REVIEW ARTICLE

Herbal Medicines in Diabetes

Zohreh Bakhtiuary

School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.

Received: 13 March 2011 - Accepted: 4 May 2011

ABSTRACT
The use of herbal medicines in diabetes is promising but still far from proven. The purpose of
this article is to examine the effect of herbal medicines in the treatment of diabetes, focusing on
potential benefits and risks.
Medline, expert interviews, books, articles and internet searches were used to identify herbal
medicines with anti-diabetic properties and their diabetes-related health effects, proposed anti-
diabetic effect, adverse effects, contraindications and drug interactions. Forty five herbs with
known effect in the treatment of diabetes were selected for review, including: Trigonella foenum
graecum L, Allium cepa L. & Allim sativum L., Silybum marianum, Mamordica charantia L.,
Camellia sinensis L. Morus nigra L., Gymnema sylvestre L., Ginkgo biloba L., ….
Anti-diabetic health effects included increasing serum insulin, decreasing blood glucose,
increasing glucose metabolism, and/or stimulating pancreatic function. Side effects were few or
not reported. Many herbal medicines can be used for treatment, prevention and control of
diabetes and as a component of diabetic patients’ diet. Of course some of these plants have
adverse effects, contraindications, and drug interactions and also interactions between herbal
medicines and synthetic drugs exist and may cause serious clinical consequences however at
these researches side effects were few or not reported, but patients should inform their physician
of the use of herbal products and consider the possibility of herb-drug interactions.
KEYWORDS: herbal medicine, diabetes, research

INTRODUCTION control, beginning and adjustment of insulin

Diabetes mellitus is one of the most important doses is important (3).
health problems in all countries, and despite According to the Iranian Diabetes Society, in
great improvement in its treatment, serious 1990, the prevalence of diabetes in Iran was
complications such as retinopathy, more than 8 percent (about 3 million people)
nephropathy and lower extremity amputation (4). High prevalence of diabetes among
are still observed (1). Diabetes is the most working segments of the society could have
common endocrine disorder that affects more serious consequences especially in developing
than 194 million people worldwide (2). If countries (5). In Isfahan in 1993, 7/54% of
nothing is done to control this disease, the people 40 years-old and older suffered from
number will exceed 333 million by 2025 diabetes (6). Insulin deficiency or reduction in
(6.3% of population) (2). diabetic patients is associated with acute and
In diabetic patients, medical education chronic metabolic complications (7). In a
programs for pharmacists and patients, study conducted in 2007, fluctuations in drugs,
offering medical advice about blood glucose especially in the case of insulin in pharmacies

*Correspondence: Zohreh Bakhtiuary, School of pharmacy and pharmaceutical sciences, Isfahan University of Medical
Sciences, Isfahan, Iran Tel: (+98) 913 2170025. Email: [email protected].

