Food, Herbs & Supplements

Common Name/Scientific Name:

            There are two primary species of cranberry: the American cranberry, scientifically known as Vaccinium macrocarpon, and the European cranberry, known as Vaccinium oxycoccos.

What is it used for?

            Cranberries are referred to as a superfood because of their rich nutrient and antioxidant profile, especially in terms of flavonoids and polyphenols. They are known to reduce the likelihood of urinary tract infections, offer potential protection against certain cancers, boost immune function, and help lower blood pressure.

How does it work?

            The abundance of antioxidant proanthocyanidins (PACs) in cranberries can potentially hinder certain bacteria from adhering to the urinary tract walls, thus aiding in infection prevention. However, a concentrated cranberry extract is typically needed to achieve this effect, as commercially available cranberry juices do not contain sufficiently high levels of PACs. Moreover, these PACs may also promote oral health by protecting teeth against a specific bacteria strain that contributes to tooth decay and by preventing gum disease.

            The antioxidants found in cranberries might enhance heart health by lowering the risk of cardiovascular disease. These antioxidants also possess anti-inflammatory properties, which could help diminish overall inflammation in the body and alleviate symptoms of conditions like arthritis. Furthermore, they may reduce LDL (bad) cholesterol levels while boosting HDL (good) cholesterol levels. Some research suggests that cranberry antioxidants could even play a role in preventing certain types of cancer such as breast, colon, prostate, and lung cancer by lessening oxidative stress and inflammation.

What are some side effects?

            Common side effects of cranberry consumption may include stomach upset, such as nausea, vomiting, or diarrhea, as well as an increased risk of kidney stones due to higher levels of oxalate in the urine. Allergic reactions are also possible. Additionally, individuals should be cautious about cranberry products with high sugar content, as they may impact blood sugar levels.

Are there any trials that support its use/non-use (efficacy)? Provide details.

            Clinical studies have shown that consuming cranberry juice or solids can effectively prevent UTIs in various populations, including women with recurrent UTIs, pregnant women, the elderly, and children. For example, a randomized, double-blind, placebo-controlled study involving women aged 28–44 years with recurring UTIs found that 70% of the subjects experienced fewer UTIs while taking 400 mg of cranberry solids daily for 3 months compared to those taking a placebo. Another study on women aged 25–70 years with a history of high UTI recurrence showed that consuming 200 mg of concentrated cranberry extract standardized to 30% phenolics twice a day for 12 weeks prevented UTI recurrence in all subjects for the study's duration. A follow-up study conducted 2 years later on these subjects found that those who continued to take cranberry remained free of infection.

Additional Considerations (Can include known drug interactions, special directions, etc.)

            Cranberries can interact with drugs like warfarin and other blood thinners, enhancing their anticlotting effects. Additionally, cranberries contain salicylic acid, so individuals who regularly take aspirin should avoid cranberry supplements or excessive cranberry juice consumption.

            It is not advisable to use cranberry products if you already have a urinary tract infection (UTI).

References:

Neto CC, Vinson JA. Cranberry. PubMed. Published 2011. https://www.ncbi.nlm.nih.gov/books/NBK92762/

Nemzer BV, Al-Taher F, Yashin A, Revelsky I, Yashin Y. Cranberry: Chemical Composition, Antioxidant Activity and Impact on Human Health: Overview. Molecules. 2022;27(5):1503. doi:https://doi.org/10.3390/molecules27051503

‌Cranberry Information | Mount Sinai - New York. Mount Sinai Health System. Published 2010. https://www.mountsinai.org/health-library/herb/cranberry

Common Name/Scientific Name: 

The name of this supplement is Omega-3 Polyunsaturated fatty acids. It is commonly referred to as fish oil. However, scientifically it can be classified to include α-linolenic acid, stearidonic acid,, eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid. 

What is it used for? 

Omega-3 polyunsaturated fatty acids can be used for a plethora of diseases. Omega-3 has been linked to improvements in diseases like cardiovascular disease, diabetes, cancer, Alzheimer’s disease and dementia, depression,  visual/neurological brain development, and lastly maternal and child health. Some of these diseases require further clinical investigation for the benefits of omega-3. 

Omega-3 is mostly known for its reduction of cardiovascular disease. This has been studied intently in many different clinical trials which I will name below. The American Heart Association (AHA) recommends that people with CHD or HF take 1,000mg of omega-3 supplements per day. Omega-3 has been linked to a lower risk of death in both men and women with CHD.  In 2017, the AHA based on new randomized clinical trials that were published “suggested that omega-3 supplementation did not provide any benefits toward preventing cardiovascular disease among patients with or at risk for diabetes mellitus and did not lower the risk of stroke among patients without a history of stroke (1)”.  Patients using Omega-3 supplementation should have a history of CVD as it does not help prevent cardiovascular disease but rather reduces the risk of mortality from the disease. 

How does it work? 

Omega-3 lowers triacylglycerol production as well as preventing arrhythmias and atherosclerosis. By reducing plasma triglyceride levels in the liver, it reduces the risk of cardiovascular disease. There are numerous mechanisms discussed as to how fish oil decreases plasma triglyceride levels. One of the mechanisms discussed is that “fish oil could activate transcription factors which control metabolic pathways in a tissue-specific manner regulating nutrient traffic and reducing plasma TG (2)”.  

What are some side effects?

Side effects of omega-3 supplements are usually mild. They include unpleasant taste, bad breath, bad-smelling sweat, headache, and gastrointestinal symptoms such as heartburn, nausea, and diarrhea (3). 

Are there any trials that support its use/non-use (efficacy)? Provide details.  

The landmark trial that introduced the benefits of Omega-3 supplements was GISSI-P. This trial showed that 1 g/day Ω-3 (EPA + DHA) decreased the risk of death, non-fatal acute MI, and stroke in patients with recent MI (<3 months) (4). Another trial was JELIS, which was studied in the Japanese population, and their diets from the beginning included fish, which is argued against a Western diet (American) that doesn’t include a lot of fish to begin with.  These studies were for the use of omega-3. However, in 2017, three different trials were published that negated the benefits of omega-3 supplementation. The OMEGA, ASCEND, and VITAL trials showed there was no reduction in CVD disease. Another trial, REDUCE-IT, published recently supported a 4g dose of omega-3 in reducing CVD risk and TG levels. 

Additional Considerations (Can include known drug interactions, special directions, etc.)

Fish oil can have antiplatelet effects at high doses, although it appears to be less potent than aspirin. We should inform patients who take medication like Warfarin and other strong anticlotting agents. Omega-3 can be found in a rich seafood diet. While one might worry about the mercury levels in their seafood, salmon, anchovies, sardines, pacific oysters, and trout are low in mercury and high in omega-3.

References:

1. Shahidi, F., & Ambigaipalan, P. (2018). Omega-3 Polyunsaturated Fatty Acids and Their Health Benefits. Annual review of food science and technology, 9, 345–381. https://doi.org/10.1146/annurev-food-111317-095850

   
   

2. Shearer, G. C., Savinova, O. V., & Harris, W. S. (2012). Fish oil -- how does it reduce plasma triglycerides?. Biochimica et biophysica acta, 1821(5), 843–851. https://doi.org/10.1016/j.bbalip.2011.10.011

   
   

3. https://www.nccih.nih.gov/health/omega3-supplements-in-depth#:~:text=Side%20effects%20of%20omega%2D3,higher%20risks%20of%20prostate%20cancer.

   
   

4. Elagizi, A., Lavie, C. J., O'Keefe, E., Marshall, K., O'Keefe, J. H., & Milani, R. V. (2021). An Update on Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Health. Nutrients, 13(1), 204. https://doi.org/10.3390/nu13010204

   
   

BIOTIN

Common Name/Scientific Name:

The name of this supplement is called biotin and it is a B vitamin, vitamin B7. Its scientific name is called 5-[(3aS,4S,6aR)-2-oxohexahydro-1H-thieno[3,4-d]imidazol-4-yl]pentanoic acid.

What is it used for?

Biotin supplements are often known for the treatment of hair loss. It promotes the increase of healthy hair skin and nails. However, a deficiency in biotin can lead to hair loss and skin and nail problems, evidence showing a benefit of supplementation is inconclusive. A small amount of case reports and small trials have shown a benefit but the study design overall was weak. Although there is a lack of evidence on the efficiency of biotin it is still very popular.

How does it work?

Biotin plays a vital role in assisting enzymes to break down fats, carbohydrates, and proteins in food. It also helps to regulate signals sent by cells and the activity of genes. It is and essential nutrient that is naturally present in some foods but also available as a dietary supplement. You can find biotin in foods such as, beef liver, eggs, salmon, avocados, sweet potatoes and seeds. Biotin is found in some multivitamins and minerals supplements, but it is also sold on its own. Most people get enough vitamin from the foods they already eat. However, certain groups of people may not which is rare. This includes people with alcohol dependance, as well as women who are pregnant and breastfeeding.

What are some side effects?

There was no evidence in humans that biotin is toxic at high intakes. However, very high intakes of biotin may interfere with diagnostic assays that use biotin- streptavidin technology and are commonly used to measure levels of hormones like thyroid hormones. It tends to give falsely normal or abnormal results. A few recent case reports have described finding false indication of Graves’ disease and severe hyperthyroidism in patients taking 10-300mg of biotin per day. Biotin can also interact with certain medications. In a study done for people with epilepsy, anticonvulsant treatments for at least one year was associated with very low serum biotin levels than in control group patients. These medications included carbamazepine, primidone and phenobarbital. Overall, the reason for this could be that anticonvulsant treatment increases biotin catabolism. This ultimately leads to reduced biotin status and inhibition of intestinal biotin absorption.

Are there any trials that support its use/non-use (efficacy)? Provide details.

Evidence on Biotin supplementation to treat brittle nails includes three smalls studies that had many flaws. The studies did not include a placebo group. Also the reports did not indicate any baseline biotin status of the participants. Reports about hair growth were also document in several case reports, however, they were all done in children. Overall, future studies are needed to determine whether biotin supplements might improve hair nails and skin.

Additional Considerations (Can include known drug interactions, special directions, etc.)

Overall, there is no Recommended daily allowance (RDA) for biotin because there is not enough evidence to support that a daily amount is needed in a healthy person. The popularity of Biotin promoting healthy hair skin and nails is more of a myth until further detailed testing is done with biotin.

Reference:

“Office of Dietary Supplements - Biotin.” NIH Office of Dietary Supplements, U.S. Department of Health and Human Services, ods.od.nih.gov/factsheets/Biotin-HealthProfessional/#h12. Accessed 25 Jan. 2024.

“Biotin – Vitamin B7.” The Nutrition Source, 7 Mar. 2023, www.hsph.harvard.edu/nutritionsource/biotin-vitamin-b7/.

Common name/scientific name: 

Milk thistle is a flowering herb known scientifically as Silybum marianum. It belongs to the Asteraceae family and is native to the Mediterranean, as well as parts of Africa and Russia.

What is it used for? 

Milk thistle is used for various medicinal purposes, with its primary applications being in support of liver health and to reduce fasting blood glucose in patients with diabetes mellitus. Regarding liver health, milk thistle is used to promote liver function and aid in the treatment of diseases such as cirrhosis, hepatitis, fatty liver disease and liver damage due to infection, alcoholism, and chemotherapy.

How does it work?

The key active ingredient in milk thistle is a flavonoid known as silymarin. Silymarin is believed to possess antioxidant and anti-inflammatory properties. The antioxidant action is essential for its hepatoprotective, glucose lowering, and, potentially, anticancer effects. Silymarin stabilizes cell membranes and acts as a free radical scavenger, preventing the entry of toxins into liver cells. Similarly, silymarin protects against DNA damage by hydrogen peroxides and inhibits mitogenic signaling pathways related to proliferation of androgen-dependent and -independent prostate cancer cells. Research suggests oxidative stress contributes to pancreatic beta-cell dysfunction, reduced insulin secretion, and insulin resistance; thus, silymarin exerts protective effects on the pancreas which likely contribute to fasting blood glucose reductions. Silymarin is believed to inhibit COX-II, regulate inflammatory mediators, and downregulate the synthesis of leukotrienes and prostaglandins. Milk thistle has also been shown to lower total cholesterol, triglycerides, and LDL cholesterol through inhibition of HMG-CoA reductase and VLDL synthesis.

What are some side effects?

Milk thistle is considered safe when used appropriately and for short durations in patients >1 year. Some individuals may experience mild side effects such as abdominal bloating, dyspepsia, nausea, diarrhea, and flatulence. If applied topically, the most common side effect is erythema. Allergic reactions, including anaphylaxis, are rare but may occur in individuals sensitive to the Asteraceae plant family (which includes ragweed, daisies, and chrysanthemums). Since milk thistle lowers blood glucose, using other medications with similar effects may increase the risk of hypoglycemia. Furthermore, milk thistle may mimic estrogen; avoid use in individuals with conditions that may be worsened by estrogen (breast, uterine, ovarian cancer).

Are there any trials that support its efficacy?

Efficacy evidence is inconsistent and existing studies vary in methodology, doses, and patient populations, making it challenging to draw firm conclusions. Additional high-quality trials are needed to establish a definitive conclusion on milk thistle’s benefit.

A meta-analysis revealed reductions of fasting blood glucose (~26 mg/dL) and A1c (~1%) in type 2 diabetes patients taking daily milk thistle for 6 months, with greater benefits shown in studies lasting < 3 months.

Studies in hepatitis B indicate some symptomatic improvement with milk thistle (such as reduced jaundice, dark urine, and scleral icterus), but evidence varies in terms of improving LFTs and liver histology. Patients with hepatitis C virus (HCV) showed improved liver function in some studies, whereas others reported no impact on LFTs or HCV RNA levels. Meta-analyses conclude the clinical effects of milk thistle in hepatitis are limited, lacking significant impacts on mortality, disease-related complications, or liver histology.

Nonalcoholic fatty liver disease (NAFLD) studies suggest milk thistle may slightly improve LFTs. Two met analyses showed reductions in AST (~7 IU/L) and ALT (~9-15 IU/L) levels; however, both suggested these reductions may not be clinically significant or reliably reflect liver histology. Other trials explore the combination of milk thistle with lifestyle modifications, with mixed results on BMI reductions and liver health markers in NAFLD patients.

Additional considerations (known drug interactions, special directions, etc.)

Drug interactions: Minor: decreased the effects of estrogens and statins.

Moderate: increased effects of raloxifene and tamoxifen, increased hypoglycemia risk with diabetes medications, increased anticoagulation with warfarin, and increased/decreased effects of morphine (milk thistle may bind mu-opioid receptors).

Pregnancy and lactation: there is insufficient, reliable data about safety in this population; avoid use.

Special directions: dosages and formulations can vary; follow recommended dosages on product labels or as directed by healthcare professionals to avoid increased risk of side effects.

