Home | Jackson Siegelbaum Gastro | Patient Education
		HERBS We have seen the craze over megavitamins, then came the mania with colloidal minerals and now the hoopla with herbs. The word, herb, can mean almost anything that grows that has medicinal or food flavoring value. The use of herbs as medicines and flavoring has a long and proud tradition. Before refrigeration, the ancients spiced their meats heartily with herbs as the meat became rancid. Indeed, this is the reason for the development of the spice trade from the Orient to Europe in the middle ages. As medicines, plants have been found to have many beneficial uses. Aspirin, for instance, comes from the bark of the white willow tree and the heart medicine, digitalis, from the foxglove plant. However, herb enthusiasts should keep in mind that just because something grows as a plant and is called "natural" does not mean that it cannot be harmful. On the contrary, certain mushrooms as well as foxglove and aspirin taken in excess will kill you. Some Chinese herbs have been found to severely damage the liver. These are perfectly natural deaths from naturally growing plants. But what is all the hype about herbs? There may be some value, somewhere, in some herbs. But don't trust the sellers of herb products to give you a straight answer, any more than the colloid mineral and megavitamin people do. As an example, a report in a reputable journal in 1999 found that the three popular herbal products, St. John's Wort, echinacea and gingko all damaged the sperm and ovary egg cells in hamsters. It doesn't mean it happens in humans but it does give one pause for thought. Certainly, you won't hear about this negative report from the Vit-Min-Herb industry. Their main goal is to sell products and if they have to shade the truth or completely avoid it, well, so be it. It is the consumer who needs to satisfy himself or herself that there is no harm in these products except to your pocketbook. Remember the comments above on the Scientific Method. It means that something has been proven by strict scientific testing. Have any good medical studies been done on most of these herb products? Studies that the FDA and the medical establishment would accept in the same manner as they do for all the prescription drugs we use? The answer is a resounding No! Most herb manufacturers and sellers don't want to do these tests as they are content to avoid the FDA and sell the promise rather than the fact. So what does the medical and scientific community know about herbs? Actually, a fair amount. In particular, there are many herbs that are downright dangerous. These include the following. Do not take these dangerous Herbs: Belladonna Blue Gohash Borage Broom Chaparrel Coltsfoot Comfrey Ephedra Germanium (Germander) Lobelia Poke Root Sassafras Skull Cap Stephania Tryptophan Wormwood Yohimbe Chinese Herbs Syo-saiko-to Kombucha (herbal, mushroom or Jin-Bu-Huan Kvass tea, kwapsan, tind kangasok) Shon-wu-ian Be especially careful of these Chinese herbs as a number of them have been found to cause serious and even fatal liver hepatitis. Ephedra deserves special mention. It has some mild benefit in asthma, has been touted for weight control and has caused deaths as a street drug used for an "herbal high." Most manufacturers no longer sell ephedra products, following the deaths of athletes and others who used it. Tryptophan, given for insomnia, caused many deaths in the past. The German government has a commission E which loosely regulates herbal products and sales. However, this oversight is not as rigorous as the FDA in the U.S. They approve herbs based on "reasonableness" of evidence, not the hard science that the FDA requires. Still, many look to Germany for guidance. Below are the leading herbal drugs in Germany. There may be some benefit in each of them, although US prescription drugs for each condition are far more effective. Leading Herbal Drugs in Germany Herb Condition St. John's Wort depression Ginkgo biloba Syo-saiko-to circulatory Horse chestnut varicose veins Yeast anti-diarrheal Urtica urinary Crataegus heart Chamomile antiphlogistic Valerian sedative Chelidonium Syo-saiko-to bile Agnes castus gynecologic Cimicfuga gynecologic Garlic God's gift to the human palate! What herb can come close to garlic in its infinite ability to caress food and delight a meal? But what is all the fuss about a health benefit? Like so many other herbs, it has been promoted as a panacea for almost all the ills of mankind, up to 125 medical uses by last count. These include prevention of heart attacks, high blood pressure, high cholesterol, low blood pressure and hemorrhoids. The mystique of garlic is perhaps related to its claim as an aphrodisiac. Of course, 99% of these claims are rubbish. One US government analysis of the published clinical trials on garlic show "severe methodologic shortcomings", meaning they are not sound enough to reach firm conclusions. There