47.2 ± 8.0

41.3 ±


38.4 ± 11.4*


*p < .05, **p < .01, ***p < .001 vs. 0 months.

#p < .05, ##p < .01, ###p < .001 vs. 2 months.

*p < .05, **p < .01, ***p < .001 vs. 0 months.

#p < .05, ##p < .01, ###p < .001 vs. 2 months.

as the principal mechanism. Evidence suggests that gel forming capacity of fiber slows the rate of glucose absorption, consequently improving the glycemic status.1'21'22

Another theory suggests the role of Spirulina proteins. Dietary proteins by themselves are known to stimulate insulin secretion and when coingested with a carbohydrate source, they markedly potentiate insulin response.23,24 Thus it is possible that the ingestion of Spirulina proteins along with the meals, as was done in the present study, may have an insulin secretagogue effect resulting in a reduction in the 2-h postprandial glycemia.1,21 This improvement in the postprandial glycemia in turn may be responsible for the decrease observed in HbA1c concentrations.

Several investigations have established an association between the presence of hyperglycemia and the end products of Hexoseamine Biosynthesis Pathway (HBP) flux.25-27 Results of the present study also highlight the strong correlation between HbA1c and the levels of glucosamine and uronic acid. With the significant improvements observed in hyperglycemia, the reaction in the glucosamine and uronic acid levels of the patients given Spirulina did not come as a surprise.

Results of the present analysis clearly highlight the efficacy of Spirulina as a lipid as well as cholesterol lowering agent. Significant reductions in the triglycerides, total lipids, total cholesterol, and its fractions except high density lipoprotein cho-lestrol (HDL-C) were observed after supplementation of Spirulina (Table 4.3). These observations are in line with the results reported by Mani1 and Nayaka.28 Various hypotheses have been proposed in an attempt to identify direct mechanisms responsible for the hypolipidemic and hypocholesterolemic potency of Spirulina. Focus has been laid on the high gamma linolenic acid (GLA) content. Spirulina is the only natural whole food source of GLA in the plant kingdom.22 GLA is a precursor for the body's prostaglandins (PG). The prostaglandin PGE1 is essential for regulating a variety of basic biochemical functions in the body including the regulation of blood pressure, cholesterol synthesis, inflammation, and cell proliferation.22,29,30 Under normal conditions, the human body can convert GLA from linoleic acid through activity of the enzyme delta-6-desaturase. Diabetes, however, is associated with inhibition of the delta-6-desaturase enzyme.30 An external food source of GLA such as Spirulina therefore, plays a crucial role in regulating the cholesterol levels in diabetic patients.

In recent years, emphasis has also been laid on the favorable effects of the amino acid compositions of "good-quality" plant proteins on serum lipoproteins. Studies have highlighted the associations of high arginine intake with decreases in serum cholesterol levels and low methionine intake with lower incidence of CHD.14,31-33 Interestingly, nutritional analysis of Spirulina proteins revealed this desirable amino acid composition.22,29 It is, however, plausible that the hypocholesterolemic properties of Spirulina may in fact be due to the integrated effect of amino acids and the nonprotein components, namely, fiber, phytonutrients, and antioxidants.13,14,22,31,34

The hypocholesterolemic and hypolipidemic property of Spirulina can also be attributed to its plausible insulin secretagogue effect. As mentioned earlier, the additive effect of Spirulina proteins and fiber may result in improved insulin secretion. Howard35 has reported decreased very low density lipoprotein (VLDL) triglyceride production as well as decreased Fractional Clearance Rate (FCR) coupled with an improvement in the peripheral VLDL clearance in the presence of insulin. This is reflected by the significant reductions seen in VLDL and triglyceride levels (Table 4.3). Furthermore, under the sustaining influence of insulin an increase in the turnover ofVLDL-apoB and LDL receptor activity is seen. The hypocholesterolemic effect can also be attributed to this mechanism.31,34

The favorable shift in the lipid and lipoprotein profile in response to Spirulina supplementation was further supported by a significant increase in the HDL-C levels, may be a result of the additive effects of various proteins and nonprotein components of Spirulina.

Apart from the standard lipid parameters, efforts are being made to identify other risk factors of CHD.36 Since apo A1 and B are the major protein components of HDL-C and LDL-C respectively, these have been most frequently investigated as the quantitative risk factors of CHD. Apo A1 and B are used independently and as a ratio to assess the risk of CHD. Studies have demonstrated that the changes as observed in this study with Spirulina supplementation, that is, a highly significant reduction in apo B causing a marked increment in the A1:B ratio (Table 4.4) is well correlated with less incidence of CHD.34 Furthermore, because apo B is independently associated with

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