Popular Natural Remedies, Part X

This will be the tenth in a series of articles that I have written about natural products. As I have previously mentioned about these articles, I am well aware, as a healthcare provider, that many patients explore alternative therapies to treat their medical conditions. In my opinion, there are two principal reasons why people choose to utilize natural products: distrust of commercial products or non-relief of a medical condition. The purpose of these articles is to write about natural products for which there is some reasonable scientific evidence that they will work to treat a given medical condition. Previous articles can viewed on the Pharmacy web page at www.wright.edu/admin/fredwhite/ pharmacy. There are four books that I used in preparing these articles, which you may find in the library or perhaps on-line, that might provide interesting reading information about natural products. The four books are: The Lawrence Review of Natural Products, The German Commission E List, Tyler's Honest Herbal, and The Pharmacist's Letter Natural Medicines Comprehensive Database.

For those of us who look in the mirror each morning and realize we're not as young as we used to be, some of us may be interested in getting the best antioxidant to help retard the aging process and perhaps prevent certain types of cancers. What I have found to be an emerging healthcare trend with natural products toward this end is a product that was never mentioned three years ago. This product is the common blueberry. Blueberries are being touted in the popular literature in five areas: antioxidant, antiaging, disease prevention, prevention of urinary tract infections, and enhancement of eyesight. The component of blueberries that has been so interesting to investigators is the pigment that makes them blue, anthocyanin. The most intriguing research at this time with regard to blueberries is preventing or diminishing the effects of Alzheimer's disease. There was a study published in August of 2002 in mice, which were genetically programmed to develop Alzheimer's disease, were fed regular food for 12 months or regular food plus blueberries for 12 months. Interestingly, when the animals were sacrificed, the brains were markedly different between the mice not fed blueberries and those fed blueberries. At this point, the information about the medical use of blueberries is still very preliminary. However, those of you who read about natural products on the Internet or in print may want to follow blueberries in the years ahead and the research that is being done on them.

A natural product that has been sold in this country for about the last 10-15 years that is applied topically to relieve pain is capsicum. Capsicum is also called cayenne pepper, chili pepper, or red pepper. For purposes of this article, we will only refer to capsicum in the topical form. Capsicum is considered unsafe when used orally, as it can cause liver or kidney damage. Topical capsicum is considered effective by The Pharmacist's Letter for the temporary relief of pain from rheumatoid arthritis, osteoarthritis, and relief of neuralgias due to shingles or diabetic neuropathy. It should be noted that capsicum has been approved by the Food and Drug Administration as an OTC drug for treatment of these conditions. The mechanism of action of capsicum is fairly well understood. Near the surface of the skin in pain nerve endings there is a chemical called substance P. This compound is involved in the transmission of painful stimuli from the periphery to the spinal cord, per The Lawrence Review of Natural Products. Initially, when a painful stimulus occurs, substance P is released causing an increase in sensation of pain. Upon repeated administration of capsicum, substance P is depleted and a lack of pain sensation then ensues. Again, per The Lawrence Review of Natural Products, the onset of pain relief is usually three days or less. It should be noted that capsicum does not penetrate more than two and a half centimeters into the body, which is approximately one inch. If a patient is suffering from pain that is particularly deep (greater than one inch), this product will not work. Adverse reactions to this product would include burning of the skin and possible contact dermatitis and rash, should the person be allergic to this plant extract. Capsicum comes topically in a 0.025% and a 0.075% strength. The product is normally applied three to four times a day. This product has several trade names, but patients can buy it significantly cheaper in the generic form if they look for it. It is suggested that patients start with the lower strength and then go to the higher strength if the condition resolution warrants. Always wash your hands after applying this product.

When one thinks of natural products, one thinks of herbs and plants that have been growing in the wild for thousands and thousands of years. However, peppermint is an exception. We can actually place the year it came into existence, 1696. In that year in England, a natural hybrid or cross sprouted in a field spearmint, and from that natural hybrid, all the peppermint plants in the world have been derived. Peppermint has been used to treat a variety of ailments over the last few centuries. However, I will only discuss the use of peppermint to treat GI disorders. Per The German Commission E List, peppermint oil consists of between 4.5% and 10% esters. Per The Pharmacist's Letter, peppermint oil is a complex mixture of compounds including the main constituent menthol, which is a volatile oil. Further, per The Lawrence Review of Natural Products, the other constituents of peppermint oil are methylacetate and menthone. Both The Lawrence Review and The Pharmacist's Letter state that the antispasmodic activity of peppermint oil on the GI tract is well known. The Pharmacist's Letter states that the antispasmodic activity demonstrated in vitro and in animals, results form the direct action on GI tract smooth muscle, characteristic of calcium antagonist action. Further, it states that peppermint oil relaxes the lower esophageal sphincter and equalizes the intraluminal pressure between the stomach and the esophagus. Peppermint oil can also decrease the symptoms of irritable bowel syndrome. It is my professional opinion, people with irritable bowel syndrome should not use peppermint oil without first checking with their physician. Per The Lawrence Review of Natural Products, some of the main adverse reactions to peppermint would include: allergic reactions, headache and flushing, particularly in those individuals with aspirin-induced asthma. Per The Lawrence Review of Natural Products, peppermint oil should not be administered to patients with heartburn or active gastric ulcers. Symptoms of these two conditions can sometimes be exacerbated. Further, patients with active hepatic disease, inflammation of the gallbladder, gallstones, or obstruction of the bile ducts should consult a physician before using peppermint oil. The dose for peppermint oil to relieve abdominal discomfort is fairly set. Per The Pharmacist's Letter, the normal dose is 0.2-0.4 milliliters, diluted three times days (this is about 6-12 drops). The average daily amount of peppermint oil for abdominal discomfort and conditions is .6 milliliters. There are several possible drug interactions. It is hypothesized that the two classes of gastric acid blocking drugs, H2 antagonist and proton pump inhibitors, could interact with peppermint oil.

