Virtually every day I get a question or statement from a patient about the use of herbal medicine.
Some would say, "I stopped my blood pressure medicine, and I am taking St. John's Wort." Or, "You told me to take this estrogen pill but my friend told me to take Koash, a natural estrogen." Or, "Doc, here is a list of the health food supplements I take." Or, "I am presently taking Creatine to build my muscles. Everyone is doing it."
After spending many years studying modern medicine, I find myself being quizzed more about herbal medicine. Why? People are accessing information with greater ease.
More books, magazines, web sites, audiotapes, videos, and Oprah interviews speak to herbal medicine. The information and advertisement for herbal medicine is more oriented to the consumer, while the information for medicines doctors prescribe were more oriented to the physician.
Many people think because it is an herb, by definition, it is completely safe.
How should I respond to patient inquiries of this nature? I could take the easy way out and disclaim all non-allopathic therapies, telling these patients to toss away their plants and tablets. But I know that I would not be meeting my responsibility to counsel and advise. The public is reaching out.
I also know that the interplay of plants and human health has been documented for thousands of years. Herbs have been integral to all medicine. Four thousand years ago, the Chinese systematized many of the herbs. More recently herbal medicines have been consumed in many forms.
Some are harvested fresh, eaten whole or mixed in food. Others are dried, sold in bulk and then remixed. Others are freeze-dried into capsules.
I remind my patients that the drugs and medicines I prescribe also started from plants. I remind my patients that the herbs are just as much a drug or medicine. I remind my patients that the reason they work is that they produce a chemical reaction in the body to change whatever is ailing the patient. They are drugs by definition. Then, what are the differences?
These are a few. Because of quality control varying from manufacturer to manufacturer, there is uncertainty about the amount of active ingredients in some herbal preparations. The rigor of testing for the medicines or drugs physicians prescribe allows us to be able to understand the safety and the side effects of the medicine.
For herbal medicines, safety should be at least as important as efficacy. But the gold standard in safety and efficiency—the double-blind, randomized, placebo-controlled trials—has rarely been applied to herbal medicines.
I will attempt to present just a few of the more commonly used herbal medicines and the information known about them that I could find.
ALOE VERA ( A. vulgari and A. barbadensis): Aloe is native to eastern and southern Africa. It is found throughout the Caribbean. Gel from the inner central zone of the leaves and latex from the pericyclic cells are used for medicinal purposes.
The capsule is 50-200 mg by mouth once a day for 10 days. The gel is applied 3-5 times a day for wound healing, skin irritation, burns, sunburn and psoriasis.
One study found that the wound healing was related to the aloe's ability to prevent dermal ischemia by reversing the effects of thromboxane synthase. Aloe's use is contraindicated in children less than 12 years of age and in older persons with suspected intestinal obstruction, inflammatory bowel disease or pregnancy.
Long-term use may result in diarrhea, especially a potassium deficiency that may be increased by the simultaneous use of thiazide diuretics, steroids or licorice root.
Caution is indicated when used in conjunction with cardiac glycosides.
GARLIC(Allium sativum): Garlic was originally from central Asia and is a
member of the lily family. Its use is documented in Sanskrit letters dating
5000 years ago and in Egyptian medical papyrus of 1550 BC.
Louis Pasteur noted garlic's antibiotic activity in 1858.
Garlic is used to lower cholesterol, protects against arterial occlusive disease, and has antibacterial, antiviral, antifungal, antiplatelet, and antihypertensive effects. Several double-blind, placebo-controlled studies showed reduction of cholesterol of up to 12.8% and reduction of triglycerides of up to 15.2%.
Other studies showed no effect on cholesterol of two garlic preparations, underscoring the need for careful evaluation of the specific garlic product.
The most effective form of garlic is freshly crushed or chewed. The amount is four grams of fresh garlic or 900 mg of powdered garlic once a day.
Allinase is released in the mouth, producing allicin which when absorbedn lowers the cholesterol. The garlic capsule must reach the intestine to release the maximum amounts of active ingredients.
The allinase activity of the tablets seemed to be inactivated by gastric acid, resulting in failure of the tablets tested to reduce the cholesterol. There are no known contraindications to garlic. There are no known drug interactions, although caution should be exercised when used with other agents that have antiplatelet effects, such as ginger, ginkyo, vitamin E, or agents with antihypertensive effects. Because of its antiplatelet effect, garlic use should be stopped before surgery.
St. John's Wort ( SJW; Hypericum perforatum): St. John's Wort is native to
Europe but grown all over the world. The flowers are used for medicine and were thought to have magical powers.
It is commonly used for depression.
The chemical, Hyperforin, in St. John's Wort may be largely responsible for the antidepressive effects. In Europe, it is prescribed seven times more often for depression than other anti depression medications.
There appear to be no contraindications but phototoxicity is seen in animals. Caution in its use in pregnancy and also when using ultraviolet light therapy. Its main side effect is stomach upset.
Lastly, in Lancet, July 24, 1999, there was a report from Guadeloupe of
muscle rigidity, tremors, slowness of movement and poor balance due to use
of teas made from either soursop, custard apple or pomme cannelle (pomegranate).
The report indicated that although many people eat these fruits, the problems to the nervous system does not occur until people are in their 60s, says neurologist Dominque Caparros-Lefebvre of the Centre Hospitalier Universitaire des Antilles. The authors caution that their work is preliminary and so it is too early to suggest that people change their diet.Studies are continuing at Harvard Medical School in Boston by a neurologist, Paul A. Rosenberg.
Many people who hesitate to take prescription medications don't think twice about self-medicating with herbal remedies. These botanicals do not have to be proven safe before they are placed on the market.
Just like prescription medicine is big business, so is herbal medicine. Just like prescription medicines must be taken in the right quantity or dose to get the desired effect, so too, do herbal medicines have to be taken in the correct dose or amount. Just like prescription drugs have side effects, so too do herbal medicines. Everyone needs more information. Learn as much as you can from reliable sources like the Food and Drug Administration's MedWatch program (800-332-1088 or 301-738-7553). Learn what works and what doesn't work.
Remember a drug is any substance used in the prevention, diagnosis, alleviation, treatment or cure of disease.
