Treatment for My Diabetes in the Market?

Treatment for My Diabetes in the Market?

By Martine David , MD

If you have diabetes you’ve probably been told that you need to watch what you eat. But are there foods or supplements that can actually treat your diabetes? Available reviews and reports suggest there are over 400 foods, minerals and nutrients that are supposed to help, but is that suggestion an “old wives’ tales” or the real deal? Here we look at cinnamon, fenugreek, bitter melon (gourds), alpha lipoic [lī-|pō-ik] acid and gymnema to examine the question, “do they really work?”

What are supplements?

Supplements are available in many forms, such as minerals, vitamins and herbs. Supplements do not need to be approved by the Food and Drug Administration (FDA), in contrast to prescription drugs, which do need FDA approval. But as a result of the Dietary Supplement Health and Education Act of 1994 (DSHEA), concerns about supplement safety were addressed. DSHEA rules and regulations define what is a dietary supplement, place the responsibility for ensuring their safety on manufacturers, identify how literature may be used in connection with sales, specify types of statements of nutritional support that may be made on labels, specify certain label requirements, and provide for the establishment of regulations for good manufacturing practices. However, the specific contents of a supplement are not regulated, so there can be a wide variation in potency of active ingredients, and there can be contaminants. Because supplements are an essentially unregulated industry, careful consideration should be given before undertaking treatment, especially for diabetes, which requires a commitment to long-term therapy.

If it’s natural that means it’s good for me, right?

Just because something is natural does not necessarily mean that it is automatically good for you, nor that it is safe to be consumed at high doses. There are no long-term studies with any of the mentioned supplements. They frequently do have an effect on the body’s metabolism, but because they have not been thoroughly studied, precise effects and knowledge of interactions with other medications is often very limited.

Cinnamon

Cinnamon is a spice that is derived from the inner bark of the cinnamonomum plants and is rich in polyphenolics [pä-lē-|fē-|nōl-iks], natural antioxidants found in plants that may have health benefits for humans. Cinnamon and its effect on diabetes is the most widely studied of the supplements that can affect diabetes blood sugar (glucose) control. Cinnamon’s effects in patients with type 1 and 2 diabetes, as well as on the blood sugar in people without diabetes, has been studied. It is thought to work by reducing insulin resistance: some mechanisms suggested include improved insulin action, increased starch production and better glucose uptake into cells, and it may work by activating other chemical processes in the body that help cells use glucose.

People with type 1 diabetes – the diabetes where antibodies form against the insulin-producing cells of the body – do not show any improvements in blood sugar control, while there is blood sugar-lowering effect in both those with type 2 diabetes (the diabetes that is most common) and healthy volunteers. The dosages studied have been between 0.5g to 6g daily -- hugely different! But the effect on blood sugar is disappointingly little.

Cinnamon can cause thinning of the blood, so if you are taking aspirin, blood-thinning drug warfarin or other blood thinners, watch out—these can all add to more thinning effects than could be safe. There have not been any long-term studies regarding the impact of cinnamon in those with diabetes: the longest was 16 weeks. There is also no safety data available for taking cinnamon beyond a 16-week period.

Fenugreek

Fenugreek seeds are used extensively in Indian and Asian cooking. You can easily find fenugreek on your grocery store spice shelf. Some of the components of fenugreek seeds are thought to work by increasing natural insulin production, slowing the absorption of carbohydrates from the stomach. It has been studied in both those with type 1 and 2 diabetes, with very weak blood sugar-lowering effects seen in both types of diabetes. Dosages used are 12.5 to 100 mg daily.

The most common side effects from fenugreek seeds are diarrhea and flatulence. More worryingly, fenugreek may cause uterine contractions and, thus, should not be used by pregnant women. Allergic reactions have also been described. Fenugreek potentially interacts with warfarin, so use with caution and only after discussing it with your doctor.

Bitter melon

Bitter melon or gourd is usually eaten as a vegetable or as an added bitter flavoring in Chinese and Indian cuisine. Besides the gourd form, it can come in a liquid form, as a dried powder and also as an extract. For the extract, dosages of between 100 and 200 mg three times a day have been used. The fruit and juice, but not the seeds, have been used as a treatment for high blood sugar and cholesterol in traditional Chinese medicine. But does it actually work? Most of the research is limited to animal studies. How that relates to humans is unknown. The research that exists in humans is inconclusive at best.

Potential side effects to watch out for with bitter melon include low blood sugar, headache, abnormal liver function tests and diarrhea.

Alpha lipoic acid (ALA)

ALA is a potent antioxidant and an important enzyme in many metabolic pathways in the human body, including the combining of sugar with oxygen to release energy. It is made in the liver, but also found in many foods. Spinach, broccoli and liver are all rich in ALAs. It has been studied in those with type 2 diabetes with small, if any, effect on blood sugars. Dosages used are between 600 and 1800 mg a day. It is thought to work as a free radical scavenger (something which removes toxic chemicals that result from normal metabolism) and has been used to treat diabetic neuropathy.

Side effects are usually mild and may include skin rash and stomach upset.

Gymnema

Gymnema [jim·nēì·m ] is an herb that grows in the forests of India. Its name in Hindi means “sugar destroyer” because of the reduced taste of sweet foods after chewing on the leaves of these plants. While the exact mechanism of action is not known, it is thought to work possibly by acting on the taste buds in the mouth or by reducing glucose absorption from the gut while increasing insulin secretion from the pancreas. In small studies of people with both type 1 and type 2 diabetes, reduction in blood sugar and HgbA1C (a form of red blood cell protein that is measured primarily to identify the average blood glucose concentration over time) was seen. But the studies were too small to draw an absolute conclusion from as to whether this herb significantly can treat abnormal blood sugar. Dosage used is usually 400 mg daily. Besides lowering blood sugar, no other side effects or drug interaction is known.

So what is the take-home message ?

Before starting any herbal supplements, minerals or compounds, it is very important that you discuss with your doctor the effects and potential interactions of any supplement you are considering taking. The potential to cause hypoglycemia, as well as the very real risk of the substance not working and the risk of worsening your diabetes, should be discussed so you are aware of what to look for. Also, some of these traditional remedies can and do interact with prescribed medications. Pregnant women should not use these compounds as effects on the developing fetus are not known, while the effects of poorly controlled diabetes on the fetus and mother can be devastating.

Whether the supplements that have been mentioned could actually work to treat diabetes remains to be seen. But some of the best choices that will affect your diabetes can still be made: choosing healthy options, opting for “good carbs” and watching portion sizes is always good advice and should be part of any diabetic treatment regimen. And that’s the best thing you can do for your diabetes the next time you are in the grocery store.

Martine David, MD is a second-year Fellow in Endocrinology, Diabetes and Metabolism at the Mount Sinai Hospital, New York, NY. She obtained her medical degree from the University of Cape Town. Before moving to New York, she completed internal medicine residency and Chief Residency at the Albert Einstein Medical Center, Philadelphia. She is board certified in internal medicine and a Member of the Royal College of Physicians of London (UK).