DYSPEPSIA AND LOSS OF APPETITE
Although controlled studies are unavailable, the increased activity of pancreatic and intestinal lipase seen in animal studies provides a theoretical basis for its use in dyspepsia.
ELEVATED LIPID LEVELS
Several clinical studies conducted in people with and without diabetes have identified significant lipid-lowering activity with different fenugreek preparations, such as defatted fenugreek, germinated seed and hydro-alcoholic extracts. As can be expected, the dose used and type of preparation tested has an influence over results. An open study using a daily dose of 18.0 g germinated fenugreek seed in healthy volunteers demonstrated significant reductions in total cholesterol and LDL-choles-terol levels. A placebo-controlled study found no effect after 3 months with a lower dose of 5 g seed daily, suggesting that higher intakes may be required for lipid-lowering activity to become significant.
Fenugreek is a popular natural treatment used to aid blood sugar regulation in diabetes. Overall, results from clinical studies have produced positive results however trials have used diverse preparations, various dosage regimens and outcome measures.
In one open study involving 60 people with type 2 diabetes, 25 g fenugreek seed powder taken together with lunch and dinner for 24 weeks produced significant reductions to fasting blood sugar levels and symptoms of diabetes, and improved glucose tolerance. A shorter 10-day randomised study of people with type 1 diabetes found that de-fatted fenugreek seed powder (50 g twice daily) significantly reduced fasting blood sugar level and improved glucose tolerance. More recently, a double-blind, placebo-controlled study involving 25 volunteers with mild to moderate type 2 diabetes showed that 1 g/day hydro-alcoholic extract of fenugreek seeds for 2 months improved insulin resistance and increased insulin sensitivity but had no effect on fasting blood glucose level at this low dose.
Studies with de-fatted fenugreek seed (100 g/day) in patients with type 1 diabetes identified significant reductions in total cholesterol, LDL- and VLDL-cholesterol and triglyceride levels but no changes to HDL-cholesterol under randomised conditions. Similar results were obtained with an ethanolic extract of defatted fenugreek seeds in vivo, which produced an 18-26% reduction in plasma cholesterol level.
A placebo-controlled study using a lower dose of 2.5 g unaltered fenugreek seed twice daily over 3 months found this was ineffective in type 1 diabetes but did have a lipid-lowering effect in patients with diabetes and coronary artery disease. In this population, total cholesterol and triglyceride levels were significantly reduced.
Although high doses of fenugreek seeds are required, a 2001 double-blind placebo-controlled study found that a dose of 1 g ethanolic extract of fenugreek was able to significantly decrease serum triglyceride levels and increase HDL-cholesterol in mild to moderate type 2 diabetes mellitus.
Although fenugreek has been used traditionally for centuries to increase milk production and improve lactation, no controlled studies are available to confirm effectiveness.
EXTERNALLY — TO REDUCE LOCAL INFLAMMATION
Although controlled studies are not available, evidence of anti-inflammatory and antinociceptive activity provides a theoretical basis for this indication.
Commission E approves the external use of fenugreek as a poultice for local inflammation.
In Ayurvedic and Unani systems of medicine, fenugreek is used for treating epilepsy, paralysis, gout, dropsy, chronic cough and piles. The seeds are reported to have nutritive properties and to stimulate digestive processes, and have been used to treat a range of gastrointestinal disorders in the Indian system of medicine. It is also used as a general tonic, mixed with milk and sugar to promote lactation and to lower lipid and glucose levels.
According to clinical studies
• General dose range: liquid extract (1:2): 2-6 mL/day.
• Diabetes: 50-100 g seed daily taken in divided doses with meals, or 1 g/day ethanolic seed extract.
• Lipid-lowering activity: according to the above studies, 18.0 g germinated fenugreek or 100 g de-fatted seeds daily taken in divided doses with meals.
• As a poultice: 50 g powdered seed in 0.5-1 L hot water applied topically to affected area.