Other herbal remedies for diabetes mellitus Ginsengs

Clinical evidence exists for both American ginseng (Panax quinquefolius L.) and Asian ginseng (P. ginseng C. A. Meyer) exerting hypoglycemic effects. Recent randomized controlled studies conducted in Canada with American ginseng in groups of ten and twelve subjects found that 1–3 g of powdered whole root, taken any time up to two hours before a glucose meal, led to a roughly 20 percent reduction in blood sugar level for patients suffering from type 2 diabetes. 47,48

A similar effect was noted in nondiabetics, except that the American ginseng had to be consumed at least forty minutes before the sugar meal; blood glucose level was not affected in the absence of glucose challenge, 49,50 thus posing no risk of hypoglycemia in nondiabetics.

Ginsenosides, the characteristic triterpene saponins of Panax species, are widely regarded as chiefly responsible for many of the roots’ activities, including hypoglycemic effects. However, the individual ginsenosides

have been shown to have different, sometimes opposing, activities. 51 In a randomized, single-blind design, twelve normal subjects (six females and six males), aged 31 ± 3 years, were administered 6 g of a batch of American ginseng root, which was different from that used in earlier successful antidiabetic trials, or placebo forty minutes before a 75-mg oral glucose tolerance test. Repeated measures of analysis of variance demonstrated no significant effect of the ginseng on incremental plasma glucose or insulin

or their AUC indices of insulin sensitivity. 52 These results suggest that changes in ginsenoside levels and profile play a role in the hypoglycemic effects; the authors of the study note particularly marked decrements in total ginsenosides and changes in the key protopanaxadiol to protopa-

naxatriol ratios, Rb 1 :Rg 1 and Rb 2 :Rc.

Widely publicized studies with mice, reported in two publications in 2002, extolled the effectiveness of a Panax ginseng berry extract as a treatment for diabetes and obesity; drastic reduction in blood glucose levels (“completely normalized”) and loss of 10–15 percent body weight in twelve days, as well as a 30 percent reduction of cholesterol levels, were

Chapter eight: Endocrine and metabolic problems 163 observed in treated diabetic mice, which ate 15 percent less food and were

35 percent more active than untreated ones. 53,54 The authors of the studies, conducted at the University of Chicago, attributed the antidiabetic effects—but not the antiobesity effect—to content of ginsenoside Re in the intraperitoneally administered berry extract, which contained five to seven times more of the ginsenoside than root extract of Asian ginseng at

a level comparable to the content of American ginseng root. An apparent Asian ginseng root extract preparation, of unspecified composition, administered to thirty-six NIDDM patients has also been reported to reduce fasting blood glucose levels. 55

Further research is needed to elucidate properly the mechanisms by which antihyperglycemic botanicals exert their antidiabetic effects. Also needed are well-designed, larger clinical trials of longer duration to firmly establish safety and efficacy.

Apart from the ultimate aim of elucidation of mechanisms of action, there is an insistent need to develop bases for standardization that tie the composition of herbs to their efficacy. The lack of a reliable basis

for ginseng led Vuksan and Sievenpiper 56 to use an acute postprandial clinical screening model to select an efficacious ginseng batch, dose, and time of administration. Upon reviewing the published evidence in support of a broad variety of herbs used in diabetes, these two authors have concluded that “compelling evidence” of efficacy from randomized controlled clinical trials exists for only one herb other than American ginseng—namely, ivy gourd [Coccinia grandis (L.) J. Voigt, syn. C. indica Wight & Arn., Cucurbitaceae].

References

1. Wilson, J. D. 1998. Approach to the patient with endocrine and metabolic disorders. In Harrison’s principles of internal medicine, 14th ed., ed. A. S. Fauci, E. Braunwald, K. J. Isselbacher, J. D. Wilson, J. B. Martin, D. L. Kasper, S. L. Hauser, and D. L. Longo, 1965–1972. New York: McGraw–Hill. 2. Robbers, J. E., M. K. Speedie, and V. E. Tyler. 1996. Pharmacognosy and pharma- cobiotechnology, 123–124. Baltmore, MD: Williams & Wilkins. 3. Huxtable, R. J., ed. 1996. Proceedings of the Western Pharmacological Society 39:1–6.

4. Hudson, T. 1996. Townsend Letter for Doctors and Patients July: 125–127. 5. Gray, S. L., B. R. Lackey, P. L. Tate, M. B. Riley, and N. D. Camper. 2004.

