BY DAVID COIL "I'm going to raid the pharmacy, treat you with tetracycline, and then give you a fungal infection." "Oh yeah, I'm going to give you botulism!" "That's fine because I'm going to give myself a fecal transplant." SHORT VERSION OF THE RULES (FOR PEOPLE WHO DON'T LIKE TO READ) 1. You can only play one Microbe per turn, otherwise play as many cards per turn as you'd like.
Ahpa 01 field guide to herbal dietary supplements c
A Field Guide
to Herbal Dietary
A publication of the AHPA Foundation for Education & Research onBotanicals (AHPA-ERB Foundation) A Field Guide toHerbal DietarySupplements A publication of the AHPA Foundation for Education & Research onBotanicals (AHPA-ERB Foundation) A Field Guide to Herbal Dietary Supplements A publication of the AHPA Foundation for Education & Research on Botanicals (AHPA-ERB Foundation) 2008 AHPA Foundation for Education & Research on Botanicals (AHPA-ERB Foundation). All rights reserved.
AHPA-ERB Foundation 8630 Fenton Street Silver Spring, MD 20910 This publication is available online at www.ahpa.org.
Reproduction for educational use expressly granted. For bulk reprint information, contact the AHPA Foundation for Education & Research on Botanicals at the address above, or email firstname.lastname@example.org.
Scientific information on therapeutic herbs is continually evolving. To ensure that the AHPA Foundation for Education & Research on Botanicals (AHPA-ERB Foundation) has the most up-to-date information, AHPA-ERB Foundation is con- stantly in the process of incorporating new scientific evaluations and re-evaluating old ones. The accuracy of the material in this publication may change over time.
The information here is not intended to be a substitute for professional medical advice. Do not use this material to diagnose or treat a health condition or dis- ease without consulting a qualified healthcare provider.
Plant chapters, pp 11–44, 1998, 2006 Steven Foster. All rights reserved.
Botanical photographs 2006 Steven Foster. All rights reserved.
Historical use of herbs Regulation of herbal dietary supplements in the U.S.
Contemporary research on herbs Responsible use of herbs Some popular herbs and their uses 10 Black cohosh 11 Echinacea 15 Ginseng 28 Saw palmetto 32 St. John's wort 36 Valerian 41 For more information 45
This Field Guide to Herbal Dietary Supplements was prepared by the
AHPA Foundation for Education & Research on Botanicals (AHPA-
ERB Foundation) to provide information on the general class of herbal
products that are marketed in the United States as dietary supple-
ments. The AHPA-ERB Foundation exists to promote education and
research on medicinal, therapeutic, and health-promoting herbs.
A conventional field guide to local or regional plants provides infor- mation that assists knowledgeable users in identifying plants in theirhabitats. Field guides do not, however, transform their readers into expertson botanical taxonomy, and it is only through years of practice and actu-al time in the field that expertise and knowledge can develop. Similarly,readers of this document will be provided with accurate informationabout herbs and herbal products, which, combined with a commitmentto seek out additional references and guidance, will provide a knowl-edgeable basis for informed decisions on using herbal supplements.
The intention of this document therefore is to provide some basic background for consumers of herbal supplements. This documentmakes no claims of being a complete collection of herbal knowledgeand no small work of this nature could hope to take the place of the vastrecords, resources, and personal experience needed to learn all thereis to know about herbs. This Field Guide to Herbal Dietary Supplements includes a short discussion of the historical use of herbs and of the current regulation ofherbal products that are marketed in the United States. There is a sec-tion devoted to contemporary research on herbs including the latestscientific findings. Responsible use of herbs is also discussed and briefdescriptions are provided for some of the most popular herbs, as wellas a listing of sources of credible information for those who wish tolearn more.
use of herbs
Throughout time, people around the world have used herbs to address
a multitude of health issues. Analyses of archeological sites show that
herbs were used long before the beginning of recorded history.
Primitive and ancient civilizations throughout the world relied on herbs
to provide the benefits that were observed with their use.
The oldest surviving medical documents come from the Ancient Egyptians. Among these is the first document concerned with medicinalherbs, known as the Ebers Papyrus. This text is approximately 3,500years old, and contains a list of 700 medicinal herbs and includes reme-dies for many diseases and maladies. Many ancient Chinese docu-ments also classify herbal medicines, and similar records can be foundthroughout Asia and Europe since recorded history. Other societies,such as Native Americans and indigenous tribes in South America andAfrica are also known to have used herbs for centuries.
Today, the World Health Organization estimates that herbal medi- cine is still the primary source of health care for approximately 80 percentof the world's population. In addition, many of the pharmaceuticalpreparations used around the world are based on plants. Herbs andherbal products, with their incredibly wide use throughout time andplace, continue to provide real health benefits while maintaining aremarkable safety profile.
the United States
The Food and Drug Administration (FDA) and its predecessor agencies
have had jurisdiction over herbal products marketed in the United
States for over 100 years. During this time herbs that have been included
in conventional foods, such as peppermint tea or vanilla extract, have
been regulated as foods, while herbs like digitalis and belladonna, which
are recognized as drugs, have been regulated as such. Many other
herbs that have long been used for therapeutic purposes or to maintain
or promote health have also been broadly sold, but for many years there
was no clearly defined regulatory category for these products.
Attempts were made to fill this regulatory gap at the beginning of the 1990s. FDA proposed at that time that herbal "dietary supplements"should be regulated in the same manner as food additives, which is to
say with the same rules that applyto added ingredients like aspar-tame. But this did not seem like alogical approach for herbs suchas chamomile, echinacea, gin-seng, and the host of other herbsthat have long been used in cul-tures around the world. Instead,in 1994 the U.S. Congresspassed the Dietary SupplementHealth and Education Act(DSHEA) that amended theFederal Food, Drug & Cosmetic Act (FFDCA), to clarify the way in which vitamins, minerals, herbs andspecialty supplements are regulated by the federal government. Almostall such products are now marketed in the U.S. as dietary supplements.
The law clarifies that herbal and other dietary supplements should be regulated in many of the same ways as foods. FDA has jurisdictionover how these products are made and labeled, and may seize anddetain herbal and supplement products that are adulterated or mis-branded. FDA may also forbid the sale of any dietary supplement oringredient any time that the agency determines that it represents a sig-nificant or unreasonable risk. And the law requires that FDA be notifiedof any "new" dietary ingredients intended for use in supplements. Federal law also defines the responsibilities of manufacturers and mar- keters of dietary supplements. Dietary supplements are required to identi-fy every dietary ingredient in the product and to state the quantity of eachingredient or proprietary blend. Claims that are made on a product's labelor labeling are strictly controlled, must be substantiated, and must notclaim to diagnose, treat, cure, or prevent any disease (even if there is evi-dence to support such a "drug claim"). Facilities in which herbal and otherdietary supplements are manufactured are held to the high standards ofFDA's Good Manufacturing Practice (GMP) regulation for dietary supple-ments. Additionally, supplement companies are required by law to tell FDAabout any reports of serious adverse events they receive from consumers. Another important benefit of the Federal law is that it explicitly allows consumers to be provided with balanced scientific information aboutherbs and other supplement ingredients. Prior to the passage of thislaw, FDA considered such information to be illegal if it contained anyreference to cure, treatment, or prevention of diseases. But theCongress decided that the government "should not take any actions toimpose unreasonable regulatory barriers limiting or slowing the flow ofsafe products and accurate information to consumers," and establishedrules to allow dissemination of truthful and non-misleading publicationsabout ingredients found in dietary supplements.
