Herbs for Health?

 Most of my patients probably spend more money on over-the-counter vitamins, herbs and weight loss remedies than they do on doctor prescription meds. So are many of the over-the-counter herbs safe? Their present popularity is largely due to the fact that the public perceives them as devoid of adverse effects. The answer is yes and no. So let’s explore three of the top-selling herbal medicinal products in the United States.

 

 

Maidenhair tree, ginkgo fruits and seeds have been used in traditional Chinese medicine (first recorded in 2800 BC) for thousands of years, but it’s the ginkgo leaf that contains the flavonoids and terpene lactones that are associated with its diverse pharmaco-medicinal properties. These trees can grow 100-120 feet tall and are prized across America for its ornamental value and its incredible ability to resist insects and pollution..

I prescribe ginkgo for improving memory in my patients that may have a blood flow problem. If it’s not a lack of blood problem, causing the memory defect, it won’t work. The studies (7 of 8 that I reviewed) showed improved global effectiveness ratings and less forgetfulness compared to placebo.

 

It was tried for Alzheimer’s Disease (Alzheimer’s Disease has over 50 different causes) and showed a moderate improvement (3% difference on the Alzheimer’s Disease Assessment Scale-Cognitive sub-test). Again, probably it improved those with a brain blood flow problem and not the others.

 

Ginkgo increases fluidity of the blood and therefore optimizes blood flow at the micro circulatory level (where the blood cells, going single file, give off their oxygen). It also inhibits sticky platelets from clumping, regulates the tone and elasticity of the blood vessels and is a free radical scavenger (antioxidant). It increases the number of brain receptors for the neurotransmitter acetylcholine. Because of these properties it was tried on tinnitus (ringing in the ears). Again there was a moderate effect over 12 weeks on the perceived loudness of the ringing, but it didn’t make the ringing go away.

 

In hardening of the arteries in the legs (claudication), causing leg pain when you walk, data shows that patients taking Ginkgo walked 34 meters farther without pain than the controls. However, compared with regular walking exercises, ginkgo is clearly less effective.

 

Serious side-effects including bleeding (like subdural hematomas, bleeding around the brain) and seizures have been reported. A rule of thumb is that any herb that starts with a "G" (Garlic, Ginger, Ginkgo, Ginseng and Goldenseal) can worsen you chance of bleeding while on a blood thinner (like Warfarin/Coumadin). Lesser side effects include: palpitations, dizziness, headache, restlessness, hives, vomiting and diarrhea. Therefore, it’s best not to take ginkgo with prescription meds or you take a chance on becoming toxic.

 

Like any herb, you need to use a standardized concentrated extract. Gingko requires 50 pounds of leaves to go through 27 different extract steps, taking up to 2 weeks, to yield just one pound of Gingko Biloba extract. Recommended dosage: 40 mg three times a day (max 320 mg/day). Noticeable effects usually take at least 4 weeks.

 

 

St. John’s Wort is a shrubby perennial found throughout the temperate world. It can be seen along roadsides and in dry fields. It has been applied topically or used systemically to treat bronchitis, burns, skin cancer, enuresis (bed wetting), gastritis, hemorrhoids, hypothyroidism, insect bites, insomnia, kidney disease, scabies and wound healing. Today, it is used almost exclusively as an herbal antidepressant. It’s mechanism of action lies in selective inhibition of serotonin, dopamine and norepinephrine reuptake in the central nervous system. Its’ active compounds are hypericin and hyperforin.

 

Of 27 randomized, double blind clinical trials St. John’s Wort showed efficacy in mild to moderate depression, but not severe or chronic depression. Ten of these studies, when comparing St. John Wort extract to several prescription meds including maprotiline, imipramine, bromazepam, amitriptyline and diazepam showed them to be equal. Thus, St. John’s Wort has been shown to be better than placebo and equal in effectiveness to low dose tricyclic antidepressants in multiple studies.

St. John’s Wort’s safety profile when taken alone (without other herbs, vitamin or prescription meds) is excellent. It has caused photosensitization (sensitivity to the sun) and induction of manic symptoms in those that are predisposed. St. John’s Wort is metabolized by the P450 cytochrome system in the liver. This system strikes fear into any physician due to its potential adverse effect with so many medicine interactions. When taken with: anticoagulants, oral contraceptives and anti-virals (including those for AIDS); these prescription medicines’ plasma blood levels will fall, thus possibly causing a clot, birth or infection, in that order. When combining St. John’s Wort with a "Prozac" family drug (Celexia, Paxil, Zoloft, Lexapro, Sarafem) it can cause serotonin overload and toxicity. St. John’s Wort can cause cataracts, so don’t combine it with light therapy (often used to treat seasonal depression), wear sunglasses outdoors (blocks UV A and UV B). Recommended dosage is 300mg of standardized extract (0.3% hypericin) three times a day. Effect takes 2 to 4 weeks to appear.

 

 

Over-collection in our area has caused ginseng to be placed on the "not to be harvested by law" list of mountain plants. In the studies there is a lack of distinction between any of the 22 plants around the world called ginseng. Siberian and Russian ginseng has different biological properties than Asian (Chinese, Korean or Japanese) or American ginseng. 16 randomized, double-blind, placebo-controlled clinical trials were reviewed for diverse indications. These include: sedative, hypnotic, aphrodisiac, antidepressant, anti-diabetic, stamina, concentration, vigilance, well-being and diuretic effects.

 

A review of animal and human studies of ginseng as an aid to physical performance concluded that compelling evidence on the efficacy of ginseng is lacking. Persons who regularly consumed fresh Korean ginseng had a significantly reduced risk of cancer. There is a questionable improvement in well-being and energy in the elderly. Ginseng vasodilates (increases blood flow), but doesn’t help sexual dysfunction. Three grams of American ginseng was shown to modulate a sugar load for both the non-diabetic and the type 2 diabetic. (Note: It must be taken with food to prevent hypoglycemia, as opposed to the other ginsengs being taken on an empty stomach).

 

Serious side-effects have been reported ranging from: insomnia, diarrhea, vaginal bleeding, severe headaches, schizophrenia, hypertension and Steven-Johnson syndrome (allergic shock). The quality of many commercial ginseng products is unknown, and adverse reactions might be caused by contaminants. Some low quality products (9 of 22 ginseng products evaluated by ConsumerLab.com) had no active ingredient at all or came from the leaves and stem with very little root. Several brands were contaminated with pesticides and heavy metals.

 

Recommended dosage is usually, 500 to 2000 mg (2 grams) of dry ginseng root (400-800 mg for the elderly), which is equivalent to 200-600 mg of extract a day for short term treatment. For continuous administration, the equivalent of 1000 mg of dry root should not be exceeded.

 

So do we know everything about these herbs that have been used for centuries? NOPE. It is possible, even very likely, that at present we, in modern medicine, fail to recognize herb benefits and herb-drug interactions simply because we have no knowledge of them?