Category Archives: Diabetes Management

Click here to review the References for this article at the iHerb Health Library.

Filed under Cholesterol and Heart Health, Diabetes Management, Herbs and Supplements, Mental Health

April 15, 2011 · 6:45 pm

Coenzyme Q10 for Heart, Hypertension and Diabetes Support

Coenzyme Q 10 (CoQ 10), also known as ubiquinone, is a major part of the body’s mechanism for producing energy. The name of this supplement comes from the word ubiquitous, which means “found everywhere.” Indeed, CoQ 10 is found in every cell in the body. It plays a fundamental role in the mitochondria, the parts of the cell that produce energy from glucose and fatty acids.

Japanese scientists first reported therapeutic properties of CoQ 10 in the 1960s. Some evidence suggests that CoQ 10 might assist the heart during times of stress on the heart muscle, perhaps by helping it use energy more efficiently.

CoQ 10’s best-established use is for congestive heart failure, but the evidence that it works is not entirely consistent. Ongoing research suggests that it may also be useful for other types of heart problems, Parkinson’s disease, and several additional illnesses. It is generally used in addition to, rather than instead of, standard therapies.

CoQ 10 supplementation might also be of value for counteracting side effects of certain prescription medications.

Sources

Every cell in your body needs CoQ 10, but there is no dietary requirement as the body can manufacture CoQ 10 from scratch.

Therapeutic Dosages

The typical recommended dosage of CoQ 10 is 30 mg to 300 mg daily; higher daily intakes have been used in some studies.

CoQ 10 is fat soluble and may be better absorbed when taken in an oil-based soft gel form rather than in a dry form such as tablets and capsules.^1,81 Dividing the total daily dosage up into two or more separate doses may produce higher blood levels.⁸¹

A finely ground up (“nanoparticular”) form of the supplement appears to be much better absorbed than standard CoQ 10 products.⁸⁶

Therapeutic Uses

Although not all studies have been positive, some evidence supports the use of CoQ 10 for treating congestive heart failure.^{33-36,51-52,66,83} Keep in mind that CoQ 10 is taken along with conventional medications, not as a replacement for them.

Weaker evidence suggests that this supplement may be useful for heart attack recovery,^63,64,67,68 cardiomyopathy,^5-7 hypertension,^8-11,58 diabetes,^40,58 strengthening the heart prior to heart surgery,⁶⁹ and migraine headaches.⁷⁵ Although CoQ 10 has been widely advertised as effective for treating and Parkinson’s disease, in fact, there is only minimal evidence that it works, and some evidence that it does not work.^57,65,86

CoQ 10 has shown the potential to prevent heart damage and other side effects caused by certain types of cancer chemotherapy.^59-61 This evidence is weak, however, and as yet it cannot be stated with any certainty that CoQ 10 is actually helpful.⁷⁰

CoQ 10 has shown some preliminary promise as an aid to the treatment of kidney failure.⁴⁹

Note: People with severe illnesses, such as heart disease, cancer, or kidney failure, should not use CoQ 10, or any supplement, except under physician supervision.

Highly preliminary studies suggest CoQ 10 might be helpful for amyotrophic lateral sclerosis.^13,14 CoQ 10 has been tried but not found effective for the treatment of Huntington’s disease.⁴⁸

Certain medications may interfere with the body’s production of CoQ 10, or partially block its function. The best evidence regards cholesterol-lowering drugs in the statin family, such as lovastatin (Mevacor), simvastatin (Zocor), and pravastatin (Pravachol), along with the supplement red yeast rice (which contains naturally occurring statins). These medications impair CoQ 10 synthesis as an inevitable side effect of their mechanism of action.^22-25,89 Since these drugs are used to protect the heart, and since CoQ 10 deficiency could in theory impair heart function, it has been suggested that this side effect may work against the intended purpose of taking statins. Furthermore, one might naturally guess that some of the side effects of statins could be caused by this induced CoQ 10 deficiency. However, studies designed to determine whether the use of CoQ¹⁰ supplements actually offers any benefit to people taking statins have returned inconsistent results at best.^{76,77,87,88,90,91}

For several other categories of drugs, the evidence that they interfere with CoQ 10 is provocative but even less reliable. These include oral diabetes drugs (especially glyburide, phenformin, and tolazamide), beta-blockers (specifically propranolol, metoprolol, and alprenolol), antipsychotic drugs in the phenothiazine family, tricyclic antidepressants, methyldopa, hydrochlorothiazide, clonidine, and hydralazine.^26-31 Again, while in theory CoQ 10 supplementation might be helpful for people using these medications, there is no direct evidence to support this hypothesis.

CoQ 10 has also been suggested as a performance enhancer for athletes. However, while one double-blind study of 25 highly trained cross-country skiers found some benefit,¹⁵ most studies evaluating potential sports supplement uses of CoQ 10 have returned negative rather than positive results.^{16-21, 78}

CoQ 10 is also sometimes claimed to be an effective treatment for periodontal disease. However, the studies on which this idea is based are too flawed to be taken as meaningful.¹² Even weaker evidence, far too weak to rely upon at all, hints that CoQ 10 might be useful in some cases of tinnitus (ringing in the ear).

One preliminary study of CoQ 10 for people undergoing treatment for HIV found conflicting results; the supplement appeared to improve general well-being, but it did not protect mitochondria (as the researchers had hoped it would) and actually seemed to worsen symptoms of nerve-related pain (peripheral neuropathy).⁷¹

Preliminary evidence, far too weak to be relied upon at all, has been used to suggest that coenzyme Q10 might be helpful for asthma,⁸² as well as reducing the side effects (specifically, cardiac toxicity) of the cancer chemotherapy drug doxorubicin.⁸⁴

CoQ 10 has additionally been proposed as a treatment for a wide variety of other conditions, including angina, cancer, male infertility, muscular dystrophy, and obesity, but there is, as yet, no evidence that it is effective.

There is also some evidence that CoQ 10 may reduce the risk of pre-eclampsia (high blood pressure during pregnancy) in women who are at risk for this condition.⁹²

What Is the Scientific Evidence for Coenzyme Q 10 ?

Congestive Heart Failure

Most but not all studies tell us that CoQ 10 can be helpful for people with congestive heart failure (CHF). In this serious condition, the heart muscles become weakened, resulting in poor circulation and shortness of breath.

People with CHF have significantly lower levels of CoQ 10 in heart muscle cells than do healthy people.³² This fact alone does not prove that the supplements will help CHF; however, it prompted medical researchers to try using CoQ 10 as a treatment for heart failure.

The largest study was a 1-year, double-blind, placebo-controlled trial of 641 people with moderate to severe congestive heart failure.³³ Half were given 2 mg per kilogram body weight of CoQ 10 daily; the rest were given placebo. Standard therapy was continued in both groups. The participants treated with CoQ 10 experienced a significant reduction in the severity of their symptoms. No such improvement was seen in the placebo group. The people who took CoQ 10 also had significantly fewer hospitalizations for heart failure.

Similarly positive results were also seen in other double-blind studies involving a total of more than 270 participants.^34-35,53,83 One double-blind study found that in people with heart failure so severe they were waiting for a heart transplant, use of CoQ 10 improved subjective symptoms.⁷²

However, two very well-designed double-blind studies published in 1999 and 2000 enrolling a total of about 85 people with congestive heart failure failed to find any evidence of benefit.^36,54 The reason for this discrepancy is not clear.

Cardiomyopathy

Cardiomyopathy is the general name given to conditions in which the heart muscle gradually becomes diseased. Several small studies suggest that CoQ 10 supplements are helpful for some forms of cardiomyopathy.^37-39

Hypertension

An 8-week, double-blind, placebo-controlled study of 59 men already taking medications for high blood pressure found that 120 mg daily of CoQ 10 reduced blood pressure by about 9% as compared to placebo.⁴⁰

A 12-week, double-blind, placebo-controlled study of 83 people with isolated systolic hypertension (a type of high blood pressure in which only the “top” number is high) found that use of CoQ 10 at a dose of 60 mg daily improved blood pressure measurements to a similar extent.⁵⁰

Similarly, in a 12-week, double-blind, placebo-controlled trial of 74 people with diabetes, use of CoQ 10 at a dose of 100 mg twice daily significantly reduced blood pressure as compared to placebo.⁵⁸

Antihypertensive effects were also seen in previous smaller trials, most of which were not double-blind.^41-43

CoQ 10 may also be beneficial in reducing the risk of high blood pressure during pregnancy (pre-eclampsia).⁹² Two hundred and thirty-five pregnant women at risk for pre-eclampsia were randomized to receive CoQ 10 (200 mg daily) or placebo for 20 weeks until they delivered their babies. The women in the treatment group had fewer cases of pre-eclampsia compared to those who took the placebo.

