hypoglycemic effect of spinach and fenugreek leaves in type 2

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Panacea Journal of Health Science
Volume 1; paper 4
HYPOGLYCEMIC EFFECT OF SPINACH AND FENUGREEK LEAVES
IN TYPE 2 DIABETICS
Karthikaa. P, M.sc Student, Ethiraj College for Women, Chennai.
Usha .T, Assistant Professor, Department of Clinical Nutrition & Dietetics, Ethiraj College for Women, Chennai.
Ph.no-9840782722, Email [email protected]
Abstract
Diabetes Mellitus is a group of conditions characterized by either a relative or a complete
lack of insulin secretion by the beta cells of the pancreas or by the defects of cell insulin
receptors. Besides various approaches in the management of diabetes, the challenge is now to
identify the hypoglycemic supplements that are safe and affordable. Green leafy vegetables are
richest in their nutritive value and cheapest of all vegetables. They are a called power house of
antioxidants and are even referred to as functional foods. The present study was done in a sample
of Type 2 diabetic subjects ( n=18) who were assigned into three groups based on the
supplementation received namely Experimental group1(n=6) who received fenugreek leaves
Khakra(2 nos), Experimental group II (n=6) (2 nos) who received spinach leaves Khakra and
control group (n=6) who did not receive any supplement. The biochemical parameters namely
fasting blood sugar , post prandial blood sugar land glycosylated hemoglobin were assessed in all
the subjects on the 0th , 30th and 60th day of supplementation. The hypoglycemic effect of
fenugreek leaves Khakra over spinach leaves Khakra were compared with each other and also
with the control group statistically using paired‘t’ test. The results revealed that supplementation
of spinach leaves khakra brought about a reduction in post prandial and HbA1C levels as
compared to fenugreek leaves khakra. The other blood parameters did not show much
significance.
Introduction
Diabetes is a global health problem .It is a chronic disease and India is now considered
as diabetes capital of the world and WHO has estimated that by 2025 the diabetic population will
be 57.2 million and the number may increase to 80.9 million by 2030 .The epidemic of diabetes
is seen even in rural areas undergoing socioeconomic development and urbanization (Chow
et.al.,2004). People with diabetes have three to five times higher risk of coronary heart disease
than non diabetics and 65% of death in individuals with type 2 diabetes are related to heart
disease and stroke (Lteif et.al., 2005). Dietary modification, weight control and regular exercise
are the main approaches in the management of diabetes.
Increasing intakes of dietary antioxidants may help to reduce oxidative damage caused
by free radicals and provide protection against the progression of a number of chronic
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Panacea Journal of Health Science
Volume 1; paper 4
diseases.(Crozier et.al .,2006).Leafy vegetables are ideal for weight management as they are
typically low in calories ,fat and high in dietary fibre, calcium, iron, Vitamin C, beta carotene ,
magnesium and manganese .It is also rich in phytochemicals such as lutein, beta-cryptoxanthin,
zeaxanthin.
Magnesium has a major role in cardiac excitability, neuromuscular transmission,
vasomotor tone and blood pressure. Studies suggests that magnesium intake was inversely
related to the incidence of Type 2 diabetes as it improves insulin sensitivity and also prevents
the incidence of stroke. (Arsenian et.al.,2007).One consequence of uncontrolled diabetes mellitus
is an increased urinary loss of magnesium. And type 2 diabetes is closely associated to
hypomagnesaemia. Therefore life style changes including adequate magnesium intake can
benefit blood pressure and promote weight loss and improve disease risk.
Spinach (Spinacia Oleracea) is a dietary vegetable that ranks high among other
vegetables in terms of antioxidant capacity. It is an excellent source of Vitamin K, Vitamin A, E,
Folate and many other nutrients like inositol and choline. It is rich in glucuronides and therefore
has anti proliferative, anti-inflammatory and antimutagenic properties (Lomnitski et.al., 2008).It
is also rich source of omega 3 fatty acids, selenium and niacin and aids in curing anemia,
constipation and supports overall wellness.(Bonora et.al 2008).Fenugreek leaves (Trigonella
Foenum Graceum) is a leguminous herb used as a diabetic folk medicine and anti-inflammatory
agent .(Vaidya et.al .,2008) It contains a mucilaginous fibre (20%) and has a total fibre content of
50%. It is a very rich source of calcium, beta carotene .The lower glycemic load after fenugreek
leaves supplementation could be due to fibre which diminishes the absorption of carbohydrate to
a point lower in the gut after colonic conversion.(Bever et.al 2008).
Diet being the cornerstone in the management of diabetes, the present study was
undertaken to study the hypoglycemic effect of fenugreek leaves and spinach leaves
incorporated and supplemented as Khakras which is a Gujarati dish prepared from wheat flour
and rolled ,shallow fried on a low flame with continous pressing to make it into a dry chappati
( pappad).