The discussion presented above addresses only the regulation of herbs and other supplements by FDA. As with any other industry, how-ever, companies that make and sell supplements must conform with theregulations of many other federal agencies, as well as state and localjurisdictions. For example, the Federal Trade Commission enforces thelaws that govern advertising of all consumer goods, and companies inthe herbal business must comply with these. Marketers of organicherbal products must be familiar with rules maintained by the U.S.
Department of Agriculture, and manufacturers of herbal extracts needto be in compliance with the legal guidelines set by the Tax and TradeBureau. The list goes on and on—the Department of Transportationrules apply to all interstate shipments; U.S. Customs and BorderProtection governs imports; the Occupational Safety and HealthAdministration protects workers in all trades; etc.
In conclusion, manufacturers and marketers of herbal supplements are subject to extensive federal laws and regulations. Each of these fed-eral agencies is responsible for enforcing their rules so that the needsof consumers are properly met, and so that companies that do not follow the rules do not gain an advantage over those that do. The lawsthat are currently in place in the U.S. were designed to ensure that safeand beneficial dietary supplements, including herbal products, are avail-able to well-informed consumers for use when making their own self-care choices. Responsible manufacturers and marketers will continueto provide these products and the citizens of the United States will con-tinue to enjoy the health freedom which they demand and deserve.
Because herbs have been used successfully since ancient times, modern
researchers worldwide are interested in using current scientific protocols
to quantify their effectiveness.
In recognition of the importance of herbs for health, the National Center for Complementary and Alternative Medicine (NCCAM) wascreated and funded by Congress, and is dedicated, in part, to investi-gating complementary and alternative healing practices through scientific experimentation and research. NCCAM and another govern-ment agency, the Office of Dietary Supplements, currently fund fiveResearch Centers focused on botanicals. The centers' researchincludes the effects of botanicals on immune function, inflammatory dis-eases, women's health issues, age-related diseases, and metabolicsyndrome. The centers are expected to advance the scientific base ofknowledge about botanicals, including issues of their safety, efficacy,and biological activity.
Another NCCAM objective is to publicize this information, which is achieved through conferences, educational programs, exhibits, and theirweb site. Additionally, thousands of science-based, clinical studies areperformed every year on a wide variety of herbs and herbal products.
Scientific inquiries continue to develop our knowledge of the benefits of plants and often validate the observations made over the past centuries.
use of herbs
Plants that enjoy broad culinary and therapeutic usage are generally
safe. We can flavor our food with any number of herbs to make a meal
more flavorful. We can appreciate a delicious cup of peppermint leaf or
ginger root tea, or benefit from the soothing properties of marshmallow
root or the inner bark of slippery elm. We can take an herbal supple-
ment containing milk thistle seed extract or
saw palmetto berries, or any number of the
other herbs. Although allergies and reac-
tions have been recorded for a few herbs
that are widely used in foods and supple-
ments, such individual concerns are also
seen with many foods, and do not diminish
the safety profile of the many herbs that are
generally recognized as safe.
On the other hand, and as everyone knows, some plants are highly toxic, evendeadly. Every ten-year-old hiker knows tostay away from poison ivy when walking inthe woods. The death sentence imposed on Socrates by an Athenian jury2,400 years ago was carried out with a fatal dose of poison hemlock. Responsible and informed use by consumers is essential to ensure that herbal products maintain their established safety profile. Be sure tofollow label directions or the recommendation of your healthcare providerfor any herbal product. And remember to tell your healthcare providerthat you're using an herbal supplement. The effect of a pharmaceuticaldrug you are taking may be either increased or decreased in the pres-ence of other factors in your diet, including herbal use.
Actaea racemosa (synonym: Cimicifuga racemosa) Source
Black cohosh, a member of the buttercup family, is found in rich woods
of the eastern deciduous forests from southern Ontario south to
Georgia, west to Arkansas, and north to Wisconsin. Most of the root is
wild-harvested. Some is grown commercially in Europe.
Among Native Americans and early settlers in North America, black
cohosh root was an important folk medicine for menstrual irregularities
and as an aid in childbirth. It served as the main ingredient in Lydia
Pinkham's famous patent medicine known as "Vegetable Compound,"
used by women in the nineteenth century for menstrual stress and nervous
tension. Adopted in medical practice in the early nineteenth century, it
had a great reputation as an anti-inflammatory for arthritis and rheuma-
tism; for normalizing suppressed or painful menses; and for relieving
pain after childbirth. It was also used for nervous disorders. The root
was an official drug in the U.S. Pharmacopoeia from 1820 to 1926.
Black cohosh root is approved for use in Germany for the treatment of
premenstrual symptoms, painful or difficult menstruation, and for
menopausal symptoms such as hot flashes. A number of pharmaco-
logical studies also suggest a mild sedative and anti-inflammatory
activity. Compounds in the root, a group of related triterpene glyco-
sides, have been associated with black cohosh's biological activity. As
ovarian function declines during menopause, estrogen production also
declines and luteinizing hormone (LH)increases. These changes are some-times associated with hot flashes. Inone study an alcohol extract of blackcohosh lowered LH in both animalsand women, reducing hot flashes(Düker, et al., 1991). In recent years scientists have focused on conducting clinical studiesinvestigating the therapeutic benefitsand safety of black cohosh alone,against placebo and in comparisonwith convention drugs such as hor- mone replacement therapy (HRT). At least twenty such studies havebeen published, and additional clinical studies are currently underway,including studies funded by the National Institutes of Health (NIH) atboth Columbia University and the University of Illinois at Chicago. Somestudies have been criticized because of lack of rigor in study designand because the duration of the studies was relatively short; conduct-ed for six months or less. Different types of preparations used in variousstudies may have also led to conflicting results. A recent randomized,multicenter, double-blind, placebo-controlled clinical study enrolled304 menopausal women, who took a 40 mg daily dose of a Germanblack cohosh preparation. The results showed that black cohosh didproduce significant benefits with no adverse side effects, especially inwomen in early stages of menopause (Osmers, et al., 2005). To date,at least fourteen positive clinical studies support the effectiveness and safety of black cohosh preparations in treating hot flashes, perspirationand mood swings associated with menopausal symptoms. Black cohosh has been widely used in Europe for over 50 years, with experience in millions of menopausal cases. As many as 10 millionmonthly units of one German black cohosh preparation alone were soldin Germany, Australia and the United States ten years ago. Now blackcohosh is the eighth best-selling herb in the American market, withsales increasing significantly after mid-2003 when a large government-sponsored trial (Women's Health Initiative) on hormone replacementtherapy (HRT) was discontinued after these conventional treatments were shown to increase unacceptable adverse effects in menopausalwomen. Efficacy and safety are generally confirmed by the long-termclinical experience, as well as recent controlled clinical studies withblack cohosh. Preparations
In the American market preparations available include tablets, capsules,
tinctures, and the dried root. Standardized products are also available. Dose
Traditionally, a decoction of 0.3–2 g (up to l⁄2 teaspoonful) of the dried
cut-and-sifted root is used. Tablets containing 20 mg of a standardized
extract are taken twice per day (or per label instructions) in Germany.
Most clinical studies have been conducted with a German extract,
named Remifemin®. In Germany use is limited to six months at a time,
with pauses in between to see if menopausal symptoms return. Follow
label instructions for commercial products. Generally, it must be taken
for a minimum of four weeks before results are seen.
