A work colleague has been taking Okra to treat his type 2 diabetes. There are many article over the internet claiming the benefits of Okra for the treatment of diabetes, including (but not limited to) a Snopes article.

There is a bit of truth to this claim in the sense that okra (also known as lady's finger, bendi, and gombo) does possess some anti-diabetic properties, namely that the viscosity of okra's carbohydrates helps to slow the uptake of sugar into the blood by reducing the rate at which sugar is absorbed from the gastrointestinal tract

That said, I've been completely unable to find any attempt at actual research trials. Even the Snopes article references two books and a newspaper article (non-primary sources).

I'm not sure that I might not be looking at this from the wrong angle. Is there any evidence that Okra is an effective treatment for diabetes?

  • 1
    to me (who has a type 1 diabetic wife) okra as well as alot of other complex carb/fiberous foods, essentially just release their sugars into the body at a much slower rate, then something such as pop. When my wifes blood sugar is low she drinks juice, pop(in very small amounts), or a couple starbursts, as the sugar can correct her low blood sugar in a mater of minutes, however, eating foods like vegies, cheese, meat, grains, have little impact, or an impact 30min-hours later. so okra to a type 2, would release its sugar at a managable rate, compared to a fast acting pop, that would make them ^ – Himarm Jan 15 '15 at 14:09
  • continuing, make them high, which is the goal of diabetics to keep your blood sugar in the 100-130 range, higher ranges damage the kidneys, liver, heart, and other organs leading to the reduced life expectancy of diabetics. to wrap this all up, eating slow acting carbs/sugars is best because it allows manageable control without rapid changes to blood sugar levels which are harmful. – Himarm Jan 15 '15 at 14:13
  • @Himarm - To be more specific, the claim is that Okra helps manage blood glucose levels by regulating the uptake of other carbohydrates/sugars coming in. Which, without some primary source to back it up, sounds like a fairly big leap of logic to make. – Rudi Jan 15 '15 at 15:07
  • this is not unheard of either, the okra's carbs are so complex that it literally slows down the whole digestive system, which slows down the release of other nutrients, i dont have anything to prove okra does this, but i know other usually highly fiberous foods do things like this, something like high fiber spaghetti, will take longer for the carbs to hit, then normal spaghetti, even though the sauce is a fast acting carb, the higher fiber slows the whole thing down. at least from personal experience. – Himarm Jan 15 '15 at 15:11

Yes: as an additional treatment option or preferred food choice this vegetable brings more than taste to the table.
The effects of the original claim are substantiated, on a certain scale, and others on top of that. It will not cure, but it may very well help. The indicators and the evidence is slowly mounting.

Traditional Uses

The fruits of this plant have a wide range of traditional Medicinal Uses:

Antispasmodic; Demulcent; Diaphoretic; Diuretic; Emollient; Stimulant; Vulnerary.

The roots are very rich in mucilage, having a strongly demulcent action. They are said by some to be better than marsh mallow (Althaea officinalis). This mucilage can be used as a plasma replacement. An infusion of the roots is used in the treatment of syphilis. The juice of the roots is used externally in Nepal to treat cuts, wounds and boils. The leaves furnish an emollient poultice. A decoction of the immature capsules is demulcent, diuretic and emollient. It is used in the treatment of catarrhal infections, ardor urinae, dysuria and gonorrhoea. The seeds are antispasmodic, cordial and stimulant. An infusion of the roasted seeds has sudorific properties.

In Vitro and In Vivo Evidence

But when reading the book mentioned in the snopes article it becomes clear that traditional use of this plant for diabetes is probably not unfounded: From Ronald Ross Watson And Victor R. Preedy (Eds.): "Bioactive Food as Dietary Interventions for Diabetes", Academic Press: London, Waltham, 2013:

