Part Four of Four:

Continued from last Week

Synopsis: The debate about old versus new, which is safer and more effective, continues. Until recently the attitude toward herbals in Europe and other parts of the world were remarkably different from that in the United states. The "old world" continued to study and use its folkloric medicine, while the U.S. opted for the "high-tech" synthesis and commercial pathways. In much of Europe and Asia, pharmacies still prescribe and dispense many botanical drugs. But times are changing. American consumers are now bombarded with promotional material with much of the information relying on tradition and local folklore testimonials "tinged" with some truth and embellished with the appeal that anything natural is better and safer than synthetic chemical drugs. These remedies are often promoted as cure alls for every ailment.

Better Living Through Chemistry: Herbs or synthetics. Which is for me?

Years ago, I spent time in India learning about herbal alternatives, but, I had not kept current with their healing properties. One day Dina, a long-term client, informed me that for the past month she had been feeling better than she could ever recall. Dina, daughter of Holocaust survivors, had battled depression her whole life. She had tried most prescription medications and although several in combination had helped for brief periods, none had ever felt quite right to her. In spite of her bouts with depression, she had become a partner in a prestigious accounting firm and she often complained that although the drugs helped her to get to work, they kept her from working as well as she believed she could. A friend had suggested she try St. John's Wort. For good measure, she added Ginko Biloba, hoping that it would make her more productive. Dina had seemed happier these last few weeks, but I had no idea why. We both waited with hopeful anticipation to see if her moments of joy would last. Dina's depression returned, but not at the level it had been. On her own she had stumbled into a branch of medicine that had been used for thousands of years and was known to often help those in distress. Buoyed by Dina's success, I suggested to several other clients that they investigate these substances. It helped some, others it did not. Once again, it was trial and error. For some people herbs can be an answer. St. John's Wort and other mood enhancers are among the oldest forms of health care aids known to man. St. John's Wort has a history extending back almost 2000 years. This “new” antidepressant is among the first to have been used in the treatment of depression. Ancient medicinal uses of olive oil, beer wine, yeast, vinegar, figs, turpentine, castor oil, aloes, garlic, cumin, opium, peppermint, coriander, fennel, anise, poppy, honey, grapes, onion, and date blossoms count among the oldest prescriptions found on Babylonian clay tablets and on the hierarchic (priestly writings) of ancient Egypt on papyrus records. Many were simultaneously used as food, spices, and drugs-all pesticide free. Ultimately, this botanical cornucopia represented an eclectic collection of the most reliable early remedies which, even to this day, serve the ills of many countries and cultures around the world. The debate about old versus new, which is safer and more effective, continues. Until recently the attitude toward herbals in Europe and other parts of the world were remarkably different from that in the United states. The "old world" continued to study and use its folkloric medicine, while the U.S. opted for the "high-tech" synthesis and commercial pathways. In much of Europe and Asia, pharmacies still prescribe and dispense many botanical drugs. But times are changing. American consumers are now bombarded with promotional material with much of the information relying on tradition and local folklore testimonials "tinged" with some truth and embellished with the appeal that anything natural is better and safer than synthetic chemical drugs. These remedies are often promoted as cure alls for every ailment. We spent between 4 and 7 billion dollars on herbal remedies and vitamins in 1998, up from $1.6 billion just four years earlier. Herbs and vitamins are now protected by the Dietary Supplemental Health and Education Act of 1994 and in 1995 Congress established the NIH Office of Alternative Medicine to indicate its support for alternative treatments of all kinds. There is little question that many drugs, herb remedies, and vitamins work. The unanswered questions are, which ones, how much, and to what extent? Most herbal remedies are probably safe for most people, at least in the short run. But there are numerous exceptions. In one instance researchers for the Food and Drug Administration determined that a large batch of imported plant material—-which had been divided up and sold to herbal companies across the U.S. for two years—was laced with digitalis, a foxglove-leaf constituent that unchecked can trigger nausea, vomiting, and an irregular heart beat. In another case, the California Department of Health Services found combinations with drug components and potentially toxic heavy metals in at least 83 of 260 imported traditional Chinese remedies. Other reports involved side effects ranging from lead poisoning from an herbal remedy for diabetes, cognitive impairment and vomiting resulting from a body building supplement, and estrogen-like side effects from a remedy used to treat prostate cancer. While purchasing herbal products from reputable companies may minimize the risk of contamination, there is no guarantee, since manufacturing standards for herbal remedies and most other dietary supplements are not yet in place. And there is still the risk of adverse effects that are not due to contaminants. Botanicals are difficult to standardize because of the innate biological variability of plants. We also are learning that complexities and variables are introduced in their collection, storage and transport. While there has not been much published on herbal drug interactions, they can and do occur. Additionally, there is increasing concern that environmental pollution may contaminate herbs that were once pure and natural. So, Consumer Beware! Compounding the confusion and the hyperbole is the odd regulatory niche into which herbs fall. The federal government classifies many herbal remedies as dietary supplements, even though consumers use them as medicine. Science still has much to learn about botanicals and their effect on human health. Until more research findings emerge, consumers can protect themselves from possible adverse effects by taking the following precautions: Read labels carefully. Become familiar with the manufacturer and its quality control standards. Labels should include the herb's scientific name, the amount of active ingredients and plant parts used, the manufacturer name and address, the batch and lot numbers, and expiration date and dosage guidelines. Purchase all herbs from a reliable source. If possible, get advice and information from a trained herbologist. Decide whether you want to use crude (dry) herbs or those that have been altered. If you have a choice between a pill and a capsule, use a capsule that has no other additives. Botanicals should be dated. Discard if over one year old. Avoid excessive dosages. Because many herbs are considered mild, the tendency is to use them for prolonged periods of time and/or to use too much at one time. If there is an unfavorable side effect or allergic reaction, discontinue. Make sure there is a good rationale for combination products, especially when coupled with vitamins and minerals. Never self-medicate a serious depression or manic episode. When unsure of what to take, wait for new research. Whatever you decide to take, prescriptions or over the counter remedies, drug interactions can be dangerous. And, the more polluted our environment gets, the greater the adverse effect can be on you. If you have side effects or are concerned about drug interactions, stop taking the medicine and notify your doctor or a herbologist. The FDA has a hotline (800 332-1088) to call if you have adverse effects. Use it. This column's for you, Dr. D. Dorree Lynn, PH.D.

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