No contraindications or drug interactions are reported, though some
women have experienced a low incidence of transient mild adverse
effects including upset stomach, headache, dizziness, breast pain, and
weight problems from use of black cohosh preparations. Furthermore,
the most recent evidence suggests the black cohosh is not estrogenic
(Mahady, 2005). Recent reports of liver toxicity associated with black
cohosh led the Australian Therapeutic Goods Association to react by
requiring a warning "Black cohosh may harm the liver in some individu-als. Use under the supervision of a healthcare professional." In all butone of the obscure clinical case reports, those who experienced liverproblems were taking other substances that could have led to liverproblems. The NIH held a one-day "Workshop on the Safety of BlackCohosh in Clinical Studies" in November of 2004 that reconfirmed therelative safety of black cohosh given the millions of doses consumed fordecades, and no understanding of how it could be dangerous (detailsonline at: http://nccam.nih.gov/news/pastmeetings/blackcohosh_mtngsumm.htm). Nevertheless, future NIH-sponsored clinical trials onthe herb will include testing parameters for liver function. Objectiveinformation on black cohosh can also be found at the NIH Office ofDietary Supplements website: http://ods.od.nih.gov/. Search for blackcohosh under the "health information" setting. For more detailed stud-ies, search PubMed, the database of the world's largest medical library,the National Library of Medicine at NIH, at the following link:www.ncbi.nlm.nih.gov/ entrez/query.fcgi Beuscher, N. 1995. Cimicifuga racemosa L. — Black cohosh. Zeitschrift für Phytotherapie. 16:301-10. Blumenthal, M., A. Goldberg, J. Brinckmann, eds. 2000. Herbal Medicine: Expanded Commission E. Monographs. Austin, Texas: AmericanBotanical Council. Düker, E.M., et al. 1991. Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats.
Planta Medica. 57:420-4. Foster, S. 1998. 101 Medicinal Herbs: An Illustrated Guide. Loveland, CO: Interweave Press.
Mahady, G.B. 2005. Black cohosh (Actaea/Cimicifuga racemosa): Review of the clinical data for safety and efficacy in menopausal symptoms.
Treatments in Endocrinology. 4(3):177-84. Osmers R., et al. 2005. Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms. Obstetrics and Gynecology. 105:1074-83.
Echinacea angustifolia Echinacea pallida Echinacea purpurea Sources
Echinacea, also known as purple coneflower, is the root or above-
ground parts (harvested in flower) of three species of large, robust
daisylike plants of the aster family. Echinacea angustifolia and
E. pallida are harvested from the prairies of the Midwestern United
States. Some commercial cultivation of these two species has devel-
oped. E. purpurea, also native to the Midwest, is the most widely used
species of the three. Most of the world's supply of E. purpurea is from
Native Americans of the prairie used echinacea for more medicinal pur-
poses than they did any other plant, for everything from colds to can-
cer. It entered formal medicine in 1895, becoming the best-selling
American medicinal plant prescribed by physicians into the 1920s.
Later replaced by antibiotics in the United States, it has enjoyed con-
tinuous popularity in Europe. In 1993, German physicians prescribed
echinacea more than 2.5 million times. Traditionally, herbalists considerit a blood purifier and aid to fighting infections. Current Status
Today most consumers use echinacea to avoid colds and other upper
respiratory tract infections and to help heal infections. Echinacea
enhances the particle ingestion capacity of white blood cells and other
specialized immune system cells, thus increasing their ability to attack
foreign invaders, such as cold or flu viruses. A recent study (Agnew, et
al., 2005) found that echinacea may also induce an immune response
by stimulating an increase in white blood cell activity and counts. An
antioxidant effect was alsoobserved. Besides stimulating ahealthy immune system to dealmore effectively with invadingviruses, it helps accelerate heal-ing if infection already exists. Over two-dozen clinical stud- ies have investigated the thera-peutic benefits and safety of var-ious echinacea species, plantparts, types of preparations anddosage regimes. Barnes, et al.
(2005), reviewed the chemistry,pharmacology and clinical prop- erties of the three most commonly used echinacea species. They statethat evidence from preclinical studies support some of the traditionaland modern uses, particularly the immunostimulant properties.
Although most clinical trials of echinacea preparations have reportedpositive effects in the prevention and treatment of upper respiratorytract infections, some well-publicized recent studies have producedmixed results. These authors suggest that different types of patientsgroups, and various preparations and dosage regimens result in a non-definitive evidence of effectiveness. Another recent meta-analysis ofechinacea preparations findings supports the results of randomized,double-blind, placebo-controlled clinical trials that report the efficacy of echinacea preparations for the prevention of spontaneous colds(Schoop, et al., 2006). The best-studied echinacea is a preparation made from the fresh expressed juice of E. purpurea used in various product forms continu-ously in Germany since 1939. No single chemical component has beenidentified as causing echinacea's medicinal action, but it may involveflavonoids, essential oils, polysaccharides, caffeic acid derivatives, alky-lamides, and other compounds. More clinical studies are needed to determine clear therapeutic indi- cations, the best preparations, and the most effective dosage.
Echinacea products include tablets, capsules, and liquids such as tinc-tures, extracts, and the expressed juice of the fresh flowering plant, onwhich most research has been done. Some products are standardizedto a variety of different chemical components. Dose
A dose of 60 drops of E. purpurea root tincture three times a day is
equivalent to 1 g of the dried root three times a day. The World Health
Organization and the Canadian Natural Health Products Directorate
suggest a dosage equivalent to at least 3 g per day. Several negative
clinical studies have used the lower dose of 900 mg per day, which was
established by German health officials in the early 1990s. Rather than
being used continuously like vitamin C to prevent colds, echinacea is
often used as needed at the onset of symptoms or in early stages of
infection. To support the immune system on an ongoing basis, some
herbalists recommend "pulsing," which is to take echinacea usually for
two weeks, followed by a resting period of one week. This is based on
theory, rather than clinical studies. Other herbalists recommended
using it during the entire cold and flu season. For commercial products,
please follow manufacturer's label instructions
Persons who are allergic to the pollen of other members of the aster
family, such as ragweed, may also be allergic to echinacea. Such aller-
gies are rare. The German government recommends that nonspecific
immunostimulants, including echinacea, should not be used in cases ofimpaired immune response (involving diseases of the immune systemitself) including tuberculosis, multiple sclerosis, and HIV infection. Thisis based on the theoretical concept that immunostimulants should notbe used when autoimmune disease is present.
Agnew, L.L., et al. 2005. Echinacea intake induces an immune response through altered expression of leukocyte hsp70, increased white cellcounts and improved erythrocyte antioxidant defenses. Journal of ClinicalPharmacy and Therapeutics. 30(4):363-9. Barnes, J., et al. 2005. Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt., Echinacea purpurea (L.) Moench): Areview of their chemistry, pharmacology and clinical properties. Journal ofPharmacy and Pharmacology. 57(8):929-54. Bauer R., H. Wagner. 1991. Echinacea species as potential immunostimulatory drugs. In: Economic and Medicinal Plant Research, vol. 5. Orlando,Florida: Academic Press. pp. 253-320. Blumenthal, M., et al., eds. 2003. The ABC Clinical Guide to Herbs. Austin, Texas: American Botanical Council. Braunig, B., et al. 1992. Echinacea purpurea radix for strengthening the immune response in flu-like infections. Zeitschrift für Phytotherapie. 13:7-13. Foster, S. 1991. Echinacea: Nature's Immune Enhancer. Rochester, Vermont: Healing Arts Press. Melchart, D., et al. 1994. Immunomodulation with echinacea: A Systematic Review of Controlled Clinical Studies. Phytomedicine. 1:245-54. See, D.M., et al. 1997. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in health subjects andchronic fatigue syndrome or acquire immunodeficiency syndromepatients. Immunopharmacology. 35:229-35. Schoop, R., P. Klein, A. Suter, S. Johnston. 2006. Echinacea in the prevention of induced rhinovirus colds: A meta-analysis. Clinical Therapeutics.
