Alternative therapies gain popularity among patients
A Canadian study recently found that 30% of all diabetic patients regularly supplement their diabetes medications with alternative therapies — a finding that parallels the boom in alternative therapy’s popularity as a whole. While patients seem to be the most willing to look beyond traditional treatments for their disease, compared to their doctors, scientific research is still trying to separate the real help from hype.
For now, a conservative approach is good for clinicians to take, observers say, but don’t rule out the supplemental therapies before reviewing some of the studies that are being done.
"Don’t dismiss these things out of hand. Keep an open mind," says Harry Preuss, MD, professor of medicine at Georgetown University in Washington, DC, and director of the National Research Council for Health.
Preuss’ first recommendation is that clinicians do their homework in order to have accurate information available when they get questions from patients.
Preuss says he has been alarmed at the level of misinformation presented at some recent professional meetings because it is turning the medical community away from some therapies that can really help diabetics, particularly Type 2 patients.
Here are some recent findings on alternative therapies for diabetics:
½k Alpha-lipoic acid
Science is showing that diabetics have significantly lower levels of antioxidants in their bodies than normoglycemics. The shortage could lead to less control over the free radical molecules that some researchers believe can contribute to nerve damage and other types of degeneration of body tissues seen in chronic disease.
Antioxidant supplements may be an answer, but the search is on now to find the proof. Some researchers say they are close to linking alpha-lipoic acid with preventing nerve damage in diabetic patients.
"Alpha-lipoic acid is the most potent, naturally occurring antioxidant known to date," says Lester Packer, PhD, professor of physics and molecular and cellular biology at the University of California in Berkeley and senior scientist at the Lawrence Berkeley Laboratory and director of the Packer Laboratory.
Packer says alpha-lipoic acid, when included in a network of antioxidants such as vitamins C and E and glutathione, "has a unique ability to promote glucose tolerance, optimum antioxidant protection, and healthy nerve function."
In rat studies, Packer found that alpha-lipoic acid supplementation brought measurable free alpha lipoic acid to the nerve cells, preventing or slowing nerve damage by up to 70%. He also found that the higher the dosage of alpha-lipoic acid, the higher the amount of the antioxidant was retained in the nerves.
Packer says he suspects that alpha-lipoic acid may be instrumental in preventing the onset of diabetes since it helps improve the utilization of glucose by muscle cells.
"If oxidative stress is a significant factor in diabetic complications, then antioxidant therapy is a logical candidate for preventing or ameliorating those complications," Packer says.
Self-medication not recommended
Packer does not recommend self-medication, but warns that clinicians should be aware that people may hear about the supplement and start taking it on their own without letting their doctor know. Taken unsupervised, alpha-lipoic acid can lead to changes in how much medication is needed to maintain healthy blood glucose levels, so doctors should ask if patients take any type of supplements and monitor their blood glucose levels closely.
In Germany, alpha-lipoic acid has been used to treat neuropathy for 25 years, but it is regulated as a drug. Researchers at Heinrich Heine University in Dusseldorf, Germany, found diabetics given 600 mg of alpha-lipoic acid a day experienced a significant reduction in nerve damage-related pain and numbness. Another German study shows that alpha-lipoic acid enhances the action of insulin and oral agents in lowering blood glucose levels. (Packer notes that both the Germans and Japanese have prescribed the supplement for decades, but research is only beginning to show how well alpha-lipoic acid can be absorbed into nerve tissue. Even more research will be needed to show how well it protects the nerves from the free radicals once it’s there.)
Alpha-lipoic acid is found in tiny amounts in potatoes, spinach, and red meat. To get 50 mg per day, one would have to consume 300 pounds of spinach. "Popeye was right," Packer says. "We’re just bringing this to practical levels."
It is sold over the counter as a nutritional supplement, generally in capsules containing 50 or 100 mg.
"We use it frequently, usually in combination with Vitamin E," says Zeno Charles-Marcel, MD, medical director of the Lifestyle Center of America in Sulphur, OK.
Charles-Marcel says his experience with alpha lipoic acid is largely through administering it to patients in intravenous infusions. He notes he thinks it is "promising" in the treatment of diabetic neuropathy.
½k Grape-seed extract
The flavonoids and polyphenols present in red grapes provide other powerful antioxidants, responsible for the cardioprotective, anti-cancer and anti-aging properties in red wine.
Numerous studies have shown the beneficial effects of red wine, particularly in providing the protection against heart disease. The question remains, however, if an extract — a fraction of the total number of antioxidants — has the same benefit as drinking the whole mixture in a glass of wine.
Preuss says that he thinks grape-seed extract may have benefits for diabetics beyond the increased risk of developing heart disease caused directly by diabetes.
As director of the independent National Research Council for Health, Preuss was in-volved in clinical studies of grape-seed extract commissioned by InterHealth Nutraceuticals, Inc. of Concord, CA, which manufactures grape-seed extract under the brand name ActiVin.
In results published in the Journal of the American College of Nutrition in 1997, Preuss found grape-seed abstract significantly reduced glycosylated hemoglobin and systolic blood pressure in normotensive rats.
"More clinical study is needed," Preuss says, "but this is good indication that the results will translate to humans and more specifically to diabetics."
Charles-Marcel agrees he would like to see more research on the benefits of grape-seed extract, but he thinks the anti-oxidant properties of grape seed show particular promise for diabetics, who are particularly susceptible to oxidative tissue damage. "It has a lot of merit that is worth pursuing," he says.
Debasis Bagchi, PhD, InterHealth’s director of research and development and a member of the peer review committee for the National Institutes of Health in Rockville, MD, has also conducted studies of ActiVin for Creighton University in Omaha, NE. He says his results have shown HbA1c levels dropped as much as 19% in diabetics using 100 mg of grape-seed extract per day.
Other notable results on grape seed from studies at the University of Connecticut not specifically targeting diabetics showed a 30% protection against myocardial infarction, a 41% reduction in oxidative damage, and up to 50% improvement in functional recovery of the left ventricle after a myocardial infarction in a normoglycemic population.
[Contact Harry Preuss at (202) 687-2000, Lester Packer at (510) 642-8313, Debasis Bagchi at (925) 827-4400, and Zeno Charles-Marcel at (580) 993-2327.]
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