Popular Natural Remedies, Part III

This is a continuation of the two previous articles that I have written about natural products. In the United States, by far and away, the great majority of the natural products are not sold in pharmacies. It is estimated that the botanical, dietary supplement sales in the U.S. now exceed $1.2 billion a year. Of this amount, only $53 million are currently sold in pharmacies. The rest are sold in health food stores and other venues. These articles are an attempt to give you some idea about those products which have scientific backing in their claims of treating certain disease states. In this article I will discuss five popular natural products whose claims do appear to be valid, and also one popular product whose claims do not seem to be backed up by scientific research.

Feverfew is a product that has been used for several thousand years. It was written up in A.D. 78 by Dioscorides as helpful in treating headaches, menstrual irregularities, stomach disorders, and especially in reducing fevers. However, during the last several hundred years, Feverfew had fallen into general disuse until recently. In 1988, in the English medical journal Lancet, in a randomized double-blind placebo-controlled cross-over studies with 72 patients, reported a reduction of frequency and severity of migraine headaches in patients taking Feverfew. Based on this article, since 1988 there has been renewed interest in Feverfew. Doses of Feverfew are 25 milligrams of the dried leaf twice a day, or 82 milligrams of the dry powdered leaves daily, which appear to be beneficial in the prevention of migraine headaches. The mechanism by which Feverfew reduces migraines is subject to a fair amount of debate. It is widely recognized that Feverfew reduces the production of prostaglandins, which are key components in the pain cascade. However, the exact mechanism by which it inhibits prostaglandin synthesis is unknown. About all researchers can tell at this point is that its mechanism of action appears to be different from that of aspirin. Feverfew also inhibits the degranulation of platelets and leukocytes, which results in decreased secretions of serotonin and histamine. It is further postulated that this decrease in serotonin and histamine is of perhaps greater benefit in relieving migraines than is the inhibition of prostaglandin synthesis. The adverse effects of Feverfew appear to be fairly minor. Chewing the fresh leaves has caused ulcerations in the mouth and swelling of the lips. People who are allergic to the Compositae family of flowers may also show hypersensitivity to this product. Feverfew has the potential to decrease platelet aggregation; therefore patients taking anticoagulant therapy (Warfarin, Plavix, Persantne, etc.) should be cautioned about taking this product and monitored for bleeding tendencies. In addition, it has been reported that commitant use of Feverfew with nonsteroidal agents (i.e., Aleve, Advil, and 18 others) can reduce the effectiveness of Feverfew.

The second natural product that I wish to discuss is Ginger. This product was originally grown in countries with warm climates, such as India, Jamaica, and China, where it has been used medicinally since 500 B.C. While it has been used worldwide as a flavoring agent, its reputation in Asian medicine for reducing motion sickness is currently getting a lot of attention. As anybody who has gone on cruise knows, there's not a lot to be given for motion sickness. The mainstay of motion sickness treatment is either scopolamine patches or over-the-counter antihistamines, which can be quite sedating to some people. In the last 15-20 years, there have been seven double-blind studies conducted on volunteers comparing 940 milligrams of powdered Ginger vs 100 milligrams of the antihistamine dimenhydrinate vs placebo, when consumed 25 minutes prior to tests conducted in a tilted, rotating chair. The initial study was done almost 20 years ago on 36 college students, and it's been repeated six times since that initial study. In four out of the six subsequent studies, the initial findings that Ginger helps prevent motion sickness have been borne out. In the initial study, 36 subjects were given either the Ginger preparation, dimenhydrinate, or placebo, and placed blindfolded in a rotating chair. Subjects who received Ginger root remained in the chair an average of 5.5 minutes, compared to 3.5 minutes for the antihistamine group, and 1.5 minutes for the placebo group. The pharmacological action of Ginger is related, it is believed, to the diterpenoid constituent of Ginger, gulonolactone, which was shown to produce activity as a 5HT₃-antagonist. This is the same mechanism of action shown by Zofranú, another antiemetic drug used in treating chemotherapy-induced nausea. At least at this time, in the literature there are no reports of any toxicities associated with Ginger. In theory, however, large doses of Ginger could depress the central nervous system and cause cardiac arrhythmias. Ginger also might tend to exacerbate bleeding tendencies in susceptible individuals in certain disease states, although this is a hypothesized, not a documented reaction. The use of Ginger in pregnancy is controversial. The German Commission E has taken a conservative stance and is advising women not to use Ginger during pregnancy for morning sickness. There is some concern, although most feel it is unfounded, that Ginger could cause spontaneous abortion.

