South African Medicinal Plants in Metabolic Disorders Management

South African Medicinal Plants in Metabolic Disorders Management: Comparison

Please note this is a comparison between Version 1 by Trevor Nyakudya and Version 2 by Peter Tang.

Metabolic syndrome (MetS) is a prevalent, multifactorial and complex disease that is associated with an increased risk of developing diabetes and other major cardiovascular complications. The rise in the global prevalence of MetS has been attributed to genetic, epigenetic, and environmental factors. The adoption of sedentary lifestyles that are characterized by low physical activity and the consumption of high-energy diets contributes to MetS development. Current management criteria for MetS risk factors involve changes in lifestyle and the use of pharmacological agents that target specific biochemical pathways involved in the metabolism of nutrients. Pharmaceutical drugs are usually expensive and are associated with several undesirable side effects. Alternative management strategies of MetS risk factors involve the use of medicinal plants that are considered to have multiple therapeutic targets and are easily accessible. Medicinal plants contain several different biologically active compounds that provide health benefits.

medicinal plants
metabolic syndrome
diabetes
hypertension
oxidative stress
non-alcoholic fatty liver disease

1. Medicinal Plants in the Management of Obesity

There has been a worldwide recent increase in non-communicable diseases such as obesity. The WHO established that a person is overweight when his/her body mass index (BMI, calculated as kg/m²) is over or equal to 25 and obese when the BMI is equal to or more than 30 ^[1][17]. The global epidemic of obesity has been on the rise, mainly due to the worldwide change of diet and an increase in sedentary lifestyle ^[2][18]. It is reported that obesity cases almost tripled between 1989 and 2011 ^[1][17]. The WHO states that obesity is the seventh cause of death, and there are approximately 2.8 million people who die every year due to risk factors associated with being overweight or obese ^[1][17]. Obesity reduces life expectancy at the age of 40 by at least 7 years ^[3][19]. Obesity occurs when there is an increase in the consumption of especially dense energy foods (carbohydrates) associated with a decrease of physical activity to burn the consumed foods ^[4][5][23,24]. Overweight has been associated with a myriad of comorbidities such as certain cancers (breast, prostate, kidney, colon), cardiovascular diseases (stroke and heart), and type 2 diabetes mellitus ^[6][7][25,26]. Here, we will list some plants that are commonly used for weight loss in South Africa, their active constituents, and their mode of action (Table 1).

Table 1.

Plants in South Africa used for weight loss.

Family Name	Species Name	Common Name

[33]; about 1,826,100 people were believed to be living with diabetes in South Africa, and an additional 1,548,500 to be living with undiagnosed diabetes ^[31][33]. A large proportion of the South African population lives below the poverty datum line and has limited access to modern healthcare, thus relies on traditional medicine for managing diabetes and its complications. The subject of traditional medicines used for diabetes control is therefore a highly relevant topic in future considerations of how to deal with this condition. Through ethnobotanical studies, scientific researchers have identified a number of plant species that are used by traditional healers and herbalists in managing diabetes mellitus. Table 2 shows the list of plants identified to possess antidiabetic activity in South Africa.

Table 2.

List of plants used for the treatment of diabetes mellitus in South Africa.

