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Perspectives on Blood Sugar Control
By Dr. Michael Friedman
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Section I Importance of Glycemic Control in NIDDM
Section II Assessment of Pharmacological Agents
Section III Holistic Perspective on NIDDM
Section IV A Review of Organ Systems within a Holistic Perspective
Section V Use of Diab-Aid as a Natural Therapeutic for the Treatment of NIDDM, Hyperinsulinemia, Hypoglycemia

CONTENTS

Perspective on Blood Sugar Control Use of DIAB-AID as a Natural Therapeutic and Treatment of NIDDM.
Hypoglycemia Herbal Remedies Focus on Blood Sugar Regulators
Hypoglycemia Herbal Remedies Focus on Blood Sugar Regulators
Clinical Results on DIAB-AID (Incl. Notes or Reference to Pharmacological Drugs).
Monographs Extracts used to formulate Diab-Aid.

Section I Importance of Glycemic Control

In the United States about 5.2 percent of the population has diabetes, which are a total of about 13 million people. 90% of them have non-insulin dependent diabetes (NIDDM). Despite the use and advance of pharmaceutical drugs for NIDDM in the last 30 years, less than 25% of these patients are able to achieve Normal glycosylated hemoglobin levels, regardless of the mode of treatment.

Elevated glycosylated hemoglobin and poor glycemic control are associated with increased mortality. Thus, if mortality due to diabetes is to be decreased, advances in new treatment for it and its complications are necessary. In the recently published UK Prospective Study, levels of glycemic control and its relationship to secondary complications were assessed. The study found that with good glycemic control, patients were able to achieve a decrease in microvascular complications, but not a decrease in macrovascular complications.

This study has been criticized for underestimating the benefits of decreased macrovascular complications due to the limits of the effective therapies available.

The UK Study put people with tight control blood sugar levels, with an HbA1c level of 7.0% into the intensive group, and put patients with HbA1c values up to 7.9% into the control group. The control group was treated with diet alone; this suggests that therapies with diet only are not nearly as effective as those that use combinations of pharmaceutical agents and diet. The intensive group had an 11% decrease in glycosylated hemoglobin which was associated with: a 12% decrease in diabetic related endpoints, mostly due to a baseline microvascular decrease, a 10% decrease in diabetic related deaths, a 6% decrease in all cause mortality, and a 25% decrease in microvascular endpoints, mostly due to a decrease in retinal photocoagulation. Thus, an 11% decrease in HbA1c levels showed a marked decrease in diabetic complications in NIDDM. They found that even a 1% decrease in HbA1c values marked a significant difference between the control and intensive group in secondary complications. However, due to the side effects of pharmacological agents, the intensive group had a higher risk of hypoglycemic episodes.

The UK Study evaluated 4,075 newly diagnosed patients with NIDDM. All the patients were put on a low fat, high complex carbohydrate, high fiber diet. These patients were then divided into two groups: diet therapy alone, and diet therapy plus one pharmaceutical agent (mono-therapy). They found that after nine years of analysis, the group that used pharmaceutical agent plus diet were two to three times as likely to achieve 7.0% HbA1c values then patients on diet therapy alone. The target level of the study was to be below 7.0% HbA1c, or less than 7.8 mmol/L (140 mg/dL). They analyzed the HbA1c values of these patients after three, six and nine years. After nine years, 8% of patients treated with diet were able to achieve this level, 24% were able to achieve this with diet and sulfonylurea pharmacological agents, and 42% were able to achieve this with diet and insulin. It is important to take into consideration that insulin is effective in Type II patients when they are thin and insulin deficient. Only 10% of NIDDM patients are thin. The study also demonstrated that over time the ability to control blood sugar levels progressively deteriorates. After three years only 50% of patients were able to achieve levels of HbA1c under 7.0% with a mono-therapy; and after nine years only 25% were able to achieve this level.

Patients have a poor response to mono-therapy. Studies have found that combination drug therapy is more effective than mono-therapy. For example a study using Metformin and Troglitazone had further decreased fasting and postprandial plasma glucose concentrations by 18% in comparison to mono-therapy.

It is time for both patients and physicians to realize that combination therapy should include the use of natural therapeutics as well. The preliminary. Diab-Aid study indicated patients who used pharmacological agents and natural therapeutics in combination had significantly decreased fasting blood sugar levels compared to patients who used pharmacological agents alone.

Section II: Assessment of Pharmacological Agents

Insulin is one type of pharmacological agent used in NIDDM. 80% of the cell membranes in the body become highly permeable to glucose within seconds of insulin binding to its receptors; rapid entry of glucose ensues which is used in the formation of substrates for metabolism. The advantage of administering insulin to thin diabetic patients is that they respond quite well, and they have decreased microvascular complications. Although the UK study found no correlation, the disadvantages of using insulin in NIDDM patients is that they can have hypoglycemic episodes, which can lead to a coma, or they can have increased risk of macrovascular complications. The use of insulin can cause weight-gain, which is a problem in NIDDM. Only a minority of patients can take insulin, since it’s usually not effective in obese patients.

Sulfonylurea is another pharmacological agent used in NIDDM. It works by stimulating insulin secretion from the beta cells of the pancreas. Following long-term use, it may also affect extra-pancreatic functions such as increased peripheral sensitivity to insulin, and a decreased hepatic glucose production.

Sulfonylureas have the advantage that there are multiple formulations available, which are relatively inexpensive. Their effectiveness was demonstrated in a study with Glimipiride: 5,000 patients with Type II diabetes had a decrease of 43-74 mg/dL more than placebo. The administration of Glyburide also decreased HbA1c values by 1.2-1.9%.

The disadvantage of sulfonylurea use is that after initial success, sulfonylureas are completely ineffective in 30% of patients. Adequate control in the long-term use of sulfonylureas only occurred in about 20-30% of patients.

Primary and secondary failure can occur with all oral agents used in the treatment of NIDDM. One study showed that the rate of death due to heart attack was 2.5 times greater in patients that had used sulfonylureas for the treatment of glycemia than the group that was treated with diet alone. Currently, there are warning labels for cardiac death on all Sulfonylureas and Metformin. However, the UK study found no correlation between increased cardiovascular death and sulfonylurea use. As in insulin therapy, there are many reported deaths due to the use of oral hypoglycemics. Other adverse effects include jaundice, decreased RAI-uptake of the thyroid, weight-gain, chronic hyperinsulinemia, severe insulin resistance, and perhaps beta cell exhaustion.

SIADH (syndrome of inappropriate anti-diuretic hormone secretion) can also occur in the use of Sulfonylureas. This side-effect is manifested by water-retention and hyponatremia. Since many diabetic patients have edema due to nephropathy, pharmacological agents must be ruled out as another cause of the edema in these patients. One patient in the Diab-Aid study with diabetic nephropathy lost all edema in her legs after discontinuation of Glyburide (a sulfonylurea drug). Sulfonylureas are contra-indicated in liver, kidney, and thyroid disease.

