Diabetes Mellitus Using Vitamins
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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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