28(2):174-183. Allium sativum Source
Few herbs are as closely tied to the human experience as garlic. It is a
member of the lily family, and is unknown in the wild. Garlic has actually
evolved under cultivation during the past 5,000 years.
Garlic has been used as food and medicine since the age of the
Egyptian pharaohs. The Greek historian and traveler Herodotus
(484–425 B.C.) wrote that inscriptions on an Egyptian pyramid recorded
the quantities of garlic consumed by the laborers. The Roman naturalist
Pliny the Elder (A.D. 23–79) declared that garlic has powerful proper-
ties, and is of great benefit against changes of water and of residence.
He recommended it to treat asthma, suppress coughs, and expel intes-
tinal parasites, but noted some drawbacks (other than garlic breath):
garlic dulled the sight, caused flatulence, injured the stomach if taken in
excess, and caused thirst. In China, garlic was traditionally used for
fevers, dysentery, and intestinal parasites. In 1858, the French microbi-
ologist Louis Pasteur (famous for "pasteurization") first reported on garlic's antibacterial activity.
In the past 30 years, garlic has been the subject of over 3,000 scientific
studies. Well-documented health benefits include reducing cholesterol
and triglycerides in the blood (while increasing high-density lipopro-
teins, so-called good cholesterol), reducing blood pressure, improving
circulation, and helping to prevent yeast infections, colds, and flu. Garlic
has also shown potential benefit in supporting the health of people with
diabetes, as well as cancer preventative potential, among many other
benefits. Garlic has good antibacterial, antifungal, antiparasitic, antioxi-
dant, anti-inflammatory, and immunostimulant properties. At least nine
epidemiological studies suggest that garlic significantly decreases the
incidence of cancer, especially cancers of the gastrointestinal tract,
among those who consume it regularly.
Nearly 3,000 patients have been involved in 18 clinical studies on the use of 600–900 mg of garlic powder to reduce blood lipids over aone- to four-month period. When taken together, the studies show anaverage reduction of 9–12 percent of total serum cholesterol, and areduction of 13 percent of triglycerides, compared with placebo. It isconsidered a useful therapeutic tool for patients with milder forms ofhyperlipidemia. The news media has focused on studies showing garlic may not have has much value as was once thought in helping to prevent cardio-vascular risks. A 2000 review of 13 clinical trials on about 800 peoplereported that garlic preparations did reduce total cholesterol more thanplacebo, but their data analysis found that the reductions was 4–6 percent,rather than the 9–12 percent reduction commonly stated in the herb literature (Stevinson, et al., 2000). Despite the controversy, positive studies seem not to be reported in the media. Garlic studies have been shown not only to reduce choles-terol, but also thin the blood and reduce arterial plaque. A recent studyfound that eating the equivalent one garlic clove a day (3 g) for severalmonths had a significant blood-thinning effect (Ali and Thompson,1995). A recent study by German researchers (Seigel, et al., 2005) found that a leading German garlic product not only helped to reducethe formation of molecular complexes that lead to the building of arterialplaque, but also help to reduce or reverse existing plaque. A 2006study (Rassoul, et al., 2006), found that a water soluble garlic extracthelped to significantly decrease the formation of molecules that create adhesion of plaque building substances in arterial walls. Therefore, thebenefits do not involve just one mechanism of action. Still variousreviews of garlic studies point out methodology flaws of positive clini-cal studies, and generally agree that more, better designed clinicalstudies involving larger numbers of patients over a longer period of timeshould be conducted to reveal garlic's cardiovascular benefits.
More than 30 controlled clinical studies involving over 45,000 subjects have been published on garlic. Although positive studies ongarlic's health benefits are voluminous, these studies are rarely reportedby the media. The degree of benefit may be debated, but the fact thatgarlic is at least beneficial is well-supported. When garlic is cut or crushed, it produces sulfur compounds, such as allicin, because a sulfur-containing amino acid, alliin, comes into con-tact with the enzyme allinase. Garlic has an extremely complex chem-istry, with more than 160 compounds identified from its bulbs andessential oil. If your food should be your medicine, garlic should be part of your diet. Preparations
Garlic is available in many product forms, including, of course, fresh and
dried garlic, as well as capsules, "odorless" garlic tablets, and aged
One average-sized clove of fresh garlic may be chewed daily as a gen-
eral preventive. Add raw garlic to cooked foods at the end of cooking
to retain sulfur compounds and volatile constituents. According to German
health authorities, the daily dose is 4 g of fresh garlic. Processed garlic
products should deliver at least 5 mg of allicin daily. Clinical and phar-
macological studies since 1988 show that 900 mg of powdered garlic
standardized to 0.6 percent allicin per 100 mg (equivalent to 5.4 mg
allicin) daily may lower cholesterol. For commercial products, please follow manufacturer's label instructions.
Rare cases of allergic reactions to garlic have been reported. Some
individuals experience heartburn or flatulence from consuming it.
Garlic's blood thinning capability has been found to potentiate the
action of the prescription blood thinner warfarin, therefore it should be
used under medical supervision when such drugs are used, and should
be avoided before surgery.
Ali, M., M. Thomson. 1995. Consumption of a garlic clove a day could be beneficial in preventing thrombosis. Prostaglandins, Leukotrienes andEssential Fatty Acids. 53(5):211-2. Blumenthal, M., A. Goldberg, J. Brinckmann, eds. 2000. Herbal Medicine: Expanded Commission E Monographs. Austin, Texas: AmericanBotanical Council. Blumenthal, M., et al., eds. 2003. The ABC Clinical Guide to Herbs. Austin, Texas: The American Botanical Council.
Foster, S. 1998. 101 Medicinal Herbs: An Illustrated Guide. Loveland, CO: Interweave Press.
Koch, H.P, L.D. Lawson, eds. 1995. Garlic—The Science and Therapeutic Application of Allium sativum L. and Related Species, 2nd ed. Baltimore:Williams & Wilkins. Reuter, H.D. 1995. Allium sativum and Allium ursinum: part 2, Pharmacology and Medicinal Application. Phytomedicine. 2(1):73-91. Rassoul, F., et al. 2006. The influence of garlic (Allium sativum) extract on interleukin 1alpha-induced expression of endothelial intercellular adhesionmolecule-1 and vascular cell adhesion molecule-1. Phytomedicine.
13(4):230-5. Siegel, G., et al. 2005. Reduction of arteriosclerotic nanoplaque formation by garlic extract. 6th Annual Conference on Arteriosclerosis, Thrombosis andVascular Biology. American Heart Association Annual Conference.
Washington, D.C., Apr 29, 2005. Stevinson, C., et al. 2000. Garlic for treating hypercholesterolemia: A meta- analysis of randomized clinical trials. Annals of Internal Medicine.
Ginkgo biloba Sources
Ginkgo products come from the leaves of the only surviving member of
the ginkgo family, a living fossil more than 200 million years old. Most
commercial leaf production is from plantations in South Carolina,
France, and China.
Ginkgo leaf is a relatively new herbal medicine, used in China only since
the fifteenth century. The leaves were traditionally used for "benefiting
the brain," treatment of lung disorders, relief of cough and asthma symp-
toms, and diarrhea. The leaf tea was applied externally to treat sores of
the skin and remove freckles.
Ginkgo leaf extracts are among the better selling herbal medicines in
Europe. Most research has focused on the use of these complex
extracts to increase circulation to the extremities as well as the brain,
especially in the elderly. Clinical use is supported by more than 400 scientific studies conducted since the late 1950s. Ginkgo extract hasalso been studied for the treatment of ringing in the ears (tinnitus), maleimpotence, degenerative nerve conditions such as multiple sclerosis,and other diseases. It has shown potential to relieve difficulties withshort-term memory, attention span, and mood in early stages ofAlzheimer's disease by improving oxygen metabolism in the brain,among other mechanisms. The vast majority of studies have involvedGerman extracts including EGb 761 (Wilmar Schwabe, Karsruhe,Germany) and LI 1370 (Lichtwer Pharma, Berlin).
