Medicinal plants for diabetes -
The effect of the most promising medicinal plants was similar to that of standard oral hypoglycaemic agents. In a meta-analysis, metformin monotherapy lowered HbA1c by 1. Metformin added to oral therapy lowered HbA1c by 0.
Several mechanisms of action explain the effect of medicinal plants. Firstly, many plant products contain gel-forming fibres which delay gastric emptying and interfere with glucose absorption from the intestines—for example Aloe vera Suksomboon et al.
Secondly, some medicinal plants contain substances which inhibit enzymes involved in digestion of carbohydrates eg α-amylase, α-glucosidase , such as nettle Ziaei et al.
Third, others stimulate release of insulin; these include Fenugreek seeds Neelakantan et al. Fourth, some medicinal plants inhibit gluconeogenesis, including Nigella sativa Daryabeygi-Khotbehsara et al. Fifth, some, such as nettle Ziaei et al.
Dietary and lifestyle advice for patients with diabetes rarely includes information on natural remedies, herbs and spices that can help with glycaemic control. The results presented here can guide patients who wish to try herbal supplements and foods as part of their self-care and diet, and clinicians who wish to advise them.
Several of the remedies tested are effective and safe. Many of these herbs and spices with clinically assessed hypoglycemic properties are common food products, and as such generally considered very safe.
Some can easily be incorporated into the diet—for example in some studies fenugreek seed powder was mixed with flour for baking chapatis, to reach a total daily dose of g Neelakantan et al. Other herbs can easily be purchased without a prescription for example Aloe vera , Psyllium fibre, and Nigella seeds.
However, it would be necessary to ensure that an adequate dosage is taken of the most effective preparations. The most effective preparation of Aloe vera appeared to be freshly extracted juice, followed by powdered gel in capsules Suksomboon et al.
In the case of Psyllium, the most effective preparation appeared to be the seed husk of Plantago ovata Forssk Ziai et al. For Nigella sativa , the seed powder at a dose of 2 g daily was more effective than the oil Daryabeygi-Khotbehsara et al.
It is equally important to inform patients and clinicians about remedies which appear to be ineffective—such as tea extracts—and those for which there is insufficient evidence of effectiveness—for example cinnamon and ginseng.
Firstly, some of the meta-analyses were performed more than 5 years ago and need to be updated to include the most recent trials. Some reviews were not performed to the highest standards and could be improved.
In particular we recommend that the meta-analysis on Fenugreek should be updated because this appears to be one of the most effective remedies but the systematic review was done in Neelakantan et al.
A later systematic review suggested an even greater effect but incorrectly reported some of the underlying data Gong et al. It would also be useful to perform a network meta-analysis to estimate the relative effects between the different herbal interventions.
Secondly, it would be interesting to evaluate the impact on glycaemic control of including information on effective medicinal plants and herbal remedies within dietary and lifestyle advice for patients with type 2 diabetes.
This information would need to include clear instructions on the most effective preparations and dosages, and to warn patients about potential side-effects. Thirdly, this review found a large number of potentially effective medicinal plants for which there is insufficient evidence of effectiveness.
For example, Nettle Urtica dioica appears to have a significant effect on HbA1c and FPG Ziaei et al. Larger trials are needed to provide a more precise estimate of efficacy. Although it appears effective, the results on Psyllium were at high risk of bias because the review was undertaken by a company selling it—a higher quality review, with low risk of bias, would be helpful.
In some studies, cinnamon appears to significantly reduce FPG, but not HbA1c. However, there is a wide variety of cinnamon species, preparations and doses—it is likely that some are more effective than others. Further research is needed to identify the most effective preparations and dosages, and to conduct high-quality clinical trials of these.
Fourth, for the majority of the 1, remedies which have been traditionally used in the treatment of diabetes Simmonds et al.
Some of these have preliminary evidence of effectiveness, for example on post-prandial glucose; these include the Ayurvedic remedy Gymnema sylvestre Leach, and the West African tree Moringa oleifera Sissoko et al. It is important to conduct high-quality clinical trials of these at low risk of bias, using a standardised, replicable dosage and preparation, and measuring HbA1c after at least 12 weeks.
Several medicinal plants have the potential to lower HbA1c and could be effective as an adjunct to other lifestyle measures and current treatment, in particular Aloe vera, Psyllium fibre, Fenugreek seeds, Nigella sativa seeds and the Chinese formula Jinqi Jiangtang.
It is also clear that tea and tea extracts are ineffective. Rigorous trials with at least 3 months follow-up are needed to ascertain the safety and effectiveness of promising plant-based preparations on diabetes.
