Diabetic Retinopathy

Diabetic retinopathy is a malady pertaining to the eyes and it concerns the retina, which is also called the ‘projection screen’ in the eye on which light that traverses the eye lens is beamed. When an individual has diabetic retinopathy, the capillaries that supply nourishment’s to the retina of the patient either seep out blood or fluids. Such seepage causes insufficient blood circulation to the cells that are receptive to light and transmit visual signals to the optic nerve, which, in turn, transports these impulses/ signals to the brain. It may be noted that diabetic retinopathy is the most widespread reason for the loss of eyesight in individuals having acute diabetes. Generally, diabetic retinopathy does not produce any symptoms till the patient begins to lose vision.

There are a number of risk factors for developing diabetic retinopathy and these may include the patient’s age, the duration for which he/ she is having diabetes as well as the presence of glycosylated hemoglobin, a gluey protein, in the patient’s blood. The presence of any growth factor akin to insulin, a hormone made in excessive amounts when one is having diabetes, is an added risk factor for developing this condition. This hormone stimulates the development of the delicate capillaries, which break easily and cause fluid leakage, in the eye. The usual or standard treatment for diabetic retinopathy comprises laser surgery that closes up the trickling blood vessels.

Treatment of diabetic retinopathy with herbs or herbal products mostly helps to prevent the development of this condition. In fact, herbs providing bioflavonoids in abundance help to make the capillaries stronger and, at the same time, inhibit the progression or put off diabetic retinopathy even in conditions when the blood sugar levels of the patient are not controlled adequately. However, the most effective precautionary measure against diabetic retinopathy is controlling the blood sugar levels carefully and also having eye tests on a regular basis to detect the problem in its early stage.

Supplements and Herbs:

There are a number of herbs and supplements that are effective in preventing diabetic retinopathy and some of them are listed below. However, before you start taking any of these herbs or supplements, it is important that you consult your physician.

Bilberry tablets taken in dosage of 240 mg to 360 mg everyday aid in putting off the formation of blood clots in the vessels that supply nourishment’s to the retina. Similarly, chanca piedra tincture taken in dosage of one full dropper in half a cup (125 ml) of water two times every day discontinues the development of compounds that harm the retina.

You may also take tablets of the herb ginkgo in a dosage of anything between 160 mg and 180 mg once every day, as they help in avoiding any damage to the retina cells whose function is to distinguish colors. You may also take hawthorn tablets in dosage of 100 mg to 250 mg thrice every day. Hawthorn tablets aid in fortifying the blood vessels that supply nutrients to the surface of the eyes. In addition, this herb also works to lessen the receptiveness of the blood vessels to emotional strain.

Intake of jambul seeds is also beneficial, as they not only bring down the level of blood sugar but also slow down the inflammation in the blood vessels. Use these seeds in cooking every day in a dosage of two teaspoons to one tablespoon (about 3 gm to 5 gm). Taking tablets containing extracts of grape seed or pine bark, which enclose oligomeric proanthocyanidin (OPC) in a dosage of 200 mg every day also strengthens the capillaries in the retina and helps to prevent diabetic retinopathy.

Antioxidants help in lessening the inflammation in the blood vessels. As mentioned earlier, grape seed extract encloses the procyanidins that make the capillaries in the retina stronger and also put off bleeding and formation of blood clots. At the same time, this herbal product supplies the retina with the essential nourishment’s retards the aging of the eyes and augments vision during the night. In addition, grape seed extract also helps in preventing as well as treating diabetic retinopathy and arteriosclerosis in the eye.

Take quercetin tablets in dosage of 125 mg to 250 mg thrice every day between your meals. This supplement inhibits the development of growth factors like insulin and also puts off the formation of blood clots. Take the tablet form of soy isoflavone concentrate in a dosage of 3,000 mg once every day, as it also retards the development of insulin-like growth factor.

