The Opuntia species of cactus (also called Nopal cactus) has been used for food and medicinal purposes in México since before the time of the Aztecs. The fruits (knowns as tunas in México) and the “leaves” (botanically known as cladodes) are eaten on a daily basis. The cladodes in particular are a tasty and nutritious green vegetable (once the spines have been removed).  As a vegetable it can be a little gummy/slimy like okra has a tendency to be when cooked.

The two species that are the most frequently used are Opuntia ficus-indica, popularly named “nopal” and Opuntia streptacantha, popularly known “xoconoxtle” (xoconostle/xoconōchtli – sour prickly pear). It is still very popular today in Mexican folk medicine as a treatment for what is known in the West as “Syndrome X”. This is not really an illness but more a collection of symptoms any one of which can lead to chronic illness. Symptoms include, obesity, high blood pressure, high blood sugar levels and high triglyceride levels. Opuntia can be used to treat all of these symptoms. It has historically been used in the treatment of both forms of diabetes.

Hypoglycaemic properties

Human studies have demonstrated that glucose and insulin levels in healthy fasting subjects were stable when eating Opuntia cladodes. Since these effects did not depend on glucagon, cortisone, and human growth hormone levels, which are closely interrelated with glucose metabolism, a gastric enterohormone was held responsible for the hypoglycaemic effect although at one stage the unidentified anti-diabetic factor was assumed to be of steroidal nature (presumably a saponin). 

The hypoglycaemic effect produced by O. ficus-indica can be explained by the fibre effect mechanism that reduces the intestinal absorption of glucose. The soluble dietary fibre is associated with control of glucose concentrations and therefore diabetes. Cactus dietary fibre is composed of several chemical components that are resistant to digestive enzymes such as cellulose, hemicelluloses, pectin, lignin, gums. Soluble fibres, including pectins, gums, and mucilages, increase the viscosity of food in the gut, slowing or reducing sugar absorption.

On the other hand, the hypoglycaemic activity suggested for O. streptacantha, is predominantly associated with the existence of hypoglycaemic substances producing activity after their absorption.

Both the fresh fried and raw despined cladodes and powdered dried plant have showed this therapeutic effect. Findings demonstrate that the addition of nopales to the usual Mexican breakfast among type 2 diabetic subjects induced a reduction in glucose concentration after the meal. Meals included chilaquiles (casserole made with corn tortilla, vegetable oil, tomato sauce, fresh farmer’s cheese, and boiled pinto beans, burritos (scrambled egg with diced red tomato and onions, vegetable oil, flour tortilla, and boiled pinto beans), and quesadillas (flour tortilla, low-fat Monterey cheese, avocado, and boiled pinto beans).

A crude aqueous extract has been shown to demonstrate a similar hypoglycaemic effect.

Anti-hyperlipidemic and anti-hypercholesterolemic properties

Nopal contains pectin, mucilage and gums that are beneficial to the digestive system. The reduction of blood lipids has been attributed to a pectin from Opuntia due to its bile acid binding capacity. It was concluded that bile absorption in the colon was also reduced.

Pectin was attributed as responsible for decreasing lipid absorption, blood lipid levels, and finally weight reduction. A reduction of total cholesterol, LDL, apolipoprotein levels, triglycerides, fibrinogen, blood glucose, insulin and urate has been reported. The anti-hyperlipidaemic effects were ascribed to the pulp pectin, by means of reducing lipid absorption and increased faecal sterol excretion. Increased consumption of dietary fibre in the diet (as contained in Opuntia spp.) is associated with lower cholesterol levels because dietary fibre causes and accelerates the secretion of bile acids and cholesterol. They bind to the fibre and are eliminated in the faeces, reducing the possibility of its reabsorption.

