Moringa for Diabetes
Moringa for Diabetes
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Fikile T. Mthiyane, Phiwayinkosi V. Dludla, Khanyisani Ziqubu, Sinenhlanhla X. H. Mthembu1, Ndivhuwo Muvhulawa, Nokulunga Hlengwa et.al. A Review on the Antidiabetic Properties of Moringa oleifera Extracts: Focusing on Oxidative Stress and Inflammation as Main Therapeutic Target. Frontiers in Pharmacology. 11 July 2022.
Moringa oleifera is one of the popular plants that have shown significant health benefits. Preclinical evidence (predominantly from animal models) summarized in this referenced review supports the beneficial effects of Moringa oleifera leaf extracts in combating the prominent characteristic features of diabetes mellitus. This includes:
- The effective control of blood glucose or insulin levels
- The enhancement of insulin tissue sensitivity
- The improvement of blood lipid profiles
- Protecting against organ damage under sustained conditions of hyperglycaemia
According to the World Health Organization, diabetes mellitus is amongst the top ten leading causes of mortality and morbidity around the world (World Health Organization, 2022). Diabetes is a metabolic disorder that is characterized by a state of hyperglycaemia, that occurs alongside dysregulations in insulin levels and in some cases, it arises concurrently to overweight and obesity (International Diabetes Federation, 2021).
Moringa oleifera is a medicinal plant that has gained a lot of interest for its diverse biological properties. Reviewed evidence indicates the biological capabilities of this plant expand to protecting against complications linked with heart disease,
cancer, fatty liver, and diabetes mellitus (Paikra et al., 2017; Vergara-Jimenez et al., 2017; Abd Rani et al., 2018).
An Overview of Moringa Oleifera and its Diverse Biological Properties
Moringa oleifera (shown in Figure 1) is a fast-growing tree that is classified as a vegetable that also serves as a medicinal plant (Gopalakrishnan et al., 2016; Trigo et al., 2020). This miracle tree originates from the sub-Himalayan parts of India, and it can be grown in both tropical and subtropical regions and is able to withstand droughts and mild frosty weather, hence it can be cultivated anywhere in the world (Gopalakrishnan et al., 2016).
Moringa oleifera has gained medical and socioeconomic popularity because it has shown great health benefit and it is easy to cultivate (Alegbeleye, 2018; Zhu et al., 2020). Traditionally, it is applied in diets to maintain healthy skin and it has also been used to relieve stress and provide energy (Mishra et al., 2011; Kumar et al., 2018). All the parts of the plant can be utilized in a diet or as medicine since they are rich in minerals, proteins, vitamins, polyphenols, flavonoids, glucosinolates, isothiocyanates, and alkaloids (Gopalakrishnan et al., 2016; Trigoet al., 2020).
The leaves are utilized the most for medicinal purposes and they are a great source of anti-inflammatory and antioxidant flavonoids, namely myricetin, quercetin and kaempferol (Vergara-Jimenez et al., 2017). Interesting, these bioactive compounds are known to contain potential anticancer, hypolipidemic, hypotensive and antidiabetic properties, antioxidant and anti-inflammatory (Vergara-Jimenez et al., 2017).
Other documented uses for this medicinal plant include its application as a diuretic, a testosterone stimulant, an antifungal and as an antibacterial (Mishra et al., 2011; Kumar et al., 2018). It can also be used to relieve a sore throat and symptoms of influenza, or as an anti-inflammatory agent (Mishra et al., 2011).
Oxidative Stress and Inflammation as Prominent Mechanisms Involved in Diabetes-Induced Complications
FIGURE 2. An overview of pathological mechanisms implicated in the development of diabetes mellitus or related metabolic complications. Briefly, overnutrition (which may be characterized by increased adipocyte size) and consistent increased levels of glucose (a state of hyperglycemia) may induce detrimental effects in major organs of the body including the skeletal muscle, liver, and kidneys, and thus aggravate metabolic complications through enhanced oxidative stress and exacerbated inflammation. This consequence is predominantly characterized by impaired glucose homeostasis/insulin signalling, ectopic lipid accumulation, mitochondrial dysfunction, endoplasmic reticulum (ER) stress insufficient or decreased antioxidant responses/increased ROS (reactive oxygen species) production and altered actions of inducible nitric oxide synthase (iNOS) and lipid peroxidation/DNA damage. This may occur along with raised pro-inflammatory markers like tumour necrosis factor-alpha (TNF-α), like nuclear factor kappa β (NF-κβ), c-Jun N-terminal kinases (JNK) and interleukin-6 (IL-6).
The Potential In-Vitro Properties of Moringa Oleifera
Antioxidants are important substances that aid in eliminating oxidizing agents. Any imbalance of antioxidants caused by oxidative stress may lead to tissue damage (Kurutas, 2016). This may further prompt the disruption of lipids, membranes, nucleic acids and proteins which may further cause detrimental effect and metabolic complications (Phaniendra and Babu, 2015; Pizzino et al., 2017).
