Note: The material is designed to inform and educate. It represents the opinions of the author based on his understanding of current medical research and is not intended to be viewed as a replacement for medical evaluation, advice, diagnosis, or treatment. If the information in this handout disagrees with personal information provided by your health care professionals, please follow their counsel.

Key Natural Strategies for Type 2 Diabetes

  • Weight reduction
  • Exercise
  • Dietary Changes
    • Replace saturated fats and trans fatty acids with monounsaturated fats
    • Emphasize high fiber choices
    • Consider a wholly plant-based diet
  • Talk with your doctor about simplifying drug regimens

Key quote: “Moreover, many drugs used by…patients may contribute to glucose intolerance. These include thiazide diuretics, glucocorticoids, beta-adrenergic blocking agents, nicotinic acid, and phenytoin.” Bressler P, DeFronzo RA. Drugs and diabetes. Diabetes Rev. 1994;2:53-84.

Supplements worthy of consideration:

  • Guar
  • Garlic
  • Bitter Melon
  • Ginseng
  • Chromium
  • Alpha lipoic acid
  • Vanadium
  • GLA
  • Bilberry
  • Gymnema sylvestre
  • Fenugreek

Insights on selected supplements

I. Garlic

So long as someone is not on a drug with a critical therapeutic window; there is evidence that garlic may have salutary effects with limited side effects.

Typical dosage: 4 grams of fresh garlic or equivalent preparations (9.6 mg allicin-releasing potential in one recent study showed beneficial lipid effects).

However, some research suggests many garlic pills release only small amounts of their active ingredients.

Garlic References: Kannar D, et al. J Am Coll Nutr 2001 Jun;20(3):225-31; Lawson LD, Wang ZJ. J Agric Food Chem 2001 May;49(5):2592-9

II. Ginseng

200 mg of Asian Ginseng (Panax ginseng) per day for eight weeks improved mood, physical activity and lowered fasting blood glucose, hemoglobin A1c levels and body weight.

Criticism of the study is that weight reduction by itself will result in blood sugar improvements.

Note that Siberian Ginseng (Eleutherococcus senticosus) does not contain the ginsenosides that are among the active blood sugar-lowering components.

More rigorous studies of American Ginseng (Panax quinquefolius) demonstrated that 3000 mg of powdered root taken with a standardized “meal” could blunt the post meal blood sugar rise in individuals with type 2 diabetes.

The same group found that doses beyond 3000 mg gave no additional blood sugar effect.

This raises the question that the threshold for blood sugar lowering may be considerably lower than 3000 mg

Ginseng concerns

Allergies, asthma in susceptible individuals

Ginseng can lower blood concentrations of warfarin

May induce mania if used concomitantly with the antidepressant phenelzine.

May have steroid-like effects including both estrogenic and corticosteroid effects

Has been associated also with hypertension, insomnia, nervousness and headache

Ginseng Conclusions

High dose American ginseng has documented effectiveness in type 2 diabetes: 3000 mg with or up to 2 hours before a meal

Not recommended for people taking medications with a critical therapeutic window such as warfarin

Relatively contraindicated in hypertension as well as conditions where estrogenic or corticosteroid effects could be detrimental

Probably not a good choice in individuals with history of need for psychiatric medications

Ginseng References:

Sotaniemi EA, Haapakoski E, Rautio A. Ginseng therapy in non-insulin-dependent diabetic patients. Diabetes Care 1995 Oct;18(10):1373-5.

Vuksan V, et al. Diabetes Care 2000 Sep;23(9):1221-6

Vuksan V, et al. Arch Intern Med 2000 Apr 10;160(7):1009-13

III. Gymnema sylvestre

  • Active constituents
  • Gymnemosides
  • Gymnemic acids

Possible mechanisms (how it seems to work)

Well established role in decreasing sweet-perceptions, may help with “sweet tooth”/sugar cravings

Demonstrated to decrease caloric intake

May decrease intestinal fat and glucose absorption

Beta-cell stimulant and “tonic”?

Insulinomimetic (acts like insulin)

May also have lipid lowering effects

Side Effects


Animal models suggest that it may raise blood pressure

Recognize that the literature is very sparse on human studies of G. sylvestre


400 mg/d of GS4, a G. sylvestre extract may aid in diabetic control, with few side effects or contraindications noted

If G. syvestre is used careful monitoring for side-effects is recommended

IV. Momordica (bitter melon, karela)

Active ingredients

  • Momordin/ charantin (hypoglycemic)
  • Momordicine alkaloid
  • Polypeptide P

Possible mechanisms (how it seems to work)

Increases glucose uptake

Increases glycogen synthesis


Side Effects

Diarrhea/ abdominal distress

Abortifacient (may cause abortions)


Favism (a severe reaction that can also occur with fava beans)

Drug Interactions



Blood sugar lowering

Animal models suggest that this plant may also lower insulin resistance.

