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ROLE OF CASHEW NUTS AND OTHER NUTS IN THE MANAGEMENT OF DIABETES: A CLINICAL REVIEW

About Authors:
Satyanand Tyagi*, Patel Chirag J1, Tarun Parashar2, Soniya2, Rishikesh Gupta3, Devesh Kaushik4
*President, Tyagi Pharmacy Association & Scientific Writer (Pharmacy),
Chattarpur, New Delhi, India-110074.
Prof. Satyanand Tyagi is a life time member of various pharmacy professional bodies like IPA, APTI and IPGA. He has published various research papers, review articles and short communications. He is member of Editorial Advisory Board for some reputed Pharmacy Journals. He is appointed as an Author for International Pharmaceutical Writers Association (IPWA). (Appointed as an author for the chapters of book on Pharmaceutical Chemistry). His academic work includes 62 Publications (52 Review Articles, 08 Research Articles and 02 short Communications of Pharmaceutical, Medicinal and Clinical Importance, published in standard and reputed National and International Pharmacy journals; Out of 62 publications, 11 are International Publications). His research topics of interest are neurodegenerative disorders, diabetes mellitus, cancer, rare genetic disorders, psycho-pharmacological agents as well as epilepsy.
1Department of Pharmaceutics, Maharishi Arvind Institute of Pharmacy, Mansarovar, Jaipur, Rajasthan, India-302020.
2Department of Pharmaceutics, Himalayan Institute of Pharmacy and Research, Rajawala, Dehradun, Uttarakhand, India-302020.
3Institute of Pharmacy, Bundelkhand University, Jhansi, Uttar Pradesh, India-284128.
4Territory Business Manager, Diabetes Division, Abbott Healthcare Private Limited, Okhla, New Delhi, India- 110020.
*sntyagi9 @yahoo.com, +91-9871111375/9582025220

ABSTRACT:
Diabetes is usually a lifelong (chronic) disease in which there are high levels of sugar in the blood. Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia). Cashew nuts have a relatively high fat content, but it's what dieticians consider “good fat.” It's good fat because it has the ideal fat ratio of 1:2:1 for saturated, monosaturated, and polyunsaturated fat.

Because of this ratio, cashew nuts are still considered to be a “low fat” nut. Cashew nuts contain less fat per serving than many other popular nuts— including almonds, walnuts, peanuts, and pecans. Cashew nuts are high in dietary fiber, which may be able to aid in weight loss and weight management.Cashew nut extract has anti-diabetic properties, a new study has found. The study was conducted by researchers at University of Montreal (Canada) and the Université de Yaoundé (Cameroon). Cashews are lower in fat than most other nuts. About 75 percent of the fat in cashews is oleic acid, or heart-healthy monounsaturated fat, which is the same type of fat found in olive oil. When added to a low-fat diet, monounsaturated fat helps reduce high triglyceride, or blood fat, levels. Individuals with type 2 diabetes often suffer from high triglyceride levels, which in turn, increase risk of heart disease. It is not only the monounsaturated fat in cashews that makes them beneficial for individuals with type 2 diabetes. An animal research study published in the Journal of Herbal Pharmacotherapy in 2005 showed that when dried cashew nut extract was given orally to healthy rats and those with induced diabetes, both groups had significantly lower blood sugar levels three hours after extract administration. Thus, cashew nuts may offer anti-hyperglycemic benefits. The aim of present article is to provide in depth knowledge about role of cashew nut in the treatment of Diabetes Mellitus (DM). An attempt is also made to focus how cashew nut and other nuts plays important role in management of this dreadful disease so called as Diabetes.


Reference Id: PHARMATUTOR-ART-1538

INTRODUCTION

DIABETES
Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).

There are three types of diabetes [1]:
1.
Type 1 Diabetes:
In this condition, the body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes.

People usually develop type 1 diabetes before their 40th year, often in early adulthood or teenage years. Type 1 diabetes is nowhere near as common as type 2 diabetes. Approximately 10% of all diabetes cases are type 1. Patients with type 1 diabetes will need to take insulin injections for the rest of their life. They must also ensure proper blood-glucose levels by carrying out regular blood tests and following a special diet. Between 2001 and 2009, the prevalence of type 1 diabetes among the under 20s in the USA rose 23%, according to SEARCH for Diabetes in Youth data issued by the CDC (Centers for Disease Control and Prevention) [2].

2. Type 2 Diabetes
In this condition, the body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance). Approximately 90% of all cases of diabetes worldwide are of this type. Some people may be able to control their type 2 diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. However, type 2 diabetes is typically a progressive disease - it gradually gets worse - and the patient will probably end up have to take insulin, usually in tablet form. Overweight and obese people have a much higher risk of developing type 2 diabetes compared to those with a healthy body weight. People with a lot of visceral fat, also known as central obesity, belly fat, or abdominal obesity, are especially at risk. Being overweight/obese causes the body to release chemicals that can destabilize the body's cardiovascular and metabolic systems.

