Herbals

Question 1

quality control

Answer 1

the wrong part of the plant may be picked (belladonna poisoning,
digitalis poisoning)
heavy metals may be found in herbal preparations(lead, arsenic
cadmium, copper, mercury)
JAMA Dec 2004 article: 20% of Ayurveda (an Indian Medical
System) herbal products sold in Boston contained toxic levels of
lead, mercury, and arsenic

Question 2

EFFICACY AND SAFETY STUDIES

Answer 2

controlled studies of herbals are not profitable
there is little motivation for manufacturers to conduct
randomized, placebo-controlled, double-blinded clinical trials to
prove efficacy because 1) they are not required to do so and 2) they cannot patent the product to recoup the estimated $500 million it
costs to prove a new drug effective and safe
with the resultant lack of solid scientific analysis in the U.S.,
claims for benefits are thus mainly supported solely with anecdotal
case reports that fail to consider the natural history of the disease
or the placebo effect. Toxic effects, if any, are seldom reported.

Question 3

black cohosh root

Answer 3

dec menopausal symptoms

Question 4

echinacea

Answer 4

improved immune functions

Question 5

garlic

Answer 5

dec LDL
low triglycerides
low plaque formation

Question 6

ginkgo biloba leaf

Answer 6

improved cognition

Question 7

ginseng root

Answer 7

low fatigue

Question 8

saw palmetto berry

Answer 8

dec symptoms of BPH

Question 9

st. john’s wort

Answer 9

antidepressant for mild to moderate depression

Question 10

valerian root

Answer 10

improved sleep quality

Question 11

soy

Answer 11

improved blood lipids

low LDLs, TG, & cholesterol

Question 12

glucosamine, chondroitin

Answer 12

decjoint pain
incjoint mobility
inc quality of life

Question 13

creatine

Answer 13

may improve muscle mass, strength, & performance during short bouts of intense exercise

Question 14

Top 10 selling herbal supplements

Answer 14

1. Garlic
2. Gingko
3. Echinacea
4. Soy (often included as a nutritional supplement)
5. Saw Palmetto
6. Ginseng
7. St. John’s wort
8. Black cohosh
9. Cranberry
10. Valerian

Question 15

Garlic

Answer 15

a. contains allin which is converted to a bioactive
compound allicin (thought to be the active ingredient);
allicin is a sulfur compound and other sulfur compounds
in garlic may also be beneficial; HMG-CoA reductase
inhibition or block of TXA2 synthesis??
b. 900 mg/day of garlic powder or 2-5 g of fresh garlic
(1-2 cloves) for hyperlipidemia and hypertension
c. Garlic has some anticoagulant properties (prolongs bleed time so caution with warfarin)

Question 16

Gingko

Answer 16

a. contains flavonoids, sesquiterpenes, and terpenes

b. 40-80 mg of gingko extract, three times a day for improved cognitive function

Question 17

Echinacea

Answer 17

a. Echinacea purpura seems to have the greatest immune effect
b. may activate NK cells and monocytes
c. 6-9 mL of fresh juice, 0.9 g of cut root or equivalent extract for colds
d. hepatotoxicity risk if used for longer than 8 weeks

Question 18

Soy

Answer 18

a. contains protein, isoflavones, fiber, and omega-6
fatty acids
b. soy protein seems to be most beneficial on blood lipids
c. 47 g/day for hyperlipidemia

Question 19

Saw palmetto

Answer 19

a. is a type of palm tree in North America (southern
U.S. mainly); the berries have the greatest effect and they contain a variety of fatty acids, esters, and sterols
b. mechanism is proposed to involve inhibition of 5-alpha reductase
c. 1-2 g of cut fruit or 320 mg of lipophilic extract for BPH

Question 20

Ginseng

Answer 20

a. active components in the root are the saponins, called ginsenosides
b. 1-2 g of dried root per day, or 100-300 mg of extract up to 3 times/day for fatigue

Question 21

St. John’s wort

Answer 21

a. the active ingredient is thought to be hyperforin though there are many other compounds proposed to
mediate the antidepressant effect ( inc 5-HT?)
b. 2-4 g of dried herb, or 0.2-1 mg of hypericin for
depression
c. seems to induce CYP450 enzymes

Question 22

Black cohosh

Answer 22

a. extracts are standardized to contain 1 mg of
triterpene saponins per 20 mg of extract
b. 40-80 mg per day for menopause

Question 23

Valerian

Answer 23

a. supplements are standardized by the level of
valerenic acid
b. 400-600 mg/day to improve sleep quality

Question 24

Glucosamine and chondroitin

Answer 24

a. glucosamine is an amino sugar while chondroitin is a glycosaminoglycan
b. 1500 mg/day of glucosamine and 800-2000 mg/day
of chondroitin for osteoarthritis

Question 25

Creatine

Answer 25

a. synthesized endogenously from glycine and
arginine (urea cycle); 95% of total body creatine is in
skeletal muscle
b. dietary sources are meat and fish (~1 g/day)
c. doses usually taken are 20 g/day for 5 days then a maintenance dose of 2-5 g/day (which may be obtained
solely from the diet) for improved exercise performance

Question 26

OTHER HERBS AND THEIR USES

Answer 26

1. Aloe: topically for burns
2. Angelica: gynecologic disorders (postmenopause, menstrual
   discomfort)
3. Bee Pollen: allergies, asthma, impotence
4. Capsicum: pain (capsaicin)
5. Coenzyme Q10: heart disease and heart failure
6. DHEA: enhance immune system
7. Dong Quai: gynecologic disorders (irregular menstruation, PMS
8. Gotu Kola: immune stimulant, antifertility
9. Horse Chestnut: varicose veins, hemorrhoids
10. Kava-Kava: seizures, anxiety
11. Licorice: peptic ulcer
12. Melatonin: jet lag, sleep induction, cancer
13. Shark Cartilage: cancer
14. Yohimbe: aphrodisiac, male impotence

Question 27

DANGERS OF USING HERBS

Answer 27

we just don’t know enough about herbs
herbs are not controlled to an extent where they can be
consistently reliable
Toxic ingredients, including pesticides, nondeclared drugs, and
added chemicals, are sometimes found in herbal preparations.
Heavy metals as well as the prescription drugs phenylbutazone
(NSAID that is no longer used due to toxicity), aminopyrine
(NSAID withdrawn from use due to potentially fatal bone marrow
toxicity), prednisone, testosterone, and diazepam, have been found
in herbal preparations.