Managing Diabetes With Amla: An Overview

Diabetes is a chronic metabolic disease in which the body cannot regulate blood glucose levels correctly. As a result, blood glucose levels can become high and can have severe negative impacts on health, placing patients at higher risk of additional health problems and disease. Following the discovery and purification of the insulin hormone in the 1920s, patients can now regulate their condition. 

Recommended strategies for diabetes management can vary greatly, depending on the patient and the condition itself. Nutritional approaches are often widely encouraged, both individually and alongside medication; here, we will look at a fruit known as amla, or Indian gooseberry, and how it can benefit diabetes patients. 

What is diabetes?

Diabetes is a chronic metabolic disease characterised by elevated blood glucose levels. According to the International Diabetes Federation, in 2021, an estimated 10.5% of the adult population between the ages of 20 and  79 years were living with diabetes. 

Glucose is a simple carbohydrate and the most abundant simple sugar. In humans, glucose is present in our blood and broken down to produce a compound known as ATP in a process known as cellular respiration. ATP is crucial as it fuels all energy-requiring processes in the body¹. People with diabetes are not always able to regulate their blood glucose levels, which can have a negative impact on patients' health. This dysregulation can be due to reduced sensitivity to a hormone known as insulin, which helps to balance blood glucose or due to insufficient secretion of this hormone.

There are two main types of diabetes:

• Type 1 – in which the body produces little to no insulin
• Type 2 – in which insulin doesn’t work effectively or there isn’t a sufficient amount of insulin produced

According to British-based research charity Diabetes UK, less common types of diabetes also include:

• Gestational – develops during pregnancy
• Maturity onset diabetes of the young (MODY) – occurs before the age of 25 and is genetic
• Neonatal – develops under the age of six months
• 3c – caused by damage to the pancreas and can impact digestion
• Steroid-induced diabetes – steroid use interfering with how the body responds to insulin

How does diabetes develop?

In our abdomen, we have an organ known as the pancreas, which is located behind the stomach. The majority of pancreas tissue plays a crucial role in digestion, producing digestive enzymes, which are then secreted into the small intestine. The remaining space in the pancreas is occupied by clusters of cells or “islets” known as the islets of Langerhans.² The islets of Langerhans contain endocrine cells, including beta cells, which are responsible for secreting insulin.

Insulin is a peptide hormone which regulates blood glucose levels in the body by increasing glucose usage and promoting glycogen production in the liver, which is the storage form of glucose.³ Different mechanisms are involved in the development of diabetes, depending on the type. 

Type 1 diabetes is classified as an autoimmune condition, but exactly what causes it remains unknown. However, it has been established the immune system plays a role, in destroying insulin-producing beta cells, leading to little to no insulin and an inability to control blood glucose levels, while a reduced sensitivity to insulin is more characteristic of type 2 diabetes.^4,5

Risk factors

There are several  factors which can increase the likelihood of a person developing diabetes. These factors are variable depending on type; below are risk factors for the two most common types of diabetes, type 1 and type 2.

Type 1:

• Family history
• Genetic factors
• Environmental factors including exposure to viruses
• Stress

Type 2:

• Weight
• Diet
• Ethnicity
• Age
• Family history
• Sedentary lifestyle

Symptoms

Symptoms can vary from person to person but often include:

• Excessive thirst
• Increased urination
• Tired
• Increased hunger
• Weight loss

If you or anyone you know are currently experiencing one or more of the above symptoms, it is essential you contact a medical professional for a consultation. Diagnostic tests usually involve checking blood glucose levels, which can be an efficient way to assess if a patient has diabetes and ensure efficient treatment.

Treatment

Currently, there is no cure for type 1 diabetes, but it can be effectively treated by regularly monitoring blood glucose levels and use of insulin injections or the pump. Strategies to address type 2 are more variable, and patients can reverse their diabetes through diet and lifestyle changes, while medication can also be prescribed to patients. Medications often include:

• Sulphonylureas – which can increase insulin production in the body
• Biguanide – which can boost  insulin sensitivity
• Alpha-glucosidase inhibitor – delays carbohydrate absorption in the gut.

Due to the possible side effects of synthetic medicines, natural alternatives and treatments are often popular.  It is crucial not to disregard your prescriptions against medical advice. Still, there are foods and drinks which you can introduce into your lifestyle to encourage more stable blood glucose levels and protect the body from further deleterious effects.