are now two good medical articles showing that garlic does not lower cholesterol. Some chemicals in garlic do produce some changes in the body's physiology, but these are not well studied medically. What is known is that you would need to eat five to twenty garlic cloves a day to see any physiologic change. So what can be recommended regarding garlic? If you have a specific medical problem such as heart disease, cholesterol or high blood pressure, there are far better ways, all proven, to deal with them. If you think it acts as an aphrodisiac, by all means use it. Fortunately, garlic is safe even in huge amounts. However, you may have a problem getting close enough to someone to enjoy your hoped for new sexual vigor. Ginkgo biloba This herb may dilate blood vessels and increase blood flow to the brain. That certainly can't be bad. A study in a reputable American medical journal studied an extract from this herb, called EGb-761. Unlike herb products bought over the counter, this extract was purified and standardized. EGb-761 was tested on Alzheimer patients. It, indeed, did seem to modestly improve memory and social function of these demented patients. Alzheimer's disease, however, is being recognized as, at least in part, a genetic disorder, so increased blood flow may not be very important. Still, if you have Alzheimer's and if you can get your hands on the standardized EGb-761 product, it may help and probably won't hurt. Unregulated ginkgo biloba purchased at nutrition stores has been reported to cause headache, abdominal discomfort and allergic skin reaction, perhaps due to the many other chemicals in this unpurified product. A 1999 report showed that it damaged the sperm and ovary egg cells in hamsters. Ginseng The active ingredients in this herb are called ginsenosides and these are reported to enhance the body's immune system. If a person is healthy, then the immune system will be healthy. Any benefit above your natural immunity is pure speculation and likely unobtainable. Further, when analyzed, many of these "ginseng" products contain none or little of these active ingredients. And it may increase the blood pressure. Saw palmetto This herb may increase urinary flow in men who have a benign form of prostate enlargement. Although a recent well controlled medical study showed no benefit. The herb may shrink the prostate a little. It is cheaper than the prescription drug, finisteride, which has been well-studied and approved by the FDA. Do not take the herb on your own. Check with your physician. Poor urine flow may mean a serious problem, i.e. prostate cancer, which the herb can neither prevent or treat. The teas made from the herb are ineffective. Of interest, there are some 1999 reports that the chemical that colors tomatoes red, lycopene, may reduce the incidence of prostate cancer. Cooked tomatoes are much higher in this possibly beneficial chemical. St. John's Wort No talk on herbs would be complete without discussion of the newest rage of St. John's Wort (SJW). A published study in the reputable British Journal of Medicine suggested a benefit in mild to moderate depression. There were few immediate side effects although increased sun sensitivity does occur. A more recent (2001), large, controlled, double-blinded study showed no benefit in treating depression. An important fact is the following. First, the modern treatment of depression has been a major advance in medicine. We know a great deal about the chemical imbalances in the brain that lead to depressed feelings. And there are now many new and very well studied drugs available, drugs proven by the scientific method, that are manufactured under regulated practices that the herb industry does not use or follow. Second, depression may be caused by other conditions or even drugs you are taking. An underactive thyroid state and the drugs, prednisone and beta blockers, come to mind. SJW does nothing in these situations. Third, serious depression can be life-threatening - i.e. suicide. Professional help is needed, not over-the-counter herbs. Finally, SJW has actions in the body similar to drugs called monamine oxidase inhibitors (MAO). MAO inhibitor drugs are old anti-depressants that have largely been replaced by many new drugs because of their toxicity. The major problem with these drugs is that when they are used with foods high in the amino acid tyramine, serious, even fatal hypertension can occur. Red wine, meat, aged cheese and fava beans are high in tyramine. A 1999 report showed that it damaged the sperm and ovary-egg cells in hamsters. An active ingredient in SJW is hypericin, which has been touted for AIDS patients. A recent medical article showed that when the drug was given IV to a group of 30 patients, it not only did not help the blood tests done for AIDS but it also caused severe reaction to sun exposure in half the patients. An editorial in the December 1999 issue of the reputable