In recent decades, some researchers assert that other newer lipid measurements, including non-HDL-C, Apolipoprotein (Apo)A-I, Apob and lipid ratios, are superior to traditional LDL-C in predicting adverse outcomes in general population. Some researchers even suggest that Apob can replace the standard “Lipid Profile” as a target for motoring and therapy in at-risk patients. High plasma lipids interact with free radicals in human body leading to develop coronary artery disease. We in this study have compared hypolipidemic effects of fenugreek, Curcuma longa and lemon. Study was conducted at Jinnah Hospital, Lahore, Pakistan from January 2018 to May 2018. Ninety hyperlipidemic patients of age group 19 to 70 were included in the study. Exclusion criteria were diabetic, alcoholic additives, hypertensive patients and those whose kidney or liver functions were impaired. Consent was taken from all participants. Their base line lipid profile was taken in Biochemistry Laboratory of the Hospital. They were divided in three groups, i.e., 30 patients in each group. Group-I was advised to take 500 mg of Curcuma longa (haldi) mixed in fresh milk without cream, thrice daily for two months. Group-II patients were advised to take 100 grams of fenugreek leaves mixed with salad in each meal (thrice daily) for the period of two months. Group-III patients were advised to take 40 ml of fresh lemon juice mixed with 40 ml mineral water thrice daily for two months. They all were advised not to take heavy meal rich with any type of fat like junk food, etc. 1 h daily brisk walk was advised to all participants. 15 days follow up visit was scheduled for them. After two months their lipid profile was re-determined. When results were compiled and statistically analyzed by applying paired ‘T’ test, it revealed that Curcuma longa decreased total cholesterol, TG, LDL cholesterol 16.10, 20.01 and 17.59 mg/dl, respectively. Fenugreek decreased total cholesterol, TGs and LDL cholesterol 14.70, 17.33 and 17.06 mg/dl, respectively. Lemon in two months therapy decreased total cholesterol, TGs and LDL cholesterol 15.45, 10.13 and 11.97 mg/dl, respectively. None of the above mentioned herbs raised HDL cholesterol significantly. It was concluded from this research work that Curcuma longa, fenugreek leaves and lemon are mild to moderately effective hypolipidemic herbs to lower total plasma cholesterol, triglycerides and LDL cholesterol but have no potential to raise HDL cholesterol when analyzed biostatistically.

Keywords: Curcuma longa, Fenugreek leaves, Cholesterol, Pakistani kitchen spices, Gylcerides

INTRODUCTION

Atherosclerotic problems are encountered with enhancement of LDL uptake by monocytes and macrophages [1,2]. In the liver, uptake of plasma LDL is mediated via specific LDL receptors, but a scavenger receptor system is employed by macrophages. Plasma LDL must be modified prior to uptake by macrophages. Analysis of the lipid content in the oxidatively modified LDL from hyper lipidemic patients revealed that the level of lysophosphatidylcholine was greatly elevated, and the high level of the lysolipid was shown to impair the endothelium-dependent relaxation of the blood vessels [3-7]. In allopathy blood lipid levels are normalized by statins, fibrates, niacin and bile acid binding resins (BABRs). All of these allopathy related drugs have low compliance ranges from mild compliance due to metalic taste  of  BABRs  to severe  side effects like rhabdomyolysis by fibrates and statins [8]. Due to low compliance and adverse effects of conventionally used hypolipidemic agents, herbal medicines are going to be famous among physicians and cardiologists [9]. Medicinal herbs like Curcuma longa, fenugreek and lemon contents are being used as mild to moderate hypolipidemic agents. Curcuma longa commonly known as haldi in India and Pakistan is used to lower plasma lipids, in view of their contents. It contains curcuminoids (curcumin, demethoxycurcumin and bisdemethoxycurcumin), turmerone, atlantone, zingiberene, proteins and resins [10]. Curcumin reduces both the oxidation and circulation of oxidized levels of LDL cholesterol which leads to reduction in the occurrence or treatment of already present atherosclerosis in the subjects [11]. Research has revealed that curcumin from turmeric is an extremely efficient agent in increasing cholesterol uptake by the liver cells [12]. Several independent studies have shown that curcumin increases the expression of cholesterol and lipoprotein receptors on the liver cells [13]. Curcumin also increases cholesterol and bile acids excretion in feces [14]. Additionally, curcumin also increases the amount of ABC (ATP-Binding Cassette) transporters. These transporters are basically involved in flushing out excess cholesterol from the inside of the macrophages. When the numbers of ABC transporters are increased on the surface of a macrophage, the deposited cholesterol is effluxes out through these channels again into the blood. Through the blood, it reaches liver where it is metabolized efficiently [15]. The composition of fenugreek includes a large number of chemical components. They include proteins and amino acids, flavonoids, saponins and steroidal saponins, coumarin, lipids, vitamins, minerals, galactomannan fiber and alkaloids, such as trigonelline. Extracts are available standardized to contain 50% saponins or 20% of the amino acid 4-hydroxyisoleucine [16]. Treatment with fenugreek seed powder normalized the enhanced lipid peroxidation and increased susceptibility to oxidative stress associated with depletion of antioxidants [17]. The steroidal saponins (diosgenin, yamogenin, tigogenin and neotigogenin) are thought to inhibit cholesterol absorption and synthesis and hence its potential role in arteriosclerosis [18]. Phenolics in Curcuma longa have potential health benefits mainly due to their antioxidant properties such as reactive oxygen species (ROS) scavenging and inhibition, electrophile scavenging and metal chelation [19]. Epidemiological studies support a relationship between the consumption of phenolic rich food products and a low incidence of coronary heart disease, atherosclerosis, certain forms of cancer and stroke [20]. Lipid peroxidation is inhibited by flavonoids and flavonones present in lemon [21].

