Smart Snacks in Schools
Such studies are not available among individuals with diabetes; however, there is little reason to suspect that the diabetic state would mitigate the adverse effects of SSBs. Effects of calcium and dairy on body composition and weight loss in African-American adults. Here's what the research has to say. Cardiovasc Diabetol ; 8: Glucocorticoids, such as prednisone, can cause calcium depletion and eventually osteoporosis when they are used for months [ ]. There may be less death in infants associated with maternal DHA consumption, with one study noting that while control experienced 12 and 5 neonatal deaths and convulsions respectively mg DHA reduced this to 3 and 0.
See the links below for additional information on calcium and breastfeeding. Hilary Flower researched this question for Adventures in Tandem Nursing: Breastfeeding during Pregnancy and Beyond.
She found three important facts that have come from the research of Dr. Ann Prentice in recent years:. For their part, scientists have moved on. Calcium supplements should be combined with magnesium in a ratio to allow for adequate assimilation into the body. Since dairy products are one of our major sources of zinc, added zinc is also recommended if you are avoiding dairy.
Adding only a calcium supplement like Tums is not the best way to go. Greatly excessive intake of calcium can cause numerous side effects. No available evidence shows that exceeding the amount of calcium retained by the exclusively breastfed term infant during the first 6 months of life or the amount retained by the human milk-fed infant supplemented with solid foods during the second 6 months of life is beneficial to achieving long-term increases in bone mineralization… Few data are available about the calcium requirements of children before puberty.
Calcium retention is relatively low in toddlers and slowly increases as puberty approaches. Infant formulas contain Extra calcium is added to infant formulas because of the lower bioavailability of the calcium from formulas as compared to human milk they aim for baby to absorb the same amount of calcium as would be absorbed from breastmilk. Riordan J and Auerbach K. Breastfeeding and Human Lactation , 2nd ed.
Jones and Bartlett, Hamosh M, Dewey, Garza C, et al: See Journal Articles below for more information. Calcium great general information from askdrsears. The Science of Feeding Your Children: An average cup of coffee contains 95 mg of caffeine per serving, so this is safe to drink more than once a day. The tea is designed to be a daily drink, and consistency will get you the best results. You can drink it anytime, without or with food.
You can drink more once a day, but drinking it too late at night may cause issues with insomnia. To brew the either of teas, you should steep it in 8 ounces of hot water for five to seven minutes. Drink the Zzztox tea whenever you want to relax. Enjoy the tea either hot or cold. You are advised to use the beverages in conjunction with a sensible diet and exercise program.
Skinny Fit claims that you should not have any side effects, but says that if you do, you should stop using the product immediately and consult with your doctor or other healthcare professional. The Skinny Fit Detox Teas are recommended for adults only. If you take any prescription medication, are pregnant, or nursing, you should speak to your doctor or another medical professional before using them. You should also speak to your doctor if you are fasting because this can cause issues with detoxification.
We were, however, able to find that the company has a complaint on Rip Off Report because they did not follow through with their money back guarantee. The company also has an F rating with the Better Business Bureau, because of all the customer complaints.
You can cancel anytime. According to the terms and conditions, they offer a day money back guarantee. All you have to do is call or email for a return merchandise authorization number and details for shipping.
Your refund will not include shipping and handling costs for the original order or reimbursement for your return shipping. Your refund should be processed within five to seven business days but may take up to 30 days to appear on your credit card statement. Regarding customer service, it appears as though many people have struggled to get their money refunded.
It also seems as though many people are automatically billed when they should not be. Our research team gathered facts about the ingredients, potential side effects and research backing the claims. So, what are our final thoughts on SkinnyFit? One of the products we like the most is Burn TS. The formula contains four clinically-tested ingredients, that have been shown to help promote weight-loss by accelerating metabolism and igniting fat loss.
Choosing the right weight-loss system can be confusing and often times frustrating. Let us know a little more about you and your goals. The ingredients in SkinnyFit line of products are yerba mate, dandelion leaf, goji berry guarana, ginseng, chamomile flower levander buds and peppermint leaf and more. Possible side effects of SkinnyFit line of products are dizziness, bloating, allergies, headaches, diarrhea, nausea, fatigue, nervousness, gas and stomach upset.
