Practice recommendations
- Limited randomized control trial data and observational studies show that the herbs Coccinia indica, holy basil, fenugreek, Gymnema sylvestre, and the herbal formulas Ayush-82 and D-400 have glucose-lowering effects. But these herbs are not as well studied as others more familiar to Western medicine. (B)
- Inform patients who ask about Ayurveda that traditional practitioners rely on the interaction of several components, of which herbs are just one, and that no formal studies have looked at Ayurveda as a whole system. (B)
Abstract
- Objective: To evaluate and synthesize the evidence on the effect of Ayurvedic therapies for diabetes mellitus.
- Design: Systematic review of trials.
- Measurements and main results: We found no study that assessed Ayurvedic as a system of care. Botanical therapy was by far the most commonly studied Ayurvedic treatment. Herbs were studied either singly or as formulas. In all, 993 titles in Western computerized databases and 318 titles identified by hand-searching journals in India were examined, yielding 54 articles reporting the results of 62 studies. The most-studied herbs were G sylvestre, C indica, fenugreek, and Eugenia jambolana. A number of herbal formulas were tested, but Ayush-82 and D-400 were most often studied. Thirty-five of the studies included came from the Western literature, 27 from the Indian. Seven were randomized controlled trials (RCTs) and 10 controlled clinical trials (CCTs) or natural experiments. Twenty-two studies went on to further analysis based on a set of criteria. Of these, 10 were RCTs, CCTs, or natural experiments, 12 were case series or cohort studies. There is evidence to suggest that the herbs C indica, holy basil, fenugreek, and G sylvestre, and the herbal formulas Ayush-82 and D-400 have a glucose-lowering effect and deserve further study. Evidence of effectiveness of several other herbs is less extensive (C tamala, E jambolana, and Momordica charantia).
- Conclusions: There is heterogeneity in the available literature on Ayurvedic treatment for diabetes. Most studies test herbal therapy. Heterogeneity exists in the herbs and formulas tested (more than 44 different interventions identified) and in the method of their preparation. Despite these limitations, there are sufficient data for several herbs or herbal formulas to warrant further studies.
Given the US population’s increasing interest in herbal and alternative therapies, it is just a matter of time before you will be fielding questions from patients about Ayurveda—a comprehensive system of health care that originated in India roughly 3000 years ago, emphasizing the relationships among body, mind, and spirit. Diabetes has been a particular focus of this medical system, and a few Ayurvedic herbs do indeed appear to exert glucose lowering mechanisms.
But how strong is the evidence? Though Ayurveda involves the interaction of many kinds of therapy, this review examines only the literature pertaining to herbal remedies your patients with diabetes are likely to ask about.
Ayurveda more than herbs
Ayurveda (Sanskrit for “knowledge of life” or “knowledge of longevity”) has now spread beyond India’s borders to include the rest of the Indian subcontinent, Sri Lanka, Malaysia, Mauritius, South Africa, Japan, Russia, Europe, and North America. At its root, Ayurveda seeks to restore an individual’s innate harmony. Primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, controlled breathing, and detoxification treatments.
Dosha imbalance. Ayurveda considers human beings a microcosm of nature. All living and nonliving things are believed to consist of 5 basic elements: ether (space), air, fire, water, and earth. In humans these elements combine and manifest in the human body as 3 humors, or doshas, known as vata, pitta, and kapha.
The doshas govern all biological, psychological, and pathophysiological functions. They are fundamental to human health, and an imbalance of the doshas brings on illness. Consequently, Ayurveda seeks to bring the doshas back into harmony. Balanced doshas, as well as good-quality tissues (dhatus), proper digestion, and elimination of excretions (malas), are considered essential in Ayurveda for maintaining health.
Dosha body type influences treatment. In addition, humans are endowed at birth with 1 of 7 body types, depending on which dosha or combination of the 3 basic doshas dominates. Body types can be dominated by a single humor (vata, pitta, or kapha), or they can be dominated by combinations: vata-kapha (when vata and kapha are present in almost equal amounts); vata-pitta; pitta-kapha; or vata-pitta-kapha. A person’s dosha body type is expressed physically and emotionally; for example, a person with a vata-dominant body type will have a thin frame and an insecure temperament. The Ayurvedic physician takes body type and imbalances among the doshas into consideration when treating a patient.
Application to diabetes. The Indian word for diabetes is madhumeha, from madhu, meaning “sweet/sweetness,” and meha, meaning excessive urination. Classical Ayurvedic therapy for madhumeha (diabetes) begins with an assessment of the dosha imbalance. In all types of pramehas (urinary disorders), kapha is vitiated, but in madhumeha, vata is often aggravated as well. Therefore, therapies will be directed at both vata and kapha simultaneously to restore the balance of the doshas.1,2