Principles of Treatment of diabetes
Classical Ayurvedic therapy for madhumeha (diabetes) follows the principles of Ayurvedic treatment. First an assessment of the dosha imbalance is made. In all types of pramehas (urinary disorders), kapha is vitiated, but in madhumeha, vata is often aggravated as well. Therefore, therapies will be directed at both vata and kapha simultaneously to restore the balance of the doshas.
Physician Caraka further classified patients with madhumeha into two groups according to their vitality, constitution, and disease etiology. Patients are either obese and strong or lean and weak. Treatment protocols are different for each type. Treatment for obese patients begins with a cleansing. Lean diabetic patients, however, are considered too frail to undertake radical cleansing; they and other frail diabetic patients customarily undergo milder cleansing procedures. Both groups are then treated with specific herbal therapy and diet.
Treatment of Diabetic Patients
Patients are often initially treated with purification (sodhana) therapy that is first started with oleation, which is the application of medicated oils to the body. If the patient has a predominance of kapha, then the oil is prepared with a kaphaghna (kapha-killing) drug. Similarly, if pitta is predominant, then the oil is processed with a pittaghna (pitta-destroying) drug. This is followed by emetic therapy, which treats excess kapha, and then by purgation therapy to balance excess pitta. Next, desaturation therapies, such as fasting, physical exercise, and herbs, are used to reduce the excess doshas.
Some early Ayurvedic experts, such as Susruta and Vagbhata, even advised administering enemas containing decoctions of medicinal herbs as a cleaning process to reduce the excess doshas.
Saturating therapies that are strengthening or restorative in nature are used to balance and remove any debility in the patient caused by the purification or cleansing. This is the final step prior to starting therapies specifically directed at the imbalanced doshas.
Exercise and diet are important adjuncts to the primary diabetes treatment. Vigorous exercise, however, is contraindicated in lean and weak patients. Instead, severe diabetic patients are advised to perform specific yoga positions that are believed to benefit them in mind and body with the least physical stress. Certain postures are believed to stimulate the endocrine pancreas and improve its function.
Diet is prescribed according to age, body constitution, season, and environment, as well as the socioeconomic status of the patient. At least one attempt has been made in the Indian literature to determine if the source of dietary carbohydrate (i.e., lentils vs. wheat) has an impact on the control of diabetes .
Herbal Therapies for Diabetes
Ethnobotanical studies of traditional herbal remedies used for diabetes around the world have identified more than 1,200 species of plants with hypoglycemic activity. These plants are broadly distributed throughout 725 different genera. The large number of traditional remedies dedicated to diabetes likely reflects the relative ease of diagnosing this disease sugar in the urine can be determined even in technology-poor societies. This traditional knowledge, derived empirically, is supported by scientific testing. When traditional diabetic remedies have been tested for antidiabetic activity, plants with a traditional indication for diabetes are more likely than randomly selected plants to show activity in standard hypoglycemic assays (81 percent vs. 47 percent)
The pharmacopoeia of India is especially rich in herbal treatments for diabetes. Eighty-five percent of the 20 antidiabetic plants most widely used around the world are prescribed in India Basic scientific data now supplement traditional lore for the most commonly used Ayurvedic herbs.
Ayurvedic herbal drugs for diabetes are selected on the principles of rasa (taste), guna (physicochemical properties), veerya (potency), vipaka (post-digestive effect), and prabhava (unique action). " Each of these principles is felt to have specific effects on the doshas and functions of the body, which is how they exert their therapeutic effects. Additional background information on Ayurvedic pharmacology is found in Mishra, Singh, and Dagenais (2001a).
Common Herbs Used in Ayurveda To Treat Diabetes
A few of the herbs commonly used by Ayurveda practitioners to treat diabetes are described below.
Gymnema sylvestreR. Br. This plant, of the family Asclepiadaceae, is a woody, climbing vine common in central and southern India. It has been used to treat diabetes for more than two thousand years. Its Hindu common name, gurmara or gurmar, means "sugar destroyer." Traditionally, the leaves are either chewed whole, taken as a powder, or drunk as a water decoction.
