Nutritional supplements for diabetes sold on the internet: business or health promotion?

BMC Public Health

Umberto Gelatti¹  Luigi Caimi³  Donatella Feretti¹  Elisabetta Ceretti¹  Michela Capelli²  Loredana Covolo¹ 

[1] Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 11, Brescia 25123, Italy;Post-graduate School of Public Health. University of Brescia, Viale Europa 11, Brescia 25123, Italy;Quality and Technology Assessment, Governance and Communication Strategies in Health Systems” Study and Research Centre - University of Brescia, Viale Europa 11, Brescia 25123, Italy

关键词: Diabetes mellitus;    Online sales;    Nutritional supplements;   

Others  :  1161896
DOI  :  10.1186/1471-2458-13-777

 received in 2013-01-23, accepted in 2013-08-02,  发布年份 2013

【 摘 要 】

Background

Diabetes is one of the most widespread chronic disease. Although many medications are available for the treatment and prevention of diabetes, many people turn to nutritional supplements (NSs). In these years, the online sales have contributed to the growth of use of nutritional supplement. The aim of the research was to investigate the type of information provided by sales websites on NSs, and analyse the existence of scientific evidence about some of the most common ingredients found in available NSs for diabetes.

Methods

A web search was conducted in April 2012 to identify web sites selling NSs in the treatment of diabetes using Google, Yahoo and Bing! and the key word used was “diabetes nutritional supplements”. Website content was evaluated for the quality of information available to consumers and for the presence of a complete list of ingredients in the first NS suggested by the site. Subsequently, in order to analyze the scientific evidence on the efficacy of these supplements a PubMed search was carried out on the ingredients that were shared in at least 3 nutritional supplements.

Results

A total of 10 websites selling NSs were selected. Only half of the websites had a Food and Drug Administration disclaimer and 40% declared clearly that the NS offered was not a substitute for proper medication. A total of 10 NS ingredients were searched for on PubMed. Systematic reviews, meta-analyses or randomized control trials were present for all the ingredients except one. Most of the studies, however, were of poor quality and/or the results were conflicting.

Conclusions

Easy internet access to NSs lacking in adequate medical information and strong scientific evidence is a matter of public health concern, mainly considering that a misleading information could lead to an improper prevention both in healthy people and people suffering from diabetes. There is a clear need for more trials to assess the efficacy and safety of these NSs, better quality control of websites, more informed physicians and greater public awareness of these widely used products.

