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Effects of garlic on blood glucose levels and HbA1c in patients with type 2 diabetes mellitus

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Effects of garlic on blood glucose levels and HbA1c in patients with type 2 diabetes mellitus

Abstract

The aim of the present study was to evaluate the effects of garlic on fasting blood sugar and HbA1c in patients with type 2 diabetes mellitus. This was a 24 week, single-blind placebo controlled study. The patients (n = 210) with fasting blood sugar above 126 mg/dl were recruited and divided into 7 groups (A, B, C, D, E, F and G), each comprised of 30 patients. Group A, B, C, D, and E were given garlic tablets at doses of 300, 600, 900, 1200, and 1500 mg per day respectively. Group F received metformin while group G received placebo. FBS and HbA1c were measured at week 0, 12 and 24. Present study showed significant decrease in fasting blood sugar and HbA1c in both dose and duration dependent manner. In each garlic treated group, significant reduction in FBS (p <0.005) and HbA1c (p <0.005) were observed when compared with placebo. Highly significant reduction in FBS and improvement in HbA1 C were observed at higher doses of garlic and with increase in the duration of study. Garlic is more effective than placebo and comparable to metformin in reducing fasting blood glucose and may be a valuable addition in the management of diabetic patients.
Journal of Medicinal Plants Research Vol. 5(13), pp. 2922-2928, 4 July, 2011
Available online at http://www.academicjournals.org/JMPR
ISSN 1996-0875 ©2011 Academic Journals
Full Length Research Paper
Effects of garlic on blood glucose levels and HbA1c in
patients with type 2 diabetes mellitus
Rizwan Ashraf M. Phil1*, Rafeeq Alam Khan1 and Imran Ashraf2
1Department of Pharmacology, Faculty of Pharmacy, University of Karachi, Pakistan.
2Department of Geriatric Medicine, King’s Hospital London, London, UK.
Accepted 8 April, 2011
The aim of the present study was to evaluate the effects of garlic on fasting blood sugar and HbA1c in
patients with type 2 diabetes mellitus. This was a 24 week, single-blind placebo controlled study. The
patients (n = 210) with fasting blood sugar above 126 mg/dl were recruited and divided into 7 groups (A,
B, C, D, E, F and G), each comprised of 30 patients. Group A, B, C, D, and E were given garlic tablets at
doses of 300, 600, 900, 1200, and 1500 mg per day respectively. Group F received metformin while group
G received placebo. FBS and HbA1c were measured at week 0, 12 and 24. Present study showed
significant decrease in fasting blood sugar and HbA1c in both dose and duration dependent manner. In
each garlic treated group, significant reduction in FBS (p <0.005) and HbA1c (p <0.005) were observed
when compared with placebo. Highly significant reduction in FBS and improvement in HbA1C were
observed at higher doses of garlic and with increase in the duration of study. Garlic is more effective
than placebo and comparable to metformin in reducing fasting blood glucose and may be a valuable
addition in the management of diabetic patients.
Key words: Garlic, diabetes mellitus, fasting blood sugar, HbA1C, complementary therapy.
INTRODUCTION
Diabetes mellitus is a group of diseases characterized by
high blood glucose levels resulting from defects in insulin
secretion, insulin action, or both. Abnormalities in the
metabolism of carbohydrate, protein, and fat are also
present (Defronzo, 1997). The prevalence of type 2
diabetes is increasing globally (Zimmet et al., 2001;
Mokdad et al., 2001). It is anticipated that by the year
2025 over 75% of all people with diabetes will belong to
the developing countries. In Pakistan, no of patients
afflicted with diabetes are estimated to increase from 4.3
million in 1995 to 14.5 million in 2025 (Shera et al., 2007).
Despite the availability of medication for management
of diabetes, the interest in alternative traditional remedies
is increasing (Pari and Umamaheswari, 2000). The use of
*Corresponding author. E-mail: drriz72@yahoo.com Tel: +92-
21-6634848. Fax: +96672355059.
natural substances has become more extensive over the
past few years, motivated certainly by the faith that they
may have fewer side effects as compared to
pharmaceuticals and by their effortless accessibility to the
populace without prescriptions or visits to the health
providers (Ashraf et al., 2005). Many natural substances
have shown the potential to condense number of
cardiovascular risk factors including diabetes mellitus
(Marles and Farnsworth, 1995; Alarcon-Aguilara, 1998).
Garlic and various forms of extracts prepared from it
represent an example of such natural substances
(Steiner and Li, 2001).
Garlic is known to possess a number of biologically
active compounds having anticoagulant (Fukao et al.,
2007), antioxidant (Banerjee et al., 2003; Lee et al.,
2009), antihyperlipidemic (Gupta and Porter, 2001) and
antihypertensive effects (Verma et al., 2008).
Antidiabetic potential of garlic has been reported in
many previous trials conducted in animal models (Marles
and Farnsworth, 1995; Alarcon-Aguilara et al., 1998;
Banerjee and Maulik, 2002; Anwar and Meki, 2003; Liu et
al., 2005; Liu et al., 2006; Eidia et al., 2006; Jelodar et al.,
2005; Lee et al., 2009).
Garlic principle active agent appears to be allicin, a
sulfur-containing compound that with its breakdown
products gives garlic its characteristic odour (Elkayam et
al., 2003). Allicin is formed enzymatically from an
odourless precursor, alliin, when garlic cloves are
mechanically disrupted (Alpers, 2009). The probable
mechanism underlying garlic hypoglycemic effects most
likely is increased insulin secretion and sensitivity (Birdee
and Yeh, 2010). Despite that the antidiabetic potential of
garlic has been confirmed in animal studies, scientific
evidence from human studies is lacking (Liu et al., 2007).
Most of the clinical studies have observed the effects of
garlic on blood glucose in normal healthy individuals but
not in diabetic patients, leaving no doubt that the role of
garlic in the management of diabetic patients still needs
to be confirmed. However, bearing in mind that garlic has
been an essential part of our diet for centuries, it is taken
for granted that garlic is safe in a wide range of doses.
Few non-specific adverse effects were reported in clinical
studies using garlic and its preparations and frequently
consist of gastrointestinal discomfort and nausea. Allergic
contact dermatitis has been reported in people with
occupational exposure to garlic. There have also been
infrequent reports of allergic conjunctivitis, rhinitis,
bloating, headache, dizziness, profuse sweating and
bronchospasm occurring in response to garlic inhalation
or ingestion. Rarely ingestion of fresh garlic and garlic
powder was reported to have synergistic effects with
anticoagulants or platelet aggregation inhibitors
increasing risk of haemorrhage (Banerjee and Maulik,
2002). Thus comprehensive clinical studies in diabetic
patients are justified to confirm the efficacy and possible
role of garlic in the management of diabetic patients
(Thomson et al., 2007).
