Dr Merlin Wilcox: In fact, most of these studies, people were taking the herbal medicine alongside their conventional medicines. They weren't being told to stop it. And there were almost no reports of any serious side effects. But there were no reports of hypos, that's when you have too low a blood sugar level, in people who are not taking insulin. So it seems to be perfectly safe to take alongside your conventional treatments.
Dr Rupy: Can you treat diabetes with herbs? It's a controversial question, but one that my next guest, Dr Merlin Wilcox, thinks he may have the answer to. Today, we are diving into the world of therapeutic herbs and spices, travelling across generations and cultures from around the world to discover traditional medicine practices, whether they hold up to scientific scrutiny, and if these herbs and spices have a place in our drug cabinets as well as our kitchens. Dr Wilcox has worked as a GP in the NHS since 2003 and currently works in a practice in Oxford. His research interests at the University of Southampton include global health, clinical trials of herbal medicines, and improving care for vulnerable people. Dr Wilcox has researched different aspects of primary healthcare in low-income countries with a particular focus on child health, malaria, and traditional medicines. He has also been involved in several clinical trials of herbal medicines in Uganda, Madagascar, Mali, and the UK and coordinates the RITAM network. That stands for Research Initiatives on Traditional Antimalarial Methods. We're talking about a bunch of compounds today, including moringa, ginseng, cinnamon, nigella, fenugreek, psyllium, and we'll be discussing their potential mechanisms of action, plus the evidence for them. But please, if you are thinking of supplementing or trying these items, particularly if you have a condition or take any drugs whatsoever, do discuss this with your own physician. In the meantime, you can also check out the YouTube channel. We had a wonderful discussion on video, so go to thedoctorskitchen.com, you can check out all the videos there, or just go to The Doctor's Kitchen on YouTube and you'll be able to see our smiling faces as we discuss all the drugs and herbs that Dr Merlin has studied for many years. You can also check out the Eat, Listen, Read newsletter. Every single week, I send you new recipes, something to listen to, something to read, something to watch, plus you can download The Doctor's Kitchen app for free. We have over a thousand reviews, averaging over 4.8 on Apple and Android. Yes, we are working on a version for you guys too. On to my podcast with Dr Merlin.
Dr Rupy: Merlin, let's talk about type two diabetes and herbs. Can we treat type two diabetes with herbs and spices that we find in our kitchen cupboards?
Dr Merlin Wilcox: So yes, and I guess my interest in diabetes and herbs first started when I was working in in Africa, in Mali in West Africa. And people there use a local plant called moringa, which actually is not such a local plant because it's found in many places in the tropics. And the leaves are incredibly nutritious. They contain protein, vitamins, minerals, and in fact they're promoted as a treatment for for malnutrition. But in in in Mali in West Africa, they also use it as a treatment for diabetes. And some friends, researchers in Mali wanted to do a clinical trial of it. So I supported them to do that. And there were some really interesting results in that they gave people 100 grams of white bread, gave them some moringa afterwards, a gram or two grams, and then measured their blood sugar levels, you know, every 10 minutes or so. And they found that the blood sugar levels in people who had taken the moringa were lower by about one millimole per litre.
Dr Rupy: Okay, yeah. So that's quite significant.
Dr Merlin Wilcox: Yeah, quite significant compared to those who hadn't. And obviously that's a very short-term measure of diabetes. So in clinical practice as GPs, we look more at a thing called HbA1c, which is the percentage of your red blood cells that are coated with sugar molecules. And it's a measure of how well your diabetes has been controlled over a period of two, three months. And so I decided, why don't we look and see what research is out there, what has already been done on different plants for treating diabetes and specifically what is their effect on HbA1c, on the long-term control of diabetes. And to our surprise, we found that there had already been 34 systematic reviews of randomised control trials.
Dr Rupy: 34?
Dr Merlin Wilcox: Yeah, that's a lot. One randomised control trial is like a big research study with maybe tens or hundreds of patients comparing a herbal medicine to placebo or something else. And a systematic review includes several of those. And so 34 systematic reviews means there's been probably at least three, four, five times as many randomised control trials, which is the sort of top notch of evidence that people look for. And we organised them in a league table with the ones that had the biggest effect at the top and then the ones that had the least effect at the bottom. And it was very interesting. So the one that came out top with the biggest effect on reducing HbA1c was aloe vera.