【 授权许可】

   
2013 Covolo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]WHO: Fact Sheet N°312: Diabetes. 2012. http://www.who.int/mediacentre/factsheets/fs312/en/ webcite
• [2]Pandey A, Tripathi P, Pandey R, Srivatava R, Goswami S: Alternative therapies useful in the management of diabetes: A systematic review. J Pharm Bioallied Sci 2011, 3:504-512.
• [3]Food and Drug Administration. http://www.fda.gov/Food/DietarySupplements/QADietarySupplements/default.htm webcite
• [4]Ervin RB, Wright JD, Kennedy-Stephenson J: Use of dietary supplements in the United States, 1988–94. Vital Health Stat 1999, 244:1-14.
• [5]Timbo BB, Ross MP, McCarthy PV, Lin CT: Dietary supplements in a national survey: Prevalence of use and reports of adverse events. J Am Diet Assoc 2006, 106:1966-1974.
• [6]Bailey RL, Gahche JJ, Lentino CV, Dwyer JT, Engel JS, Thomas PR, Betz JM, Sempos CT, Picciano MF: Dietary supplement use in the United States, 2003–2006. J Nutr 2011, 141:261-266.
• [7]COM(2008)824 final Commission of the European Communities: Characteristics and perspectives of the market for food supplements containing substances other than vitamins and minerals. 2008. http://ec.europa.eu/food/food/labellingnutrition/supplements/documents/2008_2976_F_WD1_en.pdf webcite
• [8]Satia-Abouta J, Kristal AR, Patterson RE, Littman AJ, Stratton KL, White E: Dietary supplement use and medical conditions: the VITAL study. Am J Prev Med 2003, 24:43-51.
• [9]NIH. National Institutes of Health State-of-the-Science Panel: National Institutes of Health State-of-the-Science Conference Statement: multivitamin/mineral supplements and chronic disease prevention. Am J Clin Nutr 2007, 85:257S-264S.
• [10]Bell RA, Suerken CK, Grzywacz JG, Lang W, Quandt SA, Arcury TA: Complementary and alternative medicine use among adults with diabetes in the United States. Altern Ther Health Med 2006, 12:16-22.
• [11]Saldanha LG, Dwyer JT, Andrews KW, Bailey RL, Gahche JJ, Hardy CJ, Holden JM, Picciano MF, Roseland JM, Thomas PR, Wolf WR: Online dietary supplement resources. J Am Diet Assoc 2010, 110:1426-1431.
• [12]SEO Consultants Directory. 2010. http://www.seoconsultants.com/app/webroot/search-engines/ webcite
• [13]NIH: National Institute of Health Office of Dietary Supplements. 2012. http://ods.od.nih.gov/ webcite
• [14]Ansar H, Mazloom Z, Kazemi F, Hejazi N: Effect of alpha-lipoic acid on blood glucose, insulin resistance and glutathione peroxidase of type 2 diabetic patients. Saudi Med J 2011, 32:584-588.
• [15]de Oliveira AM, Rondó PH, Luzia LA, D’Abronzo FH, Illison VK: The effects of lipoic acid and α-tocopherol supplementation on the lipid profile and insulin sensitivity of patients with type 2 diabetes mellitus: a randomized, double-blind, placebo-controlled trial. Diabetes Res Clin Pract 2011, 92:253-260.
• [16]Bartlett HE, Eperjesi F: Nutritional supplementation for type 2 diabetes: a systematic review. Ophthalmic Physiol Opt 2008, 28:503-523.
• [17]Lee T, Dugoua JJ: Nutritional supplements and their effect on glucose control. Curr Diab Rep 2011, 11:142-148.
• [18]Leach MJ: Gymnema sylvestre for diabetes mellitus: a systematic review. J Altern Complement Med 2007, 13:977-983.
• [19]Mooren FC, Krüger K, Völker K, Golf SW, Wadepuhl M, Kraus A: Oral magnesium supplementation reduces insulin resistance in non-diabetic subjects – a double-blind, placebo-controlled, randomized trial. Diabetes Obes Metab 2011, 13(3):281-284.
• [20]Sharma S, Agrawal RP, Choudhary M, Jain S, Goyal S, Agarwal V: Beneficial effect of chromium supplementation on glucose, HbA1C and lipid variables in individuals with newly onset type-2 diabetes. J Trace Elem Med Biol 2011, 25:149-153.
• [21]Król E, Krejpcio Z, Byks H, Bogdański P, Pupek-Musialik D: Effects of chromium brewer’s yeast supplementation on body mass, blood carbohydrates, and lipids and minerals in type 2 diabetic patients. Biol Trace Elem Res 2011, 143:726-737.
• [22]Ali A, Ma Y, Reynolds J, Wise JP Sr, Inzucchi SE, Katz DL: Chromium effects on glucose tolerance and insulin sensitivity in persons at risk for diabetes mellitus. Endocr Pract 2011, 17:16-25.
• [23]Cefalu WT, Rood J, Pinsonat P, Qin J, Sereda O, Levitan L, Anderson RA, Zhang XH, Martin JM, Martin CK, Wang ZQ, Newcomer B: Characterization of the metabolic and physiologic response to chromium supplementation in subjects with type 2 diabetes mellitus. Metabolism 2010, 59:755-762.
• [24]Shidfar F, Aghasi M, Vafa M, Heydari I, Hosseini S, Shidfar S: Effects of combination of zinc and vitamin A supplementation on serum fasting blood sugar, insulin, apoprotein B and apoprotein A-I in patients with type I diabetes. Int J Food Sci Nutr 2010, 61:182-191.
• [25]Hussain SA, Khadim HM, Khalaf BH, Ismail SH, Hussein KI, Sahib AS: Effects of melatonin and zinc on glycemic control in type 2 diabetic patients poorly controlled with metformin. Saudi Med J 2006, 27:1483-1488.
• [26]Neyestani TR, Shariatzade N, Kalayi A, Gharavi A, Khalaji N, Dadkhah M, Zowghi T, Haidari H, Shab-bidar S: Regular daily intake of black tea improves oxidative stress biomarkers and decreases serum C-reactive protein levels in type 2 diabetic patients. Ann Nutr Metab 2010, 57:40-49.