As previous clinical trials have cast doubt on the
proposed hypoglycemic effects of garlic and there is no
previous trial showing the effects or benefits of garlic at
different doses on blood glucose in patients with diabetes
and also keeping in mind the incidence of diabetes that is
quite high in Pakistan
and a wide spread belief among
general public that garlic has beneficial effects on various
cardiovascular risk factors, we designed a study to
evaluate the hypoglycemic effects of garlic in patients
with type 2 diabetes mellitus in comparison with the
standard antidiabetic agent metformin and placebo.
.
MATERIALS AND METHOD
This was a 24 week, single-blind study, conducted simultaneously
in different primary health care centers in Karachi, Pakistan in
cooperation with registered medical practioners. Research protocol
has been approved by Board of advanced studies and Research of
the University of Karachi.
Phil et al. 2923
Patients with previously diagnosed type 2 diabetes mellitus (n =
210) were enrolled after taking informed and written consent and
were divided randomly into 7 groups: A, B, C, D, E, F and G, each
comprised of 30 patients. Patients in group A, B, C, D and E were
given garlic tablets at the dose of 300, 600, 900, 1200 and 1500 mg
per day in divided doses respectively for 24 weeks. Group F was
given tablet metformin 500 mg twice daily for 24 weeks while
patients in Group G were given placebo.
Prior to enrollment we conducted a screening examination in
which inclusion and exclusion criteria were evaluated, informed and
written consent was taken from each study participant. All the
patients were seen at fortnightly interval. Fasting blood sugar and
HbA1c were measured at week 0, week 12 and week 24 of study.
At each visit, patients were queried about drug compliance and side
effects of drugs. Diet control consisted of asking subjects at
recruitment to keep to their usual diet throughout the study and
especially not to alter their garlic or onion intake. Patients were also
motivated to keep their nutritional plan, physical activity and general
life style as c onstant as possible t hroughout the study period. The
patients were advised to avoid taking any other medication during
the study period without informing the study physician.
Blood samples were drawn from each patient on the morning of
week 0, week 12 and week 24. Blood was drawn by venepuncture
with the help of a sterile plastic disposable syringe under aseptic
measures. Blood glucose was determined by the enzymatic
colorimetric method. Glycated hemoglobin ( HbAlc) was estimated
by Fast Ion-Exchange Resin Separation Method.
All patients in groups A, B, C, D, E, F and G were s elected
according to following criteria.
Inclusion criteria
Patients with diagnosed type 2 diabetes mellitus of either s ex with
fasting blood sugar levels above 126 mg/dl. Patients aged between
25 to 70 years.
Exclusion criteria
The patients were excluded from the study if they are, known to
have history of allergy to garlic, pregnant or lactating women,
patients with type 1 diabetes mellitus, patients having history of
myocardial infarction, coronary artery bypass grafting, established
coronary artery disease, unstable angina, clinically manifest heart
failure, patients with history of liver disease and impaired renal
function and if they are known to have any other concurrent medical
illness.
Results are presented as means ± SEM. The paired, two tailed
Student t test was performed t o compare measurements of FBS
and HbA1C at different durations of therapy. Statistical significance
was defined as p <0.05.
RESULTS
The demographic characteristics of the study population
are shown in Table 1. The patients were male (60%) and
females (40%). The mean age was 40 years in garlic
treated group and 50 years in metformin treated group
(range 25 to 70 years) (Table 1). Fasting blood glucose
and HbA1C were measured at week 0 and week 12 and
week 24 (Tables 2 and 3, Figure 1and 2).
A total of 210 patients were initially enrolled in the
study. 195 patients were associated throughout the study
2924 J. Med. Plant. Res.
Table 1. Demographic data of Garlic and standard group.
Placebo treated group Garlic treated group Metformin treated group
Men 15 90 17
Women 15 60 13
Age (years) 45 ± 4.58 40 ± 5.04 50 ± 5.80
Body weight (Kg) 69.1 ± 7.58 68.2 ± 10.45 65.4 ± 9.80
Height (cm) 166.4 ± 6.58 165.2 ± 8.81 167.60 ± 9.20
Average duration of type 2
diabetes mellitus 3 years 3 years 2.5 years
Co-morbid disease None None None
Table 2. Effect of different doses of Garlic in comparison with Placebo and Metformin on fasting blood sugar from week 0 to week
12 and week 24.
Group according to dose Fasting blood sugar (mg/dl)
Week 0 Week 12 Week 24
(Group A) Garlic 300 mg 127 ± 0.334 (n = 30) 126 ± 0.360** (n = 27) 125 ± 0.379** (n = 27)
(Group B) Garlic 600 mg 128 ± 0.311 (n = 30) 127 ± 0.369** (n = 27) 126 ± 0.446** (n = 27)
(Group C) Garlic 900 mg 128 ± 0.263 (n = 30) 126 ± 0.274** (n = 27) 124 ± 0.289** (n = 27)
(Group D) Garlic 1200 mg 128 ± 0.315 (n = 30) 125 ± 0.264** (n = 27) 123 ± 0.263** (n = 27)
(Group E) Garlic 1500 mg 129 ± 0.223 (n = 30) 126 ± 0.213** (n = 27) 123 ± 0.225** (n = 27)
(Group F) Metformin 500 mg 125 ± 1.246 (n = 30) 119 ± 1.243** (n = 27) 118 ± 1.045** (n = 27)
(Group G) Placebo 127 ± 0.192 (n = 30) 129 ± 0.241** (n = 27) 131 ± 0.363** (n = 27)
Data are presented as mean ± standard error. Asterisk denotes significant p values. * Significant p < 0.05 ** Highly signific ant p < 0.005.
Table 3. Changes in HbA1C with Garlic, Metformin and Placebo from week 0 to week 12 and week 24.
Group Blood levels of HbA1C (%)
Week 0 Week 12 Week 24 Mean difference
Group A (300 mg dose of garlic) 6.59 ± 0.044 6.26 ± 0.044** 6.02 ± 0.048** - 0.57
Group B (600 mg dose of garlic) 6.52 ± 0.055 6.33 ± 0.064 6.06 ± 0.054** - 0.46
Group C (900 mg dose of garlic) 6.60 ± 0.055 6.31 ± 0.053* 6.03 ± 0.054** - 0.57
Group D (1200 mg dose of garlic) 6.53 ± 0.056 6.26 ± 0.045 6 ± 0.053** - 0.53
Group E (1500 mg dose of garlic) 6. 73 ± 0.035 6.32 ± 0.041** 5.97 ± 0.032** - 0.76
Group F (Metformin 500 mg) 6.64 ± 0.044 6.26 ± 0.036** 6.21 ± 0.042** - 0.43
Placebo 6.31 ± 0.036 6.37 ± 0.035 6.40 ± 0.049 + 0.09
* Significant p < 0.05, ** Highly significant p < 0.005, (-) indicates decrease in mean HbA1C from week 0 to week 24. (+) indicates increase
in mean HbA1C from week 0 to week 24.
and completed the protocol till week 24. Out of the
dropped 15 patients, 3 patients were dropped from
metformin treated group, 2 patients due to vague
abdominal discomforts and refused to continue the
protocol while 1 patient complained of weight loss and did
not come for follow up after 12 weeks. The remaining
patients were dropped from different garlic treated
groups, 8 patients did not come for follow-up due to
unknown reasons, 4 patients refused to give the blood
samples for biochemical analysis so were forbidden to
continue the study. 3 patients were dropped in the garlic
treated group with 1500 mg, who reported heart burn in
the first week of study and refused to take any further
treatment. During this study, every possible attempt has
been made to keep the number of patients as much as to
provide a valid statistical data.
