Webinar Forum: Diabetes Integrative Care Cases

Today’s webinar presented information about adjunctive and alternative herbal treatments for diabetes. Natural Standard Chief Editor Catherine Ulbricht, PharmD discussed treatment goals, integrative care plans and three patient care cases.

Several herbs and supplements were mentioned. For example, gingko has been shown to be beneficial for diabetic retinopathy due to its antioxidant properties. In addition, natural products such as beta-glucan, beta-sitosterol, niacin, omega-3 fatty acids, soy and psyllium have strong supportive evidence in lowering lipid abnormalities commonly seen with diabetes. However, Ulbricht cautioned that these herbal supplements are only to be used as integrative therapies rather then replacing western medicine as the patients’ primary treatment.

Ulbricht's webinar is one of many upcoming complimentary webinars on integrative medicine. The next webinar, A Natural Standard Database Overview, will take place on November 18 from 3 p.m. to 4 p.m. Eastern Time. This upcoming presentation will provide a general overview of the database. To participate in the next webinar, please click here and call (616) 883-8055, access code 625-144-811.

Natural Standard values the opinions and views of its readers and welcomes feedback and questions about the latest webinar event. Also, if you have any suggestions for future webinar topics, please leave a comment below or send an e-mail to questions@naturalstandard.com.

Comments

[smith]

Chromium is also known to speed metabolism. Does this affect diabetes?

[anon]

I heard CoQ10 can make diabetes worse, but it helps for so many other things. Is a substitute available?

[Metu]

This is valuable information that sheds light on the little known area of natural treatments for diabetes. There is not much that can be done for diabetic retinopathy, so prevention is key. Does anyone know the doses of ginkgo for retinopathy prevention?

[red sky]

Niacin is a useful agent; however, it should be used with caution in renal impairment, and it is contraindicated in patients with liver disease. Therefore, patients should only use niacin under the advice of their health care practitioners.

[Reggie Adams]

Wow, what an excellent webinar! I've heard that there are many natural products that can have positive and negative effects on diabetes, but at the amount discussed, I was definitely shocked and impressed. Even vitamins and supplements like niacin can have an effect on the disease, even if taken for non-diabetic reasons. Topping my list of previously unknown facts is that Alfalfa can instigate/exacerbate lupus. Kudzo injections may help with microvascular complications? Wow. I definitely need to read more, as many of us know someone who is diabetic, even if we are not ourselves.

[natural rx]

I think it is high time that we include natural products in addition to the arsenal of prescription drugs used to treat diabetes. Of course, diabetes mellitus type 2 is a largely preventable disease. We can throw all the drugs (Rx and natural) we want at people, but the real problem is obesity and a sedentary lifestyle, which is responsible for the staggering prevalence of diabetes.

[fireball jane]

Hydrocotyl causes an increase in lipids? My sandwich of choice gives me enough of that! I think I’ll stick to my fish oil for now. Why would any diabetic knowingly want to consume hydrocotyl? Knowledge of the disease is important in the prevention of complications down the road. Gold stars to those who took the time to listen to this webinar and/or research their condition independently. Doctors do not have all the answers nor are they well versed in supplements in many cases. This does not mean that they cannot help you, just maybe that they are unaware of their potential impact on your diabetes.

[Steve Winnen]

Wow! I really respected how the speaker did not claim to replace all conventional medicine and therapies, but instead presented a multifaceted approach that involved merging lifestyle changes, conventional medicine and complementary medicine -- as opposed to alternative/replacement medicine in diabetes.

[Michelle]

You mentioned during the webinar that changing manufacturers of natural products may alter the therapeutic effect of the supplement. I would have never thought to ask a patient who is experiencing adverse events from an herbal product if they recently bought a different brand. Thank you for the pointer!

[Nick]

Herbal products have many different indications. As Dr. Ulbricht mentioned, Ginkgo biloba can be used to decrease blood sugar levels in patients with diabetes. Many consumers, however, are using this herbal product for memory. Now my question is would non-diabetic patients using Ginkgo biloba have an increased risk of falls and injury due to hypoglycemia?

[Tom]

During the webinar, Dr. Ulbricht mentioned the use of garlic for lipid abnormalities. Garlic is really tricky because the way it's prepared is really important. Garlic cooked on a skillet at a high temperature denatures its active ingredient and thus decreases its physiological activity. Also, aged garlic and garlic oil do not contain much allicin or alliin (one of the active ingredients); therefore, it does not have as much physiological activity as fresh garlic or garlic powder. Raw garlic has the most potent activity!

[Nick]

From my knowledge, chromium was studied in diabetic patients who were chromium deficient. Chromium helps with sugar metabolism; if a person is deficient then they will encounter problems! Once this patient population was supplemented back to normal values, this is when we saw chromium’s therapeutic effect on blood sugar levels. However, if chromium is supplemented in patients without a deficiency, this is where the controversy comes into play.