References

Achufusi TGO, Patel RK. Milk thistle [updated 2022 Sep 12]. In: StatPearls [internet]. Treasure Island (FL): StatPearls Publishing. 2023 Jan. https://www.ncbi.nlm.nih.gov/books/NBK541075/

Fried MW, Navarro VJ, Afdhal N. Effect of silymarin (milk thistle) on liver disease in patients with chronic hepatitis c unsuccessfully treated with interferon therapy: a randomized controlled trial. JAMA. 2012 Jul;308(3):274-82. https://jamanetwork.com/journals/jama/fullarticle/1217238

Jacobs BP, Dennehy C, Ramirez G, et al. Milk thistle for the treatment of liver disease: a systematic review and meta-analysis. Am J Med. 2002 Oct;113(6):506-15. https://www-sciencedirect-com.jerome.stjohns.edu/science/article/pii/S0002934302012445

Milk thistle [updated 2023 Sep]. Natural Medicines. 2023. https://naturalmedicines-therapeuticresearch-com.jerome.stjohns.edu/databases/food,-herbs-supplements/professional.aspx?productid=138

Mirhashemi SH, Hakakzadeh A, Yeganeh FE, et al. Effect of 8 weeks milk thistle powder (silymarin extract) supplementation on fatty liver disease in patients candidates for bariatric surgery. Metabol Open. 2022 Jun;14:100190. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9149185/

Voroneanu L, Nistor I, Dumea R, et al. Silymarin in type 2 diabetes mellitus: a systemic review and meta-analysis of randomized controlled trials. J Diabetes Res. 2016 Jun;2016:5147468. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908257/

Seaweed Supplements

Common Name/Scientific Name:

Seaweeds (Various species from Phaeophyceae, Rhodophyta, and Chlorophyta classes). Sold as seaweed supplements, sea moss, Irish sea moss, etc.

What is it used for?

Seaweeds serve as nutrient-rich food, containing minerals, vitamins (A, B1, B2, B9, B12, C, D, E, K), essential minerals (calcium, iron, iodine, magnesium, phosphorus, potassium, zinc, copper, manganese, selenium, fluoride), dietary fibers, proteins, essential amino acids, and polyphenols. They are consumed as whole food and utilized in various industries for bioactive compounds. Seaweed extracts are employed in agriculture, pharmaceuticals, biotechnology, and cosmetics.

How does it work?

Seaweeds offer health benefits through direct and indirect means. Directly, they can be consumed as whole food or as supplements, providing essential nutrients, antioxidants, and anti-inflammatory compounds. Indirectly, seaweeds are used in agriculture as biofertilizers, ensuring nutrient-rich soil and chemical-free crops, leading to positive health effects after consuming agricultural products. Bioactive compounds like fucoidans, carrageenans, and ulvan from different seaweed classes exhibit antibacterial, antiviral, anti-inflammatory, and anticoagulant properties.

Fucoidans from brown algae, like those found in Laminaria cichorioides and Fucus evanescens, have demonstrated anticoagulant activity comparable to heparin. Moreover, the antioxidant, anti-inflammatory, and anti-hyperglycemic activities of high-molecular-weight fucoidans extracted from Fucus vesiculosus suggest their potential as natural drugs.Agar extracted from red algae, such as Gracilaria edulis, serves as a suspension component in drug solutions and exhibits anticoagulant properties. Chlorophyta (green algae), rich in ulvan, a sulfate polysaccharide, finds applications in biomedicine, cosmetics, and pharmaceutical industries. Ulva rigida from Chlorophyta has demonstrated hypoglycemic effects in vivo.

Seaweeds also contribute to antiviral therapies. Polysaccharides extracted from Saccharina japonica show in vitro inhibition to SARS-CoV-2, suggesting their potential as natural antiviral agents. Compounds like griffithsin from red algae Griffithsia sp. exhibit antiviral activity against MERS-CoV and SARS-CoV glycoprotein.

What are some side effects?

While seaweeds are generally considered safe for consumption, it's crucial to be cautious about potential contamination by heavy metals and minerals, which can accumulate in seaweeds and may pose health risks if consumed excessively.

One must exercise caution regarding the iodine content in sea moss supplements, as excessive iodine intake can lead to adverse effects on thyroid function. The Jod-Basedow phenomenon, a rare cause of thyrotoxicosis due to excess iodine intake, may be triggered.

A case study reported a seemingly healthy individual who, unknowingly exacerbating underlying Grave's disease, experienced thyrotoxicosis due to prolonged intake of sea moss supplements. The patient's irregular consumption led to suppressing thyroid function and later caused accelerated hormone production, contributing to the Jod-Basedow phenomenon. Discontinuing sea moss resulted in clinical and biochemical improvement without requiring thionamide therapy.

It is important to note that Irish sea moss, a commonly available herbal supplement, contains variable amounts of iodine. While the recommended daily iodine intake is 150 mcg, sea moss may provide higher amounts. Patients with a history of hyperthyroidism or autoimmune thyroid disorders, such as Grave's disease, should be cautious about sea moss supplementation. Regular monitoring of thyroid function and consultation with healthcare professionals are crucial to prevent potential complications.

Are there any trials that support its use/non-use (efficacy)?

Numerous trials support the efficacy of seaweed bioactive compounds and are included in the references section. Just to list a few interesting ones: Fucoidans from Laminaria cichorioides and Fucus evanescens exhibit anticoagulant activity similar to heparin. Sargassum fulvellum extracts demonstrate pharmacological effects such as antioxidant, anticancer, anti-inflammatory, antibacterial, and anticoagulant activities. Polysaccharides from Saccharina japonica show in vitro inhibition to SARS-CoV-2, indicating potential antiviral properties. Studies also highlight the role of seaweed-derived compounds in cardiovascular health, metabolic syndrome, weight management, and as a sustainable source of omega-3 polyunsaturated fatty acids.

Additional Considerations:

It's essential to monitor and research potential harmful compounds in seaweeds, such as heavy metals and minerals. The use of seaweed bioactive compounds in biotechnological and industrial applications promotes a healthier lifestyle in a sustainable way. Ongoing research is needed to identify and neutralize potentially harmful compounds while increasing the application of seaweed compounds in various industries.

References:

Berteau O Mulloy B . Sulfated fucans, fresh perspectives: structures, functions, and biological properties of sulfated fucans and an overview of enzymes active toward this class of polysaccharide. Glycobiology. 2003;13:29R–40R.

Emma M Brown, Philip J Allsopp, Pamela J Magee, Chris IR Gill, Sonja Nitecki, Conall R Strain, Emeir M McSorley, Seaweed and human health, Nutrition Reviews, Volume 72, Issue 3, 1 March 2014, Pages 205–216

Khalifa M, Aftab HB, Kantorovich V. “Fueling the Fire” - Irish Sea-Moss Resulting in Jod-Basedow Phenomenon in a Patient With Grave’s Disease. J Endocr Soc. 2021 May 3;5(Suppl 1):A906.

Kwon P.S., Oh H., Kwon S.-J., Jin W., Zhang F., Fraser K., Hong J.J., Linhardt R.J., Dordick J.S. Sulfated polysaccharides effectively inhibit SARS-CoV-2 in vitro. Cell Discov. 2020;6:50.

Lomartire S, Marques JC, Gonçalves AMM. An Overview to the Health Benefits of Seaweeds Consumption. Mar Drugs. 2021 Jun 15;19(6):341

Millet J.K., Séron K., Labitt R.N., Danneels A., Palmer K.E., Whittaker G.R., Dubuisson J., Belouzard S. Middle East respiratory syndrome coronavirus infection is inhibited by griffithsin. Antiviral Res. 2016;133:1–8

Paradis ME Couture P Lamarche B . A randomised crossover placebo-controlled trial investigating the effect of brown seaweed (Ascophyllum nodosum and Fucus vesiculosus) on postchallenge plasma glucose and insulin levels in men and women. Appl Physiol Nutr Metab. 2011;36:913–919.

Yoon S.J., Pyun Y.R., Hwang J.K., Mourão P.A.S. A sulfated fucan from the brown alga Laminaria cichorioides has mainly heparin cofactor II-dependent anticoagulant activity. Carbohydr. Res. 2007;342:2326–2330.

Zumla A., Chan J.F.W., Azhar E.I., Hui D.S.C., Yuen K.Y. Coronaviruses-drug discovery and therapeutic options. Nat. Rev. Drug Discov. 2016;15:327–347

GINGER

Common Name/Scientific Name:

Names include Ginger, Zingiber officinale, Zingiberaceae, Amomum Zingiber, Ardraka, Gan Jiang, Gingembre

What is it used for?

Ginger can be used in any form; fresh, dry, preserved, powdered, and even crystallized. It can be taken by mouth, as a supplement or tea, used topically, or even eaten raw. Ginger has anti-fungal, antibacterial, and antioxidant properties It has shown evidence of protecting against ethanol-induced hepatotoxicity. Ginger can also be used in the treatment of pain and swelling in patients with rheumatoid arthritis, osteoarthritis, or muscle cramps/pain.  Other treatments of ginger include sore throats, cramps, asthma, and stroke. Ginger has shown effects on lowering blood sugar, so when used correctly, can help patients with pre-diabetes or diabetes mellitus. Ginger has also been shown to decrease blood pressure, treating hypertension. Ginger has also been used to treat nausea and vomiting, which may have been caused by pregnancy and chemotherapy, due to its gastroprotective properties.

How does it work?

Ginger works in similar ways as NSAIDS, like ibuprofen and naproxen. It inhibits COX1 and COX2 function which then suppresses the synthesis of prostaglandin. Unlike NSAIDS, Ginger also inhibits 5-lipoxygenase, therefore, inhibiting leukotriene synthesis. Both leukotriene and prostaglandins cause inflammation. By inhibiting them, ginger provides anti-inflammatory effects. Ginger has antioxidant properties and inhibits lipid peroxidase. This allows ginger to be used as a gastro-protective agent. Its gastroprotective properties are also contributed by ginger's stimulation of muscarinic receptors and inhibition of 5-HT receptors. By increasing muscaranic receptors, gastric motility increases.

What are some side effects?

There has been increased bleeding in patients taking ginger, therefore it’s recommended to avoid taking ginger supplements if patients have high bleeding risk. Other mild adverse effects include headache, stomach upset, and allergic reactions (hives, itching, burning of the skin). Ginger also has shown effects of heartburn, diarrhea, mouth irritation, and stomach upset.

Are there any trials that support its use/non-use (efficacy)? Provide details.

A study was done on rats with ethanol toxicity to evaluate the effects of ginger on oxidative stress. The rats were held in cages with a rat pellet diet and water. They were each given 1% body weight of ginger. According to the results, this 1% ginger intake was able to reverse the oxidative stress ethanol placed on the rats in 4 weeks.

In another preclinical study, ginger was shown to inhibit Helicobacter pylori infection. The ginger was proved effective in inhibiting the growth of H. pylori, even against the CagA+ strains, showing effects better than lansoprazole. The study showed pretreating with standard ginger dosing (100mg/kg) reduced the load of H. pylori and its side effects on mice. These side effects included mucosal and submucosal inflammation, cryptitis, and cell degeneration.

Additional Considerations

- Caution when taken with anticoagulants, such as warfarin and heparin, and anti platelet drugs, such as aspirin and clopidogrel.

- Due to its effects on the blood, avoid taking ginger for a few weeks before scheduled surgery and before the due date if pregnant.

- Caution in patients with diabetes due to its effects on blood sugar.

- Caution in patients taking hypertension medication, due to ginger's effects on blood pressure

- The common dose of ginger is 0.5-3 grams (no more than 4g) by mouth daily for up to 12 weeks

Grzanna, Reinhard et al. “Ginger--an herbal medicinal product with broad anti-inflammatory actions.” Journal of medicinal food vol. 8,2 (2005): 125-32. doi:10.1089/jmf.2005.8.125

Haniadka, Raghavendra et al. “A review of the gastroprotective effects of ginger (Zingiber officinale Roscoe).” Food & function vol. 4,6 (2013): 845-55. doi:10.1039/c3fo30337c

Food, Herbs, & Supplements (Chromium)

Common Name/Scientific Name: 

Common Name: Chromium

Scientific Name: Chromium picolinate

What is Chromium used for?

Chromium is a mineral that is commonly used as a dietary supplement. It is primarily taken to improve blood sugar control in people with type 2 diabetes and to support weight loss efforts. It helps keep blood glucose levels by improving the ways the body uses insulin. Some individuals also take chromium supplements to enhance muscle mass and improve athletic performance. 

How does Chromium work?

Chromium is an essential trace mineral that plays a role in insulin signaling and glucose metabolism. It enhances the action of insulin, a hormone responsible for regulating blood sugar levels. By improving insulin sensitivity, chromium helps cells take up glucose more effectively, thereby reducing blood sugar levels. This mechanism is particularly beneficial for individuals with insulin resistance, a common characteristic of type 2 diabetes.

What are some side effects?

Chromium supplements are generally considered safe when taken within the recommended doses. However, some individuals may experience mild side effects, such as headaches, dizziness, nausea, and digestive discomfort. In rare cases, high doses of chromium have been linked to more severe side effects, including kidney damage and liver toxicity. It is crucial to follow the recommended dosage guidelines and consult a healthcare professional before starting chromium supplementation.

Are there any trials that support its use/non-use (efficacy)? Provide details.

Research on the efficacy of chromium supplementation for blood sugar control and weight loss has yielded mixed results. Some studies have shown modest improvements in blood sugar levels and insulin sensitivity in people with type 2 diabetes, while others have not found significant benefits. Similarly, regarding weight loss, some studies suggest a small reduction in body weight and fat mass, while others report no significant effects.

The American Diabetes Association and other health organizations have stated that there is not enough evidence to recommend chromium supplementation as a standard treatment for diabetes. However, some healthcare providers may consider it as an adjunct therapy for select patients. The effectiveness of chromium for weight loss remains uncertain, and its use should not be solely relied upon as a primary strategy for managing obesity.

Additional Considerations

Drug Interactions: Chromium supplements may interact with certain medications, including antacids, corticosteroids, beta-blockers, and nonsteroidal anti-inflammatory drugs (NSAIDs). More specifically, it can cause an increase in insulin sensitivity causing possibly hypoglycemia when taken concomitantly with insulin. It also has a blood glucose-lowering effect so taking it with other diabetic medications like metformin can increase the risk of hypoglycemia. Also, a small study found it can cause lowering absorption of levothyroxine. 

Special Directions: Always follow the recommended dosage provided on the supplement label or as prescribed by a healthcare professional. Taking excessive amounts of chromium can be harmful and may increase the risk of adverse effects. Pregnant or breastfeeding women, as well as individuals with kidney or liver conditions, should exercise caution and seek medical advice before using chromium supplements.

1. Office of Dietary Supplements - Chromium. (2023). Retrieved 19 July 2023, from https://ods.od.nih.gov/factsheets/Chromium-HealthProfessional/ 

2. Jenny E. Gunton, N. Wah Cheung, Rosemary Hitchman, Graham Hams, Christine O’Sullivan, Kaye Foster-Powell, Aidan McElduff; Chromium Supplementation Does Not Improve Glucose Tolerance, Insulin Sensitivity, or Lipid Profile: A randomized, placebo-controlled, double-blind trial of supplementation in subjects with impaired glucose tolerance. Diabetes Care 1 March 2005; 28 (3): 712–713. https://doi.org/10.2337/diacare.28.3.712 

Ginkgo Biloba

Common Names: Ginkgo, ginkgo biloba, fossil tree, maidenhair tree, Japanese silver apricot, baiguo, yinhsing

Scientific Name: Gingko biloba L. maidenhair tree (Ginkgoaceae)

What is it used for?

