What is Moringa Oleifera?
Moringa oleifera is a tree native to India and some parts of the middle east and is believed to have a variety of medicinal properties by utilizing all parts of the tree. Treating anything from HIV weight gain to elevated cholesterol to menopausal symptoms, etc., the various parts of the tree can be used to supplement or help treat these conditions.10
It is important to note that ALL herbal supplements should be carefully dosed based upon an individual and there is NO evidence that Moringa oleifera will definitively cure any condition. The primary part of the tree that appears to have the most effect on the development of T2DM and elevated blood sugar levels is the leaves and in one instance the seeds, which is what I will be referencing below. Not only are the leaves beneficial for T2DM they are filled with a wide variety of vitamins/minerals and are also believed to have a variety of antioxidants.10
What is Type 2 Diabetes Mellitus?
Type 2 Diabetes Mellitus (T2DM) is a complicated disease process where the effects of insulin do not work on your body or where your body doesn’t produce enough insulin, and is currently non-reversible by modern pharmacologic and non-pharmacologic therapies. However, preventing further progression of T2DM and controlling long term blood glucose levels, determined by A1c measurements, are key to the success of both patients and providers in treating this disease process.
T2DM is a unique comorbidity because of the potential that modification of risk factors and lifestyle can have on the progression of the disease state. Many different factors are involved in lifestyle change including diet, exercise, smoking cessation, weight, medications, and more. Essentially all of these lifestyle modifications can assist a patient in maintaining a healthy blood sugar level, and helping slow the progression of T2DM.
As noted in the American Diabetes Association’s (ADA) treatment guidelines for T2DM lifestyle changes is the primary therapy for each patient to be successful at controlling the progression of the disease state. Only after a patient is willing to make the lifestyle changes necessary should a provider initiate pharmacological (medicine) therapy. Simply put, T2DM is a disease state that cannot be simply treated with a cocktail of medications, but instead should be combined with lifestyle modifications for best results. For this reason, many patients and providers alike look into alternative therapy options such as herbal supplements as adjunctive treatment agents. Common examples of these options include Moringa oleifera, cinnamon, and omega-3 supplements.1
Can Moringa oleifera be used as a solo therapy for T2DM?
Evidence is currently mixed for the usage of Moringa oleifera as a course of treatment for T2DM. Currently, the ADA treatment guidelines for T2DM do not explicitly recommend the use of Moringa oleifera.1 The ADA website states that all the research done on herbal supplements for the treatment of T2DM has not been shown to help manage diabetes mellitus.2 However, scientific reviews on this topic do not consistently agree with the ADA’s claims or recommendations on usage of herbal supplements.3 Instead, these articles outline the health benefits of Moringa oleifera on T2DM demonstrated in human subjects with absence of any safety concerns for patients undergoing treatment.
Along with the low cost and limited side effect profile, many of these articles present an opposing viewpoint with no obvious reasons for implicit bias. The conflict of recommendations by the ADA and independent researchers demonstrates the need for further, large-scale investigation of this topic.
What does the literature say?
As is often the case with research on many herbal supplements, there are few large-scale, well-designed studies published about Moringa oleifera. This is likely due to the lack of funding that regularly funds drug studies from pharmaceutical manufacturers. However, there are limited studies available on humans and animals, and although these are not guidelines for the treatment of T2DM, they can shed light on the safety and efficacy of herbal products in some patients.
One review article on this topic analyzes the results of 5 primary, published studies conducted on the effects of Moringa oleifera on humans with a total of 177 subjects.3 Although it was not specifically analyzed, there were no reported adverse safety effects, minor or major, in any of the studies.
However, there was a consistent trend in human subjects demonstrating Moringa oleifera’s
- antihyperglycemic (helped in reducing patient’s blood sugar) and
- antidyslipidemic (helped in reducing patients fat and/or cholesterol levels) effects.
Although there are difficulties in ensuring the quality of Moringa oleifera due to lack of regulation for standardization of herbal supplements, the authors of these studies attempted to control for these differences by utilizing leaf powders. This is important because herbal supplements are not regulated by the FDA the same way prescription or OTC medications are, and when an herbal supplement is purchased it is virtually impossible to see how much of a “dose” of a supplement you are actually receiving unless you measure out the leaf powder yourself.
