January 30, 2008

Alternative and Natural Treatments for Diabetes

One of the questions I'm asked most frequently by people who email me is "Aren't there any natural treatments I can use to normalize my diabetes?"

By "natural" people mean the herbs and supplements that are sold with the marketing message that the substances they contain are safer and more effective than pharmaceutical drugs.

The short answer is NO.

Very few supplements sold to help people with diabetes do anything at all but help you lose weight in your wallet. Many of them are just vitamin and mineral blends. You can read in more depth how flimsy is the data suggesting that any minerals really help with diabetes on my web page Bad and Questionable Supplements.

Many of the other supplements sold specifically for diabetes contain cinnamon, which has also been discredited as a blood sugar treatment now that we have some research that was not performed by a team of researchers headed by someone with a financial interest in cinnamon.

Occasionally you will hear on a forum or discussion group about a supplement that someone with diabetes reports has a dramatic effect on their blood sugar. Unfortunately, all too often the supplement works because it is chemically very similar to a pharmaceutical and that means--and this is extremely important--it has the same side effects as the pharmaceutical.

For example, some Chinese herbs used for controlling blood sugar turn out to be chemically very similar to sulfonylurea drugs. Bitter melon and ginseng fall into this category.

Application of modified in vitro screening procedure for identifying herbals possessing sulfonylurea-like activity. Y. Rotshteyn and S. W. Zito.

No one questions that sulfonylurea drugs work to lower blood sugar. The big problem with them, particularly the ones more like the herbs in function, is that the same chemical action that causes beta cells to pump out insulin also stimulates heart muscle in a way that increases heart attack. There is some concern that the continual stimulation of the beta cell by sulfonylureas may cause them to die over time. If your herb is stimulating insulin secretion by using the pathway sulfonylureas use, it is subject to these identical concerns.

Red rice yeast lowers cholesterol the same way as statins, because it contains natural statins, which mean when you take them you have the same risk of muscle damage and cognitive decline.

This is troubling enough, but then you run into the single biggest problem with herbs and supplements: Because they are completely unregulated, you have no idea what might be in the capsule you paid for.

When supplements are taken to the lab and analyzed they often turn out not to contain what they are supposed to contain. Even worse, they may contain other things that you didn't bargain for, be they pesticide residues or actual pharmaceutical drugs added to make them "effective."

You can read a description of what one company was selling instead of Hoodia in capsules labeled Hoodia: HERE. Sawdust was only one of the components filling the expensive capsule. Another article explains how lab analysis found that 11 out of 17 bottles of Hoodia contained NO Hoodia at all. Read it HERE.

In contrast, quite a few Chines herbs that appeared effective turned out when analyzed in the lab to contain added pharmaceutical drugs. You can read a chilling review of the various pharmaceuticals found on analysis of various Chinese herbs HERE.

Note that the drugs adulterating these herbal preparations included glibenclamide, a powerful sulfonylurea drug. Another was prednisone, which is a powerful corticosteroid that raises blood sugar and can permanently damage beta cells.

And HERE is an academic study of pesticides found in herbal supplements analyzed in the lab in 2004 which reports that "...pesticides were found in 44 out of 87 samples of botanical dietary supplements (the majority of these being ginseng products) suspected of containing pesticides. Over 30 different types of organochlorine, organophosphorus, and organonitrogen pesticide residues were present in these samples, with pentachloroaniline, pentachlorobenzene, and quintozene being the most abundant. A majority of these products contained more than one pesticide; one such sample was found to contain as many as 12 organochlorine compounds. Concentrations of pesticide residues ranged from 0.001 (pentachloroaniline and pentachlorophenyl methyl ester) to 5.57 mg/kg (quintozene)"

It's expensive to do these analyses so most of the herbs and supplements you see in the store do not get them. But based on the testing we do see, it's likely that you have a one in two chance when you buy a supplement that it either doesn't contain what you paid for, or that it contains pesticides and other dangerous contaminants.

So much for "natural" cures.

I have repeatedly heard from users of supplements who claim that the company whose products they use is different from the sleazy weasels I warn about. Further questioning always reveals that they draw this conclusion from claims made by the company itself, usually on its web site.

