Alternative & Complementary Therapy

Many people with diabetes either take or have considered taking so-called "complementary or alternative medicines" (called "CAM's" for short). Is it a good idea to take such treatment? Well, it all depends. Some substances might be good, some might be neutral and some might be very bad indeed. To assist you with making an informed choice (can you tell that I subscribe to Consumer Reports?) I'd suggest you start your investigations by having a look at:

  • Dr. Jeannette Goguen's article (displayed below). She works at the University of Toronto and has kindly allowed me to reproduce her note on this web site.
  • Health Canada's Canadian Adverse Reaction Newsletter. This is a professional publication, but the issue (entitled "Adverse reactions to natural health products") of October, 2002 is excellent reading for both lay and physician audiences and I would heartily recommend having a look at it:

In my book (Diabetes for Canadians for Dummies), I discuss a number of different alternative and complementary therapies including:

  • Aloe vera
  • Coccinia indica (ivy gourd)
  • Garlic
  • Ginseng
  • Gymnema sylvestre
  • Oolong tea
  • Vanadium

Although there are quite a variety of complementary therapies, I would like to make special note of the following:

Beta Carotene - A very important medical study ("The Heart Protection Study") looked at beta carotene and found no benefit from this.

Cinnamon - A study published in December, 2003 suggested that cinnamon could help improve blood glucose levels. i had really hoped this would be the case; imagine having a safe, effective and tasty therapy! Alas, a more definitive study published in 2007 has determined that cinnamon is, in fact, not effective in the treatment of diabetes. It is however, really scrumptious when sprinkled over apple sauce!

Vinegar - Can this be true? An article published in January, 2004 suggests that drinking 20 grams of apple cider vinegar with your meal can reduce insulin resistance and lead to significantly improved blood glucose levels. Stay tuned...

Vitamin E - Tons of people take Vitamin E. In fact I was told a few years ago by a professor at the University of Toronto that annual North American sales totalled THREE HUNDRED MILLION DOLLARS! Now that would be okay if taking extra Vitamin E actually provided some health benefit. But it probably doesn't. Two landmark have looked at this issue, but neither the HOPE Study nor the Heart Protection Study showed any benefit on one's health (in particular the heart) from taking supplemental Vitamin E.

Multivitamin/Mineral Supplements - I commonly get asked if it is necessary to take vitamin and/or mineral supplements. My feeling has been that if one eats a well-balanced diet and follows current diabetes nutrition guidelines (such as provided by the ADA and CDA), vitamin supplements generally do little except give you expensive urine. An editorial in the British Medical Journal, though not specifically talking about diabetes, expresses a similar sentiment.
 
(Note that this advice regarding vitamins does NOT apply to pregnancy (see my pregnancy web page for a discussion regarding folic acid supplements) nor to lactating women, the elderly, strict vegetarians and other select groups.)
 
Having said all this I was struck by the results of a study done in 2003 (published in the Annals of Internal Medicine) which looked at the potential use of a multivitamin/mineral supplement at reducing the risk of infections; the study found that people with diabetes taking the supplement had an absolutely astounding lowering of their risk (whereas 93 percent of people taking a placebo developed an infection over the span of a year, only 17 percent of people taking the supplement developed an infection. Even more amazing was the fact that people with diabetes taking a placebo had an 89 percent likelihood of missing a day from work, but 0 percent [yup, zero, that wasn't a typo] of people with diabetes taking the supplement missed work. Now, on the other hand, the study was made up of only a very, very small number of participants so it could be that the study results were simply a fluke. Anyhow, I think we can conclude two things from all this: 1) we have to remain open-minded; it could be that taking a multivitamin/mineral supplement may be a very good thing to do and 2) it could also be that taking a multivitamin/mineral supplement is a complete waste of money. We await more definitive studies...



So am I a sceptic when it comes to alternative & complementary therapy? You bet. And am I a sceptic when it comes to the newest prescription medication? You bet. Let's see the evidence, shall we? If a treatment (prescription, alternative, whatever) is new, it must stand both scientific scrutiny and "the test of time." And that's my soap box for the moment.

SHOULD YOU USE ALTERNATIVE MEDICINE FOR BLOOD SUGAR CONTROL IN DIABETES MELLITUS?

Alternative medicine is medicine that is not traditionally taught about in medical schools, and is not used by conventional doctors. This is because in most cases the effectiveness of alternative agents is not scientifically proven. Despite this lack of proof, there are many substances used by practitioners of alternative medicine for patients with diabetes. Studies have been done for a few of these substances in current use to determine if they can truly improve blood sugar control. There are encouraging preliminary results for some substances (e.g., chromium, American ginseng and the soluble fiber Konjac-Mannan), however at this point there is no firm evidence that any alternative medicine can lower blood sugar (see reference below).

I believe it is premature to start using alternative substances to treat high blood sugar for the following reasons:

  • There is no proof that any alternative agent works for long term blood sugar control.
  • Side effects and toxicities of alternative medicines are still largely unknown.
  • There is the possibility of a bad drug reaction if alternative medications are mixed with conventional medications.
  • The strength and purity of alternative agents can vary greatly from bottle to bottle. Currently, there is no government agency in Canada monitoring them. For example, in one study, up to 30% of traditional Chinese medicine contained heavy (toxic) metals and/or conventional medications that were not on the label.

If you do decide to take alternative medicine, please tell your doctors so that they can try to check if they interact with any of your other medications.

Jeannette Goguen, MD, FRCPC
Staff Endocrinologist
St. Michael's Hospital
Toronto, Ontario

For more details, see alternative medicine: The role of selected minerals, vitamins, fiber, and herbs in treating hyperglycemia Jeannette Goguen and Lawrence Leiter in Evidence-based Diabetes Care. Ed H. Gerstein and RB Haynes, BC Decker Inc Hamilton 2001