Metformin, a Biguinide, is a pharmacological agent developed within the last few years. Its mechanism is believed to potentiate insulin and increase insulin receptor sites, independent of pancreatic function. It also leads to weight-loss, which may be another contributing factor in its mechanism. Its effectiveness has been demonstrated in pharmacological studies. 228 patients had a HbA1c value of 9.43%. After three months it went down to 8.7%, after six months to 8.3%, and after nine months to 8.72%. Notice the slight rise in HbA1c value after long-term administration of metformin. Metformin is often prescribed following secondary failure of Sulfonylureas; however, many physicians find this to be rarely effective. The most common side-effect of Metformin is diarrhea. It also decreases absorption of vitamin B12 and folic acid. It is important to note that patients with diabetic neuropathy may have symptoms associated with both diabetes and a B12 deficiency due to the use of Metformin. Metformin is contra-indicated in kidney disease. It is important to determine whether the hyperglycemia or the pharmacological agent will present more problems to a patient with diabetic nephropathy. A rare fatal complication of Metformin is lactic acidosis.

A newly developed pharmacological agent used in the treatment of NIDDM is an alpha-glucosidase inhibitor. It works in the small intestine by delaying postprandial glucose absorption by inhibiting the enzyme glucosidase. In a study of 1,027 patients given alpha-glucosidase inhibitors, a significant decrease in blood sugar levels was found. However, one-third of the patients could not take the drug for one year due to gastrointestinal side-effects. Thus, it has marginal clinical relevance. The disadvantage of this drug is that it is costly and has many side-effects.

Pharmacological drugs have been demonstrated to be effective in decreasing glycosylated-hemoglobin, and in the complications of diabetes. However, great improvement still needs to be made in the ability of patients to achieve tight control of blood-sugar levels. Also, due to the vast amount of side-effects, the use of oral pharmacological agents should be assessed when administering drugs to NIDDM patients. It is important to note that both hyperglycemia and NIDDM pharmacological agents may cause tissue-damage. For example, kidney damage can be caused by hyperglycemia or by the use of Sulfonylureas and Biguinides. Thus, it is important to determine which is more damaging to the patient. Consistent hyperglycemia is toxic to the beta cells of the pancreas. And, there is suspicion that the sulfonylureas are also toxic to the pancreas.

Sulfonylureas are toxic and contra-indicated in patients with liver, thyroid, and kidney disease. It is important to note that these three organs are all involved in diabetes; the liver having its function in producing receptor sites, healthy thyroid function in preventing excessive weight gain, and the kidneys in maintaining blood pressure control.

When kidney function is impaired by hyperglycemia or pharmaceuticals, there is a progressive deterioration of blood pressure control, which is important for diabetics. In the UK study, patients were divided into a tight blood pressure control group, and a less tight control group. The average blood pressure in the tight control group was 144/82, and in the less tight control group 154/87. Some of the tight control group needed three to four pharmacological agents to achieve this blood pressure level. The tight blood pressure control group had a decrease in almost all microvascular complications: a 25% decrease in diabetic related endpoints; a 32% decrease in deaths related to diabetes; a 44% decrease in strokes; and a 39% decrease in microvascular endpoints. The tight control group had a significant difference compared to the less tight control group in a long-term perspective of the patient's life.

Section III - Holistic Perspective on NIDDM

There are many proposed mechanisms in NIDDM, many of which are often overlooked. The modern Western diet, containing highly refined sugars, high amounts of saturated fats, and low amounts of fiber, can contribute to the cause of reactive hypoglycemia.

The intake of refined sugar can lead to a rapid rise in blood sugar levels; this causes the pancreas to secrete insulin sometimes at a level, which can result in hypoglycemia. The adrenals then secrete epinephrine and other stress-hormones to bring blood sugar levels back to normal. If patients continually assault their bodies with this diet, it may result in both pancreatic and adrenal exhaustion.

Obesity is a significant factor in NIDDM, which tends to be hypertrophic and android. Hypertrophic is an enlarged fat cell. Android is abdominal deposition of fat tissue. The deposition of fat tissue on the android is regulated by serum insulin levels and triglycerides. Contributing lifestyle factors to obesity are poor diet and lack of exercise. Obesity may also be associated with suboptimal thyroid function. Incidentally, gluteo-femoral adiposite depositionis usually regulated by corticosteroids and estrogen.

Another postulated mechanism in NIDDM is a problem in oxidative metabolism of glucose. Glucose-metabolism is regulated by pyruvate-dehydrogenase and inhibited by isomers of pyruvate-dehydrogenase kinase. Increased levels of pyruvate-dehydrogenase kinase may cause insulin-resistance in NIDDM patients and increased fatty acid oxidation. Recent studies have found that obesity can cause an insufficient down-regulation of pyruvate-dehydrogenase-kinase-m RNA in people with insulin-resistance. This leads to increased levels of pyruvate-dehydrogenase-kinase, which impairs glucose-oxidation and thus results in increased fatty acid oxidation.

Insulin-resistance is associated with various disorders: polycystic-ovary disease, liver malfunction, cirrhosis and insulinemia. The oxidation of hepatic cell membranes, which occurs in cirrhosis, causes a decrease in liver function, which is associated with the development of diabetes.

Increased abundance of insulin, insulin-like growth factors and hybrid 1receptors are found in muscles of obese patients. An increase of in-vivoinsulin insensitivity has been found in both obese and insulinemic patients. Insulinemia is a precursor to NIDDM by several years. It is an independent risk-factor not only for NIDDM, but also for atherosclerosis. Caloric-restriction, at least in rodents, will decrease insulinemia.

Low-birth weight is a contributing factor for NIDDM. Decreased fetal nutrition can lead to abnormal development of pancreas and adipose tissue, leading to hyperglycemia in adults.

Nitric-oxide deficiency is another commonly overlooked cause of NIDDM. It is found in liver disease. It is a risk-factor for both NIDDM and insulinemia. The mechanism of nitric-oxide deficiency will be discussed later.

Levels of serum-chromium in adult diabetics have been found to be much lower than in non-diabetic subjects. However, no correlation between rate of glycemia and serum chromium levels has been found in diabetics.

Section IV - A Review of Organ Systems Within a Holistic Perspective

Glucose homeostasis and other aspects of blood sugar metabolism are regulated by the pancreas and the counter-regulatory responses of the adrenal gland and liver. The hormones involved include: glucagon, catecholamines, growth hormone and cortisol.

The role of the liver in NIDDM has been demonstrated, in both animal and human studies. Muscaline receptors on hepatic parasympathetic nerves release nitric oxide, which causes the release of Hepatic Insulin Sensitizing Substance (HISS). HISS sensitizes skeletal muscle to absorb insulin. Animal studies have shown that the blockade of nitric oxide release causes a secondary blockade of HISS, which results in insulin resistance. 26 Anti-oxidants can be used to increase nitric oxide and to support the liver. Milk Thistle is a botanical medicine that supports the liver. It contains a mixture of three flavonolignans together called silymarin, which has anti-oxidant properties.

