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Effect of Amla fruit (Emblica officinalis Gaertn.) on blood glucose and
lipid profile of normal subjects and type 2 diabetic patients
MUHAMMAD SHOAIB AKHTAR
1
, AYESHA RAMZAN
2
, AMANAT ALI
3
,&
MAQSOOD AHMAD
1
1
Department of Pharmacy, University of Sargodha, Sargodha, Pakistan,
2
Department of Home Economics, University of
Agriculture, Faisalabad, Pakistan, and
3
Department of Food Science and Nutrition, College of Agricultural and Marine Sciences,
Sultan Qaboos University, Al-Khoud, Muscat, Oman
Abstract
The present study evaluated the anti-hyperglycemic and lipid-lowering properties of Emblica officinalis Gaertn. fruit in normal
and diabetic human volunteers. The results indicated a significant decrease (P,0.05) in fasting and 2-h post-prandial blood
glucose levels on the 21st day in both normal and diabetic subjects receiving 1, 2 or 3 g E. officinalis powder per day as compared
with their baseline values. Significant (P,0.05) decreases were also observed in total cholesterol and triglycerides in both
normal and diabetic volunteers on day 21 that were given either 2 or 3 g E. officinalis powder per day. However, diabetic
volunteers receiving only 3 g E. officinalis powder exhibited a significant (P,0.05) decrease in total lipids on day 21. Both
normal and diabetic volunteers receiving 2 or 3 g E. officinalis powder significantly (P,0.05) improved high-density
lipoprotein-cholesterol and lowered low-density lipoprotein-cholesterol levels.
Keywords: Emblica officinalis Gaertn., Amla fruit, blood glucose, lipid profile, normal and diabetic human volunteers
Introduction
Although considerable progress has been made in the
treatment and management of diabetes mellitus with
conventional synthetic drugs (Davis 2007, Vinik 2007,
Freeman 2010), there is still a continuous increase in
its prevalence worldwide. The surge for the use of
natural agents and alternative therapies in diabetes
management is therefore now on the increase to lower
the overall financial burden on public health services
(Davis et al. 2009, Nampoothiri et al. 2010,
O’Loughlin et al. 2010). In folk medicine, a large
number of plants are allegedly used to treat diabetes
mellitus (Said 1969, Sabu and Kuttan 2002,
Rajagopal and Sasikala 2008, Kumar and Loganathan
2010, Sharma et al. 2010). Some of them have been
reported to have the potential to significantly reduce
the blood glucose levels when given either as a whole in
powdered form or in the form of their aqueous or
methanolic extracts (Akhtar 1992, Broadhurst et al.
2000, Khan et al. 2003, Rajagopal and Sasikala 2008).
The data from the latest studies on indigenous
medicinal plants have revealed the presence of
many active principles that could prove useful for
treating many diseases, including diabetes (Lewis and
Elvin-Lewis 1977, Akhtar 1995, Hasani-Ranjbar et al.
2010). However, a substantial number of indigenous
plants and herbs still await exploration by modern
screening methods, especially in human patients.
Emblica officinalis Gaertn, commonly called Amla
fruit or Indian Gooseberry, has traditionally been used
for different medicinal purposes to treat the cerebral
and intestinal ailments, diabetes mellitus, coronary
heart diseases as well as cancers (Rajarama-Rao and
Siddiqui 1964, Aslokar et al. 1992). E. officinalis
Gaertn. has also been used to treat rheumatic pains,
diseases of eye and genitalia, gonorrhea, constipation,
asthma, biliousness and diarrhea, as well as a tonic for
ISSN 0963-7486 print/ISSN 1465-3478 online q2011 Informa UK, Ltd.
DOI: 10.3109/09637486.2011.560565
Correspondence: Dr Amanat Ali, Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos
University, P.O. Box 34, Al-Khod 123, Sultanate of Oman, Tel: 968 24141242. Fax: 968 24413418. E-mail: amanat@squ.edu.om
International Jour nal of Food Sciences and Nutrition,
2011; Early Online: 1–8
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hair (Said 1969, Satyavati et al. 1976, Perry 1980).
