३. लोकवैद्यकशास्त्र आणि आधुनिक जगातील त्यांची व्याप्ती
लोकवैद्यकशास्त्र ही मानवी आरोग्याबद्दल जागरूक असलेल्या स्थानिक लोकांद्वारे पाळली जाणारी एक पारंपरिक आरोग्यसेवा पद्धत आहे.
आयुर्वेद, सिद्ध, युनानी, निसर्गोपचार यांसारख्या इतर सर्व पारंपरिक वैद्यकीय प्रणाली तसेच आधुनिक वैद्यकशास्त्राचा उगम यातच आहे [२७].
उपचारात्मक गुणधर्म असलेल्या वनस्पतींचे ज्ञान शेकडो वर्षांहून अधिक काळापासून, प्रयोग आणि चुकांमधून एका पिढीकडून दुसऱ्या पिढीकडे हस्तांतरित केले गेले आहे.
अनेक विकसनशील देशांमधील ग्रामीण आणि स्थानिक समुदायांमध्ये लोकवैद्यकशास्त्र मोठ्या प्रमाणावर प्रचलित आहे [२८].
जागतिक आरोग्य संघटनेकडून मिळालेल्या माहितीनुसार, जागतिक लोकसंख्येच्या सुमारे ८०% लोक पारंपरिक उपचारांवर अवलंबून आहेत [२९].
औषधी वनस्पतींना नेहमीच पारंपरिक आणि पारंपारिक अशा दोन्ही प्रकारच्या औषधांसाठी कच्च्या मालाचा एक प्रमुख स्रोत म्हणून ओळखले गेले आहे [३०].
भारतात, गरीब आणि ग्रामीण रहिवासी नैसर्गिक वनौषधींवर अवलंबून आहेत कारण त्या त्यांना सहज उपलब्ध होतात. खरंच, दुर्गम भागात राहणाऱ्या लोकांसाठी वनस्पती-आधारित औषधे हा वैद्यकीय व्यवस्थापनाचा एकमेव स्रोत आहे.
Russia,आफ्रिका आणि काही युरोपीय देशांसारख्या देशांमध्ये, विविध वनस्पतिशास्त्रज्ञ, मानववंशशास्त्रज्ञ, लोकसाहित्यिक आणि वैद्यकीय शास्त्रज्ञांद्वारे लोकऔषधांचा अभ्यास केला जात आहे [27].
लोकांना पुरेशी आरोग्यसेवा मिळवण्याची असमर्थता, आर्थिक निर्बंधांसोबतच, यामुळे अविकसित देशांतील बहुसंख्य लोकांसाठी आधुनिक आरोग्यसेवेची अपुरी तरतूद झाली आहे. [31].
अनेक लोकउपचार विविध रोगांवर (जसे की पचनसंस्थेचे विकार, त्वचेचे रोग, मूत्रपिंड आणि यकृताचे रोग, मलेरिया, अल्सर, हृदयरोग, न्यूमोनिया, मधुमेह आणि इतर अनेक) उपचार करण्यासाठी प्रभावी असल्याचे नोंदवले गेले आहे, आणि म्हणूनच, विकसित देशांनी देखील या औषधांचा वापर करण्याचा विचार केला आहे [32].
संदर्भ मॉलिक्युल्स. 2022 जुलै 3; 27 (13): 4278. doi: 10.3390/molecules27134278
पारंपरिक मधुमेह-विरोधी वनस्पतींमधून विलग केलेले औषधी दृष्ट्या सक्रिय फायटोमॉलिक्यूल्स आणि मधुमेह व्यवस्थापनातील त्यांची उपचारात्मक भूमिका
प्रवेज अन्सारी १,२,*, सामिया अख्तर १, जे एम ए हन्नान १, व्हेरॉनिक सीडेल ३, नुसरत जहान नुजात १, यासर एच ए अब्देल-वहाब २
Ref
Molecules. 2022 Jul 3;27(13):4278. doi: 10.3390/molecules27134278
Pharmacologically Active Phytomolecules Isolated from Traditional Antidiabetic Plants and Their Therapeutic Role for the Management of Diabetes Mellitus
Prawej Ansari 1,2,*, Samia Akther 1, J M A Hannan 1, Veronique Seidel 3, Nusrat Jahan Nujat 1, Yasser H A Abdel-Wahab 2
Editors: Rudolf Bauer, Jelena S Katanic Stankovic
संपादक: रुडॉल्फ बाऊर, जेलेना एस कटानिक स्टँकोविक
Ref
Molecules. 2022 Jul 3;27(13):4278. doi: 10.3390/molecules27134278
Pharmacologically Active Phytomolecules Isolated from Traditional Antidiabetic Plants and Their Therapeutic Role for the Management of Diabetes Mellitus
Prawej Ansari 1,2,*, Samia Akther 1, J M A Hannan 1, Veronique Seidel 3, Nusrat Jahan Nujat 1, Yasser H A Abdel-Wahab 2
Editors: Rudolf Bauer, Jelena S Katanic Stankovic
6. Phytochemicals and Their Impact on Diabetes
Plants are the primary source of biologically active compounds that may ultimately lead to the discovery and development of potential new drugs [238].
