Necessity of Herbal Medicine in the Management of Metabolic Syndrome

*Sarvesh Sabarathinam, Rajappan Chandra Satish Kumar and Thangavel Mahalingam Vijayakumar*

#### **Abstract**

People are more susceptible to a variety of diseases based on their lifestyle and occupational patterns. Metabolic syndrome (MS) is a worldwide health issue that is linked to a variety of risk factors, including hyperglycemia, dyslipidemia, hypertension, and obesity. Herbal medicine has been used for a long time. Herbal medicines have emerged as a significant source and major focus for future drug development and human health care. Botanicals may be useful for treating or preventing metabolic syndrome because they often have a wide range of biologically active compounds that can work together to boost each other's effectiveness or have a synergistic effect, giving more benefit than a single chemical substance. Some extracts of botanicals frequently contain natural active components that act on multiple biological targets, creating an opportunity to concurrently resolve multiple defects associated with metabolic syndrome. To find out if botanicals can be used to treat metabolic syndrome as a group, trials must be stratified to look at differences in disease severity, age, gender, and genetic variation in the sample populations.

**Keywords:** lifestyle disease, metabolic syndrome, diabetes, obesity, herbal medicines

#### **1. Introduction**

Lifestyle diseases are distinguished as changes in the metabolism profile of a population and are directly proportional to their day-to-day habits. The primary factors that induce lifestyle diseases include unorganized food habits, uninhabited exercise activities, etc. Metabolic syndrome is a common metabolic condition that is being exacerbated by rising obesity rates. The metabolic syndrome, also known as syndrome X, insulin resistance, and other terms, is a pathologic condition characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidemia, according to the World Health Organization. Prothrombotic conditions, proinflammatory states, nonalcoholic fatty liver disease, and reproductive abnormalities are some of the other comorbidities [1]. Diabetes is a chronic metabolic disorder and it puts tremendous pressure on patients as well as their socioeconomic status. In recent decades, the prevalence of diabetes has been raised gradually in certain developed countries.

As per the International Diabetes Federation (IDF) data, the diabetes prevalence may increase by 693 million in the year 2045 if successful measures of treatment are not implemented [1]. Incidence and prevalence rates of diabetes in Indian populations are illustrated in **Figure 1**.

The incidence of diabetes has risen significantly in recent decades, and it is expected to be higher in the upcoming decades. These specific complaints, in addition to cardiovascular complications, respiratory disorders, and cancers, are directly responsible for 80% of all premature noncommunicable disease (NCD) deaths [2].

Data from IDF show that diabetes is a rising concern in India. The estimated rate of diabetes patients is 8.7%, and the age range is between 20 and 70 years [3]. Formal paraphrase diabetes mellitus is a metabolic disorder correlated with carbohydrate, fat, and protein metabolism and is followed by insulin deficiency and/or insulin resistance. Diabetes mellitus has the following characteristic signs and symptoms: thirst, polyuria, blurring of vision, and weight loss [4]. The metabolic syndrome

**Figure 1.** *Incidence rate of diabetes in India in millions.*

#### *Necessity of Herbal Medicine in the Management of Metabolic Syndrome DOI: http://dx.doi.org/10.5772/intechopen.105199*

has been around for over 80 years. Over the last two decades, the number of people with metabolic syndrome has risen dramatically worldwide. This rise is linked to the worldwide obesity and diabetes epidemic. The metabolic syndrome increases the risk of diabetes and cardiovascular disease, necessitating the development of measures to combat the oncoming global epidemic [5].

