Endotext

Endotext

Book. 2000

Authors: De Groot LJ, Beck-Peccoz P, Chrousos G, Dungan K, Grossman A, Hershman JM, Koch C, McLachlan R, New M, Rebar R, Singer F, Vinik A, Weickert MO

Abstract

Clearly, many natural products including botanicals and other nutraceuticals have hypoglycemic, anti-hyperglycemic, insulin sensitizing, anti-hyperlipidemic, anti-hypertensive, and anti-inflammatory activities. There are published studies reporting the anti-diabetic activity of well-over a thousand different botanicals and nutraceuticals. The number of those treatments evaluated in clinical trials is approximately 100 [36]. In the vast major of these trials, the botanicals and nutraceuticals were evaluated as an adjunct to diet and prescription medications. Fifty-eight of the trials were controlled, and conducted in individuals with diabetes or impaired glucose tolerance. Of these, statistically significant treatment effects were reported in 88% of trials (23 of 26) evaluating a single botanical, and 67% of trials (18 of 27) evaluating individual vitamin or mineral supplements (reviewed in [36]). When reported, side effects were few and generally mild (gastrointestinal irritation and nausea). However, many of the studies suffered from design flaws including small (< 10 subjects) sample sizes, heterogeneity of subjects, and short-duration of treatment. Furthermore, there is a lack of multiple studies for many of the individual supplements. Despite the apparent lack of side effects of these treatments, it would be prudent to be aware of the potential for dietary supplements, especially botanicals, to interact with a patient’s prescription medication. One of the most important potential botanical-drug interactions is that of garlic, Trigonella, and Ginkgo biloba with non-steroidal anti-inflammatory drugs (including aspirin) or warfarin, as these botanicals possess limited anti-coagulant activity [102;467]. Another potential interaction of concern is one involving G. biloba, a botanical widely used for the treatment of memory and concentration problems, confusion, depression, anxiety, dizziness, tinnitus, and headache [468;469]. Ingestion of G. biloba extract by patients with T2D may increase the hepatic metabolic clearance rate of not only insulin but also hypoglycemic medications, resulting in reduced insulin-mediated glucose metabolism and elevated blood glucose [470]. Another issue to consider with botanicals is the potential for batch-to-batch variation due to age of the plant, geographic source, time of harvest, and method of drying and preparation, all of which can dramatically impact the purity and potency of active ingredients. None of the agents discussed here is recommended for use in pregnant or lactating women, or in children. Furthermore, patients should be advised on the proper use of any alternative treatment to avoid the risk of hypoglycemia. That being stated, several botanical and nutraceutical agents merit consideration as complimentary approaches for use in patients with T2D. Botanical treatments with the strongest evidence of clinical safety and efficacy include I. batas (caiapo), T. foenum-graecum (fenugreek), and C.cassia (cinnamon). Non-botanical nutraceutical agents with promise for improving insulin sensitivity and glycemic control include α-lipoic acid, chromium picolinate, magnesium, and resveratrol. In addition, there is evidence that α-lipoic acid improves the symptoms of individuals with microvascular complications, especially neuropathy. Clearly, Ώ-3 PUFAs (EPA, DHA, α-linolenic acid) merit strong consideration for lipid lowering, and overall cardiovascular health.

PMID: 25905290