Phil et al. 2925
110
112
114
116
118
120
122
124
126
128
130
132
Placebo G 300 mg G 600 mg G 900 mg G1200 m g G 1500 mg METFORMIN
week 0
week 12
week 24
Figure 1. Changes in mean FBS at different doses of Garlic in comparison with Placebo and
Metformin from week 0 to week 12 and week 24.
Figure 2. Percentage changes in FBS from week 0 to week 12 and from week 0 to
week 24. Gr A = Garlic 300 mg, Gr B = Garlic 600 mg, Gr C = Garlic 900 mg, Gr D =
Garlic 1200 mg, Gr E = Garlic 1500 mg, Gr F = Metformin, Gr G = Placebo. The (-) sign
denote decrease in perc entage.
The result in the present study showed significant
decrease in fasting blood sugar and HbA1C in both dose
dependent and duration dependent manner when
compared with placebo and standard antidiabetic agent
metformin. The fasting blood sugar (FBS) was reduced
from 127.4 ± 0.334 at baseline from week 0 to 126.0 ±
0.360 (p <0.05) at week 12 and to 124.8 ± 0.378 (p
<0.001) at week 24 in group. A patient who have been
given garlic at a dose of 300 mg daily. In group B, at a
dose of 600 mg the reduction in FBS was found to be
almost equivalent with that in group A with a decrease
from baseline value of 128.3 ± 0.311 at week 0 to 126.9 ±
0.369 (p <0.05) at week 12 and 125.7 ± 0.446 (p <0.001).
In group C, patients were given garlic at a dose of 900
mg and the FBS was found to be reduced from 128.4 ±
0.263 at the baseline from week 0 to 126.0 ± 0.274 (p
<0.001) at week 12 and 124.5 ± 0.289 at week 24 (p
<0.001). In group D, the dose of garlic given was 1200
mg/day. The reduction in FBS from baseline value of
128.2 ± 0.315 at week 0 to 125.3 ± 0.264 (p <0.001) at
week 12 and to 122.6 ± 0.263 (p <0.001) was found to be
highly significant when compared to group A and B at
week 12. Group E patients were given the highest dose
of garlic in the present study. The FBS decrease in this
group was highly significant from 128.7 ± 0.223 at week 0
125.8 ± 0.213 (p <0.001) and to 122.7 ± 0.225 at week 24
(p <0.001). Group F patients were given metformin at a
dose of 500 mg twice daily. In this group the FBS at week
0 was 125.1 ± 1.157, which was reduced to 119.5 ± 1.243
at week 12 (p <0.05) and to 118.0 ± 1.045 at week 24 (p
<0.001). In comparison significant increase change in the
FBS was observed in patients with placebo with the
mean increase of 4 mg/dl (P <0.005) Table 2, Figure 1
and 2. The HbA1C percentage was also found to be
improved in all the groups treated either by garlic or
metformin as compared to placebo. In group A, HbA1C at
2926 J. Med. Plant. Res.
week 0 was 6.585 ± 0.044. It was found to reduced to
6.256 ± 0.044 (p <0.001) at week 12 and to 6.019 ± 0.048
(p <0.001) at week 24. In group B, HbA1c was reduced
from 6.519 ± 0.055 at week 0 to 6.330 ± 0.064 at week 12
and 6.063 ± 0.054 (p <0.001) at week 24. This decrease
was statistically insignificant when compared from week 0
to week 12 but was found to be statistically significant
when compared from week to week 24. In group C
reduction in HbA1C was significant from baseline value of
6.596 ± 0.055 at week 0 to 6.307 ± 0.053 (p <0.05) at
week 12 and highly significant to 6.033 ± 0.054 (p
<0.001) at week 24. In group D, the HbA1C was reduced
from baseline value of 6.530 ± 0.056 to 6.256 ± 0.045 (p
<0.05) and 5.996 ± 0.052 (p <0.001) at week 12 and 24
respectively. Group E patients showed highest
improvement in HbA1C with a reduction from baseline
value of 6.726 ± 0.035 at week 0 to 6.332 ± 0.041 at
week 12 (p <0.001) and 5.974 ± 0.032 (p <0.001) at week
24. Metformin treated group F also showed similar
reduction like group E with a decrease in HBA1C value of
6.637 ± 0.044 at baseline to 6.259 ± 0.036 (p <0.001) at
week 12 and to 6.207 ± 0.042 (p <0.001) at week 24. In
comparison no significant change in HbA1C was
observed in patients who were given placebo.
DISCUSSION
The present study monitored effects of garlic in
comparison with placebo and a standard antidiabetic
agent ‘metformin’ on fasting blood sugar and HbA1c in
patients with type 2 diabetes mellitus with respect to its
ability to provoke a decrease in fasting blood sugar at
different doses and to find out the time taken for this
decrease. FBS and HbA1C were measured at week 0,
week 12 and week 24. The results observed in the
present study demonstrated significant decrease in
fasting blood glucose and improvement in serum HBA1C
when compared from week 0 to week 12 and week 24.
Garlic was found to be effective in improving the glycemic
control at all doses. Exceedingly significant changes
observed at the higher doses of 900, 1200 and 1500 mg
as compared to when garlic was administered at a dose
of 300 or 600 mg. The improvement in glycemic control
was found to be more when compared with placebo and
equivalent when compared with standard antidiabetic
agent metformin. Highly significant reduction in both
fasting blood sugar and HbA1C is observed at week 24 in
all the groups treated with garlic and metformin with
comparable efficacy as compared to placebo which
showed no significant change in FBS and HbA1C.
