Naturopathic Medical Treatment and Prevention [SH]

Clinical Nutrition

Low Glycemic Diet: The diet restrictions and allowances described for treating hypoglycemia apply to hyperglycemia.

Hypocaloric Diet: Weight loss studies with the use of hypocaloric diets have shown not only decreased cholesterol-rich particles in serum, but also, interestingly, increased serum levels of alpha-tocopherol simultaneously. Caloric-restriction, at least in rodents, will decrease insulinemia. Some foods, such as daily fish intake, not only caused weight loss compared to controls, but also showed 38% decrease of triglycerides and an increase of HDL by 24%. In this particular study performed at the University of Australia, the effects of fish intake had no statistical effect on glucose or insulin levels.

Green Tea: Studies have shown that the use of green tea extract rich in catechin polyphenols and caffeine decreases obesity by increasing fat oxidation and metabolism. It appears that the thermogenic effects are due to ingredients other than just the caffeine.

Lifestyle

Contributing lifestyle factors to obesity are poor diet and lack of exercise. Obesity may also be associated with suboptimal thyroid function, including Wilson’s temperature syndrome.

Clinical Trials

Combination Diet, Drug, and Herb Therapies

UK Prospective Study

In the recently published UK Prospective Study, levels of glycemic control and its relationship to secondary complications were assessed. The study evaluated 4,075 newly diagnosed patients with NIDDM. All the patients were put on a low fat, high complex carbohydrate, and high fiber diet. These patients were then divided into two groups: diet therapy alone, and diet therapy plus one pharmaceutical agent (monotherapy). After 9 years of analysis, the group that used pharmaceutical agents plus diet were two to three times as likely to achieve 7.0% HbA1c values than patients on diet therapy alone.
     The target level of the study was to be below 7.0% HbA1c or less than 7.8 mmol/L (140 mg/dL). They analyzed the HbA1c values of these patients after 3, 6, and 9 years. After 9 years, 8% of patients treated with diet were able to achieve this level; 24% were able to achieve this with diet and sulfonylurea pharmacological agents; and 42% were able to achieve this with diet and insulin. Insulin is effective in Type II patients when they are thin and insulin deficient. However, only 10% of NIDDM patients are thin.

Conclusions

• This suggests that therapies with diet only are not nearly as effective as those that use combinations of pharmaceutical agents and diet.
• However, the study was seriously flawed by the diabetic diet used. A diabetic diet that is conventionally prescribed by dietitians is much less strict than a naturopathic diet that forbids eating foods with higher glycemic index of 50. The glycemic index is a numerical score from 0 to 100 indicating from lowest to highest the effect of increasing blood sugar. The intensive group had an 11% decrease in glycosylated hemoglobin, which was associated with a 12% decrease in diabetic related endpoints, mostly due to a baseline microvascular decrease; a 10% decrease in diabetic related deaths; a 6% decrease in all mortality; and a 25% decrease in microvascular endpoints, mostly due to a decrease in retinal photocoagulation. An 11% decrease in HbA1c levels showed a marked decrease in diabetic complications in NIDDM. They found that even a 1% decrease in HbA1c values marked a significant difference between the control and intensive group in secondary complications. However, due to the side effects of pharmacological agents, the intensive group had a higher risk of hypoglycemic episodes.
• This study also demonstrated that over time the ability to control blood sugar levels progressively deteriorates. After 3 years, only 50% of patients were able to achieve levels of HbA1c under 7.0% with a monotherapy; and after 9 years, only 25% were able to achieve this level. The study found that with good glycemic control, patients were able to achieve a decrease in microvascular complications, but not a decrease in macrovascular complications. This study has been criticized for underestimating the benefits of decreased macrovascular complications due to the limits of the effective therapies available.32

Other Combination Therapy Studies

Other studies have found that combination drug therapy is more effective than monotherapy. For example, a study using Metformin and Troglitazone further decreased fasting and postprandial plasma glucose concentrations by 18% in comparison to monotherapy.
Furthermore, clinical trials of glucose adaptogenic herbs indicate patients who use pharmacological agents and natural therapeutics in combination have significantly decreased fasting blood sugar levels compared to patients who use pharmacological agents alone. For example, jambul (Syzigium jambulana) not only lowers blood sugar but also decreases secondary complications. Prickly pear cactus (Nopal opuntia) is also very effective. In a trial of 29 subjects including 8 healthy subjects, 14 obese subjects, and 7 diabetic subjects, glycemia decreased a mean of 63.4 mg/dl 93.5 mmol/l) in diabetics and 3.86 mg/dl (.21 mmol/l) in non diabetics, an insignificant change.
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Botanical Medicine

Several herbs have been demonstrated in clinical studies to be effective for treating Type II diabetes and supporting the glands and organs of the endocrine system. For many years, physicians have been successfully using these herbs to reduce insulin levels. The use of chromium, vanadium sulfate minerals, and fish oils are adjunctive treatments that are also helpful in reducing insulin levels.