According to studies published in the previous decade, approximately one-quarter to one-third of adults from various ethnic origins meet metabolic syndrome requirements. Metabolic syndrome becomes more common as people get older [6]. Type 2 diabetes mellitus (T2DM) was shown to be more common in specific ethnic groups, with 15% of American Indians having T2DM and only 4.30% of Chinese Americans having T2DM. South Asian Americans have a greater frequency of metabolic syndrome and abdominal obesity than other ethnic groups [7]. The factor that increases the risk of the development of the metabolic disorder is positive family history smoking, Increasing age, obesity, low socioeconomic status, Mexican-American ethnicity, postmenopausal status, physical inactivity, sugary drinks and soft drink consumption, excessive alcohol consumption, Western dietary patterns, low cardiorespiratory fitness, excessive television watching, use of antiretroviral drugs in human immunodeficiency virus (HIV) infection, atypical antipsychotic drug use (e.g., clozapine) [8]. Insulin resistance and hyperinsulinemia are regarded as key risk factors for the development of metabolic syndrome, and they may also play a role in the pathophysiology of its metabolic components [9]. Body fat distribution, particularly visceral fat accumulation, is a significant predictor of the metabolic syndrome, a collection of diabetogenic, atherogenic, prothrombotic, and proinflammatory metabolic abnormalities marked by dysfunctional adipocytes and dysregulated adipocytokine production (hypoadiponectinemia) [10]. The "lipid triad" of high plasma triglycerides, low levels of high-density lipoprotein cholesterol (HDL-C), and a preponderance of small, dense low-density lipoprotein (LDL) particles are the main components of the dyslipidemia of the metabolic syndrome, which most likely causes atherosclerotic cardiovascular disease. Therapeutic lifestyle changes are a cornerstone of treatment. Drug therapy may be indicated if it does not treat dyslipidemia. The first-line treatment for reducing LDL-C is with statins [11]. In patients with metabolic syndrome, visceral fat reduction combined with lifestyle changes might be a beneficial therapy for preventing atherosclerotic cardiovascular disease (ACVD) [10].

## **2. Overview of complementary and alternative medicines (CAM)**

CAM is a group of therapeutic and diagnostic principles that are often practiced by patients along with conventional therapies. CAM is normally not appreciated by the majority of the medical profession as traditional or mainstream medical approaches. Integrative medicine is an approach to medical care that combines standard medicine with CAM practices that are shown to be effective and safe [3].

CAM therapies are widely used all over the world. Since the majority of patients are not satisfied with their existing treatment pattern, patients do believe alternative therapies are suitable for their illnesses since they are natural and free from toxicity. Herbal medicine is the preparation of biologically active natural products that have therapeutic value. The use of herbal medicines in developed countries has expanded in the latter half of the twentieth century. Recently, the WHO estimated that 80% of people rely on herbal medicines for some aspect of their primary health care needs. More than 70% of the Indian population still uses these plant-based medicinal products for their needs. As a significance of dissatisfaction with conventional medicine, herbal remedies are becoming increasingly popular in developed nations. Herbal remedies are widely thought to be innately safe because they are "natural." Their effects are generally related to the pharmacological features and dose levels of their active ingredient, rather than their natural origin. Herbal medicines, on the other hand, can be toxic if used inappropriately or as a substitute for conventional medications. Toxic effects can indeed be linked to a variety of pharmaceutical reasons, such as ingredient toxicity, preparation contamination by pesticides, microbes, heavy metals, or synthetic pharmaceuticals. As a result, before using any herbal medicine, both users and doctors and practitioners should be capable of making the greatest risk-benefit assessment possible [12].

For the treatment of diabetes and its consequences, several different plants have been employed individually or in formulations. The active ingredients in this herbal mixture are not well described, which is one of the primary flaws. It's critical to understand the active ingredients and their molecular interactions, as this will aid in determining the product's medicinal efficacy and standardizing the manufacturing process. The absence of scientific and clinical data showing herbal medicine's efficacy and safety is a major impediment to its incorporation into modern medical procedures. Clinical research on herbal medications is required, as are the development of simple bioassays for biological standardization, pharmacological and toxicological evaluation, and the development of numerous animal models for toxicity and safety testing. Widely practiced alternative therapies in the management of metabolic syndromes are herbal supplements, acupuncture therapy, massage therapy, meditation, and yoga therapy. Plant-based medicinal products are highly consumed by the


**Table 1.**

*Clinical evidences of plant-based medicinal products in the management of metabolic syndrome.*

majority of the population. **Table 1** discusses the clinical evidence of herbal supplements in the management of obesity.

#### **3. Uses of herbal medicine in the management of metabolic syndrome**

Diabetes mellitus (DM): DM is a metabolic condition that affects millions of people worldwide. Diabetes is caused by a shortage of insulin or inadequate insulin synthesis in the pancreas. Even though several synthetic medications have been produced, none of them provides a complete cure. Long-term use of some synthetic compounds creates significant adverse effects, but there is still a desire for nontoxic, low-cost medications. Throughout human history, traditional therapies have been a highly regarded source of medicine. These are widely utilized around the world, demonstrating that herbs are becoming an increasingly important aspect of modern and high-tech medicine. A total of 21,000 plants are utilized for therapeutic reasons around the world, according to the World Health Organization (WHO), and there are around 400 plants available for the treatment of diabetes among them [13]. **Table 2** discusses the frequently used plant-based medicinal products in the management of metabolic syndrome.