26 Anti-oxidants can be used to increase nitric oxide and to support the liver. Milk Thistle is a botanical medicine that supports the liver. It contains a mixture of three flavonolignans together called silymarin, which has anti-oxidant properties.

Milk Thistle is an effective treatment for patients with diabetes secondary to cirrhosis. In a trial in Italy, 30 diabetic patients were given a regime of conventional therapy plus 600mg of Silymarin, while 30 other patients were given only conventional therapy. After four months, the group who had used 600 mg of silymarin had a decreased fasting glucose, decreased glucosuria, decreased HbA1c value, decreased fasting insulin level and a decreased exogenous insulin requirement. The control group had increased insulin levels after the study, and had a stabilization of exogenous insulin needs. Thus, the study has shown that silymarin decreased endogenous insulin overproduction and decreased exogenous insulin requirements. Silymarin may also reduce lipo-oxidation of hepatic cell membranes and help reverse insulin resistance.

Silibin, which is one of the three flavolignans in silymarin, was studied on patients with NIDDM. The sorbitol red blood cell (RBC) level for fourteen patients with NIDDM averaged 72.55nmol/g Hemoglobin; this was two times higher than the control group that didn’t have diabetes. 231 mg of silibin was administered for four weeks to the NIDDM patients, and their sorbitol RBC level dropped to 39.53 nmol/g. The study also found slightly improved nerve conduction velocity in the silibin group. Silibin, perhaps a potent aldose reductase inhibitor is valuable in the prophylaxis and prevention of complications in diabetes.

Milk Thistle is also effective in the treatment of neuropathy. Silibin is a flavonoid, which is a mono-adenoid di-phosphate-lipoxyl-transferase inhibitor. It helps to prevent protein ADP riboysilation. ADP riboysilation causes an increase in P like substance which causes and immunoreactivity level that is found in diabetic neuropathy. In the treatment of diabetic rats, silibin was found to prevent the increase of ADP riboysilation in sciatic nerves schwann cells.

The adrenal gland has a function in the regulation of insulin, this is Called the Somogyi phenomenon. In response to hypoglycemia-epinephrine, norepinephrine and cortisol are secreted by the adrenal gland. In diabetic rats, a short term diabetic state lowered the activity of their adrenal cortex. Thus, sub-clinical adrenal hypofunction should be assessed in NIDDM patients.

Following is a case study in the use of botanical medicine, within the context of a holistic paradigm in patients with NIDDM. A 56 year old, Caucasian female had a 25 year history of NIDDM. Fasting blood sugar levels averaged around 19mmol/L (342mg/dL). The patient had exhibited all the symptoms of both microvascular and macrovascular complications of NIDDM. Microvascular complications as evidenced by microalbuminemia, glaucoma and neuropathy. Macrovascular complications were evidenced by cardiovascular disease with severe hypertension, up to 200/110, even with the use of multiple pharmacological agents. This patient primarily followed a natural protocol of botanical medicine and high levels of chromium (400 mg/day). The botanical formula followed a holistic paradigm, which gave support to all the organs concerned with glucose homeostasis. The following was prescribed: Milk Thistle to support the liver, Jambul and Devil’s Club to support the pancreas, Devil’s Club to support the adrenals, golden rod to support the kidneys and St. John’s Wort to support the nerves. The prescription for this botanical combination was in the form of a tincture, with a dose of two to three teaspoons three times per day. After eight months, the patient’s fasting blood glucose levels had decreased from an average of 19mmol/L (342mg/dL) to 6.6 mmol/L (119mg/dL). This patient had not used any pharmacological agents during this time to achieve these levels. It is interesting to note that this holistic paradigm worked far better than the pharmacological agents used previously. This patient had used both Metformin and Glyburide, yet her fasting glucose levels never dropped below 10mmol/L (180mg/dL) as they did with the botanical medicine. In fact her levels averaged between 14 and 15mmol/L (252-270 mg/dL) with the use of these pharmacological agents.

After the eight months, the patient could no longer afford the botanical medicine. She then took Glyburide and Metformin. For the first time in 24 years, one year after she initially came in for treatment, she had completely normal fasting blood sugar levels, 4.8 mmol/L (86.4mg/dL). However, one month later, while on these pharmaceutical drugs, she developed severe edema in the legs and flu like symptoms. She then discontinued the pharmacological agents and the blood sugar levels rose to about 15mmol/L (270 mg/dL), which was significantly lower than the average of what it was a year before, 19mmol/L (342mg/dL), when she was not taking any medications. This showed that the botanical medicine had done something quite unusual: it stopped or reversed the progression of her diabetes. Next the patient took Diab-Aid, a natural therapeutic. Within a few days of taking it, the patient achieved an average fasting glucose level of 8.5mmol/L (153mg/dL) on waking. Note that upon waking, fasting blood sugar levels are slightly higher than other times in the day. She felt much better and no longer had symptoms or side effects from pharmacological agents; she had no flu like symptoms and no edema in the legs. The edema in her legs could have been caused by the syndrome of inappropriate anti-diuretic hormone secretion (SIADH) caused by the Glyburide.

* Dr. Michael Friedman is a Naturopathic Doctor based in Connecticut. He runs a busy state funded practice and also a private practice. He is currently the Research Director of Clinical Trial of Botanical Medicine in treatment of blood sugar disorders and benign prostatic hyperplasia. In addition, Mr. Friedman is a published journalist in reputable medical journals. He also guest appears on radio programs addressing the role natural medicine can play in the treatment of diabetes & hypoglycemia.

References

1,9 Catasol, R. Traditional pharmacological management of non-insulin dependent diabetes mellitus. Clinical and Investigative Medicine, 1995 Aug; 18(4): 288-95.

2,4,8,10 Anonymous. Intensive blood glucose control with sulfonylureas or insulin compared to conventional treatment and risk of complications in type II diabetes (UKPDS 33) UK Prospective Diabetes Study Group. Lancet, 1998 Sept 12; 352(9131): 837-53.

3 Laakso, M. Hyperglycemia and cardiovascular disease in type II diabetes. Diabetes 1999 May; 48(5): 937-42.

5 Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin or insulin in patients with type II diabetes; progressive requirement for multiple therapies. UK Prospective Diabetes Study Group. JAMA, 1999 June 2; 281(21): 2005-12.

6 Inzucchi, SE et al. Efficacy and metabolic effects of Metformin and trigladazone in type II diabetes mellitus. New England Journal of Medicine, 1998 March 26; 338(13): 867-72.

7 Guyten and Hall. Textbook of medical physiology 9th edition, W.B. Saunders Co. Philadelphia 1996.

11,12,15 Canadian Pharmacist Association. Compendium of pharmaceutical and specialties 33rd edition. WebComm Ltd. Toronto, ON 1998.

13 Swiss Locke AL, Khuu Q, Viaole E, Wu E, Lopez J, Kwan G, Noth RH: Safety and efficacy of Metformin in a restrictive formularity. American Journal of Management Care, 1999 Jan; 5(1): 62-68.

