Disease, Illness and Condition Library
Medicinal Herbs and Neutraceuticals
extracted, or otherwise prepared, used for health and wellness benefits. Neutraceuticals is a more recent and more general term that refers to a group of natural substances that include certain herbs and such products as cholesterol lowering margarines and psyllium fortified products that are used as dietary supplements and regulated as foods. Traditional systems of medicine have been used throughout the world for centuries by literally billions of people. Certain ancient systems, such as traditional Chinese medicine, Ayurveda (the holistic system of medicine from India), and Tibetan medicine, are still used extensively, particularly in their country or origin. In the United States, awareness in the therapies of such systems, particularly for the treatment of chronic illness, is growing. These therapies, usually referred to as complimentary or alternative medicine, range from medicinal herbs to acupuncture, message, chiropractic and beyond. Many of them have not been scrutinized scientifically, and nearly all are unregulated in most countries. The most commonly used alternative therapies are dietary supplements, which include medicinal herbs and nutraceuticals. Because the use of dietary supplements is widespread, the United States government passed the Dietary Supplement Health Education Act (DSHEA) in 1994. It defines a dietary supplement as any product (besides tobacco) that contains a vitamin, mineral, herb, or amino acids and that are intended as a supplement to the normal diet. The act requires that the label of a dietary supplement identify it as such. The label must state that the claims for the dietary supplement have not been evaluated by the Food and Drug Administration (FDA). The label must also list each ingredient by name, quantity, and total weight and must identify the plant parts from which each ingredient is derived. Most dietary supplements used in alternative medicine are derived from plants; some are derived from animals (an example would be lizard tail used occasionally in traditional Chinese Medicine). Because such dietary supplements are natural, some people make the assumption that they are completely safe to use. However, a substance is not necessarily safe just because it is natural. For example, many powerful poisons, such as hemlock, are derived from plants, and some, such as snake venoms, are derived from animals. Furthermore, almost all substances that affect the body – whether dietary supplements or drugs approved for medical use by the FDA have both wanted and unwanted effects (side effects). Safety and Effectiveness: Because dietary supplements are not regulated as drugs by the FDA, their manufacturers are not required to prove that dietary supplements are safe and effective (although they must have a history of safety). Consequently, few supplements have been rigorously studied for safety and effectiveness (although some may eventually be shown to be safe and effective). Furthermore, because the need to evaluate supplements has only recently been recognized, much of the available information has not yet been gathered systematically or scientifically and so it is tricky to evaluate. In contrast, both prescription and over the counter drugs have been extensively and systematically studied by researchers and reviewed for safety and effectiveness by the FDA. These studies include those in animals to detect the development of cancer and organ damage and those in humans to detect any signs of toxicity. Practitioners of herbal medicine will counter this somewhat negative argument by pointing out that these types of supplement has been used safely and effectively for at least 5,000 years, and it is in fact western medicine that lacks the long term results to substantiate their claims. They will also be quick to point out that almost all FDA approved drugs have some side effect, many of which can be serious. Both arguments are compelling, with valid points made by well intentioned medical professionals. The truth probably will be found somewhere in the middle. Purity and Standardization: Other areas of concern are the purity and standardization of supplements. Supplements, unlike drugs, are not regulated to ensure that they are pure or that they contain the ingredients or the amount of active ingredient they claim to contain. As a result, the supplement may not be pure. Or, the amount of active ingredient in a dose of a supplement may vary, especially when whole herbs are ground or made into extracts to produce a tablet, capsule, or solution. Standardization requires that each individual dosage form of the product contain a precise amount of its active ingredient or ingredients. However, most herbal products are mixtures of several substances, and which ingredient or ingredients are the most active is not always known. Therefore, determining which ingredient or ingredients should be considered active and thus would be subject to standardization can be difficult. Some supplements have been standardized and may include a designation of standardization on the label. Advice on the best way to choose a pure, standardized product vary from expert to expert. Most