The Effects of Satureja hortensis L. Dried Leaves on Serum Sugar, Lipid Profiles, hs-CRP, and Blood Pressure in Metabolic Syndrome Patients: A Double-Blind Randomized Clinical Trial


Farzad Nikaein 1 , 2 , Siavash Babajafari 1 , * , Seyed Mohammad Mazloomi 3 , Mohammadjavad Zibaeenezhad 4 , Arman Zargaran 5 , 6

1 Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran

2 Research Office for the History of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran

3 Department of Food Hygiene and Quality Control, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran

4 Department of Cardiology, Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran

5 Department of Traditional Pharmacy, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, IR Iran

6 Pharmaceutical Sciences Research Center, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IR Iran

How to Cite: Nikaein F, Babajafari S, Mazloomi S M, Zibaeenezhad M, Zargaran A. The Effects of Satureja hortensis L. Dried Leaves on Serum Sugar, Lipid Profiles, hs-CRP, and Blood Pressure in Metabolic Syndrome Patients: A Double-Blind Randomized Clinical Trial, Iran Red Crescent Med J. 2017 ; 19(1):e34931. doi: 10.5812/ircmj.34931.


Iranian Red Crescent Medical Journal: 19 (1); e34931
Published Online: June 6, 2016
Article Type: Research Article
Received: November 21, 2015
Revised: December 10, 2015
Accepted: January 9, 2016




Background: Metabolic syndrome, which includes multiple metabolic disorders in an individual, has a direct relationship with incidence of various heart diseases. Satureja hortensis L. has been considered to treat this syndrome because its active compounds have valuable therapeutic effects, including anti-inflammatory, antihyperglycemic, vasodilator, and antihyperlipidemic properties as well as being antioxidants and free radical scavengers.

Objectives: This double-blind randomized clinical trial assessed the effects of dried leave of S. hortensis on the serum sugar levels, lipid profiles, high-sensitivity CRP (hs-CRP), and blood pressures of 60 metabolic syndrome patients referred to the healthy heart institute in Shiraz, Iran during 2013.

Materials and Methods: First, components from the essential oil of the plant powder were identified using GC-MS instrumentation. Then, capsules of the plant were used in a double-blind randomized and controlled clinical trial involving 47 metabolic syndrome patients who were treated with either dried leaves from S. hortensis or a placebo capsule once daily for 10 weeks.

Results: This study was registered at the Iranian Registry of Clinical Trials (No. IRCT2014012616372N1). At the end of the study, group changes (mean ± SD) in the group that received S. hortensis showed significant reductions in total cholesterol (239.4 ± 34.6 to 222.3 ± 38.0; P < 0.05), low-density lipoprotein cholesterol (LDL-C) (138.6 ± 25.2 to 117.6 ± 20.8; P < 0.001), triglycerides (TG) (220.0 ± 67.5 to 187.5 ± 65.9; P < 0.05), diastolic blood pressure (DBP) (83.1 ± 11.3 to 75.3 ± 9.5; P < 0.001), and hs-CRP (3.03 ± 1.84 to 1.51 ± 1.76; P < 0.05) as well as an elevation in high-density lipoprotein cholesterol (HDL-C) (43.8 ± 7.4 to 47.3 ± 9.6; P < 0.05). In the placebo group, a significant increase was only observed for hs-CRP (2.31 ± 1.18 to 3.32 ± 1.52; P < 0.05). Different outcomes between the groups (means (95% CIs)) revealed statistically significant diminutions in LDL-C when the dosage was 27.1 mg/dL ((-16.3, -37.9); P < 0.001), in TG with a dosage of 39.1 mg/dL ((-19.5, -64.4); P < 0.05), in DBP with a dosage of 7.6 mm/Hg ((-4.3, -11.2); P = 0.001), and in hs-CRP with a dosage of 2.5 ng/mL ((-1.4, -5.1); P < 0.05).

Conclusions: When used as a supplement, S. hortensis could be helpful for prevention or improvement of metabolic syndrome symptoms and primary concomitant disorders.