14 Melchior WR, Jaber LA: Metformin: an antihyperglycemic agent for treatment of type II diabetes. Pharmacotherapy, 1996 Feb; 30(2): 158-64.

16 Scorpiglrione N, Bellfiglio M, Carinch F, Cavalier D, Dekurtis A, Franciosi M, Mari E, Sacco M, Tagnoni G, Nicolucci A: The effectiveness, and safety and epidemiology of the use of Ascarbose in the treatment of patients with type II diabetes mellitus. A model of medicine based evidence. European Journal of Clinical Pharmacology. 1999 June; 55(4): 239-49.

17 Anonymous. Tight blood pressure control and risk of microvasscular complications in Type 2 Diabetes: (UKPDS 38). UK Prospective Diabetes Group. BMJ, 1998 Sept.12; 317(7160): 703-13.

18,19 Pizzorno and Murray: Textbook of Naturopathic Medicine. Bastyr University Publications: Seattle, 1993.

20 Majer M et al. Insulin downregulate pyruvate dehydrogenase kinase (PDK) mRNA: potential mechanism contributing to increased lipid oxidation in insulin-resistant subjects Molecular Genetics and metabolism, 1998 Oct; 65(2):181-6.

21 Endocrine review: PCO oxidation is often associated under profound insulin resistance as well as with deficiency in insulin secretion, 1997 Sept; 18(6): 774-800.

22 Xie H, Laut WW: Insulin resistance of skeletal muscle produced by hepatic parasympathetic interruption. American Journal of Physiology, 1996 May; 270(5pt1):e858-63.

23 Journal of Clinical Endocrinology and Metabolism, 1998 Aug; 83(8):2911-5.

24 Levi-Ran A. Myogenic factors accelerate later disease: insulin as a paradigm [review]. Mechanisms of aging and development, 1998 May 1; 102(1): 95-113.

25 Vaag AA et al. Is low birth rate, a risk factor for the development of NIDDM? Ugeskriept for laeger, 1998 April 13; 160(16): 2377-81.

26 Vechi C, Tucci PL, Galvin P.Chromium and Diabetes; relationship to serum levels of cholesterol, triglycerides and lipoproteins. Medical hypothesis, 1980 Nov; 6(11):1177-89.

27 Sadri P, Lautt WW: Blockade of hepatic nitric oxide synthase causes insulin resistance.American Journal of Physiology, 1999 July; 277(1pt1): G101-8.

28 Vilusi N, Cernigoi AN, Demonte A, Dabas F, Pappa C, Zilli M. Journal of hepatology, 1997 April 26; 4: 871-9.

29 Chung, Ku Chung His I Chieh Ho Tsa Chih, 1993 Dec; 13(12):725-6, 708.

30 Gorio A, Dena Doni, ML, Finco C, DeGilio AM. Endogenous mono ADP Riboxyslation and Retinal and peripheral nervous system effects of diabetes. Adv EXP Med Biol, 1997; 419:289-95.

31 Houwing H et al. Sympathoadrenal activity during exercise in partial diabetic and diabetic rats. Hormone metabolism research 1997 Jan; 29(1): 25-9.

HYPOGLYCEMIA Low Blood Sugar Blues: Herbal Remedies Focus on Blood Sugar Regulators

How do you know if you've got the low blood sugar blues? Low blood sugar, medically called hypoglycemia, has many different symptoms which range from feeling irritable upon missing a meal, or drastic mood swings during PMS. It has such a variety of symptoms, that it is often misdiagnosed and overlooked.

Low blood sugar causes people to feel hungry in between meals. People will often crave foods that are both sweet and high in carbohydrates. However, after eating these foods patients still don't feel well, they become sluggish and tired. Before making a comprehensive treatment plan for hypoglycemia, one must look at the functions and control of blood sugar. Sugar is transported in the blood and is carried throughout the body into all cells to produce a compound called ATP. ATP is needed for all cellular activity of the body, therefore it is absolutely essential that the blood can carry this fuel at a constant level. Without adequate blood sugar levels, the body could not function, just as a car can not function without gasoline.

There are three main organs that regulate the control of blood sugar: Pancreas, liver and adrenal gland. The pancreas produces hormones called insulin and glucagon. These hormones work antagonistically to maintain blood sugar levels are neither too low or too high. The adrenal gland plays a key function in making sure blood sugar levels are high enough. There is also new research indicating that the liver helps with sugar metabolism by creating insulin receptor sites. Therefore tight blood sugar control is regulated through at least three organ systems, and therefore to maintain optimal blood sugar levels, it is imperative that each of these organs should be functioning smoothly. Thus by strengthening the health of these organs , blood sugar metabolism will be much improved. For fifteen months , research has been conducted on the use of natural medicine and blood sugar metabolism. Clinical trials found that a formula made up of five herbs was able to not only lower fasting blood sugar levels by 33% in the majority of adult onset diabetics, but also raised blood sugar levels in patients with hypoglycemia.

Thus it was shown that many of the herbs that were used traditionally to treat diabetes were also effective in treating low blood sugar levels, reinforcing the theory that herbs have adaptogeic regulating effects. The formula contains Jambul's seed, Prickly Pear Cactus, Devils’s Club, Milk Thistle, and Globe Artichoke. Jambul, also known as Java plant, is an evergreen tree, which grows up to nine meters in height. This native of Southwestern Asia and Australia produces a fruit, which tastes like an apricot. It is , however, the seed which is considered to be one of the most powerful component for diabetes in the Ayurvedic repertory. Modern research confirms these effects. Prickly pear cactus , native in hot desert regions, produces a purple edible fruit. Recent clinical trials show that taking Prickly Pear not only helps with blood sugar control , but also lowers cholesterol and triglyceride levels. Another plant known for its prickly nature is Devil’s Club. Native of the Pacific Northwest , devil’s club is prized for its tonifying and balancing effects on the body. It was one of the most powerful medicinal plants used by the aboriginal peoples of the North America west coast.

The results of clinical trials involving 22 individuals indicated promising results in the treatment of blood sugar disorders. Hypoglycemic patients were able to lower the hypoglycemic score index by 67 percent after six weeks administration of this formula. The hypoglycemic score was indicated by assinging a numerical value to the intensity and frequency of the following

symptoms.

1. Dizziness when standing up suddenly

2. Loss of vision when standing suddenly.

3. Craving sweets

4. Headaches relieved by eating sweets

5. Feeling shaky or jittery

6. Irritability if a meal is missed

7. Heart palpitations after eating sweets

8. Need to drink coffee to get started

9. Impatient, moody, nervous

10. Feeling faint

11. Forgetfullness

12. calmer after eating

13. poor concentration

Since hypoglycemic patients often have a hard time coping with their hunger between meals when the blood sugar drops, people commonly eat often. Most of the hypoglycemic patients in the study had decreased appetite between meals, thus patients were also able to lose weight. Patients had also noted that the effects were much more profound than previous treatments for hypoglycemia including chromium and B vitamin supplementation. The study showed that herbs when formulated wholistically to address all the organs involved in blood sugar metabolism, not only are effective in high blood sugar but also in low blood sugar.