The leaves, fruit as well as its aqueous and methanolic
extracts have shown hypoglycemic effects in animal
models (Akhtar 1995, Sabu and Kuttan 2002).
E. officinalis fruit and its extracts have shown anti-
inflammatory, antioxidant and free radical scavenging
properties in animal models (Asmawi et al. 1993,
Hazra et al. 2010, Muthuraman et al. 2010,
Nampoothiri et al. 2010, Reddy et al. 2010).
E. officinalis has also been reported to have beneficial
effects in the treatment of acute pancreatitis in rats
(Sidhu et al. 2010). However, systematic scientific
studies to clinically evaluate its anti-hyperglycemic and
anti-hyperlipidemic effects in human volunteers are
still limited. The present study was therefore
conducted to evaluate the effects of powdered E.
officinalis fruit on blood glucose levels and lipid profiles
in normal subjects and type 2 diabetic human patients.
Materials and methods
Representative samples of E. officinalis Gaertn. fruit
(commonly known as Amla) were obtained from local
herbal market of Faisalabad (Pakistan). The fruits
were washed with tap water, dried under shade, and
powdered in a metallic pestle and mortar. The
powdered samples were packed and sealed in
cellophane bags and stored at 48C.
A total of 32 volunteers (16 diabetic patients and 16
age-matched and gender-matched normal subjects)
participated in the present study. The volunteers were
of both sexes and their ages ranged from 30 to 60
years. The diabetic subjects were selected randomly
from the outdoor clinics of University of Agriculture
Faisalabad and Khadija Memorial Trust Hospital
Faisalabad, Pakistan. All of the diabetic volunteers had
been suffering from type 2 diabetes mellitus (i.e. non-
insulin-dependent diabetes mellitus) for the past 5
years. They were found to be mostly on different oral
hypoglycemic agents such as Daonil
w
, Glucophage
w
,
Amaryl
w
, Novanol
w
, or herbal preparation, while the
others were only using dietary management strategies.
The history of each patient was recorded in a proper
proforma and the diagnosis was confirmed with the
proper laboratory tests. The diagnostic criteria used
for the confirmation of diabetes mellitus was fasting
plasma glucose level $7.0 mmol/l or 126 mg/dl or the
2-h plasma glucose level $11.1 mmol/l or 200 mg/dl
(World Health Organization 2006). The age-matched
and gender-matched normal subjects were selected
either from the same family or from the similar socio-
economic and cultural background. The normal
subjects were apparently healthy and did not show
any abnormal glucose tolerance test and lipid profile.
The study was approved by the university ethics
committee.
The volunteers were divided into two main groups
(normal and diabetic). Each main group was then
further randomly divided into four sub-groups with
four volunteers in each. The normal human
volunteers were divided into the four groups A, B,
C and D comprising four volunteers in each
group. Carboxymethyl cellulose fiber was given to
group A that acted as control, while groups B, C and D
were given 1, 2 or 3 g powdered E. officinalis fruit orally
with 30 ml water once daily in the morning after
breakfast. Similarly the diabetic patients were also
divided into four groups (E, F, G and H), each
comprising four volunteers. The diabetic volunteers in
group E received glibenclamide orally (Daonil
w
)asa5
mg tablet twice daily and acted as control. The
diabetic human volunteers in groups F, G and H were
given 1, 2 or 3 g powdered E officinalis fruit orally with
30 ml water once daily in the morning after breakfast.
The fasting and 2-h postprandial (after breakfast)
blood glucose levels were determined on 0 (baseline),
8, 15 and 21 days post treatment. The blood glucose
levels of the volunteers were determined using glucose
strips with the help of a Glucotrend glucometer
(Roche, Milpitas, CA, USA). The blood glucose was
determined at baseline (day 0) and on post-treatment
days 8, 15 and 21 after the continuous daily oral intake
of the powdered Amla fruit in the prescribed dosage.