Dr Rupy: Aloe vera?
Dr Merlin Wilcox: Which people don't think of for for diabetes. But the the leaf, the fresh leaf crushed up or the juice had reduced HbA1c by 0.99%, so that's almost 1%. And by comparison, metformin, which is a standard anti-diabetic drug that we use, would reduce HbA1c on average by about half a percent, 0.5%. So it's about twice as effective as as metformin from these admittedly much smaller studies than the ones that we have on metformin. And then next on the list was ispaghula, psyllium seeds, which is basically used as a laxative. So that's not something you would probably cook with unless you had a problem with constipation, maybe you might put it on your porridge or something.
Dr Rupy: Yeah, yeah. Is that is that the same as psyllium?
Dr Merlin Wilcox: Yes, psyllium husk. So that's what you might find in supermarkets or health food shops.
Dr Rupy: Yeah, fibre gel or that sort of thing.
Dr Merlin Wilcox: Got you. Yeah. Yeah. So that was number two on the list. That also reduced HbA1c by about 1%. And the next thing on the list was fenugreek.
Dr Rupy: Fenugreek seeds.
Dr Merlin Wilcox: Fenugreek seeds. Yeah.
Dr Rupy: Wow. So we we call that we we use the leaves in Indian cooking or methi. Yeah.
Dr Merlin Wilcox: But people do cook with the seeds as well, don't they?
Dr Rupy: We do, yeah, yeah, absolutely. Yeah, yeah, yeah.
Dr Merlin Wilcox: And so after reading that, I had some discussions with in fact some patients from Asia who were in the previous practice where I worked and they told me that they would soak the seeds in a glass of water overnight and then drink the water from it. That was how they would take it. But in fact, I'm really enthusiastic to learn from you what recipes there are that you can make with fenugreek because I bought some seeds and I tasted it and I thought, doesn't taste great. I'm not quite and I looked up a few recipes. I'm not quite sure how I would incorporate that. But it seems that people who take it for diabetes are more using like a powder and taking it as capsules. Or I there were a couple of studies from India where people had actually incorporated the powder into chapati flour and they were making chapatis with the fenugreek powder sort of incorporated into them.
Dr Rupy: Got you. Yeah, yeah.
Dr Merlin Wilcox: And that seemed to have quite a good effect.
Dr Rupy: Fascinating.
Dr Merlin Wilcox: Yeah, absolutely. And then so the next one on the list after that was nettle, green nettles.
Dr Rupy: Green the the green nettles that just grow everywhere.
Dr Merlin Wilcox: The ordinary plant that grows everywhere. Yeah, exactly. And that one seemed to have quite a big effect in some studies. Other studies had less of an impact, but certainly the best studies showed that it also reduced HbA1c by quite a big amount.
Dr Rupy: Wow.
Dr Merlin Wilcox: So I've taken to cooking nettles from my garden. I don't have diabetes, but I've got a very good friend in Switzerland, an Italian friend who taught me a recipe for nettle risotto.
Dr Rupy: Oh, wow.
Dr Merlin Wilcox: Which is really tasty. So basically, if you've got if you've got a garden in England, you've probably got nettles in it somewhere. And so instead of just chucking them in the compost bin, you can actually cook them. You fry them or you you boil them and then mix them with rice and and it makes a really good risotto.
Dr Rupy: Amazing.
Dr Merlin Wilcox: Yeah, really tasty. So I mean, obviously the studies weren't looking at nettle risotto, they were looking at nettle powder, but you know, you can imagine that that might have an effect.
Dr Rupy: Sure. Yeah, yeah.
Dr Merlin Wilcox: And then there are a few Chinese remedies on the list that are complex mixtures of plants, probably not something you could easily bring in your diet. But then the last the last one on the top six in the list is Nigella sativa, which is the black seed.
Dr Rupy: Got you. Yeah. We use that quite a bit.
Dr Merlin Wilcox: Yep. So people put it in naan bread.
Dr Rupy: Yeah.