In fact, it is very difficult to know whether you can trust any supplement company, no matter how well-intentioned, given the complete lack of regulation and the fact that most of them buy their raw materials from China and the third world.

The problem is often beyond the control of even the most legitimate supplement vendors because of their dependence on merchants in third world countries where corruption runs rife. For example, right now, most of the vitamins sold by U.S. companies are manufactured in China and are subject to all the problems with all Chinese products: they are manufactured using polluted water heavy in pesticides and other industrial pollutants and they may very well be adulterated as the track record of Chinese companies for selling adulterated products is very poor.

Unless every batch of raw materials is subjected to extensive and very expensive testing for every possible contaminant, there is no way any company can guarantee the purity of its supplements. The capsule that contains a supplement this month, based on independent lab testing paid for by some journalist, may not contain it next month.

At least with pharmaceutical drugs, despite well-documented company shenanigans, you can trust that you are getting what you pay for in each capsule. And if you are willing to take some time and use Google Scholar you can find out what research studies have found about their effects.

My guess is that one reason for the huge success of "natural" herbs and supplements is that they stimulate the placebo effect, which is very real. People who believe something will make them better often get better--especially if what is wrong with them is something vague that isn't a real illness. But diabetes is a real illness and placebos do NOT lower diabetic blood sugars in any meaningful way.

The only way to lower blood sugar is to either a) cut way back on the carbohydrates in your food, those sugars and starches that metabolize into high blood sugars or b) use drugs that either supplement the insulin you lack, stimulate the production of more insulin by your body, or make the insulin circulating in your body more effective.

Cutting back on the carbohydrates requires no pills. Stop eating carbs and I guarantee you you will see your blood sugars drop. If they don't drop enough, it's time to research effective and safe diabetes drugs. I've done some of the work for you in various article published on the Drugs and Food section of my main diabetes site, recently renamed Blood Sugar 101.

A big part of figuring out which diet or drug might be best for you is figuring out the specific nature of your own diabetes. If you are insulin deficient, you'll need different drugs and dietary approaches from someone who is very insulin resistant but still produces a lot of insulin. That's something we'll discuss further.

But for now, resist the temptation to reach for the magic pills, no matter how beautifully packaged and how upscale the merchant selling them. If you have diabetes you don't need a placebo, you don't need mysterious and questionable substances, you need to cut back on the carbs that raise your blood sugar and if diet doesn't get the job done, you need to figure out what's wrong with you and which well-understood drug might be safe and helpful for you.


Anonymous said...

As a formulator of ethical natural products (and I'm not the only one, although we could meet in one room) I agree and I disagree.

There are a limited number of "natural" products that have demonstrable effects on blood sugars in limited circumstances. Typically if sugars are in the 10 mM range, cinnamon, for instance, will have a beneficial effect.

The benefits of natural products for people who are able to control sugars with medication are limited, but in some cases measurable.

And, of course, if a natural product maker has an herb that works as well as metformin (which, was by the way, a refinement of goat's rue extract), the issue then is, do your customers measure their blood sugars? If they don't (and one company considered packaging its herbal cure with a glucometer), then what about hypoglycemia?

Formulating a product that does any good is very difficult--and keeping the formuation intact when it goes over to Marketing is even more difficult.

So, Jenny, I'd disagree. There are natural products that are of benefit to diabetics who don't have access to medication. And even the venerable Dr. Bernstein has some commendation for alpha-lipoic acid and EPO. It's just that they're plain and simple, never a miracle, and never a blend.

Oh, one word on those 400-ingredient natural products before I sign off here. The reason they have so many ingredients has nothing to do with their effect. It's to avoid charges of patent infringement. Yes, formulators do know whether the "fillers" interact with the main ingredients and common pharmaceuticals, but by the time you get past the marketers and the lawyers, it's hard to keep the formulation simple enough to do any good.

I greatly enjoy your blog.

Jenny said...

Anonymous' posting makes me think they haven't read my blog or web site.

If they had they'd know that I consider a blood sugar of 10 mmol/L to be a near-emergency requiring immediate intervention. The tiny lowering effect of cinnamon--which has NOT been reported by anyone I would trust who has tried it--would merely delay taking the actions needed.