The fasting blood lipid profile was determined on 0
(baseline), 8, 15 and 21 days post treatment. The
blood lipid profile parameters included total lipids,
triglycerides, total cholesterol, high-density lipopro-
tein cholesterol (HDL-cholesterol) and low-density
lipoprotein cholesterol (LDL-cholesterol). The blood
lipid profile was determined with using the reagent kits
from Randox Laboratories Limited (Crumlin, UK).
Total lipids were determined with the help of a reagent
kit method (Zoeliner and Kirsch 1962). Triglycerides
were determined with the reagent kit method. Total
cholesterol was determined with the reagent kit
method (Richmond 1973). HDL-C was determined
with the reagent kit method (Lopez-Virella 1977).
LDL-C was calculated using the Friedewald Default
(Friedewald et al. 1972). The data collected were
subjected to statistical analysis using one-way analysis
of variance, and the means were compared with least-
significant-difference values and Duncan’s multiple-
range test as described by Steel et al. (1997).
Results
The average fasting blood glucose values (mean ^
standard error of the mean) in normal and diabetic
human volunteers are presented in Table I.
A significant (P,0.05) decrease in fasting blood
glucose level was observed on day 21 as compared with
baseline values (day 0) in both normal and diabetic
volunteers in all groups (B, C, D, F, G and H) that
were orally given 1, 2 or 3 g powdered Amla fruit once
daily after breakfast. Such a decrease was, however,
observed only in diabetic human subjects (group E)
on days 8, 15 and 21 who were orally given a
glibenclamide 5 mg tablet twice daily. The average
M. S. Akhtar et al.2
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blood glucose values (2-h post-prandial after break-
fast) in normal and diabetic human subjects are
presented in Table II. A significant (P,0.05)
decrease in blood glucose level was observed on days
8, 15 and 21 in normal volunteers given either 2 or 3 g
powdered Amla fruit as compared with baseline values
(day 0). However, all of the diabetic patients (groups
F, G and H) exhibited significantly (P,0.05) lower
blood glucose levels on days 8, 15 and 21 as compared
with baseline values (day 0).
The results on the effects of intake of powdered
E. officinalis fruit on the blood lipid profile in normal
subjects and type 2 diabetic human patients are shown
in Tables III–VII. A significant (P,0.05) decrease in
total cholesterol values was observed in normal
volunteers (groups C and D) as well as in diabetic
patients (groups G and H) on days 8, 15 and 21 after
treatment with powdered Amla fruit (Table lII).
Similarly a significant (P,0.05) decrease in
triglyceride levels in groups C and D was observed in
normal volunteers and diabetic patients (G and H).
However, the volunteers in groups D and H, who were
given 3 g powdered Amla fruit showed a significant
(P,0.05) decrease in their blood triglycerides levels
on the 8th day (Table IV). Similar results were
observed for the blood total lipid values (Table V).
Both the normal human volunteers (groups B, C and
D) and the diabetic patients (groups F, G and H)
showed significantly (P,0.05) lower total lipids
values on days 15 and 21 after treatment with
powdered Amla fruit as compared with baseline values
(day 0). Significantly (P,0.05) higher HDL-choles-
terol values were observed in diabetic human
volunteers who were given either 1, 2 or 3 g powdered
Amla fruit per day on days 15 and 21 as compared with
baseline values (day 0). In normal subjects, however,
such an increase was only observed on the 21st day
with a 2 g per day dose and on days 15 and 21 with a 3
g per day dose (Table VI). The average levels of LDL-
cholesterol in normal and diabetic human volunteers
Table I. Average fasting blood glucose values (mg/dl) in normal and diabetic volunteers at baseline and after daily oral treatment with three
doses of powdered Amla fruit (E. officinalis) and glibenclamide
Time interval
Treatment group 0 days 8 days 15 days 21 days
Normal individuals
A 86.7 ^6.1 87.2 ^6.7 86.2 ^7.3 85.2 ^4.8
B 92.3 ^6.4 88.0 ^4.7 82.5 ^3.6 79.0 ^3.6*
C 99.8 ^3.3 89.3 ^3.1 80.3 ^3.1*73.5 ^2.2**
D 99.0 ^3.5 81.5 ^3.9*77.0 ^2.4** 70.0 ^2.5**
Diabetic patients
E 133.0 ^16.1 96.5 ^12*91.2 ^11** 81.2 ^10**
F 139.8 ^11.8 129.5 ^11.5 100.3 ^10.3*90.0 ^6.8*
G 133.3 ^13.0 110.0 ^3.9 96.3 ^3.9*88.0 ^3.7**
H 138.5 ^1.1 91.5 ^10.6*81.3 ^8.2** 73.0 ^6.7**
Mean ^standard error of the mean (n¼16). A, carboxymethyl cellulose-treated normal group; B, C, D, normal groups receiving orally 1, 2 or
3 g Amla, respectively; E, diabetic group treated with glibenclamide (Daonil
w
) 5 mg twice daily; F, G and H, diabetic groups receiving orally 1, 2
or 3 g Amla, respectively. Significantly decreased from day 0 at *5% and **1%, respectively. All other values are non-significant (P.0.05) from
control.
