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Chapter 1

THE PROBLEM AND ITS SETTING

Introduction

According to the World Health Organization the number of people

with diabetes has risen from 108 million in 1980 to 422 million in 2014. The

global prevalence of diabetes among adults over 18 years of age has risen

from 4.7% in 1980 to 8.5% in 2014. According to the Department of Health,

diabetes is the 6th leading cause of death among Filipinos based on the data

from the 2013 Philippine Health Statistics and over 6 million Filipinos are

diagnosed to have diabetes, as declared by the Philippine Center for Diabetic

Education Foundation in 2016.

Diabetes is a metabolic disease characterized by increased levels of

blood sugar of above 120 mg/dL which can damage the kidneys, eyes, heart,

blood vessels and nerves (Lewis 2014). The blood sugar level that is

considered diabetes is based on what diagnostic test used. Hemoglobin A1c

level of 6.5% or higher, a fasting blood sugar of 126 mg/dL and above (7.0

mmol and above), and a random blood sugar test of 120 mg/dL and above is

considered as diabetes.
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Diabetes Mellitus (DM) is a chronic multisystem disease related to

abnormal insulin production, impaired insulin utilization, or both. Diabetes

Mellitus is a serious health problem throughout the world and its prevalence

is increasing rapidly. The normal glucose range is approximately 70-120

mg/dL (3.9-6.66 mmol/L) (Lewis 2014). There are several types of Diabetes.

Prediabetes, Type 1 Diabetes Mellitus, and Type 2 Diabetes Mellitus. Type

1 Diabetes is characterized by the destruction of the pancreatic beta cells. It

is thought that combined genetic, immunologic, and possibly environmental

factors contribute to beta cell destruction. Type 2 diabetes is insulin

resistance and impaired insulin secretion. Insulin resistance refers to

decreased tissue sensitivity to insulin (Brunner & Suddarths).

The risk factors of diabetes depend on the type of diabetes. Even

though the exact cause of Type 1 Diabetes is unknown that may alter an

increased risk includes family history, environmental factors such as

exposure to viral illnesses, the presence of auto antibodies, and race. On the

other hand the risk factor of prediabetes and type 2 diabetes includes weight

specifically obesity, inactivity, family history, race, age, hypertension and

other chronic diseases. According to the World Health Organization (WHO)

diabetes is the leading cause of adult blindness, end stage renal disease, and
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nontraumatic lower limb amputation. It is also a major contributing factor

for heart disease and stroke, especially in the Philippines (Lewis 2014).

There are different approaches in the treatment of diabetes. Among

them include the traditional antihyperglycemic agents and the use of herbal

leaves adjunct to diet modification. Nowadays, many studies are being done

to determine the alternative way in managing hyperglycemia or even

diabetes. This study focuses on one of the most commonly remedy used in

lowering blood sugar level and that is by taking ashitaba.

Ashitaba is botanically known as Angelica keiskei. Ashitaba is

known as a true functional super food, containing a vast spectrum of

beneficial properties and a unique array of phytonutrients, including 11

vitamins, 13 minerals, chlorophyll, enzymes, carotene, germanium,

saponins, proteins, plant fibers, glycosides, coumarines, and a potent rare

class of flavonoids called chalcones. It also contains numerous other health-

boosting phytonutrients such as nerve growth factor stimulation,

coumarines, 4-hydrodexydelisin glycosides, melatonin and natural vitamins

and mineral. Other studies show it helps cleanse the blood, promote healthy

cholesterol levels (decreasing unhealthy LDI cholesterol), stimulates the

production of nerve growth factor (NGF) for excellent nerve function,

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suppresses cell growth abnormalities such as tumors, helps decrease high

blood pressure, remove toxic wastes from the body, aids natural sleep cycle,

improves visual acuity, provides peri-menopausal relief and regulates blood

sugar level.

There are studies that show strong correlation of ashitaba in lowering

blood glucose levels and improve insulin resistance conditions. One Chinese

study entitled Effects of Angelica KiekieChaconne on Insulin Resistance of

Skeletal Muscle Cells of Type 2 Diabetic Rats by Zhao Yang showed that

ashitaba has chalcones that may decrease fasting blood glucose and

improves the insulin resistance condition of type 2 diabetic rats. Another

study published in 2007 in the Journal of Agricultural and Food Chemistry

entitled Ant diabetic Activities of Chalcones Isolated from a Japanese Herb,

Angelica keiskei by Tatsuji Enoki found that the ethanol extract from

ashitaba contains 2 chalcones that shared insulin-like activities. Ashitaba

also appears to protect the endothelial cells in those with type 2 diabetes.

