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Insulin and Insulina: Bridging the Gap

— Physicians need to be aware of patients' beliefs about medicinal plants.

MedpageToday
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Belief in one plant's ability to treat type 2 diabetes among Dominican communities is so strong that they actually call it "." A member of the ginger family, the Costus plant's leaves are brewed as a tea, and healers advise their patients to drink it for their "azucar," or sugar, as they call the diabetic condition.

It's hardly the only plant-based remedy for diabetes in the Dominican community. They believe the are helpful, as is the alquitira cactus, also known as "tuna." The same goes for the bitter-tasting , according to , an ethnomedical research specialist at the New York Botanical Garden in New York City.

"All kinds of bitter plants, the Dominican community believes it burns sugar in the blood," Vandebroek said at a press event in the institution's humid conservatory. She was recently awarded a $100,000 grant from the Cigna Foundation to study medicinal plant practices among New York's Latino and Caribbean communities and to develop training materials to foster better communication about these practices between patients and their doctors.

"There are so many remedies that the community uses, and they often don't tell their physicians they are using them," Vandebroek told ľֱ.

That could be problematic, especially because rates of type 2 diabetes have been rising in Latino populations. Some research has shown that interactions may occur between medicinal plants and standard medications. For instance, aloe vera could interact with other anti-diabetic drugs, Vandebroek said, potentially leading to hypoglycemia.

She's currently at work on a guidebook that members of the Dominican community can bring to their doctors to tell them about the use of medicinal plants and alert them to possible drug interactions.

Vandebroek specializes in urban ethnobotany, the study of how cultures use traditional medicinal plants in urban centers like New York City. She followed a PhD in neuropsychopharmacology with post-doc work in Bolivia, comparing the knowledge of its Amazonian healers with that of its Andes-based healers.

At the Botanical Garden, she focuses on underserved communities and has conducted research on the city's botanicas, shops that specialize in spiritual, and sometimes physical healing. In addition to advice about love or money, sometimes these stores employ plant specialists who help with conditions like arthritis, diabetes, and infertility.

Vandebroek said her first step is to categorize all of the various medicinal plant remedies that Latino and Caribbean communities in New York City use. She and her colleagues will compare practices of the Dominican community, for instance, with those of other Latino and Caribbean communities, including Mexicans, Puerto Ricans, and those from the English-speaking Caribbean such as Jamaicans.

Names of the plants vary by country, sometimes by region, which can complicate matters for physicians trying to better understand the potential interactions, she added.

"We're still scraping the tip of the iceberg," she said. "[Looking at] just a few plant species ... shows us the incredibly rich knowledge that just one culture has."

Once the treatments are identified and sorted, Vandebroek and colleagues plan to review the literature for efficacy and potential interactions: "For many of these remedies, there is still so much that needs to be investigated," she said.

As a health insurer, Cigna's interest in the work originates in the idea that better healthcare translates to better outcomes, according to Cigna Foundation executive director

"It's all about what makes people feel good, and what they have faith in," Vandebroek said, adding that communities will hold tight to their cultural traditions.

"It's not whether we subdue them with the laws of biomedicine and put a stamp of approval or not," she told ľֱ. "It is realizing and making space for the fact that these communities are going to continue using herbal remedies, and we need a dialog about that."