Diabetes mellitus : Herbal care -67
By Dr. Akshyakumar (Herbalist)
Contd. from last Wednesday
Diabetic diet: Deficiency of Vitamin A: The chemical structures of B-carotene and vitamin A were described in 1930 and 1931respectively.
The internationally adopted nomenclature for compounds with vitamin A activity is used in this chapter, as follows: retinol denotes is vitamin A alcohol, retinyl ester is vitamin A ester, retinal is vitamin A aldehyde and retinoic acid signifies vitamin A acid. The food and Nutrition board of the National Research Council- National Academy of Sciences has recommended that vitamin A activity in foods be expressed as the equivalent weight of retinol rather than the traditional units. In terms of international units, 1 retinol equivalent is equal to 3.33 IV retinol or 10 B-carotene.
Prevalence: Today, the areas of greatest prevalence of endemic vitamin A deficiency are found in Indonesia, India, Indochina, central America, the Middle east, and the Philippines. Vitamin A deficiency is the principal cause of blindness in the world, and yet this occurs mostly in tropical areas where the carotenoids that would prevent it are plentiful. Clinically significant vitamin A deficiency is most likely to develop in young children and the blindness in adults attributed to vitamin A deficiency usually has its origin in childhood. The real need is to educate mothers to change feeding practices which limit intake by children of foods containing vitamin A activity.
Pathogenesis: At least two forms of vitamin A alcohol are known (A 1or retinol and A*******2 or 3-dehydroretinol), together with the acid and aldehyde derivatives, retinoic acid and retinal. The vitamin A are intimately related to provitamins, the carotenes, and certain other pigmented compounds. Of these, only dietary B-carotene is of any real significance as a provitamin A. A part of ingested carotene is absorbed by the cells of the intestinal mucosa ad transformed into vitamin A. Bile is important in this process. Vitamin A is usually present as retinyl ester in foods, it is hydrolyzed in the intestinal tract and absorbed as retinol. Within the cells of the intestinal mucosa, retinol is esterified, usually by palmitic acid, and carried in chylomicrons via the thoracic duct to the liver, where it is stored. As needed, retinyl ester is hydrolyzed to the alcohol and transported to the tissues attached to retinol binding pretein, and alpha, globulin which, in turn, is bound to prealbumin. Retinol is found in the retina and is important in the visual process. The interrelations between alcohol, acid and ester forms of vitamin A have been greatly clarified. Undoubtedly, there is more than one “active form” of vitamin A. In the eye it is II-cis retinal, but in support of growth, tissue differentiation, and glycopeptides synthesis, retinoic acid is effective. Since retinoic acid does not substitute for retinal in the eye and biologically cannot e reduced to either the alcohol or the acid, there must be at least two “active forms”. Moreover, retinoic acid does not substitute for retinal or retinol in the reproductive system.
The greatest concentration of vitamin A in humans is found in the liver. Appreciable concentrations are also present in the kidney, adrenals, lungs, and the retina. Fat depots contain a small amount of the vitamin.
Vitamin A deficiency may result from dietary insufficiency of this vitamin or its precursors or because of some process which interferes with its absorption from the intestinal tract, transport or storage in the liver. Obstruction of the biliary tract or pancreatic ducts in children or adults may lead to diminished absorption of vitamin A. Diarrhea and the various types of malabsorption syndromes, when severe, may be accompanied by vitamin A deficiency. Of particular importance is the interrelation of vitamin A and protein nutrition, since retinol is transported by a specific protein which appears to be synthesized in the liver. RBP-retinol complex is further bound to prealbumin which also is thought to be synthesized in the liver. Therefore, protein deficiency may decrease synthesis of these two transport proteins and may possibly alter the activity of the hydrolyzing enzymes necessary for release of retinol from its ester from prior to binding by transport proteins. The low serum vitamin A levels in Kwashiorker may largely reflect a functional impairment in the hepatic release of vitamin A. Small amounts of retinyl ester and carotenoids are present and travel- with beta-lipoproteins.
Pathogenesis: The intricate reactions whereby vitamin A enters the visual process are summarized. Retinal is the prosthetic group of photosensitive pigment in both rods and cones. All-trans-retinol is oxidized to all-trans-retinal, the compound isomerizes in the dark to the II-cis form which, combined with opsin, from rhodopsin. After absorbing light, the II-cis isomer of retinal is converted back to the corresponding all-trans form. Energy to operate this reaction is supplied by light, and the energy exchanged stimulates impulses which travel via the optic nerve to the brain.
Pathology: The tissues chiefly affected are epithelial in nature, principally those which ordinarily are not keratinized. These include the lining epithelium of the upper and lower respiratory passages, genitourinary tract, eye and par ocular glands, salivary glands, accessory glands of the tongue and buccal cavity, and pancreas. The fundamental change is thought to the metaplasis of the normal nonkeratinized lining cells into a keratinizing type of epithelium. Altered glycoprotein synthesis is associated with the loss of mucous cells. The cornea becomes dry, wrinkled, and hazy owing to intrinsic changes as well as to lack of tears as a result of obstruction of the ducts.
The ciliated epithelium of the respiratory tract is replaced by a keratinizing lining, so that the important mechanical effects of the cilia are lost. However, the basal cells in all areas retain their potentiality for reverting to normal if their supply of vitamin A is restored.
How vitamin A maintains the integrity of epithelial structures remains a mystery. Vitamin A appears to be implicated in the metabolism of intracellular structures, the lysosomes in glycoprotein synthesis and in mucopolysucchride metabolism, and is steroid hormone formation.
Clinical findings: The term xerophthalmia is used here in an inclusive sense to refer to certain structural abnormalities of the eye resulting from vitamin A deficiency.