Gingko biloba is one of the most commonly used herbal supplements in the world. There is no FDA approved indication and insufficient evidence to support non-FDA approved use of Gingko. The extract from ginkgo leaves is promoted as a dietary supplement for many conditions, including dementia, Alzheimer’s disease, and other conditions associated with cerebral vascular insufficiency, including memory loss, headache, tinnitus, vertigo, difficulty concentrating, mood disturbances, and hearing disorders. It can also be used as an anti-hypertensive, in diabetic retinopathy and macular degeneration, and retinal damage with poor color vision. Despite the wide use of Ginkgo, its efficacy in the prevention and treatment of dementia remains controversial.

How does it work?

Ginkgo has two primary active ingredients: terpene lactones and ginkgo flavone glycosides. The extract has been shown to affect several neurotransmitter pathways and brain structures. It appears to have reversible inhibitory effects on reuptake of serotonin and dopamine and increased cholinergic transmission in the brain. It acts as a free radical scavenger and protects neurons from oxidative damage and apoptosis, which have been prominently observed in Alzheimer disease. Gingko also acts as a peripheral vasodilator by increasing nitric oxide thus improving blood flow through the small vessels. It also acts as an anti-platelet which is why it is advised to be used with caution in patients with increased bleeding risk.

What are some side effects?

The maximum recommended dose for gingko extract is 240 mg/day. Side effects of ginkgo may include headache, stomach upset, dizziness, palpitations, constipation, and allergic skin reactions.

Are there any trials that support its use/non-use (efficacy)? Provide details.

The use of Ginkgo biloba extract in the treatment for existing dementia has been contradictory. In a 52-week randomized double blind, placebo-controlled, parallel-group, multicenter study of 309 patients. The study concluded that Ginkgo extract was safe and though modestly, it appeared to stabilize and improve cognitive performance as well as social functioning of dementia in patients for six months to one year. In another 24-week randomized controlled trial of 410 patients it also found that 240mg once daily was safe and statistically significant improvement in cognition was seen. However, in a randomized controlled trial of 513 outpatients with mild to moderate dementia that found that ginkgo extract was not effective. A systematic review of 36 trials though demonstrating the safety of this supplement did not support any clinical benefit for patients with cognitive impairment of dementia. Various studies continue to outline contradicting findings to support either the use or non-use of this supplement.

Additional Considerations (drug interactions, special directions, etc.)

Ginkgo biloba is known to increase bleeding risk by decreasing the blood clotting capabilities and is therefore advised against in patients with bleeding disorders or those taking NSAIDs. Ginkgo also has properties as a monoamine oxidase inhibitor that can precipitate serotonin syndrome in patients on other antidepressant medications. It also has several interactions with other dietary supplements. If taken during pregnancy, it is considered unsafe and may cause early labor or extra bleeding during delivery. Raw gingko can contain dangerous amounts of a toxin called ginkgo-toxin which may cause seizures and alkylphenol ginkgolic acid which is a carcinogen and allergen.

References

Tan, M. S., Yu, J. T., Tan, C. C., Wang, H. F., Meng, X. F., Wang, C., Jiang, T., Zhu, X. C., & Tan, L. (2015). Efficacy and adverse effects of ginkgo biloba for cognitive impairment and dementia: a systematic review and meta-analysis. Journal of Alzheimer's disease : JAD, 43(2), 589–603. https://doi.org/10.3233/JAD-140837

Nguyen T, Alzahrani T. Ginkgo Biloba. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541024/

Ginkgo. (n.d.). NCCIH. https://www.nccih.nih.gov/health/ginkgo

Singh, S. K., Srivastav, S., Castellani, R. J., Plascencia-Villa, G., & Perry, G. (2019). Neuroprotective and Antioxidant Effect of Ginkgo biloba Extract Against AD and Other Neurological Disorders. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 16(3), 666–674. https://doi.org/10.1007/s13311-019-00767-8

Food, Herbs, and Supplements: St. John’s Wort

Common Name/Scientific Name:

Common Name: St. John’s Wort

Scientific Name: Hypericum perforatum

Use

St. John’s Wort is an invasive, flowering plant native to Europe and Asia and belongs to the Hypericaceae family and the species of the genus Hypericum. The name St. John’s wort refers to the priest, John the Baptist, since the plant blooms in late June, the time of the feast of St. John the Baptist. The plant’s flowers have a distinctive yellow color and are short-lived perennial shrubs that grow up to 1-2 feet. Its medicinal properties are derived from its stem, petals, and flowers. St John’s wort has been used for its antibacterial, antiviral, antidepressive, anti-inflammatory, and antioxidant properties dating back to ancient Greece, now available over the counter topically or as an oral herbal dietary supplement and is not FDA approved. It is indicated for those with mild to moderate depression, menopausal symptoms, ADHD, somatic symptom disorder, and obsessive-compulsive disorder. It can be used for nerve pain, anxiety, insomnia, and pain from sciatica, rheumatoid arthritis, and menstruation. Topically, it aids in wound healing from mild burns and sunburns, bruising, varicose veins, and muscle pain. It may take 4 to 6 weeks to see efficacy and is typically orally administered 300 to 400 mg three times a day with meals for the treatment of mild depression and mood disorders. Tinctures, teas, or liquid extracts are also available.

Mechanism of Action

St. John’s Worts therapeutic actions stem from its bioactive chemical makeup of flavonol derivatives, biflavones, proanthocyanidins, xanthones, phloroglucinols and naphthodianthrones. One of the principal mechanisms of action of this plant is that it acts as a serotonin reuptake inhibitor, which reduces the uptake of serotonin at neuronal synapses, thereby increasing levels of serotonin in the body. It also prevents the reuptake of dopamine and norepinephrine. Those suffering from depression may have a chemical imbalance of serotonin, hence, increasing serotonin through reuptake inhibition is used to treat this condition. Moreover, this supplement activates pregnane-X-receptor (PXR) cytochromes, thereby inducing the cytochrome P450 system, CYP3A4 enzyme and P-glycoprotein. P450s or monooxygenase enzymes metabolize the compound through hydroxylation, making it more polar, which increases its reactivity for conjugation into various polar groups. St John’s wort also inhibits monoamine oxidase A and B, which are enzymes responsible for the degradation of dopamine, serotonin, and norepinephrine. Through its monoamine oxidase inhibition, taking this supplement will increase norepinephrine levels. The bioactive constituent responsible for St. John’s wort’s antidepressant and anxiolytic effects is the phytochemical compound, hyperforin. Hyperforin acts as a serotonin and monoamine reuptake inhibitor, as well as GABA and glutamate, and activates the transient receptor potential ion channel, TRPC6. TRPC6 activation allows for the entry of sodium and calcium into the cell, which causes monoamine reuptake inhibition. Likewise, hyperforin induces CYP3A4 and CYP2C9 enzymes through binding and activation of pregnane X receptor (PXR).

Antidepressant activity is also seen due to the supplement’s activation of GABA receptors. Malfunctioning of GABA receptors can cause depression and anxiety; therefore, activating these receptors can help with mood regulation. St. John’s wort also plays in the downregulation (decrease the number of) of beta-adrenergic receptors and upregulation (increase the number of) of serotonin receptors. Beta-adrenergic receptors are activated upon the binding of epinephrine, which leads to increased heart rate and blood pressure. Due to downregulation, there is less opportunity for epinephrine to stimulate the beta-adrenergic receptors, which provide a calming effect. On the other hand, upregulation of serotonin receptors increases the chance for serotonin stimulation, thereby decreasing depressive and anxiolytic symptoms.

Side Effects, Drug Interactions, and Additional Considerations

Side effects of St. John’s Wort include insomnia, anxiety, dry mouth, dizziness, gastrointestinal symptoms, fatigue, headache, or sexual dysfunction.

There are numerous drug interactions in those taking St. John’s wort with other medications due to its induction of CYP3A4 and P-glycoprotein drug efflux transporter.

These include the following:

Decreased therapeutic efficacy of:

-Antidepressants -HIV protease inhibitors

-Birth control pills -Cancer medications, irinotecan and imatinib

-Cyclosporine -Warfarin

-Digoxin and Ivabradine -Statins

Given St. John’s wort’s mechanism of action, concomitant administration of this supplement with SSRIs may put the individual at risk for serotonin syndrome (mental confusion, agitation, sweating, tachycardia). There is an associated risk of those with bipolar depression taking St. John’s wort since it may induce manic episodes. It is advised to avoid St. John’s wort in these patients.

Additionally, St. John’s Wort may cause increased sensitivity to sunlight when taken in large doses. In regards to side effects of its topical form, it may cause severe skin reactions upon sun exposure. Therefore, it is advised in patients taking this supplement to wear sunscreen regularly and avoid sun exposure.

There is little evidence in regards to the supplement’s safety in a pregnant patient. In vitro animal studies do not show that it affects brain development or behavioral defects; however, low birth weight may occur. Further there is little evidence that the herb does not cross through breast milk or does not affect breast milk production. Additional studies need to be conducted to determine its safety in pregnant populations, and it must be used with caution.

Supporting Trials

A meta-analysis of 27 studies (total of 3,126 depressed patients) comparing efficacy and safety of St. John’s wort with SSRIs for the treatment of depression in adults from 1966 to April 2015 showed no difference in regards to clinical response, remission, and mean reduction in the Hamilton Rating Scale for Depression (HAMD) score. The primary outcome measure for treatment efficacy and safety was a change in total HAMD score between baseline and endpoint. The outcome of interest include: responder rate (reduction in HAMD score by 50%) remission rate (reduction in HAMD score by 75%), mean reduction in HAMD score, incidence of adverse events, total withdrawal rate, and withdrawals due to adverse events. St. John’s wort extract had a lower rate of adverse events compared to SSRIs evidenced by a summary relative risk: 0.77; 95% confidence interval: 0.70, 0.84, P=0.00. The safety profile of this supplement compared to SSRIs is superior. The findings of this meta analysis revealed that St. John’s Wort is comparable to SSRIs in efficacy but superior in safety evidenced by lower rates of adverse events and withdrawal due to adverse events.

References

Cui, Yong-Hua, and Yi Zheng. “A Meta-Analysis on the Efficacy and Safety of St John’s Wort Extract in Depression Therapy in Comparison with Selective Serotonin Reuptake Inhibitors in Adults.” Neuropsychiatric Disease and Treatment, 11 July 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4946846/.

G;, Dugoua JJ;Mills E;Perri D;Koren. “Safety and Efficacy of St. John’s Wort (Hypericum) during Pregnancy and Lactation.” The Canadian Journal of Clinical Pharmacology = Journal Canadien de Pharmacologie Clinique, 3 Nov. 2006, pubmed.ncbi.nlm.nih.gov/17085775/#:~:text=Conclusions%3A%20Caution%20is%20warranted%20with,but%20may%20cause%20side%20effects.

“Hyperforin.” Uses, Interactions, Mechanism of Action | DrugBank Online, go.drugbank.com/drugs/DB01892. Accessed 18 May 2023.

Peterson, Bahtya, and Hoang Nguyen. “National Center for Biotechnology Information.” St. John’s Wort, 19 May 2022, www.ncbi.nlm.nih.gov/books/NBK557465/.

Schwartz, Allan, and Mark Dombeck. “Major Depression and St. John’s Wort.” MentalHelp.Net, 26 Mar. 2019, www.mentalhelp.net/depression/st-john-s-wort/.

“St. John’s Wort.” National Center for Complementary and Integrative Health, Oct. 2020, www.nccih.nih.gov/health/st-johns-wort.

V;, Butterweck. “Mechanism of Action of St John’s Wort in Depression : What Is Known?” CNS Drugs, pubmed.ncbi.nlm.nih.gov/12775192/. Accessed 18 May 2023.

Green Tea

Common Name: green tea

Scientific Name: Camellia sinensis

What is it used for?

Tea has been used for medicinal purposes for thousands of years in China, Japan and India. Now, tea is the second most widely consumed beverage in the world. In traditional medicine, green tea is used as a stimulant, diuretic- to help rid excess fluids, and astringent- to control bleeding and help heal wounds. It is also used to treat gas, and regulate body temperature and blood sugar. Green tea improves mental alertness, relieves digestive symptoms and headaches, and promotes weight loss. It may also have protective effects against heart disease and cancer. There are studies indicating that the antioxidant properties of green tea may prevent atherosclerosis, particulary coronary artery disease. It may also lower total cholesterol and raise HDL (good cholesterol). Green tea may also help with inflammatory bowel disease by reduce inflammation in Crohn disease and ulcerative colitis. There is also a FDA approved topical ointment named Veregen, which contains sinecatechins or extracted components of green tea leaves, and is used for the treatment of genital warts.

How does it work?

The health benefits of green tea is thought to be due to polyphenols, which are chemicals with potent antioxidant potential. These antioxidants have antimutagenic, antidiabetic, antibacterial, antiinflammatory, and hypocholesterolemic properties. These polyphenols are classified as catechins- catechin, gallaogatechin, epicatechin, epigallocatechin, epicatechin gallate, and apigallocatechin gallate (also known as EGCG). EGCG is the most studied polyphenol component in green tea and the most active. Green tea also contains alkaloids- caffeine, theobromine and theophylline, which provides the stimulant effects. Lastly, it also contains L-theanine, which proves the calming effects.

What are some side effects?

Green tea is generally safe up to 8 cups per day. However, during pregnancy and breastfeeding, consuming green tea is safe up to 6 cups per day or no more than 300 mg of caffeine. Those who drink a large amount of caffeine may experience irritability, insomnia, heart palpitations and dizziness. Overdose of caffeine can cause nausea, vomiting, diarrhea, headaches and loss of appetite. Caffeine poisoning is when you start to vomit or have abdominal spasms after drinking a lot of tea.

With green tea extracts in pill form, there has been reports of liver problems such as abdominal pain, dark urine or jaundice. Therefore, people with liver disease should consult a health care provider before taking these products.

Are there any trials that support its use/non-use (efficacy)? Provide details.

· A 2006 meta-analysis of epidemiologic studies found that high intake of green tea was associated with a 20 percent reduction in the risk of breast cancer.

· A second meta-analysis found that high consumption of green tea was associated with an 18 percent reduction in the risk of colorectal cancer.

· 18,000 men were studied, and it was found that those who drank green tea were about one half as likely to develop stomach or esophageal cancer as men who drank little tea.

· 240 obese adults were studied for 12 weeks with a green tea extract beverage high in catechins and a lower catechin placebo; The results showed that the active treatment group had greater reductions in body weight, body mass index, body fat ratio, body fat mass, and waist and hip circumference.

· 40,000 Japanese adults were studied and it was found that green tea consumption was inversely associated with cardiovascular disease mortality.

· 1,000 Japanese adults in their 40s were studied and found no association between green tea intake and total cholesterol level.

