Medicinal Herbs to Support Blood Sugar Management in Non-Insulin-Dependent Diabetes

This past week I had an assignment for school that challenged me to write a professional white paper on a topic of my choosing within the scope of herbal medicine.  I immediately knew I wanted to focus my energy on diabetes due to a recent diagnosis of a close family member.  I wanted to look at the symptoms of diabetes and the research available on medicinal herbs that could potentially serve as adjunctive, complimentary, or alternative treatment for symptom management so that I could suggest this family member discuss these herbs with his primary care provider.

I have attempted to take a large amount of information and present it in a way that is easily digestible.  If you are interested in the research but find this a bit too technical or dry, you are welcome to scroll all the way to the bottom to the conclusion.

Background

Diabetes Mellitus is a chronic metabolic disorder characterized by elevated blood sugar levels (hyperglycemia) and glucose present in the urine (glycosuria).  Insulin, a hormone produced in the pancreas, regulates blood sugar by removing glucose (sugar) from the blood, allowing it to enter cells throughout the body. It is important for other metabolic processes, as well. When there is insufficient insulin, or the body is not reacting to the insulin that is present, the levels of glucose in the blood begin to rise.  Sufficiently high levels of blood glucose result in the body burning alternative sources of energy, like fats, leaving their metabolites, ketones, in the blood. Metabolic changes can result, impairing the body’s ability to handle fats, leading to a buildup of fat throughout their arteries. Ultimately this can contribute to serious health problems such as: blindness, kidney failure, heart attack, and stroke.  

There are two types of diabetes: Insulin-Dependent Diabetes Mellitus (IDDM) and Non-Insulin-Dependent Diabetes Mellitus (NIDDM).  IDDM, often referred to as Type I, is usually characterized by significant lack of insulin production. There are many theories about the cause of the disease, however it is not entirely understood. Type I diabetes must be treated with dietary modifications and exogenous insulin supplementation.

NIDDM, Type II, also involves a deficiency of insulin, however it is much less severe. Sometimes the insulin is being produced, but no longer effective.  Treatment for this type of diabetes does not require insulin since the body is still producing it. Common treatment involves the use of hypoglycemic agents, glucosidase inhibitors, dietary modifications, and preparations designed to delay absorption of glucose.   

Present Case

Herbal medicine has been used to treat diabetes for thousands of years.  There are over one thousand plants that have been used historically for treating symptoms of diabetes.  Plants and plant extracts act in a variety of specific and non-specific ways, with the secondary metabolites from the plants either directly lowering glucose levels in the blood while others impact glucose metabolism.  Metformin, the first drug created for the treatment of Type II diabetes, was developed after the discovery that goat’s rue, Galega officinalis, contained a guanidine alkaloid that potentiated the activity of insulin. That alkaloid, galegine, is structurally similar to the synthetic metformin (Bone, 2003).

Testing of plants for hypoglycemic activity is primarily focused on the bioactivity of compounds related to glucose homeostasis  The mechanisms of actions vary widely, with some effects appearing immediately, and others requiring longer periods of time. Many plants have demonstrated beneficial actions related to symptoms of diabetes other than just blood glucose regulation, however they are beyond the scope of this paper.

Clinical studies have demonstrated that certain medicinal plants can stimulate insulin secretion, augment various receptors involved in the process, prevent insulin resistance before it develops, up-regulate or promote translocation of glucose transporter type 4 (GLUT-4), inhibit glucagon-like peptide-1 (GLP-1) secretion and advanced glycation end product (AGE) formation. The number of herbs that lower blood sugar levels is extensive and prohibitively long.  

A widely used Ayurvedic herb, “gurmar”, or gymnema, (Gymnema sylvestre) was described in ancient texts as useful when urine is sweet and has been documented as an antidiabetic medication for over 2000 years. The name gurmar means “sugar destroyer” in Hindi.  Controlled trials utilizing Gymnema sylvestre found that a preparation of 400 mg/day of Gymnema extract significantly lowered blood glucose and glycosylated haemoglobin over the course of 18 to 20 minutes, resulting in levels unparalleled by the group receiving conventional treatment. The authors concluded that the herb may promote insulin production and act as a regenerative agent, to include in damaged pancreatic tissue. It is suggested that these actions are due to the gymnemic acids (El-Houri, et al., 2014). A recent randomized, double-blind controlled trial was unable to demonstrate antidiabetic effects, but did have statistically significant reductions in body weight (Martínez-Abundis, 2016).

