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Glenn D. Braunstein, M.D.

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Herbal Remedies? Be Wary of Studies, Keep Your Caregivers in the Loop

Posted: 01/ 9/2012 4:26 pm

As an allopathic practitioner, a.k.a. "regular" Western medicine doctor, I'll tread gingerly (no pun intended) on the topic of common medicinal herbs and remedies. There is certainly a wealth of research backing up the connections between nutrition and good health. And science keeps digging deeper into foods, beyond the "essential nutrients" like protein, fat, vitamins and minerals, looking for new phytonutrients, the tiny components of plants thought to enhance health.

Americans, it is clear, are not going to wait for the definitive studies needed to prove that medicinal herbs can be beneficial for certain ailments. Some 38 million people -- or one in five Americans -- say they've used a natural product for health purposes, and I suspect that percentage is even higher in the Southland.

The field once known as alternative medicine has undergone name changes reflecting changes in attitude. The term "alternative," had an either/or connotation, while "complementary," implies using non-traditional therapies alongside standard medical therapies. More recently, the term "integrative medicine" has emerged, indicating that Western physicians are integrating some of these "alternative" therapies into their practice. There are a growing number of MDs who specialize in integrative medicine and the federal government's National Center for Complementary and Alternative Medicine examines evidence of various clinical trials of herbal treatments.

But before you give up the pharmaceutical solution in favor of an herbal remedy, let me strongly urge you to keep your doctor and other caregivers (don't forget your pharmacist!) in the treatment loop. Most physicians, aware of the appeal of nontraditional health care, will want to work with you, and it's to your benefit to let them. Herbal products, considered dietary supplements, are not subject to the strict FDA testing requirements of pharmaceuticals. Many herbal products can have the same troublesome side effects as prescription drugs, and some can interact dangerously with the medicines you're already taking.

There also are multiple problems with the majority of studies that have examined the possible medical benefits of herbs.

These include: lack of randomization of subjects; problems concealing treatments because of taste and smell differences between herbs and placebos (if, indeed, placebo controls were used); low numbers of patients in many trials; issues in composition of test batches because herbs contain mixtures of different substances -- because these are natural products, content of components of these mixtures will vary from lot to lot; financial support for studies most often coming from companies that produce the herbal products, raising concerns about veracity of data and its interpretation; and publication bias, where positive results are published, while negative results are not.

Some Common Natural Products

There are hundreds of bottles on the shelves of health stores. Here are some commonly used herbal remedies.

Echinacea: The cure for the common cold is still elusive. No doubt, many of you swear by echinacea, and after hundreds of studies of the flower-derived chemical, there still is debate about whether you're wasting your money. A 2007 study showed that when echinacea is taken at the first sign of a cold, it can shorten its duration by about a day and a half. Then along came a 2010 study that found that the remedy did not significantly alter the course of a cold. The good news is that the risks are few, though some people -- particularly those with allergies to ragweed or certain flowers -- experience allergic reactions.

St. John's Wort: Used to treat depression, anxiety and sleep disorders, this yellow-flowered plant has been shown in some studies to relieve mild depression, though not in more severe depression. Side effects can include sun sensitivity, dry mouth, dizziness, headache and decreased sexual function. And the list of potentially harmful interactions with other drugs -- increased bleeding in women taking oral contraceptions, for example -- reads like the fine print warning on prescription drug labels.

Ginko: Traditionally used to treat asthma, bronchitis, fatigue and ringing in the ears (tinnitus), today many people take the extract from the ancient ginkgo tree in an attempt to improve memory or to treat Alzheimer's disease. One study followed more than 500 healthy, elderly patients, half of them receiving a placebo while the other half took 120 mg of ginkgo twice a day. After six years, there was no difference in the incidence of Alzheimer's or dementia patients between the two groups. A much shorter term study of memory, lasting just six weeks, also was a flop. It found that the memories of healthy adults did not improve on a ginkgo regimen.