Dr Merlin Wilcox: I've got a really nice a friend of mine suggested that you could put it into stir fries and it actually works really well in a stir fry with, you know, other vegetables and stuff.
Dr Rupy: Amazing.
Dr Merlin Wilcox: And that also reduces HbA1c. You have to take like two grams a day of it, you know, obviously over a period of time. And that reduces your HbA1c by 0.7%, which is again better than metformin. And then there's a lot of other plants on the list. And interestingly, some of the more traditional plants that people would traditionally associate with diabetes, like cinnamon, for example, didn't seem to have a big effect in these studies. So it yeah, I mean, yes, herbal practitioners recommend cinnamon and I love cinnamon, but it's probably not the best thing for, you know, if you want to take it as a treatment for diabetes, it probably doesn't have a massive effect.
Dr Rupy: Sure.
Dr Merlin Wilcox: Ginger was a little bit better, but again, not a massive effect. But all of these studies were looking at herbs individually. And of course, what we don't really know fully is how what what happens if you combine them. And potentially, I guess, if you put two or three different ones together, you might have a much bigger effect than any single one on its own because some of them probably have different mechanisms of action, different ways they work. So for example, the moringa that I mentioned, we know that that one inhibits some of the enzymes and so works in that way a bit like acarbose, which is a conventional medicine. So it basically slows the breakdown of carbohydrates into sugar. Whereas something like fenugreek has it works more by reducing your release of insulin and it also has some sort of soluble fibre that again slows down the release of of the sugars. And a lot of the plants remedies for diabetes have a lot of fibre. Fibre just by itself is probably good because it slows down your, you know, reduces the glycemic index, slows down the absorption of sugar, so it helps to flatten that curve of of sugar absorption.
Dr Rupy: Yeah, yeah. That is fascinating. And I I guess one of my questions is with this systematic review or the multiple ones that you came across, where are these being performed? Because I certainly didn't hear about this at med school and I don't think it's a UK thing. So are there particular countries that have an interest in this? Are they coming from places like Iran or India or or China perhaps?
Dr Merlin Wilcox: Absolutely. You're quite right. So in fact, yeah, I didn't know about them at med school either. And I think most doctors and even most diabetes specialists, most nutritionists in the UK don't know about them because it's just not part of our training, unfortunately. And you're right that most of these trials were not done in the UK. So a lot of trials done in China on traditional Chinese medicine. Most of the fenugreek trials were done in India, Asia. And the nettle trials, all of those were done in Iran, interestingly. So Iran does do a lot of research on herbal medicine. The fibre gel, the psyllium seed ones, a lot of those trials were done in the US, but sponsored by the company that makes fibre gel. So there's potentially a conflict of interest there. I don't know, it might be good to repeat some of those independently. Yeah, so not much of this has been done in the UK and I guess we do need to do more because obviously we the review only found plants that people had actually already done trials on and for which there was already a systematic review. And there's a lot of other stuff out there that hasn't had that level of research. So for example, there's a really interesting Ayurvedic remedy called gurmar is the gurmar is the I guess the Ayurvedic name for it. The Latin botanical name is Gymnema sylvestre. So if you it's something that herbalists use quite a lot in the UK. It's part of Ayurvedic medicine. If you taste it, the sort of liquid extract of it, it has a quite a magical effect in that you can't taste anything sweet afterwards. It completely inhibits your sugar receptors on your tongue.
Dr Rupy: Wow.
Dr Merlin Wilcox: So it's a favourite trick and you know, I did a course in herbal medicine and the herbalist people who are skeptical about herbal medicine should try tasting this stuff. Because the the the herbalist gave us a teaspoon of it and then he gave us a custard cream and it tastes like cardboard. And then, you know, a square of milk chocolate just tastes like butter. It's got no sweetness and it does doesn't have any interest afterwards because you know, it doesn't really taste who would want to eat cardboard, you know?
Dr Rupy: Yeah. Yeah, yeah. How long does that effect last for?
Dr Merlin Wilcox: A couple of hours probably.
Dr Rupy: A couple of hours?
Dr Merlin Wilcox: A couple of hours.
Dr Rupy: Wow.
