Use of Medicinal Plants in the Diabetes Treatment

Aparecido Jonanthan Mandú de Araújo et al., JHMR, 2020, 5:43

Review Article JHMR 2020, 5:43

Journal of Herbal Medicine Research (ISSN: 2474-106X)

Use of medicinal plants in the diabetes treatment Aparecido Jonanthan Mandú de Araújo1,2, Amanda Virgínia Barbosa2, Francisco Henrique da Silva1, Rafael Artur Queiroz Cavalcanti de Sá2, Sivoneide Maria da Silva2, Bárbara de Azevedo Ramos3, Matheus Alves Siqueira de Assunção4, Márcia Vanuza da Silva1, Maria Tereza dos Santos Correia1

1Department of Pharmacy, Federal University of Pernambuco, Recife, Pernambuco, Brazil 2Department of Biochemistry, Federal University of Pernambuco, Recife, Pernambuco, Brazil 3Department of Antibiotics, Federal University of Pernambuco, Recife, Pernambuco, Brazil 4Department of Histology and Embryology, Federal University of Pernambuco, Recife, Pernambuco, Brazil ABSTRACT Medicinal plants have been used by the population since the *Correspondence to Author: beginning as a tool to prevent and fight diseases. In addition, to Aparecido Jonanthan Mandú de Araújo1,2 1Department of Pharmacy, strengthening local culture and offering cheaper labor, this prac- Federal University of Pernambuco, tice is an alternative to conventional therapies. The use of these Recife, Pernambuco, Brazil; 2De- plants in metabolic disorders has been studied worldwide. It has partment of Biochemistry, Federal shown promising results in reducing glycemic levels and profiles University of Pernambuco, Recife, related to diabetes, such as LDL lipid profile, total cholesterol, tri- Pernambuco, Brazil glycerides, and glycated hemoglobin (HbA1c). These results can How to cite this article: be potential sources for pharmacological treatments, through the Aparecido Jonanthan Mandú de production of medicines, as well as the implementation of these Araújo, Amanda Virgínia Barbosa, plants in the diet, dispensing with the use of commercialized Francisco Henrique da Silva, Rafa- el Artur Queiroz Cavalcanti de Sá, drugs. Sivoneide Maria da Silva, Bárbara de Azevedo Ramos, Matheus Alves Keywords: Phytotherapy, diabetes, dyslipidemia Siqueira de Assunção, Márcia Vanuza da Silva, Maria Tereza dos Santos Correia. Use of medicinal plants in the diabetes treatment. Journal of Herbal Medicine Re- search, 2020,5:43.

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JHMR: https://escipub.com/journal-of-herbal-medicine-research/ 1 Aparecido Jonanthan Mandú de Araújo et al., JHMR, 2020, 5:43 Introduction pancreas when it does not produce enough insulin. Furthermore, when the body cannot effec- The use of medicinal plants by the population tively use the insulin produced. This chronic dis- has been described since ancient times as a tool ease of global importance is responsible for an for the prevention and treatment of diseases. important cause of morbidity and mortality. Also, Whereas in popular belief, they cause little or no it has a high impact on health expenses, be- adverse effects1. Although in modern medicine cause when poorly controlled, it brings compli- there is considerable progress in the drug indus- cations to patients, who need to spend more try and its correlates, these traditional practices time in direct care of hospitals5 in developing countries reach 80%. The use of medicinal plants strengthens local culture and The incidence of diabetes in Brazil has reached traditional knowledge, enriching a production a rate of 61.8% in the last 10 years. global esti- chain and is an alternative option to conventional mates indicate that the number of people living 6,7 therapy2. with diabetes could reach 592 million in 2035 . Several traditional or complementary therapies Dyslipidemia has a strong relationship with dia- have been described in the literature to deal with betes because the more fat in the body, the level this disorder. Among them, the use of medicinal of glucose and lipids in the blood increases plants has grown as a promising alternative. more. According to Agência Nacional de Vig- ilância Sanitária (ANVISA), dyslipidemia is de- Medicinal plants and diabetes fined as a disorder that changes serum levels of Among the great diversity of plants with a poten- lipids. The change in this lipid profile may include tial to combat dyslipidemia and diabetes, table 1 elevated cholesterol, triglycerides, high density covers 10 species with these properties. Among lipoprotein (HDL), and low-density lipoprotein other therapeutic activities, these species have (LDL). This can lead to the development of car- significant efficacy in clinical trials regarding the diovascular diseases that cause mortality in potential to reduce profiles of glycemic markers. thousands of people worldwide3,4. In sequence, a more detailed description of how Diabetes is a metabolic disorder caused by hy- each species acts in the fight against diabetes. perglycemia resulting from a malfunction of the

