UNDERSTANDING END-STAGE KIDNEY DISEASE

Jun 7, 2018 | News

UNDERSTANDING END-STAGE KIDNEY DISEASE

What Can You Expect in the Final Stages of Kidney Failure?

By Angela Morrow, RN 

End-stage kidney disease is the final stage of chronic kidney disease. At this last stage, the kidneys are unable to work on their own, which means that a person either needs dialysis or a kidney transplant to stay alive. While a transplant is an ideal choice as it offers a cure, not everyone is a candidate for this surgery.

Even so, it’s critical to note that most people with chronic kidney disease do not end up needing dialysis.

This is because, with early care, a person can usually slow down the disease.

If you or a loved one are in the final stages of kidney disease, what can you expect, and what is it like to die from renal failure?

Definition of Chronic Kidney Disease

Your kidneys filter waste and water out of your bloodstream. When your kidney function declines, waste accumulates in the body, and this waste buildup can eventually lead to symptoms like severe nausea and vomiting, loss of appetite, and feeling sick and weak overall.

A loss of normal kidney function may occur suddenly (called acute kidney disease) or over a period of three or more months (called chronic kidney disease). Acute kidney disease has the potential to reverse itself. But in chronic kidney disease, kidney function gradually worsens with time.

There are five stages of chronic kidney disease, with the fifth stage representing end-stage kidney disease.

In other words, without a lifesaving measure like dialysis or a kidney transplant, a person would die within a week or so.

It’s important to note that a person’s kidney function tends to slowly get worse, although the rate at which kidney function declines and transitions from one stage to the next depends on many factors (for example, the underlying health condition that caused the kidney disease in the first place).

It can take many years or decades for renal failure to progress to the final stage of the disease.

Causes 

There are many different causes of chronic kidney disease; the two most common are diabetes and high blood pressure. 

Other causes include:

• Lupus (systemic lupus erythematosus)
• Nephrotic syndrome
• Polycystic kidney disease
• Repeated urinary tract infections
• Prolonged blockage of the urinary tract (for example, from a tumour or an enlarged prostate gland in men)

It’s important for a doctor to diagnose the “why” behind your kidney disease because he may be able to slow your disease down. For example, if high blood pressure is the culprit, then your doctor may be more aggressive with monitoring your blood pressure and keeping it within a normal range. Likewise, careful management of your blood sugars if you are diabetic, may slow the decline of your kidneys.

Diagnosis 

There are a number of tests that a doctor may perform to properly diagnosis your chronic kidney disease, and some of these tests (for example, blood tests) will be repeated many times, even as you progress to the final stage.

Examples of tests that your doctor will perform to diagnosis and monitor your kidney function include:

• Blood tests that measure your kidney function (for example, BUN and creatinine level) and electrolyte levels (for example, your potassium level)

• Urine tests
• Ultrasound of your kidney
• Biopsy of your kidney (a procedure in which a small tissue sample is taken of your kidney and examined under a microscope)
• CT scan of your kidneys

Your doctor will also want to determine your glomerular filtration rate (GFR). This number allows your doctor to best understand your kidney function and determine the stage of your disease. The GFR is easily calculated using your blood creatinine level, age, gender, and race.

While some of these tests are initially ordered by an internist or family medicine doctor, a person with chronic kidney disease is eventually referred to a kidney specialist called a nephrologist, especially as he progresses to later stages.

In fact, studies have found that those who are referred to a nephrologist often live longer than those who do not see a specialist.

A nephrologist can follow your kidney function carefully and discuss a treatment plan with you if your kidneys fail. She can also monitor any complications that arise as a result of your kidney disease, such as anaemia or bone disease.

Symptoms 

Just as the progression of chronic kidney disease is variable, so are the associated symptoms. In addition, the timing at which a person begins to experience symptoms of his or her kidney disease is not cut and dry. In fact, many people feel relatively OK until their disease is advanced. This is one reason to see your doctor regularly for blood tests.

Some of the symptoms a person may experience in chronic kidney disease, especially as it advances towards the final stage, include:

Loss of Energy 

The first thing you might notice is feeling more sleepy or tired than usual. Your sleeping patterns might change. You might sleep more during the day or have difficulty sleeping at night. The fatigue associated with kidney failure is different than ordinary tiredness. You may feel tired despite a good night of sleep or a cup of coffee.