Metabolic Syndrome Medicinal Plant Persian Medicine Satureja

Copyright © 2016, Iranian Red Crescent Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Background

Metabolic syndrome, which involves multiple metabolic disorders in an individual, has a direct relationship with incidence of various heart diseases. This syndrome is a major global health concern (1), with symptoms that include hypertension, hyperglycemia, abdominal obesity, and hyperlipidemia (hypertriglyceridemia and lowered high-density lipoprotein cholesterol (HDL-C) and elevated low-density lipoprotein cholesterol (LDL-C) concentrations) (2)

This study examined the use of a medicinal plant to treat the symptoms of metabolic syndrome. Medicinal plants have played an important role in maintaining human health and improving quality of life. Some of these botanical remedies, which include plant extracts and active plant components, are known by consumers as natural and safe remedies for the prevention and treatment of many diseases. Satureja hortensis L. (summer savory), which belongs to the Lamiaceae family, is widely cultivated, and its aerial parts are usually collected during the flowering stage (3). In Farsi, it is called Marze and has been used in Persian medicine for thousands of years in Iran. Previous investigations of this plant have shown that the Saturaja species, including S. hortensis, have some therapeutic effects, including being antioxidants and free radical scavengers and having anti-inflammatory, antihyperglycemic, vasodilator, antihyperlipidemic and antipathogenic microorganism properties (4-10).

A review of available literature has shown that Satureja species are safe when administered to rats. In one study, the essential oil of S. khuzestanica was found to not be lethal in doses up to 2 g/kg of a rat’s body weight, and no signs of toxicity were seen (11). Another study suggested that S. macrostema extract was not lethal in doses up to 4 g/kg of a rat’s body weight after 72 hours of observation (12). Additionally, the LD50 of the essential oil of S. viminea is effective at doses of 556.8 mg/kg of body weight (13).

Other studies have investigated the impacts of Satureja species on specific symptoms of metabolic syndrome (14). Dorman and Hiltunen (2004) used an in vitro study to find that the dried crude extract of S. hortensis exhibited antioxidant and hydroxyl radical scavenging properties (5). Yazdanparast and Shahriyary (2008) also used an in vitro study involving human platelets and found that S. hortensis had the ability to inhibit platelet adhesion to laminin-coated wells, platelet self-aggregation, and protein secretion (15). Moreover, the study by Ramon Sanchez de Rojas et al. (1999) revealed the vasodilatory effects of S. obovata’s eriodictyol on rat thoracic aorta rings (16). Although Abdollahi et al. (2003) found a decline in normal lipid peroxidation, blood glucose, and triglycerides (TG) after using 500–1500 ppm of S. khuzestanica essential oil in the water supply of rats for 15 days, Vosough-Ghanbari et al. (2010) found no alterations in the blood glucose or TG of diabetic patients after treatment with 250 mg/day of the dried leaves of S. khuzestanica for 60 days. Nevertheless, their study revealed a significant reduction in total cholesterol and LDL-C levels and an increase in HDL-C and total antioxidant power (TAP) (7). Another study, conducted by Ahmadvand and Tavafi (2012), found a decrease in TG, LDL-C, cholesterol, fasting blood sugar (FBS), and very low density lipoprotein levels and an increase in HDL-C levels in rats given S. khuzestanica essential oil in their drinking water (500 ppm) (17).

2. Objectives

Different studies have reported the beneficial effects of Satureja species on the underlying symptoms of metabolic syndrome and have suggested that these species should be used to determine the prognoses of patients with this syndrome. The present study assessed the effects of S. hortensis on metabolic syndrome parameters.

3. Materials and Methods

3.1. Plant Collection and Capsule Preparation

Satureja hortensis L. was collected during the flowering stage (July 2013) from Lorestan, a province in Iran. A voucher specimen of the plant (No. PM670) was identified and deposited in the herbarium of the department of traditional pharmacy in the school of pharmacy at the Shiraz University of Medical Sciences (SUMS). The leaves of the plant were air dried at 25°C in the shade. After grinding the dried leaves, a soft green powder was prepared, and 450 mg of this powder was pressed into commercial hard gelatin capsules (Iran gelatin capsule co., Tehran, Iran). Similar placebo capsules were prepared using starch and green food coloring (E143).