Table II. Average 2-h postprandial blood glucose values (mg/dl) in normal and diabetic human volunteers after daily oral treatment with three
doses of powdered Amla fruit (E. officinalis) and glibenclamide.
Time interval
Treatment group 0 days 8 days 15 days 21 days
Normal individuals
A 128.5 ^9.3 127.5 ^10.7 126.0 ^9.2 122.0 ^9.3
B 127.0 ^9.5 113.5 ^7.7 109.5 ^7.9*108.0 ^18.5*
C 129.8 ^7.1 106.0 ^4.1*93.8 ^3.0** 94.5 ^2.5**
D 126.8 ^6.9 106.5 ^3.1*92 ^3.7** 90.8 ^2.5**
Diabetic patients
E 283.5 ^20.6 130.7 ^12** 107.5 ^8.4** 100.7 ^3.4**
F 289.0 ^24.9 179.3 ^20.4*168.8 ^16.5*138.5 ^14.8**
G 246.8 ^21.7 134.5 ^11.9*130.8 ^11.6** 129.8 ^10.9**
H 286.5 ^23.2 124.8 ^17.3** 111.0 ^11.4** 108.3 ^8.5**
Mean ^standard error of the mean (n¼16). A, carboxymethyl cellulose-treated normal group; B, C, D, normal groups receiving orally 1, 2 or
3 g Amla, respectively; E, diabetic group treated with glibenclamide (Daonil
w
) 5 mg twice daily; F, G and H, diabetic groups receiving orally 1, 2
or 3 g Amla, respectively. Significantly decreased from day 0 at *5% and **1%, respectively. All other values are non-significant (P.0.05) from
control.
Amla fruit (Emblica officinalis Gaertn.)in type 2 diabetes 3
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Table IV. Average fasting triglycerides values (mg/dl) of normal and diabetic human volunteers after oral treatment with three doses of
powdered Amla (E. officinalis) fruit and glibenclamide.
Time interval
Treatment group 0 days 8 days 15 days 21 days
Normal individuals
A 191.2 ^57.03 191.0 ^51.71 196.2 ^56.00 191.0 ^55.83
B 126.8 ^18.2 115.3 ^20.7 96.5 ^18.5 106.0 ^14.3
C 175.5 ^38.3 121.8 ^25.2** 115.5 ^19.4*112.0 ^15.4*
D 159.8 ^19.1 138.8 ^15.5** 126.3 ^10.7*121.0 ^13.2*
Diabetic patients
E 216.2 ^21.7 239.0 ^18.7 223.2 ^17.3 214.2 ^11.6
F 288.8 ^26.1 295.3 ^17.2 269.3 ^19.1*272.8 ^13.4*
G 280.0 ^27.9 227.3 ^26.6** 197.0 ^20.2** 147.0 ^15.7**
H 282.8 ^22.8 214.3 ^20.6** 181.3 ^19.9** 134.0 ^15.0**
Mean ^standard error of the mean (n¼16). A, carboxymethyl cellulose-treated normal group; B, C, D, normal groups receiving orally 1, 2 or
3 g Amla, respectively; E, diabetic group treated with glibenclamide (Daonil
w
) 5 mg twice daily; F, G and H, diabetic groups receiving orally 1, 2
or 3 g Amla, respectively. Significantly decreased from day 0 at *5% and **1%, respectively. All other values are non-significant (P.0.05) from
control.
