Are Vitamins and Herbal Supplements Ever Safe for Kidney Disease and Type 2 Diabetes?

From everydayhealth.com

Vitamin, mineral, and herbal supplements are tricky when you have both type 2 diabetes and chronic kidney disease (CKD). While some people with diabetes find certain supplements may support better blood glucose control and help relieve diabetes-related neuropathy pain, the use of some supplements is linked to kidney disease and may contribute to, or worsen, CKD.

These products pose a variety of risks, including harmful medication interactions, direct damage to the kidneys, and indirect kidney damage due to the toxicity that results when the kidneys aren’t able to clear waste from the body effectively. “I really cannot think of many doctor-supported reasons for supplement use in CKD and type 2 diabetes,” says Mala Sachdeva, MD, a nephrologist and professor at Hofstra University in Hempstead, New York.

In some cases, your doctor may tell you to take a specific supplement to help correct a nutritional deficiency, but most of the time, they’ll probably caution you to stay away from vitamin, mineral, and herbal supplements.

The Danger of Herbal Supplements

                                                                                                                       Everyday Health

It’s difficult to speak generally about herbal supplements, because this family of products is so vast and diverse. These pills, powders, teas, tinctures, and other products are made from natural plant ingredients, including the bark, leaves, seeds, flowers, and other parts of many different plants. Herbal supplements are not carefully regulated by the government, and can contain contaminants such as heavy metals or imprecise concentrations of active ingredients.

Herbal components that can especially be risky for people with CKD include substances that:

• Specifically interact with and harm the kidneys
• Interfere with prescription medications
• Require the kidneys to be filtered and removed from the body.

Herbal supplement labels may not make these kidney health risks clear. In fact, some supplement blends may be marketed as kidney cleanses or detoxes, but there’s typically little or no scientific evidence supporting such claims, and they may do more harm than good. Supplement blends may be especially risky because it may be difficult to verify what ingredients are present.

The use of supplements may also distract from the treatments that are scientifically proven to make a difference. Dr. Sachdeva says that prescribed medications, diet changes, regular exercise, and sustainable weight loss are the best approaches for managing diabetes, and that supplements can complicate this evidence-backed treatment journey: “Supplements can delay the proper treatment of type 2 diabetes, contributing to long-term complications like neuropathy, nephropathy, and retinopathy,” she says.

Supplements to Avoid

The following supplements may pose a particularly high risk for people with kidney disease, especially if they have kidney failure, receive dialysis treatment, or have undergone a kidney transplant:

• Aristolochia products, such as birthwort or wild ginger
• Licorice root (Glycyrrhiza glabra)
• St John’s Wort
• Yohimbe

Meanwhile, supplements that can cause adverse interactions for people with diabetes may include:

• Ginseng, which might interfere with diabetes medications
• Goldenseal, which can affect blood glucose control and lead to a slight drop in blood sugar 
• Nettle, which may interfere with diabetes medications and increase blood sugar

In addition, many herbal supplements naturally contain higher levels of potassium or phosphorus, including alfalfa, dandelion, nettle and stinging nettle, and noni. People with a later stage of kidney disease may need to limit how much of these minerals they consume.

Plenty of other products can present risks for people with type 2 diabetes and CKD as well; the National Kidney Foundation maintains a longer list of potentially hazardous herbal supplements. Always ask your doctor before trying any herbal supplement.

Every individual with type 2 diabetes and CKD has a unique level of risk when taking herbal supplements that in part depends on product quality, dosage, reason for use, duration of use, and other medications you’re taking. Ask your doctor about safe options and reputable brands before trying any herbal supplements.

Vitamin Toxicity

If you have kidney disease, taking vitamin and mineral supplements may create a risk of toxicity, because your kidneys are no longer able to filter and clear substances that are healthy in smaller concentrations.

Vitamin toxicity can occur when levels of a particular vitamin build up in the body and cause health problems. In cases of kidney disease, both water-soluble vitamins like B vitamins and vitamin C and fat-soluble vitamins like vitamins A and E can reach toxic levels.

The kidneys usually filter out water-soluble vitamins your body doesn’t use daily. But if you regularly take a B vitamin or vitamin C supplement, damaged kidneys may struggle to filter the excess. Too much vitamin C in the body can lead to kidney stones, while prolonged high B12 levels are associated with an increased risk of hip fractures and certain cancers.

Fat cells in the body store excess amounts of vitamins A and E for later use. However, most people with CKD can get enough of these vitamins in their diet and don’t need supplements. Taking more than you need could cause toxicity.

Multivitamins and similar nutrient supplements, even if they are healthy (or harmless) for most adults, are not recommended for people with kidney disease.

Nutrient Deficiencies

Sachdeva says nutrient deficiency is one legitimate reason to use supplements: “When a physician prescribes supplements, laboratory results usually guide this [decision], and the recommendation mostly involves topping up levels of certain vitamins. … A physician might prescribe vitamin D for people with low vitamin D levels, or some people might need iron or other essential vitamins if levels are low.”

Some nutrient deficiencies are common in people with CKD. Healthy kidneys maintain a delicate balance of vitamins and minerals in the body, and kidney damage can disturb this balance. Additionally, certain waste products present in CKD can prevent the body from using vitamins correctly, and if you receive dialysis, you lose some vitamins in every session. Some people with CKD also have protein, phosphorus, or potassium restrictions in their diet, which can affect their ability to get enough of the vitamins they need from food.

If you have CKD, you may be deficient in certain B vitamins, including B1, B7, B9, and B12. Other common deficiencies include vitamin C and vitamin D. If you have advanced or late-stage CKD, your body may not absorb and use vitamin D as it should. In such cases, your doctor may prescribe a special pill or an injection of activated vitamin D that you receive alongside dialysis.

Similarly, the American Diabetes Association doesn’t recommend taking any kind of supplement with type 2 diabetes unless you have a medically confirmed nutrient deficiency. Even so, it’s crucial you consult a doctor to find a safe supplement that addresses your specific deficiency. Nutrient deficiencies in people with type 2 diabetes often include iron, magnesium, vitamin B12, and vitamin D.

Ultimately, the best way to ensure you’re getting the amount of essential nutrients you need is through diet, and discussing these needs with a registered dietitian-nutritionist can help you enjoy a renal-safe diet that best supports your kidney health. “However, diet alone might not be enough to restore levels of certain vitamins in some people with deficiencies,” says Sachdeva. 

Some kidney-safe pill and liquid supplements are available, though even these should only be used if specifically recommended by your doctor, and they may require a prescription.

A healthcare professional can check your levels of various vitamins and minerals and tailor treatment to the way CKD presents for you. Only use the vitamins and at doses your doctor recommends, and don’t stop taking any vitamin without first consulting a medical professional.

The Takeaway

• The safe consumption of vitamin and herbal supplements is challenging for people with both type 2 diabetes and chronic kidney disease (CKD), as supplements can worsen CKD, interfere with medications, or lead to a dangerous build-up of nutrients.
• Herbal supplements carry a high risk for people with CKD due to lack of FDA regulation, potential contaminants, and certain substances known to provoke or aggravate kidney damage.
• While many people with type 2 diabetes and CKD have nutrient deficiencies, supplements should only be used if prescribed by a doctor following laboratory tests to address a medically confirmed deficiency.
• Nutritional supplements are not likely to be an important part of your diabetes and kidney disease treatment. Ultimately, the best approach is through your prescribed medications, a kidney-safe diet, exercise, and sustainable weight loss.
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• https://www.everydayhealth.com/diabetes/vitamins-herbal-supplements-risks/