Choosing the right product is the 1 question asked by DietSpotlight readers. We recommend trying any product before buying it and know that finding a product with a sample offer is near impossible - so we created our own product, Burn TS, with scientifically backed ingredients. SkinnyFit can be purchased using their Official Site or through Amazon. All products in the line have their dosage instruction on the labels. You should consume according to the daily servings provided.
For any enquiry, you can reach SkinnyFit customer service on phone by dialing or via email at hello skinnyfit. Yes, SkinnyFit line of products comes with a days money-back guarantee by which you can access a return or replacement.
Few cases of ineffectiveness exists on some of the products and refund problems were also expressed by some buyers who wanted a refund. Summer Banks, Director of Content at Dietspotlight, has researched over weight-loss programs, pills, shakes and diet plans. Therefore, these nutrition recommendations start by considering energy balance and weight loss strategies. The risk of comorbidity associated with excess adipose tissue increases with BMIs in this range and above.
Because of the effects of obesity on insulin resistance, weight loss is an important therapeutic objective for individuals with pre-diabetes or diabetes However, long-term weight loss is difficult for most people to accomplish. This is probably because the central nervous system plays an important role in regulating energy intake and expenditure. Look AHEAD Action for Health in Diabetes is a large National Institutes of Health—sponsored clinical trial designed to determine if long-term weight loss will improve glycemia and prevent cardiovascular events When completed, this study should provide insight into the effects of long-term weight loss on important clinical outcomes.
The role of lifestyle modification in the management of weight and type 2 diabetes was recently reviewed Although structured lifestyle programs have been effective when delivered in well-funded clinical trials, it is not clear how the results should be translated into clinical practice.
Organization, delivery, and funding of lifestyle interventions are all issues that must be addressed. Third-party payers may not provide adequate benefits for sufficient MNT frequency and time to achieve weight loss goals Exercise and physical activity, by themselves, have only a modest weight loss effect. However, exercise and physical activity are to be encouraged because they improve insulin sensitivity independent of weight loss, acutely lower blood glucose, and are important in long-term maintenance of weight loss 1.
Weight loss with behavioral therapy alone also has been modest, and behavioral approaches may be most useful as an adjunct to other weight loss strategies. The optimal macronutrient distribution of weight loss diets has not been established.
Although low-fat diets have traditionally been promoted for weight loss, two randomized controlled trials found that subjects on low-carbohydrate diets lost more weight at 6 months than subjects on low-fat diets 19 , Another study of overweight women randomized to one of four diets showed significantly more weight loss at 12 months with the Atkins low-carbohydrate diet than with higher-carbohydrate diets 20a. However, at 1 year, the difference in weight loss between the low-carbohydrate and low-fat diets was not significant and weight loss was modest with both diets.
Changes in serum triglyceride and HDL cholesterol were more favorable with the low-carbohydrate diets. In one study, those subjects with type 2 diabetes demonstrated a greater decrease in A1C with a low-carbohydrate diet than with a low-fat diet A recent meta-analysis showed that at 6 months, low-carbohydrate diets were associated with greater improvements in triglyceride and HDL cholesterol concentrations than low-fat diets; however, LDL cholesterol was significantly higher on the low-carbohydrate diets Further research is needed to determine the long-term efficacy and safety of low-carbohydrate diets Although brain fuel needs can be met on lower-carbohydrate diets, long-term metabolic effects of very-low-carbohydrate diets are unclear, and such diets eliminate many foods that are important sources of energy, fiber, vitamins, and minerals and are important in dietary palatability Meal replacements liquid or solid prepackaged provide a defined amount of energy, often as a formula product.
Use of meal replacements once or twice daily to replace a usual meal can result in significant weight loss. However, meal replacement therapy must be continued indefinitely if weight loss is to be maintained.
