Consult your diabetes care team before starting any nutritional supplement. Blood glucose levels should be checked more often to determine the effectiveness of the supplement or if a medication change is needed.

Supplement of the Month

| Jan 1, 2005

Fenugreek (Trigonella foenum-graecum) is a plant product that has been used for a variety of medicinal and other purposes, and may be used in the treatment of diabetes.

Fenugreek is a member of the Leguminosae, or Fabaceae, family and grows well in India, Egypt and other parts of the Middle East. The part used medicinally is the seeds.

Fenugreek seeds contain alkaloids, including trigonelline, gentianine and carpaine compounds. The seeds also contain fiber, 4-hydroxyisoleucine and fenugreekine, a component that may have hypoglycemic activity. The mechanism is thought to delay gastric emptying, slow carbohydrate absorption and inhibit glucose transport.

Fenugreek may also increase the number of insulin receptors in red blood cells and improve glucose utilization in peripheral tissues, thus demonstrating potential anti-diabetes effects both in the pancreas and other sites. The amino acid 4- hydroxyisoleucine, contained in the seeds, may also directly stimulate insulin secretion.

There are only a few published studies on fenugreek. In one study, published in a 1990 issue of the European Journal of Clinical Nutrition, 10 patients on insulin therapy for type 1 diabetes were assigned to either placebo or 50 grams of defatted fenugreek-seed powder twice daily in addition to their insulin therapy.

Fasting glucose decreased from an average of 272 mg/dl at baseline to 196 mg/dl. There was also a decrease in total cholesterol, LDL (“bad”) cholesterol and triglycerides.

A larger study, published in a 1996 issue of Nutrition Research, involved a six-month trial of fenugreek in 60 patients with inadequately controlled type 2 diabetes. Twenty-five grams of powdered fenugreek seed was given twice daily at lunch and dinner in addition to the current diabetes therapy.

The average fasting glucose decreased from 151 mg/dl to 112 mg/dl after 6 months. Glucose values one and two hours after meals also declined. Average A1C decreased from 9.6% to 8.4% after eight weeks.

Q: I am a 62-year-old man with type 2 diabetes and other cardiovascular conditions. I take several medications, including metformin for diabetes, a blood pressure medicine (Zestril) and a blood thinner (Coumadin).

I have noticed that since I started taking fenugreek my blood glucose has improved after meals, but I have been experiencing bruising on my arms, and I bleed more when I cut myself shaving.

What should I do?

A: It is possible that you are experiencing a drug interaction between the Coumadin and the fenugreek. Fenugreek may thin the blood; it is important to tell your heathcare professional that you are taking it. He or she may check you for blood thinning with a laboratory test called an INR (international normalized ratio). Your healthcare professional may advise you to stop taking the fenugreek or may consider adjusting the dose of the Coumadin since you are obtaining some benefit from the supplement.

Side Effects

Side effects of fenugreek include diarrhea and gas or flatulence, which usually subside after a few days of use.

Women of childbearing age should be cautioned that fenugreek may cause uterine contractions and thus cause problems with pregnancy. Pregnant women should not take fenugreek for this reason. Also, allergic reactions have been reported, including runny nose, wheezing and facial swelling.

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Jan 1, 2005

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