Heart Attack Recovery

In a double-blind trial, 144 people who had recently experienced a heart attack were given either placebo or 120 mg of CoQ 10 daily for 1 year, along with conventional treatment.^63,73 The results showed that participants receiving CoQ 10 experienced significantly fewer heart-related problems, such as episodes of angina pectoris or arrhythmia, or recurrent heart attacks.

A double-blind study of 49 people who had suffered a full cardiac arrest requiring cardiopulmonary resuscitation (CPR) found that use of CoQ 10 along with mild hypothermia (chilling of the body) was more effective than mild hypothermia plus placebo.⁷⁴

Note: Individuals recovering from a heart attack should not take any herbs or supplements except under the supervision of a physician.

Parkinson’s Disease

A study published in 2002 raised hopes that CoQ 10 might help slow the progression of Parkinson’s disease. In this 16-month, double-blind, placebo-controlled trial, 80 people with Parkinson’s disease were given either CoQ 10 (at a dose of 300 mg, 600 mg, or 1,200 mg daily) or placebo.⁵⁷ Participants in this trial had early stages of the disease and did not yet need medication. The results appeared to suggest that CoQ 10, especially at the highest dose, might have slowed disease progression. However, for a variety of statistical reasons, the results were in fact quite inconclusive.

A subsequent double-blind, placebo-controlled study of 28 people with Parkinson’s disease, which was well-controlled by medications, indicated that 360 mg of CoQ 10 daily could produce a mild improvement in some symptoms.⁶⁵ Based on these results, a more substantial study was undertaken, enrolling 131 people with Parkinson’s disease (again, well-controlled by medications).⁸⁶ This repeat trial used a specially finely ground up form of CoQ 10 that, though taken at a dose of only 300 mg daily, produced blood levels of the supplement equivalent to those produced by 1,200 mg daily of ordinary CoQ 10. Unfortunately, it didn’t work. While benefits were seen in both the placebo and the CoQ 10 group, CoQ 10 failed to prove more effective than placebo.

Further trials will be necessary to confirm (or deny) these results.

Diabetes

In the 12-week, double-blind, placebo-controlled trial of 74 people with diabetes mentioned above, use of CoQ 10 at a dose of 100 mg twice daily significantly improved blood sugar control as compared to placebo.58 Similar benefits were seen in the 8-week, double-blind, placebo-controlled study of 59 men also described above.⁴⁰ However, a third study failed to find any effect on blood sugar control.⁶²

Safety Issues

In general, CoQ 10 appears to be extremely safe. No significant side effects have been found, even in studies that lasted a year.^44,79 However, people with severe heart disease should not take CoQ 10 (or any other supplement) except under a doctor’s supervision.

As noted above, two studies suggest that CoQ 10 might reduce blood sugar levels in people with diabetes.⁴⁵ While this could potentially be helpful for treatment of diabetes, it might present a risk as well; people with diabetes who are using CoQ 10 might inadvertently push their blood sugar levels dangerously low. However, another trial in people with diabetes found no effect on blood sugar control.^46,58 The bottom line: If you have diabetes, make sure to track your blood sugar closely if you start taking CoQ 10 (or, indeed, any herb or supplement).

CoQ 10 chemically resembles vitamin K. Since vitamin K counters the anticoagulant effects of warfarin (Coumadin), it has been suggested that CoQ 10 may have the same effect.^47,55 However, a small, double-blind study found no interaction between CoQ 10 and warfarin.56 Nonetheless, in view of warfarin’s low margin of safety, prudence indicates physician supervision before combining CoQ 10 with warfarin.

CoQ 10 might also interact with reverse transcriptase inhibitors used for treatment of HIV (for example, lamivudine and zidovudine). These medications can cause damage to the mitochondria, the energy-producing subunits of cells, leading in turn to a variety of side effects, including lactic acidosis (a dangerous metabolic derangement), peripheral neuropathy (injury to nerves in the extremities), and lipodystrophy (cosmetically undesirable rearrangement of fat in the body). The supplement CoQ 10 has been tried for minimizing these side effects, but unexpected results occurred. In a double-blind, placebo-controlled study, use of CoQ10 improved general sense of well-being in people with HIV-infection using reverse transcriptase inhibitors; however, for reasons that are unclear, it actually worsened symptoms of peripheral neuropathy.80 For this reason, people with HIV who have peripheral neuropathy symptoms should use CoQ 10 only with caution.

The maximum safe dosages of CoQ 10 for young children, pregnant or nursing women, or those with severe liver or kidney disease have not been determined.

Interactions You Should Know About

You may need more CoQ 10 if you are taking:

Cholesterol-lowering drugs in the statin family
Red yeast rice
Beta-blockers (specifically propranololmetoprolol, and alprenolol)
Antipsychotic drugs in the phenothiazine family
Tricyclic antidepressants
Methyldopa
Hydrochlorothiazide
Clonidine
Hydralazine
oOral diabetes drugs (especially glyburide, phenformin, and tolazamide)

You should not take CoQ 10 except on a physician’s advice if you are taking:

Coumadin (warfarin)

CoQ 10 might improve general sense of well-being, but worsen peripheral neuropathy symptoms if you are taking:

Reverse-transcriptase inhibitors (for HIV infection)

Click here to see iHerb’s selection of COQ 10 Products! New to iHerb? Use Coupon Code WOW123 to get $5 off any first time order.

Click here to review the References for this article at the iHerb Health Library.

Filed under Cholesterol and Heart Health, Diabetes Management

February 24, 2011 · 6:49 pm

Beta Glucan for High Cholesterol and Diabetes Support

The term “beta-glucan” refers to a class of soluble fibers found in many plant sources. The best documented use of beta-glucan involves improving heart health; the evidence for benefit is strong enough that the FDA has allowed a “heart healthy” label claim for food products containing substantial amounts of beta-glucan.¹ Much weaker evidence supports the potential use of certain beta-glucan products for modifying the activity of the immune system.

Requirements/Sources

Beta-glucan is not an essential nutrient. It is found in whole grains (especially oats, wheat, and barley) and fungi such as baker’s yeast, Coriolus versicolor, and the medicinal mushrooms maitake and reishi.

Different food sources contain differing amounts of the various chemical constituents collectively called beta-glucan. Grains primarily contain beta-1,3-glucan and beta-1,4-glucan. Fungal sources contain a mixture of beta-1,3-glucan and beta-1,6-glucan. Purified products containing only the 1,3 form are also available.

Therapeutic Uses

A substantial, if not entirely consistent, body of evidence indicates that beta-glucan, or foods containing it (especially oats), can modestly improve cholesterol profile.^{2-11, 35} The most reliable benefits have been seen regarding levels of total cholesterol and LDL (“bad”) cholesterol. Modest improvements of up to 10% have been seen in studies. Possible improvements in HDL (“good”) cholesterol have only been seen inconsistently. It is thought that beta-glucan reduces cholesterol levels by increasing excretion of cholesterol from the digestive tract. This affects two forms of cholesterol: cholesterol from food, and, more importantly, cholesterol from the blood “recycled” by the liver through the intestines. However, virtually all studies involved oats and were conducted by manufacturers of oat products; independent confirmation remains minimal.³⁶

Beta-glucan may also modestly improve blood pressure levels,^12,13 though not all studies agree.¹⁴

In addition, beta-glucan may help limit the rise in blood sugar that occurs after a meal. This could, in theory, offer heart-healthy benefits, especially in people with diabetes.^15-19

The other primary proposed use of beta-glucan products involves effects on the immune system. Test-tube, animal, and a few controlled studies in humans suggest that beta-glucans can alter various measurements of immune function. In the alternative medicine literature, these effects are commonly summarized as indicating that beta-glucan is an “immune stimulant.” This description, however, is an oversimplification. The immune system is extraordinarily complicated and, as yet, incompletely understood. At the current level of scientific understanding it is not possible to characterize the effects of beta-glucan more specifically than to say that it has “immunomodulatory” actions, or that it is a “biological response modifier.” These intentionally unsensational terms indicate that we merely know beta-glucan affects (modulates) immune function, not that it improves immune function.

