Popular Natural Remedies, Part VIII

This will be the eighth in a series of articles that I have written about natural products. All of us, on a yearly basis, are aware of a number of information pieces, either on radio, television, the web, or in written form that extol the virtues of natural products that treat medical conditions. For whatever the reason, consumers in this country see these articles, and are drawn to the products they promote. Consumers frequently believe natural products may be superior to tried and true medical treatments for a condition. Unfortunately, in my opinion, probably nine out of ten of these claims are worthless. It is my opinion that, at best, one out of ten claims are valid. In the series of articles that I have written, I've largely tried to deal with products with whom there is at least some proven clinical benefit in treating a medical condition. Although, sometimes I debunk a popular natural product, as I will in this article.

One of the more common questions that we as pharmacists get are what products are available besides estrogens in the treatment of hot flashes and other menopausal symptoms in women. One product that has gotten a lot of attention in recent years is Black Cohosh. Per Tyler's book, Honest Herbal, Black Cohosh has been used for centuries in this country. Historically, Black Cohosh was used by the American Indians, somewhat generically, in the treatment of diseases of women. Subsequently, in the last century it became one of the principle ingredients in the well-known Lydia Pinkham's vegetable compound. While Black Cohosh is reportedly used for a number of medical conditions, the only medical condition that has been studied at any length is in the treatment of hot flashes and other symptoms of menopause. The Germans were the first country to extensively study Black Cohosh to this end. During the 1960s, there were 15 studies conducted in Germany involving over 1,500 patients, in which Black Cohosh was used to treat premenstrual and menopausal symptoms. Since that time there have been several other large studies outside of Germany, including one with 629 patients, where 80% of the patients in the study reported favorable results in the relief of their symptoms with Black Cohosh. Per Natural Medicines, published by the Pharmacist's Letter, in spite of numerous clinical studies, the exact chemical that would cause these clinical affects remains unknown. Black Cohosh contains at least a dozen different chemical compounds. About all that can be said at this time is that the compounds appear to bind to estrogen receptors exerting their therapeutic affect. It should be noted, while patients report improvement of clinical physical symptoms of menopause, there is no known data at this time to show whether Black Cohosh would have an affect on osteoporosis or cardiovascular disease. Per The Lawrence Review of Natural Products, Black Cohosh shows no stimulatory effect on established breast cell tumor lines. However, it is thought that it could interact with the breast cancer treatment tamoxifen. Breast cancer patients interested in using Black Cohosh to treat symptoms of menopause should always seek the advise of their physician before using this product. Per The Pharmacist's Letter, the most common adverse reaction with Black Cohosh are GI disturbances. Other adverse affects include headache, feeling of heaviness in the legs, and weight gain. Traditionally, Black Cohosh was taken as a liquid prepared from the dried root of the plant, and taken three times a day. There is a commercial product available, although I'm not sure how readily available in the United States, called Remifemin, which contains 20 milligrams of Black Cohosh, and is taken twice a day.

Ever since the 19070s when Linus Pauling claimed that large doses of Vitamin C would prevent the common cold, this nutritional supplement has been taken by a large number of people. When I look through a Pharmacist's Letter on natural products, I find that the reported uses of Vitamin C are listed in excess of treating 50 different medical conditions. Unfortunately, as I read the information on vitamin C, instead of coming away with the feeling of why doesn't everyone take this, I come away with the feeling why should anybody take this. Per the Pharmacist's Letter, vitamin C is only considered likely effective in one medical condition, and that's in improving iron absorption in people who are anemic. When I read the conditions that vitamin C could be possibly effective in treating, I see that there's a number of studies that have been done. Researchers have studied anything from vitamin C's use in Alzheimer's to the prevention of cancer, but at least at this time, there are no definitive studies that would show any of the many claims to be true. Furthermore, vitamin C is not considered effective in the treatment of the common cold. Vitamin C has been widely researched over the last 20 years, and to this time, no studies show conclusively that Vitamin C is effective in reducing the symptoms of the common cold. As by aforementioned comment, in reading the literature on Vitamin C, I'm almost of the opinion why would somebody want to take this supplement. Vitamin C can decrease the absorption of aspirin, and lead to potential high levels of salicylate in people taking high-dose aspirin therapy. Vitamin C can interfere with blood thinners, such as Coumadin. Vitamin C can interfere with up to nine different lab tests, including blood levels of certain critical medications, such as carbamazepine and theophylline. In addition, Vitamin C can interact with several different disease states. Again, per the Pharmacist's Letter, in diabetes, Vitamin C supplements can effect glycogenolysis and increase blood sugar, although this effect is controversial at this time. Large amounts of Vitamin C can cause kidney stones in susceptible individuals. In people suffering from sickle cell disease, Vitamin C can decrease blood pH and precipitate a sickle cell crisis. The current thinking of such organizations as the American Heart Association has been, it is better to obtain Vitamin C from a diet high in fruits, vegetables and whole grains rather than supplements because some of the side effects of Vitamin C are seen with the supplements, but not Vitamin C from natural sources.

