Safety and efficacy of a polyherbal formulation from traditional Persian medicine in patients with calcium kidney stones: A randomized, double-blinded clinical trial.

Background: 10%-15% of the world's population suffers from kidney stones. Nearly 50% increase was observed in diagnosing and treating nephrolithiasis in the last decades. Effective medical treatment for the disease is not yet well established. Moreover, there is an increasing global demand to manage diseases using complementary and alternative medicine. This study aimed to formulate and assess the safety and efficacy of a multi-ingredient formulation from traditional Persian medicine (TPM) known as Mofatet powder in patients suffering from calcium kidney stones. Materials and Methods: The aqueous extract of Mofatet powder was prepared, freeze-dried, and formulated as capsules. 26 patients in the drug group and 25 patients in the placebo group used 500 mg capsules of the drug/placebo twice daily for 5 weeks. Ultrasonography/kidney, ureter and bladder imaging, urine analysis, and biochemical parameters were evaluated before and after the intervention. Results: The imaging results showed a 60.73% decrease (P < 0.001) in stone size in the drug group. Moreover, the urinary calcium decreased (P = 0.02) and the urinary magnesium increased (P < 0.001) in the drug group. No remarkable changes were observed in the placebo group in these parameters. No significant effect was observed in aspartate transaminase, alanine transaminase, serum creatinine, and blood urea nitrogen levels in none of the groups. Conclusion: This study suggests that Mofatet powder was effective in reducing calcium kidney stones size with no potential nephro/hepatotoxicity. After confirming these results in larger clinical trials with longer duration, this formulation can be considered a treatment for nephrolithiasis.

The Effects of Ginger (Zingiber Officinale Roscoe) on Non-Alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus: A Randomized Double-Blinded Placebo-Controlled Clinical Trial.

Nonalcoholic fatty liver disease (NAFLD) is a prominent etiological factor for liver cirrhosis worldwide. It is frequently associated with obesity, diabetes, dyslipidemia, and hypertension. The objective of this study is to assess the efficacy and safety of ginger (Zingiber officinale Roscoe) supplementation in patients with type 2 diabetes mellitus (T2DM) who have NAFLD. In a two-arm, double-blind, placebo-controlled clinical trial, seventy-six patients diagnosed with both T2DM and NAFLD were randomly assigned to receive either ginger powder capsules (1000 mg, twice daily) or placebo capsules (administered in the same manner) for a period of three months. Anthropometric measurements, blood pressure readings, biochemical profiles, and imaging parameters were assessed before and after the intervention. Safety measures were also evaluated. In both the ginger and placebo groups, there was a significant reduction in mean body mass index (BMI), waist and hip circumferences, as well as liver transaminase levels. Moreover, significant improvements in mean systolic and diastolic blood pressures were observed in the ginger group (p = 0.02 and < 0.0001, respectively). Within the ginger group, there was a decrease in serum insulin levels and insulin resistance (HOMA-IR) (p = 0.002 and 0.004, respectively). Furthermore, the ginger group exhibited an improvement in serum HDL-cholesterol level (p = 0.01). However, there were no significant changes in the assessed inflammatory markers or the indices obtained from fibroscan imaging, including steatosis percent and controlled attenuation parameter. This study demonstrates that ginger supplementation can significantly improve mean systolic and diastolic blood pressures. However, it does not have a significant impact on inflammatory markers or fibroscan imaging indices. Nonetheless, the three-month use of ginger improves serum insulin level, insulin resistance (HOMA-IR), and HDL-cholesterol level compared to baseline values. Further investigations with longer durations and larger sample sizes are recommended.

Safflower (Carthamus tinctorius L.) oil could improve abdominal obesity, blood pressure, and insulin resistance in patients with metabolic syndrome: A randomized, double-blind, placebo-controlled clinical trial.