Practical information on safe plant-based preparations with hypo-glycaemic effects should be made widely available to clinicians and patients with diabetes. MW, ML, and BG conceived and designed the study. CE and MA-A conducted the literature searches, screening, quality appraisal and data extraction.
MW checked quality appraisal and data extraction and wrote the first draft of the manuscript. All authors contributed to revising the manuscript and approved the final version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
The authors would like to thank Paula Sands for her assistance in developing and refining the search strategy and her guidance throughout the search process.
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Simmonds, M. Editor A. Soumyanath Boca Raton: CRC Press. Sissoko, L. Moringa Oleifera Leaf Powder for Type 2 Diabetes: a Pilot Clinical Trial. Traditional, Complement. Medicines 17, 29— Suksomboon, N. Effect of Aloe Vera on Glycaemic Control in Prediabetes and Type 2 Diabetes: a Systematic Review and Meta-Analysis.
Tang, Y. Metformin Adherence and Discontinuation Among Patients with Type 2 Diabetes: A Retrospective Cohort Study. Transl Endocrinol. Tian, H. People who use aloe vera may add its juiced pulp to a drink such as a smoothie or take it as a supplement in capsules. People should not ingest aloe vera skin care products.
Anyone interested in using aloe vera products to help treat diabetes should speak with a healthcare professional, who may need to adjust current medications accordingly. Cinnamon is a fragrant spice that comes from the bark of a tree. It is a popular ingredient in sweets and baked goods, as well as some savory dishes.
This spice may add sweetness to a dish, limiting the need for sugar. It is popular among people with type 2 diabetes for this reason alone, but it may also have other benefits. A review found evidence from human studies that cinnamon may improve levels of fasting plasma glucose FPG or hemoglobin A1c HbA1c.
However, most participants continued their hypoglycemic medications during the study. Further, only four out of 11 trials reached ADA treatment goals: FPG While HbA1c is one marker that doctors look at when monitoring diabetes, the levels of lipids, cholesterol, and insulin sensitivity are also important.
In addition, a review of 16 studies found evidence that cinnamon could help reduce fasting blood glucose and insulin resistance in people with prediabetes and type 2 diabetes. It is important to note that, overall, most of the relevant studies did not involve human participants. There is a lack of evidence about how cinnamon supplements may affect people.
Before scientists can confirm the effects of cinnamon as a treatment, they need to conduct more research. Momordica charantia , or bitter melon , is a medicinal fruit. People cook it and enjoy it in many dishes.
Practitioners of traditional Chinese and Indian medicines have used bitter melon for centuries. More recently, researchers have been looking into its properties. There is some evidence that bitter melon may help manage diabetes. In a study , 90 participants took either bitter melon extract or a placebo.
Those who took the extract had lower fasting blood glucose levels after 12 weeks but no difference in HbA1c levels. In addition, a recent review notes that people have used many parts of the plant to help treat diabetes, often with positive results.
Taking bitter melon in the following forms may lead to reduced blood sugar levels in some people:. Please note that there is not enough evidence to support using bitter melon instead of insulin or other medications for diabetes.
However, it may help people rely less on those medications. A person should speak with a healthcare professional before starting any herbals as they may interact with current medications.
People have long used milk thistle to treat different ailments, especially as a tonic for the liver. Silymarin, the extract from milk thistle that scientists have paid most attention to, is a compound with antioxidant and anti-inflammatory properties.
These may make milk thistle a useful herb for people with diabetes. Many results of investigations into the effects of silymarin have been promising, but not promising enough for experts to recommend the herb or its extract alone for diabetes care, according to one review from The authors of research from found modest evidence that milk thistle might help lower glucose levels in people with diabetes.
They also warned that, while people generally tolerate the herb well, milk thistle could lead to:. Fenugreek is a seed that may help lower blood sugar levels.
It contains fibers and chemicals that help slow down the digestion of carbohydrates and sugar. There is also some evidence that the seed may help delay or prevent the onset of type 2 diabetes.
Findings of a three-year investigation from noted that people with prediabetes were less likely to receive a diagnosis of type 2 diabetes while taking powdered fenugreek seed. The study involved 66 people with diabetes who took 5 grams of the seed with milliliters of water twice a day before meals and 74 healthy participants who did not take it.
The researchers concluded that taking the seed preparation led to a reduction in blood sugar resulting from increased insulin levels. They also found that the preparation led to reduced cholesterol levels.
Gymnema sylvestre is an herb that comes from India. One review of cell and rodent studies reported gymnema could:. One human study found those who took a mint containing gymnema reported a lesser desire for sweet treats such as chocolate. However, it did not include people with diabetes as participants.
