Popular Natural Remedies, Part VI

This will be the sixth in a series of articles that I have written about natural products. Consumers are the target of numerous printed materials and a host of Internet sources about natural products. Consumers see many claims and advertisements for natural products claiming to treat a certain medical condition or disease state. Unfortunately, in my opinion, only about one out of ten products that I see in the printed media or on the Internet have merit. As I have done in previous articles, I have tried to pick natural products that have some merit and value in their claims. In this article I will review four natural products whose claims for effectiveness may have merit.

Sometime in the next several months, a fair number of those reading this article will develop the common cold. A product that has been widely used in Europe for many decades, and is gaining popularity in the United States for shortening the duration of the common cold, is Echinacea. While Echinacea is fairly widely recognized in the natural products literature as an immune system enhancer, its role in the treatment of specific disease states has always been somewhat muddled. In the last 20 years, Echinacea studies have most often occurred to test Echinacea's effectiveness in the treatment of the common cold. Studies on Echinacea efficacy have gone into one of two areas: either Echinacea used in the treatment of a cold, or Echinacea used in the prevention of a cold (ie., your roommate comes down with a cold and you don't want to get it). It can be somewhat categorically said that Echinacea does not help in the prevention of common colds. However, its use in the treatment of cold symptoms is somewhat unclear. Like a lot of drugs from plants, one of the big problems in determining if Echinacea will help in the treatment of cold symptoms is the fact that, per The Lawrence Review of Natural Products, there are actually nine different species of Echinacea plants in the United States and Canada alone. Echinacea preparations are not standardized as to which one of the nine plants they use, nor are they standardized as to what part of the plant they actually use, such as the root, upper plant parts, sap, or the whole plant. However, if one was reading a label, the German Commission E list gives a positive rating to two Echinacea species. The two Echinacea species approved by the German Commission E list are E. pallida root (herb, not leaf) and E. purpurea herb or leaf (not the root). Most of you are probably unaware of the German Commission E, which is Germany's counterpart of our FDA. The German Commission E is an advisory committee that gives thumbs up or thumbs down on natural products to be paid for by the National Health Service. Germany is the only European country that I know of where the National Health Care Prescription Service will pay not only for traditional pharmaceuticals, such as penicillin, but also for drugs derived from a plant source. The fact that the German Commission E list would list those two specific types of Echinacea has to be strongly considered when picking a product. Per the Pharmacist's Letter, Echinacea is fairly clean as far as possible interactions with drug or food. In theory, Echinacea could interfere with immunosuppressant therapy, such as that undergone by organ transplant patients. Echinacea is contraindicated in patients with chronic systemic disease states involving immune disorders, such as diabetes (may worsen metabolic control), and infertility. There are various commercial preparations of Echinacea that are being used at this time, and there does not seem to be necessarily one standardized dose. The one thing that I do get from reading the synopses of several studies is that Echinacea is most effective when used within the first 24 to 48 hours of the onset of cold symptoms. Studies of patients who start Echinacea more than three days into a cold showed it did not help them. It is my opinion that Echinacea might be useful when started very early on in the treatment of the common cold to shorten its duration.

