**8. Problems associated with use of medicinal plants/traditional medicine and diabetes control**

WHO reported that in several countries and areas, about 80% of the third world countries and 40-60% of total world population use traditional medicine instead of orthodox medicine for health-care. The process of extraction and purification of plant extracts affect the unit cost [3]. These expensive products are unaffordable for the low income countries. The low demand for drugs led to the use of medicinal plants as herbal components of health foods and for preven‐ tive medicine. This new expanding market gave rise to nutraceuticals (nutriceuticals). Culhane [5] reported nutraceuticals as "foods derived from a naturally occurring substance (in pills or powder or other medicinal forms), which can and should be consumed as part of the daily diet, and serves to regulate or otherwise affect a particular body process when ingested". These foods are known as medicinal foods, phytofoods, phytonutrients and functional foods. All of these terms meant substances that may or may not be considered as foods or parts of food but provide health benefits when eaten. However, more people prefer traditional medicine. This is because it provides holistic treatment (treatment that caters for the spirit, body and soul). The need for traditional medicine arose from the indigenous knowledge. This showed that aetiology of diseases does not only come from physiological imbalance and psychological causes as in orthodox medicine, but can come from spiritual causes, astral influence, esoteric causes and imbalance in cosmic natural forces. This could be associated with the belief by some diabetic patients that their condition is diabolical (personal communication). Every region has had, at one time or the other in its history, a form of traditional medicine. However, distinction exists between the use of traditional medicine and traditional plant foods as regards thera‐ peutic agents used in diabetes management and health promotion. The misconception in the use of these indigenous medicinal plants precipitated self-medication when such plants are used. This poses serious problem in diabetes control in Nigeria. Consumers take medicinal plants, herbal products and nutraceuticals as food and think they are safe at any dose. Concerns raised about the interaction between herbal preparation and drugs are that herbal remedies might – i) increase the effect of an antidiabetic drug and plunge blood sugar to dangerously low level; ii) decrease the effect of blood pressure medication and cause high blood pressure and stroke; iii) decrease the effect of an anti-infection agent, letting the infection get out of control; iv) increase or decrease the effect of a blood thinner such as warfarin and cause either bleeding episode or formation of a dangerous clot. The combination of orthodox and tradi‐ tional medicines has negative impact on people with diabetes in Nigeria. This may explain high incidence of cases of uncontrolled diabetes and associated complications in patients admitted in hospitals in Nigeria. The major link between the use of traditional medicine and traditional plant foods is that their uses are community-based and indigenous. Each com‐ munity has its own peculiar approach to health and diseases even at the level of ethnopathological perception of diseases and therapeutic behaviours. This gives indigenous knowledge in agriculture, medicine and health its diverse and pluralistic nature. The impli‐ cation is that success for use of any indigenous plant foods that possess antidiabetic potential when incorporated into the family diets, could offer sustainable health benefits to the com‐ munity/consumers of such plant foods.
