How To Manage Diabetes Naturally - The Nirogam Way

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How to Manage
Diabetes Naturally
The Nirogam Way
Tried and Tested Natural Remedies, Diet, and Exercise Tips
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Nirogam's Statement of Belief

Hello, my name is Puneet Aggarwal. I am the founder and CEO of Nirogam.
Thank you for downloading this free ebook on natural remedies for diabetics.
Nirogam started as a personal journey in my desire to find natural, holistic
remedies for lifestyle diseases like diabetes.
In the health industry they have a saying: You cannot sell prevention.
But you can make a ton of money selling cures.
Well, I intend to prove them wrong.
Well-being is a natural outcome of being self aware.
You have downloaded this ebook because you are looking for a solution for your diabetes. A solution that is
risk-free, safe, natural, holistic. A solution that does not make you feel like a production line puppet. Popping
a pill for one ailment and then having to pop additional pills to combat the side effects of the first pill.
What I want to tell you is this: It is very much possible to live a healthy life with your diabetes under control
using natural remedies provided you are willing to:
Wake Up. Get Real. Shed your Fear. Correct your Body, Mind, and Soul.
This ebook will give you the tools and knowledge needed to make this change.
Heres the brutal truth. Nobody can make you healthy. No pill. No ayurveda. No magic potion. No guru.
UNLESS you are willing to commit yourself to well-being.
Once you make that commitment however, the universe itself will conspire to provide you with everything
needed. It is an exciting journey once you grasp it.
My sincere wish and hope is that you will embrace this commitment and have an awesome journey through
life bursting with well-being.
While you make that journey of introspection, self-correction, and self-discovery, Nirogam is here to help you
with free content, tools, and advice.
Our commercial products and services are there to help you speed up that process of correction.
However, the best feedback Id like from this eBook is for you to tell me Puneet, I just followed the
remedies in this eBook and it brought my diabetes under control.
With best wishes for your good health,
Puneet Aggarwal
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Contents
Daily Routine for a Diabetic..............................................................................1
Natural Remedies for Diabetes........................................................................3
Healthy Diet for Diabetics.................................................................................8
Exercise for Controlling Diabetes...................................................................12
How to Determine Pre-diabetes.....................................................................16
Frequently Asked Questions...........................................................................21
Infographic on Type 2 Diabetes and Insulin...................................................25
Appendices:
(a) Salacia O Study - American Journal of Clinical Nutrition.....................................27
(b) Testimonial about Salacia-O from Mr. Satish K. Mehta.......................................34
Special Offers.................................................................................................35
Salacia-O Usage Recommendations.............................................................36
About Nirogam.com........................................................................................37
Contact Nirogam.com.....................................................................................37
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Chapter - 1
DAILY ROUTINE
FOR A DIABETIC
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DAILY ROUTINE FOR A DIABETIC

Life is difficult as it is without having to deal with diabetes. But, being diagnosed with diabetes does not mean
life has to be more difficult. Here are some simple changes that you can make to your daily life that will help
you manage diabetes better and dramatically improve the quality of your life.
Wake up Time: Wake up by 6 am in the morning as you also need ample time to exercise. Have a glass of
lukewarm water mixed with two teaspoonsful of fresh lemon juice every day.
Exercise: Exercise forms an important part of treatment for diabetic patients. A morning walk is the best
form of exercise. Yoga and meditation can also be beneficial, especially to relieve stress and bring clarity to the
mind. If your health permits, opt for exercises such as jogging, swimming, cycling, etc.
Breakfast: In the morning, take two slices of wholemeal bread with butter and fresh
milk (boiled and taken warm). Seasonal fresh fruits can be taken occasionally, with or
without milk.
At Work: If you are an office-goer, make sure you carry filling snacks with you all the time as Diabetics are
advised not to keep their stomachs empty. Instead of snacking on cheese, chips or crackers, enjoy a handful of
nuts or seeds. Go for variety with sunflower, pumpkin seeds, almonds, cashews, and walnuts.
Lunch: For lunch, opt for steamed or lightly cooked green vegetables such as
cauliflower, cabbage, tomatoes, spinach, turnip, asparagus and mushrooms.
Vegetablesouporboiledvegetablescanalsobetaken.Inaddition,twoorthreewholewheat
bread (chapatis), sprouts, salad, boiled rice, lentils (daal) etc. can be taken according to
appetite. A glass of buttermilk (salty lassi) is a nice drink to end the meal. Roasted cumin
seeds, black salt, grated ginger and green coriander leaves can be added to the butter milk
Daytime Sleep: If you are a non-working Diabetic, always remember not to
sleep during the daytime, as it increases Kledaka Kapha. A sub-dosha of Kapha, Kledaka Kapha governs the
protective mucous lining of the digestive system, thereby facilitating proper digestion. In an increased state, it
can lead to impairment of digestion, which can cause additional problems in Diabetes patients.
Evening Snacks: Have a glass of fresh fruit or vegetable juice. You can also take Ayurvedic tea with roasted
chickpeas.
Dinner: Always remember that your dinner should be light and not have too many
items. Boiled vegetables, sprouts, cottage cheese (paneer) or a bowl of salad made from
fresh raw vegetables of the season. Also, make it a point to eat at least two hours before
you go to bed.
Bedtime: Go to sleep before 10 pm. Have a glass of fresh boiled warm milk before going off to bed.
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Chapter - 2
Natural
Remedies
for Diabetes
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NATURAL REMEDIES FOR DIABETES

Medicinal herbs provide natural and safer remedies for dozens of common ailments. Therefore, the use of
herbal medicines is gaining popularity among patients.
Diabetes, the silent killer, affects 387 million people in the world and likely to go up by an additional 205
million by 2035. Apart from routine exercises and lifestyle changes below are certain home remedies that you
can try.
Herbal Remedies for Diabetes

Many of the common herbs and plant species are known to have blood sugar lowering properties. This makes
them useful as medicines for people with or at high risk of Type 2 Diabetes.
Aloe Vera drinking aloe vera juice every morning is among the most beneficial
remedies for diabetes. It has been clinically proven to help assist the body in reducing glucose
levels. Scientific studies have shown that aloe vera helps the body to metabolize sugars and
even lower glucose levels in people who are hyperglycemic.
Fenugreek this can be taken by powdering fenugreek seeds and mixing with
water or directly taking the available supplements. It is learnt to slow the absorption
of sugars in the stomach and stimulate insulin. Thus it helps lower blood sugar in
diabetics.
Cinnamon It lowers blood sugar by decreasing Insulin resistance. Studie suggest that intake of cinnamon
in the diet of people with type 2 diabetes will reduce risk factors associated with diabetes and cardiovascular
diseases.
Bitter Gourd (karela) Having a cup of karela juice on empty stomach in the
morning has shown to control/prevent diabetes. The most promising effect of this herb is
that it influences glucose metabolism not just in one organ or tissue but rather all over the
body. It contains a chemical which acts like insulin. And, that helps reduce blood sugar
levels.
Jamun fruit (Jambul) this fruit is considered as an effective medicine for diabetes
because of its effect on pancreas. You can make a powder by drying its seeds and have this
powder with water at least twice a day. Diabetics must eat jamun daily to control their sugar
levels. This ensures an increase in the insulin activity.
Guava guavas are considered to be very good for diabetics. Having this fruit regularly
reduces cholesterol and brings down high blood pressure. Its high level of dietary fiber
makes it the best pick for regulating the absorption of sugar by the body. This decreases the
chances of rapid rise and drop in insulin and glucose in the body.
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Garlic It has been learnt that those who took a garlic supplement with their
daily diabetes medications had better control over blood sugar levels. Diseased/
abnormal heart muscle is the leading cause of death among diabetes patients. Garlic
oil may help protect diabetes patients from this condition
Turmeric this queen of spices is very useful in managing diabetes. Curcumin

