Stuff that occurs to me

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Think of this blog as a sort of nursery for my half-baked ideas hence 'stuff that occurs to me'.

Contact: @JoBrodie Email: jo DOT brodie AT gmx DOT com

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Tuesday, 16 March 2010

Some thoughts on herbal remedies and diabetes

A shortened link for this post is http://is.gd/aJEfH

Medicines from plants
There are many preparations containing plant ingredients which have been claimed to help people with diabetes manage their condition. As well as the sugars, proteins and fats (oils) that plants use for fuel, storage and building blocks, plants produce many other chemicals that protect them from being eaten (for example by herbivorous animals) and help in repairing damage. Many of these chemicals have effects (whether these are beneficial or negative is often be a consequence of dose, as much as of the nature of the molecule(s) involved) in humans and have for years been exploited in medicine.

Aspirin tablets contain a chemical which has its origin in a similar chemical found in the bark of the willow tree (Salix alba) and in the woody shrub known in North America as meadowsweet (from the Spiraea family). Similarly metformin, used in the treatment of Type 2 diabetes, is a safer synthetic form of a chemical compound originally found in French lilac (Galega officinalis). A significant number of modern day pharmaceutical preparations have their origins in chemicals extracted from plants and so it is not unreasonable for people to think that plant material may be helpful in treating diabetes and other conditions.

Herbal preparations are sometimes wrongly advertised as being safer alternatives to prescription medications because they contain only natural ingredients. However it is important to remember that 'natural' does not necessarily mean 'harmless', an example being the poison ricin which is extracted from the castor bean plant (Ricinus communis).

Claims are also often made for herbs and spices which are typically used at relatively low doses in flavouring foods. At higher doses these same herbs or spices may begin to have pharmacological effects on the body and it may not be safe to take them for a long time at such high doses. In addition to the active ingredient some plants contain other chemicals that can also be harmful at higher doses.

It is important to remember that herbal preparations, and other alternative treatments, can contain:

  • an active ingredient which may be harmful
  • an active ingredient which may not be harmful by itself but which may interact with other prescribed medication(s) which can cause that medicine to work differently and can also worsen the risk of a serious hypo (low blood glucose)
  • adulterants – that is other chemicals added to the preparation, for example prescription-only medicines, medicines that have been withdrawn (Wood, 2004) or heavy metals sometimes found in Ayurvedic treatments
  • ingredients which have no or insufficient effect on blood glucose control, or which contain no ingredients at all.

I’ve previously tried to find out how harm can be categorised as I’ve assumed someone must have arrived at this problem before me… any ideas?

I'm not aware of any good evidence recommending that any herbal preparation can be effectively or safely used to treat diabetes but of course this wouldn't prevent someone from trying a treatment if they wanted to. My advice, such as it is - I am not medically trained and there's the potential to do oneself quite a lot of harm with alternative treatments, is to take a pragmatic approach to herbal products.

I'd suggest that people with diabetes discuss them with their doctor or healthcare team, consult their pharmacist for advice about any known interactions and, if appropriate, monitor their blood glucose levels more closely to prevent hypos (low blood glucose levels) or to make sure that glucose levels do not rise. If someone with diabetes needs any changes to prescription medication, this should really only be done on the advice of a medically qualified doctor.

Avoid buying products from the internet – moneyback guarantees mean very little – and ignore hype, and patient testimonials (which are unlikely to be real).

References (see also in-text links)
Wood, DM, Athwal, S and Panahloo, A (2002) The advantages and disadvantages of a 'herbal' medicine in a patient
with diabetes mellitus: a case report. Diabetic Medicine, 21 (6): 625-627.
Abstract available from http://www.ncbi.nlm.nih.gov/pubmed/15154951

A 48 year old man improved his diabetes management in the short term, and stopped taking other medication, after using herbal 'balls' purchased in India. It was subsequently discovered that the herbal preparations contained chlorpropamide, a prescription-only medicine that is no longer recommended in treating diabetes.

Recommended reading
Shane-McWhorter, L (2007) Complementary & alternative medicine (CAM) supplement use in people with diabetes: a clinician's guide. American Diabetes Association, Alexandria, Virginia.

See also
Campbell, AP (2010) Diabetes and dietary supplements Clinical Diabetes website.
Article available from http://clinical.diabetesjournals.org/content/28/1/35.full

4 comments:

  1. Aww shame I got a low score on the specious reasoning. All ears for ways on improving this :)

    ReplyDelete
  2. I should point out from the outset that I'm not a medical doctor - I think your best piece of advice in there is "consult your medical professional"

    I don't know much about diabetes, but was interested to read there were non-insulin treatments for the condition - does this treat the core of the condition (sugar metabolism)? Or side effects?

    Isn't the quantity of active ingredient also an issue for herbal preparations?

    ReplyDelete
  3. Thanks - agree that consulting doctor (also pharmacist) is a big plus, although anecdotally some doctors won't necessarily have heard of some of the herbal products (they go by so many different names).

    Also from a personal perspective I'd hope that doctors were encouraging their patients to talk to them about what herbal products they might be taking and to look at the risks of adverse reactions or interactions.

    Regarding non-insulin treatments - yes, the majority of people with diabetes have Type 2 diabetes and this does not necessarily require insulin, but medication to counteract insulin resistance (ie the person is producing insulin but their body's not responding to the signal). There are a number of different classes of oral drugs which act to prevent the liver from overproducing glucose from scratch or by enhancing take up of glucose into the tissues.

    Metformin, mentioned in the post, is a biquanide which has its chemical origin in a similar plant compound. It's a classic "Type 2 diabetes drug" and is often the first line therapy.

    To re-iterate - I'm not medically trained either :)

    ReplyDelete
  4. Karen White says "Well explained article. Diabetes is really a highly significant public health problem in the United States. I am using [redacted - a treatment for which there is little evidence on PubMed] for a long time and it gives good result."

    ReplyDelete

Comment policy: I enthusiastically welcome corrections and I entertain polite disagreement ;) Because of the nature of this blog it attracts a LOT - 5 a day at the moment - of spam comments (I write about spam practices,misleading marketing and unevidenced quackery) and so I'm more likely to post a pasted version of your comment, removing any hyperlinks.

Comments written in ALL CAPS LOCK will be deleted and I won't publish any pro-homeopathy comments, that ship has sailed I'm afraid (it's nonsense).