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Medscape
25-07-2025
- Health
- Medscape
Okra for Glucose Control: Ancient Practice or Pseudoscience?
A member of the mallow family, cousin to hibiscus, cotton, and cocoa, okra is one of the world's oldest cultivated crops, with origins in Africa — specifically around Ethiopia and Eritrea — dating back over 1000 years. Its use as both a food and a medicinal plant developed alongside its cultivation, but it took the arrival of the Internet for it to become a viral sensation for supposedly managing blood glucose levels. Okra, and specifically okra water, has gone through periods of popularity, but it's currently hotter than ever: Pinterest alone reported a 470% spike in searches for the term from June 2023 to June 2024. With its popularity at an all-time high, it's important to know the science behind the consumption of this viral veggie. Is eating okra or drinking okra water actually helpful when it comes to controlling glucose? Most importantly, is it safe for people with diabetes or for anyone seeking to improve their overall health? The Data on Okra The nutritional benefits of all of okra's various components — its leaves, pods, seeds, and mucilage — have been studied, although not widely. One of the first research efforts to identify the potential efficacy of okra in glucose control was a 1989 Japanese study. It showed that the mucilage of the vegetable has a significant hypoglycemic effect due to its backbone chain that consists mainly of L-rhamno-D-galacturonan. In 2018, further research was performed in which the water extract of the okra was prepared in order to isolate the leading polysaccharide fraction, which was again found to be rhamnogalacturonan. In this study, the rhamnogalacturonan was found to decrease blood glucose levels and glucose tolerance. A 2023 meta-analysis of studies from Medline and Scopus came to the conclusion that ' okra treatment in prediabetic and T2D [type 2 diabetes] patients has beneficial effects on glycemic control, as demonstrated by a significant reduction in the level of FBG [fasting blood glucose].' It's important to note that after a detailed literature search, various issues disqualified all but eight studies in this meta-analysis. In addition to its benefits for blood glucose, okra is high in vitamins, especially vitamin K: One cup of okra provides almost 70% of the daily recommended target for this important nutrient, which is critical for blood clotting and bone health. Okra also delivers high quantities of magnesium, folate, potassium, and calcium. As far as the science goes, it would seem that okra measures up to the hype. Doctors are skeptical, though. Ali Chappell, PhD, MS, RD 'There's very little clinical evidence that okra water has any meaningful impact on blood sugar levels,' said Ali Chappell, PhD, MS, RD, and CEO of Lilli Health, Houston, which specializes in low-insulin lifestyle design. 'That being said, it is high in soluble fiber, which can help you feel more full, leading to less overeating and, in turn, could support better blood sugar control.' Michael Aziz, MD, an attending physician at Lenox Hill Hospital in New York City, is even more strident in his cynicism regarding the efficacy of the potion. Okra is a vegetable. But using okra as the basis for a health drink? Michael Aziz, MD 'The users claim that chopping up okra, soaking it in water, and refrigerating it overnight before drinking it every morning boasts all sorts of benefits, from helping with pregnancy and diabetes to increasing sex drive and boosting gut health,' he said. Aziz said the main benefit he can see from the okra water delivery actually comes from drinking more water. He acknowledged that there may be some effect on glucose levels. 'The drinkers report feeling more energized and having a lower blood pressure. It appears okra water can drop sugar levels. There are no scientific studies to back up these claims,' he said. 'Any benefits from drinking okra water will be from staying hydrated.' Why Okra Water? Okra can be a bit of an acquired taste. While eating the whole pod provides more nutritional benefits, the mucilage, or 'slime,' that contains its beneficial compounds can be a turnoff when the vegetable is stewed or boiled. Of course, there are other ways to cook okra that don't leave it with a slimy finish, like deep-frying — not the healthiest way to eat anything — or roasting. When it comes to the use of okra for health benefits, it seems that okra water has become popular because it's a quick and easy way to get the desired nutritional compounds without actually eating a bunch of vegetables. Okra is a vascular vegetable with a high-water concentration, and the compounds shown to be effective in glycemic control come from its mucilage. Okra water is made by slicing the okra pods in half lengthwise in order to expose the most surface area, then soaking them in water overnight. The water is then strained, and the okra is discarded. The water will be a bit thick from the mucilage, but that's where the nutrients are. Who Should Steer Clear of Okra Water Okra water is generally innocuous, but doctors say that