Botanical Monographs

Among the most effective herbs for treating Type II diabetes are milk thistle (Silybum marianum), gymnema (Gymnema sylvestre), nopal (Nopal opuntia spp.), jambul (Syzygium cumini), globe artichoke (Cynara scolymus L.) and devil’s club (Oplopanax horridus). Monogarphs describing their pharmacology and clinical applications are provided here.

Milk Thistle (Silybum marianum)

Silybum marianum is currently the most researched herb in the treatment of liver disease (with over 450 published peer review papers). The active constituent of silybum is silymarin, a mixture of flavonolignans consisting chiefly of silibin, silidianin, and silichristine. Silibin is the most active of the three and is largely responsible for the benefits attributed to the silymarin complex.

Pharmacology: Silybum exerts a protective and restorative effect on the liver. The hepato-protective effects include anti-oxidation,33 anti-lipid peroxidation,34 enhanced detoxification, and protection against glutathione depletion.35 Silybum inhibits the enzyme lipoxygenase, thereby inhibiting the formation of the hepato-destructive leukotrienes.36 In damaged livers silymarin has been shown to increase protein synthesis, which might account for its hepatorestorative action. Silymarin has been shown in animal studies to possess antifibrotic activity.37 Animal and in-vitro studies have shown silybum to possess anti-diabetic,38 anti-tumor,39 anti atherosclerotic, and anti-nephrotoxic activity.

Clinical Applications: A number of studies have shown that silymarin may be valuable in the prophylaxis and treatment of diabetes and its complications. In treatment with the milk thistle flavonoid silymarin, fasting blood glucose levels, mean daily blood glucose levels, and daily glucosuria and HbA1c levels were all reduced. In addition, fasting insulin levels and mean exogenous insulin requirements were reduced. Silymarin may reduce the lipoperoxidation of cell membranes and insulin resistance, significantly decreasing endogenous insulin overproduction and the need for exogenous insulin administration. Silymarin also decreased basal and glucagon-stimulated C-peptide levels.40 In treatment with silibin, there was a highly significant reduction in RBC sorbitol, though no effect on fasting blood glucose, and an improved nerve conduction velocity, though not statistically significant.41 Silibin may be a potent aldose reductase inhibitor and may be valuable in the prophylaxis and treatment of diabetic complications. In the treatment of rats, silibin prevented the onset of diabetic neuropathy, possibly by inhibiting excessive protein mono-ADP-ribosylation.42
     Silymarin may also reduce lipo-oxidation of hepatic cell membranes and help reverse insulin resistance. Silibin, which is one of the three flavolignans in silymarin, was studied on patients with NIDDM. The sorbitol red blood cell (RBC) level for 14 patients with NIDDM averaged 72.5 mmol/g; this was two times higher than the control group that didn’t have diabetes. In this study, 231 mg of silibin was administered for 4 weeks to the NIDDM patients: their sorbitol RBC level dropped to 39.53 mmol/g. The study also found slightly improved nerve conduction velocity in the silibin group. Silibin, a potent aldose reductase inhibitor, is valuable in the prophylaxis and prevention of complications in diabetes.
     Milk thistle is also effective in the treatment of neuropathy. Silibin is a flavonoid, which is a mono-adenoid di-phosphate-lipoxyl-transferase inhibitor. It helps to prevent protein ADP ribosylation. ADP ribosylation causes an increase in P-like substance that causes an immunoreactivity level that is found in diabetic neuropathy. In the treatment of diabetic rats, silibin was found to prevent the increase of ADP ribosylation in Schwann cells.43
     The adrenal gland has a function in the regulation of insulin called the Somogyi phenomenon. In response to hypoglycemia, epinephrine, norepinephrine, and cortisol are secreted by the adrenal gland. In diabetic rats, a short-term diabetic state lowered the activity of their adrenal cortex. Thus, sub-clinical adrenal hypofunction should be assessed in NIDDM patients.

