HYPOGLYCEMIC EFFECT OF SPINACH AND

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(Vaidya et.al .,2008) It contains a mucilaginous fibre (20%) and has a total fibre content of. 50%. It is a very rich source of calcium, beta carotene .The lower ...

Panacea Journal of Health Science Volume 1, paper 4 ISSN : 2278- 4330

HYPOGLYCEMIC EFFECT OF SPINACH AND FENUGREEK LEAVES IN TYPE 2 DIABETICS Karthikaa. P, M.sc Student, Ethiraj College for Women, Chennai. Usha .T, Assistant Professor, Department of Clinical Nutrition & Dietetics, Ethiraj College for Women, Chennai. Ph.no-9840782722, Email [email protected]

Abstract Diabetes Mellitus is a group of conditions characterized by either a relative or a complete lack of insulin secretion by the beta cells of the pancreas or by the defects of cell insulin receptors. Besides various approaches in the management of diabetes, the challenge is now to identify the hypoglycemic supplements that are safe and affordable. Green leafy vegetables are richest in their nutritive value and cheapest of all vegetables. They are a called power house of antioxidants and are even referred to as functional foods. The present study was done in a sample of Type 2 diabetic subjects ( n=18) who were assigned into three groups based on the supplementation received namely Experimental group1(n=6) who received fenugreek leaves Khakra(2 nos), Experimental group II (n=6) (2 nos) who received spinach leaves Khakra and control group (n=6) who did not receive any supplement. The biochemical parameters namely fasting blood sugar , post prandial blood sugar land glycosylated hemoglobin were assessed in all the subjects on the 0th , 30th and 60th day of supplementation. The hypoglycemic effect of fenugreek leaves Khakra over spinach leaves Khakra were compared with each other and also with the control group statistically using paired‘t’ test. The results revealed that supplementation of spinach leaves khakra brought about a reduction in post prandial and HbA1C levels as compared to fenugreek leaves khakra. The other blood parameters did not show much significance.

Introduction Diabetes is a global health problem .It is a chronic disease and India is now considered as diabetes capital of the world and WHO has estimated that by 2025 the diabetic population will be 57.2 million and the number may increase to 80.9 million by 2030 .The epidemic of diabetes is seen even in rural areas undergoing socioeconomic development and urbanization (Chow et.al.,2004). People with diabetes have three to five times higher risk of coronary heart disease than non diabetics and 65% of death in individuals with type 2 diabetes are related to heart disease and stroke (Lteif et.al., 2005). Dietary modification, weight control and regular exercise are the main approaches in the management of diabetes.

