- non-woody, seed-producing plants.
arts - vegetable products used to add flavor or aroma to food.
- crude drugs of vegetable origin, used for treatment of disease states. Note:
A limited number of botanical products such as prune juice or psyllium may
qualify as either a food or a drug.
- WHO in
1985 estimated that 80% of the world population relies on herbs for
primary health care needs.
- Up to
30-40% of medical doctors in Germany
rely on herbs as primary medications.
- A 1997
survey estimated that 12.1% of adults in the U.S. had used an herbal
medicine in the past 12 months, as compared with 2.5% in a 1990 survey (JAMA. 1998. 280. 1569-1575).
on use of dietary supplements in 1997-2002 indicated that18.6% of US
adults in 2002 used herbal therapy (Tindle HA,
et al. Altern Ther Health
Med. 2005. 11. 42-49).
retail sales of botanicals have increased from $200 million in 1988 to an
estimated $5.1 billion in the U.S. in 1997. Sales
recently have actually decreased to an estimated $4.2 billion in 2001.
1998, annual sales were $151 million for ginkgo, $140 million for St. John's wort, $96
million for ginseng, $84 million for garlic, and $70 million for Echinacea.
are more dilute than over the counter or prescription drugs (Tyler V. Herbs of Choice. 1994. Pg 2).
contain many active ingredients along with some physiologically inert
substances (Tyler V. Herbs of Choice.
1994. Pg 3).
are generally regarded as safer than prescription drugs. A meta-analysis
of 39 prospective studies in U.S. hospitals found that in
1994, 2,216,000 hospitalized patients had an adverse drug reaction, and
106,000 had fatal adverse drug reactions (JAMA. 1998. 279. 1200-1205).
years of use in folk medicine does not guarantee safety (i.e. comfrey).
Preparations of herbs
– prepared by boiling the plant material in water for a period of time.
extract - usually hydroalcoholic solutions of
herbs, more concentrated than a tincture, with 1 ml usually representing 1
gram of herb.
– prepared by pouring boiling water over the herb and allowing it to steep for a period of time.
extract – prepared by evaporating all of the solvent used to remove the
active constituents from the herb; most concentrated form of an herb (but
not necessarily bioavailable, depending on the amount of compression of
the tablets, and the binders and fillers used in creating a capsule or
– usually hydroalcoholic solutions of herbs;
used when the active principles are not soluble in water or when a more
concentrated product is required to allow adequate dosage. Concentration
is usually 1-2 grams of herb per 10 ml.
Information on specific herbs
- Aloe -
superior remedy for burns; grow plant in the home. Aloe vera gel at a dose of 2-6 tablespoons one to two times
a day may help to heal peptic ulcers and may be useful in the treatment of
Crohn's disease. This can be mixed with fruit juice. Beware
that ingestion of aloe products which contain latex or the whole leaf can
cause diarrhea, GI irritation, and loss of electrolytes. The element
responsible for this is 'aloin' and some whole
leaf extracts have the aloin extracted.
- Andrographis – effective treatment for URIs.
dose is 400 mg three times a day of an extract standardized to 4-6% andrographolide content; doses as high as 2 grams
three times a day have been used. Best used in tablet form, as taste is
systematic review which searched 6 computerized databases identified 7
RCTs (n=896) which met inclusion criteria, all scoring at least 3 out of
5 on the Jadad scale for methodological
quality, and concluded that andrographis is.
The main limitation of the data is that the studies were sponsored by the
manufacturer (Explore. 2006.
second systematic review identified 4 RCTs and included 3 (n=433) in a
meta-analysis, and concluded that andrographis
alone or in combination may be more effective than placebo in treatment
of uncomplicated URIs (J Clin Pharm Ther. 2004.
- Aristocholia - definitely hazardous; should not be
consumed at all. Potent human carcinogen, and can cause kidney
failure. Traditional use in the U.S. as a digestive tonic and
for treating snakebites. A tragedy reported in 1992 in which there
were at least 30 cases of kidney failure in Belgian women using a weight
loss supplement actually involved upon careful chemical analysis inadvertant substitution of Aristocholia
for Stephania, presumably based on these
two herbs sharing the same Chinese common name, fangi.
In 2008, this is a worldwide problem, with 128 reported cases in Belgium, 116 reported cases in China,
and a few reported cases in many other countries (Kidney Int. 2008. 74. 158-169 as cited in Alt Med Alert. 2008. 11. 126-129).
- external remedy for bruises, sprains, sore muscles (do not ingest). Do
not apply to broken skin and do not ingest, because of systemic toxicity.
- Ashwagandha - Ayurvedic herb touted as an adaptogen
and for treatment of multiple sclerosis.
- Astragalus - immune stimulant considered safe for long
immunity in patients undergoing chemotherapy – widely used in China for
this purpose (J Clin
Oncol. 2006. 24. 419-430; Cochrane Database Syst
Rev. 2005. CD004540). In an 8 week RCT of 115 patients with
leucopenia (published in a Chinese-language medical journal), there was a
significant rise in WBC in the groups receiving 10 gm/day and 30 gm/day Astragalus (p<0.001) with a greater rise in WBC in
the group receiving 10 gm/day as opposed to the group receiving 30
is 500 mg (or 3 ml of 1:5 tincture) twice or three times a day. In China the
officially recognized daily dose is 9-30 grams.
in persons taking coumadin.
blood flow to the blood vessels of the eyes, and increases the capillary
slow the progression of cataracts and macular degeneration.
is 80-120 mg two to three times a day of a standardized product with 25% anthocyanosides.
bilberry is a very expensive herb ($500/kg in 2007) and thus adulteration
with azo dyes is a possibility, as these dyes will be detected as anthocyanins on UV spectrophotometry. Anthocyanin
content can be accurately detected by HPLC (Liva
R. IMCJ. 2007. 6. 31).
orange - may be hazardous. Used for centuries in TCM for
digestive problems; often an ingredient in weight loss products since
ephedra was banned, as the fruit contains synephrine,
which has thermogenic properties. Bitter orange
in weight loss formulas may induce the same adverse effects as Ephedra.
cohosh (return to Home Page and click on ‘Menopause’ for detailed
information on clinical trials and safety)
traditionally used by Native Americans.
of the symptoms of menopause.
also be beneficial in treatment of dysmenorrhea (recommended by German
Commission E based on case reports), rheumatoid arthritis, low back
pain, and muscle aches.
cancer - there are no published clinical trials as of 2006, but there is
promising in vitro and animal data (Alt
Med Alert. 2007. 10. 5-8).
of action - neither the identity of the active compounds nor the
mechanism of action of black cohosh is known. More specifically, it
is unknown whether black cohosh exerts its effect via estrogen receptors
or through another mechanism (perhaps acting as a serotonin agonist,
perhaps decreasing LH levels). Formononetin
was hypothesized to be an active ingredient, but is not present in Remifemin.
- Boldo – approved by German Commission E for dyspepsia,
but potentially toxic as per Varro Tyler (Herbs of Choice. 1994) because the volatile oil in the leaves
contains 40% ascaridole, a rather toxic
of allergic rhinitis. In a two week RCT with 125 patients, shown at a
dose of one tablet 4 times a day (carbon dioxide extract tablets, ZE
339) to work as well as cetirizine (Zyrtec) [BMJ. 2002. 324. 1-4].
- dose is 50 mg 2-3 times per day for prophylaxis, 50 mg every 2 hours
up to 6 doses per day for treatment of a migraine.
Plants contain pyrrolizidine alkaloids (PA's) that may be toxic to the
liver, so best to use pills with the PA's removed.
- Petasin is the active ingredient with spasmolytic and
- Petadolex is the best studied brand name - this is a
patented extract manufactured in Europe compliant with strict GMP; it is
made from the rhizome of the plant and standardized to 15% petasins; the final product has <0.08 ppm PA's.
- Calamus - North American type is nontoxic but Indian
type is potentially toxic
secondary to cis-isoasarone, a carcinogen (J Am Pharm Assoc. 1996. 36. 29).
- promotes wound healing if applied locally.
- digestive disorders, menstrual disorders, skin conditions, minor
infections, sedation. Allergic reactions include tongue thickness, tight
sensation in throat, angioedema of lips and eyes, diffuse pruritis, generalized urticaria,
upper airway obstruction, pharyngeal edema, and abdominal cramps. Allergy
to ragweed serves as a marker. CamoCare is
the best studied brand name.
- considered by some to be a valuable cancer treatment because its leaves
contain a potent antioxidant, but many authorities recommend against
its use because of the risk of liver damage. Available data
would suggest that the risk of adverse events is higher with the unextracted leaves than with the hydroalcoholic
tinctures (Am J Gastroenterol.
1995. 90. 831-833), and that short-term internal use of liquid extracts
should be safe to help reduce local inflammation and symptoms associated
with colds, diarrhea, and urinary tract infections (Br J Phytother. 1993-1994. 3.
(Alt Med Alert. 2008. 11. 13-16)
are many different species of cinnamon.
(anti-gas), aide digestion, and improve appetite. Approved by German
Commission E to treat loss of appetite, dyspeptic complaints such as
mild spastic conditions of the GI tract, bloating, and flatulence.
– used this way in East Asia.
of action – increases insulin sensitivity (J Am Coll Nutr.
2001. 20. 327-336) and stimulates release of insulin (Phytother Res. 2005. 19. 203-206).
– good safety in clinical trials. BEWARE though that cinnamon purchased
from the spice rack often contains coumarin, a
natural compound that can be harmful to the liver.
trials are with Cassia cinnamon – several small RCTs with conflicting
in clinical studies have ranged from 1-6 grams/day, and ½ teaspoon
approximates 1 gram.
- cough suppressant, but pyrrolizidine alkaloids are toxic, so not
recommended for oral use, or if used, only for a maximum of two weeks, and
absolutely contra-indicated in people with liver disease.
- poultice for bed sores and diabetic ulcers (mix comfrey root in a
blender with aloe vera gel). Many authorities
recommend against oral use because of significant liver
toxicity secondary to pyrrolizidine alkaloids (PA's). Comfrey
root has a much higher content of mucilage and allantoin,
which stimulates cell proliferation, compared to comfrey leaves, but the
root also has a much higher content of PA's.
Prevention and/or treatment of cystitis
2009 Cochrane Review of cranberry for treatment of UTIs found that no published trials met
inclusion criteria (Cochrane
Database Syst Rev. 2009. CD001322).
a 12 month RCT in 150 women found a 20% reduction in the absolute risk
of infection in women treated with cranberry/lingonberry juice compared
with the probiotic supplementation group and a no-intervention group (BMJ. 2001. 322. 1571).
12 month RCT in 150 women found that cranberry juice and cranberry
extract significantly decreased the number of patients having at least
one symptomatic UTI per year (Can
J Urol. 2002. 9. 1558-1562).
2004 Cochrane Review of cranberry for prevention of UTIs identified 5 trials with 304 patients
which met inclusion criteria, but overall methodologic quality was
only fair, leading the authors to conclude that there is no conclusive
evidence to support this use of cranberry (Cochrane Database Syst Rev. 2004.
CD001321). A 2008 updated Cochrane Review included 10 randomized
or quasi-randomized clinical trials (n=1049) found “some evidence” that
cranberry juice might decrease the number of symptomatic UTIs over a 12
month period, especially in women with recurrent UTIs (Cochrane Database Syst
Rev. 2008. CD001321). A 2012 update included 14 new studies,
for a total of 24 studies (n=4473) and found that cranberry products do
not reduce UTIs in susceptible populations. There was a high dropout
rate in many of the studies (Cochrane
Database Syst Rev. 2012. CD001321).
2012 systematic review of 13 RCTs (n=1616) showed that “cranberry
products are associated with a protective effect against UTIs. However,
this result should be interpreted in the context of substantial
heterogeneity across trials (Arch
Intern Med. 2012. 172. 988-996).
12 month RCT in 221 premenopausal women with recurrent UTI’s found that
TMP-SMX 480 mg once a day is more effective than cranberry capsules 500
mg twice a day at prevention of recurrent UTI’s, and that both regimens
were equally well tolerated. Downside of antibiotic prophylaxis was a
much higher rate of bacterial resistance during the trial (Arch Intern Med. 2011.
1270-1278). An invited commentary notes that bioavailablity
of cranberry extract is much lower than TMP-SMX, and that higher doses
might be more effective; dosing studies of cranberry extract have not
been performed (Arch Intern Med.
of action – proanthocyanidins prevent adherence
of bacteria to the bladder wall (JAMA.
1988. 260. 1465), antioxidant and anti-inflammatory effects too.
significant side effects (high doses can cause GI side effects, and long
term use of high amounts might increase risk of uric acid kidney stones)
or known significant drug interactions (specifically, a clinical study
looking at interaction of a cranberry juice cocktail with amoxicillin
and cefaclor found no significant overall
clinical effect [Antimicrob Agents Chem. 2009. 53.
with Coumadin – although reported in case reports, randomized clinical
trials using quantities of cranberry juice up to 600 ml (2.5 cups) show
no evidence of an interaction (Am
J Med. 2010. 123. 384-392).
is 8 ounces of unsweetened juice three times per day or 400 mg of
powdered cranberry extract twice a day.
