Tinospora cordifolia stem supplementation in diabetic dyslipidemia: an open labelled randomized controlled trial

Background: Medicinal plants are powerful health promoting nutritional agents. Among the vast library of medicinal plants Tinospora cordifolia (Willd.) has been meagrely explored. It belongs to the family Menispermaceae and is a rich source of alkaloid and terpenes. It has hepatoprotective, antioxidant, immunostimulatory, hyperlipidemic, anticancer and antidiabetic properties. The stem contains berberine, palmatine, tembetarine, magnoflorine, tinosporin, tinocordifolin. The stem starch is highly nutritive and digestive. In modern medicine it is called the magical rejuvenating herb owing to its properties to cure many diseases. The stem contains higher alkaloid content than the leaves because of which it is approved for medicinal usage. With a host of phytochemical properties present in the stem, it may hold potential to manage dyslipidemia and dysglycemia, which otherwise has been proven only in pre-clinical studies. Objective: To study the impact of tinospora cordifolia stem supplementation on the glycemic and lipemic profile of subjects with diabetic dyslipidemia. Methods: Type 2 diabetics with dyslipidemia on oral hypoglycemic agents were enrolled. Baseline data on medical history, family history of lifestyle diseases, duration of diabetes diagnosis, drug profile, anthropometric data, dietary data and physical activity data was obtained along with a fasting blood sample for estimating high sensitivity C reactive protein (hs-CRP), hepatic, renal, lipid profile and glycated hemoglobin. The participants were randomized into either of the two groups; intervention group (n=29) received 250mg of encapsulated mature stem of tinospora cordifolia pre meal twice a day along with prescribed dyslipidemic agent and control group (n=30) only on dyslipidemic agents for a period of 60 days. After 60 days all the parameters were re-assessed to analyse the impact of the intervention. Results: Majority of the subjects in both the arms were in the 50-60 years age bracket with a similar duration of diabetes, disease and drug profile. Tinospora cordifolia supplementation led to a significant decline in waist circumference (94.7 to 94.2cm, P 0.004), hip circumference (99.9 to 9.5cm, P 0.004), waist stature ratio (0.594 to 0.591, P 0.004) and systolic blood pressure (132.6 to 127.1mmHg, P 0.0017) vs. significant decline in hip circumference (100.02 to 99.7cm, P 0.01) and systolic blood pressure (134.5 to 130.1mmHg, P 0.0013) in controls. The intervention brought about a significant decline in hs-CRP (4.6 to 2.8mg/l, P 0.0007) and the prevalence of hs-CRP>3mg/l declined from 65.5% to 37.9% (P 0.037). Renal and hepatic parameters remained in the normal range. Decline in HbA1c, although non-significant, was more evident in the intervention arm (7.7 to 7.5%, P 0.09) than the controls (7.9 to 7.81%, P 0.52). Intervention led to significant reductions in total cholesterol, low density lipoprotein, triglycerides and very low density lipoprotein and among controls too, but of lesser intensity. The number of dyslipidemic features declined by 28.6% (P 0.0036) in the intervention arm and by 19.4% in controls (P 0.020). The prevalence of metabolic syndrome decreased by 13.73% from 68.9% to 55.17% in the intervention arm and reduced by 6.7% from 56.7% to 50% among controls. Conclusion: Tinospora cordifolia stem supplementation brought about more evident changes in the lipoprotein fractions, inflammatory markers and metabolic syndrome than the controls