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Updated 18 February 2013

Gymnema (Gymnema sylvestre R. Br.)

Preliminary human evidence suggests that gymnema may be effective in the management of blood sugar levels in type 1 and type 2 diabetes, as an adjunct to conventional drug therapy, for up to 20 months. Gymnema appears to lower serum glucose and glycosylated hemoglobin (HbA1c) levels following chronic use, but may not have significant acute effects. High-quality human trials are lacking in this area. Some of the available research has been conducted by authors affiliated with manufacturers of gymnema products.

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RELATED TERMS

Asclepiadaceae (family), Asclepias geminata roxb., Gemnema melicida, GS4 (water soluble extract of the leaves), gur-mar, gurmar, gurmarbooti, Gymnema inodum, Gymnema montanum, Gymnema sylvestre, kogilam, madhunashini, mangala gymnema, merasingi, meshashringi, meshavalli, miracle plant, periploca of the woods, Periploca sylvestris, podapatri, Proßeta©, ram's horn, small Indian ipecac, sarkaraikolli, shardunika, sirukurinja, vishani.

BACKGROUND

Preliminary human evidence suggests that gymnema may be effective in the management of blood sugar levels in type 1 and type 2 diabetes, as an adjunct to conventional drug therapy, for up to 20 months. Gymnema appears to lower serum glucose and glycosylated hemoglobin (HbA1c) levels following chronic use, but may not have significant acute effects. High-quality human trials are lacking in this area. Some of the available research has been conducted by authors affiliated with manufacturers of gymnema products.

EVIDENCE TABLE

Conditions

Uses
disclaimer: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Grade*

Diabetes

Preliminary human research reports that gymnema may be beneficial in patients with type 1 or type 2 diabetes when it is added to diabetes drugs being taken by mouth or to insulin. Further studies of dosing, safety, and effectiveness are needed before a strong recommendation can be made.

B

High cholesterol

Preliminary research in people with type 2 diabetes reports decreased cholesterol and triglyceride levels. Better evidence is needed before a clear conclusion can be made.

C

Weight loss

Gymnema sylvestre extract (GSE) has been shown to be effective for weight loss when used in combination with other products. The effects of gymnema are difficult to determine, and additional high-quality trials using gymnema alone are needed to confirm these results.

C

*Key to grades: A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).

TRADITION

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below. Allergy, antimicrobial, antioxidant, aphrodisiac, cancer, cardiovascular disease, constipation, cough, dental caries, digestive stimulant, diuresis, gout, high blood pressure, laxative, liver disease, liver protection, malaria, metabolic disorders, rheumatoid arthritis, snake venom antidote, stomach ailments, uterine stimulant, viral infection.

DOSING

disclaimer: The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

200 milligrams of extract GS4 taken by mouth twice daily or 2 milliliters of an aqueous decoction (10 grams of shade-dried powdered leaves per 100 milliliters) three times daily have been studied.

The manufacturer PharmaTerra recommends the dose for their product Proßeta© (GS4) to be two 250 milligram capsules taken twice daily at mealtimes (for adults weighing more than 100 pounds) or one 250 milligram capsule taken twice daily at mealtimes (for adults weighing less than 100 pounds).

Children (younger than 18 years)

There is not enough scientific evidence to safely recommend gymnema for use in children.

SAFETY

disclaimer: The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Allergy to gymnema may occur. In theory, allergic cross-reactivity may exist with members of the Asclepiadaceae (milkweed) family.

Side Effects and Warnings

Aside from lowered blood sugar and increased effects of anti-diabetic drugs following chronic use of gymnema, no significant adverse effects were reported with the herb in multiple studies up to 20 months long. Caution is advised in patients with diabetes or low blood sugar and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a qualified healthcare professional, and medication adjustments may be necessary. Based on human and animal studies, gymnema may lower blood cholesterol levels.

Gymnema is reported to suppress the ability to detect sweet tastes due to the component gurmarin. This phenomenon prompted the Hindi name gurmar or "sugar destroyer."

Pregnancy and Breastfeeding

Gymnema should not be used during pregnancy or breastfeeding due to a lack of reliable safety information.

INTERACTIONS

disclaimer: Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

Gymnema may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional. Medication adjustments may be necessary.