– a 2007 NHIS survey reported that about 1.6 million Americans used
cranberry within the past year.
- anti-inflammatory, the active ingredient in turmeric.
is 400 mg three times a day.
curcumin in the human body has (1) extremely poor absorption, (2) high
rate of metabolic conjugation, and (3) rapid clearance from the body.
- There is basic
science data that combining curcumin with piperine
(a compound in black pepper) dramatically increase percent absorption of curcumin
(CAUTION: administering piperine may increase
absorption of prescription medications too).
- Technologies which
enhance the bioavailability of curcumin include (1) lecithin bound to
curcumin (e.g. BCM-95®), (2) a “phytosome”
1:2 adduct of curcumin and phosphatidylcholine (e.g. Meriva®), and (3) a
curcumin nanoparticle colloidal dispersion (e.g. Theracumin®).
- BCM-95 has been
shown to have 6.93 fold increase in absorption compared with
standardized curcumin (Indian J Pharm Sci. 2008. 70.
- Curcumin complexed with phosphatidylcholine has been shown to
have 29 fold blood concentration, compared with standardized curcumin (J
Nat Prod. 2011. 74. 664-669).
- Curcumin dispersed
with colloidal nanoparticles has been shown to have 27 fold blood concentration,
compared with standardized curcumin (Biol
Pharm Bull. 2011. 34. 660-665).
– many extracts are contaminated with ethylene dichloride, a Class I
solvent (probable human carcinogen), based on testing done by Vital
Nutrients. This solvent is not mentioned in the COA for many batches of
raw material, even though testing shows it is present, often in
substantial concentrations (Liva R. IMCJ. 9 . 50-54).
for treatment of osteoarthritis pain based on several small studies
reported in France,
and low back pain based on a Cochrane Review (Cochrane Database Syst Rev. 2006.
is 2.0 to 2.4 gram/day of a powdered extract containing 0.3 to 0.7 grams
- DGL (deglycyrrhizinated licorice) - treats peptic ulcer
disease, indigestion. Mechanism of action is related to
strengthening the lining of the stomach, making it less susceptible to
damage from acid.
- Dong quai - female tonic, believed to be useful for
treatment of menopausal symptoms. A recent study however showed no
efficacy for this herb when used alone for the treatment of
menopause. Dose is 500-900 mg or 30 drops of tincture 3 times a day
of a standardized extract containing 0.8% to 1.1% ligustilide.
Some herbalists recommend limiting use to 3 months. May elevate the
Pro Time in patients on coumadin, so relatively
contra-indicated with coumadin.
are 9 species in the genus; commercially available herbal medications are
produced from 3 species: Echinacea augustifolia, Echinacea
pallida, and Echinacea purpurea. Furthermore, different products
use different parts of the plants, mostly the roots. Thus there is
considerable variability amongst products, and this makes the research on
Echinacea difficult to evaluate. The most common product in
this country is the root of E. purpurea.
Over 400 scientific studies worldwide.
and/or prevention of upper respiratory infections – emerging data
support a role for long term use as a preventive measure (Miller SC. Evid Based Complement Alternat
Med. 2005. 2. 309-314; Tiralongo E et al. Evid
Based Complement Alternat Med. 2012).
majority of scientific study occurred in Germany. Four German
Commission E monographs were published on Echinacea, and two were
positive (E. pallida root and E. purpurae
herb) while the two others concluded that there was insufficient
evidence to establish efficacy (E. angustofilia
root and E. angustofilia/E. pallida herb).
- A Cochrane
review of 16 randomized trials including 3396 patients (Cochrane Database Syst Rev. 2000. CD000530) found that the
methodologic quality of the studies as assessed by Jadad
score varied, with some of good quality. In the 5 trials
of prevention that had a placebo control group, the results were
inconclusive. Each of these trials tested a different Echinacea
product. In one of these trials, which included 302 patients,
Echinacea was no better than placebo (Arch Fam Med. 1998. 7. 541-545).
The three prevention trials with control groups that received no
treatment (as opposed to placebo treatment) suggested a beneficial
effect. Of the 8 treatment trials in this review, all
placebo controlled, 6 did show a favorable effect for the herb. Various
Echinacea products were used in these trials. An updated Cochrane review concluded
that inconsistencies in the data persist (Cochrane Database Syst Rev. 2006.
meta-analysis of 14 RCTs which included 1356 patients in 9 trials
evaluating a preventive effect and 1630 patients in 7 trials evaluating
treatment effect showed a 58% lower odds of contracting an URI and a
beneficial effect on duration of symptoms in those with URIs (Lancet Infect Dis. 2007. 7.
of the positive trials was a randomized, controlled trial with 160
patients who received either placebo or 900 mg of Echinacea daily in
the form of 90 drops of a root extract. The active treatment group had
resolution of upper respiratory symptoms in 9 days compared with 13
days in the placebo group (Complement
Ther Med. 1997. 5. 40-42).
this Cochrane Review was completed, another positive placebo-controlled
treatment trial has been published - this one including 80 patients
treated with Echinacin, EC31J0 (Arzneimittelforschung.
2001. 51. 563-568).
methodologically rigorous RCT in 148 students with common colds of
recent onset testing an encapsulated mixture of Echinacea purpurea herb (25% and root (25%), and E. angustifolia root (50%) taken in 1 gram doses six
times on day 1 and 3 times on each subsequent day up to 10 days showed
no detectable benefit on the severity or duration of self-reported
symptoms (Ann Intern Med.
2002. 137. 939-946).
RCT of 707 URIs in 407 children ages 2-11 treated with Echinacea purpurea for a maximum of 10 days showed no
benefit for the herb in treatment of acute URIs, but an increased risk
of rash. Note that there was a decrease in the risk of
recurrent URIs in the treatment group (a secondary endpoint). Note
that this study used the flower of the plant whereas most studies use
the root, and this may be the explanation for the higher incidence of
rash (JAMA. 2003. 290.
RCT in 282 adults instructed to take Echinacea at the first sign of
cold-related symptoms, 10 doses on the first day and 4 doses on each
subsequent day for one week, found that daily symptom scores were 23.1%
lower with Echinacea (J Clin Pharm Ther.
2004. 29. 75-83). A review of
322 published articles on Echinacea found that only 2 trials met all 11
inclusion criteria, and neither showed a difference from placebo, but 7
additional trials met most of the inclusion criteria, and 6 of these 7
were positive (Clin Infect Dis. 2005. 40.
RCT in 437 volunteers who upon testing were susceptible to rhinovirus
type 39 found no significant treatment effects for any of the 3 E. angustofolia
root products used in this trial which involved direct nasal challenge
with rhinovirus type 39. The
methodology in this study was good with the exception that the typical
dose of E. angustofilia
root is 3 grams per day and this study used only 900 mg/day! (N Engl J
Med. 2005. 353. 341-348).
RCT in 719 patients with new onset URI symptoms consistent with a
“common cold” in which the treatment group received either Echinacea
tablets containing a mix of E purpurea root 675 mg and E angustifolia root 600 mg
concluded that there was not a significant difference in illness
duration or illness severity in the treatment versus placebo group.
Mean illness duration was 6.34 days in the treatment group, compared
with 6.87 days in the placebo group (P= 0.075). The dose of Echinacea (Medi Herb product) was 2 tablets four times a day
for the first day (total dose first day of 10.2 grams dried Echinacea
root), followed by 1 tablet four times a day for the next 4 days (total
dose first day of 5.1 grams dried Echinacea root on days 2-5). If in
fact the 0.5 day reduction in duration was real and not due to chance,
prior research by this group at U of Wisconsin suggest that no more
than 1 in 4 people would consider this level of benefit worthwhile,
considering the cost, inconvenience, and possible adverse effects of
Echinacea (Ann Intern Med.
2010. 153. 769-777).
RCT of 755 healthy subjects in which the treatment group was
administered liquid Echinacea three times a day throughout the cold
season (4 months), with the dose increased to 5 times a day at onset of
URI symptoms, showed 26% fewer “cold events” in the treatment group.
The product in this study was Echinaforce, E. purpurea
(95% herba and 5% root), and
the study protocol included retaining drops in the mouth for 10 seconds
prior to swallowing. The dose of drops was 0.9 ml/day, corresponding to
of extract per day (Evid Based Compl Alt Med. 2012. doi:10.1155/2012/84131).
be useful in treatment of abscesses, burns, eczema, leg ulcers, and
Jacob Teitelbaum advocates as
part of a regimen for adrenal insufficiency in those with chronic
fatigue syndrome - 6 weeks on and 2 weeks off. Reference regarding a
stimulating effect on adrenal gland is Arzneimittel Forschung.
1953. 3. 133-137.
term use may be associated with tachyphylaxis
- best not to use for more than two weeks at a time.
of action - stimulation of the immune system (J Altern Complement Med. 1995. 1.
1997. 35. 229-235), local anesthesia, anti-inflammatory, hormonal,
antiviral, and free-radical scavenging activities.
active ingredients include polysaccharides, glycoproteins, alkamides, and flavonoids. Based on the mechanism
of action, considered contraindicated in patients on prescription
corticosteroids, and relatively contraindicated in autoimmune
disorders (multiple sclerosis, lupus).
is some data that the stimulation of the immune system is a function of alkylamides in Echinacea – these compounds are found
in roots of Echinacea angustofilia and Echinacea purpurea, and are not
found in the stem or flower – this could explain some of the variable outcomes in various
trials of Echinacea using different species and different parts of the
plant (Bone K. The Best in Phytotherapy in
2004: Solving the Echinacea Puzzle. Townsend
Letter. Feb-March 2005).
- Adverse effects are rare and consist mostly of allergic reactions, but
there are documented cases of severe anaphylactic or asthmatic
reactions. Data would suggest that atopic females are at greatest
risk for severe allergic reactions (Ann
Allergy Asthma Immunol. 2002. 88.
42-51). A prospective study of Echinacea exposure during pregnancy
found no increased risk for major malformations in 206 women who used the
herb (Arch Intern Med. 160.
3141-3143. 20000. May cause rashes, asthma, anaphylaxis,
infertility and hepatotoxicity (anecdotes, but no published data).
Products may contain organochlorine pesticides including some that have
been banned in the US
(Bull Environ Contam Toxicol. 2001.
66. 150). May be a weak inhibitor of the cytochrome P450 3A4 system,
so numerous herb-drug interactions are possible.
- varies with the preparation of the herb. 0.75-1.5 ml of
tincture daily, 6-9 ml of pressed juice daily, 900-1000 mg of freeze
dried extract in capsules 3-4 times a day, or 6-8 ounces of tea four
times a day (Alternative Medicine
Alert. 2004. 7. 41-44). In some studies the tincture contains
22% ethanol and 2.4% fructofuranosides; in
other studies the powdered extract contains 3.5% echinacosides.
preparations are typically not standardized to any particular component
because the active component(s) has not yet been identified.
- Tablet versus liquid – one human
trial indicates that tablet form and liquid preparations of Echinacea
root are equally effective at delivering alkylamides
to the bloodstream (Phytomedicine. 2007. 14. 587-590).
- A study of 59 Echinacea
products from retail stores analyzed by thin layer chromotography
showed that 6 contained no measurable Echinacea and only 9 of the 21
preparations labelled as standardized extracts actually contained in the
sample the content listed on the label.
Overall, the assay results were consistent with the labelled
content in only 31 of the59 preparations (Arch Intern Med. 2003. 163. 699-704).
Lab tested 11 brands in 2004, and 5 failed the test, meaning the
contents of the bottle were not as indicated on the label.
- Echinaguard is the best studied brand name.
- influenza. Long history of use in folk medicine.
- In a
RCT in China in 64 patients with more than 3 influenza like symptoms
(fever, headache, myalgias, cough, nasal mucous
discharge, nasal congestion) who were randomized within 24 hours to a 175
mg Elderberry extract lozenge (brand name DART Immune) versus placebo 4
times a day for 2 days, those randomized to the Elderberry had more rapid
resolution of symptoms. The rate of complete symptom relief at 48 hours
was 28% with Elderberry versus 0% with placebo; the rate of partial
symptom relief at 48 hours was 88% with Elderberry versus 16% with
placebo. A limitation of this trial was that those randomized to
elderberry had higher symptom scores at baseline (Online J Pharmacol Pharmacokin.
2009. 5. 32).
- In a
RCT in Norway in 60 symptomatic influenza patients from 4 primary care
sites, Sambucol 15 ml four times a day starting
within 48 hours of symptom onset, and for 5 days, was associated with
more rapid improvement in aches and pains, quality of sleep, mucous
discharge, and nasal congestion by visual analog scale. The scores between the placebo and
treatment groups began to diverge on day 4 , such that the magnitude of
improvement in symptoms seen in the treatment group on days 4-5 was not
seen in the placebo group until days 7-8. In terms of a global evaluation
score of symptoms, a significant improvement was seen in the active
treatment group by a mean of 3.1 days, but not in the placebo group for a
mean of 7.1 days. Influenza A was
isolated from 54 of the patients and influenza B was isolated from the
other 6 (J Int
Med Res. 2004. 32. 132-140).