Some of the immune-related effects seen in studies include alterations in the activity of certain white blood cells and changes in the levels or actions of substances, called cytokines, that modulate immune function.

Based on these largely theoretical findings, as well a small number of very preliminary human trials,^29-31 various beta-glucan products have been advocated for the treatment of conditions as diverse as allergic rhinitis, cancer, infections, and sepsis (overwhelming infection following major trauma, illness, or surgery). However, the evidence for actual clinical benefit remains highly preliminary.

One study failed to find that beta-1,3-glucan (in topical gel form) helpful for treatment of actinic keratosis, a form of sun-induced precancerous changes seen in aging skin.32 Another study found that it had no significant effect on periodontal disease (gingivitis), an inflammation of the gums caused by bacteria found in dental plaques.³⁷

Therapeutic Dosages

For improving total and LDL cholesterol, studies have found benefit with beta-glucan at doses ranging from 3 to 15 grams daily. However, benefits have been seen more consistently at the higher end of this range, and one carefully designed study found no benefit at 3 grams daily.³³

Beta-glucan products can contain molecules of various average lengths (molecular weight). Some manufacturers claim superior benefits with either high or low molecular weight versions. However, one study failed to find any difference between high molecular weight and low molecular weight beta-glucan for normalizing cholesterol and blood sugar levels.³⁴

Safety Issues

Beta-glucan, as a substance widely present in foods, is thought to have a high margin of safety. However, if it really does activate the immune system, harmful effects are at least theoretically possible in people with conditions where the immune system is overactive. These include multiple sclerosis, lupus, rheumatoid arthritis, asthma, inflammatory bowel disease, and hundreds of others conditions. In addition, people taking immunosuppressant drugs following organ transplantation surgery could, in theory, increase their risk of organ rejection. However, there are no reports as yet to indicate that any of these hypothetical problems have actually occurred. Maximum safe doses in young children, pregnant or nursing women, or people with severe liver or kidney disease have not been established.

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December 16, 2010 · 4:58 pm

The Link Between Diabetes and Cardiovascular Disease

Cardiovascular disease (CVD) is a complication and cause of premature death among people with diabetes. Unfortunately, many people with diabetes do not understand the risk of cardiovascular disease or what they can do to help prevent it.

Diabetes is a disorder in which the body does not make insulin, does not make enough insulin, or does not properly use the insulin it makes (insulin resistance). Insulin helps the body use the bodies favorite source of energy, sugar. Without insulin, glucose (sugar) from food cannot enter cells. Glucose builds up in the blood and body tissues become starved for energy. Long-term, high blood sugar levels can damage the arteries, kidneys, eyes, nerves, and other tissues.

Risk of Cardiovascular Disease

Adults with diabetes are 2-4 times more likely to have CVD than people without diabetes. In people with diabetes, high blood glucose levels are associated with the development of atherosclerosis. This is a condition in which fatty deposits (plaque) damage the lining of the arteries, causing them to narrow and harden. Atherosclerosis, the main cause of CVD, interferes with blood flow—ultimately leading to several manifestations of CVD including:

Coronary artery disease and heart attacks
Cerebrovascular disease and stroke
Peripheral artery disease and claudication (pain with walking)

Why Is There a Risk?

People with type 2 diabetes often have an increased risk of CVD for the following reasons:

Their platelets have an added tendency to clump together leading to clotting problems and poor blood flow.
They have higher rates of high blood pressure and obesity.
They tend to have unfavorable lipid profiles, particularly increased LDL or “bad” cholesterol; low levels of HDL, or “good” cholesterol; and increased levels of triglycerides.

People with diabetes who smoke double their risk of CVD.

Who Are the High-risk Groups?

Those with the highest risk for diabetes and its CVD complications include:

People with a family history of diabetes
Overweight and obese people
Older people
Special populations: African Americans, Hispanic/Latino Americans, American Indians, Asian Americans and Pacific Islanders

Management of Diabetes

According to the National Institute of Diabetes and Digestive and Kidney Diseases, the management of three critical indicators is essential for reducing the risk of heart attacks and strokes in people with diabetes:

Blood glucose is measured with the hemoglobin A1C test. The recommended goal for this test is a reading of less than 7%.
Blood pressure should be less than 130/80 mmHg.
LDL cholesterol should be less than 100 mg/dl (2.6 mmol/L).

How Do You Lower the Risk?

People with diabetes can lower their risk of CVD with therapeutic lifestyle changes such as smoking cessation, weight management, and regular exercise. Drug therapy is also available to control some risk factors for CVD and prevent or treat the complications of diabetes.

People with diabetes can take the following steps to help reduce their risk of CVD:

Get involved in treatment decisions with your healthcare team.
Be actively involved in the management of your disease.
Set lifestyle goals.
Become well-educated about diabetes and CVD.
Eat a healthy diet that’s low in saturated fat and cholesterol and low in sodium.
Eat more fiber.
Get at least 30-60 minutes of physical activity.
Diligently control your blood glucose, cholesterol, and blood pressure with and without medications.
Ask about aspirin therapy for CVD prevention.
If you smoke, quit.

RESOURCES:

National Diabetes Education Program

National Institute of Diabetes and Digestive and Kidney Diseases

CANADIAN RESOURCES:

Heart and Stroke Foundation of Canada

REFERENCES:

Complications of diabetes in the United States. American Diabetes Association website. Available at: http://www.diabetes.org/diabetes-statistics/complications.jsp. Accessed June 12, 2009.

National Diabetes Education Program. The link between diabetes and cardiovascular disease. National Diabetes Education Program website. Available at: http://ndep.nih.gov/media/CVD_FactSheet.pdf. Updated February 2007. Accessed May 24, 2010.

National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov.

Click here to see iHerb’s selection of supplements for diabetes support and here for cardiovascular support! New to iHerb? Use Coupon Code WOW123 to get $5 off any first time order.

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September 29, 2010 · 9:04 pm

Taking Care of Your Diabetes When You’re Sick

Whether you have a head cold or the flu, being sick can put all of your activities on hold. You’re forced to stop and take care of yourself. But, if you have diabetes, this demands extra attention.

Why is that? When you’re sick, you’re more likely to have a high blood sugar (glucose) level, this is called hyperglycemia. This happens because your body creates more hormones to fight infection, and these hormones can counteract the effects of insulin. If insulin cannot do its job, then glucose builds up in the blood.

Test Your Blood Sugar Often

Since being sick puts you at risk for hyperglycemia, check your blood glucose more often. You may need to test several times a day, even if your normal routine is to test just once a day.

What’s considered high? This depends on your target range. According to the American Diabetes Association, you should aim for tight control, keeping glucose levels as close to normal as possible (70-130 milligrams per deciliter [mg/dl] before a meal, less than 180 mg/dl after a meal). But not everyone is able to achieve this. Ask your doctor what levels are right for you and when you should call her, such as when you get two high tests in a row.

You also need to know how to treat high glucose levels—the amount of insulin you should give yourself to bring the levels down. If you take oral diabetes medication, find out how to adjust the dose. If you don’t already have this information, work with your doctor to create a “ sick day plan ” so that you’ll be prepared.

In addition to testing your blood glucose levels, be alert for the symptoms of hyperglycemia: having to urinate frequently, being very thirsty, and having blurry vision.

Test for Ketoacidosis

If you have diabetes and high glucose levels, you are at risk for a dangerous condition called ketoacidosis. Ketoacidosis happens because the body does not have enough insulin, prompting the liver to make chemicals (ketones) that can accumulate and cause you to become seriously ill. Symptoms usually begin with very dry mouth and frequent urination. Later, you may experience fatigue, dry or flushed skin, nausea and vomiting, abdominal pain, difficulty breathing, fruity odor on breath, and confusion. If you have any of these symptoms, call 911.

Ketone levels can be checked with urine tests that are sold at drug stores. Ask your doctor whether you should check for ketones while you are sick and when you should test (eg, blood glucose level over 240 mg/dl). Call the doctor if the results show moderate amounts of ketones after two tests.

Stick to Your Routine

When you are feeling nauseous or vomiting, the last thing you want to do is eat. But when you have diabetes, it becomes extremely important to stick to your regular meal plan. Your body needs the amount of carbohydrates that it’s accustomed to.