[James]

Great to know there are herbal supplements that are beneficial for diabetics besides Western medication. Western medications can have so many side effects that the patient often feels worse with the medication than without. Although Dr. Ulbricht discouraged cutting out Western medication, it is great that these studies were done to know that in the future we may have less invasive medical treatments available.

[Matt C.]

If these alternative therapies are proven and evidence based, are they mentioned in the ADA guidelines as adjunctive or alternative therapies? And if not, why not? If they offer real benefit in the management of diabetes, why not recommend them as adjunctive therapies? Are most herbals/supplements standardized for quality and safety? Many practitioners do not recommend these products because they are not FDA regulated.

[Leon W.]

Is ginkgo used for diabetic retinopathy treatment or prevention? Did the webinar mention anything about diabetic neuropathy? This is a complication that has received much attention. There are a few medications out there, but they are not always effective. I wonder if there are any herbs or natural supplements that have proven efficacy.

[Tony G.]

In response to Reggie Adams:

What are Kudzu injections? And what microvascular complications is it used for? Where does one get these injections? Is it self injected or practitioner injected?

[Hannah Bleck]

Diabetes is such as threat to the health of so many Americans, and it also puts a great burden on our healthcare system. It is great to see every possible avenue explored for prevention and treatment, including herbs and supplements. I hope that despite the benefits of these, that patients will keep in mind that a smart lifestyle is such an important component of this. So many Americans are overweight or obese and also inactive. The current data from the CDC show that fewer than HALF of Americans get the recommended amount of exercise and one quarter of us get NONE. This has to change too, or diabetes is sure to become an even larger problem.

[Steve]

Fireball Jane, what you said has made me curious. In what types of foods is hydrocotyl found?

[Vicki]

It is true that different brands of natural products can affect treatment. There was a news story featured on Natural Standard a while back that discussed lead contaminants found in some Ayurvedic medicines. Even if the product is not contaminated, it could be made differently and contain various amounts of ingredients that could also affect the patient.

[SUMA]

I enjoyed the format of this Webinar. The case study presentations made it more applicable to clinical practice. I also felt that using the integrative care plan was an appropriate method to educate listeners, and it provided a simple, easy-to-follow format. The overview of diabetes and complications was informative. Several different examples of natural products and their indications were presented for each complication, as well as important information on potential interactions with other medications.

The presenter also stressed the fact that these products were not meant to replace conventional drug therapy, but they could be used to complement conventional therapy instead. In addition, Ulbricht also emphasized the importance of discussing the use of herbs and supplements with healthcare providers in order to prevent potential interactions. This webinar provided useful information for clinicians to think about and utilize when dealing with diabetic patients

[liz]

This webinar is an excellent reminder of the effect of approaching treatment from various angles. It seems most patients relay on medications without considering the most important and safe form of therapy, which is diet and lifestyle modification to control and manage diseases. It is important for patients to discuss herbal supplement use with their physicians/healthcare practitioners and follow healthy diets and lifestyles along conventional medication to get an optimal healthcare outcome.

[K.K.]

The webinar was well put together and loaded with good information. The ABCs for diabetes are a good way to remember to check (hemoglobin) AC1, Blood pressure and cholesterol. Providing goals for these parameters all in the one place was certainly helpful.

I have a friend who recently was diagnosed with diabetes and often thought she went overboard checking her blood sugar, especially before eating. Now I fully understand the need and will encourage her to check even more frequently. The case studies were easy to follow and interesting, and the last slides of question and answers were particularly useful, as they provided a different look at herbal supplements and which ones worked and which did not.

[Kelly]

Nick is right. If a patient is chromium deficient, adding a supplement should improve his/her diabetes; however, it has not been shown to be beneficial to chromium replete patients.

[George]

Michelle, for many supplements, it is important for patients to stick with one brand. As dietary supplements are not regulated as stringently as other drugs, it is common to find significant variations among brands. Also, some supplements come in different forms, and switching between the two can have pretty serious effects. For instance, switching between natural and synthetic vitamin E can significantly affect patients using blood thinners.

[Tamara]

It was very interesting to know about gymnema herb supplements for controlling blood sugar. Gymnema leaves increase insulin levels by regeneration of the cells in the pancreas that secrete insulin. Other clinical research has shown that gymnema also improves uptake of glucose into cells by increasing the activity of the glucose utilizing enzymes, and prevents adrenaline from stimulating the liver to produce glucose, thereby, reducing blood sugar levels.