A number of constituents have been isolated from this plant since the first chemical studies were done at the end of the nineteenth century. Most important for the treatment of diabetes are the gymnemic acids, which were reportedly first isolated by Hooper in 1889 . Regan began modern pharmacologic studies in 1930 The best studied extract of Gymnema, GS4, contains a group of at least 15 triterpene sapinoids (the gymnemic acids) plus a polypeptide, gurmarin
The pharmacologic actions of Gymnema have been studied in a number of animal models. The plant has been able to normalize blood sugar in animals that were treated with agents that destroy beta-cell function but not in animals that have been pancreatectomized
. Conversely, Gymnema has shown little effect on the blood sugar of normal animals . This observation has not been confirmed by other investigators. Chattopadhyay, Medda, Das, et al. (1993) have shown that Gymnema in a water based extraction increased the effect of exogenous insulin in normal rats, increased the tolerance for glucose in normal and hyperglycemic rats, and decreased the plasma glucose in mildly diabetic rats.
Shanmugasundaram and colleagues observed that the powdered leaf and water-based extracts from the leaf stimulate insulin secretion in rats. Persaud, Al-Majed, Raman, et al. (1999) demonstrated increased insulin release in isolated pancreatic beta cells from rats using the GS4 extract. Further, they determined that gymnemic acid VIII was the most potent single constituent causing this effect.
Gymnema has also been demonstrated to have protective effects on the pancreas. A partial protective effect of this plant was seen in animals pretreated for 2 weeks with powdered Gymnema leaves before exposure to beryllium, a potent pancreatic toxin
. Shanmugasundaram, Gopinath, Shanmugasundaram, et al. (1990a) and Baskaran, Ahamath, Shanmugasundaram, et al. (1990) further suggested that it may also promote regeneration of islet cells in streptozotocin-treated rats. In fact, Srivastava, Venkatakrishna-Bhatt, Jhala, et al. (1986) demonstrated that alloxan diabetic rats treated with Gymnema lived significantly longer than untreated rats.
Extra-pancreatic mechanisms of action have been demonstrated to explain the hypoglycemic activity of Gymnema. Increase of the activity of key enzymes of insulin-dependent glucose utilization pathways, such as phosphorylases and gluconeogenic enzymes, has been reported in alloxan-treated rabbits.
Shimizu, Iino, Nakajima, et al. (1997) demonstrated that gymnemic acids II, III, and IV decreased absorption of glucose from isolated rat intestine. Liver glycogen also was shown to be decreased in normal and hyperglycemic rats treated with Gymnema
.
It has been traditionally observed that chewing Gymnema leaves interferes with the perception of sweet taste, an effect that can last for 1 to 2 hours. Bitter taste is also obscured, but not other tastes such as salty, pungent, acidic, or astringent
. The leaf constituents most responsible for this effect are the gymnemic acids and gurmar, via direct activity on the nerves of the sensory apparatus in the tongue
Human subjects who drank a solution prepared with Gymnema prior to eating decreased their calorie consumption; this was attributed to a reduced perception of sweet taste and a resulting decrease in appetite .
In summary, a review of the in-vitro and animal data suggests three possible physiologic mechanisms of actions for Gymnema:
(1) increased insulin secretion through action on the pancreas,
(2) increased tissue sensitivity to insulin, and
(3) decreased oral intake of calories due to an alteration in the sensation of taste. This herb is frequently included in Ayurvedic formulas for diabetes and is often used as a folk treatment for diabetes .
Generally, no significant toxicities are reported with the use of this herb. However, there are observations of nausea occurring in patients taking more than 3 g of Gymnema (Gerson, 2000).
Momordica charantiaL. An herbaceous climbing vine of the Cucurbitaceae family, this plant is the most widely used traditional remedy for diabetes. It is believed to alleviate kapha and pitta
The bitter, unripe fruit or its juice is used in India, Africa, China, the West Indies, and Central America
. Karela, the common Indian name for the gourd produced by this plant, is traditionally taken in the form of a fried vegetable or as expressed juice
The common English name for this plant is bitter gourd .
