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The Use of Herbs as Part of an Ayurvedic Treatment Approach to Diabetes Mellitus and Blood Glucose Imbalances By: Airlie Ellsworth

Introduction
The average American consumes 22.7 teaspoons of sugar per day. With this constant overdose of both refined and natural sugar it’s no surprise that 347 million people worldwide have diabetes mellitus – a figure that has climbed from 153 million just 35 years ago1. What’s even more alarming is that greater than 35% of Americans have pre-diabetes2, which puts them at increased risk for conditions such as hypertension and heart disease, Alzheimer’s, cancer, polycystic ovarian syndrome, anxiety, depression, and sleep disorders; as well as inflammation, male pattern baldness, food cravings and mood swings, poor circulation, high cholesterol, and high levels of stress hormones3.

Luckily, making small changes to our diet and lifestyle can make big improvements in our health and wellness. In this paper I will briefly review the body’s physiology as it pertains to maintaining stable blood glucose levels; the various diseases associated with imbalanced blood glucose levels: hypoglycemia, pre-diabetes, and types 1 and 2 diabetes mellitus; review and discuss several herbs which are commonly used to treat these diseases: gurmar, cinnamon, fenugreek, aloe vera, shallijit, and jambu; then consider diet and lifestyle recommendations that are beneficial in their management.
Physiology of blood sugar
Our bodies have a complex and intelligent way of maintaining homeostasis. To sustain healthy blood glucose levels, glucagon and insulin are released via a negative feedback loop as follows: the onset of hypoglycemia (a drop in blood glucose levels) stimulates the release of glucagon from alpha cells in the pancreas. The glucagon then acts on hepatocytes (liver cells) to promote the formation of glucose from lactic acid and amino acids (a process called gluconeogenesis) and accelerate the conversion of glycogen into glucose (a process called glycogenolysis).  These reactions cause hepatocytes to release glucose into the blood stream more quickly, which raises the blood glucose level. If blood glucose continues to rise, hyperglycemia (high blood glucose levels) inhibits the release of glucagon and stimulates the secretion of insulin by beta cells in the pancreas. Insulin has a variety of effects: it acts on specific cells in the body to increase facilitated diffusion of glucose into cells, it speeds up the conversion of glucose into glycogen (glycogenesis) and the synthesis of fatty acids (lipogensis), it slows glycogenolysis and gluconeogenesis, and it increases the uptake of amino acids by cells. All of these reactions cause blood glucose levels to fall. If blood glucose levels drop back into hypoglycemic range, the release of insulin is inhibited, which stimulates the release of glucagon, and the cycle repeats to right itself4.

When sugars and simple carbohydrates are ingested, the pancreas is forced to produce and secrete excess insulin to help move the sugars from the blood stream into the cells. A diet high in sugar forces insulin levels to spike more frequently than the body can handle. This fatigues the pancreas and causes the cells to become resistant to allowing in any more glucose. As a result of this excess glucose in the blood, levels remain unnaturally high. Insulin then stores this lingering glucose as fat, causing weight gain and an increase in unhealthy cholesterol5.

If hypoglycemia is ‘below-normal’ blood glucose levels and hyperglycemia is ‘above-normal’ blood glucose levels, what then are considered ‘normal’ blood-glucose levels? Nancy Klobassa Davidson, a registered nurse who specializes in diabetes, recommends a normal fasting blood glucose target range of 70-100mg/dL6, with ‘fasting blood glucose’ being the blood sugar level first thing in the morning before eating breakfast7. While this seems like a fairly broad-ranging safety zone, studies have found that the risk of cardiovascular and degenerative diseases increases significantly when fasting blood glucose levels rise above 85mg/dL. One such study, published in Diabetes Care Journal in 1999, tracked the fasting blood glucose level of 1,998 non-diabetic men over a 22-year period. This research showed that men whose fasting blood glucose level rose above 85mg/dL were 40% more likely to die of cardiovascular concerns8.
 
Conditions associated with blood glucose levels
 
Hypoglycemia
 
The Merck Manual Home Health Handbook defines Hypoglycemia as “abnormally low levels of sugar (glucose) in the blood”9. Besides being a side effect of the treatment of diabetes mellitus, there are two other types of hypoglycemia that occur due to abnormal endocrine functions: in reactive hypoglycemia blood glucose levels drop within a few hours of eating; in fasting hypoglycemia one experiences incredibly low blood glucose levels in the morning or if meals are skipped10. Symptoms of hypoglycemia generally include sweating, shaking, faintness, nervousness, hunger, palpitation, weakness, an inability to concentrate, headache, and general anxiety. If no known cause for the hypoglycemia can be detected, such as a tumor in the pancreas, a reaction to drugs, or some other disease11, then this condition can be treated Ayurvedically as a vata vitiation. When pitta is vitiated as well as vata, anger and irritability may also be exhibited12.

