What are natural treatments for diabetes?

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Treatment of the condition that causes blood sugar to reach toxic levels and to damage tissues and major organs.
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Introduction

Diabetes has two forms. In the type that develops early in childhood (type 1), the insulin-secreting cells of the pancreas are destroyed (probably by a viral infection) and blood levels of insulin drop nearly to zero. However, in type 2 diabetes (usually developing in adults), insulin remains plentiful, but the body does not respond normally to it. (This is only an approximate description of the difference between the two types.) In both forms of diabetes, blood sugar reaches toxic levels, causing injury to many organs and tissues.

Conventional treatment for type 1 diabetes includes insulin injections and careful dietary monitoring. Type 2 diabetes may respond to lifestyle changes alone, such as increasing exercise, losing weight, and improving diet. Various oral medications are also often effective for type 2 diabetes, although insulin injections may be necessary in some cases.

Principal Proposed Natural Treatments

Several alternative methods may be helpful when used under medical supervision as an addition to standard treatment. They may help stabilize, reduce, or eliminate medication requirements or may correct nutritional deficiencies associated with diabetes. However, because diabetes is a dangerous disease with many potential complications, alternative treatment for diabetes should not be attempted as a substitute for conventional medical care. Other natural treatments may be helpful for preventing and treating complications of diabetes, including peripheral neuropathy, cardiac autonomic neuropathy, retinopathy, and cataracts.

Treatments for improving blood sugar control. The following treatments might be able to improve blood sugar control in type 1 or type 2 diabetes, or both. However, for none of these is the evidence strong. The mere fact of joining a study tends to improve blood sugar control in people with diabetes, even before any treatment is begun. Presumably, the experience of being enrolled in a trial causes participants to watch their diet more closely. This indicates that for diabetes, as for all conditions, the use of a double-blind, placebo-controlled method is essential. Only if the proposed treatment proves more effective than placebo can it be considered to work in its own right.

For those persons in which a natural treatment for diabetes works, it is essential to reduce their medications to avoid hypoglycemia. For this reason, medical supervision is necessary.

Chromium. Chromium is an essential trace mineral that plays a significant role in sugar metabolism. Some evidence suggests that chromium supplementation may help bring blood sugar levels under control in type 2 diabetes, but it is far from definitive.

A four-month study reported in 1997 followed 180 Chinese men and women with type 2 diabetes, comparing the effects of 1,000 micrograms (mcg) chromium, 200 mcg chromium, and placebo. The results showed that HbA1c (glycated hemoglobin) values (a measure of long-term blood sugar control) improved significantly after twp months in the group receiving 1,000 mcg, and in both chromium groups after four months. Fasting glucose (a measure of short-term blood sugar control) was also lower in the group taking the higher dose of chromium.

A double-blind, placebo-controlled trial of seventy-eight people with type 2 diabetes compared two forms of chromium (brewer’s yeast and chromium chloride) with placebo. This rather complex crossover study consisted of four eight-week intervals of treatment in random order. The results in the sixty-seven participants who completed the study showed that both forms of chromium significantly improved blood sugar control. Positive results were also seen in other small, double-blind, placebo-controlled studies of people with type 2 diabetes. However, several other studies have failed to find chromium helpful for improving blood sugar control in type 2 diabetes. These contradictory findings suggest that the benefit, if it exists, is small.

A combination of chromium and biotin might be more effective. Following positive results in a small pilot trial, researchers conducted a double-blind study of 447 people with poorly controlled type 2 diabetes. One-half of the participants were given placebo and the rest were given a combination of 600 milligrams (mg) of chromium (as chromium picolinate) and 2 mg of biotin daily. All participants continued to receive standard oral medications for diabetes. During the ninety-day study period, participants who were given the chromium-biotin combination showed significantly better glucose regulation than participants who were given placebo. The relative benefit was clear in levels of fasting glucose and in levels of HgA1c (glycated hemoglobin).

One placebo-controlled study of thirty women with gestational diabetes (diabetes during pregnancy) found that supplementation with chromium (at a dosage of 4 or 8 mcg chromium picolinate for each kilogram of body weight) significantly improved blood sugar control. Chromium has also shown some promise for helping diabetes caused by corticosteroid treatment.

Ginseng. In double-blind studies performed by a single research group, the use of American ginseng (Panax quinquefolius) appeared to improve blood sugar control. In some studies, the same researchers subsequently reported possible benefit with Korean red ginseng, a specially prepared form of P. ginseng.

A different research group found benefits with ordinary P. ginseng. However, in other studies, ordinary P. ginseng seemed to worsen blood sugar control rather than improve it. (Another research group found potential benefit.) It seems possible that certain ginsenosides (found in high concentrations in some American ginseng products) may lower blood sugar, while others (found in high concentration in some P. ginseng products) may raise it. It has been suggested that because the actions of these various ginseng constituents are not well defined, ginseng should not be used to treat diabetes until more is known.