Contraindications: Silybum is virtually free of toxicity and can be used during pregnancy and lactation. In animals, silymarin was shown to be non-toxic when administered at high doses for short periods. Long-term administration to rats also demonstrated an absence of toxicity. Silybum can stimulate liver and gallbladder activity and can therefore produce a transient laxative effect. Mild allergic reactions have been noted.

Dosage/Toxicity: Since silymarin is not water soluble, administration as an infusion is not recommended. The standard dose of silybum is based on its silymarin content (70-210 mg capsules three times daily). A higher dosage will likely yield better results. Several animal and human studies have shown that silymarin bound to phosphatidylcholine yields better absorption and clinical effect (dose 100-200 mg twice daily).44
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Gymnema (Gymnema sylvestre)

Gymnema sylvestre is a member of the Asclepiadaceae family. It has been used in Ayurvedic medicine to treat madhu meha or "honey urine." Gymnema came to be known as gurmar or the "destroyer of sugar" because Ayurvedic physicians observed that chewing a few leaves suppressed the taste of sugar. It has been used in India for the treatment of diabetes for over 2,000 years.
     The medicinally active parts of the plant are the leaves and the roots. Plant constituents include two resins (one soluble in alcohol), gymnemic acids, saponins, stigmasterol, quercitol, and the amino acid derivatives betaine, choline, and trimethylamine.

Pharmacology: The important active ingredient in Gymnema sylvestre is an organic acid called gymnemic acid." This is a triterpene glycoside that suppresses sweetness in humans. From this glycosidic fraction, six triterpene glycosides -- gymnemosides a, b, c, d, e, and f -- were isolated. There are four triterpenoid saponins and six known gymnemic acids found in G. sylvestre. However, the principal constituents are gymnemic acid and gymnemasaponin. Gurmarin is a polypeptide isolated from the leaves that consists of 35 amino acid residues, including three intramolecular disulfide bonds. It has a molecular weight of 4,000 and is inhibitory to neural responses to sweet taste stimuli.

Clinical Applications: Gymnema sylvestre is a stomachic, diuretic, refrigerant, astringent, and tonic. Its antidiabetic activity is due to a combination of mechanisms. Recent pharmacological studies have shown that gymnema acts on both the taste buds in the oral mucosa and the absorptive surface to the intestines. The structure of the taste buds that detect sugar in the mouth is similar to the structure of the tissue that absorbs sugar in the intestines. The active ingredient, gymnemic acid, acts on both these sites.
     Gymnemic acid is made up of molecules whose atom arrangement is similar to that of glucose molecules. Those molecules fill the receptor locations on the taste buds for a period of one to two hours, thereby preventing the taste buds from being activated by any sugar molecule present in food. Similarly, the glucose-like molecules in the gymnemic acid fill the receptor locations in the absorptive external layers of the intestine, thereby preventing the intestine from absorbing the sugar molecules. Therefore, gymnemic acids from the leaves suppress the elevation of blood glucose level by inhibiting glucose uptake in the intestines. The leaves also contain chlorophyll, xanthophylls, carotene, phytol, and lime salts. Gymnema sylvestre has also been found to reduce the bitter taste of certain foods.
     Gymnema increases the activity of enzymes responsible for glucose uptake and utilization, and inhibits peripheral utilization of glucose by somatotrophin and corticotrophin. Extracts of this plant have also been found to inhibit epinephrine-induced hyperglycemia. Gymnema has even been shown to regenerate insulin-producing beta cells of the pancreas, leading to an enhancement in the production of endogenous insulin, further controlling blood sugar. Gymnema inhibits adrenocortical activity and prevents the normal hyperglycemic response of the anterior pituitary gland, which acts in turn by inhibiting peripheral glucose metabolism induced by somatotropin and corticotropin hormones. The extracts from gymnema leaves have been shown to suppress the intestinal smooth muscle contraction, decrease O2 consumption, inhibit the glucose evoked-transmural potential, and prevent increased blood glucose levels. Studies indicate that the component of gymnema inhibits the increase in the blood glucose level by interfering with the intestinal glucose absorption process.45
     Gymnema is antiviral. It increases oxygen uptake, blood pressure, and secretions of liver and pancreas. The leaves have been found to stimulate the heart, uterus, and circulatory system. It raises urine output. As an agent to promote weight loss, gymnema may help control appetite and carbohydrate cravings.
     Gymnema also increases the blood's capacity to take up oxygen, resulting in higher physical and mental performance and increased energy levels. This is beneficial for keeping in shape and staying active. The leaves are used for stomach ailments, constipation, water retention, and liver disease. The leaves are also noted for lowering serum cholesterol and triglycerides.46