Pre-Diabetes
When blood glucose levels are too high to be considered normal but not high enough to be labeled diabetes a person is considered pre-diabetic. People have prediabetes if their fasting blood glucose level is between 101 mg/dL and 126 mg/dL13.

Diabetes Mellitus – Type 1 & Type 2
Diabetes mellitus is “caused by an inability to produce or use insulin”14. As discussed in the previous section, insulin is responsible for helping usher glucose from the blood into the cells via facilitated diffusion. Without sufficient insulin, blood glucose levels remain abnormally high while levels in the cells become deficient. These two imbalances combine to produce the symptoms of diabetes mellitus15.

There are two types of diabetes mellitus. Type I, previously known as insulin-dependent diabetes mellitus, occurs when a person’s immune system destroys the pancreatic beta cells. As a result little or no insulin gets produced. Without insulin there is no means by which glucose can be carried into cells, so the cells signal to the brain that they need energy. Appetite increases and fat cells begin to break down. In order to maintain balanced blood glucose levels, patients with this condition require insulin injections. Of the two types of diabetes, type I accounts for only 10% of cases; most people with type 1 diabetes develop the condition by the age of 3016.

Madhu meha, literally ‘sweet or honey like urine’ is the Sanskrit name for type 1 diabetes mellitus.  Ayurveda attributes madhu meha to a vitiation of vata dosha17 . Though the Dravyaguna Vijnana translates madhu meha to ‘diabetes’ in general18, here we use it to mean the vataja type 1 diabetes.

The majority–90%–of cases of diabetes mellitus is type 2 diabetes.  In type 2, formerly known as ‘non-insulin-dependent diabetes mellitus’, the pancreas continues to produce insulin, but the body develops a resistance to it19. When sugar enters the bloodstream, insulin also rises to help carry the glucose into cells. If a diet is high in sugar, then over time more and more insulin is needed to complete this transfer. Dr. John Douillard writes on LifeSpa.com: “Normally just one unit of insulin is needed to deliver 10 mg of glucose into the cell, but as the blood sugars stay chronically high, it can eventually take 10 units of insulin to deliver the same 10 mg of glucose into the cell.”20
Iksu meha translates from Sanskrit as ‘sugar urine’. It is so named for the extra sweet nature of the urine, caused by the excess glucose being flushed from the body. This is the classical Ayurvedic description of type 2 diabetes, which is seen as a vitiation of kapha dosha21.

One of the hallmark symptoms of both madhu meha and iksu meha is prameha (polyuria). Dr. Preeti Kishore on MerckManuals.com explains: “When the blood glucose level rises above 160 to 180 mg/dL, glucose spills into the urine”22. This causes the kidneys to excrete additional water to dilute the large amount of glucose. As a result of this excessive urination, abnormal thirst is also a symptom of diabetes mellitus. Other indications include weight loss, excessive hunger, blurred vision, nausea, drowsiness, and decreased endurance23.

Disease management using herbs
The primary long-term effects of poor blood glucose regulation are the result of impaired circulation caused by vascular blockages. Diminished circulation may lead to kidney failure, blindness and neuropathy24. Because madhu meha is an auto-immune disease and classified as a vata vitiation, and iksu meha is caused by obesity and classically seen as a kapha vitiation, they are managed differently. There are similarities however, and so both benefit from taking herbs that help tone the endocrine system (endocrine tonics), reduce blood glucose (hypoglycemic), and increase circulation (circulatory stimulants).  Bitter and astringent herbs are also important in treating iksu meha. The following are some herbs that have been used to help regulate blood glucose level and aid in the management of hypoglycemia, madhu meha and iksu meha.

