Herbals

Question 1

Garlic

Answer 1

PURPORTED USE: hypolipidemic, reduce cholesterol, lower BP, reduce platelet aggregation, antimicrobial

ALT: statin

Question 2

Ginkgo

Answer 2

PURPORTED USE: improve memory, inhibit platelet aggregation for increased blood flow

ALT: Donzepil

• Double-blind test shows no difference from placebo

Question 3

St. John’s Wort*

Answer 3

PURPORTED USE: antidepressant, binds to GABA and serotonin (5HT) receptors

DRUG INTERACTION: sedation with SSRI increases BP and HR; decreases level of other drugs like HIV protease inhibitors, oral contraceptives, anti-leukemia drug (Gleevac)

ALT: SSRI, tricyclics, MAOI

Question 4

Ginseng*

Answer 4

PURPORTED USE: cure-all, adaptogen, “increase steroid production”

No compelling data

ADVERSE EFFECTS: hypoglycemia, abnormal periods, CNS excitation

DRUG INTERACTION: with digoxin assays (for heart failure treatment)

Question 5

Black Cohosh

Answer 5

PURPORTED USE: PMS and menopause relief

Double-blind show largely no difference between Black Cohosh and placebo

ADVRSE EFFECTS: liver toxicity

ALT: estrogen therapy

Question 6

Glucosamine

Answer 6

PURPORTED USE: osteoarthritis pain and swelling

Some efficacy but needs larger study

Question 7

Fish oils (omega-3/cod liver oil)

Answer 7

PURPORTED USE: hyperlipidemia, high PB, CV disease prevention; ADD, macular degeneration

Evidence supports decreases in triglycerides (relating to BP)! But no added benefit for person who regularly eats fatty fish 2-3x/week

ADVERSE: may increase LDL, lower vitamin E levels

Look at total lipid profile pre and post (use station if LDL too high)

Question 8

Characteristics of herbals

Answer 8

Self-treat, self-diagnosed, self-manage, self-regulated

NOT FDA APPROVED
USP verified means it contains the ingredients listed/amts

Question 9

Current herbals

Answer 9

Folklore promotes as treatment
40% of America
How it spreads: word of mouth and advertising

Question 10

Supplement (1994 Dietary Supplement Health and Education Act)

Answer 10

• intended to supplement the diet
• contains herbs or other botanicals
• taken by mouth
• labeled on the front as dietary supplement
• food, NOT drug
• FDA is excluded from approval process unless toxic

Question 11

Concerns with herbals

Answer 11

• few controlled clinical studies
• complex mixtures (What’s active? Interactions?)
• variability
• contamination (unintended ie. pesticides OR intended ie. viagra)
• misconception that US has strict standards; natural is safe