Nutritional supplements are an essential and effective part of diabesity treatment. Mild diabesity requires moderate nutritional support; more advanced cases, including diabetes, often require more intensive nutrient therapy. I will explain why supplements are so important. I will also review common medications used for diabesity and its complications, such as high blood pressure, high cholesterol, and thick blood, as well as natural alternatives to these medications.
Doctors used to think that you got all your vitamins and minerals from food and that any extra was excreted, or worse, was toxic. But the tide is shifting. Doctors now prescribe over $1 billion in fish oil supplements. Most cardiologists recommend folate, fish oil, and coenzyme Q10. Gastroenterologists recommend probiotics. Obstetricians have always recommended prenatal vitamins.
Emerging scientific evidence has proven the importance of nutrients as essential helpers in our biochemistry and metabolism. They are the oil that greases the wheels of our metabolism. And large-scale deficiencies of nutrients in our population, including omega-3 fats, vitamin D, folate, zinc, magnesium, and iron, have been well documented in extensive government-sponsored research. It may seem like a paradox but obesity and malnutrition often go hand in hand. Processed, high-sugar, high-calorie foods contain almost no nutrients yet require even more vitamins and minerals to metabolize them. It’s a double whammy.
There are four main reasons we are nutrient depleted. First, we evolved eating wild foods that contain dramatically higher levels of all vitamins, minerals, and essential fats. Second, because of depleted soils and industrial farming and hybridization techniques, the animals and vegetables we eat have fewer nutrients. Third, processed factory-made foods have no nutrients. And fourth, the total burden of environmental toxins, lack of sunlight, and chronic stress leads to higher nutrient needs.
That is why everyone needs a good multivitamin, fish oil, and vitamin D. I also recommend probiotics because modern life, diet, and antibiotics and other drugs damage our gut ecosystem, which is so important in keeping us healthy and thin. Additional nutrients are needed for people with diabesity to reset and correct metabolic imbalances, improve insulin function, balance blood sugar, and reduce inflammation.
I’m sure you are confused by conflicting studies. One day folic acid is good; the next it is found to cause cancer. One day vitamin D is a lifesaver; the next it is found to be not helpful. This media whiplash is enough to make you give up altogether. The problem with these studies is that they treat nutrients as drugs—researchers give one nutrient alone and see what happens. But nutrients work as a team. Broccoli is great for you and can help prevent and cure many diseases, but if all you ate was broccoli, you would get sick and die. Nutrients work together to maintain the proper balance in your body.
In this chapter I will focus on the basic supplements everyone needs to help prevent and reverse diabesity and insulin resistance. Then I will address the additional supplements you need if your self-assessment qualified you for the advanced plan.
Drugs are regulated. You know what you are getting when your pharmacist fills your prescription. The government makes sure of it. Supplements are not controlled in the same way. The manufacturers often cut corners. It’s a minefield for the average consumer. Here are the potential problems I avoid when choosing supplements for my patients:
The form of the nutrient may be cheap and poorly absorbed or used by the body.
The dosage on the label may not match the dose in the pill.
It may be filled with additives, colors, fillers, and allergens.
The raw materials (especially herbs) may not be tested for toxins such as mercury or lead, or may not be consistent from batch to batch.
The factory in which it is produced doesn’t follow good manufacturing standards, so products may vary greatly in quality.
I use supplements in my practice as a cornerstone of healing and repair, so I have investigated supplement makers, toured factories, and studied independent analyses of their finished products. I have learned there are a few companies I can rely on. At www.bloodsugarsolution.com, I have listed the exact products I have used effectively with thousands of patients. There are other good products on the market, but to make it easy for you, I have provided a complete list (which I may update from time to time as the science advances) of what I recommend—both for the basic and advanced plans.
Whether you follow my product recommendations or not, be sure to pick quality supplements and ones that contain nutrients and compounds research has shown to be helpful in the treatment of diabesity and insulin resistance.1 Think of them as part of your diet. You want the best-quality food and the best-quality supplements you can buy. Guidance from a trained dietitian, nutritionist, or nutritionally oriented physician or health care practitioner can be helpful in selecting products.