Several herbs, comprising extracts or bioactive constituents derived from plants, can be primarily used to treat metabolic syndrome, also in nano-formulated pharmaceutical forms. For this global concern, researchers and physicians are exploring novel, safe, complementary, and alternative therapeutic approaches. Herbal remedies are found to be a promising way to lose weight and body fat. The benefits of herbal medicines such as antihyperglycemic, anti-obesity, anti-inflammatory properties, and antioxidant agents were examined in different preclinical and clinical investigations [15]. The advantages of employing medicinal plants as just a safe, economical, approachable, and organic alternative healthcare solution for the treatment of metabolic diseases' health outcomes.

Herbal medicines promote insulin secretion and cardiovascular health while reducing gluconeogenesis, inflammation, and oxidative stress. To manage diabetes and its consequences, various plant extracts have been proposed. Nanostructured formulations of herbal extracts can improve their anti-diabetic effects by regulating their pharmacokinetics and making them more available to the body [16].


#### **Table 2.**

*Few plant-based medicinal products in the management of metabolic syndrome.*

Considering long-term use of some synthetic compounds creates significant adverse effects, there is still a necessity for nontoxic, low-cost medications. Throughout the history of mankind, traditional therapies have been a highly regarded source of treatment. These are usually employed around the world, demonstrating that herbs are becoming an increasingly important aspect of modern and high-tech medicine. The low level of side effects associated with herbal pharmaceuticals is one of their key advantages, and this has encouraged several researchers to develop novel molecules for the treatment of diabetes. Recent breakthroughs in the field of herbal medications to treat diabetes, prevent diabetes-related secondary problems, and numerous herbal compounds in various stages of clinical trials [13].

Various herbal medicines such as capsicum annum of the capsicum family showed anti-diabetic effects by increasing insulin sensitivity in peripheral tissues, improvement in glucose tolerance, protection of β cells from apoptosis, and reduction of insulin level in clinical studies. Capsaicin (the active ingredient in the capsicum family) stimulates GLP-1 secretion, thus increasing glucagon level in the blood and thus decreasing Ghrelin level (orexigenic hormone). There is evidence of inhibition of ɑ-amylase and ɑ-glucosidase activity via preclinical studies [17].

Saffron, a dried stigma of Crocus sativus used as a spice with coloring properties, demonstrated an anti-hyperglycemic effect by reducing the serum blood glucose level in streptozotocin-induced diabetic rats and showed an antioxidant effect. It also reverses the pancreatic damage, phosphorylation of AMP-activated protein kinase and mitogen-activated protein kinase (which play an important role in glucose uptake and insulin sensitivity) [18].

As per recent studies, the most potent plants for fasting blood glucose (FBS) are green tea (at 150 and 1000 mg/day), *Hibiscus sabdariffa* (at 1000 mg/day), tea (at a dose of 10 g/day), cinnamon (at doses of 550 and 3000 mg/day), and many more. A remarkable reduction in HbA1C was also noted by taking *Hibiscus sabdariffa*, *Citrus aurantium*, Sea buckthorn, Bilberries, a combination of *Proteus vulgaris* and *Ceratonia siliqua*, and a combination of grape seeds and pine bark. Moreover, it has been established in two studies that two plants, chia and *Rhus coriaria* L., can boost insulin secretion [15].

After months of consumption, *Aloe vera* extract capsules (300 mg/kg) lowered fasting blood glucose, TG, LDL, and HbA1c levels. For 3 months, *Aloe vera* powder (100, 200 mg/kg) was administered to reduce fasting and postprandial glucose, blood pressure, and HDL levels [19].

Other herbal medicines or extracts such as bitter melon, mostly used by the Asian population, reduce Fasting Blood Sugar (FBS) and post-prandial blood sugar (PPBS) by acting on the GLUT-4 receptor. Fenugreek improved blood glucose levels and increased insulin sensitivity when combined with anti-diabetic therapy. Yuquan Wan, a Chinese extract administered for 1 month, decreased FBS and improved diabetic-related complications. Xioake Wan (XAX), a Chinese medicine, showcased a significant improvement in blood lipid and blood glucose parameters when combined with anti-diabetic drugs and enhanced insulin sensitivity [20]. Most people's hypertension goes untreated or uncontrolled. The availability, cost, and side effects of antihypertensive medicines hinder the effective treatment of hypertension. Conventional treatment was unable to alleviate several hypertension-related symptoms [21]. Lifestyle adjustments, dietary changes, and the use of combination therapy with herbs are some of the most commonly used alternative measures for decreasing high blood pressure. Herbal medicines, in general, have no negative side effects while also providing additional benefits. Herbal remedies are available in almost all health stores and can be purchased without the need for a prescription. Some herbs can even

#### *Necessity of Herbal Medicine in the Management of Metabolic Syndrome DOI: http://dx.doi.org/10.5772/intechopen.105199*

be cultivated in your backyard. These treatments are ideal for people who are allergic to a variety of medications.