present in turmeric helps to balance blood sugar and glucose levels. It is also useful
in keeping the triglyceride and insulin levels low.
Neem chewing raw neem leaves or drinking neem juice regularly or taking a
neem supplement is beneficial in keeping diabetes under control. Neem keeps a
check on circulation problem in diabetics.
Salacia the most famous herb that is being used to treat diabetes for
thousands of years now. Chemicals present in salacia prevent sugars in food from
being absorbed by the body resulting in lowered blood glucose and insulin levels.
You can crush the herb and drink its juice every morning. Clinical Study done on
the effectiveness of Salacia in reducing insulin and blood glucose levels can be found
here: http://researchnews.osu.edu/archive/saloblo.htm
Oregano and Rosemary - Both herbs help you combat diabetes and are easily
available in the market in fresh and dried forms. Just add them generously to your
salads, soups, sauces, dishes and other munchies.
Shilajit (Mineral Pitch) - Due to its properties as a panacea, Shilajit is widely used in the treatment of
diabetes. It carries the sugars in the blood to their final destination. Thus sugar is not allowed to accumulate
within the bloodstream. This is a very important step in the treatment of diabetes mellitus.
Shilajit improves the function of the pancreas, which secretes insulin. Shilajit is useful
in expelling the toxins from the body through urination. Overall, Shilajit improves the
quality of blood.
Read Research Study on Shilajit here: Modulation of Oxidative and Antioxidative Status in Diabetes by
Asphaltum Panjabinum.
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Gooseberry juice mixed with turmeric powder and honey should be taken early in the morning on empty
stomach.
The milky sap of Ficus glomerata (udumbara), diluted with water, should be taken by diabetic patients. The
fruit and seed of this tree should be mixed with honey and taken regularly.
Grapefruit should be included in the daily diet. 3 grapefruits thrice daily. For pre-diabetics, 3 grapefruits
once daily.
Tender leaves of the mango tree are considered useful in diabetes.Tender leaves should be dried in the
shade, powdered and preserved for use when necessary. Half a tsp of this powder should be taken twice
daily. An infusion prepared by soaking 15 gram of fresh leaves in 250 ml of water overnight and squeezing
them well in the water in the morning. This filtrate should be taken every morning to control early diabetes.
The seeds of parslane are useful in diabetes.A teaspoon of the seeds should be taken everyday with half a
cup of water for 3-4 months. It will increase the bodys own insulin and will help in curing diabetes.
Tea made from the pods of string beans are considered useful in diabetes.
Ash gourd juice mixed with juice obtained from the stem of banana and the juice obtained by grinding a
few bilwa (bael leaf ) leaves should be mixed and taken early morning on empty stomach.
Neem leaves should be ground and made into a paste and a small bolus of this should be added to water.
This should be taken on empty stomach in the morning.
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5 Quick Kitchen Remedies for Managing Diabetes
#1 : Mix tsp Turmeric Powder + 1 tsp Amla Powder + tbsp Methi Seeds Powder in half glass of water and
take daily in the morning on empty stomach
#2 : Take 1 teaspoon of Indian gooseberry (amla; amalaki) juice mixed with 1 teaspoon of bitter gourd juice
twice a day.
#3 : Chew 10 holy basil leaves (tulsi), 10 margosa leaves (neem), and 10 bael leaves (belpatra) on an empty
stomach in the early morning.
#4 : Consume one tablespoon of ground flaxseed powder every morning on an empty stomach with a glass of
warm water. However, do not have more than 2 tablespoons per day, as it can be detrimental to your health.
#5 : Take a few drumstick leaves, wash and crush them to extract their juice. Now take about 1/4th cup of this
juice and drink it on an empty stomach, every morning to keep your sugar levels under control.
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Go for herbal remedies and get all healthier the natural way.
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Chapter - 3
Healthy Diet
for Diabetics
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HEALTHY DIET FOR DIABETICS

Eating for diabetes does not imply that you have to go totally sugar free.
If you are diagnosed with diabetes, the first thing that crosses your mind is all the sweet foods you will have to
miss. On the contrary, eating for diabetes does not imply that you have to go totally sugar free. You may enjoy
a small portion of your favourite cake once in a while. It is all about balancing your diet. A diabetic patient
should never skip his meals. Proper meals on time is a must.
How to balance your diet in diabetes?
Basically you have to plan your meals in a way that suits your daily routine and eating habits. There are 2 ways
of doing it:
The Plate Method: Here you divide your plate into 1 big and
2 small imaginary sections:
-Keep the biggest section for non starchy foods like green veggies
and salads that include spinach, beans, cucumber, onion, tomato,
lettuce, cauliflower, mushroom, carrot, radish etc.
-In one small section put all the protein rich foods. It can include
low fat cottage cheese, sprouts, tofu, fish, eggs, sea food etc.
-In the other small section you can put starchy foods and grains.
Whole grain breads, cereals, rice, pulses, pasta, oatmeal, potato,
sweet potato, lima beans, corn, popcorn etc.
-You may add one serving of fruit and a drink with minimal
calories like water, lemon water/ tea / coffee without sugar.
The Carb Counting Method: It is also called as the carbohydrate counting method. It implies that you
keep a tab on how much carbohydrate you are consuming in every meal. This technique helps manage your
blood glucose levels.
-How much carbs you should eat depends on how active you are during the day and what medicines you take
for diabetes.
-The amount of carbohydrate intake varies from person to person. Consult your doctor for best advice.
-Normally 45-60 grams of carbs in a meal are suggested. You may go for less or more as per your health
status.
-Raw salads should be taken along with afternoon meals and also for dinner.
-Sprouted horse gram, green gram, black gram, green peas etc. should be consumed more.
-Fried and grilled (BBQ) should be completely avoided.
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What Foods Can You Eat As a Diabetic?

Diabetes does not mean that you have to survive on bland food for life. You may eat any healthy and tasty food.
Here is a list of foods you can go for without raising your blood sugar levels:
Eat foods high in fibre content as they release carbohydrates slowly. They give
you lots of energy boost and keep you full for a long time. Also they prevent
sudden spike in blood sugar levels. Brown rice, bran flakes, leafy greens, whole
grain bread, rolled oats are great choices in this category.
Choose non- starchy foods like nuts, seeds, leafy greens, fresh fruits like apple,
pear, papaya, orange, lime, lemon, grapefruit, berries, peach, guava etc. They are
low in gylcemic index and prevent blood sugar levels from shooting up drastically.
Eliminate refined food items from your diet. Products made with white flour
like pasta, bakery items, canned foods and preserved foods should be avoided.
Add protein to your meals. Cottage cheese, tofu, fish like sardine and tuna,
beans etc. are great sources of protein.
If you have a sweet tooth, go for smaller portions of your favourite dessert.
Add sugar to the eatables yourself while cooking. Reduce the quantity of
sugar used. For eg. Instead of 1 tsp put 1/3 tsp of sugar in your coffee. Add
cinnamon, vanilla essence etc.
Use olive oil for cooking. Instead of frying you can bake, grill or broil the food.
Eat 5-6 meals in a day. Keep a food diary to keep count of total calorie intake. Experiment with oil free and
yummy recipes with lots of fibre.
Avoid red meat. People with diabetes are generally at an increased risk for
heart disease. Therefore, they have to be more prudent in their food habits
as eating high-fat meats puts them at an even greater risk than the average
person. Meat eaters usually consume more dietary fat and less of fiber. More
amount of dietary fat leads to increased storage of fat inside cells. This makes
the cells resistant to insulin. Also, intake of meat based diets damages tissues
and results in insulin resistance because of the preservatives added in them.
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LIGHT HEALTHY SNACKS FOR DIABETICS
Chop a small pear into small pieces and grate some light cheese into it. This snack is rich in calcium and
fiber. The cheese gives you 16% of your daily calcium requirement and the fiber 9% of your daily
recommendation.
Take about 8 halves of dried apricot if you have a strong craving for sweets. Dried apricot is a rich source
of Vitamin A and meets 20% of your daily needs.
Grab a fiber-rich small orange that will also provide you with Vitamin C. Fiber and Vitamin C bring down
blood glucose.
Mix cup low cottage cheese with 1 cup of strawberry pieces to get Vitamin C and calcium.
Another quick snack that is full of Vitamin C, is a cup of grapes.
If youre in the mood for a home made simple snack, try this recipe by Tarla Dalal:
Apple Rabdi - Tarla Dalal

Low fat milk thickened with apple. The addition of nutmeg and cardamom blends well with the subtle flavours.
Try not to peel the apple as much of the fibre is present in the peel and just below it. Select sweet apples for this
recipe as sharp apples can split the rabdi, make it bitter and render it useless.
Preparation Time: 5 mins
Cooking Time: 15 mins
Ingredients
Makes 3 servings
3 cups low-fat milk , 99.7% fat-free
3/4 cup grated apples (with skin)
1/4 tsp cardamom (elaichi) powder
a pinch of nutmeg (jaiphal) powder
1 tsp sugar substitute
Method
1.Bring the milk to boil in a deep non-stick pan and simmer it for 10 to 12 minutes, while stirring in between
and scraping the sides of the pan.
2. Add the grated apple, mix well and simmer for another 2 to 3 minutes, while stirring in between and
scraping the sides of the pan.
3. Add the cardamom powder and nutmeg powder, mix well and keep aside to cool.
4. Once the rabdi has been cooled, add the sugar substitute, mix well and refrigerate for at least 1 hour.
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Serve chilled.
Plan your meals well. Enjoy your life and stay healthy.
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Chapter - 4
Exercise for
Controlling
Diabetes
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EXERCISE, SLEEP, AND STRESS MANAGEMENT FOR