· 240 Chinese adults with mild to moderate hypercholesterolemia who received a once-daily theaflavin-enriched green tea extract reduced their LDL by 16.4 percent ± 1.1 percent (P < .01) and their total cholesterol by 11.3 percent ± 0.9 percent compared with placebo.

Additional Considerations (Can include known drug interactions, special directions, etc.)

· Green, black and oolong tea comes from the leaves of the Camellia sinensis plant.

· To make green tea, the unfermented leaves from the plant are steamed, pan fried and dried.

· Among the teas, green tea contains the highest concentration of powerful antioxidants, polyphenols.

· The main component of green tea, EGCG, does not improve mental capabilities. It is the caffeine in the tea that prevents a decline in alertness.

· Amount of caffeine on green tea products indicates only the amount of added caffeine. It does not include the caffeine that are naturally in green tea.

· Green tea dietary supplements are capsules with dried leaf tea or liquid extracts made from the leaves and leaf buds.

· Average cup of green tea has 50 -150 mg of polyphenols. Decaffeinated green tea products contains concentrated polyphenols.

· 2 to 3 cups of green tea or 100 to 750 mg of standardized green tea extract per day is recommended

· Some drug interactions include adenosine, beta-lactam, benzodiazepines, beta blockers, blood thinning medications, clozapine, ephedrine, lithium, MAOIs, birth control pills, phenylpropanolamine, quinolone antibiotics, and others.

References

1. “Green Tea.” Mount Sinai Health System, https://www.mountsinai.org/health-library/herb/green-tea.

2. “Green Tea.” National Center for Complementary and Integrative Health, U.S. Department of Health and Human Services, https://www.nccih.nih.gov/health/green-tea.

3. Schneider C, Segre T. Green tea: potential health benefits. Am Fam Physician. 2009;79(7):591-594.

Asian Ginseng

Common Name: Chinese ginseng, Korean ginseng

Scientific Name: Panax ginseng

What is it used for?

It is an herb used in Chinese medicine for thousands of years, primarily to treat weakness and fatigue. Ginseng products are referred to as tonics or adaptogens, which means an agent that increases resistance to physical, chemical and biological stress and builds up general vitality. Asian ginseng is used to increase resistance to environmental stress and to improve well-being. It is also used as a dietary supplement to improve physical stamina, concentration, and memory; stimulate immune function; reduce the risk of certain cancers; slow the aging process and relieve various health problems such as respiratory and cardiovascular disorders, diabetes, depression, anxiety, menopausal hot flashes and erectile dysfunction.

How does it work?

It contains substances called ginsenosides or panaxosides, which are thought to be the active ingredient. It affects the hypothalamus-pituitary adrenal axis and the immune system. It also enhances phagocytosis, natural killer cell activity, and the production of interferon; causes vasodilation; increases resistance to exogenous stress factors and affects hypoglycemic activity.

What are some side effects?

Ginseng appears to be well-tolerated, but there are still side effects. If taken at high doses or with caffeine, it may cause nervousness or sleepiness. Some common side effects are insomnia, menstrual problems, breast pain, increased heart rate, high or low blood pressure, headache, loss of appetite and digestive problems. Some rare side effects are restlessness, anxiety, euphoria and nose bleed.

Are there any trials that support its use/non-use (efficacy)? Provide details.

· 227 healthy volunteers demonstrated that daily administration of 100 mg of ginseng for 12 weeks enhanced the efficacy of polyvalent influenza vaccine. Those who took ginseng had a lower incidence of influenza and colds, higher antibody titers and higher natural killer cell activity levels.

· 323 healthy volunteers were given 400mg of ginseng or placebo daily for 4 months. Those who had ginseng had fewer colds that were less severe and shorter than the colds of those who had placebo.

· 36 newly diagnosed non-insulin dependent diabetic patients were given 100 or 200mg per day for 8 weeks. The study showed improved fasting blood glucose levels, elevated mood, and improved psychophysical performance. Patients that took the 200mg dose also had improved hemoglobin A1C values.

Additional Considerations (Can include known drug interactions, special directions, etc.)

· Asian ginseng is a gnarled root with stringy shoots resembling a human body with 2 arms and 2 legs. The wrinkles around the neck of the root correspond to the age of the plant. Ginseng is not used as medicine until it has grown for about 6 years.

· There are white ginseng and red ginseng. White ginseng is dried and peeled, whereas red ginseng is unpeeled and steamed before drying.

· Asian ginseng supplements are made from the root and root hairs. They are available in water, water and alcohol, or alcohol liquid extracts, and in powders or capsules. They are also available as a decoction if the Asian ginseng root is boiled in water.

· The common daily dose of 200 mg of Asian ginseng extract or 0.5 to 2 g of dry ginseng root. Products with 4% ginsenoside content are standard.

· Asian ginseng should not be taken continuously, instead taken in cycles. For example, taking it every day for 3 weeks, then stopping for 3 weeks, and then restarting. It is a time-honored approach to strengthen the body and to treat the disease.

· Asian ginseng interacts with many medications such as ACE inhibitors, calcium channel blockers, anticoagulants and antiplatelets, caffeine, diabetes medications, including insulin, drugs that suppress the immune system, stimulants, MAOIs, morphine, furosemide, and others.

· Asian ginseng may also be unsafe to take during pregnancy.

· Asian ginseng should also not be given to infants and children.

· Check with a healthcare provider before taking Asian ginseng.

References

1. “Asian Ginseng.” Mount Sinai Health System, https://www.mountsinai.org/health-library/herb/asian-ginseng.

2. “Asian Ginseng.” National Center for Complementary and Integrative Health, U.S. Department of Health and Human Services, https://www.nccih.nih.gov/health/asian-ginseng.

3. Kiefer D, Pantuso T. Panax ginseng. Am Fam Physician. 2003;68(8):1539-1542.

Vitamin D Supplements

Common Name/Scientific Name:

Vitamin D3 / Cholecalciferol

What is it used for?

This supplement is given to adults who a vitamin D deficient, which can result in loss of bone mineral content, bone pain, and muscle weakness and soft bones.

How does it work?

Majority of the population receive less than optimal levels of vitamin D. The body naturally produces vitamin D through exposure to the sun. However, the sun is often not strong enough to meet the body’s needs. There are many reasons why the body isn’t able to produce the amount of vitamin D it needs. Some of these reasons are limited sun exposure during the winter months, older age, darker skin pigmentation, and use of sunscreen or clothes that shade the skin from the sun. Vitamin D is necessary for maintaining proper bone integrity, proper neuromuscular function, normal inflammatory response, muscle strength, proper calcium absorption, healthy immune response, and normal blood pressure. Having adequate vitamin D levels is also linked to decreased stress fractures, decreased injuries in athletes, and decreased rated of upper respiratory tract infections. Obtaining normal vitamin D levels can be through certain foods or supplements. Vitamin D supplements are fat soluble vitamins that can be taken orally and help the body absorb calcium and phosphorus. The absorption of calcium helps with building and keeping strong bones.

What are some side effects?

Vitamin D supplements are considered to be very safe and toxicity is very uncommon. The reason for this is because for vitamin d toxicity to occur, a healthy person would have to extremely large doses of vitamin D over a long period of time in order to reach dangerous or toxic levels of it. Some of the symptoms of vitamin D toxicity are chest pain, shortness of breath, growth problems for children taking cholecalciferol, weakness, metallic taste in the mouth, weight loss, muscle or bone pain, constipation, nausea, and vomiting. Although these side effects are uncommon, they can still occur if an individual were to overdose on vitamin D. However, vitamin D toxicity is more common in people with certain medical conditions. These conditions include granulomatous disorders, congenital disorders, some lymphomas, and dysregulated vitamin D metabolism.

Are there any trials that support its use/non-use (efficacy)? Provide details.

There have been many trials that have been conducted to evaluate the benefits of vitamin D supplements. I found a review article discussing the results of three different trials, VITAL, ViDA and D2d. These were all randomized trials and the combined number of participants of all three are over 30,000. One of the key takeaways from these trials are that Vitamin D and calcium supplementation can modestly decrease risk of major fractures in older adults. Also, there has been delays in age related bone loss and progression to type 2 diabetes and improved lung function. Another benefit is that they found vitamin d supplementation resulted in a modest decrease in cancer mortality, but has not affect on cancer risk. There hasn’t been any drastic or obvious benefits, with using vitamin d supplements, but correcting vitamin d deficiency remains essential.

References:

1. Bouillon, R., Manousaki, D., Rosen, C. et al. The health effects of vitamin D supplementation: evidence from human studies. Nat Rev Endocrinol 18, 96–110 (2022). https://doi.org/10.1038/s41574-021-00593-z

2. Spritzler, Franziska. “6 Side Effects of Too Much Vitamin D.” Healthline, Healthline Media, 15 Dec. 2021, https://www.healthline.com/nutrition/vitamin-d-side-effects#1.-Elevated-blood-levels.

Common Name/Scientific Name:

Turmeric, Haldo (North India), Manjal (South India),

Curcuma, Curcumin

What is it used for?

Turmeric, sometimes known as the “golden spice” is used for various things such as food spice, medicine, and even cosmetic use. It is what gives curry its yellow color and atypical flavor. It can be found in manufactured food products including canned beverages, dairy, baked goods, juices, cereals, and sauces. In traditional medicine, turmeric is believed to have medicinal properties such as giving the body energy, regulating menstrual periods, treating arthritic pain, and even helping to dissolve gallstones. Many countries in South Asia use turmeric as an antiseptic and as an anti-inflammatory agent. In India, turmeric paste is made and put on the skin of the bride and groom during traditional weddings. This practice is thought to keep harmful bacteria away from the bride and groom during their wedding day as well as make their skin glow.

How does it work?

Modern medicine has shown that turmeric is an antioxidant, anti-inflammatory, antimutagenic, antimicrobial, and anticancer agent. Some studies have shown that a certain level of turmeric ingestion is capable of providing antioxidant protection throughout the body. This antioxidant activity protects the body from free radicals, causes an increase in antioxidant enzyme levels, and inhibits the peroxidation of lipids.

What are some side effects?

There are few reported side effects of turmeric. It is generally safe in large amounts. Some reported side effects during trials using turmeric were diarrhea, headache, rash, and yellow stool. The patients reporting these side effects were receiving between 500 mg -12,000 mg of turmeric in a dose-response study.

Are there any trials that support its use/non-use (efficacy)? Provide details.

There are preventative and therapeutic studies of turmeric in animal models. In a study done to evaluate turmeric’s role in inhibiting chemical carcinogenesis in rats, it was found that turmeric extract helped to protect against genomic damage. In another study where a few fruits and vegetables were tested for their effectiveness in preventing dimethylbenz[a]anthracene (DMBA)-initiated and croton oil-promoted skin tumors, it was found that turmeric was the most potent nutraceutical used as the average number of tumors forms were significantly less than the others tested.

Additional Considerations (Can include known drug interactions, special directions, etc.)

The benefits of turmeric are mostly achieved through ingestion in food. A solid understanding of proper dosing, safety, and mechanism of action is not available for this supplement, as there have been no clinical trials to test it.

References:

1. Prasad S, Aggarwal BB. Turmeric, the Golden Spice: From Traditional Medicine to Modern Medicine. In: Benzie IFF, Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press/Taylor & Francis; 2011. Chapter 13. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92752/#

2. Kotha RR, Luthria DL. Curcumin: Biological, Pharmaceutical, Nutraceutical, and Analytical Aspects. Molecules. 2019;24(16):2930. Published 2019 Aug 13. doi:10.3390/molecules24162930

Common Name/Scientific Name:

Elderberry/Sambucus Negra

What is it used for?

Elderberry has been traditionally used as alternative medicine to prevent and treat respiratory sicknesses such as the cold or flu. It has been sold over the counter for years and is given commonly to younger children who cannot take common cold medications such as ibuprofen or acetaminophen.

How does it work?

Elderberry contains a compound called anthocyanin, which is part of the overarching category of flavonoids that have possible anti-inflammatory effects. These anthocyanins attach to viral glycoproteins that allow the virus to enter host cells. By binding to the glycoproteins, the anthocyanins render the glycoprotein ineffective therefore not allowing the virus to enter the host cell. Elderberry may also influence the immune system via cytokines. It has been reported that elderberry may increase the production of inflammatory cytokines but also may reduce cytokine production.

What are some side effects?

Though elderberry is known to have beneficial effects the raw berries themselves can be poisonous and cause stomach problems. These stomach problems are caused by lectins that exist in small amounts of the bark, unripe berries, and seeds of elderberry. The actual berry must be cooked before it can be eaten. There is an estimated 3 mg of cyanide in about 100 grams of fresh elderberries, but this is not enough to be a fatal dose to a 60 kg person. Even so, elderberry that is sold or contained in any products commercialized do not contain this small amount of cyanide.

Are there any trials that support its use/non-use (efficacy)? Provide details.

There was a recent systematic review done to see if elderberry had any benefits or harms in treatment of viral respiratory infections, specifically analyzing the relationship of the inflammatory cytokines. 1187 records were screened that included 5 randomized trials on elderberry for the treatment or prevention of viral respiratory diseases. There were no studies that showed a clinical link to the use of elderberry, but there were 3 studies that looked at the production of cytokines after elderberry ingestion. The results from this study conclude that Elderberry may reduce the risk of developing a cold or lessen the severity. It may also reduce the severity of symptoms of influenza. There is no solid evidence for the use of elderberry and no evidence that it overstimulates the immune system in terms of cytokines.

References:

1. Wieland LS, Piechotta V, Feinberg T, et al. Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC Complement Med Ther. 2021;21(1):112. Published 2021 Apr 7. doi:10.1186/s12906-021-03283-5

2. Mandl E. The pros and cons of elderberry. Healthline. https://www.healthline.com/nutrition/elderberry#risks-and-side-effects. Published March 12, 2021. Accessed January 28, 2022.

Green tea

Scientific Name: Camellia sinensis

Common Name: Green tea; Green Tea Extract; Tea

What is it used for?

Tea is arguably the most well-established and popular beverages with an extensively rich history dating back several millennia. What’s interesting is that the white, green, black, and oolong varieties all come from the same tea plant; the main difference between them is how they are harvested and stored and then ultimately processed. Green tea specifically is made by heating the green tea leaves directly after harvesting, usually through steaming, pan-frying, and drying, in order to halt the oxidation process and keep the tea leaves that bright green color. This gives green tea that fresh-picked flavor profile and is also the reason behind its many touted health benefits. Green tea has been purported to support mental alertness, relieve digestive symptoms, relieve headaches, and promote weight loss. It is also a potential candidate in the fight against cancer and heart disease as some state that its various components are able to delay and/or prevent these late-stage diseases. Moreover, “evidence from clinical trials suggests that green tea plays a role in metabolic syndrome because it may have an impact on body weight, glucose homeostasis, and other cardiovascular risk factors.” Additionally, there’s interest in its potential ability to prevent strokes, COPD, and UV damage. Lastly, there is an FDA-approved preparation called Veregen (sinecatechins) ointment that is indicated for the treatment of external genital and perianal warts in immunocompetent patients 18 years and older; it was first approved back in 2006.

How does it work?

