Lecture 4

Phytotherapy and Metabolic Diseases

Dr. Noha Swilam

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Plants and Metabolic Diseases
Obesity
Clinical Picture
 Plants and Metabolic Diseases
Obesity
Clinical Picture
• Obesity is a major public health concern in the USA and UK,
where the number of obese individuals has almost trebled
over the last twenty years.

• Two-thirds of adults aged 45 years and over are now

overweight or obese.

• Obesity results from an imbalance between energy intake

and energy expenditure (a combination of excessive food
energy intake and a lack of physical activity) . Environmental
factors, such as the general availability of high-caloric food
or the limited need for physical exercise, and genetic factors
that predispose to weight gain contribute to the
development of obesity.
 Plants and Metabolic Diseases
Obesity
Clinical Picture

Drugs used to treat obesity may have one or more of

the following mechanism:

• Reduction of energy intake: appetite suppression.

• Reduction of energy intake: inhibition of absorption.

• Increase of energy expenditure.

• Modulation of fat storage.

Plants and Metabolic Diseases
Obesity
Clinical Picture
Plants and Metabolic Diseases
Obesity
Clinical Picture
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
1.Ephedra
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
Ephedra
• It consists of the dried aerial parts of Ephedra sinica Stapf.
(Fam. Ephedraceae), a shrub, 60-90 cm high coming from
China, where it has been used for thousands of years under
the name "ma-huang" for the treatment of the common cold.

• Ephedra contains ephedrine and pseudoephedrine, which

have stimulant effects on the central nervous system.

• Ephedrine is more potent than pseudoephedrine. Ephedra

does not suppress appetite, but it promotes weight loss by
increasing the metabolic rate of adipose tissue. (Increase
energy expenditures by burning fat, the truly undesirable
component of weight gain).
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
Ephedra

Is a metabolic process during which your body burns calories to produce heat.
That radiating heat you can feel if you put your hand on your body, or
what makes your body warm inside. The word refers to the heat that your
body produces.
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
Ephedra

• Side effects of ephedra are the same as ephedrine (although

to a lesser extent), which raises some doubt about whether
this herbal preparation is clinically acceptable.

• They include increased blood pressure and heart rate,

insomnia and anxiety.
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
2. Guarana
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
Guarana
• It is prepared from the seeds of Paullinia cupana.
(Fam. Sapindiaceae).

• Guarana contains 4-8% caffeine and 8% tannins. Because of its

caffeine content, it is widely used in Brazil to make a stimulating
drink.

• As with many central stimulants, guarana is believed to reduce

appetite, thus reducing food intake. As stated above, a clinical
study has shown the effectiveness of guarana in combination with
ephedra.

• As a monotherapy, no clinical studies have been performed on

guarana.
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
3.Guar gum
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
Guar gum
• It is obtained from the endosperm of the seed of Cyamopsis
tetragonolobus L. (Fam. Fabaceae).

• It contains Polysaccharides composed of straight and branched

chains of D-galactose and D-mannose polymers.

• Experimental studies have shown that guar gum reduces the

glucose, cholesterol blood serum levels and usually given with
meals.

• Because of its fiber content, it reduces food absorption from the

intestine and it has been advocated as slimming aid.

• Considering the adverse events associated with its use (i.e.

abdominal pain, flatulence, diarrhea and cramp), the risks of taking
guar gum outweigh the benefits for this indication.
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
4. Kelp
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
Kelp
• It is the thallus (whole plant) of the seaweed Fucus vesicuosus
L. (Fam. Fucaceae). belonging to the brown algae.

• The most important active component in kelp is iodine (up to

0.76% dry weight). This element plays an important role in the
treatment of obesity. Nowadays, Its use is not highly
recommended because of the untoward effects on thyroid
activity when treatment ceases.
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
Kelp
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
5. Garcinia (malabar tamarind)
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
Garcinia (malabar tamarind)

• It is the dried and cured pericarp of the fruit of Garcinia cambogia,

which grows primarily in Southeast Asia.

• Garcinia contains up to 30% hydroxycitric acid (HCA).

HCA may promote weight reduction through suppressing
fatty acid synthesis, increased lipid oxidation and reduced
food intake.
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
Garcinia (malabar tamarind)

• One potential mechanism accounting for the satiety effect of

HCA may involve inhibition of citrate lyase (Figure 15.6). This
would limit the availability of acetyl coenzyme A for lipid
synthesis during carbohydrate feeding. As a result diverted to
glycogen synthesis.