CONTROLLING DIABETES
World Health Organization (WHO) estimates that nearly 200 million people all over the world suffer from
diabetes. What is more alarming is that this number is likely to double in the coming years. Diabetes being a
lifestyle disorder, the solace is that with a few changes in our lifestyle it can be effectively controlled.
Exercising should be an integral part of a diabetics routine lifestyle. Thirty minutes to one hour of brisk
walking can do wonders for you. You could also practice Tai Chi, the Chinese form of exercise. Yoga has always
benefited people and incorporating Yoga is a must in a diabetics schedule. Moreover if you love dancing or
swimming, these form of exercises can be very helpful in reducing stress and maintaining a healthy lifestyle.
Surprisingly, Yogasanas are not popular as a management strategy for Diabetes. However, Yogis recommend
certain asanas which can work wonders in controlling blood sugar levels.
How Yoga Helps to Control Diabetes
Yoga helps beat stress (one of the factors contributing to diabetes).
Regular practice of yoga keeps a check on weight gain. Weight gain always has a negative impact on blood
sugar levels.
Yogasanas help harmonise the body and promote relaxation.
They also ensure the optimal functioning of the endocrine glands enabling the body to use insulin
effectively.
There are many Yoga poses which help Diabetes. However, we have compiled the top 6 ones which are
popular and relatively easy to practice.
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6 Top Yogasanas for Diabetes Management

1. Surya Namaskar (Sun Salutation) - Surya Namaskar increases the
blood circulation and enhances the administration of insulin in the
body. It also helps to check weight gain.
2. Pachimottan Asana (Posterior Stretching Pose) - This is known to

help the optimal functioning of the vital organs like liver, pancreas and
kidney.
3. Bhujang Asana (Cobra Pose) - This asana helps to improve the

function of the internal oragans including liver, kidney, pancreas
and gall bladder. Thus aids in controlling diabetes and weight gain.
4. Balasana (Childs Pose) - Balasana is a great stress buster which will

help promote peace and tranquility.
5. Mandukasan (Frog Pose) - This asana helps to stimulate the pancreas

and makes it healthy. And a healthy pancreas ensures insulin secretion
and blood sugar regulation.
6. Anulom Vilom (Alternate Nostril Breathing) is the simplest breath

control exercise that you can practice if you have diabetes. A great
soother of the nervous system, Anulom Vilom strengthens the heart,
helps regulate cholesterol levels and refreshes the body and calms the
mind. Thus it shows a positive effective on the
hormonal system and helps control blood sugar levels.
A word of caution:
If you have any injuries or suffer from an underlying condition like sciatica, kidney disease, hypertension,
etc., do not begin yoga practice without consulting your doctor. If you are pregnant, avoid practice unless
advised. Yoga or any strenuous exercise is best avoided during menstruation.
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Sleeping Habits
Poor sleep and diabetes are long time friends. Those
who lack quality sleep at night eat more to keep up
their energy levels. This will increase their sugar level.
If you do not eat well, then you sleep less and again, the
cycle is affected.
Lack of sleep is also linked to obesity and weight gain.
If you have diabetes and have disturbed sleep, thats not
surprising either.
For diabetes management, restrict caffeine and alcohol intake, avoid heavy dinner, exercise and take warm bath
before bedtime to improve sleep. A healthy snack before bedtime with a
consistent routine is very helpful.
Stress
If you have been doing everything thats been advised for diabetes management and preventive care but still see
no results, blame it on stress! Stress is a villain and it creates havoc in your bloodstream. When you are under
stress, it makes the body work harder to cope better by causing the flight response.
As the body gets ready to fight it takes up the stored fat to produce the energy. for flight or fight. Since there is
a lack of insulin in the Diabetic, the blood glucose released is not controlled. For stress management,
meditation and yoga are very beneficial.
Did you know stress exists as much in your body as it exists in your mind?
Certain body movements indicate negative emotions.

Tightly clenching your fists when angry is a sign that
your body is taking on the stress. Swallowing your
words when you want to yell at someone is yet another
way of lodging stress in your body. You want to disagree
but instead you simply smile and agree with the other
person. This also is a negative emotion stored in your
body.
So watch out for these cues from your body as they

are clear signs of tension building up. When stressed,
observe your breathing and take a few deep breaths,
move around a little, relax your shoulders and unclench
your fists, splash your face with cold water, step outdoors
onto a balcony or take a walk outside. All these small acts
will help you reduce the burden of stress on your body.
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Chapter - 5
How to Determine
Pre-diabetes
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HOW TO DETERMINE PRE-DIABETES

India is said to be the Diabetes capital of the world. To add to this, reports show that there are an estimated
77.2 million people in India who are suffering from pre-diabetes.
Many People Dont Know What Prediabetes is! Are You One of Them?
Prediabetes is a condition in which the amount of glucose in your blood is higher than normal. However, it is
not so high to be termed as diabetes. It is the border line or gray area between normal and diabetes. With
prediabetes there comes always a higher risk of developing Type 2 Diabetes. There is also a greater chance of
developing health problems like heart disease and stroke.
However, not all is lost because there is also some good news. Having prediabetes doesnt always mean that
Diabetes will be a by-product. In fact, you have the power to reverse the condition. This can be achieved by
making simple daily lifestyle changes such as exercising, limiting your carbohydrate intake and making
efforts to lose excess weight.
It is also seen that 15-30% of people with prediabetes will develop Type 2 diabetes within a span of 5 years if
there are no lifestyle changes incorporated.
Some people who have pre-diabetes hardly exhibit any symptoms. Therefore it is likely that you may have
prediabetes and not even be aware of it.
Tests to Determine Prediabetes
Either one of the two tests below are used by doctors to diagnose diabetes and prediabetes.
1. Fasting Plasma Glucose Test (FPG) In this test, a
FPG
RESULT
persons blood glucose level is measured first thing in the < 100 mg/dl
Normal
morning before breakfast.
100 125 mg/dl
Prediabetes
2. Oral Glucose Tolerance Test (OGTT) This
test measures a persons ability to break down
glucose. In this test, a persons blood glucose is
measured in the morning after the person has fasted
overnight or has been without food for 8 hours.
126 mg/dl or above
Diabetes
OGTT
< 140 mg/dl
140 199 mg/dl
200 mg/dl or above
RESULT
Normal
Prediabetes
Diabetes
The test is repeated again after two hours after drinking a glucose rich beverage. This test may also be used to
diagnose gestational diabetes in pregnant women.
Persons who are at higher risk of prediabetes

Some people will face an increased likelihood of having pre-diabetes. Among those who should be screened
for pre-diabetes include overweight adults aged 45 and older. Also, those who are under age 45 and are
overweight and have one or more of the following risk factors must be tested:
Family history of diabetes
Are mostly physically inactive
Have had gestational diabetes
Have elevated blood pressure
Low HDL Cholesterol
Members of certain ethnic groups like South Asian, Native American, African-American etc.
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How to Prevent Diabetes if you are Prediabetic

The two principle factors you must consider are:
1. Dietary Changes
Make healthier food choices by reducing portions and limiting added fat and sugar. Get the help of a doctor or
nutritionist. Aim at adding 25 grams of Soluble Fibre to your diet. Also have low glycemic foods, like the ones
listed below:
1. Chickpeas help prevent elevated blood sugar levels, making it a good choice
for diabetics. You can toss them in your green salads, make a tasty curry for chapati or
prepare hummus to eat along with pita bread.
2. Beans (kidney beans, black beans, white beans) if you are looking for a food item
that has high-quality carbohydrates, lean protein, and soluble fiber your search ends
with beans. Include them in your meal plans at least thrice a week as it helps stabilize
your bodys blood-sugar levels.
3. Barley Having a meal with barley instead of white rice has shown to reduce the
rise in blood sugar by almost 70%. The added advantage is that it keeps the blood sugar
lower as well as steadier for hours.
4. Broccoli is rightly termed as the antidiabetes super hero. This veggie being high
in fibers and low in carbohydrates is the most ideal pick for diabetics. Other veggies like
spinach and green beans are also included in this category.
5. Whole Grain Bread When going to the market for buying bread read the
ingredients label carefully and carry only that loaf that has wholegrain mentioned in it.
It was found that simply switching to whole grain from white bread improves sensitivity
to insulin. More coarse the bread, better it is as it will slower digestion.
6. Cranberries owing to the presence of abundant phytonutrients like
anthocyanins in them, cranberries are especially beneficial in a diabetic meal plan. You
can eat half a bowl of fresh cranberries or have it as a juice. You could also consider
adding them to you fruit salads or smoothies.
7. Fish Baked, broiled or steamed fish is a good meal for diabetics and it reduces
the risk of developing heart problems linked to diabetes.
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.
8. Oatmeal packed with soluble fiber it slows the absorption of glucose from
food in the stomach thus controlling the blood sugar levels. An oatmeal breakfast is a
healthy way to start the day.
9. Apples if you have a sweet tooth and are tempted to munch on candies, you must
instead bite into an apple. Filled with fiber this fruit along with others like pears, papaya
and grapes are a healthier option for blood sugar control.
10. Dalia/ Cracked Wheat - this wheat product is made from whole raw wheat kernels that are crushed
into smaller pieces to get coarse grains. It is more nutritious than rice, because it contains more fiber, vitamins
& minerals. It also has a better glycemic index than white rice or refined flour. It is the best food option for
those who have problems of high blood pressure with high cholesterol and diabetes. You might want to try out
those steaming dalia idlis also!
11. Ragi or Nachni - the perfect health food for any age, ragi contains higher
amounts of dietary fibre. It helps maintain optimum sugar levels in blood. It also aids
in digestion and prevents you from over-eating as it makes you feel full for a longer
span of time.
12. Raw Onions - this is considered as one of the best foods for diabetics. It has
hypoglycemic effects that are beneficial in management of Type 1 and Type 2 diabetes
patients. Onions contain an anti-diabetic compound and have the ability to reduce
blood sugar levels.
13. Bitter Gourd (karela) - contains at least three active substances with anti-diabetic properties and
can help manage diabetes better. A compound called charantin in karela keeps the glucose low and controls
sugar levels.
14. Fenugreek (methi) seeds - these seeds are helpful to diabetics as they
contain fiber and other chemicals which slow digestion and the bodys absorption of
carbohydrates and sugar. Soak about one teaspoon of methi seeds overnight & drink
this water on an empty stomach in the morning. It will help in many ways to cope with
the complications of Diabetes.
15. Drumsticks - Drumsticks can keep the glucose levels in the blood in check. Use
them in your sambars or dal. Owing to its anti-diabetes properties, you can manage
diabetes better by eating this vegetable regularly, you can manage diabetes better. Take a
few drumstick leaves, wash and crush them to extract their juice. Drink one cup of this
juice every morning before you eat anything else.
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2. Physical Activities
Thirty minutes or more of exercise daily is a must for all pre-diabetics and diabetics. Exercise increases insulin
sensitivity (i.e reduces insulin resistance). This essentially helps to tackle the root cause of Type 2 diabetes.
Exercise keeps your heart strong and makes you sleep better.
Here are some fun physical activities:
Dance to your favourite music! When was the last time you
danced? Get into some comfortable clothes, turn on the
volume, and let your body follow the beat.
Skipping. Remember how much fun you had as a kid skipping

