Sometimes things just fall into your lap. This evening I was working on a different piece, and not getting very far, when an email arrived in my in-box.
You see, when you write for the 21st most influential science blog, you get a lot of unsolicited mail (OK, fine…I get spam in my blog-related inbox. But my spam is cool.)
What’s great about a lot of this spam is that it is usually written by an actual person, and directed at me by name, which means they had to at least glance at the blog. In this case, a “glance” was all, or perhaps the writer simply suffers from poor reading comprehension. My latest correspondent is selling an herbal extract for diabetes. It seems unlikely that she’s read my writing about this particular topic. See, as an internist, I’m very well-trained in the management of diabetes. It’s what I do. And I hate, HATE, people who interfere with the treatment of this very serious disease with a bunch of cult medicine bullshit.
First, a little background (this bit is basically a cut and paste job from an old post, so if it seems familiar, it means you’re a loyal reader).
There are two main variants of diabetes: Type I (juvenile) and Type II. Type II accounts for about 95% of the 20 million cases of diabetes in the U.S. Diabetes is can be a disabling and deadly disease, but not because of the blood sugar fluctuations per se. High blood sugar damages blood vessels, which in turn damages the organs they supply.
We generally divide diabetic complications into two categories: microvascular (small blood vessel), and macrovascular (large blood vessel). For the sake of discussion, I’ll simplify things a bit more.
Microvascular complications include things like kidney failure, blindness, and nervous system damage (such as painful peripheral neuropathy).
Macrovascular complications include the big baddies like amputation, stroke, and heart attacks. Heart disease and stroke account for about 65% of deaths in diabetics.
Prevention of these complications has been the goal of diabetic treatment for years. Large-scale studies of type I and type II diabetics have shown that better control of blood sugar levels reduce the incidence of microvascular complications (DCCT and UKPDS ) . Control of cholesterol and blood pressure have been shown to prevent macrovascular complications in type II diabetes. Studies haven’t yet shown whether or not tight blood sugar control can prevent the biggest killers of diabetics—heart attack and stroke.
In sum, proper, evidence-based treatment of diabetes prevents death and disability. Improper treatment does not, and that’s where I start to get a bit angry (and you wouldn’t like me when I’m angry).
There are about 2.4 gazillion unproven herbal products available to treat diabetes. I find this one interesting for a few reasons, though.
If you look way down at the bottom of the webpage linked above, you’ll see a Quack Miranda Warning. Normally I’d stop right there, but the claims made by the company’s PR hack are so over the top, that I must go on.
According to “Rachel”:
“We are excited to share this news with your readers, as we believe mulberry can help save the lives of the millions of Americans struggling with Type 2 diabetes.”
Well, I’m excited, too. She graciously offered to send me clinical studies, but I have my own MedLine and PubMed access, and their website gives references as well. The study of which they are particularly proud was published in the American Journal of Clinical Nutrition (full citation below). This study of 20 people established that some of these plant extracts may inhibit carbohydrate absorption in the human gut. Another study in Diabetes Care (to which I do not have electronic access) looked at mulberry extracts’ effects on after-meal blood sugar levels.
Here is the real deal.
There are several classes of pharmaceuticals used in the treatment of diabetes (along with non-pharmacologic interventions). One of these classes is the alpha-glucosidase inhibitors (primarily acarbose). Acarbose essentially slows the absorption of sugar derived from ingested carbohydrates. In other words, the mulberry tea functions similarly to acarbose. In studies of acarbose, it had some minimal but significant effect on blood sugar levels. In some studies as many as a quarter of all participants stopped the drug due to severe gas, a symptom that was observed in the mulberry studies as well. Most internists and endocrinologists find these drugs to be of minimal use in treating diabetes.
So, this company is offering you a bottle of an unproven treatment that works very much like a minimally effective drug that is already available.
Cost? A one month supply is forty bucks. This same amount can buy you a four month supply of glyburide, a standard diabetes drug with similar or better efficacy and better tolerability as compared to acarbose.
As usual, they’re selling you something you don’t need, in this case an untested and unregulated version of an already-available drug that most doctors and most patients don’t like.
So, in response to your letter, Rachel, I’m quite happy to share this information with my readers.
Zhong L, Furne JK, Levitt MD. An extract of black, green, and mulberry teas causes malabsorption of carbohydrate but not of triacylglycerol in healthy volunteers. Am J Clin Nutr. 2006 Sep;84(3):551-5.