Dr Merlin Wilcox: So you know, like for people with alcohol who don't want to drink alcohol, we give them Antabuse because they get bad side effects. So for people who have a really sweet tooth and can't stop eating sugar, Gymnema would be a really good solution because you just take a teaspoon of it and then afterwards you wouldn't want to eat anything sweet for the next couple of hours. Because you lose all the pleasure.
Dr Rupy: Yeah, absolutely. Yeah. So herbal medicine is super powerful. I mean.
Dr Merlin Wilcox: That is I mean, that if you want convincing that herbal medicine works, take taste Gymnema and you know, you don't need to read any research afterwards. I mean, whether it has any effect longer term on diabetes, there's been less research on it, which is why it didn't come up in our umbrella review. But I was just googling earlier and I actually found that someone has now done a randomised control trial of it and it does reduce your HbA1c by about half a percent. So probably about as good as metformin. So that's just using it maybe as a capsule, but in fact, if you took the liquid on your tongue and it of course, people who like sugary things wouldn't want to use it because you would lose all the enjoyment of eating sweet sweet stuff. But if you, you know, if you have a sugar addiction, you can't stop, you know, you're one of these people who can't stop eating chocolate once you start, then having having a bottle of Gymnema is probably quite a good way of controlling that.
Dr Rupy: On the subject of skepticism around medical herbalism, I guess, you know, doctors who were trained within the UK system or the US system might look at these systematic reviews and say, oh, well, those were done in Iran, they've got different, you know, methods of of rigor and we can't really trust it, particularly if it's coming out of China or the rest of it. What do you say to those kind of skeptics around the studies and is there a part of you that sort of agrees that we should be repeating them on on in on European soil or do you think they're they're just as good as the way we would do it over here?
Dr Merlin Wilcox: So, I think that's a really good question. So all of the systematic reviews assessed the quality of the studies that they included. And I guess obviously it's variable. Yes, I mean, some things, you know, for example, the the results on psyllium seeds was based on only three studies. And those were done in the US, but as I mentioned, they were some of them at least were funded by the company that sells the stuff. So that's something where you would probably want to repeat it. And I guess the other issue is what's the best dose, what's the best preparation? Because for example, the fenugreek, as I mentioned, there are lots of different preparations that people used. As I mentioned, some people incorporated it in their flour for making for making chapatis, other people took it in capsules. Maybe those things aren't equivalent and I think those sorts of issues as to how you dose it is important. The Nigella seeds, there was there were some studies using the oil, some using the powder. So the ones using the powder appeared to have a larger effect than the ones using the oil, for example. Aloe vera, there were studies using the capsule and those seemed to be less effective than the ones where they were giving a fresh juice or the crushed plants. But the there were only one trial each of the fresh juice and of the crushed leaves. So I guess it would be good, you know, from a scientific point of view, it's always good to repeat research and do it better. And there are also lots of other plants that haven't had that, you know, proper research done on them. So, absolutely, there's always space for more research. But I think the key point is, yes, of course, there will always be need for more research and there are so many plants around the world that are used for diabetes. There's potentially, you know, you could spend the next 100 years doing clinical trials on them. And of course, all that needs to continue. But I guess what really surprised us is that there's already a huge body of research that's been done. And actually, I think we need to stop, doctors need to stop telling people there's no evidence because it's not true. There is evidence. And and you know, I think the beauty of a lot of this stuff is that it's not really harmful. So worst case scenario, even if it doesn't work very well, it's not going to do any huge damage. In fact, most of these studies, people were taking the herbal medicine alongside their conventional medicines. They weren't being told to stop it. And there were almost no reports of any serious side effects. I mean, a few people complained of maybe upset stomach, nausea, diarrhea. And there was one report in one study of someone who had too low a blood sugar, a hypo. And that was a person who was already taking insulin for their diabetes. So I guess if you're already