The lesions usually exibit a definite sequence of stages in development. The initial change, which is called xerosis, consists of dryness and opacity of the bulbar conjunctiva. Secretion of tears is decreased. At the lateral margin of the cornea a transgular shaped accumulation of sticky secretion may appear which projects onto the onjuctiva but not over the cornea. This is the Bitot spot, which resembles a plaque or pseudomembrane filled with bubbles.
While not pathoguomonic this lesion is highly suggestive of vitamin A deficiency. This material is difficult to scrape off. Fine pigmentation may also be present throughout the conjunctiva. These alterations are either accompanied or soon followed by haziness and dryness of the cornea. The tarsal glands along the eyelid frequently are enlarged.
Photophobia may be marked. The most serious consequence is the appearance of small, epithelial erosions on the cornea. These soon become infected and enlarged. If this ulceration continues, destruction of the cornea occurs, a process that may be extremely rapid. Thus a child with conjunctivitis and photophobia may open his eyes one morning to reveal the lens extruded, the bulb collapsed, and vision irrevocably lost. Short of this, the cornea may heal but with a scar that greatly limits vision. In general, the severity of the eye lesions and the rapidity with which they occur are inversely proportional to age.
As already noted, night blindness is an early consequence of vitamin A deficiency. Two other terms, nyctalopia and hemaralopia, have been used to refer to this condition.
Nyctalopia means an inability to see in subdued light. Hemaralopia refers to a decrease in vision that follows exposure to bright light. Defective ability to see in subdued light may be established by certain tests, however, these are difficult to perform under routine conditions and are particularly unsuited for children. The technique of electroretinography can be used to asses nyctalopia objectively in children as well as adults. Vitamin A deficiency is only one cause of night blindness, however, indeed, in the United States.
Herbal Care:
Nutmeg (Jaiphal) : Nutmeg contains an essential oil and saponin. The dry ripe seeds of the fruit contains a volatile oil and a fixed oil. The dry leaves of the tree yield an essential oil consisting of myristicin.
Nutmeg was used in the preparations of various medicines in ancient times. Even today it is used in several important and widely used pharmaceutical preparations. The oil extracted from the herb is used in liniments for impotency of diabetic persons.
Sex stimulant of diabetic patient. Nutmeg, mixed with honey and a half boiled egg, makes an excellent six tonic. It prolongs the duration of the sexual act if taken an hour before intercourse.
Onion: Chemical analysis: Protein 1.2%, fat 0.1%, fibre 0.6%, minerals 0.4%, and carbohydrate 11.1%, per 100 grams of edible portion. The carbohydrate is principally in the form of sugars. It mineral and vitamin contents are calcium, phosphorous, iron, carotene, thiamine, riboflavin, niacin and vitamin C.
Onion contain an essential oil and organic sulphides. The scales of onion contain catechol and protocatechnic acid. The odour in onion is due to organic supphur compounds, and is produced only when the tissues are cut or injured by enzyme action on a water soluble amino acid. Heat or freeze-drying prevents the enzyme action, so that cooking produces a different odour, flavor and pungency.
A phrodisiac: Onion is one of the most important aphrodisiac foods second only to garlic. It increases libido and strengthens the reproductory organs. The white variety of onion should be peeled off, crushed and fried in pure butter. This mixture acts-as an excellent aphrodisiac tonic if taken regularly with a spoon of honey on an empty stomach.
Saursurea (Kuth): The roots of the plant contain an essential oil, alkaloid saussurine and a bitter resin. The root has a pungent taste and a peculiar fragrance. It is a tonic, aphrodisiac, antiseptic and a stimulant. During its passage through the urethra the essential oil excreted in the urine produces a certain amount of irritation, acting as a stimulant. An infusion made of 3 grams of fresh Saussure and 30 ml of water with 1 teaspoon of honey, twice a day.
Pepper (Kali mirch ): An analysis of black pepper shows it to consist of moisture 13.2%, protein 11.5%, fat 6.8%, minerals 4.4%, fibre, 14.9% and carbohydrates 49.2% per 100 grams. Its mineral and vitamin contents are calcium, iron, phosphorus, carotene, thiamine, riboflavin and niacin.
Black pepper is stimulant pungent aromatic, digestive and nervine tonic. Its pungency isdue to the resin chavicine, which ismost abundant in the mesocarp. Black pepper is useful in relieving flatulence.
Eating 6 peppers with 4 almonds once daily with milk, is a nerve-tonic and acts as an aphrodisiac especially in an impotent diabetic person.
Winter cherry (Ashvagandha): The herb contains an alkaloid somniferine. Its roots contain traces of an essential oil. The water soluble portion of root extract contains indefinite amorphous substances and a quantity of sugar. The water soluble extract consists chiefly of a black resin, which contains, besides other constituents, a mixture of some fatty acids. It also contains potassium nitrate, tannin, colouring matter, glucose and some alkaloids.
The shrub as a whole is employed for several medicinal applications for its hypnotic and sedative properties. It promotes libodo. The root of the plant is a tonic and stimulant. If increases the secretion and discharge of urine and also other forms of secretion or excretion by opening the natural pores of the body. Recent experiments have shown that its roots and leaves possess antibiotic and antibacterial properties.
Two to four grams of the root with milk can be taken as an aphrodisiac to enhance libodo. The drug is beneficial in the treatment of spermatorrhoea or involuntary ejaculation. Two to four grams of the podered root can also be taken daily with honey, long pepper and milk in the treatment of these conditions.
Precautions: The drug possess properties that can abort a foetus and hence must be avoided by pregnant women. Source: Hueiyen News Service