In addition, vitamin A, as well as carotenoids, are essential for maintaining healthy eyes and also to improve your vision during the night. Also, consume spinach and get spinach extract or lutein, as they enclose carotenoid that is essential for the eye and retina tissue. It has also been found that at times the use of these substances helps to turn around several eye conditions.

In Addition:

Besides undergoing surgery, taking conventional medications and herbs as well as supplements, you may do a few more things to prevent as well as treat diabetic retinopathy. For instance, you should consume blueberries, blackberries, and cherries in the amount that is permitted in your diet. These fruits enclose proanthocyanidins, which are akin to those present in the herb hawthorn, and strengthen the minute blood vessels supplying nutrients to the retina.

In addition, you should also take glutamine in a dosage of 1,000 milligrams every day. It has been found that glutamine has the aptitude to inhibit or put off any harm to the retina by means of thwarting any damage caused by the free radicals. Nevertheless, you should not take supplements containing glutamine in case you are suffering from liver cirrhosis or any problems related to the kidneys. You should also keep away from glutamine supplements if you ever suffered from Reye’s syndrome in the past. It may be noted here that uncooked parsley and spinach are among the excellent glutamine resources.

It is important to note that you should never miss any insulin shot in an attempt to lose weight. In fact, medical literature contains several accounts of people developing diabetic retinopathy when they either took insulin shots in lessened dose or totally skipped taking the injections with a view to controlling their weight. This is all the more true in adult women and teenagers.

In addition, you need to stay away from taking supplements containing vitamin C. It may be underlined that when you augment the dose of vitamin C, it results in the deterioration of diabetic retinopathy, particularly in individuals having diabetes, but do not take insulin shots.

Also, ensure that you have your eyes examined at least once every year to check if you have developed diabetic retinopathy. While it is possible to stop vision loss or blindness by undergoing laser surgery, you should know that every laser weld results in an everlasting blind spot in the retina, even in cases where laser surgery is very successful. While at times it may become essential to undergo a laser surgery, it is always better to take precautions to prevent the development of this condition – prevention is definitely a better approach than cure.

It may be noted that tight control is a schedule where you maintain the fasting levels of blood sugar in the range of 125 to 135 milligrams for every deciliter (mg/dl), while the after a meal or post-prandial blood sugar level is maintained at around 165 mg/dl. You may backup tight control by means of having your blood examined for HbA1C or the proportion of the ‘sticky’ red blood cells (erythrocytes). Any reading of blood sugar levels less than 6.5 percent substantiates tight control. Currently, physicians recommend this program for all people having diabetes, as it helps to lessen the chances of diabetic retinopathy by approximately 60 percent.

It is worth mentioning here that tight control is just a part of a greater all-inclusive program called intensive therapy. Besides tight control, this method makes use of an arrangement comprising diet, workouts, and medicines to regulate high blood pressures. The findings of a study involving 166 diabetic patients revealed that intensive therapy lowered the occurrence of diabetic retinopathy by an added 55 percent, as well as produced even considerably lesser incidences of damage to the nerve as well as kidney ailments. However, tight control also has a downside and it is weight gain. In spite of the intake of a number of calories equal to that taken by individuals in a control group as well as consuming less amount of fat, it was found that people undergoing intensive therapy for about two years have gained an additional weight of about nine pounds (four kilograms) on average, compared to those in the control group. Nevertheless, it is possible to counterbalance this consequence of intensive therapy by using the herb wild angelica.

While acupuncture cannot replace other modes of treatment, including surgery, it has the ability to reinstate the regular blood circulation to the eyes and, at the same time, inhibit the development of diabetic retinopathy. In addition, acupuncture also has the aptitude to reduce the internal pressure of the eye attributable to glaucoma, a condition that may occur together with diabetic retinopathy.

Scientists at the National Eye Institute have induced a medical condition that bears a resemblance to diabetic retinopathy in dogs and, subsequently, treated these animals using a trial medicine known as sorbinil that works to repress the activities of an enzyme that transforms surplus blood sugar into alcohol, which is believed to damage the blood vessels supplying to the retina. The study conducted by these researchers used sorbinil successfully to obstruct the advancement of diabetic retinopathy.

