Herbs Used for Type 2 Diabetes and Cardiovascular Disease

1. Herbs Used For
Type 2 Diabetes and
Cardiovascular Disease
Melinda Jones, DTR
Dietetic Intern
Southwestern Dietetic Internship Consortium

2. Objectives
• Recognize herbs used for DM and CVD
• Understand the proposed mechanisms
• Identify possible safety issues

3. What is CAM?
• Complementary and Alternative Medicine
• Includes
 Natural Products
 Mind-Body Medicine
 Manipulation
http://nccam.nih.gov/
National Center for Complementary and Alternative Medicine

4. Reasons for caution
• Not regulated by the FDA
• Adverse effects
 Hepatotoxicity
 Nephrotoxicity
• Drug interactions
 decreased coagulation
 decreased absorption

5. Herbs
Used for DM and CVD
• Cinnamon
• Prickly Pear
• Garlic

6. Cinnamon

7. Cinnamon
• Varieties
 Cinnamomum cassia
• Chinese cinnamon
 Cinnamon verum
 true cinnamon or ceylon
• Bark is used
 Ground or extract
• Proposed benefit:
• Improves insulin sensitivity
• Decreases HbA1c
• Decreases LDL and Trigs
(Epicentre, 2003)

8. Cinnamon
Proposed mechanisms
• Active components
– Polyphenolic polymers
• type-A polymers
• Functions
•  inflammation
  gene expression of Tristetraprolin
  expression of (TNF)-alpha
•  insulin sensitivity
 increases GLUT 4 expression in adipocytes
 inhibit retinol binding protein
•  formation of advanced glycation end parts
 Antioxidant activity of catechins, polyphenols
(Anderson et al, 2002; Qin, Panickar,
Anderson,2010)

9. Effectiveness
• No significant changes in lipids
(Vanschoonbeek, Thomassen, Senden, Wodzig, van
Loon, 2007; Mang et al, 2006; Blevins et al, 2007)
• Significant changes in HbA1c
• .83% with tx group vs .37% with placebo
(Crawford, 2009)
• Significant Changes in FBG
• 10.3% with tx vs 3.4 %with placebo
(Mang et al, 2006)

10. Side effects
Medication Interactions
• No known medication interactions
• Only 1/4 studies reported any side effects.
 1/109 participants reported a rash
• (Crawford, 2009)
• Common
 Oral irritation
 Stomatitis
(Crawford 2009).

11. Cinnamon
Suggested administration
• 1 g/day-3 g/day
 = 1/2  1-1/2 tsp
• No changes in FBG or
HbA1c
– <1 g/day
(Blevins et al, 2007; Crawford,
2009; Vanschoonbeek,
Thomassen, Senden, Wodzig,
van Loon, 2007; Mang et al,
2006)

12. Prickly Pear

13. Prickly Pear
• Varieties
 Opuntia Conpressa
 Opuntia Ficus-indica
• Common names
 Nopal
 Indian fig cactus
 Prickly pear
Parts used
 The cladodes (“pads”, “Nopalitos”, “Tuna”)
 Fruits
 Eaten raw or cooked

14. Prickly Pear
Proposed benefits
• Traditionally used in Mexico for DM
•  Postprandial BG
•  Lipids

15. Prickly Pear
Proposed Mechanisms
• Active components
 Soluble fiber: Pectin, gums, mucilages
 Phytochemicals
• Mechanisms
  absorption of fats
  GI transit time
 Lutein may  oxidative stress
(Sobieraj, Freyer, 2010)

16. Prickly pear
Effectiveness
•  17.08 mg/dL in 1 hr postprandial BG
•  14.81 mg/dL in 90 min postprandial BG
•  10.35 mg/dL in 120 min postprandial BG
• No changes in HbA1c or insulin
 (Godard et al., 2010)
• 7.1% increase in HDL
• 39% of people of participants no longer dx’d with metabolic
syndrome vs 8% in the placebo group.
 (Linares, Thimonier, Degre, 2007)

17. Prickly Pear
Side Effects
and Drug Interactions
• Few adverse side effects noted
• GI upset
• Hypoglycemia
• Not suggested with other glucose lowering
agents
(Sobieraj, Freyer, 2010; Godard et al., 2010; Bush, Rayburn, Holloway, et
al.,2007).

18. Prickly Pear
Suggested Administration
• w/in 30 min. of a meals
• Dried
 400 mg1.6 g/day
• Available dried
• Broiled or juiced
• 1/2-1 medium (20 cm)
pad/day
(Godard et al., 2010, Linares, Thimonier,
Degre, 2007)

19. Garlic

20. Garlic
• Proposed benefits
 normalizes lipids
  LDL oxidation
 inhibits platelet aggregation
  BP

21. Garlic
Proposed Mechanism
• Active components
 Organosulfur compounds(allicin)
 Flavonoids
• Proposed mechanisms
 hydrogen sulfide
 cytokine modulation
 prevents oxidation

22. Garlic
Effectiveness
•  Total cholesterol 7.6%
•  LDL 11.8%
•  HDL 11.5%
• (Sobenin, Andrianova, Demidova, Gorchakova, Orekhova,2008)
•  Systolic BP of ~10.2 mmHg
• (Ried, Frank, Stocks, 2010)

23. Garlic
Side effects
Drug interactions
• Avoid with Anticoagulants
• Rash
• Heartburn
• Mouth Ulcers
• Bad breath and body odor
(Gardner et al., 2007)

24. Garlic
Suggested Administration
• Fresh
 2-4 g/day
• Dried
 300mg1g /day
 Time-released
• Cooking, aged
• 1 clove=2-4 g
• 1 clove =1/8 tsp
(Ried, Frank, Stocks, 2010; Sobenin,
Andrianova, Demidova, Gorchakova,
Orekhova,2008; Gardner et al, 2007)

25. Summary
• Garlic, cinnamon, and prickly pear
 May be somewhat effective
 Cost may out-weight benefit
 Safe if used with caution
 Not excessive
 Aware of drug-herb interactions

26. References

27. Questions?