Reviews
Natural Products Used for Diabetes

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Objective

To review the efficacy and safety of natural products commonly used for diabetes.

Data Sources

English and Spanish-language journals retrieved through a MEDLINE search of articles published between 1960 and December 2001 using these index terms: Opuntia, karela, gymnema, tecoma, alpha lipoic acid, thioctic acid, ginseng, panaxans, and diabetes.

Data Synthesis

Natural products have long been used in traditional systems of medicine for diabetes. Products in common use include nopal (prickly pear cactus), fenugreek, karela (bitter melon), gymnema, ginseng, tronadora, chromium, and alpha-lipoic acid. The popularity of these products varies among people of different ethnicities. Nopal is the most commonly used herbal hypoglycemic among persons of Mexican descent. Karela is more commonly used by persons from Asian countries. Some of these agents have gained universal appeal. For a select number of products, studies have revealed single or multiple mechanisms of action. For several of these, high soluble fiber content is a contributing factor.

Conclusion

Based on the available evidence, several natural products in common use can lower blood glucose in patients with diabetes. Commonly used natural products often have a long history of traditional use, and pharmacists who have a stronger understanding of these products are better positioned to counsel patients on their appropriate use.

Section snippets

The Fiber Connection

Throughout history, the benefits of consuming dietary fiber have been recognized.26 The Papyrus Ebers of 1550 B.C., one of the earliest records of treatments for diabetes, recommends a diet of wheat, grains, and ochre.27 In a crossover study, Chandalia et al.28 demonstrated a 10% decrease in 24-hour plasma glucose concentration in patients on a high soluble fiber diet compared with the standard diet previously recommended by the American Diabetes Association. A recent study demonstrated that a

Nopal (Opuntia fuliginosa, Opuntia streptacantha)

Nopal (plural nopales, or nopalitos in Mexico) (see Figure 1) is a member of the Opuntia genus and is known in the United States as the prickly pear cactus. The plant produces both a vegetable, nopal, and a red, egg-shaped fruit called tuna. Nopal can be found dotting the landscape throughout the arid regions of the Western Hemisphere. In the southwestern United States, it can be purchased at many markets.

As a food source, nopal is used in salads, soups, casseroles, sandwiches, and blended in

Fenugreek (Trigonella foenumgraecum)

Fenugreek is an example of an herb with a long history of traditional use that is gaining popularity among a wider audience. An annual herb native to southern Europe and Asia, fenugreek is now widely grown in the Mediterranean countries, Argentina, France, India, North Africa, and the United States. White flowers appear in early summer and develop into long, slender, yellow-brown pods containing the brown seeds that are used as medicinals and as a food source. Fenugreek is used to treat

Karela—Bitter Melon (Momordica charantia)

Momordica charantia (see Figure 2) is a plant known by many names, among them wild cucumber, bitter melon, bitter gourd, balsam apple, ampalaya (Philippines), and karela (India). In Puerto Rico, Cuba, and Santo Domingo, the plant is called cundeamor, and most persons with diabetes living in this region have used this popular diabetes remedy. The most popular plant used worldwide to treat diabetes,6 karela grows in tropical areas, including parts of the Amazon, East Africa, Asia, the Caribbean,

Gymnema (Gymnema sylvestre)

Gymnema is a woody, climbing plant native to central and southern India. The leaves have been used to treat madhu meha, or “honey urine,” for more than 2,500 years. The leaves destroy the taste of sweetness when chewed, giving the plant a common name of gur mar or “sugar killer.” It is also used as an antimalarial, digestive aid, and diuretic, for coughs, and as a snake bite antidote.64

Ginseng (Panax quinquefolius and Panax ginseng)

There are several species of ginseng. Studies using American ginseng (Panax quinquefolius) and Asian ginseng (Panax ginseng) have shown that the herb can potentially lower glucose levels. Panax has the same etymology as “panacea,” representing the cure-all properties often attributed to ginseng. The purported benefits include enhancing longevity, improving memory, acting as an aphrodisiac, helping control blood pressure and cholesterol, improving endocrine function, and use as a general tonic.

Other Natural Products

Many other natural products are used for diabetes and related conditions. Although the scientific literature on many of these is scant, three products deserve mention. Tronadora is used widely by persons of Mexican descent. Chromium and alpha-lipoic acid have an increasing amount of clinical trial data and are popular products.

Conclusion

Clinicians who work with patients with diabetes may recall one or more instances when patients achieved normal glucose levels with the use of a plant product, typically in conjunction with lifestyle changes. Clearly, there are natural products with hypoglycemic activity. When these exist as food products, it may be possible to incorporate them into a patient's diet. Several of the herbals used as hypoglycemics have high soluble fiber content and can be advocated for glucose control and lipid

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    See related article on page 278.

    The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, stock holdings, gifts, or honoraria.

    The authors wish to thank Mary Hardy, MD, medical director, Cedars-Sinai Integrative Medicine, for her thorough and insightful review of this manuscript.

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