So how do you do this? Ask your doctor or dietician how to make food exchanges so you get the nutrients that you need. For example, try eating broth-based soups, saltine crackers, and frozen fruit bars. If you’ve had vomiting or diarrhea, replenish the lost fluids. When your glucose levels fall below 70 mg/dl you may drink soft drinks (with sugar) and sports drinks (with sugar and carbs). Some of the symptoms of having a low sugar (hypoglycemia) include shakiness, dizziness, headache, sweating, and hunger.

Remember to continue taking your insulin even if you are not eating your regular diet. However, your dose of insulin may need to be adjusted. Call your doctor if you have severe vomiting or diarrhea or your eating pattern has changed a lot.

Take Your Temp and Carefully Choose Cold Medicines

Have a thermometer and cold medicine in your medicine cabinet. If your temperature is over 101°F, call the doctor. Read the labels carefully on the cold medicines because some contain ingredients, like pseudoephedrine in decongestants, that can raise your blood glucose level. Other medicines have sugar or alcohol, which are most likely fine when taken as directed. But to be safe, you may want to opt for the ones that are sugar-free and alcohol-free. Also, if you have kidney disease, avoid all products that contain ibuprofen, which can cause kidney failure. Talk to your doctor about which over-the-counter drugs are safe for you.

Monitor Your Cold

Keep close tabs on your cold. If a couple of days have passed and you don’t feel better, call the doctor. Provide details about your illness—when you got sick, what your symptoms are, what you’ve been eating and drinking, what your glucose and ketone levels are, and any other important facts. If you have fatigue, stomach or chest pain, or breathing difficulty, call the doctor right away.

Get Your Shots

Avoid the flu by getting the flu shot once a year, typically in October or November. If you have never been vaccinated against pneumonia, ask your doctor. One shot is all that’s needed to protect you from this life-threatening infection.

Make Your Sick Day Plan

If you haven’t already made a “sick day plan” with your doctor, schedule an appointment to discuss:

What blood glucose levels are considered high for you and when you should call the doctor
How to adjust your medication to bring the blood glucose level back into the normal range
How often you should test for ketones and when you should call the doctor
What food exchanges you can make if you are not feeling well enough to eat your regular diet
Which cold medications are safe for you
Whether you’ve had your flu and pneumonia shots

Being prepared can go a long way to help you to cope with your illness and to avoid problems, like hyperglycemia.

Click here to see iHerb’s selection of supplements for diabetes support! New to iHerb? Use Coupon Code WOW123 to get $5 off any first time order.

RESOURCES:

National Diabetes Information Clearinghouse

CANADIAN RESOURCES:

Public Health Agency of Canada

REFERENCES:

Diabetes and pneumonia: get the facts. Centers for Disease Control and Prevention website. Updated Accessed December 12, 2008.

Diabetic ketoacidosis. Mayo Clinic website. Updated February 2008. Accessed December 12, 2008.

Take care of your diabetes. Center for Disease Control and Prevention website. Updated December 2005. Accessed December 12, 2008.

Taking care of your diabetes at special times. National Diabetes Information Clearinghouse website. Accessed December 12, 2008.

When your blood glucose is too high or too low. National Diabetes Information Clearinghouse website. Accessed December 12, 2008.

Help! I’m sick. How do I handle my diabetes? American Diabetes Assocation website. Available at: http://www.diabete… . Published January 2008. Accessed December 12, 2008.

Schroeder K. Symptoms of type 1 diabetes. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated November 2008. Accessed December 1, 2008.

Surviving sick days. American Diabetes Association website. Available at: http://www.diabetes.org/youthzone/surviving-sick-days.jsp . Accessed December 12, 2008.

Wood D. Type 1 diabetes. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated November 2008. Accessed December 1, 2008.

Wood D. Type 2 diabetes. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated November 2008. Accessed December 1, 2008.

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September 1, 2010 · 4:04 pm

The Importance of Foot Care for Diabetics

Managing diabetes does not just mean keeping your blood sugar levels in an acceptable range. It also means taking steps toward preventing health complications that can occur with diabetes. Diabetes can put you at risk for foot complications like foot ulcers, which if not treated early, may lead to amputation. However, with proper attention and care you may be able to prevent such problems.

Diabetes and Your Feet

Poor Blood Flow and Damaged Nerves

You may be wondering, “How are diabetes and foot problems related?”

With diabetes, sugar levels build up in your bloodstream either because your body does not make enough insulin or because your body is resistant to insulin. Insulin is important because it helps move sugar from your bloodstream to your cells where it can be used for energy.

Diabetes can lead to decreased amounts of blood flow to your legs and feet. If you smoke, this can worsen blood flow problems. Poor blood flow to your limbs is called peripheral vascular disease. Diabetes can also damage nerves, a condition known as neuropathy. With damaged nerves, you may not be able to feel pain, heat, or cold.

How It All Fits Together

Having both poor blood flow and damaged nerves in your legs and feet can make it difficult for you to notice foot conditions that may arise, as well as prevent these conditions from healing properly.

For instance, what if you developed a blister or cut on your foot? Since your nerves are damaged, you may not feel the injured area to notice and treat it. Because of this, the injured area becomes infected. Since blood flow to your legs and feet is decreased, the white blood cells that fight infection may not get to your limbs fast enough, and the infection may heal slowly or not heal at all. This can lead to worsening problems like ulcers or gangrene.

Types of Foot Problems

It is essential that you routinely check your feet for any foot conditions or injuries. Doing so will allow you to spot problems before they worsen. If it is hard for you to bend down to check your feet, try using a mirror or ask someone to check for you. Here are some common foot problems to look out for:

Cuts and scrapes
Corns and calluses—thick layers of skin caused by continuous rubbing or pressure
Blisters—fluid-filled bumps caused by wearing shoes that do not fit well or by wearing shoes without socks
Ingrown toenails—when the edge of a toenail grows into the skin
Bunion—large bump on the big toe
Plantar warts—growths caused by a virus; usually found on the bottoms of feet
Hammer toe—curling of a toe caused by a problem with the middle joint of the toe
Athlete’s foot—infection caused by a fungus leading to itchy, red, cracked skin; may also infect the toenail causing it to appear thick, yellow, and brittle
Dry, cracked skin

If you do notice any foot problems, tell your doctor right away. Doing so will ensure that you get proper treatment and prevent infection.

Treat Your Feet Well

In addition to routinely checking your feet, here are other things you can do to avoid foot problems:

See your doctor regularly and make sure she checks your feet at each visit. Take off your shoes once you are in the exam room so that she sees your feet.
When cleaning your feet, avoid soaking them in water. Instead, wash your feet in warm water every day.
Completely dry your feet. Do not forget to dry between your toes!
If you have dry skin, rub lotion on your feet after they are washed and dry. Do not put lotion between your toes.
Cut your toenails straight across. It may be easier to cut them after washing your feet, since the nail will be softer. Do not cut them too short.
Use a pumice stone regularly to keep calluses thin. Do not cut at them with sharp objects.
Wear socks or stockings. Wear them to bed if your feet are cold.
Wear shoes or slippers, even if you are at home. Make sure your shoes fit well. Also, make sure they are closed-toe. Do not wear sandals.
Keep your feet away from hot places, like a fireplace; hot bath or spa; or an electric blanket.
When shopping for shoes, try to go shopping at the end of the day. Your feet are biggest during this time of day, so you will be able to buy shoes that are not too tight.
If you can do so safely, put your legs up when sitting.
Keep blood flowing to your feet by wiggling your toes or rotating your ankles several times a day.
Do not use any medicine or ointments for your feet unless your doctor says it is okay.
Changes in the shape of your feet and toes can happen with nerve damage. Talk to your doctor about special shoes you can wear, rather than trying to force your feet into regular shoes.

Paying attention to your feet, as well as maintaining a healthy lifestyle, such as not smoking, eating healthy, and exercising, will decrease the likelihood of dangerous infections, keeping you more in control of your diabetes and its complications.

Click here to see iHerb’s selection of supplements for diabetes support! New to iHerb? Use Coupon Code WOW123 to get $5 off any first time order.

RESOURCES:

National Diabetes Information Clearinghouse

CANADIAN RESOURCES:

Team Diabetes Canada
Canadian Diabetes Association

REFERENCES:

American Diabetes Association. Living with diabetes: foot complications. American Diabetes Association website. Available at: http://www.diabete…. Accessed June 23, 2010.

Cleveland Clinic. Foot and skin related complications of diabetes. Cleveland Clinic website. Available at: http://my.clevelan…. Updated March 15, 2010. Accessed June 23, 2010.