Triterpenoid and peptide constituents with hypoglycemic activity have been isolated from Momordica and tested in both in-vitro and in-vivo models. Charantin, an alcoholic extract of the fruit, contains both b-sitosterol-D-glucoside and 5,25-stigmastaadien-3-B-ol-D-glucoside in a 1:1 mixture .
In addition, a 17-amino-acid polypeptide, referred to as vegetable insulin, has been isolated from Momordica fruit, seeds, and seedlings. This polypeptide does not crossreact in immune assays for bovine insulin .
It is assumed that the polypeptide would not survive exposure to stomach acid; in fact, the studies that use this extract deliver it by injection. Bailey and Day (1989) reported isolating at least two other active components from Momordica; one has a rapid-onset of action, and the other contains a slow-acting constituent present in an alkaloid-rich fraction. The two active chemicals have not yet been fully characterized
Research attention is also being given to the bitter components common to this and many other members of the Cucurbitaceae family. They exist as a series of triterpene glycosides classified as momoridicosides; 11 have been identified so far
Both pancreatic and extra-pancreatic mechanisms have been postulated for the hypoglycemic effects of the karela (bitter gourd), based on in-vitro and animal data. Hypoglycemic activity of the raw unripened fruit and aqueous extracts of the fruit are cited
Charantin has been reported to have glucose-lowering activity in alloxan-treated rabbits, normal rabbits, rats, and cat. However, other investigators report difficulty documenting the hypoglycemic effects of this constituent
In pancreatectomized animals, the effect of Momordica was equivocal , but Raman and Lau (1996) noted efficacy of karela, also known as bitter melon, in lowering blood sugar in animals with very little pancreatic reserve. Decreased glucose uptake from intestine has been reported, as well as increased glucose uptake by muscle but not adipose tissue .
Bitter melon reportedly does not increase insulin levels in animals, despite the fact that insulin stimulation from isolated pancreatic islet cells has been reported (Raman and Skett, 1998). A purified protein called peptide V isolated from bitter melon has demonstrated hypoglycemic activity in animals and humans when injected
There are several reports of toxicity with Momordica. Bhandari and Grover (1998) noted uterine hemorrhage in pregnant rabbits given a crude extract of this plant. Cases of vomiting and diarrhea in humans have also been reported (Lewis and Elvin-Lewis, 1977). Marles and Farnsworth (1995) identified a mildly toxic lectin in the seeds and outer rind of the fruit. As a food in the Indian diet, no toxicity has been reported
Trigonella foenum-graecumLinn. Commonly known as fenugreek, this annual herb is widely cultivated throughout the world as a spice. It is in the family Leguminosae (also called Fabaceae). The herb is known in Sanskrit and Hindi as medhika or methi
In addition to its role in Ayurveda, fenugreek was included in the pharmacopoeia of many ancient cultures, including Egyptian and Greek. Volatile and essential oils give this plant its characteristic odor, and a small amount (5 percent) of bitter fixed oil contributes to its taste
The leaves are eaten in India as a vegetable. The seed, on the other hand, is used to treat diabetes. It is prepared as a gruel or a drink, or it is baked into bread or mixed into curry
Fenugreek seeds have a high fiber content, up to 50 percent; it is mucilaginous and rich in
. Trigonelline, an alkaloid derived from the metabolism of nicotinic acid, has been isolated from the seed and shown to have hypoglycemic effects
Whole seeds have been shown to be hypoglycemic in normal and mildly diabetic animals but not in those with severe disease
Bailey and Day postulate that the high fiber content of fenugreek seeds decreases absorption of glucose by slowing transit time in the gut. Defatted seeds lowered blood glucose as well as glucagon in dogs, both normal and diabetic (
Trigonelline showed a weak and transitory hypoglycemic effect when given orally to diabetic patients, presumably by slowing the metabolism of nicotinic acid, a hyperglycemic constituent
In addition to its effects on glucose, fenugreek seed, especially the fiber component, lowers cholesterol and triglyceride levels in normal and diabetic animals and patients (Indian Council for Medical Research, 1987).