• [27]Mackenzie T, Leary L, Brooks WB: The effect of an extract of green and black tea on glucose control in adults with type 2 diabetes mellitus: double-blind randomized study. Metabolism 2007, 56:1340-1344.
• [28]Albarracin CA, Fuqua BC, Evans JL, Goldfine ID: Chromium picolinate and biotin combination improves glucose metabolism in treated, uncontrolled overweight to obese patients with type 2 diabetes. Diabetes Metab Res Rev 2008, 24:41-51.
• [29]Geohas J, Daly A, Juturu V, Finch M, Komorowski JR: Chromium picolinate and biotin combination reduces atherogenic index of plasma in patients with type 2 diabetes mellitus: a placebo-controlled, double-blinded, randomized clinical trial. Am J Med Sci 2007, 333:145-153.
• [30]Revilla-Monsalve C, Zendejas-Ruiz I, Islas-Andrade S, Báez-Saldaña A, Palomino-Garibay MA, Hernández-Quiróz PM, Fernandez-Mejia C: Biotin supplementation reduces plasma triacylglycerol and VLDL in type 2 diabetic patients and in nondiabetic subjects with hypertriglyceridemia. Biomed Pharmacother 2006, 60:182-185.
• [31]Ooi CP, Yassin Z, Hamid TA: Momordica charantia for type 2 diabetes mellitus. Cochrane Database Syst Rev 2010., 2CD007845
• [32]Fuangchan A, Sonthisombat P, Seubnukarn T, Chanouan R, Chotchaisuwat P, Sirigulsatien V, Ingkaninan K, Plianbangchang P, Haines ST: Hypoglycemic effect of bitter melon compared with metformin in newly diagnosed type 2 diabetes patients. J Ethnopharmacol 2011, 134:422-428.
• [33]Losso JN, Holliday DL, Finley JW, Martin RJ, Rood JC, Yu Y, Greenway FL: Fenugreek bread: a treatment for diabetes mellitus. J Med Food 2009, 12:1046-1049.
• [34]Ashar BH, Rowland-Seymour A: Advising patients who use dietary supplements. Am J Med 2008, 121:91-97.
• [35]Laird J: Interactions between supplements and drugs: deciphering the evidence. JAAPA 2011, 24:44-49.
• [36]Shane-McWhorter L: Dietary supplements and probiotics for diabetes. Am J Nurs 2012, 112:47-53.
• [37]Petroczi A, Taylor G, Naughton DP: Mission impossible? Regulatory and enforcement issues to ensure safety of dietary supplements. Food Chem Toxicol 2011, 49:393-402.
• [38]Dietary Supplements Labels Database. http://www.dsld.nlm.nih.gov/dsld/ webcite
• [39]Federal Food, Drug, and Cosmetic Act (the Act) [21 U.S.C. § 321(g)(1)]. http://www.epw.senate.gov/FDA_001.pdf webcite
• [40]Kennedy J: Herb and supplement use in the US adult population. Clin Ther 2005, 27:1847-1858.
• [41]Cicero AF, Derosa G, Gaddi A: What do herbalists suggest to diabetic patients in order to improve glycemic control? Evaluation of scientific evidence and potential risks. Acta Diabetol 2004, 41:91-98.
• [42]Orizio G, Merla A, Schulz PJ, Gelatti U: Quality of online pharmacies and websites selling prescription drugs: a systematic review. J Med Internet Res 2011, 13:e74.
• [43]Williams-Jones B: Where there’s a web, there’s a way: commercial genetic testing and the Internet. Community Genet 2003, 6:46-57.
• [44]Sterling R: The on-line promotion and sale of nutrigenomic services. Genet Med 2008, 10:784-796.
• [45]Covolo L, Rubinelli S, Orizio G, Gelatti U: Misuse (and abuse?) of the concept of empowerment. The case of online offer of predictive direct-to-consumer genetic tests. J Public Health Res 2012, 1:3.
• [46]Anderson RM, Funnell MM: Patient empowerment: myths and misconceptions. Patient Edu Couns 2010, 79:277-282.
• [47]Fabian E, Töscher S, Elmadfa I, Pieber TR: Use of complementary and alternative medicine supplements in patients with diabetes mellitus. Ann Nutr Metab 2011, 58:101-108.
• [48]Cefalu WT, Stephens JM, Ribnicky DM: Diabetes and Herbal (Botanical) Medicine. In Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Edited by Benzie IFF, Wachtel-Galor S. Boca Raton (FL): CRC Press; 2011. Chapter 19
• [49]Fox S: Online Health Search. Washington, DC: Pew Internet & American Life Project; 2011. http://pewinternet.org/Reports/2011/HealthTopics.aspx webcite
• [50]Zickuhr K, Madden M: Older adults and internet use. Washington, DC: Pew Internet & American Life Project; 2012. http://pewinternet.org/Reports/2012/Older-adults-and-internet-use.aspx webcite
• [51]Denison HJ, Jameson KA, Syddall HE, Dennison EM, Cooper C, Sayer AA, Robinson SM: Patterns of dietary supplement use among older men and women in the UK: findings from the Hertfordshire Cohort Study. J Nutr Health Aging 2012, 16:307-311.
• [52]Larsson SC, Wolk A: Magnesium intake and risk of type 2 diabetes: a meta-analysis. J Intern Med 2007, 262:208-214.
• [53]Rodríguez-Morán M, Guerrero-Romero F: Oral magnesium supplementation improves insulin sensitivity and metabolic control in type 2 diabetic subjects: a randomized double-blind controlled trial. Diabetes Care 2003, 26(4):1147-1152.
• [54]Dong JY, Xun P, He K, Qin LQ: Magnesium intake and risk of type 2 diabetes: meta-analysis of prospective cohort studies. Diabetes Care 2011, 34:2116-2122.
• [55]Althuis MD, Jordan NE, Ludington EA, Wittes TJ: Glucose and insulin responses to dietary chromium supplements: a meta-analysis. Am J Clin Nutr 2002, 76:148-155.
• [56]Beletate V, El Dib RP, Atallah AN: Zinc supplementation for the prevention of type 2 diabetes mellitus. Cochrane Database Syst Rev 2007., 1CD005525
• [57]Suksomboon N, Poolsup N, Boonkaew S, Suthisisang CC: Meta-analysis of the effect of herbal supplement on glycemic control in type 2 diabetes. J Ethnopharmacol 2011, 137:1328-1333.