Plants produce both primary and secondary metabolites. Carbohydrates, proteins, and lipids are considered primary metabolites, necessary for the growth and development of plants and involved in essential metabolic pathways,
such as photosynthesis and glycolysis. Secondary metabolites are not required for the growth and development of plants; rather, they are responsible for interactions between plant species and the environment and have highly specific functions in plants [239].
Over 13,000 secondary metabolites have been purified and isolated from medicinal plants.
These phytochemicals can be categorized into various chemical classes such as alkaloids, flavonoids, terpenoids, phenolics, tannins, saponins, xanthones, and glycosides [78].
Many of these phytochemicals are known to exhibit medicinal properties, including antidiabetic activity [78].
Several phytochemicals isolated from various plant species have been scientifically validated for their contribution to treating and managing diabetes by exerting antihyperglycemic activity and reducing the complications associated with diabetes [171].
For example, the flavonoid rutin, present in the leaves of numerous plants, including Annona squamosa and Azadirachta indica (neem), has been reported to possess many beneficial effects such as anti-inflammatory, anti-cancer, anti-allergic, antiviral, and antioxidative properties [240].
Rutin-containing plants have also been shown to protect against heart disease, hepatotoxicity, and diabetes mellitus [240].
Rutin exerts its antidiabetic effect by lowering plasma glucose, improving the function of pancreatic β-cells, and enhancing glucose tolerance [10].
Two other flavonoids found in the leaves of Annona squamosa, namely quercetin and isoquercetin, have also been reported to possess antihyperglycemic activity by inhibiting α-glucosidase and lowering blood glucose levels [241].
Alongside rutin and quercetin, the tetranortriterpenoid meliacinolin, isolated from the leaves of A. indica, has been found to inhibit α-glucosidase and α-amylase in Type 2 diabetic mice [98].
Nimbidin, extracted from neem seeds, is another phytochemical exhibiting hypoglycemic properties [98].
Quercetin, allicin, allyl-propyl disulfide, cysteine sulfoxide, and S-allyl cysteine sulfoxide from Allium sativum (garlic) have been reported to stimulate insulin secretion from pancreatic β-cells, increase insulin sensitivity to target cells, and prevent insulin activation triggered by the liver [71].
Alliin, from garlic, has been reported to mimic the function of glibenclamide and insulin [71].
Epigallocatechin-3-gallate, epigallocatechin, epicatechin-3-gallate, and epicatechin present in Camellia sinensis (tea) leaves can also lower plasma glucose levels by improving β-cell function, increasing insulin secretion, and enhancing glucose metabolism [117].
These phytomolecules may exert their antidiabetic activity in multiple manners, most commonly by being insulinotropic, insulin-mimetic, and by improving β-cell function, increasing insulin sensitivity, improving glucose tolerance and metabolism, as well as inhibiting various enzyme activities. A summary of antidiabetic medicinal plants and their phytochemicals with potential antidiabetic effects is provided in Table 2. The chemical structures of the antidiabetic phytoconstituents of medicinal plants are given in Table 3.
Ref
Molecules. 2022 Jul 3;27(13):4278. doi: 10.3390/molecules27134278
Pharmacologically Active Phytomolecules Isolated from Traditional Antidiabetic Plants and Their Therapeutic Role for the Management of Diabetes Mellitus
Prawej Ansari 1,2,*, Samia Akther 1, J M A Hannan 1, Veronique Seidel 3, Nusrat Jahan Nujat 1, Yasser H A Abdel-Wahab 2
Editors: Rudolf Bauer, Jelena S Katanic Stankovic
4. Plant-Based Medicine versus Synthetic Medicine
Many drugs that are currently available have been derived directly or indirectly from natural sources such as medicinal plants and animals [33,34].