In a search for substances active against type 2 diabetes, seven mucilage polysaccharides from selected Thai medicinal plants, including okra and fenugreek, were studied by Palanuvej et al. (2009). Glucomannan was used as a standard in comparing the properties of entrapping glucose, inhibiting alpha-glucosidase activity, and free radical scavenging. Most of the mucilages, including those from okra and fenugreek, showed 2,2-diphenyl- 1-picrylhydrazyl (DPPH) scavenging activity that was higher than for glucomannan. Glucose entrapment was less for the mucilages from okra and fenugreek than for glucomannan but the inhibition of a-glucosidase activity was somewhat greater. Other polysaccharide or glycoprotein materials in vegetables may exert similar activities.
Early studies indicated the importance of fiber viscosity in improving glucose tolerance (Jenkins et al., 1978). During the glucose tolerance test, the greatest flattening of the glucose response was seen with guar, but the effect was abolished when hydrolyzed nonviscous guar was used. In the consumption of vegetables, there is evidence that both fiber content and structure can contribute to satiety. [p294]
There is anecdotal evidence for the amelioration of diabetes by dietary consumption of okra but what are lacking are controlled clinical trials. There are constituents of okra such as polyphenolic molecules that provide encouragement for such studies in the future. [p298]
Traditional medicine has recognized several vegetables that have beneficial effects for diabetic patients. Two of these vegetables, okra and fenugreek, were considered in some detail but others such as bitter melon (Momordica charantia) could have been considered. The actions may depend on a combination of mechanisms, including activation of AMPK, inhibition of intestinal glucose absorption, stimulation of insulin release from the pancreatic islets, reduction of insulin resistance, and antioxidant effects that may decrease AGE formation. Much of the evidence is anecdotal or based on animal models. There is a need for controlled clinical trials to further clarify the role that consumption of vegetables can play in the prevention and management of diabetes. [p301]

This points to some research that was done in beakers and rats. The most promising and best understood effects were thought to come from the braking effects of carbohydrate uptake in the gut. Slowing the blood sugar rise and therby reducing glycemic load of foods consumed together with it. But there were also promising results not restricted to mucilage:

Active subfractions of Abelmoschus esculentus substantially prevent free fatty acid-induced β cell apoptosis via inhibiting dipeptidyl peptidase-4.

Lipotoxicity plays an important role in exacerbating type 2 diabetes mellitus (T2DM) and leads to apoptosis of β cells. Recently dipeptidyl peptidase-4 (DPP-4) inhibitors have emerged as a useful tool in the treatment of T2DM. DPP-4 degrades type 1 glucagon-like peptide (GLP-1), and GLP-1 receptor (GLP-1R) signaling has been shown to protect β cells by modulating AMPK/mTOR, PI3K, and Bax. The anti-hyperglycemic effect of Abelmoschus esculentus (AE) is well known, however its mucilage makes it difficult to further examine this effect. In our recent report, a sequence of extraction steps was used to obtain a series of subfractions from AE, each with its own composition and property. Among them F1 (rich in quercetin glucosides and pentacyclic triterpene ester) and F2 (containing large amounts of carbohydrates and polysaccharides) were found to be especially effective in attenuating DPP-4 signaling, and to have the potential to counter diabetic nephropathy. Hence, the aim of the present study was to investigate whether AE subfractions can prevent the palmitate-induced apoptosis of β cells, and the putative signals involved. We demonstrated that AE, and especially 1 μg/mL of F2, decreased palmitate-induced apoptosis analyzed by flow cytometry. The result of western blot revealed that palmitate-induced decrease in GLP-1R and increase in DPP-4 were restored by F1 and F2. The DPP-4 inhibitor linagliptin decreased the expression of caspase 3, suggesting that DPP-4 is critically involved in apoptotic signaling. Analysis of enzyme activity revealed that palmitate increased the activity of DPP4 nearly 2 folds, while F2 especially inhibited the activation. In addition, AMPK/mTOR, PI3K and mitochondrial pathways were regulated by AE, and this attenuated the palmitate-induced signaling cascades. In conclusion, AE is useful to prevent the exacerbation of β cell apoptosis, and it could potentially be used as adjuvant or nutraceutical therapy for diabetes.

Doing a review of previous research, on the range of possible effects of okra, it becomes apparent:

First identification of α-glucosidase inhibitors from okra (Abelmoschus esculentus) seeds:

Infusion of roasted okra seeds has long been consumed in Turkey for diabetes mellitus therapy. Previous reports of a hypoglycemic effect observed in rats administrated with okra seed extract indicated a possible connection with inhibition of intestinal alpha-glucosidase. An attempt to identify active components was first herein conducted using alpha-glucosidase-inhibition-guided isolation, yielding two major flavonol glucosides named isoquercetin (2) and quercetin-3-O-beta-glucopyranosyl-(1"' --> 6")-glucoside (3). They selectively inhibited rat intestinal maltase and sucrase, in which isoquercetin (2) was 6-10 times more potent than its related diglucoside 3. This result suggested that an increase in hydrophilicity by the additional glucose residue in 3 led to a significant decline in the inhibitory effect and raised the possible involvement of the free 3-OH in exerting the inhibition. Our postulation was evaluated by examining alpha-glucosidase inhibition of quercetin (1), and the aglycone of 2 and 3, whose 3-OH is free from any glucose moiety. Interestingly, 1 displayed a broad inhibitory effect toward rat intestinal and baker's yeast alpha-glucosidases, with improved potency. A kinetic study of 1 indicated that it inhibited maltase by two distinct mechanisms, in competitive (K(i) 462 microM) and noncompetitive (K(i) 2153 microM) manners, whereas the mechanism underlying the inhibition of sucrase was verified as being of a competitive behavior (K(i) 218 microM).