Table III. Average fasting total cholesterol values (mg/dl) in normal and diabetic human volunteers after oral treatment with three doses of
powdered Amla fruit (E. officinalis) and glibenclamide.
Time interval
Treatment group 0 days 8 days 15 days 21 days
Normal individuals
A 175.5 ^7.1 173.8 ^8.1 177.3 ^4.2 179.8 ^4.4
B 162.5 ^2.5 128.8 ^3.1 121.3 ^3.7 114.0 ^3.5
C 169.5 ^7.5 122.5 ^6.5*118.5 ^3.4** 101.8 ^2.9**
D 167.0 ^6.5 139.5 ^3.7*114.8 ^2.9** 108.0 ^2.4**
Diabetic patients
E 213.5 ^21.7 219.7 ^12.8 210.7 ^8.38 209.2 ^5.9
F 214.5 ^23.8 203.5 ^18.2 184.3 ^14.8*177.8 ^5.5*
G 224.8 ^13.7 188.5 ^12.6*177.8 ^11.6** 163.0 ^10.2**
H 226.5 ^20.7 213.0 ^20.1*203.8 ^16.1** 168.8 ^10.9**
Mean ^standard error of the mean (n¼16). A, carboxymethyl cellulose-treated normal group; B, C, D, normal groups receiving orally 1, 2 or
3 g Amla, respectively; E, diabetic group treated with glibenclamide (Daonil
w
) 5 mg twice daily; F, G and H, diabetic groups receiving orally 1, 2
or 3 g Amla, respectively. Significantly decreased from day 0 at *5% and **1%, respectively. All other values are non-significant (P.0.05) from
control.
Table V. Average fasting total lipids levels (mg/dl) of normal and diabetic human volunteers after treatment with three doses of powdered Amla
(E. officinalis) fruit and glibenclamide.
Time interval
Treatment group 0 days 8 days 15 days 21 days
Normal individuals
A 527.2 ^18.0 521.2 ^19.4 525.5 ^16.0 539.2 ^14.9
B 487.5 ^17.6 386.1 ^13.3*363.8 ^13.2*342.0 ^12.4*
C 508.5 ^27.3 427.5 ^29.3*415.5 ^22.3*395.3 ^20.9**
D 501.0 ^20.6 418.5 ^20.0*404.3 ^18.7*384.0 ^13.1**
Diabetic patients
E 640.5 ^24.70 659.2 ^29.86 641.2 ^31.12 660.0 ^37.3
F 643.5 ^31.2 640.5 ^24.6 582.8 ^24.4*563.3 ^16.6*
G 554.3 ^31.1 555.5 ^30.9 523.3 ^20.8*519.0 ^20.6*
H 649.5 ^32.1 639.0 ^36.2 511.3 ^31.3*506.3 ^30.7*
Mean ^standard error of the mean (n¼16). A, carboxymethyl cellulose-treated normal group; B, C, D, normal groups receiving orally 1, 2 or
3 g Amla, respectively; E, diabetic group treated with glibenclamide (Daonil
w
) 5 mg twice daily; F, G and H, diabetic groups receiving orally 1, 2
or 3 g Amla, respectively. Significantly decreased from day 0 at *5% and **1%, respectively. All other values are non-significant (P.0.05) from
control.
M. S. Akhtar et al.4
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are presented in Table VII. The results reveal
that LDL-cholesterol levels decreased significantly
(P,0.05) on days 8, 15 and 21 as compared with
baseline values (day 0) in the normal volunteers
(groups B, C and D). Whereas in diabetic patients a
significant decrease in LDL-cholesterol values was
only observed on days 15 and 21 as compared with the
baseline values (day 0).