Another traditional remedy with thousands of years of use in Ayurvedic medicine is Coleus forskohlii.  The traditional use was for cardiovascular and digestive disorders, however it is a powerful herb for endocrine function because it has the unique ability to increase production of cyclic AMP (cAMP, adenylate cyclase), an important messenger used by many hormones and neurotransmitters (Bone & Mills, 2013).  While it does not cross into the cell, it is used for intracellular signal transduction, triggering changes in the cell’s function.  There are numerous physiological and biological effects from elevated levels of cAMP, however relative to the metabolic system, cAMP can trigger increased insulin production, stimulates the release of glucagon, stimulates the breakdown fat and inhibits glucose uptake.  Since obesity and adipose tissue play a role in insulin resistance, this herb could play a powerful role as both a hypoglycemic and a fat loss aid at a dosage of at least 50mg/day of forskolin, a diterpene extracted from the plant. This dosage was found to be effective in several clinical trials and studies. The results of another study found that an oral dose of 250mg/day for 12 weeks lowered body fat content in obese men, raised their testosterone levels, and increased their bone mass (Godard, Johnson, & Richmond, 2005).  Another herb that has been found to have similar impact in promoting fat loss is licorice Glycyrrhiza glabra.

Clinical trials support the use of fenugreek Trigonella foenum-graecum, leaf or seed, at 5g/day for improved blood glucose.  It is also reported to promote pancreatic cell renewal (Kalailingam et al., 2014).  Nopal, or prickly pear cactus Opuntia ficus-indica, has been used as an indigenous remedy for diabetes for hundreds of years. In vivo studies have shown that Opuntia lowers has promise in blended whole plant form, juice extracts, and isolated constituents. It has been found to both lower blood glucose and increase insulin levels (Leem, Kim, Hahm, & Kim, 2016).  The sulfur-containing compounds, allyl propyl disulfide and allicin, found in onions Allium cepa, and garlic Allium sativum, exhibit hypoglycemic effects by competitive interaction with insulin.

Cinnamon has been lauded for its support in blood sugar  management. There are conflicting studies on the efficacy and particular species responsible for the hypoglycemic action.  A meta-analysis found that 1-6 grams of powdered cinnamon (Cinnamomum verum and Cinnamomum cassia) had positive impact on blood sugar levels, however more studies are needed.  There is insufficient quality clinical date to evaluate bitter melon Momordica charantia, however one of its hypoglycemic peptides, Polypeptide-p, also known as “plant insulin” has been clinically demonstrated to be effective for humans when administered subcutaneously.

Other promising medicinal herbs with strong supporting clinical research are Ganoderma lucidum Reishi mushroom and Fucus vesiculosus, a brown algae seaweed known as “bladderwrack” in western herbal medicine. Both are nutritional powerhouses.

Conclusion:

Medicinal plants can effectively serve as an adjunctive treatment or natural alternatives  to commercial oral hypoglycemic medications.  There is insufficient clinical data to support each of the thousands of plants that have been used in traditional medicine systems for blood sugar management.  There is sufficient clinical research to support the use of some of these, such as: Gymnema sylvestre, Coleus forskohlii, licorice Glycyrrhiza glabra, and fenugreek Trigonella foenum-graecum, bladderwrack Fucus vesiculosus, and reishi mushroom Ganoderma lucidum, among others not covered in this paper.

 

References:

Bach, E., Hi, E., Martins, A., Nascimento, P., & Wadt, N. (2018). Hypoglycemic and Hypolipidemic Effects of Ganoderma lucidum in Streptozotocin-Induced Diabetic Rats. Medicines,5(3), 78. doi:10.3390/medicines5030078

Baskaran K., Kizar B, Shanmugasundaram K, et al. Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin-dependent diabetes mellitus patients.  J. Ethnopharmacol. 1990;30(3):295-300.