The Effect of Abelmoschus Esculentus on Blood Levels of Glucose in Diabetes Mellitus:

Results: Various studies on Okra (Abelmoscus esculentus) showed that Abelmoscus esculentus (AE)/Okra extract has a hypoglycemic effect that helps decrease blood glucose level. Its properties can be a useful remedy to manage diabetes mellitus. In addition, it leads to inhibition of cholesterol absorption and subsequently decreases the level of lipid and fat in the blood. The results of an investigation on diabetic mice by using this material has shown the same effect and confirmed this conclusion.
Conclusion: Based on the positive effects of Okra on reducing blood sugar level, the widespread use of this plant is recommended. Clearly, further research is required.

Although the article above is overoptimistically applying all reports into the evidence basket it has to acknowledged that the indications start to paint a clearer picture. Since further research is always required, this is doubly so for promising results from in vitro studies. So how about actual rats:

Antidiabetic and antihyperlipidemic potential of Abelmoschus esculentus (L.) Moench. in streptozotocin-induced diabetic rats:

Results: In acute toxicity study, AESP and AESP did not show any toxicity or death up to a dose of 2000 mg/kg. Therefore, to assess the antidiabetic action, one by fifth and one by tenth dose of both powders were selected. Administration of AEPP and AESP at 100 and 200 mg/kg dose in diabetic rats showed significant (P < 0.001) reduction in blood glucose level and increase in body weight than diabetic control rats. A significant (P < 0.001) increased level of Hb, TP, and decreased level of HbA1c, SGPT were observed after the treatment of both doses of AEPP and AESP. Also, elevated lipid profile levels returned to near normal in diabetic rats after the administration of AEPP and AESP, 100 and 200 mg/kg dose, compared to diabetic control rats.
Conclusion: The present study results, first time, support the antidiabetic and antihyperlipidemic potential of A. esculentus peel and seed powder in diabetic rats.

Results in Humans

But evidence based medicine will have to look at the actual results in a controlled setting that targets actual humans and measure the effect there:
Role of Mediterranean diet, tropical vegetables rich in antioxidants, and sunlight exposure in blindness, cataract and glaucoma among African type 2 diabetics:

Results: Five hundred Type 2 diabetic patients were included in this study (48% of males; 40% aged ≥60 years). There was a significant association between blindness, cataract and aging; between blindness (P<0.05), cataract (P<0.05), glaucoma (P<0.05), and physical inactivity; between blindness (P<0.05), cataract (P<0.0001), glaucoma (P<0.01) and high SES, and a very significant association between blindness (P<0.0001), cataract (P<0.0001), glaucoma (P<0.0001) and exposure to sunlight. There was also a significant association between blindness, glaucoma, and male sex. Regular intake of Mediterranean diet, Brassica Rapa, beans, Abelmoschus, Musa acuminata reduced significantly the risk of blindness, cataract and glaucoma.
Conclusion: Regular intake of Mediterranean diet, Brassica Rapa, beans, Abelmoschus, and Musa acuminata may significantly reduce the risk of blindness or its major causes among type 2 diabetes mellitus in Africa.

Randomized control clinical trial of Okra capsule in treatment of diabetic with renal damage:

Objective: To observe the curative effect of Okra capsule in treatment of diabetic with renal damage.
Methods: Thirty-six patients of diabetic with renal damage were randomly divided into treatment group which was treated with traditional therapy and okra capsule (2.5g three times per a day, duration of 8 weeks) and control group which was treated with traditional therapy.The blood urea nitrogen (BUN), serum creatinine (SCr) and 24h urine protein quantitate were respectively detected and compared before treatment and after treatment.
Results: Compared with the control group, there was significant difference in 24h urine protein quantitate between experimental group and control group (p0.05). Conclusion: Okra capsule has better curative effect on diabetic with renal damage.

An important note to add is that regular okra use should be mentioned to a practitioner since it can actually interfere with certain diabetes medications (metformin).

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