Experimental Biological Medicine 229:560–568. 6. Beckham, N. 1998. Australian Journal of Medical Herbalism 7:11–16. 7. Miksicek, R. J. 1994. Journal of Steroid Biochemistry and Molecular Biology

49:153–160. 8. Pelissero, C., G. Flouriot, J. L. Foucher, B. Bennetau, J. Dunogues, F. LeGac, and J. P. Sumpter. 1993. Journal of Steroid Biochemistry and Molecular Biology 44:263–272.

164 Tyler's herbs of choice: The therapeutic use of phytomedicinals 9. Possouw, J. E., G. L. Anderson, R. L. Prentice, A. Z. Croix, C. Kooperberg, M. L.

Stefanick, et al. 2002. Journal of the American Medical Association 288:321–333. 10. Chadwick, L. R., G. F. Pauli, and N. R. Farnsworth. 2006. Phytomedicine 13:119–131. 11. Baker, M. E. Proceedings of the Society for Experimental Biology and Medicine 208:131–138. 12. Mullins, P. M., M. C. Pugh, and A. O. Moore. 1997. Hormone replacement therapy. In Pharmacotherapy: A pathophysiologic approach, 3rd ed., ed. J. T. DiPiro, R. L. Talbert, G. C. Yee, G. R. T. Matzke, B. G. Wells, and L. M. Posey, 1635–1646. Stamford, CT: Appleton & Lange.

13. Stampfer, M. J., W. C. Willett, D. J. Hunter, and J. E. Manson. 1992. Cancer Causes & Control 3:33–39. 14. Murkies, A. L., G. Wilcox, and S. R. Davis. 1998. Journal of Clinical Endocrinological Metabolism 83:297–303. 15. Fankhauser, M. P. 1997. Premenstrual syndrome. In Pharmacotherapy: A pathophysiologic approach, 3rd ed., ed. J. T. DiPiro, R. L. Talbert, G. C. Yee, G. R. Matzke, B. G. Wells, and L. M. Posey, 1621–1633. Stamford, CT: Appleton & Lange.

16. Burton, J. 1949. Lydia Pinkham is her name, 107. New York: Farrar, Straus. 17. Hänsel, R. 1991. Phytopharmaka, 2nd ed., 223–230. Berlin: Springer–Verlag. 18. Lehmann-Willenbrock, E., and H. H. Riedel. 1988. Zentralblatt für Gynäkologie

110:611–618. 19. Düker, E.-M., L. Kopanski, H. Jarry, and W. Wuttke. 1991. Planta Medica 57:420–424. 20. Newall, C. A., L. A. Anderson, and J. D. Phillipson. 1996. Herbal medicines: A guide for health-care professionals, 80–81. London: The Pharmaceutical Press. 21. Bundesanzeiger (Cologne, Germany): January 5, 1989. 22. Blumenthal, M. 1989. Health Foods Business 35 (9): 18, 104–105. 23. Winterhoff, H., C. Gorkow, and B. Behr. 1991. Zeitschrift für Phytotherapie

12:175–179. 24. Miulewicz, A., E. Gejdel, H. Sworen, K. Sienkiewicz, H. Jedrzejak, J. Teucher, and H. Schmitz. 1993. Arzneimittel-Forschung 43:752–756. 25. Wuttke, W., C. Gorkow, and H. Jarry. 1995. Dopaminergic compounds in Vitex agnus-castus. In Phytopharmaka in Forschung und Klinischer Anwendung, ed. D. Loew and N. Rietbrock, 81–91. Darmstadt, Germany: Steinkopf. 26. Bundesanzeiger (Cologne, Germany): May 15, 1985. 27. Briggs, C. J. 1986. Canadian Pharmaceutical Journal 119:248–254. 28. Barber, A. J. 1988. Pharmaceutical Journal 240:723–725. 29. Awang, D. V. C. 1990. Canadian Pharmaceutical Journal 123:121–126. 30. Newall, C. A., L. A. Anderson, and J. D. Phillipson. 1996. Herbal medicines: A

guide for health-care professionals, 110–113. London: The Pharmaceutical Press. 31. Review of Natural Products: August 1997. 32. Budeiri, D., A. LiWan Po, and J. C. Dornan. 1996. Controlled Clinical Trials

17:60–68. 33. Commission E, German Federal Health Agency. 1992. 34. Martindale—The extra pharmacopoeia, 31st ed., 1748. London: The Royal

Pharmaceutical Society, 1996. 35. Parsons, M., M. Simpson, and T. Ponton. 1999. Australian College of Midwives International Journal 12:20–25.