National Institute of Diabetes and Digestive and Kidney Diseases. National Institute of Diabetes and Digestive and Kidney Diseases website. Prevent diabetes problems: Keep your feet and skin healthy. Available at: http://diabetes.niddk.nih.gov/dm/pubs/complications_feet/. Updated May 2008. Accessed June 23, 2010.

Click here to review the References for this article at the iHerb Health Library.

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Filed under Diabetes Management

Tagged as diabetes, diabetic

August 27, 2010 · 4:58 pm

Fish Oil May Be Helpful Towards Cholesterol, Depression, Rheumatoid Arthritis Support and More!

Fish oil contains omega-3 fatty acids, one of the two main classes of essential fatty acids. ( Omega-6 fatty acids are the other main type.) Essential fatty acids are special fats that the body needs for optimum health.

Interest in the potential therapeutic benefits of omega-3 fatty acids began when studies of the Inuit (Eskimo) people found that, although their diets contain an enormous amount of fat from fish, seals, and whales, they seldom suffer heart attacks. This is presumably because those sources of fat are very high in omega-3 fatty acids.

Subsequent investigation found that the omega-3 fatty acids found in fish oil have various effects that tend to reduce risk of heart disease and strokes. However, research into whether use of fish oil actually prevents these diseases, while somewhat positive, remains incomplete and somewhat inconsistent. In recognition of this, the FDA has allowed supplements containing fish oil or its constituents to carry a label that states: “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”

In addition, a slightly modified form of fish oil (ethyl-omega-3 fatty acids) has been approved by the FDA as a treatment for hypertriglyceridemia (high triglycerides).²³⁷ This specially processed product, sold under the trade name Omacor, is widely advertised as more effective than ordinary fish oil. However, it should be noted that Omacor has undergone relatively little study itself; the physician prescribing information notes only two small trials to support its effectiveness for this use. This is a far lower level of evidence than usually required for drug approval and also substantially lower than the body of evidence supporting standard fish oil as a treatment for high triglycerides.

Fish oil has also shown promise as an anti-inflammatory treatment for conditions such as rheumatoid arthritis, menstrual pain, and lupus. In addition, it may be helpful for various psychiatric conditions.

Requirements/Sources

There is no daily requirement for fish oil. However, a healthy diet should provide at least 5 g of essential fatty acids daily.

Many grains, fruits, vegetables, sea vegetables, and vegetable oils contain significant amounts of essential omega-6 and/or omega-3 fatty acids, but oil from cold-water fish is the richest natural source of omega-3 fats. It is commonly stated that people require a certain optimum ratio of omega-3 to omega-6 fatty acids in the diet; however, there is no real evidence that this is true, and some evidence that it is false.²³¹

Therapeutic Dosages

Typical dosages of fish oil are 3 g to 9 g daily, but this is not the upper limit. In one study, participants ingested 60 g daily.

The most important omega-3 fatty acids found in fish oil are called eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). In order to match the dosage used in several major studies, you should take enough fish oil to supply about 2 g to 3 g of EPA (2,000 mg to 3,500 mg) and about 1.0 g to 2.5 g of DHA daily (1,000 mg to 2,500 mg). Far higher doses have been used in some studies; conversely, one study found blood-pressure lowering effects with a very low daily dosage of DHA—0.7 g.²³⁸

DHA and EPA are not identical and might not have identical effects. Some evidence hints that DHA may be more effective than EPA for thinning the blood ¹⁷⁶ and reducing blood pressure.¹⁰⁵ The reverse may be true for reducing triglyceride levels, but study results are conflicting.^{160-165, 235}

Some manufacturers add vitamin E to fish oil capsules to keep the oil from becoming rancid. Another method is to remove all the oxygen from the capsule.

If possible, purchase fish oil products certified as free of significant levels of mercury, toxic organochlorines, and PCBs (see Safety Issues).

Flaxseed oil also contains omega-3 fatty acids, although of a different kind. It has been suggested as a less smelly substitute for fish oil. However, it is far from clear whether flaxseed oil is therapeutically equivalent to fish oil.^1,200

Therapeutic Uses

Consumption of fish oil alters the body’s production of certain substances in the class of chemicals called prostaglandins. Some prostaglandins increase inflammation while others decrease it. The prostaglandins whose production is enhanced by fish oil fall into the anti-inflammatory category. Based on this, fish oil has been tried as a treatment for early stages of rheumatoid arthritis, with positive results. It is thought to significantly reduce symptoms without causing side effects and may magnify the benefits of standard arthritis drugs.^37,38,179 However, while some standard medications can slow the progression of the disease, there is no evidence that fish oil can do this. Much weaker evidence hints that fish oil might be helpful for the related disease ankylosing spondylitis.²³²

Fish oil’s apparent anti-inflammatory properties are the likely explanation for its apparent benefit in dysmenorrhea (menstrual pain), as seen in two studies.^39,40 Similarly, fish oil may be helpful for the autoimmune disease lupus.^137,191 (However, two studies failed to find fish oil helpful for kidney disease caused by lupus.^138,139) Evidence has been mixed regarding whether fish oil is beneficial for Crohn’s disease or ulcerative colitis, conditions in which parts of the digestive tract are highly inflamed.^{49-51,61-68, 159,201} More recently, however, two well-designed trials enrolling a total of 738 patients convincingly failed to find any benefit for omega-3 fatty acid supplementations in the prevention of Crohn’s disease relapse.²⁵⁴

Incomplete evidence hints but does not prove that fish or fish oil might help prevent death caused by heart disease.^152,202 This effect seems to result from several separate actions. The best documented involves reducing high triglyceride levels; studies enrolling more than 2,000 people have substantiated this use.1 In addition, fish oil might raise HDL (“good”) cholesterol levels, “thin” the blood, lower levels of homocysteine, prevent dangerous heart arrhythmias, slow heart rate, improve blood vessel tone, and decrease blood pressure. ^{14,15,51,90-94,96-105,151,160-165,174,177,189,190,203-204,238} These effects also support findings that fish oil may help prevent strokes.^20,178 However, results are conflicting on whether people with angina should take fish oil or increase intake of fatty fish; one large study actually found that fish oil increased risk of sudden death.²⁰⁶

For a number of theoretical reasons, it has been suggested that fish oil and its constituents (especially a slightly modified form of EPA called ethyl-EPA) might have positive effects on various psychiatric disorders, most notably depression. However, there is no convincing evidence that low levels of omega-3 fatty acids in the bloodstream leads to even mild depression.²⁵⁹ Moreover, larger trials have generally failed to demonstrate a beneficial effect of fish oil-related products in depressed patients.^{154,168,188,192,193,207,228,234,241,242,244} Preliminary, and not altogether consistent, evidence hints that high doses of fish oil may produce benefits in bipolar disorder (more commonly known as manic-depressive illness), reducing risk of relapse and improving emotional state.^41,205,242 Other preliminary, and again not altogether consistent, evidence hints that fish oil might enhance the effectiveness of standard drugs (such as phenothiazines) for schizophrenia.^{48,148,169,170,193,247} Fish oil has also shown a bit of promise for borderline personality disorder.¹⁸⁰ In one study, DHA failed to augment the effectiveness of standard therapy for attention deficit disorder (ADD).⁸⁹ However, two studies that evaluated the potential benefits of fish oil combined with omega-6 fatty acids found some evidence of benefit for this condition.^88,194 Finally, one small trial found evidence that use of fish oil might decrease anger and aggressiveness in people with a history of aggressive behaviors, substance abuse, and problems with the law.²⁴³

Small studies also suggest that fish oil may be helpful in Raynaud’s phenomenon (a condition in which a person’s hands and feet show abnormal sensitivity to cold temperatures),^42,43 sickle-cell anemia,⁴⁵ and a form of kidney disease called IgA nephropathy.⁴⁷

According to some, but not all studies, fish oil may help treat the undesired weight loss often experienced by people with cancer.^181-182 In addition, highly preliminary evidence hints that DHA might enhance the effects of the cancer chemotherapy drug doxorubicin ¹⁵⁷ and decrease side effects of the chemotherapy drug irinotecan.¹⁵⁸

Use of fish oil by pregnant women might help prevent premature birth,^{184-185,208,236} although evidence is somewhat inconsistent. In addition, use of fish oil by pregnant women may support healthy brain function 183 and help prevent eczema and allergies in offspring.¹⁹⁵

Intriguing, but not yet at all reliable, evidence hints that fish oil, or its constituents, might be helpful for treating kidney stones or alleviating the symptoms of chronic fatigue syndrome, and reducing the risk of prostate cancer.^54,56,58,59 Results are inconsistent regarding whether the use of fish oil can decrease seizure frequency in people with epilepsy.^209,246

One study found that insulin metabolism in 278 young, overweight subjects improved on a calorie-restricted diet rich in fish oil from seafood or supplements compared to those on a diet low in fish oil, suggesting that fish oil may help delay the onset of diabetes in susceptible individuals.²⁵⁸ Fish oil has also been proposed as a treatment for many other conditions, including diabetic neuropathy,⁶⁰ allergies, and gout, but there has been little real scientific investigation of these uses.

