Ginkgo

 

Overview

Ginkgo (Ginkgo biloba) is one of the oldest living tree species and its leaves are among the most extensively studied botanicals in use today. In Europe and the United States, ginkgo supplements are among the best-selling herbal medications. It consistently ranks as a top medicine prescribed in France and Germany.

Ginkgo has been used in traditional medicine to treat circulatory disorders and enhance memory. Scientific studies throughout the years have found evidence to support these uses. Although not all studies agree, ginkgo may be especially effective in treating dementia (including Alzheimer's disease) and intermittent claudication (poor circulation in the legs). It also shows promise for enhancing memory in older adults. Laboratory studies have shown that ginkgo improves blood circulation by dilating blood vessels and reducing the stickiness of blood platelets.

Ginkgo leaves contain two types of chemicals (flavonoids and terpenoids) believed to have potent antioxidant properties. Antioxidants are substances that scavenge free radicals -- compounds in the body that damage cell membranes, tamper with DNA, and even cause cell death. Free radicals occur naturally in the body and grow in number as we age. But environmental toxins (including ultraviolet light, radiation, cigarette smoking, and air pollution) can also increase the number of free radicals. Free radicals are believed to contribute to health problems including heart disease and cancer as well as Alzheimer's disease and other forms of dementia. Antioxidants such as those found in ginkgo can help neutralize free radicals and may reduce or even help prevent some of the damage they cause.

 

 

 

Plant Description

Ginkgo biloba is the oldest living tree species. A single tree can live as long as 1,000 years and grow to a height of 120 feet. It has short branches with fan-shaped leaves and inedible fruits that produce a strong odor. The fruit contains an inner seed, and there has been a report of a human poisoning from ingesting the seed. Ginkgos are tough, hardy trees and are sometimes planted along urban streets in the United States.

Although Chinese herbal medicine has used both the ginkgo leaf and seed for thousands of years, modern research has focused on the standardized Ginkgo biloba extract (GBE), which is prepared from the dried green leaves. This standardized extract is highly concentrated and seems to be clinically more effective in treating health problems (particularly circulatory ailments) than the non-standardized leaf alone.

 

 

 

What's It Made Of?

More than 40 components isolated from the ginkgo tree have been identified, but only two are believed to be responsible for the herb's medicinal effects: flavonoids and terpenoids. Flavonoids are plant-based antioxidants. Laboratory and animal studies have shown that flavonoids protect the nerves, heart muscle, blood vessels, and retina from damage. Terpenoids (such as ginkgolides) improve blood flow by dilating blood vessels and reducing the stickiness of platelets.

 

 

 

Medicinal Uses and Indications

Based on studies conducted in laboratories, animals, and humans, gingko is used for the following:

Dementia and Alzheimer's disease

Ginkgo is widely used in Europe for treating dementia. It was used originally because it improves blood flow to the brain. Now further study suggests it may work directly to protect nerve cells that are damaged in Alzheimer's disease. A number of studies have found that gingko has a positive effect on memory and thinking in people with Alzheimer's or vascular dementia.

Clinical studies suggest that ginkgo may provide the following benefits for people with Alzheimer's disease:

Improvement in thinking, learning, and memory (cognitive function)

Improvement in activities of daily living

Improvement in social behavior

Fewer feelings of depression

Several studies have found that ginkgo may be as effective as prescription Alzheimer's medications in delaying the symptoms of dementia.

However, one of the longest and best-designed studies found ginkgo was no better than placebo in reducing Alzheimer's symptoms. In a 2008 study, 176 people in the United Kingdom with Alzheimer's took either ginkgo or placebo for 6 months. At the end of the study there was no difference in cognitive function or quality of life between the groups.

Ginkgo is sometimes suggested to prevent Alzheimer's and dementia, as well, and some studies have suggested it might be helpful. But in 2008, a well-designed study (the GEM study) with more than 3,000 elderly participants found the ginkgo was no better than placebo in preventing dementia or Alzheimer's.

Intermittent Claudication

Because ginkgo improves blood flow, it has been studied in people with intermittent claudication (pain caused by reduced blood flow to the legs). People with intermittent claudication have a hard time walking without feeling extreme pain. An analysis of eight published studies revealed that people taking ginkgo tend to walk roughly 34 meters farther than those taking placebo. In fact, ginkgo has been shown to be as effective as a prescription medication in improving pain-free walking distance. However, regular walking exercises are more beneficial than ginkgo in improving walking distance.

Glaucoma

One small study found that people with glaucoma who took 120 mg of ginkgo daily for 8 weeks had improvements in their vision.

Memory Enhancement

Ginkgo is widely touted as a "brain herb." It has been studied to see whether it can improve memory in people with dementia, and some studies found it did help. It's less clear whether ginkgo helps improve memory in healthy people who experience normal memory loss that comes with age. Some studies have found slight benefits, while other studies have found no effect on memory. The most effective dose seems to be greater than or equal to 240 mg per day. Ginkgo is commonly added to nutrition bars, soft drinks, and fruit smoothies to boost memory and enhance cognitive performance, although it's doubtful that such small amounts of gingko would be effective.

Macular Degeneration

The flavonoids found in ginkgo may help stop or lessen some retinal problems (problems with the back part of the eye). Macular degeneration (often called age-related macular degeneration or ARMD) is an eye disease that affects the retina. It is a progressive, degenerative eye disease that tends to affect older adults and is the number one cause of blindness in the United States. Some studies suggest that gingko may help preserve vision in those with ARMD.

Tinnitus

Nerve damage and certain blood vessel disorders can lead to tinnitus (ringing, hissing, or other sound in the ears or head when no external sound is present). Because ginkgo improves circulation, it has been studied to see whether it can treat tinnitus. A few poorly designed studies found it might moderately relieve the loudness of the tinnitus sound. However, a well-designed study including 1,121 people with tinnitus found that ginkgo (taken 3 times daily for 3 months) was no more effective than placebo in relieving symptoms of tinnitus. In general, tinnitus is a very difficult problem to treat.

Other

A standardized ginkgo extract was reported to significantly improve functional measures (such as coordination, energy level, strength, mental performance, mood, and sensation) in 22 people with multiple sclerosis (MS).

 

 

 

Available Forms

Standardized extracts containing 24 - 32% flavonoids (also known as flavone glycosides or heterosides) and 6 - 12% terpenoids (triterpene lactones)

Capsules

Tablets

Liquid extracts (tinctures, fluid extracts, glycerites)

Dried leaf for teas

 

 

 

How to Take It

Pediatric

Ginkgo is not generally used in children.

Adult

Initial results often take 4 - 6 weeks, but should grow stronger beyond that period.

Memory impairment and cardiovascular function: Generally, 120 mg daily in divided doses, standardized to contain 24 - 32% flavone glycosides (flavonoids or heterosides) and 6 - 12% triterpene lactones (terpenoids). If more serious dementia or Alzheimer's disease is present, up to 240 mg daily, in 2 or 3 divided doses, may be necessary.

Intermittent claudication: 120 - 240 mg per day

 

 

 

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider qualified in the field of botanical medicine.

GBE is generally considered to be safe, and side effects are rare. In a few cases, gastrointestinal upset, headaches, skin reactions, and dizziness were reported.

There have been a number of reports of internal bleeding in people who take ginkgo. However, it is not clear whether ginkgo was responsible or whether there was another cause (whether a combination of ginkgo and blood-thinning drugs caused the bleeding, for example). One human study found that ginkgo significantly prolonged bleeding time when given along with cilostazol (Pletal), a commonly used blood-thinner. However, other studies found that gingko combined with warfarin (Coumadin) did not prolong bleeding time. Because of the uncertainty, you should ask your doctor before taking gingko if you also take blood-thinning drugs.

If you take gingko, you should stop taking it at least 36 hours prior to surgery or dental procedures due to the risk of bleeding complications. Tell your doctor or dentist that you take gingko.

People who have epilepsy should not take gingko, because there is concern that it might cause seizures.

Pregnant and breastfeeding women should not take gingko.

Do not eat Ginkgo biloba fruit or seed.

 

 

 

Possible Interactions

Ginkgo may alter the metabolism and effectiveness of some prescription and non-prescription medications. If you are being treated with any of the following medications, you should not use ginkgo without first talking to your health care provider:

Anticonvulsant medications -- High doses of ginkgo could make drugs to control seizures, such as carbamazepine (Tegretol) or valproic acid (Depakote), less effective.

Antidepressants -- Taking ginkgo along with selective serotonin reuptake inhibitor (SSRIs) antidepressants may increase the risk of serotonin syndrome, a potentially fatal condition. Ginkgo may enhance the effects (both good and bad) of antidepressant medications known as MAOIs, such as phenelzine (Nardil). SSRIs include:

Citalopram (Celexa)

Escitalopram (Lexapro)

Fluoxetine (Prozac)

Fluvoxamine (Luvox)

Paroxetine (Paxil)

Sertraline (Zoloft)

Antihypertensive (blood pressure) medications -- Ginkgo may lower blood pressure. For that reason, if you take medication to lower your blood pressure you should ask your doctor before taking gingko. There has been a report of an interaction between ginkgo and nifedipine (Procardia), a calcium channel blocker used for blood pressure and arrhythmias.

Blood-thinning medications -- Ginkgo has blood-thinning properties and should not be used if you are taking anticoagulant (blood-thinning) medications. There has been bleeding in the brain reported when using a ginkgo product and ibuprofen (Advil), a non-steroidal anti-inflammatory drug (NSAID). Blood-thinners include:

Aspirin

Clopidogrel (Plavix)

Heparin

Warfarin (Coumadin)

Medications to lower blood sugar -- Ginkgo may increase insulin levels in healthy subjects and decrease insulin levels in people with diabetes. If you have diabetes, you should not use gingko without first talking to your doctor.

Cylosporine -- Ginkgo biloba may help protect the cells of the body during treatment with the drug cyclosporine, which suppresses the immune system.

Thiazide diuretics(water pills) -- There is one report of a person who took a thiazide diuretic and gingko experiencing high blood pressure. If you take thiazide diuretics, ask your doctor before taking gingko.

Trazodone -- There is one report of an elderly Alzheimer's patient going into a coma after taking ginkgo and trazodone (Desyrel), an antidepressant medication.

Ginseng

 

 

Overview

The name "ginseng" is used to refer to both American (Panax quinquefolius) and Asian or Korean ginseng (Panax ginseng), which belong to the species Panax and have a somewhat similar chemical makeup. Siberian ginseng or Eleuthero (Eleutherococcus senticosus), on the other hand, is an entirely different plant with different effects. It is distantly related to ginseng, but it does not contain the same active ingredients. Both Asian and American ginseng contain ginsenosides, substances that are thought to give ginseng its medicinal properties.

