Phytotherapy in the Management of Diabetes and Hypertension

Diabetes mellitus, a metabolic disorder, characterized by chronic hyperglycemia results from defects in insulin secretion, insulin action, or both. Insulin is an anabolic peptide hormone that possesses pleiotropic activity. It can hinder with multiple physiological processes by either upregulating or downregulating various metabolic intracellular pathways. The complex insulin signaling system makes it vital in a variety of biological responses. This chapter describes the biochemistry of type 2 diabetes mellitus, as well as the features underlying its pathophysiology.

Diabetes mellitus is one of the major health problem worldwide, its incidence and mortality are increasing day by day. Conventional antidiabetic drugs are available with unavoidable side effects. On the other hand, medicinal plants act as an alternative source of antidiabetic agents. From ancient times, herbs and spices have been widely used in the food and for medicinal purposes. In culinary practices, these are used as colorant, preservatives, and flavor substitution. In medicine, oxidative stress and inflammation associated with noncommunicable diseases can be treated or managed through herbs and spices. Phytochemicals like carotenoids, phenolic compounds, sterols, terpenes, alkaloids, glucosinolates, and other sulfur-containing compounds may be responsible for their protective and therapeutic effects. In this modern era, it is necessary to inform consumers about the benefits of botanical compounds. Many herbal plants have potential health claims that are not significantly demonstrated. Since herbs and spices can be used to get better food value and human health, as functional food ingredients they are helpful to decrease the risk of chronic diseases. Much trial evidence for the use of herbal plants to treat diabetes mellitus has uniformly demonstrated safety. However, further studies are needed to explore the health beneficial effects of these herbal plants used for diabetes mellitus.

Medicinal plants have long been the area of great interest and a hot topic of current scientific investigations for the biochemists, chemists and pharmaceutics. These researches play an important role in discovering the new natural resources and developing the potential drugs for the treatment of various unknown diseases. These drugs are supposed to have more effectiveness and no side effects unlike most other synthetically produced modern drugs. In accordance with the World Health Organization (WHO), approximately four billion people constituting eight percent population of the world, use herbal based natural drugs for the majority of primary health care problems. Diabetes mellitus and hypertension are the two most common diseases that sometimes also coexist and enhance the chances of neuropathic disorders, brain strokes, retinopathic symptoms, peripheral vascular diseases and cardiac arrest. This chapter describes various medicinal plants having anti-diabetic and antihypertensive potentials along with their detailed mechanisms and mode of actions. Some potential anti-diabetic plants are alkanet, asthma weed, bamboo, basil, caraway, chirayita, coleus, cubeb, cumin, cypress, damask rose, fennel, fenugreek, fig, frangipani, ginseng, guava, henna, Indian globe thistle, Indian pennywort, ma-huang, moringa, olive, puncture vine, saffron, sweet lemon, tree turmeric, walnut, corn and tawa tawa. Anti-hypertensive plants discussed in this chapter include basil, black piper, coleus, curry leaf, puncture vine, sesame seed, yarrow, passion fruit, onion, garlic, celery, oat, barberry, black cumin, ylang ylang, garden cress, ginger and sweet lemon.

Diabetes Mellitus (DM) has become a major and serious health problem worldwide. To overcome this lifestyle disease, natural products can be explored systematically. These natural products act on various targets and show their effect in diabetic conditions. Out of this, GLP-1 Receptor is one of the promising targets. Cells in the small intestine secrete Incretin hormones upon nutrient ingestion. Glucagon-like peptide-1 (GLP-1) is a primary incretin hormone in metabolism that has a potent antihyperglycemic effect. Insulin will release, in the presence of hyperglycemia, GLP-1 stimulates the pancreas to release insulin, stops glucagon release, gastric emptying slows down and increases satiety by acting on the hypothalamus. Storage of GLP-1 is mainly in secretory granules of L cells, in small intestinal distal portion and colon. When the cells are activated, this peptide is released into the main bloodstream.GLP-1 secreted mainly upon the ingestion of oral glucose or the ingestion of a mixed meal. Other factors like neurotransmitters and intestinal hormones also affect GLP-1 secretion from the intestine. Considering the above-mentioned parameters, regulation and control of GLP-1 are necessary as GLP-1 secretion is hampered in T2DM.