Some, but not all, studies suggest that fish oil combined with omega-6 essential fatty acids may augment the effectiveness of calcium in the treatment of osteoporosis.^86,87 One promising, but highly preliminary, double-blind, placebo-controlled study suggests that the same combination therapy may improve symptoms of the severe neurological illness called Huntington’s disease.¹⁵⁵

Use of a fish oil product as part of a total parenteral nutrition regimen (intravenous feeding) may help speed recovery after major abdominal surgery.²³³

For several other conditions, the current balance of the evidence suggests that fish oil is not effective.

For example, despite widely publicized claims that fish oil helps asthma, most preliminary studies have failed to provide evidence that it is effective, and one study found that fish oil can actually worsen aspirin-related asthma.^{69-77,171,271} However, there is some evidence that use of fish oil could help prevent exercise-induced asthma in athletes.^196,212 And, in an interesting randomized, controlled trial with long-term follow-up, mothers who take fish-oil during late pregnancy reduced the risk of asthma in their children up to 16 years later.²⁶³

One study found that fish oil did not benefit the lung function of patients with cystic fibrosis.²⁵¹

Similarly, a 16-week, double-blind, placebo-controlled study of 167 individuals with recurrent migraine headaches found that fish oil did not significantly reduce headache frequency or severity.¹⁴⁹ Conflicting results have been seen in other, much smaller trials of fish oil for migraines.^172,173

One study found weak evidence that use of fish oil might decrease aggressive behavior in young girls (but, in this study, not in young boys).²¹³ Another study found benefit in developmental coordination disorder (a condition in which children suffer from lack of physical coordination as well as problems with learning and behavior).²¹⁴

Fish oil is also sometimes recommended for enhancing immunity in HIV infection. However, one 6-month, double-blind study found that a combination of the omega-3 fatty acids in fish oil plus the amino acid arginine was no more effective than placebo in improving immune function in people with HIV.⁷⁸ Fish oil, however, might help individuals with HIV gain weight.⁷⁹

In one large, randomized, controlled trial, diets rich in fish and omega-3 fatty acids from fish were associated with a significant reduction in the risk of developing colorectal cancer among men over a 22-year period.²⁵⁵ Another study provides preliminary evidence for the benefits of fish oil in reducing the risk of prostate cancer.⁵⁷ On balance, however, there is still relatively little evidence that the consumption of fish oil reduces cancer risk.²¹⁵

Preliminary studies have suggested that fish oil could help symptoms of multiple sclerosis; however, the largest double-blind study on the subject found no difference between people taking fish oil and those taking olive oil (used as a placebo).^80-84,216

Although one study found fish oil somewhat helpful in psoriasis,¹³³ a much larger study found no benefit.¹³⁴

DHA has been evaluated as a possible treatment for male infertility, but a double-blind trial of 28 men with impaired sperm activity found no benefit.⁸⁵

Combination therapy with GLA and fish oil has failed to prove effective for cyclic breast pain.¹⁸⁶

One study failed to find fish oil more effective than placebo for treating stress.²¹⁷ DHA has also been tried for slowing the progression of retinitis pigmentosa (a condition in which the retina gradually degenerates), but without much success.^210-211 In observational studies, people who happen to consume a diet rich in omega-3 fatty acids seem to lower their risk of age-related macular degeneration (the most common cause of blindness in the elderly). However, in the absence of randomized controlled trials, it is not possible to say whether or not it is omega-3 that produces this benefit.²⁶⁰

Studies of fish oil have failed to find it helpful for Alzheimer’s disease, whether for slowing its progression or improving symptoms.^230,240 And, one well-designed study failed to find any benefit of fish oil for enhancing memory and mental function in older adults without dementia over a 26 week period.²⁶⁵

Use of essential fatty acids in the omega-3 family has also shown some promise for the treatment of non-alcoholic fatty liver.^245,270

What Is the Scientific Evidence for Fish Oil?

Heart Disease Prevention

Studies on fish or fish oil for preventing cardiovascular disease, slowing the progression of cardiovascular disease, and preventing heart-related death have returned somewhat contradictory results.^{106-125,150,156} A major review published in 2004 failed to find trustworthy evidence of benefit,²¹⁸ and a subsequent study actually found that use of fish oil increases risk of sudden death in people with stable heart disease.²¹⁹ A 2008 systematic review found that fish oil was associated with modestly reduced cardiac mortality, but not sudden cardiac death, in 11 studies totally over 32,000 patients. The reliability of these results, however, is limited by the inclusion of mostly low-to-moderate quality trials.²⁷² Though not entirely consistent, on balance the evidence does suggest that regulalry consuming oily fish or taking omega-3 fatty acid supplements can reduce the risk of cardiovascular events (eg, heart attacks) and deaths.²⁶¹ A 2009 review pooled data from 8 trials examining the effect of omega-3 fatty acids on prevention of cardiac death in almost 21,000 patients with coronary heart disease.²⁷⁴ This review separated patients into two general groups (those with previous myocardial infarction versus those with angina history) and found that omega-3 supplementation reduced risk of sudden cardiac death in patients with previous myocardial infarction, but increased risk in patients with angina. Though compelling, this finding may be limited since it was derived from a retrospective analysis of original data reorganized into subgroups.
A gigantic study (over 18,000 participants) published in 2007 was widely described in the media as finally proving beyond a shadow of a doubt that fish oil helps prevent heart problems.²³⁹ Unfortunately, this study lacked a placebo group, and therefore failed to provide reliable evidence.
As noted earlier, fish oil is hypothesized to exert several separate effects that act together to help protect the heart. The most important action of fish oil may be its apparent ability to reduce high triglyceride levels. Like cholesterol, triglycerides are a type of fat in the blood that tends to damage the arteries, leading to heart disease. According to most, though not all, studies, fish oil supplements can reduce triglycerides by as much as 25% to 30%.^{90-93,151,256} In a detailed review of 47 randomized trials, researchers concluded that fish oil is capable of significantly reducing triglyceride levels with no change in total cholesterol levels and only slight increases in HDL (“good”) cholesterol and LDL (“bad”) cholesterol.²⁶⁸ A slightly modified form of fish oil (ethyl-omega-3 fatty acids) has been approved by the FDA as a treatment for elevated triglycerides. However, in some studies, use of fish oil has markedly raised LDL cholesterol, which might offset some of the benefit. A 2009 review of 30 trials involving about 1,500 patients with type 2 diabetes demonstrated that marine-derived omega-3 polyunsaturated fatty acids (mean dose 2.4 g per day) lowered triglyceride levels about 15 mg/dL but increased LDL cholesterol by about 3 mg/dL after an average 24 weeks of treatment.²⁷⁵
Stanols and sterols (or phytosterols) are naturally occurring substances found in various plants that can help to lower cholesterol in individuals with normal or mildly to moderately elevated levels. A study investigating the possible benefit of combining a phytosterol with fish oil found that together they significantly lowered total cholesterol, LDL-cholesterol and triglycerides, and raised HDL (“good”) cholesterol in subjects with undesirable cholesterol profiles.²⁵⁷
Fish oil has been specifically studied for reducing triglyceride levels in people with diabetes, and it appears to do so safely and effectively.^3,262 It also seems to remain effective in individuals who are already using statin drugs to control lipid levels (both people with and without diabetes).^14,15,197 However, one study found that the standard drug gemfibrozil is more effective than fish oil for reducing triglycerides.⁹⁴
Some but not all studies suggest that fish, fish oil, or EPA or DHA separately may additionally raise the level of HDL (“good”) cholesterol and possibly improve other aspects of cholesterol profile as well.^{96,97,151,164,165,197} This too should help prevent heart disease.
Additionally, fish oil may help the heart by “thinning” the blood and by reducing blood levels of homocysteine,^98,176,190 although not all studies have found a positive effect.¹⁹⁸
Studies contradict one another on whether fish oil can lower blood pressure,^{99-104,177,264} but on balance the supplement does seem to exert a modest positive effect.¹⁷⁴ A 6-week, double-blind, placebo-controlled study of 59 overweight men suggests that the DHA in fish oil, but not the EPA, is responsible for this benefit.¹⁰⁵
Evidence is conflicting on whether fish oil helps prevent heart arrhythmias.^220-224,248 A large Italian trial involving almost 7,000 subjects found that fish oil may modestly reduce the risk of death or admission to the hospital for cardiovascular reasons in patients suffering from congestive heart failure.²⁶⁶
Fish oil may slightly reduce heart rate.²²⁵ This effect could contribute to preventing heart attacks and other heart problems.

