About Herbs

Introduction

I come across this product on a pharmacy shelf. My first thought was what this product is about.

Opceden Kacip Fatimah Plus

**Just a disclaimer, I am not reviewing this product here, but to have a discussion on herbs and supplements. Plus, although I have lived at Malaysia for more than 20 years, the only Malay herbs that I know of is Tongkat Ali and I never use it.**

Being trained in western medicine, I have little knowledge on herbs. A summary of what I have learned in university and own readings is

  • For most herbs, there is often a lack of quality evidence or huge clinical trials to support the use of any indication.
  • What complicates the situation more is that there could be a wide-ranging doses and differing preparations have been used in clinical studies.

Just a quick question here, do you know what is the common dose of St. John Wort, or for what is it commonly used?

  • Yup, back in university, St. John Wort is such a common herb that we highlight whenever we are discussing on potential drug-herb interactions, but we often never look deep into evidences supporting the use.

However, at community pharmacy, a customer may come and put forward a query on supplements, such as:

  • Is there any supplements that can help to improve my blood circulation?
  • I heard that fenugreek could be useful in diabetes mellitus management...
  • I am having some problems with prostate due to aging, is there any supplements that I can take?
  • Is it true that calcium supplementation increase the risks of cardiovascular diseases?

Well, the list of questions goes on.

Commonly Used Herbal Medications Commonly Used Herbal Medications Commonly Used Herbal Medications

However, is there any evidence-based source that we can look up to have a concise summary?



Reference

Below are FREE online references that I personally found to be somewhat useful.

My favourite natural product textbooks are

  • Review of Natural Products
    • Covering over 400 fully referenced, peer-reviewed monographs.
    • The same content of this book is presented in Lexicomp's Natural Product database.
  • Herbs and Natural Supplements
    • Volume 1 provides a foundation of knowledge in the clinical practice of complementary medicine.
    • Volume 2 provides current, evidence-based monographs on the 132 most popular herbs, nutrients and food supplements.

The Review of Natural Products Herbs and Natural Supplements



Regulations

In US, herbal supplements are regulated by the FDA, but not as drugs or as foods. They fall under a category called dietary supplements.

  • Under the rules for dietary supplements, manufacturers do not have to seek FDA approval before selling dietary supplements and can claim products address a nutrient deficiency, support health or are linked to body functions (but NOT allowed to make a specific medical claim).
  • FDA requires the labels of all herbal supplements to include the complete list of ingredients and manufacturers must follow good manufacturing practices (GMP) to ensure that supplements are processed consistently and meet quality standards.

In Australia, medicines approved for supply display an ARTG number.

  • The ARTG number starts with "AUST" and is followed by an "R", "L" or "L(A)".
  • Medicines with AUST R and AUST L(A) are assessed for efficacy, while those with AUST L are not.
  • In other words, for herbs or supplements to be marketed with AUST L, they are only need to be ensured for quality and safety.



Personal Stance

Well, what is my stance on the use of herbs and supplements?

  • It is complicated. I do not believe anything natural is good or safe. Neither do I think that all herbs are useless.
  • On the principle of "first, do no harm", I would say that for minor conditions such as pre-diabetes, you may give herbs and supplements a try (coupled with lifestyle changes).
  • However, please seek medical attention immediately whenever needed (for example, stroke, myocardial infarction, cancer).

Just before you start using any supplements, check with your health care professionals for any precautions that you should watch out for. Some examples are listed here:

  • Bilberry may inhibit platelet aggregation and potentially has an anticoagulant effect.
  • Increased hypoglycaemic effect when bitter melon is coadministered with some oral antidiabetic agents has been demonstrated in animals.
  • There are concerns on black cohosh regarding rare, but serious, hepatotoxicity. Signs of liver toxicity include nausea, fatigue, loss of appetite, abdominal pain, itchy skin, pale stools, dark urine and jaundice.
  • Coenzyme Q-10 may diminish or enhance the anticoagulant effect of vitamin K antagonist (e.g. warfarin).
  • Cranberry may enhance the effects of vitamin K antagonists. Monitor therapy.
  • Evening primrose oil was previously suspected to lower the seizure threshold in schizophrenic patients; however, this is now disputed.
  • Fenugreek has been documented to have uterine stimulant effects and has been used in traditional medicine to induce childbirth. Avoid in pregnancy.
  • Feverfew not to be used during pregnancy since it can cause uterine contractions. May increase the effects of antiplatelets.
  • Garlic may enhance the effects of antiplatelet agents, anticoagulants and antidiabetic drugs such as metformin.
  • Ginkgo should be used with caution in populations with bleeding risks. Case reports of increased bleeding risk exist, but clinical trials have found no effect on platelet function.
  • As glucosamine is derived from the exoskeletons of shellfish, caution should be used in patients with a shellfish allergy.
  • Use caution when administering glucosamine and chondroitin to individuals with uncontrolled diabetes.
  • Kava supplements have been linked to risk of severe liver injury (could be fatal).
  • Although no recent clinical data has been published, the German Commission E monograph concluded that the linden flower is cardiotoxic.
  • Milk thistle may lower blood sugar levels in people with type 2 diabetes.
  • Caution is warranted for passion flower with concomitant consumption of CNS-active medicines and coadministration of drugs that prolong QT interval.
  • Red yeast rice should not be taken if one already started on statins (cholesterol lowering medications).
  • Saw palmetto may enhance the adverse/toxic effect of oestrogen derivatives and the anticoagulant effect of warfarin.
  • Senna is contraindicated in patients with intestinal obstruction, ulcerative colitis, appendicitis, and Crohn disease. Senna is not recommended for children younger than 2 years.
  • St. John's wort has been reported to interact with numerous drugs. Also, it may cause increased sensitivity to sunlight, especially when taken in large doses.
  • Turmeric should not be used in patients with gallstones or bile duct or passage obstruction. Avoid use during pregnancy and lactation because of emmenagogue and uterine stimulant effects.

Last but not the least, please buy your supplements from a reputable brand. Thanks.



External Links

Comments

Post a Comment