Complementary and Alternative Medicine: Herbals

Todd T. Brown, M.D, Ph.D. and Paul A. Pham, Pharm.D.
04-02-2010

Trinidad and Tobago Specific Information

Trinidad and Tobago Information Author: Compton Seaforth, Ph.D.

                  Estimated prevalence of herbal use for diabetes in Trinidad ranked fifth — after herbal use for colds, cooling, hypertension and fevers based on ethnopharmacological survey from 2007-2008.

                  The following plants are commonly used to treat diabetes, based on survey of 30 adults in Trinidad from 1996-2006: Antigonon leptopus, Bidens alba, Bidens pilosa, Bixa orellana, Bontia daphnoides, Carica papaya, Catharanthus roseus, Cocos nucifera, Gomphrena globosa, Laportea aestuans, Momordica charantia, Morus alba, Phyllanthus urinaria and Spiranthes acaulis (Lans).

                  Carailli (Momordica charantia L.):  common names include bitter melon, karela, Caryla, Karaile, maiden’s blush, Popololo, Balsam pear, Sorrow seed.

                  The fruit and leaf parts are taken for diabetes and hypertension.

                  Effect on blood glucose: doses of 100mL juice expressed from the unripe fruit reported to be antidiabetic in adults (Raman). Bitter-tasting glycosides have been isolated from the plant (Okabe).

                   Zebapeek (Neurolaena lobata R. Br.) : leaf teas are taken under other names such as “Zeb-a -pique” for diabetes.

                  Effect on blood glucose: active constituents are unknown, but plant extracts have been shown to produce hypoglycemia in rats (Gupta) and have folk usage as an antimalarial remedy (Chariandy)

                  Paw paw (Carica papaya L.): leaf teas are taken for diabetes.

                   Effect on blood glucose: : not confirmed scientifically.

                  Olive bush (Bontia daphnoides L.): other common names include kidney bush.

                  Leaf extractives contain insecticidally-active sesquiterpene furan compound (Williams)

                  Effect on blood glucose: not confirmed scientifically.

                  Seed-under-leaf (Phyllanthus amarus Schumach.): other common names are Button under leaf; Graine amba feuille; Gwen amba fei.

                  Effect on blood glucose: not confirmed scientifically.

// REFERENCES

DEFINITION

                  Refers to use of a plant or part of a plant for medicinal purposes

                  Also called botanical medicine or phytomedicine

                  Many different herbal preparations used for treatment of diabetes (DM) in different cultures

                  Few have been systematically evaluated for efficacy and safety

                  Compounds which have had some scientific evaluation are discussed in this module

EPIDEMIOLOGY

                  In the U.S., over a third of diabetes patients use herbal or traditional therapies (Egede).

CLINICAL TREATMENT

Ginseng

                  One of the most widely used medicinal herbs

                  Two major types: Asian Ginseng (Panax ginseng), American Ginseng (Panax quinquefolius)

                  Active compounds thought to be ginsenosides (20-30 different types present in a single plant, depending on species); non-ginsenoside components may also have physiologic properties (Attele 1999)

                  Mechanisms: pre-clinical data suggest ginsenosides improve insulin resistance (Attele 2001)

                  Efficacy: clinical data limited. Use of ground root most common (Vuksan), in doses of 1-3 grams/day. Other parts of ginseng plants have also been tested (berries, leaves, etc).

                  Adverse effects: hypertension, nausea, headache, insomnia, nervousness

                  Herb-Drug Interactions: concomitant administration with warfarin reduces warfarin’s therapeutic effect (Yuan)

Cinnamon (Cinnamon cassia)

                  Mechanism: may enhance insulin signaling, increase glycogen synthase activity (Qin)

                  Efficacy: human trials have investigated 1-6 grams per day. Modest effect on reducing fasting blood glucose (5-24%) with short-term administration, but results are mixed (Kirkham)

                  Safety: no reported adverse effects

                  Herb-Drug Interactions: none known

Bitter melon (Momordica charantia)

                  Traditional diabetes remedy in many cultures, including Ayurvedic medicine.

                  Mechanism: may improve insulin resistance through activation of AMP kinase (Miura; Cheng)

                  Clinical Efficacy: some benefit in large case series, but two randomized controlled trials showed no effect (Leung). Positive studies reported using juice or fresh, rather than dried, fruit. Recent review found insufficient evidence to recommend for treatment of type 2 diabetes (Ooi)

                  Adverse Effects: some gastrointestinal distress reported, ingestion of seeds can cause favism in G6PD deficiency.

                  Herb-Drug Interactions: none known

Fenugreek (Trigonella foenum-graecum)

                  Traditional plant used in Asian and Mediterranean cultures. Leaves and seeds used in Ayurvedic medicine

                  Mechanism: contains 4-hydroxyisoleucine, which may enhance insulin secretion (Sauvarie). Also, rich in fiber.

                  Efficacy: limited, short-term data, mixed results. Doses of powdered seed 10-100 grams with meals (Basch)

                  Adverse Effects: transient diarrhea, flatulence, dizziness (Basch)

                  Herb-Drug Interactions: none known

Gymnema (Gymnema sylvestre)

                  Leaves used in Ayurvedic medicine to treat diabetes, cholesterol, and obesity. Also known as gurmar (sugar destroyer) in Hindi.

                  Mechanism: unclear. Some evidence suggests effect on insulin secretion (Liu)

                  Efficacy: some benefit noted in small trials of limited quality (decrease of ~0.6% HbA1c). Doses used: 200-400 mg twice daily of leaf extract (Leach).

                  Adverse Effects: none reported

                  Herb-Drug Interactions: none known

EXPERT COMMENTS

                  Herbal derived compounds are used in many cultures for the treatment of diabetes.

                  Although benefits of some of these compounds have been described, currently there is insufficient data to recommend any herbal remedies in the treatment of diabetes.

                  Although generally well-tolerated at the doses used, some compounds have significant herb-drug interactions (e.g. ginseng-warfarin) which require further investigation.

//

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s