Mental Changes

You might notice mild confusion or problems concentrating early on that might progress to disorientation, anxiety, irritability, or even delirium. When a person develops severe waste buildup from kidney failure, seizures and coma may occur.

Abnormal Sensations

Restless legs, burning feet, or other sensory problems may develop as a result of a significant waste buildup in the body. In fact, when this happens, it can be a sign that dialysis is urgently needed.

Muscle Changes

As minerals build up in the blood, you might notice muscle twitching or cramps, especially at night.

Skin Changes

The build-up of a chemical called urea in the blood may cause your skin to itch, and you might even develop a fine white powder on your skin. Itching can usually be controlled with topical creams or antihistamines, such as Benadryl (diphenhydramine).

Appetite and Weight Changes

Your appetite will decrease, and you might lose weight. Alternatively, you might gain weight as your body retains extra fluid.

If you are not producing much urine but still drinking fluids, you might notice that your feet, legs, and ankles swell, which is called edema.

Malnutrition in chronic kidney disease is a major problem, which is why people will often follow a special diet to optimize their nutritional status.

Changes in Urination

You might pass little or no urine at all. If this is the case for you, limiting the amount of fluid you drink might improve your comfort level by decreasing the amount of excess fluid in your body.

Others may experience changes in their pattern of urination like urinating more, losing control of their urine (called incontinence), or developing more urinary tract infections.

Sexual Dysfunction

Women often develop menstrual and fertility problems in chronic kidney disease whereas men develop erectile dysfunction. In addition, most women who reach end-stage kidney disease stop having periods.

Breathing Changes

The build-up of acids in the blood might cause changes in breathing, such as breathing faster and more shallow, but these changes are generally not uncomfortable. However, fluid can build up in the lungs and chest wall causing shortness of breath and chest pain.

Other Changes

There are other health issues associated with chronic kidney diseases such as a low blood count, low platelets (which help clot your blood and can lead to easy bruising), bone problems, malnutrition, fluid shifts, and electrolyte abnormalities. Breath odor, vomiting, and challenging hiccups may also occur.

Treatment

Treatment of your chronic kidney disease depends on the functioning of your individual kidneys. For instance, a person in a lower stage of chronic kidney disease may be able to take a diuretic to urinate out excess fluid. On the other hand, a person with end-stage kidney disease who makes no urine needs dialysis to remove excess fluid from the body.

Your doctor will also treat any complications related to your kidney disease. For example, you may need medication for anaemia or a drug to prevent bone loss.

Final Stages of Kidney Disease for Loved Ones

People can sometimes live many years with the help of dialysis. Yet, without dialysis, or if a person chooses to forego dialysis, death often occurs within a few weeks. As toxins build up in the blood (which is called uraemia), a person will begin to sleep most of the day. She may see things that aren’t there, or talk about speaking with people who have died in the past. Her skin may become mottled, and she will lose all sense of hunger. The sense of thirst may also disappear, although kidney failure can often cause excessive thirst. As she gets closer to death, she may become very congested and develop irregular breathing (Cheyne-Stokes respiration). These symptoms may be very uncomfortable for loved ones, but do not appear to be uncomfortable for the person who is dying. As she nears death, she will probably slip into a coma. At this time, simply spending time with her is important. We’ve learned that the sense of hearing is the last sense to leave, so talking to her may be a great comfort.

When compared to people dying from cancer, those dying from end-stage kidney disease were found to have higher rates of hospitalization and fewer end of life instructions. It’s thought that people with stage 5 kidney disease could benefit from better palliative care and planning at the end of life. If your loved one is facing these last stages, talk to her doctor about palliative care and options such as hospice care.

A Word From Verywell

If you have chronic kidney disease, you may experience anxiety thinking about the future. Remain resilient and continue to work closely with your doctor. Careful monitoring and early detection of kidney disease are paramount in protecting your kidneys.

If you have end-stage kidney disease and are on dialysis or very close to starting dialysis, please be sure to discuss all your questions, worries, expectations, and goals of care with your doctor.

