Popular Natural Remedies, Part VII

This will be the seventh in a series of articles that I have written about natural products. After working at Wright State University for 19½ years, I am aware that physical fitness and exercise are, perhaps, of greater importance to the people that go to school and work here than the other populations. With that thought in mind, I believe that information about natural products is of interest to many of the employees and students at Wright State. In my opinion, there is a lot of "questionable" information available about natural products, therefore, I try to write about natural products with documented effectiveness or non-effectiveness.

In writing these articles, I use four reference sources. The four resources that I primarily use are Tyler's Honest Herbal, The Lawrence Review of Natural Products, Natural Medicines Comprehensive Data Base by the Pharmacists Letter, and The Complete German Commission E Monographs. I want to stress when I write these articles that using these products is not meant to replace or take away from the judgment of your personal physician and members of the medical community. Neither is taking these natural products meant to be a replacement for tried and trued prescription products. This information is merely meant to be educational and as an avenue of self-treatment when warranted for certain disease states and conditions.

Cranberry is a generic term that applies to a number of varieties of this species that are grown commercially in this country. Since 1923, when American scientists showed urine becoming more acidic after eating large amounts of cranberries, people have used this product in the treatment of mild urinary tract infections. It has been hypothesized over the past nearly 80 years that cranberry exerts its anti-infective effect by raising urinary pH to such a high level that it inhibits bacterial growth. Cranberry has been one of the tried and true products used by tens of thousands Americans over the last 40 to 50 years to treat and prevent mild urinary tract infections. Upon extensive investigations into the mechanism of how cranberry might treat urinary tract infections, some interesting discoveries have been made. It has been determined that the urinary pH rise caused by cranberries does not affect bacterial growth. Cranberry apparently does not raise urinary pH enough to do much to inhibit bacterial growth. However, it was found upon further investigation that both cranberry and blueberry juices contain a high molecular weight compounds (identified as condensed tannins or proanthocyanidins) that inhibits the common urinary pathogen, e-coli, from adhering to infection sites within the urinary tract, thereby limiting the ability of bacteria to initiate and spread infections. This is per The Lawrence Review of Natural Products. Per Tyler's Honest Herbal, it is also believed that fructose, also present in the cranberry juice is a second compound that is also an anti-adhering agent as well. At this point there have been four recent studies that try to show whether or not cranberry juice is effective to treat UTI infections. While all four studies had some design flaws, each of the four did seem to show that cranberry juice is at least somewhat effective in treating mild urinary tract infections. It cannot be stressed enough the cranberry juice is to be used in the prevention or treatment of MILD urinary tract symptoms. Severe urinary tract infections WILL NOT respond to cranberry treatment. Also, if the patient notices a worsening of symptoms or symptoms persist more than 48 hours, they should contact their physician at once. The dose for preventing urinary tract infections is approximately three ounces of cranberry juice daily. For treating an active, mild infection the recommended dose is 12-32 ounces per day in divided increments. It should be noted that 6 capsules of dried cranberry powder are equal to three ounces of cranberry juice per The Pharmacist's Letter.

Creatinine is a product that is widely used in this country in the enhancement of athletic performance. It is estimated that the annual U.S. consumption of creatinine is four million kilograms. Creatinine's role in muscle work was first observed by Lieberg in 1847, when he found that the flesh of wild foxes killed in the chase contained 10 times more creatinine than those living in captivity. While creatinine is routinely used by a number of athletes in dozens of sports, it is interesting that creatinine's ultimate beneficial use may be confined to only a few sports. Creatinine is frequently dosed with a loading dose followed by a maintenance dose. Typically, creatinine is started at 20 grams per day (0.3 grams per kilogram) for five days, followed by a maintenance dose of two more grams (0.03 grams per kilogram) daily. Variations of this loading dose have been tried per The Pharmacist's Letter. Again, per The Pharmacist's Letter, a meta analysis of 32 creatinine studies showed no effects of creatinine supplementation on the various measures of anaerobic performance, including fatigue, power, speed, strength, and work values. This unpublished study was presented at The American College of Sports Medicine in 2000. The only sports in which creatinine has been shown to have benefit are those sports involving repeated bout of high intensity exercise like weight-lifting, cycling, and sprints lasting a very short time. For the average Joe reading this article, unless you are a top athlete training for such an event, the use of creatinine will in no way effect your performance. However, with four million kilograms of creatinine being sold a year, there are a lot of people who believe otherwise. Per The Pharmacist's Letter, most of the known adverse effects of creatinine involve the GI tract. Creatinine has been known to cause GI pain, nausea, and diarrhea. It has been reported that 25% of male collegiate athletes taking creatinine have reported cramping. There are no known interactions with other herbs. Theoretical drug interactions include cyclosporin, angiotensin converting enzyme inhibitors, and nonsteroidal anti-inflammatory agents on long-term use. It is suggested to avoid caffeine supplementation with this product. Also, people with kidney problems should avoid this product as well.