Table 1. Species with potential to diabetes management.

Species Study direction Reference

Trigonella foenum-graecum Diabetes Mellitus 10

Momordica charantia Pre-diabetics and diabetics 14

Cinnamomum verum Type II diabetes 17

Moringa oleifera Diabetes Mellitus 24

Crocus sativus L. Type II diabetes 29

Bauhinia forficata L. Type II diabetes 31

Scoparia dulcis Type II diabetes 35

Melissa officinalis L. Type II diabetes 39

Zingiber officinale Type II diabetes 41

Salvia hispanica L. Type II diabetes 43

JHMR: https://escipub.com/journal-of-herbal-medicine-research/ 2 Aparecido Jonanthan Mandú de Araújo et al., JHMR, 2020, 5:43 Trigonella foenum-graecum In a work carried out by Zare et al., (2018), they Known as “feno grego”, this species belonging proved that 1g / day of C. verum compared to the to the Fabaceae family and has been used as a placebo group, demonstrated a significant re- condiment and as a medicinal plant. Studies duction in anthropometric indices including mass have demonstrated its antioxidant, gastroprotec- index, total body fat and visceral fat. As well as, tive, hepatoprotective, antidiabetic and neuro- the glycemic index, fasting plasma glucose, gly- protective activities8,9. cated hemoglobin, and lipid profile balance. The mechanisms may be related to inhibition of gly- Geberemeskel, Debebe and Nguse (2019) used cogen synthase kinase-3 and increased expres- an aqueous solution of 25g / L of T. feonum- sion of the UCP317 gene17,18,19. graecum seed powder in diabetic patients for 30 days. This study showed a significant reduction, Moringa oleifera compared to the control group, of 13.6% of total Among the 13 species described for the cholesterol, 23.53% of triglycerides, 23.4% of Moringaceae family, M. oleifera has been the LDL, and an increase in HDL of 21.7%. Thus, the most used and studied and in traditional Ayur- authors suggest that T. feonum-graecum seed veda medicine (Ancient science created in In- powder has a potential antidislipidemic effect. dia). It has been used in the prevention and Although it is not known exactly how its mecha- treatment of diseases, including diabetes20,21,22. nism occurs, studies suggest that the seed may Because they have an incredible number of increase the excretion of bile. This causes the properties, for example, antioxidant, anti-inflam- formation of large micelles, compromising the matory, immunomodulatory and anticancer, the synthesis of triglycerides10,11. species has been nicknamed “Arvore milagrosa” 23 Momordica charantia and “presente natural” . Popularly called “melão amargo” or “mamãozi- Leone et al. (2018), concluded that the addition nho”, this species belongs to the Cucurbitaceae of 20g of the powder of M. oleifera leaves in a family and has antiviral, antimicrobial and anti- meal, reduces the postprandial response to glu- mutagenic activity. Its action against diabetes cose, which was maintained for about 3h. The mellitus has been described by indigenous pop- inhibition of α-amylase, an enzyme important for ulations in Asia, East Africa, India, America and the digestion of carbohydrates, in in vitro tests, the Caribbean12,13. has also been related to the decrease in glycemic level. Therefore, the continuous use of pow- According to Krawinkel et al. (2018), supplemen- der from these leaves can improve the manage- tation with the powder of the fruits of M. char- ment of glycemia in diabetic individuals24. antia showed a significant reduction in fasting blood glucose, by bringing the glycemic levels of Crocus sativus L. pre-diabetics to the normal level. Therefore, it is Known as “açafrão” or “açafrão do outono”, this expected that the plant will be