Mechanism of action of ginseng in Diabetes

ginsomin_packGinseng affects not only the pancreas to increase insulin production but also other tissue to utilize insulin as well as decrease insulin resistance through its various components. Root extracts and components exhibited anti-hyperglycemic activities and reduced insulin resistance and increased insulin production. Ginseng root is able to increase insulin production and decrease cell apoptosis in pancreatic ?-cells, which signifies that ginseng affects the pancreas directly. Also, ginseng has been shown to mediate various mechanisms related to muscle and fat tissue such as the GLUT4 pathway. The current reports of ginseng and ginsenosides point to the possibility of ginseng as a candidate for complementary diabetes therapy. eCAM 2009;6(4)423–427.

 Reported mechanisms of action include decreased rate of carbohydrate absorption into the portal hepatic circulation, increased glucose transport and uptake mediated by nitric oxide, increased glycogen storage, and modulation of insulin secretion. Diabetes Care 2003 Apr; 26(4): 1277-1294.

Some clinical studies have demonstrated that P. ginseng and North American ginseng improve glycemic control in T2D patients.The glucose-lowering mechanisms of both ginsengs may involve a reduction in insulin resistance and ?-cell function. Ginsenosides are the primary constituents present in ginseng roots that are claimed to benefit health. Extracts of ginseng root have been shown to protect against apoptosis of the pancreatic -cell line, Min-6 cells.

Evidence-Based Complementary and Alternative Medicine Volume 2013 (2013), Article ID 378657, 33 pages

Pharmacologically, ginseng has antioxidant properties. It also reduces ?-cell apoptosis by upregulating adipocytic PPAR-? protein expression. Ginseng impairs glucose absorption by decreasing glucosidase activity. It may also increase insulin sensitivity in peripheral tissues. One of the active components, ginsenoside Rb1, can enhance glucose transport by inducing the differentiation of adipocytes via upregulating the expression of PPAR-? and C/EBP-? . In addition, ginsenoside Rb1 can increase GLUT-4 activity leading to increased uptake of glucose from blood by adipocytes.

Evid Based Complement Alternat Med. 2013; 2013: 343594.

Ginseng in a systematic review and meta-analysis on glycemic control

One study elucidates the effect of ginseng on glycemic control in a systematic review and meta-analysis of randomized controlled trials in people with and without diabetes. This meta-analysis concluded that Ginseng modestly yet significantly improved fasting blood glucose in people with and without diabetes. In order to address the uncertainty in effect estimates and provide better assessments of ginseng’s anti-diabetic efficacy, larger and longer randomized controlled trials using standardized ginseng preparations are warranted. PLoS One. 2014 Sep 29;9(9):e107391.

One Meta-analysis results suggest that the ginseng related therapy exert better glycemic control, with an excellent safety profile. Furthermore, it might be a better option in drug na?¨ve diabetic patients, rather than as an adjunct therapy in patients on anti-diabetic medications. The authors proposed a standardized treatment regimen with duration greater than 3 months, before any strong conclusions can be drawn, on the safety and efficacy of ginseng extracts as a dietary supplement in patients with diabetes mellitus or glucose intolerance. Medicine (Baltimore). 2016 Feb;95(6):e2584.

Panax ginseng Monograph published in Alternative Medicine Review 2009 also stated ginseng helps to regulate glucose metabolism & as an adjuvant to diabetes management. Altern Med Rev. 2009 Jun;14(2):172-6.

Clinical studies on ginseng in Diabetes

In a randomized, double blind placebo controlled clinical trial, 30 patients with type 2 diabetes were contributed. They were divided into two groups (n=15 each), the randomized and placebo groups, the former received 300 mg/day G115 and placebo received 300 mg/d wheat flour. FBS, HbA1c and lipid profile were determined at baseline and at the end of study.

Subjects randomized to G115, as compared to the placebo group, had a significant decrease in HbA1c (t= -2.593,p=0.015)) and FBS levels (t=-2.13,p=0.042).