on insulin, then you need to be a bit careful because you don't want to give yourself a hypo. I mean, of course, insulin could give you a hypo even if you're not taking anything else. But there were no reports of hypos, that's when you have too low a blood sugar level, in people who are not taking insulin. So it seems to be perfectly safe to take alongside your conventional treatments. So it seems to me to be a bit of a no-brainer really. And and also, I think from my personal experience, so I've spent quite a few years working in East Oxford Health Centre where we have a very diverse population, people from about 40 different countries registered at the practice. And a lot of patients, especially the non-British patients, are really interested in herbal medicines and don't many people just don't like taking pills. And and in fact, the worst control of diabetes, people with the highest blood sugar levels were often from, you know, minority ethnic groups and so on. And often doctors are tearing their hair out, what can we do to improve the diabetes control in in in these patients? And very often they come being quite enthusiastic about a herbal remedy that they've got or even maybe if they weren't too scared of their GP, they might even ask for advice on on which herbal remedy might work. And so being able to give some evidence-based advice that, you know, if you want to try a herbal, maybe fenugreek would be good, but maybe don't bother with cinnamon because that's probably not going to make a massive difference. I mean, that could be really valuable. And in fact, I've got some friends, colleagues in Switzerland who've started to put together an information booklet with different information on those evidence-based herbs, plants, foods, in fact, spices, which can help management of diabetes. So it's coming at it from a slightly different angle because traditionally we've been focusing on these are the foods you need to avoid, you know, anything with sugar, carbohydrates, high in fat, you need to avoid. So it's a quite a negative message. And of course, all of that is true and it's important. But here's a positive message, you know, these are some foods you could choose to add to your diet that are going to help with with control of your diabetes. And an interesting one is the bitter melon, karela.
Dr Rupy: Oh, okay. Yeah, we call it karela. Karela in my household, but my my mom prepares it and it's but you have to sort of because it's quite bitter, you have to sort of mellow it with spice and stuff, but it's literally one of my favourite things that my mom makes.
Dr Merlin Wilcox: Yeah. Yeah. Well, very popular in patients in in East Oxford. And in fact, there was a systematic review on karela, which was it wasn't one of the most effective, but it did have an effect. It was certainly better than nothing.
Dr Rupy: Yeah. And there's loads of different ways in which, this is coming from my mom now, I haven't actually looked into it, but there's loads of different ways in which people prepare it, right? So you can either have it sort of sauteed like my my my family make it. You can also have it as a juice. You can also have it as a powder. You dehydrate it and put it into a powder and you add it to water or whatever. So there's various ways in which people I'm not too sure which one is more effective, but it is fascinating that this is stuff coming from different ethnicities and different parts of the population. And that was going to be one of my questions actually, regarding, you know, the location of where you tend to get more research in this field seems to marry quite nicely, at least from my anecdotal experience of A, being an Indian family myself, but also B, working within an urbanized environment where I see lots of people from diverse countries and backgrounds where they might be a lot more receptive to the idea or they will grow they grew up with the idea of herbal medicine being alongside conventional medicine or pharmaceuticals or whatever you want to call them. Is that something that you you noticed?
Dr Merlin Wilcox: Yeah, absolutely. Absolutely. Definitely. In fact, that was one of the things that really got me interested in this whole area, because as I mentioned, the practice where I worked in Oxford was very multicultural. And I did have patients coming to say, you know, doctor, what do you think of this medicine that I've I've had sent over from Pakistan or Afghanistan or whatever? And often it was just a powder and I didn't know what it was. Just in a little baggy, you don't know the name on it or anything. Exactly, exactly. But no, absolutely. And um, as I'm sure you know, the risk of diabetes is much higher in patients of Asian origin, but also black African origin. So in the UK, white British population, it's about 6-7% the prevalence of diabetes. In uh black uh ethnic groups, it's about 12%. And in some Asian ethnic groups, especially Pakistan, it's up to 20%.
Dr Rupy: 20%.