experts recommend buying from a well known manufacturer, and many recommend buying products made in Germany or the United States. Germany may have the strictest rules monitoring the production of herbal products of any country at this time. Interactions with Drugs: Supplements can interact with prescription and over the counter drugs. Such interactions may intensify or reduce the effectiveness of a drug or cause a serious side effect. Before taking supplements, people should consult their doctor, so that such interactions can be avoided. Few well designed studies have been conducted to investigate supplement to drug interactions, so most information about these interactions comes from sporadic individual reports of interactions. Overview of Some Dietary Supplements The following substances are some of the more widely know supplements. They may or may not be useful in maintaining or restoring health. Chamomile Background: The daisy-like flower of this herb is dried and used as tea or in extracts. Medical Claims: Various substances in chamomile reduce inflammation and fever. Chamomile, which has a soothing effect, is used as a mild sedative. Chamomile may be used to relieve stomach cramps and indigestion. It is also claimed to help gastric ulcers heal. Chamomile extract applied in a compress may soothe irritated skin. Studies in animals suggest that substances in chamomile inhibit Helicobacter pylori, the bacteria that can contribute to stomach ulcers. However, few studies in humans have evaluated chamomile’s effects, and there is no evidence that it speed up healing of gastric ulcers. Chamomile is generally considered safe. Possible Side Effects: Chamomile may reduce the absorption of drugs taken by mouth. Chamomile may also interact with drugs such as anticoagulants, sedatives (such as barbiturates), alcohol, and iron supplements. Some people are allergic to the pollen in chamomile products. Chromium Picolinate Background: Chromium is a mineral required in small quantities by the body. It enables insulin to function normally and helps the body process (metabolize) carbohydrates and fats. Good sources of chromium include broccoli, carrots, potatoes, whole grain products, and molasses. Picolinate, a by product of the amino acid tryptophan, is paired with chromium in supplements because it is claimed to help the body absorb chromium more efficiently. Medical Claims: As a dietary supplement, chromium picolinate is used to promote weight loss, build muscle, reduce body fat, and enhance the function of insulin, but these effects have not been proven. It may lower levels of cholesterol and triglycerides. Possible Side Effects: Some evidence suggests that chromium picolinate damages chromosomes and consequently may cause cancer. Cranberry Background: Cranberries can be consumed whole or made into food products such as jellies and juices. Medical Claims: Consuming cranberries whole or as juices prevents urinary tract infections and relieves their symptoms. The effectiveness of cranberries in preventing urinary tract infections has been documented. In one study, researchers identified one way that cranberries may prevent infections. Natural unprocessed cranberry juice contains anthocyanidins, which prevent Escherichia coli, the bacteria that usually cause urinary tract infections, from attaching to the urinary tract wall. Some people use cranberry juice to reduce fever and treat certain cancers; however, there is no scientific proof that it is effective for these uses. Possible Side Effects: No side effects are known. However, because most cranberry juice is highly sweetened to offset its tart taste, people with diabetes should not consume cranberry juice unless it is unsweetened. Sugar content is listed on the label of cranberry juice containers, so the next time you are in the market for cranberry juice make sure to check the label for low or even better zero sugar content. Creatine Background: Creatine is an amino acid made in the liver and stored in muscles. It is a readily available source of energy in the body. In the diet, creatine is found in milk, red meat, and some fish. Medical Claims: Creatine is used to improve physical or athletic performance and to decrease fatigue. A few studies indicate that creatine can increase the amount of work performed with a short maximal effort (for example, in sprinting). However, a few others indicate no improvement in this type of activity. Possible Side Effects: Creatine can cause dehydration and may cause kidney dysfunction. Dehydroepiandrosterone Backround: Dehydroepiandrosterone (DHEA) is a steroid produced in the adrenal glands and converted into sex hormones (estrogens and androgens). DHEA’s effects on the body are similar to those of testosterone. Medical Claims: DHEA supplements may stimulate the immune system. They are used to improve mood, energy, sense of well being, and the ability to function well under stress. Other uses include deepening nightly sleep, lowering cholesterol levels, and decreasing body fat. Many athletes claim that DHEA builds muscles. It is also claimed to reverse aging and improve brain function in people with Alzheimer’s disease. The medical claims of DHEA have not been substantiated. Possible