January 2013 Issue

Diabetes and Complementary Care — More Patients Are Following Alternative Diets to Manage the Disease
By Constance Brown-Riggs, MSEd, RD, CDE, CDN
Today’s Dietitian
Vol. 15 No. 1 P. 18

As diabetes cases continue to soar worldwide, people with the disease are turning more and more to alternative therapies to help manage it. Specifically, in an analysis of data from the 2002 National Health Interview Survey, Bell and colleagues found that more than 72% of people with diabetes use complementary and alternative medicine (CAM) to manage their disease.1 A literature review on the use of CAM among people with diabetes, published in 2007 in the Journal of Advanced Nursing, reported prevalence rates as high as 78%. Moreover, people with diabetes are 1.6 times more likely to use CAM therapies than people without diabetes.2

What Is CAM?
The terms “alternative medicine” and “complementary medicine” often are used interchangeably, but according to the National Center for Complementary and Alternative Medicine, “CAM is a group of diverse medical and healthcare systems, practices, and products that aren’t generally considered to be part of conventional medicine.” Complementary medicine is used with conventional medicine, whereas alternative medicine is used instead of conventional medicine.3

Examples of CAM therapies include herbs, bodywork, special diets, and dietary supplements. Most people with diabetes who use CAM follow diet-based therapies to manage the disease.1

The following are the six most common diet-based therapies people use to treat diabetes more naturally and holistically.

Alkaline Diet
This diet is based on the fact our bodies have a pH of 7.35 to 7.45, which makes them slightly alkaline.4 Proponents of the alkaline diet believe humans evolved on a diet much more alkali forming than diets eaten today. An excess of grains and animal products is believed to cause an acid overload, leading to muscle wasting, kidney stone formation, kidney damage, and the dissolution of bone.4 But Vesanto Melina, MS, RD, coauthor of Becoming Raw: The Essential Guide to Raw Vegan Diets, notes that “all the research has been theoretical.”

The fact is that the body works hard and efficiently on its own to keep the blood at the proper pH. “Our body is capable of adequately maintaining the perfect acid-base balance regardless of what we eat,” says Vandana Sheth, RD, CDE, a spokesperson for the Academy of Nutrition and Dietetics, so there’s no need to alter the diet to try to affect the pH level.

However, Sheth believes the alkaline diet can be a healthful choice for people with diabetes. “An alkaline diet is primarily a vegetarian diet, emphasizing fresh fruits, vegetables, soy, nuts, legumes, and olive oil,” she says.

Food-Combining Diet
The theory behind the food-combining diet is that if protein and starch are eaten simultaneously, the body will wear itself out by producing both alkaline and acidic digestive juices, which nullify both the protein and the starch and impair digestion.4 This diet promotes eating proteins and starches at separate meals. Vegetables can be eaten with both protein and starch, but fruits should be eaten alone. Its proponents say this diet will encourage weight loss and improve digestion. Research supports that a weight loss of 10 to 15 lbs is enough to decrease insulin resistance and improve blood glucose levels in people with diabetes.

However, there’s no scientific evidence stating this diet is beneficial for weight loss or digestion. In fact, “The research is flawed, and some of the ideas are counterproductive,” Melina says. For example, vitamin C in fruit can help increase iron absorption from iron-rich plant foods such as legumes. But according to food-combining guidelines, this combination isn’t permissible. For people with diabetes, this diet is contrary to the American Diabetes Association’s 2012 nutrition recommendations for optimal blood glucose control. Balancing a meal with both protein and carbohydrates promotes fewer carbs at the meal, resulting in more stable blood glucose and insulin levels.

Macrobiotic Diet
This diet incorporates the Asian philosophy that foods are either yin (cooler) or yang (warmer) and that certain health conditions require food that will cool or warm the body. The macrobiotic diet is vegetarian based, consisting mainly of brown rice, whole grains, and vegetables. It has gained popularity among cancer patients who understand it to be an effective way to treat the disease. Currently, there’s no evidence that a macrobiotic diet can prevent or cure cancer.

Researchers are examining whether a macrobiotic diet can prevent and treat diabetes. A study published in the September 2012 issue of the Journal of Nutrition and Metabolism found that a macrobiotic diet could be a successful therapy for type 2 diabetes. The macrobiotic diet is naturally high in fiber, which helps to slow the conversion of starch to glucose, thus keeping the blood glucose level more stable. In fact, participants in this study were able to reduce their insulin by as much as 64%.

Raw Food Diet
Based on unprocessed and uncooked plant foods, the raw food diet consists of fresh fruits and vegetables, sprouts, seeds, nuts, grains, beans, dried fruit, and seaweed. Followers believe that heating a food above 118˚F destroys helpful enzymes in food, but eating food raw or carefully dehydrated increases energy, improves digestion, promotes weight loss, and reduces the risk of chronic illnesses, including diabetes.5

This diet is very restrictive and could cause nutrient deficiencies in calcium, iron, vitamin B12, and protein.5 Contrary to the belief of raw food diet proponents, the enzymes needed for digestion are produced by the pancreas and small intestines.
Research on the raw food diet is under way, but no studies have looked at the diet’s effect on diabetes specifically.