- In a
previous randomized study in 27 Israeli adults and children, Sambucol, in a dose of 60 cc per day for adults and
30 cc per day for children, 93.3% of the treatment group showed
significant symptom improvements within 2 days, whereas it was day 6
before 91.7% of the patients in the placebo group showed significant
improvement in symptom scores (J
Alt Compl Med. 1995. 1. 361-369).
- Eleutherococcus senticosus –
Russian ginseng – see ‘ginseng’ below. Most research has been done in Russia,
in uncontrolled trials.
- Ephedra -
effective bronchodilator, and some data on efficacy for weight loss.
Banned in 2004 by the FDA based on concerns about safety - see above in
outline under "DSHEA - safety - the story of ephedra" for
primrose (Oenothera biennis)
- oil contains GLA, an essential fatty acid in the omega 6 family of
oils. GLA has anti-inflammatory effects. Borage oil and black
currant seed oil are actually better sources of GLA. Contrary to
anecdotes, current data indicates it is ineffective for PMS (premenstrual
syndrome) and eczema.. May be effective for cystic mastalgia, diabetic neuropathy, rheumatoid
arthritis. Dosage is 3-6 grams a day of evening primrose oil, or
roughly 300-600 mg GLA.
- seeds lower blood sugar and improve lipid profiles in diabetics (Eur J Clin Nutr. 1988. 42. 939-944). Supplements made
from the dried leaf alone will not provide the desired effects. Take
as a tea three times a day, boiling a teaspoon of (debittered)
seeds in 1 cup of water or take 500 mg three times a day with meals. Contraindicated in pregnancy, with
peanut allergy, and in conjunction with prescription coumadin.
Prevention of migraine headaches (Cephalagia. 1998. 18. 704-708; BMJ. 1985. 291. 569-573; Lancet. 1988. 2. 189-192; Phytother Res. 1997. 11. 508-511). A
systematic review which examined 6 randomized, controlled trials found
positive and negative trials, but concluded that the results of
randomized controlled clinical trials favor feverfew over placebo (Public Health Nutr.
2000. 3. 509-514). May also be useful in the treatment of fever,
migraine headaches, and rheumatoid arthritis.
50 mg twice a day. Capsules should have at least 0.2% parthenolide/capsule. The daily dose of parthenolide for prevention of migraines should be
0.2 - 0.5 mg.
of action: Due in part to suppression of prostaglandin production,
so concomitant use of NSAID's may reduce effectiveness. May take 4-6
months of use to note a positive effect.
Significant variation amongst brands. A Canadian study showed that no North American feverfew product
analyzed contained the recommended minimal amount of 0.2% parthenolide believed to be required for
effectiveness (Journal of Natural
Products. 1991. 54. 1516-1521).
A 10% to 18% incidence of mouth ulcers reported with chronic use.
Contraindicated in those allergic to ragweed, chamomile, yarrow. Inhibits
platelet activity, so relatively contraindicated with coumadin
(Alt Med Alert. 2008. 11. 17-20)
Thousands of papers on garlic in peer reviewed scientific literature.
properties against bacteria, viruses, parasites, and fungi.
blood pressure slightly, based on a systematic review and meta-analysis
of 11 RCTs with a n=525 (BMC Cardiovasc Disord.
2008. 8. 13).
cholesterol [go to Home Page and click on Cholesterol for detailed
information with references]
the rate of progression of atherosclerosis
protect against cancer, including cancers of the colon, stomach,
prostate, and breast
lower blood sugar, may forestall cataracts, may increase libido.
of action: Intact garlic cells contain alliin,
an odorless sulfur-containing amino acid. When garlic is crushed,
chewed, or sliced, the alliin is exposed to the
enzyme alliinase located in neighboring cells,
and allicin, an unstable odiferous compound is
formed. Allicin is converted to other
sulfur compounds such as ajoene and allyl sulfides. Alliinase
is inactivated by acids, so alliin in garlic is
NOT converted to allicin in the stomach (it can
be converted in the mouth though).
The daily dose should be at least 10 mg of alliin
or 4000 micrograms of total allicin potential
(approximately equal to 1 clove of fresh garlic). Fresh garlic
contains approximately 1% alliin. Dose of
standardized powder containing 1.3% alliin is
200-400 mg three times a day.
platelet aggregation, so relatively contraindicated with coumadin use, but no data of harm when used with coumadin (J Nutr. 2006. 136[suppl
is no evidence on an interaction with coumadin.
hepatic cytochrome P450 3A4, so herb-drug interactions are a
to garlic may affect 1% of people when it is used at a therapeutic dose
(Mol Nutr Food
Res. 2007. 51. 1386-1397).
at least 7 days before surgery.
- Kwai is the best studied brand name.
- digestive remedy, possible appetite stimulant.
- definitely hazardous; should not be consumed at all. Can
cause hepatic failure; with good documentation of this adverse effect
based on positive rechallenges in numerous cases
(Ann Intern Med. 1992. 117.
129-132; CMAJ. 1996. 154.
osteoarthritis - A 6 week RCT with 261 subjects which used 255 mg per day
of a patented ginger extract, EV.EXT 77 reported effectiveness similar in
magnitude to that reported with NSAIDs (Arthritis Rheum. 2001. 44. 2531-2538). HOWEVER another
RCT with 3 treatment periods each of 3 weeks, comparing ginger,
ibuprofen, and placebo found no overall difference between ginger extract
and placebo (Osteoarthritis Cartilage.
2000. 8. 9-12).
sickness – superior to Dramamine and placebo in one study (Lancet. 1982. 1. 655-657), but
other studies have been negative (Acta Otolarynogol. 1988. 105. 45-49; Pharmacology. 1991. 42. 111-120).
induced nausea – mixed data. Positive results in a trial of 60 children
and young adults who received 1000-2000 mg of ginger in 3 divided doses,
in addition to conventional antiemetic therapy (Pediatr Blood Cancer. 2011. 56.
234-238). However, addition to a standard regimen not associated with
added benefit (Int J Gynecol
Cancer. 2004. 14. 1063-1069).
nausea and vomiting – a systematic review of 11 RCTs found insufficient
data to draw conclusions (Br J Anaesth. 2000. 84. 367-371).
of pregnancy – a review of 33 published studies in which 6 (n=675) met
criteria for inclusion showed that ginger was superior to placebo in 4
studies and equivalent to vitamin B6 in the other two studies (Obstet Gynecol. 2005. 105.
849-856). A previous Cochrane
review also found ginger beneficial (Cochrane
Database Syst Rev. 2003. CD000145).
nausea – a meta-analysis of 5 RCTs (n=363) found ginger more effective
than placebo (Am J Obstet Gynecol. 2006. 194. 95-99).
is 250 mg of dried root 4 times a day.
of action – inhibits COX 1 and COX 2 and also inhibits 5-lipoxygenase and
inhibits inducible genes which encode for inflammatory cytokines and
chemokines (J Med Food. 2005.
in pregnancy is debated, with the American Botanical Council asserting
based on a literature review that it is safe in pregnancy (German
Commission E came to a different conclusion that ginger is not safe in
thromboxane synthetase, and therefore prolongs
bleeding time, so relatively contraindicated with coumadin
use. Inhibits thromboxane synthetase (Indian J Med Sci. 2001. 55.
83-86). It does not, however, affect INR, based on data from an open
label, three-way, randomized crossover trial in 12 men (Br J Clin Pharmacol. 2005. 59. 425-432).
CYP2D6, and 5-10% of Caucasians have a genetic polymorphism such that
this enzyme is sluggish (N Engl J Med. 2003. 348. 529-537). In these
individuals, co-administration of drugs metabolized by this enzyme can
result in toxic drug reactions.
American EGb Study Group - a 52 week RCT in
309 patients reported significant improvement in mean scores for
cognitive function and daily behavior, but not the score on the
Clinical Global Impression Scale. At 26 weeks the data would
suggest that at least 6 patients would need to be treated to obtain a
clinically meaningful change in one patient. A limitation of this study
is that only 50% of the ginkgo group and 38% of the placebo group
completed the study. There were two different patterns of response in
this study – patients with baseline mild cognitive impairment by MMSE
score showed improvement with ginkgo whereas more severely demented
patients by MMSE score showed only stabilization of the cognitive
decline (JAMA. 1997. 278.
meta-analysis of high methodologic quality of four RCT's of ginkgo to
treat Alzheimer's disease (total of 212 patients) also found benefit
for treatment with ginkgo (Arch
Neurol. 1998. 55. 1409-1415).
systematic review of adequate quality included 9 RCT's (1947 patients),
of which of which 3 had a Jadad score of 5/5
for quality, and found that results were positive in 8 of the 9 studies,
including the 3 of highest quality (Clin Drug Investigation. 1999. 17. 301-308).
review of published placebo-controlled efficacy studies of at least 6
months' duration found that ginkgo extract and second generation
cholinesterase inhibitors were equally effective in treating mild to
moderate Alzheimer's dementia (Phytomedicine. 2000. 6. 393-401).
2002 Cochrane review of 33 trials found promising evidence of
improvements in cognition and function with ginkgo (Cochrane Database Syst Rev. 2002. 4:CD003120).
- Negative trial - a 6 month
regulatory trial of 513 patients with mild to moderate Alzheimer’s
disease sponsored by Schwabe Pharmaceuticals
failed to demonstrate efficacy (Curr Alzheimer
Res. 2005. 2. 541-551).
24 week RCT comparing the EGb 761 extract of
ginkgo, 160 mg daily, with Aricept 5 mg daily in patients with mild to
moderate dementia found the two equal in efficacy (Eur J Neurol. 2006. 13. 981-985).
2007 Cochrane review of 35 trials and 4247 participants found
“inconsistent and unconvincing” evidence for clinically significant
benefits in individuals with dementia or cognitive impairment. Most of
the trials analyzed were short term trials, 6-26 weeks in duration (Cochrane Database Syst Rev. 2007. 2. CD003120).
- Negative trial - RCT in 118
participants age 85 or older, with mild cognitive impairment or
dementia, using 240 mg/day of ginkgo, and with 42 months of follow up.
There were more ischemic strokes and TIA’s in the treatment group (Neurology. 2008. 70. 1809-1817).
- Negative trial - RCT in a
community setting in Britain
in patients with mild to moderate dementia, using 120 mg/day of ginkgo
(Int J Geriatr
Psychiatry. Epub 6/9/08)
conclude that the evidence for gingko in treatment of dementia is
mixed, with the more recent studies mostly negative.
data’ promising - a systematic review of high quality found 40
controlled trials, but only 8 were deemed by the authors of the
systematic review to be of high quality. Seven of the eight high
quality studies showed positive effects of ginkgo on cognitive
function, compared to placebo (Br
J Clin Pharmacol.
1992. 34. 352-358).
RCT of ginkgo 180 mg daily in 262 cognitively intact (i.e. MMSE >
26/30) community-dwelling volunteers over age 60 found both objective
and subjective evidence of benefit (Human
Psychopharmacol. 2002. 17.
another six week RCT of ginkgo 40 mg three times a day in 230 men and
women over age 60 without baseline abnormalities in cognitive function
showed no benefit. This study
though was methodologically flawed in that there were baseline
differences between the placebo and treatment groups and the placebo
was readily distinguishable from the ginkgo in that one was a pill and
the other was a capsule (JAMA.
2002. 288. 835-840).
- A meta-analysis of 8 trials did
not find evidence for cognitive benefits in non-cognitively impaired
participants younger than age 60, treated for up to 13 weeks (Hum Psychopharmacol.
2007. 22. 265-278).
- GEM Trial - Ginkgo biloba (EGb 761) 120 mg twice a day ineffective for
dementia prevention in a multi-center RCT conducted in 5 academic
medical centers, and sponsored by NCCAM. The 3069 participants were
community volunteers (recruited by the use of voter registration records)
ages 75 or older, with normal cognition (n=2587 or mild cognitive
impairment (n=483) at baseline. Mean follow up was 6.1 years. Subgroup
analysis showed no benefit in either the large group that was
cognitively intact at baseline or the smaller group that showed mild
cognitive impairment at baseline (42% of the 383 participants with mild
cognitive impairment at baseline developed dementia over the 6 years of
follow up. Additional subgroup analysis showed that in the 25% of
patients with cardiovascular disease at baseline, there was actually an
increased risk of developing dementia in the ginkgo treatment group (RR
1.56, P=0.006). There was a non-statistically significant increase in
the risk of hemorrhagic stroke in the treatment group. Secondary outcome
measures in this study included (1) cardiovascular serious events - no
difference between treatment and placebo group, (2) total mortality -
no difference between treatment and placebo group, (3) overall
cognitive decline - results not yet reported, and (4) functional
disability - results not yet reported (JAMA. 2008. 300. 2253-2262 and editorial 2306-2308). A
follow up report which included the results of much more detailed
cognitive testing also failed to identify benefit (JAMA. 2009. 302.
biloba (EGb 761) 120 mg twice a day ineffective for dementia prevention in a 5
year RCT of 2854 individuals in France, over age 70, who had reported
memory complaints to their doctor (Vellas B
et al. Lancet Neurology.
