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Diabetes prevention and treatment with Greco-Araband Islamic-based natural products
Diabetes prevention and treatment with Greco-Arab
And Islamic-based natural products
Hilal Zaid, Omar Said, Bahaa Hadieh,
Abdalsalam Kmail & Bashar Saad
1
Abstract
Diabetes has been recognized by medieval Greco-Arab physicians and its main
symptoms were known by the increased thirst, frequent urination, and tiredness.
Arab and Muslim physicians had used series of medicinal plants for treating these
combined symptoms (named Zarab). In addition to several instructions for specific
food consumption, a mild exercise was recommended. Currently, traditional Arab-
Islamic medicine continues to be practiced in most Arab and Islamic countries. The
current form of Arab and Islamic herbal medicine has historical roots in medieval
Greco-Arab and Islamic medicine. This medicine has influenced Europe where it
formed the roots from which modern Western medicine arose in late middle ages
and early European medical education. It is important to highlight that the Greco-
Arab and Islamic medicine was not a simply translations and continuation for Greek
ideas but rather a venue for innovation and change. This review article provides a
comprehensive overview on traditional Arab-Islamic herbal medicine including the
historical background, medical innovations introduced by Arab physicians, methods
of therapies, and a state of the art description of traditional Arab herbal medicine.
KEYWORDS: Arab-Islamic herbal medicine; diabetes type II, Avicenna, Rhazes.
INTRODUCTION
Currently, we are witnessing a great progress in evidence-based modern
medicineandpharmacology.Thecharacterizationof pharmacological and
biological effects of herbal-based medicines is becoming more competitive and
complex, with the involvement in this research area of experts belonging to
different scientific fields, including botany, chemistry, biochemistry, immunology,
1
Corresponding author: Prof. Bashar Saad.
ةعماج1433 19-38
Hilal Zaid, Omar Said, Bahaa Hadieh , Abdalsalam Kmail & Bashar Saad
molecular biology, and bioinformatics. However, despite this great progress in
evidence-based modern medicine and pharmacology, traditional Arab-Islamic
medicine continues to be practiced within the Mediterranean as well as most Arab
and Islamic countries. The current form of Arab and Islamic herbal medicines use
has historical roots in Greco-Arab and Islamic medicine, which was flourished in
the golden age (seventh to fifteenth century) of the Islamic civilization. The Arab
and Muslim world refers in geopolitical sense to Muslim majority countries or
countries in which Islam dominates politically. Arab-Islamic community is spread
across many different nations and ethnic groups connected only by religion.
Medicine and pharmacology in general are considered to be one of the most
illustrious and best known facets of Arab-Islamic civilization in which Arabs most
excelled. In the history of medicine, Islamic medicine, Arabic medicine, or Greco-
Arab and Islamic medicine refers to medicine developed in the golden age of the
Islamic civilization and written in Arabic, the lingua franca of the Islamic
civilization 1-4.
Anciant Greek physicians like Hippocrates (460 370 BC) laid the foundations
of the Arab-Islamic and modern theories (Figure 1). Hippocrates proposed that
thoughts, ideas and feelings, originate in the brain, can influence health and the
process of disease. Arab and Muslim physicians proposed that the body should be
treated as a whole and not just as a series of tissues and organs, and that it was
endowed with an ability of natural healing, which depended on rest, a good diet,
fresh air and cleanliness. Rhazes (846-930) supported this concept by his
recommendation: "The physician, even though he has his doubts, must always
make the patient believe that he will recover, for state of the body is linked to the
state of the mind.” Later on, Ibn Sina (980-1037) who defined medicine as "the
science from which we learn the states of the human body with respect to what is
healthy and what is not; in order to preserve good health when is exists and restore
it when is lacking" supported the views of Rhazes. He stated that "We have to
Diabetes prevention and treatment with Greco-Araband Islamic-based natural products
understand that the best and most effective remedy for the treatment of patients
should be through the improvement of the power of the human body in order to
increase its immune system, which is based on the beauty of the surroundings and
letting him listen to the best music and allowing his best friends to be with him".