Based on the findings of this study it can be concluded that administration of 100 mg of standardized extract of Korean red ginseng (G115) before the three main meals (breakfast,lunch and dinner) is effective on blood sugar and glycosylated hemoglobin and can significantly reduce those values. The of Korean red ginseng (G115) extract can be used, alongside other drugs, to control diabetes and its associated complications. Jundishapur Journal Chronic Disease Care.2013;2(3):26-32.

One study was designed to evaluate the effect of Korean red ginseng (KRG) supplementation on glucose control in subjects with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or newly diagnosed type 2 diabetes mellitus (T2DM). The study was a 12-week randomized, double-blinded, placebo-controlled (5 g of KRG [n = 21] or placebo [n = 20] in tablet form) trial. Glucose-related biomarkers, including serum and whole blood levels of glucose, insulin, and C peptide, were measured by 2-h oral glucose tolerance tests (OGTTs) at baseline and after the 12-week intervention. After the intervention, the test group showed a significant decrease in serum levels of glucose at 30 min ( – 22.24 – 10.77 mg/dL) and whole blood levels of glucose at 30 min ( – 17.52 – 5.22 mg/dL). In addition, the test group tended to have lower whole blood levels of glucose at 0 min and glucose area under curve (AUC). However, the placebo group did not show any changes in blood glucose-related indices. The changes (difference from baseline) in serum glucose levels at 30 min, whole blood glucose levels at 60 min, and glucose AUC during OGTTs in the test group exhibited a tendency toward a decrease from those in the placebo group. There were significant decreases or trends toward a decrease in both serum insulin and C-peptide concentrations at most time intervals in the test group. In conclusion, KRG supplementation (5 g/day) may be beneficial for controlling serum and whole blood glucose levels compared with placebo among patients with IFG, IGT, or T2DM. JOURNAL OF MEDICINAL FOOD 17 (1) 2014, 128–134

A 2005 double-blind, crossover RCT examined the effects of Panax ginseng on blood glucose levels and cognitive performance during sustained mental activity. Healthy young adults (n=30) took a 10-minute test battery for baseline results, then were given 200 mg G115, 400 mg G115, or placebo. One hour later the test battery was repeated six times in rapid succession. Blood sugar levels were assessed at baseline and twice during the testing procedure. The 200-mg and 400-mg G115 doses reduced blood glucose levels significantly.

The authors concluded Panax ginseng improves mental performance, possibly by regulating glucose metabolism. J Psychopharmacol. 2005 Jul;19(4):357-65.

 

Ginseng therapy in non-insulin-dependent diabetic patients.

One study investigate the effect of ginseng on newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM) patients.

In this double-blind placebo-controlled study, 36 NIDDM patients were treated for 8 weeks with ginseng (100 or 200 mg) or placebo. Efficacy was evaluated with psychophysical tests and measurements of glucose balance, serum lipids, amino terminalpropeptide (PIIINP) concentration, and body weight.

Ginseng therapy elevated mood, improved psychophysical performance, and reduced fasting blood glucose (FBG) and body weight. The 200-mg dose of ginseng improved glycated hemoglobin, serum PIIINP, and physical activity.

Ginseng may be a useful therapeutic adjunct in the management of non-insulin-dependent diabetes mellitus.Diabetes Care. 1995 Oct;18(10):1373-5.

One randomized clinical studies assessing ginseng on long-term outcomes in type 2 diabetes, authors assessed the clinical antidiabetic efficacy and safety of 12 weeks of supplementation with a Korean red ginseng (KRG) preparation, dose, and mode of administration, selected from an acute, clinical, screening model.

19 participants with well-controlled type 2 diabetes (sex: 11 M:8 F, age: 64+/-2 years, BMI: 28.9+/-1.4 kg/m(2), HbA(1c): 6.5%) completed the study. Using a double-blind, randomized, crossover design, each participant received the selected KRG preparation (rootlets) and placebo at the selected dose (2 g/meal=6 g/day) and mode of administration (preprandial oral agent [-40 min]) for 12 weeks as an adjunct to their usual anti-diabetic therapy (diet and/or medications). The selected KRG treatment decreased 75 g-OGTT-PG indices by 8-11% and fasting-PI and 75 g-OGTT-PI indices by 33-38% and increased fasting-ISI (homeostasis model assessment [HOMA]) and 75 g-OGTT-ISI by 33%, compared with placebo (P<0.05). Safety and compliance outcomes remained unchanged.