Plant-derived natural products have played and continue to play a prominent role in drug discovery and development programs.
The increase in the number of herbal drug manufacturing companies, linked to the current increase in interest and demand for herbal medicines, can be largely expanded because of the toxicity and numerous adverse effects of allopathic medicines [35].
The convenience of accessibility, availability, inexpensiveness, and relatively low risks of side effects, have caused plant-based medicines to be an important alternative source of existing therapies, especially in rural and/or developing regions [33].
Plant-based medicines also provide a rich source of biologically active compounds that possess pharmacological activity with minimal undesirable effects [33].
Over the centuries, plant-based medicines have been widely used to treat the ailments of local communities of many developing countries that have easy access to these sources. Densely populated countries, such as China and India, have especially contributed to the advancement of sophisticated traditional medical systems such as acupuncture, ayurvedic medicine, and herbal medicine [36].
Many factors should be considered when selecting the appropriate medications for the management and treatment of diabetes. This includes efficacy, adverse effects, cost, and potential to contribute to weight gain, risks associated with hypoglycemia, comorbidities, and patient compliance. Even though oral antihyperglycemic agents can lower plasma glucose levels by improving insulin secretion or reducing insulin resistance,
they are associated with many other adverse effects.
Metformin, the mainstay of treatment in type 2 diabetes, has a high safety profile, yet it is still associated with mild side effects such as low risks of hypoglycemia and gastrointestinal tract disturbances (nausea, diarrhea, dyspepsia). Previous studies have shown that continuous use of metformin may result in vitamin B12 and folic acid deficiency in humans [37]. DPP-IV inhibitors such as sitagliptin, saxagliptin, and linagliptin, have been found to cause headaches, nasopharyngitis, and upper respiratory tract infections [38]. The most common adverse effect of sulphonylureas such as glimepiride and gliclazide is hypoglycemia.
These drugs are also associated with minor side effects such as weight gain, nausea, headaches, drowsiness, and hypersensitivity reactions. The most serious complication of insulin injections is hypoglycemia.
Insulin may also cause weight gain or loss, dizziness, confusion, and sweating [38].
In contrast to synthetic drugs, plant-based medicines do not interrupt the body’s natural healing process; instead, they accelerate the recovery process by strengthening the healing process, ultimately leading to a steady recovery.
Alongside their ability to help the body recover to a healthy status, herbal medicines are also known for boosting the immune system.
The use of highly effective herbal medicines showing fewer side effects and a strong immune system together with a healthy lifestyle promotes better body metabolism with increased nutritional absorption from the diet [35].
Whether they have insulinotropic, insulin-mimetic, or any other antihyperglycemic effects, medicinal plants are considered safer and more effective alternatives to synthetic antidiabetic drugs [39].
Ref
Molecules. 2022 Jul 3;27(13):4278. doi: 10.3390/molecules27134278
Pharmacologically Active Phytomolecules Isolated from Traditional Antidiabetic Plants and Their Therapeutic Role for the Management of Diabetes Mellitus
Prawej Ansari 1,2,*, Samia Akther 1, J M A Hannan 1, Veronique Seidel 3, Nusrat Jahan Nujat 1, Yasser H A Abdel-Wahab 2
Editors: Rudolf Bauer, Jelena S Katanic Stankovic
5. Pharmacological Activity of Plant-Based Medicines
Although knowledge of many plant-based therapies has been transmitted through generations, only a few of these have started to come to the fore recently.
However, there is still some uncertainty regarding their pharmacological activity as well as their acute/chronic side effects due to such medicines being broadly underreported [40].
Few plants have proven to be efficacious for which they were intended, whilst some were not strongly therapeutically effective and/or sufficient scientific data were lacking to support their expected effects [41].
The increase in the widespread use of plant-based therapies has led to an urgent need for a detailed scientific examination of the chemicals responsible for pharmacological activity. Indeed, such a study of the pharmacological properties and phytoconstituents of plant-based medicines may lead to the discovery of new pharmacological characteristics previously unknown or used in traditional medicine [42].