Whether you choose to have dialysis, or if not, talk to your doctor about palliative care. For people with cancer, this is often built into clinic visits, and a careful plan is made. With kidney failure, you may need to initiate this discussion to receive the best treatment and have the best quality of life with however much time you have left.

Sources:

National Institute of Diabetes and Digestive and Kidney Diseases. What is Chronic Kidney Disease? https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/what-is-chronic-kidney-disease

Raghavan, D., and J. Holley. Conservative Care of the Elderly CKD Patient: A Practical Guide. Advances in Chronic Kidney Disease. 2016. 23(1):51-6.

Rosenberg, M. Overview of the Management of Chronic Kidney Disease in Adults.UpToDate. Updated 12/06/17.

Wachterman, M., Lipsitz, S., Lorenz, K., et al. End-of-Life Experience of Older Adults Dying of End-Stage Renal Disease: A Comparison With Cancer. Journal of Pain and Symptom Management. 2017. 54(6):789-797.

https://www.verywell.com/what-is-lupus-2249968https://www.verywell.com/what-is-lupus-2249968

HOW DO PHYSICIANS TEST YOUR KIDNEY FUNCTION?

Jun 7, 2018 | News

HOW DO PHYSICIANS TEST YOUR KIDNEY FUNCTION?

By Veeraish Chauhan, MD

A common misconception that people often have is equating urine output to kidney function. Hence, the assumption is that if you are “making urine,” your kidneys are working just fine. However, nothing is further from the truth, and assessing the function of your kidneys requires lab testing and sometimes radiological imaging.

Most people know that getting a stress test is a way to test your heart’s function.

But how do you test your kidney function? You might have heard doctors mention words like “creatinine” or “GFR” when checking how good or bad your kidneys are doing. Although there are a lot of methods by which the kidneys’ performance can be measured, I will explain the ones that are used most often in a clinical setting.

Broadly speaking, you could check kidney function through either:

(1) Blood tests

(2) Urine tests

(3) Radiological imaging

Blood Tests

This is the most common and usually the most reliable method. Doctors will often order tests that could be variously worded like “basic metabolic panel (BMP),” “chem 7,” “renal function panel,” “GFR,” etc. Essentially, what they are measuring is the levels of electrolytes and two other chemicals called blood urea nitrogen (BUN) and creatinine.

BUN measures the amount of nitrogen present in your blood in the form of urea, hence the name BUN! In other words, what we are measuring is the urea level in the blood.

Urea, as you might know, is a nitrogen-containing compound present in the urine of mammals and often used as a fertilizer. Before you conclude that there is fertilizer flowing in your blood, let me make emphasize that industrial grade urea that is used in fertilizers is manufactured artificially. In fact, urea was the first “organic“ (that is, found in nature in living organisms) compound that was artificially synthesized in a laboratory when German scientist Friedrich Wohler synthesized ammonium cyanate in 1828.

BUN: An Imperfect Test

So why do we measure the urea level in the blood? That is because the blood urea level, (or BUN!) depends on the balance between processes that increase its blood level vs. the processes that decrease its blood level. Factors that increase the level of urea in the blood include dietary protein intake, the ability of your liver to synthesize urea, and the rate of normal cell breakdown (medically referred to as “catabolism”) that also leads to urea production. Finally, the process that decreases the urea level in the blood is your kidney’s ability to excrete urea in the urine.

Assuming that the factors that increase urea level stay constant on a day to day basis, you could argue that the urea level in the blood would be most dependent on your kidneys’ functioning. Hence, kidney disease could be detected by an increase in the blood level of urea, or BUN. However, please bear in mind that this is a simplistic explanation, and the BUN levels, as you might have guessed, could be influenced by diet, catabolism, and the liver function.

Creatinine Is a Better Alternative

You thus don’t need to be a medical professional to realize that BUN is but an utterly imperfect test of kidneys’ function, subject to the vagaries of a multitude of other non-renal factors.

So let’s talk about the other chemical I mentioned above: creatinine.

The word “creatinine” comes from the Greek word for flesh, and it is a product of muscle breakdown. Since your muscle mass does not change on a daily basis, the rate of creatinine production is also fairly constant. As creatinine level in the blood builds up (from muscle breakdown), the kidneys do a great job of filtering it out of your system. (A very small, and usually insignificant (unlike urea!) amount of creatinine is reabsorbed by the kidneys, which could technically influence its blood level, but for simplicity, let’s disregard that for now).

