Located in a mountainous region in the west of China on the slopes of the Himalayas, Bama County is famous for longevity. Indeed, it sometimes is called the "home of longevity" because, despite its small population of less than 230,000 people, circa 2000 there were at least 79 men and women over one hundred years old and still in good health. The ratio was 3.52 centenarians per ten thousand people, seemingly the highest found anywhere in the world. The inhabitants of Bama look younger than their chronological ages and even their grazing animals are noted for good health and long lives. The official line from the Chinese government is that the health of the inhabitants is a result of the area being blessed with good water combined with clean air and a diet consisting preponderantly of vegetables and lean pork. All true, but not particularly distinguishing from any number of mountainous areas in other parts of the world or even in China. Moreover, harsh living conditions can be quite taxing on the elderly and shorten life, for example, due to accidents and illnesses during long winters. Hence, if the Bama live longer lives than would be expected, something other than a mountainous environment would seem to be responsible.
Local residents and some medical researchers suggest that the secret to the longevity of the people of Bama is attributable, at least in part, to the daily consumption by both villagers and their herds of a plant they call shilianhua, meaning in English "rock lotus" or "stone lotus." Another Chinese name for the plant is He Hua Zhang, which, again, refers to a "lotus." "Lotus" in this context means a "wheel." The Latin taxonomical name is Sinocrassula indica; it is a type of succulent plant with rosettes of fleshy leaves. (Flora of China 8: 214-7. 2001)
Shilianhua has been used both as food and as a medicinal herb in the Bama region for hundreds of years. Yet the rock lotus has been a minor element in standard traditional Chinese medicine because, in large part, that medical system was codified around herbs that easily could be dried and brought to the Emperor's Court in Beijing. However, this obscurity may be coming to an end. Professor Ding Jian of Beijing University and a number of Japanese researchers over the last two decades have been studying the rock lotus with an eye towards uncovering its secrets. Professor Ding holds three patents covering the use of the herbal extract as a dietary supplement in Japan (1994), China (1997) and the United States (1999). Interestingly, the rock lotus long has been found in American gardens as an ornamental plant and, as a vegetable, it sometimes is available in Japanese and Taiwanese Chinese markets here in the U.S.
Blood Sugar and Liver Function
Two clinical studies have tested the effects of rock lotus. The first of these took place at Beijing Chinese Medical University, Beijing, China in 1998 and examined the benefits in Type II diabetic patients.1 These subjects were classified as having fasting blood sugar levels greater than or equal to 140 mg/dl or, at any time, blood sugar levels greater than or equal to 200 mg/dl. All sixty-two subjects continued to take their normal medications. The rock lotus group took a 200 mg tablet containing 20 mg extract three times per day with water for four weeks; the placebo arm took an identical tablet with the same protocol.
The results of the trial showed that tablets made of rock lotus extract effectively reduced blood sugar levels and relieved diabetic symptoms of the tested patients. Using their standards for clinical significance, the researchers found that 66.67 percent (17.24 percent for placebo) and 18.18 percent (41.38 percent for placebo) of the diabetic patients, respectively, showed very effective and effective response to the tablets. This means that in already medically treated patients, blood sugar levels decreased a further =30 percent (very effective) or =10 percent (effective). In total, 84.85 percent of the tested patients responded to the tablets and that this response was significant compared to placebo. These results are in line with those of an animal trial conducted independently in Japan at about the same time.2
Safety also was evaluated by running panels of tests covering liver and kidney functions plus a blood panel. These safety tests conducted before and after the trial showed that the values of red blood cells, white blood cells, platelet, transaminase, bilirubin, inosine, urea nitrogen, etc., all remained in the normal range. This safety profile mirrors the results of animal trials. One trial looking at different safety parameters found that in mice supplemented with the herb, plasma triglyceride (TG) and free fatty acid (FFA) concentrations decreased and liver glycolytic enzyme and glutathione peroxidase activities increased significantly compared with those in the non-treated control mice, which is to say, liver function improved.3 Another finding was that the effect of the herb on liver function increased over time, higher initial intakes being less effective than lower intakes consumed over a longer time frame. In another mouse trial, various groups took 1 mg/kg, 50 mg/kg and 100 mg/kg of the extract, respectively, equivalent to 10 times, 50 times and 100 times the intake for humans. At 45 and 90 days, tests showed no abnormalities in any parameter. Likewise, the extract did not lead to low blood sugar even at extremely elevated levels of intake.4
A second clinical trial took place at Jutendo Medical University in Japan and was published in a Japanese journal Eastern Medicine in 1998.5 This study lasted five months and examined both modern blood markers and traditional Japanese categories of health starting with apparently healthy subjects to establish whether rock lotus extract can prevent deterioration in what are known as the "congestion phenomena" of Japanese medicine. These phenomena are associated with the development of obesity, high uric acid, high blood pressure, high blood lipids, high blood sugar and atherosclerosis. In the Japanese model, there are important psychological and behavioral components included in congestion phenomena. In this trial, in particular, those with "intensive congestion" phenomena were under more psychological stress, great pressure to drink alcohol to excess, to eat to excess and the eat the wrong foods, to get inadequate exercise and rest, etc. The subjects in this study were mostly company managers who, due to business restructuring, were under great pressure to constantly socialize and entertain clients, which in the Japanese context meant constant eating and enforced drinking.
