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Anti-diabetic role of herbal preparations
The rapidly spreading disease diabetes mellitus is becoming a serious threat to human health in all parts of the world. Estimates indicate that there are approximately 150 million diabetics worldwide.
With respect to the relentless proliferation of people with Type II diabetes, it is alarming to note that their number is expected to double by 2025. Sadly, it has never been reported that a patient had recovered from the disease, while chemical and biochemical agents have only been successful in controlling diabetes and complications associated with it.
Despite advances in the understanding and management of the disease, rates of mortality and morbidity continue to be on the rise. People suffering from diabetes face a reduction in their life expectancy and have to make compromises vis-à-vis quality of life as well.
Diabetes mellitus is a chronic disease that requires long-term medical attention, both to prevent and to treat its devastating macro- and micro-vascular complications. It is estimated that up to 70 per cent of the patients suffering from acute myocardial infarction either have diabetes or impaired glucose tolerance.
Drugs that are clinically used to treat diabetes can be mainly divided into insulin, insulin-secretagogues, insulin sensitivity improvement factor, insulin-like growth factor, aldose reductase inhibitor, a-glucosidase inhibitor and protein glycation inhibitor. Almost all of these are chemical and biochemical in nature.
The drugs only aim at lowering the level of glucose in blood. In most cases patients taking these drugs suffer from severe side effects, such as hypoglycemia, lactic acid intoxication and gastrointestinal problems.
Diet has stood as the cornerstone of treating diabetes for a long, long time. The Ebers Papyrus (1550 BC) prescribed a diet rich in wheat germ and ochra, both of which have subsequently been shown to exert glucose-lowering efficacy.
Regarding Chinese traditional medicines, herbal components can be divided into four groups, where the effectiveness of the principal herb is aided by the supporting ones. In the four-herb combinations, any change in composition (such as one ingredient varying while the others remaining the same, different proportions of herbs or the usage of different imperial/ministerial herbs) induces various kinds of pharmacological actions.
Although clinical and biochemical hypoglycemic agents (for instance, insulin, tolbutamide, phenformin, troglitazone, rosigitazone and repaglinide) form the basis of treatment and are effective in controlling hyperglycemia, they have prominent side effects. They also fail to significantly alter the course of complications.
On the other hand, natural drugs from traditional herbal medicines are gaining popularity because of several advantages, such as fewer side effects, better patient tolerance and less cost. The principal reason is that natural products, especially herbal medicines, provide rational means for the treatment of many diseases that are obstinate and incurable in other systems of medicine.
Despite the increasing popularity of herbal medicines, many people in the developing world hesitate to go for the traditional mode of treatment. They look at their health and well-being in terms of standards laid down by modern pharmacy gurus
Despite the increasing popularity of herbal medicines, however, many people in the developing world still hesitate to use the traditional mode of treatment. They often look at their health and well-being in terms of standards laid down by modern pharmacy gurus.
Given such a scenario, the primary question that comes to mind is: what should be done to make such people accept herbal medicinal preparations as promising treatment? One way to go about this task is to inculcate traditional medical knowledge among people in the developing countries, by making them understand the more traditional theories.
Another way is to standardize and evaluate herbal medicinal preparations, uncover more scientific and experimental evidence through research work on effective constituents, and prove the benefits of crude over isolated pure forms so that people begin to have faith in the efficacy of herbal preparations.
For herbal preparations that are made from plant extracts, and are often considered to be effective due to a mixture of active ingredients rather than a single constituent, standardization is found to be exceedingly difficult. Furthermore, there exists a grave possibility of losing active principals. As a result, serious questions can be raised about the methods of applying the absolutely essential requirements of standardization.
Herbs contain a complicated mixture of organic chemicals, the levels of which may vary substantially depending upon many factors related to the environment, growth, production and processing of the herbal product. Although herbs are also believed to be natural and therefore safe, many dangerous and lethal side effects have nevertheless been reported, including direct toxic effects, allergic reactions, effects from contaminants and interaction between drugs and other herbs.
Therefore, efforts should be made to guarantee safety by evaluating toxicity and side effects and by ensuring efficacy based upon clinical scientific observations.
With respect to understanding the effectiveness of herbal medicine in treating Type II diabetes mellitus (T2DM), it is absolutely imperative to first understand the various stages of the disease. T2DM can be divided into three stages, as under:
— Slow and long-term onset of the disease due to the involvement of some known and unknown factors present either individually or in combined form;
— Crossing of the effects over the pathological threshold levels, that is, the occurrence of the disease, and;
— Long-term gradual increase in complications arising from the disease.
The first stage stands as the most crucial one, as it cannot be treated with modern allopathic medicines, due to its targeted mode of action. Alternatively, herbal preparations serve as the best option due to their modulation role and relatively minimal amount of side effects, even in the absence of the target, because the human body is better able to tolerate natural agents rather than synthetic ones.
Research on drug discovery and development must continue worldwide to identify and improve upon the efficacy of herbal medicines, both singly and in combination of active ingredients, active fractions and active prescriptions for herbal formulations. For example, 60mg of Valeriana when combined with 40mg of Humulus has the same potency as 400mg of Valeriana extract alone.
In Pakistan, where a big proportion of the population lives below the internationally defined poverty level, middle-class people cannot afford the costly treatment of diabetes. On the other hand, there is a rush of promotions and advertisements relating to anti-diabetic herbal preparations. As a result, most patients go for substandard and unreliable herbal preparations.
A large number of scientific works have been undertaken in this regard and many plants have been reported to possess anti-diabetic activity. But the data is insufficient to develop a drug.
Therefore, the need of the hour is to undertake in-depth evaluation, standardization and safety profile of this mode of treatment, especially for the underprivileged citizens in developing countries, and for the humanity at large.
Dr Anwar Waqar is an HEC-designated distinguished national professor and Sohail Shaukat a PhD scholar
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