2012. 11. 851-859).
meta-analysis of good quality pooled the results of 8 RCT's (413
patients), most of which received a Jadad
score of 4/5 or 5/5 for quality, and found that ginkgo recipients
walked 34 meters farther without pain compared with controls (Am J Med. 2000. 108. 276-281).
the largest RCT, which included 111 patients with angiographically
proven PVD, after 24 weeks the mean pain free walking distance
increased by 45 meters in the ginkgo group and 21 meters in the placebo
group; the maximum walking distance increased by 61 meters in the
ginkgo group and 25 meters in the placebo group (Vasa. 1998. 27. 106-110).
positive effect is similar in magnitude to the positive effect seen for
the prescription drug pentoxifylline, but
smaller in magnitude to the positive effect seen with regular walking
these results are statistically significant, they are of
questionable clinical significance.
systematic review of adequate quality summarized the results of 5 RCT's
(621 patients) with 4 of the 5 studies scoring high for quality by Jadad score, and found that there was a moderate
but statistically significant benefit on the perceived loudness of
tinnitus in those who took ginkgo for 12 weeks (Clin Otolaryngol. 1999. 24. 164-167).
more recent 12 week RCT of ginkgo 50 mg three times a day for in 978
subjects showed no efficacy, but this trial used extract LI 1370, and
not EGb 761 (BMJ. 2001. 322. 73-75).
- HOWEVER, a meta-analysis of 6
RCTs found no significant benefit (Clin Otolaryngol. 2004. 29. 226-231);
and a Cochrane Review also found no data to indicate that ginkgo is
effective for tinnitus. This review identified 12 trials, but 10
were excluded on methodological grounds (Cochrane Database Sys Rev. 2004. 2. CD003852).
dysfunction secondary to SSRI drugs (Prozac, Zoloft, Paxil, Celexa)
a double-blind study of the women's formulation of a proprietary
multi-ingredient supplement marketed as ArginMax
(Daily Wellness Company), which contains L-arginine, ginkgo, and a
number of other dietary supplements, 73% of the 77 participants
reported improvements in overall sexual satisfaction compared to 37% of
the placebo users (J Sex Marital Ther. 2001. 27. 541-549).
an open trial of ginkgo extract 60-120 mg per day, 91% of the 33 study
women and 76% of the 30 study men reported "enhancing
effects" on all phases of the sexual response cycle (J Sex Marital Ther.
1998. 24. 139-143).
– 240 mg daily as effective as prescription betahistine
32 mg daily, in a 12 week RCT of 168 subjects, mean age of 58 (Sokolova L et al. Int J Otolaryngol. Epub 6/25/14).
- may dissolve plaque (Atherosclerosis.
2007. 192. 438-444).
be useful in treatment of acrocyanosis,
asthma, depression, erectile dysfunction, headaches, hypoxia, macular
degeneration (Cochrane Database Syst Rev. 2003. 2:CD001775), mountain sickness,
post-phlebitic syndrome, and Raynaud's
- The dosage in clinical trials ranges from 40 mg 3 times a day to 120 mg
twice a day, of a standardized extract with 22% - 27% ginkgo flavone
glycosides and 5% - 7% terpene lactones, with dosages in some clinical
trials as high as a total of 320 mg/day. Product should contain less than
5 ppm ginkgolic acids, as they are allergenic
of action - In vitro and in vivo studies suggest antiedemic,
antihypoxic, free-radical scavenging,
antioxidant, metabolic, antiplatelet, hemorheologic
(similar to pentoxifylline), and microcirculatory
effects are usually mild, transient, and reversible, and include
headache, nausea, and vomiting.
Cochrane Review of ginkgo for dementia found no excess side effects
compared to placebo (Cochrane
Database Syst Rev. 2002. CD003120).
considered relatively contraindicated with heparin, coumadin,
aspirin, NSAID's, because Ginkgolide B is a
potent inhibitor of platelet aggregating factor.
are published case reports of subdural hematoma, hyphema,
subarachnoid hemorrhage, and intracerebral hemorrhage with gingko.
in a 14 day RCT in 32 healthy volunteers, Ginkgo biloba extract (EGb 761) at daily doses of 120 mg, 240 mg, and 480
mg did NOT alter platelet function or coagulation (Clin Lab Haematol. 2003. 25.
ginkgo does not affect INR, based on an open label, three-way,
randomized crossover trial in 12 men (Br J Clin Pharmacol.
2005. 59. 425-432).
a meta-analysis of 18 RCTs (n=1985 adults) that examined the effect of
gingko on dementia, diabetes, and peripheral vascular disease shows
that while ginkgo does lower blood viscosity, it does not have a
significant effect on ADP-induced platelet aggregation, fibrinogen
concentration, PT, or APPT, and thus the conclusion that ginkgo does
not increase the risk of bleeding (Pharmacotherapy.
2011. 31. 490-502).
may diminish the effectiveness of anticonvulsants, and may cause
- An estimated 2 billion daily doses (120 mg) have been sold from 1983-2003.
best studied brand names include Ginkgold, Ginkoba, and Ginkai.
The extract used in most clinical trials is EGb
is a label which is not precise, because there are many different types
of ginseng. These include Asian ginseng (Panax
ginseng), Siberian or Russian ginseng (Eleutherococcus
senticosus), American ginseng (Panax quinquefolius),
Vietnamese ginseng (Panax vietnamensis),
and Japanese ginseng (Panax japonicus).
A systematic review of adequate quality of 16 RCT's of any type of
ginseng extract for diverse indications, most of low methodologic quality
by Jadad score, found that the evidence from
the few high quality clinical studies did not support the use of ginseng
for any indication (Eur J Clin Pharmacol. 1999.
55. 567-575). Some experts have critiqued the conclusions of this
systematic review because different species of ginseng were grouped
together and because 5 of the 6 studies with a Jadad
score of 4/5 were actually positive (Herbalgram. 2001. 52. 20).
- build up resistance to stress. Theoretical rationale, and historical
prevention - an epidemiologic study of 4634 inhabitants of a
ginseng-growing region of Korea found that persons who
regularly consumed fresh Korean ginseng had a significantly reduced risk
of cancer of 0.31 (Int J Epidemiol. 1998. 27. 359-364).
- Panax ginseng 100-200 mg per day shown in a trial
with 36 type II diabetics to lower fasting blood sugar, and at the 200
mg dose to lower glycosylated hemoglobin (Diabetes Care. 1995. 18. 1373-1375).
ginseng (Panax quinquefolius)
3 grams shown in one small study with 10 nondiabetic
subjects and 9 Type II diabetic subjects to reduce postprandial
hyperglycemia (Arch Intern Med.
2000. 160. 1009-1013).
ginseng at doses of 3, 6, and 9 grams, taken 40 minutes before a 25
gram oral glucose challenge shown in another small study with 10 nondiabetic subjects to significantly lower mean
blood glucose levels at 30, 60, and 90 minutes post challenge, relative
to placebo (J Am Coll Nutr. 2000. 19.
psychological function - data is mixed (Am Fam
Physician. 2003. 68. 1539-1542).
physical performance - most studies have shown no effect (Am Fam Physician. 2003. 68. 1539-1542). A review of
35 in vivo studies of ginseng in both animals and humans concluded that
the quality of the research is too low to serve as convincing evidence
of ginsengs efficacy in improving human physical performance (Sports Medicine. 2000. 29.
immune system function - several positive studies (Am Fam Physician. 2003. 68. 1539-1542).
red ginseng 900 mg 3 times a day shown effective in an 8 week RCT with
45 patients with clinically diagnosed erectile dysfunction (J Urol. 2002. 168. 2070-2073).
systematic review of 7 RCTs (n=363) of Korean red ginseng root showed
that ginseng root was superior to placebo. The methodologic quality of
the trials was low and the number of subjects in the trials was small.
Dosage ranged from 1800 - 3000 mg/day and duration of study ranged from
4-12 weeks (Br J Clin Pharmacol. 2008.
of URI – all studies industry sponsored, examined a proprietary extract,
CVT-E002 (Alt Med Alert. 2007.
initial study represented a combination of 2 RCTs, and showed minimal
benefit (J Am Geriatr
Soc. 2004. 52. 13-19).
4 month RCT in which 279 subjects with a history of at least two upper
respiratory infections in the previous year took either placebo or
North American ginseng (Panax quinquefolius) 400 mg per day of an extract
standardized to 80% poly-furanosyl-pyranosyl-saccharides and 10% protein, showed that
those in the experimental group experienced fewer recurrent URIs and
fewer total symptoms per URI (CMAJ.
2005. 173. 1043-1048).
small 4 month RCT in 43 volunteers found that subjects reported
significantly fewer URI symptoms during the final 8 weeks of the study
Complement Med. 2006. 12. 153-157).
- 100-200 mg daily of standardized extract with 7% ginsenosides
(Panax) or 0.8% eleutherosides
(Siberian), or 0.5- 1 gram of dried root 3 times a day.
- A study done by the Philadelphia
College of Pharmacy analyzed
54 ginseng products and showed that 60% of those analyzed had very
little ginseng, with no ginseng at all in 25% (Whole Foods. 1979. 2. 48-53).
- Another study of ginseng
products found tremendous variability, with as little as 12% and as much
as 328% of the active ingredient in the bottle, compared to the
information on the label (Am J Clin Nutr. 2001. 73.
ginseng (Eleutherococcus senticosus)
has no known side effects, but it can interfere with the digoxin assay
and cause false elevation of digoxin levels.
- Panax ginseng interferes with platelet aggregation,
but does not affect the pharmacokinetics or pharmacodynamics of coumadin (Br J
2004. 57. 592-599), and may cause nervousness, palpitations, high blood
pressure, and sleeplessness through central nervous system stimulant
activity. It has also been reported to cause severe headache,
diarrhea, vaginal bleeding, and Stevens-Johnson syndrome. Many
experts suggest cycling with 2-3 weeks taking ginseng, followed by 1-2
weeks off the herb. Discontinue at least 7 days before surgery.
ginseng interacts with coumadin to lessen the
effect of coumadin, slightly decreasing the
INR, based on a RCT in 20 healthy subjects (Ann Intern Med. 2004. 141. 23-27).
(North American) ginseng does NOT significantly raise blood pressure
based on data in a RCT in 52 people in which 24 hour ambulatory BP was
measured after 12 weeks of consuming t his
product. Limitations of this study a small sample size with a
significant drop out rate (29%) and a 12 hour lag between the last
ingestion of ginseng and initiation of the 24 hour ambulatory
2006. 47. 791-796).
ginseng does not affect INR, based on data from an open label,
three-way, randomized crossover trial in 12 individuals (Br J Clin Pharmacol. 2004. 57. 592-599).
of action - stimulation of the central nervous system, modulation of the
immune system, and anabolic effects, accelerating hepatic lipogenesis and increasing glycogen storage.
- Ginsana is the best studied brand name.
for canker sores.
treatment for sore throats.
- Berberine, a compound in goldenseal with
antibacterial and anti-yeast properties is available in supplement form
Aquaretic (increases water excretion without
increasing sodium excretion) and therefore may worsen edematous states or
counteract effects of prescription diuretics. May inhibit
cytochrome P450 3A4. Some herbalists recommend use for a maximum of
- no clinical trials (2004),
but a growing body of basic research on the whole herb and also one of
the key constituents, berberine.
- ENDANGERED SPECIES DUE TO
for prevention or treatment of colds - it is not.
illegal or controlled substances in the urine - it does not.
250-500 mg three times a day for intestinal infections. Dose of
tincture is 2-4 ml three times a day. Dose of liquid extract is 0.3
to 1 ml three times a day. To make a tea or a mouthwash, simmer 1
gram of dried root in 150 ml of water for 10 minutes, then strain.
seed extract - see pine bark extract below for details of the possible
benefits and dose of the PCO's found in this herb.
seed extract – BEWARE
is distinct from grape seed extract.
GSE is processed by grinding the pulp and seeds without solvents, and
then adding glycerin. Commercial
GSE (ingredient in cosmetics, pesticides, dietary supplements) often
contains synthetic preservatives.
on agar plates do show activity of extract against a variety of bacteria and
fungi, BUT independent analytical analyses have identified synthetic preservatives, such as
methyl paraban, triclosan,
and benzethonium chloride, in the extracts, and
these synthetic preservatives may be responsible for the antimicrobial
activity, rather than ingredients of the grapefruit seed itself.
study showed that at concentrations of 1:1 to 1:256, GSE was bactericidal
but also toxic; at 1:512 it remained bactericidal but was no longer toxic
Complement Med. 2002. 8. 333-340).
- Gugulipid - return to Home Page and click on
‘Cholesterol’ for details on this herb.
- Gymnema sylvestre (Gumar) - may lower blood sugar in diabetics and may
decrease craving for sugar.
