# Glucose Control - **Berberine**: Typical dosing is 500 mg two to three times daily. Expected A1c reduction is 0.9–1.0% over 3–6 months, with improvement in insulin resistance. Monitor for gastrointestinal side effects and potential drug interactions. - **Psyllium**: Recommended dose is 5–10 g before meals. Expected A1c reduction is 0.97%, with improvement in fasting glucose. Advise patients to take psyllium at least 1–2 hours apart from oral medications to avoid reduced drug absorption. - **Zinc**: Typical dosing is 15–50 mg daily (20 mg in trials). Expected A1c reduction is 0.55%, with improvement in fasting glucose and insulin resistance. Monitor for copper deficiency and gastrointestinal symptoms at higher doses. - **Chromium**: Typical dosing is 200–400 mcg in trials. Expected A1c reduction is 0.54%, with improvement in fasting glucose and insulin resistance. Monitor for rare renal or hepatic toxicity at high doses. - **High-dose vitamin D**: Dosing in trials ranges from 2000-4000 IU/day. In high-risk prediabetes, vitamin D increases regression to normoglycemia by 30–48%, but effect on A1c is modest (−0.17%). | Supplement | Typical Dose | Expected A1c Reduction | Additional Benefits | Key Safety/Monitoring | | ------------------- | -------------------------------- | ------------------------ | ------------------------------------------------------------------------ | ------------------------------------------------------------------------------- | | Berberine | 500 mg two to three times daily | 0.9–1.0% over 3–6 months | Improvement in insulin resistance | Gastrointestinal side effects; potential drug interactions | | Psyllium | 5–10 g before meals | 0.97% | Improvement in fasting glucose | Take at least 1–2 hours apart from oral medications to avoid reduced absorption | | Zinc | 15–50 mg daily (20 mg in trials) | 0.55% | Improvement in fasting glucose and insulin resistance | Copper deficiency; gastrointestinal symptoms at higher doses | | Chromium | 200–400 mcg in trials | 0.54% | Improvement in fasting glucose and insulin resistance | Rare renal or hepatic toxicity at high doses | | High-dose vitamin D | 2000–4000 IU/day in trials | Modest (−0.17%) | Increases regression to normoglycemia by 30–48% in high-risk prediabetes | Calcium abnormality, Kidney Stones (generally monitor vitamin D levels) | # Cholesterol Control - **Plant Sterols and Stanols:** Recommended dose is 2 g daily. Expected LDL-C reduction is 8–10% (11–12 mg/dL) over 4–8 weeks, with modest TG reduction of 2–3% (3–4 mg/dL) and minimal effect on HDL-C. Monitor for rare GI side effects; avoid in sitosterolemia. Prefer third-party certified products. - **Viscous Soluble Fiber (Psyllium, Oat Beta-Glucan):** Recommended dose is 5–10 g daily (e.g., 7–10 g psyllium or 3–5 g oat beta-glucan). Expected LDL-C reduction is 5–10% (5–10 mg/dL) over 4–8 weeks, with no significant effect on HDL-C or TG. Monitor for GI side effects like bloating; separate from oral medications by at least 2 hours. Prefer USP-verified products. - **Red Yeast Rice:** Standardized dose providing 5–10 mg monacolin K daily. Expected LDL-C reduction is 15–25% (20–40 mg/dL) over 4–8 weeks, with TG reduction of 5–10% and minimal effect on HDL-C. Monitor for rare myopathy or hepatotoxicity, monitor liver enzymes and creatine kinase in high-risk patients. Use only tested products for monacolin K content and citrinin absence. - **Omega-3 Fatty Acids (Fish Oil):** Recommended dose is 2–4 g combined EPA/DHA daily. Expected TG reduction is 20–50% over 4–8 weeks, with mild HDL-C increase (about 5%) and neutral or slight increase in LDL-C. Monitor for GI side effects, bleeding risk in patients on anticoagulants, and potential atrial fibrillation; periodic checks of TG, liver enzymes, and coagulation in at-risk patients. Use certified products to ensure potency. - **Berberine:** Typical dosing is 500 mg two to three times daily. Expected LDL-C reduction is 10–20%, with modest TG reduction and slight HDL-C increase. Monitor for GI side effects and drug interactions (cytochrome P450 inhibition). - **Garlic:** Typical dosing is 600–1200 mg daily (aged garlic extract). Expected LDL-C reduction is 5–10%, with TG reduction of 5–6 mg/dL and HDL-C increase of 2 mg/dL. Monitor for GI upset and antiplatelet effects; caution with anticoagulants or bleeding risk. | Supplement/Class | Typical Dose | Expected LDL-C Effect | Expected TG Effect | Key Safety/Monitoring | | --------------------- | ------------------- | --------------------- | ------------------ | -------------------------------------------- | | Plant sterols/stanols | 2 g/day | ↓ 8–10% | Neutral/slight ↓ | GI upset (rare); avoid in sitosterolemia | | Viscous soluble fiber | 5–10 g/day | ↓ ~10% | Neutral/slight ↓ | GI side effects; separate from meds by 2 hrs | | Red yeast rice | 5–10 mg monacolin K | ↓ 15–25% | ↓ (modest) | Myopathy, hepatotoxicity; monitor LFTs/CK | | Omega-3 fatty acids | 2–4 g EPA/DHA/day | Neutral/minimal | ↓ 20–50% | GI, bleeding risk; monitor in at-risk pts | | Berberine | 500 mg 2–3x/day | ↓ 10–20% | ↓ (modest) | GI side effects, CYP450 interactions | | Garlic | 600–1200 mg/day | ↓ 5–10% | ↓ 5–6 mg/dL | GI upset, antiplatelet effect |