PATIENTS AND METHODS

Place and period of research work

The research work was conducted at Jinnah Hospital, Lahore from January 2018 to May 2018 with approval of Research Ethics Committee of the Hospital.

Sample size

Ninety hyperlipidemic patients were selected for research work.

Consent

Written consent was taken from all patients. specific performa was designed for the research work. Hyperlipidemic patients were selected with age range from 19 to 70 years.

Exclusion criteria

Exclusion criteria were hypertension, hypothyroidism, diabetes mellitus, alcohol addictive patients, peptic ulcer, any gastrointestinal upset, renal impairment and any hepatic or cardiac problem.

Grouping

All patients were divided in three groups (Group-I, Group-II, Group-III), 30 patients in each group. Their baseline lipid profile data were taken and filed in specifically designed Performa, at start of taking medicine, like lipid profile, blood pressure and pulse rate.

Lipid profile

Serum lipid profile (total cholesterol, HDL-cholesterol, triglyceride) parameters were determined after a 12 h overnight fast by standard methods. LDL-cholesterol level was calculated according to the Friedelwald’s formula. Thirty patients of Group-I were advised to take 500 mg of Curcuma longa (haldi) mixed in fresh milk without cream, thrice daily for two months. Group-II patients were advised to take 100 g of fenugreek leaves mixed with salad in each meal (thrice daily) for the period of two months. Group-III patients were advised to take 40 ml of fresh lemon juice mixed with 40 ml mineral water thrice daily for two months. They all were advised not to take heavy meal rich with any type of fat like junk food, etc. 1 h daily brisk walk was advised to all participants. 15 days follow up visit was scheduled for them. After two months their lipid profile was re-determined.

STATISTICAL ANALYSIS

Mean values of the day-0 and day-60 of tested parameters (total cholesterol, LDL cholesterol, triglycerides and HDL cholesterol) ± SD were taken to be analyzed statistically. SPSS 10 Version 2.00.01.10 was used to analyze pretreatment and post treatment values of all parameters. Paired ‘T’ test was applied to determine changes in pre and post treatment values. P-value >0.05 was considered as non-significant changes in tested parameters and P-values <0.01 were considered as significant changes.

RESULTS

DISCUSSION AND CONCLUSION

1.       Mwthy HG, Strain JJ (2012) The ferric reducing ability of plasma (FRAP) as a measure of “antioxidant power”: The FRAP assay. JJCM 12: 122-129.

2.       Stensvold I, Tverdal A, Solvoll K, Foss OP (1992) Tea consumption: Relationship to cholesterol, blood pressure and coronary and total mortality. Prev Med 21: 546-553.

3.       Solkth R, Thorpe G (2012) Atherosclerosis: Newer view-points. JM 4: 90-95.

4.       Serafini M, Ghiselli A, Ferro-Luzzi A (1996) In vivo antioxidant effect of green and black tea in man. Eur J Clin Nutr 50: 28-32.

5.       Leenen R, Roodenburg AJ, Tijburg LB, Wiseman SAA (2000) Single dose of tea with or without milk increases plasma antioxidant activity in humans. Eur J Clin Nutr 54: 87-92.

6.       O'Reilly JD, Sanders TA, Wiseman H (2000) Flavonoids protect against oxidative damage to LDL in vitro: Use in selection of a flavonoid rich diet and relevance to LDL oxidation resistance ex vivo? Free Rad Res 33: 419-426.

7.       Balentine DA, Wiseman SA, Bouwens LC (1997) The chemistry of tea flavonoids. Crit Rev Food Sci Nutr 37: 693-704.