ETHNOPHARMACOLOGICAL RELEVANCE: Carthamus tinctorius L. (Safflower) has been widely recommended to treat metabolic disorders in traditional herbal medicine in Persia, China, Korea, Japan, and other East-Asian countries. The anti-hypercholesterolemic and antioxidant effects of this plant have been well documented, but its protective effects against Metabolic Syndrome (MetS) have not been fully illustrated. AIM OF THE STUDY: The present study aimed to evaluate the effects of safflower oil on MetS risk factors. MATERIALS AND METHODS: In this randomized, double-blind, placebo-controlled clinical trial, 67 patients with MetS were administered either divided 8 g safflower oil or placebo daily for 12 weeks. All patients were advised to follow their previous diets and physical activities. RESULTS: Safflower oil resulted in a significant reduction in waist circumference (-2.42 ± 3.24 vs. 0.97 ± 2.53, p<0.001), systolic blood pressure (-8.80 ± 9.77 vs. -2.26 ± 8.56, p = 0.021), diastolic blood pressure (-3.53 ± 7.52 vs. -0.70 ± 6.21, p = 0.041), fasting blood sugar (-5.03 ± 10.62 vs. 2.94 ± 7.57, p = 0.003), and insulin resistance (-0.59 ± 1.43 vs. 0.50 ± 1, p = 0.012), but an increase in adiponectin level (0.38 ± 0.99 vs. -0.09 ± 0.81, p = 0.042) in the treatment group in comparison to the placebo group. The results revealed a direct relationship between leptin level and Body Mass Index (BMI) in both groups (p<0.001). In addition, increase in BMI resulted in a non-significant decrease in adiponectin level in both groups. Moreover, no significant difference was observed between the two groups regarding lipid profiles, leptin serum level, serum creatinine concentration, and other outcomes. CONCLUSION: Safflower oil without lifestyle modification improved abdominal obesity, blood pressure, and insulin resistance in patients with MetS.

Safflower seed oil improves steroidogenesis and spermatogenesis in rats with type II diabetes mellitus by modulating the genes expression involved in steroidogenesis, inflammation and oxidative stress.

ETHNOPHARMACOLOGICAL RELEVANCE: Diabetes mellitus (DM), as a multiorgan syndrome, is an endocrine and metabolic disorder that is associated with male reproductive system dysfunction and infertility. Safflower (Carthamus tinctorius L.) as an herbal remedy improves DM and infertility-related disorders. The anti-hypercholesterolemic, anti-inflammatory, and antioxidative properties of this herb have been well documented, but its role in testosterone production, male reproductive system and zinc homeostasis has not been fully illustrated. AIM OF THE STUDY: This study aimed to investigate the preventive and therapeutic properties of different doses of safflower seed oil against reproductive damage caused by type II DM by investigating zinc element homeostasis, inflammation and oxidative damage in testis tissue and their relationship with testosterone production and sperm parameters. MATERIALS AND METHODS: Eighty adult male Sprague-Dawley rats were randomly divided into eight groups and treated daily for 12 and 24 weeks in protective and therapeutic studies, respectively. Type II DM was induced by a High Fat Diet (HFD) in normoglycemic rats for three months. At the end of each study, serum level of glucose, testosterone, gonadotropins, TNF-α, insulin, and leptin were measured. Moreover, antioxidant enzymes activity, lipid peroxidation, zinc and testosterone along with the expression of Nrf-2, NF-κB, TNF-α, StAR, P450scc, and 17ßHSD3 genes in the testis were detected. RESULTS: After the intervention, the activity of antioxidant enzymes and the level of testosterone and gonadotropins significantly decreased in the rats with DM in comparison to the others. However, lipid peroxidation and serum level of insulin, leptin and TNF-α increased and the testicular level of zinc significantly changed in the rats with DM compared to the control groups (p < 0.05). The gene expression of NF-κB and TNF-α were also significantly increased and the gene expression of Nrf2, StAR, P450scc and 17ßHSD3 were decreased in the testis of diabetic rats (p < 0.05). The results showed that pretreatment and treatment with safflower seed oil could improve these parameters in diabetic rats compared with untreated diabetic rats (p < 0.05). CONCLUSION: HFD could impair the production of testosterone and sperm, and reduce gonadotropin by increasing the serum level of leptin and inducing insulin resistance, oxidative stress and inflammation. However, safflower oil in a dose-dependent manner could improve testosterone level and sperm parameters by improving the level of leptin, zinc and insulin resistance, and the genes expression involved in testosterone synthesis, inflammation and oxidative stress.

Effects of Zataria oxymel on obesity, insulin resistance and lipid profile: A randomized, controlled, triple-blind trial.