The study that concluded these findings was published by the Institute of

Nutrition. Qingdao University Medical College in China. Their conclusion

was that ashitaba protects the endothelial cells of rats with type 2 diabetes. A

2004 study found that ethanol extract of Ashitaba has insulin mimic
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compounds. Their investigation revealed that there are two insulin mimic

activities of ashitaba: (a) adipocyte differentiation activity and (b)

enhancement activity of glucose uptake.The two major chalcones peculiar to

Angelica keiskei, xanthoangelol (XA) and 4-hydroxyderricin (4HD) have

both activities (a) and (b). These results demonstrate that chronic ingestion

of "Ashitaba" Powder containing Chalcone (4HD) moderately reduces the

blood glucose and improved blood glucose control through increase of

adiponectin in subjects with borderline or mild hyperglycemia and that it is

also very safe.The Japan Society for Bioscience, Biotechnology, and

Agrochemistry published an article in 2012 investigating the effect of A.

keiskei on insulin resistance and hypertriglyceridemia in fructose-drinking

rats as a model for the metabolic syndrome. The results suggest that AE

improved the insulin resistance and hypertriglyceridemia of the fructose-

drinking rats.

Medicinal plants or herbs are in demand in today’s society especially

for the people who cannot afford high cost medicines. The purpose of this

study is to determine if there is a direct relationship between ashitaba and

blood sugar level. It also aims to determine what ashitaba can do in

regulating the blood sugar level of an individual.

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Research Locale

This study will be conducted in selected barangays in Subic,

Zambales. Subic, is a first class municipality in the province of Zambales,

Philippines. It is politically subdivided by 16 barangays:

Aningway,AsinanPoblacion, Asinan proper, Barack, Batiawan, Calapauan,

Calapandayan, Cawag, Ilwas, Mandan-vaca, Matain, Naugsol, Pamatawan,

San Isidro, Santo Tomas and Wawandue.

Subic is the second most populated area in Zambales. According to the

2015 census, it has a population of about 104,771 people. Considering that it

is one of most populated areayet Subic doesn’t have its own hospital.

Diabetes is the 6th leading cause of death among Filipinos and since Subic

doesn’t have a hospital it may increase the morbidity and mortality rate of

the said disease. The researchers used this opportunity to help the people in

Subic in monitoring their blood sugar level and also helping them to find an

alternative way of lowering their blood sugar level.

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Figure 1. Map of Subic, Zambales

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Conceptual Framework of the Study

This study was anchored from the Department of Health of the

Philippines’ (DOH) campaign entitled Diabetes Prevention and Control

Program. The goal of this program is to reduce morbidity, mortality and

disability rates due to chronic lifestyle related non-communicable diseases

through an integrated and comprehensive program on the prevention and

control of lifestyle related diseases. The objectives of this program are: (1) to

develop and promote an integrated and comprehensive program on the

prevention and control of lifestyle related diseases in the country. (2) To

engage all province-wide or city-wide health systems to adopt an integrated

and comprehensive program on the prevention and control of lifestyle

related diseases. And (3) to achieve improvement in the following key

performance indicators from 2011-2016.

This study utilizes an analytical tool which is the conceptual

framework. The identified risk factors of Diabetes or Hyperglycemia

includes: 1) Age, 2) Gender, 3) Blood Sugar Level, 4) Family History, 5)

Economic Status and 6) Lifestyle. 1.) Age of Respondents; according to the

Centers for Disease Control and Prevention (CDC) adults aged 45 to 64 were

the most diagnosed age group for diabetes. 2.) Gender; according to the
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diabetes self-managementmore than 100 million people worldwide

have Type 2 diabetes, and in many parts of the world, men have higher rates

of the condition than women.3.) Blood Sugar Level of the Respondents; a

blood sugar level equal to or greater than 130 milligrams per decilitre

(mg/dL) indicates hyperglycemia. The normal glucose range of

approximately 70-120 mg/dL (3.9-6.66 mmol/L) (Lewis 2014).4.) Family

History; according to the National Institute of Diabetes and Digestive and

Kidney Diseases most people who had type 2 diabetes have a family

member -such as mother, brother, father and sister- with the disease.5.)

Economic Status of Respondents; according to the World Health

Organization (WHO) diabetes prevalence has been rising more rapidly in

middle- and low-income countries6.) Lifestyle; according to the World

Health Organization healthy diet, regular physical activity, maintaining a

normal body weight and avoiding tobacco use are ways to prevent or delay

the onset of type 2 diabetes.