Side Effects: Theoretically, DHEA may result in breast enlargement in men and hairiness in women and may stimulate the growth of certain prostate and breast cancers, but these effects have not been substantiated. DHEA should not be used by children attempting to build muscle or enhance athletic performance. Echinacea Background: Echinacea is a perennial herb, which contains echinoside and several other active substances. Various parts of the plant are used medicinally. Medical Claims: Several substances in echinacea may stimulate the immune system. Echinacea is used to help treat viral infections in the upper respiratory tract, such as the common cold. Applied as cream or ointment, Echinacea has been used to promote healing of wounds. Many studies have evaluated the effects of echinacea, but none were designed well enough to provide conclusive results. Also, most of these studies evaluated products in which echinacea was combined with other herbs, which made evaluation of echinacea’s benefits difficult. At least two relatively well designed studies evaluated echinacea’s effectiveness in upper respiratory tract infections: In one, echinacea reduced the duration of colds and the severity of symptoms; in the other, it reduced the frequency and number of recurrences. Feverfew Background: Feverfew is a bushy perennial herb. Parthenolide and glycosides are thought to be its active components. Medical Claims: Feverfew is used to prevent migraine headaches. It may reduce inflammation. Feverfew reduces the clotting tendency of platelets (cell-like particles in the blood that help stop bleeding by forming clots). Evidence from two of three relatively small but well designed studies supports these effects. Differences in study findings may reflect the different formulations of feverfew used. In studies of people with arthritis, feverfew did not relieve symptoms. Possible Side Effects: Mouth ulcers and skin inflammation (dermatitis) may occur. Taste may be altered, and heart rate increased. Feverfew may interact with anticoagulants, drugs used to manage migraine headaches, and non- steroidal anti-inflammatory drugs (NSAIDs). It may reduce the absorption of iron. Feverfew is not recommended for children or for women who are pregnant or breastfeeding. Garlic Background: Garlic has long been used in cooking and in medicine. When a garlic bulb is cut or crushed, an amino acid by product called allicin is released. Allicin is responsible for garlic’s strong odor and medicinal properties. Medical Claims: Garlic reduces the clotting tendency of platelets. Because garlic stops microorganisms (such as bacteria) from reproducing, it can be used as an antiseptic and antibacterial. In large doses, garlic can reduce blood pressure, over activity of the intestine, and blood sugar levels (slightly). Advocates suggest that garlic lowers levels of low density lipoprotein (LDL) cholesterol – the “bad” cholesterol. However, at least one well designed study did not support this beneficial effect. Most studies have used aged garlic extracts. Preparations formulated to have little or no odor may be inactive and need to be studied. Possible Side Effects: Garlic usually has no harmful effects other than making the breath or body smell like garlic. However, consuming large amounts can cause nausea and burning in the mouth, esophagus, and stomach. Garlic may interact with anticoagulants. Ginger Background: Like garlic, ginger has long been used in cooking and in medicine. The stem of the herb contains substances called gingerols, which give ginger its flavor and odor. Medical Claims: Ginger appears to soothe the stomach, relieve intestinal cramps, and reduce inflammation and pain. Ginger may prevent nausea, vomiting, motion sickness, and dizziness (including vertigo). Ginger may be helpful in treating excessive vomiting during pregnancy. Some well designed studies indicate that ginger is effective in preventing and lessening nausea, but others do not. Possible Side Effects: Ginger is usually not harmful, although some people experience a burning sensation when they eat it. It may also cause digestive discomfort and produce a disagreeable taste in the mouth. Ginger may interact with anticoagulants. Ginkgo Background: Ginkgo is derived from the leaves of the ginkgo tree. The leaves contain several substances called ginkolides. Medicinal Claims: Ginkgo reduces the clotting tendency of platelets, dilates blood vessels (thereby improving blood flow), and reduces inflammation. Ginkgo is used to improve blood flow to the brain and in the lower legs. It may be useful in treating dizziness, headache, noise in the ears (tinnitus), memory loss for recent events, and mood disturbance. It may prevent damage to the kidneys caused by the immunosuppressant cyclosporine. Evidence supports some of these claims. Many European studies have shown that a standardized preparation of ginkgo reduces symptoms of people with reduced blood flow to the brain or in the legs. For example, in people with peripheral arterial disease, it increased the distance that could be walked without pain. One large well designed study in the United States indicated that ginkgo can stabilize or improve mental and social function in