Herbs and Diabetes: Buyer Beware

Believe it or not, there's an all-natural product that can control blood sugar and help people with diabetes live long, active lives. It's a naturally occurring hormone, not a drug. It's called insulin.

If you have type 1 diabetes, your body doesn't make insulin, and so you need regular injections of the hormone to maintain proper blood sugar levels. But is insulin the best nature can do? If you believe the claims of certain supplement makers and salespeople, insulin may be obsolete. In fact, they say, diabetes patients who spend enough money on the right herbs can put away their needles forever.

Unfortunately, herbal remedies don't always live up to their billing, and the "cures" for type 1 diabetes are no exception. Some natural products, including fenugreek seeds, can slightly lower blood sugar levels and may prove useful in people with type 2 diabetes if used under a doctor's supervision. But for people with type 1 diabetes, nothing can compete with insulin when it comes to proven power and effectiveness (though pancreatic islet cell transplantation is a new experimental option that shows promise). And as a report from the California Department of Health Services shows, people who take herbal products without consulting a physician may be endangering their health -- and even their lives.

California's warning on five herbal diabetes remedies

In 2000, the U.S. Food and Drug Administration ran a press release from California's health department reporting that at least five herbal diabetes remedies had been spiked with the prescription drug glyburide and the recalled drug phenformin, whose approval was withdrawn after it was linked to lactic acidosis. Glyburide is effective, but an excess can send blood sugar levels plummeting and push a person into a diabetic coma.

To prevent a potential tragedy, the press release urged patients to avoid the following products: Hypoglucose Capsules, Pearl Hypoglycemic Capsules, Tongyi Tang Diabetes Angel Pearl Hypoglycemic Capsules, Tongyi Tang Diabetes Angel Hypoglycemic Capsules, and Zhen Qi Capsules.

What's really in that pill?

Even if they haven't been tampered with, herbal remedies involve a degree of uncertainty. Take fenugreek seeds, for instance. Carefully controlled scientific studies show the seeds can lower blood sugar and enhance the effects of insulin. But no large, clinical studies have determined how the seeds work in humans, and there is no reliable way to know how many fenugreek pills a person should take. In the largely unregulated world of herbs and supplements, labels do not even indicate how much fenugreek is in a particular pill. Some pills may pack huge doses, but others may contain only a trace of the advertised ingredient.

Not surprisingly, some supplement enthusiasts have attempted to devise ways to eliminate such uncertainty. The journal Diabetes Educator reports that some naturopaths tell patients to "put the products under their arms and [squeeze] their hands until pain occurs. The number of hand squeezes is the number of doses of the product that the person should take each day." The journal warns diabetics not to use this "bizarre" method and urges them to consult with their physicians before trying any herbal remedies.

Furthermore, nobody should assume that products are safe just because they're natural. Consider insulin. Would anyone shoot up a few extra doses just to make sure they were getting enough? Only if they were unfamiliar with the concept of insulin shock and diabetic comas. Fenugreek seeds may be just as risky. In addition to lowering blood sugar, the seeds can cause stomach problems and can even induce labor in pregnant women.

Promising treatments

Someday, there may be a safe, effective, and proven herbal treatment for diabetes. After all, many established medications, from aspirin to the cancer drug Taxol, started as all-natural folk remedies. Tomorrow's doctors may even prescribe carefully standardized doses of fenugreek to their diabetes patients. Here are some herbs and supplements that show enough promise to warrant more thorough, large-scale studies:

Chromium picolinate. People with type 2 diabetes excrete more chromium than healthy people, and the loss of this vital nutrient may make it harder for the body to respond to insulin. Some studies have suggested that chromium supplements can help people with type 1 and type 2 diabetes control their blood sugar, but others have shown no such effect. American Diabetes Association guidelines do not recommend chromium supplements because there is no conclusive evidence that they can help treat diabetes.

Garlic. This common herb has been found to ease diabetes -- in rats. However, human trials are scant and inconsistent. In one such study, garlic didn't work any better than a placebo pill. The study included only 20 patients, and it's possible that a larger trial would prove that garlic works for people as well as for rodents. In another study researchers found garlic compounds protected low-density lipoproteins from degeneration and concluded these compounds may benefit diabetics and patients with cardiovascular disease. Lipoproteins carry cholesterol to where your body needs it. Diabetics typically have an imbalance of lipoproteins that can lead to heart disease.

Alpha lipoic acid. This antioxidant, found in potatoes, broccoli, and liver, may help slow the nerve damage that plagues many patients with diabetes. One study of 328 patients found that three doses of alpha lipoic acid, taken intravenously, substantially eased pain, burning, and numbness associated with diabetes-related nerve damage. More research is needed.

American ginseng and coccina indica. A review of studies on the impact of herbs and supplements on blood sugar found that American ginseng and coccina indica (a medicinal plant) showed the best evidence for efficacy, but warned that more research is needed.

These treatments still need thorough medical evaluation. If you or a family member has diabetes, be sure to talk to your doctor before trying any herbal product. You should also call for medical advice if any natural remedy causes fatigue, extreme hunger, profuse sweating, or numbness in the hands or feet -- these are the warning signs that your blood sugar may be dropping too low. Most important, never stop taking your insulin or any prescription medications without your doctor's agreement. No matter what those marketers say, at this point there is still only one proven all-natural remedy for diabetes -- and you can't buy it in a health food store.

References

State health director warns consumers about prescription drugs in herbal products. FDA press release. http:www.fda.gov/oc/po/firmrecalls/herbal.html

Alternative therapies: Depression, diabetes, obesity. American Family Physician.

Mayo Clinic. Islet cell transplant: Emerging treatment for type 1 diabetes. September 2005. http://www.mayoclinic.com/health/islet-cell-transplant/DA00046

Ou C. et al. Protective action on human LDL against oxidation and glycation by four organosulfar compounds derived from garlic. Lipids. Vol. 38(3):219-24. http://www.ncbi.nlm.nih.gov

American Diabetes Association. Diabetes, Cholesterol and Heart Disease. http://www.diabetes.org/diabetes-cholesterol.jsp

National Center for Complementary and Alternative Medicine. CAM and Diabetes: A Focus on Dietary Supplements. June 2008. http://nccam.nih.gov/health/diabetes/D416_GTF.pdf

Yeh, GY, et al. Systematic review of herbs and dietary supplements for glycemic control in diabetes. Diabetes Care. Vol. 26(4): 1277-94.

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