rope with your friends?
Cricket or Football with your family and friends. Organise

a weekly game followed by snacks.
Play badminton with your kids or the neighbours kids in

the late evenings.
Go swimming with friends or family for an hour or two

every weekend.
Bicycle Rides with your family and friends. Plan a route

that has the least traffic and most greenery.
Take your dog for a walk twice a day or accompany friends

who walk their dogs.
So start with a simple exercise or yoga practice and include it in your

daily routine and kick start a healthy life.
For yogasanas for diabetics, please click here:
6 Top Yogasanas for Diabetes Management
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Chapter - 6
Frequently
Asked Questions
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Frequently Asked Questions

1. Can diabetes be completely cured?
Diabetes can only be controlled with a proper diet and lifestyle modification.The probable complications of
long standing Diabetes can also be minimized effectively with Ayurvedic medicines. A permanent cure cannot
be assured.
Reversal can occur after a couple of years, but you will have to continue following the diet and lifestyle modification plan. The duration of the treatment, prognosis, etc. will depend on body constitution, diet and many
other factors.
2. What is the ayurvedic treatment for Type 2 Diabetes?
Type 2 Diabetes is a chronic metabolic disorder in which the body is unable to make proper use of glucose,
resulting in hyperglycemia and glycosuria. In this condition, the pancreas does not produce enough insulin
or the body cannot use the insulin well and the sugar builds up in the blood and the glucose doesnt reach the
bodys cells. In this condition Ayurvedic medicines like katakakhadiradi kashayam, nishamalakadi tablet, nishakatakadi kashayam, guduchi satvam, triphala churnam, shilajit etc would be beneficial.
3. Is there a treatment for Type 1 Diabetes in ayurveda?
Type 1 diabetes is where the bodys immune system destroys the beta cells in the pancreas (which produces
insulin), without insulin, the sugar builds up in the blood and if left untreated it can damage the organs. In
this condition, outside source of insulin or insulin injection is required, which will help to bring glucose to the
body cells. Along with this, Ayurvedic practitioners suggest Dhanwantaram ghritam as a supportive medicine.
4. What are the long-term side-effects of allopathic drugs for diabetes?
Metformin is commonly prescribed for Type 2 Diabetes. The common side effects of Metformin are: Vitamin
B12 deficiency, anorexia, gastrointestinal disturbances, urticaria and hepatitis. Out of these, many patients
complain of gastrointestinal disturbances. Metformin should be used with caution by people with nephropathy
(kidney disease), severe liver disease, or decreased kidney function. Another drug, Thiazolidinedione, causes
weight gain, risk of liver disease, anaemia and swelling of legs or ankles. Headache, UTI and sinusitis are seen
in patients taking Pioglitazone.
5. Can natural health and ayurvedic products be taken with allopathic drugs?
Yes, natural home remedies and Ayurvedic medicines can be taken along with Allopathic medicines. However,
the blood sugar levels should be monitored on a regular basis. Special care should be taken while taking medications and remedies so that the blood sugar levels do not drop drastically leading to hypoglycemia and other
associated problems. Homeopathic and Ayurvedic medicines should not be taken together.
6. How to manage frequent urination?
In case of frequent urination, the patient may try the following remedies:
Taking five grams of powdered pomegranate rind with water. Take it twice daily for three weeks.
Rice should be avoided during the course of treatment.
Taking a teaspoon of turmeric powder twice daily in the morning and evening with cool water can cure
polyuria. According to Ayurveda, turmeric is the best remedy for diabetes.
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Mix the juice of three Indian gooseberries with water and take it twice daily in the morning and evening for
four days. It will provide relief from polyuria.
Turmeric powder can be mixed with amla juice and taken twice daily.
Eating sesame seeds will also provide relief.
Caraway seeds mixed with sesame seeds can be taken.
Nocturia can be treated by eating spinach in the evening.
7. How to manage sugar level fluctuations during pregnancy?
Avoid products that contain coconut, palm, or palm kernel oil.
Look for products that contain unsaturated or mono-unsaturated fats such as fish, margarine, and vegetable oils.
Three small meals and three snacks at even intervals throughout the day can prevent fluctuations in blood
sugar levels. Include proteins and complex carbohydrates in those snacks and meals.
Six to eight hours without food can leave a pregnant lady with low sugar levels in the morning. A good
bedtime snack might include an apple with whole-grain crackers and low-fat cheese, or peanut butter.
Exercise burns off the extra sugar that your body has stored in your cells and helps keep sugar levels from
getting too high.
Increase the intake of dietary fiber.
8. How to control weight gain?
To control weight gain, bitter fruits and vegetables [Bitter melon, methi, grapefruit, etc.] should be consumed
more. And, instead of 3 large heavy meals, small frequent meals should be taken. Jamun, bitter gourd, fenugreek, turmeric, warming spices etc. should be included in the diet.
9. How to deal with stiffness, numbness and pain in limbs?
Magnesium, ALA, Omega 3,6 fatty acids should be taken in adequate amounts to combat peripheral neuropathy and to strengthen the nervous system. Vitamin B6 deficiency can also aggravate neuropathic pain.
Consumption of herbs like amla, giloy, bala etc can increase circulation. Massaging the affected areas with
chinchadi tailam, mahamasha tailam, sahacharadi tailam, etc. can help to improve blood circulation and relieve numbness and pain. Thyme is another herb that can help in treating circulation problems. Using a foot
soak made of thyme will help ease constricted blood vessels and this will relieve burning feet. A paste made of
ginger can be applied over the feet in case of burning sensation.
10. How does uncontrolled diabetes damage organs?
Diabetic nephropathy: The kidneys have many tiny blood vessels that filter waste from the blood. High
blood sugar from diabetes can destroy these blood vessels. Over time, the kidneys will not able to do their
functions well. Later on, they may stop working completely. This is called kidney failure.
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Diabetic retinopathy: This may be the most common microvascular complication of diabetes. The risk of
developing diabetic retinopathy or other microvascular complications of diabetes depends on both the duration and the severity of hyperglycemia (high blood sugar). The small capillaries in the retina get clogged
due to diabetes. Small capillaries also start growing at inappropriate places. This could also form scar tissue
and cause the retina to be pulled back from its normal position causing retinal detachment. Apart from
affecting small blood vessels, untreated diabetes also leads to thickening of blood vessels that supply blood
to the vital organs of the body.
Diabetics are also more prone to high blood pressure and high cholesterol, which can cause heart disease.
High blood glucose levels can contribute to the formation of fatty deposits in the blood vessels. Over time,
this can restrict blood flow and increase the risk of hardening of the blood vessels (atherosclerosis) which
leads to heart disease.
11. How to avoid drop in energy levels and intense fatigue?
Cut an unpeeled potato into slices and let the pieces soak in water overnight. In the morning, drink the
juice after straining it. This is rich in potassium, a mineral essential for transmitting nerve impulses and
making muscles move along with other vital functions.
Eating spinach daily or on alternate days can relieve fatigue. Spinach is a rich source of potassium and
Vitamin B, which is beneficial in energy metabolism.
A daily dose of Ashwagandha or COQ 10 can also help to combat stress and fatigue.
Drumstick (Moringa) leaves are high in fiber content and best known for their ability to boost energy. A
decoction made of drumstick leaves can be taken daily.
A decoction made of fenugreek seeds can also be taken regularly.
Stress management and adequate sleep are also important to fight fatigue.
Those suffering from intense fatigue may benefit by taking a short power nap of 20-40 minutes in the
afternoon.
12. Can a Diabetic consume raisins . If yes, how much per day?
Raisins have a low to moderate glycemic index. Unless and until it is consumed in large quantities it may not
have a big impact on the blood sugar levels. 1-2 tbsp of raisins can be consumed daily by diabetic patients whose
blood sugar is under control. You can read more on this at http://newdiabetesmedications.com/
13. How to lower HbA1c levels for better management of Diabetes?
It is very important for diabetics to monitor their HbA1c levels even if they check their blood sugar levels
regularly. If you wish to know the importance for diabetics read http://blog.nirogam.com/6-crucial-testsmust-diabetes/
Cinnamon is a herb with blood sugar lowering benefits. Cinnamon helps to lower glucose or HbA1C. Take 1-2
grams of cinnamon daily for 2-3 months to lower the HbA1C level. Including Omega 3 fatty acid in the diet
can also help lower HbA1C in diabetics
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TYPE 2 DIABETES AND INSULIN
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The food we eat is digested by the