Family Name	Scientific Name		Scientific Name Local Name and Region Where Used	Local Name and Region Where UsedPlant Part Used	Plant Part Used Methods of Herbal Material Preparation	Mode of Action	Plant Part Used Active Constituents	References
	Methods of Herbal Material Preparation			Methods of Herbal Material Preparation	Mechanisms	Mechanisms Scientific Model Used		Scientific Model UsedReference
		Reference
Apiacaea	Foeniculum vulgare Mill	Fennel
Aizoaceae	Carpobrotus edulis (L.) N.E. Br	Seeds		- The seeds are processed into powder which can be taken as an infusion	Reduces oxidative stress, inhibits serotonin reuptake, promotes a decrease in fat and sugar absorption	Phytoestrogens, dipentene	Leaves ^[8	The leaves are used to make an infusion which is taken orally ^]	^][99]
Moringaceae	Moringa oleifera			-		[	- 36]
Moringa, Drum stick tree (English) Limpopo province and Gauteng			Aerial	Leaf extracts	Upregulation of hepatic lipid metabolism genes, suppression of pro-inflammatory pathways		^[	Diet-induced obesity models in rats, ^32][67]	^[82]^[83][119,120]	Apocynaceae	Gymnema sylvestre R. Br
Alliaceae	Allium sativum L. fam.	Gimena	Garlic (English) Ivimbampunzi (IsiXhosa) Ikonofile (IsiZulu); Eastern Cape	Meliaceae	Ekebergia capensis	Cape ash, dogplum (English) Essenhout (Afrikaans); Mmidibidi (Nothern Sotho). Eastern Cape, KwaZulu-Natal, Limpopo, Mpumalanga Leaves	Whole plants The leaves are used to make an infusion taken orally	Leaves The different parts are used to make a decoction which is taken orally Inhibits glucose absorption and fatty acid accumulation			The leaves are used to make an infusion which is taken orally	Hypotensive	Streptozotocin- induced diabetic rats	^[71][101]

Fabaceae	Aspalathus linearis (Burm.f.) R.Dahlgren	Rooibos, red bush (English) Rooibostee, bossietee (Afrikaans) Fynbos, Northern and Western cape	Aerial parts	Aerial parts as tea, green or fermented	Hypoglycemic, hypolipidemic; reduces proteinuria	Improved lipid metabolism in adipocytesinhibit hepatic insulin resistanceregulation of AMPK Gymnemic acids	^[9]^[10][37,38]
	STZ-treated rats			3T3-L adipocyte cell culture, obese insulin-resistant rats			^[33][68]	^[84	Apocynaceae	Hoodia gordonii
^]	^[	⁸⁵	^]	[	114	,	115]	Amaryllidaceae Cactaceae (Masson)	Gethyllis namaquensis (Schönland) Oberm.	Opuntia megacantha Kalahari cactus		Sweet prickly-pear (English); turksvy (Afrikaans); itolofiya (Xhosa). Widely distributed in South Africa	Fruit	The leaves are used to make an infusion which is taken orally	Hypotensive
Apocynaceae	Hoodia gordonii	Naka tsa tholo; Limpopo Province	Stem		Bulbs Tender stems are eaten fresh or dried and milled. Often processed into capsules	Aqueous extract which is taken orally Appetite suppressant targets adipose and muscle tissues reduces calorie intake	Streptozotocin- induced diabetic rats	^[72][102]
61
	Bitter ghaap (English); Muishondghaap, wolweghaap, bergghaap, bokhorings (Afrikaans); khobab (Khoi)		Aerial		Appetite suppression, decrease adipocytes	Oxypregnane steroidal glycoside P57		- ^[	Obese rats ^11][39]
	-			^[	³²	^]	[67]	^[86][116]	Asphodelaceae		Amaryllidaceae Aloe ferox Miller	Cape Aloe	Leaves
Anacampserotaceae	Anacampseros ustulata E.Mey. ex Fenzl
Fabaceae	Allium sativum		Leaves are taken as decoctions		Sutherlandia frutescens Garlic (English), Knoffelhuisies (Afrikaans). Non-indigenous Combats water retention			Igwele (IsiXhosa); Eastern Cape ^[	Corms	Cancer bush (English), kankerbos (Afrikaans) Western cape Cloves^12][	40]
	-				-			Leaves Cold-pressed extract	Attenuation of structural nephropathy progression	Decoction, aqueous extracts	Regulation of adipocytes and lipid metabolism Streptozotocin-induced diabetic rats ^[34][35]	^[	3T3 cells and obese rats ^73][103]	^[18]^[87][46,117]	Asphodelaceae	Aloe vera Mille	Aloe vera
Anacardiaceae	Sclerocarya birrea (A. Rich) Hochst. Subsp caffra	Cider/Marula (English) Maroela (Afrikaans) Umganu (Zulu)	Leaves	Bark Leaves are taken as decoctions
]