The present study is unique from previous clinical trials
as this is the first time that effects of garlic were observed
in a dose dependent and duration dependent manner in
patients with type 2 diabetes mellitus. The changes in
fasting blood sugar and HbA1C observed in the present
study are consistent with the observations from previous
preclinical and clinical trials. Many of the trials evaluating
the hypoglycemic effects of garlic were done in animal
models. Garlic was reported to be effective in reducing
blood glucose in streptozocin-induced as well as alloxan-
induced diabetic rats and mice (Mathew and Augusti,
1973; Swanston-Flatt et al., 1990; Kasuga et al., 1999;
Ohaeri, 2001). It was also reported that ingestion of garlic
juice and aqueous garlic extracts resulted in better
utilization of glucose in glucose tolerance test performed
in diabetic animal models (Jain and Vyas, 1973; Jain and
Vyas, 1975; Jalal et al., 2007). Two of the previous
studies reported that allicin, a sulfur containing amino
acid in garlic has a potential to reduce diabetic condition
in rat almost to the same extent as did glibenclamide and
insulin (Sheela and Augusti, 1992; Sheela et al., 1995).
Although many of the previous trials in animal models
showed significant effects of garlic on glycemic control,
hypoglycemic effect of garlic in human is not well studied.
All human studies (Kiesewetter et al., 1991; Jain et al.,
1993; Ali and Thomson, 1995; Bordia et al., 1998; Zhang
et al., 2001) apart from two (Afkhami-Ardekani et al.,
2006; Sobenin et al., 2008), has showed the effect of
garlic on blood glucose level in normal healthy individuals
but not in diabetic patients. The present study confirmed
the hypoglycemic effects of garlic observed in the two
previous clinical trials in patients with type 2 diabetes
mellitus. The effects of garlic tablets preparation used in
the present study were found to produce the similar
changes in the fasting blood glucose. In addition HbA1c
was also found to be significantly improved as compared
to baseline readings. The present study contradicts with a
previous clinical trial of Bordia et al., 1998, that evaluated
the effects of garlic on serum glucose and lipids in
patients with coronary artery disease and reported no
significant change in fasting and 2 h postprandial blood
glucose levels. The changes in FBS observed in the our
study are in accordance with the previous clinical trial by
Li et al., 2000 that reported the marked decrease in blood
sugar levels in cases with hyperglycemia.
The precise mechanism of garlic as antidiabetic agent
is not unambiguous but in-vivo, (Mathew and Augusti,
1973; Jain, 1973) as well as in vitro (Augusti and Sheela,
1996) studies showed that garlic acts as an insulin
secretagogue in diabetic rats. It has also been proposed
that antioxidant effect of S-allyl cysteine sulfoxide
(isolated product from garlic) may also contribute for its
beneficial effect in diabetes (Banerjee et al., 2003). Garlic
has been reported to spare insulin from sulphydryl group
which is known to inactivate insulin. Garlic allicin can
effectively combine with compounds like cysteine and
enhance serum insulin (Mathew and Augusti, 1973). It
has also been projected that garlic can act as an
antidiabetic agent by increasing either the pancreatic
secretion of insulin from the beta cells or its release from
bound insulin (Jain and Vyas, 1975). In addition to the
aforementioned proposed mechanisms garlic is also
known to prevent the long term complications of diabetes
by inhibiting the formation of advanced glycation end
products (AGEs). Advanced glycation end-products are
recognized contributors to the pathophysiology of aging
and diabetic chronic complications. People with diabetes
have higher levels of AGEs than nondiabetic subjects
because hyperglycemia and oxidative stress both
contribute to their accumulation (Huebschmann et al.,
2006). The formation of AGEs occurs at an accelerated
rate in patients with diabetes mellitus. AGEs are not only
markers but also important causative factors for the
pathogenesis of diabetes, cataracts, atherosclerosis, and
diabetic nephropathy (Gutiérrez et al., 2010). Compounds
having both antiglycation and antioxidant properties are
recommended therapeutic preference. It has been
suggested that aged garlic extract (AGE) inhibits both the
formation of AGEs and glycation-derived free radicals. A
key constituent of aged garlic, ‘S-Allylcysteine’, is an
effective antioxidant and can inhibit AGE formation
(Ahmad and Ahmed, 2006; Ahmad et al., 2007).
Organosulfur compounds derived from garlic, diallyl
sulfide, S-ethylcysteine, S-allylcysteine, and N-
acetylcysteine, are known to protect LDL against
oxidation and glycation and this might be a possible
mechanism how garlic protects against cardiovascular
disease (Ou et al., 2003). Although garlic is generally
considered safe herbal remedy and has been used for
many common ailments since ancient times, too much
utilization of garlic may cause problems most commonly
related to gastrointestinal tract like nausea and diarrhea.
Garlic breath and halitosis or bad body odour are also
one of the main garlic side effects reported especially
when fresh garlic is ingested. Infrequent allergic response
is also a known predictable adverse effect (Ackerman et
al., 2001). In the present study, garlic did not produce any
considerable problem in patients with type 2 diabetes
mellitus and only one patient has complained of gastric
discomfort, the possible reasons for this good tolerance is
most likely to the enteric coated, odourless garlic tablet
preparation used in this study.
Conclusion
Garlic was found to reduce fasting blood glucose and
HbA1C significantly as compared to metformin and
placebo and may be an effective addition in the family of
antidiabetic agents. Clinical trials using garlic in
combination with different antidiabetic agents are
warranted to further explore the benefits of garlic in
diabetics
ACKNOWLEDGMENT
Author(s) are thankful for the help of registered medical
practioners from different primary health centers in
Karachi, Pakistan for their help in conduction of study by
Phil et al. 2927
recruitment and follow-up of patients.
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... In a study, the patients with type 2 diabetes mellitus received garlic tablets at doses of 300, 600, 900, 1,200, and 1,500 mg per day, respectively, for 24 weeks. Based on results, a significant reduction in FBS and HbA1c was observed when compared with placebo (Khan, 2011;Mirunalini et al., 2011;Aslani et al., 2016). Treatment of diabetic patients with three small cloves of raw garlic (1 clove 1.2 g) daily in fasting condition for 30 days significantly reduced the blood glucose level, serum cholesterol, TG, and LDL while increased the HDL fraction. ...
... Treatment of diabetic patients with three small cloves of raw garlic (1 clove 1.2 g) daily in fasting condition for 30 days significantly reduced the blood glucose level, serum cholesterol, TG, and LDL while increased the HDL fraction. Furthermore, garlic significantly improved SOD, catalase (CAT) and glutathione peroxidase (GPx) in erythrocytes of diabetic patients compared to the control group (Khan, 2011;Mirunalini et al., 2011;Aslani et al., 2016). ...
... Treatment of hyperlipidemic patients (n 112) with garlic (20 g) daily with 1 tablespoon lemon juice significantly decreased the total cholesterol, LDL-cholesterol, and fibrinogen compared to the control groups (Khan, 2011;Mirunalini et al., 2011;Aslani et al., 2016). Aged garlic extract did not affect blood glucose but TG concentrations declined after 3 months of intervention. ...