Aloe. The succulent aloe plant has been valued since prehistoric times as a topical treatment for burns, wound infections, and other skin problems. Today, evidence suggests that oral aloe might be useful for type 2 diabetes.

Evidence from two human trials suggests that aloe gel (the gel of the aloe vera plant, and not the leaf skin, which constitutes the drug aloe) can improve blood sugar control. A single-blind, placebo-controlled trial evaluated the potential benefits of aloe in either seventy-two or forty people with diabetes. (The study report appears to contradict itself). The results showed significantly greater improvements in blood sugar levels among those given aloe over the two-week treatment period.

Another single-blind, placebo-controlled trial evaluated the benefits of aloe in people who had failed to respond to the oral diabetes drug glibenclamide. Of the thirty-six people who completed the study, those taking glibenclamide and aloe showed definite improvements in blood sugar levels over forty-two days compared with those taking glibenclamide and placebo. While these are promising results, large studies that are double-blind rather than single-blind will be needed to establish aloe as an effective treatment for improving blood sugar control.

Cinnamon. Cinnamon has been widely advertised as an effective treatment for type 2 diabetes and for high cholesterol. The primary basis for this claim is a single study performed in Pakistan. In this forty-day study, sixty people with type 2 diabetes were given cinnamon at a dose of 1, 3, or 6 grams (g) daily. The results reportedly indicated that the use of cinnamon improved blood sugar levels by 18 to 29 percent, total cholesterol by 12 to 26 percent, LDL (bad) cholesterol by 7 to 27 percent, and triglycerides by 23 to 30 percent. These results were said to be statistically significant compared to the beginning of the study and to the placebo group.

However, this study has some odd features. The most important feature is that the study found no significant difference in benefit among the various doses of cinnamon. This is called lack of a “dose-related effect,” and it generally casts doubt on the results of a study.

In an attempt to replicate these results, a group of Dutch researchers performed a carefully designed six-week, double-blind, placebo-controlled study of twenty-five people with type 2 diabetes. All participants were given 1.5 g of cinnamon daily. The results failed to show any detectable effect on blood sugar, insulin sensitivity, or cholesterol profile. Furthermore, a double-blind study performed in Thailand enrolling sixty people, again using 1.5 g of cinnamon daily, also failed to find benefit. However, a double-blind study of seventy-nine people that used 3 g instead of 1.5 g daily did find that cinnamon improved blood sugar levels. In addition, a small study evaluated cinnamon for improving blood sugar control in women with polycystic ovary disease, and it too found evidence of benefit. Regarding type 1 diabetes, a study of seventy-two adolescents failed to find benefit with cinnamon taken at a dose of 1 g daily.

A meta-analysis (formal statistical review) of all published evidence concluded that cinnamon has no effect on blood sugar levels in people with diabetes. The evidence regarding cinnamon as a treatment for diabetes is highly inconsistent, suggesting that if cinnamon is indeed effective, its benefits are minimal at most.

Other treatments studied for their effect on blood sugar control. The food spice fenugreek might also help control blood sugar, but the supporting evidence is weak. In a two-month double-blind study of twenty-five people with type 2 diabetes, the use of fenugreek (1 g daily of a standardized extract) significantly improved some measures of blood sugar control and insulin response compared with placebo. Triglyceride levels decreased and HDL (good) cholesterol levels increased, presumably because of the enhanced insulin sensitivity. Similar benefits have been seen in animal studies and open human trials. However, it is possible that the effects of fenugreek come from its dietary fiber content.

A few preliminary studies suggest that the Ayurvedic (Indian) herb gymnema may help improve blood sugar control. It might be helpful for mild cases of type 2 diabetes when taken alone or with standard treatment (under a doctor’s supervision in either case).

Studies in rats with and without diabetes suggest that high doses of the mineral vanadium may have an insulin-like effect, reducing blood sugar levels. Based on these findings, preliminary studies involving humans have been conducted, with some promising results. However, of 151 studies reviewed, none was of sufficient quality to judge if vanadium is beneficial in type 2 diabetes. The researchers did find that vanadium was often associated with gastrointestinal side effects. Furthermore, there may be some cause for concern given the high doses of vanadium used in some of these studies.

The following herbs are proposed for helping to control blood sugar, but the supporting evidence regarding their potential benefit is, in all cases, at best preliminary; for some, there are as many negative results as positive: agaricus, blazei, berberine (goldenseal), black tea, caiapo, cod protein, cayenne, Coccinia indica (also known as C. cordifolia), garlic, green tea, guggul, holy basil (Ocimum sanctum), maitake, milk thistle, nopal cactus (Opuntia stredptacantha), onion, oolong tea, oligomeric proanthocyanidins, Salacia oblonga, Salvia hispanica (a grain), and salt bush. Additionally, the supplements arginine, carnitine, coenzyme Q10 (CoQ10), dehydroepiandrosterone (DHEA), glucomannan, lipoic acid, melatonin with zinc, and vitamin E might also help control blood sugar levels to a slight degree.