When very-low-calorie diets are stopped and self-selected meals are reintroduced, weight regain is common. Thus, very-low-calorie diets appear to have limited utility in the treatment of type 2 diabetes and should only be considered in conjunction with a structured weight loss program.
All cardiovascular risk factors except hypercholesterolemia improved in the surgical patients. Individuals at high risk for type 2 diabetes should be encouraged to achieve the U. There is not sufficient, consistent information to conclude that low—glycemic load diets reduce the risk for diabetes.
Nevertheless, low—glycemic index foods that are rich in fiber and other important nutrients are to be encouraged. Observational studies report that moderate alcohol intake may reduce the risk for diabetes, but the data do not support recommending alcohol consumption to individuals at risk of diabetes. Although there are insufficient data at present to warrant any specific recommendations for prevention of type 2 diabetes in youth, it is reasonable to apply approaches demonstrated to be effective in adults, as long as nutritional needs for normal growth and development are maintained.
The importance of preventing type 2 diabetes is highlighted by the substantial worldwide increase in the prevalence of diabetes in recent years. Genetic susceptibility appears to play a powerful role in the occurrence of type 2 diabetes. However, given that population gene pools shift very slowly over time, the current epidemic of diabetes likely reflects changes in lifestyle leading to diabetes. Lifestyle changes characterized by increased energy intake and decreased physical activity appear to have together promoted overweight and obesity, which are strong risk factors for diabetes.
Several studies have demonstrated the potential for moderate, sustained weight loss to substantially reduce the risk for type 2 diabetes, regardless of whether weight loss was achieved by lifestyle changes alone or with adjunctive therapies such as medication or bariatricsurgery see energy balance section 1. Moreover, both moderate-intensity and vigorous exercise can improve insulin sensitivity, independent of weight loss, and reduce risk for type 2 diabetes 1.
S 26 strongly support the potential for moderate weight loss to reduce the risk for type 2 diabetes. In addition to preventing diabetes, the DPP lifestyle intervention improved several CVD risk factors, including dsylipidemia, hypertension, and inflammatory markers 29 , The DPP analysis indicated that lifestyle intervention was cost-effective 31 , but other analyses suggest that the expected costs needed to be reduced Both the Finnish Diabetes Prevention study and the DPP focused on reduced intake of calories using reduced dietary fat as a dietary intervention.
Of note, reduced intake of fat, particularly saturated fat, may reduce risk for diabetes by producing an energy-independent improvement in insulin resistance 1 , 33 , 34 , as well as by promoting weight loss. It is possible that reduction in other macronutrients e.
Several studies have provided evidence for reduced risk of diabetes with increased intake of whole grains and dietary fiber 1 , 35 — Whole grain—containing foods have been associated with improved insulin sensitivity, independent of body weight, and dietary fiber has been associated with improved insulin sensitivity and improved ability to secrete insulin adequately to overcome insulin resistance There is debate as to the potential role of low—glycemic index and —glycemic load diets in prevention of type 2 diabetes.
Thus, there is not sufficient, consistent information to conclude that low—glycemic load diets reduce risk for diabetes. Prospective randomized clinical trials will be necessary to resolve this issue. A American Diabetes Association statement reviewed this issue in depth 40 , and issues related to the role of glycemic index and glycemic load in diabetes management are addressed in more detail in the carbohydrate section of this document.
Observational studies suggest a U- or J-shaped association between moderate consumption of alcohol one to three drinks [15—45 g alcohol] per day and decreased risk of type 2 diabetes 41 , 42 , coronary heart disease CHD 42 , 43 , and stroke However, heavy consumption of alcohol greater than three drinks per day , may be associated with increased incidence of diabetes If alcohol is consumed, recommendations from the USDA Dietary Guidelines for Americans suggest no more than one drink per day for women and two drinks per day for men Although selected micronutrients may affect glucose and insulin metabolism, to date, there are no convincing data that document their role in the development of diabetes.
No nutrition recommendations can be made for the prevention of type 1 diabetes at this time 1. Increasing overweight and obesity in youth appears to be related to the increased prevalence of type 2 diabetes, particularly in minority adolescents.