Bone, K. (2003). A clinical guide to blending liquid herbs: Herbal formulations for the individual patient. St. Louis: Churchill Livingstone.

Bone, K., & Mills, S. (2013). Principles and practices of phytotherapy: Modern herbal medicine (2nd ed.). Edinborough: Churchhill Livingstone Elsevier.

El-Houri, R. B., Kotowska, D., Olsen, L. C., Bhattacharya, S., Christensen, L. P., Grevsen, K.,  Christensen, K. B. (2014). Screening for Bioactive Metabolites in Plant Extracts Modulating Glucose Uptake and Fat Accumulation. Evidence-Based Complementary and Alternative Medicine,2014, 1-8. doi:10.1155/2014/156398

Godard, M. P., Johnson, B. A., & Richmond, S. R. (2005). Body Composition and Hormonal Adaptations Associated with Forskolin Consumption in Overweight and Obese Men. Obesity Research,13(8), 1335-1343. doi:10.1038/oby.2005.162

Hoffmann, D. (2003). Medical herbalism: the science and practice of herbal medicine. Rochester, VT: Healing Arts Press.

Kalailingam P., Kannaian B., Tamilmani E., Kaliaperumal R. (2014). Efficacy of natural diosgenin on cardiovascular risk, insulin secretion, and beta cells in streptozotocin (STZ)-induced diabetic rats. Phytomedicine 21 1154–1161. 10.1016/j.phymed.2014.04.005

Khanna P., Jain S. C., Panagariya A., Dixit V. P. (1981). Hypoglycemic activity of polypeptide-p from a plant source. J. Nat. Prod. 44 648–655. 10.1021/np50018a002

Leem K.-H., Kim M.-G., Hahm Y.-T., Kim H. (2016). Hypoglycemic effect of Opuntia ficus-indicavar. saboten is due to enhanced peripheral glucose uptake through activation of AMPK/p38 MAPK pathway. Nutrients 8 800

Martínez-Abundis, E. (2016, July 13). Effect of Gymnema Sylvestre on Metabolic Syndrome and Insulin[Scholarly project]. In Clinicaltrials.gov. Retrieved from https://clinicaltrials.gov/ct2/show/NCT02370121

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U.S. National Arboretum Internship

 

I had the opportunity to do my Spring 2018 internship at the U.S. National Arboretum in Washington, D.C.  The Arboretum is run by the U.S.D.A.’s Agricultural Research Service and hosts many different types of gardens and exhibits.  I had three different tasks: spend four Saturdays working in the National Herb Garden, create herbal monographs for several herbs that I worked with, and finally, to assist in the design, planning, and execution of a workshop on herbal bitters that would be held on the Arboretum grounds in August.

The work in the gardens provided a new appreciation for the hard work horticulturists put in.  My internship started with hours of carrying and planting herbs, and digging up tulip bulbs from the Spring entrance display.  The next Saturday, I planted enough corn and sugarcane to fill in the entire display we had dug up the week before. I pulled weeds, planted lemon balm, and pruned other herbs.  Dozens of people stopped to ask questions, providing an opportunity to share knowledge about the plants. During my two remaining days of work, I pulled weeds and helped shape plants in the Medicinal, Native American, and Culinary Herb Gardens.  The hard work in the garden paid off because I learned new gardening skills such as the right planting depth, proper pruning, and all about several garden pests. These skills will be very useful for cultivating my own herbs.

Creating the herbal monographs required a lot of research, my own organoleptic experience, and taking photos of properly identified plants.  The monographs can be viewed here. The final task, preparing for the Bitters Workshop, required extensive soft skills. I worked with the Arboretum staff via email, telephone, and through live collaboration sessions where we edited documents as we exchanged ideas.  

Each of the three tasks was very different from the others. I was able to do some manual labor, research, and event planning all surrounding herbs.  In the end, I walked away with some cultivation skills, experience creating monographs, and an appreciation for the amount of coordination that goes into planning events.  

Disclaimer:  Due to the beauty of Arboretum, I took an obscene amount of photos from May – July so I captured both Spring and Summer in the Herb Garden.