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INDEPENDENT EXTRANEOUS DEPENDENT

VARIABLE VARIABLE VARIABLE

AGE
INTAKE BLOOD
OF FAMILY SUGAR
HISTORY
ASHITA LEVEL
BA GENDER

Figure 2. Paradigm of the Conceptual Framework

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Statement of the Problem

This study focuses on the Effects of Ashitaba Intake to Blood Sugar

Level. Specifically, it aims to answer the following:

1. How may the subjects’s profile be described in terms of:

1.1 Age;

1.2 Gender;

1.3 Civil Status;

1.4 Economic Status;

2. How is the baseline blood sugar level be described?

3. How may the monthly blood glucose level of the subjects be described?

4. How may the subjects’s intake of ashitabain the experimental group be

described:

3.1 Part of Ashitaba taken;

3.2 Frequency of Intake; and

3.3 Manner of Intake.

4. Is there a direct relationship between intake ofashitaba and blood sugar

level?
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Hypothesis

1.) There is no direct relationship between intake of ashitaba and

blood sugar level.

Scope and Limitation

This study focuses on the Effects of Ashitaba Intake to Blood Sugar

Level. It encompasses theobservation on the effect of ashitaba on lowering

blood sugar level by taking Fasting Blood Sugar every month for 3 months.

Nevertheless, it does not include other therapeutic effects of ashitaba such as

antihypertensive, antiobesity and anti-inflammatory among others.

Significance of the Study

The completion of this study entitled “Effects of Ashitaba Intake and

Blood Sugar Level” will be significant and beneficial to the following:

Department of Health (DOH). The findings of this study will

provide the Department of Health a baseline information of people suffering

from hyperglycemia or even diabetes. This can also be their baseline data

about ashitaba for further researches.

Subic, ZambalesHealth Office. This study will provide baseline data

of those people with hyperglycemia within Subic.

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Future Researchers. It will provide additional data and source of

information for future researchers regarding the effect of ashitaba in blood

sugar level and even in other diseases.

Definition of Terms

Hyperglycemia- is an increase in blood sugar level of 120 mg/dL and

above.

Blood Sugar Level- Blood sugar, or blood glucose, is sugar that the

bloodstream carries to all the cells in the body to supply energy. Blood sugar

or blood glucose measurements represent the amount of sugar being

transported in the blood during one instant.

Ashitaba Intake- the ingestion of ashitaba of 2-3 leaves at least twice

daily.
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Chapter 2

RESEARCH METHODOLOGY

This chapter embodies the research method used, the population of the

subjects, and validation of instruments, data gathering procedure and

treatment of data.

Research Method

The design that will be used in this study is quasi-experimental. The

dependent variable which is the blood sugar level is manipulated by giving

them specified parts of ashitaba to be ingested. Participants are not randomly

assigned to conditions or orders of conditions (Cook & Campbell, 1979).

The subjectswill be instructed to chew 2-3 ashitaba leaves daily at

least twice a day. Their blood sugar level will be taken initially and will be

monitored monthly for three months. No control groupwill be employed.

Respondents

The subjects of this study are residents in selected barangay in Subic,

Zambales whose blood sugar level is within the range of 150-200 mg/dL

monitored for 5 consecutive days to establish baseline before they will be

considered as subjects. The population of the subjects is between 15-30.

Hyperglycemic subjects age 30-50 years old regardless whether the

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hypeglycemic subjects are taking ashitaba or not they will be included in this

study. The subjects should not be taking any anti-hyperglycemic. Consent

from will be secured before getting the subjects’s FBS.

According to Babbie (2016), purposive sampling is a type of

nonprobability sampling in which units to be observed are selected on the

basis of the researcher;s judgment about which ones will be most useful or

representative. The reserachers utilized the purposive sampling to identify

the hyperglycemic individuals within several barangays in Subic, Zambales.

Validation of Instruments

This research utilizes a survey-questionnaire. It will be made by

consolidating the risk factors of hyperglycemia or diabetes and by obtaining

the profiles of each of the subjects. It will be presented to three experts from

the field of Nursing, Research and Statistician for validation.

The survey-questionairre was divided into 3 parts: Part 1.)

Demographic Profile, Part 2.) Information about Blood Sugar Level and Part

4.) Client’s usage of ashitaba and response. In Part 1.) Demographic Profile

includes gathering information about the subjects namely: age, address,

gender, civil status, and the socioeconomic status. Part 2.) Information about

Hyperglycemia includes gathering about family history of diabetes, the

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subjects latest blood sugar level, if the respondents are taking medications to

lower down blood sugar level. Moreover, it also gathers history on past and

present medication prescribed by the subjects physician. And lastly part 3.)

