Melissa Hemphill MD 4172015 OAFP Spring Conference Disclosures amp Scope No disclosures Scope is Herbs that are commonly used safe and accessible to patients amp maybe a couple you havent heard ID: 382261
Download Presentation The PPT/PDF document "10 Herbal Remedies To Recommend" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
10 Herbal Remedies To Recommend
Melissa Hemphill MD
4/17/2015
OAFP Spring ConferenceSlide2
Disclosures & Scope
No disclosures
Scope is
Herbs that are commonly
used,
safe
and accessible to
patients & maybe
a couple you haven’t heard
about
Not going to cover really common known/utilized (ginger, cranberry…)Slide3
Quality
Consumerlab.com
NSF seal
USP seal
Philosophy about herbal medicine: If it doesn’t hurt, and it might help, worth a try. Slide4
Tumeric
Uses:
GI: Reduce indigestion; IBD
sx
.
May be linked to lower rate of colon
cancer.
May reduce pain from osteoarthritis
May be linked to lower rate of Alzheimer’s
dementia
Proposed mechanism:
Anti-inflammatory through COX-2 inhibition,
anti-oxidant, can suppress cytokine production, alter gene expression, and induce apoptosis.
Crosses BBB.
Doses:
400mg
curcumin
extract three times a day
Curcumin
often stays within GI tract; increase absorption with fatty meals, or mixing with black pepper (up to 2000% absorption).
Clinically tested in US: Cur-Cure, Doctor’s Best
Best
Curcumin
C3,
Nutrigold
Tumeric
Curcumin
Gold, NOW
Curcumin
Potential concerns: “GRAS”
Safety profile is excellent. Slide5
Chamomile - Matricaria
recutita
Uses
:
Calmative – used in pediatric populations often
gastrointestinal anti-spasmodic
Topical anti-inflammatory for eczema, etc.
Proposed mechanism
: anti-inflammatory, inhibits COX-2, limits histamine, may interact with GABA-receptors; may compete for estrogen receptors
Dose
: Used as tea, tincture, balm, etc. Easy to make at home.
Potential
concerns
: Generally recognized as safe “GRAS”
Do not confuse with Roman chamomile Slide6
Elderberry – Sambucus
nigra
Uses
: influenza A & B
Proposed mechanism
: neuraminidase inhibitor-like properties, anti-viral & anti-inflammatory
anthocyanidins
,
Dose
:
LIQUID: 15 mL (1 tablespoon) 4 times daily given within 48 hours of initial symptoms
Clinically tested in US:
Sambucol
by Nature’s Way
Potential concerns
:
Caution
with
autoimmune
diseases
and immunosuppressant
medications
Do not consume uncooked,
unripened
berries or leavesSlide7
Rhodiola
Uses
: fatigue, mild depression, anxiety. An “
adaptogen
”
Proposed
mechanism
: Antioxidant like tannins, flavonoids;
phenylpropanoid
glycoside called
salidroside
are “
adapteogenic
”; effects cardiac
cAMP
cycle; alpha-glucosidase activity; reduces lipid peroxidation; inhibits staph in vitro
Dose
: 340mg BID for depression, 50-100mg BID for fatigue, up to 400mg/d
Clinically tested in US: SHR-5
Evidence
:
Darbinyan
et al,
Phytomedicine
2000 – improved fatigue index in
nightfloat
physicians! My favorite study.
Potential concerns
:
May cause dry mouth or dizziness. Can lower blood sugar and blood pressure (ACEI-like), CYP interactionsSlide8
St John’s Wort
–
Hypericum
perforatum
Uses
: mild to moderate depression
Proposed mechanism
: contains and stimulates production of melatonin
Dose
:
Clinically tested products in US: Kira by
Lichtwer
,
Perika
by Nature’s Way, St John’s
Wort
Ze117 by Zeller AG
Evidence
:
Several studies suggest equal or better efficacy to SSRI; but my favorite shows they are both inferior to placebo.
Potential concerns
:
Fewer side effects: 26% vs 45% for SSRI (Linde & Murrow 1998). Those reported included photosensitivity,
pruritis
.
Many drug-drug interactions due to CYP3A4 induction (HIV &
antineoplastics
). Possibly induction of P2C9 (warfarin). Possibly induction of P-glycoprotein drug transporter (digoxin). May decrease efficacy of OCP's. Slide9
Licorice – Glycyrrhiza
spp.