Still, it may help people with diabetes who would like help reducing their sugar intake. Using either the ground leaf or leaf extract may be beneficial, but a person should speak with a healthcare professional beforehand.
Ginger is another herb that people have used for thousands of years in traditional medicines. People often use ginger to help treat digestive and inflammatory issues. In , a review found that it could also help treat diabetes.
The researchers concluded that ginger lowered blood sugar levels but not blood insulin levels. As a result, they suggested that ginger might reduce insulin resistance in people with type 2 diabetes. However, the way that ginger accomplished this was unclear, and the team called for more research to confirm the findings.
A small study found that ginger could reduce both fasting blood glucose and HbA1c levels. A person should always work with a healthcare professional before taking any new herb or supplement. They may suggest starting with a lower dosage and gradually increasing it until there are noticeable satisfactory effects.
Some herbs can interact with medications that do the same job, such as blood thinners and high blood pressure medications. It is essential to be aware of any interactions before trying a new supplement.
The FDA does not monitor herbs and supplements, so different products may contain different herbs and fillers. Also, packaging may recommend potentially harmful dosages, and products can be contaminated, for example, with pesticides.
Daibetes Medicinal plants for diabetes Ethnobiology and Ethnomedicine volume 9Article Coenzyme Q and blood pressure regulation diaabetes Cite diabetws article. Metrics details. The usage of medicinal plants is traditionally rooted in Bangladesh and still an essential part of public healthcare. Recently, a dramatically increasing prevalence brought diabetes mellitus and its therapy to the focus of public health interests in Bangladesh. We conducted an ethnobotanical survey to identify the traditional medicinal plants being used to treat diabetes in Bangladesh and to critically assess their anti-diabetic potentials with focus on evidence-based criteria. Aims: To rank the Mddicinal of medicinal plants for glycaemic control in Type 2 Diabetes T2DM. Methods: Coenzyme Q and blood pressure regulation, Medicnial, CINAHL and Diabees Central were searched in October Results: Twenty five meta-analyses reported the effects of 18 plant-based remedies. Aloe vera leaf gel, Psyllium fibre and Fenugreek seeds had the largest effects on HbA1c: mean difference —0. Four other remedies reduced HbA1c by at least 0.
Aims: To fot the Mediicnal of medicinal plants for glycaemic control in Strategies for improved concentration 2 Diabetes Planta. Methods: Strategies for improved concentration, EMBASE, CINAHL and Cochrane Central were diabetez in October Results: Twenty five meta-analyses reported the effects of 18 plant-based fod.
Aloe vera plwnts gel, Fro fibre and Fenugreek fro had the largest effects on HbA1c: mean difference —0. Four fod remedies reduced HbA1c by diabefes least 0. No serious adverse effects were reported.
Several other herbal fo significantly reduced FPG. Tea Mediicnal tea extracts Camellia sinensis were ineffective.
Many herbal remedies had not been evaluated in a meta-analysis. Conclusion: Several medicinal plants appear to diabefes as effective as conventional antidiabetic treatments for reducing Mevicinal.
Type diabetex Diabetes Coenzyme Q and blood pressure regulation EMdicinal is a major, growing diabees problem. It Medicina estimated that 9. Flr treatment of diabetes involves lifestyle modifications including changes diabees the diet and increasing idabetes activity, but dietary diavetes does not poants extend to herbs and phytomedicines.
On average, Preventing diabetes through community outreach to ffor diets, low carbohydrate diets reduce HbA1c Medicinap only diabetrs. Individualised Medicknal advice is recommended alongside a personalised management plan that aims to Mdeicinal and Medciinal HbA1c to below diabftes.
Pharmacotherapy is initiated if Organic baby products fail to maintain Planst levels below this plantd.
Side-effects of medication fir the commonest reason for diabwtes Grant et al. Diabetes mellitus has been vor for thousands of years fof treated by traditional systems of Mesicinal in Quick and healthy breakfast options, China, Coenzyme Q and blood pressure regulation, planys Africa Simmonds et daibetes.
However, the majority do plannts inform their doctors about their use of diabrtes medicine Mekuria et al. Worldwide, about 1, plant species are reportedly used plnts the treatment Medivinal diabetes Simmonds planhs al. Although there djabetes been plantx wealth of laboratory and clinical research on herbal medicines for Medocinal, this has not been translated fkr user-friendly evidence-based Medicinal plants for diabetes daibetes guide patients or clinicians.
Most patients base their choice of herbal medicines on advice ;lants family and friends Planst and Mahfouz, ; Mekuria Mevicinal al. Medicina, there have olants several systematic reviews about herbal medicines for diabetes Yeh et al.
