by Tamara Schryver, M.S., R.D.editor
 he American Diabetes Association
estimates that about 17 million
Americans have diabetes, with
several conventional-based treatments
available. While many of
the conventional treatments work when used
appropriately, some people with diabetes prefer
to augment their therapies with elements
from the alternative medicine world like
dietary supplements and/or herbs. Others are
simply looking for a way to avoid the use
of oral hypoglycemic medications, most of
which have undesirable side effects. Many of
the herb-based supplements have a rich history
of use that—despite the young science supporting
it—deserves a warranted try. One
such herb is that of fenugreek or Trigonella
foenum-graecum L, meaning “Greek hay,” a
traditional Indian curry spice.
History
Most likely you have smelled fenugreek
but just were not aware of it. It has a distinct,
characteristic aroma that reminds many
Westerners of Indian food. In Western curry
spice blends it is one of the main components.
It also flavors imitation maple syrup and is an
ingredient in baked goods and chutneys.
While originally grown in China, the
Mediterranean and Indian regions, it has
recently made its way to Saskatchewan,
Canada, where it is being heavily researched as
a potential new crop for Canadian farmers.
Fenugreek is a green, herbaceous plant that looks similar to alfalfa and is cultivated somewhat like wheat.
Indicated Uses
Fenugreek is first recorded use dates back to the time of the Egyptians where it was used to induce childbirth, as incense or with other ingredients for embalming. Traditional internal
use includes fenugreek for the treatment of
decreased appetites (common in people with
disease), an upset stomach, gastritis, calming
ulcers, high blood sugar and cholesterol levels
and generalized weakness. Topically, fenugreek
seeds have been ground with water to make a
poultice for the management of staph skin
infections, muscle pain, inflammation of the
lymph nodes, gout, wounds and leg ulcers.
More recent evidence supports the use of fenugreek
for lowering blood sugar levels in people
with diabetes, and to a lesser extent, for lowering
blood cholesterol. Additionally, the soluble
fiber content of fenugreek may play a role in
aiding weight control.
Fenugreek Plant Basics
While the green, leafy part of the fenugreek
plant is still eaten in India and supplies a good
source of beta carotene, the seed is the part that
is used for alternative medicine practices.
Unlike many plant proteins, the seed has an
unusually high proportion of protein (approximately
20–30 percent) as well as an interesting
amino acid called 4-hydroxyisoleucine, which
has potential insulin-stimulating activity. The
fatty acid composition registers between 5–10
percent, which is predominantly linoleic acid, linolenic, oleic and lastly, palmitic acid. Most
unusual is its carbohydrate proportion—of
the remaining 45–65 percent carbohydrate,
approximately 15 percent of that is galactomannan,
a soluble fiber. Along with these
macronutrients, fenugreek seed also contains
flavonoids, coumarins, saponins (1.3 percent)
and more calcium, phosphorous, iron, zinc
and manganese than most legumes.
Diabetes Basics
Most people are aware that there are two main
types of diabetes: type I and type II. Blood
sugar levels are controlled by a hormone
known as insulin that escorts sugar from the
blood stream into target cells. The presence of
insulin in the body determines whether or not
a person is type I or II. Type I diabetes is a disease
where the body does not produce any
insulin at all, allowing blood sugar levels to elevate.
It usually occurs in children. Only about
5–10 percent of all people with diabetes are
type I but that small percentage must take
insulin injections daily. On the other hand,
what was once referred to as “adult onset diabetes”
but is increasingly being seen in children,
is termed type II diabetes. In this disease
the body is making insulin but it may not be
enough or it may not be recognized by the target
cells, which results again in high levels of
circulating blood sugar.
Although it is quite possible to live a normal
life with either type I or type II diabetes,
concerns about regulating blood sugar levels
exist due to the complications that uncontrolled
diabetes can lead to such as gum disease,
foot disease, skin disorders, poor eyesight
or blindness, kidney disease, cardiovascular disease, neuropathy, and in extreme cases, organ
transplantation.
Prediabetes is the warm up to type II diabetes
and it is a very real phenomenon. Recently
renamed prediabetes, this problem used to be
referred to as having a high/impaired fasting
plasma glucose test (FPG) result or
high/impaired oral glucose tolerance test
(OGTT) result. Recent research from the
Diabetes Prevention Program showed that
about 11 percent of people with prediabetes
developed type II diabetes each year of the three
years of the follow up portion of the study, with
other research indicating that most people with
prediabetes evolve into full-blown type II diabetics
within 10 years. While this sounds discouraging,
the good news is that if you catch someone
in a prediabetic state, it is quite possible to prevent
or delay the onset of type II diabetes. In
fact, a position statement from the American
Diabetes Association is encouraging for all alternative
consumers in that it does not recommend
the use of medications but instead, recommends
lifestyle intervention. “The greater benefit of
weight loss and physical activity strongly suggests
that lifestyle modification should be the
first choice to prevent or delay diabetes.” What
this means is that modest weight reduction
(5–10 percent of body weight) and a total of 150
minutes of moderate exercise per week is more
effective in preventing or delaying type II diabetes
than medications like metformin, acarbose
and troglitazone. However, if you are currently
on these medications, do not discontinue use
without consulting your physician.