Although there are insufficient data at present to warrant any specific recommendations for the prevention of type 2 diabetes in youth, interventions similar to those shown to be effective for prevention of type 2 diabetes in adults lifestyle changes including reduced energy intake and regular physical activity are likely to be beneficial.
Clinical trials of such interventions are ongoing in children. A dietary pattern that includes carbohydrate from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health.
Monitoring carbohydrate, whether by carbohydrate counting, exchanges, or experienced-based estimation remains a key strategy in achieving glycemic control. The use of glycemic index and load may provide a modest additional benefit over that observed when total carbohydrate is considered alone. Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications.
Care should be taken to avoid excess energy intake. As for the general population, people with diabetes are encouraged to consume a variety of fiber-containing foods. However, evidence is lacking to recommend a higher fiber intake for people with diabetes than for the population as a whole. Sugar alcohols and nonnutritive sweeteners are safe when consumed within the daily intake levels established by the Food and Drug Administration FDA.
Control of blood glucose in an effort to achieve normal or near-normal levels is a primary goal of diabetes management. Food and nutrition interventions that reduce postprandial blood glucose excursions are important in this regard, since dietary carbohydrate is the major determinant of postprandial glucose levels.
Low-carbohydrate diets might seem to be a logical approach to lowering postprandial glucose. However, foods that contain carbohydrate are important sources of energy, fiber, vitamins, and minerals and are important in dietary palatability. Therefore, these foods are important components of the diet for individuals with diabetes. Issues related to carbohydrate and glycemia have previously been extensively reviewed in American Diabetes Association reports and nutrition recommendations for the general public 1 , 2 , 22 , 40 , Blood glucose concentration following a meal is primarily determined by the rate of appearance of glucose in the blood stream digestion and absorption and its clearance from the circulation Insulin secretory response normally maintains blood glucose in a narrow range, but in individuals with diabetes, defects in insulin action, insulin secretion, or both impair regulation of postprandial glucose in response to dietary carbohydrate.
Both the quantity and the type or source of carbohydrates found in foods influence postprandial glucose levels. A ADA statement addressed the effects of the amount and type of carbohydrate in diabetes management The 1-year follow-up data also indicate that the macronutrient composition of the treatment groups only differed with respect to carbohydrate intake mean intake of vs.
Thus, questions about the long-term effects on intake and metabolism, as well as safety, need further research. The amount of carbohydrate ingested is usually the primary determinant of postprandial response, but the type of carbohydrate also affects this response. Intrinsic variables that influence the effect of carbohydrate-containing foods on blood glucose response include the specific type of food ingested, type of starch amylose versus amylopectin , style of preparation cooking method and time, amount of heat or moisture used , ripeness, and degree of processing.
Extrinsic variables that may influence glucose response include fasting or preprandial blood glucose level, macronutrient distribution of the meal in which the food is consumed, available insulin, and degree of insulin resistance.
The glycemic index of foods was developed to compare the postprandial responses to constant amounts of different carbohydrate-containing foods The glycemic index of a food is the increase above fasting in the blood glucose area over 2 h after ingestion of a constant amount of that food usually a g carbohydrate portion divided by the response to a reference food usually glucose or white bread.
The glycemic loads of foods, meals, and diets are calculated by multiplying the glycemic index of the constituent foods by the amounts of carbohydrate in each food and then totaling the values for all foods. Foods with low glycemic indexes include oats, barley, bulgur, beans, lentils, legumes, pasta, pumpernickel coarse rye bread, apples, oranges, milk, yogurt, and ice cream.
Fiber, fructose, lactose, and fat are dietary constituents that tend to lower glycemic response. Potential methodological problems with the glycemic index have been noted Several randomized clinical trials have reported that low—glycemic index diets reduce glycemia in diabetic subjects, but other clinical trials have not confirmed this effect Moreover, the variability in responses to specific carbohydrate-containing food is a concern Nevertheless, a recent meta-analysis of low—glycemic index diet trials in diabetic subjects showed that such diets produced a 0.
