Popular Natural Remedies, Part XV

This will be the 15th in a series of articles that I've written on popular natural products. From my many years in the Fred White Center, I am well aware, working at Wright State, that a number of our employees and patients use natural product supplements in the treatment of a wide variety of disease states and ailments. Over the years many claims on natural products have been brought to my attention by our patients. It has always been my opinion that only one or two in ten natural products have some validity to their purported uses. In writing these articles, I usually try to pick natural products where there is some documented validity to their usefulness so that folks who wish to spend their money on natural products, at least are spending it on those products with some documented value, efficacy, and safety. In my last article, I highlighted products from the German Commission E List. In this article, I am choosing products from the Pharmacist’s Letter Natural Medicine Comprehensive Database. All of my previous articles can been seen on the Pharmacy web page www.wright.edu/admin/fredwhite/pharmacy/.

A relatively new natural product that is coming to patients' attention in the healthcare field in the treatment of osteoarthritis is gelatin. I first read a rather intriguing article concerning gelatin about four years ago in a patient-oriented rheumatology publication, where approximately 100 folks were treated with gelatin and 60%-70% of the patients had some improvement. Since that time, even though I have looked in current publications five or six times and did several drug information searches, I have not seen any further information. However, in the 2004 edition of the Pharmacist's Letter natural products database, there is, for the first time, an entry on gelatin. Per the Pharmacist's Letter, gelatin is a purified protein formed by the hydrolysis of collagen obtained from the bones and hides of pigs and cows. In the treatment of osteoarthritis there is preliminary information that suggests gelatin in combination with the antioxidant and enzyme, superoxide dismutase (SOD), might suppress joint inflammation. Further, there is preliminary research that gelatin may inhibit bone collagen breakdown in patients with osteoarthritis. The mechanism of action may be by the increased production of collagen by chondrocytes. Chondrocytes are the cells responsible for the maintenance of connective tissue in the joints. I would stress that this evidence for the efficacy of gelatin is preliminary at this point. Again, per the Pharmacist's Letter, the adverse reactions to gelatin are related to it causing unpleasant taste, a sensations of heaviness or bloating in the stomach dyspnea and belching. Cautions about gelatin, since it comes from bovine bones and skin, include allergic reactions and the transmission of mad cow disease (BSE). The safety net against BSE the industry uses is questionable. Gelatin can be dosed up to 10 grams per day.

In the area of men's health, there is some good preliminary data that taking selenium can reduce the risk of prostate cancer. In this data, I would like to point out selenium is normally given with vitamin E, which was discussed in a previous article. Selenium is purported to be used for a wide variety of disease states. People take selenium for the treatment of HIV, hypothyroidism, the Osgood-Schlatter disease, and preventing certain cancers. Selenium has been studied in the prevention of colon, prostate and, most recently, breast cancer. Per the Pharmacist's Letter, selenium has been shown to be effective in reducing the risks of prostate cancer, particularly in those individuals who's selenium levels have been shown to be low. The use of selenium in treating breast cancer is too preliminary at this point to draw any conclusions, and selenium has been shown not to have any effect on the rates of colon cancer. Per the Pharmacist's Letter, selenium's mechanism of action appears to be that it increases cancer cell death by causing apoptosis, inducing the formation of reactive oxygen species (ROS). If selenium levels are below 1000 mg/L, selenium activates glutathione peroxidase, which reduces oxidative stress by handling free radicals and hydrogen peroxide. At plasma concentrations above 2000 mg/L, selenium paradoxically increases cellular oxidation. It should be noted that selenium can cause acute toxicity, which can include the symptoms of nausea, vomiting, fatigue, irritability, and weight loss. If you chose to take selenium, you absolutely should not take any more than the recommended daily amount. The only known interaction with other herbs or dietary supplements is with dietary iron which can significantly decrease the absorption of the selenium. If you are taking a statin to lower cholesterol (Crestor, Lescol, Lipitor, Pravachol, Zocor) you should check with your doctor before taking selenium, as selenium can lower the absorption of these drugs. For cancer prevention, it is suggested per the Pharmacist's Letter, that patients take 200 micrograms of selenium per day, supplied as a 0.5 grams high selenium brewer's yeast tablets. The sources of selenium do differ, as well as their ability to prevent cancer. At this time, it's unclear which form will prove best. In the prevention of cancer it is selenium associated with brewer's yeast that has been used in the studies shown to be most effective in the prevention of prostate cancer. This may be subject to change in the years ahead.

With almost any multivitamin, if you would grab almost any over-the-counter bottle off the shelf, you see that one of the B vitamins listed is folic acid. Until recently, the only people who took folic acid supplements were pregnant women, plus patients taking medications such as methotrexate, which is a disease state modifier for arthritis. However, a recent buzz word in the risk factors for cardiovascular disease has been hyperhomocysteinemia. Per the Pharmacist's Letter, consumption of at least 300 mcg of dietary folate seems to be associated with a 20% lower risk of stroke and a 13% rate of stroke compared to patients taking 136 mcg or less per day of folic acid. The use of folic acid in coronary artery disease prevention appears to be directed towards those who have not yet experienced an event, rather than those patients who have already experienced an event. The current medical thinking is that hyperhomocysteinemia screening should be done for people of 40- to 50-year-old range, as a blood test can confirm the diagnosis of hyper cystinemia. The exact mechanism for the effects of high homocysteine levels is not fully understood. Per the Pharmacist's Letter, in patients with asymptomatic atherosclerosis, lowering homocysteine levels with folic acid reduces the progression of atherosclerosis and improves arterial blood flow. It is interesting to note that perhaps one of the biggest reasons for the decrease of folic acid levels in people are the medications that we may take. Per the Pharmacist's Letter, some of the medications that can decrease folic acid levels include drugs such as aspirin, diuretics (blood pressure), estrogen, histamine 2 blockers (stomach), metformin (diabetes), methotrexate, non-steroidal anti-inflammatory agents (arthritis), Dilantin, and proton pump inhibitors (GERD and ulcer). Per the Pharmacist's Letter, folic acid orally 0.4 mg - 0.5 mg /day lowers fasting homocysteine levels by 20% to 30% in people with normal adrenal function. However, 0.8-1 mg per day seems to provide maximal reduction of homocysteine levels.