anyone with gastrointestinal conditions like irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) should use caution when drinking okra water. Okra contains fructans, which are a type of fermentable oligosaccharide, disaccharide, monosaccharide, and polyol. These are short-chain carbohydrates that are poorly absorbed in the small intestine. For individuals with IBS or IBD, these undigested carbohydrates can ferment in the colon, leading to unpleasant gastrointestinal side effects. Additionally, even though the okra itself is discarded when making okra water, the water still gains a relatively high fiber content from the mucilage. While fiber is generally good for gut health, the type and amount of fiber can be problematic for people with IBD, particularly during a flare-up. Okra contains both soluble and insoluble fiber. While soluble fiber, like the mucilage, can be soothing and help regulate bowel movements, a sudden increase in fiber consumption or a large amount of any fiber can sometimes exacerbate symptoms like cramping and diarrhea during an IBD flare. During active inflammation, the gut lining is highly sensitive, and even beneficial fibers can be irritating or contribute to discomfort. Even though okra is in the mallow family, it's often discussed in the same context as nightshade vegetables because it contains compounds that some individuals with inflammatory conditions, including IBD, say exacerbate their symptoms. While the science regarding this connection is not fully conclusive, anecdotal evidence from patients with IBD suggests that some find relief by avoiding such foods. Lenox Hill's Aziz added some additional cautions. 'Okra water can cause bloating, as it has slimy mucilage if drunk in excess,' he said. 'It is also high in oxalates, which can lead to the formation of kidney stones.' As for its ability to control glucose, he said it can cause hypoglycemia, leading to a need for careful monitoring of blood sugar, especially when being used by people with diabetes. As with any other food, it is possible to have an allergy to okra. It's also possible to have a contact reaction to okra, though both this type of allergy and the food allergy are rare. Make This at Home To give okra water a try, take 4-6 fresh okra pods that are free from blemishes, and wash them under the tap to clean them off. Slice them in half lengthwise and put them into a jar with 1-2 cups of water — filtered or distilled is recommended. Use more water for a less viscous beverage and less water for a thicker beverage. Put the lid on the jar and refrigerate overnight. In the morning, strain the liquid through a colander or through cheesecloth into a glass. Squeeze the pods to get more of the mucilage out if so desired. Add a lemon or some mint for extra flavor. 'Adding a flavor to the water, whether it is lime or cucumber, will add a twist and more likely make you drink more water and stay hydrated,' Aziz said. Viral videos may recommend that the okra water be consumed first thing in the morning, but there is no evidence that the time of day makes any difference in whatever benefits may be derived from the okra water — or not.
Medscape
14-07-2025
- Health
- Medscape
An Elusive PCOS Diagnosis Could Explain Obesity Issues
As a teenager, Ali Chappell, PhD, CEO and founder of Lilli Health, hid food in her room. She said that while she had plenty of access to meals and snacks, she never felt satisfied. Chappell felt shame at the amount of food she consumed. 'I felt very out of control around certain types of food. The minute I woke up in the morning, it was, what was I going to eat and how much was I going to get to eat,' Chappell, now 38 years, said. 'I remember waking up in the middle of the night to go run on the treadmill because I was gaining weight and gaining weight and gaining weight.' She had a number of hormonal symptoms during the same time: Chappell battled acne that required treatment with Accutane twice while she was in high school; she only came off the drug because as a 15-year-old, her cholesterol 'got way out of control.' Ali Chappell, PhD It would be years before a doctor at her college said her symptoms, including disordered eating, very well could be polycystic ovary syndrome (PCOS). Before that, however, Chappell said she had wild mood swings during her teenage years, with her mom describing her as 'an absolute mood disaster.' Also, Chappell didn't get her period until she was 16 years — or at least, that's what she thought. She struggled for years with extremely infrequent periods, often getting her menses only once every 12 months or so. 'My mom was concerned I wasn't having a period and took me to the family doctor — we didn't have a gynecologist in our small town. The doctor ordered an ultrasound, and I just remember them saying, oh, you have a lot of cysts on your ovaries, but that's okay, it's normal,' Chappell recalled. 