3.2. Essential Oil Fingerprint of the Dried Leaves

A 200 g sample of the bulk plant powder was used to obtain essential oil using the Clevenger apparatus method (5 liter balloon). The procedure was completed over four hours, and the essential oil that was obtained was used during a gas chromatography (GC) analysis. This procedure was performed with a GC instrument (Agilent 7890), a mass specific detector (Agilent 5975C), a fused silica capillary column (Agilent DB-1MS; 30 m, 0.25 mm id and a film thickness of 0.25 μm), and helium as the carrier gas (at a 1 mL/min flow rate). A mass spectrometer was regulated in EI mode (70 eV) to a 30 - 600 m/z mass range with a 280ºC interface temperature. Finally, identification of the components was carried out using NIST, Willy mass spectra, and Adams libraries spectra. The obtained GC-MS spectrum was marked as the plant’s fingerprint.

3.3. Patient Selection

Patient recruitment began in August 2013 and ended in November 2013. The sample size was calculated using a power and sample size (PS) calculation (version 3.1.2, 2014), which gave a power of 90%, a significance area of 95%, and indicated that the appropriate sample size for this study was 30 individuals in each group. Based on this calculation, 60 adult metabolic syndrome patients were recruited using a simple random sampling method from a screening program at the healthy heart institute in Shiraz, Iran, which conducted free primary clinical and biochemistry assessments of cardiovascular diseases and was affiliated with SUMS. According to the national cholesterol education program’s (NCEP) adult treatment panel III (ATP III) guidelines (2), the inclusion criteria of the study were a waist circumference ≥ 102 cm or 40 inches for men and ≥ 88 cm or 35 inches for women, FBS levels ≥ 110 mg/dL, HDL-C levels < 40 mg/dL for men and < 50 mg/dL for women, fasting TG levels ≥ 150 mg/dL, and a systolic blood pressure (SBP) ≥ 130 mm/Hg or DBP ≥ 85 mm/Hg. All the recruited patients exhibited systematic levels for at least three of the aforementioned items. Only known cases of hypertension in nondiabetic patients (FBS < 140 mg/dL without any glucose lowering agents) who only received blood pressure lowering agents least three months prior to the trial were entered into the study.

The exclusion criteria of the study were cancer; alcoholism; smoking; pregnancy and lactation; auto immune disease; internal organ dysfunction; internal gland malsecretion; inflammatory disease; simultaneous subscriptions in other interventional studies; being on a therapeutic diet or calorie-restricted regimen; any infection at the beginning of or during the study period; oral consumption of drugs such as aspirin, propranolol, NSAIDs, steroids, and lipid or glucose lowering agents or herbs (only therapeutic doses of herbs were prohibited) three months prior to the trial; a positive history of angioplasty or heart attack; and major surgery within six months prior to the initiation of the study. The participants were encouraged not to change their physical activities or habits during the study.

3.4. Randomization and Blinding

After admission to this double-blind randomized and controlled clinical trial, simple randomization was performed by asking every subject to select a piece of paper with the numbers one or two written on it. There were 30 pieces of paper for each number (total: 60). The subjects were randomly divided into two equal groups containing 30 patients. A third party selected one of the groups to receive the placebo and the other to receive S. hortensis as interventions. The patients’ group codes were kept undisclosed by the third party until the trial ended and were revealed after the end of the data analysis process. The intervention group received one capsule containing 450 mg of S. hortensis dried leaf powder per day, preferably before a fixed meal (e.g., every morning before having breakfast) for 10 weeks, while the other group received the placebo and the same regimen.

All patients were informed of safety issues related to the use of the plant and were aware of any probable hazards during the interventions. The subjects were free to withdraw from the trial at any time, and a responsive phone number was given to all patients in case of emergency. This study followed the guidelines of the Declaration of Helsinki and was approved by the ethics committee of SUMS (Refrence. No. 92 - 6707). It was also registered with the Iranian Registry of clinical trials (No. IRCT2014012616372N1).

3.5. Sample Collection and Clinical and Dietary Intake Assessments

Blood sample collection, blood pressure measurements, and anthropometric and dietary intake assessments were completed twice for all subjects: on the day prior to the beginning of the treatment and on the day after the trial ended (the 71st day). Between 07.30 A.M. and 08.30 A.M. and after 12 - 14 hours of overnight fasting, a 7 mL blood sample was collected from each patient using clot tubes, and additional 3 mL sample was collected using EDTA containing tubes for the complete blood count (CBC) test. The clot tubes were centrifuged at 2500 rpm and 4°C for 10 minutes. After separation, the serum was stored at 80°C until the assay was performed.

