Popular Natural Remedies, Part I

I sometimes find it ironic that in pharmacy schools future pharmacists are still not taught much about natural products, much the same as I wasnât when I was at Ohio Northern almost 20 years ago. Anybody who reads the lay press knows that thereâs frequent mention of natural products in those publications. What I would like to do in this short space is go over some of the more popular natural products that are getting a lot of press today, their pros and cons, and perhaps give you some useful information.

Garlic is a natural product that has been used by mankind since the earliest recorded times. It was used extensively in ancient Egypt, China and Greece. Garlic and its properties were described in inscriptions on the Cheops pyramid in Egypt. Garlic is currently the biggest selling herb on the face of the planet. In fact one place in California, Gilroy, is considered the garlic capital of the world. Garlic is probably also the most widely studied of all the natural products. In just the last twenty years alone, an incredible 2,500 scientific studies have occurred looking into the medical benefits of this product. The uses for garlic are rather widespread. Health benefits for taking garlic include reducing cholesterol and triglycerides while increasing high density lipoproteins. At least nine epidemiological studies show that garlic decreases the incidence of cancer, especially cancer of the GI tract. Scientists in Venezuela have been able to demonstrate the effects of garlic in preventing the formation of clots caused by vascular damage. A recent study made by researchers at a clinical research center in New Orleans concluded that a garlic preparation of 1.3% allicin appeared to lower diastolic blood pressure. Oral administration of garlic oils has slowed GI transit time and stopped clinically induced diarrhea in mice. Garlic is approximately 1% as potent as penicillin in its antibiotic properties. However, like all herbs, garlic does have some contraindications. Garlic may interfere with existing hypoglycemic (low blood sugar) and anticoagulant therapies. Garlic may also potentiate the antithrombolytic effects of antiinflammatory drugs. It should also be noted that the antibacterial and antilipidemic activities of garlic appear to be provided by different constituents. The therapeutic value of deodorized garlic has been debated and disputed. The average daily dose of garlic should be 4 grams of fresh garlic, 4-12 mg of the constituent alliin, 2-5 mg of allicin, 400-1,200 mg of fully dried powder, 2-5 grams of fresh (air dried) bulk.

Whereas garlic is the most widely used herbal supplement in the world today, seventy-nine years ago in 1920 it was echinacea that was the most popular herbal preparation in the world. Even though its popularity has fallen off in recent years, it is still fairly widely used and widely researched. Echinacea is used extensively in Germany where the national Healthcare will pay for over 400 natural products. In 1993, 2.5 million prescriptions were written in Germany for this product. Unfortunately, unlike garlic there has not been a lot of good scientific research done on this product. Traditionally this product was used as a wound healing agent and an immunostimulant. Recent studies have indicated the plant does possess these two pharmacological activities that supports these traditional uses. Hopefully, the active components will soon be identified and can be evaluated for clinical usefulness. This could be a case where if man can isolate the chemicals that are responsible for these properties, new lines of pharmaceutical products could be developed by a major drug company. Echinacea does have certain contraindications as do all prescription and natural products. This drug is contraindicated in internally progressive systemic diseases (tuberculosis, multiple sclerosis, leukosis, and collagenosis). The average does of this natural product is 1 gm of dried root three times a day. It is normally taken for a period of two weeks and then given a rest period for a week.

Another widely recognized and used natural product is cayenne pepper. This particular natural product was first presented to Christopher Columbus on his second voyage to the West Indies by the Arakawa Indians. There are over 1,700 varieties of new world peppers, but this particular one has gained the most medical interest. At one time this product was used internally to stimulate digestion and to help circulation. However, in the 1990s, it is only being used extensively to manage topical neuritis and neuropathy syndromes. This particular product is available commercially over-the-counter as a 0.025% and a 0.075% concentration. Capsaicin (cayenne pepper) causes depletion of the neural peptide substance "P" from local sensory type nerve fibers. Substance "P" mediates transmission of pain impulses from the peripheral nerve to the spinal cord. This particular product penetrates less than half an inch through skin, and so for deep joint and muscle pain this product is not effective. The main type of pain therapy for cayenne pepper ( capsaicin) we see this used in community pharmacies are either for pain in the post-herpes patients or also in those patients who have neuropathy due to a disease state (usually diabetes). The product is never applied in the strongest form first, but rather the patient applies it four or five times a day at the weakest concentration until the body gets used to it and then a higher concentration may be used. This "getting used to it" may take one to two months.

The next product I will discuss is chamomile. This is a natural product who's use is fairly well known and many people are familiar with it in terms of chamomile tea which is how this product is sometimes administered. Chamomile tea has been used since the time of the Romans. Its traditional use in Europe is to quiet an upset stomach, promote urination, relieve cholic, and as a mild sleep aid. Topically it has been used to reduce inflammation, soothe aches, heal cuts, sores and bruises. In Europe this produce is currently used externally in compresses, rinses, or gargles to treat inflammation and irritation of the skin and mucous membrane. Chamomile, in tea form, is used to relieve spasms and inflammation of the GI tract and peptic ulcers. In a mild version, the tea is also used as a sleep aid for children. In addition, the most widely used and documented use of chamomile is in the significant antispasmodic activity in the GI tract. There is some evidence from animal models that components of this product may exert significant antiinflammatory properties. In one particular study, the antiinflammatory properties of this product compared so favorably with the potencies of indomethacin, one of the nonsteroidal inflammatory agents. Contraindications to this product would include people allergic to the daisy family. Because this drug has significant antispasmodic activity in the GI tract, it has the potential for delaying drug absorption from the gut and delaying the relief of symptoms.

One of the more recent entries into the natural product market, as far as its popularity, has been evening primrose. This particular plant is native to North America and it was introduced into Europe from ships ballast in the 1600s. American Indians used the whole plant for bruises, coughs, and GI complaints. Current clinical uses of evening primrose include cardiovascular disease, cancer, rheumatoid arthritis, premenstrual syndrome, multiple sclerosis, and diabetes. Claims are made it reverses neurological damage. However, in community pharmacy about the only current use that I routinely see for evening primrose is in the use of the treatment of the symptoms of rheumatoid arthritis. Again, like all products, this plant has certain contraindications. It should not be used in patients with schizophrenia or people are taking the phenothiazine-type drugs for epilepsy. A normal dose is three to six 500 mg capsules a day and this product should be taken with meals to try to reduce an upset stomach.

One particular natural product that was used widely in the middle ages and had fallen out of use until about ten years ago is St. John's Wort. The St. John's Wort is an aromatic perennial native to Europe but is now found throughout the United States and parts of Canada. It is considered an aggressive weed found in the dry ground in roadsides, meadows, woods and hedges. The plant has oval shaped leaves and yields golden yellow flowers which bloom from June to September. Some say that blooms are at their brightest coincidental with the birthday of John the Baptist on June 24 and, hence, the name St. John's Wort. This plant has gotten a lot of press in recent years for its antidepressant effect. The active component of the plant is hypericin which is used for its antidepressant effect. In the middle ages, this product was used for its antiinflammatory and wound healing abilities, but these uses are not readily validated by current scientific research. Recently over nineteen double-blind clinical trials have been used in people with this product showing its safety and effectiveness with fewer side effects than traditional anti-depressant therapy. This particular product seems to work by inhibition of serotonin uptake by post-synaptic receptors. In one study, hypericum caused a 50% inhibition of serotonin uptake by rat synapses. This particular product has several contraindications. It is not recommended to be used with concomitant antidepressant medications. Excessive doses of this product may potentiate existing MAOI antidepressant activity. People can become photosensitized by this product, particularly in higher doses and if the patients are fair skinned.