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 Z. Bakhtiuary

in Isfahan, were perfectly clear (8). On the in year 2006 which was written by Dr. Falah
other hand, while the main and effective Hosseini H et al (20).
treatments of diabetes mellitus are insulin and
hypoglycemic agents, these medications result MATERIALS AND METHODS
in such undesirable side effects as We used Medline, expert interviews, books,
hyperglycemia which could be a major safety papers and searching the internet to determine
concern (9). the effects of anti-diabetic medicinal plants,
One of the main factors for treatment to be plants which were claimed to have association
successful is the correct and logical use of with diabetes, plants which were proposed for
herbal medicines or chemical drugs (10). anti-diabetic effects as well as plants with
Although, from ancient times, medicinal plants incompatible interactions.
and their derivatives were considered in the Forty-five plants have been selected and were
treatment of diabetes mellitus and its reviewed (these plants had a role in treating
complications, the exact effectiveness of these diabetes), Such as fenugreek, garlic, onion,
drugs is not completely known (11). Mary thistle plant, bitter cucumber, green tea,
Appropriate diet and alternative therapies, can mulberry plant, plant Gymnema Sylvester,
reduce the cost of treatment and prevent or Ginkgo Biloba and ... .
cure many cases of type II diabetes and Anti-diabetic effects of herbal medicine
improve some cases of type I diabetes. include: increasing serum insulin, lowering
Medicinal plants consumption is remarkable blood glucose, increasing glucose metabolism
particularly when conventional therapies are and/or stimulating the pancreas. In this study,
not able to control the disease and patients side effects were not frequent or not reported.
need insulin (12).
Karaka and Susrota and many other medicinal DISCUSSION
plants with various oral formulations have Review on research done:
been recommended for the treatment of Fenugreek (Trigonella Foenum Graecum L), is
diabetes (13). one of the safest and most effective plants in
Of course, the use of herbal medicines instead treating diabetes. Fenugreek extract, like
of chemical drugs, depends on the physician’s insulin, significantly reduces blood sugar
opinion about this drugs in addition to patient levels (21). Clinical and laboratory studies also
beliefs (14). have shown that fenugreek seeds have anti-
Due to side effects of some chemical drugs, diabetic effects (22).
and the beliefs of some people to practice "Bitter melon" (Momordica Charantia) is an
traditional medicine, folk medicine especially alternative therapy that has primarily been
the herbal therapy used to treat diabetes and its used for lowering blood glucose levels in
values and positive aspects should be studied patients with diabetes mellitus (23). "Bitter
(1,15). melon" fruit extract reduces blood glucose and
In this study, we have reviewed the latest is effective in treating diabetes (24).
medical literature on the effect of medicinal Garlic has been reported to possess a variety
plants on diabetes and we have not intended to of medicinal properties including
advise the usage of the effective medical hypoglycemic, hypocholesterolemic and
plants on diabetes directly or indirectly. There hypolipidemic activities (25) and several
are several reviews by different authors about studies suggest that garlic and onion (Allium
anti-diabetic herbal plants (16-18). In a review Cepa L. & Allim Sativum L.) have roles in
more than 300 plant species with reducing blood glucose levels due to
hypoglycemic properties are introduced (19). producing active nitrogen compounds (2, 26).
Also in reviewing the literature, we found a Raw garlic possesses a beneficial potential in
paper entitled "Review of anti-diabetic reversing proteinuria in addition to reducing
medicinal plant used in traditional medicine" blood sugar, cholesterol and triglyceride in

IRANIAN JOURNAL OF DIABETES AND OBESITY, VOLUME 3, NUMBER 2, SUMMER 2011 89

Herbal Medicines on Diabetes

diabetic rats. Therefore, garlic could be of has the effect of compounds that are
great value in managing the effects and hypoglycemic, although their mechanism of
complications of diabetes in affected action in reducing serum glucose is not yet
individuals (2). properly clear (36).
Silybum Extract (Silybum Marianum L. Mary pea (Teucricum Vulgare) can be used to
Gaertn) or silymarin is also one of the plants control blood sugar in diabetic patients (37).
used in the treatment of liver disorders. This Madhunashini (Gymnema Sylvestre R. Br.)
herb increases the cellular sensitivity to insulin commonly known as ‘Gudmar’ in India is an
and thus reduces blood glucose (27). important medicinal climber and is extensively
In another research it was shown that used in almost all Indian System of Medicine
prescription of herbal silymarin (Mary's as a remedy for diabetes (38). Clinical
thistle) for type II diabetic patients who were research shows that this plant is effective in
candidates of insulin therapy, reduces treating patients with type I and II diabetes (39
glycosylated hemoglobin, blood glucose and 40).
(fasting and two hours postprandial) and Ginkgo biloba plant (Ginkgo Biloba L.) plays
serum total cholesterol and LDL levels in an important role in increasing blood flow in
these patients (28). diabetic patients (41). This plant as an herbal
Bitter cucumber plant fruit (Mamordica medication is capable of lowering glucose, fat,
Charantia L.) have polypeptide composition and lipid peroxide in diabetic patients (42).
similar to insulin but with less complications. According to researches in the field, hydro-
This plant doesn’t need subcutaneous injection alcoholic extract of artichoke (Cynara
and can reduce blood glucose I patients with Scolymus L.) affects blood glucose, serum
type 1 diabetes. Also sap of this plant that is lipids and lipoproteins in diabetic rats with
very bitter is used for reducing blood sugar Alexon monohydrate. The extract can repair
(29). the damaged pancreas as well, therefore,
Oral administration of mountain celery further researches are needed to investigate
(Apium Graveolens L.) for 6 weeks, in an artichokes effect on diabetic patients (43).
experimental model of diabetes mellitus had In a research for assessing hypoglycemic
no significant hypoglycemic effect, but it effects of Allium porrum L. leaves in healthy
caused desirable and beneficial changes in and streptozotocin-induced diabetic mice, this
blood lipid levels (30). result was obtained: the ethanol extract of
Green tea (leaves of Camellia Sinensis, leaves of this plant had hypoglycemic effects
Theaceae) is a popular beverage in East Asia, on diabetic animals and perhaps its mechanism
and also is used as an herbal remedy in Europe is increasing insulin release (44).
and North America (31). Green tea (Camellia In a research, the efficacy of stalk extract of
Sinensis L.) can reduce blood sugar in diabetic Rheum Ribes L. on blood lipids was
patients. Studies show that the consumption of determined in type II diabetic patients with
one and a half gram dry powder of green tea, hypercholesterolemia. Daily administration of
can improve the metabolism of blood sugar in 1200 mg of rhubarb plant stems extract to type
diabetic patients (32). Tea offers an attractive II diabetic patients with high blood fat caused
potential strategy to regulate postprandial reduced fat and fasting blood glucose
hyperglycemia toward an overall dietary concentration with no side effects on blood
support for type 2 diabetes management (33). biochemical factors related to liver and kidney
Kampuchea tea and black tea prevent weight (45).
loss in animals that is a sign of diabetes (34). Saponin from Tribulue Terrestris could
Morus Nigra, commonly known as black significantly reduce the level of serum glucose
mulberry, is widely used in Brazilian folk (46). In a study entitled "investigation of the
medicine for the treatment of diabetes (35). hypoglycemic effect of caltrop plant (Tribulus
Black mulberry (Morus Nigra L.) leaves also Terrestris L.) extract on diabetic rats" fruit