[LT]

Nick,

Raw garlic has the most active allicin, but it also has an often-too-strong scent/flavor, and it can cause heartburn. It’s like a headline in a fake newspaper I saw last week that was titled something along the lines of “Man lives 38 seconds longer from consuming large quantities of smelly fish products over his lifetime.” There is a cutoff of efficacy versus social acceptability with garlic. If you want the most benefit, you need to become the least attractive to guests and social circles in regard to garlic intake.

[Alex]

How convenient it is to be able to attend a great lecture from the pleasure of my own home! Webinars are a great tool!

[Katie]

The speaker mentioned the use of niacin for lipid abnormalities. It should be noted, however, that peripheral vasolidation is a common adverse reaction characterized by flushing, warmth and burning or tingling of the skin, especially the face. This adverse event is more commonly seen in immediate-release preparations rather then sustained-release.

Therefore, if a patient decides to supplement with niacin to lower lipids, they should be counseled to choose a sustained-release product like Niaspan® (S for sustained release, an easy way to remember).

Other important counseling points include:
*Patients should avoid alcohol or hot drinks since it can precipitate flushing.
*Flushing can be minimized by taking niacin with food, begin on a low dose and titrate dose upwards every two weeks.
*Also, taking aspirin 30 minutes before each dose can help prevent and reduce flushing.

[Skeptical Skip]

Supplements also have a problem with consistency. They can vary in the actual amount of said ingredients from bottle to bottle and lot to lot as much as 10-fold below or above said amount. There really is no regulation on this either. I hope someday this problem can be fixed so that practitioners can more confidently recommend herbs and supplements to their patients with diabetes or any other condition.

[Bob]

Another great webinar! Glad to see integrative medicine get more and more exposure. I believe integrative medicine will become mainstream one day, and webinars like these help doctors and patients begin to think in a different way that incorporates conventional medicine with complementary and alternative medicine.

[C.M.]

Time out. Although many of these herbs are healthy and complementary efficacious, they will not get used by most type II diabetics, as they generally are more difficult to take than a pill. However, this is great for that rare bird who is focused on improving his/her condition coupled with necessary lifestyle modifications. I guess Natural Standard is a great place for this. People on the site generally are into improving their health more than the average person, as they cared enough to invest in a subscription.

[Linus]

In regard to James' comments: "Many practitioners do not recommend these products because they are not FDA regulated," there is another reason why practitioners don't recommend alternative therapies.

It's called Money. Indeed, there is a national debate over the influence of industry money on medical practice. In a positive development, the New York Times reported that Eli Lilly & Merck will begin publicly reporting payments they make to outside doctors.

[Herb]

As a follow-up to Tamara's comment, the NS database states that gymnena can be unsafe "when used in patients taking other hypoglycemic agents, because of possible potentiation of effects. Hypoglycemic effects associated with gymnema have been noted in both diabetic and non-diabetic individuals." The use of alternative diabetes treatments must be combined with blood glucose monitoring, as an important monitoring parameter for diabetes control.

[Anna H.]

This forum has re-introduced facts that have been long spoken about (i.e. the use of herbal medicines for treatment of diabetes). However, it would have been better if they had conducted a survey of taking herbal medicines in lieu of western medicines, instead of supplementing them as adjuvants. Western medicines are already proved to be effective, and their supplements are not required. Instead, it would be better if this study is directed to find alternative herbal medicines to minimize the use of drugs and to take advantage and exploit the enormous wealth of natural resources in nature, where there is a lot of potential.

[Becca]

This was my favorite lecture so far. It was definitely the most applicable to my clinical practice as an RD.It gives an awesome refresher of diabetes and the health risks associated with uncontrolled blood sugar levels. I have to admit, I made a nice little cheat sheet that I will keep with me while I work on all the blood level ranges.

This lecture also gave great examples of natural products and their indications, as well as what to watch out for as far as interactions with other medications or supplements a patient may be taking.

What I really enjoyed is that the lecture didn’t take away from but promoted the fact that the most important part of treating diabetes includes diet, exercise and lifestyle choices. Also, natural products should only be used to compliment treatment and should never replace conventional treatment for diabetes.

[Lory]

It is great that these herbs have been shown to improve diabetes. I think Ulbricht made a very important point to mention that patients shouldn't replace their diabetes medications for only these herbs. I would also be concerned in knowing if they interact with any medications and how much has been shown to be effective.

[SZ]

I’m so glad that Dr. Ulbricht cautions that “these herbal supplements are only to be used as integrative therapies, rather than replacing western medicine as the patients’ primary treatment.” My primary concern is the suggestion that ginkgo may help with diabetic retinopathy. Too many patients (and their family members) are tired of toxic medications and/or surgery to treat visual complications, and may be too quick to jump on ginkgo as an adequate replacement. Vision is too precious to risk, so I hope that Dr. Ulbricht’s recommendation is heeded.

[diabetes gestational]

Thanks for the information.