• Because HCA does not appear to enter the brain, it does not
elicit CNS side-effects that may limit its acceptability.
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
Garcinia (malabar tamarind)
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
6. Psyllium (Plantago seeds)
 Plants and Metabolic Diseases
Obesity
Botanical Products for Weight Reduction
Psyllium (Plantago seeds)
• The crude drug consists of the ripe seed of Plantago psyllium,
annual herb growing in the Mediterranean area.

• Ground seeds should not be employed, because the pigment

of the seed coat may be absorbed and accumulated in the
kidney tubules.

• The mucilage increases the fecal elimination of cholesterol

and bile acids and decreases their intestinal reabsorption.

• It also increases the viscosity in the gut and slows down the
reabsorption of sugar.
Plants and Metabolic Diseases
Diabetes Mellitus
Clinical Picture
• Diabetes mellitus is an inability to metabolize carbohydrates resulting
from inadequate insulin production or utilization. There are two types
of diabetes mellitus, type 1 and type 2
• Insulin-dependent diabetes mellitus (Type I diabetes). This type
of diabetes is thought to result from an autoimmune
destruction of pancreatic-cells, with the consequent inability to
secrete insulin. As a result of the destruction of beta-cells, the
pancreas fails to respond to ingestion of glucose. Type I diabetic
patients require exogenous insulin to control hyperglycemia.
Natural therapies cannot cure type 1 diabetes, but they
may help by making the body more receptive to insulin
supplied by injection.
• Non-insulin-dependent diabetes mellitus (Type II diabetes). In
these patients insulin is secreted, but is ineffective in
normalizing plasma glucose. The decreased responsiveness to
both endogenous and exogenous insulin is termed "insulin
resistance". The goal in treating Type II diabetes is to maintain
blood glucose concentration within normal limits and to
prevent the development of long-term complications of
diabetes mellitus. Type 2 diabetes frequently responds
well to natural therapies.
Plants and Metabolic Diseases
Diabetes Mellitus
Phytotherapy of Diabetes
1. Gymnema
 Diabetes Mellitus
Phytotherapy of Diabetes
Gymnema
• It consists of the leaves of Gymnema sylvestre, a woody, climbing
shrub that grows in the tropical forests of India.
• The hypoglycemic (blood sugar-lowering) action of gymnema
leaves was first documented in the late 1920s. This action is
attributed to members of a family of substances called gymnemic
acids (Saponin glycosides).
• Several mechanisms could contribute to the gymnema
antidiabetic effects; experimental studies have shown that
Gymnema leaves raise insulin levels, this may be due to
regeneration of the cells in the pancreas that secrete insulin, or
by increasing the secretion of insulin from these cells.
• Gymnema can also increases the uptake of glucose into the cells,
and reduces glucose absorption from the intestine.(Figure 15.7).
 Plants and Metabolic Diseases
Diabetes Mellitus
Phytotherapy of Diabete
Gymnema

Other animal studies have shown that extracts of gymnema

leaves can lower serum cholesterol and triglycerides and
prevent weight gain.
Plants and Metabolic Diseases
Diabetes Mellitus
Phytotherapy of Diabetes
2.Opuntia
 Plants and Metabolic Diseases
Diabetes Mellitus
Phytotherapy of Diabetes
Opuntia

• It consists of the cladodes [A flattened organ arising from the

stem of a plant] of Opuntia streptacantha.

• Opuntia contains high molecular weight polysaccharides (up

to 50%) and other substances which reduce absorption of
glucose and cholesterol from the gastrointestinal tract.

• It showed that broiled stems of O. streptocantha lowers the

glucose and insulin levels in non-insulin-dependent diabetic
patients but not in healthy volunteers.
Plants and Metabolic Diseases
Diabetes Mellitus
Phytotherapy of Diabetes
3. Bitter melon (karela)
 Plants and Metabolic Diseases
Diabetes Mellitus
Phytotherapy of Diabetes
Bitter melon (karela)
• It consists of the seeds of Momordica charantia (Fam.
Cucurbitaceae).

• It contains Steroidal glycosides, bitter principles;

cucurbitacins, terpenoids and polypeptide which was shown
to be ‘’insulinomimetic’’ exhibit insulin-like activity when
administered SC.

• Studies performed in vitro with karela fruit extract indicated

enhancement of glucose uptake in muscle tissue and of
glycogen accumulation in muscle and hepatic tissue.