Obesity and diabetes are often paradoxically states of malnutrition. It has been said that diabetes is starvation in the midst of plenty. The sugar can’t get in the cells. Your metabolism is sluggish and the cells don’t communicate as a finely tuned team. Nutrients are an essential part of getting back in balance and correcting the core problem—insulin resistance. There are two ways in which supplements work—they make your cells more sensitive to insulin and more effective at metabolizing sugar and fats, and special fibers can slow the absorption of sugars and fats into the bloodstream. This leads to a faster metabolism, more balanced blood sugar, improved cholesterol, less inflammation, fewer cravings, more weight loss, and more energy.
Everyone reading this book should get on the basic plan of supplements and stay on them for life. Even if you are “cured” of diabesity, you will need to keep taking them, because you need special vitamins, minerals, and herbs to help compensate for your genetic tendency toward insulin resistance.
Below are the supplements that should be in your daily regimen. The good news is that many of these components can be obtained by taking combination supplements. I suggest you find combination supplements that match my recommendations as closely as possible. Getting these ingredients in the listed dosage ranges is important. At www.bloodsugarsolution.com, I share exactly which supplements I recommend and tell you how to purchase them.
All supplements except the fiber should be taken with a meal, such as breakfast and dinner.
You can also use hypoallergenic protein powders to add to a morning protein shake.
In addition to these, most people should use high-quality probiotics, but this is optional. For more details on the probiotics I recommend, see www.bloodsugarsolution.com.
Let’s take a few moments to review specifics about each of these supplements or ingredients and why they are so important in the treatment of diabesity.
The right multivitamin will contain all the basic vitamins and minerals. Often special formulations for diabesity are available that include many of the ingredients listed for the basic plan above. On The Blood Sugar Solution website (www.bloodsugarsolution.com), I review the exact forms and amounts of nutrients that should be in any good-quality multivitamin. I also review specific instructions for testing and monitoring of your nutrient levels that can be done with your physician.
Keep in mind that getting the optimal doses usually requires 2–6 capsules or tablets a day. Some people may have unique requirements for much higher doses that need to be prescribed by a trained nutritional or functional medicine physician.
Note that B complex vitamins are especially important for those with diabesity, as they help protect against diabetic neuropathy, or nerve damage, and improve metabolism and mitochondrial function.
Antioxidants such as vitamin E, C, and selenium are also important as they may help reduce oxidative stress, which is a significant cause of diabesity.
Vitamin D deficiency is epidemic, with up to 80 percent of modern humans deficient or suboptimal in their intake and blood levels. Depending on what’s in your multivitamin, I recommend taking additional vitamin D.
Vitamin D3 improves metabolism by influencing more than 200 different genes that can prevent and treat diabetes2 and metabolic syndrome.3
There are many important things to keep in mind as you take vitamin D:
Take the right type of vitamin D—D3 (cholecalciferol), not D2. Most doctors prescribe vitamin D2. Do not take prescription vitamin D; it is not as effective and not very biologically active.
For serious deficiencies, you may need more vitamin D, as much as 5,000–10,000 IU a day for 3 months or more. Do this with your doctor’s supervision if needed.
Monitor your vitamin D status with your doctor. Get your blood level to 45–60 ng/dl. Check the right blood test, which is 25 OH vitamin D.
Give time to fill up your tank. It can take 6–12 months for some people. The average daily dose for maintenance for most people is 1,000 IU–2,000 IU a day.
These important fats improve insulin sensitivity, lower cholesterol by lowering triglycerides and raising HDL, reduce inflammation, prevent blood clots, and lower the risk of heart attacks.4 Fish oil also improves nerve function and may help prevent the nerve damage common in diabetes.5
Diets low in magnesium are associated with increased insulin levels, and magnesium deficiency is common in diabetics. Magnesium helps glucose enter the cells and turn those calories into energy for your body.
Some with severe magnesium deficiency may need more than the amount outlined above. Some may need less. If you are concerned you may be severely deficient, discuss the details with your doctor. Diarrhea is often a sign that you are getting too much magnesium. If this occurs, just back off on the dose, and avoid magnesium carbonate, sulfate, gluconate, or oxide. They are the cheapest and most common forms found in supplements but are poorly absorbed. Switch to magnesium glycinate. If you tend to be constipated, use magnesium citrate. People with kidney disease or severe heart disease should take magnesium only under a doctor’s supervision.