The very thought that you may become blind can itself be terrifying and, in such cases, you will benefit by consulting a therapist. Your physician too will be able to help you by providing a referral. Alternately, you may also find that the company and support offered by any support group are useful for you. Hence, it is advisable that you talk to your physician regarding the support groups for individuals having diabetic retinopathy in your locality.

In case your vision has already been damaged to some extent, you should consult your physician regarding low vision products plus services, which are capable of making your daily life easier. For instance, you may opt for special lenses, magnifiers as well as video magnifiers.

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Ginkgo Extract Is Safe in Patients with Hepatocellular Carcinoma and Does Not Affect Tumor Response, but It May Increase Survival

Hepatocellular carcinoma (HCC) is a type of liver cancer and is the third greatest cause of cancer-related death worldwide. When diagnosed in the advanced stage, it is associated with a poor prognosis and death after a median of 6 months if untreated. A common therapy is a sorafenib, which is an oral multikinase inhibitor that increases median survival times by 2-3 months. HCC involves many signaling pathways, so researchers are looking at combining sorafenib with other therapies to increase the benefits. Many in vitro studies have shown that ginkgo (Ginkgo biloba, Ginkgoaceae) leaf extract (GBE) has activities against a variety of cancer cells, and it is reported to inhibit the development of HCC in a rat model. Hence, the purpose of this prospective, open-label, non-randomized study was to evaluate the efficacy and safety of a combination of GBE and sorafenib in treating patients with advanced HCC.

Patients (n = 27 in Phase 1 and n = 32 in Phase 2, aged ≥ 20 years) diagnosed with HCC by histological examination or typical diagnostic images participated in this study conducted at Tianjin First Center Hospital; Tianjin, China. Study dates were not given. Included patients had no indication for surgical resection or any other local therapy (e.g., ablation, chemoembolization, radiation therapy); had had no systemic chemotherapy; had measurable disease based on Response Evaluation Criteria in Solid Tumors (RECIST) of ≥ 1 untreated target lesion and ECOG (Eastern Cooperative Oncology Group) performance status 0-1; had neutrophil count ≥ 1500/μL, hemoglobin ≥ 9.0 g/dL, platelets ≥ 50,000/μL, total bilirubin < 3.0 mg/dL, aspartate aminotransferase (AST)/alanine aminotransferase (ALT) < 5x the upper limit of normal (ULN), albumin ≥ 2.8 g/dL, serum creatinine ≤ ULN, prothrombin time ≥ 40%, and Child-Pugh score A; were able to take food and drugs orally; and had life expectancy of ≥ 12 weeks. Patients were excluded if they had received previous therapy for HCC, an albumin preparation or blood transfusion, or any major surgery ≤ 30 days before study entry; had any surgery ≤ 15 days before study entry; had portal vein tumor thrombus in the primary trunk; had uncontrollable hypertension; had clinically significant pleural effusion, ascites, or pericardial fluid; had symptomatic hepatic encephalopathy, bone metastasis, brain lesions, or any central nervous system tumor; had active infection other than hepatitis B virus and hepatitis C virus (HCV) infection; had serious gastrointestinal bleeding ≤ 30 days before study entry; had gastroesophageal variances requiring treatment; were pregnant, lactating, or did not agree to use contraception during study treatment; or had a second primary cancer, except for in situ carcinoma or a cancer treated > 5 years ago without recurrence.