But if you read postings from people with diabetes who have tried cinnamon you will see them repeated over and over that it didn't do anything worthwhile.

Moreover, the expensive cinnamon pills and extracts are no more effective than the cheap stuff you buy at the supermarket. There is a lot of dishonest supplement advertising that suggests that this is not true but the original studies done to prove that cinnamon had an effect were done with the cassia form of cinnamon they sell in every grocery store.

If someone wants to test cinnamon, they can take a teaspoon of the regular stuff with each meal for a few days. But they should be sure to test their blood sugar at 1/2 hour because when I did this I saw a dramatic high that was much higher than anything I'd observed for many months. Yes, I was a bit lower later, but only as a reactive low. That earlier high would make it a very bad idea.

Finally, metformin DOES NOT CAUSE HYPOS. The only oral drugs that do are the sulfonylurea drugs.

If an herb is capable of causing hypos it is probably using the mechanism of a sulfonylurea and Dr. Bernstein specifically warns against them.

I have a page where I list the few supplements that people have found to possibly be helpful and I include ALA. But despite Dr. Bernstein's enthusiasm for ALA, it's blood sugar lowering properties only seem to work for people who are, like him, highly insulin sensitive Type 1s. NOT type 2s who are insulin resistant.

ALA may have properties that help neuropathy, which I discuss on my page about supplements that are not utter garbage. But given how expensive ALA is, and how few people report significant results with it, it is rarely worth bothering with unless lowering blood sugars below 140 mg/dl at all times does not reverse neuropathic pain. For many people it will.

Anonymous said...

Just so you'll understand, I don't have to search the internet to know the effects various herbs have on diabetics in clinical settings. I've helped run some of the trials. And Cinnamomum cassia is not the cinnamon sold in every supermarket's spice shelf. Cinnamomum zeylanicum is the cinnamon that's in cinnamon rolls, for instance, and, again, I was a member of the taxonomic board that makes those distinctions. That being said, the cinnamon in the form that works is still cheap. There's no reason to pay more than 10 cents a dose, and the higher priced supplements actually are junk, because they are made with the cinnamon sold in the supermarket. It's as their manufacturers didn't understand the literature, as you yourself do not.

If you have nothing else, cinnamon is a godsend. I'm happy you, at least, live in a privileged world where diabetics can afford to keep their sugars below 10 mM.

Red Sphynx said...

Good post, and a very good followup post. Thanks.

Just to be a smart-aleck, let me tweak your statement that the substances which lower blood sugar either (1) supplement the insulin you lack, (2) stimulate the production of more insulin by your body, or (3) make the insulin circulating in your body more effective.

Let me list some more:

(4) mimic insulin (e.g. vanadium sulfate)

(5) increase the non-insulin-mediated glucose disposal by muscles (e.g. PUFA)

(6) decrease the rate at which the body disposes of insulin (no examples with insulin, but true of many other hormones, e.g. Januvia's effect on incretins)

(7) downregulate glucogenesis, glycogenesis or gluconeogenesis – different ways that the body puts sugar into the blood stream other than the direct effect of digesting carbs, (e.g. anything that damps the counterregulatory hormones.)

(8) block the digestion of carbs (e.g. Precose and other Α-glucosidase inhibitors)

Adam Becker Sr

Jenny said...

Anonymous, since you are posting anonymously there is no way to evaluate your claims.

Anderson's studies were done with the kind of cinnamon you buy at the supermarket. He stated this himself in his work. His point was to test the cheap stuff that is available everywhere. And his studies were the only ones that found any effect. Diluted by his owning patents for cinnamon extracts.

The "lowering" of blood sugar in studies may be an artifact of when the testing is done, as was my experience. And if cinnamon causes an extremely high spike, it's subsequent lowering effect is meaningless as the spike can drive glucose into nerve tissue and eye.

It would be great if there was a cheap substance available in the third world that lowered blood sugars in a way that might impact health, but there isn't.

Some reports from people in India tell me that the fresh leaves of Fenugreek may be mildly effective--probably again because of a sulf like activity. But the same reports suggest the powdered forms don't do much, hence I don't recommend them.

