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People with diabetes are taking steps to enhance their lives and feel better using complementary therapies in conjunction with their prescribed medical treatments. Practicing complementary therapy is a way of integrating non-western treatments with conventional medicine.
"I generally prefer 'complementary' medicine to 'alternative' because it implies an integration and synergy, a mainstreaming, with conventional western medicine," says Gary Arsham, MD, PhD, California Pacific Medical Center.
An article in Time, Fall 1996, reports, "A third of adult Americans, most of whom consult medical doctors as well, spend an estimated $13.7 billion a year out of their own pocket on a bewildering array of breakaway treatments including... naturopathy, guided imagery and Shiatsu massage."
Some health management organizations have recognized the increase in the popularity of complementary therapies and are beginning to give people what they want.
Oxford Health Plans, Inc., the first major health provider in the country to offer coverage of alternative medicine at pre-negotiated rates, is one HMO participating in this movement. For an additional two to three percent on top of the premium costs, Oxford offers insured coverage on their network of alternative medicines: acupuncturists, massage therapists, chiropractors, registered dietitians, clinical nutritionists, yoga instructors and, in Connecticut, naturopathic physicians. According to The Wall Street Journal, in addition to Oxford's existing network of 33,000 traditional doctors, they are establishing a network of 1,000 new holistic providers.
Health Maintenance Organizations and Alternative Medicine: A Closer Look, a survey conducted in 1995 by Sheri Chow at Landmark Healthcare, takes a look at HMOs and their opinions on alternative medicine. Out of the 156 HMOs surveyed nationwide, 80 responded. Fifty-eight percent of these HMOs indicated that they plan to offer alternative care therapies. The survey focused on seven therapies, including some used by people with diabetes: massage therapy, biofeedback and acupuncture. Interactive Guided ImagerySM and naturopathy, not included in the survey, are also being used by people with diabetes.
"Diabetics in general have more muscle tension due to living with the constant stress of fluctuating blood sugars," says Mary Kathleen Rose, a certified massage therapist who has had diabetes since 1985. "We also have what I describe as greater muscle density. This is the result of glycosylation of the connective tissue. Because of these factors, diabetics have to work harder than the average person to relax and stay limber."
Aside from circulation, flexibility and stress reduction, proponents claim massage therapy has the ability to help improve the self esteem of an individual with diabetes.
"It helps create a comforting feeling and an individual leaves therapy feeling nurtured," says Rose. "When someone is more relaxed there are better blood sugar levels because of the reduction of stress hormones."
Rose is author of The Gift of Touch: Massage Therapy and Comfort for the Elderly, the Chronically Ill and Terminally Ill, a 60-page booklet published by Hospice of Boulder County. She recommends both massage and daily stretches as valuable tools for people with diabetes to keep their bodies flexible.
Interactive Guided ImagerySM
Some health professionals are beginning to be trained to understand, evoke and work directly with the imagery process. The process, known as Interactive Guided ImagerySM, is said to help people skillfully use their imagination to achieve relaxation rather than anxiety, problem-solving rather than helplessness, and self-confidence rather than self-denigration.
The Academy for Guided Imagery also claims that Interactive Guided ImagerySM helps promote latent and innate healing abilities to support rehabilitation recovery and health promotion. This process has helped people with diabetes as well, says Martin L. Rossman, MD, co-director of the Academy for Guided Imagery in Mill Valley, California.
Jane Davis (name changed upon request) was diagnosed with type II diabetes while in her late fifties. Her care givers-doctors and diabetes educators-told her of the proper ways to control her illness. Despite their recommendations to control stress, eat healthier and lose weight, Jane was having trouble integrating the new lifestyle into her busy daily routine. Her doctor, realizing that lecturing Jane was not doing any good, decided to take an alternative approach called Interactive Guided ImagerySM. Jane's doctor referred her to Dr. Rossman.
"I had her relax, close her eyes, focus on the word diabetes and tell me what she saw," recalls Rossman of their first meeting. "What came to her mind was a ball and chain connected to her ankle that was slowing her down and in her way. She had a lot of anger toward her illness."