Anacardiaceae		Sclerocarya birrea
Asphodelaceae	Marula (English); Morula (Southern Sotho). KwaZulu-Natal, Limpopo, Mpumalanga			Aloe vera Leaves	Improves carbohydrate metabolism and reduces obesity-induced glucose intolerance	Aloe sterols	^[13]^[14	The bark is used to make a decoction which is taken orally ^]		Aloe (English); Aalwyn (Afrikaans); Hlaba, Lekhala (Southern Sotho); Icena (Ndebele); Imboma (Zulu). Widely distributed in South Africa The leaves are used to make an infusion which is taken orally		Leaves	Gel extract Reduces blood glucose, increases insulin levels Phenolic compounds hypotensive [41,	STZ-treated rats42]
		^[	³⁵	^]	^[	³⁶	Phytosterols, decrease hepatic lipid accumulation In vitro analyses ^][69,70	^[74	Zucker obese rats]	^][104]	^[14][42]	Asteraceae
Cactaceae	Taraxacum officinale F.H. Wigg.	Dandelion
Apocynaceae	Catharanthus roseus (L.) G.Don		Opuntia ficus-indica (L) Mill Madagascar periwinkle Leaves	Leaves, whole plants Leaves are taken as decoctions	Prickly pear (English), Limpopo province	Fruit The leaves are used to make an infusion which is taken orally	Seed extracts Inhibits pancreatic lipase	Increased expression of	Decrease inflammation, prevent steatosis
Moraceae	Ficus thonningii	Giant-leaved fig (English); Reuseblaarvy (Afrikaans); Umvubu, Omkhulu (Zulu); Umthombe, uluzi (Xhosa), KwaZulu-Natal	Stem bark	GLUT-2	and	Stem–bark aqueous extract GLUT4 transporter gene expression in the liver Hypoglycemic; hypolipidemic; increases the activity of glycolytic pathway enzymes; activates nuclear peroxisome proliferator and hence regulates gene expression in metabolic pathways; upregulates glucokinase activity	Decrease in mean arterial pressure Caffeic and chlorogenic acid	STZ-treated rats; alloxan-treated rats; in vitro enzyme assays; alloxan-treated rabbits cultured human cells Anesthetized rat model	^[	High-fat fed rats ^[15][43	^[37] ⁷⁵ ^[^16],44]
^[	³⁸	^]	^[	³⁹	^]	[	71^[,72 ^][105]
	^[	⁸⁸	^]	[	121	]		Cannabaceae.	Cannabis sativa L.	Oleaceae	Olea europea Marijuana
Myrtaceae		Syzigium aromaticum	Leaves	Wild olive (English), Olienhout (Afrikaans); Mohlware (Nothern Sotho, Southern Sotho), Umnquma (Zulu, Xhosa, Swati). Widely distributed in South Africa The leaves are used to make an infusion taken orally	Psychoactive rapid and long-lasting downregulation of CB1R causes reduction of energy storage and increases metabolic rates	Cannabinoids		Clove (English), Naeltjies (Afrikaans). Non-indigenous, grown as ornamental tree Leaves ^[	The leaves are used to make a decoction which is taken orally ^17]^[18]^[19][45,46,47]
⁴⁰	,	73	^]	,	74	]
Apocynaceae	Plumeria obtusa L.	Mohlare wa maswi wa sukiri; Limpopo Province	Leaves	The leaves are used to make an infusion which is taken orally		Cloves -	Diuretic, anti-atherosclerotic, and anti-hypertensive effects -	Insulin-resistant genetic rodent models ^[32][67]	Cold-pressed extract (oleanolic acid) ^[76	Developmental programming Regulation of hepatic lipid metabolism pathways ^][77	Cucurbitaceae	Cucumis africanus L.f.	Scarlet gourd	Whole plant
^]	[	106	,	107	]	Araliaceae The plant is used to make an infusion taken orally	Weight loss		Cussonia spicata Thunb. Flavonoids	Limpopo Province	Roots	The root bark is used to make a decoction which is taken orally	- ^[20]^[21][48,49]
	-			^[	³²	^]	[67]	Cucurbitaceae	Kedrostis africana (L.) Cogn.	Baboon′s cucumber
Asphodelaceae		tuber		The tuber is used to make a decoction which is taken orally		Aloe ferox Mill α-amylase, α-glucosidase, and lipase inhibitory activities	Ikhala (IsiXhosa) Bitter Aloe (English); Eastern Cape	Leaves	The leaves are used to make an infusion which is taken orally	Hypoglycemic; increases insulin secretion Luteolin and kaempferol	STZ-treated rats ^[22][50]
		^[	¹²	^]	^[	⁴¹	^][40,75]	Curtisiaceae	Curtisia dentata (Burm.f.) C.A. Sm.	Assega	Bark	The bark is used to make a decoction which is taken orally	Weight loss
Asphodelaceae	Aloe marlothii A. Berger subsp. Marlothii			-				-	- ^[17][45]
	^[	³²	^]	[	67	]		Fabaceae	Acacia mearnsii De Wild	Black wattle	Bark	Whole plants The bark is used to make a decoction which is taken orally		Different parts of the plant are used to make into a which is taken orally Increases energy expenditure in skeletal muscle and decreases fatty acid synthesis	- Proanthocyanidins,
Asphodelaceae	^[		-	²³	^]	^[	²⁴	Bulbine abyssinica A.Rich. ^][51	,52]
		^[	⁴²	^]	[	59	]	Lamiaceae	Rosmarinus officinalis L.	Rosemary	Leaves	The leaves are used to make a decoction which is taken orally	Reduces body fluid
Asphodelaceae		Carnosic acid			Bulbine frutescens (L.) Willd.	Ibhucu (IsiXhosa); Eastern Cape		Roots ^[	The root is used to make a decoction which is taken orally ²⁵	- ^]	- [53]
	^[	⁴³	^]	[	34	]		Menispermaceae	Cissampelos capensis L.f.	David root	Roots	The root is used to make a decoction which is taken orally	Stimulates body energy		^[
Asphodelaceae	Bulbine natalensis (Syn. B. latifolia) Mill. (L.f.) Roem. et Schult.	¹⁷	Ibhucu (IsiXhosa); Eastern Cape	^]	Roots	[