3. Gestational Diabetes
This type affects females during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose. Diagnosis of gestational diabetes is made during pregnancy. The majority of gestational diabetes patients can control their diabetes with exercise and diet. Between 10% to 20% of them will need to take some kind of blood-glucose-controlling medications. Undiagnosed or uncontrolled gestational diabetes can raise the risk of complications during childbirth. The baby may be bigger than he/she should be.

Scientists from the National Institutes of Health and Harvard University found that women whose diets before becoming pregnant were high in animal fat and cholesterol had a higher risk for gestational diabetes, compared to their counterparts whose diets were low in cholesterol and animal fats [3].

The symptoms of Diabetes are described in fig.1.

FIG. 1: Main Symptoms of Diabetes

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Diabetes-A Metabolic Disorder:
Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood - it is the principal source of fuel for our bodies. When our food is digested, the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present - insulin makes it possible for our cells to take in the glucose.

Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, as soon as glucose enters the cells blood-glucose levels drop. A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements. Diabetes mellitus is a metabolic disorder characterized by a fasting plasma glucose ≥ 7.0 mmol/l or a 2-hour plasma glucose level ≥ 11.1 mmol/l; these numbers clearly differentiate people at high and low risk for subsequent retinopathy and nephropathy [4].  Type 2 diabetes is a lifelong (chronic) disease in which there are high levels of sugar (glucose) in the blood. Type 2 diabetes is the most common form of diabetes.  In people with diabetes, higher glucose levels predict a higher risk of microvascular and macrovascular disease [5-8].

CASHEW NUTS AND DIABETES
It's no surprise that nuts are heart-healthy but it's also possible that they are beneficial foods for individuals with diabetes. Several research studies have shown that consuming tree nuts, in conjunction with other dietary changes, improves glycemic control in individuals with type 2 diabetes. Consuming nuts not only appears to improve blood sugar levels in individuals with non-insulin dependent, or type 2, diabetes but also improves blood cholesterol levels in these individuals. Almonds decrease post-meal blood sugar surges, according to a research study published in the Journal of Nutrition in 2006. Researchers fed 15 healthy subjects five meals comparable in carbohydrate, fat and protein content; three test meals that consisted of almonds, bread, boiled rice and instant mashed potatoes; and two control meals. Blood samples, taken pre-meal and four hours after each meal, showed that almonds lowered the rise in blood sugar and insulin levels four hours after eating. Additional research, published in Metabolism in 2007, showed that eating almonds with a high glycemic index food reduced the rise in blood sugar post-meal. There was a dose-dependent relationship. The more almonds consumed, the lower the rise in participants' blood sugar levels after eating. Eating 3 oz. of almonds with a white bread meal caused a rise in blood sugar of only 1.6 mmol/L, less than half the rise seen after eating the white bread only meal.

A research study published in Diabetes Care in December 2004 showed that including 1 oz. of walnuts in the diet of patients with type 2 diabetes significantly improved their cholesterol profile, reducing risk of heart disease. Fifty-eight men and women of an average age of 59 were assigned one of three diets, all with 30 percent total calories from fat: a traditional low-fat diet; a modified low-fat diet; and a modified low-fat diet that included an ounce of walnuts daily. After six months, those on the low-fat walnut diet had a better HDL-to-total cholesterol ratio than the other groups and 10 percent lower LDL, or bad, cholesterol levels [9]. Cashews are lower in fat than most other nuts. About 75 percent of the fat in cashews is oleic acid, or heart-healthy monounsaturated fat, which is the same type of fat found in olive oil. When added to a low-fat diet, monounsaturated fat helps reduce high triglyceride, or blood fat, levels. Individuals with type 2 diabetes often suffer from high triglyceride levels, which in turn, increase risk of heart disease. It is not only the monounsaturated fat in cashews that makes them beneficial for individuals with type 2 diabetes. An animal research study published in the Journal of Herbal Pharmacotherapy in 2005 showed that when dried cashew nut extract was given orally to healthy rats and those with induced diabetes, both groups had significantly lower blood sugar levels three hours after extract administration. Thus, cashew nuts may offer anti-hyperglycemic benefits [10]. Cashew nut extract has anti-diabetic properties, a new study has found. The study was conducted by researchers at University of Montreal (Canada) and the Université de Yaoundé (Cameroon). Diabetes is caused when a person has high blood sugar because their body does not respond well to insulin and/or does not produce enough of the hormone.

"Of all the extracts tested, only cashew seed extract significantly stimulated blood sugar absorption by muscle cells," says senior author Pierre S. Haddad, a pharmacology professor at the University of Montreal’s Faculty of Medicine. Cashew tree products have long been alleged to be effective anti-inflammatory agents, counter high blood sugar and prevent insulin resistance among diabetics. "Our study validates the traditional use of cashew tree products in diabetes and points to some of its natural components that can serve to create new oral therapies," adds Dr. Haddad, who is also director of the Canadian Institutes of Health Research Team in Aboriginal Anti-Diabetic Medicines at the University of Montreal. The study has been published in Molecular Nutrition and Food Research journal [11].