In this meeting Dr. Rossman attempted to help Jane understand her anger and work towards living a healthier life through bargaining and acceptance.
By their second meeting, according to Dr. Rossman, Jane had responded well to her therapy. After accepting her illness, the ball and chain connected to her ankle transformed in her mind into a puppy dog on a leash.
Biofeedback is a treatment in which breathing patterns, muscle tension and peripheral temperatures are measured in order to learn how to consciously control them.
The procedures are painless. "It's like having a thermometer taped on their finger," says Donald Nadler, PhD, who practices biofeedback in San Francisco.
The measurement readings are displayed on a computer monitor so a person can see them. Once a person sees the measurements, they are taught how to control them.
"It's like learning to play tennis," Nadler says. "Basically, in a relatively short period of time you learn and then you do it on your own."
"For people with diabetes, biofeedback can help with blood circulation to the limbs (hands and feet)," says Dr. Nadler. Diabetes is a regulation disorder, he explains. "With biofeedback, people learn how to control their bodies. They learn to self-regulate their temperature and blood flow."
In a November 1992 Research Report, Diabetes Health refers to a University of Wisconsin at La Crosse study on the use of thermal biofeedback-assisted relaxation training. The study found that the average toe temperature of people with type I and II diabetes increased by 31 percent using the biofeedback-assisted relaxation training audio tape, compared to an 8.7 percent increase in temperature when the subjects used their own method of relaxation, like reading a newspaper.
Acupuncture, a traditional Asian therapy, is based on the belief that inserting needles at various bodily points, representing specific organs, will balance a nebulous "life force" and influence the course of various diseases.
Kaiser Permanente Medical Center of Vallejo, California has established an acupuncture program. When the program was first started there was only one acupuncturist practicing at Kaiser. Today there are three. Currently, Kaiser uses acupuncture to treat only chronic pain, not chronic diseases.
Dr. Rossman, who practices both acupuncture and Interactive Guided ImagerySM, has used acupuncture to treat people with diabetes for discomfort. Last year, one of his patients was suffering from diabetic neuropathy. Unable to control her bladder muscles, she was having to go to the bathroom up to 12 times a night.
After two acupuncture sessions the woman saw remarkable progress, says Dr. Rossman. She only had to get up one to three times a night. She continued acupuncture for ten to 12 sessions and was able to live more comfortably. When the problem recurred she would return to Dr. Rossman for a single acupuncture session to have it resolved.
Since his success with this patient, Dr. Rossman has treated other people with diabetes suffering from foot discomfort as well. After treating these people with acupuncture they have had positive results, he says. For serious diabetic problems, Dr. Rossman recommends a patient be treated by an acupuncturist who is a medical doctor as well. This will ensure a person that the doctor has a comprehensive medical understanding of the illness as well as the skills to treat it with acupuncture.
Naturopathy is the practice of combating medical conditions using nutritional supplements, vitamins and herbal medicines. Many medical professionals criticize the use of natural products because most haven't been properly tested.
"Out of 27 natural products that have made claims to help people with diabetes, only three have been properly studied," says R. Keith Campbell, RPh, CDE, professor of the Pharmacy Department at Washington State University. "Out of these three natural products none of them have had an effect on people with diabetes."
Despite the lack of evidence, the survey Health Maintenance Organizations and Alternative Medicine: A Closer Look reveals that people are still trying new remedies. Some natural products being used or promoted to help people with diabetes include ginseng, grape seed extract, Gymnema sylvestre and bilberry.
A Finnish study published by Diabetes Care in 1995 reported ginseng, a plant extract used for centuries to reduce fatigue and elevate mood, can reduce blood glucose levels in people with type II diabetes. The study found that a "200 mg dose of ginseng improved glycated hemoglobin...and physical activity." In addition, positive mood changes occurring in the studied group motivated patients to make healthy changes in their lifestyles.
Campbell says ginseng does not have an effect on a person with diabetes. But new methods do get people excited, encouraging them to change their diet and exercise routine, he says.