Discussion
The use of natural agents and alternative therapies in
the treatment and management of diabetes mellitus is
becoming increasingly popular not only to reduce the
side effects of synthetic medicines but also to lower the
overall financial burden caused by the disease (Morelli
and Zoorob 2000, Davis et al. 2009, Nampoothiri et al.
2010, O’Loughlin et al. 2010). Many indigenous
medicinal plants and herbs contain a number of active
principles, which have shown anti-hyperglycemic,
anti-hyperlipidemic and anti-inflammatory effects in
animal models and could therefore be useful for
treating many diseases including diabetes (Lewis and
Elvin-Lewis 1977, Akhtar 1995, Rajagopal and
Sasikala 2008, Hasani-Ranjbar et al. 2010, Kumar
and Loganathan 2010). E. officinalis Gaertn., which is
commonly called Amla fruit or Indian Gooseberry, has
traditionally been used in folk medicine to prevent and
treat many diseases such as rheumatic pains, diseases
of the eye and genitalia, constipation, asthma, cerebral
and intestinal ailments, diabetes mellitus, coronary
heart diseases as well as cancers (Rajarama-Rao and
Siddiqui 1964, Said 1969, Satyavati et al. 1976,
Aslokar et al. 1992).
The results of the present study indicated a
significant decrease (P,0.05) in fasting and 2-h
post-prandial blood glucose on day 21 in normal
subjects and diabetic patients as compared with
baseline values (day 0). The supplementation of
powdered Amla fruit at all the given doses did not
Table VI. Average fasting HDL-cholesterol values (mg/dl) of normal and diabetic human volunteers after treatment with three doses of
powdered Amla (E. officinalis) fruit glibenclamide.
Time interval
Treatment group 0 days 8 days 15 days 21 days
Normal individuals
A 65.8 ^25.5 66.8 ^2.7 66.0 ^3.0 64.2 ^2.9
B 37.0 ^1.4 36.8 ^1.2 37.5 ^1.3 37.8 ^1.4
C 39.5 ^1.0 37.5 ^0.8 37.5 ^0.9 46.5 ^1.2*
D 39.3 ^1.4 36.5 ^1.5 46.8 ^0.9*56.5 ^0.5**
Diabetic patients
E 47.5 ^5.3 49.5 ^4.7 48.2 ^4.9 47.2 ^5.4
F 46.8 ^4.5 48.8 ^4.2 48.8 ^4.2*50.3 ^2.8*
G 48.3 ^3.9 47.3 ^2.6 63.0 ^2.9*69.3 ^2.9*
H 49.8 ^3.9 46.3 ^5.9 59.8 ^4.3*83.3 ^3.1*
Mean ^standard error of the mean (n¼16). A, carboxymethyl cellulose-treated normal group; B, C, D, normal groups receiving orally 1, 2 or 3
g Amla, respectively; E, diabetic group treated with glibenclamide (Daonil
w
) 5 mg twice daily; F, G and H, diabetic groups receiving orally 1, 2 or
3 g Amla, respectively. Significantly decreased from day 0 at *5% and **1%, respectively. All other values are non-significant (P.0.05) from
control.
Table VII. Average fasting LDL-cholesterol values (mg/dl) in normal and diabetic human volunteers after treatment with three doses of powder
Amla fruit (E. officinalis) and glibenclamide.