A 1996 prospective, randomized, double-blind, placebo-controlled multicenter study looked at the effect of EGb 761 in the treatment ofoutpatients with pre-senile and senile primary degenerative dementiaassociated with Alzheimer's. It looked at the effects on 216 patientsover a 24-week period. Three established psychiatric evaluation criteriawere used to assess the patient's response. After 24 weeks, informa-tion was available on 156 patients, including 79 in the treatment group,and 77 in the placebo group. Twenty-eight percent of patients in thetreatment group responded positively to the ginkgo leaf extract, com-pared with 10 percent in the placebo group (Kanowski, et al., 1966). The first large-scale American clinical study on ginkgo was pub- lished in 1997 by the Journal of the American Medical Association. Itfocused on the effects of ginkgo leaf extracts in improving the short-term memory of early diagnosed Alzheimer's syndrome. The 52-weektrial, in the end, evaluated data on 202 patients diagnosed with eitherAlzheimer type dementia or multi-infarct dementia. Patients received40-mg tablets before each primary meal per day, delivering a total dailydose of 120 mg of the extract, EGb 761. The researchers concludedthat the Ginkgo biloba leaf extract, EGb 761, was safe and both stabi-lizing, and in a significant number of patients, improved cognitive per-formance and social functioning of demented patients (LeBars, et al.,1997). Ginkgo extract's usefulness has been attributed to various neu-rological and metabolic effects.
Other clinical studies have shown mixed or negative results such as Solomon, et al. (2002), which showed negative results for memory loss and early stages of Alzheimer's dementia. The designed outcome wasbased on measuring the claims for which ginkgo was being marketed.
Other examples, both pro and con, can be cited. One aspect usuallylost in the clinical debate is the cost and safety benefits of ginkgo ver-sus other treatment options. In recent years cholinesterase (ChE)inhibitors are the drugs of choice for dementias of Alzheimer's type.
Various prescription ChE inhibitors currently in use, adverse drug reac- tions cause 10 times more adverse reactions than ginkgo and cost atleast five times more. (Schulz, 2003).
Most of the focus on ginkgo leaf extracts is related to its use in improving memory function in early stages of age-related problems. Arecent review of the benefits of ginkgo extracts in healthy people sug-gests that evidence is growing for safety and efficacy of ginkgo extractto enhance performances on tasks assessing different aspects of mem-ory, attention, and the speed of processing abilities. (Crews, et al.,2005, Blumenthal, 2005). To date more than 140 clinical trials docu-ment the safety and efficacy of ginkgo extracts. Ginkgo's effects have been attributed to compounds called flavonol glycosides, as well as unique compounds—ginkgolides—which are potentinhibitors of a platelet-activating factor involved in the development ofinflammatory, cardiovascular, and respiratory disorders. The ginkgolides'activity helps explain the herb's broad-spectrum biological effects. Another important effect is strong antioxidant activity. With its ability to "scavenge" reactive oxygen forms known as free radicals, ginkgo leafextract directs antioxidant effects to the brain, central nervous system,and cardiovascular system. This is one of the mechanisms that make itpromising in treatment of age-related declines of brain function. Preparations
Ginkgo is one of the few herbs that uses highly standardized products
to achieve predictable results. Nearly all studies have been conducted
on a highly concentrated ginkgo leaf extract standardized to 24 percent
flavonol glycosides, further calibrated for six percent ginkgolides, with
potentially toxic ginkgolic acid removed. The results of studies on the
complex leaf extract do not apply to the dried leaf or leaf tea.
For predictable results with standardized ginkgo leaf extracts, the dose
is very specific and cannot be translated into kitchen measures. Typical
dosage ranges for ginkgo leaf extract are 120–160 mg daily (divided
into three doses). Some German physicians prescribe 240 mg daily
doses. Ginkgo is generally used for six to eight weeks before results
are evident. For commercial products, please follow manufacturer's
Some individuals have shown hypersensitivity to ginkgo leaf extracts
including rare cases of gastrointestinal upset, headaches, or skin aller-
gies. In such cases, use of ginkgo should be discontinued. Ginkgo has
also been associated with blood-thinning, and should not be used in
conjunction with blood-thinning drugs except under a physician's care.
Blumenthal, M. 2005. The benefits of ginkgo in healthy people. HerbalGram.
Crews, D.W., et al. 2005. The neuropsychological efficacy of ginkgo prepara- tions in healthy and cognitively intact adults: A comprehensive review.
HerbalGram. 67:43-62. DeFeudis, E V. 1991. Ginkgo biloba Extract (EGb 761): Pharmacological Activities and Clinical Applications. Amsterdam: Elsevier.
Foster, S. 1998. 101 Medicinal Herbs: An Illustrated Guide. Loveland, CO: Interweave Press.
Funfgeld, E.W., ed. 1988. Rokan (Ginkgo biloba), Recent Results in Pharmacology and Clinic. Berlin: Springer-Verlag. Kanowski, S., et al. 1996. Proof of efficacy of the Ginkgo biloba special extract EGb 761 in outpatients suffering from mild to moderate primary degener-ative dementia of the Alzheimer type or multi-infarct dementia.
Kleijnen, J., P. Knipschild. 1992. Ginkgo biloba for cerebral insufficiency.
British Journal of Clinical Pharmacology. 34:352-8. LeBars, P.L., et al. 1997. A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. Journal of the AmericanMedical Association. 278:1327-32. Schulz, V. 2003. Ginkgo extract or cholinesterase inhibitors in patients with dementia: What clinical trials and guidelines fail to consider.
Phytomedicine. 10 Suppl 4:74-9.
Sohn, M., R. Sikora. 1991. Ginkgo biloba extract in the therapy of erectile dysfunction. Journal of Sex Education and Therapy. 17:53-61. Solomon, P.R., F. Adams, A. Silver, J. Zimmer, R. DeVeaux. 2002. Ginkgo for memory enhancement: A randomized controlled trial. Journal of theAmerican Medical Association. 288(7):835-40.
Panax quinquefolius (American ginseng)Panax ginseng (Asian ginseng) Sources
Ginseng is the root of two different herbs from opposite sides of
the world—American ginseng and Asian ginseng. American ginseng
is wild-harvested and grown in North America. Asian ginseng, which
includes both Korean and Chinese ginseng, is cultivated in China, Korea,
According to Harvard University botanist Shiu Ying Hu, the earliest
mention of ginseng is in the 2,000-year-old herbal of Shen Nong: "It is
used for repairing the five viscera, quieting the spirit, curbing the emo-
tion, stopping agitation, removing noxious influence, brightening the
eyes, enlightening the mind and increasing wisdom. Continuous use
leads one to longevity with light weight." Ginseng use is little changed
in 2,000 years.
In the last 40 years, Asian ginseng (but not so much American ginseng)
has been extensively studied. Ginseng is an adaptogen. The late I.I.
Brekhman, the leading Russian researcher on ginseng, described an
"adaptogen" as an innocuous substance that causes minimal disorders
of an organism's function. It must have a "nonspecific action" that nor-
malizes body functions, irrespective of the condition or disease. And an
adaptogen must be safe. Adaptogens are essentially general tonics.
