Diabetes Self-Management Blog

Love ‘em or hate ‘em, dietary supplements are big business: According to the Centers for Disease Control and Prevention (aka, the CDC), more than 50% of adults in the US take one or more dietary supplements every day. Some of the heavy hitters include multivitamins, calcium, vitamin D, and folic acid.

Researchers think that supplement use is up, in part, due to the economy: Self-treating for an affliction can be less expensive than a doctor’s visit, paying for expensive medicine, or having a surgical procedure (but self-treating is not always wise or safe).

My mantra has always been to discuss the use of supplements with your physician. I realize that not all physicians (or health-care professionals, for that matter) are receptive to the idea of supplements, so if that’s the case, talk to a dietitian about what you’re taking or if you’re planning to start taking a particular supplement.

You know by now that “natural” or “herbal” doesn’t necessarily mean “good” or “safe,” so you need to understand what you’re taking, what the possible side effects (good and bad) are, and if your supplement might interact with any medicine that you take, whether it’s for your diabetes, your blood pressure, your cholesterol, or any other condition. Supplement/drug interactions can be just as serious as drug/drug interactions, so do your homework and arm yourself with information.

A good source of information is the National Center for Complementary and Alternative Medicine, which is part of the National Institutes of Health. You can get a lot of useful, accurate information about supplements on this Web site.

You can always ask your pharmacist about supplement/medicine interactions, too. In the meantime, here are a few combinations to be particularly aware of:

St. John’s Wort. This herbal supplement is frequently used to help treat depression, anxiety, and sleep disorders. It can interact with the following types of medicines:

Warfarin (brand name Coumadin, a type of blood thinner): May make this drug less effective, increasing the chances of a blood clot.

Birth control pills: May reduce the effectiveness of “the pill,” possibly increasing the chance of unplanned pregnancy.

Antidepressants: May increase the risk of a condition called “serotonin syndrome,” a potentially life-threatening condition.

Certain statins (cholesterol-lowering pills): May decrease levels of this class of drugs, making them less effective at lowering your cholesterol

Cinnamon. More than just a spice that makes food tasty, cinnamon is used as an herbal supplement to treat a number of conditions, including high blood glucose, stomach upset, flatulence, and the common cold. Cinnamon is relatively harmless (unless you happen to be allergic to it), but it can interact with some medicines.

Certain diabetes medicines (glyburide [Micronase and others], glipizide [Glucotrol], glimepiride [Amaryl], insulin, and others): While studies haven’t come to any firm conclusions, plenty of folks have noticed that cinnamon helps to lower their blood glucose. This can be a good thing, unless you happen to take any of the above listed diabetes meds and end up with low blood glucose (hypoglycemia). If you take cinnamon, tell your physician and be diligent about checking your blood glucose with your meter. Let him know if you’re having more frequent lows.

Medicines that may harm the liver (acetaminophen [Tylenol and others], methotrexate [Trexall, Methotrexate], fluconazole [Diflucan], phenytoin [Dilantin], statins, methyldopa, and more): This is a partial listing of medicines that have the potential to damage the liver if not taken properly or in the right amount. If you take any of these and you take cinnamon, your risk of possible liver damage goes up. Again, talk to your physician or pharmacist about any medicines that you take, how they might affect your liver, and if it’s safe to take cinnamon.

Glucosamine. Glucosamine is a natural substance that’s found in cartilage. People with osteoarthritis often take glucosamine to help strengthen their cartilage, and some studies have shown that it may be particularly helpful for knee arthritis. Like many supplements, glucosamine may interact with certain medicines.

Warfarin (Coumadin): There’s evidence that taking glucosamine along with warfarin can increase the risk of bruising and bleeding. It’s actually best to stay away from this supplement if you’re taking warfarin.

Cancer medicines: Cancer medicines work in different ways, but those that slow the replication of tumor cells may be hindered by glucosamine.

Diabetes medicines (glyburide [Micronase and others], glipizide [Glucotrol], glimepiride [Amaryl], insulin, and others): The evidence is a little murky regarding the effect (if any) of glucosamine on blood glucose. It’s possible that glucosamine can affect your blood glucose, however, which could in turn, affect the dosing of your diabetes medicines. Check your blood glucose more often than you usually do if you start taking glucosamine and inform your physician if your glucose levels are running higher or lower than usual.