To understand how green tea is potentially a remedy for all these diseases, we have to understand its complex chemical composition. The reason for its complexity lies within the fact that there are numerous components and factors that play a role in the formation of its chemical composition from maturation to harvest to processing. In essence, tea leaves contain a myriad of polyphenols in different quantities as well as caffeine, theanine, theobromine, theophylline, phenolic acids, minerals, and trace elements. Of the polyphenols, there exists also catechins, which play an essential role in preventing cell damage through various mechanisms. Not only that, but there also exists tannins, essential oils, riboflavin, niacin, folic, ascorbic, pantothenic, malic, and oxalic acids, all of which play a role in healthy body functions. There are, in total, more than 2,000 chemicals identified so far in green tea and the really important ones are the catechins, such as (-)-epigallocatechin-3-gallate (EGCG). These catechins are thought to be largely responsible for the aforementioned health benefits as they act as potent antioxidants. Their role as antioxidants are to essentially scavenge for free radicals in the body that cause DNA damage via reactive oxygen species. Moreover, these polyphenols are shown to inhibit tumor cell proliferation, induce apoptosis in laboratory and animal studies, inhibit angiogenesis, reduce tumor cell invasiveness, protect against UVB radiation, modulate immune system function, and provide detoxification enzymes, such as GST and quinone reductase. All of these characteristics are attributed to the potent antioxidant effects of tea, however, the precise mechanisms of action are still yet to be laid out.

What are some side effects?

· Excess intestinal gas

· Nausea

· Heartburn

· Stomach ache

· Abdominal pain

· Dizziness

· Headache

· Muscle pain

· Tachycardia

· Palpitations

· Insomnia

· Restlessness

· Nervousness

· Tremors

· Diarrhea

· Diuresis

· Dry mouth

· Nocturia

· Light-headedness

· Sore throat

· Increased appetite

Are there any trials that support its use/non-use (efficacy)? Provide details.

· A double-blind interventional trial involving 59 people with leukoplakia showed that 3 grams of mixed tea product given both orally and topically for 6 months elicited a partial regression in oral lesions in 38% of the participants, as compared to 10% in the placebo group

o There was also a lower percentage of patients with an increase in lesion size at the end of study

o Another study with 39 people showed no differences in response between green tea extract and placebo

· Two trials showed the effect of tea on a biomarker of oxidative DNA damage

o 8-hydroxydeoxyguanosine (8-OHdG) is a predictor of increased cancer risk and is especially concentrated in breast, lung, liver, kidney, brain, stomach, and ovarian tumor tissue

o One trial with 133 adult heavy smokers showed that green tea reduced urinary 8-OHdG levels by 31% while black tea had no change

o Another trial with 124 patients with hepatitis B and aflatoxin exposure showed that green tea reduced urinary 8-OHdG levels significantly after 3 months

o However, it’s inconclusive whether or not 8-OHdG levels are definitely linked to cancer risk

· A double-blind, placebo-controlled study with 60 men at increased prostate cancer risk showed that fewer prostate cancers were detected in the green tea extract group compared to placebo

o However, two other uncontrolled trials found no evidence of such a reduction

· Other trials with different other cancers also showed inconclusive or clinically ambiguous results

Green tea has been widely used in all regions of the world for thousands of years and many people correlate it to increased longevity. To some extent, there is definitely a potential for green tea to be helpful in all of these aspects; however, it is held back by improper study designs and the still explored and ambiguous realm of cancer risk identification. Though it’s relation to cancer is inconclusive presently, green tea is still very safe to consume as a beverage with most adverse effects only present in oral supplements and extracts. More than that, one could argue that there really is no harm in drinking green tea due to its non-existent toxicology and adverse reaction profile, with only the upside to consider in potential cancer risk prevention. Professionally speaking, I cannot either recommend or not recommend green tea for any medical purposes but it still is and will remain to be a very popular and great tasting beverage for the masses.

References:

1) Bettuzzi S, Brausi M, Rizzi F, et al. Chemoprevention of human prostate cancer by oral administration of green tea catechins in volunteers with high-grade prostate intraepithelial neoplasia: A preliminary report from a one-year proof-of-principle study. Cancer Research 2006; 66(2):1234–1240.

2) Cabrera C, Giménez R, López MC. Determination of tea components with antioxidant activity. Journal of Agricultural and Food Chemistry 2003; 51(15):4427–4435.

3) Choan E, Segal R, Jonker D, et al. A prospective clinical trial of green tea for hormone refractory prostate cancer: An evaluation of the complementary/alternative therapy approach. Urologic Oncology: Seminars and Original Investigations 2005; 23(2):108–113.

4) Chow HH, Hakim IA, Vining DR, et al. Effects of dosing condition on the oral bioavailability of green tea catechins after single-dose administration of polyphenon E in healthy individuals. Clinical Cancer Research 2005; 11(12):4627–4633.

5) Chow HS, Cai Y, Hakim IA, et al. Pharmacokinetics and safety of green tea polyphenols after multiple-dose administration of epigallocatechin gallate and polyphenon E in healthy individuals. Clinical Cancer Research 2003; 9(9):3312–3319.

6) Elmets CA, Singh D, Tubesing K, et al. Cutaneous photoprotection from ultraviolet injury by green tea polyphenols. Journal of the American Academy of Dermatology 2001; 44(3):425–432.

7) Hakim IA, Harris RB, Brown S, et al. Effect of increased tea consumption on oxidative DNA damage among smokers: A randomized controlled study. Journal of Nutrition 2003; 133(10):3303S–3309S.

8) Hamajima N, Tajima K, Tominaga S, et al. Tea polyphenol intake and changes in serum pepsinogen levels. Japanese Journal of Cancer Research 1999; 90(2):136–143.

9) Henning SM, Niu Y, Lee NH, et al. Bioavailability and antioxidant activity of tea flavanols after consumption of green tea, black tea, or a green tea extract supplement. American Journal of Clinical Nutrition 2004; 80(6):1558–1564.

10) Jatoi A, Ellison N, Burch PA, et al. A phase II trial of green tea in the treatment of patients with androgen independent metastatic prostate carcinoma. Cancer 2003; 97(6):1442–1446.

11) Lambert JD, Yang CS. Mechanisms of cancer prevention by tea constituents. Journal of Nutrition 2003; 133(10):3262S–3267S

12) Li N, Sun Z, Han C, Chen J. The chemopreventive effects of tea on human oral precancerous mucosa lesions. Proceedings from the Society of Experimental Biology and Medicine 1999; 220(4):218–224.

13) Luo H, Tang L, Tang M, et al. Phase IIa chemoprevention trial of green tea polyphenols in high-risk individuals of liver cancer: Modulation of urinary excretion of green tea polyphenols and 8-hydroxydeoxyguanosine. Carcinogenesis 2006; 27(2):262–268.

14) Seeram NP, Henning SM, Niu Y, et al. Catechin and caffeine content of green tea dietary supplements and correlation with antioxidant capacity. Journal of Agricultural and Food Chemistry 2006; 54(5):1599–1603.

15) Steele VE, Kelloff GJ, Balentine D, et al. Comparative chemopreventive mechanisms of green tea, black tea and selected polyphenol extracts measured by in vitro bioassays. Carcinogenesis 2000; 21(1):63–67.

16) Tsao AS, Liu D, Martin J, et al. Phase II randomized, placebo-controlled trial of green tea extract in patients with high-risk oral premalignant lesions. Cancer Prevention Research 2009; 2(11):931–941.

17) Wang LD, Zhou Q, Feng CW, et al. Intervention and follow-up on human esophageal precancerous lesions in Henan, northern China, a high-incidence area for esophageal cancer. Gan To Kagaku Ryoho 2002; 29(Suppl 1):159–172.

Echinacea

Scientific Name: Echinacea purpurea, Echinacea angustifolia, Echinacea pallida

Common Name: American coneflower; Black Sampson; Black Susan; Comb flower; Echinacea; Echinaceawurzel; Hedgehog; Igelkopfwurzel; Indian head; Kansas snakeroot; Narrow-leaved purple coneflower; Purple coneflower; Purpursonnenhutkraut; Racine d'echininacea; Radix Echinaceae; Rock-up-hat; Roter sonnenhut; Scurvy root; Snakeroot; Sonnenhutwurzel

What is it used for?

Echinacea is a medicinal plant of 9 known species, all of which are native to eastern and central North America. It was widely used by Native Americans as a traditional remedy to promote immune system health and regulation in conjunction to preventing the common cold. But with the advancement of medicine and the introduction of antibiotics, Echinacea fell out of favor after its four century-long run as one of the top treatment choices for infections and as a general “cure-all.” In the modern day, Echinacea is promoted as an over-the-counter (OTC) oral dietary supplement that will help fight the common cold/flu by shortening the duration and reducing the symptoms. Moreover, it has also been compounded into a topical application for skin and soft tissue infections. Additionally, it’s been theorized to have a role in adipogenesis, alcoholic liver disease, inflammation, bronchodilation, cancer, anxiety, immunomodulatory, and performance enhancement. However, most of its clinical efficacy is lacking in terms of data and there are really only small-scale studies and/or animal models that support these claims.

How does it work?

Based on the information available and the laboratory studies done on Echinacea, it’s suggested that it contains biologically active components that stimulate the immune system, reduce inflammation, and have other anti-infective outcomes. These specific constituents are relatively well-studied and they comprise of volatile oils, alkamides, polyalkenes, polyalkynes, caffeic acid derivatives, and polysaccharides. These polysaccharides are known to activate the immune system and stimulate it to work at an enhanced pace; but it is the combination of all of these biologically active components that function together to elicit Echinacea’s remedial effects. However, there are also toxic pyrrolizidine alkaloids that have also been found at low levels, which could be the reason for some adverse effects observed in some patients. It should be noted that different parts of the plant have different chemical compositions. So the above-ground parts, including the stem and the leaves, have more polysaccharides, while the roots have more volatile oils. In Germany, the above-ground portions of the plant are approved by their government to treat colds, URTIs, UTIs, and slow-healing wounds; meanwhile, the root of the plant is also approved for flu-like infections. The dosing for boosting the immune system is to take it three times a day with food and a glass of water for up to 10 days until symptoms resolve.

What are some side effects?

· Allergic reactions

· Nausea

· Stomach pain

· Rashes

· Dry eyes

· Dizziness

· Temporary numbing and tingling of the tongue

· Facial edema

· Mild transient GI complaints

· Leukopenia

· Acute cholestatic hepatitis

· Deaths (possibly associated with IV use)

Are there any trials that support its use/non-use (efficacy)? Provide details.

· Echinacea’s use in fighting the common cold still remains controversial

· Some studies have suggested that it reduces duration of sickness, while other studies show no correlation

· One study containing 95 people with cold and flu symptoms showed that drinking several cups of Echinacea tea every day for 5 days reduced symptoms and severity as compared to the group that did not

· A meta-analysis of 14 clinical trials found that Echinacea reduced the chances of catching a cold by 58% and the duration by a range of 1-4 days.

o The only problem is that the study wasn’t without design flaws and so the strength of the evidence remains controversial, as stated just before

· Another drawback is that there isn’t a standardized strength or amount of Echinacea used in all of these studies, and so that further retracts from the validity of the purported claims

· The studies have generally found that Echinacea is safe to take, but not for pregnant or breastfeeding women as there is a lack of evidence

Echinacea was and is still a popular OTC herbal remedy to cold and flu symptoms, with use dating back hundreds of years with the Native Americans in the eastern and central plains of North America. However, due to lack of efficacy data and standardized dosages, modern day antibiotics have taken the stage in terms of mainstay therapy and primary approach to infections. Even though there is controversial data on the proposed health benefits of Echinacea, it is still relatively safe to use as soon as the early cold and flu symptoms start to appear. Of course, this is no substitute for tried and true antibiotics, but it can potentially help when there are no other alternatives available for eccentric groups of patients. And of course with all supplements, consultation with a primary care doctor should be necessitated, especially in those with immunocompromised health as Echinacea could have immunomodulatory effects that could interact with medications and/or disease states.

References:

1) Barrett B, Brown R, Rakel D, Mundt M, Bone K, Barlow S, Ewers T. Echinacea for treating the common cold: a randomized trial. Ann Intern Med. 2010;153(12):769-77.

2) Barnes J, Anderson LA, Gibbons S, Phillipson JD. Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt., Echinacea purpurea (L.) Moench): a review of their chemistry, pharmacology and clinical properties. J Pharm Pharmacol. 2005;57(8):929-954.

3) Bradley PR, ed. British Herbal Compendium. Vol 1. British Herbal Medicine Association; 1992:81-83.

4) ConsumerLab.com. Product review: echinacea. Accessed on April 1, 2002. 5) Di Pierro F, Rapacioli G, Ferrara T, Togni S. Use of a standardized extract from Echinacea angustifolia (Polinacea) for the prevention of respiratory tract infections. Altern Med Rev. 2012;17(1):36-41.

6) Duke J. Handbook of Biologically Active Phytochemicals and Their Activities. CRC Press Inc; 1992.

7) Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. [Review]. Ann Intern Med. 2002;136(1):42-53.

8) Frank LG. The efficacy of Echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double blind, placebo-controlled study. J Comp Alt Med. 2000;6(4):327-34.

9) Goel V, Lovlin R, Barton R, et al. Efficacy of a standardized echinacea preparation (Echinilin) for the treatment of the common cold: a randomized, double-blind, placebo-controlled trial. J Clin Pharm Ther. 2004;29(1):75-83.

10) Islam J, Carter R. Use of Echinacea in upper respiratory tract infection. South Med J. 2005;98(3):311-8.

11) Karsch-Volk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2014;2:CD000530.

Gingko

Scientific Name: Ginkgo biloba L.

Common Name: Ginkgo, ginkyo, kew tree, maidenhair tree, yinhsing (Japanese silver apricot);fossil tree, baiguo

What is it used for?

Ginkgo has long been used in traditional eastern medicine as a remedy for numerous medical conditions, and especially for the treat of memory deficits. As the world’s oldest living tree species, many traditional practitioners regarded it as the cure for Alzheimer’s, dementia, asthma, bronchitis, kidney disorders, bladder disorders, and a myriad of neurological and physiological problems that result in a decreased lifespan. Individual ginkgo trees could grow for as long as a millennium and the fruit that comes from it can be eaten for it’s supposed medicinal properties. It’s considered a sacred tree in China and throughout Asia, and it’s use in traditional Chinese medicine has persisted for over 1,000 years. Though touted to be a cure-all for many things, modern scientific medicine has failed to really find sufficient evidence to support these claims. Multiple studies have been done to extensively research the benefits of ginkgo and all have turned out to be quite inconclusive. These trials have ranged from small to large, and yet there still isn’t enough quality evidence to support the use of ginkgo medically for any indications. There exists an interest for its use in chemotherapy, but it appears that the benefits don’t outweigh the risks and so that also seems to be a dead-end. It is commercially available in many dosage forms, all of which are orally administered.

How does it work?

