Poor glycaemic control, overweight and obesity are key contributors to metabolic complications such as non-alcoholic fatty liver disease (NAFLD). In type 2 diabetes mellitus (T2DM), insulin resistance drives dysregulated lipid metabolism and increased hepatic fat accumulation.^1,2 Sometimes, even with pharmacological management, glycaemic control may remain suboptimal, allowing metabolic stress to persist and adversely affect hepatic function.

Initial Presentation

A male patient aged 67 years presented with T2DM and persistently high fasting plasma glucose (FPG) [14 mmol/L] and HbA1c of 8.3%. This was despite ongoing conventional drug therapy with metformin and sitagliptin. He weighed approximately 115 kg and was taking a proton pump inhibitor (PPI) for reflux. Alanine transaminase (ALT) and gamma-glutamyl transferase (GGT) were elevated, findings consistent with fatty liver disease though not diagnostic on their own.³

Prescription

Given alongside advice to increase exercise and reduce intake of carbohydrates, alcohol and red meat, the 5-point microcirculation diet was recommended.

5-point Microcirculation Diet

• Boost dietary nitrate: green leafy vegetables, but especially beetroot as juice or supplement

• Increase cocoa intake: 85 to 90% chocolate (20 g/day)

• Increase berry anthocyanin intake: blueberries, strawberries, raspberries, and blackberries (50 to 100 g/day)

• Fresh crushed-raw garlic: ½ to 1 clove/day

• Increase herbs and spices: especially Green Tea (3 to 4 cups/day), Turmeric and Ginger

The patient was prescribed the following herbal treatments:

• Tablets containing Gymnema sylvestre (Gymnema) leaf extract for its antidiabetic activity and potential to restore damaged pancreatic beta cells:⁴ 1 tablet before each meal

• Tablets containing to Citrus reticulata (Mandarin) fruit peel extract, Zingiber officinale (Ginger) rhizome extract, Tanacetum parthenium (Feverfew) leaf extract, Gentiana lutea (Gentian) root extract, Artemisia absinthium (Wormwood) herb extract, and Mandarin oil cold pressed: 1 tablet before each meal. This bitter digestive formula was intended to promote the incretin response and ultimately improve glycaemic control, decrease weight and improve pancreatic cell function.^5-7

• Tablets containing Silybum marianum (St Mary’s Thistle) extract, standardised to contain flavonolignans calculated as silybin 168 mg for fatty liver:⁴ 1 tablet before each meal

Follow Up

Of his own volition, the patient chose to discontinue his diabetic medication and take herbal treatment alone. With this treatment FPG reduced to 9.3 mmol/L and HbA1c to 7.7%. He lost 13 cm from his waist circumference and 5.5 kg from his body weight.

The following was added to his prescription:

• Tablets containing Trigonella foenum-graecum (Fenugreek) seed extract, standardised to contain 4-hydroxyisoleucine (4HIL) 20 mg; Momordica charantia (Bitter Melon) fruit extract; Cinnamomum verum (Cinnamon) stem bark extract; and Nigella sativa (Black Cumin) extract: 1 tablet with each meal. This metabolic support formula was intended to further improve glycaemic control and metabolic health.^5,8

Clinical Thoughts

With the incidence of T2DM continuing to rise,⁹ practitioner understanding of how best to utilise diet, exercise and herbal medicine to support glycaemic control, potentially reverse metabolic dysfunction and manage its associated complications is paramount to effective treatment.

References

1. Akshintala D, Chugh R, Amer F, Cusi K. Nonalcoholic fatty liver disease: the overlooked complication of type 2 diabetes. In: Feingold KR, Adler RA, Ahmed SF, Anawalt B, Blackman MR, Chrousos G, et al., editors. Endotext [Internet]. South Dartmouth: MDText.com, Inc; 2019 [cited 2026 May 29]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544043/

2. Afolabi BI, Ibitoye BO, Ikem RT, Omisore AD, Idowu BM, Soyoye DO. The relationship between glycaemic control and non-alcoholic fatty liver disease in Nigerian type 2 diabetic patients. J Natl Med Assoc. 2018 Jun;110(3):256-264. DOI: 10.1016/j.jnma.2017.06.001

3. Antunes C, Azadfard M, Hoilat GJ, Gupta M. Fatty liver [Internet]. Treasure Island: StatPearls; 2023 [cited 2026 May 28]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441992/

4. Bone K, Mills S. Principles and practice of phytotherapy: modern herbal medicine. 2nd ed. London; Churchill Livingstone. 2013.

5. MediHerb. Metabolic dys-function – session 3 – Kerry Bone [seminar on the internet]. Eight Mile Plains: Integria Practitioner; 2019 [cited 2026 May 29]. Available from: https://practitioner.integria.com/events/metabolic-dys-function

6. Dotson CD, Vigues S, Steinle NI, Munger SD. T1R and T2R receptors: the modulation of incretin hormones and potential targets for the treatment of type 2 diabetes mellitus. Curr Opin Investig Drugs. 2010 Apr;11(4):447-454.

7. Meyerhof W, Batram C, Kuhn C, Brockhoff A, Chudoba E, Bufe B, et al. The molecular receptive ranges of human TAS2R bitter taste receptors. Chem Senses. 2010 Feb;35(2):157-170. DOI: 10.1093/chemse/bjp092

8. Setiyorini E, Qomaruddin MB, Wibisono S, Juwariah T, Setyowati A, Wulandari NA, et al. Complementary and alternative medicine for glycemic control of diabetes mellitus: a systematic review. J Public Health Res. 2022 Jul;11(3):22799036221106582. DOI: 10.1177/22799036221106582

9. Hossain MJ, Al-Mamun M, Islam MR. Diabetes mellitus, the fastest growing global public health concern: early detection should be focused. Health Sci Rep. 2024 Mar;7(3):e2004. DOI: 10.1002/hsr2.2004