It is now clear that the mind and the body interact, influence and regulate each
other. Recent research has indicated that the perception of stress can lead to
anism to regulate
their own production and the production of certain cytokines. These cytokines act
on the brain to modify behavior and the ability to perceive and to respond to
be
Based on recommendations of Rhazes and Avicenna, Greco-Arab and Islamic
healers treated patients through a scheme starting with physiotherapy and diet; if
this failed, drugs were used. Rhazes's treatment scheme started with diet therapy,
he noted that "if the physician is able to treat with foodstuffs, not medication, then
he has succeeded. If, however, he must use medications, then it should be simple
remedies and not compound ones". Drugs were divided into two groups, simple
and compound drugs. Physicians were aware of the interaction between drugs,
thus, they used simple drugs first. If these failed, compound drugs, consisting of
two or more compounds were used. If these conservative measures failed, surgery
was undertaken 1-8.
Hilal Zaid, Omar Said, Bahaa Hadieh , Abdalsalam Kmail & Bashar Saad
Figure 1. Development of Greco-Arab and Islamic medicine.
Prophetic
medicine
Pre-Islamic
medicine
Innovations by
Arab and Muslim
scholars
Greco-Arab and Islamic medicine:
Golden Age of the Arab-Islamic civilization
Dark Ages of the Western world
Roman medicine
Renaissance
Modern Western medicine
Mesopotamian
medicine
Holy Quran
Sunna
Indian medicine
Greek medicine
Egyptian medicine
Persian medicine
Chinese medicine
Diabetes prevention and treatment with Greco-Araband Islamic-based natural products
Greco-Arab medicine hisrtory at a glance
The Greco-Arab and Islamic medicine is devided into three phases: Phase I,
Greek into Arab; Phase II, Arab; and Phase III, Arab into Latin. The first phase of
the Greco-Arab and Islamic medicine was the period of translation of Greek
scientific and philosophical works into Arabic. This started in the eighth century
when Islam covered nearly two-thirds of the world (known at their time). The
Khalifa al- to translate the
Greek science. Large number of medical works of Hippocrates and Galen, as well
as philosophical works by Plato and Aristotle and mathematical works of Euclid
and Archimedes were translated into Arabic. Hospitals and medical schools
flourished during that period, first in Baghdad and later in the main provincial
cities.
The second phase began when the chief works of Galen and Hippocrates were
made available in Arabic, Christians lost their monopoly of medicine, and several
Muslims reached such a stature in medical science that they stood far above their
immediate predecessors and were roughly on a level with the greatest of the
Greeks. Some notable scholars of the science of Arab medicine were: Al Tabbari
(838-870), Al Razi (Rhazes) (846-930), Al Zahrawi (930-1013), Ibn Sina
(Avicenna) (980-1037), Ibn Al Haitham (960-1040), Ibn Al Nafees (1213-1288),
and Ibn Khaldun (1332-1395).
The third phase "Arab into Latin" began in the twelfth century when European
scholars who were interested in science and philosophy came to appreciate how
much they needed to learn from the Arabs. As such, they set about studying Arab
manuscripts in these disciplines and translating the most important ones into Latin.
The most outstanding writer on medicine in Arabic was Ibn Sina, or as he was
known in the West, Avicenna. Like Al Razi, Ibn-Sina wrote on many subjects, and
was known to have been a greater philosopher than a physician. Nevertheless, his
Hilal Zaid, Omar Said, Bahaa Hadieh , Abdalsalam Kmail & Bashar Saad
vast "Canon of Medicine" is rightly acclaimed as the "culmination and masterpiece
of Arab systematization." It was translated into Latin in the twelfth century, and
continued to dominate the teaching of medicine in Europe until at least the end of
fifteenth century, twenty editions in the sixteenth century, and several more in the
seventeenth century. His book classifies and describes diseases, and outlines their
assumed causes. It also discusses hygiene, simple and complex medicines, the
symptoms and complications of diabetes, and functions of parts of the body. Ibn
Sina even asserted that tuberculosis was contagious, which was later disputed by
Europeans, but turned out to be true 1-6.
