Treating Type 2 Diabetes 

with Dietary Supplements 

Key Points

• There is limited scientific evidence on the effectiveness of dietary supplements 

as complementary and alternative medicine (CAM) for type 2 diabetes. The 

evidence that is available is not sufficiently strong to prove that any of the six 

supplements discussed in this report have benefits for type 2 diabetes or its 

complications. A possible exception may be the use of omega-3 fatty acids to 

lower triglyceride*

 levels. 

• It is very important not to replace conventional medical therapy for diabetes 

with an unproven CAM therapy. 

• To ensure a safe and coordinated course of care, people should inform their 

health care providers about any CAM therapy that they are currently using 

or considering. 

• The six dietary supplements reviewed in this report appear to be generally safe 

at low-to-moderate doses. However, each can interact with various prescription 

medications, affecting the action of the medications. People with type 2 

diabetes need to know about these risks and discuss them with their health care 

provider. Prescribed medicines may need to be adjusted if a person is also using 

a CAM therapy. 

1. What is diabetes? 

Diabetes is a chronic condition in which the body cannot properly convert food 

into energy. Most food that a person eats is eventually broken down into blood 

glucose (also called blood sugar), which cells need for energy and growth. Insulin is 

a hormone that helps glucose enter cells. In people with diabetes, the body does 

not make enough insulin, or it does not respond to insulin properly. This causes 

glucose to build up in the blood instead of moving into the cells. The most

common type of diabetes is type 2 diabetes (formerly called adult-onset diabetes or 

noninsulin-dependent diabetes). People can develop type 2 diabetes at any age, even 

in childhood.

 

*

 Terms that are underlined are defined in the dictionary at the end of this report. 
The symptoms of diabetes include fatigue, nausea, a need to urinate frequently, excessive thirst, 

weight loss, blurred vision, frequent infections, and sores that do not heal. However, some people 

with diabetes do not have any symptoms. Over time, the high blood glucose levels caused by 

diabetes can lead to complications in the eyes, blood vessels, nerves, kidneys, feet, teeth, skin, and, 

especially, the heart. Such complications can be prevented or delayed by keeping blood glucose, 

blood pressure, cholesterol, and triglycerides in a normal or close-to-normal range. 

Some people develop a condition called insulin resistance before they develop type 2 diabetes. 

When insulin resistance is present, the body does not respond properly to the insulin it has 

released to lower blood glucose. So, the pancreas releases more insulin to try to keep up with the 

excess glucose. If the pancreas cannot produce enough insulin, over time this leads to type 2 

diabetes. Obesity, aging, and lack of exercise can all play a role in developing insulin resistance and 

heightening the risk for diabetes. 

To find out more about diabetes and related conditions, contact the National Diabetes 

Information Clearinghouse (see “For More Information”). 

2. How is diabetes managed in conventional medicine? 

In conventional medicine’s†

 approach, people with diabetes learn to keep their blood glucose in as 

healthy a range as possible. They do this by following a healthy food plan, being physically active, 

controlling their weight, and testing their blood glucose regularly. Some people also need to take 

medicine, such as insulin injections or prescription diabetes pills. When lifestyle changes and 

medical treatment are combined to rigorously maintain and control blood sugar in the normal 

range, this approach to managing type 2 diabetes minimizes the serious complications of the 

disease. This enables patients to lead productive, full lives. 

3. What CAM therapies are discussed in this report? 

There are many different CAM therapies used for diabetes and its complications, and it is beyond 

the scope of this report to discuss them all. Scientific information on any CAM therapy for 

diabetes can be sought in the PubMed database on the Internet and from the National Center for 

Complementary and Alternative Medicine (NCCAM) Clearinghouse (for both, see “For More 

Information”). Overall, there have been few rigorous studies published on the use of CAM 

approaches for type 2 diabetes. Most of the literature has looked at herbal or other dietary 

supplements (see box on page 3), which reflects the tradition in certain whole medical systems of 

using plant products with claimed effects on blood sugar. This report focuses on six of the dietary 

supplements that people try for diabetes: alpha-lipoic acid (ALA), chromium, coenzyme Q10, 

 

†

 Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) 

degrees and by their allied health professionals, such as nurses, physical therapists, and dietitians. Complementary and 

alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not 

presently considered to be part of conventional medicine. Complementary medicine is used along with conventional 

medicine, and alternative medicine is used instead of conventional medicine. Some practitioners of conventional 

medicine are also practitioners of CAM. 