I think most people who are reading this would recognize that heart disease is a significant cause of death among adults in this country. One of the more novel ideas in recent years for reducing cardiovascular disease has been that drinking a glass of wine and/or grape juice at least several times a week might help reduce your risk of cardiovascular disease. The first evidence of wine's ability to help prevent cardiovascular disease was a clinical phenomenon nicknamed the French Paradox. It was noted that in certain countries where there is an extremely high fat content in the diet, such as Switzerland, Italy, and France, the population had very low heart disease mortality rates. It was postulated that the lower incidence of heart disease was because the daily consumption of wine was highest in these three countries. The Copenhagen City Heart Study was initiated in 1976, and it lasted for 16 years, and was to determine the risk factors of first strokes. While a number of factors were looked at in this, it was suggested that wine had beneficial effects in preventing a first stroke. It should be noted, in all the materials I read on this subject, none stated that it is the alcohol content of wine that causes the decreased risk in cardiac disease. Researchers feel there are other components in wine that make it useful in preventing cardiovascular disease. Per The Lawrence Review of Natural Products, it has been observed that red wine's phenolic compounds have a positive effect on plasma antioxidants capacity. Antioxidants prevent the oxidation of LDL cholesterol into plaque, which are known to clog arteries leading to cardiovascular disease. The most potent phenolic antioxidants affecting LDL found in wine, in descending order, are epicatechin, catechin, and resveratrol. As already mentioned, it should be noted that while most of the reports have dealt with wine, it is widely believed by most people who have researched this particular area that if someone did not want to drink wine, purple grape juice may have the same effect as red wine in reducing heart disease risk. There are various brands of purple grape juice out there that researchers postulated would have the same effect as wine. As far as adverse reactions, I believe that everyone is well versed in the adverse effects of alcohol in the social and family context. It should be stressed that the amount of wine needed a day to reduce heart disease is usually four ounces or less. While the adverse reactions of wine, I think, are fairly well known, the drug interactions with wine are not. Per the Pharmacist's Letter, there are several significant drug interactions with wine. Patients taking aspirin and nonsteroidal agents can increase GI bleeding time if they drink wine. Any drug causing CNS depression, such as antianxiety or antidepressant agents, can increase sedation. The use of H2 receptor antagonist (Tagamet, Zantac, Axid, and Pepcid) with alcohol can increase blood alcohol levels. Patients taking Dilantin (seizures) or Coumadin (blood thinner) should use caution.

A product that has been used by millions of Americans for a long time is Aloe Gel. I can remember as a boy growing up, seeing an Aloe plant in my Grandmother's kitchen. I asked her what it was, and she told me it had been given to her when she got married some 60 years before because family members figured that as a new bride, my grandmother would burn herself in the kitchen. When this happened, my grandmother would just break a leaf off whenever she had a burn and put the plant gel on. Some people do take parts of the Aloe plant orally for various systemic effects, but I absolutely do not recommend this, and will confine this to the topical applications of the plant. Like all plants, you have leaves, external and internal parts, and roots. However, when it comes to the therapeutic use of Aloe for the skin, I am talking about the Aloe Gel (Aloe Vera) or mucilage as a thin, clear, jelly-like material obtained from the so-called parenchymal tissue making up the inner portion of the leaves. Per Tyler's definitive book, Honest Herbal, Aloe Vera is prepared from the leaf by various procedures, all of which involve its separation not only from the inner cellular debris, but especially from the specialized cells known as the paracyclic tubules that occur just beneath the epidermis or rind of these same leaves. Per The Pharmacist's Letter, Aloe Gel is deemed possibly effective when applied topically for reducing pain and inflammation and enhancing the healing of burns and skin ulcerations. Per The Lawrence Review of Natural Products, it states the effective topical use of Aloe Gel in the treatment of minor burns and wounds has not been established, although several human trials indicate a potential therapeutic effect. Aloe Gel is highly concentrated, and its commercial purity runs between 99 and 100% pure. People apply Aloe liberally as needed 3-5 times a day to the affected skin. This product, when used topically, is considered safe with few side effects. However, as aforementioned, the product taken orally is not recommended due to drug interactions and similar issues of toxicity. Also, as with any agent derived from plants, there will be a few people who will develop a topical allergic reaction.

The last product I wish to discuss comes from the family of B vitamins. Niacin has been used for the last 15 or 20 years extensively in the treatment of elevated cholesterol. It is particularly useful in the treatment of elevated cholesterol when the HDL levels (good cholesterol) are low. No other agent has been proven more successful in elevating HDL cholesterol than Niacin. The normal dose of Niacin in treating elevated cholesterol is 1,000 to 2,000 milligrams a day. Most patients will take the sustained release form, usually 250 or 500 milligram capsules. Taking the sustained release form reduces one unpleasant side effect, which can be severe flushing. Niacin should not be used in strength over 2 grams a day (2,000 milligrams). This drug can cause liver toxicity, and periodic monitoring by your physician is recommended. In addition, it has the potential to raise fasting blood sugar 10 to 15 points, in both the diabetic and nondiabetic patients as well.

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