For decades physicians have minimized (or even neglected) the role of non-pharmaceutical compounds in their treatments for medical disorders. However, as a more educated and medically savvy patient population has emerged over the past few years, physicians have found themselves confronted with questions about the use of herbs and other “natural” compounds in the treatment of medical conditions. As this “alternative” approach has become more popular, many companies have jumped on the bandwagon and are turning out various “natural” compounds for use for everything from insomnia to PMS to chronic fatigue to arthritis.
Physicians, on the other hand, have generally not embraced this trend, simply because most were not trained to do so and, in addition, many feel uncomfortable prescribing compounds for which there is limited hard data regarding effectiveness, risks and side effects, and correct dosing; and very little control over purity and strength of compound.
But the public is clamoring for these agents for several reasons: 1) they assume that because herbs are “natural” they are better than the prescription medications which have been produced in a laboratory (most coming to market after years of time-consuming research); 2) they are readily available without prescription; 3) they are usually cheaper than prescription medications; 4) many patients have had side effects on prescription drugs and hope that an herbal medication might have less adverse effect.
There is no way to make a blanket statement about whether herbs are better than traditional medications or not. But one thing is for certain: much more objective study needs to be done in this area, and this information needs to get out to the public.
Unfortunately, honest, objective information about alternative medications has just not been very readily available.
But without objective information, how can we ever answer the big questions, such as: 1) for which disorders might herbs be effective? 2) Which herb or natural compound is worth trying as an alternative to a prescription medicine? 3) What is the correct dose? 4) What are the side effects and the potentials for herb-drug interactions? And finally, how pure and reliable is the herb one is taking?
Because the FDA does not regulate natural compounds, many “less than honest” companies can make claims about their products without much scrutiny. But now that is all changing. Recently a group based at the Massachusetts General Hospital (you know, the “Harvard guys”) has begun to explore, in a scientific way, the effectiveness, side effects, and suggested strengths of many of the more common herbal medicines.
Prior to this group’s work the naturopathic community has had to rely on the German Commission E report, which does contain information on specific herbs and what they are used for, but does not have detailed safety information, and also fails to address the specific efficacy of the herbs themselves when compared (under rigorous scientific studies) to other available synthetic prescription compounds. This group at Mass General hopes to change all that.
For example, the group rigorously studied Valerian for insomnia (see below for discussion on effectiveness). The group found that of 17 over the counter Valerian compounds studied, eight failed their tests. Four of the eight did not have any Valerian substance in them at all, and the other four had only about the amount indicated on the bottle. You can see the potential problems, can’t you? That is why one must be careful.
Well, without further delay let me detail some of the more commonly used herbs, with comments about effectiveness, safety, side effects, and drug interactions, as we currently know them.
Garlic: this was the most used herb in 2002, according to surveys. It purportedly reduces blood fats, and therefore theoretically should reduce cardiovascular disease risk. Some studies indicate that it does seem to be slightly effective at reducing cholesterol; unfortunately, some very recent studies did not confirm this, and most experts do not feel it is any better than placebo. At least it does no harm, and it tastes good (I am Italian).
One should be careful taking garlic supplements if one is on a blood thinner (i.e. Coumadin or Heparin or aspirin), or is pregnant or breast feeding.
Ginkgo: promoted for enhancing memory, improving concentration, and treating dementia. In studies it was no better than placebo for all of the above, except for Alzheimer’s dementia, where is seemed to help a little. There were no significant risks in taking Gingko extract, but one should be careful taking it if one is on anticoagulant medication (C oumadin, Heparin, Aspirin) or if one is having surgery soon.
Soy: contains isoflavones, which are structurally related to plant-derived estrogens. These are converted in the body into weak estrogens. They have been promoted for menopausal symptoms, but studies do not indicate that they are any better than placebo. Red clover, a legume rich in phytoestrogens, is more biologically active than soy, but again, studies were disappointing for menopausal symptoms. Studies have not been done to see how safe these compounds are when used in the long term.