Like American ginseng, Asian ginseng is a light tan, gnarled root that often looks like a human body with stringy shoots for arms and legs. Thousands of years ago, herbalists thought that because of the way ginseng looks it could treat many different kinds of ailments, from fatigue and stress to asthma and cancer. In traditional Chinese medicine, ginseng was often combined with other herbs and used often to bring longevity, strength, and wisdom to its users.

Ginseng is sometimes called an "adaptogen," an herb that helps the body deal with various kinds of stress, although there is no scientific evidence of adaptogens. But ginseng has been studied for several conditions, and it remains of the most popular herbs in the United States. Many of the studies examining Asian or Korean ginseng have used combinations of herbs, so it's not always possible to say whether ginseng alone had any benefit. Research on Asian ginseng has included the following:

Immune system health

Asian ginseng is believed to enhance the immune system, possibly helping the body fight off infection and disease. Several clinical studies report that Asian ginseng can improve immune function. Studies have found that ginseng seems to increase the number of immune cells in the blood, and improve the immune system's response to a flu vaccine. In one study, 227 participants received either ginseng or placebo for 12 weeks, with a flu shot administered after 4 weeks. The number of colds and flu were two-thirds lower in the group that took ginseng.

Cardiovascular health

Asian ginseng seems to have antioxidant effects, meaning it helps rid the body of free radicals, substances which can damage DNA and are thought to contribute to heart disease, diabetes, and other conditions. Preliminary studies suggest Asian ginseng may improve the symptoms of heart disease in humans. It also may decrease "bad" LDL cholesterol levels and raise "good" HDL cholesterol.

Its effect on blood pressure is more complicated. Some studies have found it seems to lower blood pressure, while others find it causes blood pressure to rise. That had led some people to theorize that ginseng may increase blood pressure at usual doses but lower it when doses are higher. Until researchers know for sure, you should not take ginseng if you have high blood pressure unless your doctor tells you it's OK.

Type 2 diabetes

Although American ginseng has been studied more for diabetes, both types of Panax ginsengs may lower blood sugar levels in those with type 2 diabetes. However, in a few studies it appeared that Asian or Korean ginseng worsened blood sugar levels. Some people think that the ginsenosides found in American ginseng might lower blood sugar while the different ginsenosides in Asian ginseng could raise blood sugar levels. Until more is known, you should not take ginseng if you have diabetes without your doctor's strict supervision and monitoring.

Mental performance

People who take ginseng often say they feel more alert. Several studies report that Asian ginseng may slightly improve thinking or learning. Early research shows that Asian ginseng may improve performance on such things as mental arithmetic, concentration, memory, and other measures. More research in this area, although not easy to do, would be helpful. Some studies have also found a positive effect with the combination use of Asian ginseng and Ginkgo biloba.

The studies have varied in what kinds of mental function they measured, making it hard to know exactly what the effects of ginseng are. For example, one study found an increase in the ability think abstractly among those who took ginseng, but no change in their reaction time or concentration levels.

Physical endurance

There have been a number of studies using Asian ginseng for athletic performance in humans and laboratory animals. Results have been mixed, with some studies showing increased strength and endurance, others showing improved agility or reaction time, and others showing no effect at all. Nevertheless, athletes often take Asian ginseng to boost both endurance and strength. Asian ginseng was also found to reduce fatigue in a study of 332 patients.

Stress andwell-being

Asian ginseng is sometimes called an "adaptogen," something that helps the body deal with stress, whether physical or mental. While that can be difficult to study, there is some evidence that ginseng (both Asian and American types) can improve quality of life -- although quality of life can be hard to measure, too. A study of 501 men and women living in Mexico City found significant improvements in quality of life measures (energy, sleep, sex life, personal satisfaction, well-being) in those taking Asian ginseng. Another well-designed study found that people taking a nutritional supplement with ginseng reported better quality of life than those taking the same supplement without ginseng.

Fertility/erectile dysfunction

Asian ginseng is widely believed to be capable of enhancing sexual performance, but there aren't many studies to back this up. In animal studies, Asian ginseng has increased sperm production, sexual activity, and sexual performance. A study of 46 men has also shown an increase in sperm count as well as motility. Another study in 60 men found that Asian ginseng increased libido (sex drive) and decreased erection problems.

Alzheimer's disease

Individual reports and animal studies indicate that Asian ginseng may slow the progression of Alzheimer's, decrease senility, and improve memory and behavior. Studies of large groups of people are needed.

Cancer

Several studies suggest that Asian ginseng may reduce the risk of some types of cancers. In one observational study, researchers followed 4,634 people for 5 years and found that those who took ginseng had lower risk of lung, liver, pancreatic, ovarian, and stomach cancer. However, the study could not rule out other factors being responsible for the lower risk of cancer (including eating habits). And it found that taking ginseng as few as 3 times a year led to a dramatic reduction in cancer risk, which is hard to believe.

A number of studies have found that Asian ginseng seems to inhibit the growth of tumors, although researchers aren't yet sure how it might work in humans. More research is needed.

Menopausal symptoms

There have been only a few studies examining ginseng for menopausal symptoms. Two well-designed studies evaluating red Korean (Asian) ginseng suggest it may relieve some of the symptoms of menopause, improving mood (particularly feelings of depression) and sense of well-being. The ginseng product was used in combination with a vitamin and mineral supplement. But another double-blind, placebo-controlled study of 384 women found no effect.

 

 

 

Plant Description

The ginseng plant has leaves that grow in a circle around a straight stem. Yellowish-green umbrella-shaped flowers grow in the center and produce red berries. Ginseng has a taproot that roughly resembles the human body, with 2 "arms" and 2 "legs." Wrinkles around the neck of the root tell how old the plant is. Ginseng is not ready for medicinal use until it has grown for about 6 years. Asian or Chinese and Korean ginseng are the same plants, but grown in different areas. American ginseng is a relative in the same species, native to North America.

 

 

 

What's It Made Of?

Asian ginseng supplements are made from the ginseng root, and the long, thin offshoots, called root hairs. Both Asian or Korean and American ginseng contain ginsenosides, saponins that are ginseng's active ingredients. In addition to ginsenosides, Asian ginseng also contains glycans (panaxans), polysaccharide fraction DPG-3-2, peptides, maltol, B vitamins, flavonoids, and volatile oil.

 

 

 

Available Forms

White ginseng (dried, peeled) or red ginseng (unpeeled root, steamed before drying) is available in water, water-and-alcohol, or alcohol liquid extracts, and in powders or capsules. Asian ginseng root is also available for making decoctions (boiling the root in water)

Be sure to read the label carefully so that you are purchasing the type of ginseng that you want. If you are looking for Asian ginseng, make sure you buy Korean, red, or Panax ginseng. If you are looking for American ginseng, you should buy Panax quinquefolius. Eleuthero (Eleutherococcus senticosus), which is sometimes called Siberian ginseng, may also be found in health food stores or pharmacies. It does not have the same active ingredients as Asian or American ginseng.

 

 

 

How to Take It

Pediatric

Ginseng is not recommended for use in children because of its stimulant properties.

Adult

Standardized extract: 200 mg, 1 - 3 times daily, standardized to contain 4 - 5% ginsenosides

Fresh root: 1 - 2 g, once daily for up to 3 months

Dried root: 1/2 - 2 g, chew and swallow once daily

Tincture (1:5): 1 - 2 teaspoonfuls, 1 - 3 times daily

Fluid extract (1:1): 1/4 - 1/2 teaspoonful, 1 - 3 times daily

In healthy people who wish to increase physical or mental performance, to prevent illness, or to improve resistance to stress, Asian ginseng should be taken in cycles. For example, take every day for 2 - 3 weeks, then stop for 2 weeks, then resume.

For help recovering from an illness, older people should take larger doses, such as 500 mg, 2 times daily for 3 months. Alternatively, they may take the same dosage (500 mg, 2 times daily) for 1 month, followed by a 2-month break. This can then be repeated if needed. Ask your health care provider for more information.

 

 

 

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider qualified in the field of botanical medicine.

Asian ginseng may cause nervousness or sleeplessness, particularly if taken at high doses or when combined with caffeine. Other side effects are rare but may include:

High blood pressure

Insomnia

Restlessness

Anxiety

Euphoria

Diarrhea

Vomiting

Headache

Nosebleed

Breast pain

Vaginal bleeding

To avoid hypoglycemia (low blood sugar), even in people without diabetes, take Asian ginseng with food.

People with hypertension (high blood pressure) should not take Asian ginseng products without the close supervision of their doctor. At the same time, people with low blood pressure, as well as those with an acute illness, should use caution when taking Asian ginseng.

People with bipolar disorder should not take ginseng, because it may increase the risk of mania.

Pregnant or breastfeeding women should not take Asian ginseng. Asian ginseng may cause vaginal bleeding.

Women who have a history of breast cancer should not take ginseng.

Stop taking Asian ginseng at least 7 days prior to surgery. Asian ginseng may act as a blood thinner, increasing the risk of bleeding during or after a procedure.

 

 

 

Possible Interactions

If you are currently being treated with any of the following medications, you should not use Asian ginseng without first talking to your health care provider:

ACE inhibitors (blood pressure medications) -- Asian ginseng may interact with angiotensin-converting enzyme (ACE) inhibitors. These medications include:

Captopril (Capoten)

Benazepril (Lotensin)

Enalapril (Vasotec)

Lisinopril (Prinivil, Zestril)

Fosinopril (Monopril)

Ramipril (Altace)

Perindopril (Aceon)

Quinapril (Accupril)

Moexipril (Univasc)

Trandolapril (Mavik)

Calcium channel blockers (heart and blood pressure medications) -- Asian ginseng may alter the effects of certain heart medications, including calcium channel blockers. These medications include:

Amlodipine (Norvasc)

Diltiazem (Cardizem)

Nifedipine (Procardia)

Blood thinning medications (anticoagulants) -- Asian ginseng may decrease the effectiveness of the blood-thinning medication warfarin. In addition, ginseng may inhibit platelet activity. For this reason, it should probably not be used with aspirin.

Caffeine -- Ginseng may increase the stimulant effect of caffeine, possibly causing nervousness, sweating, insomnia, or irregular heartbeat.

Diabetes medications -- Ginseng may lower blood sugar levels, increasing the risk of hypoglycemia (low blood sugar).