Clinical Trials

Gymnema sylvestre Therapy for Diabetes

Recent clinical trials have shown that Gymnema sylvestre is useful for treating both insulin-dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM). The first scientific confirmation of gymnema's use in diabetes came almost 70 years ago when it was demonstrated that the leaves reduced urine glucose in diabetics. Four years later, it was shown that gymnema had a blood glucose lowering effect when there was residual pancreatic function, but was without effect in animals lacking pancreatic function, suggesting a direct effect on the pancreas.
     Another study showed that in diabetic rats, fasting blood glucose levels returned to normal after 60 days of gymnema with oral administration. The therapy led to a rise in serum insulin to levels closer to normal fasting levels. In diabetic rat pancreas, gymnema was able to double the islet number and beta cell number.47
       In 1981, it was demonstrated that oral administration of the dried leaves of gymnema brings down blood glucose and raises serum insulin levels. In 1988, a study showed a normalization of glycosylated hemoglobin and plasma proteins (indicators of long term glucose control) from gymnema administration. In 1990, it was shown that administration of gymnema extract to diabetic animals was accompanied by a regeneration of beta cells in the pancreas. This brought about glucose homeostasis through increased serum insulin levels provided by repair/regeneration of the pancreas.
      A study was conducted on both Type I and II diabetics given a standardized gymnema extract, from the leaves, for a period of 2 years. 27 patients with IDDM who were on insulin therapy were administered 400 mg/day of gymnema for 6 to 30 months. Insulin requirements were decreased by about one-half and the average blood glucose decreased from 232 mg/dL to 152 mg/dL. Glycosylated plasma protein levels also decreased. Gymnema appeared to enhance endogenous insulin by regeneration of the residual beta cells in IDDM. Serum lipids also returned to normal levels with gymnema therapy, which may help prevent cardiovascular disease. Most impressively, an increase in C-peptide levels were found, which is a strong indication of restoration of insulin production.48

