Popular Natural Remedies, Part XI

This will be the 11th in a series of articles that I have written on natural products. As a pharmacist, I recognize the fact that many patients use natural products to treat a variety of medical conditions. As I have repeatedly stated in these articles, it's my opinion that probably only one in 10 natural products actually have some proven medical validity as to their claims for treatment of given conditions. For the most part, in these articles I have tried to pick natural products which I believe have some validity for their claims of medical effectiveness. Although, sometimes, as in this article, I will try to debunk a product. It is my opinion that we all wish to spend our money on healthcare on products that work, whether it be a prescription or a natural product. It is my hope that these articles will point people toward products with proven value and efficacy. Previous articles may be viewed at our newly upgraded website: www.wright.edu/admin/fredwhite/pharmacy/.

Many of you reading this article remember that last summer there was considerable press about the increased risks of cancer with estrogen supplements in women. Since that time we have had dozens of requests at the Pharmacy seeking information of alternatives to prescription estrogen replacement. We have discussed several of these alternative in previous articles, and in this article, another alternative I will discuss is red clover. Historically, red clover was used for a number of medical conditions. In the early 1900s, more than a dozen companies marketed red clover products in this country. However, in 1912 a report came out from the government that said red clover was essentially worthless for any known medical condition, and its use fell off dramatically. It has only been in the last five or six years that red clover has been revisited by researchers in this country. Interestingly, it has been largely ignored by researchers in Europe during this time. Per the Pharmacist's Letter, there are over 100 different chemicals contained in red clover. Two of these 100 chemicals are phytoestrogens, which are structurally similar to estrogens. The principal isoflavones found in red clover are biochanin A and formononetin. When ingested, biochanin A and formononetin are metabolized to the isoflavinoids genistein and diazein. In postmenopausal woman with low endogenous estrogen, isoflavinones are likely to act as weak estrogens. Isoflavinones have a high affinity for the beta estrogen receptor. The beta estrogen receptor predominates in the heart, vascular, bone, and bladder, which may account for some of red clover's beneficial effects. Osteoporosis in postmenopausal women is related to declining estrogen levels. Red clover is thought to be beneficial for preventing osteoporosis due to its weak estrogen effect. The adverse reactions of red clover are fairly minimal. Orally, red clover is generally well tolerated. It can cause rash-like reactions, myalgia, headache, nausea, and vaginal spotting. The greatest concern is the potential drug interaction of red clover with anticoagulant drugs. These are theoretical reactions and have not been clinically documented. Patients who have any kind of bleeding disorder or are taking any type of anticoagulant drug, should not use red clover without checking with your personal physician. Again, per the Pharmacist's Letter, because red clover is excreted to the body through the cytochrome P-450 system, there are certain drugs with which it may interact. Theoretically, red clover could interact with common drugs such as Mevacor, Nizoral, Sporanox, Allegra, and Halcion. This particular natural product has no known interactions with food or lab tests. The daily dose of red clover is to be between 40 and 80 milligrams per day. Per The Lawrence Review of Natural Products, doses higher than 80 milligrams a day should not be taken.

A natural product that had fallen out of use during the last century that is being revisited is Butcher's broom. It is getting press that may be warranted Butcher's broom is a product that may help with circulation in older patients, particularly in the legs. Butcher's broom was used historically in Europe for hundreds of years, but by the early 1900s had fallen out of use. However, in the 1950s French scientists discovered that certain chemicals within butcher's broom seemed to have an effect upon the veins in the human body. Butcher's broom has been paid for by the German national healthcare system since the publication of its monologue in the German Commission E list on July 12, 1991. Per the German Commission E list, butcher's broom is used to support a therapy for discomforts of chronic venous insufficiency, such as pain and heaviness, as well as cramps in the legs, itching and swelling. Again, per the German Commission E list, in animal experiments butcher's broom were shown to increase venous tone, have an electrolyte reaction on the cell wall of capillaries, and to be a mild diuretic. Per the Pharmacist's Letter, the mechanism of action of butcher's broom is thought to be due to the steroidal saponin constituents: rusecogenin and neoruscogenin, which produce vasoconstrictive effects by direct activation of the alpha estrogen receptor. Per The Lawrence Review of Natural Products, it is further postulated that butcher's broom activates alpha 1 and alpha 2 receptors in the vascular smooth muscles. The safety of this particular natural products appears to be very good. The only adverse reactions listed for butcher's broom, per the Pharmacist's Letter, are GI disorders. Again, per the same text, there are no interactions with other herbs or dietary supplements. Butcher's broom has no known interactions with drugs or foods. Further, butcher's broom has no interactions with lab tests/contraindications with disease states or medical conditions. It should be noted at this time that the clinical studies on butcher's broom have been small; under 100 patients. The work at this time looks promising that butcher's broom is a product that may help circulation in older patients. This may be a product that you would want to watch in the upcoming years to see what further research is done on it.

The next product I wish to discuss is cat's claw. In the case of cat's claw, I will be trying to debunk a rather popular natural product that I've heard people mention at the Pharmacy counter on more than one occasion over the years. Cat's claw is an interesting product in that it ranks 7th as a most popular herb of U.S. sales in the late 1990s, despite there is very little scientific evidence affording its efficacy or safety. Per the Pharmacist's Letter, cat's claw has a long history as the miracle herb used by the Ashaninka, Native American Indians of Peru. It has been used by the Ashaninka in Peru as a general cure-all for hundreds of years, going back to the time of the Incas. Cat's claw probably would have stayed in the background as a little known product used by the Native Americans of Peru except for a book written by Nicole Maxwell in 1990 called "Witch Doctor's Apprentice: Hunting for Medicinal Plants in the Amazonian." In this particular book, she touted the virtues of cat's claw. Per Tyler's definitive book, Honest Herbal, there was a lot of initial excitement in the American market in the early '90s, that this was a folk remedy that was a natural answer to treating cancer, AIDS, as well as other infectious diseases. It is of note that the German Commission E list, which is a list of products that the German healthcare system will pay for, does not include cat's claw in the almost 400 natural products that it will pay for. However, in trying to be fair to the product, one of the reasons that the research on cat's claw could possibly be inconclusive is, per The Lawrence Review of Natural Products, there are actually 34 species of cat's claw grown and marketed in the world. More recent research is specifically honed in on two of these 34 species whose chemical contents are actually vastly different from each other. It is thought that perhaps research has been done with different varieties of cat's claw, and perhaps not the two varieties most actively researched. Also, mixing different species of cat's claw into a single product seems to antagonize the alkaloids in different varieties of cat's claw and make them ineffective. The current thinking is that future research of this product should be done on the two species that have the most potency, and perhaps this yield better results. At this time, the only promising use for cat's claw is in the use of inflammation. Freeze-dried extracts of cat's claw seem to help relieve pain due to physical activity. The main adverse reaction to cat's claw are headache, dizziness, and vomiting, per the Pharmacist's Letter. As far as warnings, since cat's claw, in theory, can lower blood pressure, people doing exercise should be cautioned when using it initially to monitor their blood pressure. Also, theoretically, cat's claw could interfere with immunosuppressive therapy. Cat's claw could interfere with any medicine that is metabolized by the cytochrome P-450 system in the liver. Cat's claw has no known interactions with food or lab tests. The normal dose of cat's claw is 100 milligrams daily for osteoarthritis and 60 milligrams daily for rheumatoid arthritis in three divided doses.

Alan C. McKelvey, R.Ph.
Pharmacist, Frederick A. White Health Center