The Herbal Drugstore

CHAPTER 1

WHAT IS HERBAL MEDICINE?

HERBS WERE THE FIRST DRUGS that we humans had at our disposal. Our ancestors learned over time which plants harmed them and which plants seemed to help them. They developed ways to preserve and extract the healing com£ds from these plants. The world over, most cultures have some knowledge about local plants that can do them good.

In some cases, what ancient civilizations learned about treating illnesses with herbs has been proven correct by modern researchers. Echinacea, for example, has been shown to increase the activity of immune cells and help fend off infection by viruses and bacteria--attributes that help explain the herb's cold-fighting power. Italian cooks of centuries ago added fennel seeds to sausage recipes; it turns out that the seeds help digestion and dispel gas.

The first herbal drugstore, then, encompassed all of nature, with its amazing array of medicinal plants. By comparison, the modern drugstore seems far removed from its natural roots. You can take herbs as capsules or liquids or sprays that bear little resemblance to living plants. You can use products that contain combinations of herbs or com£ds that have been chemically isolated from herbs and highly concentrated. And you can buy these products just about anywhere--in health food stores and conventional pharmacies as well as in supermarkets, from mail-order catalogs, and over the Internet.

DEFINING THE LANGUAGE

To choose wisely among the many remedies available to you, it's best to have a basic knowledge of what herbs are, how they work, and what they can do for you.

First of all, what's an herb? For the purpose of this book, an herb is any plant material that's used to alleviate unwanted symptoms or boost overall health. So in this context, garlic (a bulb), cayenne (a spice), and ginkgo extract (from the leaves of a tree) can all properly be called herbs. So can reishi, a mushroom, even though you're most likely to take it in the form of a liquid or tablet. One of the few herbs that you might still take in its fresh, green form is feverfew, used to relieve headaches.

Herbal medicine, then, is the use of plants, plant extracts, or plant preparations to improve health. It is one of a number of healing techniques that fall into the category of alternative medicine. (For information about other healing disciplines, see "'Alternative Medicine': What Is It Really?")

There are two fundamental principles that herbal medicine shares with other alternative therapies. One is the concept of working with the body instead of against a disease, as mainstream medicine does. Rather than killing germs, alternative therapies seek to enhance the body's innate ability to fight disease and return itself to health. That's why practitioners of many alternative therapies, including herbal medicine, put an emphasis on diet, exercise, deep relaxation, and massage.

The other principle common to many alternative therapies is the use of medicinal plants instead of pharmaceutical drugs. Medicinal plants are the basis of not only herbal medicine but also aromatherapy and flower therapies. Herbs play central roles in homeopathy, Traditional Chinese Medicine, Ayurvedic medicine, and naturopathy. In addition, medicinal plants are connected to nutritional therapies because some herbs, such as onions and apples, are foods.

This book focuses mainly on herbal medicine, a discipline that offers remedies for most health problems. For some conditions, it will also touch on vitamins and supplements, dietary changes, and other ways you can support your own health.

HOW HERBS AND DRUGS ARE ALIKE

While medicinal plants and pharmaceutical drugs are often viewed as opposites, they actually have a good deal in common.

"ALTERNATIVE" MEDICINE: WHAT IS IT REALLY?

Alternative medicine, natural medicine, holistic medicine, and complementary medicine are all loose umbrella terms for an enormous number of healing arts, including the following:

. Nutritional therapies, notably low-fat eating, vegetarianism, and elimination diets

. Supplementation, the therapeutic use of vitamins, minerals, and com£ds such as coenzyme Q10, sometimes in large doses

. Relaxation therapies, among them: meditation, biofeedback, hypnotherapy, and visualization therapy

. Exercise, notably walking and the meditative disciplines: yoga, tai chi, and qi gong

. Manipulative therapies, including massage, chiropractic, osteopathy, and the many schools of bodywork

. Herbal medicine, the therapeutic use of medicinal plants as substitutes for or in combination with pharmaceutical drugs

. Aromatherapy, the therapeutic use of the essential oils found in medicinal plants, notably to enhance relaxation

. Flower therapies, the use of essences that deliver minute to infinitesimal amounts of therapeutic substances, or even vaguely described "energies," from medicinal plants

. Homeopathy, a healing system whose medicines are microdoses of medicinal plants and other substances

. Traditional Chinese Medicine, which combines herbal medicine, nutritional approaches, and acupuncture