Alpha lipoic acid is a powerful antioxidant and mitochondrial booster that has been shown to reduce blood sugar and heal a toxic liver. It may also be useful in preventing diabetic nerve damage and neuropathy. It can improve the clearance of glucose from the blood by 50 percent.6
Chromium is very important for proper sugar metabolism and insulin sensitivity, and can help you make more insulin receptors.7 Biotin has been shown to enhance insulin sensitivity, lower triglycerides, reduce expression of cholesterol-producing genes, and improve glucose metabolism.8
A number of herbs, including cinnamon9 and catechins10 from green tea, are helpful in controlling blood sugar and improving insulin sensitivity. Green tea can even increase fat burning and metabolism. The best products provide combinations of herbs in one supplement.
PGX is a very viscous fiber from a Japanese tuber or root combined with seaweeds into a novel super fiber. It has profound effects on insulin, glucose, and hemoglobin A1c.11 It reduces the absorption of sugars and fats in your bloodstream and helps control appetite, weight loss, blood sugar, and cholesterol.12 When taken before meals with a glass of water, it can be a critical component to overcoming diabesity. It can lower your insulin response after a meal by 50 percent while lowering LDL cholesterol by 20 percent and blood sugar by 23 percent. I have had patients lose up to 40 pounds just by using this super fiber.
I strongly encourage the use of a high-quality, hypoallergenic rice, pea, hemp, chia, or soy protein powder. Some of these powders are anti-inflammatory and support detoxification. Soy protein from whole soy foods with isoflavones can lower blood sugar13 and cholesterol.14 A protein shake also serves as an excellent breakfast and snack option, helping balance your blood sugar and heal your liver. See here for great shake recipes.
If your diabesity self-assessment quiz qualified you for the advanced plan, you will follow the supplement routine outlined for the basic plan but will add the supplements below. When combined with the basic plan supplements, these herbs will help improve blood sugar balance and insulin sensitivity.
The advanced plan supplements should be taken for at least one year. After one year you should repeat your lab tests with your doctor, repeat the self-assessment quiz, and evaluate your progress. If your numbers are in the ideal ranges and your symptoms better, then you can scale back to the basic plan supplement recommendations.
I use combination products to help my patients achieve these goals at a reasonable cost with a reasonable amount of supplements. Please refer to www.bloodsugarsolution.com to learn more about which products I use with my patients and how to purchase them.
Let’s look at these supplements in more detail.
A new class of herbal supplements from the hops plant regulates critical signaling factors that control your genes. These are called protein kinases. The iso alpha acids in hops (RIAA, or reduced iso alpha acids) and acacia, also known as selective kinase response modulators (SKRMs), have been clinically shown to improve insulin sensitivity and fat metabolism.15
For advanced diabesity, I recommend fenugreek, bitter melon gourd,16 and gymnema leaf.17 Fenugreek is used in India and the Middle East. It contains 4 hydroxyisoleucine, which assists insulin function and helps lower triglycerides and raise HDL cholesterol. Bitter melon gourd helps reduce blood sugar in diabetes through its phytonutrients. Gymnema is an Ayurvedic herb that lowers blood sugar levels and may help repair or heal the pancreas.
Certain supplements may be useful in treating conditions associated with diabesity. While I strongly discourage you from going off any medication without your doctor’s supervision, you can integrate these supplements into your regimen to help you overcome the conditions listed below. To learn the specific products I recommend and use with my patients, see www.bloodsugarsolution.com.
Red rice yeast powder is derived from Monascus purpureus, an organism grown on rice. After centuries of use in traditional Chinese medicine, it was discovered that red rice yeast is useful in helping to maintain a healthful balance of cholesterol and related blood lipids in the body.18
Naturally derived plant sterols can also be useful in maintaining healthy cholesterol levels.19 Plant sterols are one class of phytonutrients. Taking them in high concentrations can enhance their potency.