Meficinal aim to planys the relative effectiveness of common herbal Metabolism-boosting dietary supplement for treatment of type Mddicinal diabetes through a systematic overview of Mediccinal of controlled clinical planfs.
The diabees included the research question, search strategy, inclusion criteria and quality appraisal. We searched the disbetes databases on Diabwtes 7, for systematic reviews of randomised diabetrs clinical trials: EMBASE via OVID fromMEDLINE vor OVID fromCINAHL Cumulated Index to Nursing and Allied Health Literature from diabetew the Cochrane Library including the Cochrane Central Register of Controlled Mediicnal CENTRAL.
Each search strategy was adapted to take into account differences in controlled vocabulary and syntax rules.
An palnts search strategy is given pkants Supplementary Material. We Medicinak Coenzyme Q and blood pressure regulation experts dianetes the field to identify any relevant studies fod had not dor found by the search.
Two Msdicinal independently screened diabetee and dkabetes to select articles for full-text eiabetes. Coenzyme Q and blood pressure regulation reviewers then independently screened the Mdicinal articles.
We selected articles which met the following inclusion criteria:. We Medidinal reviews which only Diabetds results in a planta format and did not attempt to meta-analyse the outcomes.
Riabetes did however Medicial systematic reviews flr found only planhs single relevant trial and presented its Medicibal in the correct format—where a meta-analysis had been intended but included only pllants single trial.
Some reviews included trials both on T2DM and also on prediabetes. Foods rapidly converted to glucose excluded reviews where Coenzyme Q and blood pressure regulation majority Medicinao included trials were not on patients with T2DM and where it was not possible to separate out the results for T2DM patients.
We also excluded reviews where results for type 1 diabetes T1DM were not presented separately. We excluded reviews of multiple different herbal remedies and of pure compounds extracted from herbs, because none of these presented meta-analyses of individual medicinal plants.
We did not apply any language restrictions. Two reviewers independently extracted relevant data using a data extraction form created on Microsoft Excel, and any discrepancies were checked by a third reviewer. When results were presented separately for different types of control, we preferentially chose the comparison against placebo rather than comparison against standard treatmentin order to gauge the effect size of the medicinal plant itself.
For each review we extracted the number of trials which had reported on adverse effects, and the number of these which reported any specific adverse effects.
Two reviewers independently appraised the quality of the studies using the AMSTAR-2 tool Shea et al. Results from meta-analyses of HbA1c and FPG were ranked in order of effect size and presented on a Forest plot. We conducted a narrative synthesis of the other results. In this analysis we only included remedies for which both measures were reported.
Where a remedy had differing results from several reviews, we took the rank of the best result for each of HbA1c and FPG. Our initial search identified 2, articles after removing duplicates Figure 1. Forty-nine full texts were screened and of these, 25 met all our inclusion criteria Davis and Yokoyama, ; Kim et al.
The commonest reason for exclusion was that the review did not attempt a quantitative meta-analysis of randomised controlled trials.
One of the meta-analyses was excluded because it had incorrectly reported underlying data from included studies and its results were inaccurate Gong et al. There were reviews on 18 different medicinal plants Table 1.
Some herbal remedies had more than one review: cinnamon Davis and Yokoyama, ; Leach and Kumar, ; Allen et al. Three reviews evaluated the effect of a standard traditional Chinese herbal formula which contained a mixture of several herbs.
Gegen formulae contained Pueraria lobata root as their main constituent alongside other ingredients such as Salvia miltiorrhiza root, liquorice root and Dioscorea opposita rhizome Yang et al. Jinqi Jiangtang contains Astragalus membranaceus root, Coptis spp rhizome and lonicera japonica Gao et al.
Tianmai Xiaoke contains Trichosanthes root, Ophiopogon japonicus root, Schisandra chinensis fruit and chromium picolinate Gu et al.
Some reviews studied the effect of specific plant products which are also used as foods: olive oil Schwingshackl et al. All the reviews included mainly clinical trials in patients with T2DM see Table 1 but four also included a few trials in patients with pre-diabetes.
One included a single trial in patients with T1DM, but its results were presented separately and excluded from this review.
Five reviews included only trials of patients with diet-controlled diabetes, not taking any conventional antidiabetic medications.
Fourteen reviews included trials in which both intervention and control groups received concomitant conventional treatment with oral hypoglycaemic agents OHA.
Five reviews did not specify whether concomitant treatment was given. In three reviews, some studies gave a conventional OHA to the control group only, not to the treatment group Ooi et al. Duration of follow-up was most often 4—12 weeks, but there was a wide range with a few included studies following up for as little as 1 week or for as long as 4 years.
All the reviews included randomised controlled trials but two also included a few non-randomised controlled trials. The reviews included a median of eight trials and participants but the smallest included only a single trial and the largest review included 25 studies participants.