'I had another two or three ultrasounds (between) ages 16-21, and they kept saying I had cysts on my ovaries, but it's okay.' Chappell's disordered eating continued to worsen as she completed her undergraduate studies in nutrition at Texas A&M University, College Station, Texas. Finally, the summer before she turned 22 years, she went to the university hospital to get a prescription for contraceptives. The doctor there ordered bloodwork, which revealed that Chappell's thyroid was underactive, and her testosterone was high; she also ordered an ultrasound. At the conclusion of the tests, the doctor brought all of Chappell's symptoms together under one name, one she'd never heard before. 'She said, 'You've got a lot of cysts on your ovaries, you're not having a period, you're having acne. All of this lines up to be PCOS,'' Chappell said. 'So that was it. She said, 'You're going to need to watch your weight, and I'm going to put you on these birth control pills so we can get you a cycle started.' She gave me a pamphlet about polycystic ovary syndrome. I'd never heard of it. And that was the end of that.' Chappell was sent on her way with a lot of questions. As a nutrition major, and as someone who'd had an unhealthy relationship with food all her life, her thoughts immediately turned to a potential relationship between PCOS and diet — what could watching her weight possibly have to do with her ovaries? That question would define her scholarly career and her life's work. PCOS is a hormonal disorder that affects women of reproductive age. It's characterized by a combination of symptoms, including all of those Chappell experienced: irregular or absent menstrual periods, higher-than-normal levels of androgens, and often, but not always, the development of many small fluid-filled sacs on the ovaries — though cysts don't have to be present. This hormonal imbalance can lead to additional symptoms such as excess hair growth, acne, weight gain, and thinning hair, and can also cause infertility. While the exact cause isn't fully understood, factors like genetics, insulin resistance, and low-grade inflammation are thought to play a role, and if left unmanaged, PCOS can increase the risk for long-term health issues like type 2 diabetes and heart disease. World Health Organization statistics show that PCOS affects as many as 1 in 8 women worldwide, but that up to 70% of women affected by this disorder may never receive a diagnosis. Additionally, Katherine Schafer, PhD, MEd, a licensed clinical psychologist and assistant professor at Vanderbilt University Medical Center in Nashville, Tennessee, said that the type of disordered eating Chappell experienced is common in women with PCOS. 'The best scientific research that we have shows that PCOS and disordered eating are closely linked,' she said. A recent meta-analysis showed that women who had PCOS were more likely than healthy controls to have disordered eating and meet criteria for eating disorders, including bulimia nervosa. 'In fact, when we look at the women who had PCOS, up to 12% of them met criteria for bulimia nervosa in their lifetime, which was much higher than in the general population, where we see only 3% of women meeting criteria for bulimia nervosa in their lifetime. 'This link between disordered eating and PCOS might be driven through hormones and neurotransmitters and create a self-amplifying cycle between eating pathology and PCOS symptoms,' Schafer said. Women who have PCOS often have disturbances in their levels of hormones and neurotransmitters including serotonin, leptin, and cortisol, which may leave them susceptible to developing eating disorders, which in turn might intensify and exacerbate hormonal disturbances, she said. Katherine Schafer, PhD, MEd Upon receiving the diagnosis of PCOS, Chappell vowed to get educated. She quickly found that all her research led her in one direction. 'I went to PubMed and I downloaded and printed out every single article that I could find that was about PCOS. Everything kept going back to one single point, and that was insulin,' she said. 'By that point, the only thing I'd learned about insulin was that you gave it to diabetics to lower their blood sugar. Never once (in school) did I learn anything about insulin resistance or what that meant.' Chappell earned both her master's and doctorate degrees at Texas Tech University, Lubbock, Texas. She arrived at grad school on a mission — she wanted to research the connection between insulin and PCOS in a clinical setting. Before she even started her master's degree, Chappell had already written a 100-page proposal outlining this research. Chappell said that as she completed that degree, her PhD advisor suggested she try to get the funding for her own research and pointed her in the direction of The Laura W. Bush Institute for Women's Health. 'She said 'This is something they would love. You just have to find a fertility specialist who's willing to work with you so that they put a little bit more credibility to what you're doing,'' Chappell said. 'I think I'd already put in the grant application before I'd even finished my master's.' Chappell's advisors at Texas Tech were impressed with her thoroughness and tenacity. 'Ali was very knowledgeable about PCOS and enthusiastic about how her (low-insulin) nutritional approach had worked for her,' said Mallory Boylan, PhD, RD, LD, a member of the research faculty at Texas Tech's Center of Excellence in Obesity and Cardiometabolic Research. 