Dr Merlin Wilcox: The age-standardised prevalence of diabetes is massive. And also the control of diabetes is less good. So there was a study in in Glasgow in Scotland, which showed that the percentage of diabetic patients who had poor control, which was defined as having HbA1c less sorry, greater than 7.5%, which is the sort of target that we treat to. So in white patients, white Scottish patients, it was 47% were above that, so poorly controlled. So that's pretty bad already, 47%. For black patients in Glasgow, it was 57%. And for patients of Pakistani origin in Glasgow, it was 66%. So two-thirds had poor control of diabetes. And obviously that then translates into more complications, so heart disease, kidney disease, all the rest of it. So it's really important to, you know, redouble our efforts to try and improve control of diabetes, especially in patients from ethnic minorities. And this is a real opportunity because this is something that people are really excited about, they find it interesting. As you say, it's part of people's culture, what they grew up with. And if medicine can embrace that and say, look, you know, this is something that you can do to help your diabetes. I think it would help to engage people more, get them more interested. And maybe then, you know, take on board some of the other advice as well about reducing carbohydrates and stuff. But yeah, I I I completely agree that I think people who've come from a different culture are probably much less skeptical about herbal medicine than maybe, you know, your standard white British person who over the decades has been indoctrinated that, you know, this stuff is not scientific, there's not much evidence that it works and but even there, I mean, I think quite a lot of white British people actually are interested in herbal medicine. I think it's just a lot of people automatically assume their doctor's going to have a negative reaction to it and then they don't even bother mentioning it.
Dr Rupy: Yeah, yeah.
Dr Merlin Wilcox: Because over the years, I mean, traditionally medicine has been quite negative about, you know, herbals and stuff. And I think often people have been sort of had negative comments made like, oh, that's a load of rubbish or don't bother with that, there's no evidence. So a lot of people, I think, don't even bother asking their doctor about it.
Dr Rupy: Absolutely. And I guess, you know, when we look back at these studies and obviously it's impossible to design to design the perfect study and particularly if you're doing a review of existing studies, you know, you can't go back and tinker with them. But let's say we were starting from a clean slate, what are the issues with using HbA1c as a marker itself? And what would be perhaps a better way of measuring the anti-diabetic effect of a either a pharmaceutical or a or a herbal medicine? And B, in terms of the heterogeneity in terms of the actual substances used, we mentioned powders, oils, the actual uh plant itself in a juice, like aloe vera juice. I guess you'd ideally want to, you know, do the the the review on a specific form and just use studies grouped in with those. Um, so yeah, what what what would you do differently if you if you did have a magic wand and you could change everything?
Dr Merlin Wilcox: Okay. I wish I did have a magic wand. My name's Merlin, unfortunately, I don't have one.
Dr Rupy: I didn't want to go there, but
Dr Merlin Wilcox: No. So, well, first of all, in terms of how you measure the effect on diabetes. So there are lots of different measures that people use. As I mentioned earlier with the study on moringa, the simplest thing to do is just to measure people's actual blood sugar. But obviously that's a short-term measure and it's not fasting blood sugar is is one measure, but it's only it's a bit of a snapshot in time. It doesn't really tell you how good your diabetes control has been over the last few months. So HbA1c is better that it's giving you an average of how your control has been over the last two or three months. I mean, obviously, you know, the the absolute um gold standard, which has been done for some of the modern medicines like metformin, is looking at mortality, effect on, you know, does it actually save lives? Does it reduce deaths? But that requires massive numbers of patients and, you know, very long-term follow-up, obviously. So I would say that HbA1c is quite a good compromise, but obviously you need to have a follow-up of at least two or three months. I mean, there are some studies that only follow people up for a few weeks and that really isn't long enough to know what the true effect is. And and I guess if you can follow people up for six months or a year, that would be even better because I'm sure, you know, it takes a while to actually have an impact. So I guess if I was starting with a clean slate, I would I would want to follow up patients for a year. I would want to check their hemoglobin maybe every I mean, their HbA1c every every three months over that period of time. And obviously, as you say, you would want to pick the preparation that seems to be the most effective, either from what herbalists or traditional medicine recommends or from what the existing evidence is. But yes, I mean, there have been trials done on all sorts of different preparations of some of these herbs. And I guess I would I would go with the one that seemed to be the most effective.
Dr Rupy: If you could pick one preparation for all of them that appears to have the largest effect, which one would you go for? Would it be a tincture, an oil, a powder, a capsule?