even more effec- species belonging to the Iridaceae family and tive in patients who already have diabetes in- has been used as a natural product since an- stalled. The mechanisms by which this reduction cient times. Persians, Egyptians and Europeans in blood glucose occurs are still poorly known14. used it as an aphrodisiac, to decrease low back 25,26,27 Cinnamomum verum pain and against poisoning . studies have brought its therapeutic efficacy in several parts Often referred to by its synonym, Cinnamomum of the gastrointestinal system, in addition to an- zeylanicum Blume, and popularly known as tioxidant effects, anticancer, antigenotoxic, anti- “canela”, this plant belonging to the Lauraceae inflammatory, among others28. family. It has shown antimicrobial, anti-inflammatory, antifungal properties and helps in reduc- The work of Aleali et al. (2019) concluded that ing the risk of colon câncer15,16. consumption for three months of encapsulated JHMR: https://escipub.com/journal-of-herbal-medicine-research/ 3 Aparecido Jonanthan Mandú de Araújo et al., JHMR, 2020, 5:43 hydroalcoholic extract of C. sativus significantly “erva bode”or “vassoura doce”. Studies have re- reduced fasting blood glucose, glycated hemo- lated S. dulcis with analgesic, anti-inflammatory, globin (HbA1c), total cholesterol and LDL in pa- antidiuretic, and antimicrobial potential33,34. tients with type II diabetes. One of the suggested The clinical trial conducted by Senadheera, Eka- mechanisms is that the extract causes inhibition nayake and Wanigatunge (2015), with porridge of intestinal glucose absorption. Therefore, the from the extract of the leaf of S. dulcis, demon- results show that the consumption of saffron can strated a significant reduction in fasting blood improve hyperglycemia and that further studies glucose and a reduction in the levels of glycated are needed to show the mechanisms of action of hemoglobin (HbA1c). In addition, there was no 29 its positive effects . increase in creatinine, urea, and C-reactive pro- Bauhinia forficata tein (CRP). The author also approaches, Naturally native to the Atlantic Forest and com- through the analysis of other studies, that the monly known as “pata de vaca” or “unha de consumption of S. dulcis extract can reduce oxi- vaca”, B. forficate belongs to the Caesapinoi- dative stress in pancreatic cells. Also, it signifi- deae subfamily and the Fabaceae family. This cantly reduces the concentrations of triglycer- species has been used popularly for the treat- ides, LDL, and total carbohydrates. However, it ment of several pathologies, especially diabetes, is worth mentioning that this last analysis was pain and inflammatory processes30. observed in studies with rats, which can also support its use35,36. The study by Mariángel et al. (2019), showed that tea from the dry leaves of B. forficate, twice Melissa officinalis L. daily for a period of three months, significantly Better known as “erva cidreira”, “citronela” or reduced triglycerides, total cholesterol, and gly- “melissa”, M. officinalis belongs to the Lami- cated hemoglobin (HbA1c). The mechanisms aceae family. Some studies have shown its anti- proposed for this reduction imply hepatic lipid bacterial, antimicrobial, antioxidant, sedative ac- metabolic stimulation, in which it reduces plasma tivity, among others37,38. lipid levels. The authors also compared their re- The pioneering study by Asadi et al. (2018), de- search with other studies. through experimental termined the clinical effect and tolerability of models, treatment with B. forficate interferes with 700mg /day for three months of M. officinalis in hepatic glucose, glycogenesis, and lactate