Article
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Objective: Metabolic disorders (MD) can disturb intracellular metabolic processes. A metabolic disorder can be resulted from enzyme deficits or disturbances in function of various organs including the liver, kidneys, pancreas, cardiovascular system, and endocrine system. Some herbs were used traditionally for spices, food additives, dietary, and medicinal purposes. Medicinal plants possess biological active compounds that enhance human health. We aimed to provide evidence about therapeutic effects of some medicinal herbs on MD. Data Sources: PubMed, Scopus, and Google Scholar were explored for publications linked to MD until February 2021. The most literature reports that were published in the last 10 years were used. All types of studies such as animal studies, clinical trials, and in vitro studies were included. The keywords included “Metabolic disorders,” “ Nigella sativa L.,” “Thymoquinone,” “White tea”OR “ Camellia sinensis L.” “catechin,” and “ Allium sativum L.” OR “garlic” were searched. Results: Based on the results of scientific studies, the considered medicinal plants and their active components in this review have been able to exert the beneficial therapeutic effects on obesity, diabetes mellitus and non-alcoholic fatty liver disease. Conclusions: These effects are obvious by inhibition of lipid peroxidation, suppression of inflammatory reactions, adjustment of lipid profile, reduction of adipogenesis and regulation of blood glucose level.
... quercetin in vivo and in vitro models enhances glucose uptake by a MAPK insulin-dependent mechanism, increases phosphorylation of PI3K/Akt signalling pathways, interacts with PPARγ receptor, inhibits alpha-glucosidase and alpha-amylase activities [127,141,142] STZ-induced rats improves β-cells action [143] naringin fructose-fed rats improves insulin signalling [144] high-carbohydrate + high fat-fed rats improves mitochondrial dysfunction in the liver [145] high fat-fed rats reduces blood glucose and cholesterol levels by upregulation of PPARγ [146] in vitro (rat skeletal L6 myoblast cell line) upregulates of 5 AMPK in skeletal muscle cells [146] in vivo and in vitro models inhibits serum DPP-4 levels [129] db/db mice enhances hepatic glycolysis and glycogen concentration, reduces hepatic gluconeogenesis [129] rutin db/db mice reduces blood glucose level, modulates insulin secretion, inhibits AGEs formation, positively affects IRS-2/PI3K/Akt/GSK-3β signalling pathway [147] kaempferol diet-induced obese mice prevents hyperglycaemia development, suppresses hepatic gluconeogenesis by reducing pyruvate carboxylase activity [148] STZ-induced + high-fat diet rats improves insulin sensitivity by inhibiting pro-inflammatory cytokines, leading to reduced inflammatory responses and hepatic inflammatory lesions [149] PLANT FRUITS, VEGETABLES AND OTHER PRODUCTS garlic in vivo and in vitro models increases insulin secretion and sensitivity [150,151] obese patients with T2DM (open-label, prospective, comparative trial, n = 60) ...
... The antidiabetic active substances of garlic include allicin and hydrogen sulphide. Garlic supplementation promotes increased insulin secretion and sensitivity in animals [150,151]. On the contrary, studies demonstrating its hypoglycaemic impacts on humans are contradictory. The meta-analysis of Hou et al. [152] revealed a reduced postprandial blood glucose level in humans consuming garlic, while that of Emami et al. [151] revealed opposite findings. ...
... The meta-analysis of Hou et al. [152] revealed a reduced postprandial blood glucose level in humans consuming garlic, while that of Emami et al. [151] revealed opposite findings. The potential side effects of consuming garlic include allergic contact dermatitis, allergic conjunctivitis, rhinitis, bloating, headache, dizziness, and profuse sweating [150]. ...
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Type 2 diabetes mellitus (T2DM) is the most widespread form of diabetes, characterized by chronic hyperglycaemia, insulin resistance, and inefficient insulin secretion and action. Primary care in T2DM is pharmacological, using drugs of several groups that include insulin sensitisers (e.g., biguanides, thiazolidinediones), insulin secretagogues (e.g., sulphonylureas, meglinides), alpha-glucosidase inhibitors, and the newest incretin-based therapies and sodium–glucose co-transporter 2 inhibitors. However, their long-term application can cause many harmful side effects, emphasising the importance of the using natural therapeutic products. Natural health substances including non-flavonoid polyphenols (e.g., resveratrol, curcumin, tannins, and lignans), flavonoids (e.g., anthocyanins, epigallocatechin gallate, quercetin, naringin, rutin, and kaempferol), plant fruits, vegetables and other products (e.g., garlic, green tea, blackcurrant, rowanberry, bilberry, strawberry, cornelian cherry, olive oil, sesame oil, and carrot) may be a safer alternative to primary pharmacological therapy. They are recommended as food supplements to prevent and/or ameliorate T2DM-related complications. In the advanced stage of T2DM, the combination therapy of synthetic agents and natural compounds with synergistic interactions makes the treatment more efficient. In this review, both pharmaceutical drugs and selected natural products, as well as combination therapies, are characterized. Mechanisms of their action and possible negative side effects are also provided.
... A systematic meta-analysis highlighted the significance of garlic as it has beneficial effects on; improving serum levels of blood glucose in fast, glycosylated hemoglobin and consequences of cardiovascular diseases and diabetes. Their results showed that garlic can improve blood levels and lipid profile parameters in patients of diabetes and cardiovascular diseases [95][96][97]. ...
Research
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Diabetes is one of the serious metabolic disorders occurred due to the imbalance of glucose level because of damaged pancreatic β-cells and lower production of insulin in body. Type 1 diabetes mellitus (TD1) and Type 2 diabetes mellitus (TD2) are main types of diabetes. Major portion of the world is suffering from Type 2 diabetes mellitus. Drugs used for diabetes are insulin, biguanides, sulfonylurea and inhibitors for α-glucosidase. Traditional medicines are under trial to reduce diabetic complications with no/minimum side effects. Many antidiabetic plants are under potential research i.e., strawberry, jamun, mulberry, fenugreek, turmeric, black pepper, garlic, ginger, grapefruit, and cinnamon. All of these have antidiabetic potential. These plants have bioactive compounds present in minute amounts. These compounds act against inflammation, diabetes, bacteria, fungi, other microbial infections, and obesity. These plants have antioxidant potential as well. Through HPLC "High-performance liquid chromatography" screening, the compounds identified were caffeic acid, isoquercetin, kaempferol and other flavonoids. These compounds showed hypoglycemic activity. They are responsible for the increased uptake of glucose by the adipose and muscle tissues due to the activation of specific receptors i.e., PPARα "Peroxisome proliferator-activated receptors α" and PPARγ (Peroxisome proliferator-activated receptor γ). These activate the enzymes like glutathione, glutathione-S-transferase and catalase. Glutathione peroxidase inhibit the α-amylase then α-glucosidase lower glucose level. Effect of phytochemicals present in antidiabetic plants were studied in vitro and in vivo in animal models by inducing diabetes in them by streptozotocin, alloxan and diet on diabetic patients. Types of phytochemical compounds and their composition vary due to environmental factors, extraction and separation techniques which can have effect on clinical analysis. Bioavailability of oral drugs was also studied synergistically with these plants. Synthetic drugs, if are used with these natural compounds, they have no harmful effect but increase effectiveness. These herbal medications are more preferable, safe to use and cost effective due to which it is easily affordable by people. This review report covers the impact of these plants on diabetes mellitus reported so far.
