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HEALTH BENEFITS OF DATES

INTRODUCTION

Phoenix dactylifera L, routinely termed the date palm tree, is a flowering plant that has long been one of the most important fruit crops grown in the arid countries in the Arabian Peninsula, North Africa, and in the Middle East. Throughout the last three hundred years, dates have also been introduced to new areas in Australia, Mexico, India, Pakistan, Southern Africa, South America, and the United States. The cultivation of dates is a main income source and the dates themselves are a staple food for the local populations in the many areas in which they are grown. The cultivation of dates has been an important economic activity in these countries, and has had a significant role to play in the society and the environment of these countries (1).

The date palm is one of the oldest known fruit crops. For at least 5000 years, it has been cultivated in North Africa and the Middle East. Cultivation of dates and their trade and distribution has a long history and as such it is unclear the exact origin of the date but it is hypothesized that they probably originated from either Mesopotamia (the area that is now Southern Iraq) or Western Pakistan. From here, the cultivation of dates then spread throughout to the countries of the Arabian Peninsula, North Africa, and the Middle East. Date cultivation later spread to areas as far as Southern Spain in Europe and other parts of Asia with the spread of Islam, and the Spanish people were the first to introduce date palms outside the areas in which they were not originally grown such as the America (2).

The influence of date cultivation on the history of the Middle East region is undisputed. The cultivation provided a food supply that was able to sustain large populations in the harsh desert environment. Caravan trade routes across the deserts existed for hundreds of years and were mainly used for the transportation and trade of dates. Great cultural and spiritual significance is attached to dates by the people of the Middle East. Imagery of date palms and the culture around dates is depicted against in ancient Assyrian tablets with depictions of date palms also being encountered in ancient Egyptian, Syrian, Libyan, and Palestinian writings. There is mention in the Jewish, Christian and Muslim religions of the date palm tree and its fruit. This is thought to be due to the influence of Abraham, who is a central figure in these three religions, who grew up in the land of Ur, in which date palms grew in abundance. Of these three faiths, none places as much importance on the date as Islam. Dates are considered special and are mentioned severally in the Holy book of the Qur’an. The Prophet Muhammad is said to have urged the Muslim people to eat dates, tend to the date palm tree and to use them as cures for various ailments. Dates are the first food item usually consumed to break the fast during the Holy Month of Ramadhan.

Currently it is estimated that there are about 100 million date palm trees growing in the world in over 30 countries. Between 2.5 and 4 million tonnes of fruit are produced annually, most of which is consumed in the countries in which the cultivation occurs (2).

The main product of the date palm tree is the date palm fruit which can be consumed when fresh, dried or in various processed forms. The fruit can be harvested when it is at different stages of ripening, depending on the use for which it is intended. There are 5 distinct stages of development of the date fruit, characterised by changes in colour and chemical composition of the fruit. The 5 stages in order of ripening are Habakuk, Kimri, Khalal, Rutab and Tamar.
The dates fruit are available in different forms, such as whole pitted and unpitted, dried pieces. Dates are used in various products cereal, pudding, bread, cakes, cookies, candy bars, ice cream, and date shakes. The date fruit also can be made into juice, vinegar, jam, wine, beer, sugar, jellies, syrup, honey, date cubes, chutney, pickle, date sugar powder, paste, dip, and food flavoring.

There are many different varieties of dates, with some of the popular ones being Barhee, Halawy which are both high quality soft dates originally from Iraq, Hayany from Southern Egypt, Deglet Noor originally from the Algerian Sahara and is one of the most common cultivars grown in North Africa, Medjool originally from Morocco and is widely grown in different parts of the world, Khadrway from Iraq, Thoory, Dayri and Zahidi.

