What Supplements Actually Help with Diabetes Management?

0:00
Before kicking off this weeks episode, wanted to share some news that I am thrilled about.

We have officially launched our signature one-on-one coaching program 12 weeks to lower your A1C.

If you’re feeling overwhelmed with diabetes or pre diabetes, we got you.

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0:55
Welcome back to another episode of the Diabetes Digital Podcast.

Today we’re talking all about supplements, and this is a topic that we get asked about all the time, especially for people with diabetes.

There’s so many supplements out there that people talk about in the context of helping lower their blood sugar, including cinnamon, bitter melon, chromium, alpha lipoic acid.

1:16
And today we’re going into all of the science behind these supplements, whether or not they actually work, what they’re doing in the body, like the mechanism of action that we call it, and if they are effective, what dose you should take it at.

We’ll even get into the potential side effects.

1:33
And the surprising thing is most of these supplements do have side effects.

Some of them are more minor and others were more serious, like the potential for liver damage.

So definitely going to want to know all those details.

We’ll even get into apple cider vinegar because we can’t talk about supplements without talking about that and whether or not there’s research to support it.

1:51
And I think the most important part of this episode is the one supplement that our guests definitely does not recommend for people with diabetes.

In other words, what is the one supplement that you should not be taking if you have diabetes?

And it’s a popular one.

So tune in for that.

2:08
I also like that the guest gives very specific recommendations, including her favorite multivitamin brands and why she likes them.

So TuneIn till the end to get all that info.

Our guest today is none other than Constance Brown Riggs, who is an award-winning registered dietitian, certified diabetes educator, and the national spokes person for the American Dietetic Association and co-author of the Diabetes Guide to Enjoying the Foods of the World.

2:33
We’re actually both co-authors on that book, which is insane that I got to work with the legend Constance Brown Riggs.

She’s also the author of the African American Guide to Living Well with Diabetes and Eating Soulfully and Healthfully with Diabetes.

Over the course of her career, she has established herself as an expert on the subject of nutrition, diabetes, and the cultural issues that impact the health and healthcare of people of color.

2:57
The work has been featured in national magazines such as Essence, Heart and Soul, Real Health, and Diabetic Cooking.

We are honored to have Constance Brown Riggs, also known as Connie, on the podcast today.

Welcome to the Diabetes Digital Podcast.

I’m Wendy.

3:12
And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.

Through our telehealth platform, Diabetes digital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes and pre diabetes.

Visit diabetesdigital.co, that’s Co to book your first appointment.

3:31
We accept insurance and offer affordable self pay options.

Now let’s get into today’s episode.

Welcome to the podcast, Connie.

Thank you.

Thank you.

Excited to be here.

Well.

3:46
We’re just going to jump right in because we always talk about you on this podcast is being one of the pioneering dietitians, especially in the diabetes space, but just in general.

And so we are honored to have you on the pod.

I feel like you’re one of the biggest dietitians in general in terms of like, everybody knows who you are and you’ve worked with all the different brands and you’ve had a private practice.

4:14
And I remember I always looked up to you when I was in school and you would do these private practice like webinars series on how to start a private practice.

So yeah, it’s just an honor to have you and especially to talk about diabetes and supplements.

So my first question is, there’s a lot of information on social media about supplements and especially supplements for diabetes.

4:36
Now we have Tiktok and everyone is kind of sharing what they’re finding, whether or not it might be evidence based.

And there’s also a ton of supplements that may play a role in managing diabetes.

So hey, just to get started, do you feel like there are supplements that are actually helpful in managing diabetes that you would recommend to people?

4:59
Or do you feel like for the most part, there’s not strong evidence behind supplements in diabetes care?

For the most part, there’s not strong evidence, but there’s some evidence.

And so when we look at whether or not to recommend a particular supplement, I look at the individual.

5:18
I look at the studies and then look at the individual as well.

So for an example, if we’re talking about alpha lipoic acid, I’m reminded of a gentleman that I had in the office who was having severe pain from neuropathy and he wanted to try alpha lipoic acid.

5:40
Now I know that, you know, as long as he’s not overdoing it in terms of dosage that it’s pretty safe for him to take.