(some authorities say is must be used for 6-12 months before a benefit is
heart failure (CHF)
a European multi-center observational study of 1011 patients with New
York Heart Association class II CHF, 24 weeks of treatment with a
standardized formulation (WS 1442) 450 mg twice a day, clinical
improvements were seen in exercise tolerance, fatigue, and dyspnea.
Decreases in ankle edema and nocturia were
also reported, as were improvements in blood pressure and ejection
1999. 24. 465-474).
systematic review of 8 RCT's (433 patients) of hawthorn in class II CHF
showed improvements in subjective symptoms and exercise
tolerance. These trials were of variable methodological quality,
mostly 8 weeks or less in duration (Fortschr Med. 1996. 114. 27-29).
a multi-center RCT of 209 patients with class III CHF for at least 6
months, and with a 4 week run-in phase combining placebo with
diuretics, those treated with 1800 mg WS 1422 daily showed
significantly increased maximal workload compared to both placebo and
the group of 69 patients treated with 900 mg daily of WS 1422 (Am Heart J. 2002. 143. 910-915).
meta-analysis of 13 trials, 8 of which evaluated the effect on maximal
work load, and 5 of which evaluated the effect on symptoms, found
significant benefit with regard to both of the above endpoints; adverse
effects were generally mild and transient (Am J Med. 2003. 114. 665-674).
results trial – SPICE trial. This multicenter trial (156 centers in 13
European countries) examined the effect of 450 mg twice a day of WS
1422 as an adjunct to conventional treatment on mortality in class II
or III heart failure and EF < 35%.
2681 patients were randomized; enrollment started in 10/98.
Hawthorn had no impact upon the primary endpoint (composite of cardiac
mortality, nonfatal MI, hospitalization due to CHF progression).
However, in subgroup analysis, hawthorn did protect against sudden
cardiac death in those with an EF of 255-35%. There was no added
symptomatic benefit with addition of hawthorn to conventional treatment
(Eur J Heart Fail. 2008. 10.
trial - HERB-CHF Trial, sponsored by NCCAM. This was a 6 month RCT
which compared 450 mg twice a day of extract WS 1422 with placebo in
120 patients with mild to moderate CHF, and an EF<40%. There was no
effect on 6 minute walk distance (Eur J Heart Failure. 2004. 6. 953-955). Retrospective
secondary analysis of data from this trial showed that hawthorn does
NOT reduce heart failure progression, and surprisingly may increase the
risk for early heart failure progression (Eur J Heart Fail. 2008. 10. 587-593).
meta-analysis reported benefit (Am
J Med. 2003. 114. 665-674).
systematic review of 6 RCTs, a nonrandomized cohort study, and a
prospective cohort study identified numerous beneficial effects of
hawthorn (Eur J Heart Failure. 2008. 10.
Cochrane review of 14 RCTs concluded “there is significant benefit in
symptom control and physiologic outcomes from hawthorn extract as an
adjunctive treatment for chronic heart failure” (Cochrane Database Syst Rev. 2008.
– slight BP (~2-6 mm Hg) lowering noted in several clinical trials (Phytother Res. 2002. 16. 48-55; Drugs Exp Clin Res. 2004. 30. 221-225; Br J Gen Pract.
2006. 56. 437-443). Review article (Alt
Med Alert. 2008. 11. 1-4).
also be useful in Raynaud's and coronary artery disease.
is 4-5 ml three times a day of tincture (1:5), 1-2 ml three times a day
of fluid extract (1:1), or 300-900 mg twice a day of standardized extract
of the leaf and flower of the plant.
of action - antioxidant, anti-inflammatory, positive inotropic effects,
beta blocking effects, vasodilator.
safe; adverse effects reported in only 1.3% of 3664 patients
participating in a post marketing analysis evaluating daily treatment
with 900 mg of extract (Am J Med.
2003. 114. 665-674)
effects may include and dizziness and vertigo (most common), GI upset,
rash, headache, diaphoresis, palpitations, insomnia.
may potentiate the action of digoxin, based on its effects on p-glycoprotein.
HOWEVER, lack of interaction in a pharmacokinetic trial in 8 healthy
volunteers (J Clin
Pharmaacol. 2003. 43. 637-642).
- HeartCare is the best studied brand name. RCTs
included in the Cochrane review used either standardized extract WS 1442
(standardized to or 18.75% oligomeric procyanidins) or LI 132 (standardized to 2.2%
flower extract - anxiety, insomnia, approved by The German Commission E.
chestnut seed extract - chronic venous insufficiency, 300 mg capsules
twice a day, standardized to 18-27% ascein.
- In a
12 week RCT with 240 patients, 50 mg ascein
twice a day was as effective as compression stockings (Lancet. 1996. 347. 292-294).
Cochrane review identified 17 trials (n=1581) which met inclusion
criteria. Of these, 12 were placebo controlled, 4 were controlled against
O-beta-hydroxyethyl rutoside, 2 were controlled
against compression stockings, and 1 was controlled against pycnogonel. Heterogeneity precluded
meta-analysis. In aggregate, the trials showed significant reduction
in leg edema (Cochrane Database Syst Rev. 2006. CD003230). A commentary indicates
that only short durations of treatment were studied and that GI upset and
dizziness were fairly common side effects (ACP Journal Club. 2006. 145. 20).
effects in clinical trials include dizziness, nausea, headache, and pruritis. May interact with coumadin
and prolong INR.
- Venastat is the best studied brand name.
- excellent substitute for steroids for treatment of poison ivy dermatitis
(Annals of Allergy. 1958. 16.
– aquaritic/antiseptic herb which is potentially
toxic as per Varro Tyler (Herbs of
Choice. 1994) because the oil contains terpene hydrocarbons which can
cause kidney damage.
- Kava-Kava (Alt Med Alert. 2007. 10.
- Treatment of anxiety, including perimenopausal
anxiety. May also be useful for treatment of insomnia.
systematic review of 7 RCT's including a total of 377 patients found
that most of these were of good quality, 4 with a Jadad
score of 5/5. The 4 studies which could not be combined in a
meta-analysis along with the 3 studies meta-analyzed (all 3 studies used
kava extract WS 1490 100 mg three times a day) all showed a greater
reduction in anxiety for kava extract than for placebo.
Measurement of efficacy was based on scores on the Hamilton Rating Scale
for Anxiety. (J Clin Psychopharmacol.
2000. 20. 84-89).
Cochrane review of 7 RCT's also concludes that kava shows superiority
over placebo (Cochrane Database Syst Rev. 2002. CD003383).
update of the Cochrane review included 11 trials and 645 participants (Cochrane Database Syst
Rev. 2003. CD003383).
8 week RCT in 129 outpatients comparing kava 400 mg of L1 150 with buspirone 10 mg with opipramol
100 mg found kava as effective as the pharmaceutical agents (Phytomedicine.
2003. 10[suppl 4]. 38-49).
RCT in 40 patients showed that kava allowed for dosage tapering of
benzodiazepines without loss of anti-anxiety effect (Psychopharmacology. 2001. 157.
- A 3
week crossover RCT in Australian patients, using an aqueous extract from
the roots of noble cultivars at a standardized dose 250 mg kavalactones per day, showed both safety and
2009. 205. 399-407).
trials – 3 small RCT’s failed to show benefit (Int Clin Psycopharmacol.
2006. 21. 249-253), but these were 4-8 weeks in duration, and onset of
beneficial effect may not occur for 8 weeks
- 70-240 mg 3 times a day of a standardized extract containing
30%-70% kavalactones or 1 dropperful
of a standardized liquid extract 3 times a day. Most controlled
trials used a dose of 100 mg three times a day of a preparation with 70% kavalactones. For sedation, suggested dose is 180-210
mg of kava lactones 1 hour before bedtime. Good quality liquid
extract should numb the tongue.
of action - Uncertain, but may enhance binding of the neurotransmitter
GABA to its receptor in the amygdala, without acting as a direct agonist.
Kavapyrones also have a central muscle-relaxing action and anticonvulsant
- Long history (at least 1500
years) of traditional use (of a water extract) by indigenous populations
in the South
with no apparent safety concerns.
good in controlled trials - a systematic review of 7 RCTs including a total of 377 patients
did not identify any safety issues (J
2000. 20. 84-89).
2001, the German Federal Drug Agency announced 24 cases of liver
toxicity and one death.
were published case reports of hepatotoxicity and hepatic failure (BMJ. 2001. 322. 139; Ann Intern Med. 2001. 135.
was banned in several European countries
the FDA released a Consumer Advisory 3/25/02. The FDA advisory
recommends suggest limiting the daily dose to 300 mg of total kavalactones and limiting daily use to a 4 week
the TGA (Therapeutic Goods Administration) issued a Fact Sheet in April
of 2005 (updated 9/20/10) which recommended a limit of 125 mg kavalactones per tablet or capsule, and a limit of
250 mg of kavalactones per day.
- With regard to the case
reports of hepatotoxicity, the British Medicines Control Agency
concluded after careful review that in 12 of the 27 case reports, kava
as the cause was either unlikely or inaccessible. In 12 of the
remaining 15 case reports, the individuals were taking conventional
medication with hepatotoxic potential along with kava. In two of
the remaining 3 case reports, there was high alcohol consumption in
association with kava ingestion. Nonetheless, in these initial 27 case
reports of hepatotoxicity, there were six positive dechallenges
and two positive rechallenges.
- In the United States, close inspection in 2001
of adverse event reports on file with the FDA showed that many of them
were in association with a single instance of an adulterated product
which actually contained no kava distributed at a New Year’s Eve rave in
Los Angeles. An article in the New York Times 1/16/02 erroneously cited 60 kava-related
adverse event reports by including the 29 “fX”
cases in which there was actually no kava in the product distributed at
analysis of the German report concluded that the death was due to
alcoholic liver failure and not kava, that 4 of the 24 cases were listed
twice, that 3 of the 24 cases had no connection to kava, that in 11 of
the 24 cases other medications were involved, and that 10 other cases
had uncertain connections to kava.
Three of the 24 cases did appear related to kava, and 2 of the 3
appeared related to overdoses, leaving only one case in which kava
monotherapy at recommended doses was associated with hepatotoxicity (Phytomedicine.
2003. 10. 440-446).
investigation by the World Health Organization confirmed a (rare) risk of
hepatotoxicity with kava consumption (WHO Document Production Services.
clinical review confirmed the association of kava ingestion with
hepatotoxicity on rare occasions – this review incorporated structured,
quantitative, liver-specific causality assessment (Ann Hepatol. 2010. 9. 251-265).
as reports of toxicity surfaced in the early 2000’s, Swiss researchers
linked the toxicity to an acetone-extraction manufacturing process which
is widely used in German and Swiss products, and creates a highly
concentrated final product. However,
subsequent data shows that liver injury has been caused in some cases by
the traditional water-based kava extracts (WHO Document Production
Services. 2007; Liver Int. 2010. 30. 1270-1279). There is electron
microscopy data suggesting that kavain has an
adverse effect on hepatocytes (World
J Gastroenterol. 2008. 14. 541-546).
Preliminary data suggests that flavokavain B
might be responsible for hepatotoxicity (Zhou P et al. FASEB J. epub
8/9/10). Nonetheless, the use
of ethanol or acetone as solvents, as compared to a water extract, might
increase the risk of hepatotoxicity.
use of kava involves an extract prepared from the peeled rhizome – some
of the cases of hepatotoxicity might have arisen from use of aerial
parts of the plant, as stems and leaves might contain a toxin, pipermethysticin (Phytochemistry. 2003. 63.
- Further investigation into
kava hepatotoxicity revealed the existence of more than 200 varieties of
this herb, referred to as cultivars. Traditional use involves
consumption of kava from a group of 28 cultivars known as ‘noble,’ with Borugu as one of the preferred noble cultivars for
- Case reports of overdoses of
kava not associated with hepatotoxicity suggest that hepatotoxicity is
an idiosyncratic reaction and not a dose-dependent direct toxicity. A
polymorphism of cytochrome P450 2D6, not detected in Pacific Islanders,
but with a 10% prevalence in Europeans may cause poor detoxification of kavalactone metabolites, and thus accumulation (Ann Intern Med. 2001. 135.
- CONCLUDE in 2010 that safety is
maximized by using only a water-based extract derived from peeled
rhizomes of a noble cultivar such as Borogu,
and at a maximum dose of 250 mg kavalactones
based on an estimate of 250 million daily doses of ethanolic
kava extract consumed in the previous decade, with only 2 causal cases
of hepatotoxicity, one report quoted an incidence rate of 0.008
adverse effects per million doses of kava compared with 2.12 per million
doses of diazepam (Duetsche Apotheker-Zeitung. 2002. 142. 58-63).
effects include excessive sedation (especially if taken with
benzodiazepines or alcohol), stomach complaints, restlessness, headache,
term use occasionally associated with a skin reaction similar to
psoriasis (J Am Acad Dermatol. 1994.
Peptic ulcer disease, aphthous ulcers,
inflammation, plaque reduction in the mouth.