Dates have long been considered to have numerous health benefits from the olden days. Anecdotal evidence mentions their use medicinally in curing various ailments such as sore throats, the common cold and fevers. Their use was recommended in mouth washes, as laxatives or in gynecologically related interventions. They were believed to improve fertility and improve the chances of conception especially when consumed unripe. They were also believed to be useful during the pregnancy period. They were used in various ointments, bandages and ophthalmic prescriptions. They were also believed to improve fertility especially in males (2). Additional medicinal uses which includes cold, fever, edema, sore throat, bronchial catarrh, low sperm count, cystitis, and abdominal trouble to mention few. Seeds are used in a paste to relieve ague. The gum that is tapped from the trunk can be used for the treatment of diarrhoea, and can have a counter effect on alcoholic intoxication. The roots of the date palm can be used against tooth ache and pollen supply estrogens. A special date cultivar known as Ajwah is said to be the most medicinal date fruit in all the date palm varieties. Dates also have a high tannin content and can therefore be as a detersive and astringent in intestinal upsets (3).

NUTRITIONAL BENEFITS

In modern times with improvements in science, these purported health benefits have begun to be appreciated more. A 2008 review article detailed the numerous nutritional and functional constituents of dates and their seeds. Date flesh was found to have low levels of fat and protein but was found rich in sugars, mainly fructose and glucose. It is reported to be a high source of energy. Ten trace minerals were reported to be found, mainly selenium, copper, potassium, and magnesium. The main vitamins found in dates are the B-complex vitamins and vitamin C. Date flesh is also high in dietary fiber with insoluble dietary fiber being the major fraction. Dates are also a good source of antioxidants, mainly carotenoids and phenolics. Date seeds contain higher protein and fat as compared to the flesh (1).

Dates are primarily composed of carbohydrates, about 40-80%, most of which is the sugars glucose and fructose. They also contain a small amount of starch and dietary fibre. The high sugar content of dates makes them a good alternative to processed sugar for use as a sweetener. 100g of dates provides about 284 calories. The sugar contained in dates makes them a good source of energy that is easy for the body to digest.

People may avoid eating dates due to the belief that date consumption will significantly raise their blood glucose level. Studies have shown that this belief is erroneous. While dates do contain a high amount of natural sugars, they are actually a low-glycemic index (GI) food. A study conducted among both healthy and diabetic patients in the United Arab Emirates (UAE), using 5 different types of commonly consumed dates showed that they do not cause a significant rise in the post-prandial blood sugar levels. For each participant the blood glucose levels were measured before and after consumption of the dates and then these values averaged and used to calculate the glycemic index of the fruits. No statistically significant differences were noted between the GIs in the healthy and in the diabetic patients for the 5 varieties of dates tested. The consumption of the dates did not also result in a statistically significant excursion in the post-prandial glucose levels suggesting that diabetic patients can consume them in similar quantities as healthy patients. However careful observation of the caloric content of the dates in the patient’s meal plan as dates are high in calories (4).

Dates have a high fiber content. 100g of Medjool dates contains 6.7g of fiber, while Deglet-Noor dates contain 8g of fiber, which is about 6 to 7 percent of the recommended daily intake. The proportion of insoluble dietary fiber is the highest. The soluble fiber dissolves in water forming a gel-like constituency and it can help lower blood cholesterol and glucose levels. The insoluble fiber promotes the movement of digested material through the gut and increases the bulk of stool, and can therefore be beneficial to those who struggle with irregular stools or with constipation.

As mentioned above the fiber in dates has the ability to lower cholesterol levels. A study done by researchers in Israel at the Technion-Israel Institute of Technology reports that dates have better results at lowering triglyceride levels and their studies showed that consuming dates may lower triglyceride levels by 8 to 15 percent. Lower triglyceride levels are associated with a lower risk of atherosclerosis, heart attack and stroke and therefore dates are a healthy option to include in the diet.

The addition of dates in the diet delivers vital vitamins and minerals in one’s body. There are at least 15 types of minerals in dates. Dates are an excellent source of potassium. (0.5 percent in some seeds and 0.9 percent in the flesh). Additional minerals and salts that can be found in various proportions include phosphorus, sodium, cobalt, copper, fluorine, potassium, magnesium, manganese, iron, boron, calcium and zinc. Additionally, the seeds may also contain sulphur, lead, chloride, cadmium and aluminium in various proportions. The consumption of 100g of dates provides up to 15% of the recommended daily allowance of these minerals. Dates also contain elemental fluorine that safeguards against tooth decay. Selenium also found in dates, is believed to help prevent cancer due to its antioxidant properties and is thought to be important in immune function. Dates contain numerous vitamins including a small amount of vitamin C, and the B-complex vitamins: B1 thiamine, B2 riboflavin, nicotinic acid (niacin) as well as vitamin A. Dates are a natural source of folic acid which is an important micro nutrient (5).