One of the more widely written about natural products is soy. There have been over 7,000 articles written in the medical literature concerning soy and its use to treat various medical conditions. This particular plant was originally cultivated in China over 3,000 years ago. Since that time, it's cultivation has spread around the world. There are four areas where soy is considered to have certain health benefit: cancer prevention, treating menopausal/osteoporosis symptoms, treating cardiovascular and lipid disease disorders, and GI benefits. While there are many claims that soy reduces cardiovascular disease, the only thing that can be said with any certainty is that soy can reduce total cholesterol, which should decrease cardiac morbidity and mortality. It is interesting that according to The Lawrence Review of Natural Products, soy doesn't seem to have much effect on patients with "normal" lipid levels, but only on those patients with elevated levels. Further, per the Pharmacist's Letter, soy will only work when it's in combination with a diet that is low in saturated fat and cholesterol. There are specific dietary guidelines set by the FDA, as far as soy and its ability to lower cholesterol. Probably the most widely questioned use of soy that I am asked concerns the use of soy to help ease menopausal symptoms and to help stop osteoporosis. Per the Pharmacist's Letter and The Lawrence Review of Natural Products, soy contains the chemical, isoflavones. This is hydrolyzed beta-glucosidasis in the jejunum, releasing the phytoestrogens, genistein and daidzen. It is noted that these compounds reach a peak concentration in 4 to 8 hours and are wholly excreted from the body in 24 hours. This means that these products may need to be given in several doses over the course of the day for optimum therapeutic effect. These phytoestrogens have a higher affinity for beta-estrogen receptor than the classical alpha-estrogen receptors used in prescription estrogen products. The beta-estrogen receptors predominates in the heart, blood vessels, bone, and bladder, which may account for some of its effects. Interestingly, per the Pharmacist's Letter, with the control of hot flashes, soy's effect doesn't seem to correlate to the level of phytoestrogens. Meaning, if you double the amount of phytoestrogens in the blood stream, it doesn't necessarily do a thing to reduce one's hot flashes. Therefore, it has been postulated by some researchers, there is an ingredient other than the isoflavinoids in soy that account for its effect in menopausal symptoms. In regard to the use of soy in the bowel, because of the fact it is a fiber, it tends to help prevent constipation and the incidence of bowel disease. Soy's possible interactions or contraindications include people with asthma or allergic rhinitis. I think most people would recognize that people can have soy allergies, which would worsen if you used soy to treat medical conditions. There is some thought that people with breast cancer, that being a phytoestrogen, that they could increase the tumor risk, although that is unproved at this point. More worrisome, however, are reports as recently as this month, that show that phytoestrogens in breast cancer patients taking tamoxifen (the drug to treat breast cancer), that the phytoestrogens seemingly antagonize the tamoxifen and make it less effective in stopping the recurrence of breast cancer. There is also some evidence that soy can cause a suppression of the thyroid and cause a hypothyroid state.

Since many people at WSU might be interested in learning more about natural products, here are some of the Web Page Listings from The Lawrence Review of Natural Products.

American Journal of Natural Medicine - www.impakt.com
Botanical Review - www.nybg.org/bsci/spub/botr/frontpage.html
Canadian Journal of Botany - www.nrc.ca/cgi-bin/cisti/journals/rp/rp2_desc_e?cjb
Canadian Journal of Herbalism - no website given
Economic Botany - www.econbot.org
European Journal of Herbal Medicine - www.ejhm.co.uk
Herb Companion Press - no website given
Herb Quarterly - www.herbquarterly.com
HerbalGram - www.herbalgram.org/herbalgram/index.html
Journal of Natural Products - http:\\pubs.acs.org/journals/jnprdf/index.html
Medical Herbalism: A Journal for the Clinical Practitioner - http:\\medherb.com/MHHOME.SHTML
Natural Health - www.naturalhealth1.com
Natural Product Letters - www.gbhap.com/journals/724/724-top.htm
NCAHF Newsletters - www.ncahf.org/nl/nlindex.html
Pharmaceutical Biology - www.swets.nl/sps/journals/pb.html
Plant Foods for Human Nutrition - www.wkap.nl/jrnltoc.htm/0921-9668
Planta Medica: Natural Products and Medicinal Plant Research - www.thieme.de/plantamedica/fr_inhalt.html
Veterinary and Human Toxicology - no website given
American Botanical Council - www.herbalgram.org
American Herbalists Guild - http:\\www.americanherbalistsguild.com/top.htm
Complementary & Alternative Methods - http:\\www.cancer.org/alt_therapy/index.html
Herb Research Foundation - http:\\www.herbs.org
Herbal Education Services - http:\\www.botanicalmedicine.org
Herbal Medicine: Internet Resources: Alternative Medicine - http:\\www.pitt.edu/~cbw/herb.html
HerbMed - http:\\www.herbmed.org/
International Herb Association - http:\\www.iherb.org
MEDLINEplus: Alternative Medicine - www.nlm.gov/medlineplus/alternativemedicine.html
National Center for Complementary and Alternative Medicine - http:\\nccam.nih.gov/