     Dr Baskaran and Dr Ahamath, at the Department of Biochemistry, Post-Graduate Institute of Basic Medical Sciences in Madras, India, investigated the therapeutic properties of an extract from the leaves of Gymnema sylvestre in controlling hyperglycemia in 22 Type II diabetic patients on conventional oral anti-hyperglycemic agents. Gymnema sylvestre (400 mg/day) was administered for 18 to 20 months as a supplement to the conventional oral drugs. During supplementation, the patients showed a significant reduction in blood glucose, glycosylated hemoglobin, and glycosylated plasma proteins. Conventional drug dosage could be decreased. Five of the 22 diabetic patients were able to discontinue their conventional drug and maintain their blood glucose homeostasis with Gymnema sylvestre alone. These data suggest that the beta cells may be regenerated/repaired in Type-2 diabetic patients on Gymnema sylvestre supplementation. This is supported by the appearance of raised insulin levels in the serum of patients after gymnema supplementation. Additionally, gymnema significantly improved cholesterol, triglyceride, and free fatty acid levels that were elevated.49
     Some authors are speaking of the "adaptogenic" nature of gymnema, since it increases the body's ability to adapt to the presence of sugar. The increase in longevity noted above was ascribed to "cardiotonic and adaptogenic characteristics produced by increasing resistance and immunity in diabetic animals." It would have to be a characteristic of a true adaptogen to "normalize" function, not just prolong life. Recently, researchers have reported gymnema prevents death due to hypoglycemia in rats injected with beryllium nitrate. That gymnema prevents both rises and falls in blood sugar and causes no significant change in normal blood sugar levels and appears to be in full harmony with the concept of an adaptogen.
     In other animal studies, gymnema has been found to double the number of insulin-secreting beta cells in the pancreas and return blood sugar to almost normal. Most cases have shown it to lower blood sugar to normal levels and not to a point below normal, as seen with many other antidiabetic drugs. However, studies conducted in India as early as 1930 showed that the leaves could cause hypoglycemia in experimental animals.
     The anti-sweet peptide, gurmarin, purified from the leaves of Gymnema sylvestre, is highly specific to sweet taste so that responses to various sweeteners are all suppressed. Gurmarin acts on the apical side of the taste cell, possibly by binding to the sweet taste receptor protein.50
In a very thorough animal study, gymnema greatly reduced the blood glucose levels in alloxan-induced diabetic rabbits. It was thought Gymnema effects were mediated through stimulation of insulin release resembling what was observed with sulfonylureas, or through inhibition of intestinal absorption of glucose as observed with the biguanides, or through stimulation of one of the insulinogenic signals promoting insulin release.51
     Gymnema reversed the glycogen and protein depletions and lipid accumulation in the diabetic animals. The theory that gymnema works by increasing the levels of circulating insulin was supported by observations of altered enzyme activities in the liver, kidney and muscles. Most of the insulin-dependent enzymes (hexokinase, glycogen synthetase, glyceraldehyde-3-phosphate dehydrogrenase, and glucose-6-phosphate dehydrogenase) were significantly more active in the gymnema-treated animals than in control diabetic animals. It also increased the activity of enzymes affecting the utilization of glucose by insulin-dependent pathways: phosphorylase, gluconeogenic enzymes, and sorbitol dehydrogenase. Pathological changes in liver and kidney were reversed by the treatment. The study reports in great detail findings supporting the notion that gymnema corrects the metabolic derangements in diabetic rabbit liver, kidney, and muscle tissues.52
     Other studies have found similar normalizing effects of various enzymes and chemicals of the kidney, heart, liver and brain, including hexuronic acid, hexoses, hexosamines, non-amino polysaccharides, hyaluronic acid, heparin sulfate, chondroitin sulfates, and sialic acid.
In another study utilizing alloxan diabetic rabbits and one human patient, gymnema brought down the fasting blood glucose levels, together with serum cholesterol and triglyceride levels, while improving serum protein levels. The hypoglycemic action took several weeks to develop. Oral administration in normal rats apparently has no significant effect, but only in rats made hyperglycemic experimentally (alloxan, anterior pituitary-treated, tolbutamide, adrenaline).53
     While gymnema does not lower blood sugar levels in normal subjects, it does appear to prevent a rise in blood sugar levels in normal subjects. This result has been attributed to a pancreotropic effect due to sensitization of beta cells of islets of Langerhans for secreting larger amounts of insulin in response to glucose. In addition, it markedly inhibited somatotropin- and corticotropin-induced elevations in blood sugar levels.54
     An interesting finding in clinical tests showed that healthy people with normal insulin levels showed no lowering of blood sugar levels or hypoglycemic effects after taking the herb.

Dosage/Toxicity: Gymnema sylvestre in tea form offers the best results. It has been determined that a daily dose of 200 mg is optimal in order to utilize its effectiveness in the area of weight management. The typical therapeutic dose (for treatment of hyperglycemia), standardized to contain 24% gymnemic acids, is 400-600 mg daily. In adult-onset diabetics, ongoing use for periods as long as 18 to 24 months has proven successful. In reducing the symptoms of glycosuria, the dried leaves are used in daily doses of 3-4 grams for 3 to 4 months. Because it acts gradually, gymnema extract should be consumed regularly with meals for several days/weeks and can be taken for months/years with no significant side effects.