Fish oil supplements. People concerned about their heart health are likely to pop fish oil capsules for their omega-3 fatty acids. Omega-3 fatty acids are beneficial fats that may help lower triglycerides (blood fats) and prevent heart disease and stroke. In addition, fish oil is taken for other conditions, including depression, dry eye, and asthma. But, of course, there are some precautions when taking fish oil with medicines.

Blood thinners (warfarin [Coumadin], heparin, clopidogrel [Plavix], aspirin, ibuprofen [Advil, Motrin, and others], naproxen [Anaprox, Naprosyn, and others]): While probably not a huge issue, it’s possible that fish oil can enhance the effect of medicines that slow blood clotting, potentially boosting the risk of bruising and bleeding. If you’re scheduled for surgery, you may need to stop your fish oil supplements ahead of time.

Blood pressure medicines: Some people find that fish oil lowers their blood pressure. If you are taking blood pressure medicine, your blood pressure may drop too low.

Orlistat (Xenical, Alli): Orlistat reduces fat absorption in the digestive tract, thereby helping one lose weight. It’s possible that it may also decrease fish oil absorption, so orlistat and fish oil should be taken at least two hours apart.

I could go on and on with a listing of various dietary supplements and how they can seemingly interact with numerous medicines. Hopefully, though, I’ve made my point: Do research on any supplement that you take, tell your physician that you’re taking it, and ask your pharmacist if you’re unsure if and how it may affect you.

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Comments
  1. Thank you!

    You are right about a pharmacist being able to help you. They are able to prevent many problems, but you need to speak up as they can miss things as well, especially when they are busy.

    Dietitians are also as valuable resource as you mentioned, but when working for physicians that are against supplements, this also can create problems. I also suggest RNs that work for caring doctors as a resource. Some CDEs are reliable sources. My suggestion is asking questions and if the response is not one of concern and how it may affect prescribed medications - move onto the next resource.

    It has taken me many years to find people I can trust, but my biggest improvement happened when I spoke up. This is a must.

    Posted by Bob Fenton |
  2. Amy:

    When one is a diabetic; I would offer that under guidance and approval, diabetics really could use some supplements as a good safe bet and possible help.

    The french seem to suffer less herat attacks not withstanding all the butter and eggs they eat. They appear to drink dark red wine. I also drink that - 2 glasses a day along with lutein, some multi vitamins, B12 for metformin, Vitamin E3, fish oil supplements.

    For the young and healthy - probably not huge issue but with alzheimers luring around the corner, it may well be wise to check out some things considered helpful ( but no guarantee nor proven studies really!) As long as these are safe bets and not exceeding Doctors order’s recommendations or black magic spells and notions I prefer to ensure I have best bets on line as well as proper meds.

    Posted by jim snell |
  3. I have always depended on my pharmacist for guidance. They have my profile and this is their field of expertise.l myself can say that if l encounter one l don’t feel satisfied with then l agree with move on.l will confess l have 39 yes experience in acute care you see. I’m an RN.Thank you

    Posted by nancy Alvarez |
  4. What is the feeling as to whether the 30 Day Diabetes Cure Book can be helpful to those with
    diabetes? That would be Dr. Ripich and Dr. Healthy’s book.

    Posted by Judy |
  5. So what is the cost of cinnamon? And if it tastes good on your food and lowers your glucose levels, why wouldn’t someone opt for that and diminish expensive medications? In fact, why would people not always opt to treat themselves with natural food substances and herbal supplements and avoid pharmaceutical products wherever and whenever possible? Naturopathic and homeopathic remedies, whenever they work for what ails you, should be considered first. Proper breathing technique will lower your blood pressure by a good 20 points. You may be able to use proper breathing techniques to avoid taking blood pressure medications. And, in case you were wondering, yes, it actually is a good thing. They should just make it clear that if you are on medications, these are the interactions. And once you become aware that there are non-pharmaceutical products that are safe and will do the same thing, you should do due diligence in incorporating those into your lifestyle in lieu of “medicines”. True medicine should come from good nutrition, good exercise habits and lifestyle adjustments unless your condition is beyond those options.

    Posted by Eugene Gaudreau |
  6. I believe one of the reasons that supplement use is on the rise is that a number of physicians are starting to take note of their usefulness in managing illness. My heart specialist (professor of preventive cardiology at a major medical school) encourages all his patients to take at least 4,000 units of fish oil a day.