Gurmar
Gurmar (gymnena sylvestre), specifically the leaf, has an astringent quality and is one of the primary herbs used in Ayurvedic medicine to treat blood glucose imbalances such as madhu meha, especially during the initial onset of the disease, and to prevent it from worsening. It’s also proven useful in swaying sugar dependency, thus helping to reduce excessive blood glucose levels. Its Sanskrit name, madhunashini, translates to “what destroys the sweet taste”25. In their book ‘The Yoga of Herbs’, Doctors David Frawley and Vasant Lad explain that gurmar “counters our cravings for sugar, dulling the taste buds, and soothing the nerves. It helps control the appetite and reduce sugar cravings. It calms and soothes the liver and pancreas.”26  

This herb has an active component called gymnemic acid that has been found to successfully decrease glucose absorption, thus aiding in weight loss. There are also elements of this herb that prevent the accumulation of triglycerides in the liver and muscles, and help to decrease the accumulation of fatty acid in the circulatory system27. While these are beneficial side effects that help reduce the accumulation of kapha dosha associated with iksu meha, the other effects of the herb–dulling of the taste buds, reduction of sugar cravings–diminish the amount of sugar ingested, thus decreasing its tax on the body in a pre-emptive way.  

Cinnamon
Dr. John Douillard reports that “according to the US Department of Agriculture, cinnamon helped reduce risk factors associated with diabetes and heart disease”28. Despite this claim, cinnamon (cinnamomum zeylanicum), an easily accessible and popular circulatory stimulant and alterative, has yielded mixed results when tested in its efficacy to balance blood glucose levels.

In 2013 a meta-analysis was done to address these conflicting results of past research. (The primary focus of the experiments and research reviewed had been on iksu meha patients.) This meta-analysis, which included a total of 543 participants who had been administered varying doses of cinnamon, concluded that the ingestion of cinnamon lead to significant statistical decreases in fasting blood glucose levels29.

Two such studies support these findings.

In 2003, 30 men and 30 women with iksu meha were divided randomly, some given cinnamon, the others a placebo. After 40 days, those in the placebo group showed no change in their blood glucose levels while the cinnamon showed to have reduced fasting blood glucose levels–as well as reduced triglyceride levels, LDL cholesterol and total cholesterol–in the treatment group. This study concluded that the inclusion of cinnamon in the diet of those suffering from iksu meha would help reduce the risk factors associated with this disease30.

A similar study was performed in 2012 with 44 participants and the results were on par; after eight weeks of taking three grams of cinnamon per day, fasting blood glucose levels in those in the placebo group were unaffected while those in the treatment group showed a significant reduction31.

In 2011 a group of researchers at Mahidol University in Bangkok did a similar meta-analysis that yielded different results than those in the 2013 review. After identifying and statistically comparing nine randomized placebo-controlled trials with almost 500 participants total, they found no evidence that cinnamon helped control blood glucose levels. Their calculations did, however, substantiate that fenugreek may prove effective in doing so32.

Fenugreek
Fenugreek (trigonella foenum-graecum) has been cited in both Ayurvedic and Traditional Chinese Medicine texts as being useful in the treatment of madhu meha and iksu meha.  The seeds in particular have an affinity for regulating insulin33. Meta-analysis of 10 western clinical trials moderately supports this therapy, though the researchers report that a more “well characterized fenugreek preparation of sufficient dose are needed to provide more conclusive evidence.”34
It is the bitter nature of fenugreek that is beneficial, as bitter herbs are useful in reducing fat and regulating glucose metabolism. In this way fenugreek is helpful in such conditions as diabetes35.

Aloe Vera
Another bitter tonic that has been shown in clinical trials to be valuable in the regulation of blood glucose levels in iksu meha is aloe vera. Aloe regulates sugar and fat metabolism36. A study completed in Iran analyzed the results of 85 studies (18 human and 67 animal) that measured the efficacy of glucose lowering abilities of medicinal plants. The findings placed aloe vera at the top of the list37.

Shallijit
Shallijit is described in The Yoga of Herbs as “one of the wonder medicines of Ayurveda… It is not an herb, but a kind of natural mineral pitch from the Himalayas and carries the healing power of these great mountains… [It] possess great curative powers and is considered capable of treating many diseases…including diabetes…”38 As an endocrine tonic, shallijit supports the pancreas in insulin secretion and so is beneficial in treating both madhu meha and iksu meha.

Jambu
Though less common in the west, jambu (syzygium cumini) is cited in the Dravyaguna Vijnana as being, “an esteemed drug for diabetes mellitus...one of the important anti-diabetic drugs studied”39. The fruit is sometimes used, however, it’s the seeds that really prove an effective hypoglycemic agent. They are recommended to be taken orally in powder form as a single drug or as part of an herbal anti-diabetic formula. In either form of administration, the seeds’ power is useful to reduce blood and urine sugar in diabetes40.

