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Ryan Bradley, ND, MPH Chalenges NCCAM's Dismissal of Dietary Supplements for People with Diabetes PDF Print E-mail
Written by John Weeks   

Ryan Bradley, ND, MPH Challenges NCCAM's Dismissal of Dietary Supplements for Treatment of People with Diabetes

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Argues zero value in supplements for diabetes
On November 15, 2013, the NIH NCCAM issued a Clinical Digest on Type 2 Diabetes and Dietary Supplements. The conclusions are a one-two knock-out punch against the practices of virtually all integrative practitioners whether these are medical doctors, naturopathic doctors, integrative nurses or any others taking a whole person, natural health and medicine approach. First, the digest concluded: "Overall, there is not enough scientific evidence to show that any dietary supplement can help manage or prevent type 2 diabetes." Then: "There is no strong evidence that any herbal supplement can help to control diabetes or its complications."

What gives? I asked clinician-researcher and whole person care expert for people with diabetes Ryan Bradley, ND, MPH, for his perspective. Bradley is the former director of the Center for Diabetes and Cardiovascular Wellness at Bastyr University and the author of the exceptional whole-practice Adjunctive Naturopathic Care for Type II Diabetes: Patient-Reported and Clinical Outcomes after One Year. Here are Bradley's comments.
____________________________________


Regarding NCCAM's Digest on Dietary Supplements in Treatment of People with Diabetes

"This Announcement by NCCAM about the limitations of dietary supplements for type 2 diabetes demonstrates the overly simplified perspective we have all come to expect from the NIH.

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Ryan Bradley, ND, MPH
"This Announcement by NCCAM about the limitations of dietary supplements for type 2 diabetes is a reductionistic perspective. 

While dietary supplements do not have an essential role in the treatment and management of all patients with type 2 diabetes - provided patients maintain a plant-based diet, exercise daily, and manage their stress - many supplements are useful for the control of certain symptoms of diabetes and can be helpful in the reduction of risk factors.

"The art of practice for practitioners who use dietary supplements, e.g., naturopathic doctors, clinical nutritionists, chiropractors, integrative medicine doctors, etc., is to determine which supplements, or combinations of supplements, are indicated based on that patient's medical history, lifestyle choices, nutritional status, current medical risk, and constellation of symptoms. This is not a process of generalization, but of individualization.


"The commentary on magnesium is an example. The Announcement states: ‘There is no evidence from clinical trials that magnesium is beneficial in managing diabetes in the absence of magnesium deficiency.' The statement downplays the importance of magnesium generally without citing the statistic that 48% of the general US population consumes less than the recommended intake of magnesium in the diet (PMID: 22364157), and deficiency may be as high as 38% in people with diabetes (PMID: 9589224).

   
 "[NIH's] statement downplays the importance
of magnesium generally without citing the
statistic that 48% of the general US population
consumes less than the recommended
intake of magnesium in the diet."


 
"Additionally, the statement that there are no beneficial effects in the absence of magnesium deficiency is not entirely accurate. Mooren and colleagues published a small randomized, placebo-controlled trial demonstrating improvements in blood glucose and insulin sensitivity in participants with diabetes who were not magnesium deficient (PMID: 21205110).

"When we consider the other potential hazards of magnesium deficiency beyond glucose control alone, we learn there are other important reasons to consider magnesium supplements, For example, magnesium deficiency increases risk of depression in people with diabetes (PMID: 17845894), may be associated with lower beta-cell functioning (PMID: 19780401), and increases mortality in critically ill patients with type 2 diabetes (PMID: 19009819). When one takes a more comprehensive view of its potential benefits, and applies an appropriate clinical assessment, supplemental magnesium regains importance in practice- and should not be dismissed as ineffective."


"Decisions regarding the use of dietary supplements should be made by clinicians who are trained in nutritional biochemistry, dietary assessment and clinical nutrition therapy and who have a holistic orientation to health and medical risk assessment. This allows them to move beyond the myopic ideology that diabetes=glucose to the understanding that type 2 diabetes is a multi-system, physical, emotional-and often cognitive- disease resulting from chronically poor nutritional and lifestyle choices - none of which are alleviated by the drugs approved for treating diabetes. 



"Are dietary supplements the solution for diabetes? Absolutely not. But the over 300 million people worldwide with diabetes need safe, practical, long-term solutions that address the causes of the disease. Those solutions are not coming quickly from international food manufacturers, pharma, health insurers, most physicians, or funding agencies, even though it is their responsibility."


Comment: First, kudos to Bradley for speaking his voice directly here on a hot topic issue. The failure of the NIH to begin in earnest to bridge the gap between their drug-induced reductionism and the whole person thinking Bradley represents is an immense barrier to our learning about whether or not supplements may, in fact, be part of the solution for people with diabetes. .

US Senator Harkin and his colleagues directed NCCAM to examine real world complementary and alternative medicine "modalities, systems and disciplines" in Section C of the NCCAM mandate. In a world that is not topsy turvey, in which the NIH does not blows off Congressional intent, significant dollars would be looking at the real world of integrative practice for people with this condition. We would have a chance to see whether the populations of people with diabetes are positively or negatively impacted by using the kind of whole person care that typically includes supplements. Bradley's own
research with Dan Cherkin, PhD and others provides interesting evidence that there may be real value to human health here. This is particular clear when one considers the remarkable impact of this treatment as shown in a follow-up paper from Erica Oberg, ND, MPH, Braley, Cherkin and others published on the patient experience of this form of treatment.

But because NIH is violating the priorities of the mandate, we end up with the usual lose-lose that comes from drug research on supplements. The research doesn't reflect individualized treatment from, as Bradley rightly says, "clinicians who are trained in nutritional biochemistry, dietary assessment and clinical nutrition therapy and who have a holistic orientation to health and medical risk assessment that allows them to move beyond the myopic ideology." Best bet is that the public health suffers from its greater adherence to its own reductionism than examining these in the real-world context of integrative practice. 




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