Amid a national opioid epidemic that has killed tens of thousands of Americans, the U.S. Food and Drug Administration (FDA) is warning about an unregulated supplement that has addictive and potentially dangerous health effects. In a statement, the FDA’s commissioner, Scott Gottlieb, MD, who is based in Silver Spring, Maryland, says some people are using the botanical substance, called kratom, for pain relief and to treat opioid withdrawal symptoms. As of February 2018, the FDA had received reports of 36 deaths linked with kratom. “Compounds in kratom make it so it isn’t just a plant — it’s an opioid,” Gottlieb says in the statement. “And it’s an opioid that’s associated with novel risks" because of the way it’s being formulated and used. Those risks, which include brain effects similar to those of morphine, also affect people living with type 2 diabetes. Blogs, message boards, and Reddit threads suggest a subset of people with the disease are experimenting with the substance in hopes of increasing insulin sensitivity and lowering their blood sugar. The problem, the FDA and experts say, is there’s no proof kratom will do that. “Kratom should not be used to treat medical conditions, nor should it be used as an alternative to prescription opioids,” Gottlieb says in the statement. “There is no evidence to indicate that kratom is safe or effective for any medical use.” RELATED: 5 Ways to Lower Your A1C Because supplements are not subject to the same rigorous safety tests as approved prescription drugs, there haven’t been large, long-term studies that show the substance is safe. While the FDA hasn’t indicated that insulin sensitivity is one of the known use cases of kratom, it says such practices could be dangerous. “Because this product has not been reviewed for safety or efficacy, we have no information on what people with diabetes specifically should know about using this product,” says Lyndsay Meyer, an FDA spokeswoman also based in Silver Spring. That said, she added, “our general warning stands: The FDA is urging all consumers not to use kratom products.” Marilyn Tan, MD, the chief of the Stanford Endocrine Clinic in Stanford, California, says she has not heard of kratom being used to treat type 2 diabetes, but she emphasized people should not use supplements that are not recommended by their doctors, especially when managing a condition like type 2 diabetes. She points out that supplements are not regulated or tested for efficacy. “Make sure your doctor knows every supplement you take,” she says. “These things are not regulated, and [manufacturers] can make any claims they want.” Dr. Tan says she’s seen people with type 2 diabetes try to replace their insulin with supplements without a doctor’s approval, and the results were disastrous. “Patients think this could be a replacement for prescribed insulin,” she says. “They come in and get hospitalized with diabetic ketoacidosis and they end up in the ICU.” Diabetic ketoacidosis occurs when insulin levels are low and ketones, or blood acids, are present at high levels, potentially poisoning the body. This condition is a health emergency that can result in a diabetic coma or even death, according to the Mayo Clinic. RELATED: What’s the Difference Between Ketosis and Diabetic Ketoacidosis? Tan says she’s heard of patients taking supplements from cumin, which is innocuous, along with more worrisome substances like ground-up animal extracts. She says there aren’t any supplements that are proven to be helpful for type 2 diabetes specifically. One concern about kratom is that its opioid-like qualities may disable you from managing your blood sugar effectively. For example, Tan says, if you were to eat a carb-heavy meal and fall asleep or pass out before checking your blood sugar levels, you could be in distress while asleep. If you have diabetes, blood sugar control is key for preventing potentially serious health complications, such as diabetic neuropathy (nerve damage), retinopathy (eye damage), and heart disease. A much better way to manage type 2 diabetes is through diet, exercise, and medication, and insulin if your doctor has prescribed it, Tan says. While there has been no research on whether kratom is safe and effective for treating health conditions, early research has led to debates in the medical community over whether the substance holds promise for treating diseases in the future, or whether it may cause more harm than good. Kratom is a plant native to Southeast Asia, and it has historically been described as a “folk medicine” used to allegedly aid in opiate withdrawal, fatigue, and diarrhea. A study published in Natural Product Research suggests kratom may increase glucose transport to muscles in rats. A report published in December 2016 in the Journal of the American Osteopathic Association suggests kratom contains pharmacologically active ingredients that the authors say merit its study as a potential opioid withdrawal drug. “While the DEA [Drug Enforcement Agency] and physicians have valid safety concerns, it is not at all clear that kratom is the culprit behind the adverse effects,” says Anita Gupta, DO, PharmD, a special adviser to the FDA, in a November 2016 press release for the report. In the single year 2016, the latest year for which data are available, opioid overdoses contributed to the total of 64,000 drug overdose deaths in the U.S., according to the National Institute on Drug Abuse. That’s more than the 58,220 Americans who died in the entire Vietnam War. As of February 2018, kratom was legally banned in several states, including Alabama, Tennessee, Indiana, and Arkansas, according to the FDA release.