Panacea Journal of Health Science Volume 1, paper 4 ISSN : 2278- 4330

Increasing intakes of dietary antioxidants may help to reduce oxidative damage caused by free radicals and provide protection against the progression of a number of chronic diseases.(Crozier et.al .,2006).Leafy vegetables are ideal for weight management as they are typically low in calories ,fat and high in dietary fibre, calcium, iron, Vitamin C, beta carotene , magnesium and manganese .It is also rich in phytochemicals such as lutein, beta-cryptoxanthin, zeaxanthin. Magnesium has a major role in cardiac excitability, neuromuscular transmission, vasomotor tone and blood pressure. Studies suggests that magnesium intake was inversely related to the incidence of Type 2 diabetes as it improves insulin sensitivity and also prevents the incidence of stroke. (Arsenian et.al.,2007).One consequence of uncontrolled diabetes mellitus is an increased urinary loss of magnesium. And type 2 diabetes is closely associated to hypomagnesaemia. Therefore life style changes including adequate magnesium intake can benefit blood pressure and promote weight loss and improve disease risk. Spinach (Spinacia Oleracea) is a dietary vegetable that ranks high among other vegetables in terms of antioxidant capacity. It is an excellent source of Vitamin K, Vitamin A, E, Folate and many other nutrients like inositol and choline. It is rich in glucuronides and therefore has anti proliferative, anti-inflammatory and antimutagenic properties (Lomnitski et.al., 2008).It is also rich source of omega 3 fatty acids, selenium and niacin and aids in curing anemia, constipation and supports overall wellness.(Bonora et.al 2008).Fenugreek leaves (Trigonella Foenum Graceum) is a leguminous herb used as a diabetic folk medicine and anti-inflammatory agent .(Vaidya et.al .,2008) It contains a mucilaginous fibre (20%) and has a total fibre content of 50%. It is a very rich source of calcium, beta carotene .The lower glycemic load after fenugreek leaves supplementation could be due to fibre which diminishes the absorption of carbohydrate to a point lower in the gut after colonic conversion.(Bever et.al 2008). Diet being the cornerstone in the management of diabetes, the present study was undertaken to study the hypoglycemic effect of fenugreek leaves and spinach leaves incorporated and supplemented as Khakras which is a Gujarati dish prepared from wheat flour and rolled ,shallow fried on a low flame with continous pressing to make it into a dry chappati ( pappad). The objectives of the study were 1) To screen and select a homogenous group of type 2 diabetics using a structured interview schedule. 2) To assess the initial fasting blood sugar, Post prandial blood sugar and glycosylated hemoglobin levels of all subjects. To assign the subjects into three groups based on the type of supplement received as experimental group 1 (Fenugreek leaves Khakra) and experimental group II (Spinach leaves Khakra) and the control group who did not receive any supplement. The efficacy of supplementation was assessed based on the biochemical values on the 0th, 30th and 60th day of supplementation in the experimental and the control group.

Panacea Journal of Health Science Volume 1, paper 4 ISSN : 2278- 4330

Materials and methods The research study was undertaken to determine the effect of fenugreek leaves and spinach leaves on Type 2 diabetic subjects. The study was conducted at Dr. V. Seshiah diabetes centre, Chennai. The sample design adopted for the study was purposive sampling. The experimental design consisted of “Experiment before and after with control group design”. The study was conducted in three phases .During the first phase , the subjects were screened using a structured interview developed by the researcher, which consisted of demographic details and information regarding their overall health profile like the Anthropometry ( ht, wt, BMI and waist circumference) and three day dietary recall. After initial screening, 18 subjects were selected for the study and were divided into experimental group I , experimental group II and control group consisting of six subjects in each group. Biochemical parameter namely Fasting, post prandial and HBA1C were assessed initially for all the subjects. The second phase of the study consisted of development and standardization of the fenugreek khakras. 40grams of the fenugreek leaves were washed and chopped finely and mixed with wheat flour,. Salt, chill powder, turmeric powder were added and rolled into a dough. The balls were made into thin chappatis and roasted until a crisp texture was obtained .Same procedure was followed for the preparation of spinach leaves Khakra.

The subjects were contacted at their residence with the consent of the physician. The subjects belonging to the experimental group I received fenugreek leaves khakra and experimental group II received spinach leaves khakra. The subjects were asked to consume two khakras daily containing 40g of fenugreek leaves and spinach leaves as their evening snack. The subjects were contacted once in three days and fresh khakras were distributed. Since khakra is a dry product it has a long shelf life. The supplementation period was 60 days. The fasting and Post prandial blood sugar levels was measured on the 30th and 60th of the supplementation period. The HbA1C value was measured on the 0th and 60th day of the supplementation period as it is indicates the average blood glucose. Based on the above biochemical assessment the efficacy of supplements were compared in the study group with the control group. The data obtained were analyzed statistically using percentage, arithmetic mean, standard deviation and paired’t test’. Results and discussion The present study aimed at analyzing the efficacy of fenugreek leaves and spinach leaves khakra over one another in their blood glucose lowering effect.

