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Expert: herbs, lifestyle changes can be effective in diabetes.

SAN DIEGO -- Use of natural herbs along with a holistic approach of diet, exercise, stress management, and a variety of nutritional supplements should serve as frontline treatment for diabetes whenever possible, according to a specialist in the practice of complementary and alternative medicine.

Dr. Edward Linkner, a founding member of the American Board of Integrative Holistic Medicine and current member of their board of directors, addressed a meeting sponsored by the Scripps Center for Integrative Medicine and the American Board of Integrative Holistic Medicine.

Although Dr. Linkner, who practices in Ann Arbor, Mich., prescribes diabetes medications for his patients with the disease, he said he does so reluctantly because the available drugs on the market "can't correct the underlying nutrient deficiencies."

Diabetes drugs "treat numbers such as high lipids, glucose, or blood pressure; some may not treat the insulin resistance," he added. "Then there are side effects. For example, metformin will decrease folic acid and vitamin [B.sub.12] and increase homocysteine levels."

Similarly, herbs need to be used with caution by patients who are already on prescription medications, Dr. Linkner noted, because they may lower glucose and possibly cause hypoglycemia in combination. His list of recommendations includes:

* Ginseng. Taking 1-3 g 40 minutes before a meal "will lower postprandial glucose levels," Dr. Linkner said. It may also slow digestion and absorption of carbohydrates, "and it helps mood and helps people lose weight." He cautioned that ginseng may inhibit the effect of warfarin in patients.

* Bitter melon (Memordica charantia). Native to Asia, Africa, and South America, this herb contains polypeptide-p, which resembles insulin. It can reduce insulin resistance by increasing glucose transport proteins in muscle. The recommended dose is 5-15 mL of tincture or 100-200 mg caps of standardized extract t.i.d.

* Gurmar (Gymnema sylvestre). Native to the forests of India, this herb increases the production of endogenous insulin from the beta cells and may decrease glucose absorption in the gut. It may not help insulin resistance, however.

The recommended dose is 400-600 mg/day of extract. "Don't dissolve it in the mouth, because it may decrease the sense of taste for sweet foods," he warned.

* Fenugreek (Trigonella foenum-graecum). Widely used in India, the defatted seed of this herb contains trigonelline, nicotinic acid, and coumarin. It has been found to lower glucose, total cholesterol, and triglycerides (J. Assoc. Physicians India 2001;49:1057-61).

"It also increases HDL cholesterol," noted Dr. Linkner.

About 50% of the seed is fiber. The dose is 10-100 g powder daily in divided doses.

* Garlic. This herb is believed to lower glucose by competing for insulin sites in the liver and therefore increasing free insulin. The recommended dose is 4 g of fresh garlic per day or 200-400 mg/day in capsule form.

* Salacia reticulata. In a double-blind, randomized, placebo-controlled trial in the treatment of patients with type 2 diabetes mellitus, a statistically significant drop in hemoglobin [] was seen in study participants who took an herbal preparation containing Salacia reticulata, compared with a rise on hemoglobin [] in those who took placebo (J. Ethnopharmacol. 2005;97:215-8).

* Berberine. Results from murine studies indicate that this purified plant extract can reduce body weight and improve glucose intolerance, possibly by stimulating AMP-activated protein kinase activity (Diabetes 2006; 55:2256-64).

The recommended dose is up to 400 mg daily.

Other natural substances that have been found to benefit patients with diabetes include green tea extract, bilberry, aloe vera juice, saltbush, biotin, silymarin, pterocarpus marsupium, and cinnamon.

Dr. Linkner, who also is affiliated with the University of Michigan, Ann Arbor, stated that he had no relevant financial conflicts of interest to disclose.


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Title Annotation:CLINICAL ROUNDS
Author:Brunk, Doug
Publication:OB GYN News
Date:Jan 15, 2009
Previous Article:Patient history drives metformin efficacy in IGT: lifestyle changes and metformin were equally effective in women with a history of GDM.
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