Red Rice Yeast: This herbal remedy has been shown to lower cholesterol, an important finding for the 10 percent or so statin-users who don't tolerate the prescription drug. Still, red rice yeast can cause the same side effects as statins, such as liver damage or muscle pain. And the problem of lower standards of regulation for natural remedies rears its head with this product, as evidenced by a recent study. Researchers looked at 12 red rice yeast products on the market and found levels of active ingredients to be highly inconsistent. Findings such as these underscore the wisdom of working with a physician to ensure getting the proper medicine.

First, Do No Harm

Some remedies, while their potential benefits are still being studied, are highly unlikely to hurt you.

Green Tea: The brew can increase mental alertness, probably because of caffeine. There is hope, but little proof, that it can help in weight loss programs. A big hope is that it can help prevent a variety of cancers, and while animal studies have shown promise that green tea can inhibit tumor growth in various organs, human studies are inconclusive. Probably the greatest danger comes when people think that if a little is good, a whole lot is better, and there have been a few reports of liver problems in people taking large doses of green tea extract. Stick to the steeped beverage, feel warm and cozy, and maybe you'll do yourself some good.

Ginger: It's delicious added to butternut squash soup, and what would most Asian cuisine be without it? It's used to treat stomachaches, nausea and diarrhea. Short-term use can relieve pregnancy-related vomiting and some studies suggest that it can make travel easier by relieving motion sickness. Studies on ginger's effectiveness in treating arthritis are inconclusive, but ongoing. When taken it small doses, it has few side effects, though bloating, gas and nausea have been reported with powdered ginger supplements.

Garlic: This stinky bulb has been used for thousands of years for medicinal purposes. Some studies have indicated that it can slightly lower cholesterol levels, but a federal study of fresh garlic and garlic tablets found no such effect. Garlic may have some cancer-preventing properties, though the evidence is largely from population studies comparing cultures that consume a lot of garlic with those that don't. Results from the gold standard of evidence -- the clinical trial -- are less clear. Side effects like bad breath, body odor and heartburn, are usually not serious. But garlic, like aspirin, can thin the blood, so if you're having dental work or surgery, hold the garlic.

Cranberry: This little red bog berry can be effective in preventing urinary tract infections, though ineffective at treating the infections. They may also help prevent ulcers by interfering with H. pylori, the bacteria associated with stomach ulcers, although definitive data proving this is lacking.

Serious Safety Concerns

Ephedra: Utter the word "ephedra" for a quick reminder of the dangers lurking on health supplement shelves. Used for more than 5,000 years in China and India to treat colds, flu, fever and headaches, it took off as a weight loss aid in the mid-1990s. Then the phone started ringing at various poison control centers across the country. In April 2004, the FDA banned the sale of ephedra, which contains a natural substance very like amphetamine. It can powerfully stimulate the nervous system and heart, and led to some 37 heart attacks, strokes or deaths.

Kava: Used to treat insomnia, anxiety and menopausal symptoms, this supplement now carries an FDA warning, linking it to severe liver damage. People with liver disease, or those taking medications such as statins which can affect the liver, should not take kava without consulting a physician.

Integrate Your Care

What's frightening to me is the patient who may dispense with Western medicine in the false belief that anything plant-based or natural is risk-free and worthy of consideration. A measure of the tragedy of the recent death of Steve Jobs is the revelation, as discussed in Jobs' authorized biography by Walter Isaacson, that the high-tech pioneer put off surgery for pancreatic cancer for nine months, instead turning to holistic treatments. It is unknown whether this delay would have made any difference in the course of his disease. But his family, friends and millions of admirers would wish he had, at minimum, integrated his care, undergoing surgery earlier while simultaneously exploring herbal medicines and other nontraditional treatments.

The truth is that the bottles in the herbal medicine cabinet are still not as thoroughly researched for safety and effectiveness as are pharmaceuticals. But there is certainly room for traditional healthcare to keep an open mind about the wisdom of ancient remedies if contemporary science supports their use.