Rheumatoid Arthritis

The results of numerous small double-blind trials indicate that omega-3 fatty acids in fish oil can help reduce the symptoms of rheumatoid arthritis.^{126,127,179,187} At least one small study suggests that it may help rheumatoid arthritis patients lower their dose of nonsteroidal anti-inflammatory medication (eg, ibuprofen).²⁵³ The benefits of the fish oil effect may be enhanced by a vegetarian diet.¹⁸⁷ Simultaneous supplementation with olive oil (about two teaspoons daily) may further increase the benefits.²²⁶ However, unlike some conventional treatments, fish oil probably does not slow the progression of rheumatoid arthritis.

Menstrual Pain

Regular use of fish oil may reduce the pain of menstrual cramps.
In a 4-month study of 42 young women aged 15 to 18, half the participants received a daily dose of 6 g of fish oil, providing 1,080 mg of EPA and 720 mg of DHA daily.¹²⁸ After 2 months, they were switched to placebo for another 2 months. The other group received the same treatments in reverse order. The results showed that these young women experienced significantly less menstrual pain while they were taking fish oil.
Another double-blind study followed 78 women, who received either fish oil, seal oil, fish oil with vitamin B 12 (7.5 mcg daily), or placebo for three full menstrual periods.¹²⁹ Significant improvements were seen in all treatment groups, but the fish oil plus vitamin B 12 proved most effective, and its benefits continued for the longest time after treatment was stopped (3 months). The researchers offered no explanation why vitamin B 12 should be helpful.

Bipolar Disorder

A 4-month, double-blind, placebo-controlled study of 30 individuals suggests that fish oil can enhance the effects of standard treatments for bipolar disorder, reducing risk of relapse and improving emotional state.¹³⁰ Eleven of the 14 individuals who took fish oil improved or remained well during the course of the study, while only 6 out of the 16 given placebo responded similarly.
Another small study found that ethyl-EPA (a modified form of EPA) is helpful for the depressive phase of bipolar disease.²²⁷

Depression

A 4-week, double-blind, placebo-controlled trial evaluated the potential benefits of fish oil in 20 individuals with depression.¹⁵⁴ All but one participant were also taking standard antidepressants and had been taking them for at least 3 months. By week 3, the level of depression had improved to a significantly greater extent in the fish oil group than in placebo group. Six of 10 participants given fish oil, but only one of 10 given placebo, showed at least a 50% reduction in depression scores by the end of the trial. (A reduction of this magnitude is considered a “cure.”)
A double-blind, placebo-controlled study of 70 people who were still depressed despite standard therapy (such as SSRIs) found that additional treatment with ethyl-EPA (a modified form of EPA) improved symptoms.¹⁷⁵ Similar add-on benefits were also seen in other double-blind studies of ethyl-EPA or mixed essential fatty acids.^{192-193,228,250} However, one study failed to find benefit with fish-oil as an add-on treatment.²²⁹ Another double-blind study failed to find DHA alone helpful for depression.¹⁸⁸ A third relatively large placebo-controlled study found no benefit for fish oil in improving “mental well-being” among 320 older adults without a diagnosis of depression.²⁶⁷
The effectiveness of fish oil supplementation in treating or preventing peripartum depression is, as of yet, unclear. A small preliminary study of women found that fish oil was significantly more effective than placebo at alleviating post-partum depression.²⁵² However, another small, placebo-controlled study was unable to show a benefit in women suffering from depression whether before or after delivery.²⁴⁹ In addition, a 2009 trial of 182 pregnant women with suspected low intake of docosahexaenoic acid (DHA) found that daily DHA supplementation (with or without arachidonic acid) did not reduce risk of postpartum depression compared to placebo.273

Raynaud’s Phenomenon

In small, double-blind studies, fish oil has been found to reduce the severe finger and toe responses to cold temperatures that occur in Raynaud’s phenomenon.^131,132 However, these studies suggest that a higher than usual dosage must be used to get results, perhaps 12 g daily.

Osteoporosis

There is some evidence that essential fatty acids may enhance the effectiveness of calcium in osteoporosis. In one study, 65 postmenopausal women were given calcium along with either placebo or a combination of omega-6 fatty acids (from evening primrose oil) and omega-3 fatty acids (from fish oil) for a period of 18 months. At the end of the study period, the group receiving essential fatty acids had higher bone density and fewer fractures than the placebo group.¹³⁵
However, a 12-month, double-blind trial of 42 postmenopausal women found no benefit.¹³⁶
The explanation for the discrepancy may lie in the differences between the women studied. The first study involved women living in nursing homes, while the second studied healthier women living on their own. The latter group of women may have been better nourished and already received enough essential fatty acids in their diet.

Lupus

Lupus is a serious autoimmune disease that can cause numerous problems, including fatigue, joint pain, and kidney disease. One small, 34-week, double-blind, placebo-controlled crossover study compared placebo against daily doses of EPA (20 g) from fish oil.¹³⁷ A total of 17 individuals completed the trial. Of these, 14 showed improvement when taking EPA, while only 4 did so when treated with placebo. Another small study found similar benefits with fish oil over a 24-week period.¹⁹¹ However, two small studies failed to find fish oil helpful for lupus nephritis (kidney damage caused by lupus).^138,139

Attention Deficit and Hyperactivity Disorder (ADHD)

Based on evidence that essential fatty acids are necessary for the proper development of brain function in growing children, EFAs have been tried for the treatment of ADHD and related conditions.
A preliminary double-blind, placebo-controlled trial found some evidence that a supplement containing fish oil and evening primrose oil might improve ADHD symptoms.140 However, a high dropout rate makes the results of this trial somewhat unreliable. Another small study examined fish oil in children with ADHD who had thirst and skin problems. Benefits were seen with fish oil, but they also occurred with placebo and to about the same extent.¹⁹⁴
In a double-blind, placebo-controlled trial of children already using stimulant therapy, addition of DHA for 4 months failed to further improve symptoms.¹⁴¹

Safety Issues

Fish oil appears to be generally safe. The most common problem is fishy burps. However, there are some safety concerns to consider.

For example, it has been suggested that some fish oil products contain excessive levels of toxic substances such as organochlorines and PCBs.¹⁶⁶ If possible, try to purchase fish oil products certified not to contain significant levels of these contaminants. Note: Various types of fish contain mercury, but this has not been a problem with fish oil supplements, according to reports on Consumerlab.com.

Fish oil has a mild blood-thinning effect;269 in one case report, it increased the effect of the blood-thinning medication warfarin (Coumadin).¹⁹⁹ Fish oil does not seem to cause bleeding problems when it is taken by itself ¹⁴² or with aspirin.¹⁴³ Nonetheless, people who are at risk of bleeding complications for any reason should consult a physician before taking fish oil.

Fish oil does not appear to raise blood sugar levels in people with diabetes.^144,145 Nonetheless, if you have diabetes, you should not take any supplement except on the advice of a physician.

Fish oil may modestly increase weight and lower total cholesterol and HDL (“good”) cholesterol levels.269 It may also raise the level of LDL (“bad”) cholesterol; however, this effect may be short-lived.^146,147

If you decide to use cod liver oil as your fish oil supplement, make sure you do not exceed the safe maximum intake of vitamin A and vitamin D. These vitamins are fat soluble, which means that excess amounts tend to build up in your body, possibly reaching toxic levels. The official maximum daily intake of vitamin A is 3,000 mcg for pregnant women as well as other adults. Look at the bottle label to determine how much vitamin A you are receiving. (It is less likely that you will get enough vitamin D to produce toxic effects.)