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garlic, magnesium, and omega-3 fatty acids. Discussions of the research findings on these 

supplements begin in Question 5. 

About Dietary Supplements 

Dietary supplements were defined in a law passed by Congress in 1994. A dietary supplement 

must meet all of the following conditions: 

• It is a product (other than tobacco) intended to supplement the diet, which contains one 

or more of the following: vitamins; minerals; herbs or other botanicals; amino acids; or 

any combination of the above ingredients. 

• It is intended to be taken in tablet, capsule, powder, softgel, gelcap, or liquid form. 

• It is not represented for use as a conventional food or as a sole item of a meal or the diet. 

• It is labeled as being a dietary supplement. 

Other important information about dietary supplements: 

• They are regulated as foods, not drugs, so there could be quality issues in the 

manufacturing process. 

• Supplements can interact with prescribed or over-the-counter medicines, and other 

supplements. 

• “Natural” does not necessarily mean “safe” or “effective.” 

• Consult your health care provider before starting a supplement, especially if you are 

pregnant or nursing, or considering giving a supplement to a child. 

4. What should people do if they have diabetes and are considering using any CAM therapy? 

• People with diabetes need to be under the care of a physician or other health care provider 

who will help them learn to manage their diabetes and will monitor their efforts to control it. 

Dietitians and diabetes educators help people learn and use the skills needed for managing 

diabetes on a daily basis. In addition, many patients need to be under the care of one or more 

specialists, such as an endocrinologist, an ophthalmologist, and/or a podiatrist. 

• It is important to not replace scientifically proven treatments for diabetes with CAM 

treatments that are unproven. The consequences of not following one’s prescribed medical 

regimen for diabetes can be very serious, even life-threatening. 

• People with diabetes should tell their health care provider about any dietary supplements or 

medications (prescription or over-the-counter) that they are using or considering. Prescribed 

medicines for diabetes and all other major health conditions may need to be adjusted if a 

NCCAM -3
person is also using a CAM therapy. Pharmacists can be another helpful source of information 

about dietary supplements. 

• If they decide to use supplements, they should know that what they see on the label may not 

accurately reflect what is in the bottle. Some herbal supplements, for example, have been found 

to be contaminated; some tests of dietary supplements have found that the contents did not 

match the labeled dose on the bottle. The NCCAM Clearinghouse (see “For More Information”) 

has publications on this topic. 

• Women who are pregnant or nursing, or people who are thinking of using supplements to 

treat a child, should use extra caution and be sure to consult their health care provider. 

• If people with diabetes decide to use a supplement and notice any unusual effects, they should 

stop and contact their health care provider. 

5. What is known about the safety and effectiveness of these six dietary supplements as CAM 

treatments for diabetes? 

Below is a brief overview of each dietary supplement and what is known from research about its 

effectiveness and safety in use for diabetes. 

Alpha-Lipoic Acid 

Alpha-lipoic acid (ALA, also known as lipoic acid or thioctic acid) is a chemical that is similar to a 

vitamin. It is an antioxidant—a substance that prevents cell damage caused by substances called free 

radicals in a process called oxidative stress. High levels of blood glucose are one cause of oxidative 

stress. ALA is found in some foods, such as liver, spinach, broccoli, and potatoes. ALA can also be 

made in the laboratory. ALA supplements are marketed as tablets or capsules.‡ It is theorized that 

ALA may be beneficial because of its antioxidant activity. 

Summary of the research findings 

The evidence on ALA for type 2 diabetes and obesity is limited. There are a number of small 

studies in animals and in people that have shown hints of beneficial effects. In a few of these 

studies, some possible benefit from ALA was seen in glucose uptake in muscle; sensitivity of the 

body to insulin; diabetic neuropathy; and/or weight loss. More research is needed to document 

whether there is any benefit of ALA in diabetes and to better understand how ALA works. 

