Popular Natural Remedies, Part IX

This will be the ninth in a series of articles that I have written about natural products. As a healthcare worker, I am aware that many people, take natural products for various medical conditions. As I have stated before, there is a lot of information out there about reported uses of natural products. Unfortunately, I am still of the opinion, having written these nine articles, that, at best, only one in 10 natural products actually have some validity as to their claims for a medical use. In this article, I will write about four natural products that have some valid basis for medical use. In this article, since the Pharmacy will be having some patient education luncheons in the area of elevated cholesterol, I will address two natural products that are used in the management of cholesterol. I also will look at caffeine and grapefruit juice.

Probably one of the oldest drugs known to man is caffeine. I would suspect that there's not many people reading this article, whom in the last 30 days have not had either a soda or some other drink containing caffeine, such as tea or coffee. The stimulant effects of caffeine are well known and do not need to be re-examined here. However, the use of caffeine and its effect on analgesia (pain relieve) in headache and dental patients is sometimes overlooked. Thirty years ago there were a number of over-the-counter analgesics on the market that had caffeine in them. Those of us old enough to remember, will recall a product called APC, acetaminophen, phenacetin, and caffeine, and was the mainstay of many home medicine cabinets for years. In 2002, caffeine has disappeared from almost all over-the-counter pain relief products. Even in prescription products, there are only a couple of items, such as Fiorinal, which still contain caffeine. However, it is recognized that for certain types of pain, that when combined with a nonsteroidal agent such as Aleve (naproxen), Advil (ibuprofen), aspirin or Tylenol (acetaminophen), caffeine is useful in the relief of pain. The types of pain that are most commonly relieved with caffeine are dental pain and headache pain. The amount of caffeine used to treat these conditions ranges between 30 and 50 milligrams. A cup of coffee probably has about 60 to 80 milligrams of caffeine, and a can of Mountain Dew, which is heavy in caffeine, has around 50 milligrams of caffeine. By example, some of the over-the-counter caffeine stimulants, with which our students are probably highly aware, such as No-Doz and Vivarin, contain 100 milligrams and 200 milligrams of caffeine, respectively. The side effects of caffeine, I think, are well known. It can stimulate the heart rate, increase blood pressure, and has a host of undesirable medical side effects. Further, most of us are aware of the fact that taking more than a couple hundred milligrams of caffeine a day can lead to dependence upon the product. However, if a patient has dental pain and/or a headache and takes an over-the-counter analgesic, having some tea or a half a cup of coffee with it may indeed potentiate the pain-relieving effect of your favorite over-the-counter analgesic.

When I was a little boy growing up in Dayton, Ohio, I remember that my dad had oat bran for breakfast every morning. I remember asking my dad why he ate oat bran because I didn't think it tasted very good. He told me that his grandmother had told him when he was a boy that it was healthy to eat oat bran, and he had been eating it ever since. As it turns out, apparently my great-great-grandmother was correct in her admonitions to my father. In the last 10 to 15 years, oat bran has received considerable press for being important in the management of heart disease and elevated cholesterol. Oats, of course, would be considered dietary fiber. Per the definitive book, Tyler's Honest Herbal, bran has the following definition. "Dietary fiber may be defined as all foods eaten by a monogastric (one stomach) animal that reach the large intestine essentially unchanged. This includes cellulose, the skeletal material of plant cell walls, and lignin, the rigid component of peach pit and nut shells, for instance. Together these materials are known as 'crude fiber'. Add to crude fiber such basically and indigestible plant cell constituents as gums, mucilages, pectinic substances, hemicelluloses, and certain complex polysaccharides, the total collectively referred to as dietary fiber." And of all these sources of dietary fiber, oat bran has been at the forefront with the lay and medical press for reducing cholesterol and reducing heart disease. The current popularity of oat bran has to do with its fiber content. Soluble fiber is much better at reducing cholesterol levels than insoluble fiber. Per The Lawrence Review of Natural Products, a serving of Quaker Oat Bran™ hot cereal provides 4.1 grams of total dietary fiber, which 1.9 grams is soluble and 2.2 grams is insoluble. There are several postulated mechanisms by which oat bran actually works to lower cardiac risk. In the case of diabetic patients, dietetic fiber is thought to reduce the risk of cardiovascular disease by decreasing fasting insulin levels and also giving a more uniform absorption of sugars from the gut, making peaks and valleys less frequent with blood sugars. With regard to directly lowering cholesterol, the bran itself tends to surround cholesterol molecules in the gut and keep them from absorbing into the bloodstream. There are only several medical concerns with the use of oat bran. The biggest concern would be particularly in the elderly and younger patients with decreased intestinal motility. In patients who have decreased intestinal motility or a predisposition to diverticulitis (narrowing of the intestine), oat bran could lead to an intestinal obstruction. Secondly, in closely controlled diabetics, in theory, the use of oat bran could lower blood sugar enough to trigger a low blood sugar reaction, although there have been no documented cases of this.