Fasting serum glucose concentrations were measured using the GOD/POD method (Parsazmun Co., Tehran, Iran), and TG and total cholesterol levels were measured using commercial diagnostic kits (Pishtazteb Co., Tehran, Iran) and standard enzymatic methods. Additionally, LDL-C and HDL-C levels were measured using precipitation techniques, and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) concentrations were determined using the IFCC method (Parsazmun Co., Tehran, Iran). The hs-CRP concentrations of the serum were measured using an ELISA kit (Diagnostics Biochem Canada Inc.) according to the manufacturer’s instructions, and CBCs were determined using an automated hematology analyzer (Sysmex). SBP and DBP were measured with a mercury sphygmomanometer (Riester), and anthropometric measurements, such as abdominal circumference, weight, and height were taken according to the national health and nutrition examination survey (NHANES) anthropometry procedures manual (January 2007) examination protocols (18). All the measurements were taken using calibrated equipment based on NHANES guideline. Each procedure was observed by one person. All participants were required to provide three-day estimated food records (including one weekend day) twice: at the beginning and during the last week of the study.

3.6. Statistical Analysis

All statistical analyses were performed using the SPSS statistical software, v. 20.0 (SPSS Inc., Chicago, IL). P Values < 0.05 were considered to be statistically significant. The results were expressed as the mean ± SD or as mean changes (95% CI). First, a one-sample Kolmogorov–Smirnov normality test was performed to confirm normal distribution of the data. Within-group differences between the baseline and post-intervention values were analyzed using paired t-tests, while between-group differences were assessed using unpaired t-tests. Chi-square tests were used to analyze the categorical data, if applicable.

4. Results

4.1. Plant Fingerprint

The mean oil yield was 1%. Figure 1 shows the GC-MS spectrum of S. hortensis essential oil, which is the plant’s fingerprint. The components in the essential oil and their percentages are shown in Table 1. The main components (those with more than 1% concentrations) in the essential oil and their molecular structures are presented in Figure 2.

GC-MS Spectrum of the Essential Oil of Satureja hortensis L., Which is the Plant’s Fingerprint
Figure 1. GC-MS Spectrum of the Essential Oil of Satureja hortensis L., Which is the Plant’s Fingerprint
Table 1. The Content of the Essential Oil of Satureja hortensis L. Determined Via GC-MS
ComponentMatch ScoreRetention TimeKIConcentration %
R [+]-Limonene84.28.8721,0240.23
Carvacrol Acetate9021.1671,3700.56
The Main Components of the Plant’s Essential Oil
Figure 2. The Main Components of the Plant’s Essential Oil

4.2. Patients’ Characteristics

After screening more than 600 patients who had been referred to the healthy heart institute, 60 cases fulfilled the enrolment criteria and were randomly assigned to group one (n = 30) and group two (n = 30). During the intervention, five subjects withdrew from the study because of personal reasons (travel, hesitation, etc.), four were excluded because of drug treatment (statin, aspirin, and propranolol), three left during the follow-up, and one subject showed an allergic reaction (Figure 3). At the end of the study, the female/male ratio was 12/11 in the placebo group (blinded as group one) and 14/10 in the intervention group (blinded as group two). The baseline characteristics of the subjects who participated in the two groups are presented in Table 2. All data distributions were normal.

Table 2. Baseline Characteristics of the Study Populationa
TotalPlacebo (Group 1)S. hortensis (Group 2)P Value
Age, y54.26 ± 7.6256.5 ± 6.352.1 ± 8.20.321
Sex, M/F21/2611/1210/140.503
Energy intake, kcal2328.6 ± 445.52292.9 ± 352.22363.0 ± 535.10.512
BMI, kg/m229.05 ± 2.3628.96 ± 2.4329.15 ± 2.310.471
WC, cm100.6 ± 6.5101.6 ± 6.899.8 ± 6.40.243
T-cholesterol, mg/dL225.3 ± 38.4210.5 ± 37.4239.4 ± 34.60.598
FBS, mg/dL112.0 ± 23.9111.8 ± 22.7112.3 ± 25.40.434
HDL-C, mg/dL45.0 ± 9.446.2 ± 11.143.8 ± 7.40.269
LDL-C, mg/dL131.6 ± 30.4124.2 ± 34.2138.6 ± 25.20.989
TG, mg/dL213.1 ± 67.7206.0 ± 68.6220.0 ± 67.50.210
DBP, mm/Hg83.2 ± 9.483.3 ± 7.283.1 ± 11.30.394
SBP, mm/Hg131.6 ± 13.0133.6 ± 9.6129.7 ± 15.50.712
Hemoglobin, g/dL14.2 ± 1.715.0 ± 1.813.5 ± 1.20.559
Platelet, × 109/L245.0 ± 62.6233.4 ± 57.6256.0 ± 66.40.580
RBC, × 109/L5.2 ± 0.465.3 ± 0.455.0 ± 0.40.169
WBC, × 109/L7.3 ± 2.17.6 ± 2.27.1 ± 2.00.176
Hs-CRP, ng/mL2.67 ± 1.512.31 ± 1.183.03 ± 1.840.062
ALT, IU/L15.8 ± 8.215.2 ± 6.116.3 ± 9.90.091
AST, IU/L19.2 ± 5.718.5 ± 8.518.2 ± 6.70.362

Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, bodymassindex, DBP, diastolic blood pressure, FBS, fasting blood sugar, HDL-C, highdensity lipoprotein cholesterol; hs-CRP, high-sensitivity C-reactive protein; LDL-C, low-density lipoprotein cholesterol; RBC, red blood cell; SBP, systolic blood pressure; TG, triglyceride ; WBC, white blood cell; WC, waist circumference.

aValues are for the mean ± SD, unless indicated otherwise.

4.3. Lipid Profiles and hs-CRP, Blood Pressure, and Glucose Levels

Mean changes in the main outcomes and differences between the groups are shown in Table 3. Group changes are measured as the mean ± SD (post intervention result - baseline value = change), and the S. hortensis group showed significant reductions in the total levels of cholesterol (239.4 ± 34.6 to 222.3 ± 38.0; P < 0.05), LDL-C (138.6 ± 25.2 to 117.6 ± 20.8; P < 0.001), TG (220.0 ± 67.5 to 187.5 ± 65.9; P < 0.05), DBP (83.1 ± 11.3 to 75.3 ± 9.5; P < 0.001), and hs-CRP (3.03 ± 1.84 to 1.51 ± 1.76; P < 0.05) as well as an elevation in HDL-C (43.8 ± 7.4 to 47.3 ± 9.6; P < 0.05). In the placebo group, a significant increase was only observed in hs-CRP levels (2.31 ± 1.18 to 3.32 ± 1.52; P < 0.05), while other parameters presented no significant changes. FBS and SBP did not show significant changes in either the placebo or the S. hortensis groups. However, treatment effects (i.e., between group differences (mean (95% CIs)), revealed statistically significant diminutions in LDL-C at a dosage of 27.1 mg/dL ((-16.3, -37.9); P < 0.001), TG at 39.1 mg/Dl ((-19.5,-64.4); P < 0.05), DBP at 7.6 mm/Hg ((-4.3, -11.2); P = 0.001), and hs-CRP at 2.5 ng/mL ((-1.4, -5.1); P < 0.05) (Table 3).

Table 3. Within-Group Mean Changes (95% CIs) from Baseline and Between-Group Differences After 70 Days of Intervention
S. hortensis Group (n = 24)Placebo Group(n = 23)Treatment Effecta
ChangeP ValueChangeP ValueDifferencesP Value
FBS, mg/dL0.6 (6.0 to -4.8)0.8200.9 (4.3 to -2.5)0.586-0.3 (6.0 to -6.6)0.923
T-cholesterol, mg/dL-17.1 (-0.2 to -33.9)0.047-1.7 (20.9 to -24.4)0.876-15.4 (11.8 to -42.6)0.261
LDL-C, mg/dL-20.9 (-13.1 to -28.8)< 0.0016.1 (14.0 to -1.6)0.117-27.1 (-16.3 to -37.9)< 0.001
HDL-C, mg/dL3.5 (6.0 to 1.0)0.0081.5 (4.07 to -0.98)0.2181.9 (5.4 to -1.4)0.255
TG, mg/dL-32.5 (-15.3 to -49.6)0.0016.6 (20.3 to -7.1)0.331-39.1 (-19.5 to -64.4)0.005
DBP, mm Hg-7.7 (-4.4 to -11.1)< 0.001-0.1 (0.4 to -0.6)0.664-7.6 (-4.3 to -11.2)0.001
SBP, mm Hg-2.8 (3.5 to -9.2)0.3690.9 (2.0 to -0.2)0.123-3.7 (2.7 to -10.1)0.249
Hs-CRP, ng/mL-1.5 (-.3 to -3.1)0.0241.0 (2.1 to 0.2)0.031-2.5 (-1.4 to -5.1)0.008