Diab-Aid Study Methods

Ten (10) cases with NIDDM were given Diab-Aid for a three month period.

Two patients - one with with Type I and the other with type II was given Diab-Aid for three months.

One patient with hyperinsulinemia was given Diab-Aid for three months, and seven patients with sub-clinical hypoglycemia were given Diab-Aid for six weeks. All the patients in the study were concurrently taking pharmacological agents, except for one NIDDM patient and the hypoglycemia patients.

Criteria
Patients who had a weight change of more than five pounds within three months were not included in this study. Patients who had made dietary, lifestyle, and or prescription drug changes were disqualified. Patients who had not taken prescribed Diab-Aid dosages were also disqualified. Setting: Five outpatient clinics in Canada, the United States and India, supervised by medical doctors and licensed Naturopathic physicians.

Disqualifications
Five people were disqualified for not fitting the above criteria.

Outcome

Patient #1
Onset of Diabetes: Six years
Type of Diabetes: II
Pharmacological agents used were Metformin 500 mg BID and Diamichron 160 mg BID. Progression of diabetes before the study: She had poor blood sugar control even with the medicine. She had tried chromium with little result. Natural medicine prescribed was Diab-Aid three pills TID. Fasting blood sugar levels: May 23 1999 Average for the week was about 16mmol/L (288mg/dL)
During the first week, her average on June 1st was 15.9 mmol/L (286 mg/dL)
her average on June 7th was 13.6 mmol/L (245 mg/dL)
her average on June 14th was 12.2 mmol/L (220 mg/dL)
her average on June 21 was 12.3 mmol/L (221 mg/dL)
her average on June 27 was 9.5 mmol/L (171 mg/dL)
after three months she averaged about 11.2mmol/L (201.6 mg/dL). She had noticed positive results within two weeks. Her glycosylated hemoglobin HbA1c value was 10.2% and after three months of treatment was 9.8%. She maintained all pharmacological agents during the treatment.

Patient #2
Onset of diabetes: Ten years
Type of Diabetes: II
Pharmaceutical drugs prescribed for her NIDDM were: Humulin 44 am and pm, Toronto am and six units of insulin - pm. Progression of diabetes before the study was nine years of oral hypoglycemics and 1 year of insulin. During this time the patient developed hypertension, angina, chronic renal failure - 60% failure in both kidneys. The natural medicine prescribed was Diab-Aid one pill TID, and 600 mcg of Chromium. A Golden Rod Tincture was prescribed for kidney support. Fasting blood sugar levels before the study were 12.2 mmol/L (220mg/dL). After three months, these levels dropped to 8.8 mmol/L (158 mg/dL). Glycosylated hemoglobin was 7.9% before the study and after three months was 7.8%. Blood sugar levels were reduced even while she had lowered her pharmaceutical drugs. She had lowered her insulin levels at the same time to 42 Humulin and 4 Toronto. Now she only needs three as opposed to five injections daily. The patient also experienced less back pain, which was quite significant because the patient was able to start walking, which she was unable to do before, due to the severe back pain from her kidney damage. Her creatinine level was decreased from 138 to 115 umol/L .

Patient #3
Onset of diabetes: 25 years
Type of Diabetes: II
Pharmaceutical drugs prescribed for NIDDM: Metformin 500 mg - two pills BID, Glyburide 5mg BID. These pharmaceutical drugs were discontinued upon starting Diab-Aid. Patient was able to achieve normal blood sugar levels while on the drugs. However, due to the severe side effects she had seen with the use of the pharmaceutical agents, specifically leg edema and flu like symptoms, she had discontinued the drugs. Fasting blood sugar levels on waking averaged around 15 mmol/L (270 mg/dL). She maintained this level for several weeks without the use of any treatment. After the use of Diab-Aid, within several days, her fasting blood sugar level went down to 9 mmol/L (162mg/dL). She was quite pleased because she had no leg edema and no flu like symptoms, which were the side effects of the pharmaceutical agents. Her glycosylated hemoglobin was normal before the study, and after was 7.0%. She was just able to achieve the American Diabetic Association recommendation target range of glycosylated hemoglobin even with the absence of pharmacological agents of both a sulfonylurea and a biguanide, and this with the sole addition of a natural therapeutic, Diab-Aid. The patient had no kidney pain, nor edema in her legs after the study.

Patient #4
Onset of diabetes: 25 years
Type of Diabetes: II
Pharmaceutical drugs prescribed for NIDDM: Insulin for the last 25 years. She took Diab-Aid two pills BID, and 400 mg of Lipoid acid and Goldenrod tincture for kidney support. Note at this dose, Lipoid acid has no effect on fasting blood sugar level. Her fasting blood sugar level averaged around 158 mg/dL (8.8 mmol/L). After three months her level averaged around 100mg/dL (5.56mmol/L), achieving completely normal blood sugar levels. Her diabetic nephropathy had decreased and her edema and blood streaks in her legs were completely gone at the end of this study. Exogenous insulin requirements were also decreased by half.

Patient #5
Onset of Diabetes : 2 years
Type of Diabetes: II
Pharmaceutical drugs prescribed for NIDDM: Glyburide 5mg BID. Diab-Aid 3 pills TID was prescribed. Fasting blood sugar levels before the study were around 12 mmol/L (216 mg/dL) and after the study were 10 to 12 mmol/L (180 - 216 mg/dL). The patient had no decrease in fasting blood sugar level with the use of Diab-Aid. The patient also had an increase in pharmacological agents, of Glyburide from two pills two times per day to two pills three times a day, again with no effect. This patient was an interesting case. The patient did not respond to either natural therapeutics, or pharmacological agents. This patient’s body type was thin, while all the other patients in this study were obese. This was the only NIDDM patient that did not respond to natural therapeutics. Thin body types in NIDDM are often the hardest type of patients to treat.

Patient #6
Onset of insulinemia: two years
Pharmaceutical drugs prescribed for insulinemia: Metformin 2 pills BID.
Natural medicine prescribed: Diab-Aid 3 pills TID. Fasting insulin levels before the study were 36.8u/ml after three months on Diab-Aid, her levels dropped to 28.7 u/ml. Within two weeks she had noticed symptomatic relief. A rash around her neck went away, which she attributed to the Insulinemia. She also stated that she felt much better within a few weeks of taking the Diab-Aid.

Patient #7
Diabetes type: Type I
Onset of diabetes: two years
Pharmaceutical drugs prescribed for diabetes: Insulin. Natural medicine prescribed: Diab-Aid 3 pills TID. Fasting blood sugar levels were completely normal before the study. After the study, no decrease of daily exogenous insulin requirements was noticed. However, a decrease in insulin injections was not needed after rigorous exercises.