Dr Merlin Wilcox: I think that's on a case-by-case basis. It depends on which herb. So as I mentioned for the aloe vera, it was a fresh leaf and the fresh juice that seemed to have the largest effect. For the um psyllium, that's a powder. That's like, you know, the fibre gel sachets. For the Nigella seeds, it was the powder again. But, you know, there weren't any trials on actually using the whole seeds in in cooking, for example. So it was powder or it was oil. There wasn't a trial on the on the on the other. For fenugreek, I have to be honest, I can't remember which one came out best. And the review on fenugreek was a bit old. So we're actually in the process of updating it now with colleagues. We're going to redo it, look, there are more trials and in fact, we're collaborating with the university in China. So we're going to look at all the trials done in China as well where they use fenugreek. And hopefully when we've finished that, that will give us a lot more uh clearer information on what is the best preparation of fenugreek and the best dose, the best dose to take.
Dr Rupy: Yeah, yeah. That would be awesome. And in terms of um aloe vera, I just want to double click on that for a second. So aloe vera fresh appears to be best. Uh do you remember how much uh that they would use?
Dr Merlin Wilcox: Yes. So if it was the crushed leaf, it was 15 grams twice a day.
Dr Rupy: 15 grams twice a day. Okay. So that's a fair amount. I'm just thinking of the leaf because it comes out like a gel, doesn't it?
Dr Merlin Wilcox: It does. Yeah. Yeah.
Dr Rupy: And then you just take it as a
Dr Merlin Wilcox: I guess so. And the juice, um the studies on juice, fresh aloe vera juice was I think 150 mils once daily.
Dr Rupy: Oh, right. Okay. That's quite expensive.
Dr Merlin Wilcox: It is it could be quite expensive. So in this country, I guess it would be, but in the the more sort of exotic climates where you find aloe vera just growing.
Dr Merlin Wilcox: Well, aloe vera grows really, you can easily grow it as a house plant.
Dr Rupy: Oh, can you?
Dr Merlin Wilcox: So yeah, I've got in fact, I've got so many at home that my wife keeps nagging me to get rid of them and give them away. I mean, I I bought one in a in a fete about 15 years ago and it's had so many offspring. I mean, I've probably donated literally hundreds to different, you know, fetes and things over the place, you know, or just given them as to to friends and stuff. And it just keeps sprouting up more babies all all all the time. I keep repotting them and, you know, it just doesn't stop. So it's very easy to grow it yourself on all you need is a, you know, well, a window sill or you don't even need a window sill really. It grows very well indoors.
Dr Rupy: Yeah, yeah. Brilliant. Okay, cool. So aloe vera. And and on aloe vera, um we talked a bit about the mechanism of action for psyllium husk, you know, creating essentially um a barrier of absorption. So you're going to have less of the sugars absorbed quicker. So you essentially give your body a bit of time to release the appropriate amount of insulin and you have a nice sort of uh glucose uh flattened curve. What happens with aloe vera? Does it work in a similar way? Is it the fibre constituents or are there other sort of compounds that might be working?
Dr Merlin Wilcox: That's a very good question and I have to be honest, I'm not 100% sure. I suspect the I mean, I know that aloe vera itself and the gel have a laxative effect. Um and I I guess the gel may contain some sort of soluble fibres, but whether it has another pharmacological activity, I would need to look that up and get back to you because I'm not I'm not 100% sure.
Dr Rupy: All good. Uh any particular mechanisms of action for the other top six that struck you perhaps?
Dr Merlin Wilcox: Yes. So fenugreek stimulates release of insulin and it also contains gel-forming fibres that delay the stomach emptying and interferes with glucose absorption from the intestines.
Dr Rupy: So that's super interesting because that's working on multiple actions. Yeah. Uh compared to the drugs that we use. So we use a plethora of different drugs to do those those different actions. That's fascinating.
Dr Merlin Wilcox: Exactly. It's a many herbs are like that. They're like a natural combination therapy that already have a number of different um activities. And obviously, you could incorporate two or more herbs in, you know, a recipe or whatever. And in fact, um my colleagues in Switzerland have been trying that approach with the recipes and a list of plants that can be useful for diabetes. They've been trying that in Ethiopia. And I think the the study is still underway. They've got about 63 patients, I think, on board already. But their preliminary results are really promising that just that approach of advising patients, okay, here's a list of herbs you can take, try and incorporate them into your diet. You can pick, you know, two or three from the list. And they've found really significant reductions already in those patients' HbA1c levels. Just through that provision of advice.
