Fenugreek - Uses and Side Effects

Fenugreek has been used for millennia both as a medicine and as a spice in Egypt, India, and the Middle East. Traditional medicinal uses include the treatment of wounds, bronchitis, digestive problems, arthritis, kidney problems, male reproductive conditions, boils, diabetes, cellulitis, tuberculosis, and GI problems. Investigations in animals have found the seeds to reduce serum cholesterol and glucose levels.

Active components in fenugreek include mucilages, proteins, steroid saponins, flavonoids, and volatile oils. Trigonelline, an alkaloid found in fenugreek, is degraded to nicotinic acid (niacin), which may partially explain its ability to lower serum cholesterol levels. Steroid saponins may also lower blood glucose and plasma glucagon levels and enhance food consumption and appetite. The seeds contain up to 50% mucilaginous fiber that, because of their ability to absorb and expand, are commonly used to treat diarrhea and constipation. The seeds also contain coumarin compounds. Fenugreek is available as capsules, paste, powder, ripe seeds, dried seeds, and as a spice.

Reported uses

Fenugreek is used to treat GI complaints and to relieve upper respiratory tract congestion and allergies. It's also used to lower cholesterol, blood glucose, insulin, and hemoglobin AlC levels, to improve glucose tolerance, and as an appetite stimulant.

Topically, a preparation of fenugreek is applied to treat skin inflammation, muscle pain, and gout, and to aid in the healing of wounds or skin ulcers.

Administration

External: A poultice is prepared by mixing 50 g of powdered fenugreek with 1 qt (1 L) of water, and applied topically to the affected area, as needed

Internal: An infusion is prepared by steeping 0.5 g of fenugreek in cold water for 3 hours, and then straining. Honey may be used to sweeten the infusion. The dosage is 6 g by mouth, or a cup of tea taken several times a day.

Hazards

Adverse reactions to fenugreek include maple-syrup odor to urine, hepatotoxicity, jaundice, nausea, vomiting, increased bilirubin level, hypoglycemia, contact dermatitis (with external use), flushing, wheezing, watery eyes, numbness, rash, and angioedema (after inhalation, ingestion, or topical anesthesia).

When taken with adrenergic blockers, there is an additive vasodilating effect that may lead to hypotension. There is risk of increased prothrombin time (PT) and International Normalized Ratio (INR), and potential risk of abnormal bleeding, when fenugreek is taken with anticoagulants such as aspirin, NSAIDS, heparin, low-molecular-weight heparins, and warfarin. Fenugreek also has the potential to decrease blood glucose levels when administered to those taking hypoglycemics, including insulin. A decreased uricosuric effect is noted with probencid and sulfinpyrazone. Because of the fibrous content in fenugreek seeds and its binding potential, absorption of drugs may be altered. Advise patient to avoid using fenugreek within 2 hours of other drugs.

Pregnant patients should avoid use because of the herb's potential abortifacient properties; alcohol and water extracts of the herb may stimulate uterine activity. Those with liver disease, peptic ulcers, or severe hypotension should avoid use because of the formation of nicotinic acid. Breast-feeding patients, and those who have had a previous allergic reaction to fenugreek or nicotinic acid, should also avoid use.

Clinical considerations

If patient is taking an anticoagulant, monitor PTT, INR, and PT. Monitor the patient for abnormal bleeding.

Appearance of rash or contact dermatitis may indicate sensitivity to fenugreek.

Nausea, vomiting, jaundice, or elevated bilirubin level may indicate liver damage and hepatotoxicity from nicotinic acid. If patient develops these signs or symptoms, he should immediately stop using the herb.

If patient is pregnant, planning to become pregnant, or breast-feeding, advise her not to use fenugreek.

Caution patient that a rash or abnormal skin change may indicate an allergy to fenugreek and that nausea, vomiting, and skin color changes may indicate liver damage. Tell patient to discontinue use if such signs and symptoms appear.

Remind patient not to take fenugreek at the same time as other drugs and to separate administration times by 2 hours.

Tell patient to remind pharmacist of any herbal or dietary supplement that he's taking when obtaining a new prescription.

Advise patient to consult his health care provider before using an herbal preparation because a conventional treatment with proven efficacy may be available.

Research summary

Current studies continue to elucidate the mechanism of fenugreek's abilities to lower cholesterol and glucose levels. Recent studies also show the ability of the plant to decrease the quantity of calcium oxalate deposited in the kidneys.

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