Hence, assuming a steady muscle mass, the level of creatinine in the blood should only be influenced by the kidney’s ability to filter it out. Therefore, increase in blood level of creatinine usually implies worse kidney function.

The blood’s creatinine level is hence a useful piece of data that can help physicians estimate the rate at which kidneys filter blood using validated formulas and equations (that we obviously don’t need to worry about here). That rate is referred to as Glomerular Filtration Rate or GFR; a term you might hear physicians throw around a lot when talking about your kidney function. For most average sized people, a normal GFR would lie between 60 to 120 ml/min.

Normal Is Normal for Normal People!

GFR estimation is based on a formula that was designed for average sized normal people. Since the calculation depends on the blood creatinine level, which in turn depends on the muscle mass, it may not be applicable in people in extremes of age (kids, people over 70 yrs.), or muscle mass (people with muscle wasting, liver failure, etc). In other words, a creatinine level of 1.2 (considered “normal” as per most lab ranges) might be ok for a muscular person like Arnold Schwarzenegger but could reflect significant kidney disease in a 90-year-old woman. Just like the BUN level, a medical professional should be able to tell when to consider creatinine and GFR levels really abnormal.

Urine Tests

Testing the urine to look for protein or blood, and its chemical composition may help in indicating the presence of kidney disease. Protein or blood should usually not be detectable in urine and are non-specific markers of kidney disease. A physician should determine whether further specific workup and/or a referral to a nephrologist is warranted.

Radiological Imaging

These techniques entail taking pictures of the kidneys using different methods like ultrasound, CT scan, or MRI. This can help in determining the shape and size of the kidneys. The kidneys are smooth bean-shaped organs approximately 8-14 cm (3-5.5 inches) in size (depending on the person’s size). Most chronic kidney diseases, with some exceptions, tend to distort the kidneys’ architecture and this can be picked up easily on imaging. One might also be able to pick specific causes of kidney disease/dysfunction like stones, obstructions, hydronephrosis, polycystic kidney disease, etc.

Source:

Hall JE, Guyton AC. (2011). Guyton and Hall textbook of medical physiology. Philadelphia, PA: Saunders Elsevier.

EARLY TIME-RESTRICTED FEEDING IMPROVES BLOOD SUGAR CONTROL AND BLOOD PRESSURE, STUDY SHOWS

Jun 6, 2018 | News

EARLY TIME-RESTRICTED FEEDING IMPROVES BLOOD SUGAR CONTROL AND BLOOD PRESSURE,S TUDY SHOW

A new pilot study conducted by UAB Department of Nutrition Sciences Assistant Professor Courtney Peterson, Ph.D., shows that eating early in the daytime and fasting for the rest of the day improves blood sugar control, blood pressure and oxidative stress, even when people don’t change what they eat.

“We know intermittent fasting improves metabolism and health,” Peterson said. “However, we didn’t know whether these effects are simply because people ate less and lost weight.”

Peterson and her colleagues decided to conduct the first highly controlled study to determine whether the benefits of intermittent fasting are due solely to eating less. The study was also the first to test a form of intermittent fasting called early time-restricted feeding (eTRF) in humans. eTRF involves combining time-restricted feeding -; a form of intermittent fasting wherein people eat in a 10-hour or shorter period each day -; with eating early in the day to be in alignment with the body’s circadian rhythms in metabolism; it is tantamount to eating dinner in the mid-afternoon and then fasting for the rest of the day.

In the study, eight men with prediabetes tried following eTRF and eating at typical American meal times for five weeks each. On the eTRF schedule, the men each started breakfast between 6:30-8:30 each morning, finished eating six hours later, and then fasted for the rest of the day -; about 18 hours. Everyone finished dinner no later than 3 p.m. By contrast, on the typical American schedule, they ate their meals spread across a 12-hour period. The men ate the exact same foods on each schedule, and the researchers carefully monitored the men to make sure they ate at the correct times and ate only the food that the researchers gave them.

Peterson and colleagues found that eTRF improved insulin sensitivity, which reflects how quickly cells can take up blood sugar, and it also improved their pancreases’ ability to respond to rising blood sugar levels. The researchers also found that eTRF dramatically lowered the men’s blood pressure, as well as their oxidative stress levels and their appetite levels in the evening.