Uses
: cough, colds, sore throat,
“
gastroprotectant
” GERD/gastritis
or IBD.
Proposed
mechanism
: increase prostaglandins that stimulate stomach cell proliferation and mucus lining.
Dose
: DGL 700-800mg 20 min before a meal for 3-4 weeks
There are no clinically tested products available in the US.
Potential
concerns
:
Contraindicated in
cholestatic
liver disease or cirrhosis, hypokalemia, renal disease, pregnancy, and ill advised if CHF or edema due to
pseudoaldosteronism
. However preparations without glycyrrhizin are called DGL and have no such safety concerns.
May interact with diuretics, corticosteroids, anti-
hypertensives
Safe for periodic short-term use, up to 3g/d for 3-4 weeksSlide10
Ginseng – Panax
quinquefolis
& ginseng
Uses
:
Mental and physical fatigue (cancer related fatigue); shortening URIs; poor concentration; lowers blood sugar
Proposed
mechanism
:
ginsennosides
activate
monocytes, NK’s, Interferon-gamma, stimulates IL2 production, induce
tumor necrosis factor (TNF)-
alpha; may sensitize to insulin, may be estrogenic & decrease LH.
Dose
: Infusion of 5oz boiling water over 1-2 grams powdered root and steeped for 10 minutes
Clinically tested in US:
Ginsana
by
Pharmaton
; Prince of Peace American Ginseng
Potential
concerns
:
British guidelines contraindicate use during pregnancy; German do not.
Overdose may cause diarrhea, jitters, insomnia, menopausal bleeding,
hypertony
Pesticides are a problem in production
Russian or Siberian Ginseng does not count.Slide11
Feverfew - Tanacetum
arthenium
Uses
: migraine prevention. Sometimes combined with riboflavin, magnesium, or butterbur
Proposed mechanism
:
parthenolide
inhibits COX-2, TNF-a, and IL-1. But
parthenolide
probably not active, but a surrogate
marker
Dose
: Optimal doses have not been established, but most recommend 125-250mg/day of
parthenolide
. Of herb, fresh leaf is 1-2 leaves per day; dried leaf is 50-250mg per day.
Potential
concerns
: Contraindicated during pregnancy due to uterine stimulation. Inhibits serotonin-induced platelet aggregation. Rebound headache upon discontinuation. Ragweed family. Slide12
Valerian root – Valeriana
officinalis
Uses
: for restless or anxiety-induced sleep disturbances
Proposed mechanism
: no agreement on this
Dose
:most
benefit from 400-500mg 2 hours before bedtime
Homemade infusion: pour 5oz water over 1tsp of root & steep 10-15minutes
Tincture: 1-3mL 1-3 times a day
Clinically tested products:
Sedonium
, Valerian Night Time by Nature’s Way,
Alluna
Sleep
Potential
concerns
: Safety profile is good, caution with other sedatives. Overdose may cause
agitative
sx
(HA, vision, restless, nausea) and cardiac disturbances * Slide13
Chasteberry -
Vitex
agnus-castu
Uses
: premenstrual syndrome, irregular menses,
mastodynia
Proposed mechanism
: reducing prolactin via binding D2 receptors, increasing progesterone in the luteal phase,
increasing dopamine, and
binding opiate receptors.
Dose
: highly variable
500mg dried fruit in AM; or fluid extract 0.5-1mL per day.
Vitex
Nature’s Way 400mg BID-TID;
Prefemin
20-40mg daily
Concerns:
Uncertain hormonal effects during pregnancy, may reduce lactation in animal models. Do not use with other dopaminergic agonists. Theoretical concern about use with OCP.
Slide14
Arnica
Uses:
topically for sprains,
bruises
Proposed
mechanism
:
sesquiterpene
lactones have
anti-inflammatory, analgesic, and platelet-inhibitory effects
Dose
: thin layer topically
Potential
concerns
: GRAS in food, but not for internal use in supplement doses.
Orally, arnica can cause irritation of mucous membranes, drowsiness, stomach pain, vomiting, diarrhea, tachycardia, shortness of breath, coma, and
death*
*A bad outcome.Slide15
Sources
Arizona Center for Integrative Medicine monographs
Natural Medicines Comprehensive Database
ConsumerLab.com
HerbClip.com
NIH Supplement Fact sheets
Individual journal article citations available on request