Natural Strategies for Diabetes-Part I

Outline of Natural Approaches to Diabetes Control

David J. DeRose, MD, MPH

Note: The material is designed to inform and educate. It represents the opinions of the author based on his understanding of current medical research and is not intended to be viewed as a replacement for medical evaluation, advice, diagnosis, or treatment. If the information in this handout disagrees with personal information provided by your health care professionals, please follow their counsel.

Key Natural Strategies for Type 2 Diabetes

  • Weight reduction
  • Exercise
  • Dietary Changes
    • Replace saturated fats and trans fatty acids with monounsaturated fats
    • Emphasize high fiber choices
    • Consider a wholly plant-based diet
  • Talk with your doctor about simplifying drug regimens

Key quote: “Moreover, many drugs used by…patients may contribute to glucose intolerance. These include thiazide diuretics, glucocorticoids, beta-adrenergic blocking agents, nicotinic acid, and phenytoin.” Bressler P, DeFronzo RA. Drugs and diabetes. Diabetes Rev. 1994;2:53-84.

Supplements worthy of consideration:

  • Guar
  • Garlic
  • Bitter Melon
  • Ginseng
  • Chromium
  • Alpha lipoic acid
  • Vanadium
  • GLA
  • Bilberry
  • Gymnema sylvestre
  • Fenugreek

Insights on selected supplements

I. Garlic

So long as someone is not on a drug with a critical therapeutic window; there is evidence that garlic may have salutary effects with limited side effects.

Typical dosage: 4 grams of fresh garlic or equivalent preparations (9.6 mg allicin-releasing potential in one recent study showed beneficial lipid effects).

However, some research suggests many garlic pills release only small amounts of their active ingredients.

Garlic References: Kannar D, et al. J Am Coll Nutr 2001 Jun;20(3):225-31; Lawson LD, Wang ZJ. J Agric Food Chem 2001 May;49(5):2592-9

II. Ginseng

200 mg of Asian Ginseng (Panax ginseng) per day for eight weeks improved mood, physical activity and lowered fasting blood glucose, hemoglobin A1c levels and body weight.

Criticism of the study is that weight reduction by itself will result in blood sugar improvements.

Note that Siberian Ginseng (Eleutherococcus senticosus) does not contain the ginsenosides that are among the active blood sugar-lowering components.

More rigorous studies of American Ginseng (Panax quinquefolius) demonstrated that 3000 mg of powdered root taken with a standardized “meal” could blunt the post meal blood sugar rise in individuals with type 2 diabetes.

The same group found that doses beyond 3000 mg gave no additional blood sugar effect.

This raises the question that the threshold for blood sugar lowering may be considerably lower than 3000 mg

Ginseng concerns

Allergies, asthma in susceptible individuals

Ginseng can lower blood concentrations of warfarin

May induce mania if used concomitantly with the antidepressant phenelzine.

May have steroid-like effects including both estrogenic and corticosteroid effects

Has been associated also with hypertension, insomnia, nervousness and headache

Ginseng Conclusions

High dose American ginseng has documented effectiveness in type 2 diabetes: 3000 mg with or up to 2 hours before a meal

Not recommended for people taking medications with a critical therapeutic window such as warfarin

Relatively contraindicated in hypertension as well as conditions where estrogenic or corticosteroid effects could be detrimental

Probably not a good choice in individuals with history of need for psychiatric medications

Ginseng References:

Sotaniemi EA, Haapakoski E, Rautio A. Ginseng therapy in non-insulin-dependent diabetic patients. Diabetes Care 1995 Oct;18(10):1373-5.

Vuksan V, et al. Diabetes Care 2000 Sep;23(9):1221-6

Vuksan V, et al. Arch Intern Med 2000 Apr 10;160(7):1009-13

III. Gymnema sylvestre

  • Active constituents
  • Gymnemosides
  • Gymnemic acids

Possible mechanisms (how it seems to work)

Well established role in decreasing sweet-perceptions, may help with “sweet tooth”/sugar cravings

Demonstrated to decrease caloric intake

May decrease intestinal fat and glucose absorption

Beta-cell stimulant and “tonic”?

Insulinomimetic (acts like insulin)

May also have lipid lowering effects

Side Effects


Animal models suggest that it may raise blood pressure

Recognize that the literature is very sparse on human studies of G. sylvestre


400 mg/d of GS4, a G. sylvestre extract may aid in diabetic control, with few side effects or contraindications noted

If G. syvestre is used careful monitoring for side-effects is recommended

IV. Momordica (bitter melon, karela)

Active ingredients

  • Momordin/ charantin (hypoglycemic)
  • Momordicine alkaloid
  • Polypeptide P

Possible mechanisms (how it seems to work)

Increases glucose uptake

Increases glycogen synthesis


Side Effects

Diarrhea/ abdominal distress

Abortifacient (may cause abortions)


Favism (a severe reaction that can also occur with fava beans)

Drug Interactions



Blood sugar lowering

Animal models suggest that this plant may also lower insulin resistance.

A water-soluble extract of the fruits significantly reduced blood glucose concentrations during a 50 g oral glucose tolerance test in the diabetics and after force-feeding in the rats.

Fried karela (momordica) fruits consumed as a daily dietary supplement produced small but significant improvements in glucose tolerance.

Improvement in glucose tolerance was not associated with an increase in insulin production.

Selected reference: Leatherdale BA, Panesar RK, Singh G, Atkins TW, Bailey CJ, Bignell AH. Improvement in glucose tolerance due to Momordica charantia (karela). Br Med J (Clin Res Ed) 1981 Jun 6;282(6279):1823-4

V. Soluble Fiber-Rich Plant Products

Examples: guar gum, psyllium, beta-glucan rich barley

Lipid lowering effects in addition to blood sugar lowering effects

Favorable effect on prolonging blood levels of CCK (cholecystokinin) which has been shown to reduce food intake in animals and humans


Am. J. Physiol. 274 (Gastrointest. Liver Physiol. 37): G607–G613, 1998

Am J Clin Nutr 1999;69:55–63.

See Part II for information on fenugreek, alpha lipoic acid, vanadium, chromium, and niacinamide (nicotinamide)