Interactions You Should Know About

If you are taking warfarin (Coumadin) or heparin, do not take fish oil except on the advice of a physician.

If you’d like to see iHerb’s selection of Fish Oil products, click here. Use Coupon Code WOW123 to get $5 off any first time order.

2 Comments

Filed under Arthritis and Osteoarthritis, Cholesterol and Heart Health, Diabetes Management, Herbs and Supplements, Mental Health

Tagged as bipolar disease, cholesterol, depression, fish oil, lupus, menstrual pain, osteoporosis, Raynaud's Phenomenon, rheumatoid arthritis

July 15, 2010 · 3:24 pm

Fenugreek for Diabetes and Cholesterol Support

For millennia, fenugreek has been used both as a medicine and as a food spice in Egypt, India, and the Middle East. It was traditionally recommended for increasing milk production in nursing women and for the treatment of wounds, bronchitis, digestive problems, arthritis, kidney problems, and male reproductive conditions.

What Is Fenugreek Used for Today?

Present interest in fenugreek focuses on its potential benefits for people with diabetes or high cholesterol. Numerous animal studies and preliminary trials in humans have found that fenugreek can reduce blood sugar and serum cholesterol levels in people with diabetes. Like other high-fiber foods, it may also be helpful for constipation.

What Is the Scientific Evidence for Fenugreek?

In a 2-month, double-blind study of 25 individuals with type 2 diabetes, use of fenugreek (1 g per day of a standardized extract) significantly improved some measures of blood sugar control and insulin response as compared to placebo.⁵ Triglyceride levels decreased and HDL (“good”) cholesterol levels increased, presumably due to the enhanced insulin sensitivity.

Similar benefits have been seen in animal studies and open human trials, as well.^1,2,3

Dosage

Because the seeds of fenugreek are somewhat bitter, they are best taken in capsule form. The typical dosage is 5 to 30 g of defatted fenugreek taken 3 times a day with meals. The one double-blind study of fenugreek used 1 g per day of a water/alcohol fenugreek extract.

Safety Issues

As a commonly eaten food, fenugreek is generally regarded as safe. The only common side effect is mild gastrointestinal distress when it is taken in high doses.

Animal studies have found fenugreek essentially non-toxic,⁶ and no serious adverse effects have been seen in 2-year follow-up of human trials.⁷

However, extracts made from fenugreek have been shown to stimulate uterine contractions in guinea pigs.4 For this reason, pregnant women should not take fenugreek in dosages higher than is commonly used as a spice, perhaps 5 g daily. Besides concerns about pregnant women, safety in young children, nursing women, or those with severe liver or kidney disease has also not been established.

Because fenugreek can lower blood sugar levels, it is advisable to seek medical supervision before combining it with diabetes medications.

Interactions You Should Know About

If you are taking diabetes medications, such as insulin or oral hypoglycemic drugs, fenugreek may enhance their effects. This may cause excessively low blood sugar, and you may need to reduce your dose of medication.

If you’d like to see iHerb’s selection of Fenugreek products, click here. Use Coupon Code WOW123 to get $5 off any first time order.

Click here to review the References for this article at the iHerb Health Library.

Filed under Cholesterol and Heart Health, Diabetes Management, Herbs and Supplements

Tagged as cholesterol, diabetes, Fenugreek

July 1, 2010 · 4:10 pm

Diabetes Management at School and/or Work

Like most people, you’re busy—trying to accomplish a lot in a small amount of time. But when you have diabetes, you have to keep track of your blood glucose levels, give yourself medication, eat right, and exercise. These steps are essential to your health, and skipping any one of them can negatively impact your diabetes. When your days are filled with school or work, how can you put your health first and live your life?

Being at School

You have five classes, gym, and after-school activities, but you also have diabetes. What’s the best approach to manage all of this? Have a diabetes management plan in place and share this with the school staff—nurses, teachers, coaches, guidance counselor, cafeteria manager, and even bus drivers. The more people who know about your condition, the more support you’ll get.

Your parents can schedule a meeting at the school to go over your plan. This is important because everyone that works with you should know what to do if you have a reaction. Also, you need the flexibility to test your blood sugar, give yourself an insulin injection, and have a snack or drink to treat low blood sugar ( hypoglycemia). You may also need a schedule where you have lunch at the same time every day.

These steps can help you to get through your school day:

Try to stick to your regular schedule of eating, testing glucose, giving yourself an injection or taking oral medication, and being active.
Do you have an especially busy day ahead? Any change to your schedule can affect diabetes. Have a kit on hand to treat hypoglycemia. This kit can include items like glucose tablets, fruit juice, soft drinks (with sugar), hard candy, or sugar packets. Ask your doctor how much you should take. For example, 3-4 glucose tablets may be what you need to adjust the levels. If you have an exam coming up or a strenuous gym class, remember to check your glucose right before.
Prepare for the school day. Pack all of the supplies that you’ll need—testing strips, medications, and kit to treat hypoglycemia. Bring a healthful lunch that includes snacks and drinks. Wear or carry identification that says you have diabetes. There are a lot more options than having to wear the stainless steel medic alert bracelet. Online you can find jewelry in all kinds of styles that alert people to your condition.
If your schedule has changed a lot, like participating more in sports, talk to your doctor. You may need a new diabetes management plan. In general, it’s a good idea to exercise after lunch. Or, have a snack before being active.
Find out what you should do if you have a substitute teacher or if the nurse is not in school. Keep a copy of your diabetes management plan at the school (eg, in your locker) in case you need to show it to the staff.
If you are bullied at school because you have diabetes, tell an adult right away. Talk to someone you trust, whether it is a parent, teacher, or guidance counselor. It’s their job to keep you safe, and you have the right to feel comfortable in your school.
Talk to your friends. Chances are they will be understanding about your condition and will offer support.
Ask your doctor what the warning signs are for hyperglycemia and hypoglycemia. Know when you need to call 911.

Being at Work

If you have diabetes, laws in the United States, such as the Americans With Disabilities Act, stop employers from firing, refusing to hire, or refusing to promote you because of your disability. The laws also mean that your employer must make accommodations for you. These can involve giving you extra time to test your blood glucose level, give yourself an injection or medication, and eat snacks and lunch. If you have problems related to diabetes, like poor vision or foot pain, your employer must also accommodate you. For example, if your job usually requires that you stand up for long periods, you may be allowed to do your work sitting down.

Following these strategies can help you manage your diabetes while climbing the corporate ladder:

Share your diabetes management plan with your boss, coworkers, and nurse or medical team (if your company has one). It’s important that they know what to do if you have a reaction. In your desk and car, keep items like glucose tablets, hard candy, sugar packets, fruit juice, and soft drinks (with sugar) to treat hypoglycemia. Ask your doctor how much you should take to bring the glucose levels back up.
If your work schedule changes, talk to your doctor. She may need to revise your diabetes management plan.
Prepare for your work day by packing everything that you’ll need—diabetes supplies (eg, testing strips, syringes, needles) and medicine. In addition to carrying a diabetes identification card in your wallet, remember to wear your medic alert bracelet. If you feel uncomfortable wearing it, look online to find ID bracelets, necklaces, and charms in many styles.
Take the time to prepare a healthful lunch that includes fresh fruits and veggies. For busy days, have on hand canned soup, tuna, fruit juice, and vegetable juice (like V8). Going out to lunch? Read the menu first; many restaurants have the menu online. Once there, make good choices, like ordering a broth-based soup or salad, skipping the rolls and butter, eating smaller portions, and splitting dessert. In general, try to eat lunch at the same time every day.
Exercise can help your body use insulin better. Take a half hour to walk or workout in the gym. To avoid hypoglycemia, exercise after eating lunch, or have a snack before the activity.
If you have an especially demanding task, test your blood sugar right before.
Be sure you know what symptoms should trigger you to call the doctor right away.

Whether you are preparing for an exam or trying to meet a deadline at work, you still need to monitor your diabetes. This all comes down to being prepared and having good communication with your doctor.

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RESOURCES:

National Diabetes Information Clearinghouse

CANADIAN RESOURCES:

REFERENCES:

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Type 1 diabetes in school. Juvenile Diabetes Research Foundation International website. Available at: http://www.jdrf.org/index.cfm?page_id=103439 . Published July 2004. Accessed December 12, 2008.

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