Popular Natural Remedies, Part V

This article will be the fifth in a series that I have written about natural products. The previous four articles on natural products have generated a fair number of comments from people who visit the Pharmacy. I'm often asked if I have old copies of these products. While I do not keep copies of old articles at the pharmacy, copies of these articles can be found on our Web page. When you pull up the Wright State Web page, go to Administrative Services, then click on the Pharmacy, and then find and click on previous articles. For someone outside of WSU not on the campus network, our Web page is www.wright.edu/admin/fredwhite/pharmacy/. I hope you find this article to be informative and interesting.

The first natural product that I wish to discuss is slippery elm. This product has been used for hundreds of years in this country. Originally it was used by the Native Americans, and then by the early settlers of this country. Over the centuries, slippery elm has been purported to treat a wide variety of medical conditions such as gout, rheumatism, cold sores, ulcers, and toothaches. However, none of these conditions has been shown clinically to respond to slippery elm. Recently the one medical condition in which slippery elm has been proven useful is in the treatment of sore throat. According to the Pharmacist's Letter, the FDA has stated slippery elm to be safe and effective used as an oral demulcent. I do not recommend going out and finding your local slippery elm tree, taking off the bark, and trying to figure out if you need the inner bark, outer bark, or middle bark (there is a difference in therapeutic effect between the parts of the bark). It is better to buy a commercial preparation of slippery elm. This is because the commercial product provides a sustained release of mucilage to the throat. There are no known contraindications for slippery elm. It should be noted, in the past, since slippery elm was employed as an abortive agent, it is recommended that pregnant women do not use this product, even though no credible documentation of this use has ever been given. Also, like any drug from a plant source, there is an oleo resin that can in a rare individual cause a contact dermatitis. This would appear as sores and ulcers in the mouth. However, at least to this date, none of the commercial preps used for sore throat have been known to have any reports of this.

Probably one of the most sought-after things that I am asked about, as a health care professional, is a product for a good night's sleep. There are countless articles, folklore, and urban legends about products that will ensure a good night's sleep. One product that has gotten a fair amount of press in the last 12 to 14 years is melatonin. Unfortunately, for the average insomniac, melatonin probably is not the panacea that most people might hope it to be. Per the Pharmacist's Letter, melatonin is likely effective when used orally for reducing the symptoms of jet lag, and used for circadian rhythm sleep disorders (people who work third shift). Melatonin is only to be used temporarily/short-term. In individuals in these aforementioned two categories, such as airplane pilots or people working third shift at GM, melatonin has been found to be useful in the short-term treatment of insomnia. Per the Pharmacist's Letter, melatonin is synthesized endogenously in the pineal gland. Melatonin is produced from tryptophan, which is converted to 5-hydroxytryptophan, then serotonin, then N-acetylserotonin, and finally, to melatonin. Light inhibits melatonin secretion, and darkness stimulates it. Taking oral low dose exogenous melatonin has a rapid transit, mild sleep-inducing effect. It will decrease alertness, body temperature, and performance for three to four hours after administration without hangover the following day. Melatonin is not a "magic bullet" to treat insomnia, but should be used sparingly. Melatonin has a number of adverse reactions, such as transient depression, daytime fatigue, drowsiness, dizziness, abdominal cramps, irritability, and reduced alertness. Additionally, melatonin has a number of drug interactions, such as benzodiazepines, beta-blockers, CNS depressants, Prozac, immunosuppression drugs, and verapamil.

The third product that I wish to discuss is pygeum. It is used in men's health to treat enlarged prostate, and probably ranks second to saw pamento in the popular literature for men's health in the treatment for enlarged prostate. Pygeum comes from Africa and the tree Pygeum africum. The tree is present in the Highland Mountain Forests of Africa and Madagascar in elevations of 4500 to 6000 feet. Unfortunately, over-exploitation of this tree has had a devastating effect on the wild population of this species. It is currently on the CITES list (Convention on International Trade and Endangered Species of Wild Fauna and Flora) because of the decreased numbers of this tree in the wild. Per Tyler's book, Honest Herbal, pharmacological studies have shown that the extracts possesses anti-inflammatory activity (by inhibiting enzymes involved in the depolymerization of proteoglycans and prostate connective tissue), reduces cholesterol levels in the prostate (limiting androgen synthesis), and inhibits prostaglan synthesis. Per the Pharmacist's Letter comprehensive database, pygeum is listed as likely effective for treating the functional symptoms of benign prostatic hyperplasia. A typical dose of symptoms of BPH is 100 milligrams standardized lipophilic extract per day in six to eight week cycles.