The protein in dates contains 23 types of amino acids, some of which are absent in the most commonly consumed fruits such as oranges and bananas. Dates contain a high concentration of Aspartic acid, histidine, Glycine, proline, Valine, Lysine, isoleucine, Leucine and Arginine, but low concentrations of methionine, Serine, threonine, Isoleucine, lysine, Phenylalanine and tyrosine and very low concentration of Alanine. Dates therefore contains suitable amounts of essential and non-essential amino acids thus causing increasing their nutritional value (5). The date fruit contains flavonoids, sterols, procyanidins, carotenoids and anthocyanins.

ANTIOXIDANT ACTIVITY

Dates have been shown to have various roles to play in disease prevention due to their antioxidant activity (6). Antioxidants are chemicals found in the body that interact and deactivate the free radical compounds, therefore preventing them from causing harm. Preventing the actions of free radicals is an important step in disease management. Medicinal plants such as dates and their constituents play a vital and significant action due to their antioxidant activity to neutralize or inhibit the free radicals. Date palms play a significant role in neutralization of free radicals and consequently avert the emergence of maladies. Earlier investigation found that palm date has a potent ability to suppress free radicals (6).

A recent report showed the presence of antioxidant, antimicrobial and anti-mutagenic activity in the aqueous extracts of the date palm fruit (7). An important finding showed that dates have the highest concentration of polyphenol compounds among the dried fruits and that they are a good source of antioxidants. The redox properties of the phenolic compounds are what contributes the most to their antioxidant activity and helps them to play an important role in neutralizing and absorbing free radicals. Phytochemicals have a significant antioxidant capacity and capability in lowering the prevalence and lower mortality rates of cancer. Another study showed that dates have good antioxidant activity due to the relatively high concentration of compounds such as carotenoids and phenolics in them, which varies depending on the type of date. Of the three types of dates studied i.e. Khalas, Fard and Khalab, the Khalas variety was shown to have the best antioxidant activity due to having the highest concentration of the carotenoids and phenolics (6).

ANTITUMOUR ACTIVITY

Medicinal plants have various constituents such as flavonoids and phenol which play a significant role in the control of oncogenesis through the regulation of genetic pathways with minimal adverse effects. The constituents of dates fruit have shown similar antitumour activity but the exact mechanism of action of dates and their constituents in the prevention of cancer development is not known exactly and is yet to be studied.

Studies done earlier reported the presence of antitumour activity in the beta D-glucan from dates. A dose dependent anticancer activity with an optimum action against tumour at certain threshold levels of the date extract was exhibited in studies done on animal models.

This hypothesized to be due to the inhibition of the activity of phase I enzymes and enhancement of the activity of the phase II enzymes by constituents of the date extract. An experimental study showed that date pits exhibit some antigenotoxicity which is thought to be either due to the ability of the constituents to scavenge alkyl radicals, the ability to inhibit the aromatase activity of cytochrome P-450 or by blocking the reaction between methane diazonium ion and DNA (8).

ANTIMICROBIAL ACTIVITY

Development of antimicrobial drug resistance by microbial pathogens is one of the major health threats currently being faced and is increasing significantly worldwide. Many first-line antibiotics have now been rendered ineffective due to development of resistance, making it increasingly difficult to treat what were thought to be simple infections, and more expensive as more costly drugs are required, with a greater risk of adverse effects.

The medical community is now increasingly looking beyond conventional antimicrobial drugs to alternative ways of dealing with these infections. Natural products and their constituents appear to be a good approach in the control of infection. They have minimal side effects and they are effective and inexpensive. The date palm fruit and its constituents may potentially play a significant role in the prevention or treatment of bacterial diseases.

An important study showed the growth of some bacterial species namely: F. oxysporum, Fusarium sp., F. solani, A. alternata, Alternaria sp was inhibited by the effect of acetone and methanol extracts of leaves and pits Phoenix dactylifera.

