Related Webinar: Annatto Tocotrienol: The Superior Source of Vitamin E

With over 30 million Americans living with diabetes and an additional 84 million having prediabetes, at an annual cost to the US of $320 billion (ADA, 2017), it’s time to pull out all the stops when it comes to helping people manage their blood sugar and turn the tide on this devastating metabolic illness.

Low-carb and ketogenic diets have been shown to result in substantial improvement in T2D, to the point that many patients are able to completely discontinue insulin injections and eliminate or reduce the doses of several oral diabetes medications. Reducing carbohydrate intake is a highly effective intervention for diabetes and metabolic syndrome, but even with a low carb diet, some people still need an extra leg up. Vinegar is an underappreciated helper for blood glucose management, and of course, there are old steadies, such as chromium, berberine, and alpha-lipoic acid.

But there are new compounds on the block here—or, maybe not new compounds, but new roles for an old friend: vitamin E. Specifically, the tocotrienols that make up half of the 8-member vitamin E complex (4 tocopherols and 4 tocotrienols). Lest anyone think that alpha-tocopherol is the key player in vitamin E, tocotrienols have properties that tocopherols lack, and alpha-tocopherol has even been shown to interfere with some of the positive effects of tocotrienols.

Mouse studies consistently show that delta-tocotrienol reduces adipocyte inflammation and hypertrophy, and also dose-dependently increases markers of fatty acid oxidation while reducing markers of fatty acid synthesis in adipose tissue and the liver. This suggests that supplementation with delta-tocotrienol may help ameliorate the pathology of obesity and fatty liver. Fortunately, we don’t have to hang our hats on mouse studies. Data in humans are encouraging as well.

Along with the American Heart Association’s now defunct “Step-1 diet,” 60 days of supplementation with rice bran extract, a rich source of vitamin E tocotrienols, significantly reduced HbA1c and fasting glucose in both type 1 and type 2 diabetics. Total cholesterol, apoB, and triglycerides were also reduced in both types of diabetes. In type 2 diabetics, HbA1c and fasting glucose were reduced as much as 15% and 33%, respectively, so these were not just “statistically significant” improvements, but may have real world clinical relevance.

Other findings are mixed, though. Epidemiological evidence suggests vitamin E intake is inversely associated with risk for T2D. (This study was based on food frequency questionnaires, the use of which has been called into question repeatedly, most recently in response to fervor around a study that seemed—on the surface, anyway—to suggest that low carb diets shorten lifespan.) However, a 2011 systematic review found that vitamin E supplementation, as a monotherapy, had no beneficial effects on glycemic control in T2D, and a 2014 meta-analysis found that overall, vitamin E supplementation had no significant beneficial effects on fasting glucose, fasting insulin, or HbA1c. However, subgroup analysis revealed a small improvement in HbA1c and fasting insulin among subjects with low vitamin E status at baseline. So it’s possible that in people who are already vitamin E replete, additional vitamin E doesn’t do much, but in those whose vitamin E status is suboptimal, brining levels up to sufficiency can help.

Many of these trials also likely employed the full vitamin E complex, or more probably, alpha-tocopherol and/or gamma-tocopherol as stand-ins for “vitamin E.” As noted earlier, alpha-tocopherol may interfere with some of the beneficial effects of tocotrienols, so it may be that tocotrienols, dosed independently from tocopherols, would show a more noticeable effect.

More research remains to be done, but these under-recognized roles for tocotrienols may make these compounds a valuable addition to the supplement regimens of those with metabolic syndrome or type 2 diabetes.

By Amy Berger, MS, CNS