Panacea Journal of Health Science Volume 1, paper 4 ISSN : 2278- 4330

Test of homogeneity Onset of diabetes is directly correlated with BMI and waist circumference and many studies have indicated 34% increase in blood sugars with high BMI and WC . TABLE 1 MEAN AND STANDARD DEVIATION OF ANTHROPOMETRIC PARAMETERS Parameters Weight Height BMI Waist Circumference

Mean ± SD 68.56± 5.86 160.4 ± 3.74 26.6 ± 2.70 39.69 ± 2.23

Data on the anthropometric assessment of the study group showed a mean weight of 68.56± 5.86SD, and the height was 160.4±3.74, BMI 26.6±2.70 and their waist circumference was 39.69±2.23.The data reveals that the subjects were homogenous with respect to their anthropometric measurements.Table-1. Other aspects namely presence of chronic diseases like cardio vascular disease, obesity, hypertension, cancer and renal disorders were assessed and those who had these co morbid conditions were not included in the study.Subjects who had moderate control of blood sugar with a initial fasting blood sugar 100-150mg/dl , post prandial blood sugar level of 180-250mg/dl and HBA1C levels of 6.1-8.0 % were included and those who had uncontrolled diabetes were excluded. Table 2 TABLE-2 BLOOD GLUCOSE VALUES OF THE SELECTED SUBJECTS IN COMPARISON TO THE NORMAL VALUES Blood glucose levels

Normal values(WHO 2003)

Fasting Post prandial HBA1C *WHO 2003

70-110mg/dl 140-160mg/dl 3.5-5.5%

Values selected for the study 100-150 mg/dl 180-250mg/dl 6.1-8.0%

With respect to the physical activity pattern of the subjects, those had the habit of exercising regularly like walking, cycling for 30 minutes to 1 hr were selected for the study as physical activity has a major impact on the blood sugar levels. Similarly those subjects who were on allopathic treatment alone were included while those undergoing other forms of treatment were excluded.

Panacea Journal of Health Science Volume 1, paper 4 ISSN : 2278- 4330

Three day dietary recall was used to assess the average nutrient intake and those subjects, who had the habit of consuming green leafy vegetables alone were included for the study.

Test of significance Table 3 elucidates the mean values of fasting , post prandial and HBA1C values of the subjects on the 0th day of the supplementation. The values show that the subjects had similar blood glucose levels indicating that they were homogenous. The ‘t ‘values did not show any significance TABLE 3 SIGNIFICANCE LEVELS OF BLOOD PARAMETERS ASSESSED ON THE 0TH DAY LEVELS FASTING

CONTROL 126.33± 13.648

‘t’ values POST PRANDIAL

0.070 NS 223.17± 35.290

HBA1C

0.522NS 7.767± 0.516

‘t’ VALUES

0.429NS

EXP I 126.83± 10.759

CONTROL 126.33± 13.648

209.83± 51.720

0.206NS 223.17± 35.290

7.917± 0.682

0.168NS 7.767± 0.516 1.206NS

EXP II 124.67± 14.306

EXP I 126.83± 10.759

EXP II 124.67± 14.306

219.67± 36.958

0.296 NS 209.83± 51.720

219.67± 36.958

7.317± 0.760

0.379NS 7.917± 0.682

7.317± 0.760

1.439NS

FIGURE 1 shows the mean levels of fasting and Post prandial blood glucose levels on the 30 day of supplementation. All the groups did not differ significantly indicating the fact that the supplement did not have effect with in such a short time period The mean values of post prandial blood glucose ,showed significant reduction and the ‘t’ values were 3.196 which was significant at 1% level. The control and experimental group II showed a ‘t value to be 2.913 which was significant at 5% level. There was no significant difference between the experimental groups. However there was significant reduction in the postprandial blood sugar level on comparing with the control groups .A study on the anti-diabetic property of 25g of fenugreek leaves on insulin dependent diabetics showed that the half life of plasma glucose shortened due to the increased metabolic clearance and erythrocyte insulin receptors activation.(Sahay et.al.,1994). (Fig 2) th