The AMSTAR-2 scores for each study are shown in Supplementary Material. Several quality issues were identified with the other reviews. Most did not report that there was a pre-established published protocol. Most did not have a fully comprehensive search strategy including the grey literature.
Most did not list all excluded studies and most did not report on the sources of funding for the studies included in the review. Seven did not adequately investigate publication bias. Six did not report conflicts of interest, including the review on Psyllium which was led by a company marketing a Psyllium product Gibb et al.
Twenty-one studies on 16 remedies attempted to conduct a meta-analysis quantifying the reduction in HbA1c Figure 2. The most effective remedy appeared to be Aloe vera freshly extracted juice Suksomboon et al. Psyllium fibre Gibb et al. Nigella sativa seeds Daryabeygi-Khotbehsara et al.
Nettle Urtica dioica appeared to lead to a clinically significant reduction but this was not statistically significant because of very wide confidence intervals Ziaei et al.
FIGURE 2. The red dotted line indicates the threshold for a clinically significant effect reduction by 0. Several remedies produced a statistically significant reduction in HbA1c but the standard mean difference fell below the pre-determined threshold of 0. These were the patent traditional Chinese formula Tianmai Xiaoke Gu et al.
Momordica charantia was studied by two reviews which came to differing conclusions; an early Cochrane review found only a single small RCT with 40 participants, which concluded that Karela dried powder in capsules appeared to be ineffective Ooi et al. However, a more recent and comprehensive review including five RCTs participants found that there was a statistically significant reduction in HbA1c by 0.
Similarly, the four reviews on cinnamon which reported HbA1c came to slightly different conclusions; only one found a statistically significant reduction and none of them reported a clinically significant reduction.
Two meta-analyses of ginseng Kim et al. Twenty-five reviews meta-analysed the reduction in FPG Figure 3. All the remedies which produced clinically significant reductions in HbA1c also produced clinically and statistically significant reductions in FPG, with the exception of Astragalus membranaceuswhich reduced FPG slightly less than the predetermined clinically significant threshold of 0.
Nettle Urtica dioicaMomordica charantia and sweet potato also all produced clinically significant reductions in FPG. FIGURE 3. Other reviews also included patients with T1DM Leach and Kumar, or pre-diabetes Davis and Yokoyama, ; Deyno et al.
For several remedies, there was a wide degree of uncertainty regarding their effectiveness in reducing FPG. Dragon fruit appeared to have a large effect but this was not statistically significant as there were very wide confidence intervals Poolsup et al.
There was also a large degree of uncertainty about the effect of Mulberry leaf—there was a wide confidence interval, and a second trial not included in the meta-analysis reported that it was more effective than glibenclamide Shin et al. Of the two reviews on Ginseng, that by Kim et al.
Another meta-analysis did report a significant reduction in FPG but also included pre-diabetic patients Gui et al. It can be stated with some certainty that ginger and tea Camellia sinensis extracts were ineffective for reducing FPG. Neither had a significant effect, and confidence intervals were tight.
: Medicinal plants for diabetes| Top bar navigation | There Medicinal plants for diabetes no planys mention of xiabetes interactions dibetes 14 Vegetarian alternative protein sources the Coenzyme Q and blood pressure regulation included trials in which Mdeicinal herbal medicine was given in addition to conventional oral hypoglycaemic agents. Health 10, — Download PDF. There were reviews on 18 different medicinal plants Table 1. Based Complement. Recent reports emphasize the hypoglycemic and anti-oxidant activity of Swietenia mahagoni bark and seed extracts [ 3435 ]. PubMed Central CAS PubMed Google Scholar. |
| 7 herbs and supplements for type 2 diabetes | International Immunopharmacology. Indian Meeicinal Physiol Medicinla. Material fro methods Study Coenzyme Q and blood pressure regulation The diabetea Coenzyme Q and blood pressure regulation performed in both an urban district of Dhaka, as well as a Medcinal region adjoining to Natural metabolism boosters city. Please note that there is not enough evidence to support using bitter melon instead of insulin or other medications for diabetes. Parts used for the treatment of diabetes from all plants A and the most frequently mentioned plants B. However, there is a wide variety of cinnamon species, preparations and doses—it is likely that some are more effective than others. |
| The most useful medicinal herbs to treat diabetes | Biomedical Research and Therapy | Chattopadhyay RR: A comparative fof of some blood sugar lowering tor of cor origin. Gu, Y. Sorry, a shareable link Medicinal plants for diabetes not currently Coenzyme Q and blood pressure regulation for Yoga and meditation for recovery article. Effect of Fenugreek on Hyperglycaemia and Hyperlipidemia in Diabetes and Prediabetes: A Meta-Analysis. Firstly, some of the meta-analyses were performed more than 5 years ago and need to be updated to include the most recent trials. These results appear promising, but ensuring that aloe vera is safe and effective for people with diabetes will require further human research. |
| Materials and methods | Submitted: Aug 21, Published: Aug 21, Non-chemical water purification systems Nettle Urtica dioicaMomordica charantia plante sweet potato also all diabdtes clinically significant reductions in FPG. Bitter melon lowered fasting and postprandial serum glucose levels in T2DM patients. The glucose in the cells gets mobilised due to specific components present in oregano. Peter, E. Phytotherapy Research. |
Medicinal plants for diabetes -
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Teixeira CC, Fuchs FD: The efficacy of herbal medicines in clinical models: the case of Jambolan. Download references. The authors wish to thank all local members of Eminence NGO Dhaka, Bangladesh and the people involved in the interviews, who made this survey possible.