people with mild to moderate dementia, including Alzheimer’s disease. Another study indicated that it can improve mental function in healthy older people. Possible Side Effects: Although ginkgo leaf extracts usually have no side effects except mild digestive upset, the use of ginkgo should be supervised by a doctor; it is not suitable for self medication. Ginkgo may interact with anticoagulants, aspirin, and other non-steroidal anti-inflammatory drugs (NSAIDs), and it may reduce the effectiveness of anticonvulsants. Contact with the fruit pulp, which may be encountered under ginkgo trees (planted for ornamental purposes), can cause severe skin inflammation (dermatitis). The fruit is not used in ginkgo products. Ginseng Background: Ginseng is usually derived from two different species of plant: American and Asian ginseng. American ginseng is milder than Asian ginseng. Ginseng is available in many forms, such as fresh and dried roots, extracts, solutions, capsules, tablets, cosmetics, sodas, and teas. The active components are panaxosides in American ginseng and ginsenosides in Asian ginseng. Siberian ginseng is not really ginseng and contains different active components, but it has anti-stress effects similar to those of American and Asian ginseng. Ginseng products vary greatly in quality; many contain little or no detectable active ingredient. In a very few cases, some ginseng products from Asia have been purposefully mixed with mandrake root, which has been used to induce vomiting, or with phenylbutazone or aminopyrine – drugs that were removed from the market in the United States because of unacceptable side effects. Medical Claims: Ginseng is used to improve physical (including sexual) and mental performance and to increase energy and resistance to the harmful effects of stress and aging. Ginseng appears to reduce blood sugar levels and increase levels of high density lipoprotein (HDL) cholesterol – the “good” cholesterol. It may also increase hemoglobin and protein levels in the blood. Evaluating some of ginseng’s effects is difficult because measuring an increase in energy and other quality of life effects is difficult. In one small study of people with diabetes, ginseng reduced blood sugar levels and improved mood and energy. In one large but short study, ginseng improved overall quality of life, according to this subjective study. Possible Side Effects: Ginseng has a reasonably good safety record. The most common side effects are nervousness and excitability, which usually decreases after the first few days. The ability to concentrate may be decreased, and blood sugar may decrease to abnormally low levels (causing hypoglycemia). Because ginseng has an estrogen like effect, women who are pregnant or breastfeeding should not take it, nor should children. Occasionally, there have been reports of more serious side effects, such as asthma attacks, increased blood pressure, palpitations, and, in postmenopausal women, uterine bleeding. To many people the taste of ginseng is not desirable. Ginseng can interact with anticoagulants, aspirin, other non-steroidal anti- inflammatory drugs (NSAIDs), corticosteroids, digoxin, estrogen replacement therapy, monoamine oxidase inhibitors (MAOIs – used to treat depression), and drugs that decrease blood sugar levels (hypoglycemic drugs, used to treat diabetes). Goldenseal Background: Goldenseal, and endangered plant, that is related to the buttercup. Its active components are hydrastine and berberine, which have antiseptic activity. Berberine is also active against diarrhea. Medicinal Claims: Goldenseal is used as an antiseptic wash for mouth sores, inflamed and sore eyes, and irritated skin and as a douche for vaginal infections. It has been combined with echinacea as a cold remedy, but the effectiveness of goldenseal as a cold remedy has not been substantiated. Goldenseal is also used as a remedy for indigestion and diarrhea. In two relatively well designed studies, berberine isolated from goldenseal reduced diarrhea. Possible Side Effects: Goldenseal can produce many side effects, including digestive irritation and upset, contractions of the uterus, jaundice in newborns, and worsening of high blood pressure (hypertension). If taken in large amounts, goldenseal can cause seizures and respiratory failure and may affect contraction of the heart. Goldenseal may interact with anticoagulants. Women who are pregnant or breastfeeding, newborns, and people who have heart disease, epilepsy, or problems with blood clotting should not take goldenseal. Licorice Background: Natural licorice, which has a very sweet taste, is extracted from the root of a shrub and used medicinally. Most licorice candy made in the United States is artificially flavored and does not contain true licorice. Medical Claims: Licorice is used to suppress coughs, to soothe a sore throat, and to relieve stomach upset. Applied externally, it is thought to soothe skin irritation (for example, eczema). Possible Side Effects: Licorice may cause fluid retention. Frequently taking large amounts of licorice can result in high blood pressure (hypertension). Melatonin Background: Melatonin is a hormone produced by the pineal gland, located in the middle of the brain; it