BACKGROUND: Obesity is a major public health problem and its occurrence is markedly increasing in developed and developing countries. However, few studies have investigated the use of natural products to treat obesity. The effects of taking a combination of oxymel and Zataria multiflora Boiss. (ZM), herein referred to as Zataria oxymel (ZO), on obesity, lipid profile and insulin resistance have not yet been studied. OBJECTIVE: This study evaluates the effects of oxymel and ZO on obesity, lipid profile and insulin resistance. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: In this randomized, controlled, triple-blind trial, overweight patients were randomly divided into three groups and received doses of study compounds twice per day for twelve weeks. Group A received 0.75 g ZM in 10 mL oxymel in each treatment; group B received 1.5 g ZM in 10 mL of oxymel in each treatment and group C (control) only received 10 mL of oxymel in each treatment. MAIN OUTCOME MEASURES: Anthropometric parameters, including body mass index (BMI), waist circumference and hip circumference, were measured at the time of registration. Blood tests were carried out at the beginning and once again at end of the study. Blood parameters included fasting blood sugar (FBS), insulin levels, serum lipid profile (total cholesterol, triglyceride, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol) and liver enzymes (aspartate transaminase and alanine transaminase). Serum creatinine was also measured at the beginning of the project and in monthly intervals for three months. The homeostasis model assessment index was calculated as fasting insulin (µIU/mL) × FBS (mg/dL)/405. RESULTS: The results showed that patients receiving ZO experienced significant reduction in waist circumference in groups A, B and C, respectively (P < 0.001) but no significant change in BMI. Group A also experienced reduction in hip circumference (P = 0.01). Groups B and C had reduction in the homeostatic model assessment of insulin resistance (P = 0.05 and P = 0.01, respectively), with no significant reduction in FBS. No effect on lipid profile, liver enzymes or serum creatinine was observed in the three groups. CONCLUSION: In this study, treatment with ZO and oxymel reduced insulin resistance, and waist and hip circumferences in overweight patients. Nonetheless, the traditional Persian use of ZO as a beverage to improve the anthropometric indices in overweight individuals still requires further research with a larger sample size. TRIAL REGISTRATION: Iranian Registry of Clinical Trials Code IRCT20171220037976N1.

Overview of herbal and traditional remedies in the treatment of cutaneous leishmaniasis based on Traditional Persian Medicine.

This study aims to describe the herbal and traditional remedies in the treatment of cutaneous leishmaniasis (CL) with an overview on related available evidence in modern medicine. This study is a review that focuses on the most important Traditional Persian Medicine (TPM) sources including Avicenna's Canon of Medicine, Jorjani's Zakhira-yi Kharazmshahi, and Aazam-Khan's Eksir-e-Aazam, as well as pertinent information from Embase, PubMed, Scopus, Scientific Information Database, and Google Scholar by using the keywords salak, rish-e-balkhi, cutaneous leishmaniasis, and leishmaniasis for selected remedies. Several oral and topical herbal remedies, such as Vitis vinifera L. (Unripe grapes), Berberis vulgaris L., Rheum ribes L., Santalum album L., Cinnamomum camphora (L.) J.Presl (Camphor), Brassica nigra (L.) K. Koch, Crocus sativus L., Juniperus excelsa M. Bieb, honey, and Alum root, were mentioned in TPM resources for the treatment of CL. Furthermore, cauterization, cupping, and leech therapy were considered for this purpose. In this review, some evidence-based studies will also be presented that have demonstrated the therapeutic properties of some of these products. In conclusion, the sages of TPM have recommended several systemic or topical medications, in addition to physical procedures, for treatment of CL, all of which could be a base for conducting further research on its efficacy.

Thyme oxymel by improving of inflammation, oxidative stress, dyslipidemia and homeostasis of some trace elements ameliorates obesity induced by high-fructose/fat diet in male rat.