Innovations introduced by Arab physicians
Avicenna was the first to use ice to treat fever diseases and separate medicine
from pharmacological science. Arab physicians introduced the use of animal
testing and combined different sciences such as chemistry, medicine,
pharmacology, agriculture, and plant science in order to develop new treatments
for their patients. In surgery, Al Zahrawi was the first to develop various surgical
equipments and tools, some of which were unique for surgery on females. Later on,
Ibn Al Haitham improved the surgery of eyes and studied the process of sight for
the first time. Arab doctors were also aware of the contagious qualities of diseases.
Other medical innovations introduced by Arab and Muslim physicians included:
The discovering of the immune system and the introduction of microbiological
science. 1-6.
Arab physicians introduced many new ideas and upgraded the knowledge about
herbs and their potential medical efficacy and safety. For example, Al-Rhazes
discovered the origin of smallpox and showed that one could only acquire it once;
indicating the existence of the immune system. Jaber Ibn Hayan and others
extracted different anesthetic compounds from local herbs for local or general
Diabetes prevention and treatment with Greco-Araband Islamic-based natural products
anesthetization. Daoud Al-Antaki, used different herbs for treating patients and
published a book on medicinal herbs summarizing the knowledge of his
predecessors. Ibn Al-Bitar, in Andalusia, Spain, introduced around 350 new plant
species as medicinal herbs for treating human diseases. Abu Al-Abbas and other
herbalists published several books and dictionaries on the use of medicinal plants
describing each plant species, the plant parts used, the preparation procedure used
for each remedy, and the treatment procedure of certain diseases. Avicenna
published several books such as "Alkanoon Fi Altib" (Canonof Medicine) in
into several different languages. Up until a few centuries ago, these two books
were the primary medicinal literature, and they are still in use in different libraries
in Europe 7-13.
At the Eighth-century, Arabs in Baghdad region were the first to separate
medicine from pharmacological science (Figure 2). At that point, patients started to
deal with experts in the pharmaceutical sciences working on the extraction and
preparation of remedies, and not with physicians who were now responsible for the
diagnosis of diseases and follow-up with the applied treatments. This fact resulted
in a huge development in pharmaceutical science; pharmacologists and ethno
pharmacologists started to search for different ingredients and extracts to be used
as remedies, and they even started to study the chemical properties of the materials
used in the treatment of various diseases and ailments. For the first time, chemists
such as Jaber Bin Hayan started to search for methods to extract and purify
different compounds including alcohol, nitric acids, sulfuric acids, and royal acid.
The latter was used to dissolve gold. Abu Bakr Al-Razi (Rhazes) was the first to
use animal gut for suture material. He had also started to use animals in the
laboratory in order to test the safety and efficacy of the extracted active ingredients.
The first animal used in these experiments to test the effects of mercury on the
body was a monkey 7-13.
Hilal Zaid, Omar Said, Bahaa Hadieh , Abdalsalam Kmail & Bashar Saad
Figure 2. Development of Arab-Islamic and modern pharmacy.
Chemists such as Jaber Bin Hayan started to search for methods to extract and
purify different compounds. Avicenna devoted a whole volume to simple drugs in
Canon. He described about 700 preparations, their properties, mode of action and
their indications. Rhazes promoted the medical uses of chemical compounds. Al-
Zahrawi (Abulcasis) described a large number of recipes and explained how to
prepare the simple drugs as well as complex drugs. Shapur ibn Sahl, was, however,
the first physician to initiate pharmacopoeia, describing a large variety of drugs and
remedies for ailments. Al-Biruni gave in his Saydanah fit-Tib detailed knowledge
of the properties of drugs and outlined the role of pharmacy and the functions and
Zahrawi:
Preparation
of simples and
complex drugs by
sublimation and
distillation.
Al-Kindi: application of
mathematics into
pharmacology.