Herbal medicines have been suggested to exert their mechanism of action by concurrently targeting multiple physiological processes via interactions between different biochemicals and cellular proteins [43].
Herbal medications may be able to alter the biological systems from disease to a healthy state by causing the interactions between multi-component and multi-target. Because of the therapeutic properties of the phytomolecules, a lower dosage may be used, resulting in less toxicity and adverse effects. [43]
. The antidiabetic activity of medicinal plants is dependent upon the phytochemicals that act through multiple pathways, such as cAMP: which stimulates insulin secretion without affecting the KATP channel [44];
PI3K: which facilitates glucose uptake by the translocation of the glucose transporter in skeletal muscles, adipose tissue, or liver [45];
AMPK: The activation of 5ʹ-adenosine monophosphate-activated protein kinase pathway improves insulin sensitivity by limiting lipolysis and lipogenesis, and AMPK also enhances glucose uptake in skeletal muscles by translocating GLUT4-containing intracellular vesicles across the plasma membrane [46,47].
For example, phlorizin obtained from the bark of apple and pear trees increases glucose excretion in urine by decreasing glucose reabsorption in the kidneys via the inhibition of SGLT and thus, lowers plasma glucose concentration [48].
Some of the phytomolecules have the potential to regenerate and protect pancreatic beta cells from destruction by reducing the glucose load [49],
inhibiting α-amylase and α-glucosidase activity, inducing glucose uptake in 3T3L1 cells [50,51], inhibiting aldose reductase enzyme activity, glycogen metabolizing enzymes, exerting hepato-pancreatic protective activity, inhibiting glucose-6-phosphate and DPP-IV, reducing lactic dehydrogenase, γ-glutamyl transpeptidase, glycosylated hemoglobin levels, and inhibiting glycogenolysis and gluconeogenesis in the liver [20,52].
As an example, a summary of the different pathways involved in the antidiabetic activity of flavonoids is illustrated in Figure 1. A summary of antidiabetic medicinal plants and their pharmacological actions has been shown in Table 1. Continued
Fig
re 1.Figure 1
Flavonoids exerting antidiabetic activity via different mechanistic pathways: Flavonoids increase insulin secretion and improve β-cell function via the PI3K/AKT signaling pathway; increase GLUT-4 translocation through AMPK activation to increase glucose uptake in adipose tissues and skeletal muscles; activate PPAR-γ expression to decrease insulin resistance; activate cAMP/PKA pathway to reduce blood glucose levels and improve glucose tolerance; increase glutathione peroxidase activity to reduce HbA1c levels; decrease G-6-Pase, PEPCK, glycogen phosphorylase, fructose 1,6-biphosphatase and DPP-IV activity in liver to decrease gluconeogenesis, glycogenolysis, and glycoslysis; inhibit SGLT pathway in kidney to decrease renal glucose reabsorption; inhibit GLUT-2, α-amylase and α-glucosidase activity to decrease glucose absorption in the small intestine.
Flavonoids exerting antidiabetic activity via different mechanistic pathways: Flavonoids increase insulin secretion and improve β-cell function via the PI3K/AKT signaling pathway
3. Ethnomedicines and Their Scope in the Modern World
Ethnomedicine is a traditional health care practice followed by indigenous people concerned with human health.
It is the origin of all other traditional medical systems, including Ayurveda, Siddha, Unani, Nature Cure, as well as modern medicine [27].
Knowledge of plants presenting therapeutic properties has been passed on by experimenting through trials and errors from one generation to the next for more than hundreds of years.
Ethnomedicines are highly prevalent in the rural and native communities of several developing countries [28].
According to information collected from the World Health Organization, about 80% of the global population relies upon traditional remedies [29].
Medicinal plants have always been recognized as a major source of raw materials for both conventional and traditional medicines [30].
In India, the poor and rural residents are dependent upon natural herbal remedies since they are easily obtainable to them. Indeed, plant-based medicines are the sole source of medical management for people living in remote areas.
In countries such as Russia, Africa, and a few European countries, ethnomedicines are being studied by various botanists, anthropologists, folklorists, and medical scientists [27].
The inability for people to access adequate healthcare, alongside financial restrictions, has resulted in the under-provision of modern health care for a majority of the people in underdeveloped countries. [31].