Patient #8
Sub-clinical hypoglycemia
Onset: 15 to 20 years
Within two weeks of taking Diab-Aid three pills three times a day, there was a significant decrease in hypoglycemic hunger and the patient’s frequent need to eat. The patient also noted a significant decrease in sugar cravings. The patient had taken 500 mcg of Chromium daily for the previous six months. She did not notice any significant changes with the past use of Chromium. Before the study, fasting blood sugar levels averaged 2.2mmol/l (40 mg/dl). After the study fasting blood sugar levels rose to 4.4 mmol/l(80 mg/dl).

Patient #9
Type of diabetes: II
Onset of Diabetes: 15 to 20 years
Pharmacological agents being used: Insulin.
Natural medicine prescribed: Diab-Aid one pill TID. During the last week of the study, the dosage was increased to two pills TID. Fasting glucose level before insulin therapy was 200 to 240 mg/dL (11.1 - 13.3 mmol/L). Fasting glucose level on insulin therapy was between 150 and 160 mg/dL (8.3 -8.8 mmol/L). Fasting glucose after three months on Diab-Aid was (7.4 mmol/L) 133 mg/dL.

Patient#10
Subclinical hypoglycemia
Onset:10 years
After three weeks of taking Diab-Aid three pills three times a day she noticed a decreased need to eat as often, did not feel jittery when missing a meal and overall felt much better. She had taken chromium before but never noticed any changes as significant as this. Patient lost 2 pounds a week while taking Diab-Aid. She had tried to lose weight before with diet, but was not able to achieve this level of loss per week.

Patient #11
Subclinical hypoglycemia
The patient took 3 pills three times a day of Diab-Aid. She had taken other supplements concurrently during study to treat other illnesses. She took Smilax Solid Extract, ca/mg supplement, St John's Wort, and a homeopathic remedy. Before taking Diab-Aid her Hypoglycemic score was 33. After taking Diab-Aid for six weeks it went down to 6. Patient noted results in symptomology within days of taking Diab-Aid and Smilax. Improvements were noted in significant decreases in the following symptoms; dizziness when standing up, vision loss when standing up, sweet carvings, irritability upon missing meals, heart palpitations after sweets, coffee requirements to get started, mood disturbances, fatigue after eating, memory weakness, general feeling of faintness, poor concentration, forgetfulness. Patient also reported that her mood was not affected by food and that she no longer developed headaches upon missing meals. Patient noticed no side effects.

Patient #12:
Subclinical Hypoglycemia
Patient had taken Diab-Aid three pills three times per day. She noticed gastric acidity when taking the medicine on an empty stomach. Before study, patient had to eat 6 meals a day to avoid hypoglycemic symptoms. Patient also suffered from pernicious anemia. Other supplements taken were vitamin c 500 mg, B12 injections monthly. Hypoglycemic score before study was 26, after taking Diab-Aid was 8. The patient reported significant improvements over the course of the study in feelings of shakiness, irritability upon missing meals, heart palpitations after eating sweets, coffee requirements to get started, mood disturbances, fatigue after eating, general feelings of faintness, poor concentration, forgetfulness, calmer after eating. The only symptom that was not improved was food cravings. Before the study period, patient noticed waking headaches relieved by food. After she experienced only two waking headaches per week.

Patient #13
Diabetes Type: Type I and II
Pharmaceutical drugs prescribed for diabetes were GE NPH Insulin 20 units at bedtime, humalog insulin fast acting 12 units breakfast, 15 units lunch, 15 units supper. Progression of diabetes before study; started with hypoglycemics (sulfonylurea) for one year then switched to insulin. Diab-Aid three pills three times a day was prescribed. Patient's blood sugar was more stabilized and ranged from 4-10 now. This was an improvement from 4 to 15 previously. Also, before a high reading would last for a day or more. After, only one high reading per day was noted. He also experienced less lows since taking Diab-Aid. His insulin level decreased by 5 units each at noon and bedtime. Before taking Diab-Aid, insulin levels were increasing over time.

Patient # 14
Subclinical Hypoglycemia
Patient took Diab-Aid three pills three times a day. Initially the patient reported increased hunger, which disturbed her as she was trying to lose weight. She was instructed to reduce dose to two pills three times a day. Following this, she noticed a big improvement in her energy levels, so much so that she was able to quit smoking during the study period. Initially her hypoglycemic score was 28, after 13. Biggest improvements were, significant decreases in irritability, headaches and feeling shaky. The only symptoms not improved were related to memory, concentration, forgetfulness, and sweet cravings. No other effects were reported.

Patient #15
Subclinical Hypoglycemia
Patient took Diab-Aid three pills three times a day. She also took multi-B, magnesium, vite, and dgl to treat her other conditions. Patient's hypoglycemic score before study was 28, after six weeks 13. Improvement noted in dizziness, loss of vision when standing, sweet cravings, palpitations and feeling tired after eating. No help with concentration. She reported improvement in fibromyalgia pain, but this may be due to other factors. No side effects reported.

Conclusion:
Diab-Aid was an effective treatment in 5 out of 6 patients with NIDDM after three months. It was effective in all five obese NIDDM patients. Most NIDDM patients noticed effect within two months. One patient with Insulinemia noticed significant decrease in fasting insulin after three pills three times a day after three months. One patient with Type 1 and Type 11 noticed a decrease in fasting blood sugar levels after taking three pills three times a day after two months. One patient with Type 1 noticed no decrease in fasting blood sugar after taking Diab-Aid 3 pills three times a day for three months. Six patients with Hypoglycemia all noticed a decrease in hypoglycemic score within six weeks. Many hypoglycemic patients noticed
relief within a week of taking Diab-Aid. In total Diab-Aid was an effective treatment in 13 patients out of 15. One NIDDM patient it was not effective. Nor was it effective in the Type 1 patient. Patients reported decrease in diabetic complications, and the progression of the illness itself.

Possible Side Effects: One patient noticed an increase in fasting blood sugar levels the first month, but then it began to decrease after that. This case was disqualified due to patient not receiveing Diab-Aid on timely basis from distributor - therefore it caused a break in consistency of her oral pattern. It was difficult to make any judgments on this case as a result. One patient initially noticed increase in hunger after taking Diab-Aid, but it went away after a week, upon lowering the dosage to 2 pills three times a day. Lowering of dosage may be coincidental or not. One patient noticed gastric acidity upon taking Diab-Aid more than 15 minutes apart from a meal.

Notes of Reference to Pharmacological Drugs.
Oral hypoglycemic drugs such as sulfonylureas have no long term effect in about 20 to 30 percent of NIDDM patients.
The following is a study of Glucophage to indicate a comparison of effectivity to Diab-Aid. In a study of Glucophage of 228 patients, glycosolated Hemoglobin levels of patients started at 9.43, after six months went down to 8.30, and after 9 months went up to 8.72. Diab-Aid Study Methods

Ten (10) cases with NIDDM were given Diab-Aid for a three month period.

Two patients - one with with Type I and the other with type II was given Diab-Aid for three months.

Disqualifications
Five people were disqualified for not fitting the above criteria.