... In general, out of 213 plants censored, approximately 8.92% (n 19) have been validated by clinical evidence. These are Allium cepa (Jafarpour-Sadegh et al., 2017), Allium sativum (Ashraf et al., 2011), Balanites aegyptiaca (Rashad et al., 2017), Citrus aurantium (Campbell-Tofte et al., 2011), Elaeis guineensis (Kalman et al., 2013), Laurus nobilis (Khan et al., 2009), Momordica charantia , Morinda cordifolia (Algenstaedt et al., 2018), Moringa oleifera (Leone et al., 2018), Rauvolfia-Citrus (Campbell-Tofte et al., 2011), Salvia officinalis , Terminalia chebula (Pingali et al., 2020), Trigonella foenum-graecum (Hadi et al., 2020); Urtica dioica , Vernonia amygdalina (Okolie et al., 2008), Zea mays (Sands et al., 2009), and Zingiber officinale (Shidfar et al., 2015). ...
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Several studies have been conducted and published on medicinal plants used to manage Diabetes Mellitus worldwide. It is of great interest to review available studies from a country or a region to resort to similarities/discrepancies and data quality. Here, we examined data related to ethnopharmacology and bioactivity of antidiabetic plants used in the Democratic Republic of Congo. Data were extracted from Google Scholar, Medline/PubMed, Scopus, ScienceDirect, the Wiley Online Library, Web of Science, and other documents focusing on ethnopharmacology, pharmacology, and phytochemistry antidiabetic plants used in the Democratic Republic of Congo from 2005 to September 2021. The Kew Botanic Royal Garden and Plants of the World Online web databases were consulted to verify the taxonomic information. CAMARADES checklist was used to assess the quality of animal studies and Jadad scores for clinical trials. In total, 213 plant species belonging to 72 botanical families were reported. Only one plant, Droogmansia munamensis, is typically native to the DRC flora; 117 species are growing in the DRC and neighboring countries; 31 species are either introduced from other regions, and 64 are not specified. Alongside the treatment of Diabetes, about 78.13% of plants have multiple therapeutic uses, depending on the study sites. Experimental studies explored the antidiabetic activity of 133 plants, mainly in mice, rats, guinea pigs, and rabbits. Several chemical classes of antidiabetic compounds isolated from 67 plant species have been documented. Rare phase II clinical trials have been conducted. Critical issues included poor quality methodological protocols, author name incorrectly written (16.16%) or absent (14.25%) or confused with a synonym (4.69%), family name revised (17.26%) or missing (1.10%), voucher number not available 336(92.05%), ecological information not reported (49.59%). Most plant species have been identified and authenticated (89.32%). Hundreds of plants are used to treat Diabetes by traditional healers in DRC. However, most plants are not exclusively native to the local flora and have multiple therapeutic uses. The analysis showed the scarcity or absence of high-quality, in-depth pharmacological studies. There is a need to conduct further studies of locally specific species to fill the gap before their introduction into the national pharmacopeia.
... A systematic meta-analysis highlighted the significance of garlic as it has beneficial effects on; improving serum levels of blood glucose in fast, glycosylated hemoglobin and consequences of cardiovascular diseases and diabetes. Their results showed that garlic can improve blood levels and lipid profile parameters in patients of diabetes and cardiovascular diseases [95][96][97]. ...
Article
Full-text available
Diabetes is one of the serious metabolic disorders occurred due to the imbalance of glucose level because of damaged pancreatic β-cells and lower production of insulin in body. Type 1 Diabetes Mellitus (TD1) and Type 2 Diabetes Mellitus (TD2) are main types of diabetes. Major portion of the world is suffering from Type 2 diabetes mellitus. Drugs used for diabetes are insulin, biguanides, sulfonylurea and inhibitors for a-glucosidase. Traditional medicines are under trial to reduce diabetic complications with no/minimum side effects. Many antidiabetic plants are under potential research i.e. strawberry, jamun, mulberry, fenugreek, turmeric, black pepper, garlic, ginger, grapefruit, and cinnamon. All of these have antidiabetic potential. These plants have bioactive compounds present in minute amounts. These compounds act against inflammation, diabetes, bacteria, fungi, other microbial infections, and obesity. These plants have antioxidant potential as well. Through HPLC “High- Performance Liquid Chromatography” screening, the compounds identified were caffeic acid, isoquercetin, kaempferol and other flavonoids. These compounds showed hypoglycemic activity. They are responsible for the increased uptake of glucose by the adipose and muscle tissues due to the activation of specific receptors i.e. PPARa “Peroxisome Proliferatoractivated Receptors a” and PPARγ (Peroxisome Proliferator-Activated Receptor γ). These activate the enzymes like glutathione, glutathione-S-transferase and catalase. Glutathione peroxidase inhibits the a-amylase then a-glucosidase lower glucose level. Effect of phytochemicals present in antidiabetic plants were studied in vitro and in vivo in animal models by inducing diabetes in them by streptozotocin, alloxan and diet on diabetic patients. Types of phytochemical compounds and their composition vary due to environmental factors, extraction and separation techniques which can have effect on clinical analysis. Bioavailability of oral drugs was also studied synergistically with these plants. Synthetic drugs, if are used with these natural compounds, they have no harmful effect but increase effectiveness. These herbal medications are more preferable, safe to use and cost effective due to which it is easily affordable by people. This review report covers the impact of these plants on diabetes mellitus reported so far.
... ↓FBS and HbA1c [111] F8 Kyolic aged garlic extract 48 Extract (3g/day) 3 months ...
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Background relevance: A plethora of literature is available regarding the clinical trials for natural products however; no information is available for critical assessments of the quality of these clinical trials. Aim of study: This is a first time report to critically evaluate the efficacy, safety and large scale applications of up-to-date clinical trials for diabetes, based on the three scales of Jadad, Delphi, and Cochrane. Methodology: An in-depth and extensive literature review was performed using various databases, journals, and books. The keywords searched included, "clinical trials," "clinical trial in diabetes," "diabetes," "natural products in diabetes," "ethnopharmacological relevance of natural products in diabetes," etc. Results: Based on eligibility criteria, 16 plants with 74 clinical trials were found and evaluated. Major drawbacks observed were; "non-randomization and blindness of the studies," "non-blindness of patients/healthcare/outcome assessors," "lack of patient compliance and co-intervention reports," "missing information regarding drop-out/withdrawal procedures," and "inappropriate baseline characteristics." Principal component analysis and Pearson correlation revealed four components with %variability; PC1: 23.12, PC2: 15.83, PC3: 13.11, and PC4: 11.38 (P ≤ .000). According to descriptive statistics, "non-blinding of outcome assessors" was the major drawback (82%) whereas, "not mentioning the timing of outcome assessment" was observed lowest (6.8%). An in-house quality grading (scale 0-24) classified these clinical trials as; poor (67.6%), acceptable (19.9%), and good quality trials (13.5%). Conclusion: Proper measures in terms of more strict regulations with pharmacovigilance of plants are utmost needed in order to achieve quality compliance of clinical trials.