At least 16 European clinical studies showed that standardized extracts decreased reaction time to visual and auditory stimuli;increased respiratory performance, alertness, power of concentration,and grasp of abstract concepts; and improved visual and motor coordi-nation. Sometimes conflicting results indicate the need for further clini-cal studies, especially on products with well-defined levels of activecompounds. More than 60 clinical studies have been carried out on aEuropean dry extract of Asian ginseng, standardized to 4 percent ginsenosides, widely consideredthe most relevant biologicallyactive group of compounds. Inaddition to clinical studies on itsadaptogenic effects, other humanstudies have explored ginseng'svalue in cancer prevention, dia-betes, fatigue, immunostimula-tion, menopausal symptoms,male reproduction and respiratoryeffects (Blumenthal, et al., 2003). American ginseng, although less well studied, has been thesubject of recent clinical trials showing potential benefit in the support-ive treatment of type 2 diabetes. Additional clinical studies haveexplored its use for athletic performance and reflexes. Clearly, morestudies are needed. Like its Asian counterpart, it has been shown to bean effective antioxidant. Ginseng is also a nonspecific immunostimulant, similar to echinacea.
There are at least 40 active chemicals called ginsenosides in Asian gin-seng. American and Asian ginsengs contain some of the same, as wellas different, ginsenosides, which helps to explain their different actionsas expressed in Traditional Chinese Medicine (TCM). Milder Americanginseng helps to reduce the heat of the respiratory and digestive sys-tems, whereas the stronger Asian ginseng is a heat-raising tonic for theblood and circulatory systems. In Germany, Asian ginseng products may be labeled as tonics to treat fatigue, reduced work capacity, lack of concentration, and convalescence. Preparations
Asian ginseng is available as whole root, powder, and in various forms
including "white" and "red" ginseng. White ginseng is simply the dried
root; steaming the roots for three hours, then drying them, makes
translucent, rust-colored "red" ginseng; it is considered stronger than
white ginseng. Product forms include tinctures, capsules, tablets, teas,
and extracts. Asian ginseng products standardized to contain 4–7 per-
cent ginsenosides are widely sold and may produce more reliable
effects than other forms. American ginseng is generally available as the
whole or powdered root, as well as standardized extracts.
The German Commission E monograph on ginseng recommends a
daily dosage of 1–2 g of Asian ginseng root, divided into three portions.
TCM prescribes 1–9 g of Asian ginseng or 2–9 g of American ginseng.
Higher dosages may be prescribed by healthcare practitioners as
needed. For standardized products, 100 mg one or two times a day is
the usual recommended dose. For commercial products, please follow
manufacturer's label instructions.
Use at normal dosage levels is generally not associated with side
effects; however, some persons have experienced over stimulation or
gastrointestinal upset and some women have reported breast tender-
ness or menstrual problems with long-term use. If you have high blood
pressure, use ginseng with caution. Avoid ginseng during pregnancy.
Possible drug interactions have been suggested for phenelzine (an
MAO inhibitor), the blood thinner warfarin, and the HIV drug zidovidine.
Discuss ginseng use with your physician if these or similar drugs havebeen prescribed. As ginseng may lower blood glucose, diabeticpatients should discuss insulin dose with their physicians. Blumenthal, M., et al., eds. 2003. The ABC Clinical Guide to Herbs. Austin, Texas: American Botanical Council. Foster, S. 1998. 101 Medicinal Herbs: An Illustrated Guide. Loveland, CO: Interweave Press.
Hu, S.Y. 1976. The genus Panax (ginseng) in Chinese medicine. Economic Botany. 30:11-28. ——. 1977. A contribution to our knowledge of ginseng. American Journal of Chinese Medicine. 5:1-23. LeGal, M., P. Cathebras, K. Strüby. 1996. Pharmaton capsules in the treatment of functional fatigue: A double-blind study versus placebo evaluated by anew methodology. Phytotherapy Research. 10(1):49-53.
Ng, T.B., H.W. Yeung. 1986. Scientific basis of the therapeutic effects of gin- seng. In: Folk Medicine, The Art and the Science. Washington, D.C.:American Chemical Society. pp. 139-51. Shibata, S., O. Tanaka, J. Shoji, H. Saito. 1985. Chemistry and pharmacology of Panax. In: Economic and Medicinal Plant Research, vol. 1. Orlando,Florida: Academic Press. pp. 218-84. Serenoa repens Source
Saw palmetto products are made from the fruit of a small shrub in the
palm family native to the southeastern United States from South
Carolina to southern Mississippi and throughout Florida. Most of the
fruit is wild-harvested in Florida.
Saw palmetto was introduced into medicine by J.B. Read, of Savannah,
Georgia, in an 1879 issue of the American Journal of Pharmacy: "By
its peculiar soothing power on the mucous membrane, it induces sleep,
relieves the most troublesome coughs, promotes expectoration,
improves digestion, and increases fat, flesh and strength. Its sedative
and diuretic properties are remarkable."
The first mention of its use for prostate problems is an "original com- munication" in the July 1892 issue of The New Idea that stated, "It alsoexerts a great influence over the organs of reproduction, mammoa,ovarium, prostate, tests [sic], etc. Its action on them is a vitalizer, and is said to be the greatest known, tending to increase their activity and addgreatly to their size." Current Status
Saw palmetto preparations are used by more than 2 million men in
America as an alternative and primary solution for benign prostatic
hyperplasia (BPH), a benign (non-malignant) enlargement of the
prostate that eventually affects more than half of men over 50 years of
age. Pressure of the enlarged prostate on the bladder may cause many
of these men to awaken four or five times a night with an urge to urinate
and decreased urinary flow and volume. Twenty of at least 25 clinical
studies on saw palmetto preparations show that it decreases symp-
toms associated with BPH, especially reducing the urge to urinate dur-
ing the night. Components of fat-soluble extracts of the fruit reduce
prostate size and inhibit inflammation. A French double-blind clinical
trial involving 110 BPH patients, published in 1984, reported that saw
palmetto reduced the number of times patients had to urinate at night
by more than 45 percent and increased urinary flow rate by more than50 percent. Painful or difficult urination was significantly reduced in thetreatment group as compared to the placebo group. More than 3,000patients have now been evaluated in clinical trials. A 1996 major multi-center study was published in thejournal The Prostate compar-ing the use of Permixon® (aEuropean saw palmettoextract available composed of90 percent free and 7 per-cent esterfied fatty acids) withthe convention drug finas-teride (Proscar®) in the treat-ment of 1,098 patients diag-nosed with BPH. It was givento patients for 26 weeks at a dose of 160 mg (two times a day morn-ing and evening). Head to head, the researchers concluded that bothtreatments do relieve symptoms of BPH in about two-thirds of patients.
The conventional drug, finasteride, produced a significant decrease inprostate volume size. The saw palmetto product did not reduce prostatesize, suggesting different mechanisms of action for the efficacy of both.
One of the known side effects of finasteride is decreased libido andimpotence. The saw palmetto product produced fewer complaints ofdecreased libido or impotence.
This study confirms that the saw palmetto product is equally effec- tive as the conventional drug in relieving symptoms of benign prostatichyperplasia while producing fewer side effects. That's a winner for ahead to head test of a conventional drug with a phytomedicine popula-tion (Carraro, et al., 1996). A 2006 study published in the New England Journal of Medicine found no significant difference between those taking saw palmetto pillsand those taking a placebo in 225 men with moderate to severe symp-toms of BPH. Given the study design, the results might have been pre-dicted. Both the German government's official monograph on saw pal-metto and the World Health Organization's saw palmetto monographrecommend saw palmetto for the treatment of mild to moderate casesof BPH. Therefore, it might be expected that men with advanced BPH,for which saw palmetto is not recommended, would not respond to thetreatment. No such distinction of this important difference was general-ly reported in the media, which chose instead to use the conclusions ofthe authors of the study "saw palmetto did not improve symptoms orobjective measures of benign prostatic hyperplasia" without distinctionof the important detail that advanced cases were treated in the study.