Clients usage of Ashitaba and Response includes gathering of information

how the respondents take ashitaba, the duration of their use, its observed

effectiveness and side effects.

Data Gathering.

Permission to conduct this study will be secured by the researchers

from the Dean ofColumban College- College of Nursing. Second, a letter of

request will be submitted to the office of the Mayorand/or to the Offices of

the Barangay Kagawad to execute the questionnaires to the respondents.

Treatment of Data

The gathered data will be analyzed and interpreted accordingly. The

following treatments will be used:

1. Percentage - will be used to determine the percentage of the

subjectswho had a decreased in blood sugar level after taking

ashitaba.

Formula:

%=F
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N x 100

2. Spearman’s Rho –is a test used to measure the strength of

association between two variables which is the intake of Ashitaba

and Blood Sugar Level.

Formula:

3. Phi Coefficient –is a measure of the degree of association between

the Ashitaba intake and blood sugar level.

Formula:
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APPENDICES
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APPENDIX A
LETTERS

May 23, 2018

Thru: Dr.Leonardo Afable

RHU Physician, Subic Rural Health Unit

Dear Dr. Afable,

We , the third year Nursing Students of Columban College Olongapo City,

will be conducting a research entitled “Correlates of Ashitaba Intake and
Blood Sugar Level” in partial fulfillment of the course NC123 – Research II
RLE.
In connection with this may we ask permission from your office to allow us
to distribute questionnares in selected barangays in Subic, Zambales that will
be used for our research study.
Rest assured that all data obtained during the survey will be treated with
utmost confidentiality.

We hope for your favorable response and consideration.

Thank you very much.

Very respectfully yours,

The Researchers

Noted by:

Maria AmaluzFontillas RN, MASE

Research Adviser
Approved by:

Leilani E. Capili, RN, Ed.D

Dean – College of Nursing
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APPENDIX B
SAMPLE QUESTIONNAIRE

Dear Respondents,

The BSN-III, group 2 will conduct a research entitled “Correlatesof Ashitaba

Intake and Blood Sugar Level” and will be conducted in selected barangays
in Subic, Zambales.

Kindly fill-up this questionnaire and rest assured for confidentiality.

Thank you and God Bless.

Very respectfully yours,

The Researchers

I. Demographic Profile

A. Name: (Optional)___________________________________
Age:_________
Address:__________________________________________

Gender: Male Female

Civil Status: Single

Married

Widowed
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B. Socio Economic Status
Occupation: Employed Unemployed

Others Please specify:_________

C. Family Monthly Income

Below ₱5,000

₱5,001 - ₱10,000

₱10,001 - ₱15,000

₱15,001 - ₱20,000

₱20,001 - ₱25,000

₱25,001 – ₱ 30,000

₱30,001- ₱35,000

₱35,001 – ₱40,000

₱40,001 - ₱45,000

₱45,001 – ₱50,000

₱50,000 and Above

II. Information about Blood Sugar Level

1. Family History of Diabetes

(May history basapamilyana may diabetes)

Yes (Oo) No(Hindi)

2. Do you check your Blood Sugar Level regularly?

(Madalasmo bang pinapachekangiyong blood sugar level?)
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Yes No

How often:(Gaanokadalas?) __________

3. When was the last time your blood sugar level was checked?
(Kailananghulingbesesnachineckangiyong sugar?)

_____________________

4. Have you been told by a health professional in past year that

you have elevated blood sugar?

(Sinabihankaba ng isang health professional noon

mganakaraangtaonnamataasangiyong sugar?)

Yes(Oo) No(Hindi)

If yes, when: (Kung oo, kailan)________________________

5. Are you currently taking medication prescribed by a doctor to

lower your blood sugar level?

(Kasalukuyanka bang umiinom ng gamotnanireseta ng
doktorupangbumabaangiyong sugar?)

Yes(Oo) No(Hindi)

If yes, please specify: (Kung oo,pakitukoy)

_______________________

6. Have you had symptoms of high blood sugar level lately?

(May mgasintomaskaba ng pagtaas ng sugar kamakailan?)

Yes(Oo) No(Hindi)
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If yes, which of the ff:(Kung oo, anosamgasumusunod)

Fatigue(Pagkapagod)

Hunger(Pagkagutom)

Thirst(Pagkauhaw)

Frequent desire to urinate(Madalasnapag-ihi)

Trouble focusing vision

III. Client’s Usage of Ashitaba and Response

1. Which part of ashitaba do you consume?

(Anongbahagi ng ashitabaangginagamitmo?)

Leaves(Dahon)
Stem (Tangkay)
Roots (Ugat)

2. How do you take ashitaba?

(Sapaanongparaanmoginamitangashitaba?)