Some other important findings showed that the growth of both gram positive and gram negative bacteria was reasonably inhibited by the methanol and acetone extracts of the P. dactylifera pits. Another recent study showed support of P. dactylifera effects as an antimicrobial agent against Klebsiella pneumonia and Escherichia coli. The study also showed its role in reducing the side effects due to the use of certain drugs such as methylprednisolone.

Another study also showed that the extract of the date palm fruit has antibacterial effect against Enterococcus fecalis, indicating that this extract has the potential to be used in treating enteric diseases (8).

ANTI DIABETIC EFFECT

One of the most common metabolic disorders is diabetes mellitus, with about 2.8% of the world’s population affected. The current mode of treatment of diabetes and its complications such as diabetic retinopathy, is based on synthetic medicines such oral hypoglycemic agents. This approach is effective but it also presents many adverse effects and alterations of the metabolic and genetic pathways. The natural products and their constituents are less toxic and free from side effects and therefore present a good approach in the control of diabetes when compared to synthetic ones. They may play a significant role in the management of diabetes and its complication including through the modulation of metabolic and molecular pathways. Plants also show significant effects in managing the pancreatic function via stimulation an increase in insulin production and inhibiting glucose absorption in the intestines. Although the exact mechanism is not fully understood, the action of dates in diabetes control is postulated to involve the increase of insulin production and reducing glucose absorption as mentioned above. Various active compounds present in the date palm fruit extract such as flavonoids, steroids, phenol and saponines, may play a role as anti-diabetic agents, and in diabetic rats have been shown to scavenge the free radicals liberated by alloxan. The flavonoid compounds from the epicarp of the dates fruit have been shown to potentially play a significant role in improving the biochemical derangements seen in diabetic rats.

An experimental study done in animal models showed that oral administration of date palm fruit extract and its various constituents improved body weight via decreased water intake and caused hypoglycaemia in alloxan-induced diabetic rats. As mentioned earlier, the consumption of dates may be of benefit in glycaemic and lipid control of diabetic patients due to the low glycemic index of dates. They provide a good alternative to other food items that may have a high glycemic index.

ANTI INFLAMMATORY EFFECT
Inflammation is amongst the most important primary physiologic defences against different insults such as infection, physical injuries e.g. burns, toxic chemicals, allergens and other stimuli. An imbalance in the inflammatory process has been shown to play a vital role in not only the development but also the progression of various diseases including malignancies. Transcription factors such as NF-kB play a significant role in the inflammation that occurs in cancer, diabetes and other diseases (9). Thus the regulation of transcription factors is an important and critical step in disease prevention. Inhibitors of the activity of transcription factors have been showed to play a vital role in preventing the action of transcription factors. Presently used inhibitors however show numerous adverse effect and are also very costly.

Natural products have shown potential as a good remedy in the suppression of NF-kB activity and they act as anti-inflammatory agents. Plant constituents such as phenolics and flavonoids have been shown to act as excellent anti-inflammatory agents. Dates fruit which contain a significant amount of these constituents play a significant role as anti-inflammatory agents. A report showed that ethyl acetate, methanolic, and water extracts of the Ajwa variety dates inhibit the cyclooxygenase enzymes COX-1 and COX2. A study in animal models showed that the pollen from the date fruit palm has potential protective effects via modulation of the expression of cytokines. An important finding in the support of dates fruit reported that the methanolic extracts of the palatable portions of the fruit showed a vital role in reducing the levels of plasma fibrinogen during an inflammatory process. A study in the support of dates as anti-inflammatory agents showed that the date leaves can be considered as a rich source of natural antioxidant and anti-inflammatory drugs due to their constituents (8).

As shown above, dates have numerous health benefits, and they also have the potential to be used in the management of numerous diseases. Current treatment approaches for chronic diseases such as diabetes mellitus and malignancy are based on synthetic drugs. Not only are they expensive, but they also exhibit numerous unwanted adverse effects and involve unintended alterations to genetic and metabolic pathways. Therefore, an affordable alternative that is also safe and effective would be required to help controlling the development of these diseases. Dates and their constituents show great potential for use in this area. They have been shown to have a therapeutic effect due to their antioxidant activity and anti-inflammatory properties and they do present a possible novel strategy in the management of these conditions (10). Further investigation in both animal models and in clinical trials would be necessary to identify the exact mechanism of action of the date fruit and its constituents in prevention of these diseases.