12 weeks of supplementation with the selected Korean red ginseng treatment maintained good glycemic control & improved plasma glucose, plasma insulin regulation safely beyond usual therapy in people with well-controlled type 2 diabetes. Nutr Metab Cardiovasc Dis. 2008 Jan;18(1):46-56.

In Randomized double-blind placebo-controlled crossover trial (20 diabetic patients) receives Panax ginseng supplementation 2×369 mg 3 times daily for 4 wk, the authors mentioned that Glucose & insulin? , HOMA-IR ? , Ginseng supplementation can salvage at-risk subjects or delay the onset of diabetes by decreasing insulin resistance.Diabetes Obes Metab. 2008 Nov;10(11):1125-7.

These results suggest that chronic use of Panax ginseng by non-diabetic individuals will have little long-term effect on glucose regulation. The benefits to glucose regulation associated with long-term ginseng use may only be present in populations with compromised glucose control; however, further research is needed to confirm such a speculation. Br J Nutr. 2009 Jun;101(11):1673-8.

 

Peroxisome proliferator-activated receptors (PPARs) are transcriptional factors, which play a key role in modulating glucose and lipid metabolism and in the pathogenesis of atherosclerosis. Ginsenosides are the active components of ginseng, which is a perennial aromatic herb that is widely used in China for medicinal purposes. The aims of this study were to investigate mononuclear macrophage PPARgamma mRNA expression of type 2 diabetes and the effect of ginsenosides on PPARgamma mRNA expression and glucose and lipid metabolism. The results showed that subjects with type 2 diabetes had lower PPARgamma mRNA levels compared with normal controls. Following 2 weeks of 41 mg/day ginsenoside treatment, the expression of PPARgamma mRNA in patients with type 2 diabetes was significantly increased, the total cholesterol and triglyceride levels were significantly decreased, and the blood glucose level also decreased (but without statistical significance) compared to the control group. These results demonstrated that ginsenosides improved PPARgamma expression and lipid metabolism. Thus, ginsenosides may be applied as an adjuvant for treating type 2 diabetes. Mol Biol Rep. 2010 Jul;37(6):2975-9.

The glycaemic effects of single doses of Panax ginseng in young healthy volunteers.

The results of two acute placebo-controlled, double-blind cross-over studies assessing the effect of Panax ginseng (G115) on blood glucose levels are reported. In study 1, thirty participants received three treatments: placebo; 200 mg G115; 400 mg G115. In study 2, 27 participants received 4 treatments: placebo (0 mg ginseng and 30 mg saccharin); ginseng (200 mg ginseng and 30 mg saccharin); placebo-glucose (0 mg ginseng and 25 g oral glucose); ginseng-glucose (200 mg ginseng and 25 g oral glucose). Blood glucose levels were measured at baseline (at 09.00 hours after an overnight fast) and then 60, 90 (study 1 only) and 120 min post-dose. Both studies demonstrated that G115 alone significantly lowers fasting blood glucose levels. Conversely, in study 2 there was a significant drink ginseng interaction suggesting opposing glycaemic effects of ginseng under fasting and raised blood glucose conditions. These data have implications for the use of ginseng in individuals with poor gluco-regulation. Br J Nutr. 2006 Oct;96(4):639-42.

 

Conclusion

Based upon the evidence from cell lines and animal models, along with the improvements from the some human subject trials, ginseng appears to be anti-diabetic supplement.

This data is still insufficient evidence to draw definitive conclusions; however, Ginseng appears to be generally safe & larger number and long term randomized controlled trials using ginseng preparations are warranted in diabetes management.

But the available data suggest that “Ginseng may help to improve blood glucose levels & acts as an adjuvant to diabetes management”.

Comments are currently closed.