And so he wanted to try it, said OK, let’s try it.

So it’s individual.

5:56
It’s not just across the board.

You come in my office, you have diabetes, you’re going on supplements.

It doesn’t work that way.

Do you find that people often think supplements are better than, for example, taking medication like let’s just say metformin?

6:13
Do you feel like people are thinking like, oh, supplements are natural and like I should start there, or people like they’re indifferent to it from your experience?

They’d rather take the supplement than the medication, just as you said, because it’s natural.

They feel OK, well, this is going to be much better.

6:31
But what I have to educate and what we’re doing now is educating individuals to make them aware that, let’s put it this way, an earthquake is a natural occurrence, but you wouldn’t want to be in an earthquake.

So it’s the same thing with supplements.

6:47
They are natural, but they also have side effects.

They can interact with other medications that you may be on that you may be taking.

So it’s not something that you just go about like you’re eating candy or something.

You just don’t start taking supplements.

7:05
You need to be evaluated with the healthcare provider, discuss what medications you’re on, what conditions you have other than diabetes, and determine whether or not there may be an interaction with the medication that you’re on and with the supplement.

7:23
But unfortunately, everyone is looking for a quick fix.

They’re looking for the easy way out, as they call it.

So they think avoiding medication taking the supplement is going to be the end all for them.

In the meantime, they’re not taking care of their diabetes because the supplement 1 takes much longer to work in the system than the medication does.

7:48
So in the meantime, diabetes is still out of control.

Yeah, well, let’s go through some of the most common that I see, whether it’s on the Internet or people talking about them.

And you can tell us what your thoughts are, what the evidence says, as well as if you have noticed that the evidence says there’s might be side effects or that you see side effects with people, maybe how it’s believed to work.

8:15
And if it does work, I guess work in quotes for some people, like what the dose might be.

OK, so let’s start with cinnamon.

What does the evidence say about cinnamon?

All right.

Well, the cinnamon has been talked about in the diabetes space for a long time.

And basically, if you look at the current research, I actually happened to look at the most recent meta analysis and what it shows.

8:40
They actually looked at 16 randomized control trials and it showed that cinnamon does have the ability to reduce blood glucose levels.

So it reduced fasting blood glucose by about 10 milligrams per deciliter and that’s significant.

8:58
And then also there was reduction in A1C as well.

So cinnamon, the thought is that it actually helps to improve insulin sensitivity.

That’s how it works, and it’s generally safe.

The caveat, however, is generally safe, but if you take too much, you can run into problems with liver disease.

9:21
It does affect the liver, and there are two different types of cinnamon.

So in the research, most of the time they’re using the cassia type cinnamon and that’s because that’s readily available.

It’s it’s cheaper than using the Ceylon, Ceylon type of cinnamon.

9:41
So that’s the important thing.

Cinnamon actually has a compound called coumarin and that coumarin is what attacks or affects the liver, if you will.

So Siloam Cinnamon actually has less coumarin than the Cassia, so that’s why you know it’s recommended if you’re taking a cinnamon supplement, to take the Cylon type of supplement.

10:09
That’s so good to know.

Yeah, but you do have to be careful with that for just about everything.

I have, you know, an anecdote of an individual that was taking the cinnamon capsules and the capsule burst in her mouth.

Oh.

My God.

Yes.

And so she almost choked to death.

10:27
So you got to be very careful for many different reasons when you’re taking these supplements.

Oh my God that’s so scary.

Do you recommend capsules or that people just because I remember back in the day I used to.

I like the taste of cinnamon, so I put some in my smoothie.

10:44
Like is that a way that people can have it?

And then how much should people take?

My recommendation is to sprinkle, sprinkle, sprinkle just as you said, to add it to smoothies, put it on your cereal, have a cup of tea, coffee with cinnamon and to use it that way because chances are much less of you getting too much if you’re using it as an additive seasoning, you know, to liven the the taste and flavor of your food as opposed to taking a capsule or powder.

11:17
And again, when you think of the risk in terms of liver toxicity, is it really worth it?

You know the benefit?

I don’t think so.

I wouldn’t recommend taking a supplement.

