Nutritional and Herbal Flashcards
St. Johns Wort
MOA: Inhibits metabolism and reuptake of serotonin, dopamine, and epinepherine
TRUTH: no more effective than placebo for mild-mod depression, not effective for major depression
LIMITS: short duration, did not use DSM, variable doses used
RECOMMEND: associated with allergic reactions and photosensitization, inexpensive, drug interactions (CYP and P-glycoprotein), Patients should not self treat depression
Echinacea
MOA: enhances phagocytosis, stimulates certain cytokines, bacteriostatic, anti-inflammatory actions
TRUTH: beneficial for early treatment of URTI, no benefit over placebo
RECOMMEND: may help with early intervention of cold’s severity and duration, safe for short term use, allergies and GI pain are common, LT use should be avoided
Ginkgo Biloba
MOA: free readical scavengers, inhibits platelet activation factor, increases GABA
TRUTH: no effect beyond placebo, might increase memory and attention, improved behavioral performance and cognition of patients with alzheimers and vascular dementia, no effect on mild to mod dementia or age associated memory impairment
RECOMMEND: may increase mental function in some, but benefits are modest at best, allergies are observed, seeds are toxic, long term ingestion can lead to cancer (in mice), may increase risk of bleeding, should not self medicate and should still see physician
Saw Palmetto
MOA: inhibit 5-alpha-reductase, blocks testosterone and dihydrotestosterone uptake by the prostate, anti- inflammatory activity
TRUTH: improved urologic symptoms and flow when compared to finasteride with fewer side effects, is not better than placebo in some studies
RECOMMEND: may decrease prostate symptoms, probably safe, limited drug reactions
Garlic
MOA: potentially inhibits choleterol synthesis, also effects on plasma protein and cell membrane remodeling
TRUTH: mixed results on lipid lowering ability, might have modest ability to lower LDL, possible antihypertensive effect, antiplatelet, antithrombotic, and fibronolytic activity seen
RECOMMEND: mixed results showing a benefit in lowering cholesterol, probably safe, inexpensive, well tolerated with few side effects, drug interactions due exist, must use high doses to see any effect
Ginger
MOA: potentially affects GI mobility
TRUTH: hyperemesis gravidarum (severe morning sickness), results are mixed for treating motion sickness and nausea associated with surgery or chemo
RECOMMEND: safe/inexpensive, readily available, can be used as an antiemetic, drug interactions might exist
Ginseng
MOA: proposed central cholinergic and dopaminergic effects and stimulation of the HPA axis
TRUTH: claims to increase energy and improve mental abilities, some studies have shown
no effects on exercise performance, mood, memory or concentration
RECOMMEND: very limited human studies, not cheap, drug interactions
Herbal agents used for pain relief
- Arnica montana: Used externally for muscle pain increased by movement, often used as homeopathic preparation
- Black Cohosh: Generally used to treat symptoms of menopause, though high quality trials show no effect
- Chamomile: Used for stomach and gastrointestinal pain, cramps, rheumatism, neuralgia, inflammation, ulcers
- Boswellia Serrata ‐Frankincense: Contains boswellic acids which are believed to disrupt the enzymes which cause inflammatory pain
- Evening Primrose Oil: Proposed anti-inflammatory actions -> arthritis, joint and back pain.
- Kava: Linked to liver damage/failure; Mild central nervous system depressant; May be useful in the treatment of anxiety
- Peppermint: Analgesic, anti-‐spasmodic-‐menthol; Evidence suggests use for treating pain associated with IBS: Use externally for muscle pain, neuralgia and headaches
- Piscidia ‐Jamaican Dogwood: Sedative and hypnotic which works on the central nervous system; Used for migraine, neuralgia, ovary pain; Known to be toxic ‐use with caution!
- SAM-e: MAO-B inhibitor and increases dopamine: Osteoarthritis, fibromyalgia
- St. Johns Wort: External analgesic, anti-inflammatory: Sciatica, wounds, burns, lacerations, neuralgias
- Willow Bark: The original aspirin containing salicin, similar to aspirin in structure and function: Headaches, inflammatory pain and minor injuries
- Wintergreen Oil: Anti‐rheumatic, analgesic; Externally used for joint and muscle stiffness, swelling, rheumatism, arthritis; Methyl Salicylate
Glucosamine and Chondroitin
• Exact mechanism is not known (and effect has not been demonstrated)
- Both glucosamine and chondroitin have in vitro anti‐inflammatory activity and are proposed to prevent breakdown of synovial structures
•Exogenous glucosamine has been shown to distribute to joints (knees) and increase the synthesis of hyaluronic acid
Glucosamine and chondroitin concerns
- Not FDA regulated: No proven safety or efficacy, FDA can restrict sale only if problems occur with their use
- Allergic reactions can still occur: Can be serious such as anaphylactic shock
- Toxicities: Direct, Unlisted poisonous ingredients, Excessive pharmacologic activity
- Adulteration/Contamination: May contain elements such as lead, mercury, arsenic, zinc, aluminum and tin; May contain conventional drugs such as Tylenol or aspirin
The dirty dozen
- aristolochic acid
- comfrey
- androstenedione
- chaparral
- germander
- kava kava
- bitter orange
- organ/glandular extracts
- lobelia
- pennyroyal oil
- scullcap
- yohimbe