Stimulants -- Ginseng may increase the stimulant effect and side effects of some medications take for attention deficit hyperactivity disorder, including amphetamine and dextroamphetamine (Adderall) and methylphenidate (Concerta, Ritalin).

MAOIs (monoamine oxidase inhibitors) -- Ginseng may increase the risk of mania when taken with MAOIs, a type of antidepressant. There have been reports of interaction between ginseng and phenelzine (Nardil) causing headaches, tremors, and mania.

Isocarboxazid (Marplan)

Phenelzine (Nardil)

Tranylcypromine (Parnate)

Morphine -- Asian ginseng may block the painkilling effects of morphine.

Goldenseal

 

Overview

Goldenseal (Hydrastis canadensis) was originally introduced to early American settlers by Native American tribes, who used it primarily for skin problems, digestive disorders, and as a wash for sore eyes. It is now one of the most popular herbs in the United States, although there is little scientific evidence for its effects.

Part of goldenseal's popularity is likely due to the rumor that taking the herb can help mask a positive test for illegal drugs. There's no real evidence that it works, and several studies have reported that taking goldenseal does not alter the results of a drug test.

Goldenseal is often combined with echinacea in cold remedies, but there is no evidence that it works. However, as goldenseal has soared in popularity, it has become overharvested. In 1997, the Convention on International Trade in Endangered Species of Wild Fauna and Flora reported that goldenseal is at risk of becoming an endangered species. As a result, the international trade of goldenseal continues to be closely controlled and monitored.

 

 

 

Plant Description

Goldenseal is a small plant with a single hairy stem. It has two five-lobed, jagged leaves, small flowers, and raspberry-like fruit. The bitter-tasting rhizome, or root, is a bright yellow-brown in color, twisted, and wrinkled. Goldenseal can be found growing wild in rich, shady soil in the northern United States, but is now grown mostly on farms.

 

 

 

What's It Made Of?

Goldenseal contains a compound called berberine that kills many types of bacteria in test tubes, including the ones that cause diarrhea. Berberine has also been shown to kill a wide range of other types of germs in test tubes, such as those that cause candida (yeast) infections and various parasites such as tapeworms and Giardia. Berberine may also activate white blood cells, making them more effective at fighting infection and strengthening the immune system. Berberine is sometimes used as an antibiotic and disinfectant, both externally and internally. Berberine may also be useful in heart failure. However, it's traditionally thought that the berberine in goldenseal isn't absorbed well in the intestinal tract.

 

 

 

Medicinal Uses and Indications

Antibiotic or Immune Booster

Today, goldenseal is marketed as a tonic to aid digestion, sooth upset stomach, and as an antibacterial agent. It is considered a natural antibiotic and is most often combined with echinacea in preparations designed to strengthen the immune system. However, only one study found that goldenseal might help boost white blood cells (a measure of the infection-fighting ability of the immune system), and it wasn't well designed.

Upper respiratory problems

Goldenseal is often found in herbal remedies for hay fever (also called allergic rhinitis), colds, and the flu. There's no real evidence that it works in humans to treat upper respiratory infections or allergies, however. It may help ease a sore throat, which often accompanies cold or flu.

Minor wounds

Because goldenseal appears to have antiseptic properties in test tubes, it's sometimes used to disinfect cuts and scrapes.

Other

It is commonly used to treat several skin, eye, and mucous membrane inflammatory and infectious conditions (such as sinusitis, conjunctivitis, and urinary tract infections). It is also available in mouthwashes for sore throats and canker sores.

Goldenseal has not been investigated in many scientific studies. Some trials have looked at berberine, one of the active compounds in goldenseal. Berberine is widely used in Traditional Chinese Medicine to treat dysentery and infectious diarrhea. Berberine may be effective in humans for malaria, heart failure, and various types of infections, including upper respiratory problems. It may also dilate blood vessels and help in treating heart failure. However, oral goldenseal contains only trace amounts of berberine, so it's impossible to say whether the herb would be effective or not.

 

 

 

Available Forms

Goldenseal supplements are available as tablets and capsules (containing the powdered root), liquid extracts, and glycerites (low-alcohol extracts). Goldenseal is commonly found in combination with the herb echinacea.

 

 

 

How to Take It

Pediatric

Goldenseal is not recommended for children unless under a doctor's supervision.

Adult

Capsules or tablets: 500 - 1,000 mg, up to 3 times daily

Standardized extract: 30 - 120 mg, up to 3 times daily

Tinctures (1:5): 2 - 3 mL, three times daily

For disinfecting cuts, scrapes, boils, and acne: Place goldenseal liquid extract on a clean cloth, and press the cloth gently on the affected area.

For sore throat, gums, or mouth, make a mouthwash as follows: In one cup of warm water, mix 1/4 tsp salt and 1/2 tsp (or the contents of one capsule) of goldenseal powder. (It will not dissolve completely.) Rinse and spit out.

For vaginal irritation, make a goldenseal douche as follows: Mix 1/4 tsp salt and 1/2 tsp (or the contents of one capsule) of goldenseal powder in 1 cup of warm water. Let the mixture settle, and strain out any suspended particles before using it. (Keep the mixture as clean as you can.) Douching can make you more susceptible to certain kinds of vaginal infections. See your health care provider if your symptoms do not improve after a few days.

For eye infections and irritations, make an eyewash as follows: Use one cup of sterile water with 1/4 tsp salt and 1/2 tsp goldenseal and strain out all particles. Discard if the solution becomes cloudy, which indicates bacterial growth or spoilage.

 

 

 

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider qualified in the field of botanical medicine.

Pregnant or breastfeeding women should not use goldenseal.

People with high blood pressure, liver disease, or heart disease should ask their doctor before taking goldenseal.

Goldenseal can irritate the skin, mouth, throat, and vagina. It may also cause an increased sensitivity to sunlight.

Goldenseal may interfere with the metabolism and effectiveness of certain medications. If you are taking prescription or non-prescription medications, ask your doctor before taking goldenseal.

 

 

 

Possible Interactions

A few studies report interactions between berberine (a major component of goldenseal) and prescription or non-prescription medicines.

Tetracycline -- One study reported that berberine may decrease the effectiveness of tetracycline antibiotics.

Anticoagulants (blood thinners) -- Theoretically, goldenseal and berberine could increase the risk of bleeding, especially if you take blood thinners. These medications include:

Warfarin (Coumadin)

Aspirin

Other laboratory studies report that berberine may change liver metabolism, possibly affecting the levels of medications processed in the liver. Several studies suggest that goldenseal itself does not interact with medicines metabolized by the liver (including an antiviral drug used in HIV infection and digoxin). However, if you are taking prescription or non-prescription medications, ask your doctor before taking goldenseal.

Green Tea

 

Overview

Archeological evidence suggests that people consumed tea leaves steeped in boiling water as many as 5,000 years ago. Botanical evidence indicates that India and China were among the first countries to cultivate tea. Today, tea is the most widely consumed beverage in the world, second only to water. Hundreds of millions of people drink tea around the world, and studies suggest that green tea (Camellia sinesis) in particular has many health benefits.

There are three main varieties of tea -- green, black, and oolong. The difference between the teas is in their processing. Green tea is made from unfermented leaves and reportedly contains the highest concentration of powerful antioxidants called polyphenols. Antioxidants are substances that scavenge free radicals -- damaging compounds in the body that alter cells, tamper with DNA (genetic material), and even cause cell death. Free radicals occur naturally in the body, but environmental toxins (including ultraviolet rays from the sun, radiation, cigarette smoke, and air pollution) also give rise to these damaging particles. Many scientists believe that free radicals contribute to the aging process as well as the development of a number of health problems, including cancer and heart disease. Antioxidants such as polyphenols in green tea can neutralize free radicals and may reduce or even help prevent some of the damage they cause.

Green tea has been consumed throughout the ages in India, China, Japan, and Thailand. In traditional Chinese and Indian medicine, practitioners used green tea as a stimulant, diuretic (to promote the excretion of urine), astringent (to control bleeding and help heal wounds), and to improve heart health. Other traditional uses of green tea include treating flatulence (gas), regulating body temperature and blood sugar, promoting digestion, and improving mental processes.

Green tea has been extensively studied in people, animals, and laboratory experiments. Results from these studies suggest that green tea may be useful for the following health conditions:

Atherosclerosis

Population-based clinical studies indicate that the antioxidant properties of green tea may help prevent atherosclerosis, particularly coronary artery disease. (Population-based studies means studies that follow large groups of people over time or studies that are comparing groups of people living in different cultures or with different dietary habits.) Researchers aren't sure why green tea reduces the risk of heart disease by lowering cholesterol and triglyceride levels. Studies show that black tea has similar beneficial effects. In fact, researchers estimate that the rate of heart attack decreases by 11% with consumption of 3 cups of tea per day. In May 2006, however, the U.S. Food and Drug Administration (FDA) rejected a petition from teamakers to allow tea labels to claim that green tea reduces the risk of heart disease. The FDA concluded that there is no credible evidence to support qualified health claims for green tea or green tea extract reducing the risk of heart disease.

High cholesterol

Research shows that green tea lowers total cholesterol and raises HDL ("good") cholesterol in both animals and people. One population-based clinical study found that men who drink green tea are more likely to have lower total cholesterol than those who do not drink green tea. Results from one animal study suggest that polyphenols in green tea may block the intestinal absorption of cholesterol and promote its excretion from the body. In another small study of male smokers, researchers found that green tea significantly reduced blood levels of harmful LDL cholesterol.

Cancer

Several population-based clinical studies have shown that both green and black teas help protect against cancer. For example, cancer rates tend to be low in countries such as Japan where people regularly consume green tea. However, it is not possible to determine from these population-based studies whether green tea actually prevents cancer in people. Emerging clinical studies suggest that the polyphenols in tea, especially green tea, may play an important role in the prevention of cancer. Researchers also believe that polyphenols help kill cancerous cells and stop their progression.

Bladder cancer. Only a few clinical studies have examined the relationship between bladder cancer and tea consumption. In one study that compared people with and without bladder cancer, researchers found that women who drank black tea and powdered green tea were less likely to develop bladder cancer. A follow-up clinical study by the same group of researchers revealed that bladder cancer patients (particularly men) who drank green tea had a substantially better 5-year survival rate than those who did not.