Fenugreek is also used to treat dysentery, dyspepsia, rheumatism, and chronic cough and to increase milk production. The leaves, made into a poultice, are applied topically to reduce swelling and treat abscesses or other wounds.
Generally, no significant toxicities are reported with the use of this herb.
Coccinia indica Wight and Arun. Also known as C. grandis and C. cordifolia Cogn., this leafy creeping plant of the Cucurbitaceae family grows wild over much of India and elsewhere (e.g., Hawaii) where it is a weed. The common English name is ivy gourd; in Hindi it is kanduri, and in Sanskrit it is bimba
Traditionally, the leaves, root, fruit, and bark have been used medicinally. However, more recent scientific studies have focused primarily on the leaf
Coccinia indica has not been studied as much as some of the other traditional remedies for diabetes, but the available data on this plant are chemically and pharmacologically interesting. The juice contains an amylase as well as b-sitosterol and a cucurbitacin, B-glycoside
Water-soluble fractions of the leaf that test positive for alkaloids show hypoglycemic activity
A novel saponin has also been identified from an alcohol extract of the leaf (
The mechanism of action of Coccinia indica is not clearly understood, but studies with rats demonstrate involvement in the repression of a key gluconeogenic enzyme, glucose-6-phosphatase
. Other studies showed that a suspension of the powdered leaf of C. indica lowers blood sugar in alloxan-treated dogs but not in normal animals
. This suspension also reduced blood glucose in both normal and diabetic dogs during a glucose tolerance ). Both alcohol and water extracts of the root show antidiabetic activity in healthy rabbits
. Researchers have variously reported a rapid onset of action for C. indica or a delayed onset of at least 3 weeks (Azah Khan, Akhtar, and Mahtab, 1979).
Other traditional uses for this plant include the treatment of jaundice, wounds (when applied topically), bronchial complaints, psoriasis, ringworm, and sexually transmitted diseases such as syphilis and gonorrhea
No toxic side effects of this plant have been reported in the literature.
Pterocarpus marsupiumRoxb. andPterocarpus santalinusLinn. These two closely related species are used as folk remedies for diabetes in southern India. P. marsupium is a large deciduous tree common in central India. Its English name is false teak, in Sanskrit it is pitasala, in Hindi it is bijasal, and it is also known as vijayasara. P. santalinus, or red sandalwood, is a smaller tree found in the deciduous forests of southern India. It is known as Rakta chandana in Sanskrit and as Lal chandan in Hindi (
The wood and bark of the trees are most commonly used, often as a decoction. In addition, a novel method of using P. marsupium medicinally has been reported. Heartwood is carved into a cup, which is filled with water that is allowed to steep overnight. Diabetic patients then drink the water, called beeja water, the following day. It is not clear from the sources if the cup can be used more than once
The sap from P. marsupium yields a reddish gum, called kino, which is high in tannic acids. Not surprisingly, epicatechins have been isolated from bark and heartwood
These flavonoids have demonstrated an ATP-dependent enhancement of glucose-stimulated insulin release from isolated pancreatic islet cells in vitro
. Less substantiated claims have been made that the flavonoids contribute to the regeneration of beta cells in the pancreas
Phenolic constituents isolated from P. marsupium, identified as marsupin, ptersupin, and pterostilbene, have demonstrated hypoglycemic activity in rats
Contradictory data have been reported about the efficacy of P. marsupium to lower blood sugar in animal models
A series of experiments in rats using a 95 percent alcohol extract of wood powder from P. santalinus showed a hypoglycemic effect in healthy albino rats and in streptozotocin-treated rats
Additional traditional uses for these plants include the treatment of diarrhea, toothache, and skin wounds and infections (when applied topically). The gum from P. santalinus is often included in other medicinal salves.
