Cinnamon and Prickly Pear Cactus -- Should They Be Part of a Type 2 Diabetes Diet?

Nopal (Prickly Pear Cactus), Fenugreek, Cinnamon, and Gymnema for Type 2 Diabetes: What Works? What Doesn't?

Désirée Lie, MD, MSEd

Disclosures

June 30, 2010

Case Discussion

Although Mr. Lopez is US-born and educated, he lives with his extended family, some of whom are first-generation Americans. His health belief system is likely stem from a combination of familial and cultural influences (see Additional Resources), as well as information gleaned from the contemporary press, friends, and the Internet. He has shared valuable information about his family's recommendations and set up a scenario that allows negotiation, so that his provider can help him make an informed decision.

Mr. Lopez is motivated to make changes in his lifestyle in order to avoid additional medications. Given his work in a restaurant, adherence to an American Diabetes Association diet will be challenging. Referral to a dietician familiar with Mexican diets would be valuable to help him make healthy choices, especially outside of the restaurant environment. As a start, he can convert to nonfat or low-fat milk and cut down on some of the carbohydrates and fats for breakfast.

Because his mother cooks dinner, her participation in the process of dietary change would be helpful, and Mr. Lopez should be encouraged to bring her in at his next visit. An interpreter should be provided if she does not speak English.

Of the CAM therapies that Mr. Lopez has asked about, nopal and cinnamon seem to hold the most promise for glucose control in persons with A1c levels greater than 7.0%, and both would be easy to introduce into his meals. Using the doses included in trials, a minimum dose of 85 g of broiled nopal stems should be used; up to 500 g a day, if palatable, would be safe.

Mr. Lopez can further increase the fiber content of his meals by adding his favorite vegetables and fruits. The evidence for the hypoglycemic effect of Gymnema and fenugreek is weak, but small amounts, such as those used in cooking, are not harmful, and supporting their use will allow greater participatory decision-making.

If Mr. Lopez does decide to incorporate all of these additional CAM therapies into his diet, it will be prudent to perform baseline liver function tests. His blood glucose levels should also be followed closely; this may be an ideal setting in which to introduce self-monitoring to increase his diabetes self-management. His glucose, A1c, and lipid profile should be obtained within 3 months of starting these new treatments. In subsequent visits, building on his motivation for self-sufficiency and avoidance of medication, exercise can be addressed as yet another means of improving glucose and lipid control.

Additional Resources

For more discussion of different diets across cultures, please see:

Lie DA, Vega C. The case of Maria Morales. In: Hark LA, DeLisser HM. Achieving Cultural Competency: A Case-Based Approach to Training Health Professionals. Philadelphia, PA: Wiley-Blackwell Press; 2009.

National Diabetes Information Clearing House (NDIC). Hispanics/Latinos and Diabetes. January 2009. Available at: http://diabetes.niddk.nih.gov/dm/pubs/hispanicamerican/index.htm Accessed May 29, 2010

Office of Minority Health. Latino/Hispanic Culture and Health. Available at: http://www.health.ri.gov/chic/minority/lat_cul.php Accessed May 29, 2010.

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