Herbal Medicine Today Botanical Medicine Differences and Similarities

Herbal Medicine Today Botanical Medicine

Differences and Similarities of Drugs and Medicinal Plants o Today there at least 120 distinct chemical substances derived from plants that are considered important drug and are currently in use in one or more countries in the world o Some of these drugs are simply a chemical or chemicals extracted from plant materials and put into a capsule, tablet or liquid.

Herb may cut breast cancer risk Source: International Journal of Cancer April 2007 o Women taking supplements of black cohosh may cut their risk of breast cancer by more than 50 per cent

Ingredients in Green Tea may prevent arthritis Source: Experimental Biology April 29 2007 o (EGCG) extracted from green tea may inhibit the production of inflammatory molecules associated with and joint damage in people with rheumatoid arthritis, scientists have reported. o The results add to an ever-growing body of science linking consumption to a wide range of health benefits, including lower risk of certain cancers, weight loss, heart health, and protection against Alzheimer's.

Green and Black Tea o Tea contains many active compounds that may alter BP, including flavonoids, which are polyphenolic compounds with vasodilatory and antioxidant effects, theanine, theobromine, quercetin, epigallocatechin-3 -0 -gallate (EGCG), gamma-glutamylmethylamide (GMA), thearubigins and theaflavins. o Additional studies in humans will be required to accurately assess these BP effects. Houston, MC, "The Role of Vascular Biology, Nutrition and Nutraceuticals in the Prevention and Treatment of Hypertension", The Journal of the American Nutraceutical Association, Supplement No. 1 April 2002 ISSN-1521 -4524 p 30

Green Tea Evidence-increased consumption correlates to decreased risk of several cancers and possibly heart disease in studies on Japanese; extracts may lower cholesterol but evidence is weak Cautions-caffeine! Although the amount is less than in a cup of coffee; contains vitamin K so be careful with warfarin Products-? Green tea or black? Capsules or tea? Questions-how much? Does black tea have the same effect? How much benefit?

Herbs for Longevity o Ginseng (may slow aging process by improving body’s ability to use and absorb oxygen) o Ginkgo Biloba (enhances age-related memory impairment) o Green Tea (benefits immune system, protection from cancer and strokes, lowers blood pressure) Sources: Huguet, F. , et al. Decreased cerebral 5 -HT 1 A receptors during aging: reversal by ginkgo biloba extract. Journal Of Pharmacy and Pharmacology. 46: 316 -318, 1994. Serafina, M. , et al. In vivo antioxidant effect of green and black tea in man. European Journal of Clinical Nutrition. 50: 28 -32, 1996.

Milk Thistle o Botany n Silybum marianum n Asteraceae family (daisy, thistles, ) o History n long used to treat “liver problems o Chemistry n fruits/seeds contain flavonolignans n silymarin=crude mixture of flavonolignans; actually is mixture of several e. g. silybinin n Seeds generally used

Milk Thistle Silybum marianum

Milk Thistle o Pharmacology n silymarin has strong antioxidant properties n has ability to block toxin entry through membranes n stimulates liver regeneration; undergoes enterohepatic circulation n increases glutathione n stimulates ribosomal RNA polymerase n has anti-carcinogenic activities in vitro and in animals o. Uses n liver cirrhosis n hepatitis A, B, C n liver toxin poisoning (e. g. amanita mushroom)

Viral Hepatitis (A or B) in several studies patients “normalized” hepatic function tests faster in the milk thistle group compared to placebo; shorter hospital stay Hepatitis C –known efficacy; Tanamley et al. (Dig Liver Dis. 2004 Nov; 36(11): 752 -9) were able to show improvement compared to a multivitamin control at 1 yr (n=141). Toxin and Drug Inducted Hepatitis both animal and some small patient studies show protective effect of milk thistle or silymarin Alcohol Related Liver Disease some improvement in liver function tests compared to placebo in limited studies cirrhosis: Pares et al. J. Hepatol 28: 615 -621, 1998; no effect on survival or clinical course of alcoholics; n=200; 2 yr study cirrhosis: (Ferenci et al. J. Hepatol 9: 105 -113, 1989 showed 58% 4 yr survival in treated vs 39% placebo (p=0. 036); 4 yr study Lucena et al. (Int J Clin Pharmacol 2002; 40: 2 -8) showed increase in glutathione and decreased liver peroxidation in patients with alcoholic cirrhosis but no change in routine liver tests in treated compared to placebo. N=60 Alcoholic cirrhotic diabetics. Velussi et al. 1997; 26: 871 -879. N=60. Open label. Improved. A meta-analysis (Am J Med 2002; 113: 506 -15) concluded no strong benefit but more studies needed; animal studies indicate considerable promise for beneficial activities

