Originally published in The Ottawa Citizen September 2, 2003
Original Title: Eau Naturelle

Herbal remedies are medical concern. A substantial minority of people use them. Indeed, many people do not tell their doctor about herbal medication use unless directly asked. This is not a recipe for good comprehensive health assessment. Some herbal preparations will adversely interact with prescription medications.

At times, there may be an automatic dismissive response on the part of physicians should patients bring up the topic of herbal treatment options. This reaction comes in part from the outrageous claims (without supportive evidence) for some of these remedies. Some herbals list a multitude of unrelated diseases. Claims for Echinacea, for example, include using it to treat acne, strep throat, gonorrhea and even typhoid fever.

There is a saying, “Extraordinary claims require extraordinary evidence”. Physicians face the overwhelming task of trying to explain why the herbal/drug does not work for a particular condition(s) in five minutes or less. It is the responsibility of the claimant to prove the veracity of the health benefits, not the physician.

The popularity of herbal preparations rests in part on the notion that “natural is safe”. In fact, nature produces some of the most potent toxins and poisons known like botulinum toxin, lysergic acid (a component of LSD), cyanide, snake venom, belladonna and alcohol among others. Marijuana, peyote, mushrooms and moulds all produce substances that alter our body’s normal physiologic processes. All herbal products contain biochemical compounds as all organic living matter does.

Physicians need factual and credible scientific information to address their patients’ questions and concerns. Research continues to present interesting applications for some herbal regimens. For this reason, all herbal preparations should face the same safety assessment playing field, as do all prescription and over-the-counter medications because they are indeed drugs. Where they come from is irrelevant.

If we accept that herbal preparations possess the ability to alter our physiology then we must determine if it has beneficial therapeutic effects. Let us look at some of the latest research for some of the more popular herbal/plant medications; Echinacea, St. John’s wort, garlic, Gingko Biloba and Saw Palmetto. Do they stand up to scrutiny?

Echinacea, derived from the Asteraceae or Compositae family of plants, is purported to fight the common cold, urinary tract infections, vaginal yeast infections and genital herpes among 15 other uses.

Native Americans first used it to treat respiratory infections, snakebites and other ills. It use in the 1800s was a blood purifier and dizziness treatment. In the early 1900s, it was used to treat cold and flu and as an anti-infection agent.

Echinacea preparations may decrease the duration and severity of colds and flu but does not prevent them. Because of the multitude of Echinacea plant sources each with different chemical compositions, it is unclear which preparation is most efficacious. It fails to treat urinary tract infections, genital herpes and vaginal yeast infections.

Saw Palmetto is used to treat the symptoms of an enlarging prostate gland or Benign Prostatic Hypertrophy (BPH). Many clinical studies lasting up to 48 weeks show significant improvement in many symptoms. Patients report a reduced number of daytime and nighttime bathroom visits, easier start to urinary flow, less dribbling after urination and less painful urination.

Its effectiveness seems to be on par with the prescription drug Proscar. However, it does not reduce prostate size or PSA levels. Other BPH medications such as Flomax and Hytrin seem to be superior to Saw Palmetto for relieving symptoms.

The active ingredient of St. John’s wort, hypericin, is possibly as effective for the treatment of mild to moderate depression as the selective serotonin reuptake inhibitors (SSRIs) like Zoloft and Prozac. It is not indicated for severe depression. There is insufficient evidence to support other claims as a treatment Hepatitis C and diabetic nerve pain.

Of the 30 health claims for Gingko Biloba, several studies indicate it seems to be possibly effective for the treatment of dementia from Alzheimer’s or stroke, acute altitude sickness in mountain climbers, vertigo and distance walking leg pain in people with blocked arteries of the lower limbs.

Studies lasting three months to a year show that Gingko leaf extract can stabilize or improve some measures of cognitive and social functioning in patients with different types of dementia. In effect, the research indicates this improvement amounts to a six- month delay in disease progression. There are no head-to-head studies comparing Gingko to conventional medications for the treatment of dementia.

Garlic’s main use is in the prevention of cardiovascular disease. Most of the evidence shows it does reduce total cholesterol levels by four to 12 per cent but is ineffective raising the HDL or good cholesterol levels. Statin medications (lipitor and others) decrease levels by 17 to 32 percent and do raise HDL levels. Garlic can also interfere with blood thinner medications increasing bleeding risk. Patients who need a significant reduction of their cholesterol levels should not use garlic.

Further research will help identify the therapeutically active ingredient(s) of these plants. Consult with your doctor and pharmacist about drug interactions and drug safety concerns before starting any herbal medication especially if you are taking prescription medication.

Links: ConsumerLabs (http://www.consumerlab.com/)
Health Central (http://www.healthcentral.com/centers/OneCenter.cfm?Center=Herbal_Remedies).

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© Dr. Barry Dworkin 2003