1. Canadian Diabetes Association Clinical Practice GuidelinesNatural Health Products in Type 2 Diabetes Chapter 21 Richard Nahas, Jeannette Goguen

2. Natural Health Product Checklist 2013 • ASK about natural health products being used to treat diabetes • BE AWARE that no natural health products are proven and some may be harmful

3. Commonly Used by Patients, Poorly Understood by Practitioners Concerns • Purity • Standardization • Contamination • Lack of evidence for efficacy and safety Prospects • May have some effect • May be sources of future therapies (eg. metformin from French lilac)

4. Some Have Shown Benefit in Small Trials • Cocciniacordifolia(ivy gourd) • Ganodermalucidum(reishi mushroom) • Salaciareticulata • Soybean-derived pinitol extract • Touchi soybean extract • Pterocarpusmarsupium(Indian kinotree) • Etc... ↓ A1C by ≥0.5% in trials lasting ≥3 months in T2DM

5. But Some Have Been Harmful • Citrulluscolocynthis(bitter cucumber)can induce diarrhea • Momordicacharantia(bitter melon) is an abortifacient • Hypericumperforatum (St. John’s wort) alters drug metabolism

6. Recommendation 1 • Natural health products are not recommended for glycemic control for individuals with diabetes, as there is insufficient evidence at this time regarding efficacy and safety [Grade D, Consensus]

7. Recommendation 2 • Healthcare providers should ask about the use of natural health products [Grade D, Consensus]

8. CDA Clinical Practice Guidelines http://guidelines.diabetes.ca – for professionals 1-800-BANTING (226-8464) http://diabetes.ca – for patients