Breast cancer. Clinical studies in animals and test tubes suggest that polyphenols in green tea inhibit the growth of breast cancer cells. In one study of 472 women with various stages of breast cancer, researchers found that women who consumed the most green tea experienced the least spread of cancer (particularly premenopausal women in the early stages of breast cancer). They also found that women with early stages of the disease who drank at least 5 cups of tea every day before being diagnosed with cancer were less likely to suffer recurrences of the disease after completion of treatment. However, women with late stages of breast cancer experienced little or no improvement from drinking green tea. In terms of breast cancer prevention, the studies are inconclusive. In one very large study, researchers found that drinking tea, green or any other type, was not associated with a reduced risk of breast cancer. However, when the researchers broke down the sample by age, among women under the age of 50, those who consumed 3 or more cups of tea per day were 37% less likely to develop breast cancer compared to women who didn't drink tea.

Ovarian cancer. In a clinical study conducted on ovarian cancer patients in China, researchers found that women who drank at least one cup of green tea per day survived longer with the disease than those who didn’t drink green tea. In fact, those who drank the most tea, lived the longest. Other studies found no beneficial effects.

Colorectal cancer. Clinical studies on the effects of green tea on colon or rectal cancer have produced conflicting results. Some clinical studies show decreased risk in those who drink the tea, while others show increased risk. In one study, women who drank 5 or more cups of green tea per day had a significantly lower risk of colorectal cancer compared to non-tea-drinkers. There was no effect in men, however. Other studies show that regular tea consumption may reduce the risk of colorectal cancer in women. Further research is needed before researchers can recommend green tea for the prevention of colorectal cancer.

Esophageal cancer. Studies in laboratory animals have found that green tea polyphenols inhibit the growth of esophageal cancer cells. However, clinical studies in people have produced conflicting findings. For example, one large-scale population-based clinical study found that green tea offered significant protection against the development of esophageal cancer (particularly among women). Another population-based clinical study revealed just the opposite -- green tea consumption was associated with an increased risk of esophageal cancer. In fact, the stronger and hotter the tea, the greater the risk. Given these conflicting results, further research is needed before scientists can recommend green tea for the prevention of esophageal cancer.

Lung cancer. While green tea polyphenols have been shown to inhibit the growth of human lung cancer cells in test tubes, few clinicial studies have investigated the link between green tea consumption and lung cancer in people and even these studies have been conflicting. One population-based clinical study found that Okinawan tea (similar to green tea but partially fermented) was associated with decreased lung cancer risk, particularly among women. A second clinical study revealed that green tea and black tea significantly increased the risk of lung cancer. As with colon and esophageal cancers, further clinical studies are needed before researchers can draw any conclusions about green tea and lung cancer.

Pancreatic cancer. In one large-scale clinical study researchers compared green tea drinkers with non-drinkers and found that those who drank the most tea were significantly less likely to develop pancreatic cancer. This was particularly true for women -- those who drank the most green tea were half as likely to develop pancreatic cancer as those who drank less tea. Men who drank the most tea were 37% less likely to develop pancreatic cancer. However, it is not clear from this population-based study whether green tea is solely responsible for reducing pancreatic cancer risk. Further studies in animals and people are needed before researchers can recommend green tea for the prevention of pancreatic cancer.

Prostate cancer. Laboratory studies have found that green tea extracts prevent the growth of prostate cancer cells in test tubes. In a large clinical study conducted in Southeast China researchers found that the risk of prostate cancer declined with increasing frequency, duration and quantity of green tea consumption. However, both green and black tea extracts also stimulated genes that cause cells to be less sensitive to chemotherapy drugs. Given this potential interaction, people should not drink black and green tea (as well as extracts of these teas) while receiving chemotherapy.

Skin cancer. The main polyphenol in green tea is epigallocatechin gallate (EGCG). Scientific studies suggest that EGCG and green tea polyphenols have anti-inflammatory and anticancer properties that may help prevent the onset and growth of skin tumors.

Stomach cancer. Laboratory studies have found that green tea polyphenols inhibit the growth of stomach cancer cells in test tubes, but clinical studies in people have been less conclusive. In two studies that compared green tea drinkers with non-drinkers, researchers found that people who drank tea were about half as likely to develop stomach cancer and gastritis (inflammation of the stomach) as those who did not drink green tea. However, a clinicial study including more than 26,000 men and women in Japan found no association between green tea consumption and stomach cancer risk. Some clinicial studies even suggest that green tea may increase the risk of stomach cancer.

Further clinicial studies are underway to determine whether green tea helps reduce the risk of stomach cancer. Although green tea is considered safe for people at risk for stomach cancer, it is too soon to tell whether green tea reduces the likelihood of developing this disease.

Inflammatory Bowel Disease (IBD)

Green tea may help reduce inflammation associated with Crohn's disease and ulcerative colitis, the two types of IBD. If green tea proves to be helpful for preventing colon cancer, this would be an added benefit for those with IBD because they are at risk for colon cancer.

Diabetes

Green tea has been used traditionally to control blood sugar in the body. Animal studies suggest that green tea may help prevent the development of type 1 diabetes and slow the progression once it has developed. People with type 1 diabetes produce little or no insulin, a hormone that converts glucose (sugar), starches, and other foods into energy needed for daily life. Green tea may help regulate glucose in the body.

A few small clinical studies have found that daily supplementation of the diet with green tea extract powder lowered the hemoglobin A1c level in individuals with borderline diabetes.

Liver disease

Population-based clinical studies have shown that men who drink more than 10 cups of green tea per day are less likely to develop disorders of the liver. Green tea also seems to protect the liver from the damaging effects of toxic substances such as alcohol. Animal studies have shown that green tea helps protect against the development of liver tumors in mice.

Results from several animal and human studies suggest that one of the polyphenols present in green tea, known as catechin, may help treat viral hepatitis (inflammation of the liver from a virus). In these studies, catechin was isolated from green tea and used in very high concentrations. It is not clear whether green tea (which contains a lower concentration of catechins) confers these same benefits to people with hepatitis.

Weight loss

Clinical studies suggest that green tea extract may boost metabolism and help burn fat. One study confirmed that the combination of green tea and caffeine improved weight loss and maintenance in overweight and moderately obese individuals. Some researchers speculate that substances in green tea known as polyphenols, specifically the catechins, are responsible for the herb's fat-burning effect.

Other uses

Drinking green tea has been found effective in a small clinical study for dental caries, or tooth decay. More studies need to be performed. Green tea may also be useful in inflammatory diseases, such as arthritis. Research indicates that green tea may benefit arthritis by reducing inflammation and slowing cartilage breakdown. Chemicals found in green tea may also be effective in treating genital warts and preventing symptoms of colds and influenza. Studies also show that drinking green tea is associated with reduced risk of all cause mortality.

 

 

 

Plant Description

Green, black, and oolong tea are all derived from the leaves of the Camellia sinensis plant. Originally cultivated in East Asia, this plant grows as large as a shrub or tree. Today, Camellia sinensis grows throughout Asia and parts of the Middle East and Africa.

People in Asian countries more commonly consume green and oolong tea while black tea is most popular in the United States. Green tea is prepared from unfermented leaves, the leaves of oolong tea are partially fermented, and black tea is fully fermented. The more the leaves are fermented, the lower the polyphenol content (See: "What's It Made Of?") and the higher the caffeine content. Green tea has the highest polyphenol content while black tea has roughly 2 - 3 times the caffeine content of green tea.

 

 

 

What's It Made Of?

The healthful properties of green tea are largely attributed to polyphenols, chemicals with potent antioxidant properties. In fact, the antioxidant effects of polyphenols appear to be greater than vitamin C. The polyphenols in green tea also give it a somewhat bitter flavor.

Polyphenols contained in teas are classified as catechins. Green tea contains six primary catechin compounds: catechin, gallaogatechin, epicatechin, epigallocatechin, epicatechin gallate, and apigallocatechin gallate (also known as EGCG). EGCG is the most studied polyphenol component in green tea and the most active.

Green tea also contains alkaloids including caffeine, theobromine, and theophylline. These alkaloids provide green tea's stimulant effects. L-theanine, an amino acid compound found in green tea, has been studied for its calming effects on the nervous system.

 

 

 

Available Forms

Most green tea dietary supplements are sold as dried leaf tea in capsule form. Standardized extracts of green tea are preferred. There are also liquid extracts made from the leaves and leaf buds. The average cup of green tea contains between 50 - 150 mg polyphenols (antioxidants). Decaffeinated green tea products contain concentrated polyphenols. Caffeine-free supplements are available.

 

 

 

How to Take It

Pediatric

There are no known scientific reports on the pediatric use of green tea, so it is not recommended for children.

Adult

Depending on the brand, 2 - 3 cups of green tea per day (for a total of 240 - 320 mg polyphenols) or 100 - 750 mg per day of standardized green tea extract is recommended. Caffeine-free products are available and recommended.

 

 

 

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, people should take herbs with care, under the supervision of a practitioner knowledgeable in the field of botanical medicine.

People with heart problems, kidney disorders, stomach ulcers, and psychological disorders (particularly anxiety) should not take green tea. Pregnant and breastfeeding women should also avoid green tea.

People who drink excessive amounts of caffeine (including caffeine from green tea) for prolonged periods of time may experience irritability, insomnia, heart palpitations, and dizziness. Caffeine overdose can cause nausea, vomiting, diarrhea, headaches, and loss of appetite. If you are drinking a lot of tea and start to vomit or have abdominal spasms, you may have caffeine poisoning. If your symptoms are severe, lower your caffeine intake and see your health care provider.

 

 

 

Possible Interactions

If you are being treated with any of the following medications, you should not drink green tea or take green tea extract without first talking to your health care provider:

Adenosine -- Green tea may inhibit the actions of adenosine, a medication given in the hospital for an irregular (and usually unstable) heart rhythm.

Antibiotics, Beta-lactam -- Green tea may increase the effectiveness of beta-lactam antibiotics by reducing bacterial resistance to treatment.

Benzodiazepines -- Caffeine (including caffeine from green tea) has been shown to reduce the sedative effects of benzodiazepines (medications commonly used to treat anxiety, such as diazepam and lorazepam).

Beta-blockers, Propranolol, and Metoprolol -- Caffeine (including caffeine from green tea) may increase blood pressure in people taking propranolol and metoprolol (medications used to treat high blood pressure and heart disease).

Blood Thinning Medications (Including Aspirin) -- People who take warfarin, a blood thinning medication, should not drink green tea. Since green tea contains vitamin K, it can make warfarin ineffective. Meanwhile, you should not mix green tea and aspirin because they both prevent platelets from clotting. Using the two together may increase your risk of bleeding.

Chemotherapy -- The combination of green tea and chemotherapy medications, specifically doxorubicin and tamoxifen, increased the effectiveness of these medications in laboratory tests. However, these results have not yet been demonstrated in studies on people. On the other hand, there have been reports of both green and black tea extracts stimulating a gene in prostate cancer cells that may cause them to be less sensitive to chemotherapy drugs. Given this potential interaction, people should not drink black and green tea (as well as extracts of these teas) while receiving chemotherapy for prostate cancer in particular.