Numerous folk remedies are recorded as being effective in treating various diseases (such as digestive tract disorders, skin diseases, renal and liver diseases, malaria, ulcers, heart diseases, pneumonia, diabetes, and many others), and thus, even developed countries have also considered utilizing these medicines [32
Ref Molecules. 2022 Jul 3;27(13):4278. doi: 10.3390/molecules27134278
Pharmacologically Active Phytomolecules Isolated from Traditional Antidiabetic Plants and Their Therapeutic Role for the Management of Diabetes Mellitus
Prawej Ansari 1,2,*, Samia Akther 1, J M A Hannan 1, Veronique Seidel 3, Nusrat Jahan Nujat 1, Yasser H A Abdel-Wahab 2
Editors: Rudolf Bauer, Jelena S Katanic Stankovic
Molecules. 2022 Jul 3;27(13):4278. doi: 10.3390/molecules27134278
Pharmacologically Active Phytomolecules Isolated from Traditional Antidiabetic Plants and Their Therapeutic Role for the Management of Diabetes Mellitus
Prawej Ansari 1,2,*, Samia Akther 1, J M A Hannan 1, Veronique Seidel 3, Nusrat Jahan Nujat 1, Yasser H A Abdel-Wahab 2
Editors: Rudolf Bauer, Jelena S Katanic Stankovic
Introduction
Diabetes mellitus is one of the most common endocrine metabolic disorders characterized by chronic hyperglycemia caused by varying degrees of insulin resistance,
deficiency in insulin secretion, or both [1].
Nearly 10.5% of the worldwide population is affected by diabetes, with its prevalence increasing at an alarming rate. According to data collected from the International Diabetes Federation (IDF), about 783.2 million people are estimated to be diagnosed with diabetes by 2045 [2].
Diabetes mellitus can be classified into two major categories: Type 1 and Type 2 diabetes, where Type 2 diabetes accounts for about 90% of all cases.
Type 1 diabetes, previously known as insulin-dependent diabetes, is an autoimmune disorder that occurs due to the destruction of the pancreatic beta cells leading to significantly reduced secretion of insulin [3].
It is a non-hereditary genetic condition that mainly affects the juvenile under thirty years of age.
Type 2 diabetes, also known as non-insulin-dependent diabetes, is the most common form of diabetes, with its prevalence rapidly rising worldwide [4].
It is a hereditary condition caused as a result of insulin resistance, insufficient insulin secretion, or a combination of both, largely affecting an older population than Type 1 diabetes [5].
Both forms of diabetes alter carbohydrate, protein, and fat metabolism.
The effect of insulin resistance leads to high blood sugar levels by hindering the uptake and efficient use of glucose by most cells of the body [6].
KeThe progression of the disease is accompanied by tissue or vascular damage resulting in severe complications,
including retinopathy, diabetic neuropathy, nephropathy, cardiovascular, pulmonary, cerebral, and peripheral vascular diseases, ulcers, and thyroid gland disorders, leading to serious morbidity and mortality [1,7,8,9].
Available therapies currently in use for the treatment and management of diabetes include insulin and several oral hypoglycemic agents such as metformin, sulfonylureas, α-glucosidase inhibitors, meglitinide analogues, thiazolidinediones, DPP-IV inhibitors, SGLT-2 inhibitors, and GLP-1 mimetics. However, these drugs, intended to boost insulin sensitivity and increase insulin secretion together with the reduction in circulatory plasma glucose levels by increasing glucose excretion or uptake in adipose tissue, are usually associated with many side effects.
These include, among others, weight gain, hypoglycemia, gastrointestinal tract disturbances, liver injury, renal failure, hypersensitivity reactions, flatulence, diarrhea, and abdominal bloating [1,10,11].
In addition, these drugs have been known to have other major disadvantages, including drug resistance, and there is also a lack of therapies to prevent the long-term complications of the disease.
The complications associated with insulin and oral antidiabetic agents, together with limited drug tolerability, adverse effects, and cost, have accelerated the search for alternative medicines with better efficacy, potency, and fewer side effects [12].
Interestingly, there has been an increase in popularity surrounding drug discovery research into natural antidiabetic agents, especially those derived from medicinal plants, which could enhance β-cell function and treat diabetes-associated complications with fewer adverse side effects [13].