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hydro-alcoholic extract of this plant caused a Prescription of meat extracts from leaves of
dose-dependent decrease of blood sugar in Aloe (Aloe Vera L.) significantly reduced
diabetic rats and the authors proposed longer blood glucose in both types of diabetes (Type I
investigations with more focus on side effects and Type II); this plant is effective in
among the target population (47). preventing diabetic complications such as
Use of plant cactus fruit (Opuntia Ficus - diabetic ulcers (53).
Indica L.) by some indigenous people also New studies show that Salacia Oblonga, a
have been reported for diabetes, but in a study pharmaceutical plant in medicine of ancient
about cactus fruit effect on blood glucose India, can help to control blood glucose in type
levels in streptozotocin-induced diabetic rats 2 diabetic patients. In ancient Indian medicine
with, no significant effects on fasting blood the stem and root of this plant which grows in
glucose levels and weight of streptozotocin- India and Sri Lanka with the names Ponkoranti
induced diabetic rats and also in non-diabetic and Saptrangi was used for obesity and
rats was seen (48). diabetes.
Colocynth (Citrullus Colocynthis) is This plant besides appropriate diet, physical
prescribed by many medicinal plants sellers activity and consumption of medications are
for decreasing blood sugar in diabetic patients, able to control type II diabetes (54).
but scientific valid information about the On a study it was shown that long-term and
clinical anti-diabetic effects and toxicity of oral administration of plant Walcott (Allium
this plant does not exist. In a study, Ursinum L) in an experimental model of
administration of 100 mg colocynth three diabetes mellitus, was effective in reducing the
times a day to patients with type II diabetes contractile response of the vascular system and
reduced fasting blood glucose and HbA1C and prevention of the development of hypertension
administration of this dose 2 months to the in diabetic rats (55).
patients didn’t cause any gastrointestinal, liver Fig leaf reduces blood glucose in diabetic rats
and renal side effects. But at the conclusion of (56). The laboratory and the animal studies
this research, to ensure about the efficacy of show that cinnamon raises the glucose
this dose of colocynth another study with metabolism about twenty times. Diabetic
larger sample size and longer duration was patients can help themselves by adding a little
proposed (49). cinnamon to their food. Cinnamon helps to
Hypoglycemic effect of alcoholic extract of recognize fat cells and respond to insulin.
olive leaf (Olea Europaea L.) in healthy adult Bioactive compounds may increase the effects
male rats which have become diabetic by of insulin (57).
streptozotocin was shown; Oral administration Borage plant can stimulate insulin secretion
of alcohol extract of olive leaf caused and be effective in the treatment of diabetic
significant increase in serum insulin levels of patients (58).
diabetic animals and this is similar to the Sage (Salvia Officinalis) reduces blood sugar.
effect of gliben clamide (50). Of course, you must be careful in taking it too,
Olive leaf extract inhibits high glucose- because taking high doses of it can cause
induced neural damage and suppresses significant hypoglycemia and even death (59).
diabetes-induced thermal hyperalgesia. The Ginseng plant is used for treatment and
mechanisms of these effects may be due to prevention of diabetes (60).
reduced neuronal apoptosis (51). Plant crap (Securigera Securidaca) is one of
Also a study on wheat bran and plantain show the plants of traditional medicine with
that wheat bran increased serum HDL (p attributed lowering blood sugar effect. Hydro-
<0.01) and plantain consumption increased alcoholic extract of Securigera Securidaca
HDL (p <0.001) and reduced LDL (p <0.02) seeds can reduce blood glucose levels in the
(52). rats and probably with more researches this