OBJECTIVE: Thyme oxymel is a mixture of vinegar, sugar and thyme which is traditionally used in many folk medicines as syrup to treat metabolic disorders. The molecular mechanisms of anti-hyperlipidemic and anti-inflammatory and antioxidant effects of thyme oxymel or oxymel and its role on homeostasis of trace elements are not fully understood. The aim of this study was to evaluate the anti-inflammatory, antioxidant and anti- hyperlipidemic effects of different doses of thyme oxymel and oxymel on obesity induced by high-fat/-fructose diet (HFFD) in male rat. METHODS: Eighty adult male Sprague-Dawley rats were randomly divided into eleven groups and treated daily for 24 weeks. At the end of the study, serum levels of liver enzymes, lipid profiles, blood glucose, insulin, antioxidant enzymes and lipid peroxidation and TNF-α were measured. The hepatic oxidative biomarkers and the genes expression of SREBP-1c, CPT-1, Nrf-2 and NF-κB were also studied to determine the molecular mechanism involved in this disease. RESULTS: The results showed that HFFD could significantly change the level of oxidative biomarkers, lipid profiles, TNF-α, liver enzymes, leptin, insulin and the levels of some trace elements in obese rats compared to control group (p < 0.05), while pretreatment and treatment with thyme oxymel and oxymel in obese rats could significantly ameliorate them and bring some of them back to normal (p < 0.05).The molecular results also showed that HFFD significantly up-regulated the expression of SREBP-1c and NF-κB and down-regulated CPT-1 and Nrf-2 expression(p < 0.05). While, pretreatment and treatment with thyme oxymel or oxymel in obese rats could significantly ameliorate them (p < 0.05). CONCLUSIONS: It can be concluded that thyme oxymel or oxymel can alleviate HFFD-induced obesity through improving oxidative stress, inflammation, lipid metabolism, homeostasis of some trace elements, and weight-regulating hormones.

Oil and extract of safflower seed improve fructose induced metabolic syndrome through modulating the homeostasis of trace elements, TNF-α and fatty acids metabolism.

ETHNOPHARMACOLOGICAL RELEVANCE: Safflower (Carthamus tinctorius) has many applications in folk medicine. Its oil is used traditionally to treat obesity and other metabolic disorders. The anti-hypercholesterolemic and antioxidant effects of this plant have been well documented, but the anti-inflammatory effects and its role on fatty acid oxidation and homeostasis of trace elements are not fully understood. OBJECTIVE: The aim of this study was to evaluate the protective effects of different doses of oil and extract of safflower seed against fructose induced metabolic syndrome by investigating the homeostasis of trace elements, TNF-α, and fatty acids metabolism. METHODS: Eighty adult male Sprague-Dawley rats were randomly divided into ten groups and treated daily for 16 weeks. At the end of the study, plasma levels of liver enzymes, lipid profiles, blood glucose, insulin and TNF-α were measured. The levels of antioxidant enzymes and lipid peroxidation were also measured along with the expression of CD36, fatty acyl-CoA synthetase (FAS), and Carnitine palmitoyl transferase I (CPT-1) beta genes in the liver. RESULTS: The antioxidant enzymes activity significantly decreased and lipid peroxidation, lipid profiles, liver enzymes, and TNF-α significantly increased in fructose-induced metabolic syndrome compared to the control groups, as well as the level of some trace elements significantly changed (p < 0.05). Treatment with oil and safflower seed extract in a dose dependent manner could improve biochemical parameters in groups of metabolic syndrome treated with oil and extract compared to metabolic syndrome (p < 0.05). The results also showed that the expression of above mentioned genes significantly increased in groups of metabolic syndrome treated with oil and extract compared to control and metabolic syndrome groups (p < 0.05). CONCLUSION: It can be concluded that safflower seed extract and its oil can improve fructose-induced metabolic syndrome through antioxidant and anti-inflammatory effects, adjustment of homeostasis of trace elements, and enhancing the beta-oxidation capacity of the liver by increasing the expression of CD36, FAS, and CPT-1beta genes.

A panoramic view of medicinal plants traditionally applied for impotence and erectile dysfunction in Persian medicine.

Erectile dysfunction (ED) and impotence are common male sexual problems, and they are highly prevalent in male adults with a history of hypertension or diabetes mellitus. This review aims to bring together the standpoints of the early Persian physicians on these disorders and to identify the respective medication in comparison with conventional contemporary medicine. The main medical and pharmaceutical manuscripts of traditional Persian medicine (TPM) are from 9th-18th century AD. Besides the medieval findings, the current knowledge on ED and impotence, and the related effects of the cited medicinal herbs were studied. In the medieval and traditional literature, male potency is called bah. According to the TPM approaches, the first step in the mitigation of impotence focuses on the treatment of the main body organs including the heart, brain, and liver. The TPM approaches for diagnosis and treatment include the evaluation of the quality of semen, sexual habit, and quality of urine. The treatment strategies in TPM involve lifestyle modification and prescription of natural medicaments. Many medicinal herbs have been traditionally used for the mitigation of impotency. There could be numerous possibilities for bringing out new natural medicaments with aphrodisiac effects supported by the early medical literature.