Clozapine -- The antipsychotic effects of the medication clozapine may be reduced if taken fewer than 40 minutes after drinking green tea.

Ephedrine -- When taken together with ephedrine, green tea may cause agitation, tremors, insomnia, and weight loss.

Lithium -- Green tea has been shown to reduce blood levels of lithium (a medication used to treat manic/depression).

Monoamine Oxidase Inhibitors (MAOIs) -- Green tea may cause a severe increase in blood pressure (called a "hypertensive crisis") when taken together with MAOIs, which are used to treat depression. Examples of MAOIs include phenelzine and tranylcypromine.

Oral Contraceptives -- Oral contraceptives can prolong the amount of time caffeine stays in the body and may increase its stimulating effects.

Phenylpropanolamine -- A combination of caffeine (including caffeine from green tea) and phenylpropanolamine (an ingredient used in many over-the-counter and prescription cough and cold medications and weight loss products) can cause mania and a severe increase in blood pressure. The FDA issued a public health advisory in November 2000 to warn people of the risk of bleeding in the brain from use of this medication and has strongly urged all manufacturers of this drug to remove it from the market.

Hawthorn

 

 

Overview

Hawthorn (Crataegus species) has been used to treat heart disease as far back as the 1st century. By the early 1800s, American doctors were using it to treat circulatory disorders and respiratory illnesses. Traditionally, the berries were used to treat heart problems ranging from irregular heartbeat, high blood pressure, chest pain, hardening of the arteries, and heart failure. Today, the leaves and flowers are used medicinally, and there is good evidence that hawthorn can treat mild-to-moderate heart failure.

Animal and laboratory studies report hawthorn contains antioxidants, including oligomeric procyandins (OPCs, also found in grapes) and quercetin. Antioxidants are substances that destroy free radicals -- compounds in the body that damage cell membranes, tamper with DNA, and even cause cell death. Free radicals occur naturally in the body and grow in number as we age. Environmental toxins (including ultraviolet light, radiation, smoking, some medicines, and air pollution) can also increase the number of these damaging particles. Free radicals are believed to contribute to the aging process (such as wrinkling) as well as the development of a number of health problems including cancer and heart disease. Antioxidants found in hawthorn may help stop some of the damage from free radicals, especially when it comes to heart disease.

 

 

 

Plant Description

Hawthorn is a common thorny shrub in the rose family that grows up to 5 feet tall on hillsides and in sunny wooded areas throughout the world. Its flowers bloom in May. They grow in small white, red, or pink clusters. Small berries, called haws, sprout after the flowers. They are usually red when ripe, but they may also be black. Hawthorn leaves are shiny and grow in a variety of shapes and sizes.

 

 

 

What's It Made Of?

Hawthorn contains many substances that may benefit the heart. These antioxidant flavonoids -- including OPCs -- may help dilate blood vessels, improve blood flow, and protect the blood vessels from damage.

The berries, leaves, and flowers of the hawthorn plant have been used for medicinal purposes. Most modern preparations use the leaves and flowers, which are believed to contain more of the flavonoids than the berries.

 

 

 

Medicinal Uses and Indications

Hawthorn is used to help protect against heart disease and help control high blood pressure and high cholesterol.

Heart failure

Hawthorn has been widely studied in people with heart failure (a condition in which the heart is unable to pump enough blood to other organs in the body). A number of studies conclude that hawthorn significantly improved heart function. Studies also have found that the herb can improve the ability to exercise in a person with heart failure. Participants in studies have reported that hawthorn significantly improved symptoms of the disease (such as shortness of breath and fatigue). One study found that hawthorn extract (900 mg/day) taken for 2 months was as effective as low doses of captopril (a prescription heart medication) in improving symptoms of heart failure.

A large study found that a standardized hawthorn supplement was effective in 952 patients with heart failure. The study compared conventional methods of treating heart failure (with different medications) with hawthorn alone and in addition to the drugs. After 2 years, the clinical symptoms of heart failure (palpitations, breathing problems, and fatigue) decreased significantly in the patients taking the hawthorn supplement. People taking hawthorn also took less medications for their condition.

Heart failure is a serious condition, and you should never try to self-treat with hawthorn. Ask your doctor if hawthorn is right for you.

Chest pain (Angina)

Some preliminary evidence suggests hawthorn may help combat chest pain (angina), which is caused by low blood flow to the heart. In one early study, 60 people with angina were given either 180 mg/day of hawthorn berry-leaf-flower extract or placebo for 3 weeks. Those who received hawthorn experienced improved blood flow to the heart and were also able to exercise for longer periods of time without suffering from chest pain. However, more studies would be needed to say for sure whether hawthorn was effective.

High blood pressure

Although hawthorn has not been studied specifically in people with high blood pressure, some people think that its benefits in treating heart disease may carry over to treating high blood pressure (hypertension). However, so far not enough research has been done to say whether hawthorn is effective at lowering blood pressure -- and if so, by how much.

In one study, a hawthorn extract was found to be effective for hypertension in people with type 2 diabetes who were also taking their prescribed medicines. Participants took 1,200 mg hawthorn extract daily or placebo for 16 weeks. Those taking hawthorn had lower blood pressures than those taking the placebo.

You should talk with your doctor before taking hawthorn if you have high blood pressure.

 

 

 

Available Forms

Hawthorn is available in non-standardized and standardized capsules and liquid extracts, along with tinctures and solid extracts. A bitter-tasting tea can also be made from dried hawthorn leaves, flowers, and berries.

 

 

 

How to Take It

Pediatric

Hawthorn should not be given to children.

Adult

To decrease symptoms of heart failure:

160 - 900 mg daily for at least 6 weeks, standardized to 2 - 3% flavonoids or 18 - 20% oligomeric procyanidins (OPCs)

240 - 480 mg daily for at least 6 weeks, standardized to 18.75% OPCs

 

 

 

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that may trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider qualified in the field of botanical medicine.

Hawthorn is considered a safe herb. Side effects are rare, but may include headache, nausea, and palpitations (a feeling of a racing heart). A recent review of 29 clinical studies with more than 5,500 patients found that hawthorn was safe when used in recommended dosages. Doses found to be safe were from 160 - 1,800 mg daily and from 3 - 24 weeks in length.

Heart disease is a serious condition. Do not self-treat heart conditions without telling your doctor. You should use hawthorn only under your doctor's supervision.

If you are pregnant or breastfeeding, do not use hawthorn.

It is important to note any changes you feel while you are taking hawthorn. People experiencing more pain, more angina attacks, or more exhaustion while walking or exercising should stop taking hawthorn and seek emergency medical attention. Even if you don't experience any of these symptoms, see your health care provider if your condition hasn't improved after 6 weeks of hawthorn treatment. Your progress should always be monitored by your doctor.

 

 

 

Possible Interactions

If you are taking prescription or non-prescription medicines, talk to your health care provider before taking herbal supplements. If you are currently being treated with any of the following medications, you should not use hawthorn without first talking to your health care provider:

Digoxin -- Hawthorn may enhance the activity of digoxin, a medication used for irregular heart rhythms.

Beta-blockers -- These drugs are used to treat heart disease by lowering blood pressure and dilating blood vessels. Hawthorn can make the effects of these drugs stronger. They include:

Atenolol (Tenormin)

Metoprolol (Lopressor, Toprol-XL)

Propranolol (Inderal, Inderal LA)

Calcium channel blockers -- These drugs are used to treat high blood pressure and angina by dilating blood vessels. Hawthorn can make the effects of these drugs stronger. They include:

Norvasc (amlodipine)

Cardizem (diltiazem)

Procardia (nifedipine)

Phenylephrine -- In a laboratory study, an alcoholic extract of hawthorn fruit reduced the effects of phenylephrine, a medication that constricts blood vessels and is commonly found in nasal decongestant products.

Milk thistle

 

 

Overview

Milk thistle (Silybum marianum) has been used for 2,000 years as an herbal remedy for a variety of ailments, particularly liver and gall bladder problems. Several scientific studies suggest that substances in milk thistle (especially a flavonoid called silymarin) protect the liver from toxins, including certain drugs such as acetaminophen (Tylenol), which can cause liver damage in high doses. Silymarin has antioxidant and anti-inflammatory properties, and it may help the liver repair itself by growing new cells.

Although a number of animal studies demonstrate that milk thistle can be helpful in protecting the liver, results in human studies are mixed.

Liver disease from alcohol

Milk thistle is often suggested as a treatment for alcoholic hepatitis and alcoholic cirrhosis. But scientific studies show mixed results. Most studies show milk thistle improves liver function and increases survival in people with cirrhosis or chronic hepatitis. But problems in the design of the studies (such as small numbers of participants and differences in dosing and duration of milk thistle therapy) make it hard to draw any real conclusions.

Viral hepatitis

Milk thistle is widely used in the treatment of viral hepatitis (particularly hepatitis C). But studies show mixed results. Some found improvements in liver function, while others did not. None of the studies compared milk thistle with interferon or other medications for viral hepatitis.

Mushroom poisoning

Based on traditional use, milk thistle has been used as an emergency antidote to poisoning by deathcap mushroom (Amanita phalloides). Animal studies have found that milk thistle extract completely counteracts the toxic effects of the mushroom when given within 10 minutes of ingestion. If given within 24 hours, it significantly reduces the risk of liver damage and death.

Cancer

Early laboratory studies also suggest that silymarin and other active substances in milk thistle may have anti-cancer effects. These substances appear to stop cancer cells from dividing and reproducing, shorten their life span, and reduce blood supple to tumors. More studies are needed, however, to show whether milk thistle has any effects in the body (not just test tubes).

 

 

 

Plant Description

Milk thistle is native to the Mediterranean region, and is now found throughout the world. This stout thistle usually grows in dry, sunny areas. The spiny stems branch at the top, and reach a height of 4 to 10 feet. The leaves are wide, with white blotches or veins. Milk thistle gets its name from the milky white fluid that comes from the leaves when they are crushed. The flowers are red-purple. The small, hard-skinned fruit is brown, spotted, and shiny. Milk thistle spreads quickly (it is considered a weed in some parts of the world), and it matures quickly, in less than a year.

 

 

 

What's It Made Of?