stomach, using acids and enzymes,
which converts the carbohydrates (the
starches and sugars) in the food into
glucose.
This glucose is absorbed by the

stomach and the intestines and
released into the bloodstream.
The glucose in the bloodstream is

ready for use as energy but our
cells can absorb the glucose only
with the help of insulin.
Without the right amount of insulin to transport

the glucose to the cells, the excess glucose
will remain in the bloodstream and the cells
will not have sufficient energy causing you
intense fatigue. The kidneys will try to get rid
of the excess glucose through the urine, which
is the cause of frequent urination and
subsequent thirst.
In a person with Type 2 Diabetes, the
In a healthy person, the beta cells in the
production of insulin is low and/or not
pancreas check the glucose in the blood
performing as it should, so it is all the more
every few seconds and produce as much
important to eat a healthy diet to avoid
insulin as necessary to transport the
overburdening the limited action of insulin.
glucose into the cells.
A healthy diet and regular exercise can help maintain normal blood glucose levels to ensure
supply of energy to the body resulting in a more active and productive life.
l i a steady
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APPENDICES
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Extract of Salacia oblonga lowers acute glycemia in patients with
type 2 diabetes"?'
JenniferA Williams, Yong S Choe, Michael J Noss, Carl J Baumgartner, and Yikkie A Mustad
ABSTRACT
Background: Two previous studies tested the efficacy of Salacia
oblonga extract in healthy adults.
Objective: This study evaluated the effect of an herbal extract of
Salacia obionga on postprandial glycemia and insulinemia in pa
tients with type 2 diabetes after ingestion of a high-carbohydrate
meal.
Design: Sixty-six patients with diabetes were studied in this ran
domized.double-blinded crossover study. In a fasted state. subjects
consumed 1 of the following3 meals: a standard liquid control meal,
a control meal + 240mg Salaciaoblongaextract, and a controlmeal
+ 480 mg Salacia obionga extract. Serum glucose and insulin sam
ples were measured at baseline and at postprandial intervals up to
180 min.
Results: Both doses of the Salacia extract significantly lowered the
postprandial positivearea under the glucose curve (14% for the 240
mg extract and 22% for the 480 mg extract) and the adjusted peak
glucose response (19% for the lower dose and 27% for the higher
dose of extract) to the control meal. ln addition, both doses of the
herbal extract significantly decreased the postprandial insulin re
sponse, lowering both the positive area under the insulin curve and
the adjusted peak insulin response (14% and 9%. respectively, for
the 240 mg extract; 19% and 12%, respectively, for the 480 mg
extract) in comparison with the control meal.
Conclusions: The extract of Salaciaoblanga lowers acute glycemia
and insulinemia in persons with type 2 diabetes after a high
carbohydrate meal. The results from this study suggest that Salacia
may be beneficial to this population for postprandial glucose
control.
Am J Clin N11tr 2007;86:124-30.
KEY WORDS
Salacia oblonga, postprandial glycemia,
herbal extract, o-glucosidase inhibitor
INTRODUCTION
Diabetes results in both public health and financial burdens to
the society. In2005. the estimated total prevalence of diabetes in
the United States was 20.8 million persons, or 7.0% of the pop
ulation (l). In addition, 20.9% of persons aged 2::60 y bas the
disease. which was the sixth leading cause of death in 2002 (1).
The financial burden of this disease translates to an estimated
$132 billion in medicalexpenditures, disability, and lost produc
tivity in the United States (2). Because the risk of developing long
term complications can be dramatically reduced with appropriate
glycemic control (3), food ingredients that can attenuate postpran
dial glucose in persons with diabetes would be useful.
124
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One such ingredient, the root extract of Salacia oblonga.

inhibits the breakdown of oligosaccharides and polysaccha
rides into monosaccharides by competitive inhibition of
o-gluccsidase activity within the lumen of the intestinal tract.
Historically,the Salacia plant bas been used as part of the tradi
tional Ayurvedicsystem oflndian medicine to treatdiseases such
as diabetes (4); currently, extracts of Salacia are consumed in
commercial foods and food supplements in Japan for the treat
ment of diabetes and obesity. Yoshikawa el al (5) isolated active
components of a Salacia extract and concluded that their mode of
action was the inhibition of a-glucosidase enzymes. Two com
pounds isolated from Salacia extracts, salacinol and kotalanol,
inhibit the action of the small intestinal enzymes sucrase.
maltase, and isomaltase (6). Therefore, naturally derived
e-glucosidase inhibitors may be powerful nutritional adjuncts
for the treatment of diabetes mellitus by lowering postprandial
blood glucose.
The potential genotoxicity and safety of Salacia oblonga ex
tract (SOE) were evaluated with a standard battery of tests (re
verse mutation assay, chromosomal aberrations assay, mouse
micronucleus assay) recommendedby the US Food and Drug
Administration for food ingredients (7), and in a 92-93-d feeding
study in rats with doses of 250, 1250. and 2500 mg kg-1 d-1
by oral gavage (8). SOE was determined not to be genotoxic, and
the no observable adverseeffectlevel was determined to be 2500
mg kg-1 d-1 after daily subcbronic oral gavage administra
tions to rats (8).
Two previous studies in healthy adults were conducted to
determine the effect of SOE on postprandial glycemiaand insu
linemia aftera controlmeal (9, 10). Both studies showed efficacy
on postprandial glycemia with 1000 mg SOE. The primary ob
jective of this study was to compare the effectof2 different doses
of SOE on the glycemic and insulinemic response in patients with
type 2 diabetes. Because previous experiments were conducted
with healthy subjects. a logical next step was to test SOE within
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From the Ross Products Divisionof Abbott Laboratories, Columbus, OH
(JAW, YSC, and VAM); Radiant Research, Cincinnati, OH (MJN), and
Radiant Research, Edina, MN (CJB).
2 Presented in part at the 66th Scientifie Session ofthe American Diabetes
Association, Washington, DC, June 9-13, 2006.
3
Supported by Abbott Laboratories.
4
Address reprint requests toJA Williams, Ross Products Division, Abbott
Laboratories, D105220, RP3-2, 625 Cleveland Avenue, Columbus, OH
43215. E-mail: jennifer.williams@abbou.com.
ReceivedOctober 14, 2006.
Accepted forpublication March 16, 2007.
Am J Cli11 N11tr 2007;86: 124-30. Printed in USA. <o '2007 American Society for Nutrition
27
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HERBAL EXTRACT LOWERS GLYCEMIA
the population most likely to benefit from its effects on postpran
diaJ glycemia-patients with type 2 diabetes.
SUBJECTS AND METHODS
Subjects
This was a 2-center, randomized, double-blinded, 3-period,
3-treatment crossover study. Eighty-two subjects were enrolled,
41 per site, and 66 successfully completed tbe study according to
protocol by meeting all entry criteria, complying with meal tol
erance test preparation, having nonmissing data for the primary
variable at all 3 treatment visits, and consuming all test products.
For the 16 subjects who were not included in the protocol evalu
able analysis, 8 of the subjects bad missing or mistimed blood
samples, 2 were ineligible, 2 had changes to their antihypergly
cemicmedications during the study, l withdrew before treatment
visits. l was randomly assigned incorrectly, l withdrew after a
visit because of the subject's complaint of shakiness, and 1 with
drew at a treatment visit after symptoms of nausea and vomiting.
The 66 protocol evaluable subjects (53 men and 13 nonpregnant,
nonlactating women) bad the following characteristics: mean
(SEM) ageof61.3 1.1 y, weightof87.3 1.5 kg, and body
mass index (BMI; in kg/m2) of 28.8 0.4. The self-reported
ethnicity of the subjects was l American Indian or Alaskan na
tive, 7 African Americans, and 58 non-Hispanic whites. All sub
jects were patients with type 2 diabetes mellitus based on use of
antihyperglycemic medication(s), but they did not use exoge
nous insulin for glucose control. These subjects were free from
hepatic disease. active malignancy, end-stage organ failure,
chronic infectious disease, or active metabolic disease (exclud
ing diabetes) that would interfere with nutrient absorption, me
tabolism, or excretion. In addition, subjects did not have a recent
infection, surgery, or corticosteroid treatment and did not have a
significant cardiovascular event within 12 wk of study start. The
study protocol was reviewed and approved by the Schulman
Associates Institutional Review Board (Cincinnati, OH), and all
enrolled subjects provided informed consent before the start of
the study. The trial was conducted in accordance with the prin
ciples of Good Clinical Practice and the Declaration of Helsinki.
Study procedures
The 3 meal tolerance tests were administered in random order
at least 3 d apart at each of the 2 clinical research centers. The 3
treatments were as follows: J) control was 510 g (two 8-fl oz
bottles) of a liquid meal replacement (chocolate Ensure; Ross
Products Division, Abbott Laboratories, Columbus, OH) and
30.0 g maJtodextrin (Polycosc; Ross Products Division, Abbott
Laboratories), 2) control + 240 mg SOE (agglomerated with
960 mg maltodextrin), and J) control+ 480 mg SOE (agglom
erated with 1920 mg maltodextrin). The manufacture release
criteria for the SOE lot 040304 was 46 ,g/mL (IC50) inhibition
of e-glucosidase action. The SOE ingredient is a proprietary
ethanol and water extract produced at Takama Co, Ltd (Yamagu
chi, Japan), supplied through Tanabe Seiyaku Co, Ltd (Osaka,
Japan). The control meal consisted of 110 g carbohydrate (55 g
maltodextrin, 31 g sucrose, 25 g corn syrup), 12 g fat, 18 g
protein, and 620 kcaJ. An unblinded product coordinator opened
sealed envelopes containing the randomization sequences for
subjects and prepared the test meals according to the assigned
order. The test meaJs were prepared by mixing with a blender.
Disc a mer
125
The product coordinator was independent from all other study