Drug Interactions: Patients taking gymnema may require dosage adjustments of other antidiabetic drugs. However, in some cases, it may make the treatment more effective. Some patients do develop hypoglycemia when taking gymnema along with other medications. This is because improved insulin production and release during gymnema therapy may decrease the need for other medication, and thus low blood glucose levels, unless the dosage of conventional oral medication or insulin is lowered.
     Some of the effects of gymnema may be enhanced by MAOI antidepressant medications, fenfluramine, salicylates, and tetracyclines. Its actions may even be decreased by concomitant use of oral contraceptives, epinephrine, phenothiazines, marijuana, and thyroid hormones. Gymnema has diuretic action that increases the renal excretion of sodium and chloride, and may potentiate the hyperglycemic and hyperuremic effects of glucose elevating agents. Patients using diuretics may require dosage adjustments of antidiabetic drugs.
     Certain medications, including antidepressants (St. John’s wort) and salicylates (white willow and aspirin) can enhance the blood sugar-lowering effects of Gymnema sylvestre, whereas certain stimulants such as ephedra (Ma Huang) may reduce its effectiveness. The antidiabetic ability of this herb may be decreased by concomitant use of acetazolamide, oral contraceptives, corticosteroids, dextrothyroxine, epinephrine, ethanol, glucagon, guanethidine, and marijuana. The antidiabetic effects may also be decreased when used in conjunction with phenothiazines, rifampin, thiazide diuretics, and thyroid hormones.
     The antidiabetic action of gymnema may be enhanced when it is used with allopurinol, anabolic steroids, chloramphenicol, clofibrate, fenfluramine, guanethidine, MAOI, phenylbutazone, probenecid and phenyramidol. This action of gymnema may also be enhanced when used in conjunction with salicylates, sulfinpyrazone, sulfonamides, and tetracyclines. The ability of gymnema to increase insulin production and secretion may be antagonized by heparin.55

Adverse Reactions: At typical recommended doses, dietary supplements containing gymnema are not associated with significant adverse side effects. Mild gastrointestinal upset may occur if gymnema is taken on an empty stomach; therefore, consumption with meals is recommended. Caution is urged, however, with extremely high doses, which may have the potential to induce hypoglycemia in susceptible individuals. It can also alter the bitter and sweet taste sensation.
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Nopal (Nopal opuntia spp)

Also known as prickly pear and beaver tail, nopal is native to arid and semi-arid areas of North America and South America. Nopal has no leaves, except at the start of new growth. These leaves are actually stems called cladodes that grow one on top of another in an irregular, beavertail shape pattern. It has spiny, thickened stems that form the plant and produce yellow, orange and red rose-like flowers in the spring. These flowers mature into prickly pears, which are yellow, orange, red or purple. The fruits are sweet, with numerous hard seeds. They survive under a ferocious variety of climates and can regenerate themselves. The pads are skinned, diced and prepared in Mexican salads and tacos.

Pharmacology: In patients with NIDDM, studies have shown that nopal significantly reduced glucose and fasting insulin serum concentrations. Nopal lowered blood sugar when orally administered to animals with induced states of moderate hyperglycemia. Nopal does not significantly modify fasting glucose levels and insulin serum concentrations in healthy individuals; however, it reduces the elevation of glucose and insulin serum concentrations after an oral glucose load. The mechanism of nopal is unknown; however, one study suggested it was associated with gastric distension and enterohormones. In another study, the mechanisms of cellular sensitivity to insulin in addition to dietary fiber was suspected, because blood sugar was reduced in the absence of an oral carbohydrate load; this study further showed that serum insulin concentration diminished after taking nopal, thus ruling out an enhancement of insulin release. A different study ruled out the involvement of insulin antagonist hormones, like glucagon, cortisol and growth hormone.
      In addition to the diabetic effect, nopal reduced LDL cholesterol, total cholesterol, and triglycerides when taken before each meal for ten days. The triglyceride levels were decreased in obese and diabetic patients, but not in healthy subjects with low triglyceride levels.56
     Nopal contains vitamin B, vitamin C, calcium, iron, potassium, B-carotene, and the carbohydrates: hexoses, pentoses, cellulose hemicellulose, and mucilage. Nopal is high in fiber, protein, and amino acid composition.

Clinical Applications: Nopal is hypoglycemic, hypolipidemic, anti-microbial, vulnerary, demulcent, and nutritive. It is used for gastritis and peptic ulcers, high cholesterol, enlargement of the prostate gland and diabetes. Externally, it is used for dry, itchy scalp and wound healing.

Drug Interactions: Since nopal has no effect in lowering blood sugar, it is highly unlikely that hypoglycemia might occur; however, hypoglycemia drugs might need to be decreased.

Dose: 100 grams of nopal stems grilled, or 3 tablespoons of prickly pear fruit concentrate daily.
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Jambul (Syzygium cumini)

Jambul is native to southern Asia, India, Indonesia and Australia. The seed is hard, oval, and red brown to brown. Jambul fruit is eaten as a preserve; it tastes faintly astringent and aromatic, like a ripe apricot. The fruit contains volatile oil, fixed oil, resin, tannins, and gallic acid, as well as phenols, tannins, triterpenoids, glycosides, volatile oils, and alkaloids (jambosine).