With the advance of chemical isolation technology in the 1960s, it was possible to isolate the active compounds of ginkgo. It’s theorized that the major flavonoids (quercetin, kaempferol, isorhamnetin) in ginkgo are potent anti-oxidants and free radical scavengers, and that the major terpenes (ginkgolides A, B, C, J, M, and bilobalide) inhibit platelet-activating factors in the blood. Despite its controversial use in the U.S., it’s commonly prescribed in Europe for anxiety, allergies, dementia, eye problems, peripheral artery disease, and other health conditions; standardized ginkgo leaf extracts have been studied at daily doses of 120 to 240 mg with no established contraindications and interactions at these doses. Oral bioavailability is highest when fasting and food intake delays the time that it takes to reach maximum plasma concentration; however, this doesn’t necessarily bode well or bad as there are no conclusive data on what dose is beneficial and/or harmful and for what use specifically.

What are some side effects?

Oral

· Bleeding risk

· Headache

· Dizziness

· Heart palpitations

· GI reactions

· Dermatologic reactions (allergic dermatitis)

· Seizures

· Constipation

· Liver and thyroid cancer in rodents

Injectable/Parenteral (withdrawn from market due to severe adverse effects)

· Circulatory disturbances

· Skin allergy

· Hepatotoxicity

· Phlebitis

Are there any trials that support its use/non-use (efficacy)? Provide details.

· No conclusive evidence for the benefits of ginkgo for any health condition

· Ginkgo Evaluation of Memory Study:

o Funded in part by the National Center for Complementary and Integrative Health (NCCIH)

o Enrolled more than 3,000 older adults (ages 75 or older)

o Took place between 2000 and 2008

o Half of the participants took gingko while the other half did not

o All participants took cognitive function tests

o 120 mg of standardized ginkgo extract taken orally twice daily was no effective in reducing incidence of dementia, reducing cognitive decline, reducing blood pressure, reducing hypertension, reducing cardiovascular disease events

Based on its extensive history, ginkgo is a widely popular herbal supplement taken by the masses for its touted and reputed effects. However, modern research and trials have shown that ginkgo might actually be more detrimental than it is beneficial. As with all supplements of any kind, especially those that are unregulated and are sold over-the-counter (OTC), necessary research, consultation, and evaluation of the risk-benefit ratio should be done before considering intake/supplementation. Hopefully this will help one make a more educated decision on what it is that they’re buying and taking.

References:

1) Asher GN, Corbett AH, Hawke RL. Common herbal dietary supplement-drug interactions. American Family Physician. 2017;96(2):101-107.

2) DeKosky ST, Williamson JD, Fitzpatrick AL, et al; Ginkgo Evaluation of Memory (GEM) Study Investigators. Ginkgo biloba for prevention of dementia: a randomized controlled trial [published correction appears in JAMA. 2008;300(23):2730]. JAMA. 2008;300(19):2253-2262.

3) Ginkgo. Natural Medicines website. Accessed at naturalmedicines.therapeuticresearch.com on March 9, 2020. [Database subscription].

4) Kang JM, Lin S. Ginkgo biloba and its potential role in glaucoma. Current Opinion in Ophthalmology. 2018;29(2):116-120.

5) Quidel Kramer F, Ortigoza Á. Ginkgo biloba for the treatment of tinnitus. Medwave. 2018;18(6):e7295.

6) Strømgaard K, Vogensen SB, Steet J, et al. Ginkgo. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopedia of Dietary Supplements, 2nd ed. New York, NY: Informa Healthcare; 2010:332-338.

7) Yang G, Wang Y, Sun J, et al. Ginkgo biloba for mild cognitive impairment and Alzheimer’s disease: a systematic review and meta-analysis of randomized controlled trials. Current Topics in Medicinal Chemistry. 2016;16(5):520-528.

Common Name/Scientific Name: Ashwagandha/Withania somnifera, Indian ginseng, Winter cherry

What is it used for?

Ashwagandha is a popular herb used in the Indian Ayurvedic system of medicine for stress relief and to improve general health.

How does it work?

Ashwagandha contains several active metabolites including alkaloids (isopelletierine, anaferine), steroidal lactones (withanolides, withaferins), and saponins which encompass anti-stress activity. Research suggests it suppresses stress-induced increases of dopamine receptors in the brain.

What are some side effects?

Side effects include stomach upset, diarrhea, vomiting and drowsiness.

Are there any trials that support its use/non-use (efficacy)?

In a randomized, double-blind, placebo-controlled sixty-day study, ashwagandha

extract was investigated in stressed, healthy adults. Sixty adults were randomly selected to take either a placebo or 240 mg of ashwagandha extract once daily. The outcomes were measured using the Hamilton Anxiety Rating Scale and Depression, Anxiety, and Stress Scale -21. It was found that with ashwagandha supplementation, there was a statistically significant reduction in the HAM-A (P = .040) and a reduction in the DASS-21 (P = .096) as compared to the placebo. There was also an observable decrease in morning cortisol (P < .001). Nevertheless, there needs to be further research done with larger sample sizes and for a longer period of time.

Additional Considerations:

Ashwagandha should not be ingested while pregnant as there is some evidence that it might cause miscarriages. It also should not be used by patients with hyperthyroidism or a borderline hyperactive thyroid as ashwagandha can increase thyroid function.

References:

Lopresti, Adrian L et al. “An investigation into the stress-relieving and pharmacological

actions of an ashwagandha (Withania somnifera) extract: A randomized, double-

blind, placebo-controlled study.” Medicine vol. 98,37 (2019)

Singh, Narendra et al. “An overview on ashwagandha: a Rasayana (rejuvenator) of

Ayurveda.” African journal of traditional, complementary, and alternative

medicines: AJTCAMvol. 8,5 Suppl (2011): 208-13.

Common Name/Scientific Name:

Ginkgo biloba, fossil tree, maidenhair tree, Japanese silver apricot, baiguo, yinhsing

What is it used for?

It is commonly used for the treatment of a variety of ailments including early-stage Alzheimer's disease, vascular dementia, peripheral claudication, and tinnitus.

How does it work?

Ginkgo biloba acts as several things like a neuroprotective agent, an antioxidant, a free-radical scavenger, and an inhibitor of platelet-activating factor. As a free radical scavenger, it protects our neurons from oxidative damage and apoptosis, seen prominently in Alzheimer’s disease. Ginkgo biloba has two primary elements responsible for its effects: terpene lactones and ginkgo flavone glycosides. The terpene lactones inhibit the binding of platelet-activating factor to its receptor. It improves blood flow throughout the body by restoring the balance between prostacyclin and thromboxane A2.

What are some side effects?

Side effects of ginkgo biloba include headache, stomach upset, dizziness, palpitations, constipation, allergic skin reactions and increased risk of bleeding.

Are there any trials that support its use/non-use (efficacy)? Provide details.

Although gingko biloba has been used as a traditional herbal remedy for thousands of years, there is a lack of sufficient evidence for its efficacy in treatment or prevention of dementia. The Ginkgo Evaluation of Memory study is the largest clinical trial in evaluating ginkgo’s effect on dementia over the course of 8 years in California, Maryland, North Carolina, and Pennsylvania. 3069 participants aged 75 years and above with normal cognitive or mild cognitive impairment enrolled and were randomly assigned to two groups, one group receiving 120 mg of ginkgo extract twice a day, and the other receiving a placebo. Participants were assessed every 6 months for dementia and followed for six years. During this period, 523 participants were diagnosed with dementia - 47% in the placebo group and 53% in the ginkgo group. The study concluded that 120 mg of ginkgo extract twice a day does not reduce the overall incidence rate of dementia in older adults.

Additional Considerations:

Ginkgo biloba causes the inhibition of the platelet-activating factor which can be harmful if the patient is also taking warfarin aspirin, or other antiplatelet agents. Other herbal medications that may increase the risk of bleeding if used simultaneously with ginkgo are feverfew, garlic, ginseng and red clover. The dosage of ginkgo is 120 to 240 mg daily, taken in two to three doses for patients with dementia. The dosage for patients who have tinnitus and peripheral vascular disease is no more than 160 mg per day.

Reference:

Mei, Nan et al. “Review of Ginkgo biloba-induced toxicity, from experimental studies to

human case reports.” Journal of environmental science and health. Part C,

Environmental carcinogenesis & ecotoxicology reviews vol. 35,1 (2017): 1-28.

Sierpina, Victor et al. “Ginkgo Biloba.” AAFP.org, American Family Physician Journal,

Sept. 2003.

Natalie Eshaghian & Donna Salib

Echinacea

Common Name/Scientific Name: Echinacea Angustifolia, Echinacea Pallida, Echinacea Purpurea

What is it used for? Echinacea contains immunostimulant properties, essentially boosting your immune system to fight off infections. Echinacea is an herbal product used for the prophylaxis of bacterial and viral infections. It is seen to treat and prevent upper respiratory-tract infections, such as the common cold.1,3

How does it work? Echinacea is seen to active macrophage and release TNF, interleukin-1, interleukin-6, and interferon. In addition, it is seen to fight viral infections such as the flu, herpes, and poliovirus. Furthermore, echinacea possesses antioxidant activity due to the phenolic compound in echinacea. Lastly, this herbal product is seen to have anti-inflammatory activity from the inhibition of lipoxygenase and cyclooxygenase (COX), as well as stimulate the anterior pituitary-adrenal cortex.2

What are some side effects? When echinacea is used for a short period of time, some might experience GI and skin related adverse effects, which are typically short term and reversible effects. This includes hypersensitivity reactions as well as anaphylaxis. In addition, rare allergic reactions such as urticaria and angioedema have been seen. Lastly, enzyme elevations and liver injury have been seen from excessive use of echinacea.1,3

Are there any trials that support its use/non-use (efficacy)? Provide details. A meta-analysis of 14 randomised controlled studies shows that echinacea does decrease the incidence and duration of the common cold, although it was acknowledged that larger prospective studies controlling for several variables (e.g. species) are needed before it can be routinely recommended.7

A randomized double blind placebo-controlled study 4 evaluated the efficacy of a standardized preparation of Echinacea purpurea in reducing symptom severity and duration of the common cold. This study included patients that received either 100mg of Echinacea purpurea (freeze-dried pressed juice from the aerial portion of the plant) or a lactose placebo 3 times daily until cold symptoms were relieved or until the end of 14 days, whichever came first. Compared to most studies, it was unable to conclude the effect of echinacea on reducing symptoms (cough, sneezing, headache, nasal congestion) and duration of a common cold.

According to the National Center for Complementary and Integrative Health,5 taking echinacea might slightly reduce your chances of catching a cold, but it has not been shown to shorten the length of a cold. There also isn’t enough evidence to show whether echinacea is helpful for other health conditions.

When looking at a review on pharmacological and therapeutic properties of Echinacea6, studies of Echinacea for the common cold have had mixed results, and whether or not Echinacea helps prevent or treat the common cold remains under debate. These differences make it hard to compare the results, therefore it’s not clear as to whether Echinacea might be effective for this purpose or not.

Additional Considerations (Can include known drug interactions, special directions, etc.)

According to the MHRA in the UK, oral echinacea is not recommended in children under 12 years old since the risks outweigh the benefits (the potential risk of severe allergic reactions in the young age group).3 Echinacea is also contraindicated in patients who have progressive systemic diseases, such as tuberculosis, leukemia, and leukemia-like diseases, collagen disorder, MS, and other autoimmune diseases. In addition, certain echinacea products are also contraindicated in AIDS and HIV, since echinacea has immunomodulatory activity. Overall, it is recommended to avoid echinacea in immune-related diseases.8

REFERENCES:

1Echinacea. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; April 10, 2019.

https://www-ncbi-nlm-nih-gov.jerome.stjohns.edu/books/NBK548440/

2UpToDate. Date Accessed: July 29, 2021. Available here: https://www.uptodate.com/contents/clinical-use-of-echinacea#H2

3Lexicomp. Date Accessed: July 29, 2021. Available here: https://online.lexi.com/lco/action/doc/retrieve/docid/martindale_f/1356081?cesid=79Iwy7E2bL7&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dechinacea%26t%3Dname%26va%3Dechinacea

4 Yale SH, Liu K. Echinacea purpurea Therapy for the Treatment of the Common Cold: A Randomized, Double-blind, Placebo-Controlled Clinical Trial. Arch Intern Med. 2004;164(11):1237–1241. doi:10.1001/archinte.164.11.1237

5https://www.nccih.nih.gov/health/echinacea

6 Ganjuri, M., Darakhshan, S., & Taghizad, F. (2016). A Review on Pharmacological and Therapeutic Properties of Echinacea.

7Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis [published correction appears in Lancet Infect Dis. 2007 Sep;7(9):580]. Lancet Infect Dis. 2007;7(7):473-480. doi:10.1016/S1473-3099(07)70160-3

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106401/

8Manayi A, Vazirian M, Saeidnia S. Echinacea purpurea: Pharmacology, phytochemistry and analysis methods. Pharmacogn Rev. 2015;9(17):63-72. doi:10.4103/0973-7847.156353

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441164/

Black Cohosh

Common Name/Scientific Name- Cimicifuga racemosa L

What is it used for- Black cohosh is now commonly used to treat menopausal symptoms, especially for the treatment of hot flashes. There are some recent studies indicating that the combination of Black cohosh with St. John's wort could even be more effective than Black cohosh alone in treating menopausal symptoms.

How does it work- Black cohosh (Cimicifuga racemosa L.) is an herb that has been proposed for treatment of menopausal symptoms. Cimicifuga roots and rhizomes contain triterpene glycosides (examples of this include- actein, 27-deoxyactein, and cimifugaside) and alkaloids (examples of this include- cytisine and N-methyl cytisine), derivatives of phenylpropane (examples of this include- ferulic acids and isoferulic acids), and cimicifugine (25–50% of the root components). Albeit the exact mechanisms underlying the effects of Black cohosh have not yet been determined, its medical effects have been demonstrated to have a relation to triterpene glycosides. It functions in a serotonergic manner rather than an estrogenic manner, binds to estrogen receptors, and also selectively suppresses luteinizing hormone secretion with no effect on follicle-stimulating hormone. This is the basis for the underlying preposition that black cohosh can be used to treat menopausal symptoms.

What are some side effects- Side effects are rare as black cohosh is generally well tolerated and is also generally safe. However, some insignificant side effects, such as nausea, vomiting, headaches, and dizziness were reported as well. Clinical studies have yet to find and confirm data for toxic doses of Black cohosh. In summary, black cohosh may cause mild gastrointestinal upset symptoms. There have also been some reports of other side effects with doses higher than 160 mg/day, including nausea, vertigo, uterine contractions, and bradycardia.

Are there any trials that support its use/non-use (efficacy)? Provide details.

A randomized, placebo-controlled trial was conducted for this study. There were a total of 84 menopausal women who were randomly allocated into treatment and control groups based on a block randomization with block sizes of 4 and 6 and an allocation ratio of 1:1. Through the identification of computerized random numbers, the allocation sequence was determined. Afterwards, the sequentially numbered sealed envelopes of the same shape and size containing either the Black cohosh or placebo tablets were then used to conceal the allocation and also in order to maintain the blinding (to ultimately maintain this as a randomized and placebo-controlled trial). Every envelope contained 56 pills of Black cohosh or placebo. The 84 participants were instructed to take one tablet per day after dinner for a total of 8 weeks. The results demonstrated that there was no loss to follow-up during the 8 weeks of treatment. The Greene climacteric scale (GCS- scale that provides a brief measurement of menopausal symptoms) total score (this is the primary outcome) in the treatment group was significantly lower than that in the control group at both week 4. The treatment group showed significantly more improvement than the control group in all of the GCS subscale scores (vasomotor, psychiatric, physical, and sexual symptoms; secondary outcomes). The differences between the treatment and control groups at week 8 were statistically significantly higher (P < 0.001) than those at week 4 in terms of the total scores and the vasomotor and psychiatric subscale scores. No side effects were reported.