Gymnema may lower blood cholesterol levels. Therefore, increased effects may occur if taken in combination with drugs that lower cholesterol such as "statins" (HMGCoA reductase inhibitors) like lovastatin (Mevacor©) or atorvastatin (Lipitor©).

Gymnema may have additive effects with weight loss drugs.

Interactions with Herbs and Dietary Supplements

Gymnema may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Gymnema may lower blood cholesterol levels. Therefore, increased effects may occur if taken in combination with herbs or supplements that lower cholesterol, such as fish oil, garlic, guggul, or niacin.

Absorption of oleic acid (a fatty acid) may be decreased by gymnema.

Gymnema may have additive effects with herbs and supplements that help with weight loss. It may interact with chromium, fat-soluble vitamins, and garcinia.

ATTRIBUTION

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

  • Ananthan R, Baskar C, NarmathaBai V, et al. Antidiabetic effect of Gymnema montanum leaves: effect on lipid peroxidation induced oxidative stress in experimental diabetes. Pharmacol Res 2003;48(6):551-556. View abstract
  • Cicero AF, Derosa G, Gaddi A. What do herbalists suggest to diabetic patients in order to improve glycemic control? Evaluation of scientific evidence and potential risks. Acta Diabetol 2004;41(3):91-98. View abstract
  • Gholap S, Kar A. Effects of Inula racemosa root and Gymnema sylvestre leaf extracts in the regulation of corticosteroid induced diabetes mellitus: involvement of thyroid hormones. Pharmazie 2003;58(6):413-415. View abstract
  • Khare AK, Tondon RN, Tewari JP. Hypoglycaemic activity of an indigenous drug (Gymnema sylvestre, "Gurmar") in normal and diabetic persons. Indian J Physiol Pharm 1983;27:257-258. View abstract
  • Kothe A, Uppal R. Antidiabetic effects of Gymnema sylvestre in NIDDM - a short study. Indian J Homeopath Med 1997;32(1-2):61-62, 66.
  • Meiselman HL, Halpern BP. Effects of Gymnema sylvestre on complex tastes elicited by amino acids and sucrose. Physiol Behav 1970;5(12):1379-1384. View abstract
  • Porchezhian E, Dobriyal RM. An overview on the advances of Gymnema sylvestre: chemistry, pharmacology and patents. Pharmazie 2003;58(1):5-12. View abstract
  • Preuss HG, Bagchi D, Bagchi M, et al. Effects of a natural extract of (-)-hydroxycitric acid (HCA-SX) and a combination of HCA-SX plus niacin-bound chromium and Gymnema sylvestre extract on weight loss. Diabetes Obes Metab 2004;6(3):171-180. View abstract
  • Satdive RK, Abhilash P, Fulzele DP. Antimicrobial activity of Gymnema sylvestre leaf extract. Fitoterapia 2003;74(7-8):699-701. View abstract
  • Shanmugasundaram ERB, Rajeswari G, Baskaran K, et al. Use of Gymnema sylvestre leaf extract in the control of blood glucose in insulin-dependent diabetes mellitus. J Ethnopharm 1990;30(3):281-294. View abstract
  • Shapiro K, Gong WC. Natural products used for diabetes. J Am Pharm Assoc (Wash) 2002 Mar-Apr;42(2):217-26. View abstract
  • Simons CT, O'Mahony M, Carstens E. Taste suppression following lingual capsaicin pre-treatment in humans. Chem Senses. 2002 May;27(4):353-65. View abstract
  • Xie JT, Wang A, Mehendale S, et al. Anti-diabetic effects of Gymnema yunnanense extract. Pharmacol Res 2003;47(4):323-329. View abstract
  • Ye W, Liu X, Zhang Q, et al. Antisweet saponins from Gymnema sylvestre. J Nat Prod 2001 Feb;64(2):232-5. View abstract
  • Yeh GY, Eisenberg DM, Kaptchuk TJ, et al. Systematic review of herbs and dietary supplements for glycemic control in diabetes. Diabetes Care 2003;26(4):1277-1294. View abstract
disclaimer: Natural Standard Bottom Line Monograph, Copyright © 2011 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions. disclaimer: While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy. disclaimer: The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

Copyright © 2011 Natural Standard (www.naturalstandard.com)



Copyright © 2011 Natural Standard (www.naturalstandard.com)
 
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