Safety studies indicate that fenugreek is extremely safe. When consumed as 20% of the diet, it did not produce toxic effects in animal tests.
One clinical study found that a dose of 50 g taken twice daily produced mild gastrointestinal symptoms, such as diarrhea and flatulence, which subsided after 3-4 days. Allergic reactions have been reported, but are rare.
Where controlled studies are not available, interactions are speculative and based on evidence of pharmacological activity and case reports.
Additive effects are theoretically possible in diabetes — monitor concomitant use and monitor serum glucose levels closely — potentially beneficial interaction.
Frequent use of fenugreek can inhibit iron absorption — separate doses by 2 hours.
Although there is a theoretical concern that concomitant use could increase bleeding risk due to the herb’s coumarin content, this is unlikely. A placebo-controlled study found that fenugreek does not affect platelet aggregation, fibrinolytic activity or fibrinogen.
Contraindications and Precautions
Fenugreek is contraindicated in people with allergy to the herb, which has been observed in several case, or those with allergy to chickpeas, because of possible cross-reactivity. Monitor patients with thyrotoxicosis when using this herb at doses above usual dietary intake.
When taken in usual dietary amounts, fenugreek is likely to be safe; however, the safety of larger doses has not been scientifically evaluated.
Practice Points / Patient Counselling
• Fenugreek’s seeds and leaves are used not only as food but also as an ingredient in traditional medicine systems.
• Clinical studies have identified significant hypoglycaemic and lipid-lowering activity; however, dosage forms and treatment regimens varied.
• In animal studies fenugreek has been shown to exert immunostimulant, anti-inflammatory and antinociceptive activity, stimulate digestive enzyme production and provide significant antiulcerogenic effects.
• Externally it is made into a poultice with hot water and used as an anti-inflammatory application.
Answers to Patients’ Frequently Asked Questions
What will this herb do for me?
Fenugreek can lower blood sugar levels in patients with diabetes, reduce cholesterol levels and stimulate digestion. It may also protect the gastrointestinal tract from ulcers, stimulate immune function and provide anti-inflammatory and antipyretic effects. Traditionally, it has also been used to promote lactation.
When will it start to work?
Studies suggest that blood sugar effects can be seen within 10 days in type 1 diabetes, whereas lipid-lowering effects can take up to 3 months to establish. Traditionally, digestive effects are thought to occur soon after ingestion of the seeds.
Are there any safety issues?
Used as a food, fenugreek appears extremely safe but may interact with blood-thinning medicines. When used in high doses as a medicine, it may cause flatulence, diarrhea and mild stomach discomfort. Allergies to fenugreek are possible. When used with diabetic medicine, it may increase sugar-lowering activity and safety should be monitored.