Panacea Journal of Health Science Volume 1, paper 4 ISSN : 2278- 4330

250 200 150

179.83 114.33

196.83 122.67

211.67 129.33

100 50 0

Fasting Post Prandial

FIGURE 1 Fasting and Post prandial blood glucose levels on the 30th day of supplementation. The mean values of post prandial blood glucose ,showed significant reduction and the ‘t’ values were 3.196 which was significant at 1% level. The control and experimental group II showed a ‘t value to be 2.913 which was significant at 5% level. There was no significant difference between the experimental groups. However there was significant reduction in the postprandial blood sugar level on comparing with the control groups .A study on the antidiabetic property of 25g of fenugreek leaves on insulin dependent diabetics showed that the half life of plasma glucose shortened due to the increased metabolic clearance and erythrocyte insulin receptors activation.(Sahay et.al.,1994). (Fig 2) On comparing the HbA1c values on the 60th day between the control group and experimental groupI the ‘t’ values showed no significance. whereas the experimental group II and control groups showed 5 % level of significance with a ‘t ‘value of 2.255.the experimental groups did not differ significantly .The results shows that experimental group II subjects on spinach leaves khakra showed a good reduction in the HBA1C values as compared to those who were on fenugreek leaves supplement. The present study correlates with the study conducted by Mani et.al 1994 who found lower glycemic response in subjects who were supplemented with 50g of cereal green leafy combination made of fenugreek and spinach leaves (Fig 3)

Conclusion In conclusion it can be said that green leafy vegetables can be a valuable supplement and diabetics can derive tremendous benefits by including green leafy vegetable in their daily diet. The above study reveals that spinach leaves khakra showed good glucose reducing effect when supplemented for 60 days as seen in the post prandial ad HBA1C values. The fenugreek leaves also had hypoglycemic effect when compared the control group on the 60th day of supplementation. Therefore both the supplements are beneficial for diabetics.

Panacea Journal of Health Science Volume 1, paper 4 ISSN : 2278- 4330

227.83 250

185.67

165.67

200 150 100 50 0 Experimental Group I

Experimental Control Group Group II

Post Prandial

Fig 2 Mean Values of Post Prandial blood glucose on the 60th day

7.667 7.8 7.6 7.4 7.2 7 6.8 6.6 6.4

7.2 6.883

HbA1C Experimental Experimental Group I Group II

Control Group

HbA1C

Fig 3 Mean HbA1C values on the 60th day

References 1. Arsenian. M.A.(2007) Magnesium and cardiovascular disease.American Journal of Clinical Journal 64:270--284. 2. Bever, B.O, Zahand. G.R, Loper. M, Wolever. M, Jenkins. A.J.(2008).Palnts with hypoglycemic action, Diabetologia 41: 505 505-512.

Panacea Journal of Health Science Volume 1, paper 4 ISSN : 2278- 4330

3. Bonora.E, Corrao. G, Bagnardi. V, Criello. A, Comaschi.M, Montanari.P.(2008).Oxidants, Antioxidants and the degenerative disease of aging. Diabetologia 49: 846-854. 4. Chow.C.K,Raju.R, Srinath Reddy, Cardona. M,Celermajer. D.S, Neal. B.C.(2004).The prevalence and management of diabetes in rural india .Diabetes Care29:1717-1720 5. Crozier. A, Clifford. M.N, Ashihara.H.(2006).Total antioxidants capacity of plant foods .American Journal of Clinical Nutrition 80:15-21. 6. Lomnitski. L, Bergman.M, Nysk.A, Ben Shaul. V, Grossman.S.(2008). Composition efficacy and safety of spinach extracts. Journal of agriculture and food chemistry 46 (222-231). 7. Lteif, A, Han.K, Mather. K.J. (2005). Obesity, insulin resistance and metabolic syndrome.Diabetes Care16:434-440. 8. Mani.U.V, Iyer.U.M,Ravi.V,Parulkar. J.(1994). Study on the glycemic index of selected cerals and ceral green leafy vegetable combination on non insulin dependent diabetes mellitus patients .Diabetes Care 27: 210-214 9. Sahay, B.K, Raghuram .T.C, Sivakumar. B. (1994). Effect of fenugreek leaves of intravenous glucose diposition in Non-Insulin dependent diabetic patients phytotherapy research :83-86. 10. Vaidya.A.B, Antarkar. D.S, Joshi, B.S. (2008). Traditional remedies for diabetes mellitus.Diabets Care 42: 186-191.

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