The best supplements to help lower blood pressure are fish oil and magnesium, which I have already reviewed, and coenzyme Q10.20 (To learn about CoQ10 see Chapter 24, Step 6.) They are an important part of treating diabesity. You can also add the following:
This herbal remedy has been shown to play an important role in heart muscle function and coronary artery blood flow. It has also been shown to lower blood pressure in diabetics.21
Aspirin is often recommended to thin the blood in patients with diabesity and may be helpful for some, but there is increased risk of stroke and gastrointestinal bleeding. Therefore, I generally recommend natural blood thinners that don’t carry that risk.
This enzyme, found in the traditional Japanese fermented soy food called natto, helps maintain healthy blood flow and supports the body’s natural clotting processes.22 It is also useful in supporting blood vessel health.
Lumbrokinase is among the few fibrinolytic, or blood-thinning supplements, available. It is useful in helping the body maintain normal coagulation processes.23
When taking supplements, there are a few things to keep in mind.
Take them with food—with the meal or just before. Taking supplements after a meal may upset your stomach. If you still have an upset stomach, find a doctor who can help correct any digestive problems, which might be the source of intolerance.
Take fish oil just before meals to prevent any fish taste from coming up. Or freeze the supplement so the capsule is in your intestine before it dissolves.
I recommend the use of capsules whenever possible. They are generally easier to swallow. However, if you have trouble with capsules, open them and sprinkle the contents onto food or put into shakes. You can crush tablets and mix them with food or a little applesauce. There are also powdered and liquid forms of some nutrients.
There are several different classes of medications that are currently used in the treatment of diabesity. One of the most important studies in medicine, the Diabetes Prevention Program,24 found that medication did not work nearly as well as lifestyle changes, and this effect lasted even 10 years after the study ended. Patients who follow The Blood Sugar Solution may need less and less medication, and many may get off medication completely, or use the natural alternatives I just reviewed. Nonetheless, it’s useful to know what’s out there.
The only medication that I sometimes find helpful is metformin, or Glucophage. It is well tolerated, has been around a long time, and has been well studied. Most of the other medications cause serious complications or make things worse by boosting insulin levels and increasing the risk of death and heart attacks. Other medications are prescribed for diabesity, but they have limited benefits and significant risks, which I explain below. That is why I stay away from most of them. Nutrition, exercise, supplements, and stress reduction always work much more quickly and dramatically than medication.
Oral hypoglycemic medications fall into this category of medications that can make things worse, not better, by pushing your pancreas to make more insulin. Some of the medications now available are new and have not withstood the test of time. I always think of something I read in a medical editorial years ago: “Be sure and use a new medication as soon as it comes on the market, before the side effects develop.” Think Prempro, Avandia, Vioxx, to name a few.
Medications can be used alone or in combination. Here are the main classes of medications used to treat diabetes.
Biguanides, especially metformin (Glucophage), are among the best medications used to improve insulin sensitivity. They can help lower blood sugars by improving your cells’ response to insulin.
Thiazolidinedione drugs, including rosiglitazone and pioglitazone (Avandia and Actos), are a new class of diabetes medication that can help improve the uptake of glucose by your cells by making you more insulin sensitive. These medications also reduce inflammation and help improve metabolism by working on the PPAR, a special class of cell receptors that control metabolism, but the costs can be high. Known side effects include weight gain and liver damage. Avandia, the world’s number one blockbuster diabetes drug, has been shown to increase the risk of heart attacks, and from 1999 to 2010 it has been responsible for 47,000 cardiac deaths. It can now be prescribed only with special warnings and under certain conditions. Therefore, I am very cautious about prescribing these medications.
Sulfonylureas, which are older medications, include glipizide, glyburide, and glimepiride. I strongly recommend against these medications, because they only reduce your sugar in the short term and can increase insulin production over the long term. In addition, the FDA requires special black box warnings notifying patients that these drugs actually increase the risk of a heart attack, which is what you are trying to prevent in the first place. In short, they treat the symptoms rather than the cause.
