FP Report -- 1999 Post-Assembly Edition
Herbal therapies: Are they good medicine if used properly?
Assembly speaker discusses specific herbal therapies that are popular with consumers
An estimated 60 million Americans use herbal medicines every year, spending more than $3 billion annually on the botanical products. At least a third of these people never tell their physicians they are taking alternative medicines, despite the fact that herbals can cause side effects, interact with prescription drugs and mimic other illnesses.
Are herbal remedies safe and effective medicines or just the subject of old wives' tales? Raul Zimmerman, M.D., associate director of the Halifax Medical Center Family Practice Residency Program in Daytona Beach, Fla., said many herbals can be good medicines if used properly. He spoke at a Sept. 16 Assembly clinical seminar on herbal therapies in Orlando, Fla.
A 1997 Journal of the American Medical Association article found that ginkgo modestly stabilized mild to moderate dementia by improving memory. Americans take herbal medicines for various reasons. Many believe that because herbs are natural, they are safe. Or they think that conventional medicine is too technical, impersonal and expensive, and may have certain fears about prescription drugs due to highly publicized recalls, such as the withdrawal of fen-phen from the market.
Herbal medicines have been used for thousands of years by native cultures around the world, Zimmerman said. In many poor countries today, herbals are the only affordable medicines. Native Americans have a long tradition of using herbs for medicinal purposes, and Europeans brought herbal remedies from their homelands to the United States.
However, the widespread abuses engendered by snake-oil salesmen and other quacks in the 19th century patent medicine era led to the establishment of the Food and Drug Administration and strict regulation of drugs in America, he said. But herbals are not regulated by the FDA as long as they are sold as food supplements.
Under the 1994 Dietary Supplement and Health Education Act, herbal products may go to market without testing for efficacy and without proof of safety. To remove an herbal remedy from the market, the FDA must show that it is harmful and ineffective, Zimmerman noted. Manufacturers and marketers of herbal products must not, however, claim that the product can cure or prevent disease. Nonetheless, labels may describe how the supplement may affect a body structure or function.
Zimmerman discussed specific herbal therapies that are popular with consumers, including these:
- St. John's wort is promoted as an antidepressant, anxiolytic and antiinflammatory herbal medicine. An article published in the British Journal of Medicine in 1996 gives some scientific evidence that St. John's wort may be equally as effective as pharmaceuticals for mild to moderate depression, he said. Adverse reactions to the herb may include photosensitivity when it is taken in large quantities, and the tannins it contains may cause a feeling of fullness or constipation.
- Ginkgo biloba is promoted as a cerebrovasodilator, antioxidant and antiplatelet aggregant indicated for dementias, intermittent claudication, vertigo, Raynaud's disease, vascular tinnitus and selective serotonin reuptake inhibitor-induced sexual dysfunction. A 1997 Journal of the American Medical Association article found that ginkgo modestly stabilized mild to moderate dementia by improving memory, Zimmerman said. Adverse reactions may include rare gastrointestinal effects. Its platelet antiaggregant properties may intensify anticoagulant therapy.
- Feverfew is promoted as an antiplatelet aggregant and analgesic indicated for migraine and cluster headaches. Zimmerman said scientific evidence for its effects on migraine is good, although side effects can include oral ulcers and rebound headaches.
- Saw palmetto, a common plant in Florida, is promoted as a mild estrogenic having antiandrogenic activity, an anti-inflammatory and a diuretic indicated for benign prostatic hyperplasia and impotence. Scientific data support its use for symptoms of BPH, Zimmerman said. Adverse reactions include rare gastric complaints and failure to change libido.
- Ginger is promoted as an antiemetic, an antispasmodic and a positive inotrope indicated for loss of appetite, motion sickness and dyspepsia. Scientific data support its use as an antiemetic with no known adverse reactions at recommended doses, Zimmerman said. However, it may be a potential anticoagulant, and those who overdose on ginger have shown symptoms of hypertension, central nervous system depression and dysrhythmia. It may also exacerbate existing cholelithiasis.
- Valerian is promoted as a sedative or hypnotic, smooth-muscle relaxant and antispasmodic indicated for insomnia, menstrual cramps and anxiety. Evidence supports its use as a hypnotic, he said. Adverse reactions include, paradoxically, stimulation in 5 to 10 percent of those who use it and rare heart palpitations.
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
FP Report | Headlines |AAFP Home | Search