journal, Lancet, reviews the published data on SJW. It is true that there are substantially fewer side effects with the herb than with synthetic antidepressants Nevertheless, there are likely interactions between SJW and other drugs. Hypericin increases the metabolic activity of certain enzyme processes in the liver, thereby, lowering the effect of other drugs one may take. These drugs include theophylline, cyclosporine, estrogen combinations, digoxin (Lanoxin) and warfarin (Coumadin). So, should you take St. John's Wort? The following advice is condensed from the Johns Hopkins Health After 50 medical letter. St. John's Wort is advised, if at all, for only mild to moderate depressive symptoms. If you have suicidal thoughts or have withdrawn from friends, daily activities, sex or other interests, see your physician. Take the herb only for three weeks to test the effect. If depressed feelings persist, see your physician. Do not mix the herb with other antidepressants or medications. Do not stop prescribed antidepressants. Avoid tyramine rich foods Do not take SJW for AIDS. The bottom line is that SJW is an active drug in the body. It can have side effects and can adversely interact with other medications you take. Be sure your physician knows you are taking SJW. Enough for St. John's wort. Echinacea What doesn't this one do - enhance your immune system? Cure cancer? Cure the common cold? Heal wounds? It is now even put in soaps and shampoos! It comes in many forms and it is expensive. So what are the facts? There are nine different kinds of echinacea grown in this country, the most common being e. purpurea. As with all herb products, it is a mix of many chemicals, none of which have been submitted to rigorous testing as would occur with a prescription drug. The results are conflicting. Some seem to work in the test tube. When injected into humans, some studies suggest that there is "immune boosting". This is a very unscientific term which can mean just about anything the writer wants it to mean. In most of these studies, the drug was injected by needle which is not possible with the over-the-counter products. At last count, 15 different active compounds have been identified but none of them have been tested in clinical trials, so no one really knows if there is any benefit at all. There may be side effects. Usually there are with any drug that has a powerful action in the body. Some researchers think it harms certain white blood cells which protect us from infection. Another recent study demonstrated injury to the sperm and ovary egg cells in hamsters. Certain people should not take echinacea. These include those allergic to daisies and people with the following diseases: lupus, rheumatoid arthritis, tuberculosis, multiple sclerosis and AIDS or HIV positive people. Pregnant or nursing women and small children should also avoid the herb. Final Thoughts on Herbs As noted above in several European countries, especially Germany, physicians frequently prescribe herbs and insurance pays for them. However, there is some regulatory oversight of these products there which is not present in this country. Here the claims made for most herbal products are poorly or totally unsupported by facts. Most physicians are not very knowledgeable in the herb field as there is hardly any formal training in medical school. So what to do? If you are not willing to do your own homework, the best advice is to do nothing. Leave the herbs to your friends. If you insist on taking herbs, there are several good references. Herbs of Choice; Varro Tyler, Haworth Press, about $15, 800-342-9678. The Honest Herbal; Varro Tyler, Haworth Press, about $18, 800-342-9678. If you really are into it, the following are written for health care providers. Herbal Medicines, A Guide for Health Care Professionals; Carrol Newall and others, Pharmaceutical Press, London, 800-345-7105, about $72. Monographs From Germany's Commission E, a Government Regulatory Agency; now in English, American Botanical Council, 800-373-7105, about $190 for a complete set. In closing, remember that each plant contains hundreds or thousands of compounds which can vary from plant to plant and brand to brand. The manufacturers have no regulatory requirement for uniformity, safety, testing or sterility. The medical newsletters from Harvard, Johns Hopkins, the University of California Medical Centers at Berkley as well as Consumer Reports all agree with these comments. As the above guru herbologist and author, Varro Tyler, writes, "Such a lack of information and quality assurance is detrimental to the health and welfare of the American consumer. Ignorance encourages quackery". Amen. Frank W. Jackson MD © 1998 fwj updated 8/2006 fwj@comcast.net
		Health Essays: On Good Health | Jackson Fiber Cocktail | Jackson Fountain of Youth Gastroenterology: Patient Education | Diseases/Disorders | Procedures | Diets | Drugs | Endoscopy Images | Links