Effect of chamomile on chemotherapy-induced neutropenia in pediatric leukemia patients: A randomized triple-blind placebo-controlled clinical trial.

OBJECTIVE: Chemotherapy-induced neutropenia is one of the main side effects of acute lymphoblastic leukemia (ALL) treatment. In this trial, we evaluated the efficacy of chamomile in management of neutropenia. MATERIALS AND METHODS: This randomized triple-blind placebo-controlled clinical trial was carried out in 2-18-year-old children with ALL. Participants in each group daily received 2.5 ml of either chamomile syrup or placebo syrup for a period of 30 days. Participants' white blood cell (WBC), and absolute neutrophil count (ANC), as well as their quality of life were evaluated. RESULTS: The study was completed with a total of 40 patients. An increasing trend of ANC was observed in the treatment group despite the decreasing trend in placebo group, which was statistically significant between the two groups (P Interaction=0.019, 95% confidence intervals=15.076-171.324). No serious side effects were reported. CONCLUSION: Using chamomile syrup as a complementary therapy in children with leukemia could improve their immunity (as it increased WBC) by minimizing chemotherapy-induced neutropenia.

The Effect of Viola Odorata L. Oil for Fever in Children: A Randomized Triple-blinded Placebo-controlled Clinical Trial.

INTRODUCTION: Finding non-systemic antipyretic option in cancer patients who simultaneously receive several other drugs seems be logical. This study was designed to evaluate complementary therapy with Viola odorata L. oil for fever control in febrile neutropenic children. METHODS AND MATERIALS: In a randomized placebo controlled clinical trial, 41 febrile children were divided into two groups. Children in the active drug group received viola oil (20 drops) to be rubbed on the peripheral margin of the patient umbilicus. Primary outcome measure of the study was the mean axillary temperature in the 30, 60, and 240 minutes after the intervention. RESULTS: The mean temperature reduced significantly in the viola group after 30 minutes of administration (p =0.005), while there was no significant change in the placebo group (p =1.00). The number of patients who received paracetamol as the rescue treatment was significantly lower in the viola group than that in the placebo group (5 vs. 17, p =0.001). CONCLUSION: The results of our study showed the safety and efficacy of complementary therapy with Viola odorata L. oil for fever control in febrile neutropenic children during hospital course.

Insomnia in Traditional Persian Medicine

Insomnia is a common complaint in outpatient clinics. It usually affects quality of life neg-atively, especially in severe cases. Nowadays, routine medical interventions comprise pharmacological approaches and cognitive behavioral therapy. Common medications used by afflicted patients are not competent enough in addition to their annoying side effects. It would naturally denote the need for considering novel strategies for treating insomniac patients. Approach to insomnia in traditional Persian medicine (TPM) has been cited in a scrutinized manner focusing on its main causes. Accordingly, its treatment is tailored based on the constitution of the patient, intensity of the disease, and type of the cause. In this paper we have discussed the causes of insomnia, diagnostic approach, and various medical interventions proposed in valid sources of TPM.

Effects of intranasal administration of violet oil in dry eye disease.

BACKGROUND: Dry eye disease is a disorder of the tear film. In this study, the effect of Viola odorata L. oily extract was examined for the treatment of patients suffering from dry eye disease. METHODS: A randomised, double-blind, placebo-controlled study was designed. During the trial, Schirmer's test, tear breakup time, Oxford staining and the Ocular Surface Disease Index were assessed. Overall, 105 patients with dry eye symptoms between the ages of 18 and 60 years were allocated to the violet-almond oil, almond oil and placebo (1% w/v hydroxypropyl methylcellulose solution) groups. The treatment and placebo were administered intranasally, two drops three times a day for one month. The patients were followed up for four weeks. A total of 91 patients (32, 29 and 30 in the violet-almond oil, almond oil and placebo groups, respectively) completed the study. RESULTS: At baseline, there was no difference between the three groups in terms of demographic data and the measurement parameters. After the intervention, the results revealed that the Schirmer's score without local anaesthesia and the tear breakup time results significantly improved in the violet-almond oil group. One-way ANOVA indicated a significant improvement in the Schirmer's score, tear breakup time and Ocular Surface Disease Index of the treatment group, as compared with the other groups (p < 0.05). However, the obtained results did not present any significant mean difference between and within the groups of the Oxford staining grade (p > 0.05). CONCLUSIONS: This trial showed that the intranasally administered V. odorata L. oily extract enhances tear production and improves tear film stability.