Raw

Infusion

Decoction

3. How often do you take ashitaba?

(Gaanokadalasmokainin o inuminangashitaba?)
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Everyday(Araw-araw)

Every other day(Tuwingmakalawa)

Once a week (Isangbesessaisang lingo)

When my blood sugar level is above 130 mg/dL

(Kapaganglebel ng sugar ko ay mataas sa130 mg/dL?)

4. Does your blood sugar level decrease after taking ashitaba?

(Bumababaang sugar monanguminom/kumainka ng ashitaba?)

Yes(Oo) No (Hindi)

5. Monthly blood sugar level(Lebel ng sugar buwan-buwan)

January (Enero) 2018 ________

February (Pebrero) 2018 ________
March (Marso) 2018 ________
April (Abril) 2018 ________
May (Mayo) 2018 ________
June (Hunyo) 2018 ________
July (Hulyo) 2018 ________
August (Agosto) 2018 ________
September (Setyembre) 2018 ________
October (Oktobre) 2018 ________
November (Nobyembre) 2018 ________
December (Disyembre) 2018 ________
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REFERENCES
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BOOK SOURCES

Lewis, et. al. Medical Surgical Nursing 2014 9th Ed. Mosby and
Elsevier Inc., Canada, 2014

Brunner &Suddarth’s. Textbook of Medical-Surgical Nursing 10th

Ed. Lippincott Williams & Wilkins

Dr. David Cababaro Bueno Introduction to Statistics (Concepts and

Applications in Research), 2016

Cristeta B. Tan A Research Guide in Nursing Education Third

Edition , Visual handbook, 2006

JOURNALS

Philippine E-Journals. Beneficial Effects of Ashitaba

(Gynuranepalensis): Users’ Testimonies.
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INTERNET SOURCES

http://ashitabaplant.blogspot.com/2011/06/

https://www.neutraceuticalssworld.com/contents/view_supplier-
research/2010-04-06/ashitaba-chalcones-show-efficacy-in-battling-visce/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435568/pdf/IEMA
MC-13-185.pdf, 2013

http://web.archive.org/web/20100330183645/http://www.organicashitaba.co
m/articles.html

https://www.deepdyve.com/lp/wiley/effects-of-dietary-angelica-
keiskei-on-lipid-metabolism-in-stroke-WB0zC0oQmW, 2003

http://biofundations.org/wpcontent//uploads/2015/08/AshitabaBookV
er11.pdf

http://www.ecellgen.com/index.php?option=com_content&view=artic
les&id=20&Itemid=31

http://www.ashitabatea.com/research.php&ved=2ahUKEwigz_Gg8Z3
ZAhVCLpQKHSIOA3OQFjAGegQICBAB&usg=AOvVawOwssoPkhGTz
9plrPYde79j
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CURRICULUM
VITAE
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Jesselyn S. Campit
09469510115 * jsslyncmpt@gmail.com
Purok 6 Brgy. Antipolo, San
Antonio,Zambales

EDUCATIONAL BACKGROUND

Tertiary : Columban College Inc.

Rizal St. Extension Bo. Barretto, Olongapo City

Secondary : Luzon Technical Institute

San Antonio, Zambales

Primary : San Gregorio Elementary School

San Antonio, Zambales

LEADERSHIP AND CERTIFICATIONS

16th National Conference for Nursing Students

Basic Life Support

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Michelle Galindez
09305453576 * michgalindez@gmail.com

#0773 Purok 3C Sitio Tahimik

Calapacuan, Subic

EDUCATIONAL BACKGROUND

Tertiary : Columban College Inc.

Rizal St. Extension Bo. Barretto, Olongapo City

Secondary : Subic National High School, Mangan-Vaca

Primary : Calapacuan Elementary School

LEADERSHIP AND CERTIFICATIONS

16th National Conference for Nursing Students

Basic Life Support

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Jhocelyn Lazo Guiling

09302131024
jhocelynguiling.jg@gmail.com

#46 Silahis St. Prk 4 New Cabalan,

Olongapo City

EDUCATIONAL BACKGROUND

Tertiary : Columban College Inc.

Rizal St. Extension Bo. Barretto, Olongapo City

Secondary : New Cabalan National High School

Primary : Boton Elementary School

LEADERSHIP AND CERTIFICATIONS

Youth for Environment in Schools Organization-Award of Excellence

Youth for Environment in Schools Organization Division Camp and

Festival

Top Ten outputs in Feature Writing-English

Division Training Workshop for Campus Journalist and School Paper

Advisers

16th National Conference for Nursing Students

Basic Life Support