. Ayurvedic medicine, the ancient Indian discipline that combines herbal medicine, nutritional approaches, massage, and exercise, specifically yoga

. Naturopathy, which focused on nutrition a century ago, but today encompasses all of the above therapies

One little-known similarity is that an estimated 25 percent of all pharmaceuticals are still derived directly from plants. The world's first "wonder drug," the malaria treatment quinine, was extracted from South American cinchona bark almost 500 years ago. Digitalis, used to treat congestive heart failure, comes from foxglove. Aspirin was originally an extract of white willow bark and meadowsweet, both of which contain aspirin's chemical precursor, salicin. The active ingredient in the mouthwash Listerine is the antiseptic thymol, which comes from thyme essential oil. And surgical salves that help speed the healing of wounds often contain allantoin, a com£d derived from comfrey.

The list goes on and on, and new drugs continue to be derived from plant sources. One of the biggest breakthroughs in recent years is the discovery of taxol, a com£d derived from the yew tree and used in the treatment of breast and ovarian cancer.

Another similarity is that both medicinal plants and synthetic drugs contain com£ds that alter body processes. That's the whole point of using them to treat illness--to change things from bad to better. When you have an infection, you might take a pharmaceutical antibiotic or the natural antibiotics contained in garlic or goldenseal. In either case, com£ds from the drug or the herb enter the bloodstream and help the immune system eliminate the micro-organism that's causing the problem.

What's more, scientists study herbs and drugs in much the same way, using what they call randomized, placebo-controlled, double-blind trials. "Randomized" means that the subjects are not specially preselected, which might bias the results. Instead, they may be all the residents of a certain nursing home, or the next 250 patients to visit a particular clinic.

"Placebo-controlled" means that some of the participants take the active herb or drug, while others receive an inactive substance, or placebo. Because of the ability of the mind to stimulate the immune system, placebos typically provide significant relief for around one-third of those who take them. To be judged effective, the drug or herb being tested must significantly outperform the placebo.

Finally, "double-blind" means that neither the participants nor the researchers know in advance who took the test com£d and who got the placebo. This prevents the researchers from treating subjects differently, which might bias the results.

Researchers at Albert Einstein College of Medicine in New York City used a randomized, placebo-controlled, double-blind study to test an extract of ginkgo as a treatment for Alzheimer's disease. They recruited 309 people newly diagnosed with Alzheimer's and gave them either ginkgo extract or a placebo for a year. Compared with the placebo, the ginkgo significantly slowed the participants' mental deterioration. Several previous studies had hinted that ginkgo might be an effective Alzheimer's treatment. But because this study was large and scientifically rigorous (that is, randomized, placebo-controlled, and double-blind), it got published in the Journal of the American Medical Association, made headlines, and established ginkgo as a viable treatment for Alzheimer's.

HOW HERBS AND DRUGS DIFFER

As you can see, medicinal herbs and pharmaceutical drugs have quite a bit in common. But they also have several key differences.

Dose for dose, most herbs are less potent than drugs. While this may sound like a disadvantage, it actually makes herbs safer to take.

To make conventional pharmaceuticals, manufacturers extract unique chemical constituents from plants or create synthetic versions in the laboratory, then pack the substances into pills or capsules that can hold large quantities. With most herb products, however, the plant material itself limits how much of the medicinal com£ds you get.

Sometimes, you want drug-level potency--even at the risk of experiencing side effects. If you're in severe pain from rheumatoid arthritis, then you may opt to take strong anti-inflammatory drugs, even if they cause abdominal distress. But if you have a run-of-the-mill tension headache, you probably don't need such strong medication. You probably don't even need two aspirin. A cup of chamomile tea might be enough to soothe your nerves-- with a substantially lower risk of side effects. (Some products concentrate herbal ingredients for greater potency. However, such products usually come at a premium price.)

HOW HERBS ARE REGULATED

Herbs are classified by the United States government not as drugs but as dietary supplements. This broad category also includes vitamins, minerals, enzymes, and other nutritional products.

What this means for you is that you don't have to wait years for costly research to be done on the herbs you want to take. But it also means that the manufacturers of herbal products are limited in the claims they can make on the labels--even when those claims have research to support them.

Specifically, manufacturers are permitted to make what's called structure and function claims--in other words, they can say only that a product affects the structure and function of a body part or system. So a product label for a standardized ginkgo extract can say, "increases microcirculation to the brain." But it cannot say "cures early-stage Alzheimer's" or "alleviates tinnitus"--even though there is research to support the ability of ginkgo extracts to do just that.