One placebo-controlled study found hints that the use of medium-chain triglycerides by people with type 2 diabetes might improve insulin sensitivity and aid weight loss. The herb bitter melon (Momordica charantia) is widely advertised as effective for diabetes, but the scientific basis for this claim is limited to animal studies, uncontrolled human trials, and other unreliable forms of evidence. The one properly designed (that is, double-blind, placebo-controlled) study of bitter melon failed to find benefit. Conjugated linoleic acid (CLA) has shown promise in preliminary trials. However, other studies have found that CLA might worsen blood sugar control.

One study found that insulin metabolism in 278 young, overweight persons improved on a calorie-restricted diet rich in fish oil from seafood or supplements compared with those on a diet low in fish oil. Though preliminary, the results suggest that fish oil may help delay the onset of diabetes in susceptible persons. In another study of fifty people with type 2 diabetes, 2 g per day of purified omega-3-fatty acids (fish oil) was able to significantly lower triglycerides levels. However, it had no effect on blood sugar control.

Other herbs traditionally used for diabetes that might possibly offer some benefit include Anemarrhena asphodeloides, Azadirachta indica (neem), Catharanthus roseus, Cucurbita ficifolia, Cucumis sativus, Cuminum cyminum (cumin), Euphorbia prostrata, Guaiacum coulteri, Guazuma ulmifolia, Lepechinia caulescens, Medicago sativa (alfalfa), Musa sapientum L. (banana), Phaseolus vulgaris, Psacalium peltatum, Rhizophora mangle, Spinacea oleracea, Tournefortia hirsutissima, and Turnera diffusa.

Combination herbal therapies used in Ayurvedic medicine have also shown some promise for improving blood sugar control. One study attempted to test the effectiveness of whole-person Ayurvedic treatment involving exercise, Ayurvedic diet, meditation, and Ayurvedic herbal treatment. However, minimal benefits were seen.

A double-blind study of more than two hundred people evaluated the effectiveness of a combination herbal formula used in traditional Chinese herbal medicine (Coptis formula). This study evaluated Coptis formula with and without the drug glibenclamide. The results hint that Coptis formula may enhance the effectiveness of the drug but that it is not powerful enough to treat diabetes on its own. Another randomized trial, this one lacking a control group, found no added benefit for Tai Chi in the treatment of blood glucose and cholesterol levels among fifty-three people with type 2 diabetes during a six-month period.

One study claimed to find evidence that creatine supplements can reduce levels of blood sugar. However, because dextrose (a form of sugar) was used as the “placebo” in this trial, the results are somewhat questionable. In another study, the herb Tinospora crispa did not work, and it showed the potential to cause liver injury.

One study found hints that the supplement DHEA might improve insulin sensitivity. However, a subsequent and more rigorous study failed to find benefits. Relatively weak evidence hints that genistein (an isoflavone extracted from soy) might help control blood sugar.

It has been suggested that if a child has just developed diabetes, the supplement niacinamide (a form of niacin, also called vitamin B3) might slightly prolong what is called the honeymoon period. This is the interval during which the pancreas can still make some insulin and the body’s need for insulin injections is low. However, the benefits (if any) appear to be minor. A cocktail of niacinamide plus antioxidant vitamins and minerals has also been tried, but the results were disappointing. Niacinamide has also been tried for preventing diabetes in high-risk children. According to most studies, fructo-oligosaccharides (also known as prebiotics) do not improve blood sugar control in people with type 2 diabetes.

Massage therapy has shown some promise for enhancing blood sugar control in children with diabetes. A review of nine clinical trials found insufficient evidence to support the traditional Chinese practice of qigong as beneficial for treatment of type 2 diabetes.

Treating Nutritional Deficiencies

Both diabetes and the medications used to treat it can cause people to fall short of various nutrients. Making up for these deficiencies (through either diet or the use of supplements) may or may not help with diabetes specifically, but it should make a person healthier overall. One double-blind study, for example, found that people with type 2 diabetes who took a multivitamin-multimineral supplement were less likely to develop an infectious illness than those who took placebo.

People with diabetes are often deficient in magnesium, and inconsistent evidence hints that magnesium supplementation may enhance blood sugar control. People with either type 1 or type 2 diabetes may also be deficient in the mineral zinc. Vitamin C levels have been found to be low in many people on insulin, even though these persons were consuming seemingly adequate amounts of the vitamin in their diets. Deficiencies of taurine and manganese have also been reported. The drug metformin can cause vitamin B12 deficiency. Taking extra calcium may prevent this.