I’m very conservative when it comes to to supplements.

11:33
Very conservative.

OK.

Yeah.

And I understand why you mentioned already alpha lipoic acid, also known as Ala.

Can you talk about that and what the research may or may not suggest that it can be helpful for?

Yes, yes, OK.

11:49
Alpha lipoic acid also acts as an antioxidant and we know that in terms of diabetes that there is a lot of stress and inflammation in the body.

So it actually will work that way as far as reducing that oxidative stress.

12:06
And the studies show that it can help with pain, with the neuropathy, with the burning sensation that patients have that it did actually lower, that it lessen the pain.

And the dose on that is about 600 to 1200 milligrams per day is what’s recommended.

12:27
Again, there are possible side effects, Nausea, skin rash is some of the side effects that were observed through the studies.

And if you know someone wants to take out for lipoic acid, again, it’s generally considered safe as long as they’re not overdoing it.

12:45
The dosage is about 600 milligrams per day, 600 to 1200 in the studies.

Most studies use 600.

OK, that would be a recommended start.

And again, my philosophy there is start low and go slow.

Yeah.

13:02
And also I think it’s good that we’re pointing out what these supplements might be helpful for.

So it’s like if someone is having that nerve pain, then maybe this is one they want to try.

But if they’re not, then maybe they try something else.

Exactly.

Exactly.

Yeah, OK, Bitter Melon, that’s one that I always hear about is being helpful for diabetes.

13:21
What are your?

Thoughts.

Yes, it is helpful.

It can bring blood glucose levels down.

Studies looking at individuals with type 2 diabetes found that there was a decrease in fasting blood glucose as well as overall glucose.

13:39
Again, there are some caveats there.

Individuals had upset stomach.

If they took too much of it, they actually ended up with very low blood glucose level.

So that’s something that has to be watched out for.

13:54
Also it causes for many people cramping in the stomach and also for individuals it’s not recommended for anyone who was pregnant, it has been associated with causing miscarriage because of the contractions that it causes.

14:11
So bitter melon got to be very careful with that.

And any of these, the reason that you want to check with your healthcare provider and to be monitored is because, you know, if you’re taking this along with medication, that’s when it really can become very dangerous and you end up with hypoglycemia.

14:31
Yeah, yeah.

But the bitter melon does, it does help.

It is helpful in bringing down blood glucose levels.

OK.

And what dose might somebody try bitter melon out to start?

Bit of melon, if it’s an extract, it’s about 200 to 400 milligrams per day, and if it is juice, just a bit of melon juice, it’s about 50 to 100 milliliters.

14:57
Okay, okay, great.

And then moving on to Chromium, any thoughts on that one?

Yeah, chromium is, I’d say the all time favorites that have been out there associated with diabetes.

And of course, you know, we know chromium is an essential mineral.

15:14
It’s something that we do need, but most people don’t have a deficiency of chromium.

And unless there’s a deficiency based on the studies, it really doesn’t have any effect.

It’s not going to help to improve blood glucose, but if there is a deficiency, then definitely chromium is something that you’d want to take and it will help to bring down your hemoglobin A1C.

15:40
So for that reason, if there’s a deficiency, then I recommend chromium.

You know, as I said, most people don’t have a deficiency, but generally it’s considered safe.

And again, for that reason, I, you know, I feel comfortable if someone wants to try chromium and we start at a low dose, which is 200 micrograms per day and the range it goes from 200 to 1000.

16:06
But again, start low and go slow.

See what the outcome is, how the individual is feeling, what’s happening with their blood glucose, if it makes any difference, and you.

Mentioned like if people have a deficiency then it might be helpful.

I’ve never had a doctor test me for chromium.

16:24
Is this something that people with diabetes should ask that they get tested for?

Or how would they know if they were low?

Right.

They would have to have a blood test in order to determine that.

Another way that gives you an idea that they may be deficient is doing a nutrient analysis.

16:42
And that’s one of the things I generally would start with is the nutrient analysis to get some idea of what they’re eating, what foods they’re deficient in.

And of course, that gives us an idea of what they may be deficient in.

16:57
It’s not definitive, but it helps to give us some idea where we should be going.