		High-fructose-fed rats			^[	⁸⁹	^][123]	Amaryllidaceae	Tulbaghia violacea	Wild garlic or society garlic (English), Wildeknoflok (Afrikaans); Utswelane (Xhosa); Incinsini (Zulu). Eastern Cape, KwaZulu-Natal, Limpopo	Leaves and flowers	The leaves are used to make a decoction which is taken orally	ACE inhibitors	In vitro assays	^[78]^[79][110,111] The root is used to make a decoction which is taken orally 45	- ]
	-			^[	⁴³	^]	[34]	Moringaceae	Moringa oleifera Lam.	Moringa
Asteraceae	Artemisia afra Jacq. ex Willd.		Leaves	The leaves are used to make a decoction which is taken orally	Lowers body weight, total cholesterol, triglycerides, organ weight, and blood glucose level, promotes energy expenditure	Umhlonyane (IsiXhosa) African wormwood	Leaves, roots	The roots are used to make a decoction; leaves are used to make a decoction which is taken orally Quercetin-3-O-β-dglucoside	Hypoglycemic and hypolipidemic effects ^[26	STZ-treated Wistar rats ^]	^[44]^[27[76^][28][54,55,56]
]		Poaceae	Coix lacryma-jobi L.	Job’s tears
Asteraceae	Brachylaena discolor DC.		Seeds		Leaves, roots, and stems The seeds are used to make a decoction which is taken orally	The roots are made into a decoction which is taken orally Neuroendocrine activity downregulation of adipogenesis			Inhibits α-amylase and α-glucosidase; increases glucose utilization in Chang liver cells, 3T3-L1, and C2C12 muscle cells ^[29][	In vitro enzyme assays; in vitro cultures of preadipocytes, hepatocytes, and muscle cells57]
		^[	⁴⁵	^]	^[	⁴⁶	^][77,78]	Polygonaceae	Persicaria hydropiper (L.) Spach.
Asteraceae		Water pepper	Leaves	The leaves are used to make infusions which are taken orally	Callilepis laureola DC. Combats adipogenesis in 3T3-L1 cells		Phela (Sepedi); Limpopo Province Isoquercitrin	^[30][58]