'She had reviewed literature that related to the topic and found very little that directly related to her research topic. She worked tirelessly to find a clinician who would collaborate with her so she could get a grant for the research.' In 2011, The Laura W. Bush Foundation made a grant to Chappell in the amount of $25,000 to perform her doctoral research. Chappell's 8-week dissertation study 'Effect of a Low Insulinemic Diet on Clinical, Biochemical, and Metabolic Outcomes in Women with PCOS, enlisted 24 women with polycystic ovary syndrome.' Prior to the study, they discontinued insulin sensitizers, oral contraceptives, and cyclic progesterone. Ten of the participants underwent testing using a metabolic cart to analyze fasting and after-meal energy expenditure, respiratory exchange ratio, and macronutrient oxidation after consuming a high-saturated fat shake. The participants were placed on a low insulinemic diet, instructed to eat as much as they cared for of the following foods: lean animal protein; non-starchy vegetables; fruits, including fatty fruits; and nuts, seeds, and oils. Participants older than 21 years were allowed one 6-ounce glass of red wine per night, and all subjects were allowed up to 1 ounce of prepared or fresh, full-fat cheese each day. The diet excluded all grains, beans, and pulses; all dairy products except cheese and butter; and all forms of sugar and sweeteners because of their insulinotropic properties, although sugar substitutes were allowed. The individuals in the study were not advised to count calories or carbohydrates, and they were encouraged to eat until they were satisfied, but not to overeat. They were instructed to continue their normal exercise routine for the duration of the study. The study's participants realized significant improvements. They saw marked reductions in weight, BMI, fat mass, and waist/hip circumference, alongside significantly lower fasting and 2-hour insulin, triglycerides, very low-density lipoprotein, and testosterone levels — with all the changes showing very high statistical significance ( P <.0001 for most). The diet also dramatically shifted metabolism toward increased fat oxidation and led to significant improvements in binge eating behaviors and overall quality of life. Chappell said one critical component of the low insulinemic lifestyle is that it is not about calories. She emphasized that individuals who adopt this way of eating can eat to satiety, and that just as in the clinical studies she has performed, it is about eating as many of the nontriggering foods as possible, while staying away from those that are insulinotropic. She said it is an approach that differs greatly from the traditional approach some clinicians take, telling patients with PCOS that they should lose weight. Sometimes the treatment for PCOS can actually precipitate disordered eating, as clinicians underestimate underlying causes of the disease. 'Many patients with PCOS are advised that their condition is related to their weight and the treatment is weight loss which for some individuals may actually precipitate the onset of an eating disorder,' Elizabeth Wassenaar, MD, DFAPA, CEDS-S, regional medical director with Eating Recovery Center and Pathlight Mood & Anxiety in Denver. 'This is problematic for many reasons; it reinforces diet culture and disordered eating and distracts from understanding weight neutral interventions.' Kim Hopkins, PhD, WHNP-BC Chappell has been an investigator on nine published studies, five of which are specifically in the area of PCOS. She continues the research to this day — now, with the purpose of providing products and services to benefit other women with PCOS via her Galveston, Texas-based company, Lilli Health. Through Lilli, Chappell realized a very important moment in her personal and business lives recently: She made her first research grant in the company's name. 'I have so many plans for research studies in many different areas. That's where I want to go,' she said. 'I just started the first Lilli Health Research grant and I gave a grant award to an investigator at the University of Texas Medical Branch at Galveston. I felt like I'd made the full circle, now I can actually give back to the research. We're in a time when women's health research is dwindling, and getting to be the funder, to be able to give back, is amazing.' Kim Hopkins, PhD, WHNP-BC, a PCOS specialist who practices out of PCOS Paragon Health Services & Consulting in Waldorf, Maryland, said it's long overdue that the clinical community has the opportunity to move beyond one-size-fits-all advice for PCOS. 'Understanding that PCOS exists along a spectrum, has multiple varying symptoms, and impacts overweight, normal weight and lean persons (is important),' she said. 'The only way we're truly going to improve symptoms and long-term outcomes is by addressing the root cause, and that means making insulin-lowering strategies the foundation of treatment. I'm proud to see Lilli Health working behind the scenes to finally bring insulin-lowering strategies to the forefront of PCOS care where it belongs.'