Outcome

Patient #1
Onset of Diabetes: Six years
Type of Diabetes: II
Pharmacological agents used were Metformin 500 mg BID and Diamichron 160 mg BID. Progression of diabetes before the study: She had poor blood sugar control even with the medicine. She had tried chromium with little result. Natural medicine prescribed was Diab-Aid three pills TID. Fasting blood sugar levels: May 23 1999 Average for the week was about 16mmol/L (288mg/dL) During the first week, her average on June 1st was 15.9 mmol/L (286 mg/dL)
her average on June 7th was 13.6 mmol/L (245 mg/dL)
her average on June 14th was 12.2 mmol/L (220 mg/dL)
her average on June 21 was 12.3 mmol/L (221 mg/dL)
her average on June 27 was 9.5 mmol/L (171 mg/dL)
after three months she averaged about 11.2mmol/L (201.6 mg/dL). She had noticed positive results within two weeks. Her glycosylated hemoglobin HbA1c value was 10.2% and after three months of treatment was 9.8%. She maintained all pharmacological agents during the treatment.

Patient #6
Onset of insulinemia: two years
Pharmaceutical drugs prescribed for insulinemia: Metformin 2 pills BID. Natural medicine prescribed: Diab-Aid 3 pills TID. Fasting insulin levels before the study were 36.8u/ml after three months on Diab-Aid, her levels dropped to 28.7 u/ml. Within two weeks she had noticed symptomatic relief. A rash around her neck went away, which she attributed to the Insulinemia. She also stated that she felt much better within a few weeks of taking the Diab-Aid.

Patient #9
Type of diabetes: II
Onset of Diabetes: 15 to 20 years
Pharmacological agents being used: Insulin. Natural medicine prescribed: Diab-Aid one pill TID. During the last week of the study, the dosage was increased to two pills TID. Fasting glucose level before insulin therapy was 200 to 240 mg/dL (11.1 - 13.3 mmol/L). Fasting glucose level on insulin therapy was between 150 and 160 mg/dL (8.3 -8.8 mmol/L). Fasting glucose after three months on Diab-Aid was (7.4 mmol/L) 133 mg/dL.

Patient#10
Subclinical hypoglycemia
Onset:10 years
After three weeks of taking Diab-Aid three pills three times a day she noticed a decreased need to eat as often, did not feel jittery when missing a meal and overall felt much better. She had taken chromium
before but never noticed any changes as significant as this. Patient lost 2 pounds a week while taking Diab-Aid. She had tried to lose weight before with diet, but was not able to achieve this level of loss per
week.

Onset of Diabetes: Six years
Type of Diabetes: II
Pharmacological agents used were Metformin 500 mg BID and Diamichron 160 mg BID. Progression of diabetes before the study: She had poor blood sugar control even with the medicine. She had tried chromium with little result. Natural medicine prescribed was Diab-Aid three pills TID. Fasting blood sugar levels: May 23 1999 Average for the week was about 16mmol/L (288mg/dL)
During the first week, her average on June 1st was 15.9 mmol/L (286 mg/dL)
her average on June 7th was 13.6 mmol/L (245 mg/dL)
her average on June 14th was 12.2 mmol/L (220 mg/dL)
her average on June 21 was 12.3 mmol/L (221 mg/dL)
her average on June 27 was 9.5 mmol/L (171 mg/dL)
after three months she averaged about 11.2mmol/L (201.6 mg/dL). She had noticed positive results within two weeks. Her glycosylated hemoglobin HbA1c value was 10.2% and after three months of treatment was 9.8%. She maintained all pharmacological agents during the treatment.

Patient #9
Type of diabetes: II
Onset of Diabetes: 15 to 20 years
Pharmacological agents being used: Insulin. Natural medicine prescribed: Diab-Aid one pill TID. During the last week of the study, the dosage was increased to two pills TID. Fasting glucose level before insulin therapy was 200 to 240 mg/dL (11.1 - 13.3 mmol/L). Fasting glucose level on insulin therapy was between 150 and 160 mg/dL (8.3 -8.8 mmol/L). Fasting glucose after three months on Diab-Aid was (7.4 mmol/L) 133 mg/dL.

Conclusion:
Diab-Aid was an effective treatment in 5 out of 6 patients with NIDDM after three months. It was effective in all five obese NIDDM patients. Most NIDDM patients noticed effect within two months. One patient with Insulinemia noticed significant decrease in fasting insulin after three pills three times a day after three months. One patient with Type 1 and Type 11 noticed a decrease in fasting blood sugar levels after taking three pills three times a day after two months. One patient with Type 1 noticed no decrease in fasting blood sugar after taking Diab-Aid 3 pills three times a day for three months. Six patients with Hypoglycemia all noticed a decrease in hypoglycemic score within six weeks. Many hypoglycemic patients noticed relief within a week of taking Diab-Aid. In total Diab-Aid was an effective treatment in 13 patients out of 15. One NIDDM patient it was not effective. Nor was it effective in the Type 1 patient. Patients reported decrease in diabetic complications, and the progression of the illness itself.

Possible Side Effects:
One patient noticed an increase in fasting blood sugar levels the first month, but then it began to decrease after that. This case was disqualified due to patient not receiveing Diab-Aid on timely basis from distributor - therefore it caused a break in consistency of her oral pattern. It was difficult to make any judgments on this case as a result. One patient initially noticed increase in hunger after taking Diab-Aid, but it went away after a week, upon lowering the dosage to 2 pills three times a day. Lowering of dosage may be coincidental or not. One patient noticed gastric acidity upon taking Diab-Aid more than 15 minutes apart from a meal.

MONOGRAPHS

Opuntia spp. - Prickly Pear cactus, Beaver Tail, Nopal - Description: Nopal is native to arid and semi-arid areas of North America and South America. Mexico City’s original name was derived from this plant. Nopal has no leaves, except at the start of new growth. These leaves are actually stems called cladodes that grow one on top of another in an irregular, beavertail-shaped pattern. Nopal has spiny, thickened stems that form the body of the plant and produce yellow, orange and red rose-like flowers in the spring. These flowers mature into prickly pears, which are yellow, orange, red or purple. The fruits are sweet, with numerous hard seeds. They survive under a ferocious variety of climates and can regenerate themselves. The pads are skinned, diced and prepared in Mexican salads and tacos. Description: Nopal is native to arid and semi-arid areas of North America and South America. Mexico City’s original name was derived from this plant. Nopal has no leaves, except at the start of new growth. These leaves are actually stems called cladodes that grow one on top of another in an irregular, beavertail-shaped pattern. Nopal has spiny, thickened stems that form the body of the plant and produce yellow, orange and red rose-like flowers in the spring. These flowers mature into prickly pears, which are yellow, orange, red or purple. The fruits are sweet, with numerous hard seeds. They survive under a ferocious variety of climates and can regenerate themselves. The pads are skinned, diced and prepared in Mexican salads and tacos.

Constituents:

Constituents: Nopal contains vitamins B, C, calcium, iron, potassium, beta-carotene, and the carbohydrates: hexoses, pentoses, cellulose hemicellulose, and mucilage. Nopal is high in fiber, protein, and amino acid composition.