Herbal medicines contain a diversity of phytochemicals and have been traditionally used for treating a wide variety of diseases.
They are considered to be naturally safe and efficacious with fewer side effects [12].
The control and management of diabetes using herbal drugs have proven to be more advantageous over synthetic medicines due to their accessibility, reduced cost, lesser complications, and lower side effects. Herbal medicines act via different mechanisms aiming at reducing insulin resistance, increasing insulin secretion, protecting pancreatic beta cells, and thereby lowering circulating blood glucose levels [14].
Throughout the years, thousands of plant species have been used for their medicinal uses as integrative medicines for various diseases, of which more than 800 plants have been reported to exhibit antidiabetic effects [15].
Such plants have been examined for their use in the treatment of the different types of diabetes and could be potential sources for new natural antidiabetic drug discovery research [16].
A number of medicinal plants used traditionally for their antidiabetic activity are currently under investigation to be formulated commercially as modern drugs.
This is particularly the case in developing countries where the cost of allopathic medicine is high, and the traditional use of plants to treat diabetes is common practice [15].
Traditional natural medicines are extensively prescribed in Asian countries (e.g., China, India, Bangladesh, Pakistan, Sri Lanka, Thailand, Nepal, Bhutan, Japan, and others) [17].
Among the medicinal plants possessing hypoglycemic effects, the most common ones used as remedies for diabetes include Acacia arabica, Aegle marmelos, Allium cepa, Allium sativum, Aloe vera, Annona squamosa, Azadirachta indica, Berberis vulgaris, Camellia sinensis, Capsicum frutescens, Cassia alata, Cinnamomum zeylanicum, Eucalyptus globulus, Eugenia jambolana, Helicteres isora, Momordica charantia, Panax ginseng, Punica granatum, Swertia chirayita, Trigonella foenum-graecum, and others [15,16,18,19].
The antidiabetic activity of these plants is thought to be mediated via various mechanisms, including the stimulation of insulin secretion from pancreatic β-cells, increasing insulin binding to receptors, reduction in insulin resistance, and improving glucose tolerance.
Other modes of action include enhancing glucose metabolism, improving β-cell mass and function, and increasing plasma insulin, thus decreasing circulating blood glucose levels [20,21,22,23].
In addition to being used to treat diabetes, these plants have also been traditionally employed to treat other conditions such as ulcers, wounds, inflammation, infections, diarrhea, dysentery, malaria, rheumatism, hypertension, obesity, pneumonia, and kidney diseases [12,19,24,25,26].
The main objective of this review is to explore the traditional plant-based therapies and/or their phytoconstituents available for the treatment of diabetes. These could provide the basis for the discovery of new antidiabetic drugs with fewer side effects and stronger efficacy than currently available medicines.
To be continued
Ref
Int J Mol Sci. 2023 May 22;24(10):9085. doi: 10.3390/ijms24109085
The Management of Diabetes Mellitus Using Medicinal Plants and Vitamins
Clement G Yedjou 1,*, Jameka Grigsby 2, Ariane Mbemi 3, Daryllynn Nelson 4, Bryan Mildort 5, Lekan Latinwo 1, Paul B Tchounwou 6,*
Editor: Malgorzata Zakłos-Szyda
Abstract
Diabetes mellitus (DM) is a serious chronic metabolic disease that is associated with hyperglycemia and several complications including cardiovascular disease and chronic kidney disease.
DM is caused by high levels of blood sugar in the body associated with the disruption of insulin metabolism and homeostasis.
Over time, DM can induce life-threatening health problems such as blindness, heart disease, kidney damage, and stroke. Although the cure of DM has improved over the past decades, its morbidity and mortality rates remain high. Hence, new therapeutic strategies are needed to overcome the burden of this disease.
One such prevention and treatment strategy that is easily accessible to diabetic patients at low cost is the use of medicinal plants, vitamins, and essential elements.
The research objective of this review article is to study DM and explore its treatment modalities based on medicinal plants and vitamins.