The objectives of the study were 1) To screen and select a homogenous group of type 2
diabetics using a structured interview schedule. 2) To assess the initial fasting blood sugar, Post
prandial blood sugar and glycosylated hemoglobin levels of all subjects. To assign the subjects
into three groups based on the type of supplement received as experimental group 1 (Fenugreek
leaves Khakra) and experimental group II (Spinach leaves Khakra) and the control group who
did not receive any supplement. The efficacy of supplementation was assessed based on the
biochemical values on the 0th, 30th and 60th day of supplementation in the experimental and the
control group.
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Panacea Journal of Health Science
Volume 1; paper 4
Materials and methods
The research study was undertaken to determine the effect of fenugreek leaves and
spinach leaves on Type 2 diabetic subjects. The study was conducted at Dr. V. Seshiah diabetes
centre, Chennai. The sample design adopted for the study was purposive sampling. The
experimental design consisted of “Experiment before and after with control group design”. The
study was conducted in three phases .During the first phase , the subjects were screened using a
structured interview developed by the researcher, which consisted of demographic details and
information regarding their overall health profile like the Anthropometry ( ht, wt, BMI and waist
circumference) and three day dietary recall. After initial screening, 18 subjects were selected for
the study and were divided into experimental group I , experimental group II and control group
consisting of six subjects in each group. Biochemical parameter namely Fasting, post prandial
and HBA1C were assessed initially for all the subjects.
The second phase of the study consisted of development and standardization of the
fenugreek khakras. 40grams of the fenugreek leaves were washed and chopped finely and mixed
with wheat flour,. Salt, chill powder, turmeric powder were added and rolled into a dough. The
balls were made into thin chappatis and roasted until a crisp texture was obtained .Same
procedure was followed for the preparation of spinach leaves Khakra.
The subjects were contacted at their residence with the consent of the physician. The
subjects belonging to the experimental group I received fenugreek leaves khakra and
experimental group II received spinach leaves khakra. The subjects were asked to consume two
khakras daily containing 40g of fenugreek leaves and spinach leaves as their evening snack. The
subjects were contacted once in three days and fresh khakras were distributed. Since khakra is a
dry product it has a long shelf life. The supplementation period was 60 days. The fasting and
Post prandial blood sugar levels was measured on the 30th and 60th of the supplementation
period. The HbA1C value was measured on the 0th and 60th day of the supplementation period as
it is indicates the average blood glucose. Based on the above biochemical assessment the
efficacy of supplements were compared in the study group with the control group. The data
obtained were analyzed statistically using percentage, arithmetic mean, standard deviation and
paired’t test’.
Results and discussion
The present study aimed at analyzing the efficacy of fenugreek leaves and spinach leaves
khakra over one another in their blood glucose lowering effect.
Test of homogeneity
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Panacea Journal of Health Science
Volume 1; paper 4
Onset of diabetes is directly correlated with BMI and waist circumference and many
studies have indicated 34% increase in blood sugars with high BMI and WC .
TABLE 1 MEAN AND STANDARD DEVIATION OF ANTHROPOMETRIC
PARAMETERS
Parameters
Weight
Height
BMI
Waist Circumference
Mean ± SD
68.56± 5.86
160.4 ± 3.74
26.6 ± 2.70
39.69 ± 2.23
Data on the anthropometric assessment of the study group showed a mean weight of
68.56± 5.86SD, and the height was 160.4±3.74, BMI 26.6±2.70 and their waist circumference
was 39.69±2.23.The data reveals that the subjects were homogenous with respect to their
anthropometric measurements.Table-1.
Other aspects namely presence of chronic diseases like cardio vascular disease, obesity,
hypertension, cancer and renal disorders were assessed and those who had these co morbid
conditions were not included in the study.Subjects who had moderate control of blood sugar with
a initial fasting blood sugar 100-150mg/dl , post prandial blood sugar level of 180-250mg/dl and
HBA1C levels of 6.1-8.0 % were included and those who had uncontrolled diabetes were
excluded. Table 2
TABLE-2
BLOOD GLUCOSE VALUES OF THE SELECTED SUBJECTS IN
COMPARISON TO THE NORMAL VALUES
Blood glucose levels
Normal values(WHO 2003)
Fasting
Post prandial
HBA1C
*WHO 2003
70-110mg/dl
140-160mg/dl
3.5-5.5%
Values
selected
for the study
100-150 mg/dl
180-250mg/dl
6.1-8.0%
With respect to the physical activity pattern of the subjects, those had the habit of
exercising regularly like walking, cycling for 30 minutes to 1 hr were selected for the study as
physical activity has a major impact on the blood sugar levels. Similarly those subjects who were
on allopathic treatment alone were included while those undergoing other forms of treatment
were excluded.