Herbal anti-diabetic and blood glucose stabilizing formulas can easily be found at reputable herbal pharmacies or can be created at home using well-sourced herbs. One such formula, designed and sold by Dr. John Douillard includes gurmar (leaf), fenugreek (seed), cinnamon (bark) and shallijit, each of which have been discussed here as valuable herbs in the treatment of blood glucose related diseases.    

Diet & Lifestyle
Besides the use of ‘plant drugs’, the Caraka Samhita stresses dietary regulation in the treatment of these diseases. It also prescribes baths and physical exercise in their management41. More so than in herbal treatment, madhu meha and iksu meha differ in how they’re managed using diet and lifestyle.  

It’s important when treating madhu meha Ayurvedically that the patient also be working with a western medical doctor to receive insulin injections. As it is a vata-type disease, a vata reducing diet and lifestyle should be strictly maintained. Western doctors encourage the same, suggesting adherence to routines, especially around eating. The Mayo Clinic maintains, “Healthy eating is a cornerstone of any diabetes management plan. But it's not just what you eat that affects your blood sugar level. How much you eat and when you eat matters, too”42. It is recommended that patients follow a traditional diabetic diet, eating the right mix of vegetables, fruits, proteins, fats and starches at each meal, and to be extra mindful of taking in the same amount of carbohydrates at every meal and snack because of its effects on blood glucose levels. Small meals at regular intervals are the best way to keep blood glucose levels in check. If there’s weight loss, tonifying foods such as nuts, bone marrow, whole grains and meat should be emphasized43.

Exercise can help because of the way it improves the body’s response to insulin44, though caution should be taken to avoid anything too strenuous; gentle or restorative yoga is optimal. Meditation and yoga nidra are also recommended because of their grounding, stabilizing and rejuvenative power. Mantra can be used as a form of meditation, reciting the bija sounds of  ‘lam’ (Muladhara chakra) and ‘vam’ (Svadhisthana chakra) to reduce the light, mobile quality of vata and increase the denser, heavier qualities of earth and water. Oil therapies such as abhyanga and shirodhara are worthwhile as they reduce stress and build ojas. Vata-pacifying aromas such as sandalwood, cinnamon, rose and lavender can be added to the oil for potency.  

People suffering from iksu meha can benefit greatly from Ayurvedic treatments. As it is a kapha vitiation, diet should be light and should emphasize the bitter and astringent tastes so as to support weight loss45. A nutritious balance to any meal is 50% vegetables, 25% protein, and 25% whole grain or healthy starches46. Fruit, though full of important vitamins, is high in sugar and so should be eaten minimally, especially dried fruit as the drying process concentrates the sugar content47. Along with the bitter herbs discussed in the last section, pungent spices such as ginger, oregano, turmeric and basil can be added to food.  If possible, patients should complete a Pancha Karma treatment to purify their tissue and remove the toxins that block the glucose from entering the cells.

Besides weight loss, vigorous exercise is a wonderful way to reduce blood glucose levels as it makes cells more receptive of glucose; glucose passes more readily through the cell membrane when we exercise. The more strenuous the activity, the longer the effects last48. Invigorating pranayama practices like surya bhedana and kapalabhati are valuable because of their capacity to increase circulation. Abhyanga can be productive, though dry powders should be used to increase stimulation. Both circulation and stimulation are also enhanced by spicy scents such as clove, patchouli, cedar and eucalyptus.

Conclusion
Maintaining homeostasis of blood glucose levels is a complex process involving the release and use of insulin to carry glucose out of the blood stream and into cells. Imbalance and disease occur when the pancreas is unable to produce enough insulin to support the movement of glucose from the blood to the cells, when the body builds up a resistance to insulin, or when the cell receptor sites become blocked and no longer allow glucose to pass through. Hypoglycemia, madhu meha (type 1 diabetes mellitus) and iksu meha (type 2 diabetes mellitus) are conditions associated with the imbalance of blood glucose levels.

Herbs have proven to be effectual in the management and stabilization of blood glucose levels as well as in treatment of madhu meha and iksu meha. This paper highlighted a select sample of those that have garnered attention for their usefulness in this therapy.  

Though cinnamon is a widely accepted ‘plant drug’ used to regulate blood glucose levels, statistical findings are rather inconclusive in its efficacy as it pertains to these two diseases. It does, however, hold enough character to be regarded as beneficial in stabilizing blood glucose in those prone to episodes of hypoglycemia. While doing research for this paper, clinical trial reports and meta-analytical reviews on herbal treatments for hypoglycemia were not found to be as prevalent in the public databases.