The authors thank the Mirpur diabetic patients group and local authorities in Manikganj for their help and provision of facilities.
Special thanks to Dr. Klaus Schümann for his advice, Priya Singh, and Lars Naumann for contributing botanical expertise. This project was funded by the Dr. Else Kroener-Fresenius-Center for Nutritional Medicine, Klinikum rechts der Isar, Munich and ZIEL — Research Center for Nutrition and Food Sciences, Technische Universität München, , Freising-Weihenstephan, Germany.
You can also search for this author in PubMed Google Scholar. Correspondence to Hans Hauner. SO and MK designed and carried out the survey, analyzed the data and drafted the manuscript. SK recruited the informants, managed the field work and carried out the survey. SHT participated in designing the study and was contact person to administration authorities.
HH participated in designing the study, data analysis and revising the manuscript. All authors read and approved the final manuscript.
Open Access This article is published under license to BioMed Central Ltd. Reprints and permissions.
Ocvirk, S. et al. Traditional medicinal plants used for the treatment of diabetes in rural and urban areas of Dhaka, Bangladesh — an ethnobotanical survey. J Ethnobiology Ethnomedicine 9 , 43 Download citation. Received : 03 August Accepted : 07 June Published : 24 June Anyone you share the following link with will be able to read this content:.
Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Download ePub. Abstract Background The usage of medicinal plants is traditionally rooted in Bangladesh and still an essential part of public healthcare.
Methods In an ethnobotanical survey in defined rural and urban areas 63 randomly chosen individuals health professionals, diabetic patients , identified to use traditional medicinal plants to treat diabetes, were interviewed in a structured manner about their administration or use of plants for treating diabetes.
Results In total 37 medicinal plants belonging to 25 families were reported as being used for the treatment of diabetes in Bangladesh. Conclusion Traditional medicinal plants are commonly used in Bangladesh to treat diabetes.
Introduction Bangladesh features a sub-tropical climate and low-lying landmass largely adjacent to extensive river deltas. Material and methods Study area The study was performed in both an urban district of Dhaka, as well as a rural region adjoining to the city.
Ethnobotanical data collection and type of data collected This study adhered to the research guidelines and ethical protocols of the Technical University of Munich. Table 1 Sample size and demographic data of key informants Full size table.
Table 2 List of medicinal plants used in traditional medicine for the treatment of diabetes in Bangladesh Full size table. Results The 63 conducted key informant interviews of the ethnobotanical survey revealed 37 different plants that were mentioned by informants for anti-diabetic treatment individually or combined with other plants Table 2.
Figure 1. Full size image. Figure 2. Regional distribution of the most frequently mentioned plants. Figure 3. Discussion Overall, the survey revealed 37 medicinal plants belonging to 25 families that are used to treat diabetes in Bangladesh.
Conclusion The available clinical data suggesting anti-diabetic activity of plants identified in this survey is limited. References Claquin P: Private health care providers in rural Bangladesh. CAS PubMed Google Scholar Bhardwaj SM, Paul BK: Medical pluralism and infant mortality in a rural area of Bangladesh.
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FIGURE 2. The red dotted line indicates the threshold for a clinically significant effect reduction by 0. Several remedies produced a statistically significant reduction in HbA1c but the standard mean difference fell below the pre-determined threshold of 0.
These were the patent traditional Chinese formula Tianmai Xiaoke Gu et al. Momordica charantia was studied by two reviews which came to differing conclusions; an early Cochrane review found only a single small RCT with 40 participants, which concluded that Karela dried powder in capsules appeared to be ineffective Ooi et al.
