Evening primrose oil
Supplementing with 4 grams of evening primrose oil per day for six months has been found in double-blind research to
improve nerve function and to relieve pain symptoms of diabetic neuropathy.117
Glucomannan is a water-soluble dietary fiber derived from konjac root (Amorphophallus konjac)that delays stomach
emptying, leading to a more gradual absorption of dietary sugar. This effect can reduce the elevation of blood sugar levels
that is typical after a meal.1 1 8 After-meal blood sugar levels are lower in people with diabetes given glucomannan in their
food,1 1 9 and overall diabetic control is improved with glucomannan-enriched diets, according to preliminary and controlled
clinical trials. 120 121 122 One preliminary report suggested that glucomannan may also be helpful in pregnancy-related
diabetes.1 2 3 For controlling blood sugar, 500 to 700 mg of glucomannan per 100 calories in the diet has been used
successfully in controlled research.
People with low blood levels of vitamin E are more likely to develop type 1 and type 2 diabetes.124 125Vitamin E
supplementation has improved glucose tolerance in people with type 2 diabetes in most,126 127128 but not all,129 double-blind
trials. Vitamin E has also improved glucose tolerance in elderly people without diabetes.130 131 Three months or more of at
least 900 IU of vitamin E per day may be required for benefits to become apparent.
In one of the few trials to find vitamin E supplementation ineffective for glucose intolerance in people with type 2 diabetes,
damage to nerves caused by the diabetes was nonetheless partially reversed by supplementing with vitamin E for six
months.132 Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic
retinopathy and nephropathy,133 134 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,135 136 137 138 139although not all,140 141 142 studies.
In one report, vitamin E was found to impair glucose tolerance in obese patients with diabetes.143 The reason for the
discrepancy between reports is not known.
Vitamin E appears to lower the risk of cerebral infarction, a type of stroke, in people with diabetes who smoke. A review of a
large Finnish study of smokers concluded that smokers with diabetes (or hypertension) can benefit from small amounts of
vitamin E (50 IU per day).144
As with vitamin E, vitamin C may reduce glycosylation.145 Vitamin C also lowers sorbitol levels in people with
diabetes.146 Sorbitol is a sugar that can accumulate inside the cells and damage the eyes, nerves, and kidneys of people
with diabetes. Vitamin C may improve glucose tolerance in type 2 diabetes,147 148although not every study confirms this
benefit.149 Vitamin C supplementation (500 mg twice a day for one year) has significantly reduced urinary protein loss in
people with diabetes. Urinary protein loss (also called proteinuria) is associated with poor prognosis in diabetes.150 Many
doctors suggest that people with diabetes supplement with 1 to 3 grams per day of vitamin C. Higher amounts could be
problematic, however. In one person, 4.5 grams per day was reported to increase blood sugar levels.151
One study examined antioxidant supplement intake, including both vitamins E and C, and the incidence of diabetic
retinopathy (damage to the eyes caused by diabetes).152 Surprisingly, people with extensive retinopathy had
a greater likelihood of having taken vitamin C and vitamin E supplements. The outcome of this trial, however, does not fit
with most other published data and might simply reflect the fact that sicker people are more likely to take supplements in
hopes of getting better. For the present, most doctors remain relatively unconcerned about the outcome of this isolated
Many people with diabetes have low blood levels of vitamin B6.153 154 Levels are even lower in people with diabetes who also
have nerve damage (neuropathy).155 Vitamin B6 supplementation has improved glucose tolerance in women with diabetes
caused by pregnancy.156 157 Vitamin B6 supplementation is also effective for glucose intolerance induced by birth control
pills.158 In a trial that included people with type 2 diabetes, 1,800 mg per day of a special form of vitamin B6pyridoxine
alpha-ketoglutarateimproved glucose tolerance dramatically.159 Standard vitamin B6 has helped in some,160 but not all,
A controlled trial in Africa found that supplementing with both vitamin B1 (25 mg per day) and vitamin B6 (50 mg per day)
led to significant improvement of symptoms of diabetic neuropathy after four weeks.162However, since this was a trial
conducted among people in a vitamin B1deficient developing country, these improvements might not occur in other people
with diabetes. Another trial found that combining vitamin B1 (in a special fat-soluble form) and vitamin B6 plus vitamin B12
in high but variable amounts led to improvement in some aspects of diabetic neuropathy in 12 weeks.163 As a result, some