A Look Into Human and Animal Studies
Of the five studies done in humans, all five reported a positive overall effect of Moringa oleifera on blood glucose reduction. The first study with six patients reduced fasting blood sugar by 21% by patients taking 5g of Moringa oleifera leaf powder extract daily with meals.4
The second study analyzed 46 patients taking 8g of Moringa oleifera powder for 40 days. This study showed the clinical efficacy of Moringa oleifera compared to Azadirachta indica in patients with T2DM specifically with regards to hypoglycemic effect and mean blood lipid levels. Of the 46 patients that received the therapy of 8g of Moringa oleifera powder and 6 grams of the Azadirachta indica powder per day there was a statistically significant reduction in fasting blood glucose and postprandial(after a meal) blood glucose with (p <0.01 and p < 0.05) respectively.
Additionally, there was also a significant reduction in average blood lipid levels of the subjects in the experiment group, and Moringa oleifera powder was shown to be more effective than the Azadirachta indica powder. This study group had a collective reduction of 28% in fasting blood glucose levels and slight improvements were also found in LDL-cholesterol levels.5
The third study contained 35 T2DM patients that were treated with a once daily tablet of 4.6g of Moringa oleifera for a period of 50 days, which showed a slight reduction in cholesterol levels.6
The fourth study examined Moringa oleifera’s effect on A1c after a three month administration period. The study group of 60 patients were given either two daily doses of Moringa oleifera or placebo. After the 3 month time period, postprandial blood glucose was reduced by 29% in the study group compared to the control group, and the A1c decreased by 0.4%.7
The fifth and final study in humans was a group of 30 postmenopausal women who took 7g of Moringa oleifera for three months. This group also showed a significant decrease in fasting blood sugar of 13.5% along with other biochemical markers.8
There are also many studies in animals over various hypotheses, however one specifically looked into Moringa oleifera’s effect of T2DM.9 This study investigated the effects of Moringa oleifera on rats with diabetes induced by treatment with streptozotocin. Rats were divided into 4 groups one with control, one with solely streptozotocin, one with streptozotocin and low dose Moringa oleifera, and lastly one with streptozotocin and high dose Moringa oleifera. The result of streptozotocin treatment on the rats were pathologies consistent with diabetes mellitus.
Principally, this effect was realized by the change in baseline fasting blood glucose which was consistently elevated to >200 mg/dL in rats treated with streptozotocin. Upon receiving a course of treatment with Moringa oleifera, the researchers found that many of the pathologies of diabetes were reversed in the rats that were previously exhibiting hyperglycemic symptoms and pathologies related to T2DM.
It is unclear whether this reversal of diabetes in the rats treated with Moringa oleifera was dose-dependent or not for all metrics that were used for analysis; however, for the levels of fasting blood glucose, the reduction was more prominent in the high dose group than in the low dose group. A1c also showed a similar reduction made upon administration of Moringa oleifera.9
Is Moringa oleifera safe?
In terms of safety, Moringa oleifera has been studied mostly in animal subjects. Several studies with animal models have shown dose-dependent toxicity related to kidneys, liver, and neural-glial cells. However, these doses greatly exceed commonly consumed doses in humans, and these effects were not found in humans. No toxicity or adverse effects were noted in animal subjects with doses lower than 3000mg/kg per day. This daily dose is much higher than any commonly taken or studied dose in humans.
A variety of sources show that taking certain other parts of the tree can be unsafe when taken in too large of quantities. Some sources say that eating the roots or bark are unsafe while others claim to be safe and have potential benefits.
Are there side effects of taking Moringa oleifera?
Possible adverse effects from taking Moringa oleifera include:
- hypoglycemia (low blood sugar)
- kidney stones
But, the studies I analyzed did not mention these adverse effects, so it is safe to assume that the leaves, when taken in correct dosages, should have limited side effects.