Side effects and possible risks 

While ALA appears to be safe for the general adult population, people with diabetes need to know 

that ALA might lower blood sugar too much, and thus they would need to monitor their blood 

sugar level especially carefully. ALA may also lower blood levels of minerals, such as iron; interact 

with some medicines, such as antacids; and decrease the effectiveness of some anti-cancer drugs. 

Other possible side effects of ALA include headache, skin rash, and stomach upset. 

 

‡

 There is some use, reported from outside the United States, of ALA delivered intravenously (IV). These trials are not 

discussed in this report.

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Chromium 

Chromium is a metal and an essential trace mineral. Chromium is found in some foods, such as 

meats, animal fats, fish, brown sugar, coffee, tea, some spices, whole-wheat and rye breads, and 

brewer’s yeast. It is marketed in supplement form (capsules and tablets) as chromium picolinate, 

chromium chloride, and chromium nicotinate. 

Summary of the research findings 

There are scientific controversies about the use or need for chromium supplementation by persons 

with diabetes. First, it is difficult to determine, including through tests, whether a person has a 

chromium deficiency. Second, it is not known whether it is beneficial to take chromium 

supplementation in diabetes, and there is a lack of rigorous basic science studies to explain or 

support any evidence of benefit. In sum, there is not enough evidence to show that taking 

chromium supplements is beneficial for diabetes. 

Side effects and other risks

At low doses, short-term use of chromium appears to be safe in the general adult population. 

However, chromium can add to insulin in its effects on blood sugar; this might cause the blood 

sugar to go too low. Possible side effects at low doses include weight gain, headache, insomnia, 

skin irritation, sleep problems, and mood changes. High doses can cause serious side effects. The 

foremost concern for persons with diabetes who use chromium is the development of kidney 

problems. Other possible effects include vomiting, diarrhea, bleeding into the gastrointestinal 

tract, and worsening of any behavioral or psychiatric problems. 

Coenzyme Q10 

Coenzyme Q10, often referred to as CoQ10 (sometimes written as CoQ10; other names include 

ubiquinone and ubiquinol) is a vitamin-like substance. CoQ10 helps cells make energy and acts as 

an antioxidant. Meats and seafood contain small amounts of CoQ10. Supplements are marketed 

as tablets and capsules. 

Summary of the research findings 

There have been few studies on CoQ10 and type 2 diabetes so far. The evidence is not sufficient to

evaluate CoQ10’s effectiveness as a CAM therapy in diabetes. CoQ10 has not been shown to affect 

blood glucose control. In theory, it might have use against heart disease in people with diabetes, but 

well-designed studies looking at heart disease outcomes are needed to answer this question. 

Side effects and other risks

CoQ10 appears to be safe for most of the adult population. However, it may interact with and 

affect the action of some medicines, including warfarin (a blood thinner) and medicines used for 

high blood pressure or cancer chemotherapy. Other possible side effects of CoQ10 include nausea, 

vomiting, diarrhea, loss of appetite, and heartburn. 

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Garlic 

Garlic (Allium sativum) is an herb used to flavor food. Garlic can also be processed and made into 

dietary supplements. In some cultures, garlic is used for medicinal purposes. The chemical in garlic 

of most interest for health purposes is allicin, which gives garlic its strong taste and odor. One of 

the claims for garlic is that the rates of certain diseases are lower in countries where lots of garlic is 

consumed. However, it has not been proven that garlic (and not some other factor such as lifestyle) 

is the reason. 

Summary of the research findings 

Few rigorous studies have been conducted on garlic, allicin, or both, for type 2 diabetes. In the 

studies that have been done, findings have been mixed. There are some intriguing basic science 

studies that suggest that garlic has some biological activities that are relevant to the treatment of 

diabetes. However, the evidence so far does not support that there is any benefit from garlic for 

type 2 diabetes. 

Side effects and other risks

Garlic is safe for most adults. However, garlic appears to interact with various types of drugs. For 

example, when combined with certain medicines used to treat HIV/AIDS (NNRTIs and 

saquinavir), garlic may decrease their effectiveness. Garlic may also interact with and affect the 

action of birth control pills, cyclosporine, medications that are broken down by the liver, and 

blood thinners (including warfarin). Other possible side effects of garlic include an odor on the 

breath or skin, an allergic reaction, stomach disorders, diarrhea, and skin rash. 