Classical Ayurvedic therapy for madhumeha (diabetes) follows the principles of Ayurvedic treatment. First an assessment of the dosha imbalance is made. In all types of pramehas (urinary disorders), kapha is vitiated, but in madhumeha, vata is often aggravated as well. Therefore, therapies will be directed at both vata and kapha simultaneously to restore the balance of the doshas.
Physician Caraka further classified patients with madhumeha into two groups according to their vitality, constitution, and disease etiology. Patients are either obese and strong or lean and weak. Treatment protocols are different for each type. Treatment for obese patients begins with a cleansing. Lean diabetic patients, however, are considered too frail to undertake radical cleansing; they and other frail diabetic patients customarily undergo milder cleansing procedures. Both groups are then treated with specific herbal therapy and diet.
Treatment of Diabetic Patients
Patients are often initially treated with purification (sodhana) therapy that is first started with oleation, which is the application of medicated oils to the body. If the patient has a predominance of kapha, then the oil is prepared with a kaphaghna (kapha-killing) drug. Similarly, if pitta is predominant, then the oil is processed with a pittaghna (pitta-destroying) drug. This is followed by emetic therapy, which treats excess kapha, and then by purgation therapy to balance excess pitta. Next, desaturation therapies, such as fasting, physical exercise, and herbs, are used to reduce the excess doshas.
Some early Ayurvedic experts, such as Susruta and Vagbhata, even advised administering enemas containing decoctions of medicinal herbs as a cleaning process to reduce the excess doshas.
Saturating therapies that are strengthening or restorative in nature are used to balance and remove any debility in the patient caused by the purification or cleansing. This is the final step prior to starting therapies specifically directed at the imbalanced doshas.
Exercise and diet are important adjuncts to the primary diabetes treatment. Vigorous exercise, however, is contraindicated in lean and weak patients. Instead, severe diabetic patients are advised to perform specific yoga positions that are believed to benefit them in mind and body with the least physical stress. Certain postures are believed to stimulate the endocrine pancreas and improve its function.
Diet is prescribed according to age, body constitution, season, and environment, as well as the socioeconomic status of the patient. At least one attempt has been made in the Indian literature to determine if the source of dietary carbohydrate (i.e., lentils vs. wheat) has an impact on the control of diabetes .
Herbal Therapies for Diabetes
Ethnobotanical studies of traditional herbal remedies used for diabetes around the world have identified more than 1,200 species of plants with hypoglycemic activity. These plants are broadly distributed throughout 725 different genera. The large number of traditional remedies dedicated to diabetes likely reflects the relative ease of diagnosing this disease sugar in the urine can be determined even in technology-poor societies. This traditional knowledge, derived empirically, is supported by scientific testing. When traditional diabetic remedies have been tested for antidiabetic activity, plants with a traditional indication for diabetes are more likely than randomly selected plants to show activity in standard hypoglycemic assays (81 percent vs. 47 percent)
The pharmacopoeia of India is especially rich in herbal treatments for diabetes. Eighty-five percent of the 20 antidiabetic plants most widely used around the world are prescribed in India Basic scientific data now supplement traditional lore for the most commonly used Ayurvedic herbs.
Ayurvedic herbal drugs for diabetes are selected on the principles of rasa (taste), guna (physicochemical properties), veerya (potency), vipaka (post-digestive effect), and prabhava (unique action). " Each of these principles is felt to have specific effects on the doshas and functions of the body, which is how they exert their therapeutic effects. Additional background information on Ayurvedic pharmacology is found in Mishra, Singh, and Dagenais (2001a).
Common Herbs Used in Ayurveda To Treat Diabetes
A few of the herbs commonly used by Ayurveda practitioners to treat diabetes are described below.
Gymnema sylvestreR. Br. This plant, of the family Asclepiadaceae, is a woody, climbing vine common in central and southern India. It has been used to treat diabetes for more than two thousand years. Its Hindu common name, gurmara or gurmar, means "sugar destroyer." Traditionally, the leaves are either chewed whole, taken as a powder, or drunk as a water decoction.