Holistic Approach to Functional Constipation: Perspective of Traditional Persian Medicine.

Traditional Persian medicine (TPM) proposes a different viewpoint to the chronic diseases. Diagnosis and implemented treatment are based on individual differences among patients. Constipation or Ea'teghal-e-batn is a condition in which the patient develops difficult or painful defecation. Based on TPM concepts, the fifirst digestion step starts from halq (oral cavity), and ends via defecation from the maq'ad (anus). Avicenna believed that four faculties, ha'zemeh (digestive), ja'zebeh (absorptive), ma'sekeh (retentive) and da'fe'eh (propulsive), are involved in the process of digestion and absorption of the ingested food and expelling the waste materials. The bowel movement and appearance of the stool is a measure for evaluating the gastrointestinal healthy function. Defecation should be with no pain and fecal material should have no burning and acuity. Low food intake or foods with dry temperament, dryness of gastrointestinal tract, diaphoresis and heavy exercise as well as intestine sensory loss were discussed as main causes of constipation. Management of constipation in TPM includes dietary schemes, oil massages and subsequently simple herbal medicines. According to TPM theories, the fifirst step in treating a disease is the elimination of disease causes (asbabe- maraz) and also providing the causes of health (asbab-e-sehhat). Health care providers should know the proper condition which the herbal medicines should be administered in and be able to guide the patients about the benefifits and hazards of herbal remedies, commonly used in their living origin.

Prolegomena to a True Integrative Medical Paradigm.

When a paradigm starts to show signs of failure to cope with significant questions in any basic/applied branch of human knowledge, there come on the scene those who have perused the related literature enough to either answer those major questions according to the established paradigm or proffer a (wholly) new way of looking at things. In the latter case, the history of science tells us, a paradigm shift takes place. Modern medicine cannot be proven to be totally disconnected from its traditional roots. Where traditional medicine came to give its place to present-day conventional medicine, a number of humanistic aspects of healing, in addition to some axioms of old wisdom, were actually lost. Employing a personalized strategy by considering the patient's specific conditions, integrative medicine endeavors to apply all appropriate interventions from a whole set of science branches to bring back health. However, this does not remain fully without its own challenges from almost all sides. Complementary and alternative medicine, on the one hand, and evidence-based medicine, on the other, have their own rightful say in the affair. Delving deep into the details of medical history's ups and downs, and examining-from the philosophy of medicine's and philosophy of science's standpoints-the pros and cons of integrative medicine, this present treatise makes a systemic, interdisciplinary effort to put forward the best possible paradigmatology in a methodical way as far as the demands of society are concerned.

The effects of Zataria multiflora Boiss. (Shirazi thyme) on nonalcoholic fatty liver disease and insulin resistance: A randomized double-blind placebo-controlled clinical trial.

OBJECTIVE: The aim of the study is to evaluate the effects of Zataria multiflora Boiss. (Shirazi thyme) (ZM) supplementation on nonalcoholic fatty liver disease (NAFLD) and related insulin resistance (IR). DESIGN: In this randomized double-blind placebo-controlled clinical trial, 85 patients with NAFLD were administered either 700 mg ZM powder or placebo twice daily for 12 weeks. All patients were advised to follow the recommendations for diet modification. RESULTS: ZM supplementation resulted in a significant reduction in serum insulin level (-2.72 ± 0.80 vs -0.67 ± 0.90, P=0.030), insulin resistance (-0.80 ± 0.22 vs 0.06 ± 0.22, P=0.023), systolic (-3.44 ± 1.05 vs 1.03 ± 0.98, P= 0.002) and diastolic (-2.33 ± 0.77 vs 0.26 ± 0.63, P= 0.009) blood pressure in patients with NAFLD in comparison with the placebo group. There was no significant difference between two groups regarding serum levels of alanine aminotransferase (ALT), high sensitive C-reactive protein (hs-CRP), Tumor necrosis factor-α (TNF-α), grade of fatty liver in ultrasonography, lipid profiles, and other outcomes. CONCLUSION: ZM supplementation with daily dose of 1400 mg for 12 weeks improved insulin resistance in patients with NAFLD. Further studies with longer duration and larger sample size are recommended.