Prevention

Niacinamide. Evidence from a large study conducted in New Zealand suggests that the supplement niacinamide might reduce the risk of diabetes in children at high risk. In this study, more than twenty thousand children were screened for diabetes risk by measuring certain antibodies in the blood (ICA antibodies, believed to indicate risk of developing diabetes). It turned out that 185 of these children had detectable levels. About 170 of these children were then given niacinamide for seven years (not all parents agreed to give their children niacinamide or to have them stay in the study for that long). About ten thousand other children were not screened, but they were followed to see if they developed diabetes.

The results were positive. In the group in which children were screened and given niacinamide if they were positive for ICA antibodies, the incidence of diabetes was reduced by almost 60 percent. These findings suggest that niacinamide is an effective treatment for preventing diabetes. (The study also indicates that tests for ICA antibodies can very accurately identify children at risk for diabetes.)

An even larger study that attempted to replicate these results in Europe (the European Nicotinamide Diabetes Intervention Trial) failed to find benefit. This study screened 40,000 children at high risk and selected 552. The results were negative. The rate of diabetes onset was not statistically different in the group given niacinamide compared with those given placebo. Another study also failed to find benefit.

Dietary changes. The related terms “glycemic index” and “glycemic load” indicate the tendency of certain foods to stimulate insulin release. It has been suggested that foods that rank high on these scales, such as white flour and sweets, might tend to exhaust the pancreas and therefore lead to type 2 diabetes. For this reason, low-carbohydrate and low-glycemic-index diets have been promoted for the prevention of type 2 diabetes. However, the results from studies on this question have been contradictory and far from definitive.

There is no question, however, that people who are obese have a far greater tendency to develop type 2 diabetes than those who are relatively slim; therefore, weight loss (especially when accompanied by increase in exercise) is clearly an effective step for prevention. One review suggests that a weight decrease of 7 to 10 percent is enough to provide significant benefit.

Other natural treatments. Studies investigating the preventive effects of antioxidant supplements have generally been disappointing. In an extremely large double-blind study, the use of vitamin E at a dose of 600 international units every other day failed to reduce the risk of type 2 diabetes in women. Another large study, which enrolled male smokers, failed to find benefit with beta-carotene, vitamin E, or the two taken together. Another large study of female health professionals who were more than forty years old with or at high risk for cardiovascular disease found that long-term supplementation (an average of just more than nine years) with vitamin C, vitamin E, or beta-carotene did not significantly reduce the risk of developing diabetes compared with placebo. In a smaller (but still sizable) trial involving a subgroup of these same women, supplementation with vitamins B6 and B12 and folic acid also did not reduce risk of type 2 diabetes.

Several observational studies suggest that vitamin D may also help prevent diabetes. However, studies of this type are far less reliable than double-blind trials. One observational study failed to find that high consumption of lycopene reduced risk of developing type 2 diabetes.

Supplements to Use Only with Caution

In a double-blind, placebo-controlled study of sixty overweight men, the use of conjugated linoleic acid (CLA) unexpectedly worsened blood sugar control. These findings surprised researchers, who were looking for potential diabetes-related benefits with this supplement. Other studies corroborate this as a potential risk for people with type 2 diabetes and for overweight people without diabetes. Another study, however, failed to find this effect. Nonetheless, people with type 2 diabetes or who are at risk for it should not use CLA except under physician supervision.

Unexpected results also occurred in a study of vitamin E. For various theoretical reasons, researchers expected that the use of vitamin E (either alpha tocopherol or mixed tocopherols) by people with diabetes would reduce blood pressure; instead, the reverse occurred. People with diabetes should probably monitor their blood pressure if they take high-dose vitamin E supplements.

There are equivocal indications that the herb ginkgo might alter insulin release or insulin sensitivity in people with diabetes. The effect, if it exists, appears to be rather complex; the herb may cause some increase in insulin output and, yet, might actually lower insulin levels overall through its effects on the liver and perhaps on oral medications used for diabetes. Until this situation is clarified, people with diabetes should use ginkgo only under the supervision of a physician.

Despite hopes to the contrary, it does not appear that selenium supplements can help prevent type 2 diabetes, but rather might increase the risk of developing the disease. Contrary to earlier concerns, vitamin B3 (niacin) and fish oil appear to be safe for people with diabetes. A few early case reports and animal studies had raised concerns that glucosamine might be harmful for persons with diabetes, but subsequent studies have tended to allay these worries.

Finally, if any herb or supplement does in fact successfully decrease blood sugar levels, this could lead to dangerous hypoglycemia. A doctor’s supervision is strongly suggested

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