The worldwide prevalence of diabetes mellitus has been increasing in recent years and the Philippines is no exception. While there has been an increase of available medications, these are beyond the means of many Filipinos.

The folkloric use of herbal medications has been with us for a long time. Herbal medications are generally thought to be safe because it is derived from natural sources. The reader is forewarned that this impression can lead to a false sense of security. As we have learned from Western medicine, adverse effects are dependent on the dose (of the main and other ingredients), number and amount of impurities, and any concomitant food or drug intake. Absence of data on adverse effects is not the same as absence of adverse effects.

The National Center for Complementary and Alternative Medicine (NCCAM) of the United States of America lists the following supplements that have been used for diabetes, with a focus on some that have been studied in clinical trials, such as alpha-lipoic acid, chromium, omega-3 fatty acids, and polyphenols. Other supplements listed include garlic, magnesium, coenzyme Q10, ginseng, vanadium, prickly pear cactus, gurmar, Coccinia indica, aloe vera, fenugreek, and bitter melon.

Alpha-lipoic acid (ALA) is a very important micronutrient found in food (especially high in spinach, broccoli, and tomatoes) and sold as a nutritional supplement. It improves glycemic control and polyneuropathies associated with diabetes mellitus probably by stimulating glucose uptake and improving insulin sensitivity. However, only about 30% of the supplement is absorbed and ALA is rapidly eliminated from the body.

Chromium (Cr) is a trace element essential in carbohydrate, lipid, and protein metabolism. It is a cofactor for insulin function resulting in enhanced glucose transport into liver, muscle, and adipose tissue. Dietary sources of Cr include brewer’s yeast, beer, whole grains, cheese, egg yolks, broccoli, liver, and meat. The refining of grains and sugars and the processing of foods remove most of the absorbable Cr. Cr supplementation, provided as 1000 microgram per day as Cr picolinate, enhanced insulin sensitivity in subjects with type 2 diabetes mellitus. The United States Food and Drug Administration (USFDA) opined that there is very limited credible evidence for qualified health claims that chromium picolinate may reduce the risk of insulin resistance and type 2 diabetes.

Ampalaya (Momordica charantia) is a popular folk remedy for diabetes in the Philippines and in other Asian countries. Not all preparations in the market containing ampalaya have data showing glucose lowering effect. The most promising is the “Makiling variety” ampalaya leaf tablet developed by the National Integrated Research Program on Medicinal Plants (NIRPROMP), under the leadership of Dr. Nelia Maramba, and the sponsorship of the Philippine Center for Health Research and Development (PCHRD) and the Department of Science and Technology (DOST). To our knowledge, this preparation is the most extensively studied to date and its application to be a prescription drug is still under evaluation by the Philippine Food and Drug Administration (FDA). It was shown in a clinical trial that the ampalaya leaf tablet taken at 100 mg/kg/day have similar glycemic control to glibenclamide 5 mg/day (unpublished data). Because of its abortifacient property, ampalaya preparations in general are not recommended for pregnant women.

Data regarding cinnamon (cinnamomum cassia) is inconclusive. Some studies showed improvement in fasting and/or postprandial blood glucose and another one showed improvement in HbA1c. The decrease in plasma glucose seem to be more beneficial for those with poorer glycemic control. A meta-analysis, however, concluded that cinnamon does not appear to improve HbA1c, FBG, or lipid parameters in patients with type 1 or type 2 diabetes. However, different doses have been used in various studies, making results comparisons challenging at best.

Fenugreek (Trigonella foenum-graecum) is a common condiment in Indian cooking and is used as medicine for diabetes in India and China. Mechanisms proposed include decreased carbohydrate absorption and increased insulin secretion. While there are studies that show improved glycemic control with fenugreek, these studies are of lower quality and more studies are needed.

Nopal (Opuntia streptacantha) or the prickly pear cactus, found in arid regions throughout the Western hemisphere, is commonly used for glucose control by those of Mexican descent. It has a high soluble fiber and pectin content, which may affect intestinal glucose uptake, partially accounting for its hypoglycemic actions.” Human studies published in English report decreases in serum glucosela and serum insulin, suggesting an improvement in insulin sensitivity. All articles on Nopal came from the same group of investigators. While the studies on nopal’s hypoglycemic effect are promising, the sample sizes are small and we do not know how many subjects the different publications have in common.

Magnesium is another mineral that we need. The mechanism is most likely improved insulin sensitivity. Dietary sources include whole grains, beans, nuts, and green, leafy vegetables. Magne sium deficiency is associated with poor glucose control in patients with diabetes. However, supplementation of magnesium did not produce clear long-term benefits in type 2 diabetes.

Gymnema sylvestre (Gurmara) has been used in Ayurveda to regulate sugar metabolism for several centuries. Gymnemic acid molecules are similar to that of glucose molecules molecules and may curb the sugar craving. It has been postulated to increase insulin production, regenerate pancreatic cells, increase utilization of glucose, and causes inhibition of glucose absorption from intestine. American ginseng (P. quiquefolius) has been studied for a possible hypoglycemic effect. However, the trials are small and longer term studies are needed.

Liu et al (2004) systematically reviewed traditional Chinese herbal medicines and found that while some Traditional Chinese herbal medicines were shown to be beneficial in both placebo and actively controlled clinical trials, there were limitations in the conduct of these trials.

In summary, alpha-lipoic acid, chromium and the “Makiling variety” ampalaya leaf tablet offer the most promise in terms of adjunctive treatment of diabetes mellitus. The other supplements discussed may benefit from more studies.

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