    Other supplements I take regularly include cinnamon and resveratrol. All with my physician’s knowledge and approval, of course.

    Posted by Joe |
  7. The 30 Day Diabetes cure book really helped me as well as my husband.I have fibromyalgia &diabetes2.my husband had high blood pressure and was 60 lbs over weight.The book got us eatting much better.now 60 days after starting we have both lost weight,his blood pressure is were it should be and my diabetes is staying well with in range. My fibromyalgia is better I’ useing a lot less med’s for it. Read it and do some reseach on vitamins on our own. Hope this helps you!It sure did us..

    Posted by Sarah |
  8. Hi Jim,

    Thanks for your comment. I agree — I think people can benefit from taking certain supplements (I take some myself). The key is to learn about them and make sure they’re not interacting with certain conditions or medicines, however, as well as to take a reasonable (safe) dose. It’s not uncommon for people to think that if some is good, more is better — and we know better than that!

    Posted by acampbell |
  9. Hi Judy,

    I confess that I’m not thoroughly familiar with the “30 Day Diabetes Cure” but from what little I’ve learned about it, it’s essentially a fairly low carbohydrate eating plan that takes a phased approach (phase 1 is the strictest phase). The title is misleading, as diabetes isn’t really “cured,” but it’s possible that it could be better managed. My advice, if you’re interested in this, is to discuss it with your physician and/or a dietitian if you’re interested in this plan and to find out if it’s safe for you.

    Posted by acampbell |
  10. Hi Eugene,

    One of the issues with using herbal or natural “remedies” for treating chronic conditions, such as diabetes and high blood pressure, is that there isn’t much research behind them. Very few studies, let alone well done studies, have been done to show that they are indeed effective. In terms of cinnamon, some studies show benefit on blood glucose control, while others haven’t. The reality is that medicine is often needed to, say, lower blood pressure or cholesterol to a safe level. ometimes deep breathing, reducing sodium, losing weight, or getting enough physical activity just isn’t enough. They’re definitely helpful and important, but in many instances, people need help from medicine.

    Posted by acampbell |
  11. I am 86 years old and take so many meds I wonder if I am over medicated? Always carry the list with me and all my doctors know what I am taking…7 pills every morning, three supplements at noon and 6 welchol 625 mg. with dinner. What to do? I do not feel well..have to use a walker because of side effects of three statin drugs one doctor had me take…question…do drug companies pay doctors to prescribe their meds? If so, is that OK/? I doubt it is. Oh well. I try to eat right, exercise and be positive but it is getting more difficult each day to do so.

    Posted by Norma Smith |
  12. I have taken my medication regularly and also vitamins and supplements for 54 years as a Type 1 diabetic. My doctors always know what vit & supplements I am taking. At times they suggest not doing so due to a change in medication, and I follow their advice. I am healthy, active most of the time. I also have had a perfect Lipid panel for years.

    It is always wise to check with our doctors and pharmacists.

    Posted by joan |
  13. DEAR NORMA
    MY 75 YEAR OLD BROTHER WALKED EVERY MORNING AND LIFTED WEIGHTS. WAS IN GREAT SHAPE FOR HIS AGE. THEN HE WAS PUT ON STATINS TO LOWER HIS CHLORESTEROL. IN ONE YEAR HE WAS CONFINED TO BED, COULD NOT EVEN BUTTON HIS SHIRT. HIS BODY ACHED SEVERLY. I KEPT TELLING HIM IT WAS THE STATINS. A NURSE TOLD HIM ANYTHING 250 OR LOWER WAS GOOD FOR ANYONE AND AS WE GET OLDER WE NEED MORE CHLORESTEROL THAN YOUNGER PEOPLE. THE DOCTORS WANTED HIS 100! AFTER GOING THROUGH EVERY TEST THEY COULD GIVE HIM, THEY FOUND NOTHING. I FINALLY TOOK HIM A REACTION NOTICE THAT LIPATOR HAD IN A MAGAZINE.HE TOOK LIPITOR AND CHANGED TO CRESTOR ( RESULTS TO MUSCLE THE SAME) HE STOPPED STATINS. IT HAS BEEN 3 YEARS, HE STILL HAS SOME ARM PAIN BUT THANK GOD HE LISENED. STATINS WORK ON MUSCLES, REMEMBER, YOUR HEART IS A MUSCLE! THANK GOD YOU JUST NEED A CANE. AFTER I WAS PUT ON LIPITOR , IN JUST ONE WEEK, I COULD NOT STAND WITHOUT KNEE PAIN. I WENT OFF AND WILL NEVER GO ON THEM AGAIN, I TAKE ONE FISH OIL MORNINGS AND ONE FLAX SEED CAPSULE EVENINGS.DO RESEARCH