The active ingredient -- the one that protects the liver -- in milk thistle is known as silymarin. Silymarin is actually a group of flavonoids (silibinin, silidianin, and silicristin), which are thought to help repair liver cells damaged by alcohol and other toxic substances. Silymarin also keeps new liver cells from being destroyed by these same toxins. It reduces inflammation (which is why it is often suggested for people with liver inflammation or hepatitis), and is a strong antioxidant.

Most milk thistle products are standardized preparations made from the seeds of the plant. Most preparations are standardized to contain 70 - 80% of silymarin.

 

 

 

Available Forms

Capsules of standardized dried herb (each capsule contains about 120 - 140 mg silymarin)

Liquid extract

Tincture

Silymarin phosphatidylcholine complex

A few studies show that a silymarin-phosphatidylcholine complex may be absorbed more easily than regular standardized milk thistle. Phosphatidylcholine is a key element in cell membranes. It helps silymarin attach easily to cell membranes, which may keep toxins from getting inside liver cells. Alcohol extracts should be avoided by anyone with alcohol-related liver disease.

 

 

 

How to Take It

Pediatric

There are no studies showing whether it is safe to give milk thistle to a child. Liver problems can be serious and should be diagnosed by a physician. Talk to your doctor before giving milk thistle to a child.

Adult

If you think you have a liver problem, you should see a doctor. Liver disease can be life threatening.

Recommended dose: 280 - 450 mg per day in divided doses or silymarin-phosphatidylcholine complex 100 - 200 mg two times per day.

 

 

 

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care practitioner.

Milk thistle is generally regarded as safe. Side effects are usually mild and may involve stomach upset and diarrhea. Some people may get a rash from touching milk thistle plants.

Milk thistle should not be used by pregnant or breastfeeding women.

People with a history of hormone-related cancers, including breast and uterine cancer and prostate cancer, should not take milk thistle.

 

 

 

Possible Interactions

If you are currently being treated with any of the following medications, you should not use milk thistle without first talking to your healthcare provider.

Antipsychotics -- includes butyrophenones (such as haloperidol) and phenothiazines (such as chlorpromazine, fluphenazine, and promethazine)

Phenytoin(Dilantin) -- a medication used for seizures

Halothane -- a medication used during general anesthesia

Milk thistle may interfere with the following medications, because both milk thistle and these medications are broken down by the same liver enzymes:

Allergy drugs -- such as fexofenadine (Allegra)

Drugs for high cholesterol -- including statins such as lovastatin (Mevacor, Altocor)

Anti-anxiety drugs -- including alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan)

Antiplatelet and anticoagulant drugs (blood thinners) -- including clopidogrel (Plavix) and warfarin (Coumadin)

Some cancer drugs

St. John’s Wort

 

Overview

St. John's wort (Hypericum perforatum) has a history of medicinal use dating back to ancient Greece, where it was used to treat a range of illnesses, including various "nervous disorders." St. John's wort also has antibacterial and antiviral properties and, because of its anti-inflammatory properties, has been used topically to help heal wounds and burns. St. John's wort is one of the most commonly purchased herbal products in the United States.

In recent years, there has been renewed interest in St. John's wort as a treatment for depression and there has been a great deal of scientific research on this topic. Most studies show that St. John's wort may be an effective treatment for mild-to-moderate depression, and has fewer side effects than most other prescription antidepressants. But the herb interacts with a wide variety of medications, so it is important to take it only under the guidance of a health care provider.

It is also important to note that severe depression (characterized by an inability to function with daily activities, thoughts of suicide or of harming yourself or others) should not be treated with herbs. Always see a doctor if your depression is serious (See "Precautions" section).

Depression

Several studies have shown that St. John's wort is effective in reducing symptoms in people with mild-to-moderate but not severe (or major) depression. In certain studies it appears to work as well as selective serotonin reuptake inhibitors (SSRIs), a popular type of antidepressant that includes fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft) without one of the most common side effects, loss of libido.

St. John's wort contains several chemicals, including hypericin, hyperforin and flavonoids. Researchers aren't exactly sure how St. John's wort works, although it has been suggested that the herb acts like an SSRI, making more serotonin, dopamine and norepinephrine available to the brain. These neurotransmitters help improve one's mood. Scientists thought that hypericin was responsible for these effects, but now they believe that other chemicals in St. John's wort have a beneficial effect.

Not all studies agree, however. In one study, St. John's wort was found to be no more effective than placebo for treating depression; however, in the same study, Zoloft also failed to show any benefit in treating depression. A number of other studies have compared St. John's wort to Prozac, Celexa, paroxetine (Paxil), and Zoloft, and found that the herb is just as effective as the drug. Other studies are ongoing.

Other Uses

St. John's wort has also shown promise in treating the following conditions, a few of which are related to depression.

Bacterial and viral infections: In laboratory studies, St. John's wort has demonstrated the ability to fight certain infections, including some bacteria that are resistant to antibiotics. But it isn't known whether St. John's wort would have the same effect in people.

HIV infection and AIDS: While laboratory research suggests that St. John's wort may kill or slow the growth of human immunodeficiency virus (HIV), St. John's wort interferes with medications used to treat people with the virus. In addition, it appears that the doses of St. John's wort that would be needed are so high that side effects become intolerable. For now, people with HIV or AIDS should not take St. John's wort.

Premenstrual syndrome (PMS): An early study suggests that St. John's wort may help relieve physical and emotional symptoms of PMS, including cramps, irritability, food cravings, and breast tenderness.

Menopause: Studies suggest that St. John's wort, especially in combination with black cohosh, is useful in alleviating mood and anxiety changes during menopause.

Seasonal affective disorder (SAD): Used alone, St. John's wort has improved mood in those suffering from SAD (a type of depression that occurs during the winter months because of lack of sunlight). This condition is usually treated with photo (light) therapy. There is some evidence that using St. John's wort together with phototherapy produces even better results.

Eczema, wounds, minor burns, hemorrhoids: St. John's wort has antibacterial properties and may also help fight inflammation. Applied topically (to the skin), it may relieve symptoms associated with minor wounds and skin irritation.

Obsessive compulsive disorder, social phobia: St. John's wort has been proposed as a treatment for these conditions, but two preliminary studies in 2005 showed that the herb was not effective in relieving symptoms.

 

 

 

Plant Description

St. John's wort is a shrubby plant with clusters of yellow flowers that have oval, elongated petals. Scientists believe it is native to Europe, parts of Asia and Africa, and the western United States. The plant gets its name because it is often in full bloom around June 24, the day traditionally celebrated as the birthday of John the Baptist. Both the flowers and leaves are used for medicinal purposes.

 

 

 

What's It Made Of?

The best-studied active components are hypericin and pseudohypericin, found in both the leaves and flowers. Now research suggests, however, that these best-studied components may not be responsible for the plant's medicinal effects. Scientists are now studying St. John's wort's essential oils and flavonoids to see if they have benefits.

 

 

 

Available Forms

St. John's wort can be obtained in many forms: capsules, tablets, tinctures, teas, and oil-based skin lotions. Chopped or powdered forms of the dried herb are also available. Most products are standardized to contain 0.3% hypericin.

 

 

 

How to Take It

Pediatric

Most studies on St. John's wort have been conducted in adults. However, one study (more than 100 children under age 12) indicated that St. John's wort may be a safe and effective way of treating mild-to-moderate symptoms of depression in children. Talk to your doctor before giving St. John's wort to a child -- do not give your child a dose without medical supervision. Children being treated with St. John's wort should be carefully monitored for side effects, such as allergic reactions or upset stomach.

Adult

Dry herb (in capsules or tablets): The usual dose for mild depression and mood disorders is 300 mg (standardized to 0.3% hypericin extract), 3 times per day, with meals. St. John's wort is available in time-release capsules.

Liquid extract (1:1): 40 - 60 drops, 2 times per day.

Tea: Pour one cup of boiling water over 2 - 4 tsp of dried St. John's wort and steep for 10 minutes. Drink up to 3 cups per day for 4 - 6 weeks.

Oil or cream: To treat inflammation, as in wounds, burns or hemorrhoids, an oil-based preparation of St. John's wort can be applied topically.

It may take 3 - 4 weeks to feel any effects from St. John's wort.

 

 

 

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.

St. John's wort is often used to treat depression. If your depression is severe -- causing problems with your daily life or accompanied by thoughts of suicide or of harming yourself or others -- you need to see a doctor immediately. St. John's wort should not be used to treat severe depression.

You should see a doctor to make sure you have the right diagnosis before taking St. John's wort. Your doctor can help you determine the right dose and make sure you are not taking any other medications that might interact with St. John's wort.

Side effects from St. John's wort are generally mild and include stomach upset, hives or other skin rash, fatigue, restlessness, headache, dry mouth, and feelings of dizziness or mental confusion. St. John's wort can also make the skin overly sensitive to sunlight (called photodermatitis). If you have light skin and are taking St. John's wort on a regular basis, be careful about sun exposure. Wear long sleeves and a hat, and use a sunscreen with at least SPF 15 or higher. Avoid sunlamps, tanning booths, and tanning beds.

Since St. John's wort can interact with medications used during surgery, you should stop taking it at least 5 days before surgery. Make sure your doctor and surgeon know you are taking St. John's wort.

Do not take St. John's wort if you have bipolar disorder.

St. John's wort should not be taken by women who are pregnant, trying to become pregnant, or breastfeeding.

 

 

 

Possible Interactions

St. John's wort interacts with a large number of medications. In most cases, St. John's wort decreases the effectiveness of the medication. In other cases, however, St. John's wort may increase the effects of a medication.

If you are currently being treated with any of the following medications, you should not use St. John's wort without first talking to your doctor:

Antidepressants -- St. John's wort may interact with medications used to treat depression or other mood disorders, including tricyclic antidepressants, SSRIs, and monoamine oxidase inhibitors (MAOIs). Taking St. John's wort with these medications tends to increase side effects, and could lead to a dangerous condition called serotonin syndrome. Do not take St. John's wort with other antidepressants, including:

SSRIs: Citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft)

Tricyclics: Amitriptyline (Elavil), nortryptyline (Pamelor), imipramine (Tofranil)

MAOIs: Phenelzine, (Nardil), tranylcypromine (Parnate)

Nefazodone (Serzone)

Allergy drugs (antihistamines) -- St. John's wort may reduce levels of these drugs in the body, making them less effective:

Loratadine (Claritin)

Cetirizine (Zyrtec)

Fexofenadine (Allegra)

Dextromethorphan (cough medicine) -- When taken at the same time as dextromethorphan, a cough suppressant found in many over-the-counter cough and cold medicines, St. John's wort can increase the risk of side effects, including serotonin syndrome.