Magnesium 

Magnesium is a mineral. Foods high in magnesium include green leafy vegetables, nuts, seeds, 

and some whole grains. Various supplemental forms of magnesium are marketed as tablets, 

capsules, or liquids. 

Magnesium has many important functions in the body, including in the heart, nerves, muscles, 

bones, handling glucose, and making proteins. Low levels of magnesium are commonly seen in 

people with diabetes. Scientists have studied the relationship between magnesium and diabetes for 

a long time, but it is not yet fully understood. 

Summary of the research findings 

There have been a handful of studies on magnesium and type 2 diabetes, many of them very small 

in size and/or short in length and primarily looking at blood glucose control. The results have 

been mixed, with most finding that magnesium did not affect blood glucose control. Some studies 

have suggested that low magnesium levels may make glucose control worse in type 2 diabetes 

(interrupting insulin secretion in the pancreas and increasing insulin resistance) and contribute to 

diabetes complications. There is evidence that magnesium supplementation may be helpful for 

insulin resistance. Additional controlled studies are needed to establish firmly whether magnesium 

supplements have any role or benefit as a CAM therapy for type 2 diabetes. 

NCCAM -6
Side effects and other risks

Magnesium supplements appear to be safe for most adults at low doses. High doses can be unsafe 

and cause such problems as nausea, diarrhea, loss of appetite, muscle weakness, difficulty 

breathing, extremely low blood pressure, irregular heart rate, and confusion. Magnesium can 

interact with and affect the action of certain drugs, including some antibiotics, drugs to prevent 

osteoporosis, certain high blood pressure medicines (calcium channel blockers), muscle relaxants, 

and diuretics (“water pills”). 

Omega-3 Fatty Acids 

Omega-3 fatty acids (omega-3s, for short) are a group of polyunsaturated fatty acids that come from 

food sources, such as fish, fish oil, some vegetable oils (primarily canola and soybean), walnuts, 

wheat germ, and certain dietary supplements. As supplements, omega-3s are marketed as capsules 

or oils, often as fish oil. 

Omega-3s are important in a number of bodily functions, including moving calcium and other 

substances in and out of cells, the relaxation and contraction of muscles, blood clotting, digestion, 

fertility, cell division, and growth. Omega-3s have been the subject of much media attention in 

recent years, because of studies finding they may be useful for such purposes as decreasing the rate 

of heart disease, reducing inflammation, and lowering triglyceride levels. Some countries and 

organizations have issued formal recommendations on the intake of omega-3s, through meals, oils, 

and possibly supplementation. Omega-3s have been of interest for diabetes primarily because 

having diabetes increases a person’s risk for heart disease and stroke. 

Summary of the research findings 

Randomized clinical trials have found that omega-3 supplementation reduces the incidence of 

cardiovascular disease and events (such as heart attack and stroke) and slows the progression of 

atherosclerosis (hardening of the arteries). However, these studies were not done in populations 

that were at higher risk, such as those with type 2 diabetes. 

With regard to studies on omega-3 supplementation for type 2 diabetes, there is somewhat more 

literature available than for most other CAM therapies for this condition. A 2001 analysis was 

published by the Cochrane Collaboration, of 18 randomized placebo-controlled trials on fish oil 

supplementation in type 2 diabetes. The authors found that fish oil lowered triglycerides and 

raised LDL cholesterol but had no significant effect on fasting blood glucose, HbA1c, total 

cholesterol, or HDL cholesterol. (The authors did not identify and include studies with 

cardiovascular outcomes, but noted that this is an area for further research.) Another analysis was 

published in 2004 by the Agency for Healthcare Research and Quality, of 18 studies on omega-3 

fatty acids for a number of measurable outcomes in type 2 diabetes. This study confirmed virtually 

all the Cochrane authors’ findings, except for finding no significant effect on LDL cholesterol. 

Additional studies are needed to determine whether omega-3 supplements are safe and beneficial 

for heart problems in people with type 2 diabetes. Studies that look specifically at heart disease 

outcomes in this population are needed. 