Time interval
Treatment group 0 days 8 days 15 days 21 days
Normal individuals
A 71.5 ^4.2 68.8 ^4.9 72.6 ^7.5 77.4 ^8.1
B 100.1 ^2.2 68.9 ^1.0*64.5 ^0.5*54.5 ^1.2*
C 94.9 ^3.0 60.6 ^7.3*57.9 ^5.5*57.9 ^7.4**
D 95.7 ^6.6 75.2 ^5.6*42.7 ^6.8*47.7 ^5.6**
Diabetic patients
E 122.8 ^18.3 122.4 ^19.5 117.8 ^11.1 119.2 ^42.2
F 109.9 ^18.9 95.6 ^14.1 81.6 ^11.4*72.9 ^8.8*
G 120.8 ^6.6 95.7 ^14.9 75.4 ^3.9*64.3 ^3.2**
H 119.9 ^8.4 124.1 ^8.0 107.7 ^6.4** 58.7 ^2.4**
Mean ^standard error of the mean (n¼16). A, carboxymethyl cellulose-treated normal group; B, C, D, normal groups receiving orally 1, 2 or 3
g Amla, respectively; E, diabetic group treated with glibenclamide (Daonil
w
) 5 mg twice daily; F, G and H, diabetic groups receiving orally 1, 2 or
3 g Amla, respectively. Significantly decreased from day 0 at *5% and **1%, respectively. All other values are non-significant (P.0.05) from
control.
Amla fruit (Emblica officinalis Gaertn.)in type 2 diabetes 5
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show any negative impact on blood glucose levels in
both the normal and diabetic subjects as these values
remained within the normal blood glucose range; that
is, 70– 110 mg/dl (World Health Organization 2006).
These results are in line with the previously reported
data that showed different medicinal plants and herbs
have the potential to significantly and consistently
reduce the blood glucose levels in normal and alloxan-
induced diabetic rats and rabbits (Akhtar 1982, 1992,
Mossihuzzaman et al. 1994). Cuminum nigr um (black
cumin) seeds when given at different doses (1, 2, 3 or 4
g/kg body weight) produced a significant hypoglyce-
mic effect in normal and alloxan-induced diabetic
rabbits (Akhtar et al. 1981, Akhtar and Ali 1985,
Mushtaq et al. 2000). Kumar and Loganathan (2010)
suggested that Spinacia oleraceae possesses anti-
diabetic principle and can be useful for the treatment
of diabetes. E. officinalis has also been reported to be
beneficial in the treatment of acute pancreatitis in rats
(Sidhu et al. 2010). The potent antioxidant, anti-
inflammatory and free radical scavenging activities of
E. officinalis fruits extracts might play an important
role for its beneficial effects in controlling the
hyperglycemia and dyslipidemia and may reduce the
risk of diabetes and other diseases (Hazra et al. 2010,
Nampoothiri et al. 2010, Muthuraman et al. 2010,
Reddy et al. 2010). Kim et al. (2010) suggested that
polyphenol rich fractions of E. officinalis Gaertn. can
attenuate the fructose-induced metabolic syndrome.
The higher antioxidant activity of E. officinalis has also
been attributed to its vitamin C content (Scartezzini
et al. 2006).
Measurement of the serum lipid profile is con-
sidered one of the important screening procedures to
find out the cardiac risk in population. A lipid profile is
a direct measure of blood components such as total
lipids, triglycerides total cholesterol, HDL-cholesterol
and LDL-cholesterol. Factors such as age sex, genetic,
diabetes and diet influence the lipid profile (Robert
2002). Significant (P,0.05) decreases in total
cholesterol and triglyceride levels were observed in
both the normal and diabetic volunteers on day 21
who were given either 2 or 3 g herbal powder. The
volunteers in the diabetic sub-group, who received 3 g
herbal powder, exhibited a significant (P,0.05)
decrease in total lipids on day 21. Both the normal and
diabetic volunteers in all the sub-groups receiving 2 or
3 g herbal powder showed a significant (P,0.05)
improvement in the LDL-cholesterol values on days
15 and 21 as compared with baseline values (day 0).