The Japanese study found that rock lotus extract reduced excess body fat significantly, including excess fat associated with the inner organs. Of particular note, rock lotus extract consumption led to improvements in liver function tests. Rock lotus was judged useful in preventing the development of arteriosclerosis and fatty liver and was found to be helpful in lowering blood sugar levels. Rock lotus extract was useful in all the groups tested with the exception of the "intensive congestion" group. In this group alone, it did not reduce the consumption of excess alcohol and had no significant impact on blood sugar levels or body fatness. In other words, rock lotus extract was judged to be of significant benefit in all groups under relatively normal conditions, but could not undo great excesses in the consumption of alcohol and food coupled with lack of exercise and lack of rest.
In short, rock lotus extract in human trials has proved to be useful in blood sugar regulation in both diabetics and non-diabetics without causing low blood sugar. Over a period of months, the extract in one trial reduced excessive body fat and, in general, greatly improved biochemical markers of liver function. Both clinical and animal trials have confirmed the safety of rock lotus extract in humans.
A Calorie Restriction Mimetic
Japanese researchers have identified a number of strongly anti-diabetic compounds in rock lotus.6 However, the truth is that despite the success of the clinical trials testing blood glucose regulation, the real promise of rock lotus for most people lies elsewhere, in a word, longevity. Longevity is the benefit that the Bama County inhabitants find with rock lotus. The question is, why. Scientists have undertaken a number of experiments that have gone a long ways toward uncovering the answer.
As a result of studies on resveratrol, much has been made of the role of the cell regulators known as sirtuins in longevity. Under various types of dietary excesses, resveratrol has been shown to preserve health in animals, such as mice, similar to controls. However, the sirtuins have not been demonstrated to actually extend lifespan in higher organisms. Only two mechanisms have been shown to be successful in higher organisms, as opposed to, say, yeast cells and fruit flies. The first is lowering the levels of insulin and insulin-like growth factor 1 (IGF-1). The second is restricting calories, which usually has, as one result, a lowering of circulating insulin levels.
Rock lotus influences both of these mechanisms. With regard to insulin, although this has not been tested directly, the extract has been demonstrated, including in humans as noted above, to improve blood glucose regulation significantly. Importantly, neither human nor animal trials report low blood sugar even when rock lotus extract was consumed at a rate 100 times what a human would normally take, which suggests that rock lotus' mechanism of blood sugar regulation does not involve elevating insulin output. This is in contrast with the actions of a number of herbs, including Gymnema sylvestre, which act by increasing insulin release. Similarly, according to the Jutendo Medical University clinical trial, rock lotus improves liver function and fatty liver. This action is similar to that of compounds known to reduce insulin levels as an aspect of improved blood glucose control.
Next, rock lotus is a calorie restriction mimetic. Restricting calories influences quite directly the energy metabolism of cells. In fact, the activation of sirtuins is merely one downstream effect of altered energy metabolism. This alteration in energy metabolism usually is expressed as a change in the ratio of NAD+ to NADH where NAD is nicotinamide adenine dinucleotide.7 The explanation of the biochemistry is complicated, but the essential point is that in calorie restriction, the ratio is increased in favor of NAD+ over NADH in the body (cytoplasm) of the cell; in conditions such as diabetes, the reverse is true. The impact of rock lotus supplementation is to change the ratio in favor of NAD over NADH in a way similar to that accomplished by caloric restriction.8 This knowledge comes from very nice work done in Japan using Dr. Ding's rock lotus extract. The mechanism demonstrated for rock lotus (the malate-aspartate NADH shuttle system) has itself been suggested as a regulator of longevity.9
Rock lotus has been shown to influence several of the physiologic pathways associated with caloric restriction. The extract improves carbohydrate and fat metabolism while helping to control body weight and body fat levels. It lowers serum glucose. It modulates some known inflammatory factors by improving liver function and the liver's production of key antioxidant enzymes, such as glutathione. Other factors remain to be tested. For instance, it would be nice have research on the impact of rock lotus supplementation on the expression of the gene regulator nuclear factor-kappa ß (NF-kB) and its most common and damaging cytokine product, tumor necrosis factor-alpha (TNF-alpha).
Using the Right Herb
Shilianhua research has been subject to more than its fair share of confusion. Japanese researchers on occasion have referred to the herb as Echevaria glauca and by the Japanese common name Nikasyou instead of Sinocrassula indica or the correct Japanese, Sekirenka. The plants look very similar and most taxonomies list both as Crassulaceae species. However, Echevaria glauca apparently is found only in the Americas. This has not been a problem because all published research not only has been positive, but also has been based on materials from Dr. Ding. However, one set of prominent researchers in the United States, despite the images freely available showing the proper plant and numerous texts showing that Sinocrassula indica is a succulent with leaves is rosettes, actually claimed that "shilianhua is the Chinese name for houseleek, which is widely distributed in the world.10 and performed research on, well, a leek, including pictures of this leek. It is curious how this mistake could have been made, especially as these same researchers had purchased a commercial tablet made with Dr. Ding's material and found excellent results in animal experiments. Keep in mind that in Chinese, shilianhua quite literally means "rock lotus," which is to say, it does not refer to a leek. The point is that one must be careful to acquire the right material from the right plant. In this case, the right material is the material patented by Dr. Ding in Japan, China and the United States. The proper amount of the supplement is 60 to 120 mg of the extract daily divided between two or three servings.