NCCAM -7
Side effects and possible risks 

Omega-3s appear to be safe for most adults at low-to-moderate doses. There have been some safety 

questions raised about fish oil supplements, because certain species of fish can be contaminated with 

substances from the environment, like mercury, pesticides, or PCBs. Fish oil is on the list of food 

substances that the U.S. Food and Drug Administration considers to be “generally recognized as 

safe.” How well a product is prepared is another factor for consumers to consider. Women who are 

pregnant or breastfeeding should not take fish oil supplements. Fish oil in high doses can possibly 

interact with, and affect the action of, certain medications, including blood-thinning drugs and drugs 

for high blood pressure. Potential side effects of fish oil include a fishy aftertaste, belching, stomach 

disturbances, and nausea.

6. What research is being done on CAM therapies for diabetes? 

Recent NCCAM-supported research projects are studying the effects of: 

• Chromium on high blood glucose levels 

• Yoga on glucose control in people at risk for diabetes 

• Ginkgo biloba extract on diabetes medicines 

Also, researchers in the Diabetes Unit of NCCAM’s Division of Intramural Research are studying 

many aspects of diabetes, including what happens when the body does not properly react to 

insulin. Recent clinical trials, for example, have been studying whether vitamin C supplements are 

beneficial in diabetes, the safety of glucosamine with respect to insulin resistance, and whether 

dark chocolate lowers blood pressure and improves insulin sensitivity. Diabetes Unit staff note 

that a category of functional foods containing polyphenols (also available as extracts) may be of 

benefit for further study in diabetes, including green tea (epigallocatechin gallate), dark chocolate 

(epicatechin), and red wine (resveratrol). 

Definitions 

Basic science study: A laboratory study done at the molecular level of biology and/or chemistry, to 

obtain necessary knowledge and background for later research such as animal studies and clinical trials. 

Blood glucose: The main sugar found in the blood. Glucose serves as the body’s primary source 

of energy. 

Clinical trial: A research study in which a treatment or therapy is tested in people to see whether it 

is safe and effective. Clinical trials are a key part of the process in finding out which treatments 

work, which do not, and why. Clinical trial results also contribute new knowledge about diseases 

and medical conditions. 

Controlled study: A clinical trial in which one group receives a treatment under study and another 

group (the control group) receives either a placebo, standard treatment, or no treatment. 

NCCAM -8
Diabetic neuropathy: A nerve disorder caused by diabetes. This disorder leads to pain or loss of 

feeling in the toes, feet, legs, hands, or arms. 

Endocrinologist: A specialist in diseases and conditions of the glands (organs that make hormones). 

Essential trace mineral: A mineral that is required in minute amounts by the body and must be 

obtained from dietary sources. 

Fasting blood glucose: Blood glucose level after a person has not eaten for 8 to 12 hours 

(usually overnight). 

Free radical: A highly reactive chemical that attacks molecules that are key to cell functioning, by 

capturing electrons and thus changing chemical structures. 

Functional food: A food that has biologically active components (such as fish oils or plant 

estrogens) that may provide health benefits beyond basic nutrition. 

HbA1c: Hemoglobin A1c, a blood test that measures a person’s average blood glucose level over a 

period of weeks or months. 

Hormone: A chemical made by glands in the body. Hormones circulate in the bloodstream and 

control the actions of certain cells or organs. Some hormones can also be made in laboratories. 

Ophthalmologist: A specialist in diseases and disorders of the eye. 

PCB: Short for polychlorinated biphenyl. PCBs have had various uses in industry, but most uses 

were banned by the U.S. Environmental Protection Agency in 1979 because of hazards to human 

health. When discharged into the environment, PCBs stay in the environment for a long period of 

time and build up in certain species of fish and wildlife. 

Placebo: An inert or sham treatment, such as a sugar pill. 

Podiatrist: A specialist in care of the foot and treatment of foot disorders. 

Polyphenols: A group of substances that are found in many plants. They give some flowers, fruits, 

and vegetables their color. Polyphenols have antioxidant activity and are being studied as possible 

CAM treatments. 

Polyunsaturated fatty acid: One of the three types of fatty acids. Polyunsaturated fatty acids are 

liquid at room temperature. They contain a chain of carbon atoms and hydrogen and oxygen 

molecules, with two or more double bonds between the carbon atoms. 

