Letter from the publisher

Townsend Letter for Doctors and Patients,  Dec, 2002  

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With the holidays soon upon us and with our collective sugar-binge about to commence, it is fitting that this issue examines natural approaches to diabetes and liver disease. Actually both are sugar disorders, but adult-onset diabetes is generally preceded by an expanding waist line and a few too many Cokes and French fries, while liver disease is thought to be more the result of too many nights at the bar. In fact, adult-onset diabetics may have seen their disease begin with too many six-packs of Budweiser; while more than a few cirrhosis patients acquired their fatty liver from overeating snacks while being armchair quarterbacks. The concern with the over-consumption of sugar has been a prevalent topic of this magazine for the past 2 decades. Natural-based practitioners have especially championed the idea that insulin misbehavior is brought on by an eating pattern characterized by over-consumption of carbohydrates. Such thinking is the basis of dysinsulinism, what medicine has belatedly termed Syndrome X, a condition manifested by obesity, hypertension, pre-diabetes, coronary artery plaque, high lipids and depressed male/female hormones. One wonders what the state of health would be in America if our diets were reduced in sugar consumption. Not every case of diabetes and liver disease would disappear, but certainly there would be fewer individuals who would be at risk for developing the complications of both disorders. How much better would our national health be without the great season of overeating and overdrinking?

One of the more interesting differences separating conventional medical practice from naturopathy is the approach both camps have to treating liver conditions. Medicine's primary approach to detoxifying the liver is to inform the patient to get off the sauce. And that is probably an excellent recommendation for the pot-bellied, overweight male who likes his Budweiser. But it doesn't really make much sense for someone who has a glass of wine or cocktail weekly. The liver is probably not being greatly taxed by a limited amount of alcohol. More likely, medications prescribed are an overburden to the liver. As much as hypertension requires anti-hypertensive medication, and as much as elevated cholesterol requires cholesterol-lowering medications, the tradeoff is that the liver needs to metabolize and eliminate these drugs. Too many medications will\insult the liver, markedly increasing liver enzymes, initiating early liver damage.

Beyond drugs (prescriptive, over-the-counter, and recreational) and alcohol abusing the liver, viral infection poses the greatest acquired threat to the liver. We are diagnosing Hepatitis-C in many patients now not based on a history of jaundice and serious illness. Instead, we are screening patients with simple liver function tests and those who have elevated LFT's are subsequently screened for Hepatitis C (not surprisingly more than a few are positive for Hepatitis C). The conventional camp asks the patient to eliminate alcohol, continue the drugs (prescriptions are needed to treat other disorders), and wait-and-see. Naturopaths argue that the liver is the key to health and vitality and deserves regular, routine detoxification. Dietary changes, nutritional supplementation, herbal treatments (traditional, Chinese, Ayurvedic), acupuncture, and colon "cleansing" are all natural approaches to treating a dis-eased liver. It is unsettling to hear conventional MD's lecture patients against the use of herbal approa ches to liver treatment. On the other hand, we have seen a loud backlash taking place over the past year against herbal and natural medicine, based on the odd notion that herbals lead to serious drug interactions and induce liver damage. Given the fact that pharmaceuticals commonly increase the risk of liver toxicity, it would appear ingenuous to state that herbs are the "real" cause of liver toxicity. The widespread publicity by the media about kava kava inducing liver toxicity has led to a general characterization of herbal medicine being dangerous to the liver. Combined with recent media sensationalizing the failure of herbals to improve depression and Alzheimer's, herbal medicine is now viewed with great skepticism.

Unlike liver disease, diabetes has come under tremendous pharmacologic innovation over the past 5 years. New pharmacologic agents for diabetes are among the hottest topics at medical meetings. However, at least one new pharmaceutical for the treatment of diabetes needed to be recalled in 2000 because of its role in causing liver failure in a large number of diabetics. With this avalanche of new diabetic medication, what need is there for natural treatment approaches? First, as good as the diabetic medications are, they are new and pose risks which will still be unknown for years to come. Second, one of the great boons of natural medicine has been the discovery that as patients improve, their need for medication decreases and in some cases, may be eliminated. How many diabetics are deficient in the trace elements chromium and ultra-trace element, vanadium? How many are deficient in B-vitamins and vitamin C? How many are deficient in essential fatty acids, alpha-lipoic acid, and carnitine? How many are allergic to foods in their diet? Natural medicine plays a very important role in the prevention and treatment of diabetes. In this issue we examine some of those approaches that natural medicine plays in diabetes and liver disease.