Is Alternative Care Going to Help or Hurt My Diabetes?

By: 
Tara Kim, MD and Rodolfo J. Galindo, MD

If you’re a patient with diabetes, odds are that you’ve walked down the vitamin aisle in a pharmacy and wondered whether any natural supplement or herbal extract could help improve your sugar control. Or, perhaps a neighbor mentioned to you that his three-month glucose average (known as hemoglobin A1c , or HbA1c) improved after eating prickly pears or bitter melon. Maybe you’ve read on a blog that an Ayurvedic diet (see below) is the best diet for weight loss and diabetes. Armed with all this information, you’ve most likely feel confident taking supplements or following diets outside of your doctor-prescribed medication. If so, you’re not alone.

Up to 30 to 40 percent of patients with or without diabetes may be opting for alternative care and have yet to discuss these considerations with their doctors. As physicians, we recognize that patients have varied ethnic backgrounds, cultural preferences and opinions related to alternative care. Let’s help you sort through the information.

Defining alternative care

Alternative care is the general practice of prescribing substances to treat diseases when the U.S. Food and Drug Administration (FDA) has not approved their use because of a lack of scientific evidence. This can also be termed “unconventional,” or when used in combination with FDA-approved medicines, “complementary” therapy.

Dietary supplements are defined as a vitamin or mineral, an herb or other plant-based chemical used to supplement total dietary intake. Dietary supplements are not foods in their natural form or a meal substitute such as Ensure® or Boost®. Nutraceuticals are dietary supplements that contain a concentrated form of a substance that is presumably derived from food, but in a non-food form. For example, soy protein is a dietary supplement, but ipriflavone – a synthetic derivative of the isoflavone daidzein found in soy protein – is a nutraceutical. Both dietary supplements and nutraceuticals can be purchased without a prescription.

What are some botanicals or plant extracts marketed for improving diabetes and do they work?

Momordica charantia: Also known as bitter melon/lemon/orange, this is widely grown in Asia, Africa and the Caribbean. Some experimental studies in animal models have demonstrated antidiabetic effects. When consumed in raw or juice form, glucose levels can be lowered. However, when taken in capsule or oral form, glucose and A1c levels do not decrease significantly.

Trigonella foenum-graecum (fenugreek): This is used as an herb, spice or vegetable in many Indian dishes. Traditionally, fenugreek has been associated with lowering cholesterol and improving glycemic control. To date, there is lack of conclusive published evidence to support the use of fenugreek in the treatment of diabetes.

Additionally, cinnamon, green and black teas, allspice, bay leaves, nutmeg and sage are culinary agents that have been found to have insulin-sensitizing effects in rat studies, but there is no good data to support its use in patients with diabetes.

What about alpha-lipoic acid, chromium or vanadium? Will they help improve my diabetes?

Alpha-lipoic acid is a sulfur-containing compound that is believed to have antioxidant effects on neuropathy (nerve damage in the extremities) while also increasing the action of insulin in diabetes. It can be found in foods such as spinach, broccoli, yeast extract, kidney and liver. Several studies have shown that there may be beneficial, but inconsistent, effects in improving neuropathic symptoms in patients with peripheral neuropathy.

Chromium is a chemical substance that people take in an attempt to lose weight, lower cholesterol and control diabetes. Chromium may play a role in appetite suppression and making the nervous system more sensitive for insulin. A safe and adequate daily dietary intake for chromium is 50 to 200 micrograms. Studies have shown chromium to have inconsistent benefits and effectiveness and, therefore, cannot be recommended consistently, although some believe that it can be beneficial in chromium deficient diets. However, Western diets are not likely to be chromium deficient.

Vanadium is a trace element used by some individuals for management of diabetes. Vanadium can mimic insulin and prevent sugar stores in the liver from being released. Usual intake ranges from 10 to 60 micrograms daily. Food sources of vanadium include mushrooms, black pepper, grains, dill and lobster. Overall, there is lack of conclusive evidence for its use in type 2 diabetes. Adverse effects include stomach, kidney and neurologic symptoms.

Will Chinese medicines or Ayurvedic treatments work in my favor?

Traditional Chinese Medicine (TCM) has been used to treat diabetes for some time. A few examples of herbal medicines in this category include ginseng, licorice, aloe vera and turmeric. TCM may have some glucose-lowering effects that are partly due to its anti-inflammatory mechanisms, but further studies are still required.

Ayurveda means “science of life” and considers physical, spiritual, mental and social aspects of life. Ancient Indian physicians treated diabetes with an Ayurvedic approach, which includes herbal preparations (turmeric, bitter gourd, fenugreek, cinnamon, etc.), yoga and breathing exercises. Thus far, studies have not shown that whole-system Ayurvedic treatment decreases fasting blood sugars and HbA1c, though some herbal mixtures may have glucose-lowering effects.

Some adverse effects include metal contamination with lead, gastrointestinal side effects and hypersensitivity reactions.

Some words of caution

Dietary supplements and nutraceuticals may be used only if the proven benefit exceeds the risks. Patients must be alert to the possibility of fraudulent products. If you see a product utilizing words such as “detoxify,” “purify,” or “energize” on its label, caution is in order as these products may do more harm than good. And if a product claims to be a “secret,” “miracle” or “cure” for any disease, beware.

If alternative medicine is appealing to you based on testimonial data, it is strongly recommended you consider the risk involved with such agents and potential harmful interactions with your current medications by discussing it with your doctor. The best approach you can take in managing diabetes is to work with your doctor and registered dietician to come up with a plan that is safe and effective for your individual circumstance. After all, there is no doubt that a healthy diet and lifestyle – instead of adding “supplements” – is optimal to maintaining good health.

Here are some good resources for information:

University of Maryland Medical School http://umm.edu/health/medical/altmed

National Institutes of Health: NIH: https://nccih.nih.gov/

EmPower Your Health: http://empoweryourhealth.org/magazine/vol5_issue2/treatment_for_my_diabe...