The first phase was to determine the maximum tolerated dose of GBE. A dosing scheme common to cancer trials was employed. Dosing was increased until a dose-limiting toxicity (DLT) occurred. DLTs included non-hematologic grade 3 or grade 4 toxicities that required treatment interruption for ≥ 7 days or that took ≥ 7 days to resolve to ≤ grade 1 despite treatment (excluding a list of common chemotherapy side effects, such as alopecia, hypertension, hypercholesterolemia, hand-foot skin reaction, and vomiting); hematologic toxicities of grade 4 or of grade 3 with specified complications or needing dose interruptions for > 7 days; increase in bilirubin or creatinine to ≥ 2x ULN; and hepatitis B reactivation or HCV flare. All patients received 400 mg sorafenib 2x/day. The first dose of GBE (obtained from Xi’an Honson Biotechnology Co.; Xi’an, China) was 60 mg/day (Cohort 1, n = 6). The second dose was 120 mg/day (Cohort 2, n = 8). The third dose was 240 mg/day (Cohort 3, n = 10). The fourth dose was 360 mg/day (Cohort 4, n = 3). The enrollment schedule was planned to minimize exposure of more patients than necessary to a dose that proved to be toxic. Patients remained on treatment until disease progression or toxicity. In the second phase, which enrolled 32 patients, the efficacy, and safety of the optimal GBE dose were evaluated. All patients were followed for 1 year for survival. Physical examination, vital signs, height and weight, ECOG performance status, and laboratory parameters were assessed. Best overall response rate (efficacy) was evaluated by RECIST with tumors assessed by standard computed tomography/magnetic resonance imaging of the abdomen at baseline and at 8-week intervals until the end of treatment. Blood was collected for pharmacokinetic assessment.

In Phase 1, no patient in Cohort 1 or 2 had a DLT. In Cohort 3, 1 patient had a DLT (grade 4 AST/ALT elevation). In Cohort 4, 2 of 3 patients had a DLT (grade 3 hand-foot skin reaction [Note: The paper elsewhere suggested that such reactions were not enumerated among DLTs.] and grade 3 gastrointestinal bleeding). Due to the high rate of DLTs in Cohort 4, it was decided that the dose used in Cohort 3 (240 mg/day GBE plus 400 mg 2x/day sorafenib) would be the maximum tolerated dose and the dose used in Phase 2.

In Phase 2, 2 patients (6%) stopped treatment because of adverse effects (AEs). Treatment-related AEs included hyperbilirubinemia (94% of patients), AST elevation (94%), thrombocytopenia (84%), anemia (72%), ALT elevation (66%), hand-foot skin reaction (59%), and fatigue (53%). The most common grade 3/4 AEs were AST elevation (28%), thrombocytopenia (19%), neutropenia (19%), hyperbilirubinemia (13%), and ALT elevation (13%). This toxicity profile was comparable to the expected toxicity of sorafenib monotherapy, except that the frequency of elevated liver enzymes was higher than that expected from either sorafenib or GBE monotherapy.

Regarding efficacy, 3 patients (9.4%) had a partial response, 21 patients (65.6%) had stable disease, and 8 patients (25%) had progressive disease. Mean overall survival was 11.6 months. Time to disease progression was a median of 2.5 months, which is similar to sorafenib monotherapy, and the tumor response rate and disease control rate did not significantly differ from those reported in a previous study of sorafenib monotherapy. However, median survival time was 11.6 months, which represented a “slightly” improved overall survival compared with the prior cohort treated with sorafenib alone. In terms of pharmacokinetics, the increase in the maximum concentration of unspecified compounds with increasing dose was usually proportional to the dose, whereas the increase in minimum concentration was more than dose-proportional.

The authors conclude that since treatment-related toxicity was similar to that observed with sorafenib monotherapy, the combination was safe and tolerable. Since the addition of GBE to sorafenib did not appear to improve tumor response, yet might have modestly improved median survival by some other mechanism, the authors suggest that further research is warranted. Limitations of the study include the small sample size and those only Chinese patients were included. The results could differ in other populations. The authors state no conflict of interest.

Resource:

Cai Z, Wang C, Liu P, Shen P, Han Y, Liu N. Ginkgo biloba extract in combination with sorafenib is clinically safe and tolerable in advanced hepatocellular carcinoma patients. Phytomedicine. November 15, 2016;23(12):1295-1300.