Abbreviations: DBP, diastolic blood pressure; FBS, fasting blood sugar, HDL-C, high-density lipoprotein cholesterol; hs-CRP, high-sensitivity C-reactive protein), LDL-C, low-density lipoprotein cholesterol; SBP, systolic blood pressure; TG, triglyceride.

aChanges between groups (S. hortensis versus placebo) and means (95% CI).

The secondary outcomes, including hemoglobin concentrations, platelet counts, red blood cell (RBC) counts, white blood cell (WBC) counts, and ALT concentrations, showed no significant changes within and between groups. However, slight attenuation was found in AST concentrations at 3.01 IU/L (18.5 ± 8.5 to 20.9 ± 6.8 in the placebo group and 18.2 ± 6.7 to 17.6 ± 3.9 in the S. hortensis group; P < 0.05) (data not shown). The interventions were well tolerated in both groups, and adherence to the advised treatment regimen (one capsule per day for 70 days) was good. The mean number of missed capsules after recount of empty packages was less than 4%. Comparison of baseline and final three-day food records showed no significant changes in the participants’ dietary habits, including energy intake (24 hours) and macronutrient intake (proteins, carbohydrates, fats, and alcohol). No remarkable adverse events were reported, except for one allergic reaction in the form of skin redness and rashes and two other reports of gastric irritation (probably indicating an over-secretion of acid) less than 30 minutes after consuming the capsule.

5. Discussion

To the knowledge of the researchers, this is the first study on the use of S. hortensis in metabolic syndrome patients. The study results revealed the effectiveness of using S. hortensis for treating some metabolic syndrome symptoms. Different studies on Satureja species have also shown their efficacy for treatments of metabolic disorders (4-8, 11-17). The following discussion includes the substantiated mechanisms involved in the pathogenesis of metabolic syndrome’s main concomitant disorders.

Reduction in LDL-C (7, 17) and TG (6, 17) after treatment with some Satureja species has been proven in many studies, which is in agreement with the findings of this study. In the present study, no statistically significant between-group differences were observed for HDL-C and total cholesterol changes. However, a mild increase in HDL-C of 1.9 ± 5.7 IU/L (P < 0.05) and diminution in total cholesterol of 17.1 ± 38.9 mg/dL (P < 0.05) were found in the S. hortensis group after treatment, compared to baseline. Similar alterations in HDL-C and total cholesterol levels were also reported in other surveys (7, 12, 17).

S. hortensis contains carvacrol as the main component in its essential oil, which has the ability to suppress cholesterol synthesis by regulating the key enzyme in such synthesis (i.e., hydroxy-methylglutaryl coenzyme-A reductase (HMG-CoA reductase)) (19). Isoprenols, which are hemiterpenes found in many herbal medicines, are capable of activating peroxisome proliferator-activated receptors (PPARs) (20). PPARγ activation could improve insulin resistance and lipoprotein lipase activity, leading to amelioration of HDL-C and other metabolic syndrome parameters (21-23). Moreover, PPARα activation is related to lipid catabolism and results in clearance of circulating lipids by modulating hepatic apolipoprotein A-I and C-III mRNA expression (24). Thus, it may be concluded that stimulating liver and adipocytes PPARα and PPARγ expression may contribute to improvement of hyperlipidemia.

Oxidative stress is known to be an early cause of increased concentrations of cholesterol, LDL-C, and TG (25). Previous findings have shown that S. hortensis contains large amounts of flavonoids as polyphenol components, and the flavonoid, triterpenoid, and carvacrol components of S. hortensis exert antioxidative activity (26). Enhancing patients’ antioxidant power after treatment with this herb may be another reason for amelioration of hyperlipidemia and improvement of HDL-C concentrations in this study. The antioxidant property combined with the steroid-like components of this plant could be responsible for its anti-inflammatory effects (27). Hajhashemi et al. (8) conducted a study on rats and mice, revealing the anti-inflammatory effects of S. hortensis and confirming the findings of this study regarding the attenuation of hs-CRP. In addition to free radical scavenging during over production of reactive substances in inflammation, flavonoids can inhibit the release of histamine and expression of pro-inflammatory cytokines (28, 29). Carvacrol, one of the main components of Satureja species, was found to be a potent suppressor of expression of cyclooxygenase-2, which is a key enzyme for inflammation cascade initiation (30). Consequently, the inflammation biomarker reduction observed in this clinical trial might have originated from the presence of flavonoids, carvacrol, and steroids, and the suggested mechanisms are prostaglandin synthesis modulation and scavenging reactive oxygen species (31).