Peterson and colleagues’ research is important because it shows for the first time in humans that the benefits of intermittent fasting are not due solely to eating less; practicing intermittent fasting has intrinsic benefits regardless of what you eat. Also, it shows that eating early in the day may be a particularly beneficial form of intermittent fasting. Peterson hopes the research will also raise awareness of the role of the body’s internal biological clock -; called the circadian system -; in health.

“Our data also indicate that our feeding regimen has to be synchronized with the circadian rhythm and our biological clock,” said Eric Ravussin, Ph.D., director of the Nutrition Obesity Research Center at the Pennington Biomedical Research Center.

Ravussin served as a collaborator with Peterson on the study.

“If you eat late at night, it’s bad for your metabolism,” Peterson said. “Our bodies are optimized to do certain things at certain times of the day, and eating in sync with our circadian rhythms seem to improve our health in multiple ways. For instance, our body’s ability to keep our blood sugar under control is better in the morning than it is in the afternoon and evening, so it makes sense to eat most of our food in the morning and early afternoon.”

Peterson notes that her research sheds light on why intermittent fasting approaches that limit eating to the late afternoon and evening may have failed to find any benefits.

These findings could lead to better ways to help prevent Type 2 diabetes and hypertension. In light of these promising results, Peterson says more research is needed on intermittent fasting and meal timing to find out how they affect health and to figure out what types of approaches are achievable for most people.

Source:

https://www.uab.edu/news/research/item/9433-etrf-improves-blood-sugar-control-and-blood-pressure-pilot-study-says

NUS RESEARCHERS FIND NOVEL PATHWAY TO REGULATE BLOOD PRESSURE

Jun 6, 2018 | News

NUS RESEARCHERS FIND NOVEL PATHWAY TO REGULATE BLOOD PRESSURE

New and better ways to fight hypertension and low blood pressure may be in the offing, thanks to the National University of Singapore scientists’ discovery of how our blood pressure is controlled.

The finding by the multidisciplinary team from the NUS Yong Loo Lin School of Medicine (NUS Medicine) was published online in the April 2018 issue of Circulation, a leading journal in the cardiovascular field. The team showed that Galectin-1, a protein in our body, influences the function of another protein known as L-type (CaV1.2) calcium channel found in the arteries that normally acts to contract the blood vessels. By reducing the activity of these calcium channels, Galectin-1 is able to lower blood pressure.

This project was led by Professor Soong Tuck Wah from the Department of Physiology together with Dr Hu Zhenyu, the lead author of the study. It takes medical science a step closer toward fighting cardiovascular disorders, which are serious global healthcare issues.

Hypertension – a silent killer

Hypertension is a common problem in Singapore and worldwide. About one in four Singapore residents aged 30 to 69 years have hypertension. Importantly, age is a major risk factor for the development of hypertension. Notably, in the 60 to 69 years age group, more than one in two persons in Singapore have hypertension.

According to the World Health Organization, elevated blood pressure is estimated to cause 7.5 million deaths globally, which represents more than 12 percent of all deaths. This is because hypertension is associated with major killers like coronary heart diseases and stroke. In addition, hypertension can also cause renal impairment, retinal hemorrhage, and visual impairment.

Fighting hypertension – the next wave

As hypertension is a common denominator to many serious conditions described above, nipping the problem at its bud will significantly improve our health.

Although patients with Stage I hypertension are mostly recommended to make lifestyle changes to reduce the risks of suffering other cardiovascular diseases, those with Stage 2 hypertension or above have to take anti-hypertensive medicines to control blood pressure.

Calcium channel blockers (CCB) are traditionally used in the clinics to lower blood pressure, but the use of such medications has been associated with increased risk for heart failure in hypertensive patients, particularly those with heart problems, due to their bad side effects.1 Therefore, the development of drugs that could adjust the activity of the L-type (CaV1.2) calcium channel, rather than blocking its normal function altogether, has emerged as a novel research direction for anti-hypertensive therapeutics. The discovery that Galectin-1 can perform such a desired function represents a pathway to control blood pressure

Galectin-1 reduces the activity of L-type (CaV1.2) calcium channels by blocking their insertion in the cell membrane. The good news is that Galectin-1 only targets this specific type of calcium channel in the blood vessels. It spares other types of calcium channels that are important for the general functions of our body.