Digoxin -- St. John's wort may decrease levels of the medication and reduce its effectiveness. Do not take St. John's wort if you take digoxin.

Drugs that suppress the immune system -- St. John's wort can reduce the effectiveness of these medications, which are taken after organ transplant or to control autoimmune diseases. In fact, there have been many reports of cyclosporin blood levels dropping in those with a heart or kidney transplant, even leading to rejection of the transplanted organ.

Adalimumab (Humira)

Azathioprine (Imuran)

Cyclosporine

Etanercept (Enbrel)

Methotrexate

Mycophenolate mofetil (CellCept)

Tacrolimus (Prograf)

Drugs to fight HIV -- St. John's wort appears to interact with at least two kinds of medications used to treat HIV and AIDS: protease inhibitors and non-nucleoside reverse transcriptase inhibitors. The Food and Drug Administration recommends that St. John's wort not be used with any type of antiretroviral medication used to treat HIV or AIDS.

Birth control pills -- There have been reports of breakthrough bleeding in women on birth control pills who were also taking St. John's wort, and it is possible that the herb might interfere with the effectiveness of birth control pills, leading to unplanned pregnancies.

Reserpine -- Based on animal studies, St. John's wort may interfere with reserpine's ability to treat high blood pressure.

Sedatives -- St. John's wort can increase the effect of drugs that have a sedating effect, including:

Anticonvulsants, such as phenytoin (Dilantin) and valproic acid (Depakote)

Barbiturates

Benzodiazepines, such as alprazolam (Xanax) and diazepam (Valium)

Drugs to treat insomnia, such as zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta), and ramelteon (Rozerem)

Tricyclic antidepressants, such as amitriptyline (Elavil)

Alcohol

Theophylline -- St. John's wort can reduce levels of this medication in the blood. Theophylline is used to open the airways in those suffering from asthma, emphysema, or chronic bronchitis.

Triptans (used to treat migraines) -- St. John's wort can increase the risk of side effects, including serotonin syndrome, when taken with these medications:

Naratriptan (Amerge)

Rizatriptan (Maxalt)

Sumatriptan (Imitrex)

Zolmitriptan (Zomig)

Warfarin -- St. John's wort reduces the effectiveness of warfarin, an anticoagulant (blood-thinner).

Other drugs -- Because St. John's wort is broken down by certain liver enzymes, it may interact with other drugs that are broken down by the same enzymes. Those drugs may include:

Antifungal drugs, such as ketoconazole (Nizoral), itraconazole (Sporanox), fluconazole (Diflucan)

Statins (drugs taken to lower cholesterol)

Some calcium channel blockers (taken to lower blood pressure)

Saw Palmetto

 

Overview

Saw palmetto (Serenoa repens/Sabal serrulata) is a palm-like plant with berries that were a staple food and medicine for the Native Americans of the southeastern United States. In the early 1900s, men used the berries to treat urinary tract problems, and even to increase sperm production and boost libido. Today, the primary use of saw palmetto is to treat benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland. Researchers aren't sure exactly how saw palmetto works, but it contains plant-based chemicals that may be effective for BPH. Researchers think that saw palmetto may affect the level of testosterone in the body, and perhaps reduce the amount of an enzyme that promotes the growth of prostate cells. Saw palmetto is often combined with nettle extract to treat BPH.

Benign Prostatic Hyperplasia (BPH)

Evidence is mixed about whether saw palmetto works to treat BPH. A number of studies suggest that the herb is effective for treating symptoms, including too-frequent urination, having trouble starting or maintaining urination, and needing to urinate during the night. The urethra, the tube that empties urine from the body, runs through the prostate gland in men; when the prostate gland is enlarged, men may have trouble urinating.

Some studies show that saw palmetto is as effective in treating symptoms as finasteride (Proscar) without side effects such as loss of libido. Other studies suggest that saw palmetto may actually shrink the size of the prostate gland. Due to the short duration (usually less than 3 months) of these studies, it's not possible to say for sure that saw palmetto is truly effective for preventing complications of BPH. In fact, a well-conducted study published in the February 9, 2006, edition of the New England Journal of Medicine found that saw palmetto was no better than placebo in relieving the signs and symptoms of BPH.

It is important to receive a proper diagnosis of BPH from your doctor to rule out prostate cancer.

Other Uses

Animal studies have shown that saw palmetto inhibits the growth of tumor cells indicating that it may be a helpful in the treatment of prostate cancer. Other studies have shown that saw palmetto improves urinary tract symptoms related to BPH. While these studies are promising, more research is needed to determine whether saw palmetto is effective for these conditions.

 

 

 

Plant Description

Saw palmetto is a fan palm that grows as a tree or shrub that can reach heights of 10 feet in warm climates with leaf clusters that can reach 2 feet or more. It has a creeping, horizontal growth pattern. In the United States, it grows in the warm climates of the southeast coast, from South Carolina to throughout Florida. Lush, green, "saw-toothed" leaves fan out from thorny stems. The plant has white flowers, which produce yellow berries. The berries turn bluish-black when ripe, and are dried for medicinal use.

 

 

 

What's It Made Of?

Saw palmetto's active ingredients include fatty acids, plant sterols, and flavonoids. The berries also contain high molecular weight polysaccharides (sugars), which may reduce inflammation or strengthen the immune system.

 

 

 

Available Forms

Saw palmetto can be purchased as dried berries, powdered capsules, tablets, liquid tinctures, and liposterolic extracts. The product label should indicate that contents are standardized and contain 85 - 95% fatty acids and sterols. Read labels carefully and buy only from reputable companies.

 

 

 

How to Take It

Children

Saw palmetto is not recommended for children.

Adult

Liposterolic extract in capsules: The recommended dosages for early stages of BPH is 160 mg, twice a day. The supplement should be a fat-soluble saw palmetto extract that contains 85 - 95% fatty acids and sterols.

Liquid extract: 5 - 6 mL per day. This preparation has not been tested in any studies, so its effectiveness is not known.

Tea: Saw palmetto can be taken as a tea, but its active ingredients (fatty acids) are not soluble in water, so tea may not be effective. It has not been tested in any studies. Capsules are recommended instead of tea.

 

 

 

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.

Saw palmetto is generally thought to be safe a when used as directed. Side effects are very rare, although mild stomach complaints and minor headaches may occur. In at least one case, significant bleeding during surgery was attributed to saw palmetto.

Do not self-treat for BPH with saw palmetto; see your doctor for a proper diagnosis to rule out prostate cancer.

Saw palmetto may have effects similar to some hormones, and should not be used in pregnant or nursing women, or women who have had or are at risk for hormone-related cancers.

Saw palmetto may interfere with the absorption of iron.

 

 

 

Possible Interactions

Finasteride(Proscar) -- Because saw palmetto may work similarly to finasteride (Proscar), you should not use this herb in combination with finasteride or other medications used to treat BPH.

Antiplatelet and anticoagulant drugs (blood-thinners) -- Saw palmetto may affect the blood's ability to clot, and could interfere with blood-thinning drugs, including:

Warfarin (Coumadin)

Clopidogrel (Plavix)

Aspirin

Oral contraceptives -- Because saw palmetto may have hormone-like effects, it may make oral contraceptives less effective, raising the risk of unplanned pregnancy.

Alpha-Lipoic Acid

Overview

Alpha-lipoic acid is an antioxidant that is made by the body and is found in every cell, where it helps turn glucose into energy. Antioxidants are substances that attack "free radicals," waste products created when the body turns food into energy. Free radicals cause harmful chemical reactions that can damage cells in the body, making it harder for the body to fight off infections. They also damage organs and tissues.

Unlike other antioxidants, which work only in water (such as vitamin C) or fatty tissues (such as vitamin E), alpha-lipoic acid is both fat- and water-soluble. That means it can work throughout the body. In addition, antioxidants are depleted as they attack free radicals, but evidence suggests alpha-lipoic acid may help regenerate these other antioxidants and make them active again.

In the cells of the body, alpha-lipoic acid is converted into dihydrolipoic acid. Alpha-lipoic acid is not the same as alpha linolenic acid, which is an omega-3 fatty acid that may help heart health (See also: Alpha linolenic acid. Confusion can arise because both are sometimes abbreviated ALA.

Diabetes

Alpha-lipoic acid can lower blood sugar levels, and its ability to kill free radicals may help reduce pain, burning, itching, tingling, and numbness in people who have nerve damage caused by diabetes (called peripheral neuropathy). Alpha-lipoic acid has been used for years for this purpose in Europe, and at least one study found that intravenous (IV) doses of alpha-lipoic acid helped reduce symptoms. However, the evidence indicating that taking alpha-lipoic acid orally will help is weaker. Most studies have been small and poorly designed. One 2006 study did show benefit from taking alpha-lipoic acid for diabetic neuropathy compared to placebo.

Taking alpha-lipoic acid does appear to help another diabetes-related condition called autonomic neuropathy, which affects the nerves supplying the heart. One study found that 73 people with autonomic neuropathy improved when taking 800 mg of alpha-lipoic acid orally compared to placebo.

Liver Disease

Alpha-lipoic acid has been proposed as a treatment for alcohol-related liver disease, but so far there is no evidence that it works. Alpha-lipoic acid has been administered by IV along with silymarin to treat people who have eaten the poisonous mushroom Amanita, which causes liver damage.

Brain Function and Stroke

Because alpha-lipoic acid can pass easily into the brain, it has protective effects on brain and nerve tissue. Scientists are investigating it as a potential treatment for stroke and other brain disorders involving free radical damage. Animals treated with alpha-lipoic acid, for example, suffered less brain damage and had a four times greater survival rate after a stroke than animals who did not receive this supplement. More research is needed to understand whether this benefit applies to people as well.

Other

Some preliminary studies suggest alpha-lipoic acid may be helpful in treating glaucoma, but there is not enough evidence to say for sure whether it is beneficial. In test tubes, alpha-lipoic acid appears to inhibit growth of the HIV virus, but it isn't known whether the supplement would have the same effect in people.

 

 

 

Dietary Sources

A healthy body makes enough alpha-lipoic acid. It is also found in red meat, organ meats (such as liver), and yeast (particularly Brewer's yeast).

 

 

 

Available Forms

Alpha-lipoic acid supplements are available as capsules. It may also be given by injection under the supervision of a health care provider.

 

 

 

How to Take It

Pediatric

Because alpha-lipoic acid has not been studied for pediatric use, do not give it to children.

Adult

Alpha-lipoic acid can be purchased in doses of 30 - 100 mg tablets. There are no established recommended doses.