Three day dietary recall was used to assess the average nutrient intake and those subjects,
who had the habit of consuming green leafy vegetables alone were included for the study.
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Panacea Journal of Health Science
Volume 1; paper 4
Test of significance
Table 3 elucidates the mean values of fasting , post prandial and HBA1C values of the
subjects on the 0th day of the supplementation. The values show that the subjects had similar
blood glucose levels indicating that they were homogenous. The ‘t ‘values did not show any
significance
TABLE 3 SIGNIFICANCE LEVELS OF BLOOD PARAMETERS ASSESSED ON THE
0TH DAY
LEVELS
FASTING
CONTROL
126.33±
13.648
EXP I
126.83±
10.759
CONTROL
126.33±
13.648
EXP II
124.67±
14.306
EXP I
126.83±
10.759
EXP II
124.67±
14.306
‘t’ values
POST
PRANDIAL
0.070 NS
223.17±
35.290
209.83±
51.720
0.206NS
223.17±
35.290
219.67±
36.958
0.296 NS
209.83±
51.720
219.67±
36.958
HBA1C
0.522NS
7.767±
0.516
7.917±
0.682
0.168NS
7.767±
0.516
7.317±
0.760
0.379NS
7.917±
0.682
7.317±
0.760
‘t’ VALUES
0.429NS
1.206NS
1.439NS
FIGURE 1 shows the mean levels of fasting and Post prandial blood glucose levels on the
30 day of supplementation. All the groups did not differ significantly indicating the fact that the
supplement did not have effect with in such a short time period The mean values of post prandial
blood glucose ,showed significant reduction and the ‘t’ values were 3.196 which was significant
at 1% level. The control and experimental group II showed a ‘t value to be 2.913 which was
significant at 5% level. There was no significant difference between the experimental groups.
However there was significant reduction in the postprandial blood sugar level on comparing with
the control groups .A study on the anti-diabetic property of 25g of fenugreek leaves on insulin
dependent diabetics showed that the half life of plasma glucose shortened due to the increased
metabolic clearance and erythrocyte insulin receptors activation.(Sahay et.al.,1994). (Fig 2)
th
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Panacea Journal of Health Science
Volume 1; paper 4
250
200
150
179.83
114.33
196.83
122.67
211.67
129.33
100
Fasting
50
Post Prandial
0
FIGURE 1 Fasting and Post prandial blood glucose levels on the 30th day of
supplementation.
The mean values of post prandial blood glucose ,showed significant reduction and the ‘t’
values were 3.196 which was significant at 1% level. The control and experimental group II
showed a ‘t value to be 2.913 which was significant at 5% level. There was no significant
difference between the experimental groups. However there was significant reduction in the
postprandial blood sugar level on comparing with the control groups .A study on the antidiabetic property of 25g of fenugreek leaves on insulin dependent diabetics showed that the half
life of plasma glucose shortened due to the increased metabolic clearance and erythrocyte insulin
receptors activation.(Sahay et.al.,1994). (Fig 2)
On comparing the HbA1c values on the 60th day between the control group and
experimental groupI the ‘t’ values showed no significance. whereas the experimental group II
and control groups showed 5 % level of significance with a ‘t ‘value of 2.255.the experimental
groups did not differ significantly .The results shows that experimental group II subjects on
spinach leaves khakra showed a good reduction in the HBA1C values as compared to those who
were on fenugreek leaves supplement. The present study correlates with the study conducted by
Mani et.al 1994 who found lower glycemic response in subjects who were supplemented with
50g of cereal green leafy combination made of fenugreek and spinach leaves (Fig 3)
Conclusion
In conclusion it can be said that green leafy vegetables can be a valuable supplement and
diabetics can derive tremendous benefits by including green leafy vegetable in their daily diet.
The above study reveals that spinach leaves khakra showed good glucose reducing effect when
supplemented for 60 days as seen in the post prandial ad HBA1C values. The fenugreek leaves
also had hypoglycemic effect when compared the control group on the 60th day of
supplementation. Therefore both the supplements are beneficial for diabetics.
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Panacea Journal of Health Science
Volume 1; paper 4
227.83
250
185.67
165.67
200
150
100
50
0
Experimental
Group I
Experimental Control Group
Group II
Post Prandial
Fig 2 Mean Values of Post Prandial
blood glucose on the 60th day
7.667
7.8
7.6
7.4
7.2
7
6.8
6.6
6.4
7.2
6.883
HbA1C
Experimental Experimental
Group I
Group II
Control
Group
HbA1C
Fig 3 Mean HbA1C values on the
60th day
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Panacea Journal of Health Science
Volume 1; paper 4
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