• In clinical trials 73% of patients (Type2) showed improved glucose

tolerance with oral administration of karela fruit juice.
 Plants and Metabolic Disease
Diabetes Mellitus
Phytotherapy of Diabetes
4. Ginseng (Panax ginseng)
• It contains ginsenosides that promote an
insulin release and increases the number
of insulin receptors.

• Ginseng also contains glycans designated

panaxans A to E, which have hypoglycemic
activity through an increase of insulin
secretion from pancreatic islets.

5. Aloe vera (syn Aloe barbadensis)

• A recent systematic review suggests that Aloe
vera juice might be effective in reducing blood
glucose in diabetic patients; however, the
results are too preliminary.
 Plants and Metabolic Disease
Diabetes Mellitus
Phytotherapy of Diabetes
6. Heglig (the fruits and bark of Balanites
aegyptiac , Zygophylaceae).
• Balah el sokar, it contains furanocoumarins,
sugar, organic acid and saponins. The fruits
are used as anti-hyperglycaemic for type 2.

7. Fenugreek, Trigonella foenum-graecum, Leguminosae)

• Contains N-methyl derivative of nicotinic acid trigonelline.
• It acts by increase glucose uptake from blood and its
subsequent oxidation.
• Free radical scavenger, prevent  -cell destruction in
insulin dependant DM.
 Phytotherapy Gynaecological disorders
Estrogen Deficiency

•Many plants contain estrogenic substances (phyto-estrogens)

They act as mild estrogens or as anti-estrogens (by binding to
estrogen receptors and preventing occupation by natural
estrogens).

•The main chemical types of phyto-estrogens are the

isoflavones and lignans.

•Some species of Palm even contain hormones similar to those

found in the human body (e.g. estroil)

•Menopausal symptoms in woman are lowered, in societies

consuming significant amounts of foods containing these
substances in their normal diet. 35
 Plants and Metabolic Diseases
Phytotherapy Gynaecological disorder
Estrogen Deficiency
1.Soy

Soy , Glycine max, Fabaceae:

• Soy, a staple food in many Asian countries, contains valuable constituents,

including protein, isoflavones, saponins, and phytosterols.

• The mild estrogenic activity of soy isoflavones may ease menopause symptoms
for some women, without creating estrogen-related problems.

•Soy may help regulate hormone levels in premenopausal women.

Soy may also be beneficial in preventing osteoporosis. Isoflavones from soy have
protected against bone loss in animal studies.
 Plants and Metabolic Diseases
Phytotherapy Gynaecological disorder
Estrogen Deficiency
2. Red Clover

Red Clover, Trifolium pratense, Fabaceae

•Modern research has focused on a red clover extract high in isoflavones

as a possible treatment for symptoms associated with menopause and
cardiovascular health in menopausal women.

•Although the isoflavones in red clover may help prevent certain forms of
cancer (e.g., breast and prostate ), further studies are needed before red
clover is recommended for cancer patients.
 Menstrual Pain Treatment
Menstrual Pain Causes
Prostaglandins cause many of the symptoms associated with
menstrual discomfort. The tissue that lines the uterus makes these
chemicals. Prostaglandins stimulate the uterine muscles to
contract. Women who have high levels of prostaglandin
experience more intense contractions of their uterus and more
pain. Prostaglandins may also be responsible for vomiting,
diarrhea and headaches.
Self-Care at Home
Anti-inflammatory medication. Ibuprofen, naproxen and ketoprofen
-These medications work better if taken before the start of
menstruation and can be continued as long as needed.
-The following strategies may help relieve menstrual cramps:
-A heating pad to the pelvic area
-Massage to the back and lower abdomen
-Exercise, especially prior to the start of a period
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-Calcium and magnesium 1200 mg daily
 Phytotherapy of Menstrual Pain Treatment

Emmenagogues are herbs said to stimulate blood flow in the pelvic area
and uterus.

Plants such as mugwort, parsley and ginger have been used by women
hoping to be not pregnant.

Many herbs traditionally used for painful menstruation contain constituents

that also inhibit prostaglandins.

Ginger, (Zingiber off.) perhaps the most widely used emmenagogue in folk
medicine
Other traditional plants for dysmenorrhea (painful menstruation) , including
cinnamon (Cinnamomum verum),basil (Ocimum basilicum), yarrow (Achillea
millefolium), tansy (Tanacetum vulgare), juniper berry (Juniperus communis),
and chamomile (Matricaria chamomile) each contain prostaglandin-
inhibiting .

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Thank you for your attention