8.       Ito T, Yoshida H, Ayaori M, Nishiwaki M, Yonemura A, et al. (2001) Conventional hypolipidemic medicines and their compliance. Libyan J Nutr 66: 261-266.

9.       Sesso HD, Gaziano JM, Buring JE, Hennekens CH (2014) Hypolipidemic constituents in herbs. J Epidemiol 149: 162-167.

10.    Hodgson JM, Puddey IB, Croft KD, Burke V, Mori TA, et al. (2014) Chemical contents of Curcuma longa. J Nutr 71: 1103-1107.

11.    Klatsky AL, Friedman GD, Armstrong MA (2012) Curcuma longa affects LDL-oxidation. Med J Epidemiol 132: 479-488.

12.    Hertog MG, Sweetnam PM, Fehily AM, Elwood PC, Kromhout D (1997) Antioxidant flavonols and ischemic heart disease. Am J Clin Nutr 65: 1489-1494.

13.    Kono S, Shinchi K, Ikeda N, Yanai F, Imanishi K (2013) Miraculous hypolipidemic herb: Curcuma longa. Jpn Prev Med 21: 526-531.

14.    Fogelman AM, Shechter I, Seager J, Hokom M, Child JS, et al. (2015) Curcuma longa inhibits enterohepatic circulation. J Surg Med Ind 77: 2214-2218.

15.    Lowry OH, Rosenbrough NJ, Farr AL, Randall RJ (2013) ATP-binding cassette transporter and efflux of lipids. J Biol Chem 193: 265-275.

16.    Keda I, Imasato Y, Sasaki E, Nakayama M, Nagao H, et al. (2013) Chemical compounds found in fenugreek seeds. J Biochem 1127: 141-146.

17.    Yang CS, Landau JM (2014) Handling LDL oxidation with herbal medicine. J Clin Nutr 130: 2409-2412.

18.    Keli SO, Hertog MG, Feskens EJ, Kromhout D (1996) Dietary flavonoids, antioxidant vitamins and incidence of stroke. Arch Intern Med 156: 637-642.

19.    Mukhtar H, Ahmad N (2014) Metallic chelation by Curcumin. J Clin Med 71: 1698s-1702s.

20.    Princen HM, Van Duyvenvoorde W, Buytenhek R, Blonk C, Tijburg LB, et al. (2014) Phenolic compound rich foods for cure of Cad. J Health Med Ethiop 18: 833-841.

21.    Hertog MG, Feskens EJ, Hollman PC, Katan MB, Kromhout D (2015) Lemon juice for treating hyperlipidemia and Cad. J Ind Med 42: 1007-1011.

22.    Wiseman SA, Balentine DA, Frei B (2014) Antioxidant potential of pectin present in herbs. J Med Ir 37: 705-718.

23.    Tijburg LB, Mattern T, Folts JD, Weisgerber UM, Katan MB (2014) Favonoids and cardiovascular disease: A review. J Biol Pak 37: 771-785.

24.    Gidez LI, Miller GJ, Burstein M, Slagle S, Eder HA (2015) Moa of hypolipidemic herbs. J Med Ther 23: 206-223.

25.    Bingham SA, Vorster H, Jerling JC, Magee E, Mulligan A, et al. (2015) Obesity, hypercholestrelemia, metabolic syndrome and options of their cure. Med J Prev Med 78: 41-55.

26.    Reaven PD, Witztum JL (2013) Oxidized low density lipoproteins in atherogenesis: Role of dietary modification. J Ethiop Med 16: 51-71.

27.    Mattern T, Witztum JL, Weisgerber UM (2012) Turmeric seeds oil interrupts enterohepatic circulation of Bas. J Lipid Res 53: 2490-2514.

28.    Geleijnse JM, Launer LJ, Hofman A, Pols HA, Witteman JC (2014) How fenugreek is antioxidant? Food Sci 159: 2170-2174.

29.    Magee E, Mulligan A, Constrv YL (2014) Consumption of foods rich in flavonoids is related to a decreased cardiovascular risk. J Med Nutr 134: 23-26.

30.    Jhumarr J, Yulda C, Helov T (2013) Fruits can prevent diseases. MJN 8: 99-104.

31.    Loversa T, Mught R, Loferr T, Ilova H (2013) Phytochemistry of some plants. J Clin Nutr Res 12: 44-48.

32.    Hundahg P, Urhav I, Ytrag R (2012) Therapeutic approach with medicinal herbs. JRMS 7: 66-80.

33.    Sueawath JJ, Howan RR, Mekba TG, Illahu RF, Ulkav BT (2015) Lemon is antioxidant fruit. IJRM 7: 111-119.