A water-soluble extract of the fruits significantly reduced blood glucose concentrations during a 50 g oral glucose tolerance test in the diabetics and after force-feeding in the rats.

Fried karela (momordica) fruits consumed as a daily dietary supplement produced small but significant improvements in glucose tolerance.

Improvement in glucose tolerance was not associated with an increase in insulin production.

Selected reference: Leatherdale BA, Panesar RK, Singh G, Atkins TW, Bailey CJ, Bignell AH. Improvement in glucose tolerance due to Momordica charantia (karela). Br Med J (Clin Res Ed) 1981 Jun 6;282(6279):1823-4

V. Soluble Fiber-Rich Plant Products

Examples: guar gum, psyllium, beta-glucan rich barley

Lipid lowering effects in addition to blood sugar lowering effects

Favorable effect on prolonging blood levels of CCK (cholecystokinin) which has been shown to reduce food intake in animals and humans

VI. Fenugreek

Appears to help lower blood sugar by multiple mechanisms

  • Delays glucose absorption
  • Prolongs gastric transit
  • Fiber effects
  • Note: also appears to have lipid lowering properties

VII. Alpha lipoic acid

Demonstrated benefits in both type 1 and type 2 diabetes

May help prevent diabetes pathologies including:

  • macular degeneration
  • cataracts
  • neuropathy

Demonstrated to help treat peripheral and autonomic diabetic neuropathy.

Dosages of 600 – 800 mg/d often used

Older studies show neuropathy benefits with as little as 50 mg twice daily

Appears to have beneficial effects in improving insulin sensitivity and treating and/or preventing diabetic complications

Regimens in the range of 600 -1800 mg/day have often been used

the absence of a dose response effect in some studies raises the question as to whether lower doses may be efficacious

It may be reasonable to start at dosages as low as 50 mg twice daily while assessing clinically

Appears to have few side effects

VIII. Vanadium

A recent study led further credence to the value of this micronutrient in diabetes

11 patients with type 2 diabetes received daily vanadyl sulfate for 6 weeks

over two weeks titrated up to 150 mg/d

dosed as 50mg thrice daily with meals

Multiple improvements were noted:

  • lowering of HbA1c and fructosamine
  • decreased FBS; evidence of improved insulin sensitivity
  • fall in total cholesterol and LDL

Vanadyl sulfate appears well tolerated and potentially useful in type 2 diabetes

gradually titrate dosage over 6 wk

target dosage of 150 mg/day

May be a useful short-term strategy

Concerns with long term use: vanadium accumulation and potential for side-effects

This concern has been underscored by the failure to demonstrate vanadium deficiency in patients with diabetes

IX. Chromium

Research has demonstrated that chromium has a variety of salutary effects in glucose metabolism.

These include:

  • increased number of insulin receptor
  • improved insulin binding to the receptors
  • enhanced insulin internalization
  • augmented beta cell sensitivity

All of this culminates in increases in insulin sensitivity.

An important study…

180 Chinese subjects with type 2 DM

Randomized to twice daily regimen of either placebo, 100, or 500 micrograms of chromium picolinate for 4 months.

At four months, HBA1c (average blood sugar indicator) compared to placebo group:

22% lower in 1000 mcg/d group

12% lower in 200 mcg/d group

Additionally, improvements in fasting and post meal insulin levels in both chromium groups

Lowered cholesterol in the 1000 mcg/d group

Chromium Summary

Appears to be a generally safe and reasonable supplement to improve glucose homeostasis

No compelling data supporting its use as a weight reduction aid

May have favorable effects on lipids

Dosage may be best guided by degree of glucose intolerance. Some suggest the following considerations:

200 mcg/day Cr if mildly glucose intolerant

More than 200 mcg/day in individuals with greater glucose intolerance and/or diabetes

Dosages in the range of 1000 mcg per day may be necessary in some individuals with diabetes

X. Niacinamide (nicotinamide)

An agent of promise in both type 1 and type 2 diabetes

May help preserve insulin-producing capacity in early type 1 diabetes

A provocative study in type 2 diabetes:

18 patients with type 2 diabetes enrolled in a 6 month single blind study:

All had failed to control their blood sugar with the maximum dosage of standard oral medications (sulphonylureas)

Some randomized to nicotinamide 500 mg TID

Results in those using nicotinamide:

Achieved metabolic control indistinguishable from patients treated with insulin.

increased C-peptide release (an evidence of increased insulin production by the pancreas)


Am. J. Physiol. 274 (Gastrointest. Liver Physiol. 37): G607–G613, 1998

Am J Clin Nutr 1999;69:55–63.

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