Generic Name

White mulberry

Mechanism

• α‑Glucosidase inhibition: 1‑deoxynojirimycin (DNJ) binds competitively to intestinal disaccharidases, delaying carbohydrate breakdown and glucose absorption.
• α‑Amylase inhibition: Minor activity reduces post‑prandial glucose rise.
• Increased GLP‑1 release: Leaf extracts enhance glucagon‑like peptide‑1 secretion, improving insulin sensitivity.
• Anti‑oxidative & anti‑inflammatory effects: Polyphenols (e.g., flavonoids) scavenge ROS, down‑regulate NF‑κB, and mitigate endothelial dysfunction.

These actions synergistically lower post‑meal glycemia and may modestly improve lipid profiles.

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Pharmacokinetics

• Absorption: Oral bioavailability of DNJ ~30‑40 % after whole‑leaf consumption; absorption is accelerated in fasted state.
• Distribution: DNJ mainly binds to gut mucosa; systemic exposure is limited.
• Metabolism: Primarily glucuronidation in liver and gut.
• Elimination: Renal excretion of glucuronide conjugates; half‑life of free DNJ ~4‑6 h.
• Drug interactions: May enhance effects of α‑glucosidase inhibitors (e.g., acarbose) and potentiate hypoglycaemic actions of metformin.

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Indications

• Type 2 diabetes mellitus – adjunct to diet and exercise, often combined with metformin or α‑glucosidase inhibitors.
• Pre‑diabetes / impaired glucose tolerance – to blunt post‑prandial hyperglycaemia.
• Obesity / metabolic syndrome – modest weight‑loss effects (~1–3 kg) through appetite suppression and lipogenesis inhibition.
• Hypertension – preliminary evidence of BP reduction via endothelial vasodilation.

> *Clinical trials (RCTs, meta‑analyses) support moderate efficacy in lowering HbA1c by 0.3–0.5 %.*

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Contraindications

• Pregnancy & lactation – data insufficient; avoid use.
• Severe hepatic or renal impairment – unstudied; use caution.
• Hypoglycaemia – risk of additive hypoglycaemic effect when combined with other agents; monitor glucose.
• Allergic reactions – rare hypersensitivity to *Morus* species.

> *Individuals on diabetes medication should consider dose adjustment of glucose‑lowering drugs.*

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Dosing

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Adverse Effects

• Common (≤10 %): abdominal discomfort, diarrhea, bloating, mild hypoglycaemia.
• Serious (≤1 %): hepatotoxicity (rare), severe hypoglycaemia (esp. with insulin/ sulfonylureas), allergic rash.

> *Routine liver‑function tests are reasonable for prolonged use (>3 months).*

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Monitoring

• Fasting plasma glucose & HbA1c – every 3 months.
• Liver transaminases (ALT/AST) – baseline, 3 months, then annually if prolonged therapy.
• Renal function (creatinine, eGFR) – baseline if on renal‑excreted hypoglycaemic agents.
• Blood pressure & lipid profile – baseline, 6 months, then annually.
• Symptom diary – capture GI events, hypoglycaemic episodes, rash, or other allergic signs.

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Clinical Pearls

• Synergy with metformin: Combining *M. alba* with metformin increases fasting glucose and HbA1c decline by ~0.4 % vs. metformin alone.
• Timing matters: Take before meals for maximal α‑glucosidase blockade; avoid right after high‑fat meals, which delay absorption.
• Standardized extracts: Look for DNJ content ≥0.1 % on label to ensure consistent efficacy.
• Avoid in pregnancy: While generally considered safe, embryotoxicity data in rodents necessitates caution.
• Check for polypharmacy: Concomitant CYP3A4 inhibitors may modestly raise DNJ levels, heightening hypoglycaemia risk.
• Weight‑loss note: Effect sizes are modest; use as an adjunct to calorie restriction and exercise, not a standalone weight‑loss strategy.

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