regulates the sleep wake cycle. Melatonin used in supplements is derived from animals or produced artificially. Medical Claims: Melatonin is used to treat insomnia and to help minimize the effects of jet lag. People who are traveling across time zones may benefit from melatonin given on the day or night of departure and for 2 or 3 nights after arrival. Melatonin has been used to prevent pregnancy, to enhance the immune system, and to prevent cancer. Evidence suggests that melatonin supplements can affect the sleep wake cycle. However, in one large well designed study, melatonin supplements did not relieve symptoms of jet lag, and only a few small studies suggest that these supplements can treat insomnia. There is no evidence that melatonin can prevent pregnancy or cancer. Possible Side Effects: Drowsiness may occur 30 minutes after taking melatonin and lasts for about 1 hour. Whether melatonin is safe when used long term is not known. Theoretically, a viral or prion infection could result from taking melatonin derived from animal brains but not from taking artificially produced melatonin. Headache and transient depression have been reported. In people who are depressed, melatonin may worsen symptoms. Melatonin is best taken under medical supervision. Milk Thistle Background: The main active ingredient, silymarin, is found in the seeds of this prickly leafed, purple flowered plant. Medical Claims: Mild thistle affects primarily the liver, spleen, and kidneys. It increases production of protein by the liver and stimulates regeneration of liver tissue. It is claimed to protect the liver from toxic substances (such as viruses, alcohol, and the toxin from death cap mushrooms) and from certain drugs (such as the analgesic acetaminophen, the antidepressant amitriptyline, and the antibiotic erythromycin). Thus, mild thistle is used to prevent and treat mushroom poisoning and other liver disorders, such as cirrhosis and hepatitis C. Two well controlled studies of milk thistle in people with cirrhosis had mixed results. In reports that have collected information about many individual patients with mushroom poisoning, milk thistle reduced the death rate. Possible Side Effects: Brief stomach upset and mild allergies, but no serious side effects, have been reported. Milk thistle may intensify the effects of drugs that increase blood sugar levels (hypoglycemic drugs). Saw Palmetto Background: The plant’s berries can be made into tea. Saw palmetto is also available as tablets, capsules, and a liquid extract. Medicinal Claims: Saw palmetto opposes the actions of testosterone. It is used to treat benign enlargement of the prostate gland (benign prostatic hyperplasis also known as BPH). In seven of eight relatively well designed studies, saw palmetto relieved the symptoms of an enlarged prostate gland, such as the frequent urge to urinate. Claims that it increases sperm production, breast size, or sexual vigor are unproven. Possible Side Effects: Headache and diarrhea occasionally occur. Because saw palmetto may have hormonal effects, women who are pregnant or who may become pregnant should not take it. Women taking hormone replacement therapy should consult their doctor before they take saw palmetto. Saw palmetto may interact with estrogen replacement therapy and oral contraceptives. St. John’s Wort Background: The reddish substance in the plant’s flowers contains hypericin, which is the main active component. Medical Claims: In many small, mostly short term, moderately well designed studies, St. John’s wort relieved symptoms in people with mild to moderate depression. However, in a recent large, well designed study, St. John’s wort was found to be ineffective in treating major depression. St. John’s wort has been used in the treatment of HIV infection and vitiligo, but its overall effectiveness in treating these disorders is unproven. Possible Side Effects: When used as directed, St. John’s wort does not seem to have the side effects or interactions with foods containing tyramine that can occur with other monoamine oxidase inhibitors (MAOIs). It can make the skin very sensitive to sunlight (photosensitive). Pregnant women should not take this supplement because it increases muscle tone in the uterus and thus may increase the risk of a miscarriage. St. John’s wort may interact with oral contraceptives; protease inhibitors (such as indinavir and ritonavir), which are used to treat HIV infection; MAOIs and other antidepressants; the immunosuppressant cyclosporine; digoxin; iron supplements; and the anticoagulant warfarin. Valerian Background: The plant’s dried root contains valepotriates, which may have calming effects. Medical Claims: Valerian is used as a sedative and sleep aid, especially in parts of Europe. In two relatively well designed studies, valerian improved sleep quality and shortened the time needed to fall asleep. Possible Side Effects: Headaches, excitability, uneasiness, and heart disturbances have been reported. Valerian may lengthen the effect of other sedatives (such as barbiturates) when it is taken with them. People who are driving or performing other activities requiring alertness should not take it. 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