The leading cause of sickness worldwide is hypertension. Patients who are prescribed pharmacological therapy may refuse it due to the asymptomatic nature of their hypertension, opting for other remedies instead. Herbal medicines such as DiaNo decoction, Yiqi Huaju Recipe, Daotan decoction, Gegen Shanzha decoction, Qinggan Jiangtang tablet, Modified Banxia Baizhu Tianma decoction, Pinggan Jiangya pill, Huanglian Wendan decoction, Xueguan Ruanhua decoction, Shengjiangtongmai powder, and Shenling Jianpihuashi decoction showed a significant reduction in blood pressure in many clinical studies. It was also found that Shenling Jianpihuashi decoction had the same effect as nifedipine in animal studies, and a double-blind study, saffron, and its constituents exhibit vasomodulatory effects and improve endothelium-dependent acetylcholine (ACh) relaxation via the endothelial nitric oxide pathway. Various animal-based studies and a double-blind study showed decreased systolic blood pressure. It also showed an effect via blocking calcium release in the cytosol [18]. In preclinical studies, Panax Ginseng (3 g/kg) used for 12 weeks reduced arterial stiffness and systolic blood pressure via endothelial nitric oxide synthase (eNOS) activation and the nitric oxide pathway [22]. Several of the synthetic medications employed possess unfavorable side effects. Herbal supplements can be used in addition to or instead of pharmaceutical treatments for weight loss and maintenance. They are beneficial, safer, and much less expensive than pharmaceutical drugs. Medicinal herbs include pharmacodynamic bioactive chemicals that have a synergistic and additive medicinal impact on the treatment of metabolic diseases. Herbs possess anti-obesity effects through a variety of mechanisms, including appetite suppression and satiety enhancement, increased energy expenditure, low-fat digestion, and increased fat lipolysis [23].

Obesity is a metabolic condition where there is an abnormal accumulation of fat in the body, and it is linked to the augmentation of disorders such as hypertension, dyslipidemia, type 2 diabetes mellitus, osteoarthritis, kidney disease, sleep disorders, etc. There are currently only a few effective medicines for treating obesity, despite ongoing investment in research. As a result, patients and researchers are seeking complementary and alternative treatment options for obesity, such as the use of medicinal plants and their products. According to research findings, herbal plants could be an alternative therapy for hyperlipidemia in patients who are statin-intolerant or unwilling to take modern antihyperlipidemic medicines.

In several clinical studies, herbal plants have been shown to reduce body fat percentage (BF%), fat mass (FM), and fat free mass (FFM) in several ways. FM and BF% were significantly decreased by green tea (green tea at dose of 6000 mg/day and catechins at doses of 458, 468, and 886 mg/day), *H. sabdariffa* (dose of 75 mg/day), *Phaseolus vulgaris* (at dose of 445 mg/day, G. cambogia (at doses of 2400 and 3000 mg/day, *Ecklonia cava* (at doses of 72 and 144 mg/day, cumin (dose of 3000 mg/day, Coleus forskolii (at dose of 250 mg/day), Sorghum tea (at dose of 1000 ml/day), *Gynostemma pentaphyllum* (at dose of 450 mg/day), and cinnamon (at dose of 550 mg/day), *Ginkgo biloba*. L (120 mg/kg) with Metformin (500 mg) in the 90 days of treatment showed a reduction in HbA1c, BMI, and fasting serum glucose level [24].

In a clinical trial using capsaicinoid (6 mg/kg) for 12 weeks, it was found that there was a significant fat reduction. Capsaicin, a water-soluble derivative of homovanillic acid and an active ingredient of capsicum plants, is responsible for various anti-inflammatory properties in skin problems, gastritis problems, migraines, hemorrhoids, anorexia, etc. Recent studies conducted via in vivo and vitro methods

demonstrated that capsaicin acts as an antihyperlipidemic agent by activating peroxisome proliferator activated receptor (PPAR-) and by reducing intestinal absorption and elevation of bile acid secretion. Thus, activation of peroxisome proliferatoractivated receptors (*PPARs*) leads to a reduction of LDL, triglycerides, and serum cholesterol and an increase of HDL [17].