Additional Considerations- There are no known drug/botanical interactions with black cohosh.

References-

Chandrandabi, S, Shahnazi, M. Efficacy of black cohosh (Cimicifuga racemosa L.) in treating early symptoms of menopause: a randomized clinical trial. Chinese Medicine. 2013, November 8. 8: 20.

10 Top Selling Botanicals: What They Do. University of Minnesota. https://www.takingcharge.csh.umn.edu/explore-healing-practices/botanical-medicine/10-top-best-selling-botanicals-what-they-do#blackcohosh

Yes it is important to always verify what the supplements the patient is taking alongside medications. Especially in this case, if the patient is also on blood thinners there would have to be extra caution taken or we must advise the patient to discontinue. In regards to the vaccine, most maintenance medications do not affect the immune system so most would not interact with the COVID vaccine this includes atorvastatin and lisinopril. However, drugs that directly impact the immune system such as immunosuppressants and chemotherapies they may interact with the COVID vaccine and even lessen the effectiveness of the vaccine. This is due to the fact that those medications may weaken the immune system which can impair the body's ability to form a full response against the vaccine.

Do COVID-19 Vaccines Interfere With Common Prescription Drugs? American Association for Retired Persons. https://www.aarp.org/health/conditions-treatments/info-2021/covid-vaccine-medication-interaction.html. Reviewed 2021 February 25. Accessed 2021 June 14.

Thank you for this excellent work. Do you feel that covid clinics should ask if the patient is taking Ginkgo, when asking about "blood thinners?"

Turmeric is an Asian spice that comes from the root of the turmeric plant and it is used as a dye in cosmetics and food and for its health benefits. It is also known as Curcuma longa, Curcuma domestica, or Curcuma aromatica. Curcumin is the primary active constituent in turmeric that also contributes to its vibrant yellow color. Turmeric also contains minerals, like iron and potassium, and fatty acids. Turmeric is believed to have some benefits in inflammatory conditions, Alzheimer’s disease, pain, arthritis, cancer, depression, diabetes, gingivitis, infections, cardiovascular disease, and weight loss. It is also reported to have antioxidant, antithrombotic, and skin benefits. Research suggests that curcumin decreases the production of inflammatory cytokines and prostaglandins from monocytes and neutrophils to provide benefits in inflammatory conditions, arthritis, jaundice, hepatitis, and gingivitis. In Alzheimer’s disease, curcumin may prevent amyloid and/or tau accumulation in the amygdala and hypothalamus. Curcumin’s analgesic effect is unclear but may be related to inhibition of transient receptor potential vanilloid-1 (TRPV-1)-mediated pain hypersensitivity. Curcumin is suggested to induce apoptosis in cancer cells and inhibit angiogenesis to have chemopreventive and growth inhibitory effects in several types of cancer. In depression, curcumin may play a role by decreasing cortisol levels, inhibiting monoamine oxidase, and increasing neurotransmitter levels. For diabetes, turmeric may reduce blood glucose levels and HbA1c and increase plasma insulin levels. There is also evidence of turmeric contributing to protection against diabetic nephropathy, retinopathy, and neuropathy. Turmeric may have some weak antimicrobial, antiviral, and antiparasitic properties against microbes like E. coli, HIV, and Plasmodium. As an antioxidant, turmeric decreases levels of free radicals and reactive oxygen species and may increase levels of antioxidant enzymes. Curcumin’s antithrombotic effects may involve antiplatelet activity and interruption of thromboxane synthesis. Evidence suggests that turmeric may protect against myocardial infarction by reducing inflammatory cytokines and extracellular matrix proteases. Other possible cardiovascular benefits include blood pressure reduction, vasorelaxation, lipid level reduction, and endothelial function improvement. Topical curcumin may benefit skin conditions, especially those with pruritus. While these are just some of the off-label uses of turmeric and curcumin, there is still not enough evidence to strongly support turmeric or curcumin as a pharmacologic recommendation. Many of the evidence we have now is based on traditional anecdotes, in vitro studies, or animal studies. Some of the stronger clinical evidence points to turmeric and curcumin being possibly effective in allergic rhinitis, depression, hyperlipidemia, non-alcoholic fatty liver disease, osteoarthritis, and pruritus. For example, a clinical trial published in 2016 compared the treatment of allergic rhinitis with oral curcumin vs placebo and found that curcumin contributed to reduction in nasal congestion, sneezing, and rhinorrhea by reducing nasal airflow resistance and inflammatory mediators (1). On the other hand, a meta-analysis published in 2019 evaluating the use of curcumin in Alzheimer’s disease did not show any improvement in cognitive function or positive effect on cognitive decline (2). Topical or oral turmeric is generally well-tolerated but some possible side effects include constipation, dyspepsia, diarrhea, nausea, vomiting, contact urticaria, and pruritus.

Works Cited:

1. Wu S, Xiao D. Effect of curcumin on nasal symptoms and airflow in patients with perennial allergic rhinitis. Ann Allergy Asthma Immunol. 2016;117(6):697-702.e1. doi:10.1016/j.anai.2016.09.427

2. Zhu LN, Mei X, Zhang ZG, Xie YP, Lang F. Curcumin intervention for cognitive function in different types of people: A systematic review and meta-analysis. Phytother Res. 2019;33(3):524-533. doi:10.1002/ptr.6257

3. Turmeric (Monograph). Natural Medicines. https://naturalmedicines-therapeuticresearch-com.jerome.stjohns.edu/databases/food,-herbs-supplements/professional.aspx?productid=662. Updated December 16, 2020. Accessed March 10, 2021.

Product: Gingko Biloba

What is it used for? Gingko is a seed plant traditionally used in Chinese medicine to treat circulatory disorders, asthmas, tinnitus, vertigo, and cognitive problems. Today, Gingko extracts are used in Europe as a nootropic agent in old age and dementia. Prescribed along with cholinesterase inhibitors and memantine, patients take gingko as a supplement. Gingko extract contains mainly terpenoids, flavonol glycosides, and proanthocyanidins.

How does it work?

As an antioxidant and terpenoid, gingko can help improve circulation by dilation of the blood vessels and reducing ‘stickiness’ of platelets.

Side Effects and Additional Considerations:

Primarily, pharmacists should monitor patients for an increased bleed risk. This is particular in combined use of high-dose aspirin (325mg). However, in a meta-analysis including 18 randomized trials and almost 2000 patients, there was no significant effect of gingko biloba on platelet aggregation, prothrombin time, or activated partial thromboplastin time.2

Milder symptoms include gastrointestinal upset and headaches as well as blisters or itching in terms of allergic reactions.

Clinical Trial:

In 1987, there was a 12 week study on outpatients, 20 of which were females and 34 of which were males. The mean age was 73.1 years and they received 120mg of EGb or placebo each. The test items included cognitive test battery and automated psychometric test battery.3 The batteries comprised of the Benton Visual Retention Test, Immediate Word Recall, Number Matching Task, Rapid Visual Information Processing Task, CRT, DSST, and Word Recognition

The results indicated that EGb was superior to placebo incognitive tests after administration for 12 weeks. The same results were repeated in another clinical trial in 1991.

1. A Systematic Review and Meta-Analysis of Ginkgo biloba in Neuropsychiatric Disorders: From Ancient Tradition to Modern-Day Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3679686/

2. Clinical use of gingko biloba, https://www.uptodate.com/contents/clinical-use-of-ginkgo-biloba

3. An Updated Review of Randomized Clinical Trials Testing the Improvement of Cognitive Function of Ginkgo Biloba Extract in Healthy People and Alzheimer’s Patients, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047126/

Stress is a condition that comes from external, physical, or mental overload. Stress makes a person feel nervous, anxious, or otherwise less capable of a normal response to their environment. Prolonged exposure to stress can affect the mental and physiological state of a person, resulting in other illnesses like depression, high blood pressure, cardiac diseases and metabolic disorders. Adaptogens are herbs that improve an individual's ability to cope with stress. These herbs normalize the physiological process of the body and help the body adapt to changes. Old texts, animal and clinical studies describe Ashwagandha, commonly known as Indian Ginseng, as a safe and effective adaptogen. This study was a double-blind, randomized, placebo-controlled trial, which attempted to evaluate the efficacy of high-concentration full-spectrum Ashwagandha root extract in reducing stress and anxiety. A total of 61 subjects, after excluding 3, complaining of mental stress were enrolled into the study for a duration of 60 days. In the Ashwagandha group, by Day 60, there was a significant reduction in scores corresponding to all of the categories tested: 77% for the depression category, 75.6% for the anxiety category, and 64.2% for the stress category. In contrast, in the placebo-control group, the corresponding reductions in scores were much smaller: 5.2%, – 4.3% and 10.4%, respectively. After 60 days of treatment, a significant reduction of 27.9% in serum cortisol levels from baseline was observed in the Ashwagandha group. In contrast, a reduction of only 7.9% was observed in the placebo-control group. The findings suggest that high-concentration full-spectrum Ashwagandha root extract improves an individual's resistance towards stress and thereby improves self-assessed quality of life.

References

Chandrasekhar K, Kapoor J, Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med. 2012;34(3):255-62.

Ashwagandha, also known as “Indian ginseng” or Withania somnifera is a significant herb of Ayurveda, which is the traditional system of medicine in India. The root of this herb smells like horse, which is called ashwa, hence its name. It has been around for about 6000 years and the chemical structure is composed of alkaloids, steroidal lactones and saponins. Ashwagandha is known as an adaptogen so it enhances the body’s natural ability to respond to stress. It can also improve the body’s defense against different diseases and contains antioxidant properties. In a swimming endurance stress test study, Ashwagandha was shown to be effective with an increase in stamina, prevention of stress induced gastric ulcer and increase in swim performance in rats. The rats also had a decrease in cortisol and ascorbic acid content levels so it is found useful in prevention of stress induced ulcers. In another study, Ashwagandha had an inhibitory effect on Chinese Hamster Ovary cells carcinoma. Research has shown that this herb can act as an anticancer while also reducing the side effects of anticancer agents and an immunomodulatory agent by also increasing white blood cell count.  It is used for various health benefits including enhancement of the brain and improvement of memory. Ashwagandha can be used in neurodegenerative diseases such as Parkison’s, Huntington’s and Alzheimer’s because it can slow or reverse neuritic atrophy and synaptic loss. It has GABA-mimetic properties so it can help the symptoms of tardive dyskinesia. Other studies with standard tests showed that Ashwagndha has anxiolytic properties similar to Lorazepam and antidepressant effects comparable to imipramine. Overall, the scientific research and trials showed that Ashwagandha can be used for a wide variety of diseases due to its multiple beneficial pharmacologic effects. 

References 

Singh N, Bhalla M, de Jager P, Gilca M. An overview on ashwagandha: a Rasayana (rejuvenator) of Ayurveda. Afr J Tradit Complement Altern Med. 2011;8(5 Suppl):208-213. doi:10.4314/ajtcam.v8i5S.9

Ginseng

What is it used for?

In traditional Chinese medicine, Asian ginseng is used as a tonic to replenish energy, improve general well-being, physical stamina, and concentration; stimulate immune function; slow the aging process; and relieve various health problems such as respiratory disorders, cardiovascular disorders, depression, anxiety, erectile dysfunction, and menopausal hot flashes.

How does it work?

The root of Asian ginseng contains chemical components called ginsenosides( panaxosides) that are thought to contribute to the herb’s claimed health-related properties.

What are some side effects?

The most common side effects of ginseng are headaches, sleep problems, and digestive problems.

Are there any trials that support its use/non-use (efficacy)? Provide details.

• One study investigated the effects of having 18 young male athletes take 2 grams of Korean red ginseng extract three times per day for seven days. The men then had levels of certain inflammatory markers tested after performing an exercise test. These levels were significantly lower than in the placebo group, lasting for up to 72 hours after testing

• However, it should be noted that the placebo group got a different medicinal herb, so these results should be taken with a grain of salt and more studies are needed.

Additional Considerations (Can include known drug interactions, special directions, etc.)

Ginseng might interact with certain medications, such as the anticoagulant, warfarin. It is recommended to consult the doctor before using ginseng products.

https://www.ncbi.nlm.nih.gov/pubmed/21494373

https://www.nccih.nih.gov/health/asian-ginseng

Melatonin What is it used for? People commonly use melatonin for sleep disorders, such as insomnia and jet lag. Unlike many sleep medications, there is a low risk of dependency on melatonin, have a diminished response after repeated use (habituation) or experience a hangover effect. How does it work? Melatonin is a hormone made by the pineal gland that plays a role in sleep. The production and release of melatonin in the brain are connected to the time of day. During the day the pineal is inactive. When the sun goes down and darkness occurs, the pineal is “turned on” and begins to actively produce melatonin which makes you feel less alert. Melatonin production declines with age. What are some side effects? Headache, dizziness, nausea, drowsiness

Are there any trials that support its use/non-use (efficacy)? Provide details. Meta-analysis: melatonin for the treatment of primary sleep disorders.

• Intervention: Melatonin compared to placebo.

• Results: Nineteen studies involving 1683 subjects were included in this meta-analysis. Melatonin demonstrated significant efficacy in reducing sleep latency and increasing total sleep time

• Overall sleep quality was significantly improved in subjects taking melatonin (standardized mean difference = 0.22 [95% CI: 0.12 to 0.32], Z = 4.52, p<0.001) compared to placebo.

References https://www.mayoclinic.org/drugs-supplements-melatonin/art-20363071

https://www.sleepfoundation.org/articles/melatonin-and-sleep

https://www.ncbi.nlm.nih.gov/pubmed/23691095

Saffron

Common Name/Scientific Name:

Saffron

Crocus sativus

Family: Iridaceae

What is it used for?

Saffron is a spice or coloring agent that can be used for asthma, vomiting, Alzheimer’s disease, cancer, cough, sore throat, vomiting and flatulence. There is very limited evidence showing benefits to all of these conditions, however, there are some studies that show promising results.

What are some side effects?

Higher doses of saffron extract can be associated with GI and dermatological effects. Some side effects include decreased or increase appetite, nausea, vomiting

Are there any trials that support its use/non-use (efficacy)? Provide details.

A small clinical trial studied the effects of saffron with Alzheimer’s disease. Saffron extract was given 15 mg orally twice a daily for 16 weeks to improve the cognitive ability and disease progression of patients with Alzheimer’s disease. This was compared to the placebo and showed promising effects. Another study also studied patients 55 years and older with dementia and possible Alzheimer’s disease. Saffron extract was compared to donepezil, a well known Alzheimer’s disease medication, 10 mg daily.

