Diabetes: new findings from alternative medicine

by Dr. Jacki Hart

Diabetes is a chronic condition that often requires several lifestyle changes to manage it. In addition to medication, diet, and exercise, new therapies may be emerging from the field of complementary and alternative medicine.

Thirteen million Americans, or about 6% of the population, have diabetes, a disorder of the endocrine system, which is involved in metabolizing food and regulating the amount of glucose in the bloodstream—referred to as "blood sugar." There are two forms of diabetes—type 1 or insulin-dependent diabetes, and type 2 or non-insulin-dependent diabetes.

People with type 1 diabetes are usually diagnosed as children or young adults and must take injections of the hormone insulin, because their pancreas does not produce insulin. People with type 2 diabetes, which is far more common than type 1 and affects mostly adults, do have insulin, but for reasons that are not fully known, their bodies dont utilize it effectively.

There are oral medications available to help people with type 2 diabetes control their blood sugars and some people with type 2 may require insulin injections. In addition to insulin and oral medications, individualized diet and exercise programs are a key component of managing both type 1 and type 2 diabetes.

Now additional options for managing diabetes may be emerging from the world of complementary and alternative medicine. Heres a rundown of some of the interesting research findings.

Exercise has long been known to help people with diabetes reduce blood sugars and achieve and maintain a healthy weight. A recent study confirmed this, but with two new, interesting twists.

First, this trial, known as the Nurses Health Study, studied women, whereas most previous trials studied the association between exercise and diabetes in men. For eight years the researchers followed more than 70,000 women who did not have diabetes or other health problems, to see how many would develop diabetes during that time and whether development of diabetes had anything to do with intensity of physical activity; 1419 women developed diabetes during the study. The less physically active the women were, the more likely they were to develop the disease.

The second interesting twist and very important point to make about this study is that even moderate exercise, particularly walking, had a positive impact on lowering blood sugar levels. This is very important because walking is one of the simplest, least time-consuming, and most accessible activities available. In the Nurses Health Study, 60% of the women questioned walked at least one hour per week, compared with only 6% who jogged, 12% who swam, 30% who bicycled, and 5% who played tennis.

Water-soluble dietary fiber, such as psyllium, decreases blood sugar and insulin levels after eating. A study recentlypublished in the American Journal of Clinical Nutritiontried to answer the question of whether fiber, specifically psyllium, provides a benefit to people with type 2 diabetes. During part of the study, participants stayed in an inpatient setting where their food intake was controlled; blood sugars were lower in the people who ate psyllium twice a day compared with those who received a placebo. But, during the portion of the study conducted in a "real-world" outpatient setting, there was no difference between groups. Further research to test the benefit of psyllium or other forms of soluble fiber is needed, but the preliminary results are somewhat intriguing.

Recent scientific reviews have found that two commonly used herbal remedies—aloe and ginseng—may be useful in lowering blood sugars. In one study, 36 subjects received either 100 or 200 milligrams of ginseng or a placebo every day for eight weeks. The people who received ginseng experienced significant improvement in their blood sugar levels.

Two aloe vera studies, one in which people with type 2 diabetes were on no medications and the other in which they were on a single medication used to treat high blood sugars, found that of the combined 114 participants, those who received aloe vera reduced their average blood glucose by more than 100 points.

Biofeedback therapy is a process by which the therapist uses special equipment to train the patient to control certain bodily functions that are thought to be involuntary, such as temperature, heartbeat, and blood pressure. I think of it as bringing the unconscious to the conscious by helping people become more aware of the subtle signs that indicate stress, anxiety, agitation, etc., so that they may learn to control those reactions and relax.

It has been hypothesized that biofeedback therapy could be helpful to people with diabetes, because stressful life events, depression, and anxiety can raise blood sugar in people with diabetes. Two studies from the mid-1980s and early 90s suggested that weekly biofeedback therapy together with daily home relaxation practices led to improved control of blood sugars in people with type 1 diabetes.

But a study published within the last few months by the same group did not find any correlation between weekly biofeedback and daily relaxation and improved diabetes control. The researchers did find, however, that the more depressed or anxious an individual was, the less likely he/she was to achieve clinical benefits of biofeedback.

The most promising of these new studies seem to be the ones on exercise, psyllium, and herbal supplements. The Nurses Health Study offers new information regarding the importance of exercise in preventing type 2 diabetes in women; plus, it suggests that moderate exercise, particularly with an activity that is relatively easy to do, has enough of a benefit for preventing diabetes, without requiring rigorous exercise.

The psyllium study only produced positive results in an unnatural, controlled setting, but additional trials may show benefit in an outpatient setting. Until then, I would recommend eating a high-fiber diet, rich in whole grains, fruits and vegetables, without adding psyllium or other soluble fiber supplements to control blood sugars.

The studies of ginseng and aloe vera are particularly interesting, but further studies evaluating the safety and efficacy of these herbs in people with diabetes are needed.

Finally, the possibility of using biofeedback or other relaxation techniques to manage diabetes is intriguing; perhaps part of the reason for contradictory conclusions in the studies that have been done to date is the small number of subjects in each trial. Further studies with greater numbers of people may answer the question of whether stress reduction treatments offer any benefit in controlling diabetes. But it seems somehow intuitive that relaxation, along with proper diet and exercise, would positively affect diabetes.