Modern Western
Pharmacy
Ibn Sahl: Initiated
pharmacopoeia,
describing a large
variety of drugs
Separation between
pharmacy and
medicine:
First pharmacy in
Baghdad
Ibn Sina:
experimentation
and quantification, clinical
pharmacology, efficacy tests
of drugs
Al Razi
: Promoted the
medical uses of chemical
compounds.
Al-Biruni:
The Book of Drugs,
detailed knowledge of properties of
drugs and outlined the duties of the
pharmacist.
Ibn Zuhr: Herbal
medicines and their
preparations
Ibn Hayan: Search for
methods to extract and
purify different
compounds
Diabetes prevention and treatment with Greco-Araband Islamic-based natural products
duties of the pharmacist. Al-Kindi introduced the application of mathematics into
medicine, particularly in the field of pharmacology.
Diabetes in Greco-Arab medicine
Herbal-based anti-diabetic medicines have been a part of traditional medicine
for centuries. Plants have been used for medicinal purposes for as long as history
has been recorded. Mesopotamia, Egypt, China, India, and later on the Arab
Islamic world appear to have been the places which cradled the use of herbs. In
addition to plants, other natural products from animals and minerals have also been
used as a source of medicines from ancient times. Hundreds of wild plants as well
as wild and domestic animals and their by-products (e.g., bones, feathers, hooves,
skins, and tusks) form important ingredients in the preparation of curative,
protective and preventive medicine.
The Chinese were the first who detected diabetes (in the third century), they
noticed that the sweetness of urine attracts dogs. Later on, Indian physicians (in the
sixth century) rel
treat it [14]. Diabetes was recognized by medieval Greco-Arab physicians by its
main symptoms: increased thirst, frequent urination, and tiredness. Greco-Arab
physicians and practitioners had used series of medicinal plants for treating these
combined symptoms (named Zarab). During the ninth and tenth centuries, Rhazes
(846930), translated and enriched the Arabic literature with information about
diabetes. The basic source which he relied upon was the Hindu writings beside his
valuable contribution [15]. Rhazes said: "I use in the treatment of diabetes things
that cool thirst and thickens the blood
skin turns green because it tightens the bladder muscle, cools the kidney and stops
thirst and perscribed licorice [10].
Avicenna described diabetes as: "diabetes is that the water exits [from the body]
as it was drunk, in a short time" [9]. According to Avicenna, diabetes is caused by
Hilal Zaid, Omar Said, Bahaa Hadieh , Abdalsalam Kmail & Bashar Saad
malfunction of the kidneys, namely weakness or an excessive attraction of
moisture. The kidney naturally has to push the surplus moisture forward, since it
attracts much more moisture than it can maximally retain. Avicenna prescribed
emetics and medicines that stimulate perspiration for diabetes. He recommended
avoiding foods that stimulate urination and to exercises [16].
Treatment of type 2 diabetes revolves around controlling circulating glucose
levels (either through glucose production or utilizing or through increasing insulin
secretion and effectiveness) or by reduction of energy intake or increasing energy
expenditure. The natural herbs for diabetes treatment focus on lowering blood
sugar and reducing the damaging effects of the disease. The anti-diabetic
mechanism of plant are usually: insulin sensitizer, insulin mimics, insulin
secretagogues and inhibitors of intestinal carbohydrate digestion and absorption.
Insulin sensitizers include plants that increase glucose uptake and disposal by
muscle, fat and hepatic cells as well as those that regulate hepatic glycogen
metabolism. In this category, garlic (Allium sativum) and onion (Allium cepa)
decrease blood glucose levels by normalizing liver hexokinase and glucose-6-
phosphatase activity [17]. Nigella sativa and Cinnamomon cassia (cinnamon) were
suggested to have insulin mimetic properties, through enhancing insulin signaling
pathway independently of insulin [18]. The comonly used Greco-Arab anti-diabetic
herbs are summerized in table 1.