It is interesting to note as well that the placebo group had significantlyhigher rate of adverse effects. German health authorities allow saw palmetto fruit preparations for difficulty of urination in early stages of BPH. Preparations
The dried fruit is available in whole or ground form, as well as in cap-
sules, tablets, and tinctures. Benefits are most likely to be achieved with
standardized products made with fat-soluble carriers containing high
levels of certain fatty acids.
Traditionally, standardized preparations are taken one or two times a
day for a daily dose of 320 mg. A recent clinical trial compared a twice-
daily dose of 160 mg with a one-time-a-day dose of 320 mg. One hun-
dred and thirty-two patients were randomized into two groups. No sig-
nificant differences were found between the two dosage regimes, so it
seems 320 mg once a day is an appropriate dosage. The equivalent of
1–2 g (1⁄2–1 tsp.) of the dried fruit is the average daily dose of other
preparations. For commercial products, please follow manufacturer's
Few side effects or contraindications besides rare stomach upset have
been reported. The primary condition for which the fruit is used, BPH,
can only be diagnosed by a physician, so consult one for proper exam-
ination and treatment.
Bent, S., et al. 2006. Saw palmetto for benign prostatic hyperplasia. New England Journal of Medicine. 354(6):557-66.
Blumenthal, M., et al., eds. 2003. The ABC Clinical Guide to Herbs. Austin, Texas: American Botanical Council. Braeckman, J., J. Bruhwyler, K. Vandekerckhove, J. Géczy. 1997. Efficacy and safety of the extract of Serenoa repens in the treatment of benign prosta-tic hyperplasia: The therapeutic equivalence between twice and oncedaily dosage forms. Phytotherapy Research. 11(8):558-63. Carraro, J-C., et al. 1996. Comparison of phytotherapy (Permixon) with finas- teride in the treatment of benign prostate hyperplasia: A randomizedinternational study of 1,098 patients. The Prostate. 29:213-40. Champault, G., et al. 1984. The medical treatment of prostatic adenoma— A controlled study: PA-109 versus placebo in 110 patients. Annals ofUrology. 6:407-10. Hale, E. M. 1898. Saw Palmetto. Philadelphia: Boericke & Tafel.
St. John's wort products are made from the dried herb or flowering tops
of a member of the St. John's wort family, native to Europe and natural-
ized in Asia, Africa, North America, South America, and Australia. In
1793 the first recorded specimen in the United States was collected in
Pennsylvania. Commercial supplies come from plants cultivated and
wild-harvested in Chile, the United States, and Europe.
St. John's wort has interested herbalists since the first-century
Greek physicians Galen and Dioscorides recommended it as a diuret-
ic, wound-healing herb, and treatment for menstrual disorders.
During the Middle Ages, remarkable, even mystical, properties were
attributed to it—St. John's wort was thought to be best if harvested
on St. John's Day (June 24). In nineteenth-century America, physicians
used it for wound healing, especially for lacerations involving damaged
nerve tissue, and as a diuretic, astringent, and mild sedative. Externally,
St. John's wort oil is used for the treatment of wounds, abrasions, nervepain, and first-degree burns.
St. John's wort emerged as one of the most popular selling herbs in the
United States thanks to a segment aired June 27, 1997, on an ABC
News 20/20 program, which reported that St. John's wort outsold
Prozac® by more than twenty-to-one in Germany. Then, in 2000, a
letter-to-the-editor in the British medical journal, The Lancet, warned of
possible drug interactions between St. John's wort and a drug used for
the treatment of AIDS and a drug used to help the body not reject
transplanted organs. Consequently, St. John's wort became an obses-
sion with conventional medical researchers—along with other herb-drug
interactions. Of 727 references to St. John's wort on all scientific top-
ics at the PubMed database of the National Institutes of Health recent-
ly, 173 papers dealt with the topic of St. John's wort's safety. In a recent
article (Schulz, 2006) analyzing safety data on St. John's wort in more
than 14,000 patients, the incidence of adverse effects was ten times
St. John's wort
less compared with conventional antidepressant drugs.
Like grapefruit juice, St. John's wort interferes with the enzyme sys- tem involved in the metabolism of about 50 percent of prescriptiondrugs. St. John's wort increases the metabolizing activity of this systemand therefore lowers the concentration in the blood stream of theseprescription drugs, including birth control pills. This reduces their ther-apeutic activity and is actually the opposite of what grapefruit juice isknown to do. Grapefruit juice can greatly increase the level of thesesame prescription drugs in the blood stream, putting people at risk ofoverdose after drinking just one glass of juice a day. The bottom line: ifyou use St John's wort (or drink grapefruit juice), have your physiciancheck the literature to see if the activity of any prescribed drug might be affected.
Over three-dozen controlled clinical studies involving more than 3,000 patients diagnosed with mild to moderate depression have beendocumented. In all but a handful of studies, positive results were report-ed. In most of the studies, St. John's wort was significantly better thanplacebo, and just as effective as conventional antidepressant drugs for mild to moderate depressionwith far fewer and less seri-ous side effects. Clinicalstudies on St. John's wort'sbenefits for severe depres-sion, predictably, have pro-duced negative results. It hasnever been a phytomedicineindicated for major depres-sion. It has always been usedonly for mild to moderatedepression. Further, lest we be too critical of St. John's wort in these trials, one third of studies onpharmaceutical antidepressant drugs fail to show a significant benefit.
In various clinical studies, patients who took St. John's wort extracts felt significant improvement in depressive mood indicators such as feel-ings of sadness, hopelessness, helplessness, and uselessness, as wellas fear and difficult or disturbed sleep. Few significant side effects wereobserved. Researchers conclude that St. John's wort extract, comparedwith synthetic antidepressants, produced side effects of minor signifi-cance and can be recommended for the treatment of mild and moder-ate depression (Roder, et al., 2006, Whiskey, et al., 2001).
The dried herb and flowering tops may be made into tea or soaked in
olive oil (imparting a red pigment, hypericin, to the oil) and used for
external applications. Products standardized to contain 0.2 to 0.3 per-
cent hypericin are commonly available. While most products are stan-
dardized to hypericin, other components, such as hyperforin, could be
involved in antidepressant action. Some evidence suggests flavonoid
components could also be involved in its action. Capsules, tablets, tinc-
tures, extracts, and other products are also found in the American market.
A daily dose of 2–4 g (1⁄2–1 tsp) of the dried herb (containing 0.2–1.0
mg hypericin) is used in tea. Extracts standardized to 0.3 percent
hypericin are taken in doses of 300 mg three times a day to deliver 1 mg
of hypericin daily. Other products are standardized to hyperforin at
2–4.5 percent. For commercial products, please follow manufacturer's
St. John's wort may result in significant interactions with prescription
drugs, and should not be taken at the same time as other antidepres-
sants, coumarin-type anticoagulants, the immunosuppressants such as
cyclosporine and tacrolimus, certain HIV drugs, birth control pills, and
certain drugs used in chemotherapy. Reported cases of interaction are
rare and, with medical supervision, easily avoided (Schulz, 2006).
Hypericin from the flowers may cause light-skinned animals that con- sume the plant to break out in hives or blisters upon exposure to sun-light, a reaction called photodermatitis. If you have fair skin, be aware of St. John's wort
this potential problem, especially if you are likely to be exposed to brightsunlight after taking the herb. At least of one woman who frequentedtanning salons while taking St. John's wort developed severe photoder-matitis. She did not tell her physician she was taking St. John's wort, sohe attributed the reaction to other causes. Since St. John's wort is a"natural product," the woman could not conceive of it having sideeffects. If you are taking St. John's wort, avoid sun bathing and the tan-ning salon. Yes, herbs are natural. Treat nature with respect.