Better to concentrate our efforts on growing insulin in plants--a technology which is currently in clinical trials, and which has a lot of potential to help people in the third world.

ADAM is of course right.

Anonymous said...

I wonder if anyone has an opinion on what appears to be the newest Rx for type 2 DM. I am referring to a bypass of the duodenum and first part of the jejunum. This is not bariatric surgery since it does not cause the individual to lose weight, but somehow by having nurtrients bypass the first part of the small intestine causes type 2 DM to be cured! Obviously this new surgery is in its early stages without lengthy follow up but it is provocative.

Jenny said...

Surgical treatment does not CURE diabetes. It restores normal blood sugars. Most Type 2s can do the same thing by cutting down carbs to 20-30 grams a day. Some do.

The surgery makes it impossible to eat enough carbs to raise blood sugar. In addition, the bypass appears to affect incretin hormones in a way similar to drugs like Byetta.

Unfortunately, the surgery that is being so heavily promoted also has a kill rate of around 3%. That means 3 out of every 100 people who have it die.

And even worse, many people who have the sugery end up regaining the weight. Others end up with malapsorption syndromes.

Surgeons declare a surgery a "success" based on how the patient is within a 6 week period. The follow up for Weight Loss Surgery reveals a lot of problems that don't get a lot of play in the press.

There are people for whom WLS surgery works, but it should only be considered as a last resort after low carb dieting and perhaps Byetta have been given a good try.

Anonymous said...

Thank you for your comments on surgery for type 2 DM. However, I think you are confusing bariatric surgery with surgery in patients who are not obese but nevertheless have type 2. A duodenal-proximal jejunal bypass without surgery on the stomach is not a weight loss operation. However, in experiments on diabetic rats and in a few humans in which it has been tried it has "reversed" type 2 DM. Please look at Surgery for Obesity and Related Diseases 3 (2007) 195–197. There presently a protocol at a small community hospital in Westchester, NY doing such a study. This surgery is quite safe. Of course the main issue is what will the long term follow up be?

Jenny said...

The stomach surgery that has been in the news this past week with claims that it "cures" diabetes is obesity surgery and it "works" by severely limiting the amount of food a person can eat and possibly changing the way incretin hormones are secreted.

The surgery you are discussing sounds like it would affect the incretin hormones, too. Altering the digestive tract won't restore secretion from dead or dysfunctional beta cells--the main reason for diabetes in people of normal weight with Type 2.

It is more likely that this operation also limits the amount of food, especially starchy food, a person can eat. If you do a surgery that results in extreme pain and gas when a person eats a "normal" amount of carbs people stop eating them.

But there is no such thing as a "completely safe" surgery that involves opening the abdomen. In a world full of hospitals where people get MRSA and people dying from cosmetic surgeries that only involve layers of skin and glands you'd have to be deluded to think that there can be no problems with "diabetes" surgery.

We know that cutting carbs back severely will give most people with some functioning beta cells normal blood sugars.

It disgusts me that the same medical establishment which after decades of proof that low carb diets can provide normal blood sugars for people with diabetes STILL dithers around saying, "We need further studies because low carb diets might not be safe after twenty years" gets excited about radical surgical solutions that have no track record at all, though current gastric surgery solutions for diabetes have terrible, often fatal outcomes.

Could it have something to do with the fact that such a surgery would earn $20,000 a pop for surgeons and hospitals while low carb dieting makes money for no one?

Anonymous said...

Thanks again for your comments. A few further remarks- you are right the latest news regarding surgery for DM refers to bariatric surgery which does mean a surgical procedure which among other things causes restriction of food intake. I am not referring to such a procedure. The idea of the jejunal duodenal bypass would be for those who have had type 2 Dm for less than 5 years and do have C peptide indicating they still have functioning beta cells. In studies done on diabetic rats as well as the few human studies done there is no evidence that food intake is limited or that there is severe gas etc. causing limiting carb intake. Regarding no operations being completely safe, of course this is so but also no meds are completely safe-witness Rezulin,etc. Even insulin is not completely safe since hypoglycemia is possible even in a compulsive diabetic. What we should look at is relative risk. Finally I would avoid terms such "medical establishment". Of course hospitals would like to increase their revenues by doing operation on type 2 DM's etc. Similarly surgeons are always looking for other operations to do. Similar comments can be made about pharmaceutical companies the manufactures of test strips,meters, etc. I agree that skepticism is warrented but I would not dismiss this out of hand by implying the motives of surgeons/hospitals are not pure-that is a given.