Because madhu meha is an auto-immune disease, herbs act more as a support to western treatment than as a treatment in an of themselves. Fenugreek shows to aid in insulin regulation, and shallijit supports the pancreas by its endocrine tonifying tendencies.

With regards to the herbs discussed in this paper, iksu meha is more versatile in its response to herbal remedies. Gurmar is favourable because it counters sugar cravings and decreases glucose absorption. Fenugreek is a successful medicine because of its ability to metabolize fat. Similarly, aloe metabolizes fat and also regulates sugar.  

Shallijit’s ability to support the pancreas benefits those who suffer from iksu meha as well as madhu meha. Though no reported research on jambu was reviewed, it has long been esteemed for its hypoglycemic action and so is useful in reducing blood glucose in those who either cannot produce enough insulin naturally or for those who have build up a tolerance to it.

Scientific measurement proves that herbs can successfully assist in the treatment of these diseases, but changing dietary and lifestyle habits are paramount. By reducing and/or eliminating those physical, mental and emotional behaviours, as well as addressing the mental, emotional and spiritual beliefs that lead to an imbalance in the first place, herbs become a complementary support to a greater Ayurvedic treatment plan that affects wellness and healing on every level of our being.

End Note References

[1] John Douillard’s LifeSpa, John Douillard, DC, The Not-So-Sweet History of Sugar Part II. http://www.lifespa.com/not-so-sweet-history-sugar-part-ii.html

[2] Center for Disease Control and Prevention, CDC Staff, 2011 National Diabetes FactSheet. http://www.cdc.gov//diabetes/pubs/estimates11.htm

[3] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 6.

[4] Gerard J. Tortora & Bryan Derrickson, Principles of Anatomy & Physiology 13th Edition (John Wiley & Sons, Inc., 2012), 709.

[5] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 5.

[6] Mayo Clinic, Nancy Klobassa Davidson, RN, Know Your Blood Glucose Target Range. http://www.mayoclinic.org/diseases-conditions/diabetes/expert-blog/blood...

[7] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 11.

[8] VJ Bjornholt, G Erikssen, E Aaser, et al. “Fasting Blood Glucose: An Underestimated Risk Factor for Cardiovascular Death. Results from a 22-Year Follow-Up of Healthy Nondiabetic Men.” Diabetes Care (January 1999): 45-49

Abstract: Because of the available conflicting epidemiological data, we investigated the possible impact of fasting blood glucose as a risk factor for cardiovascular death in nondiabetic men. This study reports the results from a 22-year prospective study on fasting blood glucose as a predictor of cardiovascular death.  Of the 1,998 apparently healthy nondiabetic men (aged 40-59 years), a total of 1,973 with fasting blood glucose < 110 mg/dl were included in the study in which also a number of conventional risk factors were measured at baseline.  After 22 years of follow-up, 483 men had died, 53% from cardiovascular diseases. After dividing men into quartiles of fasting blood glucose level, it was found that men in the highest glucose quartile (fasting blood glucose > 85 mg/dl) had a significantly higher mortality rate from cardiovascular diseases compared with those in the three lowest quartiles. Even after adjusting for age, smoking habits, serum lipids, blood pressure, forced expiratory volume in 1 s, and physical fitness (Cox model), the relative risk of cardiovascular death for men with fasting blood glucose > 85 mg/dl remained 1.4 (95% CI 1.04-1.8). Noncardiovascular deaths were unrelated to fasting blood glucose level.
Fasting blood glucose values in the upper normal range appears to be an important independent predictor of cardiovascular death in nondiabetic apparently healthy middle-aged men.

[9] Merck, Preeti Kishore, MD, Hypoglycemia. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet...

[10] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3.57-58.
[11] Merck, Preeti Kishore, MD, Hypoglycemia. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet...

[12] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3-60.

[13] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet...

[14] Gerard J. Tortora & Bryan Derrickson, Principles of Anatomy & Physiology 13th Edition (John Wiley & Sons, Inc., 2012), 721.

[15] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet...

[16] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet...

[17] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3-40.

[18] Dr. Gyanendra Pandey, Dravyaguna Vijnana (Materia Medica – Vegetable Drugs), Vol. I, (Chowkhamba Krishnadas Academy, 2005), 910.

[19] Gerard J. Tortora & Bryan Derrickson, Principles of Anatomy & Physiology 13th Edition (John Wiley & Sons, Inc., 2012), 721.