Awang, D.V.C. St. John's wort. 1991. Canadian Pharmaceutical Journal.
Blumenthal, M. et al., eds. 2003. The ABC Clinical Guide to Herbs. Austin, Texas: American Botanical Council. Harrer, G., H. Sommer. 1994. Treatment of mild/moderate depressions with Hypericum. Phytomedicine. 1(1):3-8. Linde, K., et al. 1996. St. John's wort for depression: An overview and meta- analysis of randomized clinical trials. British Medical Journal. 313:253-8. Roder, C., et al. 2004. Meta-analysis of effectiveness and tolerability of treat- ment of mild to moderate depression with St. John's wort. Fortschritte derNeurologie-Psychiatrie. 72(6):330-43.
Schulz, V. 2006. Safety of St. John's wort extract compared to synthetic anti- depressants. Phytomedicine. 13(3):199-204. Suzuki, O., et al. 1984. Inhibition of monoamine oxidase by hypericin. Planta Medica. 50:272-4. Whiskey, E., et al. 2001. A systematic review and meta-analysis of Hypericum perforatum in depression: A comprehensive clinical review. InternationalClinical Psychopharmacology. 16(5):239-52. Sources
Valerian is the root of a perennial member of the valerian family found in
eastern, southeastern, and east-central Europe, to south Sweden and
the Southern Alps. It escaped from cultivation in the northeastern
United States and is commercially grown in Europe, the United States,
Valerian, not a major medicinal plant of the ancient classical authors,
was best known to them as a diuretic and treatment for menstrual diffi-
culties. The Greek physician Galen used it for epilepsy in children and
adults. An Italian nobleman, Fabio Colonna, born in 1567, suffered from
epilepsy and found Galen's reference. He took valerian himself and
claimed it completely restored his health. His words stimulated interest
in the plant as a sedative. Use of valerian to relieve spasms and as a
sleep aid evolved in the seventeenth and eighteenth centuries. Valerian
was an official remedy in the U.S. Pharmacopoeia from 1820 to 1936.
Valerian is widely used in Europe as a mild nerve sedative and sleep aid
for insomnia, excitability, and exhaustion. Experimental studies have
shown that it depresses the central nervous system and relieves mus-
cle spasms. Its sedative action is attributed to a number of chemical
fractions, with no single compound emerging as the active principle.
In the 1980s, Swiss researchers were the first to perform clinical studies on the effects of valerian water extracts on sleep patterns.
Sleep quality was assessed by the patients and by laboratory meas- ures. The time taken to fall asleepwas reduced, especially in olderpatients and insomniacs. Dreamrecall and nocturnal movementwere apparently not affected. Nohangover effect, a common com-plaint among users of syntheticsedatives, was reported the fol-lowing morning (Chauffard, 1982;Leathwood, et al., 1982).
Upwards of 30 clinical studies are published on the benefits of valerian preparations for the treatmentof anxiety, sleep disorders, and mood. The majority of these studiesshow that valerian is more effective than placebo in improving sleep incases of sleep disturbances. Valerian has also been studied in combi-nation products, along with hops (Humulus lupulus), lemon balm(Melissa officinalis), St. John's wort (Hypericum perforatum), hawthorn(Crataegus laevigata), and other herbs. Valerian is generally used fortreatment of acute insomnia. However, a 1996 study involving 121patients who were administered a valerian extract for 4 weeks usingfour different rating scales found significant differences between place-bo and treatment groups after the four-week period. A statistically sig-nificant difference was observed by patients and physicians after four-teen days, suggesting valerian's benefits are enhance if used for two tofour weeks to improve daily mood and sleep disturbance patterns(Vorbach, 1996). German health authorities allow use of valerian in sedative and sleep-inducing preparations, for states of excitation, and for difficulty infalling asleep due to nervousness. Valerian provides an excellent exam-ple of the benefits and complexities of developing effective drugsbased on plant extracts or whole parts rather than single isolated com-ponents. While various valepotriates, valerenic acid and other compo-nents have been suggested as possible active compounds for Valeriana species, no single compound or group of compounds has been proven responsible for the activity of this widely used phytomedi-cine (Houghton, 1988).
Given its history of use, positive pharmacological, chemical and clin- ical studies, and its wide therapeutic use as a sleep aid particularly inEurope, valerian is one of the most accepted phytomedicines from ascientific and clinical viewpoint Preparations
Dried valerian root is available in whole, cut-and-sifted, and powdered
form for teas, capsules, tablets, tinctures, extracts, and other prepara-
tions. Some products are standardized to contain at least 0.5 percent
The standard daily dose is 2–3 g (about l⁄2 tsp) of the root divided into
two or three doses each day. Products standardized to 0.5 percent
essential oil may be taken at a dose of 300–400 mg per day. As a sleep
aid, valerian is taken one hour before bedtime. For commercial prod-
ucts, please follow manufacturer's label instructions.
Some individuals may experience temporary stomach upset.
Compounds called valepotriates have been shown to destroy and
cause mutations in animal cells. Despite these findings, valerian is gen-
erally considered safe. Although official texts do not caution against
using valerian during pregnancy and lactation; avoid it to be on the safe
side. Animal studies suggest that if valerian is taken with sedatives, it
may increase their effect, therefore such use should be avoided.
Chauffard, F., et al. 1982. Detection of mild sedative effects: Valerian and sleep in man. Experimentia. 37:622. ESCOP. Valerianae Radix. In ESCOP Monographs on the Medicinal Use of Plant Drugs. Vol. 4. Exeter, United Kingdom: ESCOP Secretariat. 1997.
Foster, S. 1998. 101 Medicinal Herbs: An Illustrated Guide. Loveland, CO: Interweave Press.
Houghton, R.J. 1988. The biological activity of valerian and related plants.
Journal of Ethnopharmacology. 22:121-42. Leathwood, P.D., E. Chauffard, E. Heck, R. Munoz-Box. 1982. Aqueous extract of valerian root (Valeriana officinalis) improves sleep quality in man.
Reduces sleep latency to fall asleep in man. Pharmacology Biochemistry& Behavior. 17:65-71. Schulz, V., R. Hänsel, V.E. Tyler. 1998. Valerian. In: Rational Phytotherapy: A Physician's Guide to Herbal Medicine. Berlin: Springer. pp. 73-81.
Vorbach, E., R. Gortelmayer and R. Runing. 1996. Treatment of insomnia: efficacy and tolerance of a valerian extract. Psychopharmakotherapie.
3:109-15. For more
For more information on herbs visit:
The American Herbal Products Association www.ahpa.org The Dietary Supplement Information Bureauwww.supplementinfo.org PubMed, a service of the National Library of Medicine www.pubmed.gov HerbMed®—an interactive, electronic herbal database www.herbmed.org International Bibliographic Information on Dietary Supplementshttp://grande.nal.usda.gov/ibids/index.php Southwest School of Botanical Medicinewww.swsbm.com A publication of the AHPA Foundation for Education & Research onBotanicals (AHPA-ERB Foundation)
Laboratorio di pratica – SMC 3L I edizione – ottobre 2007 CPC Centro Professionale Commerciale Via Vincenzo Vela 7 Tel: +41 (0) 91 697 63 20 (info 4) fax: +41 (0) 91 697 63 29 • EDITORIALE • IN MEMORIA DI EMANUELE PURICELLI • COMUNICAZIONI DELLA DIREZIONE / LA NOSTRA SCUOLA • SPAZIO DOCENTI