A number of constituents have been isolated from this plant since the first chemical studies were done at the end of the nineteenth century. Most important for the treatment of diabetes are the gymnemic acids, which were reportedly first isolated by Hooper in 1889 . Regan began modern pharmacologic studies in 1930 The best studied extract of Gymnema, GS4, contains a group of at least 15 triterpene sapinoids (the gymnemic acids) plus a polypeptide, gurmarin
The pharmacologic actions of Gymnema have been studied in a number of animal models. The plant has been able to normalize blood sugar in animals that were treated with agents that destroy beta-cell function but not in animals that have been pancreatectomized
. Conversely, Gymnema has shown little effect on the blood sugar of normal animals . This observation has not been confirmed by other investigators. Chattopadhyay, Medda, Das, et al. (1993) have shown that Gymnema in a water based extraction increased the effect of exogenous insulin in normal rats, increased the tolerance for glucose in normal and hyperglycemic rats, and decreased the plasma glucose in mildly diabetic rats.
Shanmugasundaram and colleagues observed that the powdered leaf and water-based extracts from the leaf stimulate insulin secretion in rats. Persaud, Al-Majed, Raman, et al. (1999) demonstrated increased insulin release in isolated pancreatic beta cells from rats using the GS4 extract. Further, they determined that gymnemic acid VIII was the most potent single constituent causing this effect.
Gymnema has also been demonstrated to have protective effects on the pancreas. A partial protective effect of this plant was seen in animals pretreated for 2 weeks with powdered Gymnema leaves before exposure to beryllium, a potent pancreatic toxin
. Shanmugasundaram, Gopinath, Shanmugasundaram, et al. (1990a) and Baskaran, Ahamath, Shanmugasundaram, et al. (1990) further suggested that it may also promote regeneration of islet cells in streptozotocin-treated rats. In fact, Srivastava, Venkatakrishna-Bhatt, Jhala, et al. (1986) demonstrated that alloxan diabetic rats treated with Gymnema lived significantly longer than untreated rats.
Extra-pancreatic mechanisms of action have been demonstrated to explain the hypoglycemic activity of Gymnema. Increase of the activity of key enzymes of insulin-dependent glucose utilization pathways, such as phosphorylases and gluconeogenic enzymes, has been reported in alloxan-treated rabbits.
Shimizu, Iino, Nakajima, et al. (1997) demonstrated that gymnemic acids II, III, and IV decreased absorption of glucose from isolated rat intestine. Liver glycogen also was shown to be decreased in normal and hyperglycemic rats treated with Gymnema
.
It has been traditionally observed that chewing Gymnema leaves interferes with the perception of sweet taste, an effect that can last for 1 to 2 hours. Bitter taste is also obscured, but not other tastes such as salty, pungent, acidic, or astringent
. The leaf constituents most responsible for this effect are the gymnemic acids and gurmar, via direct activity on the nerves of the sensory apparatus in the tongue
Human subjects who drank a solution prepared with Gymnema prior to eating decreased their calorie consumption; this was attributed to a reduced perception of sweet taste and a resulting decrease in appetite .
In summary, a review of the in-vitro and animal data suggests three possible physiologic mechanisms of actions for Gymnema:
(1) increased insulin secretion through action on the pancreas,
(2) increased tissue sensitivity to insulin, and
(3) decreased oral intake of calories due to an alteration in the sensation of taste. This herb is frequently included in Ayurvedic formulas for diabetes and is often used as a folk treatment for diabetes .
Generally, no significant toxicities are reported with the use of this herb. However, there are observations of nausea occurring in patients taking more than 3 g of Gymnema (Gerson, 2000).
Momordica charantiaL. An herbaceous climbing vine of the Cucurbitaceae family, this plant is the most widely used traditional remedy for diabetes. It is believed to alleviate kapha and pitta
The bitter, unripe fruit or its juice is used in India, Africa, China, the West Indies, and Central America
. Karela, the common Indian name for the gourd produced by this plant, is traditionally taken in the form of a fried vegetable or as expressed juice
The common English name for this plant is bitter gourd .