For years, the first line of drugs for metabolic complications such as diabetes and related metabolic disorders have been metformin, thiazolidinediones and rosiglitazone but literature has proven that plant polyphenols and their bioactive compounds may potentially provide more efficacy in alleviating diabetes, especially through targeting oxidative stress and inflammation to promote human health (Marimoutou et al., 2015; Singh et al., 2016; Taïl et al., 2020; Do et al., 2021).
For example, a study showed that Moringa oleifera has great scavenging activity, as measured through the DPPH (1,1-diphenyl-2-picrylhydrazyl (DPPH)-2,2- diphenyl-1-picrylhydrazyl) and ABTS (2,2′-azino-bis (3- ethylbenzothiazoline-6-sulfonic acid) (Pakade and Chimuka, 1996).
FIGURE 3. An overview of therapeutic mechanisms associated with the ameliorative effects of Moringa oleifera extracts in preclinical (animal) models of diabetes. Briefly, overwhelming evidence supports the beneficial effects of this plant in enhancing intracellular antioxidants such as catalase (CAT), glutathione (GSH) and superoxide dismutase (SOD) to block the detrimental effects reactive oxygen species (ROS), lipid peroxidation and organ damage. This is in part by also improving glucose control (hyperglycemia) and reducing prominent pro-inflammatory markers like tumor necrosis factor-alpha (TNF-α), interleukin (1L)-β, IL-6, monocyte chemoattractant protein-1 (MCP-1) and COX-2-cyclooxygenase-2 (COX-2). Abbreviations: CD36-cluster of differentiation 36; FFA-free fatty acid; PKC-protein kinase C. Indicators: red lines-detrimental effects, bold lines/green lines-protective effects of Moringa oleifera extracts.
The Safety and Toxicity Profile of Moringa Oleifera
Accumulative research shows that Moringa oleifera exhibits a lot of important biological properties such as antioxidant, anti-inflammation, anti-hyperglycaemic properties over the past years proving that it is a good plant to use as an alternative therapeutic for diabetes (Omodanisi et al., 2017b; Gothai et al., 2017; Paula et al., 2017; Abd et al., 2020; Xiong et al., 2021). In vitro and in vivo studies that have been conducted to show that this Moringa Oleifera has no lethal dose and is safe to use.
In 2016, Anthanont and co-workers showed that capsules of Moringa oleifera leaf powder (at a dose of 4 g), taken after an overnight fast and every 2 weeks, could significantly increase insulin secretion in healthy subjects (Anthanont et al., 2016).
Dixit and co-workers (Dixit et al., 2018) reported that intake of extracts of Moringa oleifera (LI85008F) at 900 mg/day (combined with modest calorie restriction and physical activity) for 16 weeks could reduce waist and hip circumferences, and improved lipid profiles in overweight participants. Also, this was relevant to reduced low-density lipoprotein (LDL) cholesterol decreased, while high-density lipoprotein (HDL) cholesterol increased, resulting in a significantly improved LDL/HDL ratio.
Gómez-Martínez and co-workers reported that giving subjects with prediabetes six daily capsules of Moringa oleifera leaf powder (2,400 mg/day) improved fasting blood glucose and glycated haemoglobin (HbA1c) when compared to the controls.
Summary and Future Perspective
The increased prevalence of diabetes warrants urgent investigation into novel therapies to protect and better manage this chronic medical condition (International Diabetes Federation, 2021). Metformin and insulin, which are commonly used antidiabetic therapies, have certainly prolonged the lives of patients with diabetes (Joya-Galeana et al., 2011; Foretz et al., 2014; Bailey, 2017). Correspondingly, other effective interventions like physical exercise and caloric striction can be used to manage diabetes (Nyawo et al., 2021; Shakoor et al., 2021; Mthembu et al., 2022), however only a few individuals can constantly adhere to such strenuous interventions.
Plants have been studied for their therapeutic properties and they are also cheap, easily accessible and safer than synthetic conventional drugs (Ahmad et al., 2019). There is growing evidence that plants not only serve as a food source but as medicine, nutraceuticals and so forth (Alegbeleye, 2018). Also, they are a body of polyphenols, vitamins, flavonoids, alkaloids and other important phytochemicals.
Moringa oleifera has been proven in a number of studies to alleviate insulin resistance by activating the insulin-independent pathway PI3K/AKT and also through AMPK pathway in the skeletal muscle and it can also improve skeletal muscle oxidative metabolism through the NADdependent deacetylase (SIRT1)-PPARα pathway and also through improving fatty acid peroxidation (Bao et al., 2020; Duranti et al., 2021.
The evidence summarized in this review supports the beneficial effects of Moringa oleifera in improving blood glucose levels, lipid profiles and insulin sensitivity, in addition to protecting against hepatic (liver) or nephrotic (kidney) damage in preclinical (animal) models of T1D/T2D (Table 1 and 2).
The current literature review indicates the common use of leaf extracts of Moringa oleifera, within a range 100–300 mg/kg, from initial treatment duration of 2 weeks up until 8 weeks (Tables 1, 2).