procedures. Subjects prepared for each meal tolerance test by
consuming an average of ~150 g carbohydrate/d for the 3 d
before test visit, which was documented on a 3-d diet record.
Subjects did not consume alcohol or participate in strenuous
exercise for the 24 h before the test visits. Subjects fasted (except
for water and antibyperglycemic medications) for 8-16 h before
the meal tolerance tests, and subjects refrained from taking oral
antihyperglycemic medications on the morning of test visits.
Subjects consumed the test meals within 10 min, and all post
prandial blood samples were drawn based on the time of start of meal
consumption, which was considered time zero. Eight venous blood
samples were drawn for glucose and insulin measurements at a
central laboratory (Quest Diagnostics, Collegeville, PA) at the fol
lowing times: baseline (before meaJ consumption) and 30. 45, 60,
90. 120, 150, and 180 min after the start of meaJ consumption. The
serum samples were allowed to clot in serum separator tubes at room
temperature and centrifuged at 1000 x g for 15 min at room tem
perature. Glucose was measured with the use of an enzymatic
method (bexokinase glucose), and insulin was measured with the
use of a radioimmunoassay procedure (DPC Immulite 2000 assay;
DPC Biermann, Bad Nauheim, Germany).
Statistics
This was a randomized, double-blinded,
3-period,
3-treatment, crossover study conducted at 2 sites. A total of 82
subjects were randomly assigned to l of 6 treatment sequences.
J) A-B-C, 2) B-C-A, J) C-A-B, 4) C-B-A, 5) A-C-B, and 6)
B-A-C (A, control; B, control + 240 mg SOE; C, control + 480
mg SOE). Sixty-six subjects were included in the protocol evalu
able analysis, which was the minimum number of subjects re
quired in the power analysis before study start.
With the use of data from a previous study, a sample size of 66
was calculated to have 83% power to detect a 20% of the control
difference in treatment means with the use of a single-group re
peated measures analysis of variance with a 0.05 significance level.
Statistical softwareNQUERY ADVISOR 5.0 (StatisticaJ Solutions,
Los Angeles, CA) was used for the sample size estimation.
Each variable was analyzed by using parametric or nonpara
metric (if declared nonnonnal) 3-period, 3-treatment, crossover
analysis. The parametric analysis was performed by using re
peated measures analysis of variance with variance components
covariance structure and Satterthwaite df with site, treatment,
and period as fixed effects and subject nested within site as
random effect. The 3 pairwise differences of least squares means
of the treatments were tested with the use of Tukey-Kramer P
value adjustments. If the parametric approach was determined to
be inappropriate by the Shapiro-Wilk test for normality. then 3
pairwise treatment differences were analyzed with the use of
signed rank test with stepdown Bonferroni (Holm) P value ad
justments. A result was declared to be statistically significant if
and only if a P value of an analysis was < 0.05. Statistical
software SAS release 8.2 (SAS Institute lac, Cary, NC) was used
for the analyses.
RESULTS
Scrum glucose
No significant differences were observed between treatments
for baseline serum glucose concentrations. Baseline and post
prandial values for both serum glucose and insulin are presented
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126
WILLIAMS ET AL
TABLE 1
Serum glucose and insulin by treatment in all available subjects'
Control
Glucose
Baseline fasting (mg/dL)
Peak value (rng/dL)
Adjusted peak value (mg/dL)
AUC (mg rnin/dL)
Positive AUC (mg rnin/dL)
Insulin
Baseline fasting (TU/mL)
Peak value (TU/rnL)
Adjusted peak value (TU/rnL)
AUC (TU rnin/rnL)
Positive AUC (TU min/rnL)
Control
143 5
303 9
158
44 327 1339
I 8 570 860"
14
80
67
10693
8223
I
6
5
997
846"
+ 240 mg SOE
Control
143 5
2727
130 5b
41742 1196
16100 732b
14
73
60
9552
7122
+ 480 mg SOE
146
263
116
40 570
14 328
14
72
58
9009
6520
5
4
751
598b
4
7
5
I145
726
I
5
5b
630
525
All values arei SEM; n = 61-79 (sample size differed according to data available for specific variables). SOE, Salacia oblonga extract; AUC, area
under the curve. Values in a row with different superscript letters are significantly different,P < 0.05.
in Table 1 and Table 2 for all available subjects and the protocol
evaluable set of subjects, respectively. Because the protocol
evaluable analysis was the primary analysis and because results
for both datasets are similar, only protocol evaluable data are
presented in the data figures. The net changes in serum glucose
concentrations are shown in Figure 1. Both doses of SOE sig
nificantly decreased the adjusted peak serum glucose response,
19% and 27%, respectively, for the 240-mg and 480-mg doses of
SOE compared with the control meal alone (Figure 2). In addi
tion, both doses of SOE significantly lowered the positive serum
glucose area under the curve (A UC) for 0-180 min postprandial
in comparison with the control meal, with a 14% reduction for tbe
240-mg dose and a 22% decrease for tbe480-mg dose (Figure 3).
Serum insulin
No significant differences were observed in serum insulin
across treatments at baseline. The net changes in serum insulin
concentrations are sbown in Figure 4. The 2 doses of SOE
significantly lowered the adjusted peak serum insulin response
9% and 12%, respectively, for the 240-mg and 480-mg doses of
SOE in comparison to the response by the control meal alone
(Figure 5). Also, compared with tbe control meal, both doses of
SOE significantly reduced the postprandial positive serum insu