However, it appears that most individuals already consume a moderate—glycemic index diet 39 , Thus, it appears that in individuals consuming a high—glycemic index diet, low—glycemic index diets can produce a modest benefit in controlling postprandial hyperglycemia.
In diabetes management, it is important to match doses of insulin and insulin secretagogues to the carbohydrate content of meals. A variety of methods can be used to estimate the nutrient content of meals, including carbohydrate counting, the exchange system, and experience-based estimation. By testing pre- and postprandial glucose, many individuals use experience to evaluate and achieve postprandial glucose goals with a variety of foods.
To date, research has not demonstrated that one method of assessing the relationship between carbohydrate intake and blood glucose response is better than other methods.
Palatability, limited food choices, and gastrointestinal side effects are potential barriers to achieving such high-fiber intakes. Substantial evidence from clinical studies demonstrates that dietary sucrose does not increase glycemia more than isocaloric amounts of starch 1. Thus, intake of sucrose and sucrose-containing foods by people with diabetes does not need to be restricted because of concern about aggravating hyperglycemia. Sucrose can be substituted for other carbohydrate sources in the meal plan or, if added to the meal plan, adequately covered with insulin or another glucose-lowering medication.
Additionally, intake of other nutrients ingested with sucrose, such as fat, need to be taken into account, and care should be taken to avoid excess energy intake. In individuals with diabetes, fructose produces a lower postprandial glucose response when it replaces sucrose or starch in the diet; however, this benefit is tempered by concern that fructose may adversely affect plasma lipids 1. Therefore, the use of added fructose as a sweetening agent in the diabetic diet is not recommended.
There is, however, no reason to recommend that people with diabetes avoid naturally occurring fructose in fruits, vegetables, and other foods. Reduced calorie sweeteners approved by the FDA include sugar alcohols polyols such as erythritol, isomalt, lactitol, maltitol, mannitol, sorbitol, xylitol, tagatose, and hydrogenated starch hydrolysates.
Studies of subjects with and without diabetes have shown that sugar alcohols produce a lower postprandial glucose response than sucrose or glucose and have lower available energy 1.
When calculating carbohydrate content of foods containing sugar alcohols, subtraction of half the sugar alcohol grams from total carbohydrate grams is appropriate. Use of sugar alcohols as sweeteners reduces the risk of dental caries. However, there is no evidence that the amounts of sugar alcohols likely to be consumed will reduce glycemia, energy intake, or weight. The use of sugar alcohols appears to be safe; however, they may cause diarrhea, especially in children.
The FDA has approved five nonnutritive sweeteners for use in the U. These are acesulfame potassium, aspartame, neotame, saccharin, and sucralose. Before being allowed on the market, all underwent rigorous scrutiny and were shown to be safe when consumed by the public, including people with diabetes and women during pregnancy.
Clinical studies involving subjects without diabetes provide no indication that nonnutritive sweeteners in foods will cause weight loss or weight gain It has been proposed that foods containing resistant starch starch physically enclosed within intact cell structures as in some legumes, starch granules as in raw potato, and retrograde amylose from plants modified by plant breeding to increase amylose content or high-amylose foods, such as specially formulated cornstarch, may modify postprandial glycemic response, prevent hypoglycemia, and reduce hyperglycemia.
However, there are no published long-term studies in subjects with diabetes to prove benefit from the use of resistant starch. Two or more servings of fish per week with the exception of commercially fried fish filets provide n-3 polyunsaturated fatty acids and are recommended. The primary goal with respect to dietary fat in individuals with diabetes is to limit saturated fatty acids, trans fatty acids, and cholesterol intakes so as to reduce risk for CVD.
Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. In nondiabetic individuals, reducing saturated and trans fatty acids and cholesterol intakes decreases plasma total and LDL cholesterol. Reducing saturated fatty acids may also reduce HDL cholesterol.
Studies in individuals with diabetes demonstrating the effects of specific percentages of dietary saturated and trans fatty acids and specific amounts of dietary cholesterol on plasma lipids are not available. Therefore, because of a lack of specific information, it is recommended that the dietary goals for individuals with diabetes be the same as for individuals with preexisting CVD, since the two groups appear to have equivalent cardiovascular risk.