... No serious adverse events were reported from the use of garlic and prescription medicines in these studies. Garlic was also found to significantly reduce the level of fasting blood glucose in T2DM patients in several randomized control trials of patients treated with garlic and anti-diabetic drugs compared to control groups [18][19][20][21]. In these studies, significant improvements in total blood cholesterol, high density lipoprotein and low-density lipoprotein were also obtained after garlic administration. ...
Article
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Background: The simultaneous or intermittent use of alternative treatments and prescription medications for hypertension and type 2 diabetes mellitus can have adverse health effects. Objectives: To identify beliefs and practices associated with the use of alternative treatments for hypertension and type 2 diabetes mellitus among patients. Methods: A mixed-methods study including an investigator-administered survey and focus group discussion sessions using convenience sampling was conducted among patients aged ≥18 years during May to August 2018. Descriptive statistics were used to describe and compare demographic characteristics among groups of survey participants using JMP Pro 14.0. Thematic analysis was conducted to analyze the qualitative data using NVivo. Results: Most study participants (87-90%) were on prescription medication for their condition. Of survey participants, 69% reported taking their medication as prescribed and 70% felt that prescription medicine was controlling their condition. Almost all participants (98%) reported using alternative treatments, mainly herbal medications, and 73-80% felt that herbal medicines controlled their conditions. One-third believed that herbal medicines are the most effective form of treatment and should always be used instead of prescription medication. However, most participants (85%) did not believe that prescription and herbal treatments should be used simultaneously. Most (76-90%) did not discuss herbal treatments with their healthcare providers. Four themes emerged from the focus group sessions: 1) Simultaneous use of herbal and prescription medicine was perceived to be harmful, 2) Patients did not divulge their use of herbal medicine to healthcare providers, 3) Alternative medicines were perceived to be highly effective, and 4) Religiosity and family elders played key roles in herbal use. Conclusions: This study provides useful insights into perceptions and use of alternative treatments by patients that can be used by healthcare providers in developing appropriate interventions to encourage proper use of prescription medicines and alternative medicines resulting in improved management of these chronic diseases.
... Among the herbal products, garlic is know from ancient times (Matsutomo, 2020). For centuries, it has been an essential part of Diet among the Pakistani population (Ashraf et al., 2011). Worldwide, Asia is contributing to the production of 80% of total garlic (Miraj and Ali, 2014). ...
Article
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The association between diet, age, gender, socioeconomic status, ethnicity and hypertension are well recognized among developing countries. However, the main factors causing hypertension in Pakistan are still not clear. Hypertension is complex and multi factorial. The current article summarizes some of the known factors responsible for hypertension within populated cities of Pakistan. This review was focused on ethnic group of people living within country. Random or multistage screening, socioeconomic status or hypertensive condition was considered during selection of subjects. The dietary patterns in relation with hypertension and other health problems were studied. Studies showed a prominent occurrence among urban adults, particularly women. The Diet transition towards the DASH Diet has been attributed to lower blood pressures. This review highlights the fact that dietary pattern, socioeconomic status, gender, age and obesity is associated with hypertension.
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Original Article Abstract Background and Purpose: Resistance exercise can reduce inflammation. On the other hand, garlic sup-plementation may have beneficial effects in combination with resistance training due to its wide-ranging effects, including its effect on inflammation. Therefore, this study aimed to investigate the effect of eight weeks' progressive resistance training with garlic supplementation on serum hs-Crp levels and insulin resistance in overweight young women. Materials and Methods: Forty-eight healthy age range: 20 to 40 years, randomly divided into four groups: resistance training + supplement (age=31.3 ± 3.1y, BMI=28.2 ± 2.7kg/m2), resistance training + placebo (age=30.7 ± 3.8y, BMI=26.4 ± 2.4 kg/m2), Garlic supplement (age=27.9 ± 2.5y, BMI=26.7 ± 3.9 kg/m2) and control (age=29.7 ± 3.8y, BMI=28.8 ± 3.3 kg/m2). Before and after eight weeks of training period, anthropometric data, one repetition maximum (1-RM), C-reactive protein (CRP), insulin and glucose were measured and insulin resistance (IR) was calculated. The subjects of the training group performed a progressive resistance training program for eight weeks, three sessions per week, including three sets with 10 repetitions maximum and one minute rest between sets and movements. Subjects in the supplement and placebo groups took two 500mg tablets of garlic or placebo daily in the morning and at night with a meal. Changes in the results before and after the in four research groups were examined using one-way analysis of variance. If statistical analysis were significant, the Bonferoni posthoc test was used for finding the place of differences. Results: Significant decrease in serum CRP levels, insulin resistance and glucose was observed in the training + supplement group compared to other groups (P < 0.05). In contrast, insulin levels did not show significant changes in all groups (P > 0.05). Regarding body composition analysis, the results were accompanied by a significant decrease in fat mass and a significant increase in lean body mass, especially in the training + garlic group (P < 0.05). Conclusion: Although hs-CRP data and insulin resistance index of the present subjects were in the normal range and seemed safe, but in general, according to the results of the present study, it seems that the progressive resistance training program with garlic supplementation had double effects on CRP as important inflammatory index and insulin resistance in overweight women compared to either alone. How to cite this article: Mohammadi Sarableh N, Tahmasebi W, Azizi M, Abdullahzad H. The effect of eight weeks of progressive resistance training with garlic supplementation on serum levels of C-re-active protein and insulin resistance in overweight women. Journal of Sport and Exercise Physiology. 2022;15(3):46-56.
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In this study the hypoglycaemic, hypocholesterolaemic and hypotriglyceridaemic effects of garlic were studied in streptozotocin (STZ)-induced diabetic rats. Compared to normal (non-diabetic) rats, STZ-induced diabetic rats had approximately 200% higher serum glucose, 50% higher serum cholesterol and 30% higher serum triglyceride levels as well as 86% higher urinary protein levels. Daily treatment of STZ-induced diabetic rats with an extract of raw garlic (500mg/kg intraperitoneally) for seven weeks significantly lowered serum glucose, cholesterol and triglyceride levels. Compared to control diabetic rats, garlic-treated rats had 57% less serum glucose, 40% lower serum cholesterol levels and 35% lower triglyceride. In addition, urinary protein levels in garlic-treated diabetic animals were 50% lower compared to the diabetic controls. In contrast, the increased urine output and water intake of diabetic rats were not affected by garlic treatment. These results indicate that raw garlic possesses a beneficial potential in reversing proteinuria in addition to reducing blood sugar, cholesterol and triglycerides in diabetic rats. Therefore, garlic could be of great value in managing the effects and complications of diabetes in affected individuals.
