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Question: From Glencoe, Illinois, USA:
In light of the growing evidence that antioxidants may inhibit the formation of advanced glycosylation endproducts, our eight year-old daughter who has ben diagnosed with Type 1 for a little over one year has been taking 100 IU's of vitamin E and 250 mg of vitamin C per day. Some recent articles have suggested substantially higher levels for adults. What would be prudent for a child of her age? Are there any other vitamins you would recommend? How about the multivitamins advertised specifically for people with diabetes?
Answer:
The position of the American Academy of Pediatrics is that a normal healthy 8 year old in the U.S. does not need supplementary vitamins or minerals. In diabetes (and it has been mostly in adult onset or Type 2 Diabetes) claims have been made for a variety of micronutrients: chromium picolenate, Fenugreek, Ginkgo, Gymnema, Thioctic acid and shark cartilage, to mention just a few. Some of the preparations that claim to be beneficial may often contain as many as thirty ingredients. Scientific corroboration of the claims has been thin on the ground however.
Antioxidants in Type 1 Diabetes deserve more serious consideration. The argument has been that the infiltration of lymphocytes around the islets in the early stages of the autoimmune process generates 'free radicals' and it is these molecules which ultimately destroy the insulin producing cells. Antioxidants or free radical scavengers are therefore a rational therapy in the early stages of Type 1 Diabetes and they have indeed shown to be successful in the NOD mouse model. In man results have been uniformly disappointing, vitamin E has been used most and usually with nicotinamide. There has been no evidence that insulin dependance can be reduced or averted. The explanation is that the inflammatory destruction of the islets is already almost complete by the time the diabetes is clinically apparent. There is till a big trial going on in Europe however to try to find out if nicotinamide, given before the clinical onset, is of benefit, and there is some evidence from a trial in New Zealand that it is.
There has also been some evidence that Vitamin E and Ascorbic acid may be of value in preventing microvascular complications and trials of this possibility are under way.
For the reasons I have given, I would not recommend giving additional vitamins or higher doses of C and E to your daughter, nor would I presently advocate any of the current multinutrient preparations that are promoted for diabetes. The best you can possibly do to help this girl is to try the best you can to achieve meticulous control of her blood sugars, something that is easier than it was; but still requiring a lot of patience and understanding. The added vitamins are not harmful and may be of significant subjective benefit to the whole family.
Original posting 26 May 97
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Last Updated: Sun Jan 15 12:01:31 2006
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