2. South African Medicinal Plants for Diabetes Mellitus

Diabetes mellitus is one of the most common metabolic disorders in South Africa, with an incidence and prevalence that have increased at an alarming rate in the past 20 years. By 2017, the global prevalence of diabetes mellitus was estimated at 450 million ^[31]


Roots


The roots are used to make a decoction which is taken orally


-


-

	^[	³²	^]	[	67	]
Asteraceae	Helichrysum caespititium (DC) Harv.	Bokgatha/Mabjana/Mmeetse; Limpopo Province	Whole plant	The different parts are used to make a decoction which is taken orally	-	-	^[32][67]
Asteraceae	Helichrysum gymnocomum DC. var. acuminatum DC.	Imphepho (Xhosa); Eastern Cape	Leaves	The leaves are used to make an infusion which is taken orally	-	-	^[32][67]
Asteraceae	Herichrysum odoratissimum L.	Imphepho; Eastern Cape	Whole plant	The different parts are used to make a decoction which is taken orally	-	-	^[43][34]
Asteraceae	Herichrysum nudifolium L.	Ichocholo; Eastern Cape	Leaves, roots	The leaves are used to make an infusion which is taken orally	-	-	^[43][34]
Asteraceae		-	-		Increases glucose uptake in Chang liver cells, 3T3-L1 pre-adipocytes	In vitro cultures of preadipocytes and hepatocytes	^[47][60]
Asteraceae	Tarchonanthus camphoratus L.	Limpopo Province, Eastern Cape	Roots, leaves/soft twigs	The leaves are used to make an infusion which is taken orally	Increases glucose utilization in Chang liver cells and C2C12 muscle cells	In vitro cultures of myocytes and hepatocytes	^[48][79]
Asteraceae	Herichrysum petiolare H & B.L.	Imphepho; Eastern Cape	Whole plant	The different parts are used to make a decoction which is taken orally	-	-	^[43][34]
Buddlejaceae	Chilianthus olearaceus Burch.	Umgeba (IsiXhosa); Eastern	Leaves, and twigs	The twigs are used to make a decoction which is taken orally	-	-	^[43][34]
Cactaceae Opuntia	ficusindica Mill.	Motloro; Limpopo Province	Roots	The roots are used to make a decoction which is taken orally	Hypoglycemic	Type 2 diabetic patients; STZ-treated mice; alloxan-treated mice	^[49]^[50][80,81]
Caricaceae	Carica papaya L.	Mophopho; Limpopo Province	Leaves, toots, seeds, pulp	The leaves are used to make an infusion which is taken orally	Hypoglycemic, hypolipidemic; increases the regeneration of pancreatic β-cells and renal cuboidal cells; anti-atherogenic	STZ-treated rats; alloxan-treated rats	^[51]^[52]^[53][66,82,83]
Caryophyllaceae	Dianthus thunbergii S.S.Hooper forma thunbergii.	Indlela-zimhlope	Roots	The roots are used to make a decoction which is taken orally	-	-	^[34][35]
Celastraceae	Elaeodendron transvaalense (Burtt Davy) R.H.Archer	Venda, Limpopo	Stembark	The stem barks are used to make a decoction which is taken orally	Increases glucose uptake in 3T3-L1 pre-adipocytes	In vitro cultures of preadipocytes	^[47][60]
Celastraceae	Lauridia tetragona (L.f.) R.H.Archer	Umdlavuza; Eastern Cape	Barks		-	-	^[34][35]
Cucurbitaceae	Cucurbita pepo L.	Intsunga (pumpkin leaves) Newcastle KZN	Upper parts (leaves and stems)		α-glucosidase activity in vitro	In vitro enzyme assays	^[54][64]
Cucurbitaceae	Momordica balsamina L.	Mothwatwa; Limpopo Province	Roots		-	-	^[32][67]
Cucurbitaceae	Mormordica charantia L	Monamelala; Limpopo Province	Leaves, fruit	The leaves are used to make an infusion which is taken orally	Hypoglycemic, hypolipidemic	Diabetic patients; STZ-treated rodent models	^[55]^[56][84,85]