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Context Recent reports show that obesity and diabetes have increased in the United States in the past decade.Objective To estimate the prevalence of obesity, diabetes, and use of weight control strategies among US adults in 2000.Design, Setting, and Participants The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in all states in 2000, with 184 450 adults aged 18 years or older.Main Outcome Measures Body mass index (BMI), calculated from self-reported weight and height; self-reported diabetes; prevalence of weight loss or maintenance attempts; and weight control strategies used.Results In 2000, the prevalence of obesity (BMI ≥30 kg/m2) was 19.8%, the prevalence of diabetes was 7.3%, and the prevalence of both combined was 2.9%. Mississippi had the highest rates of obesity (24.3%) and of diabetes (8.8%); Colorado had the lowest rate of obesity (13.8%); and Alaska had the lowest rate of diabetes (4.4%). Twenty-seven percent of US adults did not engage in any physical activity, and another 28.2% were not regularly active. Only 24.4% of US adults consumed fruits and vegetables 5 or more times daily. Among obese participants who had had a routine checkup during the past year, 42.8% had been advised by a health care professional to lose weight. Among participants trying to lose or maintain weight, 17.5% were following recommendations to eat fewer calories and increase physical activity to more than 150 min/wk.Conclusions The prevalence of obesity and diabetes continues to increase among US adults. Interventions are needed to improve physical activity and diet in communities nationwide.
Article
Background: Commercially available garlic preparations in the form of garlic oil, garlic powder and pills are widely used for certain therapeutic purposes, including lowering blood pressure and improving lipid profile. Despite the impressive effects of garlic most studies are limited by lack of controlled methods and suitable double-blinding, and by the use of preparations with unknown amounts and chemical identification of the active ingredient. Allicin, a synthetic preparation of an active constituent of garlic, was found to lower blood pressure, insulin, and triglycerides levels in fructose-fed rats. Thus, it was considered important to assess its effect on the weight of the animals.
Article
C omplementary and alternative medicine (CAM) refers to a wide range of clinical therapies outside of conventional medicine.1 The term “complementary” refers to therapies that are used in conjunction with conventional medicine, whereas “alternative” medicine includes therapies that are used in place of conventional medicine. The term “integrative” medicine has been advocated by some CAM providers and researchers as representing a combination of conventional medicine, CAM, and evidence-based medicine.2 The National Center for Complementary and Alternative Medicine, a federal scientific agency for CAM research, categorizes CAM into five domains: biologically based practices, mind-body medicine, manipulation and body-based practices, energy medicine, and whole-medical systems (Table 1). Biologically based practices and mind-body medicine are the most common CAM modalities used and studied for the treatment of diabetes in the West and are the focus of this review. In the United States, CAM is frequently used by adults, with 40% reporting use in the past 12 months.3 An estimated 34% of adults with diabetes use some type of CAM therapy.4 The estimated out-of-pocket expense in 2007 on CAM therapies was $44 billion.5 Although some CAM therapies have been shown to affect glycemic control, the clinical efficacy and mechanism of many CAM therapies for diabetes is controversial, and safety issues are a concern. Adverse effects of many CAM therapies are not well documented. Because patients with diabetes often take multiple prescription medications, there exists the potential for herb-drug and herb-dietary supplement interactions, leading to adverse events.6,7 At least 63% of the general population do not disclose use of CAM therapies to their physicians.8 The purpose of this clinical review is to discuss selected CAM therapies frequently used for patients with diabetes and to provide a framework to advise patients on CAM use. INBRIEF More than …
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Non-enzymatic glycation and the accumulation of advanced glycation end products (AGEs) are associated with various diseases states, including complications of diabetes and aging. Hydroalcoholic extracts of several kinds of spices (16) and chilies (21) of culinary used in traditional Mexican cuisine were tested for in vitro inhibition of non-enzymatic glycation of bovine serum albumin. Of these, plants Piper auritum, Origanum majorana, Crotolaria longirostrata, Bixa orellana, Satureja macrostema , Allium ascalonicum, and Curcuma longa exhibited significant inhibitory activity against AGEs formation with IC 50 values ranging from 23.1 to 188.8 µg/ml. The most active P. auritum displaying an IC 50 value of 23.07 µg/ml, was more effective than aminoguanidine, (IC 50 = 27.1 µg/ml) a know inhibitor of glycation. O. majorana with IC 50 value of 38.16 µg/ml was the second most active extract followed by C. longirostrata IC 50 being 77.24 µg/ml, B. orellana with an IC 50 of 94.32 µg/ml, S. macrostema (IC 50 = 106.1 µg/ml) , A. ascalonicum (IC 50 = 111.77 µg/ml), and C. longa, (IC 50 of 188.77 µg/ml). INTRODUCTION Nonenzymatic protein glycation by reducing sugars such as glucose, fructose or ribose is a complicated cascade of condensations, rearrangements, fragmentations, and oxidative modifications that lead to a training of compounds collectively called advanced glycation end products (AGEs). The reaction is initiated by the reversible formation of a Schiff base which undergoes a rearrangement to form a relatively stable Amadori product. The Amadori product will further undergo a series of reactions through dicarbonyl intermediates to form AGEs. It is also known that AGEs are formed by sequential glycation and oxidation reactions termed glycoxidation. The accumulation of the reaction products of protein glycation in living organisms leads to structural and functional modifications of tissue proteins (Takeuchi, et al., 2004).
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Diabetes mellitus is a debilitating and often life-threatening disease with increasing incidence in rural populations throughout the world. A scientific investigation of traditional herbal remedies for diabetes may provide valuable leads for the development of alternative drugs and therapeutic strategies. Alternatives are clearly needed because of the inability of current therapies to control all of the pathological aspects of diabetes, and the high cost and poor availability of current therapies for many rural populations, particularly in developing countries. This review provides information on more than 1200 species of plants reported to have been used to treat diabetes and/or investigated for antidiabetic activity, with a detailed review of representative plants and some of great diversity of plant constituents with hypoglycemic activity, their mechanisms of action, methods for the bioassay of hypoglycemic agents, potential toxicity problems, and promising directions for future research on antidiabetic plants. The objective of this work is to provide a starting point for programs leading to the development of indigenous botanical resources as inexpensive sources for standardized crude or purified antidiabetic drugs, and for the discovery of lead compounds for novel hypoglycemic drug development.