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Ryan Bradley, ND, MPH Chalenges NCCAM's Dismissal of Dietary Supplements for People with Diabetes |
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Written by John Weeks
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Ryan Bradley, ND, MPH Challenges NCCAM's Dismissal of Dietary Supplements for Treatment of People with Diabetes
 Argues zero value in supplements for diabetes
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.
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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.
 Ryan Bradley, ND, MPH
"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).
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"[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."
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"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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