To achieve our objective, we searched scientific databases of ongoing trials in PubMed Central, Medline databases, and Google Scholar websites. We also searched databases on World Health Organization International Clinical Trials Registry Platform to collect relevant papers. Results of numerous scientific investigations revealed that phytochemicals present in medicinal plants (Allium sativum, Momordica charantia, Hibiscus sabdariffa L., and Zingiber officinale) possess anti-hypoglycemic activities and show promise for the prevention and/or control of DM. Results also revealed that
intake of vitamins C, D, E, or their combination improves the health of diabetes patients by reducing blood glucose, inflammation, lipid peroxidation, and blood pressure levels. However, very limited studies have addressed the health benefits of medicinal plants and vitamins as chemo-therapeutic/preventive agents for the management of DM. This review paper aims at addressing this knowledge gap by studying DM and highlighting the biomedical significance of the most potent medicinal plants and vitamins with hypoglycemic properties that show a great potential to prevent and/or treat DM.
3.2. Vitamins and Their Anti-Diabetic Properties
Vitamins exert important effects on the risk of DM as well as its progression and complications. The intake of Vitamins C, D, E, or a combination of them all has been associated with decreased risk of diabetes in the general population. For example, Vitamins C, D, or E has been hypothesized to exhibit anti-diabetic properties by regulating insulin secretion or insulin sensitivity, producing anti-inflammatory, immunomodulatory, antioxidant, hypolipidemic, and hypoglycemic effects [69,70,71].
3.2.1. Vitamin D and Its Application to Diabetes Mellitus
Vitamin D (calciferol) is a fat-soluble vitamin that plays a role in the enhancement of the immune system, regulation of bone growth, and absorption of calcium, iron, magnesium, phosphate, and zinc [72,73].
Vitamin D (Vit D) exists in two forms including cholecalciferol (Vitamin D3) and ergocalciferol (Vitamin D2) [74,75].
It is found naturally in fish (salmon, tuna, sardines), dairy (milk), green (spinach, okra, kale), beans (soy and white), meat (beef liver), and exposure to ultraviolet B [74]. Skin exposure to solar ultraviolet B radiation synthesized Vitamin D3; meanwhile, Vitamin D2 is synthesized by plants [76,77]. The receptors for Vitamin D are found in most tissue or organs and are involved in several biological functions such as promoting calcium absorption in the gut, maintaining adequate serum calcium and phosphate concentration, reducing inflammation, and modulating several processes, including cell growth, immune function,
glucose metabolism, and insulin sensitivity [78]. However, the impairment of pancreatic beta cells and insulin-resistance have been associated with a deficiency in Vitamin D [79,80].
Recent investigations have shown that low level of Vitamin D is associated with impaired fasting glucose,
hypertension, obesity, glucose intolerance, and the development of T2DM [80].
Preclinical studies have demonstrated that pancreatic beta cell function properly with an adequate level of
Vitamin D because it helps in promoting the conversion of proinsulin to insulin, increasing insulin output, and enhancing insulin action through the regulation of the calcium pool [81,82,83].
Vitamin D further serves as a chemical messenger and is involved in the regulation of transcription such as the down-regulation of pro-inflammatory cytokine genes such as Interleukin-2, interleukine-12, tumor necrosis factors -α, production of
anti-inflammatory cytokines, and protection of beta-cell destruction [82].
A randomized control double-blind intervention study noted a significant improvement of insulin sensitivity in diabetic patients supplementing 4000 IU of Vitamin D for 6 months compared to a placebo [84].
A similar study also noted that Vitamin D supplements affect insulin secretion in prediabetics patients compared to control [85].
Furthermore, Vitamin D supplements are associated with a reduction in the level of metabolic parameters, including total cholesterol, low-density lipoprotein, glycated hemoglobin, triglyceride, and diabetic complication [86,87].
3.2.2. Vitamin E and Its Application to Diabetes Mellitus
Vitamin E is found mainly in plant-based oils (peanuts, olive, soybean oil), nuts (almonds), seeds (sunflower seeds), fruits (mango, red bell pepper), and vegetables (collard green, spinach, and beets green). It is a collective group of fat-soluble compounds with eight isoforms that can be categorized into tocopherol and tocotrienol isoforms. The tocopherol isoforms can be classified into alpha (α), beta (β), gamma (γ),
and delta (δ) categories and have a saturated side and chain on the chromanol ring. Meanwhile, tocotrienol isoforms have an unsaturated side chain, and the two types can be further categorized into α, β, γ, and δ, and the α tocopherol best meets the dietary requirements of humans.