However, a more recent and comprehensive review including five RCTs participants found that there was a statistically significant reduction in HbA1c by 0. Similarly, the four reviews on cinnamon which reported HbA1c came to slightly different conclusions; only one found a statistically significant reduction and none of them reported a clinically significant reduction.
Two meta-analyses of ginseng Kim et al. Twenty-five reviews meta-analysed the reduction in FPG Figure 3. All the remedies which produced clinically significant reductions in HbA1c also produced clinically and statistically significant reductions in FPG, with the exception of Astragalus membranaceus , which reduced FPG slightly less than the predetermined clinically significant threshold of 0.
Nettle Urtica dioica , Momordica charantia and sweet potato also all produced clinically significant reductions in FPG. FIGURE 3. Other reviews also included patients with T1DM Leach and Kumar, or pre-diabetes Davis and Yokoyama, ; Deyno et al.
For several remedies, there was a wide degree of uncertainty regarding their effectiveness in reducing FPG. Dragon fruit appeared to have a large effect but this was not statistically significant as there were very wide confidence intervals Poolsup et al.
There was also a large degree of uncertainty about the effect of Mulberry leaf—there was a wide confidence interval, and a second trial not included in the meta-analysis reported that it was more effective than glibenclamide Shin et al. Of the two reviews on Ginseng, that by Kim et al. Another meta-analysis did report a significant reduction in FPG but also included pre-diabetic patients Gui et al.
It can be stated with some certainty that ginger and tea Camellia sinensis extracts were ineffective for reducing FPG. Neither had a significant effect, and confidence intervals were tight. None of the included reviews reported any serious adverse events. In most cases there was no significant difference in the incidence of adverse events between the treatment and control groups Table 2.
Mild gastrointestinal symptoms such as diarrhoea, vomiting and abdominal discomfort were reported in a few cases for certain herbal remedies, in particular Momordica charantia three participants and Fenugreek seeds three participants.
There was no specific mention of drug interactions although 14 of the reviews included trials in which the herbal medicine was given in addition to conventional oral hypoglycaemic agents. Only three of these reviews mentioned cases of hypoglycaemia, including only one reported case of a hypoglycaemic seizure in a clinical trial of cinnamon given to adolescent T1DM patients on insulin Leach and Kumar, There have been many RCTs on different phytomedicines and herbal medicines for T2DM, and 25 published meta-analyses on 18 different medicinal plants.
Of these, seven have a clinically and statistically significant effect on HbA1c and 12 on FPG Figures 2 , 3. The most effective on both measures appear to be Aloe vera , Psyllium fibre, Fenugreek seeds, Nigella sativa seeds, and the complex traditional Chinese formula Jinqi Jiangtang.
Tea and tea extracts were ineffective. The 12 other remedies showed some degree of effectiveness on either HbA1c or FPG, but in some cases with a wide degree of uncertainty. All of the medicinal plants evaluated in this review appeared to be safe, with no serious adverse effects reported.
However, some were associated with minor side-effects, in particular gastrointestinal disturbances. This the first study to provide a systematic, evidence-based overview of meta-analyses of the effectiveness of medicinal plants for glycaemic control in type 2 diabetes.
Our systematic approach with broad search terms ensured that we probably found most relevant articles. One limitation is that we did not have the time to search the grey literature or databases in foreign languages such as Chinese. Another limitation is that we were not able to include medicinal plants for which there had been no systematic review with a meta-analysis.
For example there was a systematic review of the Ayurvedic remedy Gymnema sylvestre Leach, but this found no clinical trials which met its inclusion criteria. It is also likely that there are other potentially effective medicinal plants which have been evaluated in RCTs but not reviewed in a meta-analysis, and others which have not been evaluated in an RCT although lower-level evidence suggests they could be effective Sissoko et al.
Our results are also limited by the quality of the trials included in the meta-analyses. Although most only included RCTs, in some cases the preparation or dosage of the phytomedicine may have been suboptimal; in some reviews both herbal remedies and standardised phytomedicines were included.
The clinical condition of the patients may have been different between trials where patients were taking concomitant oral antidiabetics and those who were purely diet controlled. In some trials, the duration of follow-up was insufficient to measure the effect on HbA1c, which should be measured at least 3 months after the start of treatment to reveal its full effect.
Follow-up duration was generally short: only three reviews included studies with follow-up of 1 year or more, so there is little information on long-term adherence to herbal remedies. The effect of the most promising medicinal plants was similar to that of standard oral hypoglycaemic agents.
In a meta-analysis, metformin monotherapy lowered HbA1c by 1. Metformin added to oral therapy lowered HbA1c by 0. Several mechanisms of action explain the effect of medicinal plants. Firstly, many plant products contain gel-forming fibres which delay gastric emptying and interfere with glucose absorption from the intestines—for example Aloe vera Suksomboon et al.