One of the current darlings of the natural products market is SAMe, which is known by its chemical name of S-adenosyl-L-methionine. Like most natural products, SAMe is purported to help a whole slew of medical conditions that takes up almost six complete lines of print in my small print book. However, the two best documented uses, as well as the ones that are likely effective, are in SAMe's use in the treatment of depression and osteoarthritis. It is interesting that this product has been available by prescription only in Europe since the mid-1970s, but in the U.S. market, it is available as a nutritional supplement. In a study with over 20,000 people, the discontinuation rate of SAMe was only about 5%. There have been numerous clinical trials with SAMe in treating osteoarthritis. Per the Lawrence Review of Natural Products, these studies have shown that SAMe is superior to placebo, and comparable to the nonsteroidal anti-inflammatory agents for decreasing osteoarthritis symptoms. These studies have ranged in length from several months to up to two years. The other use of SAMe is in the treatment of depression. It can either be used alone or in combination with tricyclic antidepressants. Per the Pharmacist's Letter, the dose of SAMe varies by the clinical condition that you are treating. The dose of SAMe for depression is 400-1600 milligrams per day. In most clinical trials, the daily dose used is 1600 milligrams. In the treatment of osteoarthritis, an oral dose of 200 milligrams three times a day is typically used. Most of the adverse reactions to this drug are related to the GI tract, such as flatulence, vomiting, diarrhea, nausea. Headache has also been reported. This product is absolutely contraindicated in people with bipolar (manic depressive syndrome) as it can exaggerate the manic episodes. As far as its use with antidepressants, it should only be used with the older tricyclic antidepressants. It should not be used with the newer antidepressants, the serotonin reuptake inhibitors (Prozac, Zoloft, Paxil, and Celexa) because it can trigger the sometimes fatal serotonin syndrome. As a note to people who may be taking this, as a pharmacist, and checking the price of this product, I find that it is a rather pricey natural product. No-where in the literature have I read that this product works any better than other prescription products in the treatment of osteoarthritis and depression. It is merely an alternative. Do not be fooled by the idea that because it's a natural product, it's better, because it is not. It is merely an alternative and a fairly expensive one at that.

A fifth product that has received a lot of press in the natural products literature over the years is green tea. Much like the aforementioned SAMe, the list of things that green tea is purported to help is rather lengthy. However, clinical studies would only indicate green tea is possibly effective for improving cognitive performance, probably due to its caffeine content. In epidemiological studies higher consumption of green tea was associated with a significantly lower total cholesterol, triglycerides, and LDL, as well as increased HDL levels. Other uses for green tea cannot be purported at this time. There are some significant adverse reactions and interactions with green tea that, in my opinion, should limit its usefulness. The list of drug interactions with green tea is rather extensive, and what I'm about to mention, is by no means all-inclusive. It interacts with aspirin, acetaminophen, Tylenol, antipsychotic drugs, benzodiazepines, Tagamet, lithium, oral contraceptives, Dilantin, verapamil, and Coumadin. Most of the adverse effects of green tea would have to do with the increased caffeine content and side effects thereof. The FDA has advised that women who are or may become pregnant should avoid caffeine-containing products such as green tea. Caffeine-containing beverages may also alter female hormone levels, including estradiol. There is also some data that says that green tea may be an asthma-producing agent as well. For improving cognitive function, you would need to drink about three cups a day, which is about 60 milligrams of caffeine per cup. However, to treat elevated cholesterol, to be truly effective you would have to take at least 10 cups a day or better, which given the already noted amount of caffeine, would mean that your possibilities of a good night's sleep may be somewhat remote. The caps per day is equivalent to six to eight No-Doze™ tablets.

Alan C. McKelvey, R.Ph.
Pharmacist, Frederick A. White Health Center