Simultaneously a significant decrease in the LDL-
cholesterol levels was observed. The data indicated
that the intake of powdered E. officinalis fruit worked
in a dose-dependent and time-dependent manner in
reducing the blood glucose levels and lipid profile
in normal subjects as well as type 2 diabetic human
patients. Mand et al. (1991) observed a decrease in
plasma lipids and cholesterol levels and an increase
in lipid mobilization and catabolism in experimental
hypercholesterolemic rabbits when they were given E.
officinalis (Amla fruit powder) for 12 weeks. The fresh
juice of E. officinalis when given to cholesterol-fed
rabbits acted as an anti-hyperlipidemic agent. It has
been suggested that E. officinalis can be used as a
pharmaceutical tool to lower lipid profile in hyperlipi-
demic subjects (Mathur et al. 1996). E. officinalis
Gaertn. (Amla fruit) contains high quantities of
polyphenols, vitamin C and dietary fiber (Scartezzini
et al. 2006, Muthuraman et al. 2010) that might have
been effective in achieving the cholesterol lowering
effects in both normal and diabetic subjects. Higher
intakes of dietary fiber are associated with lowering of
blood cholesterol and triglyceride levels in diabetic
subjects (Pedersen et al. 1992, He et al. 1995, Vessby
et al. 2000). Studies suggest that blood triglyceride
levels .400 mg/dl could first be treated with non-
pharmacologic approaches including weight loss, low-
fat diet, avoidance of excess alcohol and regular
aerobic exercise before the use of drugs (Lorgeril
1999). Diets low in saturated fat or very low in total fat
contents are considered to be associated with lowering
of low-density lipoprotein cholesterol (Grundy 1998).
Under such conditions, the use of E. officinalis Gaertn.
(Amla fruit) could be a good alternative therapy to
treat the hyperlipidemia.
Obviously the oral anti-hyperglycemic agents from
plants and herbs are of no great value in the treatment
of any type of severe diabetes as b-cells (Islets of
Langerhans) in diabetic patients have already been
damaged to the extent that they might have lost all
their potential to secrete insulin. The search for more
effective and safer anti-diabetic agents is therefore
continuing to be an area of active research. The
present study in human subjects has confirmed the
previous results already obtained in animal models. It
is therefore conceivable that the hypoglycemic
principles contained in the E. officinalis Gaertn.
(Amla fruit) may act by stimulating the insulin release
from the b-cells of the normal and type 2 diabetics.
The Amla fruit, however, appears to contain more
than one active principle (Muthuraman et al. 2010,
Naampothiri et al. 2010, Reddy et al. 2010), which
may act not only indirectly by initiating the release of
insulin but may also have a direct insulin-like effect as
shown in alloxan-induced diabetic animals, because
their b-cells are unable to produce and release any
insulin. The results of this study support the
hypothesis that in mild and moderate type 2 diabetic
patients, the oral administration of powdered Amla
fruit would be sufficiently effective to control their
blood glucose levels if given in appropriate doses.
However, in severely diabetic patients the plant drug
may have to be supplemented with small doses of any
other oral anti-hyperglycemic drug such as sulphony-
lureas. It is possible that this cheap medicinal fruit may
ultimately prove to be an extraordinarily valuable anti-
diabetic agent since, in addition to its non-toxic insulin
releasing and insulin-like activities, it can also
M. S. Akhtar et al.6
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For personal use only.
compensate for the mineral deficiencies that occur in
diabetes due to osmotic diuresis (Laurence and
Bacharach 1964, Garg et al. 2005). Virtually,
E. officinalis Gaertn. (Amla fruit) is being used as a
food and drug in traditional medicine for centuries and
has already been reported to be safe for human use.
Conclusion
Overall, the results of the present study suggest that
Amla fruit (E. officinalis, Gaertn.) has both anti-
hyperglycemic and lipid-lowering properties and
might be used as an ideal plant food supplement in
developing successful alternative therapies in the
prevention and treatment of diabetes, dyslipidemia,
obesity and cancers in general population. However,
further comprehensive phytochemical studies, fol-
lowed by pharmacological evaluations in animal
models and subsequently in humans, are required to
evaluate and pinpoint the real hypoglycemic prin-
ciple(s) and to precisely determine the mechanism(s)
of its hypoglycemic actions.
Acknowledgements
The authors would like to thank the volunteers for
their sincere cooperation towards the successful
completion of the present study.
Declarations of interest: The authors report no
conflicts of interest. The authors alone are responsible
for the content and writing of the paper.
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