The third product is Valerian Root, which has received extensive attention as a sleep aid and a mild antianxiety agent. As with most natural products, the mechanism of action of Valerian Root is unknown. As I got ready to write this article, I read three different sources on natural products, and each had a different hypothesis as to why Valerian Root works. So, the best that can be said for Valerian Root, at this point, is that no one knows what the exact mechanism of action is. The usual dose of Valerian Root for night time sedation is 2-3 grams, which is approximately half a teaspoon. It is given approximately one hour before bedtime. It is important to note that the Valerian Root does not work immediately. The noted and esteemed pharmacognosist, Barrow Tyler, reports that the recent German Commission E studies showed that sleep improved over 28 days, not immediately. The authoritative American source on natural products, The Lawrence Review of Natural Products, also states that in a study with 121 persons with serious insomnia, that it took 2-4 weeks to see an improvement. Yet another publication on pharmacist continuing education said that the onset of sleep improvement was approximately 7-10 days from the initial dose before the users reported an improvement in their sleep patterns. The German Commission E lists no contraindications or known side effects for this drug. Antecedol reports with chronic users of Valerian talk of headache, excitability, and changes in cardiac disturbances. Valerian Root is a long-term solution for insomnia, not a short-term or situational cure.

The fourth product I'll pertains to men's health: Saw Palmetto. Like most natural products, Saw Palmetto has a wide variety of proported claims. In the last 15-20 years Saw Palmetto has been used in treating the problems of decreased urinary flow in men with an enlarged prostate. The Saw Palmetto plant is primarily grown and harvested in the southeastern parts of the United States. Historically, most of the medicinal Saw Palmetto came from around the Cape Canaveral area in Florida, although now the berries are harvested anywhere in the state of Florida, and sometimes southern Georgia as well. This product was listed through 1950 in the National Formulary, when it was taken off. Saw Palmetto's pharmacological action is apparently due to a combination of both anti-androgenic and anti-inflammatory actions. It is interesting to note that while this particular product helps to increase urinary flow in men with enlarged prostates, it does not decrease the size of the prostate gland. Symptoms of dysuria, nocturemia, and frequency, as well as increased residual volume, can be significantly reduced by 320 milligrams of Saw Palmetto a day, to be used for 30-90 days. Per the German Commission E-List, there are no known adverse reactions or side effects. There was one case of cholestatic hepatitis observed in a 65-year-old man taking a combination product that contained Saw Palmetto. Particularly high doses of this natural product have been reported to cause diarrhea. Saw Palmetto should be used with caution by men whose partner could be contemplating becoming pregnant. There is some belief among the medical community that this product could cause significant harm to the developing fetus. It is my opinion that before men start using Saw Palmetto to reduce the signs/symptoms of enlarged prostate, they should see their physician to rule out prostate cancer. Prostate cancer can mimick some of the signs/symptoms of enlarged prostate. Like all cancers, prostate cancer can best be treated when found early, and not after taking Saw Palmetto for a few years treating the wrong problem. Other reported medical conditions that Saw Palmetto is reported to help, but does not, are building sexual vigor, increasing sperm production, reversing atrophy of the testes, and increasing the size of the female breast.

Probably one of the most hyped natural products in the last 20 years in this country has been Ginseng. This product has been reported to cause people's endurance and stamina to increase, fight off stress, help recuperate from illnesses, fight fatigue, and enhance performance (physical and sexual). Ginseng is supposedly an adaption product, which means it helps the body to adapt to both internal and external stressors. In the good new/bad news category about Ginseng, the following is true. The good news with Ginseng is that there are hundreds of tests on small animals that show Ginseng can prolong swimming time, prevent stress-induced ulcers, and make the immune system more active, among other claims. The bad news is that there have been no human studies that show the same thing. It is the current thinking among the medical community in both America and other countries, that there need to be more controlled, long-term studies with human subjects before appropriate claims for Ginseng can be made. One of the problems in buying Ginseng (that it is well known among people who analyze Ginseng products) is that Ginseng products are notorious for being adultered with other drugs or chemicals. There are frequently other drugs/chemicals mixed with Ginseng products when a person buys Ginseng for consumption. There are some significant adverse reactions associated with Ginseng. High doses of Ginseng can result in headaches. People with high blood pressure are absolutely contraindicated from taking Ginseng. Ginseng and the adulterants with it can cause abnormal vaginal bleeding and mastalgia in patients who consume it. People who take Ginseng and have estrogen-dependent malignancies (breast cancer) may need to avoid taking Ginseng, as it could increase growth rates of cancerous cells. There are two significant drug interactions with Ginseng. Ginseng can affect platelet adhesiveness and blood coagulation. Therefore, people who are on antiplatelet therapy should be closely monitored. Ginseng also has the potential to cause hypoglycemia, which is low blood sugar, in patients with diabetes who are taking blood glucose lowering agents. It should be noted that there is a product called Siberian Ginseng, which is chemically different than the regular Ginseng, which comes from Russia. However, all the reports about Siberian Ginseng are not from controlled studies, neither do they seem to involve any studies that are reproducible.