Pilot study evaluating the use of Emblica officinalis standardized fruit extract in cardio-respiratory improvement and antioxidant status of volunteers with smoking history

Clinical effects of Emblica officinalis fruit consumption on cardiovascular disease risk factors: a systematic review and meta-analysis

BACKGROUND

Emblica officinalis (EO) fruit consumption has been found to have a beneficial effect on cardiovascular disease (CVD) physiological risk factors in preliminary clinical intervention trials; however, questions remain regarding the overall effectiveness of EO on CVD risk. The purpose of this systematic review and meta-analysis is to: 1) systematically describe the clinical research examining EO; and 2) quantitatively assess the effects of EO on CVD physiological risk factors.

METHODS

The Pubmed, Embase, Web of Science, and Google Scholar electronic platforms were searched for relevant randomized controlled trials (RCTs) published until April 7, 2021. Studies were included if they involved adults (age ≥ 18 years) ingesting a form of EO fruit; included blood lipids, blood pressure, and/or inflammatory biomarkers as outcomes; had clearly defined intervention and control treatments with pre- and post-intervention data; were peer-reviewed; and were written in English. Studies were excluded if they compared EO with another risk reduction intervention without a usual care control group. RCTs were assessed for methodological quality using the Cochrane risk-of-bias version 2 (ROB2) tool, qualitatively described, and quantitatively evaluated using random and fixed effect meta-analysis models.

RESULTS

A total of nine RCTs (n = 535 participants) were included for review. Included studies followed parallel-group (n = 6) and crossover (n = 3) designs, with EO dosage ranging from 500 mg/day to 1500 mg/day, and treatment duration ranging from 14 to 84 days. Meta-analyses revealed EO to have a significant composite effect at lowering low-density lipoprotein cholesterol (LDL-C; Mean difference (MD) = -15.08 mg/dL [95% Confidence interval (CI) = -25.43 to -4.73], I² = 77%, prediction interval = -48.29 to 18.13), very low-density lipoprotein cholesterol (VLDL-C; MD = -5.43 mg/dL [95% CI = -8.37 to -2.49], I² = 44%), triglycerides (TG; MD = -22.35 mg/dL [95% CI = -39.71 to -4.99], I² = 62%, prediction interval = -73.47 to 28.77), and high-sensitivity C-reactive protein (hsCRP; MD = -1.70 mg/L [95% CI = -2.06 to -1.33], I² = 0%) compared with placebo.

CONCLUSIONS

Due to statistical and clinical heterogeneity in the limited number of clinical trials to date, the promising effects of EO on physiologic CVD risk factors in this review should be interpreted with caution. Further research is needed to determine if EO offers an efficacious option for primary or secondary prevention of CVD as either monotherapy or adjunct to evidence-based dietary patterns and/or standard pharmacotherapy.

The impact of Emblica Officinalis (Amla) on lipid profile, glucose, and C-reactive protein: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND AIMS

Emblica Officinalis (Amla) is a plant often utilized in traditional medicine due to its purported anti-inflammatory, antioxidant, hypoglycemic, and hypolipidemic properties. However, current evidence regarding its potential for preventing and treating metabolic abnormalities associated with chronic diseases remains unclear.

METHODS

This systematic review and meta-analysis aimed to examine the effects of Amla supplementation on lipid profile, glucose, and C-reactive protein (CRP) concentrations in adults. We completed a systematic search (current as of December 2022) of all available randomized controlled trials (RCTs) in the database including ISI Web of Science, PubMed, Scopus, and Embase. Any effect's mean difference (MD) was calculated using a random-effects model. Weighted mean difference (WMD) and 95% confidence intervals (CIs) were calculated also calculated using a random-effects model.