Echinacea: used widely for treatment of infections such as the common cold virus; Echinacea does seem to help somewhat if used for the short term in adults (a grade of B for moderately effective). However, it did not prevent the cold infection, it simply seemed to shorten its duration by a few days). Echinacea does seem to boost the immune system in adults in the short term (less than 8 weeks use). However, it can actually suppress the immune system if used longer than 8 weeks (exactly opposite of what you want from the drug). Echinacea can interact with antibiotics, antifungals, and certain immunosupressants used in arthritis and cancer. It can also cause liver damage and severe allergic reactions, but these are rare.
Saw Palmetto: used for benign prostatic enlargement (BPH); received a grade of A in the studies. It does work for this condition. But others have promoted its use for male baldness; for this it does not work. There are no known herb-drug interactions, and long term safety studies are ongoing.
Ginseng: used to treat fatigue, depression, and improve thinking (cognition). Studies are ongoing, but so far they do not seem to indicate effectiveness in any of these areas. More studies may be more informative. Ginseng can inhibit platelet action, so again be careful using it if you are on a blood thinner or anticipating surgery. It can also lower blood sugar, so diabetics must be careful. It should not be used in pregnancy or breast-feeding.
St John’s Wort: this is the popular herb used as an alternative to anti-depressant medications such as Prozac and Zoloft. For true clinical depression (moderate to severe depression), St John’s Worth got a grade of C (probably not effective). For milder depression, in got a grade of A (effective-but so then is Prozac and Zoloft, which also get grades of A; but yes, they are very expensive). St John’s wort could potentially interfere with oral contraceptives, seizure medications, thyroid medications, and digitalis. It also can cause skin sensitivity to sunlight (burn very easily), and delayed allergic reactions. It should not be taken in pregnancy or breast-feeding. St John’s wort was ineffective for anxiety disorder and premenstrual syndrome.
Valerian Root: Valerian earned a grade of B for insomnia (works pretty well), but a C grade for anxiety. Side effects include headache and stomach ache. It could theoretically interact badly with alcohol. The effective does is 300 to 600 mg.
Ginger: Effective for some causes of nausea, but it depends on the cause of the stomach upset. Example: ginger gets a grade of B for pregnancy-induced nausea, but only a C for nausea after surgery. Ginger is not effective for arthritis (grade C).
Black cohosh: this herb has been advocated for use in menstrual symptoms, and has received a grade of “B” for effectiveness (this means there is data to support its effectiveness, but the data did not rise to the level of “definite”, which is an A grade);
it is also promoted for joint pain, but received a “C” grade in this indication, meaning the studies have shown only mixed effectiveness, or the studies are not very large or well grounded. Black cohosh is known to interact negatively with anti-coagulant medications and hormones.
Evening Primrose Oil: This herb gets a B grade for allergic dermatitis (allergic skin rash), indicating it is probably effective. Unfortunately, evening primrose has been advocated for several other conditions, ranging from asthma to Raynaud’s disease, but the evidence does not support its use for these conditions at all. In some studies, evening primrose oil raised blood pressure. Pregnant women and patients with seizure disorder should avoid it.
Bilberry: promoted for a number of eye conditions and vascular disease, it earned a grade of C for all of them (probably not effective).
Cranberry: for years people have touted the use of cranberry juice for treatment of urinary tract infections in women-and guess what? It seems to work (somewhat). It got a grade of B in effectiveness (i.e. moderately helpful-but of course, if your urine is burning and stinging you may want to get a traditional antibiotic, which is usually more than 95% effective).
Drinking cranberry juice on a regular basis did not seem to work in preventing urinary tract infectious. Cranberry juice is generally safe, unless you are a diabetic (lots of sugar in there).
Wild Yam: may have hormonal and lipid-lowering properties, but studies varied from a grade of B to C (slight to no effectiveness). Wild yam can cause skin rash and low blood sugar.
The “Avoid” List: There are many herbs which are down-right dangerous and should be avoided. The list includes yohimbe, bitter orange, kava, andro, skullcap, aristocholic acid (also known as birthwort, snakeroot, snakeweed, and wild ginger), pennyroyal oil, lobelia, germander, chaparral, and comfrey.
I also strongly caution against the use of organ or glandular extracts.