Also, it is important to consult with your physician before taking any herbal supplements. Lastly, it is crucial to note that the FDA does not regulate or monitor herbal supplements so it is difficult to determine if what you purchase and take according to the instructions on the label is the “true” dose. Since there is not proof that a given supplement contains X mg of ingredient.
Evidence-Based Conclusions and Recommendations
Overall, the evidence for treatment with Moringa oleifera continues to be mixed, which implies that further investigation with quality study designs are needed.
A key takeaway from this review is the fact that there are minimal, if any, safety concerns for patients taking Moringa oleifera.3 The previous studies listed did not describe any adverse effects, so it should be safe to take smaller doses while closely monitoring your blood sugar and other symptoms. As a result of those studies, they brought to light some of the benefits, with each showing a reduction in blood sugar and in some A1c percentage.
In terms of a possible treatment agent for T2DM, it would be beneficial to have more research into the average A1c reduction that a course of therapy with Moringa oleifera. Similarly, a major concern for patients currently undergoing treatment with other medications for diabetes is the risk of hypoglycemic (low blood sugar) episodes. Hypoglycemia, especially in the geriatric population, has the potential to lead to many other acute complications such as dizziness, unconsciousness, falls, resulting in possible bone fractures, death or hospitalizations.
Although it is unlikely that Moringa oleifera has the same blood sugar lowering properties as sulfonylureas (Ex. Diabeta, Glynase, Glyburide, glipizide, etc.) it is still in the best interest of the patient to continue monitoring blood glucose levels while being treated with Moringa oleifera.
The study which investigated the effect of Moringa oleifera on rat subjects treated with streptozotocin should be taken with a grain of salt due to the significant claims made about the overall reversal of diabetes symptoms by Moringa oleifera.9 The article contains limited information about the methods used to assess the quantitative outcomes, and is not powered statistically to show dose-related differences between the low and high dose Moringa oleifera groups. However, this article does provide limited evidence for the possible health benefits of Moringa oleifera in induced-diabetic rats, and further research should be conducted in their human counterparts before clinical utilization of this study.
Based on the current literature, it is clear that there is not sufficient evidence for Moringa oleifera to be a first line choice of therapy for treatment of T2DM. However, one concept that the literature does elucidate about usage of this plant in human subjects is a relatively safe adverse effect profile.3 In 177 patients, no serious adverse effect or medication related problem was identified. This provides a level of confidence for medical providers interested in prescribing Moringa oleifera as a possible adjunctive therapy for T2DM.
In similar regard, there is no clearly defined benefit on blood glucose because of the limited number of patients studied and flaws in study designs. However, with this in mind, there does appear to be some positive effect of Moringa oleifera on blood glucose, A1c, and cholesterol. These results should not be excluded from the decision-making process solely due to it being an herbal supplement when making medical recommendations for a patient.
The Bottom Line
With this evidence at hand, there is little reason to avoid a recommendation of Moringa oleifera to a patient interested in this alternative therapy. It would be prudent to counsel patients on the current lack of strong evidence of Moringa oleifera “curing” their T2DM, but it may provide an added benefit. Similarly, remind patients who decide to take Moringa oleifera that they should always be vigilant and on the lookout for adverse effects in addition to monitoring their blood glucose to reduce the risk of hypoglycemia.
In conclusion, it is appropriate to recommend Moringa oleifera as an adjunctive therapy for T2DM after initiation of lifestyle modifications and proper pharmacotherapy.
- There is no cure for T2DM, but taking appropriate medications along with lifestyle modifications like increased exercise, and healthy diet may help with disease progression
- Moringa oleifera in human and animal studies do show a reduction in blood sugar levels and cholesterol levels, but have some flaws in study design
- ALL herbal supplementation should be discussed with a medical provider before taking
- Most herbal supplements are not regulated by the FDA and as a result could have inaccurate amounts of supplement or in general misinformation on labeling
- Moringa oleifera leaves are a safe additional therapy for T2DM as long as blood sugar is monitored and dosage is kept around 5 grams per day (ADA does not have this as a recommendation)
- More research needs to be done on Moringa oleifera due to mixed results, small studies, and with poor design