Randomized clinical trial: In a randomized clinical trial, each participant is assigned by chance 

(through a computer or a table of random numbers) to one of two groups. The investigational 

NCCAM -9
group receives the therapy, also called the active treatment. The control group receives either the 

standard treatment, if there is one for their disease or condition, or a placebo. 

Triglyceride: The form in which fat is stored in the body. High triglyceride levels in the blood may 

raise the risks for heart attack or stroke. 

Whole medical system: A system that employs practices from among the four CAM domains—

mind-body medicine, biologically based practices, manipulative and body-based practices, and 

energy medicine. Conventional medicine is one example of a whole medical system. An example 

of a CAM whole medical system is traditional Chinese medicine. 

Sources 

Question 1: References 1-4 

Question 2: References 1, 3-5 

Question 3: N/A 

Question 4: N/A 

Question 5: 

• Alpha-lipoic acid: References 6-13 

• Chromium: References 11, 14-18 

• Coenzyme Q10: References 7, 19-21 

• Garlic: References 11, 22-28 

• Magnesium: References 11, 15, 29-33 

• Omega-3 fatty acids: References 34-42 

Question 6: N/A

References 

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2. National Institute of Diabetes and Digestive and Kidney Diseases. Insulin Resistance and Pre-Diabetes. National

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NCCAM -10 
5. National Institute of Diabetes and Digestive and Kidney Diseases. Medicines for People With Diabetes. National

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40. U.S. Environmental Protection Agency. Consumer fact sheet on polychlorinated biphenyls. U.S. Environmental 

Protection Agency Web site. Accessed at 

http://www.epa.gov/safewater/contaminants/dw_contamfs/pcbs.html on May 10, 2005. 

41. U.S. Food and Drug Administration. Letter regarding dietary supplement health claim for omega-3 fatty acids and 

coronary heart disease. U.S. Food and Drug Administration Web site. Accessed at 

http://vm.cfsan.fda.gov/~dms/ds-ltr11.html on May 10, 2005.

42. U.S. Food and Drug Administration. What You Need to Know About Mercury in Fish and Shellfish. U.S. Food and

Drug Administration Web site. U.S. Food and Drug Administration Web site. Accessed at 

http://www.cfsan.fda.gov/~dms/admehg3.html on May 19, 2005.

For More Information 

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on CAM and on NCCAM, including publications 

and searches of Federal databases of scientific and medical literature. The Clearinghouse does not 

provide medical advice, treatment recommendations, or referrals to practitioners. 

Toll-free in the U.S.: 1-888-644-6226 

TTY (for deaf and hard-of-hearing callers): 1-866-464-3615 

Web site: nccam.nih.gov 

E-mail: info@nccam.nih.gov 

NCCAM -12 
National Diabetes Information Clearinghouse 

A service of the National Institute of Diabetes and Digestive and Kidney Diseases, National 

Institutes of Health (NIH), the clearinghouse responds to inquiries, offers diabetes publications, 

makes referrals, and maintains the diabetes subfile of the Combined Health Information Database 

(chid.nih.gov). 

Toll-free in the U.S.: 1-800-860-8747 

Web site: www.diabetes.niddk.nih.gov 

National Diabetes Education Program 

The National Diabetes Education Program is a program sponsored by NIH and the Centers for 

Disease Control and Prevention, with many Federal, state, and local partners. Among its services 

are information and publications. 

Telephone: 1-301-496-3583 

Web site: www.ndep.nih.gov 

PubMed®

A service of the National Library of Medicine (NLM), PubMed contains publication information and 

(in most cases) abstracts of articles from biomedical journals. CAM on PubMed, developed jointly by

NCCAM and NLM, is a subset of NLM’s PubMed system and focuses on the topic of CAM. 

Web site: www.ncbi.nlm.nih.gov/entrez 

CAM on PubMed: www.nlm.nih.gov/nccam/camonpubmed.html 

NCCAM -13 
This publication is not copyrighted and is in the public domain.

Duplication is encouraged. 

NCCAM has provided this material for your information. It is not intended to substitute for 

the medical expertise and advice of your primary health care provider. We encourage you to 

discuss any decisions about treatment or care with your health care provider. The mention 

of any product, service, or therapy in this information is not an endorsement by NCCAM. 

National Institutes of Health 

♦♦♦

U.S. Department of Health and Human Services

Created June 2, 2005 D267