Chapter eight: Endocrine and metabolic problems 165 36. Beckett, A. H., F. W. Belthle, K. R. Fell, and M. F. Lockett. 1954. Journal of

Pharmacy and Pharmacology 6:785–796. 37. Bamford, D. S., R. C. Percival, and A. U. Tothill. 1970. British Journal of Pharmacology 40:161P–162P. 38. Castleman, M. 1991. The healing herbs, 294–296. Emmaus, PA: Rodale Press. 39. Bricklin, M. 1982. Encyclopedia of natural home remedies, 379–381. Emmaus, PA:

Rodale Press. 40. Harvey, R. 1995/1996. British Journal of Phytotherapy 4:55–65. 41. Winterhoff, H., H.-G. Gumbinger, U. Vahlensieck, F. H. Kemper, H. Schmitz,

and B. Behnke. 1994. Arzneimittel-Forschung 44:41–45. 42. Weiss, R. F. 1988. Herbal medicine, 275–278. Gothenburg, Sweden: AB Arcanum. 43. Yongchaiyudha, S., V. Rungpitarangsi, N. Bunyapraphatsara, and Choke- chaijaroenpron. 1996. Phytomedicine 3 (3): 241–243. 44. Khan, A., M. Safdar, M. Khan, K. N. Khattak, and R. A. Anderson. 2003. Diabetes Care 26 (12): 3215–3218. 45. Gupta, A., R. Gupta, and B. Lal. 2001. Journal of the Association of Physicians in India 49:1057–1061. 46. Mani, U. V., S. Desai, and U. Iyer. 2000. Journal of Neutraceuticals, Functional & Medical Foods 2 (3): 25–32. 47. Vuksan, V., J. L. Sievenpiper, V. Y. Y. Koo, T. Francis, U. Beljan-Zdravkovic, Z. Xu, and E. Vigden. 2000. Archives of Internal Medicine 160:1009–1013. 48. Vuksan, V., M. P. Stavrp. J. L. Sievenpiper, U. Beljan-Zdravkovic, L. A. Leiter, R. G. Josse, and Z. Xu. 2000. Diabetes Care 23:1221–1226. 49. Vuksan, V., M. P. Stavro, J. L. Sievenpiper, V. Y. Y. Koo, E. Wong, U. Beljan- Zdravkovic, T. Francis, A. L. Jenkins, L. A. Leiter, R. G. Josse, and Z. Xu. 2000. Journal of the American College of Nutrition 19:738–744.

50. Vuksan, V., J. L. Sievenpiper, J. Wong, Z. Xu, U. Beljan-Zdravkovic, J. T. Arnason, V. Assinewe, M. P. Stavro, A. L. Jenkins, L. A. Leiter, and T. Francis, T. 2001. American Journal of Clinical Nutrition 73:753–758.

51. Park, J. D., D. K. Rhee, and Y. H. Lee. 2003. Phytochemistry Reviews 4:159–175. 52. Sievenpiper, J. L., J. T. Arnason, L. A. Leiter, and V. Vuksan. 2002. European Journal of Clinical Nutrition 56:1–6. 53. Xie, J. T., Y.-P. Zhou, L. Dey, A. S. Attele, J. A. Wu, M. Gu, K. S. Polonsky, and C.-S. Yuan. 2002. Phytomedicine 9:254–258. 54. Attele, A. S., Y.-P. Zhou, J.-T. Xie, J. A. Wu, L. Zhang, L. Dey, W. Pugh, P. A. Rue, K. S. Polonsky, and C.-S. Yuan. 2002. Diabetes 51:1851–1858. 55. Sotaniemi, E. A., E. Haapakoski, and A. Rautio. 1995. Diabetes Care 18:1373–1375. 56. Vuksan, V., and J. L. Sievenpiper. 2005. Nutrition Metabolism and Cardiovascular Diseases 15:149–160.

chapter nine

Arthritic and musculoskeletal disorders

Other herbal remedies for diabetes mellitus Ginsengs