Alpha-glucosidase inhibitors, including acarbose and miglitol, can help lower the absorption of sugar and carbohydrates in the intestines. These may be occasionally useful, but I find PGX fiber much more effective in slowing the absorption of sugars into the bloodstream. Touchi extract from black soybeans has been shown in laboratory studies to block alpha-glucosidase, the enzyme responsible for the breakdown of carbohydrates into simpler sugars, and slow the metabolism of certain sugars. I often recommend 300 mg before each meal for my diabesity patients.
Incretins are the new kids on the block. They work by prompting the release of insulin from the pancreas by stimulating glucagon-like peptide-1 (GLP1) receptors or inhibiting the enzyme DPP-4, which normally breaks down GLP-1. This helps keep blood sugar down. Over 58 percent of those who take the medication experience nausea, and 22 percent have vomiting. Not a fun way to lower your blood sugar. Long-term studies are not available to adequately assess the risks. A large scientific study known as NAVIGATOR25 showed that it was not effective in reducing risks associated with pre-diabetes, and in fact, a year after being on the medication, insulin and glucose levels were higher than they were before the medication was started. Based on this data, I avoid using these drugs.
Insulin is the last resort, after all other measures have failed, because it can lead to weight gain, increased cholesterol, and higher blood pressure.
Combinations of these medications may be helpful. But as you can see, many come with risks that can easily be avoided and eliminated if you make the necessary dietary and lifestyle changes to treat the underlying causes of your condition.
There are a few other kinds of medication often prescribed to people with diabesity.
Niacin (Niaspan) is a very useful medication. What you may not know is that it is actually vitamin B3. When used in high doses (1,000–2,000 mg) under a doctor’s supervision, it can be effective in lowering triglycerides and raising HDL—something statins are not very good at. However, niacin intake should be monitored carefully as it can cause liver damage when taken in high doses. It is my favorite medication to use if we cannot get HDL or triglycerides normalized using dietary and lifestyle measures alone. It also has the benefit of increasing your cholesterol particle size and reducing particle numbers, which statins don’t do. It has been shown in studies to reverse cholesterol plaques in arteries.26 Some studies have shown that combining a low-dose statin with niacin can also reverse plaque. Other studies have shown no benefit when combined with a statin.
Statins (Lipitor, Crestor, Zocor, etc.) have been shown to help lower LDL cholesterol and reduce heart attack risk and death but only in high-risk patients. However, they don’t significantly improve lipid particle size, lower triglycerides, or raise HDL. They also seem to increase insulin levels and can cause muscle damage and neurologic problems. They actually increase the risk of diabetes by about 9 percent.27 I find that the natural statins in red rice yeast can work well without the side effects. Statins lower inflammation as an unintended, but good, side effect. However, there are better ways to reduce inflammation, including an anti-inflammatory diet, exercise, fish oil, and even a multivitamin. For more information, see my blogs about cholesterol and statins at www.drhyman.com/cholesterol, including “7 Tips to Fix Your Cholesterol Without Medication,” “Do Statins Cause Diabetes?” and “Pharmageddon.”
Aspirin. Many patients with diabesity have inflammation and sticky blood. The recommendation offered by most physicians is to take a baby aspirin (81 mg) every day. This can be helpful but is not without risks. Gastrointestinal bleeding and hemorrhagic stroke can result. Three natural blood thinners are fish oil, nattokinase, and lumbrokinase. See here for more information.
Safely lowering blood pressure is important in diabesity. For most people, simply following The Blood Sugar Solution may result in lower blood pressure. But if you need to take high blood pressure medication, there are a few things you should know.
In general, ACE inhibitors such as Altace, ARB blockers such as Diovan, and even diuretics can safely lower blood pressure. The ACE inhibitors and ARB medications can help slow the progression of kidney disease. I would recommend staying away from beta-blockers, however, because they make insulin resistance worse. Studies have shown that they reduce glucose uptake into cells by about 25 percent. Natural alternatives to high blood pressure medication are hawthorn, fish oil, coenzyme Q10, and magnesium. See here for how to use natural alternatives to blood pressure medication.
The key with high blood pressure is to treat the cause. Most high blood pressure is actually caused by insulin resistance. Obstructive sleep apnea, magnesium or potassium deficiency, omega-3 fat deficiency, and environmental toxins such as lead and mercury are other treatable causes of high blood pressure that are often overlooked.