RESULTS

Five RTCs were included in the meta-analysis. Following Amla supplementation, pooled results showed a significant reduction in CRP (p = 0.002), fasting blood glucose (FBG) (p < 0.001), low-density lipoprotein cholesterol (LDL-c) (p < 0.001), total cholesterol (TC) (p < 0.001), and serum triglyceride (TG) (p < 0.001) concentrations as well as an increase in high-density lipoprotein cholesterol (HDL-c) (p < 0.001). The baseline concentration of biochemical indicators was used for subgroup analysis.

CONCLUSION

Amla supplementation shows promise for improving metabolic parameters in adults. In general, the populations included in the analysis were generally 40-58 years with an average BMI of 25.5 and a length of intervention ranging from 3 to 12 weeks. Thus additional investigations are warranted to confirm and expand the findings presented herein.

Jawarish Shahi: A special dosage form of herbal formulations for functional gastrointestinal disorders in Unani medicine- A comprehensive review

ETHNOPHARMACOLOGICAL RELEVANCE

Functional gastrointestinal disorders (FGIDs) are the most common diagnoses in gastroenterology and represent a group of chronic unexplained gut syndromes. The best-known disorders are irritable bowel syndrome (IBS) and functional dyspepsia (FD). Jawarish Shahi (JS) is used for gastrointestinal disorders in Unani Medicine (UM).

AIMS OF THE STUDY

The present review aims to evaluate the FD and IBS in Unani medicine and scientific evidence for the safety and efficacy of JS and its herbal ingredients in the management of FD and IBS.

MATERIAL AND METHODS

Sources of data are from the classical literature of UM, Canon of medicine, Khazainul Advia, Indian Medicinal Plants-An Illustrated Dictionary. Databases, PubMed, Science Direct, Scopus, Google Scholar, were explored for related studies.

RESULTS

An updated review on the concept of FGIDs in Unani medicine, its pathophysiology, and management is presented. Comprehensive information on JS and its traditional and ethnopharmacological clinical attributes, standardization and toxicity study, biomedical studies of herbs in JS for their efficacies in FD and IBS are presented.

CONCLUSIONS

The outcome of the work clearly indicates that disease conditions similar to FD and IBS and their successful treatment are described in Unani Medicine. JS has been used for disease conditions similar to FD and IBS by the physicians of the medieval period. The herbs in JS are widely researched for pharmacologically active substances and were reported for antioxidant, immunomodulatory, gastroprotective, antispasmodic, analgesic, antidiarrheal, antisecretory, laxative, anti-inflammatory, anxiolytic, and antidepressant properties. Nevertheless, further explorations, particularly well-designed clinical trials are required for efficacy.

Functional and Nutraceutical Significance of Amla (Phyllanthus emblica L.): A Review

Phyllanthus emblica L. (also popularly known as amla) is a tree native to the India and Southeast Asia regions that produces fruits rich in bioactive compounds that could be explored as part of the increasing interest in naturally occurring compounds with biological activity. Thus, this review aims to highlight the nutritional aspects, rich phytochemistry and health-promoting effects of amla. Scientific evidence indicates that polyphenols are central components in fruits and other sections of the amla tree, as well as vitamin C. The rich composition of polyphenol and vitamin C imparts an important antioxidant activity along with important in vivo effects that include improved antioxidant status and activity of the endogenous antioxidant defense system. Other potential health benefits are the anti-hyperlipidemia and antidiabetic activities as well as the anticancer, anti-inflammatory, digestive tract and neurological protective activities. The promising results provided by the studies about amla bioactive compounds support their potential role in assisting the promotion of health and prevention of diseases.

Evaluation of the effects of a standardized aqueous extract of Phyllanthus emblica fruits on endothelial dysfunction, oxidative stress, systemic inflammation and lipid profile in subjects with metabolic syndrome: a randomised, double blind, placebo controlled clinical study

BACKGROUND

Endothelial dysfunction (ED) has been observed in individuals with metabolic syndrome (MetS) and contributes to the initiation and progression of atherosclerosis. The primary management of MetS involves lifestyle modifications and treatment of its individual components with drugs all of which have side effects. Thus, it would be of advantageous if natural products would be used as adjuncts or substitutes for conventional drugs. The aim of the present study was to evaluate the effect of standardized aqueous extract of fruits of Phyllanthus emblica (P. emblica) 250 mg and 500 mg twice daily on ED, oxidative stress, systemic inflammation and lipid profile in subjects with MetS.

