On treating obesity and diabetes with herbal preparations

I am often surprised when I receive advertisements – online - clearly targeting the obese population that offer to reduce weight over a short period of time and without significant diet or exercise. The ads describe some fat altering diet supplement that can be purchased, and there is some urgency to purchase, as the offer is usually time limited. And accompanying the ad there is often a before and after photo over a very short period (weeks) demonstrating a dramatic change in body image. I often wonder who would have such expectation of – weight loss and improvement in body image over such a short period? And what of the complications of obesity that are not obvious in the body image photos? In these ads there is little or no mention of any of the complications associated with obesity such as diabetes rather just the focus on the before and after image.  Should health consequences of being overweight or obese be mentioned in weight loss ads?

Obesity is linked to type II diabetes mellitus (DM).  Data obtained form the NHANES (National Health and Nutrition Examination Survey) collected over a five-year period studied a large population (over twenty-one thousand) with diabetes. Over 80% of patients with DM had a BMI (body mass index – a measure of body fat using height and weight) over 25% placing them in the overweight category, and 50% had BMI of over 30% placing them in the obese category¹.  In obese individuals the body’s production and sensitivity to insulin (the hormone secreted by the pancreas that regulates blood sugar levels – glucose) can be altered and either you don’t produce enough or there may be resistance to insulin.  Even if you take insulin (exogenous) obesity can alter the way the body reacts to it, and if there is resistance to insulin higher levels may be needed to keep the blood glucose level under control. DM related complications are quite serious. They affect every organ in the body. The most well known complications are kidney disease – leading to dialysis, cardiovascular disease – leading to heart attacks and strokes, and the effects on the circulatory system leading to limb loss; these are a few of the most serious complications. Knowing the significance of DM’s consequences it is hard to believe that obesity, which is linked to DM, is not taken as seriously as it should be by those individuals who are obese and at risk for DM?  Lifestyle modification (the foundation of the treatment of obesity) includes diet, and exercise.  And healthcare providers should repeatedly reinforce this to their patients. Lifestyle modifications alone have been documented to significantly reduce weight and reduce the risk of developing diabetes, and if medications are ultimately needed for treatment of DM they should be administered by a knowledgeable healthcare professional in addition to the lifestyle modifications.

Would you attempt to treat DM yourself with herbal medications without the guidance of a healthcare professional? Lately I have been paying attention to online ads that promote the treatment of DM using herbal preparations. I am not sure where the science is that documents the efficacy and safety of these products - I have not found it in peer review journals. But a disease such as DM should be monitored under the supervision of a healthcare professional, and not self treated with online mail order preparations that have not been properly been evaluated by regulatory agencies. At very least these preparations will probably not provide the desired effect and at worst they may even do harm. So please, consult your healthcare professional about these and other alternative medications. If one were to attempt to use a supplement for DM and glucose control (and I am not advocating this) how would you monitor the efficacy of the preparation? This leads into a discussion about monitoring blood glucose levels, and the over all periodic evaluation required when dealing with DM or any other chronic disease.

1- JAMA 2006 April 5, 295 (13) 1549.