The authors of the Jutendo Medical University study on rock lotus make an important distinction regarding herbs and health. As they note, there is "treatment medicine and preservation health medicine. The former is to cure the disease when one gets the disease, i.e. 'treatment medicine' (cure after disease). The latter is applicable to the daily life, 'living medicine.' This medicine can also be called 'preservation health medicine' (cure before disease)."
If we follow the wisdom of the saying, "an ounce of prevention is worth a pound of cure," rock lotus is an ounce of prevention. It supports normal blood sugar metabolism and liver function and it improves carbohydrate and fat metabolism while helping to control body weight and body fat levels. This much is known from clinical and animal trials. The "hidden" promise of rock lotus is that experienced by the Bama: the promise of longevity.
- Available under the title, "Report of "Le Tang An"(Shilianhua) Tablet Clinical Trial on Humans" as part of an English introduction to Shi Lian Hua. Abbreviated formats available in Chinese and the full report is on record at Research Institute of Information Administration and DME, Research Institute of Prevention Medicine, Faculty of Health Administration, Beijing Chinese Medical University.
- The clinical data is in accordance with animal data, such as in Arai T, et al., Changes in Activities of Blood Cell Enzymes in Diabetic Dogs Treated with Herb (Nikasyou). Bulletin of Nippon Veterinary and Animal Science University. 1999;48:15-20. In this trial, the activities of key glycolytic enzymes, hexokinase, glucokinase and pyruvate kinase were significantly restored by the herbal treatment in streptozotocin-induced diabetes.
- Arai T, et al. Effect of herb supplement on hepatic enzyme activities in ddY mice. Lab Anim. 2001 Jul;35(3):288-91.
- This small animal safety trial write-up is available in Chinese with an English translation.
- Ei Ryu, Yasushi Fukuwatari, Nobuhiro Sato, Ryuzo Kawamori. Scientific approach to "mibyouigaku" [pre-symptomatic medicine] medicine. Prevention of lifestyle habit disease by Nikashou. Eastern Medicine 1998;14(4):9 – 22, Supplement. Also available in Japanese with English parts as Rock Lotus shilianhua report 2 in full English translation as Rock Lotus English_ Jutendo Medical University Japan.
- Yoshikawa M, Wang T, Morikawa T, Xie H, Matsuda H. Bioactive constituents from Chinese natural medicines. XXIV. Hypoglycemic effects of Sinocrassula indica in sugar-loaded rats and genetically diabetic KK-A(y) mice and structures of new acylated flavonol glycosides, sinocrassosides A(1), A(2), B(1), and B(2). Chem Pharm Bull (Tokyo). 2007 Sep;55(9):1308-15. Also Morikawa T, Xie H, Wang T, Matsuda H, Yoshikawa M. Bioactive constituents from Chinese natural medicines. XXXII. aminopeptidase N and aldose reductase inhibitors from Sinocrassula indica: structures of sinocrassosides B(4), B(5), C(1), and D(1)-D(3). Chem Pharm Bull (Tokyo). 2008 Oct;56(10):1438-44. Also Morikawa T, Xie H, Wang T, Matsuda H, Yoshikawa M. Acylated flavonol bisdesmosides, sinocrassosides A3-A7 and B3, with aminopeptidase N inhibitory activity from Sinocrassula indica. Chem Biodivers. 2009 Mar;6(3):411-20.
- Reducing the cellular NADH/NAD ratio also is the primary mechanism of caloric restriction in inducing sirtuin activation. See Calorie restriction extends yeast life span by lowering the level of NADH. Genes & Dev. 2004;18:12–16)
- Animal work has demonstrated that the activities of malate dehydrogenase (MDH) and aspartate aminotransferase (AST) in the malate-aspartate shuttle increased remarkably in mitochondria of leukocytes from dogs fed the herb supplementation at the rate of 2 mg/kg body weight. The authors suggested that supplementation might activate NADH shuttle systems and mitochondrial energy metabolism in dogs. See Arai T, et al. Changes in activities of enzymes related to malate-aspartate shuttle in leukocytes from dogs given a herb supplement. J Vet Med Sci. 2001 Jun;63(6):695-7.
- Easton E, et al. The malate-aspartate NADH shuttle components are novel metabolic longevity regulators required for calorie restriction-mediated life span extension in yeast. Genes & Dev. 2008 22: 931-944
- Yin J, Zuberi A, Gao Z, Liu D, Liu Z, Cefalu WT, Ye J. Effect of Shilianhua extract and its fractions on body weight of obese mice. Metabolism. 2008 Jul;57(7 Suppl 1):S47-51.