- In a
4 week double blind study of 50 patients with duodenal ulcer and 6
patients with gastric ulcer, DGL demonstrated efficacy using symptoms
and radiographic healing as endpoints. Both groups received two
tablets three times a day after meals. The tablets in the
experimental group (Caved-S) consisted of DGL 380 mg, bismuth subnitrate 100 mg, aluminum hydroxide gel 100
mg, magnesii carbonas
200 mg, sodium bicarbonate 100 mg, and powdered frangula
bark 30 mg (Gut. 1968. 9
48-51). Positive results were also found in a one month double blind
trial in 33 patients with gastric ulcer, using the same active treatment
and using radiographic endpoints (Gut.
1969. 10. 299-302). However, in another 30 day double blind
trial in 47 patients with active duodenal ulcer using the same dose of
the same active treatment above, results were negative (Gut. 1971. 12. 449-451).
a study in 100 patients with gastric ulcers, DGL 760 mg three times a
day was as effective as prescription Tagamet 200 mg 3 times a day
or 400 mg at bedtime, after 6 and 12 weeks of treatment. In
another study in 874 patients with chronic duodenal ulcers, DGL compared
favorably with Tagamet, with 90% healing in both groups at 12
weeks. The relapse rate with DGL was significantly lower, 8.2%
versus 12.9% with Tagamet (cited in Hospital
Practice. 8/15/01. 55-59).
there are several negative placebo-controlled RCT's too. These
include a 4 week trial in 96 patients with gastric ulcer (Gut.
1978. 19. 779-782), an 8 week trial in 34 patients with active duodenal
ulcers (BMJ. 1977. 2. 1123),
and a 6 week multicenter trial in 90 men with relapse of chronic
duodenal ulcer who received 760 mg DGL three times a day (BMJ. 1971. 3. 501-503).
Inhibits hepatic cytochrome P450 3A4, so multiple herb-drug interactions
are possible. Prolonged use can cause pseudohyperaldosterism;
use in conjunction with thiazide diuretics can cause marked
hypokalemia. Avoid these problems with DGL (deglycyrrhizinated
5-15 grams of licorice, containing 200-600 mg glycyrrhizin a day for up
to 6 weeks, or 2-4 250-380 mg chewable tablets of DGL 30 minutes before
root - unsafe secondary to
pyrrolizidine alkaloids (J Am Pharm
Assoc. 1996. 36. 29).
acute and chronic viral hepatitis, alcoholic liver disease, cytoprotection, anticarcinogen,
Amanita phalloides poisoning (used
intravenously in Germany).An evidence report/technology assessment from
the Agency for Healthcare Research and Quality published 12/4/00
identified 16 prospective studies evaluating milk thistle in liver
disease, 14 of which were placebo controlled, and concluded that the
current evidence is inadequate for consideration as evidence in favor of
milk thistle. Despite this conclusion, some data are suggestive,
according to a review article (Am J
Gastroenterol. 1998. 93.
139-143). Another review article reports in the abstract that
“Clinical studies are largely heterogeneous and contradictory” (Am Fam
Physician. 2005. 72. 1285-1288).
of action – silymarin has ability to raise intrahepatic glutathione
200-400 mg/day of silymarin; use a standardized extract with 70% - 90%
generally well tolerated; may significantly lower blood sugar in diabetics
with alcoholic cirrhosis. In 2005,
Vital Nutrients found that all
brands tested had solvent residue (this company switched to using a crude
extract rather than a standardized extract contaminated with residual
$15 – $30/month.
- Thisylin is the best studied brand name. Ultrathistle
is a seed extract bound to phosphatidylcholine, and is much more
possible anti cancer effects if administered by
injection. Very popular in Europe, and usually injected subcutaneously. Mistletoe is used primarily as adjunctive therapy.
on the effectiveness of mistletoe is mixed, with clinical studies
failing to “produce convincing data that mistletoe extract can
positively affect relevant endpoints” (Alt Med Alert. 2005. 8. 55-59).
systematic review found that several prospective studies have reported
benefits; the highest quality evidence supports beneficial effects on
quality of life and reduction of side effects of cytotoxic cancer
treatments (Eur J Med Res. 2007. 12. 103-119).
which seem to respond include colon, rectum, stomach, breast, and lung (Altern Ther
Health Med. 2001. 7. 57-66, 68-72, 74-78).
RCT of 477 patients with squamous cell cancer of the head and neck who
received standard treatment alone or standard treatment plus mistletoe
found no significant added benefit of mistletoe at 4 year follow up (Eur J Cancer. 2001. 37. 23-31).
of action – immunomodulation mediated by lectins; cytotoxicity mediated
– individualized, with doses given 3-7 times per week over weeks to
- Iscador is the oldest product of mistletoe.
- Iscar, which is a brand name of Iscador,
has been listed since 1999 with the U.S. FDA in accordance with the
requirements for homeopathic medicines.
the 2002 Bioterrorism Act, the FDA disallowed importation or distribution
of injectable mistletoe extracts, including homeopathic formulations, so
it is only the oral form that is available commercially in the U.S.
- chest congestion and dry bronchial coughs. Dosage is
3-4 teaspoonfuls containing 1.5-2 grams in a
- tranquilizer. Dosage is 3-6 teaspoonfuls
containing 4-8 grams/day in a tea. A RCT of 36 patients with
generalized anxiety of greater than 6 months duration, with a HAM-A score
of greater than 14 showed that those given 45 drops per day of a
commercial Passionflower extract (Passipay) for
28 days showed as much improvement as those given oxazepam
30 mg per day, with significantly less impairment of job performance (J Clin Pharm Ther. 2001. 26. 363-367). Approved monograph
in The Commission E.
sidoides (Alternative Medicine Alert.
2005. 8. 8-11; Alternative Medicine Alert. 2007. 10. 43-45)
Plant is native to coastal regions of South Africa;
an extract of the root is used therapeutically for URI’s.
- In a
RCT in 143 children aged 6-10, all of whom had a negative rapid strep
screen and a tonsillopharyngitis
severity score > 8 points, 20 drops tid for
6 days of EPs 7630 was beneficial. The decrease in the severity score at
day 4 was 7.1 points in the treatment group and 2.5 points in the control
group. Duration of illness was 2 days shorter in the treatment
group (Altern Ther Health
Med. 2003. 9. 68-78).
In a RCT in 468 adults with acute bronchitis of less than two days duration and a BSS > 5,
those who received 30 drops (1.5 ml) 3 times a day of EPs 7630 30 minutes
before or after a meal had a significantly greater decrease in the BSS score
(p<0.0001) and were able to return to work two days sooner (p<0.0001).
Adverse events were comparable to placebo (Phytomedicine. 2003. 10. Suppl 4. 7-17).
In another RCT in 124 adults with acute bronchitis with symptoms > 48
hours and a BSS > 5, benefit was seen in the group that received 30 drops
(1.5 ml) 3 times a day of EPs 7630. Adverse events were comparable to placebo (Explore. 2005. 1. 437-455).
Beneficial in the common cold (i.e. viral URI) based on data from 9 randomized trials
conducted on a total of 1477 patients, including 680 children ages 6-12.
In a multicenter RCT in 103 adults with the
common cold, 30 drops 3 times a day of EPs 7630 reduced the severity of
symptoms and shortened the duration of illness.
Entry criteria were at least two major and one minor cold symptoms, or
one major and 3 minor cold symptoms (maximum CIS symptom score of 40 points),
for 24-48 hours. After 10 days, 78.8% of the treatment group versus 31.4% of
the placebo group were clinically cured (p<0.0001). The mean duration of
inability to work was 6.9 days in the treatment group versus 8.2 days in the
placebo group (p=0.0003) [Explore.
2007. 3. 573-584].
Open-label observational studies in more than
2500 adults and children found adverse effects in 1.2-15.5% - effects largely
mild and generally GI or skin related.
Contra-indicated in pregnancy and lactation,
based on lack of data.
Dose of the extract is 20 drops (1 ml) tid in children and 30 drops (1.5 ml) 3-5 times per day in
Brand names include EPs 7630, an ethanolic root extract manufactured by Dr. Willmar Schwabe Pharmaceuticals in Germany,
and Umcka ColdCare, a
homeopathic 1X preparation, available in the U.S. from Nature’s Way.
- may be hazardous. Reports of liver damage, kidney damage,
- digestive problems, menstrual cramps. (Contraindicated in GERD).
Mechanism of action - spasmolytic. In a small double-blind 3 week
crossover trial, enteric coated peppermint capsules with 0.2 ml of oil,
1-2 capsules TID, were associated with significant relief of abdominal
symptoms (p<0.005). [BMJ.
1979. 2. 835-836]. A meta-analysis of 8 randomized, controlled trials
indicates that peppermint oil could be effective for symptom relief in
irritable bowel syndrome (Am J Gastroenterol. 1998. 1131-1135).
bark extract (Pycnogenol) - potent anti-oxidant, but expensive. Active
ingredient, referred to as OPC's, by chemical analysis have antioxidant
activity 50 times greater than vitamin C or E. May be useful
for general health and also for treatment of venous insufficiency,
capillary fragility, diabetic retinopathy, macular degeneration. In
an open, controlled 4 week comparative study in 40 patients with chronic
venous insufficiency, Pycnogenol 360 mg per day was found to be more
efficacious than horse chestnut seed extract 600 mg per day, with regard
to both subjective scores and measurement of leg circumference.
Pycnogenol also significantly reduced cholesterol and LDL cholesterol
levels (Phytotherapy Research. 2002. 16. S1-S5).
Dose is 50 mg per day for prevention or 150-300 mg per day for treatment.
Grape seed extract is less expensive than pine bark extract, and contains
92% to 95% OPC's compared to 80% to 85% in pine bark extract.
– unsafe (J Am Pharm Assoc. 1996. 36. 29).
- bulk laxative (Aliment Pharmacol Ther. 1995. 9.
639-647), and also lowers cholesterol. In one study 15 cc (one
tablespoon) twice a day lowered cholesterol 15% and LDL cholesterol 20% in
adults on a Step I American Heart Association Diet (Arch Intern Med. 1988. 148. 292-296). A
meta-analysis of 5 studies using a total of 10.2 grams per day of psyllium
seed husk as an adjunct to Step I AHA diet found that psyllium was
associated with significant reductions in total cholesterol and LDL
cholesterol (Am J Clin Nutr. 2000. 71.
- Pygeum africanum
literature search found 18 randomized trials of 1562 men. A
meta-analysis of six of these studies which were placebo controlled and
in which diagnosis was confirmed and treatment lasted at least 30 days
found that nocturia was reduced by 19% and
peak flow increased 23% and residual volume fell 24% in the treatment
group. Adverse effects were mild and generally comparable to
placebo (Am J Med. 2000. 109.
Cochrane Review of the 18 RCT's which compared the herbal extract to
placebo found limited evidence that the extract is more effective than
placebo for improving symptoms and urodynamics.
Problems cited with the individual studies included small size, short
duration (mean of 64 days, range of 30-122 days), varied doses and
preparations, and lack of use of standardized validated measures of
efficacy (Cochrane Database Sys
Rev. 2002. CD001044).
is 100-200 mg per day of a standardized extract (12-13% phytosterols).
decrease hot flashes in menopausal women – Return to Home Page and click
on Menopause outline for detailed information
uses include bronchitis, childhood eczema, pharyngeal inflammation,
psoriasis, whooping cough, and as a component of the Hoxsey
– unsafe (J Am Pharm Assoc. 1996. 36. 29) and has no significant
therapeutic utility as per Varro Tyler.
palmetto (partially dried, ripe fruit of Serenoa repens)
BPH, may also enhance sperm
production, increase breast size, and may be beneficial in treatment of
hair loss, polycystic ovary disease, acne, and asthma.
- A 2009 Cochrane review of 30
trials concluded that saw palmetto has little or no efficacy over
placebo for treating BPH symptoms, although it appears to be safe (Cochrane Database Syst
Rev. 2009. CD001423). This was a change from the conclusions of 2
earlier Cochrane reviews. A 2012 update, based on analysis of 32 RCTs
(n=5666) reached similar conclusions: “…a saw palmetto extract, does not
improve symptom scale scores or peak urine flow but may improve
self-reported symptoms of benign prostatic hyperplasia” (Cochrane Database Syst
Rev. 2012. CD001423).
2001 review of 10 placebo controlled studies of monopreparations,
3 studies of combinations of saw palmetto and other herbal products, 2
studies which compared saw palmetto with finasteride,
and 1study which compared saw palmetto with another herbal product
concluded that saw palmetto was efficacious (Cochrane Database Syst Rev. 2001.
update which included 3 new trials with 230 additional men (total of
3139 men and 21 RCTs lasting 4-48 weeks) came to similar conclusions (Cochrane Database Syst Rev. 2002. CD001423).
multicenter RCT of 369 men aged 45 or older, conducted at 11 North
American clinical sites, in which saw palmetto was dosed at 320 mg a day
for 24 weeks, then 640 mg a day
for 24 weeks, then 960 mg a day for the final 24 weeks of this 72 week
study found no benefit with
regard to lower urinary tract symptoms (JAMA. 2011. 306. 1344-1351).
methodologically rigorous one year RCT of 225 men over age 49 with
moderate to severe symptoms of BPH found no benefit to a saw palmetto extract 160 mg twice a day.