In metabolic studies in which energy intake and weight are held constant, diets low in saturated fatty acids and high in either carbohydrate or cis -monounsaturated fatty acids lowered plasma LDL cholesterol equivalently 1 , However, high—monounsaturated fat diets have not been shown to improve fasting plasma glucose or A1C values.
In other studies, when energy intake was reduced, the adverse effects of high-carbohydrate diets were not observed 53 , Individual variability in response to high-carbohydrate diets suggests that the plasma triglyceride response to dietary modification should be monitored carefully, particularly in the absence of weight loss. Diets high in polyunsaturated fatty acids appear to have effects similar to monounsaturated fatty acids on plasma lipid concentrations 55 , 56 — Very-long-chain n-3 polyunsaturated fatty acid supplements have been shown to lower plasma triglyceride levels in individuals with type 2 diabetes who are hypertriglyceridemic.
Although the accompanying small rise in plasma LDL cholesterol is of concern, an increase in HDL cholesterol may offset this concern Glucose metabolism is not likely to be adversely affected.
Very-long-chain n-3 polyunsaturated fatty acid studies in individuals with diabetes have primarily used fish oil supplements. In addition to providing n-3 fatty acids, fish frequently displace high—saturated fat—containing foods from the diet Two or more servings of fish per week with the exception of commercially fried fish filets 63 , 64 can be recommended.
Plant sterol and stanol esters block the intestinal absorption of dietary and biliary cholesterol. A wide range of foods and beverages are now available that contain plant sterols. If these products are used, they should displace, rather than be added to, the diet to avoid weight gain. Soft gel capsules containing plant sterols are also available. In individuals with type 2 diabetes, ingested protein can increase insulin response without increasing plasma glucose concentrations. Therefore, protein should not be used to treat acute or prevent nighttime hypoglycemia.
High-protein diets are not recommended as a method for weight loss at this time. Although such diets may produce short-term weight loss and improved glycemia, it has not been established that these benefits are maintained long term, and long-term effects on kidney function for persons with diabetes are unknown. The RDA is 0. Good-quality protein sources are defined as having high PDCAAS protein digestibility—corrected amino acid scoring pattern scores and provide all nine indispensable amino acids.
Examples are meat, poultry, fish, eggs, milk, cheese, and soy. In meal planning, protein intake should be greater than 0. A number of studies in healthy individuals and in individuals with type 2 diabetes have demonstrated that glucose produced from ingested protein does not increase plasma glucose concentration but does produce increases in serum insulin responses 1 , Abnormalities in protein metabolism may be caused by insulin deficiency and insulin resistance; however, these are usually corrected with good blood glucose control However, the effects of high-protein diets on long-term regulation of energy intake, satiety, weight, and the ability of individuals to follow such diets long term have not been adequately studied.
Dietary protein and its relationships to hypoglycemia and nephropathy are addressed in later sections. Although numerous studies have attempted to identify the optimal mix of macronutrients for the diabetic diet, it is unlikely that one such combination of macronutrients exists. The best mix of carbohydrate, protein, and fat appears to vary depending on individual circumstances. For those individuals seeking guidance as to macronutrient distribution in healthy adults, the Dietary Reference Intakes DRIs may be helpful It must be clearly recognized that regardless of the macronutrient mix, total caloric intake must be appropriate to weight management goals.
Further, individualization of the macronutrient composition will depend on the metabolic status of the patient e. If adults with diabetes choose to use alcohol, daily intake should be limited to a moderate amount one drink per day or less for women and two drinks per day or less for men.
To reduce risk of nocturnal hypoglycemia in individuals using insulin or insulin secretagogues, alcohol should be consumed with food. In individuals with diabetes, moderate alcohol consumption when ingested alone has no acute effect on glucose and insulin concentrations but carbohydrate coingested with alcohol as in a mixed drink may raise blood glucose.