[20] John Douillard’s LifeSpa, John Douillard, DC, Western Docs Are Not Prescribing This Critical Test! http://www.lifespa.com/western-docs-are-not-prescribing-this-critical-te...

[21] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3-39.

[22] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet...

[23] Merck, Preeti Kishore, MD, Diabetes Mellitus. http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/diabet...

[24] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3-42.

[25] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 243.

[26] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 243.
[27] R Pothuraju, RK Sharma, J Chaggalamari, et al. “A Systemic Review of Gymnema Sylvester in Obesity and Diabetes Management.” Journal of the Science of Food and Agriculture (March 2014): 834-840.
Abstract: The prevalence of obesity is associated with many health-related problems. Currently, more than 300 million people are considered to be obese. According to the World Health Organization (WHO), by 2030, 87 and 439 million people will be affected in India and the world, respectively. Today, herbal medicines are gaining interest in the treatment of obesity and diabetes, because of their minimal side effects. Gymnemic acid - an active component isolated from Gymnema sylvestre - has anti-obesity and antidiabetic properties, decreases body weight and also inhibits glucose absorption. Several components extracted from Gymnema prevent the accumulation of triglycerides in muscle and liver, and also decrease fatty acid accumulation in the circulation. In this paper, an attempt has been made to review the effects of various extracts from Gymnema sylvestre in the regulation of carbohydrate and lipid metabolism in both animal and clinical studies.
[28] John Douillard’s Life Spa, Jouhn Douillard, DC, Have a Cinnamon Holiday Season! http://lifespa.com/have-a-cinnamon-holiday-season.html
[29] RW Allen, E Schwartzman, WL Baker, et al. “Cinnamon Use in Type 2 Diabetes: An Updated Systematic Review and Meta-Analysis”. The Annals of Family Medicine (September/October 2013): 452-459
Abstract: Cinnamon has been studied in randomized controlled trials (RCTs) for its glycemic-lowering effects, but studies have been small and show conflicting results. A prior meta-analysis did not show significant results, but several RCTs have been published since then. We conducted an updated systematic review and meta-analysis of RCTs evaluating cinnamon’s effect on glycemia and lipid levels.  MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched through February 2012. Included RCTs evaluated cinnamon compared with control in patients with type 2 diabetes and reported at least one of the following: glycated hemoglobin (A1c), fasting plasma glucose, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), or triglycerides. Weighted mean differences (with 95% confidence intervals) for endpoints were calculated using random-effects models.  In a meta-analysis of 10 RCTs (n = 543 patients), cinnamon doses of 120 mg/d to 6 g/d for 4 to 18 weeks reduced levels of fasting plasma glucose (−24.59 mg/dL; 95% CI, −40.52 to −8.67 mg/dL), total cholesterol (−15.60 mg/dL; 95% CI, −29.76 to −1.44 mg/dL), LDL-C (−9.42 mg/dL; 95% CI, −17.21 to −1.63 mg/dL), and triglycerides (−29.59 mg/dL; 95% CI, −48.27 to −10.91 mg/dL). Cinnamon also increased levels of HDL-C (1.66 mg/dL; 95% CI, 1.09 to 2.24 mg/dL). No significant effect on hemoglobin A1c levels (−0.16%; 95%, CI −0.39% to 0.02%) was seen. High degrees of heterogeneity were present for all analyses except HDL-C (I2 ranging from 66.5% to 94.72%).  The consumption of cinnamon is associated with a statistically significant decrease in levels of fasting plasma glucose, total cholesterol, LDL-C, and triglyceride levels, and an increase in HDL-C levels; however, no significant effect on hemoglobin A1c was found. The high degree of heterogeneity may limit the ability to apply these results to patient care, because the preferred dose and duration of therapy are unclear.
[30] A Khan, M Safdar, MMA Khan, et al. “Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes”. Diabetes Care Journal (December 2003) 3215-3218.
Abstract: The objective of this study was to determine whether cinnamon improves blood glucose, triglyceride, total cholesterol, HDL cholesterol, and LDL cholesterol levels in people with type 2 diabetes.  A total of 60 people with type 2 diabetes, 30 men and 30 women aged 52.2 ± 6.32 years, were divided randomly into six groups. Groups 1, 2, and 3 consumed 1, 3, or 6 g of cinnamon daily, respectively, and groups 4, 5, and 6 were given placebo capsules corresponding to the number of capsules consumed for the three levels of cinnamon. The cinnamon was consumed for 40 days followed by a 20-day washout period.  After 40 days, all three levels of cinnamon reduced the mean fasting serum glucose (18–29%), triglyceride (23–30%), LDL cholesterol (7–27%), and total cholesterol (12–26%) levels; no significant changes were noted in the placebo groups. Changes in HDL cholesterol were not significant.  The results of this study demonstrate that intake of 1, 3, or 6 g of cinnamon per day reduces serum glucose, triglyceride, LDL cholesterol, and total cholesterol in people with type 2 diabetes and suggest that the inclusion of cinnamon in the diet of people with type 2 diabetes will reduce risk factors associated with diabetes and cardiovascular diseases.
[31] M Vafa, F Mohammadi, F Shidfar, et al. “Effects of Cinnamon Consumption on Glycemic Status, Lipid Profile and Body Composition in Type 2 Diabetic Patients”. International Journal of Preventative Medicine (August 2012): 531-536.
Abstract: Type 2 diabetes is the most common metabolic disorder worldwide. Traditional herbs and spices can be used to control blood glucose concentrations. The objective of this study was to evaluate the effects of the daily intake of three grams cinnamon over eight weeks on glycemic status, lipid profiles and body composition in type 2 diabetic patients.  A double blind, randomized, placebo controlled clinical trial was conducted on 44 patients with type 2 diabetes. Participants were randomly assigned to take either a three g/ day cinnamon supplement (n=22) or a placebo (n=22) for eight weeks. Weight, height, body fat mass and systolic and diastolic blood pressure were measured at baseline and after intervention. The fasting blood glucose, insulin, HbA1c, total cholesterol, LDL C, HDL C, Apo lipoprotein A I and B were measured at baseline and endpoint.  From 44 subjects participated in this study 37 completed the study. There were no significant differences in baseline characteristics, dietary intake and physical activity between groups. In the treatment group, the levels of fasting blood glucose, HbA1c, triglyceride, weight, BMI and body fat mass decreased significantly compared to baseline, but not in placebo group. No significant differences were observed in glycemic status indicators, lipid profile and anthropometric indicators between the groups at the end of intervention.  These data suggest that cinnamon may have a moderate effect in improving glycemic status indicators.
[32] N Suksomboon, N Poolsup, S Boonkaew, et al. “Meta-Analysis of the Effect of Herbal Supplement on Glycemic Control in Type 2 Diabetes.” Journal of Ethnopharmacology (October 2011): 1328-1333.