METHODS

In this randomised, double-blind, placebo-controlled clinical study endothelial function was measured by calculating reflection index (RI) using digital plethysmograph. Oxidative stress biomarkers used were nitric oxide (NO), glutathione (GSH) and malondialdehyde (MDA). Systemic inflammation was measured by determining high sensitivity C-reactive protein (hsCRP) and dyslipidemia by lipid profile. ANOVA, paired and unpaired t-test were used. P-value < 0.05 was considered statistically significant.

RESULTS

Out of 65 screened subjects all 59 enrolled completed the study. P. emblica aqueous extract (PEE), 250 mg and 500 mg twice daily dosing, showed significant reduction in mean RI, measure of endothelial function, at 8 and 12 weeks (p <  0.001) compared to baseline and placebo. Significant mean % change was seen in oxidative stress biomarkers, NO (+ 41.89%, + 50.7%), GSH (+ 24.31%, + 53.22%) and MDA (- 21.02%, - 31.44%), and systemic inflammation biomarker, hsCRP (- 39.68%, - 53.77%) (p <  0.001) at 12 weeks with 250 mg and 500 mg twice daily dosage respectively. Significant mean % change was also seen at 12 weeks with TC (- 7.71%, - 11.11%), HDL-C (+ 7.33% + 22.16%, p <  0.05), LDL-C (- 11.39%, - 21.8%) and TG (- 9.81%, - 19.22%) respectively with 250 mg and 500 mg twice daily (p <  0.001). PEE 500 mg twice daily was significantly more efficacious than the 250 mg twice daily and placebo. No participant discontinued the study because of adverse events.

CONCLUSIONS

P.emblica aqueous extract significantly improved endothelial function, oxidative stress, systemic inflammation and lipid profile at both dosages tested, but especially at 500 mg twice daily. Thus, this product may be used as an adjunct to conventional therapy (lifestyle modification and pharmacological intervention) in the management of metabolic syndrome.

TRIAL REGISTRATION

This study was registered with Clinical Trials Registry - India (CTRI) with the registration number of CTRI/2017/09/009606 . The study was registered retrospectively on 4th September 2017.

Allelopathic Effect of the Invasive Ludwigia hexapetala on Growth of Three Macrophyte Species

The release of allelochemicals by plants can affect the performance of other organisms positively or negatively. We tested the effects of aqueous extracts and leachates derived from the leaves and roots of the invasive water primrose (Ludwigia hexapetala) on one submerged native species - Ceratophyllum demersum, and two exotic species - the submerged Egeria densa and the emergent growth form of Myriophyllum aquaticum. The effect of the aqueous extracts and leachates of L. hexapetala on photosynthetic yield, growth (i.e., relative growth rate, leaf area), root length, and length of the lateral shoots of each species were analyzed in spring and in autumn. In autumn, an allelopathic effect was established on the traits of the three macrophytes species. The root extracts stimulated leaf area and the photosynthetic yield of C. demersum and of E. densa, whereas leaf treatments (leachates and extracts) and root leachate reduced the leaf area of M. aquaticum. The autumnal root leachate of L. hexapetala decreased the relative growth rate of C. demersum, whereas it had no effect on the two others plants. The root extract increased the length of lateral branches of M. aquaticum in autumn, suggesting a positive effect of L. hexapetala on the lateral growth of M. aquaticum. Three main allelochemicals were identified in leaves: quercitrin, prunin, myricitrin. The concentrations of these allelochemicals were greater in the leaf extract taken from L. hexapetala in autumn than in spring, and those found in the leaf leachates for both seasons. This assessment of autumnal allelopathy could help to explain the patterns of plant community succession in invaded areas.