Diabetes prevention and treatment with Greco-Araband Islamic-based natural products
Table1. Medicinal Plants Used to Treat Diabetes Based on the Traditional Arab
Medicine
Latin name
Arabic name
Part used
Achillea fragrantissima
Kaisom
leaf and stem
Achillea millefolium
Akhiliaem alf waraka
leaf and flower
Allium cepa
Basal
bulb and seed
Artemisia Arborescens
Sheba
leaf
Artemisia herba-alba
Sheh
foliage
Asparagus aphyllus
Halion
shoots
Atriplex halimus
Qataf
leaves
Bidens pilosa
Huseke
whole plant
Centaurea iberica
Murrar
whole plant
Ceratonia siliqua
Kharob
leaves, fruits and
seeds
Cichorium pumilum
A'elet )
leaves
Citrullus colocynthis
Hanzal
seeds, fruits and fruit
pulps
Coridothymus capitatus
Zaa'tar faresi
foliage
Crataegus aronia
Zaa'ror sha'ek
fruit, flower and
leaves
Cupressus sempervirens
Saro
fruit and leaf
Inula viscosa
Tayyon
foliage
Juglans regia
Juz
leaf and flower
Hilal Zaid, Omar Said, Bahaa Hadieh , Abdalsalam Kmail & Bashar Saad
Latin name
Arabic name
Part used
Lupinus albus / pilosus
Tormus barre
seed
Lycium europaeum
A'awsaj
root
Mercurialis annua
A'eshbet el jarat
leaf
Morus nigra
Tot
leaf, stem and fruit.
Olea europaea
Zaiton
leaf and fruits
Paronychia argentea
Rejel El hamama
leaf and flower
Pinus halepensis
Snobar
leaf and seed
Portulaca oleracea
Farfahena
foliage
Quercus calliprinos
Ballot
fruit and bark.
Salvia fruticosa
Merameye
foliage
Sarcopoterium spinosum
Bellan
leaf, seed and root
Teucrium capitatum
/polium
Jea'det el sebyan
foliage
Trigonella foenum-
graeceum
Helbe
seed
Urtica dioica
Qurres
Foliagle and seeds
Traditional herbs as a novel source for anti-diabetes treatment
To consider anti-diabetic plants for clinical use, the ideal plant has to possess the
following properties: has traditionally been used in more than one country, has
experimentally documented constituents, hypoglycaemic activity and very low
toxicity as well as to be botanically abundant. According to recent surveys carried
Diabetes prevention and treatment with Greco-Araband Islamic-based natural products
out among practitioners of Arabic medicine in the Middle East, 26 plant species for
the treatment of diabetes mellitus have been disclosed. We had tested four of the
best anti-diabetic herbs candidates: Juglans regia (walnut), Atriplex halimus
(saltbush), Olea europaea (olive), and Utica dioica (nettle). A mixture of these four
antidiabetic herbs was developed according to the extensive herbal knowledge of
the GrecoArab medical system [19]. The safety and efficacy of this mixture
(Glucolevel) were tested in our laboratories. We hypothesized that extracts from
the four plants when combined may disclose synergistic effects on different levels
of glucose-insulin homeostasis adding thus to the therapeutic efficacy.
Following the evaluation of Glucolevel anti-diabetic activity in animal models,
sixteen test persons were recruited for our study. Their ages ranged from 48 to 67
years and none of them took any pharmacological drug during the study period
(four weeks). They were asked to continue their daily activities and diet habits
unchanged and to take one tablet of Glucolevel three times daily. They were also
asked to restrain from consuming any medications during the study period. Each
subject was given a free-of-charge box containing 90 tablets of Glucolevel and was
asked to fill an informed consent.
No minor or major adverse effect was noted and the Glucolevel was well
tolerated by all subjects. During the first week of Glucolevel consumption, baseline
glucose levels were reduced from 290 ± 40 to 210 ± 20 mg/dL in these subjects.
According to baseline glucose levels, a subgroup of 11 subjects had glucose levels
below 300 mg/dL and the other subgroup had levels above 300 mg/dL. The former
subgroup achieved clinically acceptable glucose levels during the second and third
weeks of Glucolevel consumption. The higher blood glucose level subgroup,
needed one week more to achieve clinically acceptable glucose levels.
Hilal Zaid, Omar Said, Bahaa Hadieh , Abdalsalam Kmail & Bashar Saad
Figure 3: Proposed Glucolevel mechanism of action.