Milk Thistle o Cautions n Nothing special o Interactions n None of significance reported as yet. Recently shown to not affect indinavir pharmacokinetics o Products n flavonolignans are not water soluble n extract used n extracts containing at least 70% silymarin are best n A lipid complex of silibin has high bioavailability

Echinacea (Echinacea purpurea) o Member of daisy family o Active ingredient(s) n Polysaccharides, alkylamides, flavinoids, caffeic acid o Physiologic effect(s): n Activates T lymphocytes, stimulates IFN, TNF- , ILs o Most common use: n Prevention/reduction of cold and flu symptoms

Echinacea purpurea Cochrane review : 16 RCT 3396 patients Suggests some preparations are superior to placebo in acute infection Rec: 3 – 6 grams / day Melchart D, Cochrane Database Systematic Review 2000

Garlic (Allium sativum) o Active ingredient(s) n Allicin n Ajoene o Physiologic effect(s): n Inhibits platelet aggregation n Inhibits cholesterol metabolism o Most common use: n Reduces cholesterol (decreases triglycerides, LDLs, increases HDLs)

Garlic o Anticoagulation increase with warfarin n Ajoene: irreversible platelet inhibition o Case report of spontaneous spinal epidural hematoma and associated platelet dysfunction Rose KD, Crossant PD, Parliament CF, Levin MP. Spontaneous Spinal Epidural Hematoma with Associated Platelet Dysfunction From Excessive Garlic Ingestion: A Case Report. Neurosurgery. 1990; 26(5): 880 -882.

Garlic garlic increases fibrinolytic activity & diminishes human platelet aggregation; Garlic / 400 mg twice daily / 12 weeks reduced spontaneous platelet aggregation 59% vs placebo in 80 patients Combining with aspirin may increase risk of hemorrhage. Bordia AK, Joshi Hk, Sanadhya YD, Bhu N. 1977. . Atheroscler, 28: 155 -9 Kiesewetter H, Jung F, Jung EM, Mrowietz C, Koscielny J, Wenzel E. 1993. Eur. J. Clin. Pharmacol. 454: 333 -336. Harenberg J, Giese C, Zimmermann R. 1988. Atheroscler, 74: 247 -249, 1988

Ginger (Zingiber officinal) o Active ingredient(s) n Sesquiterpenes, aromatic ketones o Physiologic effect(s): n Inhibits arachidonic acid metabolism o Most common uses: n Antiemetic, diuretic, digestion aid

Gingko (Gingko biloba) o Active ingredient(s) n Flavone glycosides n Flavonoids n Terpene lactones o Physiologic effect(s): n Antioxidant, prevent platelet aggregation, antagonize PAF, increases cerebral perfusion o Most common use(s): n cerebral vascular insufficiency, peripheral vascular disease (eg: Raynaud’s disease), Alzheimer disease

Ginkgo 40 mg twice daily of a 50: 1 ginkgo extract induced spontaneous bleeding following 3 year aspirin use by a 70 -year-old man. Subdural hematoma was reported after chronic ginkgo use in humans. Combining with aspirin may increase risk of hemorrhage 32 healthy young males : ginkgo extract 2 wks 120, 240 or 480 mg daily hemostasis, coagulation and fibrinolysis were not significantly altered

HDI in Humans: Ginkgo o Relatively potent platelet inhibitor n Ginkgolide B may inhibit platelet activating factor causing increase of inhibition of aggregation o Increased bleed risk n n Monitor for signs of bleed, immediate d/c if occurrence consider PT/INR monitor at onset of TX until stable with continued monitoring Rosenblatt M, Mindel J. Spontaneous Hyphema Associated With Ingestion Of Ginkgo Biloba Extract(Letter). N Engl J Med. 1997; 336: 1108. Matthews MK. Association of Ginkgo biloba with intracerebral hemorrhage. Neurology 1998; 50: 1933 -1934.