Over the years, one of the natural products whose name I hear people mention that they take is Kava. Per Tyler's Honest Herbal, kava is a plant found in the Pacific Ocean region in the area of New Guinea, from the Solomon Islands to the Banuatu. It is grown and cultivated on numerous Pacific islands including Fiji, Hawaii, and Samoa. Traditionally, Pacific islanders consume kava beverages at dusk before an evening meal. Per The Pharmacist's Letter, kava is used to treat anxiety disorders, stress, insomnia, and restlessness. Kava would probably be unknown to the Western World, except for the fact kava was introduced into Europe in the 1860s and became the darling of the German pharmacies late by the last quarter of the 19th Century. To this day, you will find a fairly good monologue on kava in The German Commission E List. The mechanism of action for kava remains unclear at this time. Per The Pharmacist's Letter, kava contains a number of lactones, which include but are not limited to, kawain, dihydrokawain, methysticine, and dihydromethysticine. Kava is not thought to effect the benzodiazepine or GABA receptors. However, there is some evidence that it does affect the limbic system. It is unknown as to which kava lactones affect this and exactly where they bind in the brain. The main concerns, as far as drug interactions or medical conditions to avoid, would be the fact that kava is a sedative. Kava can potentiate the effects of prescription hypnotics, as well as alcohol. Also, in people with depression, it is hypothesized that kava could make the depression worse. Per The Lawrence Review of Natural Products, serious concerns about the safety of kava arose in 2002. "A string of reports of fulminant hepatic failure have been made in Europe and the USA in which kava has been implicated." Even though the incidence of such adverse reactions is on the order of 1 per million doses consumed, kava has been removed from the pharmacy shelves in Germany, Switzerland, France, Ireland, and the UK. Warnings about the hepatotoxicity of kava have been given by the governments of Canada, Australia, and the United States. At this time it is my professional opinion, caution would dictate that patients with any predisposition to liver problems should avoid the use of kava. Per The German Commission E List, kava's dose is normally 60-120 milligrams of kava pyrones.

One of the more common questions that we get at the Pharmacy over the years, has been whether grapefruit juice will interfere with a patient's medication. I believe that most people drink grapefruit juice as part of their daily routine, rather than for any particular health benefit. With regard to health benefits, grapefruit pectin has been found to reduce cholesterol, and to promote the regression of arteriosclerosis. Grapefruit was first introduced to the Western world in 1750 as the forbidden fruit of Barbados. In 1823, grapefruit was introduced in Florida by a French count, Odette Fillipe, but did not gain popularity until the end of the 19th Century. During the 1930s, one of the original Hollywood fad diets was known as the Grapefruit Diet and was very popular, however, it was extremely unhealthy. Per The Lawrence Review of Natural Products, grapefruit juice has been found to increase the bioavailability of certain drugs by inhibition of cytochrome P-450 3A4 (CYP 3A4) isozyme found in the liver and gut wall. However the effects of grapefruit juice are primarily on the isozyme found in the gut wall. As a result of this inhibition, more of the drug is absorbed and the plasma concentration increases. It has been reported that grapefruit juice can increase the plasma concentrations of the benzodiazepines (Xanax, Ativan, and others), which are antianxiety agents. However the clinical significance of this is expected to be low. Perhaps one of the most significant drug interactions occurs with the class of drugs known as calcium channel blockers, which are used to treat hypertension. The dihydropyridine subgroup of calcium channel blockers, which include Norvasc, Plendil, and Procardia, are most affected by grapefruit juice. Again, per The Lawrence Review of Natural Products, plasma concentrations of Plendil increased by 300% when grapefruit juice is ingested. The plasma increases of Norvasc were about 15%, and the plasma increases of Procardia were approximately 35% with the resultant further reduction in blood pressure when patients drink grapefruit juice. Interestingly, the calcium channel blocker, diltiazem, was not affected by grapefruit juice, but it is from a different subgroup of calcium channel blockers. Another class of drug affected by grapefruit juice are the HMG-COA reductase inhibitors, which lower elevated cholesterol levels. Grapefruit juice increases the absorption and concentration of lovastin (Mevacor), simvastatin (Zocor), and atorvastatin (Lipitor). It does not affect pravastatin.

Other Drugs Affected by Grapefruit Juice
Tegretol (carbamazepine) - treats epilepsy - ­ blood levels
Coreg (carvedilol) - cardiac patients - ­ blood levels
Anaframil (clomipramine - obsessive compulsive behavior -
Neoral, Sandimmune (cyclosporin) - organ transplant -
Sporanox (itraconazole) - fungus infections in the nails -
Cozaar (losartan) - hypertension -