Ebenaceae	Euclea undulata Thunb.	Venda, Limpopo	Rootbark	The root bark is used to make a decoction which is taken orally	Increases glucose uptake in Chang liver cells, 3T3-L1 pre-adipocytes, and C2C12 myocytes; inhibits α-glucosidase activity	In vitro cultures of preadipocytes, myocytes, and hepatocytes; in vitro enzyme assays	^[47][60]
Fabaceae	Lessertia microphylla (Burch. Ex DC.)Goldblatt & J.C. Manning	Mosapelo; Limpopo Province	Roots	The roots are used to make a decoction which is taken orally	-	-	^[32][67]
Fabaceae	Senna alexandria Mill.	Senna leaves; Newcastle KwaZulu-Natal	Leaves	The leaves are used to make an infusion which is taken orally	Inhibits α-amylase and α-glucosidase activity in vitro	In vitro enzyme assays	^[54][64]
Fabaceae	Sutherlandia frutescens (L.) R.Br.		Leaves, shoots		Hypoglycemic, increases glucose uptake in muscle and adipose tissue	STZ-treated rats	^[57][86]
Hyacinthaceae	Albuca setosa Jacq.	Eastern Cape	Corms				^[34][35]
Hyacinthaceae	Hypoxis argentae L.		Corms		Increases glucose uptake in cultured L6 myotubes and HepG2 cells; increases pancreatic beta cell proliferation	In vitro cultures of rat skeletal muscle cells, human hepatocellular carcinoma cells, and	^[58][65]
Hyacinthaceae	Hypoxis colchicifolia Bak.	Inongwe; Eastern Cape	Corms		-	-	^[43][34]
Hyacinthaceae	Hypoxis hemerocallidea Fisch. & C. A	African potato Inongwe; Eastern Cape	Corms		Hypoglycemic ethyl acetate extract inhibits α-amylase and α-glucosidase activity in vitro; acetone extract increases insulin release from cultured islet cells	STZ-treated rats, in vitro enzyme assays; cultured Sprague Dawley rat pancreatic islet cells	^[54]^[56]^[59]^[60][64,85,87,88]
Hyacinthaceae	Hypoxis iridifolia Baker Monna maledu; Limpopo Province	Monna maledu; Limpopo Province			-	-	^[32][67]
Lamiaceae	Leonotis leonorus (L.) R.Br.	wild dagga, lion′s ear, leonotis (Eng.); wildedagga, duiwelstabak (Afr); umfincafincane, umcwili, imunyane, utshwalabezinyoni (isiZulu)	Whole plants	The different parts are used to make a decoction which is taken orally	Hypoglycemic, hypolipidemic	STZ-treated rats	^[61]^[62][89,90]
Loganiaceae	Strychnos henningsii Gilg				Hypoglycemic, hypolipidemic; increases insulin sensitivity in 3T3- L1 cells	STZ-treated rats; in vitro cultures of rat pre-adipocytes	^[34]^[63][35,
Menispermaceae	Cissampelo capensis L.	Umayisake (IsiXhosa)/David root (English); Eastern Cape	Roots	The roots are used to make a decoction which is taken orally	Improves glucose utilisation in 3T3- L1 cells	In vitro cultures of preadipocytes	^[17]^[45][45,77]
Poaceae	Cymbopogon citrutus Stapf	Isiqunga (lemon grass); Newcastle KZN	Whole plant	The different parts are used to make a decoction which is taken orally	Inhibits α-amylase and α-glucosidase activity in vitro	In vitro enzyme assays	^[54][64]
Sapotaceae	Mimusops zeyheri Sond.	Mmupudu; Limpopo Province			-	-	^[32][67]
Solanaceae	Solanum aculeastrum Dunal	Umtuma; Eastern Cape	Roots	The roots are used to make a decoction which is taken orally			^[63][61]
Stilbaceae	Nuxia floribunda Benth.	Umlulama (forest elder) Newcastle KZN	Whole plant	The different parts are used to make a decoction which is taken orally	α-glucosidase activity in vitro	In vitro enzyme assays	^[54][64]

