products in Diabetes. Diabetes Spectrum. 2001. 14(4):199-208. Doi:10.2337/diacare.26.4.1277.
  8. Reeds DN, Patterson BW, Okunade A, Holloszy JO, Polonsky KS, Klein S. Ginseng and Ginsenoside Re do not improve β-cell function or insulin sensitivity in overweight and obsese subjects with impaired glucose tolerance or diabetes. Diabetes Care. 2011. 34(5):1071-76.

Disclaimer

This information is presented for informational purposes only and is not meant to be a substitute for advice provided by qualified health care professionals. You should contact your qualified health care provider if you have or suspect any health problems. This article is not intended to provide medical advice for its readers


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