General antioxidant support: 20 - 50 mg per day

Diabetes and diabetic neuropathy: 800 mg per day in divided doses

 

 

 

Precautions

Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a health care provider.

No evidence suggests whether or not alpha-lipoic acid is safe for women who are pregnant or breastfeeding, so such women should not take alpha-lipoic acid.

Side effects are generally rare and may include skin rash.

Alpha-lipoic acid can lower blood sugar levels, so people with diabetes or hypoglycemia should take alpha-lipoic acid only under the supervision of their doctor. (See "Interactions" section.)

Results of animal studies suggest that people who are deficient in thiamine (vitamin B1), a condition often associated with alcoholism, should not take alpha-lipoic acid.

 

 

 

Possible Interactions

If you are currently being treated with any of the following medications, you should not use alpha-lipoic acid without first talking to your health care provider.

Insulin and drugs that lower blood sugar -- Apha-lipoic acid can combine with these drugs to further reduce blood sugar levels, resulting in hypoglycemia (low blood sugar). Tell your doctor before taking alpha-lipoic acid and monitor your blood sugar levels closely; your doctor may need to adjust your medication doses.

Thyroid-regulating medications, Levothyroxine -- Apha-lipoic acid may lower levels of thyroid hormone. Blood hormone levels and thyroid function tests should be monitored closely in people taking thyroid hormones who are also taking alpha-lipoic acid.

Coenzyme Q10

 

Overview

Coenzyme Q10 (CoQ10) is a compound found naturally in the energy-producing center of the cell known as the mitochondria. CoQ10 is involved in making an important molecule known as adenosine triphosphate (ATP). ATP serves as the cell's major energy source and drives a number of biological processes, including muscle contraction and the production of protein. CoQ10 also works as an antioxidant.

Antioxidants are substances that scavenge free radicals, damaging compounds in the body that alter cell membranes, tamper with DNA, and even cause cell death. Free radicals occur naturally in the body, but environmental toxins (including ultraviolet light, radiation, cigarette smoking, and air pollution) can also increase the number of these damaging particles. Scientists believe free radicals contribute to the aging process, as well as the development of a number of health problems, including heart disease and cancer. Antioxidants, such as CoQ10, can neutralize free radicals and may reduce or even help prevent some of the damage they cause.

 

 

 

Uses

CoQ10 boosts energy, enhances the immune system, and acts as an antioxidant. Clinical research suggests that using coenzyme Q10 supplements alone or in combination with other drug therapies and nutritional supplements may help prevent or treat some of the following conditions:

Heart disease

Researchers believe that the beneficial effect of CoQ10 in the prevention and treatment of heart disease is due to its ability to improve energy production in cells, inhibit blood clot formation, and act as an antioxidant. One important clinical study, for example, found that people who received daily CoQ10 supplements within 3 days of a heart attack were significantly less likely to experience subsequent heart attacks and chest pain. In addition, these same patients were less likely to die of heart disease than those who did not receive the supplements.

Heart failure (HF)

Levels of CoQ10 are low in people with congestive heart failure (HF), a debilitating disease that occurs when the heart is not able to pump blood effectively. This can cause blood to pool in parts of the body, such as the lungs and legs. Information from several clinical studies suggests that CoQ10 supplements help reduce swelling in the legs, enhance breathing by reducing fluid in the lungs, and increase exercise capacity in people with HF. Not all clinical studies agree, however. As a result, some experts conclude that CoQ10 supplements do not contribute any benefit to the usual conventional treatment for HF. More research is needed to resolve the debate.

High blood pressure

Several clinical studies involving small numbers of people suggest that CoQ10 may lower blood pressure. However, it may take 4 - 12 weeks before you will see any beneficial effects. In fact, after reviewing 12 clinical studies, researchers concluded that CoQ10 has the potential to lower systolic blood pressure by up to 17 mm Hg and diastolic blood pressure by 10 mm Hg, without significant side effects. More research with greater numbers of people is needed to assess the value of CoQ10 in the treatment of high blood pressure.

High cholesterol

Levels of CoQ10 tend to be lower in people with high cholesterol compared to healthy individuals of the same age. In addition, certain cholesterol-lowering drugs called statins (such as atorvastatin, cerivastatin, lovastatin, pravastatin, simvastatin) appear to deplete natural levels of CoQ10 in the body. Taking CoQ10 supplements can correct the deficiency caused by statin medications without affecting the medication's positive effects on cholesterol levels. Plus, studies show that CoQ10 supplementation may decrease the muscle pain associated with statin treatment.

Diabetes

CoQ10 supplements may improve heart health and blood sugar and help manage high cholesterol and high blood pressure in individuals with diabetes. High blood pressure, high cholesterol, and heart disease are all common problems associated with diabetes. Despite some concern that CoQ10 may cause a sudden and dramatic drop in blood sugar (called hypoglycemia), two recent clinical studies in people with diabetes given CoQ10, 200 mg 2 times daily, showed no hypoglycemic response. If you have diabetes, talk to your doctor or registered dietitian before using CoQ10.

Heart damage caused by chemotherapy

Several clinical studies suggest that CoQ10 may help prevent heart damage caused by certain chemotherapy drugs (namely adriamycin or other athracycline medications). More studies are needed to evaluate the effectiveness of CoQ10 in preventing heart damage in cancer patients undergoing chemotherapy. Talk to your doctor before adding any supplements to your regimen if you are undergoing chemotherapy.

Heart surgery

Clinical research indicates that introducing CoQ10 prior to heart surgery, including bypass surgery and heart transplantation, can reduce damage caused by free radicals, strengthen heart function, and lower the incidence of irregular heart beat (arrhythmias) during the recovery phase.

Breast cancer

Studies of women with breast cancer suggest that CoQ10 supplements (in addition to conventional treatment and a nutritional regimen including other antioxidants and essential fatty acids) may shrink tumors, reduce pain associated with the condition, and cause partial remission in some individuals. However, the beneficial effects these women experienced cannot be attributed to CoQ10 alone. Additional antioxidants used in these studies include vitamins C, E, and selenium.

Periodontal (gum) disease

Gum disease is a widespread problem that is associated with swelling, bleeding, pain, and redness of the gums. Clinical studies show that people with gum disease tend to have low levels of CoQ10 in their gums. In a few clinical studies involving small numbers of subjects, CoQ10 supplements caused faster healing and tissue repair. CoQ10 is used in mouth rinse products for this condition. Additional studies in humans are needed to evaluate the effectiveness of CoQ10 when used together with traditional therapy for periodontal disease.

Other

Preliminary clinical studies also suggest that CoQ10 may:

Improve immune function in individuals with immune deficiencies (such as acquired immunodeficiency syndrome or AIDS) and chronic infections (such as yeast, bacteria, and viral infections)

Increase sperm motility leading to enhanced fertility

Be used as part of the treatment for Alzheimer's disease and Parkinson's disease

Reduce damage from stroke

Boost athletic performance

Enhance physical activity in people with fatigue syndromes

Improve exercise tolerance in individuals with muscular dystrophy

Improve symptoms of tinnitus, or ringing in the ears

Be beneficial in cosmetics for healthy skin

Delay the aging process and increase longevity

Clinical research in all of these areas is underway to determine whether CoQ10 can be safely and effectively used in people with these health problems and needs.

 

 

 

Dietary Sources

Primary dietary sources of CoQ10 include oily fish (such as salmon and tuna), organ meats (such as liver), and whole grains. Most individuals obtain sufficient amounts of CoQ10 through a balanced diet, but supplementation may be useful for individuals with particular health conditions (see "Uses" section) or those taking certain medications (see "Interactions" section).

 

 

 

Available Forms

CoQ10 is available as a supplement in several forms, including soft gel capsules, oral spray, hard shell capsules, and tablets. CoQ10 is also added to various cosmetics.

 

 

 

How to Take It

Pediatric

Use of CoQ10 in children under 18 years of age is only recommended under the supervision of a health care provider.

Adult

For adults 19 years and older: The recommended dose for CoQ10 supplementation is 30 - 200 mg daily. Soft gels tend to be better absorbed by the body than capsules or other preparations.

CoQ10 is fat-soluble so should be taken with a meal containing fat for optimal absorption. Also, taking CoQ10 at night may help with the body's ability to use it.

CoQ10 may be used as an oral mouth rinse for gum disease (periodontal). Rinse with 1 teaspoonful (5 mL), 1 - 2 times daily.

 

 

 

Precautions

Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a knowledgeable health care provider.

Coenzyme Q10 appears to be generally safe with no significant side effects, except occasional stomach upset. However, the safety of CoQ10 supplementation during pregnancy and breastfeeding is unknown and, therefore, should not be used during that time until more information is available.

 

 

 

Possible Interactions

If you are currently being treated with any of the following medications, you should not use CoQ10 without first talking to your health care provider.

Daunorubicin and doxorubicin -- CoQ10 may help reduce the toxic effects on the heart caused by daunorubicin (Cerubidin) and doxorubicin (Adriamycin), two chemotherapy medications that are commonly used to treat several kinds of cancer. Always speak to your oncologist before taking antioxidants along with chemotherapy.

Blood pressure medications -- In a clinical study of individuals taking blood pressure medications, including diltiazem (Cardizem), metoprolol (Lopressor or Toprol), enalapril (Vasotec), and nitroglycerin (Nitrostat or Nitrobid), CoQ10 supplementation allowed the individuals to take lower dosages of these drugs. This suggests that CoQ10 may enhance the effectiveness of certain blood pressure medications, but more research is needed to verify these results.

Blood-thinning medications -- There have been reports that CoQ10 may decrease the effectiveness of blood-thinning medications such as warfarin (Coumadin) or clopidigrel (Plavix), leading to the need for increased doses. Therefore, given that this medication must be monitored very closely for maintenance of appropriate levels and steady blood thinning, CoQ10 should be used with warfarin only under careful supervision by your health care provider.

Timolol -- CoQ10 supplementation may reduce the heart-related side effects of timolol drops (Betoptic), a beta-blocker medication used to treat glaucoma, without decreasing the effectiveness of the medication.

Other -- Medications that can lower the levels of CoQ10 in the body include statins for cholesterol , including atorvastatin (Lipitor), lovastatin (Mevacor), pravastatin (Pravachol, and simvastatin (Zocor), fibric acid derivatives for cholesterol, including gemfibrozil (Lopid), beta-blockers for high blood pressure, such as atenolol (Tenormin), labetolol (Normodyne), metoprolol (Lopressor or Toprol), and propranolol (Inderal), and tricyclic antidepressant medications, including amitriptyline (Elavil), doxepin (Sinequan), and imipramine (Tofranil).