IRANIAN JOURNAL OF DIABETES AND OBESITY, VOLUME 3, NUMBER 2, SUMMER 2011 91

Herbal Medicines on Diabetes

plant will probably be introduced as a drug to anti-diabetic effects. The plant's active
treat diabetes (61). ingredient is Myrtylyn anthocyanosides and
The effect of Allium Ampeloprasum has effects similar to insulin, but weaker (68).
consumption on serum level of glucose, Saffron is used in folk medicine for treatment
triglyceride, and total cholesterol of diabetic of diabetes (69).
rats was identified. Oral administration of In another study entitled "protective effect of
Allium Ampeloprasum for one month caused saffron extract and crocin on reactive oxygen
significant reduction in the level of glucose, species-mediated high glucose-induced
cholesterol and triglyceride in experimental toxicity in PC12 cells" showed that crocin in
models of diabetes mellitus induced by saffron can affect diabetes but this
streptozotocin in rats (62). combination has not been tested on people
In a research entitled "effect of nutrients with diabetes by now, however, preliminary
containing bean and chicory on blood glucose results show saffron has a positive effect on
of diabetic rats" results showed that the diet diabetes (70).
containing chicory, reduced blood glucose Finally (Securigera Secuidaca L) seed , that is
concentration. Chicory diet for reducing blood known as bitter lentils in grocery stores, is
sugar in diabetic animals is more effective commonly used for reducing blood sugar in
than beans diet and chicory and also has a diabetic patients in Iranian traditional
direct relation with consumption percentage of medicine, but so far no scientific clinical study
chicory. This diet is probably effective in the have been reported for evaluation of its
treatment of type I diabetes mellitus in humans therapeutic effects or toxicity in diabetic
(63). patients (71).
Study on the effect of coriander, pomegranate
and walnut leaves on serum biochemical CONCLUSION
parameters of diabetic rats showed that Many herbs can help to treat, prevent and
consumption of pomegranate significantly control diabetes, but some of them have side
reduced cholesterol, triglyceride and enzyme effects or interactions.
activity of serum AST and ALT (P<0/05), but On the other hand, there are interactions
the most effective ones in reducing glucose, between herbal and synthetic drugs that can
cholesterol, triglyceride, and enzyme activity lead to adverse clinical results, although in
of ALP, AST, ALT were walnut tree leaves most researches little or no side effects were
(64). reported, nonetheless the patient and the
In a study on diabetic rats, glucose, physician should take care when using
cholesterol, triglyceride, urea nitrogen, medicinal plants.
creatinine, ALT, AST and ALP, were
compared with healthy rats that used celery, ACKNOWLEDGMENTS
carrot and apple tart. All of them showed The study was supported by the School of
significantly reduced blood sugar, but overall, Pharmacy and Pharmaceutical Sciences,
the most effective one in reducing glucose, Isfahan University of Medical Sciences.
creatinine and serum AST and ALT enzyme Author is grateful to Dr. Ali Mohammad
activity, was celery (65). Sabzghabaee (associate professor of
Dietary fibers such as psyllium can reduce pharmacotherapy and academic faculty
blood sugar (66). member of Isfahan University of Medical
Salt grass plant (Atriplex Halimus L.) is Sciences) for his valuable and sincere helps and
effective in the treatment of type II diabetic also Mrs. Fatemeh Talati (nursing graduate
patients (67). student) for her collaboration.
Black Gylh (Vaccinium Arctostaphylos L.)
which grows in the forests of northern Iran has

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 Z. Bakhtiuary

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