The Maker’s Diet
The Maker’s Diet is based on eating foods that God “intended” for us to eat, such as whole natural foods, including organic meats, fruits, and vegetables. It also encompasses the four pillars of health—physical, spiritual, mental, and emotional—including increasing physical activity, reducing stress, and finding faith.6 The diet claims to improve health and promote weight loss, which will lower the risks of chronic illnesses, including diabetes.

There are many benefits to adopting a lifestyle that will increase physical activity, reduce stress, and help one find faith. This is particularly true when it comes to diabetes, which can be a challenge physically, spiritually, and emotionally.

The diet is broken down into three phases that last a total of 40 days—the first of which allows no carbohydrates. The next two phases slowly reintroduce healthful foods, including whole grains, fruits, and vegetables, and organic meats such as beef and chicken.6

The diet recommends a large number of supplements that Jordan Rubin, the author of the book, happens to sell on his website. Rubin claims the diet is well researched in clinical trials and studies. However, there are no significant peer-reviewed journal articles on the Maker’s Diet.6

Ayurvedic Diet
The Ayurvedic diet, popularized by author Deepak Chopra, MD, is based on a system of medicine that originated in ancient India. It attempts to balance and restore harmony in the body by using diet, yoga, and herbs.

The diet is built on a theory that people are born with unique characteristics based on the combination of “doshas” in the gene structure. The doshas are dynamic forces within the universe, including earth, water, fire, and wind. A person’s chances of developing certain types of diseases are thought to be related to the way doshas are balanced, the state of the physical body, and mental or lifestyle factors.7

Ayurvedic doctors determine which doshas are strongest and which are out of balance, and give a diet prescription that strengthens and balances them. Ayurvedic practitioners claim this diet will bring harmony back to the body and, in doing so, help with weight loss and decrease the likelihood of chronic illnesses, including diabetes.

Ayurvedic treatments rely heavily on herbs and other plants, such as oils and common spices. “Turmeric, holy basil, Coccinia indica, gumar, fenugreek, and jambul powder are commonly used for diabetes,” Sheth says. And there’s evidence suggesting Coccinia indica, holy basil, fenugreek, and Gymnema sylvestre have a glucose-lowering effect.8

Most clinical trials of Ayurvedic approaches have been small and not well done. Therefore, scientific evidence for the effectiveness of Ayurvedic practices varies. More rigorous research is needed to determine which practices are safe and effective.7

Tips for Dietitians
“It’s important for RDs to increase their knowledge and awareness of alternative approaches to diabetes self-management,” Sheth says, as more people with the disease turn to CAM to manage it. This will enable RDs to more effectively counsel their clients. To ensure coordinated and safe care, Sheth encourages RDs to communicate with their clients’ alternative medicine practitioners as well.

— Constance Brown-Riggs, MSEd, RD, CDE, CDN, is the national spokesperson for the Academy of Nutrition and Dietetics, specializing in African American Nutrition, and author of the African American Guide to Living Well With Diabetes and Eating Soulfully and Healthfully With Diabetes.

 

Resources
You don’t need to know everything about complementary and alternative medicine, but you should know where to find credible information. The following resources can help:

Resources for Patients
• National Center for Complementary and Alternative Medicine (NCCAM) (http://nccam.nih.gov)

• NCCAM Time to Talk Tips on Complementary Health Practices (http://nccam.nih.gov/health/tips)

• MedlinePlus (www.nlm.nih.gov/medlineplus)

Federal Resources for Providers
• NCCAM Resources for Health Care Providers (http://nccam.nih.gov/health/providers)

• NCCAM Clinical Digest monthly e-newsletter (http://nccam.nih.gov/health/providers/digest)

• NCCAM Complementary and Alternative Medicine Online Continuing Education Series (http://nccam.nih.gov/training/videolectures)

 

References
1. Bell RA, Suerken CK, Grzywacz JG, Lang W, Quandt SA, Arcury TA. Complementary and alternative medicine use among adults with diabetes in the United States. Altern Ther Health Med. 2006;12(5):16-22.

2. Egede LE, Ye X, Zheng D, Silverstein MD. The prevalence and pattern of complementary and alternative medicine use in individuals with diabetes. Diabetes Care. 2002;25(2):324-329.

3. Complementary and alternative medical therapies for diabetes. National Diabetes Information Clearinghouse website. http://diabetes.niddk.nih.gov/dm/pubs/alternativetherapies. Last updated January 24, 2012. Accessed November 18, 2012.

4. Davis B, Melina V, Berry R. Becoming Raw: The Essential Guide to Raw Vegan Diets. Summertown, TN: Book Publishing Co; 2010: 176-178.

5. Raw food diet. WebMD website. http://www.webmd.com/food-recipes/guide/raw-food-diet. Reviewed February 20, 2010. Accessed November 11, 2012.
6. Longe JL. The Gale Encyclopedia of Diets: A Guide to Health and Nutrition. Farmington Hills, MI: Gale; 2007: 643-646.

7. Ayurvedic medicine: an introduction. National Center for Complementary and Alternative Medicine website. http://nccam.nih.gov/health/ayurveda/introduction.htm. Last updated July 2009. Accessed November 11, 2012.

8. Hardy ML, Coulter I, Venuturupalli S, et al. Ayurvedic interventions for diabetes mellitus: a systematic review. Evid Rep Technol Assess (Summ). 2001;(41):2p.