Abstract: A variety of herbs have been used in traditional medicine for the treatment of diabetes. However, evidence is limited regarding the efficacy of individual herbs for glycemic control. We performed a systematic review and meta-analysis to evaluate the effect of herbal supplement on glycemic control in type 2 diabetes.  Randomized controlled trials were identified through electronic searches (MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials) up until February 2011, historical searches of relevant articles and personal contact with experts in the area. Studies were included in the meta-analysis if they were (1) randomized placebo-controlled trial of single herb aimed at assessing glycemic control in type 2 diabetes, (2) of at least 8 weeks duration, and (3) reporting HbA(1c). Treatment effect was estimated with mean difference in the final value of HbA(1c) and FBG between the treatment and the placebo groups.  Nine randomized, placebo-controlled trials (n = 487 patients) were identified. Ipomoea batatas, Silybum marianum and Trigonella foenum-graecum significantly improved glycemic control, whereas Cinnamomum cassia did not. The pooled mean differences in HbA(1c) were -0.30% (95% CI -0.04% to -0.57%; P = 0.02), -1.92% (95% CI -0.51% to -3.32%; P = 0.008), and -1.13% (95% CI -0.11% to -2.14%; P = 0.03), respectively, for Ipomoea batatas, Silybum marianum, and Trigonella foenum-graecum. The corresponding values for FBG were -10.20mg/dL (95% CI -5.32 mg/dL to -15.08 mg/dL; P<0.0001) and -38.05 mg/dL (95% CI -9.54 mg/dL to -66.57 mg/dL; P = 0.009), respectively, for Ipomoea batatas and Silybum marianum.  The current evidence suggests that supplementation with Ipomoea batatas, Silybum marianum, and Trigonella foenum-graecum may improve glycemic control in type 2 diabetes. Such effect was not observed with Cinnamomum cassia. Given the limitations of the available studies and high heterogeneity of the study results for milk thistle and fenugreek, further high quality, large controlled trials using standardized preparation are warranted to better elucidate the effects of these herbs on glycemic control in type 2 diabetes patients.