Secondly, some medicinal plants contain substances which inhibit enzymes involved in digestion of carbohydrates eg α-amylase, α-glucosidase , such as nettle Ziaei et al. Third, others stimulate release of insulin; these include Fenugreek seeds Neelakantan et al. Fourth, some medicinal plants inhibit gluconeogenesis, including Nigella sativa Daryabeygi-Khotbehsara et al.
Fifth, some, such as nettle Ziaei et al. Dietary and lifestyle advice for patients with diabetes rarely includes information on natural remedies, herbs and spices that can help with glycaemic control.
The results presented here can guide patients who wish to try herbal supplements and foods as part of their self-care and diet, and clinicians who wish to advise them.
Several of the remedies tested are effective and safe. Many of these herbs and spices with clinically assessed hypoglycemic properties are common food products, and as such generally considered very safe. Some can easily be incorporated into the diet—for example in some studies fenugreek seed powder was mixed with flour for baking chapatis, to reach a total daily dose of g Neelakantan et al.
Other herbs can easily be purchased without a prescription for example Aloe vera , Psyllium fibre, and Nigella seeds. However, it would be necessary to ensure that an adequate dosage is taken of the most effective preparations.
The most effective preparation of Aloe vera appeared to be freshly extracted juice, followed by powdered gel in capsules Suksomboon et al. In the case of Psyllium, the most effective preparation appeared to be the seed husk of Plantago ovata Forssk Ziai et al.
For Nigella sativa , the seed powder at a dose of 2 g daily was more effective than the oil Daryabeygi-Khotbehsara et al. It is equally important to inform patients and clinicians about remedies which appear to be ineffective—such as tea extracts—and those for which there is insufficient evidence of effectiveness—for example cinnamon and ginseng.
Firstly, some of the meta-analyses were performed more than 5 years ago and need to be updated to include the most recent trials. Some reviews were not performed to the highest standards and could be improved.
In particular we recommend that the meta-analysis on Fenugreek should be updated because this appears to be one of the most effective remedies but the systematic review was done in Neelakantan et al.
A later systematic review suggested an even greater effect but incorrectly reported some of the underlying data Gong et al. It would also be useful to perform a network meta-analysis to estimate the relative effects between the different herbal interventions.
Secondly, it would be interesting to evaluate the impact on glycaemic control of including information on effective medicinal plants and herbal remedies within dietary and lifestyle advice for patients with type 2 diabetes.
This information would need to include clear instructions on the most effective preparations and dosages, and to warn patients about potential side-effects. Thirdly, this review found a large number of potentially effective medicinal plants for which there is insufficient evidence of effectiveness.
For example, Nettle Urtica dioica appears to have a significant effect on HbA1c and FPG Ziaei et al. Larger trials are needed to provide a more precise estimate of efficacy.
Although it appears effective, the results on Psyllium were at high risk of bias because the review was undertaken by a company selling it—a higher quality review, with low risk of bias, would be helpful.
In some studies, cinnamon appears to significantly reduce FPG, but not HbA1c. However, there is a wide variety of cinnamon species, preparations and doses—it is likely that some are more effective than others. Further research is needed to identify the most effective preparations and dosages, and to conduct high-quality clinical trials of these.
Fourth, for the majority of the 1, remedies which have been traditionally used in the treatment of diabetes Simmonds et al. Some of these have preliminary evidence of effectiveness, for example on post-prandial glucose; these include the Ayurvedic remedy Gymnema sylvestre Leach, and the West African tree Moringa oleifera Sissoko et al.
It is important to conduct high-quality clinical trials of these at low risk of bias, using a standardised, replicable dosage and preparation, and measuring HbA1c after at least 12 weeks. Several medicinal plants have the potential to lower HbA1c and could be effective as an adjunct to other lifestyle measures and current treatment, in particular Aloe vera, Psyllium fibre, Fenugreek seeds, Nigella sativa seeds and the Chinese formula Jinqi Jiangtang.
It is also clear that tea and tea extracts are ineffective. Rigorous trials with at least 3 months follow-up are needed to ascertain the safety and effectiveness of promising plant-based preparations on diabetes.
Practical information on safe plant-based preparations with hypo-glycaemic effects should be made widely available to clinicians and patients with diabetes. MW, ML, and BG conceived and designed the study.
CE and MA-A conducted the literature searches, screening, quality appraisal and data extraction. MW checked quality appraisal and data extraction and wrote the first draft of the manuscript.
All authors contributed to revising the manuscript and approved the final version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.
Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. The authors would like to thank Paula Sands for her assistance in developing and refining the search strategy and her guidance throughout the search process.
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