Glucolevel proposed action mechanism. Scientific evidences obtained so far
indicate hypoglycemic and antioxidant properties of each of the four herbs
contained in Glucolevel.
a) Olive leaf extracts possesses antibiotic, anti-aging, immunostimulator as well as
anti-diabetic proporties. In clinical studies, Olive leaf lowered blood and act as
antibacterial, antifungal, and anti-inflammatory agent in vitro [20]. The main
active ingredient in olive leaf is oleuropeoside that disclosed a distinct
hypoglycemic effect at a dose of 16 mg/kg, concomitant with hypotensive and
hypolipidemic properties. Oleuropein aglycone is also believed to be effective
against type 2 diabetes because of its protection against aggregate cytotoxicity
reported using a RIN-5F rat insulinoma cell model. Antioxidant effect of olive oil
Oleic acid has been shown to increase
Diabetes prevention and treatment with Greco-Araband Islamic-based natural products
insulin production and to reverse the inhibitory insulin effect of tumor necrosis
factor alpha (TNF- -1. In islets of
Langerhans from mice supplemented with extra virgin olive oil, the expression and
activity of the antioxidant enzymes, catalase and glutathione peroxidase, were
increased significantly . Furthermore, after incubation with hydrogen peroxide,
islets from extra virgin olive oil-supplemented mice had a higher glucose-
stimulated insulin secretion compared to the control group. In vitro investigations
have found that olive oil phenols are potent antioxidants, which may provide
potential chemoprotective properties [20].
b) Tannins and polyphenolics in walnut leaves were found to be potent antioxidants
and reveal a strong scavenging activity against both superoxide and hydroxyl
radicals [21].
c) Saltbush is an extremely effective antidiabetic herb and shows an insulin
potentiating effect in animal model for diabetogenesis and obesity [22]. In vitro
experiments have shown that Glucolevel facilitates glucose entry into yeast cells
during anaerobic fermentation. This observation may be attributed to an effect of
saltbush content on Glucolevel.
d) Urtica dioica extracts can be used to treat arthritis, hay fever, kidney problems,
pain and anemia. Moreover, its exctract is in use to stop bleeding because of its
high Vitamin K content and was shown to reduce TNF-
cytokines [23]. The nettle extract is effective in lowering blood glucose levels via
decreasing glucose production by the liver. Such an effect was evidenced in our
experiments with the inverted intestine segment.
Hilal Zaid, Omar Said, Bahaa Hadieh , Abdalsalam Kmail & Bashar Saad
Conclusions
Greco-Arab herbs have been used for hundreds of years either in their crude forms
or as herbal teas, syrups, and powders in treatment and prevention of diverse
diseases including diabetes [24-29]. Despite the mentioned remarkable successes in
all aspects of medicine, Greco- Arabic medicine did not provide strong
achievements in the treatment of diabetes due to inability to understand and
diagnose correctly the diabetes, besides the complete relaying on the four humor
theory in the drug discovery process.
The four humor theory is believed to be a serious knowledge barrier for the classic
medical Greco-Arabic medical system and prevented understanding and diagnosing
diabetes correctly. Nevertheless, the non-philosophic Arabic traditional medicine
was free to offer us a long list of effective herbs for treating diabetes. More than
50% of the modern pharmaceuticals used in conventional medicine today have
natural plant origins. Among them the anti-diabetic drug, metformin, was derived
from the flowering plant, Galega officinalis
was a common traditional remedy for diabetes [30].
Nowadays, alternative herbal-based treatments for diabetes mellitus is prevalent
in most Arab and Islamic countries, these medications are unregulated and are not
standardized which poses a risk for their use, although some would debate that
natural ingredients would not be harmful to their health unless taken in
significantly increasing amounts. Any medication, be it herbal or chemical, should
always be taken in moderation
responsibility to provide scientific evidence based of traditional health care and
promote health literacy for diabetic subjects.
Diabetes prevention and treatment with Greco-Araband Islamic-based natural products
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