What is amla?

Amla (Emblica officinalis), also known as the Indian gooseberry, is native to South Asia and is popular in cosmetic applications for hair and skin products. It can be used as an oil to revive hair and scalp health, dried and ground into powder, and applied to the skin to revitalise the complexion. It is a tart, often delicious fruit that can be consumed raw, in juice form, made into pickles and used as a powder. Amla has been used in traditional medicine for many years and is reported to have a number of wonderful properties, such as anti-ageing, anti-inflammatory and promoting heart health and blood glucose regulation which is why it is beneficial for diabetics.

Amla is known for its antioxidant properties and is a potent source of bioactive compounds, including:

• Vitamin C
• Gallic acid
• Tannins
• Flavonoids

Amla has been shown to reduce hyperglycaemia

We can break down the word hyperglycaemia into two parts, “hyper” meaning above normal and “glycaemia” which refers to the concentration of glucose in the blood. Hyperglycaemia is a state of elevated blood glucose which can result from compromised insulin sensitivity and insufficient production of the hormone in patients with diabetes. Over prolonged periods, it can cause damage to organs, including the heart, eyes and nervous system, unless resolved.

A study in which a group of diabetic and non-diabetic patients were treated with amla fruit powder revealed hypoglycaemic properties in which blood glucose levels were taken after fasting and eating were significantly reduced⁶. The diabetic volunteers in this study were living with type 2 diabetes and, therefore could still produce insulin, which means results could differ for type 1 patients. It is possible that amla can initiate insulin secretion in the body due to its strong antioxidant and free radical scavenging properties, which lower blood glucose levels and prevent hyperglycaemia.

Amla extracts have also shown inhibition of carbohydrate digesting enzymes, this slows down the breakdown of carbohydrates and absorption of glucose into the gut, which could also help to prevent high blood glucose levels in diabetics.⁷ 

Amla has cholesterol-reducing properties

Diabetes has been linked to an increased risk of developing a condition known as dyslipidemia in which low-density lipoproteins (LDL) or “bad cholesterol” and triglycerides, which are a type of fat present in the body are elevated above normal levels. Amla is a great source of dietary fibre which is known to reduce LDL and triglyceride levels, studies have demonstrated this, showing volunteers who were given amla supplements had significantly reduced LDL and triglycerides in their blood⁶.

Can prevent the negative side effects of diabetes

There are several diabetes-related complications which can arise due to long periods of hyperglycaemia. This can be disheartening to hear, which is why it's so important to consult your medical professional for help and advice on how you can tailor your treatment to your individual needs and maintain a healthy lifestyle, which will greatly reduce the risk of developing any complications.

Mitochondria are the cell’s powerhouses,   responsible for generating energy and are key for physiological and biological functions. Dysfunction of mitochondria can indicate diabetes-related complications. However, studies in which amla extracts have been administered have shown an increase in energetic output from the mitochondria, suggesting it has protective properties against mitochondrial damage.⁷

Diabetic retinopathy is a condition which can result from long-term diabetes, leading to dysfunction of small blood vessels in the eye, resulting in a negative impact on eye health and vision. Inflammation free radicals and reactive oxygen species (ROS) have been identified as possible causes. Amla is packed full of antioxidants which can bind and neutralise ROS, preventing damage to tissues in the body, such as vitamin C which protects retinal cells against oxidative stress.⁸

Summary

Diabetes is a chronic metabolic health disorder prevalent on a global scale. Due to the discovery of insulin in the 20^th Century, there are now many effective treatments available to help people living with diabetes manage their condition. However, there are always additional ways we can improve our lifestyle, and by incorporating nutritious foods, we can further boost blood glucose regulation, staving off further chronic health conditions. 

Amla, the Indian gooseberry, has been used in traditional Ayurveda medicine for the treatment of diabetes due to it being low in carbohydrates and high in fibre, helping to prevent glucose spikes. Amla is a rich source of antioxidants that can also reduce oxidative stress due to hyperglycaemia and encourage insulin production. It can make a wonderful addition to your diet alongside a prescribed strategy for your diabetes management. Still, it is always advisable to check with a medical professional before adding to your diet.