[33] M Tierra, CA, ND, Planetary Herbology (Lotus Press, 1988) 301-302.

[34] N Neelakantan, M Narayanan, RJ de Souza, et al. “Effect of Fenugreek (Trigonella foenum-graecum L.) Intake on Glycemia: A Meta-Analysis of Clinical Trials.” Nutrition Journal (January 2014): 13-17.

Abstract: Fenugreek is a herb that is widely used in cooking and as a traditional medicine for diabetes in Asia. It has been shown to acutely lower postprandial glucose levels, but the long-term effect on glycemia remains uncertain.  We systematically reviewed clinical trials of the effect of fenugreek intake on markers of glucose homeostasis. PubMed, SCOPUS, the Cochrane Trials Registry, Web of Science, and BIOSIS were searched up to 29 Nov 2013 for trials of at least 1 week duration comparing intake of fenugreek seeds with a control intervention. Data on change in fasting blood glucose, 2 hour postload glucose, and HbA1c were pooled using random-effects models.  A total of 10 trials were identified. Fenugreek significantly changed fasting blood glucose by -0.96 mmol/l (95% CI: -1.52, -0.40; I² = 80%; 10 trials), 2 hour postload glucose by -2.19 mmol/l (95% CI: -3.19, -1.19; I² = 71%; 7 trials) and HbA1c by -0.85% (95% CI: -1.49%, -0.22%; I² = 0%; 3 trials) as compared with control interventions.  The considerable heterogeneity in study results was partly explained by diabetes status and dose: significant effects on fasting and 2 hr glucose were only found for studies that administered medium or high doses of fenugreek in persons with diabetes. Most of the trials were of low methodological quality.  Results from clinical trials support beneficial effects of fenugreek seeds on glycemic control in persons with diabetes. However, trials with higher methodology quality using a well characterized fenugreek preparation of sufficient dose are needed to provide more conclusive evidence.

[35] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 56.

[36] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 100.

[37] AA Rashidi, SM Mirhashemi, M Taghizadeh, et al. “Iranian Medicinal Plants For Diabetes Mellitus: A Systemic Review.” Pakistan Journal of Biological Science (May 2013): 401-411.
Abstract: In the Iranian traditional medicine a significant usage of herbs is promoted for their anti-diabetic activity. The aim of this review to assess the efficacy of glucose lowering effects of medicinal plants cultivated in Iran. An electronic literature search of MEDLINE, Science Direct, EMBASE, Scopus, Web of Science, Cochrane Library Database, Ebsco and Google Scholar from database inception conducted up to May 2012. A total of 85 studies (18 humans and 67 animals) examining 62 plants were reviewed. The quality of Randomized Controlled Trials (RCTs) assessed by using the Jadad scale. Among the RCTs studies, the best results in glycemic control was found in Aloe vera, Citrullus colocynthus, Plantago ovata, Silybum marianum, Rheum ribes and Urtica dioica. The majority of plants that have been studied for antidiabetic activity showed promising results.

[38] Dr. David Frawley & Dr. Vasant Lad, The Yoga of Herbs (Lotus Press, 2008), 250-251.

[39] Dr. Gyanendra Pandey, Dravyaguna Vijnana (Materia Medica – Vegetable Drugs), Vol. I, (Chowkhamba Krishnadas Academy, 2005), 826.

[40] Dr. Gyanendra Pandey, Dravyaguna Vijnana (Materia Medica – Vegetable Drugs), Vol. I, (Chowkhamba Krishnadas Academy, 2005), 826.

[41] PV Sharma, Caraka Samhita, Vol II (Chaukhamba Orientalia, 1983), 118.

[42] Mayo Clinic, Mayo Clinic Staff, Diabetes Management: How Lifestyle & Daily Routine Affect Blood Sugar. http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes...

[43] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3-44.

[44] Mayo Clinic, Mayo Clinic Staff, Diabetes Management: How Lifestyle & Daily Routine Affect Blood Sugar. http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes...

[45] Dr. Marc Halpern. Clinical Ayurvedic Medicine 6th Edition. (California College of Ayurveda, 2012), 3-46.

[46] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 9.

[47] John Douillard, DC, Blood Sugar Secrets for Health and Longevity ebook (LifeSpa ProductsTM, 2013), 20.

[48] Mayo Clinic, Mayo Clinic Staff, Diabetes Management: How Lifestyle & Daily Routine Affect Blood Sugar. http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes...