ASK DR. BAUGHAN                                                         October 24, 1997

THE HERBAL JUNGLE

Every week I get asked by several patients about the safety and efficacy of herbal remedies.  I was relieved to see reviews of the current herbal hit parades in two reputable publications, Hippocrates magazine and Patient Care medical journal.  So I hope I can give a little more information than my usual “I’m not for it, I’m not agin’ it” response.

One dilemma with herbs is knowing whether the ingredients match the label.  The quality control does not compare with OTC or prescription drugs.  One study of ginseng products found many not to contain ginseng at all.  The strength may vary widely if different strains of a plant are used.  Another caution is the fallacy that, “If it is natural, it must be safe.”  Even those who say that will not eat mushrooms they cannot identify.  Even a safe product can be risky if someone takes more than recommended.

We can thank the Germans for much of the information we have on herbal medicines.  The German government in 1978 established the Commission E that was an expert committee of physicians , pharmacologists, toxicologists, and others to review available evidence of different substances.  They have published monographs on herbal products since then.  An English translation of a compilation of the monographs is currently being published and will be available (reportedly for $189!).  Contact the American Botanical Council, Box 201660, Austin TX 78720, Phone 512-331-8868, Web site http://www.herbalgram.org.

Probably the two most common herbal products I am questioned about are St. John’s Wort and Gingko biloba.

ST. JOHN’S WORT, or Hypericum perforatum, currently outsells all prescription drugs for depression in Europe.  It has achieved the respectability afforded by a study in the British Medical Journal in August 1996 which reviewed 23 studies comparing it with placebo or other antidepressants.  Overall, 55% of participants responded, compared with 22% taking placebo.  This compares favorably with the usual 70% who respond to prescription antidepressants.  Side effects were generally few and brief.  Doses varied, but the most common recommendation was 300mg three times a day.  Cautions were not to rely on self-diagnosis if symptoms are severe, and not to mix St. John’s Wort with other medications without medical supervision.

GINGKO BILOBA has been used for several problems, including memory difficulties and dementia, claudication (leg pain when walking), tinnitus (ringing in the ears), and vertigo (dizziness).    It can act as a brain anti-oxidant, increase cerebral arterial dilation and increase oxygen, glucose, and neurotransmitter uptake by neural cells.  It has not been shown to have a preventive effect, although many hope it does so.  A person may need to take it for 8 weeks to see any effect.  Current recommended doses are 120-240mg a day divided into 2-3 doses.  It can affect how platelets stick together just as aspirin does, so taking both together requires caution.

The following references have been cited by the above articles, but I cannot say I have reviewed them myself:

BOOKS:  The Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies, Tyler, VE.  Herbal Medicine, Weiss, RF.

JOURNALS:  Alternative and Complementary Therapies, Mary Ann Liebert, Inc., Larchmont, NY.  HerbalGram, American Botanical Council, Austin, TX  78720.

ON-LINE:  HealthWorld Online, http://www.healthy.net/

The Phytochemical Database:  http://www.ars-grin.gov/ngrlsb/