Alternative medicines for diabetes in India: maximum hype, minimum science
Authors: Anoop Misra, Seema Gulati, Atul Luthra
Journal: The Lancet Diabetes & Endocrinology (2016)

The use of alternative medicines for the management of diabetes is widespread in the Indian subcontinent, mostly in the form of so-called nutraceuticals (eg, capsules made of fenugreek or bitter melon extract). In 2014, the Indian Government created an independent Ministry of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy), emphasising the prominence of alternative medical practices in the country. Furthermore, Ayurveda and other forms of alternative medicine are increasingly visible in the public domain, with some officials describing them as effective and emphasising a supposed absence of side-effects. We searched the scientific literature to gauge whether firm claims of efficacy and safety regarding Ayurvedic treatments could be made, as is increasingly being done in the mainstream media in India. We identified three major systematic reviews of studies investigating the use of Ayurvedic treatments for diabetes. In 2001, Hardy and colleagues1Hardy ML Coulter I Venuturupalli S et al.Ayurvedic interventions for diabetes mellitus: a systematic review.Evid Rep Technol Assess (Summ). 2001; 41: 2Google Scholar discussed the major methodological limitations in the evidence base: few randomised trials, underpowered studies, and the use of inappropriate statistical methods. That human trials with Ayurvedic medicines fall short of methodological standards was again emphasised in a systematic review in 2004.2Elder C Ayurveda for diabetes mellitus: a review of the biomedical literature.Altern Ther Health Med. 2004; 10: 44-50PubMed Google Scholar About 7 years later, Sridharan and colleagues3Sridharan K Mohan R Ramaratnam S Panneerselvam D Ayurvedic treatments for diabetes mellitus.Cochrane Database Syst Rev. 2011; 12 (CD008288)Google Scholar reviewed the existing literature and noted that, because of methodological deficiencies and small sample sizes, no definite conclusions regarding the efficacy of Ayurvedic treatments could be drawn, affirming that there was insufficient evidence to recommend their use in routine clinical practice. There are other important issues pertaining to alternative medicines in India. For example, there is indistinct compartmentalisation between herbs, Ayurvedic medicines, and functional foods. As such, there is the possibility of interactions between the potential bioactive ingredients of the herbs used in alternative medicines (which are often given as mixed formulations), the toxicity of which should be properly studied in keeping with national guidelines (appendix). Notably, Indian guidelines have waived or relaxed the rules for rigorous pharmacological and toxicology studies for Ayurvedic products (appendix), provided that medicines are "prepared in same way as mentioned in ancient Ayurvedic treatises" such as Charaka Samhita or similar texts, purported to have been written and rewritten between the 6th century BCE and the 1st century CE. The safety of Ayurvedic preparations is also a major concern. In addition to several reports of heavy metal toxicity due to these drugs, in one study, a fifth of Ayurvedic medicines manufactured in the USA and India contained detectable lead, mercury, or arsenic compounds, which exceeded one or more standards for acceptable daily intake of toxic metals.4Saper RB Phillips RS Sehgal A et al.Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the internet.JAMA. 2008; 300: 915-923Crossref PubMed Scopus (364) Google Scholar Among the metal-containing products, 95% were sold by US websites and 75% were claimed to have been manufactured in accordance with good manufacturing practices. If Ayurvedic medicines are to be recommended for use in diabetes care, their active components should be defined, their precise pharmacodynamic actions identified, and bioassays for their standardisation developed; essentially, rigorous methods of modern pharmaceutical drug testing should be applied. Importantly, toxicity of these compounds remains an area of major concern. Based on current scientific data, there is scant scientific basis for the use of these products in the management of diabetes. We declare no competing interests. Download .pdf (.2 MB) Help with pdf files Supplementary appendix Ayurveda for diabetes in India – Authors' replyWe thank Rajiv Vasudevan and Zankhana Buch for their interest in our Correspondence1 on alternative medicines for diabetes in India. The authors suggest that the pathogenesis of diabetes and disease management have been well characterised in Ayurvedic medicine without providing any references. This omission is important, because whether such characterisation of diabetes and its treatment in Ayurveda is based on ancient treatises written by individuals thousands of years ago, or on principles of modern science, is the central issue. Full-Text PDF Ayurveda for diabetes in IndiaWe believe that Anoop Misra and colleagues' depiction of Ayurvedic medicine in their Correspondence (April, 2016)1 on alternative medicines for diabetes in India contains several inaccuracies. Full-Text PDF