pro- type II diabetic individuals. They observed a sig- duction. In addition, it diminishes blood glucose nificant decrease in fasting blood sugar, gly- 31,32 and is anti-diabetic in rats . cated hemoglobin (HbA1c) and systolic blood In addition, another species of Bauhinia, Bau- pressure compared to the control group. In addi- hinia monandra Kurz, presents hypoglycemic tion, there is a reduction the inflammatory and hypotensive activity. It was also evidenced marker CRP39. that when hydrocoolic extract of B. monandra Zingiber officinale developed insulin-like effect, that is, it may be Known as “gengibre” Z. officinale is one of the able to interact or modulate the specific binding common functional foods used worldwide as capacity of insulin, competing by the same re- condiments for various foods and drinks. For gin- ceptor. The morphological and morphometric re- ger, some medicinal uses have been described, sults of the hydroalcoholic extract allowed us to for example, antispasmodic, digestive and vaso- infer that B. monandra Kurz possibly caused dilatory action, expectorant, bronchodilator, top- recovery of B cells44 ical stimulant, analgesic, antiflatulent, aphrodis- Scoparia dulcis iac and aperitive40. S. dulcis belongs to the Plantaginaceae family In the study by Shidfar et al. (2015), ginger sup- and is commonly known as “erva de alcaçuz”, plementation was done with 3g / day for three JHMR: https://escipub.com/journal-of-herbal-medicine-research/ 4 Aparecido Jonanthan Mandú de Araújo et al., JHMR, 2020, 5:43 months. When compared to the control group, [2]. Brasil. Plantas Medicinais e Fitoterápicos no the results showed a decrease in insulin-re- SUS. Ministério da Saúde. Disponível em: https://www.saude.gov.br/acoes-e- sistant glucose, hs-CRP, lipid peroxidation, and programas/programa-nacional-de-plantas- increased levels of paraoxonase-1 (PON-1). medicinais-e fitoterapicos-ppnpmf/plantas- These data were compared with other animal medicinais-e-fitoterapicos-no-sus. Acesso: 23 studies using hydroalcoholic and alcoholic ex- de março de 2020. tracts of ginger. Some of the possible mecha- [3]. ANVISA. AGÊNCIA NACIONAL DE VIGILÂNCIA SANITÁRIA. Boletim Saúde e nisms are related to the inhibition of glycogen Economia nº 6. Disponível em: phosphorylase, which is responsible for break- http://portal.anvisa.gov.br/publicacoes12?tag ing down glycogen in the liver. One of the possi- sName=dislipidemia. 2011. Acesso: 15 de ble effects is also related to the antioxidant po- maio de 2020. tential of ginger41. [4]. Pereira, R. A relação entre Dislipidemia e Diabetes Mellitus tipo 2. Cadernos UniFOA. Salvia hispanica L. 2011. “Salba-chia” or “chia”, a plant belonging to the [5]. ANVISA. AGÊNCIA NACIONAL DE Lamiaceae family, is a seed with a good source VIGILÂNCIA SANITÁRIA. Diabetes: o que é, of protein, phenolic compounds, and essential tipos, sintomas e tratamento. Disponível em: fatty acids. In addition, it has a high amount of https://saude.gov.br/component/content/articl e/746-saude-de-a-a-z/44609-diabetes-tipos- fiber42. causas-sintomas-tratamento-e-prevencao. Vuksan et al. (2016), determined the benefits of 2019. Acesso: 15 de maio de 2020. consuming 30g / day of ground tea from S. his- [6]. FioCruz. Taxa de incidência de diabetes panic for six months. In this study, there was a cresceu 61,8% nos últimos 10 anos. significant reduction in body weight and android Disponível em: https://portal.fiocruz.br/noticia/taxa-de- and gynoid fat. There were also no major ad- incidencia-de-diabetes-cresceu-618-nos- verse events, only mild and transient discom- ultimos-10-anos. 2018. 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