“Because Galectin-1 is predominantly found in our blood vessels and because of its selectivity for the Cav1.2 channels, Galectin-1-specific drugs designed to lower our blood pressure are predicted to have minimal side effects,” explained Prof Soong, the lead investigator of the study.

“Currently, calcium channel blockers (CCB) are the most popular class of drugs used to treat high blood pressure because of their good side effect profile and their efficacy. However, many patients are troubled by side effects like leg swelling. Galectin-1-specific drugs have the potential for improved control with fewer side effects,” said A/Prof James Yip, Senior Consultant, Department of Cardiology at the National University Heart Centre, Singapore.

Added Professor Vernon Oh, Department of Medicine, NUS Medicine, “The reported effects of Galectin-1 protein, and of its analogs, on the blood pressure in various models of human arteries and the circulatory system are encouraging. The results suggest that there is a reasonable likelihood of fabricating an antihypertensive treatment-molecule, based on Galectin-1, which will consistently suppress, without negating, the v1.2 calcium channel in human impedance (resistance) arteries, so lowering the blood pressure in persons with pulmonary hypertension. The results from human pulmonary arteries suggest that the candidate treatment-molecule might also be useful in the condition known as pulmonary arterial hypertension, for which highly cost-effective drugs are lacking.” Prof Oh is also a senior consultant at the Division of Advanced Internal Medicine, National University Health System (NUHS).

Conversely, the team also found that interrupting the interaction of Galectin-1 and the L-type calcium channels could raise blood pressure. This finding could lead to new treatments for conditions in which blood pressure is too low, such as sepsis.

Source:

http://nusmedicine.nus.edu.sg/medias/news-info/1810-nus-scientists-discover-a-new-way-to-control-blood-pressure

NATURAL REMEDIES FOR TYPE 2 DIABETES

Jun 6, 2018 | News

NATURAL REMEDIES FOR TYPE 2 DIABETES

Reviewed by Sabrina Felson, MD

From supplements to guided meditation, your diabetes treatment could include traditional medicines, alternative therapies, and natural remedies, too.

The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, defines complementary and alternative medicine as a “group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.” Complementary medicine is used with conventional treatments, whereas alternative medicine is used instead of conventional medicine.

Although some may be effective, others aren’t or can even be harmful. If you want to try complementary or alternative medicine, talk to your doctor about the pros and cons and what may be a good idea for you.

Alternative Treatments

Acupuncture is a procedure where a practitioner inserts very thin needles into specific points on your skin. Some scientists say that acupuncture triggers the release of the body’s natural painkillers. Acupuncture has been shown to offer relief from chronic pain and is sometimes used by people with neuropathy, the painful nerve damage that can happen with diabetes.

Biofeedback is a technique that helps you become more aware of — and learn to deal with — your body’s response to pain. This therapy emphasizes relaxation and stress-reduction techniques.

Guided imagery is a relaxation technique that some professionals who use biofeedback also practice. With guided imagery, you’ll think of peaceful mental images, such as ocean waves, or perhaps images of controlling or curing your disease. People using this technique say these positive images can ease their condition.

Natural Dietary Supplements

The benefit of taking  chromium has been studied and debated for several years. You need the mineral to make glucose tolerance factor, which helps insulin work better. Several studies suggest that chromium supplements may improve diabetes control, but we don’t have enough information to recommend it to treat diabetes yet.

Several types of plants are referred to as ginseng, but most studies have used American ginseng. They’ve shown some sugar-lowering effects in fasting and after-meal blood sugar levels, as well as in A1c results (average blood sugar levels over a 3-month period). But we need larger and more long-term studies. Researchers also found that the amount of sugar-lowering compound in ginseng plants varies widely.

Although the relationship between magnesium and diabetes has been studied for decades, we still don’t fully understand it. Low magnesium may worsen blood sugar control in type 2 diabetes. Scientists say that it interrupts insulin secretion in the pancreas and builds insulin resistance in the body’s tissues. And evidence suggests that a magnesium deficiency may contribute to some diabetes complications. People who get more magnesium in their diet (by eating whole grains, nuts, and green leafy vegetables) have a lower risk of type 2 diabetes.