Vitamin E is considered a powerful antioxidant that limits the production of ROS formed when fat undergoes oxidation and, therefore, helps prevent or slow chronic conditions associated with free radicals.
Research has demonstrated that a high dose of vitamin E reduces oxidative stress biomarkers and increases immune defense.
A randomized study in patients with diabetic nephropathy showed that supplementing 800 IU vitamin E for 12 weeks significantly increased the levels of glutathione peroxidase (GPx) compared to the placebo [88]. A similar prospective study on type 2 diabetics with or without complications supplementing 4000 IU of vitamin E along with hypoglycemic drugs daily for 9 months showed a gradual decrease in fasting blood sugar,
serum glycated hemoglobin (HbA1C), and BMI compared to control [89]. In sum, the antioxidant properties of vitamin E have the potential to delay diabetic complications.
3.2.3. Vitamin C and Its application to Diabetes Mellitus
Vitamin C, or ascorbic acid, is an antioxidant and plays several functions such as enzyme cofactors, radical scavengers, electron transport donors, or receptors in the plasma membrane [90].
Deficiency of Vitamin C leads to defective formation of collagen, blood vessels, and connective tissue in the bone, dentine, cartilage, skin, and oxidative stress [90].
Oxidative stress often leads to glucose metabolism and hyperglycemia.
Hyperglycemia promotes the oxidation of glucose to form free radicals. The free radical generation above the scavenging potential of endogenous antioxidants may result in macro- and microvascular dysfunction [91].
Vitamin C biomolecules can protect from oxidation by participating in oxidation-reduction reactions, in which dehydroascorbic acid will be oxidized and reduced back into ascorbate [92].
The main sources of Vitamin C are fresh fruits, vegetables, and aromatic herbs [90].
The vernacular names of fruits with high
contents of Vitamin C include the Kakadu plum from Australia, camu-camu from South America, fruit star, guava, kiwi, strawberry, orange, lemon, and pear [93,94].
The cruciferous vegetables and aromatic herbs expressing elevated levels of Vitamin C include broccoli, kale, pepper, cabbage, parsley, chives, and coriander [95].
Temperature plays an important role in Vitamin C preservation and stability. The gentle way to preserve Vitamin C content, and avoid possible leaching out into water, degradation, and pH changes, is steaming or boiling in a small quantity of water for very short-time and deep freezing for long-term storage [96,97].
As many fruits and vegetables contain Vitamin C, a prospective cohort study of 23,953 men who were diabetic-free as a baseline discovered that 1741 men who developed type 2 diabetes increased their vegetable and fruit intake to 1.6 servings per week (10) [98].
Mason et al. (2018) in a study found that type 2 diabetic patients supplementing ascorbic acid experienced a reduction in blood sugar as well as blood pressure in 4 months compared to placebo [99].
In addition, a cross-sectional study investigating the correlation between
Vitamin C serum level and fasting blood sugar, glycated hemoglobin, serum malondialdehyde, and lipid levels in diabetic patients noted that
low levels of Vitamin C significantly increase the systolic blood pressure, glycated hemoglobin, and malondialdehyde levels, leading to an increase in oxidative stress biomarkers [70].
The report also noted an inverse relationship
between fasting blood sugar, total cholesterol,
and Vitamin C levels [70]. A similar result was found in a retrospective study exploring Vitamin C levels, renal dysfunction, and obesity in patients with type 1 diabetes and type 2 diabetes [100]. To sum up, these findings suggest Vitamin C therapy to ameliorate glycemic and blood pressure in diabetic patients.
3.3. Medicinal Properties of Selected Medicinal Plants and Vitamins
The literature review revealed that Allium sativum, Momordica charantia, Hibiscus sabdariffa L., Zingiber officinale, and Vitamins (C, D, and E) have in common night (9) medicinal properties, including anti-diabetic, hypolipidemic, hypoglycemic, immunomodulatory, antioxidant, anti-inflammatory, anti-cancer, anti-bacterial, and anti-fungal properties (Figure 2 and Table 1).
Summary of medicinal properties of Allium sativum, Momordica charantia, Hibiscus sabdariffa L., Zingiber officinale, and Vitamins (C, D, and E). The medicinal plants listed in Figure 2 are common herbs consumed worldwide as a functional food and traditional home remedies for the prevention and/or treatment of diabetes.
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