Side effects in the saw palmetto group were similar to those in the
placebo group, and there was no significant change in PSA, but there was
no significant improvement in symptom scores (AUASI), maximal urinary
flow rate, prostate size, residual volume after voiding, or quality of
life. The lead investigator of this trial commented that finding a true
placebo control such that participants could not differentiate the
active herb from the placebo by smell and taste was a challenge
successfully met in this study, and lack of successful blinding may be a
reason that previous trials were positive. This trial differed from many
other trials though in that the men enrolled had moderate to severe BPH
at baseline, with AUASI baseline scores of 8-35. This study was funded
by the NIH and the saw palmetto was provided by Rexall-Sundown (N Engl J Med. 2006. 354. 557-566 and editorial
a systematic review that included 18 randomized trials with 2939 men
found that saw palmetto improved symptoms of BPH.
Improvement in symptoms and urinary flow measures was similar to that
produced with the prescription medication finasteride
(Proscar). Most of these trials were conducted
in men with mild to moderate BPH symptoms (stages 1 and 2). The
reviewers did note that some of the studies included in the review were
flawed (JAMA. 1998. 280.
- Standardized liposterolic extract, 80-160 mg
twice a day, standardized to contain 85% to 95% fatty acids and 0.2% to
0.4% sterols. Allow at least 2-3 months before judging whether or
not it is beneficial.
of action - inhibits 5-alpha reductase activity (similar to Proscar in this regard), inhibits DHT binding to
cellular and nuclear receptors, inhibits cyclooxygenase and
5-lipoxygenase and has spasmolytic activity.
one study of 6 months duration, did not affect the PSA level (Urology. 1998. 51. 1003-1007).
active constituents are fatty acids and sterols.
- Adverse effects are rare and usually mild, and may include
gastrointestinal upset, diarrhea, constipation, urine retention,
headache, and decreased libido. In studies comparing with finasteride (Proscar), side
effect profile better for saw palmetto (Prostate. 1996. 29. 231-240 and Urology. 1998. 51. 1003-1007).
- Quanterra and ProstActive
are the best studied brand names. In 2000, Consumer Lab reported
that 17 of 21 leading brands passed the test of quality, containing at
least 85% fatty acids.
- Schizandra - touted for treatment of liver conditions,
but safety and efficacy unproven as per Varro Tyler.
- stimulant laxative, but it can cause cramping and intestinal discomfort,
and long term use can create bowel dependency and dangerous electrolyte
imbalances, so use with caution.
- the reports of hepatoxicity (listed in Consumer Reports 5/04 ‘Dirty
Dozen’) appear to be associated with products adulterated with germander (Teucrium chamaedrys)
[Botanical Safety Handbook.
1997; Pharmaceut J. 1984. 233. 80-82; Ann Intern Med. 1992. 117.
elm - sore throats. Declared safe and effective by the FDA, as per
- St. John's wort
depression; might be useful in treatment of back pain, burns and in
general for wound healing.
- A meta-analysis of 23 randomized
studies, none published in English, including a total 1757 patients,
also showed efficacy for St. John's wort,
with St. John's
wort more efficacious than placebo in 17 of the 23 original studies, and
equal in efficacy to prescription antidepressants in the other 6
original studies (BMJ. 1996.
number of other reviews and meta-analyses
have been reported, all of them finding efficacy for St John's wort in
treatment of mild to moderate
depression (Eur Neuropsychopharmacol.
1999. 9 501-505; Arch Intern Med. 2000. 160.
152-156; J Nerv Ment Dis.
1999. 187. 532-538; Ann Intern Med.
2000. 132. 743-756).
- A meta-analysis
of 27 RCT's with an average Jadad score for
quality which was "good" found that the 17 trials which
were placebo controlled showed
efficacy of St. John's wort in mild to moderate depression,
and the 10 trials which compared St. John's wort to prescription
medications showed apparent equivalence to maprotiline,
imipramine, bromazepam, amitriptyline, and
diazepam (Cochrane Database Syst Rev. 2000. CD000448).
a rigorous three-armed RCT not included in any of the above reviews in
which 263 patients with moderate
depression received either St. John's wort extract 1050 mg/day,
imipramine/day, or placebo for 8 weeks found St. John's wort more
efficacious than placebo and equal in efficacy to imipramine. The
placebo response rate in this trial was 63%, which suggests that the
results may not be generalizable (BMJ.
1999. 319. 1534-1538).
a large European 6 week RCT
found St. John’s
wort (WS 5570 300 mg tid) more effective than
placebo at reducing HAM-D scores in outpatients with mild to moderate
depression (Am J Psychiatry.
2002. 159. 1361-1366).
- However, an
8 week NIH-sponsored RCT in 200 outpatients at 11 U.S. academic medical
centers with severe major
depression (baseline HAM-D score of at least 20) concluded that St.
John’s wort (Jarson 300 mg tid)
was not any more effective than placebo. The primary outcome
measure was the rate of change on the HAM-D over the treatment
period. Headache was the only adverse effect which occurred more
frequently in the active treatment group than placebo. This trial included a 1 week single
blinded run-in of placebo. With regard to a secondary outcome measure, St. John’s wort did
produce a significantly greater remission rate than placebo in this
study (14.35% vs. 4.9%). The subjects in this trial had chronic
depression, with average duration of symptoms prior to the trial of two
years (JAMA. 2001. 285.
1978-1986). Even though there was
no active control in this RCT, a non-blinded extension of this trial
found that non-responders to St. John’s wort in this study who were
subsequently treated with a prescription antidepressant of the
investigator’s choice for 24 weeks did respond to treatment (J Clin Psychiat. 2004. 65. 1114-1119).
- Furthermore, another 8 week RCT in 340
adult outpatients at 12 different centers with severe major depression, with baseline HAM-D scores of at
least 20 which compared St John's wort (LI160 300 mg tid,
titrated up to 1500 mg/day) to both placebo and Zoloft (50-100 mg/day)
found that neither the St John's wort nor Zoloft outperformed placebo in
terms of either primary outcome measurement, improvement in HAM-D or
improvement in CGI-I (clinical global impression scale). The
overall response rate (including partial and full response) in this
study was 38.1% for St John's
wort, 43.1% for placebo, and 48.6% for Zoloft. Full responses were
seen in 32% of placebo treated patients, 25% of Zoloft treated patients,
and 24% of St John's
wort treated patients. While critics of St
John's wort have cited this as another study showing the
lack of efficacy of St John's
wort, this is not a valid conclusion from this study when the Zoloft
also did not outperform placebo.
This study was sponsored by Pfizer, the manufacturer of Zoloft,
and conducted at Duke
University. Note that the media coverage of this
trial which reported inaccurately that this trial showed St John’s wort
ineffective was based on a press release which in hindsight was not
balanced (JAMA. 2002. 287.
- A 6
week RCT in 140 patients with moderate depressive disorder found that hypericum extract STW 3-VI 900 mg once/day was
effective (Adv Ther.
2004. 21. 265-265).
- A 6
week RCT in 251 patients with moderate to severe acute major depression
found that hypericum extract WS5570 was not
inferior to paroxetine (Paxil).
This study used hypericum extract WS
5570 initially 300 mg tid or Paxil 20 mg
daily, with the dose in nonresponders
increased at 2 weeks to 600 mg tid or 40 mg
daily. Patients with symptoms for greater than one year were
appropriately excluded from this study because of data that chronic
major depression responds better to the combination of psychotherapy and
pharmacotherapy. An editorial
indicates that this was a methodologically sophisticated study which
addressed weaknesses in previous studies (BMJ USA. 2005. 5. 154-155). A weakness of this study is that
3 of the authors had ties to the manufacturer of the St. John’s wort (BMJ. 2005. 330. 503-506).
12 week RCT in 241 patients with moderate depressive disorder who
received either St John’s
wort 612 mg/day or sertraline 50 mg/day showed equal efficacy (Pharmacopsychiatry.
2005. 38. 78-86).
6 week RCT in 163 adult
outpatients with major depression found neither St. John’s wort (LI 160
300 mg tid) nor Prozac (20 mg daily) was
superior to placebo in terms of the primary outcome measures of change
in HAM-D from baseline to week 4 and week 6, but both the herb and the
prescription medication improved remission rates compared to placebo (Eur Arch Psychiatry Clin
Neurosci. 2005. 255. 40-47).
12 week RCT in 135 patients with major depression found that extract LI
160 at a dose of 900 mg/day was more effective than fluoxetine 20 mg/day
but not more effective than placebo (J
2005. 25. 441-447).
- A more recent meta-analysis of
RCT’s, which included 37 trials, including 26 comparisons with placebo
(n = 3320 patients) and 14 comparisons with prescription antidepressants
(n = 2283 patients) concludes that “current evidence…is inconsistent and
confusing” (Br J Psychiatry.
2005. 186. 99-107). Note that this sophisticated meta-analysis excluded
30 trials, including 7 trials that had been included in previous
published reviews by the same group of authors. In the 6 trials comparing St John’s wort to SSRIs in those with major
depression, there was no difference in response rates, but in the 12
trials comparing St John’s
wort to placebo in those with major depression, the herb was only
slightly more effective than placebo.
In contrast, trials not restricted to major depression showed
marked benefits for St John’s
multicenter 3-arm RCT in 388 patients suffering from moderate depression
found that 900 mg/day of hypericum extract was
superior to placebo and similar in efficacy to citalopram 20 mg/day,
with better safety and tolerability than citalopram (Pharmacopsychiatry. 2006.
RCT in 332 patients with mild to moderate major depression found that
both 600 mg/day and 600 mg twice a day of extract WS 5570 were safe and
more effective than placebo (BMC
Med. 2006. 23. 14).
- A Cochrane review of St John’s
wort for major depression
examined 29 studies and almost 5500 adults and concluded that "…the hypericum
extracts tested in the included trials a) are superior to placebo in
patients with major depression; b) are similarly effective as standard
antidepressants; c) and have fewer side effects than standard
Database Syst Rev. 2008 (4): CD000448).
systematic review found that St
John’s wort was more effective than placebo and
as effective as standard therapy with better tolerability (Linde K. Forsch Komplementmed.
2009. 16. 146-155).
- 300 mg three times a day of an extract standardized to
contain either 0.3% hypericin or 1% - 6% hyperforin, or 1-1.5 ml of tincture three times a
of action - unclear, but thought to be related to selective inhibition of
reuptake of serotonin, dopamine, and norepinephrine in the central
nervous system. The active component is probably hyperforin
and not hypericin.
safety profile is excellent, with the herb tolerated as well as placebo
in controlled trials.
cause photosensitivity, headache, gastrointestinal upset – observational
trials suggest adverse effects occur in only 1-3% of individuals.
it induces cytochrome P450 3A4, after as little as a 14 day course, (JAMA. 2003. 290. 1500-1504), and
also induces P-glycoprotein, and therefore may increase the elimination of and thus decrease the
effectiveness of 50% of all marketed medications, including
amitriptyline, benzodiazepines, beta-blockers, calcium channel blockers,
cyclosporine, digoxin, macrolide antibiotics such as erythromycin, oral
contraceptives (birth control pills), protease inhibitors for HIV such
as indivir, statins such as Lipitor, and theophylline.
- The clinical relevance of many of
the St. John’s
wort – drug interactions remains unclear.
clinical signs despite 25-50% decreased serum levels of benzodiazepines
(Int J Clin Pharmacol Ther. 2004.
clinical signs in a study of 12 patients, despite decreased amitryptiline levels (Int J Clin Pharmacol
Ther. 2004. 42. 139-148).
there are case reports of unwanted pregnancies in women taking St John’s wort and oral contraceptive, a small RCT
in 18 healthy females on low dose oral contraceptive found “no evidence of ovulation during low-dose oral
contraceptive and St John's
wort extract combination therapy” (Br
J Clin Pharmacol.
2003. 56. 683-90).
increase the toxicity of antidepressants such as Serzone
or Paxil (See Medical Letter
6/26/00 for numerous references regarding drug interactions).
Cytochrome P450 2C9 may also be induced.
are case reports of reduction in anticoagulant effect of coumadin, and data from one clinical trial that
shows reductions in INR (Br J Clin Pharmacol. 2004.
at least 5 days before any surgery.
control is a problem - a study subjecting 8 randomly sampled commercial
products using HPLC to simultaneously measure hypericin
and hyperforin found that the claim on the
label regarding hypericin content did not
correlate well with the measured content, and 6 of the 8 had a subtherapeutic hyperforin
content (Am J Health Syst Pharm. 2002. 59. 545-547).
best studied brand names include Quanterra,
Kira, Perika, and Movana.
relieves urethral and bladder irritation at a dose of 4-6 grams/day –
approved by German Commission E.
(freeze-dried extract) effective in allergic rhinitis (randomized, double
blind study of freeze-dried preparation (Planta Med. 1990. 56. 44-47).