Sedatives BZD Barbituates Et. OH Non-BZD Valerian Goldenseal Chamomile Melatonin

Herbs and Surgery o On average, herbs used by 17. 6 to 22% of pre-surgical patients o Among those who used herbs, most commonly used: n n n Ginkgo 32. 4% Garlic 26. 5% Ginseng 26. 5% Ang-Lee MK, Moss J, Yuan C-S. Herbal medicines and perioperative care. JAMA 2001; 286: 208.

Herbs and Surgery Advise discontinuation of anti-thrombotic natural supplements 7 – 10 days prior to surgery or invasive procedures

the interface of nutrition and therapeutics u Valeriana officinalis Ø As functional food : « promote sleeping » Ø As phytomedicine : neurosedative

Valerian & Surgery o o o Increased sedation Interference with anesthetics Withdrawal potential post surgical Begin dose taper weeks in advance of surgery If unable to taper, continue use through surgery and treat potential withdrawal with BZD University of Chicago Hospitals, July 11, 2001, JAMA

Ginseng Botany o Source -- American Ginseng, Panax quinquifolius, Asian or Chinese Ginseng, P. ginseng, and Siberian Ginseng, Eleutherococcus senticosus. o Active Part -- Root

Ginseng (Panax ginseng) o Active ingredient(s) n Tritepenoid saponin glycosides o Physiologic effect(s): n May have effect on pituitary similar to corticosteroids, improves Hb. A 1 c n Hypertensive at low dose; hypotensive at high dose o Most common use: n Couteracts physical/mental fatigue n Improvement of body’s ability to fight stress and disease

Ginseng Chemical Constituents o Ginsenosides (panaxosides) -- American and Chinese o Eleutherosides -- Siberian o Vitamins (A, B, C, D) in varying concentrations o Essential oils o Resins

Ginseng Proposed Uses o Although different uses exist for the various forms of Ginseng, the numerous uses for any may include diabetes mellitus and stress and for their adaptogenic, immuno-stimulant, anti-cancer, and cognitive (American and Chinese) actions.

Ginseng Pharmacology o May act as agonists at mineralocorticoid, glucocorticoid, progestin, and œstrogen (Siberian) receptors. o Decrease both fasting and post-prandial blood glucose levels o Has been shown to increase T lymphocyte cell counts. o American ginseng has been shown to have numerous opposing effects

Ginseng Dosing Recommendations o Wide ranges of doses have been used for ginseng. o Ranges from 200 mg to 2 G daily.

Ginseng (Siberian) Adverse Effects o Diarrhœa o Difficulting in concentrating o Dizziness o Euphoria o Hypertension o Increased Agitation o Nervousness o Skin Eruptions o Vaginal bleeding and other œstrogenic effects

Ginseng Contraindications o Pregnancy o Known Hypersensitivity

Ginseng Clinical Considerations o Most literature, including herbal literature, recommend use for no more than three (3) weeks o Patients should be monitored for any changes in stress response for electrolyte abnormalities

Ginseng & antibiotics o ginseng extract (100 mg twice daily) increased pulmonary bacterial clearance during acute attacks of chronic bronchitis when used with amoxicillin and clavulanic acid more than when the antimicrobials were used alone Scaglione F, Weiser K, Allessandria M. 2001. Effects of the Standardised Ginseng Extract G 115� in Patients with Chronic Bronchitis: A Nonblinded Randomised, Comparative Pilot Study. Clin. Drug Invest, 21(1): 41 -45.

between botanicals and drugs u St Johns Wort o Antidepressive plant o Molecular interactions with diverse drugs (ciclosporine, theophylline, digoxine, anticonceptionals, anti. AIDS drugs…) Hypericum perforatum (Hypericaceae)

SJW & Menopause o 301 women o Black cohosh (80 – 120 mg/day) and SJW (1200 mg / day) o Reduction in MRS 50% o Placebo 19. 6% at 16 weeks Uebelhack, Obstet Gyn 2006 Level Evidence A

Chamomile Matricaria recutita j Dose: use the flowering top j Infusion: 1 cup (2 tsp herb) 1 -3 x day j Tincture: 1 -4 ml 3 x day j Homeopathic tablets: use 6 x as needed for colicky or teething babies, irritable children j Caution - rarely, people are allergic to chamomile.