Date palm fruit extract have been shown to have some protective effects on the kidneys. A study done in a rat model with nephrotoxicity induced by gentamicin showed that the use of the date palm fruit extract from the pits and the flesh of the fruit had a significant effect in reducing the rise in levels of plasma creatinine and urea induced by the drug and also improved the proximal tubular damage.

Different medicinal herbs and their derivatives play a significant role in relieving pain and also in causing relaxation during delivery. Several medicinal plants have been shown to have an effect in stimulation of all the phases of labor. A study of the role that medicinal plants play in labor showed that the extracts from several plants may have a contractile effect on uterine myometrial cells. A premier important study on the role that dates may have in the labor process has shown that dates showed a number of significant effects in women who consume the fruit such as higher mean cervical dilatation, reduced need for induction and labor rise when compared to those who did not consume the fruit.

Dates fruit have various constituents and each of which may play a unique role in the management of matters of fertility. Anecdotal evidence mentions the use of different parts of the date palm fruit to aid in conception and increase the fertility of a couple. Numerous studies or reports appear to be in support of the use of dates in tackling issues of infertility. Micro elements contained in the extract of date palm pollen (DPP) such as estrone and sterols have been shown by early reports to have an influence on male fertility. A study carried out on an animal model showed that constituents such as cholesterol, rutin, carotenoids and estrone contained in the date palm pollen extract were recognized to have an effect on gonadotrophin action in the rat. Certain threshold concentrations of the date palm pollen extract were shown to have the best effect on sperm parameters and that when the use of the date palm pollen extract ceases, there was an increase in the plasma levels of estradiol in the male rats (11).

NEURO PROTECTIVE EFFECTS

The date palm fruit provides a crucial physical benefit to the brain, known as the neuro- or cerebroprotective effect. Generally, this neuroprotective effect guards the brain tissue from the catastrophic effects of reactive oxygen species (ROS) which are products of cellular metabolism or are exogenously acquired. This effect can be considered an extension from the previously explained antioxidant effect of the date palm fruit as the basic concept is similar. Date palm has been found to be an excellent antioxidant agent and due to the high concentrations of constituents such as phenolic compounds, flavonoids and anthocyanins. A study was done on a rat model to investigate this basic antioxidant effect on the brain in order to evaluate its beneficial effects (12).

Based on previous studies, it was noted that two different parts of the date palm: the fruit extract and the seed extract, can be used to exhibit this beneficial effect on the brain. The fruit extract was obtained by drying the fruits at room temperature then grinding them before extraction with a methanol-water solution. To obtain the seed extract, the seeds were soaked in distilled water and washed before drying at room temperature then ground and distilled water used to extract the powder.

To expose the rat brain to the effect of reactive oxygen species, ischemia was induced by either occlusion of the common carotid arteries bilaterally or occlusion of the middle cerebral artery which restricted blood flow to the brain. Following the occlusion, the rat brain was then reperfused. Restoration of blood supply by reperfusion leads to damage to the cell membrane by exposing the cell’s macromolecules to ROS, and thus leads to neuronal death.
The studies showed that treatment of the rat with either the fruit extract or the seed extract had various beneficial effects. It was found that neuronal damage in the form of shrinkage, atrophy and necrosis was greatly reduced. It is thought that how the date palm extract works is by decreasing the peroxidation of the lipid content of the brain tissue and as well by restoring the altered antioxidant enzymes caused by ROS. The shortfall of these earlier studies however is that the constituents of the fruit and seed extract were not analyzed and quantified. This makes it difficult to relate the neuroprotective effects to the phytochemical composition which can vary with the variety of the date and the stage at which it was harvested. Sun dried dates may also lose some of their antioxidant constituents as compared to fresh dates due to the physical changes that come about with drying.