Triterpenoid and peptide constituents with hypoglycemic activity have been isolated from Momordica and tested in both in-vitro and in-vivo models. Charantin, an alcoholic extract of the fruit, contains both b-sitosterol-D-glucoside and 5,25-stigmastaadien-3-B-ol-D-glucoside in a 1:1 mixture .
In addition, a 17-amino-acid polypeptide, referred to as vegetable insulin, has been isolated from Momordica fruit, seeds, and seedlings. This polypeptide does not crossreact in immune assays for bovine insulin .
It is assumed that the polypeptide would not survive exposure to stomach acid; in fact, the studies that use this extract deliver it by injection. Bailey and Day (1989) reported isolating at least two other active components from Momordica; one has a rapid-onset of action, and the other contains a slow-acting constituent present in an alkaloid-rich fraction. The two active chemicals have not yet been fully characterized
Research attention is also being given to the bitter components common to this and many other members of the Cucurbitaceae family. They exist as a series of triterpene glycosides classified as momoridicosides; 11 have been identified so far
Both pancreatic and extra-pancreatic mechanisms have been postulated for the hypoglycemic effects of the karela (bitter gourd), based on in-vitro and animal data. Hypoglycemic activity of the raw unripened fruit and aqueous extracts of the fruit are cited
Charantin has been reported to have glucose-lowering activity in alloxan-treated rabbits, normal rabbits, rats, and cat. However, other investigators report difficulty documenting the hypoglycemic effects of this constituent
In pancreatectomized animals, the effect of Momordica was equivocal , but Raman and Lau (1996) noted efficacy of karela, also known as bitter melon, in lowering blood sugar in animals with very little pancreatic reserve. Decreased glucose uptake from intestine has been reported, as well as increased glucose uptake by muscle but not adipose tissue .
Bitter melon reportedly does not increase insulin levels in animals, despite the fact that insulin stimulation from isolated pancreatic islet cells has been reported (Raman and Skett, 1998). A purified protein called peptide V isolated from bitter melon has demonstrated hypoglycemic activity in animals and humans when injected
There are several reports of toxicity with Momordica. Bhandari and Grover (1998) noted uterine hemorrhage in pregnant rabbits given a crude extract of this plant. Cases of vomiting and diarrhea in humans have also been reported (Lewis and Elvin-Lewis, 1977). Marles and Farnsworth (1995) identified a mildly toxic lectin in the seeds and outer rind of the fruit. As a food in the Indian diet, no toxicity has been reported
Trigonella foenum-graecumLinn. Commonly known as fenugreek, this annual herb is widely cultivated throughout the world as a spice. It is in the family Leguminosae (also called Fabaceae). The herb is known in Sanskrit and Hindi as medhika or methi
In addition to its role in Ayurveda, fenugreek was included in the pharmacopoeia of many ancient cultures, including Egyptian and Greek. Volatile and essential oils give this plant its characteristic odor, and a small amount (5 percent) of bitter fixed oil contributes to its taste
The leaves are eaten in India as a vegetable. The seed, on the other hand, is used to treat diabetes. It is prepared as a gruel or a drink, or it is baked into bread or mixed into curry
Fenugreek seeds have a high fiber content, up to 50 percent; it is mucilaginous and rich in
. Trigonelline, an alkaloid derived from the metabolism of nicotinic acid, has been isolated from the seed and shown to have hypoglycemic effects
Whole seeds have been shown to be hypoglycemic in normal and mildly diabetic animals but not in those with severe disease
Bailey and Day postulate that the high fiber content of fenugreek seeds decreases absorption of glucose by slowing transit time in the gut. Defatted seeds lowered blood glucose as well as glucagon in dogs, both normal and diabetic (
Trigonelline showed a weak and transitory hypoglycemic effect when given orally to diabetic patients, presumably by slowing the metabolism of nicotinic acid, a hyperglycemic constituent
In addition to its effects on glucose, fenugreek seed, especially the fiber component, lowers cholesterol and triglyceride levels in normal and diabetic animals and patients (Indian Council for Medical Research, 1987).