Onychomycosis (fungal infection of the fingernail or toenail), acne.
multicenter, RCT in 117 patients with culture proven subungal
onychomycosis in which the control group applied 1% clotrimazole
solution twice a day for 6 months reported that at the end of treatment
the two groups were comparable, with culture evidence of a cure in 18%
of the tea tree oil group and 11% of the clotrimazole
group. Partial or complete clinical remission was seen in 60% of
the tea tree oil group and 61% of the clotrimazole
group (J Fam
Pract. 1994. 38. 601).
a single blind randomized trial in 124 patients with mild to moderate
acne, 5% benzoyl peroxide was more effective in healing the inflamed lesions
and faster acting than the 5% tea tree oil, but only 44% of the tea
tree oil patients experienced side effects compared to 79% of the
benzoyl peroxide patients (cited in Hospital
Practice. 7/15/01. 57-60, cited on www.mothernature.com).
For onychomycosis, apply 100% oil topically twice a day, for acne 5% to
15% oil topically four times a day.
May cause tissue damage if used on burns or lacerations, so
contra-indicated in these situations. DO NOT INGEST, only use
- Triphala - mixture of 3 fruits, mild laxative effect
but does not cause dependency even if taken regularly.
- anti-inflammatory; main ingredient is curcumin (see curcumin above,
including safety concern regarding extracts)
is 1.5-3 grams per day in 2 or 3 divided doses.
- There is basic
science data that combining curcumin with piperine
(a compound in black pepper) dramatically increase percent absorption of
curcumin (not an issue if turmeric is used to treat bowel inflammation)
is an alternative to NSAIDs.
interact with coumadin, may increase the risk
of calcium oxalate kidney stones (Am
J Clin Nutr.
2008. 87. 1262-1267), contraindicated in pregnancy.
- Uva ursi (bearberry) -
irritation and inflammation of the urinary tract. Considered to be
bacteriostatic. Dose of tincture (1:5) is 4-6 ml TID, dose of fluid
extract (1:1) is 0.5-2 ml TID.
Note excellent review articles in (American Family Physician. 2003. 67. 1755-1758; Alt Med Alert.
2007. 10. 109-113)
insomnia - The evidence for a single dose effect is contradictory, but
insomnia - Research has focused on subjective evaluations of sleep
patterns, and study populations have primarily consisted of
self-described poor sleepers.
are numerous clinical trials, at least 62 published as of 2007, and
some of these trials are positive (Pharm
1989. 32. 1065-1066; Pharmacopsychiatry. 1994. 27. 147-151; Pharmacopsychiatry.
2000. 33. 47-53). The latter study showed no significant effect after a
single dose, but a significant effect at the end of 14 days.
systematic review of 9 RCT's concludes that the data is inconclusive,
and that more rigorous trials are necessary (Sleep Med. 2000. 1. 91-99).
multicenter 6 week RCT published after the systematic analysis compared
600 mg of valerian extract with 10 mg of oxazepam
in 202 patients diagnosed with non-organic insomnia and found that the
two agents were equally effective in increasing sleep quality (Eur J Med Res. 2002. 25. 480-486).
systematic review of 16 RCTs (n=1093) found that most studies had
methodologic problems, and that the valerian doses, preparations, and
length of treatment varied completely. In 6 studies in which the outcome
was dichotomous (i.e. sleep either improved or not improved), a
statistically significant benefit was seen with valerian treatment, but
there was evidence of publication bias in this summary measure (Am J Med. 2006. 119. 1005-1012).
of action is about 1 hour, so it should be taken 30-60 minutes before
- Data supporting this indication are limited, with no published
positive RCTs as of 2007.
1-3 gm of valerian root decocted to a tea by soaking in one cup of hot water
for 10-15 minutes; or 270-450 mg of aqueous extract; or 300-600 mg of a
70% ethanol extract. The valerian should smell sweet and aromatic
and taste spicy.
studies suggest that valerian blocks the breakdown of GABA.
a small RCT, two 300 mg tablets of a 5:1 extract of valerian root (Sedonium) given 1 hour before bedtime was shown to
reduce sleep latency (time taken to fall asleep) AND to increase
the amount of slow wave sleep and REM sleep (benzodiazepines do the
opposite with regard to slow wave sleep and REM sleep.
RCT including 102 volunteers concluded that neither single nor repeated
evening administrations of 600 mg valerian root extract had a negative
impact on reaction time, alertness, or concentration the morning after
1999. 32. 235).
data suggests that long term use is not associated with hangover,
tolerance, rebound insomnia, or addiction (Pharmacopsychiatry. 2000.
- Valepotriates in valerian may be mutagenic;
water-soluble extracts avoid this issue since these chemicals are not
extracted when water is used.
with barbiturates (phenobarbital).
has been reported in some individuals taking multi-ingredient herbal
medicines including valerian, but it is unclear whether valerian was
truly the culprit (BMJ. 1989.
inhibit cytochrome P450 3A4; clinical significance unclear.
term studies of safety are lacking.
- Sedonium is the brand name of a 70% ethanol extract
used in some clinical trials; Valdispert is the
name of an aqueous extract used in some clinical trials.
- Vitex (chaste tree berry) - treatment of PMS, but may
require 6 months of use to note a positive effect.
high quality RCT over 3 menstrual cycles in 170 women at 6 clinics, using
a dose of one 20 mg tablet of dried extract daily (Ze
440, standardized to casticin, 60% ethanol m/m,
extract ratio 6-12:1) in the 86 active patients, and placebo in 84
controls, found that 52% of active patients had a 50% reduction in
symptoms (including irritability, anger, headache, bloating, and breast
fullness) compared to 24% of controls (p<0.001). Differences in
self-assessment and clinical global impression were also statistically
significantly better in the active treatment group. (BMJ. 2001. 322. 134-137).
RCT using the same extract in 43 women followed for 8 menstrual cycles
(two baseline, three active treatment, and three post-treatment) and
assessed with the validated Moos menstrual distress questionnaire found a
43% reduction in mean score by the end of treatment. Symptoms
gradually returned during the post-treatment phase, but a significant 20
% improvement remained (Arch Gynecol Obstet. 2000. 264. 150-153).
RCT in 175 women followed over 3 cycles and comparing the commercial
preparation Agnolyt to pyridoxine (vitamin B6)
found that scores on the Premenstrual Tension Syndrome Scale
significantly decreased in both groups. At the end of the study,
36% of the Vitex group and 21% of the vitamin
B6 group were asymptomatic (Phytomedicine. 1997. 4. 183-189).
drug-monitoring study in 1542 women describing the use of Agnolyt for menstrual complaints, including PMS,
reported a response rate of 90%, with an average length of treatment of
135 days and an average dose of 40 drops per day on an empty stomach (Gynecol. 1990. 12. 422-425). A
second drug-monitoring study in 1571 women describing the use of Agnolyt at an average dose of 42 drops per day for
menstrual complaints, including PMS, reported 33% of patients reported
total relief of symptoms and an additional 57% reported partial relief (Therapiewoche Gynakologie.
1992. 5. 60-68).
also be effective in treatment of symptoms of menopause, but no
controlled trial data.
of action appears to be a progesterone-modulating effect, via increased
LH levels, possibly through an inhibitory action on prolactin, through
its dopamine agonist activity.
effects - acneiform rash, urticaria (hives).
average dose of Agnolyt used in several published
drug monitoring studies including several thousand women was 40 and 42
drops per day on an empty stomach (Gynecol.
1990. 12. 422-425; Therapiewoche Gynakologie.
1992. 5. 60-68). According to Alternative
Medicine Alert, 1/04, products should be standardized to 0.6% agnuside. Dosing options include 0.5-1 gram of
dried fruit three times a day, 3.5-4.5 mg/day of dried extract, or 1-5 ml
of a 1:5 tincture, or 1-4 ml of a 1:2 extract.
- Femaprin and Agnolyt are
the best studied brand names - these are tinctures of Vitex
that contain 9 grams of a 1:5 tincture for each 100 grams of
aqueous-alcoholic solution - the dose is 4 mg daily.
bark - precursor to aspirin.
Cochrane review identified 2 RCTs in patients with low back pain and
concluded there is evidence of efficacy (Cochrane Database Syst Rev. 2006.
in relieving pain in osteoarthritis of the knee and hip in a RCT
- Take one teaspoon (4 droppersfull) of liquid
extract or one capsule standardized to 120-240 mg salicin.
bark use is not associated with serious GI side effects (Am J Med. 2000. 109.
9-14). BEWARE of risk of anaphylaxis in ASA allergic patients (Ann Pharmacother.
2003. 37. 832-835).
studied brand name – Asalixx. Other brand names
in clinical trials – Rheumalex, Salix, Salgesic.
– bitter herb which is potentially toxic as per Varro Tyler (Herbs of Choice. 1994) because the
volatile oil contains a mixture of thujone and isothujone.
- Yohimbe - effective in treatment of impotence.
Dosage is 5.4 mg TID (Yocon is brand name of
prescription medicine). Side effects include agitation, tremors, insomnia,
tachycardia, and hypertension, so use with caution.
J et al. Herbal Medicines: A Guide for Health Care Professionals.
M (ed). The
Complete German Commission E Monographs. 1998.
JA. The Green Pharmacy
S and Varro Tyler. Tyler’s Honest Herbal
AS. The Health Professional’s Guide to Popular Dietary Supplements.
American Dietetic Association. 2003.
P. Dietary Supplements. 2009.
Pocket Companion Series – concise information on 88 supplements.
- Mills S and K Bone. ABC Clinical Guide to Herbs. 2005. Recipient of ABC award
based upon “provides a rational and well-referenced approach to
determining the relative safety of many botanicals in the market place and
how these herbs can be used responsibly by consumers” as per Mark
Michael. The Healing Power of
- McCaleb RS et al. The Encyclopedia of Popular Herbs
A. The American Pharmaceutical
Association Practical Guide to Natural Medicines. 1999.
MB et al. Herb, Nutrient, and Drug Interactions.
Clinical Implications and Therapeutic Strategies. 2008. Comprehensive
compilation with thousands of references.
VE. Herbs of Choice. 1994.
- PDR for Herbal Medicines. Medical
Economics Company. 1998.
- PDR for Nutritional Supplements.
Medical Economics Company. 2001.
- New England Journal of Medicine. 2002. 347.
1997-1998. Perspective: Herbal
Medicines - What's in the Bottle? Straus S.
- New England Journal of Medicine. 2002. 347.
2046-2056. Review Article: Herbal
Remedies. De Smet P.
- New England Journal of Medicine. 2002. 347.
2073-2076. Sounding Board: Botanical
Medicines - The Need for New Regulation. Marcus DM and Grollman AP.
- Annals of Internal Medicine. 2002.
136. 42-53. The Risk-Benefit
Profile of Commonly Used Herbal Therapies: Ginkgo, St. John's wort, Ginseng, Echinacea, Saw
Palmetto, and Kava. Ernst E.
- JAMA. 2001. 286. 208-216. Herbal Medicines and Perioperative Care.
Ang-Lee MK, Moss J, Yuan C.
- Archives of Internal Medicine.
1998. 158. 2192-2199. Herbs as
Medicines. Winslow LC and Kroll DJ.
- Archives of Internal Medicine.
1998. 158. 2200-2211. Herbal Medicinals. Miller LG.
- Archives of Internal Medicine.
1998. 158. 2225-2234. Herbal
Medicine for the Treatment of Cardiovascular Disease. Mashour
NH, et al.
Botanical Council. http://abc.herbalgram.org Box 201160; Austin, TX 78720
Herbal Products Association www.ahpa.org/companies/htm
links to companies which conform to this trade group's standards for
independent analysis of content to see whether what is in the bottle is
the same as listed on the label, with a listing of brands that pass and
fail for common supplements
- HerbMed www.herbmed.org - free information on herbs including
clinical trials. Click on the
letter of the alphabet, then click on the herb. Site sponsored by the
Alternative Medicine Foundation.
Research Foundation at www.herbs.org/index
A-Z at http://www.nlm.nih.gov/medlineplus/druginfo/herb_All.html
- Memorial Sloan-Kettering Cancer
Medicine Service. Unbiased
monographs that cite scientific literature www.mskcc.org/aboutherbs or www.mskcc.org/mskcc/html/11571.cfm?herbsaccept=yes
Medicines Comprehensive Database www.naturaldatabase.com - each herb reviewed is rated as likely
safe, possibly safe, possibly unsafe, or likely unsafe based on a thorough
review of published data, which is referenced. Safety of each herb
in pregnancy and lactation is also ranked. For each possible
indication, each herb is rated as likely effective, possibly effective,
possibly ineffective, likely ineffective, or insufficient reliable
evidence to rate.
Standard Research Collaboration at Massachusetts General Hospital
www.naturalstandard.com - grades safety and efficacy of herbs
(i.e. A,B,C,D,F) for various conditions based on
rigorously researched evidence-based information.
Office of Dietary Supplements International Bibliographic Information on
Dietary Supplements (IBIDS) at http://ods.od.nih.gov/databases/ibids.html (over 730,000 scientific citations and
links to more than 1600 journal web sites, as of 2004)
Updated January 25, 2015] [Return
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