Another important discovery made by Pujari et al in a separate study showed that in rats treated with the date fruit extract, they had increased levels of endogenous antioxidants in their brain tissue. This contributes to the neuroprotective effects of the date palm by helping to counter the oxidative stress brought about by ROS. These endogenous antioxidants, namely glutathione (GSH) and glutathione reductase (GR)act by the removal of lipid peroxides and hydrogen peroxide (H2O2) and thus helping to guard tissue from oxidative damage. In case of brain ischemia when subjected to oxidative damage, the normal result is that the antioxidants levels such as GSH and GR among others in the brain decrease as they are used up to remove lipid peroxides and H2O2 brought about by oxidative damage. However, this study showed that in rats treated with a high concentration of the date fruit extracts, the levels of endogenous GSH and Gr were higher and upon histological examination of the brain tissue, there was less neuronal loss in terms of neuron shrinkage and atrophy.
Another study showed the benefits of date palm to the brain in rats treated with date palm fruit extract, that to a large extent prevented the formation of abnormal myelinated fibers in their neuronal tissue.

Based on these studies, both the date fruit and date seed extract have been shown to possess some neuroprotective properties. It is however not clear which of the two are better since these studies were conducted using different parameters and they conclusions drawn from them are based on different results. Despite these shortfalls, these studies do demonstrate the neuroprotective effects of the date palm fruit. They indicate that the date palm fruit has the potential to be used as a potential therapeutic agent in the management of brain ischemia and degenerative disease of neuronal tissue. This however would require more investigation as research work done on the brain is still limited.

Anecdotal reports have mentioned possible psychological effects of the date palm fruit. A study was done on animal models to investigate the potential psychological effects of the date palm fruit extract on the brain and possible potential for use in the treatment of nervous system disorders. This study however did not show any significant effects of the fruit extract on the behavior of the animals based on various parameters that were tested. Further research will therefore be required to establish whether indeed they have any effect at all (13).

Date extract has been hypothesized to have protective effects on the liver. A study was done in animal models to investigate this activity of an aqueous date extract against liver damage induced by dichloroacetic acid. The different polyphenolic compounds, tannins and flavonoids in the date extract were identified. The date extract was then administered orally to rats that had been previously treated with different concentrations of dichloroacetic acid. It was noted that the levels of the hepatic marker enzymes were lowered significantly following administration of the date extract. The study also demonstrated that the liver’s histological architecture was improved. Oxidative stress was reduced by decreasing the extent of formation of hepatic thiobarbituric acid reactive substances which restores the activity of various hepatocellular enzymes and also by reducing the fragmentation of hepatic DNA. The study showed that aqueous date palm extract has a protective effect on the rate liver and therefore has potential therapeutic use in management of liver disease. (14)

Dates have also been associated with some gastroprotective functions. Folklore and anecdotal evidence indicates their use in ameliorating stomach ailments. A study done on a rat model sought to investigate whether dates would be beneficial in treating gastric ulcers. Extracts from the date fruit flesh and pits were prepared in both aqueous and ethanolic media. They were then administered to a group of rats orally for 14 days. On the final day of treatment, the rats were starved for 24 hours then given 80% ethanol through gastric intubation to induce the development of gastric ulcers. These rats were then killed within an hour of intubation and their stomachs examined for the incidence and severity of ulceration. The concentrations of histamine and mucus in the gastric mucosa as well gastrin levels in plasma were also estimated. A control group of rats was fated for 24 hours then administered a single dose of lansoprazole orally then given ethanol in a similar manner to the test animals. This group served as the positive control. The results of the study indicated that extracts of the dates fruit and to a lesser extent the date pits, had a significant effect in reducing the severity of gastric ulceration and mitigating against the increases in concentrations of gastrin and histamine, and the decrease in the amount of gastric mucus that were induced by ethanol. The ethanolic fruit extract was seen to be the most effective. This gastroprotective effects are possibly multi-factorial and are likely to involve the antioxidant activity of the constituents of the date fruit.

CONCLUSION

Dates have been shown to have numerous health benefits and potential for use in the management of different conditions. Further research will now be required to quantify and qualify these benefits in order for them to be fully harnessed in the management of disease.

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