lin AUC for0-180 min, with a 14%decrease fortJJe240-mgdose
and a 19% decrease for the 480-mg dose (Figure 6).
Safety and gastrointestinal tract tolerance
Twenty-three protocol evaluable subjects experienced ad
verse events during the study with all but one (moderate) event
considered mild in severity. Sixteen of these subjects bad symp
toms related to gastrointestinal (GI) tolerance such as flatulence,
belching, abdominal pain, nausea, and diarrhea which lasted
::524 h after a test meal. Two subjects bad GI symptoms after
ingesting tbe control meal, 8 did after the 240-mg dose of SOE,
and 12 subjects experienced GI symptoms after ingesting the
480-mg dose of SOE. Ten subjects bad mild adverse events not
related to GI symptoms, which included flu or sinus symptoms,
bruised arms as a result of blood draws, study product aftertaste,
vertigo, and pain or injury to tbe back or extremities.
DISCUSSION
This study presents the first published results on the effects of
SOE on postprandial blood glucose in patients with diabetes.
TABLE2
Serum glucose and insulin by treatment in protocol-evaluable subjects/
Control
Glucose
Baseline fasting (mg/dL)
Peak value (rngldL)
Adjusted peak value (rngldL)
AUC (mg min/dL)
Positive AUC (mg rnin/dL)
Insulin
Baseline fasting(TU/rnL)
Peak value (IU/rnL)
Adjusted peak value (TU/mL)
AUC (f.lru minlmL)
Positive AUC (TU min/mL)
143
305
160
44 444
18 680
5
10
7
1409
90-,.
13
77
65
10355
8092
I
5
5
1027
889-
Control
+ 240 mg SOE
144
274
130
41979
16084
5
8
e
1304
77lb
12 I
71 5
59 5b
9163 770
6986 651b
Control
+ 480 rng SOE
145
262
116
40 522
14 535
8
6
1266
787
13 1
706
57 5b
8906 713
6551 60lb
All values are x SEM; 11 = 55-66 (sample size differedaccording to data available for specific variables). SOE, Salaciaoblonga extract; AUC, area
under the curve. Values in a row with different superscript letters are significantly different, P < 0.05.
I
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127
...J
160
:g, 140
E
';' 120
11)
8:::,
100
.3:
80
Cl
E
:::,
60
black diamonds= Control
black squares= Control + 240 mg SOE
black triangles= Control + 480 mg SOE
Q)
'O
40
11)
:::,
:s'
<
20
0
30
60
90
120
150
180
Time(min)
FIGURE 1. Mean (SEM) net change from baseline in serum glucose concentrations in patients with type 2 diabetes in the 3 meal groups (,i = 62-66).
SOE. Salacia obtonga extract. No statistical analyses were conducted for these variables.
Both doses of the herbal extract had significant effects on post

prandial glycemia and insulinemia after a high-carbohydrate
meal. The results from the current study corroborate with previ
ous data observed in healthy adult subjects (9, 10). However, the
doses of extract for this study are much lower than the 1000-mg
dose found to be efficacious in the 2 previous experiments. One
possible reason for the difference is that a different extraction
process was used for product in the current trial. The extract used
in the 2 trials with healthy subjects was made by a bot water
extraction process, and the SOE for the current study was created
by an ethanol and water extraction, which may result in greater
concentrations of active components. It is also possible that the
glycemic responses of patients with diabetes were different from
that of the healthy subjects of the 2 previous studies by evidence
of the prolonged glucose excursion, resulting in larger differ

ences between treatments for positive AUC. In addition, the
difference in efficacious doses of SOE may be accounted for by
the different amount of carbohydrate in the 2 control meals: 82 g
carbohydrate (61 % of energy intake) in the healthy subject study
compared with 110 g carbohydrate (71 % of energy intake) in the
present study with patients with type 2 diabetes.
Postprandial glycemia is important for overall glycemic con
trol. An expert panel concluded that postprandial hyperglycemia
is a risk indicator for microvascular and macrovascular compli
cations in both patients with type 2 diabetes and persons with
impaired glucose tolerance (11). In a number of prospective
clinical trials, postprandial glucose excursions were linked to
increased mortality from cardiovascular disease. and decreasing
200
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a
160
Q)
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0
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120
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: ::,
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'O
Q)
-;;
40
::::,
:s<
0
Control
Control+
240mg SOE
Control+
480mgSOE
Treatments
FIGURE 2. Mean (SEM) adjusted peak serum glucose concentrations in patients with type 2 diabetes after the control meal and after the control meal
plus2differentdoses ofSataciaobtonga extract (SOE): 160 7 mg/dL(11 = 55) for the control meal, 130 6 mg/dL(11 = 63) for the control+ 240 mg SOE
meal, and 116 6 mg/dL (11 = 63) for the control+ 480 mg meal. Values with different superscript tellers are significantly different. Both doses of SOE
significantly reduced the adjusted peak value COIJ1)ared with the control meal (P < 0.0001 for both), and the 480-mg dose significantly reduced the adjusted
peak value corrpared with the 240.mg dose of SOE (P = 0.0050). The data were analyzed with the use of a mixed-model repeated-measures ANOVA with
variance components covariance structureand Satterthwaite df with site, treatment, and visit as fixed effects and subject nested within site as a random effect.
The 3 pairwise differences of least-squares means of the treatments were tested with the use of Tukey-Kramer P value adjustments.
Disc a mer
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30
30
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128
WILLIAMS ET AL
24
::::i'
20
16
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0
::::,
4(
Cl)
e.
ui
0
0
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Control+
Control+
240~SOE
480mgSOE
Treatments
FIGURE 3. Mean (SEM) positive area under the curve (AUC) for serum glucose concentrations in patients with type 2diabetes from Oto 180 min after
the control meal and after the control meal plus 2 different doses of Salacia oblonga extract (SOE): 18 680 907 mg min/dL (11 = 66) for the control meal,
16084 771 mg min/dL(,1 = 66) for the control+ 240 mg SOE meal, and 14 535 787 mg min/dL(11 = 66) for the control+ 480 mg SOE meal. Values
with different superscript letters are significantly different. Both doses of SOE significantly reduced the positive AUC compared with the control meal (P <
0.0001 for both), and the 480-mg dose significantly reduced the positive AUC compared with the 240-mg dose of SOE (P = 0.0193). The values were divided
by 60 and analyzed with the use of a mixed-model repeated-measures ANOV A with variance components covariance structure and Satterthwaite df with site,
treatment, and visit as fixed effects and subject nested within site as a random effect.The 3 pairwise differences of least-squares means of the treatment, were
tested with the use ofTukey-Kramer P value adjustments.
postprandial glucose by therapeutic agents will decrease the pro

gression of retinopalby, neuropathy, and nephropathy in patients
with diabetes (12). So, when designing strategies for reducing the
burden of diabetic complications, both a quantitative effect of
hyperglycemia (postprandial hyperglycemia and glycated hemo
globin) and a qualitative component (glucose stability through
out the day) should be considered (13).
Therapy with o-glucosidase inhibitors can benefit patients
with diabetes beyond lowering postprandial glucose. For exam
ple, in the STOP-NIDDM (Study to Prevent NIDDM) trial, the
group randomly assigned to acarbose not only had a reduction in
body weight, BMI, waist and hip circumferences, systolic and
.-..J
.::::,
"3..
diastolic blood pressures. blood triacylglycerols, and 2-h post

prandial glucose during a 3-y period following subjects with
impaired glucose tolerance but also experienced a significantly
reduced incidence of cardiovascular events and hypertension
(14). A meta-analysis of 7 long-term studies showed that
o-glucosidase inhibitors significantly reduce the risk of myocar
dial infarction or any cardiovascular event (15). Recent research
testing SOE shows that the extract improves cardiac lipid me
tabolism and postprandial hyperlipidemia in rats and possesses
activating properties for peroxisome-proliferator activated
receptor-a (16, 17). In addition, a study conducted in rats shows
that Salacia reticulata, another species of the Salacia plant,
80
70
60
:5::::, so
(/)
.5 40
E
::::,
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Q)
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j
(/)
::::,
=o
<
30
black diamonds =Control

black squares= Control+ 240 mg SOE
black triangles = Control + 480 mg SOE
20
10
0
0
30
60
90
120
150
180
Time(min)
FIGURE 4. Mean (SEM) net change from baseline in serum insulin concentrations in patients with type 2 diabetes in the 3 meal groups (,1 = 62-66).
SOE. Sa/acia oblonga extract. No statistical analyses were conducted for these variables.
l i
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129

........ 100
-...J
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:i
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:ai,
.!:
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80
a
60
...
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a,
~('a
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40
20
:::,
:s-
<
0
Control+
240rng SOE
Control
Control+
480mgSOE
Treatments
FIGURE 5. Mean (SEM) adjusted peak serum insulin concentrations in patients with type 2diabetes after the control meal and after the control meal plus
2 different doses of Salacia obtonga extract (SOE): 65 5 ,IU/rnL (11 = 55) for the control meal, 59 5 IU/mL (11 = 63) for the control + 240 mg SOE
meal, and 57 5 IU/rnL (n = 61) for the control + 480 mg SOE meal. Values with different superscript letters are significantly different. Both the 240-mg
(11 = 53) and 480-mg (11 52) doses of SOE significantly reduced the adjusted peak value compared with the control meal (P 0.0126 and P 0.0021,
respectively), but the values after the 2 doses of the extract did not differ significantly. The 3 pairwise treatment differences were analyzed with the use of a
signed-rank test with stepdown Bonferroni (Holm) P value adjustments.
inhibits lipase and has a mild antiobesity effect (18). Therefore.