When any manufacturer puts a product on the market that bears a structure and/or function claim, the company must also create a file of research evidence that supports that claim. Then the Food and Drug Administration (FDA) has 30 days in which to investigate and challenge this evidence. Whether or not the agency chooses to do so, the file must remain available for inspection indefinitely at the manufacturer's place of business. If credible research exists, the FDA may not prohibit the manufacturer from making reasonable claims--as long as they are stated in terms of structure and function rather than curing disease.

The herb and supplements industry has its own organizations that informally regulate against harmful products or outright fraud. For example, the American Herbal Products Association--a group of herbalists, researchers, and manufacturers--has created a Code of Ethics that members are expected to abide by. It also releases product safety alerts regarding adulteration-- that is, contamination with an unlabeled substance--of herbal products and it publishes an important reference work, the Botanical Safety Handbook.

There's also the Natural Nutritional Foods Association (NNFA), a group of manufacturers and retailers devoted to product quality and truth in packaging and advertising. Among its many activities, the NNFA supports a True Label Program intended to ensure that the products put out by its members actually contain what their labels claim.

Other countries take different approaches in regulating herbs. In Germany, HERBAL REMEDIES are overseen by a specific body, known as the Commission E. This government panel evaluates the available research on an herb's effectiveness for an ailment, its tradition of use, and its safety. Panel members then approve the sale of some herbs and combination products for specific conditions. German doctors can prescribe herbs or herbal products just as they would drugs.

Reduced risk of side effects is a big reason why medicinal herbs have become so popular. Just check out the potential side effects of any over- the-counter cold remedy--or, if you really want to read a lot of small print, the side effects of any blood-pressure medication. They may make you feel worse than the condition itself! For this book, we list only common side effects of the most commonly prescribed drugs.

By comparison, many medicinal herbs have no known side effects for people who are otherwise healthy and are not taking other prescription or over-the- counter drugs. Many are safe for everyone except pregnant or nursing mothers and infants. Some are even safe enough for babies.

But just like any medicine, HERBAL REMEDIES must be used with care. One of the worst mistakes people can make is to assume that because medicinal plants are natural, they're completely harmless.

Cascara sagrada, for example, is a potent laxative that can help relieve constipation. But in large doses, it causes abdominal distress, intestinal cramping, and diarrhea. Licorice root is a scientifically proven treatment for ulcers. But if you take unusually large amounts or take it for extended periods, you may experience water retention that raises your blood pressure to possibly hazardous levels. That's why there's a form of licorice that has certain com£ds removed, developed especially for people with ulcers who need to take licorice for a period of months.

The point is this: Just like drugs, herbs and herbal products have the potential to do good when used responsibly. But they may cause harm when used carelessly.

In addition to being less potent than drugs, herbs are usually cheaper. As an example, consider the "statin" drugs now widely prescribed to reduce cholesterol. Garlic also reduces cholesterol--not as dramatically, but a lot more economically. If your cholesterol is sky high, a statin-type drug might be the most medically advisable treatment. But if your cholesterol is only mildly elevated--as is the case for millions of Americans--garlic from the grocery store may well be all you need.

A big reason why drugs are so much more expensive than herbs is that drugs must be approved by the Food and Drug Administration (FDA) before they're made available to the public. Pharmaceutical companies spend millions of dollars to prove that their drugs are safe when taken as directed (though sometimes hazardous side effects are discovered only after FDA approval, as was the case with the diet drug Fen-phen). They also have to prove that their drugs actually work for each disorder they're prescribed for.

ESSENTIAL Herb Safety Tips

While herbal medicines generally have far fewer and far milder side effects than pharmaceuticals, they may still cause problems if used improperly. Here's how to take herbs safely.

. Become well-informed. Read up on herbs before you use them. This book is a good place to start. Don't follow a friend's advice about dosage (unless that friend is a practitioner with years of clinical experience). Get your information from a reliable source that includes safety warnings.

. Start with a low dose. Herb dosages are typically presented as ranges; for example, 1 to 2 teaspoons of herb per cup of just-boiled water, steeped for 10 to 20 minutes and taken two or three times a day. Begin at the low end of the recommended range--with 1 teaspoon steeped 10 minutes twice a day. If a low dose does not provide sufficient relief, gradually move toward the top of the recommended range. If you still do not experience noticeable benefit, consult an herbalist, a naturopath, or your physician.