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Medicine Making in the Woods

During early Spring, as the plants were just beginning to poke out of the ground, I had the privilege of once again working with the students of Washington College.  The workshop this time was all about making medicine in the woods so we took it offsite and explored the flora (and fauna!) of the beautiful land owned by the school on Maryland’s Eastern Shore.

This workshop allowed us to examine medicinal herbs in their natural habitat.  We discussed the plants from both an ethnobotanical and chemical perspective.  Thanks to permaculturist Shane Brill, identification was quick and easy. After we identified the plants, we discussed their historical use by various world cultures and the main chemical compounds that are responsible for their therapeutic actions.

The students were able to touch, smell, and in some cases, taste, the materials we were discussing.  Most students had some prior knowledge of some of the plants, making for a few hours of interesting and educational conversation while we explored the woods.

While I am normally all about ratios, measurements, and precise chemistry, it isn’t always practical in real life scenarios.  I can’t imagine that most people have weight scales, liquid measuring cups, and the like with them when they have first aid emergencies in the woods.  For the “medicine making” portion of this trip, we made medicine the way our ancestors did.  As the village medicine woman in this scenario (that’s really fun to say!), I passed down my knowledge of the plants as everyone was gathered in a circle. The students harvested plants and combined them in jars to make their medicine.  We used Apple Cider Vinegar to extract the fat-soluble constituents and all those vitamins and minerals that come out best in acetic acid. The students also made a simple infusion that they could take him and try.

Check out the highlight reel and photos below.

 

 

 

 

 

Natural Remedies for Combating Symptoms of the “Low-carb Flu”

Have you recently taken the plunge and undertaken a low carb, no-sugar diet like Whole30, Paleo, or Keto? If you have and you have found you are suffering from some of the many symptoms (and you want relief), then keep reading.

Design

“Low carb flu”, “carb flu”, and “keto flu” are all terms used to refer to the many unpleasant symptoms that may occur when switching to a low-carb, no sugar lifestyle. 

The symptoms may range from mental fog, nausea, fatigue, headaches, cramps, digestive issues, low energy levels, twitchiness, crankiness, and exhaustion.  Some people have characterized it as feeling like they were withdrawing from heroin. For me, I was an emotional terrorist, snapping at anyone in my path and only vaguely remembering why five minutes later.  I was one of the “lucky” ones.  I didn’t experience the other physical symptoms. Mine was mental and emotional.  I accidentally walked down the bread aisle and imagined myself ripping through a bag of bagels with my bare teeth and devouring every last one.

If you committed to one of these diets and have taken the time to do the tedious meal planning, I assume you were aware these symptoms could or would happen.  I will also assume that you have read about why.  I will provide a brief and not overly scientific explanation before moving on to what you can do to help alleviate the symptoms using some natural remedies.

WHY???  First, sugar.  Sugar is highly addictive.  It is as addictive, or more addictive, than many narcotic drugs.  Read that twice and let it sink in.  Here is just one study that shows that sugar is more addictive than cocaine. You are going through withdrawal from a highly addictive substance, just like a junkie.  Making it worse is that sugar is sugar. That means healthy sugar, imitation sugar (which is the devil), and carbohydrates (because your body converts unused carbs to sugar!) are all fueling your addiction.  Now that you are denying yourself all that pleasure-center activating sugar, you are going to feel like crap.

The other reason for all the unpleasantness has to do with your gut. Each of us have unique flora in our gut. This is determined by a lot of factors, most notably, your diet.  Your old diet, like 2-7 days old, is going to play a part in how you feel now.  Any drastic dietary changes will trigger a reaction where your gut needs to find some harmony. 

Until it does, you may suffer the dreaded “flu”.  Moving on… what can we do to make it better?

You should have read up before kicking off your diet.  There are some standard nuggets of wisdom: find a support network, get sufficient rest, exercise, drink tons of water, etc. 

 Those are critical to your success (and comfort!).  But you didn’t come here because I’m a diet expert (I’m not).  Sometimes those things just aren’t enough and you want some extra help.  If you are looking for natural, safe, mild alternatives, you are in the right place.  

 

I have created a list of things that you can try to help alleviate each symptom. To make it easy for you, it is in a completely free, downloadable infographic (the one above). Let me know what you think!