The present chapter focuses on scientific information about natural products specifically acting as GLP- 1 Receptor Agonist (GLP-1 RA).

Diabetes mellitus is a chronic metabolic disorder and is one of the major leading causes of death worldwide. According to the World Health Organisation, the burden of diabetes has increased almost two-fold in 2014 compared to 1980 in lowand middle-income countries. Uncontrolled levels of glucose in the blood are because of improper insulin secretion or insulin action which is associated with abnormalities in metabolic, genetic and hemodynamic systems. The term cardiovascular disease is used for all types of disorders associated with heart and blood vessels. Many researchers are trying to develop new therapeutic approaches for the treatment of diabetes and cardiovascular disease. Herbal medicines are one of the oldest and alternative therapeutic treatment options for diabetes and hypertension. Around 1200 traditional medicinal plants have been used for their beneficial effects on diabetes. These plants are rich in alkaloids, glycosides, flavonoids, polyphenols and terpenoids. Terpenoids are a diverse category of cyclic compounds obtained naturally from the isoprene unit. Among all reported natural products, about 60% of compounds are from terpenoids. More than 40,000 terpenoids are isolated from secondary metabolites of plants. Most of them are of plant dietary origin. Plants produce terpenoids as a secondary metabolite. More than hundreds of new terpenoid structures are reported every year for their activity in many disease conditions like cancer, malaria, inflammation, and a variety of infectious diseases. Various reports have shown that terpenoids are beneficial in the treatment of diabetes and cardiovascular diseases. The chapter is focused on terpenoids and their role in the treatment and management of diabetes and cardiovascular diseases.

Diabetes mellitus and hypertension are the two most common diseases in modern civilized countries. It is suggested that hypertension is more likely to be associated with type II diabetes as the patient acquires both diseases at old age. Though several therapeutic approaches were developed to treat the complications, plant-based therapeutics remains one of the most promising approaches. Moreover, traditional medicine remains as a primary health care system in the resource constraint societies. The use of medicinal plants for therapeutic uses has a long tradition in Asia in the form of Ayurveda, Traditional Chinese Medicine, Unani, Jamu, etc. In recent years, the scientific community has focused on natural products derived from ethnomedicinal plants for their wide therapeutic potentials, including diabetes mellitus and hypertension. Phenformin, metformin, repaglinide (Prandin), nateglinide (Starlix), pioglitazone, rosiglitazone, acarbose, miglitol are some of the antidiabetic marketed drugs of plant origin. Lignans, cinnamaldehyde, and protodioscin are newly isolated anti-diabetic drugs from plant sources. This chapter attempts to highlight the medicinal plants of Asia used for antidiabetic and antihypertensive purposes with regard to their phytochemical potentials, biosafety, and scientific evaluation of their traditional uses.

Chrysophyllum cainito L. is part of the family Sapotaceae and native to the Greater Antilles and the West Indies. This specie is a medicinal plant used around the world by many cultures, commonly known as “star apple” or “caimito”. Some studies have reported that C. cainito possesses many pharmacological properties as antidiabetic, anti-hypersensitivity, antihypertensive, anti-inflammatory, antimicrobial, antinociceptive, antioxidant, gastroprotective and immunosuppressive. Also, phytochemical evidence has revealed that the main secondary metabolites in C. cainito are alkaloids, tannins, flavonoids, phenols, sterols, coumarins and triterpenes which are responsible for their pharmacological benefits. In vitro and in vivo toxicology studies have suggested human consumption of Chrysophyllum cainito leaves as safe. This chapter includes scientific information of pharmacology, toxicology and phytochemistry of C. cainito seeds, leaves, and fruits with the purpose to contribute valuable scientific information to future research in drug development based on C. cainito as a source of raw material.