Fenugreek for Diabetes
Even more promising is that fenugreek seeds,
which are high in soluble dietary fiber, have
a track record of helping to control blood
sugar levels. While fenugreek is used to treat
type II diabetes, some have suggested that it
may play an integral role in persons in the
prediabetes state. In either case, the research
is promising.
A typical fenugreek research study includes
people with type II diabetes on a standard diet
with divided doses of fenugreek seed or extract
with meals. The patients may have varying levels
of complications and are generally on oral medication.
For example, 60 patients with type II
diabetes were placed on 25 grams of fenugreek
seed powder divided into two doses, delivered at
lunch and dinner. Results revealed that postprandial
blood glucose (or glucose levels measured
after a meal) and urine sugar significantly
decreased compared to the start of the study.
In another study, 25 newly-diagnosed persons
with type II diabetes were randomly divided
into one of two groups: 1) 1 gram of
fenugreek extract group or 2) placebo group. At
the end of the two-month testing period, group
one had decreased insulin resistance and a
decreased area under curve (AUC) of blood glucose.
This means that group one’s blood sugar
levels were elevated for a shorter period of time
than group two. Similar lowering of blood glucose
levels were found in healthy subjects fed 25
gm/day fenugreek and type II diabetics fed 15
gm/day.
Finally, while this article is too short to
evaluate all the literature, Natural Medicines
Comprehensive Database gives fenugreek a
“possibly effective” rating for its ability to lower
blood sugar.
Fenugreek in Weight Control
In addition to controlling diabetes, the soluble
fiber portion of fenugreek is thought to promote
weight loss mainly by producing a feeling of
fullness or satiety. Viscous fibers, such as fenugreek
galactomannan, form a thick gel in the
gastrointestinal tract. This slows the rate that
food and nutrients (including glucose for blood
sugar control) leave the stomach and enter the
intestine. Delayed gastric emptying allows individuals
to feel full because the stomach is full for
longer periods of time. Delayed nutrient absorption,
particularly of glucose, can reduce the
glycemic index of food consumed. Low
glycemic index meals have been associated with
feelings of satiety in several studies.
Further, diets rich in fiber are generally low
in energy density. Fiber does not contribute
calories but is bulky. Therefore individuals can
reduce the caloric value of a given volume of
food by displacing other nutrients with fibers
from fenugreek. They will still be eating the
same amount of food but less calories, while at
the same time producing a greater feeling of
fullness.
Practical Points
Fenugreek is currently available in seed form—either ground or whole for its medicinal properties—or as a dietary supplement, predominantly as fenugreek fiber. While the Herbal Medicines Monograph recommends
6 grams a day of crushed or cut seed, typical
dosages found in clinical research range between
15–100 grams, with the most commonly used
amount of 25 grams (equal to 3.75 grams of soluble
galactomannan fiber). For those who don’t
normally consume fenugreek seeds, 25 grams
seems like a lot—and it is. Fenugreek extracts,
which concentrate the galactomannan portion,
make it possible to reduce the total intake to 3–5
grams a day, or 1–2 grams three times daily
(approximately equal to 3–4.8 grams of soluble
galactomannan fiber from a 60–85 percent
extract). Additionally, some manufacturers of
fenugreek supplements have been able to
deodorize the product, making it much more
acceptable to consumers in the U.S. Fenugreek is
generally recognized as safe (GRAS) for use both
as a spice and as a fiber.
 Fenugreek fiber is most effective in lowering
postprandial blood glucose when consumed
with a meal. Those wishing to use it should be
safe in doing so, provided they consume it with
a meal and monitor their blood glucose levels.
As well, it’s important to inform your physician
or dietitian about this new dietary change so
that they too can help you monitor your blood
sugar. Because of fenugreek’s coumarin content,
it could potentially interact with herbs, supplements
and other medications with anticoagulant
activity. It could potentiate MAO inhibitors,
inhibit corticosteroids and possibly interfere
with hormone therapy.
Tamara Schryver, M.S., R.D., has worked with clients and patients in both the hospital and public health setting. She is an active member of the American Dietetics Association. Currently
she is a freelance nutrition writer pursuing her doctorate in nutrition at the University of Minnesota. She can be reached at 952-898-2577;
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