Actions: Hypoglycemic, hypolipidemic, anti-microbial, vulnerary, demulcent, nutritive. Indications: It is used for gastritis and peptic ulcers, 1 high cholesterol, enlargement of the prostate gland and diabetes.2 Externally it is used for dry, itchy scalp, and wound healing.2

Pharmacology: In patients with NIDDM, Nopal significantly reduced glucose and fasting insulin serum concentrations. Nopal lowered blood sugar when orally administered to animals with induced states of moderate hyperglycemia.3 Nopal does not significantly modify fasting glucose levels and insulin serum concentrations in healthy individuals. However, it reduces the elevation of glucose and insulin serum concentrations after an oral glucose load.1 The mechanism of Nopal is unknown, although one study has suggested it is associated with gastric distension and enterohormones.2 In another study, the mechanisms of cellular sensitivity to insulin in addition to dietary fiber was suspected, because blood sugar was reduced in the absence of an oral carbohydrate load.

This study further showed that serum insulin concentration diminished after taking Nopal, thus ruling out enhancement of insulin release.4 A different study ruled out the involvement of insulin antagonist hormones, like glucagon, cortisol and growth hormone.1

In addition to the diabetic effect, Nopal reduced LDL cholesterol, total cholesterol and triglycerides when taken before each meal for ten days. The triglyceride levels were decreased in obese and diabetic patients, but not in healthy subjects with low triglyceride levels. 5 Dose: Tea from fruit and pads: 2 ½ cups of fruit or pad in 1 ½ quarts of water cook for 25 minutes. Drink three cups / day. Powder: 5 capsules / day.

References
1 Simopoulos AP: Plants in human nutrition. Karger: New York. 1995.

2 Heinerman, J. Encyclopedia of healing herbs and spices. Parker Publishing Co: Englewood Cliffs, NJ, 109-111 1996.

3 Journal of Ethnopharmacology (7:175-181, 1983)

4 Frati et al: Hypoglycemc effect of Opuntia streptacantha. Archives deinvestigacion medica (Mexico), 1991; 22(1) 53-5.

5 Frati-munari Y Cola. Nopal on lipids, diabetes and obesity. Archives deinvestigacion medica (Mexico), 1983; 117-9.

Syzygium cumini - Jambul. Description: Jambul is from southern Asia, India, Indonesia and Australia. The seed is hard, oval, and red brown to brown. Jambul is eaten in the form of preserves. It tastes faintly astringent and aromatic, like a ripe apricot.

Constituents: The fruit contains volatile oil, fixed oil, resin, tannins and gallic acid, phenols (methylxanthoxylin), triterpenoids, glycosides, and alkaloids (Jambosine). Actions: Astringent, carminative, hypoglycemic, anti-spasmodic, stomatic, and an aphrodisiac.

History: The seed is considered to be one of the most powerful hypoglycemic agents in the Ayurvedic repertory. In India, as little as one teaspoon per day of ground seed was a traditional treatment for NIDDM.

Indications: Diarrhea, especially with colic;1 dysentery, 2 atonic and spastic constipation. 3 Diabetes (high blood sugar, glucosuria,3 polyuria, excess thirst; 3 and diabetic associated fatigue and diabetic retinopathy). Nervous disorders; depression, and exhaustion.3 Externally the astringent action is useful for nose-bleeds and wounds.

Pharmacology: Animal studies have shown a pronounced hypoglycemic effect.4 It also has an anti-inflammatory effect in animals. 3 The method of action may be independent of pancreatic function; it may alter the conversion of carbohydrates to glucose.

Contra Indications: Caution in controlled diabetics. Dose: 0.3 - 2g infusion, 1:1 in 25% alcohol 2-4ml TID. References 1Mills, S: The Dictionary of Modern Herbalism. Healing Arts Press. Rochester, VT. 1988, ;130
2Chevallier, A: The Encyclopedia of Medicinal Plants. New York. Dic Publishing. 1996
3PDR for Herbal Medicines. Medical Economics Co. Montvale, NJ. 1998; 1168-1169.
4Wren RC: Potter’s New Cyclopaedia of Botanical Drugs and Preparations. C.F.
Daniel Company, ltd. Essex, England. 1988; 158-159.

Cynara scolymus - Globe Artichoke
Description: A perennial plant, found in the Mediterranean and Canary Islands, Southern Italy, and South America. It has tuberous roots and a strong erect stalk - up to two meters high, with alternate thistle-like leaves that are grayish green and woolly white underneath.

Constituents: Flowerheads contain 12% sugar (inulin), 3% protein, tannin, cynarin. vitamins A, B1, B2, B3, C, caffeic acid, flavonoids (rutin), and sesquiterpenes lactones.

Actions: Tonic, choleretic, cholagogue, diuretic, laxative, anti-galactic, alterative, aphrodisiac. It stimulates liver cells to regenerate and is also hepatoprotective. Finally, it supports the kidneys, and has a hypoglycemic effect in diabetes.

Indications: Arteriosclerosis, jaundice, dyspepsia, anorexia, liver insufficiency, chronic albuminuria, post-operative anemia. 1 Gallbladder and biliary disease, chronic liver disease, and impairment; kidney disease - Nephrotic Syndrome, 2 It increases excretion and decreases synthesis of total cholesterol. It helps to prevent gallstone formation.

Historically it was used for arteriosclerosis, hyperlipidemia, and diabetes. In France it was used for the trio: Gallstones, obesity and rheumatism.

Pharmacology: Inulin is a polymer of fructose that is not digested and does not increase blood sugar. 3 It decreases postprandial hyperglycemia4 20g caused only a mild rise in blood sugar, which was significantly lower than the same dose of fructose. 4 Inulin, which may be broken down to fructose in cold weather or winter months and converted back in summer months, promotes chemotaxis of neutrophils, monocytes, and eosinophils and may also stimulate interferon.

5Cynarin (15 %) content in roots stimulates bile 3 and has a direct effect on liver function. It is broken down into caffeic acids which act on the liver. The bitters may also contain small amounts of caffeic acid.

Contra Indications: Theoretically for biliary tree blockage and colic, which may be due to active gallstones. Adverse Reactions: Skin reaction to on-the-job contact with artichoke. Dose: 1-4g dried leaves TID, or up to 15-30 ml of tincture per day.

References
1 Lust, J: The Herb Book. New York. Banton Books. 1974; 102.
2 Mills, S: The Dictionary of Modern Herbalism. Healing Arts Press. Rochester, VT. 1988, 27.
3 Busse R, Goldberg A, Gruenwalk J, Hall T, Riggins CW, Rister RS: The complete German Commission E4 Monographs. Austin, TX. American Botanical Council. 1991; 84, 264-266.. 4Werbach, MR, Murray MT: Botanical Influences on Illness. Tarzana, CA, Third Line Press. 1994; 147.
5 Pizzorno J, Murray M: Textbook of Natural Medicine. Bastyr University Publications. Seattle. 1992. Sections V, VI.

Oplopanax horridus - Devil’s Club
Description: Devil’s