Abstention from alcohol should be advised for people with a history of alcohol abuse or dependence, women during pregnancy, and people with medical problems such as liver disease, pancreatitis, advanced neuropathy, or severe hypertriglyceridemia. If individuals choose to use alcohol, intake should be limited to a moderate amount less than one drink per day for adult women and less than two drinks per day for adult men. One alcohol containing beverage is defined as 12 oz beer, 5 oz wine, or 1.
Moderate amounts of alcohol, when ingested with food, have minimal acute effects on plasma glucose and serum insulin concentrations However, carbohydrate coingested with alcohol may raise blood glucose. For individuals using insulin or insulin secretagogues, alcohol should be consumed with food to avoid hypoglycemia. Evening consumption of alcohol may increase the risk of nocturnal and fasting hypoglycemia, particularly in individuals with type 1 diabetes Occasional use of alcoholic beverages should be considered an addition to the regular meal plan, and no food should be omitted.
Excessive amounts of alcohol three or more drinks per day , on a consistent basis, contributes to hyperglycemia In individuals with diabetes, light to moderate alcohol intake one to two drinks per day; 15—30 g alcohol is associated with a decreased risk of CVD The type of alcohol-containing beverage consumed does not appear to make a difference.
There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes compared with the general population who do not have underlying deficiencies. Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety. Benefit from chromium supplementation in individuals with diabetes or obesity has not been clearly demonstrated and therefore can not be recommended.
Uncontrolled diabetes is often associated with micronutrient deficiencies Individuals with diabetes should be aware of the importance of acquiring daily vitamin and mineral requirements from natural food sources and a balanced diet.
Health care providers should focus on nutrition counseling rather than micronutrient supplementation in order to reach metabolic control of their patients. Research including long-term trials is needed to assess the safety and potentially beneficial role of chromium, magnesium, and antioxidant supplements and other complementary therapies in the management of type 2 diabetes 71a , 71b.
In select groups such as the elderly, pregnant or lactating women, strict vegetarians, or those on calorie-restricted diets, a multivitamin supplement may be needed 1. Since diabetes may be a state of increased oxidative stress, there has been interest in antioxidant therapy. Unfortunately, there are no studies examining the effects of dietary intervention on circulating levels of antioxidants and inflammatory biomarkers in diabetic volunteers. The few small clinical studies involving diabetes and functional foods thought to have high antioxidant potential e.
Clinical trial data not only indicate the lack of benefit with respect to glycemic control and progression of complications but also provide evidence of the potential harm of vitamin E, carotene, and other antioxidant supplements 1 , 72 , In addition, available data do not support the use of antioxidant supplements for CVD risk reduction Chromium, potassium, magnesium, and possibly zinc deficiency may aggravate carbohydrate intolerance.
Serum levels can readily detect the need for potassium or magnesium replacement, but detecting deficiency of zinc or chromium is more difficult In the late s, two randomized placebo-controlled studies in China found that chromium supplementation had beneficial effects on glycemia 76 — 78 , but the chromium status of the study populations was not evaluated either at baseline or following supplementation. Data from recent small studies indicate that chromium supplementation may have a role in the management of glucose intolerance, gestational diabetes mellitus GDM , and corticosteroid-induced diabetes 76 — However, other well-designed studies have failed to demonstrate any significant benefit of chromium supplementation in individuals with impaired glucose intolerance or type 2 diabetes 79 , Similarly, a meta-analysis of randomized controlled trials failed to demonstrate any benefit of chromium picolinate supplementation in reducing body weight The FDA concluded that although a small study suggested that chromium picolinate may reduce insulin resistance, the existence of such a relationship between chromium picolinate and either insulin resistance or type 2 diabetes was uncertain http: There is insufficient evidence to demonstrate efficacy of individual herbs and supplements in diabetes management In addition, commercially available products are not standardized and vary in the content of active ingredients.
Herbal preparations also have the potential to interact with other medications Therefore, it is important that health care providers be aware when patients with diabetes are using these products and look for unusual side effects and herb-drug or herb-herb interactions.