The debatable outcome of the current survey was that S. hortensis treatment lowered only DBP and did not change SBP significantly, either within groups or between groups. Studies on the vasorelaxant activity of some compounds derived from different herbs determined that compounds found in S. hortensis (borneol and carvacrol) exhibited vasodilatory activity involving different mechanisms (32). Peixoto-Neves et al. (2010) performed a study on isolated rat aortas to investigate the endothelium-independent vasorelaxant effects of carvacrol. They suggested that the mechanisms likely involved were smooth muscle Ca2+ sensitivity regulation and/or the inhibition of the sarcoplasmic reticulum release of calcium. Additionally, they found that low concentrations of carvacrol stopped transmembrane Ca2+ influx (33). Silva-Filho et al. (2011) examined borneol vasodilatory activity and demonstrated similar effects to those mentioned above, suggesting similar mechanisms and potassium channel activation (34). Regardless, intracellular decreased Ca2+ or increased potassium concentrations in blood vessels induce smooth muscle results during dilation.

Ferulic acid is another component of S. hortensis (3, 4) that is a beta1-adrenoceptor antagonist with partial beta2-agonist activity without any activity on alpha-adrenoceptors. These findings suggest that ferulic acid could potentially increase cardiac output and dilate arteries to skeletal muscles, leading to negative chronotropic effects (35).

The reason for lowered DBP without any alteration in SBP after treatment with S. hortensis occurred in the present study because some cardiac glycosides (4) possess positive inotropic or cardiotonic effects. Unfortunately, this study did not assess cardiac function. Further studies are recommended to evaluate more effective mechanisms of this plant that can affect variables such as pulse rate, stroke volume, basal metabolic rate, and adrenal releasing hormones.

Another limitation of this study was the dosage of S. hortensis. Almost all animal studies have used the essential oil of S. hortensis, and a limited number of studies have been conducted using this plant in humans. Thus, choosing a suitable dose of the whole herb was difficult in this study, and the results showed no significant changes in FBS levels, although there are controversial results from other studies for this variable. Therefore, further research is required to assess the use of higher dosages over longer intervention periods to investigate if significant changes can be detected for this parameter (6, 7, 36).

The most important strengths of this study were the stabilized dietary and physical activity habits of the patients, which resulted in no significant weight change after the intervention. The fact that any alteration in weight could significantly affect metabolic indicators, such as FBS, blood pressure, and lipid profiles (37), has been neglected in some studies. Additionally, this study used the whole plant instead of chemical extractions because the literature review revealed that different areas of S. hortensis contain variant active components possessing dissimilar activities. This research did not observe significant side effects or intolerance to the substances used in either the drug or placebo group. Previous studies agree with this result (14).

5.1. Conclusion

S. hortensis is consumed as a spice or herbal remedy by many people and has no known adverse effects on human health. One strength of this study was its use of a nutritional strategy to maintain physical activity, dietary intake, and as a consequence, BMI in patients. This included consulting, planning, and monitoring patients’ diets during the study. This research was also the first to use the whole plant as a supplement without any processing or extracting; thus, the results can be compared to regular consumption of this plant rather than being limited to supplementary use alone. This is the also the first study of the effects of a common herb on such a significant general health concern.

5.2. Limitations

Limitations of this research included a lack of functional cardiac testing (i.e., echocardiography) and not using the energy metabolism rate or indicators. According to the results of this clinical trial, as well as other studies, S. hortensis exerts antihyperlipidemic, anti-inflammatory, and vasodilatory effects. Therefore, S. hortensis supplementation can be effective in the treatment or prevention of the symptoms of metabolic syndrome, as well as its main concomitant disorders, such as atherogenic dyslipidemia, hypertension, and elevated inflammatory status.




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