Anna said...

Hmmm, I'm in a normal weight range, a "normal" diet raises my BG levels into the 200s (often with reactive lows in the 60s or 70s later), a carb restricted diet normalizes my BG into a fairly tight range of not too high and not too low (85-115), and I don't take medications yet. My beta cells are still working but I don't seem to have a good first phase response so there obviously is some beta cell impairment.

So why would I opt for a bypass operation? Just so I could eat some bread and pizza?

Jenny said...


jpatti said...

I think a whole heck of a lot of this sort of thing can be addressed by diet. I mean, cinnamon is a *food* - just eat some and see if it helps. Cocoa is a *food* - who needs to "force" themselves to eat chocolate to up their antioxidants?!? CLA supplements are wicked expensive - pasture-raised beef is cheap by comparison, not to mention that eating a steak is more pleasant than swallowing a pill. Reseveratol capsules or a glass of wine? Querctin pills or some buttered shallots? Apple cider vinegar pills or a nice salad dressing?

I mean, some of this stuff is just silly that people buy pills at all - just eat the food and see if it makes a difference.

Most nutrient issues can be handled by getting the majority of your carbs from a wide variety of fresh vegetables and by choosing proteins that have the healthiest fatty acid profiles. That is simple enough - eat good food instead of swallowing pills.

Nevertheless, I don't agree with your post overall. There are reputable companies, companies that have their products tested by third parties, companies that follow GMP practices even though they don't legally have to. Buying from reputable companies makes a lot of difference.

And there are things worth supplementing, IMO. I've seen a lot of diabetics say that ALA improved their IR. I've seen a lot of folks with arthritis claim that chondroitin & glucosamine have helped them. Between research and anecdotal reports, I'm inclined to buy these.

Personally, I take fish oil and vitamin D3 because I have heart disease and I can't eat enough of the foods I would need to get the doses of these that I want. I take 6g of fish oil and 2000 IU of vitamin D3 daily (the vitamin D3 level is appropriate for me based on blood work).

Since heart disease risk is high in diabetics, I tend to recommend these supplements to everyone with bg issues, though I usually recommend more like 4g fish oil and 1000 IU of D3.

I also take a general multivitamin/multi-mineral (without iron) pill daily as generic health insurance that is dead cheap.

I take 2000mg/day of SloNiacin, cause the prescription form costs about ten times as much. Niacin seems preferable to me to statins because it not only lowers LDL, but raises HDL.

I also take a generic tums-like product for calcium because I lost a height of inch sometime in the last couple years. (I would not recommend anyone take calcium unless they *also* take vitamin D3 though - extra calcium floating around in your blood seems to increase the risk of heart disease, you need the D3 to put the calcium where it needs to be).

There's a few other supplements I think are useful - milk thistle, CoEnzymeQ10, extra B vitamins. Depends on what is wrong if anyone needs these or not.

Red yeast rice isn't one of the useful ones. The effective stuff contains a statin, and it's actually illegal to sell in the US. So the stuff you see sold in the store is worthless crap. Besides which, I don't like statins anyways - it's not got to do with whether the stuff is "natural" or not, it has to do with their mode of action. Statins work by interfering with the liver's production of cholesterol, and hence with the body's natural steroid synthesis process. That's bad stuff whether it's "natural" or not via Merck.

Jenny said...

There may be ethical supplement companies out there somewhere, but the general public has NO way of knowing who they are.

All the companies claim to be ethical including the ones whose products turn out to contain crap.

ALA and benfotiamine look to me like they might be of some use. I am still taking Vitamin D though I have seen some research that suggests that the current hype about it ignores some problems it causes.

Otherwise, I agree that it makes much more sense to eat high quality locally grown foods as much as possible.

Linda said...

Similar to an earlier reference I'd made on another post, there's an excellent (and impartial!) reference resource to natural products that can help with diabetes over at the Dietary Supplement Information Bureau.