Therapeutic applications of Fenugreek - Fenugreek

Alternative Medicine Review, Feb, 2003 by Ethan Basch, Catherine Ulbricht, Grace Kuo, Philippe Szapary, Michael Smith

Potential Drug Interactions

Products rich in fiber (such as fenugreek fiber) can interfere with the absorption of oral medications because its fiber is mucilaginous and has high viscosity in the gut. Prescription medications, therefore, should be taken separately from fenugreek-containing products. Because concomitant use of fenugreek with other hypoglycemic agents might lower serum glucose levels more than expected, the level should be monitored closely. (19,21-25,32,33) An aqueous extract of fenugreek reduced potassium levels in a small group of healthy subjects 14 percent. (15) Consequently, fenugreek may precipitate hypokalemia when used in combination with some diuretics, laxatives, mineralocorticoids, or other hypokalemic agents. (32) Fenugreek is also purported to contain an estrogenic constituent. Decreases in the serum level of [T.sub.3] and in the [T.sub.3]/[T.sub.4] ratio, as well as an increase in the serum level of [T.sub.4], have been observed in mice and rats given fenugreek. (35)

Toxicology

Toxicological evaluation of 60 diabetic patients who took powdered fenugreek seeds at a dose of 25 g per day for 24 weeks disclosed no clinical hepatic or renal toxicity and no hematological abnormalities. (27) in an animal study, the acute oral [LD.sub.50] was found to be >5 g/kg in rats, and the acute dermal [LD.sub.50] was found to be >2 g/ kg in rabbits. (38) In another animal study, fenugreek powder failed to induce any signs of toxicity or mortality in mice and rats who received acute and subchronic regimens. (39) Moreover, there were no significant hematological, hepatic, or histopathological changes in weanling rats fed fenugreek seeds for 90 days. (40)

Dosage

Defatted powdered fenugreek seeds (100 g), divided in two equal doses, (25) have been used to treat type 1 diabetes. Fenugreek seed powder in capsule form (2.5 g twice daily for three months) (22) and in seed powder (25 g divided into two equal doses) (7,27,28) have been used to treat type 2 diabetes. Fenugreek has also been used to treated hyperlipidemia, both as seed powder in capsule form (2.5 g twice daily for three months) (22) and as defatted powdered seeds (100 g divided in two equal doses). (25) Commercially, fenugreek is available in seed powder capsules, teas, and pulverized seeds that can be mixed in water.

Conclusions and Future Direction

The incidence of type 2 diabetes is increasing dramatically worldwide, resulting in large measure from the increasing prevalence of obesity. (41) In addition, research is uncovering the importance of the "pre-diabetic" state or metabolic syndrome, when insulin resistance gives rise to impairment of glucose metabolism. (41,42) Unfortunately, patients who have metabolic syndrome or diabetes are at greatly increased risk of cardiovascular morbidity and mortality. (42,43) Thus, dietary supplements that can modulate glucose homeostasis and potentially improve lipid parameters would be desirable. This is especially true for diabetes prevention in patients with metabolic syndrome. These patients already manifest abnormalities of glucose handling and could benefit from a low-risk, inexpensive, food-based intervention aimed at normalizing their metabolic milieu. Fenugreek is a dietary supplement that may hold promise in this regard. The data generated to date are sparse but will hopefully lead to the development of well-designed, adequately powered, randomized, clinical trials evaluating the effect of fenugreek seed powder on measures of insulin resistance, insulin secretion, and cholesterol metabolism.