Glucomannan (Amorphophallus konjac K. Koch)
Guar Gum (Cyamopsis tetragonolobus [L.] Taub)
Stevia (Stevia rebaudiana Bertoni)
Pine Bark Extract (Pinus pinaster)
Bilberry (Vaccinium myrtillus)
Milk Thistle (Silybum marianum)
3. Nonbotanical CAM Supplements to Treat Diabetes
4. Botanical and Nonbotanical CAM Supplements that May Treat Complications of Diabetes
Policosanol (Saccharum officinarum L.)
Red Yeast Rice (Monascus purpureus Went)
St. John’s Wort (Hypericum perforatum L.)
6. Closing Comments and Advice for Clinicians
Bibliography and Useful Websites for Clinicians
Acknowledgments
I would like to thank my family, friends, and support personnel, who have provided much encouragement, support, and counsel during my work on this book. Specifically, I would like to thank my husband, Jerry, as well as my children, Chris, Sandy, Randy, and David, and my grandson, Cody. I would like to give a special thank you to my friend Dick for his invaluable technical support.
Finally, I would also like to thank Victor Van Beuren of the American Diabetes Association, who believed this was a worthwhile endeavor.
1.
Introduction
Medical journals, the lay press, and the Centers for Disease Control and Prevention have highlighted the ever-increasing number of diabetes cases, now exceeding 20 million in the U.S.1 Although there are numerous conventional, or allopathic, therapies to treat diabetes, there is also a tremendous interest in emerging therapies, including nontraditional, or complementary and alternative, medicine. Complementary and alternative medicine therapeutic modalities have become increasingly popular, and it is estimated that consumers spent $17.7 billion dollars on oral supplements in 2001.2
Two distinct definitions of these unique therapies are important for clinicians to differentiate. One is the definition of complementary and alternative medicine (CAM) and the other is the definition of dietary supplements. The National Center for Complementary and Alternative Medicine (NCCAM) has provided a definition of complementary and alternative medicine. NCCAM states that CAM therapies cover a broad range of healing philosophies, approaches, and treatments. CAM is defined by NCCAM as treatments and health care practices not widely taught in medical schools, not generally used in hospitals, and not usually reimbursed by insurance companies.3 In CAM therapy, the health care practitioner considers the whole person, including not only physical, mental, and emotional characteristics, but also spiritual aspects. Hence the term “holistic” is used to characterize treatment. Some of these therapies are used alone and referred to as “alternative.” Other therapies are combined with other alternative or conventional therapies and referred to as complementary.3 NCCAM has categorized CAM into four different domains: biologically based therapies, mind-body medicine, energy medicines, and manipulation and body-based practices.
Biologically based therapies include the use of herbs and dietary supplements. Oral CAM therapies may include botanical products or nonbotanical products such as vitamins and minerals, and are sometimes referred to as “dietary supplements.” A definition of dietary supplements has been provided by the Dietary Supplement Health and Education Act of 1994.4 A dietary supplement is “a product taken by mouth that contains a “dietary ingredient” intended to supplement the diet and may include vitamins, minerals, herbs or other botanicals, amino acids, enzymes or glandulars, or some type of concentrate, metabolite, or extract.”5
Thus, CAM therapies have included dietary supplements (herbals and vitamins) and other treatments such as acupuncture, relaxation techniques, massage, chiropractic, and spiritual healing.6 In diabetes, certain types of CAM therapies that have been considered useful include not only herbal and homeopathic products but also certain diets, acupuncture, energy healing, biofeedback, hypnotherapy, reflexology, massage therapy, and yoga.7
This book will use the term “CAM supplements” to describe nontraditional oral agents that are of botanical or nonbotanical origin. Hundreds of different plant species have been recorded as being useful to treat diabetes.7,8 Indeed, metformin is a biguanide that is widely prescribed in patients with type 2 diabetes, and this class of agents is related to Galega