Fenugreek is also used to treat dysentery, dyspepsia, rheumatism, and chronic cough and to increase milk production. The leaves, made into a poultice, are applied topically to reduce swelling and treat abscesses or other wounds.
Generally, no significant toxicities are reported with the use of this herb.
Coccinia indica Wight and Arun. Also known as C. grandis and C. cordifolia Cogn., this leafy creeping plant of the Cucurbitaceae family grows wild over much of India and elsewhere (e.g., Hawaii) where it is a weed. The common English name is ivy gourd; in Hindi it is kanduri, and in Sanskrit it is bimba
Traditionally, the leaves, root, fruit, and bark have been used medicinally. However, more recent scientific studies have focused primarily on the leaf
Coccinia indica has not been studied as much as some of the other traditional remedies for diabetes, but the available data on this plant are chemically and pharmacologically interesting. The juice contains an amylase as well as b-sitosterol and a cucurbitacin, B-glycoside
Water-soluble fractions of the leaf that test positive for alkaloids show hypoglycemic activity
A novel saponin has also been identified from an alcohol extract of the leaf (
The mechanism of action of Coccinia indica is not clearly understood, but studies with rats demonstrate involvement in the repression of a key gluconeogenic enzyme, glucose-6-phosphatase
. Other studies showed that a suspension of the powdered leaf of C. indica lowers blood sugar in alloxan-treated dogs but not in normal animals
. This suspension also reduced blood glucose in both normal and diabetic dogs during a glucose tolerance ). Both alcohol and water extracts of the root show antidiabetic activity in healthy rabbits
. Researchers have variously reported a rapid onset of action for C. indica or a delayed onset of at least 3 weeks (Azah Khan, Akhtar, and Mahtab, 1979).
Other traditional uses for this plant include the treatment of jaundice, wounds (when applied topically), bronchial complaints, psoriasis, ringworm, and sexually transmitted diseases such as syphilis and gonorrhea
No toxic side effects of this plant have been reported in the literature.
Pterocarpus marsupiumRoxb. andPterocarpus santalinusLinn. These two closely related species are used as folk remedies for diabetes in southern India. P. marsupium is a large deciduous tree common in central India. Its English name is false teak, in Sanskrit it is pitasala, in Hindi it is bijasal, and it is also known as vijayasara. P. santalinus, or red sandalwood, is a smaller tree found in the deciduous forests of southern India. It is known as Rakta chandana in Sanskrit and as Lal chandan in Hindi (
The wood and bark of the trees are most commonly used, often as a decoction. In addition, a novel method of using P. marsupium medicinally has been reported. Heartwood is carved into a cup, which is filled with water that is allowed to steep overnight. Diabetic patients then drink the water, called beeja water, the following day. It is not clear from the sources if the cup can be used more than once
The sap from P. marsupium yields a reddish gum, called kino, which is high in tannic acids. Not surprisingly, epicatechins have been isolated from bark and heartwood
These flavonoids have demonstrated an ATP-dependent enhancement of glucose-stimulated insulin release from isolated pancreatic islet cells in vitro
. Less substantiated claims have been made that the flavonoids contribute to the regeneration of beta cells in the pancreas
Phenolic constituents isolated from P. marsupium, identified as marsupin, ptersupin, and pterostilbene, have demonstrated hypoglycemic activity in rats
Contradictory data have been reported about the efficacy of P. marsupium to lower blood sugar in animal models
A series of experiments in rats using a 95 percent alcohol extract of wood powder from P. santalinus showed a hypoglycemic effect in healthy albino rats and in streptozotocin-treated rats
Additional traditional uses for these plants include the treatment of diarrhea, toothache, and skin wounds and infections (when applied topically). The gum from P. santalinus is often included in other medicinal salves.