French Maritime Pine Tree Bark or Grape Seed Extract
Each year, 25,000 Americans lose their sight due to diabetic retinopathy, according to the American Academy of Ophthalmology. In France, Pycnogenol is the most frequently prescribed agent for diabetic retinopathy. A study reported in the book, Pycnogenol: The Super "Protector" Nutrient, written by Drs. Passwater and Kandaswami, claims that the antioxidant extracted from French maritime pine bark, contained in Pycnogenol, strengthens capillaries. Recently introduced to the American medical community, Pycnogenol is the same antioxidant found in grape seed extracts.
Campbell received a call from a man who claimed his blood sugar levels had normalized after three days of taking a grape seed extract. The caller said he was going to stop taking his insulin injections. Within a week of discontinuing his insulin, the man was hospitalized after slipping into a coma.
"I'm not a big fan of natural products," says Campbell. "People oftentimes go off on a tangent trying to find a quick fix for their diabetes and end up risking their health," he explains.
A climbing plant, Gymnema sylvestre has medicinally active properties and is claimed to be an effective treatment for type I and II diabetes by Eastern traditional doctors.
Over 2,000 years ago, physicians observed that chewing a few leaves of the plant temporarily reduced one's appetite for sweet-tasting food. Today Gymnema sylvestre, in doses of three to four grams for three months or more, can be used as a complementary therapy to treat diabetes, according to an article written by Dr. Kumar Pati, from New Editions Health World Magazine. Studies conducted in India recorded the plant helped people with diabetes lower their blood sugars to normal levels.
"I have recommend this 'sugar destroyer' to a number of people, who report that it takes away their sugar cravings," writes Andrew Weil, MD, in an article in Self Healing, November 1996.
The Diabetes Herbal Treatment Home Page recognizes the active ingredient in Gymnema sylvestre to be gymnemic acid. The active ingredient, it says, prevents the taste buds from being activated by any sugar molecules in the food and it also prevents the intestine from absorbing sugar molecules.
Closely related to North American blueberries and currants, the bilberry is part of the genus Vaccinium. The fruits of the bilberry plant contain a powerful antioxidant believed to protect blood vessels.
Dr. John Norris, an ophthalmologist in San Francisco, California describes it as, "... sort of a feel good medicine for the eyes and an antioxidant."
Bilberry became popular after World War II. For cat-like night vision, British and American pilots would eat bilberry jam. Naturopathists recommend people with diabetes use bilberry to help strengthen their eyes and reduce the risk of retinopathy.
Michael Levy, who was diagnosed with type II diabetes three and a half years ago, holds the view that western medicine doesn't have all the answers. He buys bilberry tea bags from a health food store. "The tea helps strengthen my eyes and has a regulatory effect," he says.
Tzu Chi Institute
Similar to HMOs, medical hospitals are beginning to integrate a new approach to medicine by incorporating non-traditional therapies with western medical practices. In October 1996, Vancouver Hospital opened the Tzu Chi Institute for Complementary and Alternative Medicine. The idea behind the Institute is to integrate Western medicine with the traditional therapies of Asia. The Institute offers work space to a variety of healers. The techniques practiced at the Institute are subjected to rigorous research to verify or disprove their value.
The list of complementary therapies being used is extensive and, it is difficult to narrow it down to those being used primarily for healing diabetes. In 1993, The New England Journal of Medicine reported that although a third of Americans used alternative medicine in 1990, most of them never tell their conventional doctors.
Mixing some therapies can be devastating if not properly administered. For a therapy to gain recognition from the American Diabetes Association it has to adhere to the established safety and efficacy regulations. It also has to be approved for use by the FDA or supported by data obtained in at least two independent, well-controlled studies published in peer-reviewed scientific publications. It must also be endorsed or recommended by the ADA's Professional Practice Committee, or by an appropriate medical specialty organization.
It is crucial to consult a physician before incorporating any new treatments into one's lifestyle. People with diabetes who are considering new therapies should first take time to learn about a treatment before investing money. If somebody is selling a product that sounds too good to be true, "then it probably is," says Campbell.
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