3. The Use of South African Medicinal Plants in the Management of Cardiovascular Disorders

Cardiovascular disorders (CVDs) are the leading cause of the global increase in mortality among individuals in developed ^[64][91] and, more recently, in developing countries such as South Africa ^[65][92]. CVDs and their risk factors include hypertension, myocardial infarction, angina pectoris, stroke, atherosclerosis, peripheral artery disease, and transient ischemic attack, to name but a few ^[66][93]. Lowering high blood pressure using anti-hypertensive regimens is considered an effective way of preventing complications associated with CVDs. Most traditional anti-hypertensive pharmaceutical drugs include angiotensin receptor blockers, β-blockers, thiazide diuretics, calcium channel antagonists, and vasodilators ^[67][96]. Several plant extracts that possess therapeutic potential for the treatment of CVDs such as hypertension, atherosclerosis, ischemic heart disease, and congestive heart failure, among others, have been identified ^[68][69][97,98]. Common plants that are used in the treatment of cardiovascular diseases are shown in Table 3.

Table 3.

Plants used in the management of cardiovascular diseases in South Africa.

Family Name	Scientific Name	Local Name and Region Where Used	Plant Part Used	Methods of Herbal Material Preparation	Mechanisms	Scientific Model Used	Reference
Asteraceae	Helichrysum ceres	Blombos straw flower (English); Izangume (Zulu) Northern Cape, Western Cape	Leaves	The leaves are used to make an infusion which is taken orally	Hypotensive	Dahl salt-sensitive genetically hypertensive rats	^[70

ACE, angiotensin-converting enzyme.

4. South African Medicinal Plants for Non-alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is a major cause of morbidity and mortality worldwide. Although non-alcoholic fatty liver disease is generally associated with obesity and has been considered as the metabolic manifestation of MetS, recent evidence shows that it can develop independently of metabolic syndrome ^[80][112]. The diagnosis of NAFLD requires the use of either diagnostic biopsies or advanced technology. Consequently, traditional medical practitioners are highly unlikely to be able to diagnose NAFLD in patients. Therefore, in reporting on medicinal plants used for the management of or showing biological activity against NAFLD, this work will focus on South African plants which have been confirmed to demonstrate activity against hepatic steatosis. The available literature is also mainly from lab animal studies. High-fructose diets have been implicated in the development of NAFLD. ItWe hasve recently been shown that aqueous extracts of Terminalia sericea leaves prevented the development of NAFLD in Wistar rats fed a high-fructose diet for 12 weeks ^[81][113]. There are several plants with demonstrated efficacy for prophylaxis and/or treatment of NAFLD in experimental models of the disease (Table 4).

Table 4.

List of plants with laboratory-tested potential for use in the treatment of non-alcoholic fatty liver disease in South Africa. AMPK, AMP-activated protein kinase.

Family Name