One of the newer entries to the market for enhancing athletic performance is HMB. Chemically, HMB is Beta-hydroxy-beta-methylbutyrate. Of all the products that I have read about with regard to increasing athletic performance, this alone seems to be the one product where there seems to be some evidence of increased muscle building and strengthening effects in weight-training exercises in both the "average Joe" and the experienced athlete and, perhaps, even senior citizens. However, the one bad thing about HMB is that it is such a relatively new agent, that there is not a lot in the material about it. Most studies show it to be used for at most four weeks. Per The Pharmacist's Letter, a normal dose of this product is 1.5 to 3.0 grams per day. I suspect that the one thing that bothers me, as a pharmacist, with this product is that while initially in the first few years the product seems to be effective, it has not been long enough for us to know what the long-term side effects might be. The longest study on this product only lasted four weeks.

Back in my second newsletter I talked about ephedra being used in various products. In that particular article, I came out very negative on the product. Because of the fact that ephedra seems to be in an ever-increasing number of products, I'm going to once again revisit this product to give my thoughts on the matter of what I believe to be a dangerous product that is widely used. Per The Lawrence Review of Natural Products, ephedra has many names: ma?huang, yellow horse, yellow astringent, joint fur, squaw tea, warm and tea, a popotillo, and tea master's tea. Whatever the name, ephedra can be a dangerous compound. Ephedra is a chemical cousin to the decongestants and also to the amphetamines. People use ephedra because it does give them a caffeine-like effect, and they perceive that they have more energy. The energy that they perceive is not because their body is working better or their performance is enhanced, but it is rather from the stimulant effect of ephedra. Ephedra is in a number of weight loss and performance products. Currently on the market are very popular products that some of our students use called Ripped Fuel. Ephedra is almost certainly a component of a number of these products. After all, what weight reduction product company wants to have users of its products being fatigued and tired? Ephedra is not meant to be used for more than seven days per The Pharmacist's Letter. Use of this for greater than seven days can be associated with developing a tolerance and ACTUAL PHYSICAL DEPENDENCE upon the product. It's probably only legitimate medical use is in the short-term treatment of diseases of the respiratory tract. This is an old use that was probably popular 50 years ago, but in today's market there are certainly dozens of prescription products that are better than ephedra to be used in respiratory tract ailments. The side effects of ephedra are what you would think for a stimulant. It can affect blood pressure and heart rate. Ephedra can cause anxiety and its related disorders. In an older patient, because of the fact ephedra can affect the heart and blood vessels, it could cause stroke, as well as heart attacks. In a span of time between 1993 and 1985, there was 685 volunteer reports filed with the FDA for the adverse effects of ephedra. There were 39 fatalities in these 685 reports.

Some people who read this article will either be diabetics themselves, or know people in their families or friends who are diabetic. Two of the very serious long-term consequences of diabetes are neuropathy (damage or destruction of the peripheral nerves) and retinopathy (destruction of the retina with result in blindness). Unfortunately, most diabetics will exhibit one or both of these side effects of the disease. These are two of the most widely feared side effects of diabetes. Recently, it has been suggested that vitamin E might help prevent both side effects. Researchers have found that 1,800 milligrams of vitamin E a day can reduce platelet aggregation, decrease insulin resistance, and improve lipid profiles. Preliminary research that says 1,800 milligrams of vitamin E daily for four months, patients with type I diabetes, who have had the disease for less than 10 years, can normalize creatinine clearance in the kidneys. Also, patients taking 1,800 milligrams vitamin E for four months have found that they can increase the retinal blood flow to the back of the eye comparable to that of a nondiabetic patient within four months of taking vitamin E, thus decreasing the chance of retinopathy. A lot of diabetics, however, take lipid lowering drugs. There is some information of late that vitamin E may make these drugs less effective. We encourage patients to discuss this with their personal physicians.