Vanadium is a compound found in tiny amounts in plants and animals. Early studies showed that vanadium normalized blood sugar levels in animals with type 1 and type 2 diabetes. When people with diabetes were given vanadium, they had a modest increase in insulin sensitivity and were able to lower their need for insulin. Researchers want to understand how vanadium works in the body, find potential side effects and set safe dosages.

Coenzyme Q10, often referred to as CoQ10 (other names include ubiquinone and ubiquinol), is a vitamin-like substance that’s in meats and seafood. CoQ10 helps cells make energy and acts as an antioxidant. But it hasn’t been shown to affect blood sugar control.

Plant Foods

Most plant foods are rich in fiber, vitamins, and minerals. People with type 2 diabetes may focus on:

• Brewer’s yeast
• Buckwheat
• Broccoli and other related greens
• Cinnamon
• Cloves
• Coffee
• Okra
• Leafy greens
• Fenugreek seeds
• Sage

Some studies show that certain plant foods may help your body fight inflammation and use insulin, a hormone that controls blood sugar. Cinnamon extracts can improve sugar metabolism, triggering insulin release, which also boosts cholesterol metabolism. Clove oil extracts (eugenol) have been found to help insulin work and to lower glucose, total cholesterol, LDL, and triglycerides. An unidentified compound in coffee (not caffeine) may enhance insulin sensitivity and lower the chances of developing type 2 diabetes.

The scientific evidence thus far doesn’t support the role of garlic, ginger, ginseng, hawthorn, or nettle for blood sugar control in people with diabetes.

If you’re considering eating or using any plant-based remedies, talk to your doctor first.

Weight Control: Are Herbs Safe?

Since being overweight and having diabetes are linked, many people with diabetes turn to natural alternative therapies that claim to help with weight loss, including:

• Chitosan
• Garcinia cambogia (hydroxycitric acid)
• Chromium
• Pyruvate
• Germander
• Momordica charantia (Chinese bitter melon)
• Sauropus androgynus (sweet leaf bush)
• Aristolochic acid

There is also skin patch (transdermal) systems as well as oral sprays that supposedly curb your appetite and make it easier to lose weight. (One patch system uses homeopathic amounts of 29 different compounds to reduce appetite!)

What’s the bottom line? Check with your doctor, because many of these so-called “obesity remedies” haven’t been studied, aren’t effective, or just aren’t safe.

In 2003, ephedrine — also known as ma huang — became the first herbal stimulant ever banned by the FDA. It was a popular component of over-the-counter weight loss drugs. Ephedrine had some benefits, but it could cause far more harm, especially in high doses: insomnia (difficulty falling and staying asleep), high blood pressure, glaucoma, and urinary retention. This herbal supplement has also been associated with numerous cases of stroke.

Chitosan comes from seashells and can bind to fat to prevent absorption. Studies thus far haven’t been encouraging for weight loss though.

Germander, Momordica charantia, Sauropus androgynus, and aristolochic acid have been linked with liver disease, pulmonary disease, and kidney disease.

A survey of herbal preparations for obesity found that many had lead or arsenic and other toxic metals. Some also had other ingredients that weren’t included on the label. And sometimes, the wrong plant was listed.

What to Consider

You should talk to your doctor about any drugs, herbal products, or alternative and complementary treatments to make sure they’re not going to interfere with your treatment or cause other problems.

Beware of claims that seem too good to be true. Look for scientific-based sources of information. The National Diabetes Information Clearinghouse collects resource information for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Reference Collection, a service of the National Institutes of Health. To learn more about alternative therapies for diabetes treatment, contact the National Center for Complementary and Alternative Medicine Clearinghouse.

Select brands of natural products carefully — “natural” doesn’t automatically mean it’s good for you. Avoid products made with more than one herb. Read labels: Look for the herb’s common and scientific name, the name and address of the manufacturer, a batch and lot number, expiration date, dosage guidelines, and potential side effects.

Stop taking the product and call your doctor right away if you:

• Feel queasy or throw up
• Have a fast heartbeat
• Feel more anxious, worried, or unsettled than usual
• Can’t sleep
• Get diarrhea
• Get skin rashes

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