Do you know which foods are good sources of chromium?

For chromium, broccoli, grapes, whole grain products, green beans, nuts, beef, those are all good sources of chromium.

17:17
So if someone is not eating generally, we’ll say green vegetables and you know, fruits, they’re deficient in fruits and whole grains, then there’s a chance that they may be deficient in chromium.

OK, OK.

That’s good to know.

And then the other one, I think this is the last one that I hear specifically for diabetes, Berberine, I don’t know if that’s how you pronounce it, Berberine.

17:41
I said Berberine.

Berberine, OK, Because my husband’s Eritrean and they have something called berberi and I’m like, is it berberi?

Probably not because it’s really spicy.

Can you let us know what’s the 411 on that one?

17:57
Yes, that actually was big time in the news last year.

What did they call it?

They connected it with Ozempic.

OK.

Because it has the ability to cause weight loss as well as bring down blood sugar levels.

18:14
So that’s where it got a lot of press.

And, you know, I’m a lot on social media, of course.

But as far as studies go, there was a review recently with that and they found that it is as effective as metformin OK, in bringing down blood glucose.

18:33
Fasting blood glucose levels reduced 21 milligrams per deciliter and A1C came down almost 1.1 percentage point on the A1C.

So it definitely does work.

That’s great.

And any negative side effects.

18:49
Yeah.

The dose on that was 500 milligrams two to three times daily and it comes in capsules.

We looked them all up too before.

So I have gastrointestinal issues like Constipation, diarrhea, stomach pain, and potential interactions with other medications.

19:08
Yes, the gastrointestinal discomfort with the berberine, it was interesting looking at where it’s available.

It comes from many different plants, so it’s not as if there’s one plant.

It’s found in Golden Seal and several other plants as well.

19:26
OK, wow, it sounds like that one is pretty promising, so long as it doesn’t disrupt someone’s GI tract.

Right, right.

OK.

And then there’s two more that aren’t necessarily related.

Well, they are related to diabetes, but they’re not ones that you hear solely in conjunction with diabetes.

19:44
And that’s magnesium and omega-3 fatty acids, right?

Are those two that you’d recommend that people just supplement with in general?

Because I know a lot of people tend to be low in magnesium.

I’m curious on your thoughts.

Yeah.

The magnesium is linked to diabetes.

20:00
Low levels are associated with more insulin resistance.

So definitely magnesium is something that we want to make sure.

You know our patients are getting sufficient amounts of and starting point would be to look at the food that they’re taking and if we feel they need a supplement then it is recommended.

20:20
Magnesium citrate is the best form because of the bioavailability of that.

So that is what is recommended.

Looking at 2020 review that was in the Diabetes and Metabolism Journal, it actually showed that it improved insulin sensitivity as well as reduced glucose levels by about four milligrams.

20:43
And that was specifically looking at people with type 2.

OK, Now the important thing to remember with magnesium is that high doses will cause diarrhea.

And again, another one of my stories, I had a little lady that came into my office complaining of severe diarrhea.

21:03
She’d been to the doctor, she had been to the GI specialist and worked up.

And it’s amazing that no one really paid attention to what supplements she was taking.

She was taking so much magnesium individually.

21:19
Oh, wow.

In combination with other supplements that she was taking.

And that’s why she was having severe diarrhea and of course, weight loss and everything else that goes along with that.

Oh, no, yeah.

Yeah, magnesium, definitely watch out.

21:34
It can cause diarrhea if you know individuals are taking too much.

Yeah, the dosage on magnesium is 250 to 350 milligrams per day.

Okay, love it.

And the good news is, it’s available readily.

21:51
Available in food.

So yeah.

Is there a couple of foods that you recommend people try who are wanting to get more magnesium in their diet?

Dairy yogurt.

Yogurt is a great source of magnesium.

22:07
Leafy greens, nuts, seeds, Avocado.

That’s one that most people wouldn’t think of, but avocado Also good source of magnesium as well as fish.

OK, great.

And then Speaking of fish, last but not least for the supplements, omega-3 fatty acids, do you recommend people take these to help with blood sugar regulation or just people with diabetes in general for heart health?