Another product that has gotten extensive press during the last decade is fish oil. Fish oil is commonly referred to as omega-3 fatty acids. The two fatty acids that are used interchangeably with the term omega-3 are eicosapentaenoic (EPA) and docosahexaenoic (DHA). Per The Lawrence Review of Natural Products, marine sources containing the highest content of omega-3 fatty acids are fatty fish (mackerel, halibut, salmon, blue fish, mullet, sable fish, menhaden, anchovy, herring, lake trout, coho, and sardines. Again, per The Lawrence Review of Natural Product, omega-3 fatty acids are metabolized into a class of biologically active, 20 carbon compounds called eicosanoids. These eicosanoids are potent regulators of blood pressure, blood clotting, childbirth, and gastric secretions, as well as immune and inflammatory responses. However, for the purpose of this article we will only be interested in their cardiovascular effects. The original research article that pointed out the value of omega-3 acids and the prevention of cardiovascular diseases, was a result of an observation by a researcher that Greenland Eskimos, despite consuming over 40% of their calories as fat, they exhibited a very low incidence of coronary heart disease. The benefit of fish oil has been demonstrated in reducing cardiovascular events in at least four well-known, large studies. The 1989 Diet and Reinfarction Trial (DART), found almost a 30% decrease over two years in overall mortality in men who ate fatty fish twice a week over those who did not. Worldwide, literally tens of thousands of people have been enrolled in studies to evaluate the effect of fish oil on cardiovascular mortality. There's a growing body of evidence that strongly suggests a cardio-protective effect of fish oil. Per The Pharmacist's Letter, the mechanism of action of fish oil is thought to be lowering triglycerides by decreasing secretion of VLDLs, increasing VLDL, apolipoprotein B secretion, possibly by increasing VLDL clearance and by reducing triglyceride transport and decreasing VLDL size. Fish oils also increase fatty acid oxidation by peroxisomal hepatic uptake of triglycerides and down regulation of fatty acid esterifying enzymes. Fish oils also decrease cholesterol absorption and cholesterol synthesis. For lowering triglycerides, the normal dose of fish oil is 1 to 2 grams per day. For lowering blood pressure, studies have used 4 grams of fish oil per day. There are a few adverse reactions involving fish oil. One is breath, including halitosis, with a fishy odor. Also, belching and heartburn are possibilities, as well as nose bleeds. High doses of fish oil can cause nausea and loose stools. Fish oil can interact with a number of herbal supplements. If you are thinking about taking an herbal supplement along with fish oil, you should check with your healthcare provider about what should be avoided, as the list is rather lengthy. Fish oil can effect vitamin E absorption, and so vitamin E supplementation may be indicated with long-term use. There are some possible drug interactions with fish oil. Since it is known to have a blood thinning effect, fish oil should never be used with patients taking anticoagulant therapy of any type without first checking with their physician. Theoretically, although not clinically proven, fish oil can effect serum glucose blood levels. Also, patients taking blood pressure lowering drugs might find their blood pressure lowered even further with fish oil, and so blood pressure checks, when going on fish oil, should be done.