ROLE OF CASHEW NUTS AND OTHER NUTS IN MANAGEMENT OF DIABETES
1. Reduce your risk of diabetes:
A significant study of almost 84 000 women found that eating nuts can reduce the risk of developing type 2 diabetes [12]. Women who ate a 28g serve of nuts (a handful) five or more times per week had a 27% lower risk of diabetes compared to those who never or rarely ate nuts.

2. Improve blood glucose levels:
Studies have found that including nuts in meals can reduce the rise in blood glucose levels following the meal [13-15].High blood glucose after eating is common in people with diabetes and contributes to diabetes related complications (involving damage to eyes, kidneys, nerves and blood vessels).

3. Prevent heart disease:
People with diabetes are more than twice as likely to die from cardiovascular disease as those with normal blood glucose [16].Studies have shown that eating a handful of nuts most days can reduce the risk of heart disease by 30–50%. This can be attributed to the healthy fats, dietary fibre, plant sterols, arginine and antioxidant vitamins and minerals (including vitamin E) nuts contain. One study found women with type 2 diabetes who ate at least five serves of nuts per week reduced their risk of heart disease by almost half [17].

4. Improve blood fats:
People with diabetes are more likely to have abnormal blood fat levels, including higher ‘bad’ LDL cholesterol and triglycerides, and lower ‘good’ HDL cholesterol [18].Eating nuts regularly can improve blood fats, particularly by lowering LDL cholesterol8. Incorporating walnuts into the diet of those with type 2 diabetes improved their HDL cholesterol significantly more than a low fat diet or a modified fat diet without nuts.

5. Lower blood pressure risk (BP):
An important Australian study of people with diabetes found that compared to those with normal blood glucose levels, people with diabetes were more than three times as likely to suffer from high BP1. In another study young adults who were followed for 15 years found that those who ate the most nuts reduced their risk of developing high blood pressure by 15% [19].

6. Control your weight:
Carrying extra weight is a major risk factor for type 2 diabetes and can make managing your diabetes more difficult. A major Australian study also found that almost three times as many people with diabetes were obese compared to those with normal glucose levels1. The good news? Eating nuts may help with weight management. A study of nearly 9,000 Mediterranean University graduates found that over a 28 month period those who ate a 50g portion of nuts two or more times per week were 31% less likely to gain weight than those who never or almost never ate nuts[20]. Other studies have also shown a trend towards a lower body mass index (BMI) in those who eat more nuts.

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WHY ARE NUTS SO GOOD FOR DIABETES?
? Low Glycemic Index (GI):  While not a high carbohydrate food, nuts have a GI-lowering effect – they reduce the overall GI of a meal. A low-GI diet has been shown to reduce the risk of type 2 diabetes and help in its management [21].

? Rich Source of Healthy Fats: Nuts contain mostly healthy monounsaturated and polyunsaturated fats, plus are low in saturated fat and free of trans fats [22].Like other plant foods, they also contain no cholesterol.

? A Good Source of Fibre: Diets high in fibre may help manage diabetes and weight and can reduce the risk of developing type 2 diabetes[23].

? High in potassium and low in sodium, providing benefits for blood pressure and heart health.

? A natural source of plant sterolswhich can help to lower cholesterol levels by reducing cholesterol reabsorption in the intestine [24, 25].

? A Good Source of Arginine: This amino acid helps keep blood vessels elastic and helps prevent blood clotting [26]. Hardening of the arteries and blood clotting can lead to heart disease.

? A Rich Source of Magnesium:A higher intake of magnesium is linked with a reduced risk of type 2 diabetes [27, 28].

? High in Vitamin E: An essential vitamin and antioxidant which can help protect against heart disease. Some studies suggest that vitamin E may protect against diabetes complications such as nerve, eye and kidney disease[29-31].

DISCUSSION AND CONCLUSION
The diabetes is both a disease that can cause significant signs and symptoms related to hyperglycemia and a risk factor for poor health outcomes and tremendous health care expenditures. The high, and growing, prevalence of diabetes and its health impact also suggest that it is a major public health problem that affects society, as well as a clinical problem that affects individuals. Both public health and clinical approaches to the problem are therefore likely to reduce the impact diabetes in the future. In what is best described as a proof of the effectiveness of cashew tree products in diabetes, scientists studying its natural components have postulated that it might be a cure for diabetes probably in the future. Scientists at the University of Montreal and the University of Yaoundé in Cameroon studying how cashew products affected the responses of rat liver cells to insulin found out that only the cashew seed extract increased the absorption of blood sugar by muscle cells. Cashew nuts and other nuts not only lower blood pressure risk but also prevent from various heart diseases. They improve blood glucose level and reduce risk of diabetes. Last but not least, they are also useful in weight management, which is a major risk factor for type 2 diabetes.

ACKNOWLEDGEMENT
The corresponding author, Prof. Satyanand Tyagi is highly thankful to his Parents, Teachers, wife Pooja, and daughter Tanisha for their moral support and encouragement. Last but not the least, support of all my students and the one above all of us, the omnipresent God, for answering my prayers for giving me the strength to plod on despite my constitution wanting to give up and throw in the towel, thank you so much Dear Lord.

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