22:35
Yeah.

It’s more in general for heart health and it’s anti-inflammatory properties that it has.

It doesn’t really impact blood glucose levels, but it is something that is recommended for people with diabetes because it’s beneficial in terms of cardiovascular health.

22:53
We know along with diabetes there is that increased risk for heart disease, so it also will as part of that will help to reduce triglyceride levels anywhere from 15 to 30%.

Oh, wow, yeah, that’s so significant.

23:08
OK, now I know we went over a lot of supplements, and I’m sure, you know, there might be some people who are like, Oh my gosh, I don’t even know what to do because there’s so many.

I’m wondering, as someone who has worked in diabetes for so long, out of all of these supplements, are there any that you tend to recommend more than others to your patients?

23:29
And then why or why not?

What I generally recommend is a supplement that is put together, you know, a multiple vitamin for an example.

I don’t know if you use name brands, but there’s one in particular that I use that I recommend generally.

23:48
And then after that, as I said, if someone has a particular interest in a supplement, then I would help them along with that, direct them how to take it, you know, looking at their blood work, looking at their history, whether or not they should or shouldn’t take it, what medications are they taking?

24:11
Is it going to interact with the medication?

And we do have to be very careful with that.

Some supplements will actually interfere with the absorption of a particular medication.

Yeah.

And you can share name brands.

I want to take a guess at what name brand you’re going to say.

24:28
So I really like Ritual, but I feel like I hear a lot of dietitians talk about Centrum.

Is that it?

Centrum or alphabetic also.

I don’t know that one.

OK.

And is Centrum one of the ones you recommend?

Because from what I remember, they have like 100% daily value for everything versus it being like 5000%.

24:50
So it’s just kind of more balanced.

More balance and alphabetic as well.

OK.

And again, it’s targeting, it has the alpha lipoic acid in it.

It has, you know, chromium in it.

It has all of those things basically that we’re looking at, but it’s more balanced because it’s a multivitamin as opposed to taking each one individually.

25:13
The other thing that I’m very conscious of is most of the people that I see are actually taking all kinds of medication by the time they get to me, unfortunately.

And so, you know, to ask them to take five additional vitamins A day.

25:31
Most are resistant to that, yes.

You know, so generally, if they’re coming to me, they’re interested in one particular supplement or maybe they have no idea at all.

And again, that’s where the multiple comes in.

Yeah.

So I call that an insurance policy just in case.

25:49
Yeah, I think that’s a great idea idea to just take the one that has a little bit of everything.

I think that makes it easy.

And then if there’s something in particular that you like based on what we said, you know, the research says it might help with, then maybe add one on, ideally with the consulting of a healthcare provider, like a dietitian.

26:07
But that’s great advice.

Now, I couldn’t have you on without asking about apple cider vinegar because it’s so popular for diabetes.

What is your take on that?

Is it helpful?

It’s helpful.

It can help.

OK, Yeah, there’s some research that shows that it has a benefit.

26:25
Just to add with all of these, it’s not that there’s no research, There’s not enough, you know, and maybe the research on many of them is conflicting.

You know, some studies show a benefit, some studies show no benefit or very little benefit.

26:44
So, you know, until there’s much more research done, these supplements are not going to be recommended as preventative or even as part of a regimen for someone with diabetes.

It’s not going to be generally recommended through the American Diabetes Association or you know, any of the credible organizations in terms of making guidelines and setting standards.

27:10
But that’s not to say because we’re individual practitioners and we look and evaluate and assess.

And so it doesn’t mean that we’re not going to make any recommendations at all for our patients.

We do based on the individual.

27:27
Yeah, kind of reminds me, and this is off the topic, but with low carb, and I know, you know, many people don’t believe in low carb, but before it became a big thing, I always watch the carb for my patients because many of them insulin resistance and we’re taking much too much carbohydrate.

27:50
Yeah.

So it wasn’t low to the extreme, but it was lower by the standards of most people you know.

Yeah, well, and I think part of it is people don’t realize which foods have carbs.

Exactly how?

28:05
Many, they have, you know, like even I was eating, I went to the movies last night.