Pharmacology: Animal studies have shown a pronounced hypoglycemic effect. It also has an anti-inflammatory effect in animals. The method of action may be independent of pancreatic function; it may alter the conversion of carbohydrates to glucose.57

Clinical Applications: Jambul is astringent, carminative, hypoglycemic, anti-spasmodic, and stomatic. The seed is considered to be one of the most powerful hypoglycemic agents in the Ayurvedic repertory. In India, as little as one teaspoon per day of ground seed was a traditional treatment for NIDDM. Externally, the astringent action is useful for nosebleeds and wounds.

Dose: 0.3-2 g infusion, 1:1 in 25% alcohol, 2-4 ml t.i.d.
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Globe Artichoke (Cynara scolymus L.)

Globe artichoke is a perennial plant found in the Mediterranean region and South America. Constituents of the flower heads are 12% sugar (inulin), 3% protein, tannin, cynarin, vitamins A, B1, B2, B3, C, caffeic acid, flavonoids (rutin), and sesquiterpenes lactones.

Pharmacology: Inulin is a polymer of fructose that is not digested and does not increase blood sugar. It decreases postprandial hyperglycemia. In research, 20g caused only a mild rise in blood sugar, which was significantly lower than the same dose of fructose. Inulin, which may be broken down to fructose in cold weather or winter months and converted back in summer months, activates the complement pathway and promotes chemotaxis of neutrophils, monocytes, and eosinophils. It also may stimulate interferon. Cynarin (15% content in roots) stimulates bile and has a direct effect on liver function. It is broken down into caffeic acids, which act on the liver. The bitters may also contain small amount of caffeic acid.

Clinical Applications: Globe artichoke is attributed with tonic, choleretic, cholagogue, diuretic, laxative, anti-galactic, alterative, and aphrodisiac qualities. It stimulates liver cells to regenerate; and is also hepato-protective. It supports the kidneys and has a hypoglycemic effect in diabetes.
     Traditionally, it was used for arteriosclerosis, hyperlipidemia, and diabetes. In France, it was used for gallstones, obesity, and rheumatism. Globe artichoke is indicated for arteriosclerosis, jaundice, dyspepsia, anorexia, liver insufficiency, chronic albuminuria, post-operative anemia, gallbladder, and biliary disease, chronic liver disease and impairment, and kidney disease. It increases excretion and decreases synthesis of total cholesterol.58 It helps to prevent gallstone formation.59

Contraindications: Theoretically, globe artichoke is contraindicated for biliary tree blockage and colic, which may be due to active gallstones.

Dose: 1-4 g dried leaves t.i.d. or up to 15-30 ml of tincture per day.
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Devil’s Club (Oplopanax horridus)

Devil’s club constituents possibly include saponins and inulin. In North America, Southwest natives believed regular use could prevent cancer.

Pharmacology: Devil’s club attracted medical attention in 1938 when Dr Brocklesby (MD) discovered that a patient was stabilizing diabetes with an infusion of devil’s club. In lab tests conducted by Brocklesby and Large in 1938, devil’s club showed no apparent toxicity. The hypoglycemic effect of devil’s club extract is especially significant in view of the longstanding controversy over the use and toxicity of present antidiabetic drugs. Experiments done on rabbits demonstrated that an extract of the herb would substantially reduce blood sugar without any toxic side effects.

Clinical Applications: Devil’s club is used for arthritis, rheumatism, stomach pains, constipation, and especially for the prevention and treatment of diabetes. The bark can be burnt and applied to cuts. A paste can be made out of the root powder and applied as a poultice to decrease pain and swelling from insect bites and stings.

Dose: 1-2 g t.i.d.

Contraindications: None known.
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Selected Clinical Studies and Literature Reviews

For the therapeutic effect of the Ayurvedic herb C. tamala in diabetes, see Hari M. Chandola and Surendra N. Tripathi, “Hypoglycemic Response of C. tamala in Diabetes,” in Selected Clinical Studies and Literature Reviews, pp. xx-xxx.

For a study of the application of Ayurvedic medical principles to understanding and treating the progression of diabetes, see H.M. Chandola, S.N. Tripathi, and K.N. Udupa, “The Role of Psychosomatic Constitution (Prakriti) in the Progression and Prognosis of Diabetes Mellitus and Response to Treatment,” in Selected Clinical Studies and Literature Reviews, pp. xx-xxx.