Metabolic syndrome

Metabolic syndrome describes the increasing incidence of type 2 diabetes in association with obesity, hyperinsulinemia associated with disorders of metabolism of carbohydrates and lipids. Opuntia ficus-indica dehydrated leaves can be consumed as a dietary supplement to improve some blood lipids parameters and reduce the risk factors in the case of metabolic syndrome. Consumption of opuntia can cause significant reductions in percentage body fat, blood pressure, and total cholesterol.  Significant reductions in body mass index, percentage of body fat, systolic and diastolic blood pressures, and total cholesterol have been observed.

Antioxidant Capacity and atherogenic properties

The Opuntia ficus-indica exhibits diverse pharmacological actions through its antioxidant activity: it protects cells against oxidative damage, acts as a radical scavenger, reduces lipid peroxidation and increases GSH levels. It has been reported that Opuntia ficus-indica contains phenolic compounds like ferulic acid, feruloyl-sucrose and sinapoyl-diglucoside, fatty acids like palmitic acid, stearic acid, oleic acid, vaccenic acid and linoleic acid (found in the seeds, peel and juicy pulp). It has been observed that Opuntia ficus-indica oil extract with these components present antioxidant and anti-free radical activity as does the presence of total phenolic and polyphenolic compounds which include aromadendrin, taxifolin or dihydroquercetin, isorhamnetin, vitexin, kaempferol, quercetin, betalains, betacyanins, rutin and isorhamnetin and derivatives like myricetin, orientin and some derivatives of pyrone.

Diuretic effect

Potassium (K) intake increased while sodium (Na) intake decreased as the level of Opuntia cladodes in the diet is increased. Diuretic properties of Opuntia spp. can partly be attributed to the effects its high K concentration exerts on renal epithelia. Drugs and plants with diuretic activities are characterized by high K:Na ratio. Nopal juice can be used to reduce inflammation of the urinary system and reduce pain in the kidneys or bladder.

Anti-ulcerogenic Effect

Stomach lesions triggered by hydrochloric acid/ethanol or hydrochloric acid/acetylsalicylic acid were reduced. The secretion rate of both gastric juice as well as the pH value remained constant, the protective effect was ascribed to the cladodes’ hydrocolloid acting as a buffer, spreading out on the gastric mucosa and increasing mucus production by enhancing the number of secretory cells.

Anti-inflammatory Properties

An ethanolic extract of the cladodes demonstrating a fast regeneration of the tissue was attributed to inflammation inhibition, stimulation of fibroblast migration with accelerated collagen formation and faster healing process. The O. ficus-indica accelerates wound healing, probably by involving the proliferation and migration of the keratinocytes in the healing process. Opuntia ficus-indica cladodes contain a polysaccharide fraction and various reports show that polysaccharides from different plants can be responsible for the effects associated with the healing of wounds. Some polysaccharides have an influence on the immune system and the polysaccharides, all coming from plants used for wound healing in folk medicine, can influence the complement system.

Toxicology of Opuntia ficus indica

In books of traditional folk medicine and case reports it has been noted that, orally, Opuntia ficus-indica is usually well tolerated. However, it has been reported that it may cause mild diarrhoea, nausea, increased stool volume, increased stool frequency, abdominal fullness, headache and low colonic obstruction. Please ensure adequate intake of fluids when taking the dried supplement of this plant.

Drug Interactions

Moderate Interactions: Chlorpropamide, Glyburide, Metformin (Glucophage), Antidiabetic drugs (including glimepiride (Amaryl), insulin, pioglitazone (Actos), rosiglitazone (Avandia), glipizide (Glucotrol), tolbutamide (Orinase), Concurrent use can cause hypoglycaemia. Monitor your blood sugar closely. The dose of antidiabetic drugs might need to be changed. There is the potential for lower doses of diabetic drugs to be used.

Nopal may decrease levels of lipids in the bloodstream. Use cautiously in patients taking cholesterol-lowering medications due to possible additive effects.

Opuntia is very high in fibre. This fibre may affect the absorption of some medications. Take away from other medications.

Dosages

• 100-500 grams of grilled cladodes daily. Doses are often divided into three equal amounts and given throughout the day. Eat it like a green vegetable. It can also be added raw to smoothies
• Dried powder – 250mg three times daily.

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