Chasteberry Vitex agnus castus j Acts on the hypothalamic-pituitaryovarian (HPO) axis, which is easily disrupted in women<20 years old j Increases LH, favors progesterone j Inhibits prolactin j Herbal actions: carminative, dopaminergic, galactagogue, HPO regulator, ovulaation stimulant, progesterogenic, uterine tonic

Vitex, cont j Qualities: cooling or warming potential, dry, neutral, tonic j Toxicology: none known j Indications: PMS, infertility, menopausal sx including mood changes, migraines, menorrhagia, polymenorrhoea, menstrual cramping, insomnia, hot flashes, to restore balance after hormonal contraceptives.

Vitex, cont j Known in writings of Hippocrates (450 BC), Dioscorides (500 AD), Pliney, the Eclectics, and others. j Dose: is slow working, take for 3 -6 months j Tincture - 1 ml 3 times daily j Infusion - 1 tsp/cup 3 times daily j Capsules - 1 daily

Menstrual Problems j Hormonal imbalance, often caused by poor diet, congestion in liver, adversely affecting hormonal relationships j Treatment j Whole food diet, rich in fruits & vegetables j Herbs: burdock j Mayan Uterine Massage - a technique taught by Rosita Arvigo, of the ancient art of abdominal massage.

Infertility j Vitex - normalizes hormones j Mayan/Mexican Uterine Massage

Menopause j Hot flashes - Vitex, j Insomnia, anxiety, depression, tension St. John’s wort, oats, valerian, kava j Genitourinary symptoms j Hypertension & atherosclerosis hawthorn, motherwort, garlic,

Hawthorn Crataegus oxyacantha j Actions: cardiotonic, diuretic, astringent, hypotensive j Indications: j most heart conditions, including hypertension, j to prevent development of cardiac disease, j as part of post MI program j all persons over age 50, postmenopausal women

the interface of nutrition and therapeutics u Crataegus oxyacantha Ø As functional food : « calming for the heart » Ø As phytomedicine : for cardiac erethism in the adult (healthy heart)

Hawthorn Crataegus oxyacantha j Scientific research in Europe j isolated constituents have insignificant effects j whole plant effects are significant j Based on a study by the German Federal Ministry of Health, hawthorn is recognized as a major heart remedy in Europe j effects: improves coronary circulation, dilating coronary arteries, reducing angina; enhances nutrition and activity of heart muscles

Hawthorn Crataegus oxyacantha j No toxicity known j Dose: j Tincture - 1 -2 ml 3 x day j Infusion - use 2 tsp dried herb, drink 3 x day j Capsules - 2 caps 1 -3 x day

Nettle Botany o o Source -- Urtica dioica L. , a perennial of the nettle family (Urticaceæ), native world-wide. The plant grows 2 -3 feet high with heart-shaped, serrated leaves. Plants are gender specific, with flowers in long, branched clusters appearing June-September. The plant is hirsute, with each hair serving as a small, hollow, needle-like form of protection. Active Parts -- Leaves, Stems, Roots

Nettle Chemical Constituents o Stems (non-therapeutic) -n Histamine, serotonin, choline, formic acid o Roots -n Phenylpropanes and lignans o Roots and Flowers -n Scopoletin, steryl derivatives, lignan glycosides, flavonol glycosides o Whole Plant -n B, C, and K vitamins, sitosterol and other steroid related compounds

Nettle Proposed Uses o Diuresis -- hypertension, heart failure, and urinary, bladder, and kidney dysfunction o Benign Prostatic Hypertrophy o Other Uses -- Rheumatoid arthritis, antispasmodic, expectorant, asthma, cough, tuberculosis, locally for alopecia, epistaxis, uterine bleeding, diabetes, gout, cancer, eczema, wound healing.

Nettle Pharmacology o Nettle apparently does possess some diuretic activity, although the mechanism is not known. o Shown to stimulate uterine contractions in rabbits. o Possesses immunostimulant (lectin protein) and anti-inflammatory actions (scopoletin) o Inhibits BPH in mice.