the application for o-glucosidase inhibitors in patients with type
2 diabetes may extend beyond postprandial glucose control.
Of 66 subjects, only 24% had GI symptoms because of study
product consumption. with 12% of all subjects having symptoms
with the 240-mg dose of SOE and 18% with the 480-mg dose. It
is not uncommon for o-glucosidase inhibitors to cause GI symp
toms because of fermentation of undigested carbohydrates in the
bowel (19). The difference in the number of GI events between

the 2 doses of SOE is obvious and probably dose dependent. The
o-glucosidase inhibitor acarbose was found to cause a dose
dependent increase in the amount of carbohydrate entering the
colon. which leads to an increase in colonic fermentation and GI
symptoms (20). In addition, the large amount of carbohydrate in
the control meal (110 g) for this study may have caused some of
the intolerance. Daily carbohydrate consumption for persons
12
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10
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cii'
:::> "O
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-:E
:::,
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c:
(.)
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4
:::>
<
G)
>
.:::
U)
0.
0
Control
Control+
240mgSOE
Control+
480mgSOE
Treatments
FIGURE 6. Mean (SEM) positive area under the curve (AUC) for serum insulin concentration in patients with type 2 diabetes from Oto 180 min after
the control meal and after the control meal plus 2 different doses of Salacia oblonga extract (SOE): 8092 889 IUmin/rnL (11 = 65) for tile control meal,
6986 651 fUmin/mL (11 = 66) for the control + 240 mg SOE meal, and 6551 601 IUmin/mL (11 = 66) for the control + 480 mg SOE meal. Values
with different superscript letters are significantly different. Both the 240-mg and 480-mg doses of SOE significantly reduced the positive AUC compared with
the control meal (P = 0.0183 and P = 0.0004, respectively), but the values after the 2 doses of the extract did not differ significantly. The 3 pairwise treatment
differences were analyzed with the use of a signed-rank test with stepdown Bonferroni (Holm) P value adjustments.
l i
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130
WILLIAMS ET AL
with diabetes is typically <50% of energy intake (20), so the

large quantity of carbohydrate, 71 % of test meal calories, may
have increased symptoms in study subjects. In addition to low
ering the amount of carbohydrates consumed, another way to
decrease GI symptoms would be to adjust the dose of SOE over
a period of time, which is a common practice when administering
o-glucosidase inhibitors (21).
Novel ingredients such as SOE may be ideal for medical nu
tritional therapy. Lifestyle modifications consisting of diet and
exercise were shown to be effective for reducing macrovascular
complications in patients with type 2 diabetes and for lowering
relative risk of developing tbe disease in high-risk persons (22,
23). Although diabetes and its encompassing symptoms can be
altered by diet and exercise, behavioral obstacles can prevent the
occurrence of appropriate changes. Several situational obstacles for
adults with diabetes were identified for dietary adherence, such
as resisting temptation, eating out, feeling deprived, plan ning
meals, social events, and so forth (24, 25). Nutritional ad juncts,
including ingredients that lower postprandial glycemia. can
provide more flexibility with meal planning and eating with
family and friends. These adjuncts may also enable patients with
type 2 diabetes to eat a greater variety of foods and carbohydrates
with less restriction.
Historical and present uses of Sa/acia in India and Japan show
that this herbal extract is used as a nutritional adjunct, either as a
tea or supplement, taken with meals for its antidiabetic proper
ties. SOE does lower postprandial glycemia in patients with type
2 diabetes. So, the long-term benefits of this herbal extract on
glycemic control should be explored within this population to
determine its value in the realm of nutritive therapy.
We thank the study subjects, study coordinators Pegi Deuss and Jane
Gillingham, and numerous other study personnel for their dedication and
invaluable contributions.
The author's responsibilities were as follows-JAW: study design, review
of the original data, and draft of manuscript; YSC: statistical design, Final
analysis of the data, and manuscript preparation; MJN and CJB (principal
investigators): conduct of study at their clinical sites; and V AM: oversight of
the study and editorial revisions of the manuscript. All authors reviewed and
approved the final version of manuscript.JAW, YSC, and VAM have per
sonal and financial contlictsof interest as errployees of the sponsor company,
Abbott Laboratories. MIN and CJB do not have personal or financial con
flicts of interest.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
REFERENCES
I. Centers for Disease Control and Prevention: National Diabetes Fact
Sheet, United States, 2005. Jntemet: http://www.edc.gov/diabeles/pubs/
pdf/ndfs_2005.pdf (accessed 20 September 2006).
2. American Diabetes Association. Economic costs of diabetes in the U.S.
in 2002. Diabetes Care 2002;26:917-32.
3. American Diabetes Association. National Diabetes Fact Sheet. Internet:
http://www.diabetes.org/ucdocuments/NationalDiabetesFactSbeelRev.
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oblonga. Food Chem Toxicol 2003;41:867-74.
5. Yoshikawa M, Murakami T, Yashiro K, Matsuda H. Kotalanol. A potent
o-glucosidase inhibitor with thiosugar sulfonium sulfate structure, from
Disclaimer
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1998;46: 1339-40.
Matsuda H, Yoshikawa M, Morikawa T, Tanabe G, Muraoka O. An
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Flammang A.\1,Erexson GL, Mecchi MS, Murli H. Genotoxicity testing
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AammangAM, ErexsonGL, MirwaldJM, Henwood SM. Toxicological
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chronic study. Food Chem Tox (in press).
Heacock PM, Hertzler SR, Williams JA, Wolf BW. A medical food
containing an herbal o-glucosidase inhibitor on postprandial glycemia
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Collene AL, Hertzler SR, Williams JA, WolfBW. Effects of a nutritional
supplement containingSa/acia oblongaextract and insulinogenic amino
acids on postprandial glycernia, insu linernia, and breath hydrogen re
sponses in healthy adults. Nutrition 2005;21:848-54.
Heine RJ, Balkau B, Ceriello A, Del Prato S, Horton ES, Taskinen MR.
What does postprandial hyperglycemia mean? Diabet Med 2004;21:
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Ahmed N, Babaei-Jadidi R, Howell S, Thomalley PJ, Beisswenger PJ.
Glycated and oxidized protein degradation products are indicators of
fasting and postprandial hyperglycemia in diabetes. Diabetes Care 2005;
28:2465-71.
Del Prato. In search of norrnoglycaemia in diabetes: controlling post
prandial glucose. Int J Obes Relat MetabDisord 2002;26(supp):S9-S 17.
Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M.
Acarbose treatment and the risk of cardiovascular disease and hyperten
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trial. JAMA 2003;290:486-94.
Hanefield M, Cagatay M, Petrowitsch T, Neuser D,Petzinna D, RuppM.
Acarbose reduces the risk for myocardial infarction in type 2 diabetic
patients: meta-analysis of seven long-term studies. Eur Heart J 2004;25:
10-6.
Huang TH, Yang Q, Harada M, et al. Salacia oblonga root irrproves
cardiac lipid metabolism in Zucker diabetic fatty rats: modulation of
cardiac PPAR-a-mediated transcription of fatty acid metabolic genes.
Toxicol Appl Pharmacol 2006;210:78-85.
Huang TH, Peng G, Li GQ, Yamahara J, Roufogalis BO, Li Y. Salacia
oblonga root improves postprandial hyperlipidernia and hepatic steato
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Phannacol 2006;210:225-35.
Yoshikawa M, Shimoda H, Nishida N, Takada M, Matsuda H. Salacia
reticulata and its polyphenolic constituents with lipase inhibitory and
lipolytic activities have mild antiobesity effects in rats. J Nutr 2002; 132:
1819-24.
Mertes G. Safety and efficacy of acarbose in the treatment of type 2
diabetes: data from a 5-year surveillance study. Diabetes Res Clin Pract
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Wolever TMS, Chiasson JL, Jesse RG, et al. No relationship between
carbohydrate intake and effect of acarbose on HbA10 or gastrointestinal
symptoms in type 2 diabetic subjects consuming 30-60% of energy
from carbohydrate. Diabetes Care 1998;21: 1612-8.
Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M.
Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM
randomised trial. Lancet 2002;359:2072-77.
Barnard RJ, Jung T, lnkeles SB. Diel and exercise in the treatment of
NJDDM. The need for early emphasis. Diabetes Care 1994;17: 1469-72.
Yamaoka K, Tango T. Efficacy of lifestyle education to prevent type 2
diabetes: a meta-analysis of randomized controlled trials. Diabetes Care
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Schlund! DG, Rea MR, Kline SS, Pichert JW. Situational obstacles lo
dietary adherence for adults with diabetes. J Am Diet Assoc 1994;94:
874-9.
HaJI RF, Joseph OH, Schwartz-Barcou D. Overcoming obstacles to
behavior change in diabetes self-management. Diabetes Educ 2003;29:
303-11.
33
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NATURAL REMEDIES FOR DIABETES

Herbal Remedies for Diabetes

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Turmeric this queen of spices is very useful in managing diabetes. Curcumin

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Another quick snack that is full of Vitamin C, is a cup of grapes.

Apple Rabdi - Tarla Dalal

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EXERCISE, SLEEP, AND STRESS MANAGEMENT FOR

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Yoga helps beat stress (one of the factors contributing to diabetes).

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6 Top Yogasanas for Diabetes Management

2. Pachimottan Asana (Posterior Stretching Pose) - This is known to