    Posted by Linda |
  14. ABOUT CINNAMON
    I TRIED THE CAPSULES UNTIL ONE NIGHT AFTER I WENT TO BED, I BURPED!!! THE POWDER WENT INTO MY LUNGS AND I THOUGHT I WOULD DIE FOR LACK OF BREATH. JUST BE CAREFUL AND EAT SOMETHING BEHIND THESE CAPSULES. I NOW EAT IT BLENDED WITH GOOD BUTTER ON TOAST.

    Posted by Linda |
  15. My wife is a heavy supplement user. Some of them are listed here others are not. Being a diabetic, I am always concerned about these supplements interacting with her meds. One in particular is Purity products H.P. formula.. I don’t know what it is or does.Do you have any update on this product.
    Also krill oil, black currant,are not on your list??????
    thanks!!!!!

    Posted by shelly simon |
  16. Hi shelly,

    I looked for Purity HP formula and all I could find was the HA formula. Is this what your wife is taking? HA is hyaluronic acid, a substance found in the fluid in your joints and your eyes. People take it for arthritis, as well as for cosmetic reasons. I’m not aware of this affecting diabetes or medications, but it’s certainly something that her doctor should be aware of. Krill oil is similar to fish oil (omega-3 fatty acids) which is used to promote heart health. Black currant oil is often used by postmenopausal women to help with symptoms of menopause. The concern with taking both krill oil and black currant oil is that both can thin the blood a bit, possibly increasing the risk of bleeding. It may be helpful for her physician or a dietitian to review her supplements with her and discuss her reasons for taking them, as well as any side effects to be aware of.

    Posted by acampbell |
  17. I take Simvistatin for high cholesterol and have been sprinkling cinnamon on everything for diabetes. It does bring down my blood glucose but I was interested to read the cinnamon and simvistatin are not a good mix for liver health.
    Thanks

    Posted by Elizabeth Bogue |
  18. I am curious on this response about cinnamon and simvistatin. Who reported this. What extensive studies are there or is this another margerine/butter/egg bad lead fracas with no real data.

    The story of simvistatin causing diabetes is another one of those statistical events not a proven causitive effect. I was on this 2 years before I got mess arrested and 2 years after that after stopping mess. Simvistatin presence did not seem to have any bearing on this as best as I can tell.

    There is too many of these eureka - stories - I found it before the jury and real data are in.

    Caution is always recommended but? Presently I would be more inclined to keep sharp watch on actos/avandia first and get off if I could first.

    Posted by jim snell |
  19. I meant to add that the biggest problem I see with these herbal supplements of natural items is the broad spectrum of things in them and response across body compared to a purified single drug that has been sequenced and tested deeply - and yet sometimes even there things get missed.

    Who knows what they are affecting/helping - hurting the body.

    Posted by jim snell |
  20. Hi Jim,

    I believe the concern is for someone who may have liver disease or high levels of liver enzymes, and is taking both cinnamon and a statin, both of which could be potentially harmful to the liver.

    Posted by acampbell |
  21. thank you for clarification and excellent response.

    Posted by jim snell |
  22. Hello- First time –accidently found this page -
    Yes–Cinnamon is good–you can get Powder –fro any Indian Grocery store–in large cities –much cheaper–you can sprinkle on yogurt, salad or as suggested here by one reader –on toast with honey
    or flax seed oil — yes–there are several other supplements –specially for Type 2 diabetes–
    not sure If I can mention names –but Dr Whitaker
    in California is really good–at reversing diabetes and other –for Norma ( 85 years old )
    he can help– I have read –one white male –85 years old was taking 12 prescription medicine –for
    diabetes, heart attack, high BP, kidney, arthritis and some else–he reduced to only 4 medicines –by
    natural supplement therapies –

    Posted by Ricahrd |

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