I got some Starbursts or something.

And I was just like curious, looking on the back.

And I was like, OK, yeah, this is a significant amount of carbs.

And if you were to eat this whole thing, I mean, it was like hundreds of carbs if you were to eat the whole bag.

Yeah.

28:20
And so somebody, yeah, who’s watching their what they’re eating or worried about, you know, the blood sugar management like that can be pretty significant.

So just like I think, yes, like you said, the education around like what foods have carbs and how many in a day for certain people is super helpful.

28:38
OK.

So are there any supplements that you definitely do not recommend for diabetes that you see people taking?

Yes, Saint John’s Ward, that’s one of the major ones.

And again, because it’s the liver toxicity that can interfere with medication, it can actually cause in some cases, the medication to be more concentrated in the system.

29:03
So they’re getting a higher dose than what they’re actually taking.

And it can also interfere from the opposite way.

It can cause a decrease in that medication.

John Ward is the deadliest, I’d say.

Yeah.

OK.

29:18
That’s helpful.

Because I feel like a lot of people take that you mentioned a couple times medications and interactions.

Is there a way that patients can figure out, like if these supplements do interact with meds they’re taking, like, how do they best go about being safe about it all?

29:35
Yeah, go to the National Center of Complementary and Integrative Health, and that is where they can look up any supplement that they’re interested in taking and it will tell them what the risk are, side effects, dosage, and what medication it may interfere with.

29:57
And also from the other perspective, Good RX is a great resource so that you look up the exact medication that you’re on and then that will give you any indication what you should avoid when you’re on that particular medication.

30:14
OK, that’s very helpful.

So everybody definitely bookmark those websites if you’re if you have diabetes and or just in general and you want to know like what meds interact.

OK, in wrapping, what is the most important piece of advice that you would give as a diabetes dietitian to somebody with diabetes who is considering supplements?

30:35
Speak to your healthcare provider.

That’s the best thing that you can do.

Speak to your healthcare provider.

Let them know that you’re interested in taking a particular supplement.

Find out all that you can about that supplement.

30:51
If you decide to go on your own, make sure you’re getting a good brand of that particular supplement.

So look for the USP indication on the label and that’s United States Pharmacopier.

31:06
And what that does is it indicates that that particular vitamin supplement is good in terms of strength that what you’re getting.

If it says chromium picolinate, you’re getting chromium picolinate.

If it says Salon cinnamon, you’re getting that.

31:24
So it’s being informed, doing your homework before you start.

You know, once you have that conversation with your physician and you feel comfortable, sometimes, you know, as I said, I’m conservative, but some physicians are worse than I am when it comes to anything from herbal supplements.

31:43
You know, if they hear that word, no, you don’t need that, then maybe you need to change your healthcare provider if they’re not willing to have a conversation and help you along the way.

So it shouldn’t just be no, don’t take it.

It’s let’s see how we can work this out.

31:59
Great advice.

And last but not least, can you let people know where they can find you if you are online these days?

Because I know at the top of the call you mentioned you’re like slowly retiring.

But yeah, we’re like just any work that you want to point people to that you’ve done in the past.

32:18
My Instagram page, that’s my passion.

That’s my passion since I’ve semi retired and it’s filled with information on diabetes and that’s exactly what it’s geared towards and what my purpose is, is to continue to educate individuals as far as living well with diabetes.

32:38
That’s my mission.

Well, thank you so much, Connie.

This was incredible and I feel people got some very solid information in a Safeway, yes, where they can go and incorporate supplements if they choose to.

So I appreciate it.

32:54
It was lovely having you on and thanks again.

Yes.

It was good to see you.

Thanks for joining us for today’s episode.

If you’re interested in nutrition counseling with one of our expert dietitians to help improve your pre diabetes or diabetes, visit us at diabetesdigital.co.

33:11
Also, if you found our conversation helpful, do us a favor and rate and review this podcast on iTunes, plus share with someone who might find this helpful.

You can also connect with us on Instagram at Diabetes Digital.

Dot Co and TuneIn every Wednesday for practical, inclusive, and culturally humble diabetes insights.

33:30
We’ll catch you later.

Bye.