References:

Akhondzadeh S, Sabet MS, Harirchian MH, Togha M, Cheraghmakani H, Razeghi S, Hejazi SSh, Yousefi MH, Alimardani R, Jamshidi A, Zare F, Moradi A. Saffron in the treatment of patients with mild to moderate Alzheimer's disease: a 16-week, randomized and placebo-controlled trial. J Clin Pharm Ther. 2010 Oct;35(5):581-8.

Akhondzadeh S, Sabet MS, Harirchian MH, et al. A 22-week, multicenter, randomized, double-blind controlled trial of Crocus sativus in the treatment of mild-to-moderate Alzheimer's disease. Psychopharmacology 2010;207:637-43.

Tea Tree Oil

Common Name/Scientific Name: melaleuca

What is it used for? 

• Tea tree oil also exerts antioxidant activity and has been reported to have broad-spectrum antimicrobial and antiseptic activity against bacterial, viral, fungal, and protozoal infections affecting skin and mucosa.

How does it work?

• It has a minimum content of terpinen-4-ol and a maximum content of 1, 8-cineole. Terpinen-4-ol is a major tea tree oil component that exhibits strong antimicrobial and anti-inflammatory properties.

What are some side effects?

• if used a high dose, skin irritation can occur

Are there any trials that support its use/non-use (efficacy)? Provide details.  

• Several studies have suggested the use of this oil for the treatment of acne vulgaris, seborrheic dermatitis, and chronic gingivitis.

  • a study comparing a 2.5% tea tree gel, a 0.2% chlorhexidine gel, and a placebo gel found that although the tea tree gel group had significantly reduced gingival index and papillary bleeding index scores, their plaque scores were actually increased

• It also accelerates the wound healing process and exhibits anti-skin cancer activity.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360273/

https://www.ncbi.nlm.nih.gov/pubmed/22998411

Moringa

Scientific Name: Moringa oleifera

Common Name: Arango, Ben Nut Tree, Benzolive, Chinto Borrego, Clarifier Tree, Drumstick Tree, Horseradish Tree, Indian Horseradish, Jacinto, Kelor Tree, Malunggay, Marango, Mlonge, Moringe de Ceylan, Mulangay, Narango, Nebeday, Sahjna, Saijan, Saijhan, Sajna, Shagara al Rauwaq, Shigru, Terebinto, Tree of Life.

What is it used for?

Moringa is native to the indian subcontinent and has been used for generations in south asian cuisine. It’s popularity has spread throughout the world and can be found in many tropical countries. As a therapeutic agent, moringa has been used for anemia, asthma, cancer, constipation, diabetes, diarrhea, epilepsy, headache, cardiovascular disease (CVD), lactation, menopausal symptoms, hyperthyroidism, malnutrition, etc.

How does it work?

Moringa leaves are a rich source of vitamins A and C, beta-carotene, calcium, iron, potassium, protein, and essential amino acids such as methionine, cystine, tryptophan, and lysine. The exact mechanism in which moringa works is not well understood but it is said to have antioxidant properties and other components that can be attributed to its therapeutic effects.

What are some side effects?

Moringa seems to be well tolerated and not many side effects have been reported.

Are there any trials that support its use/non-use (efficacy)? Provide details.

Diabetes

• One study showed that eating a meal containing 50 grams of moringa drumstick leaves reduces postprandial glucose levels by 7%.

Hyperlipidemia

• One study in patients with type 2 diabetes showed that powdered moringa leaves taken daily for 40 days reduced low-density lipoprotein and total cholesterol by 13% and triglyceride levels by 10% when compared to the control group.

Lactation

• Trials conducted on lactation and moringa are contradictory and inconsistent.

References

https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=1242#adverseEvents

https://www.ncbi.nlm.nih.gov/pubmed/12499084?dopt=Abstract

http://online.lexi.com.jerome.stjohns.edu:81/lco/action/doc/retrieve/docid/fc_rnp2/6030841?cesid=1s1EzXcozRf&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dmoringa%26t%3Dname%26va%3Dmoringa#adr-nested

Honey

Scientific Name: Apis mellifera

What is it used for?

Experimental research illustrated its bioactivities and medicinal effects including antibacterial, antiviral, anti-inflammatory, and antioxidant activities.

How does it work?

Honey induces leukocytes to release cytokines, which is what begins the tissue repair cascades. Proliferation of B- and T-lymphocytes and the phagocyte activity has also been reported by honey. Also, it activates the immune response to infection by inducing the generation of antibodies.

What are some side effects?

Honey is relatively safe for age 1+. We want to avoid giving honey to babies under the age of 1 year as it can cause rare but serious gastrointestinal conditions (infant botulism) caused by exposure to Clostridium botulinum spores. Bacteria from the spores can grow and multiply in a baby's intestines, producing a dangerous toxin.

Are there any trials that support its use/non-use (efficacy)? Provide details.

7 men and 3 women received a strictly controlled regular diet during a 2-week control period, followed by daily consumption of 1.2 g/kg body weight honey. At the end of each period, results showed that honey increased antioxidant agent( increased blood vitamin C concentration by 47%, beta-carotene by 3%, uric acid by 12%, and glutathione reductase by 7%. Honey increased serum iron by 20% and decreased plasma ferritin by 11%. It increased the percentage of monocytes by 50% and increased lymphocyte and eosinophil percentages slightly. Honey reduced serum immunoglobulin E by 34% and increased serum copper by 33%)."

https://www.ncbi.nlm.nih.gov/pubmed/12935325/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424551/

Bitter Melon

Scientific Name: Momordicacharantia L.

Common Name: Art pumpkin; Balsam apple; Balsam pear; Bitter cucumber; Bitter gourd; Carilla cundeamor; Cerasee; Corilla; Karela; Kor-kuly; Ku gua; Ku kua karela

What is it used for?

Bitter melon has primarily been used to treat diabetes. It can be found in tropical areas (Amazon, Africa, India, and the Caribbean). The plant is a climbing and flowering vine that can grow up to 16 feet. The fruit/vegetable is cucumber shaped with bumps. In traditional medicine it has been used to treat indigestion, intestinal gas, wounds, inflammation, fever, and hypertension. In the country of Guyana, it has also been used as an antiviral.

How does it work?

Bitter melon contains glycosides, saponins, triterpenes, alkaloids, oils, steroids, resins, proteins, phenolic and flavonoid compounds and a number of vitamins and minerals. It’s activity as an antiviral is attributed to the MAP30 protein which has shown to have effects on multiple stages of the viral life cycle in acute and chronic conditions. Bitter melon’s ability to treat diabetes is said to come from an insulin-like polypeptide known as polypeptide P which has an onset of action of about 30-60 minutes and a duration of action of about 4 hours. Apart from this, bitter melon is said to decrease hepatic gluconeogenesis and increase pancreatic insulin secretion.

What are some side effects?

Abdominal pain, diarrhea and headache.

Are there any trials that support its use/non-use (efficacy)? Provide details.

There are a number of trials that have been conducted to assess the efficacy of bitter melon in treating conditions such as diabetes. Four randomized controlled trials with up to a 3 month duration and including 479 patients were reviewed to assess safety and efficacy of bitter melon. Two of these trials compared bitter melon to placebo for glycemic control and the results showed that there was no statistically significant difference between the two arms. Another study compared bitter melon to metformin or glibenclamide and similarly, there was no significant difference. It is important to note that there were no serious side effects reported from any of these trials. In order to determine how effective bitter melon is as a therapeutic agent, more large scale studies are required.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315906/

https://www.ncbi.nlm.nih.gov/pubmed/7665070

https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=795#mechanismOfAction

https://www.ncbi.nlm.nih.gov/pubmed/20078273?dopt=Abstract

http://online.lexi.com.jerome.stjohns.edu:81/lco/action/doc/retrieve/docid/fc_rnp2/3750047

Fenugreek

Scientific Name: Trigonella foenum-graecum L.

Common Name: Faenum graecum; Fenugreek; Huluba; Methi; Semen Trigonellae

What is it used for?

Fenugreek is commonly used for a number of reasons including digestive problems, dietary supplement for diabetes, stimulation of milk, dressing for wounds, etc. It is a herb that has been used for centuries as a cooking additive and remains a popular ingredient in curry powders and other spices. The maple aroma and flavor of fenugreek has led to its use in imitation maple syrup. It has also been used in many commercial products.

One tablespoon (11.1 grams) of whole fenugreek seeds contains 35 calories and several nutrients :

Fiber: 3 grams

Protein: 3 grams

Carbs: 6 grams

Fat: 1 gram

Iron: 20% of the Daily Value (DV)

Manganese: 7% of the DV

Magnesium: 5% of the DV

(Healthline)

How does it work?

Fenugreek's ability to treat diabetes is said to be due to the seed extracts ability to lower blood glucose levels. Insulinotropic and antidiabetic properties also have been associated with the amino acid 4-hydroxyisoleucine. It is also said to have some antioxidants properties.

What are some side effects?

• Bloating

• Diarrhea

• Flatulence

• Nausea

• Dizziness

• Hypoglycemia

Are there any trials that support its use/non-use (efficacy)? Provide details.

• A few small studies found that fenugreek may help lower blood sugar levels in people with diabetes. However, the evidence provided is weak.

• There isn’t enough scientific evidence to support the use of fenugreek for any health condition.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978122/

https://www.ncbi.nlm.nih.gov/books/NBK501779/

https://www.webmd.com/vitamins/ai/ingredientmono-733/fenugreek

https://www.healthline.com/nutrition/fenugreek#what-it-is

INCLUDE THE FOLLOWING:

Common Name/Scientific Name:  Charcoal

What is it used for? 

a special form of carbon that can bind other substances on its surface (adsorption).It is also used to adsorb drugs in the gut so the drugs don't enter the body.

How does it work?

Activated charcoal adsorbs xenobiotics within the GI tract. It only adsorbs xenobiotics that are in the dissolved liquid phase via direct contact. Most xenobiotics will have decreased systemic absorption in the presence of activated charcoal, including acetaminophen, aspirin, barbiturates, tricyclic antidepressants, theophylline, phenytoin. It is important to note that activated charcoal does not effectively adsorb alcohols, metals such as iron and lithium.

What are some side effects?

Side effects of activated charcoal include constipation and black stools. More serious, but rare, side effects are a slowing or blockage of the intestinal tract, regurgitation into the lungs, and dehydration.

Are there any trials that support its use/non-use (efficacy)? Provide details.  

An 18-month consecutive case series of all patients for whom activated charcoal administration was recommended in the home. The comparison was made for patients who initially had home activated charcoal recommendations but who ultimately were treated in the emergency department

• Home administration of activated charcoal was recommended in 138 cases.

• A total of 115 individuals (83%) were treated with activated charcoal in the home, with no failures to administer activated charcoal.

• Time to activated charcoal administration after ingestion was a mean of 38 minutes (+/-18.3) for home treatment vs 73 minutes (+/-18.1) for ED treatment.

• Eight children (6.9%) who were treated at home vomited after activated charcoal vs 3 (13%) who received emergency department treatment. No aspirations or complications occurred.

Conclusion:

activated charcoal can be administered successfully by patients at home because at-home use of it significantly reduces the time to administration.

https://www.ncbi.nlm.nih.gov/pubmed/11731627

https://www.ncbi.nlm.nih.gov/books/NBK482294/

Common Name/Scientific Name: Zinc

What is it used for? 

• Zinc supplements are commonly used to alleviate a number of conditions, including zinc-deficiency, diarrhea, age-related macular degeneration, upper respiratory infection, wound healing, Wilson's Disease and HIV

How does it work?

• Zinc is a cofactor for polymerases and proteases involved in many cellular functions (wound repair, intestinal epithelial cell regeneration). Zinc is also a cofactor for thymulin, a thymic hormone essential for T-cell maturation.

What are some side effects?

• Common adverse effects of excessive zinc intake include metallic taste, nausea, vomiting, abdominal cramping, and diarrhea

Are there any trials that support its use/non-use (efficacy)? Provide details.  

• A meta-analysis including 12 RCTs with a total of 5,512 children in developing countries found a reduction in URI incidence in those using zinc supplements compared with placebo (8 percent; 95% CI, 1 to 15 percent).

• Wilson's disease can be successfully treated with zinc because of its ability to compete with copper for binding sites.

• It has been approved by the U.S. Food and Drug Administration for maintenance therapy.

Additional Considerations (Can include known drug interactions, special directions, etc.)

• Recommended daily intake of zinc depends on several factors such as age, sex, weight, and content of diet.

• The US Food and Nutrition Board recommended intake of 11 mg/day and 8 mg/day for adult males and females, respectively

Saper, R. B., & Rash, R. (2009). Zinc: an essential micronutrient.American family physician,79(9), 768–772.

Gammoh, N. Z., & Rink, L. (2017). Zinc in Infection and Inflammation.Nutrients,9(6), 624. https://doi.org/10.3390/nu9060624

St. Johns Wort

Scientific Name: Hypericum perforatum

Common Name: Hierba de San Juan; Hiperikum; Hipérico; Hyperici Herba; Hypericum; Hypericum Perforatum; Johannesört; Johanniskraut

What is it used for?

St John's wort is frequently used for self-medication in the treatment of depression. St. John’s wort is also commonly used for the treatment of disorders such as insomnia and anxiety, especially in patients who have reached menopause. St John's wort oil may also be used as an astringent.

How does it work?

The mechanism of action of St John's wort still remains unclear. Products with St. Johns wort extracts contain at least 10 active constiutients. Hypericin is one major ingredients of St John's wort that was believed to be an effective antidepressant because it had an inhibitory action on monoamine oxidase in vitro. More recent studies show potential in hyperforin may be one of the major constituents responsible for the antidepressant effect. Hyperforin works by inhibiting the reuptake serotonin, dopamine, and noradrenaline.

What are some side effects?

Some adverse effects include gastrointestinal symptoms, dizziness, photosensitivity, headache, confusion, urinary frequency, allergic reactions, and fatigue. The photosensitivity reactions have been due to the hypericin and pseudohypericin.

Are there any trials that support its use/non-use (efficacy)? Provide details.

A systematic review was done of randomized controlled studies for St John's wort extracts to treat depression. Specifically is look at St. John’s wort as compared to placebo to see which was more effective in the treatment of mild to moderate depressive disorders.

Another more focused, systematic review included only studies in with patients who met the diagnostic criteria for major depression. In this review, the St John's wort was found to be superior to placebo, and showed a similar efficacy to standard antidepressants but with less adverse effects. It should be noted that the antidepressant doses of standard therapy were also generally at the lower dose of the recommended range.

Additional Considerations (Can include known drug interactions, special directions, etc.)

St John's wort is known to cause numerous drug-drug interactions by inducing enzyme metabolism. This includes some cytochrome P450 isoenzymes and the transport protein P-glycoprotein. These interactions have been reported with cyclosporine, digoxin, HIV-protease inhibitors, NNRTIs, oral contraceptives, tacrolimus, theophylline, and warfarin. St. John’s wort can cause serotonin syndrome and should not be taken with other medications known to increase serotonin levels without consulting a doctor.

https://www.ncbi.nlm.nih.gov/pubmed/10625118?dopt=Abstract

https://www.ncbi.nlm.nih.gov/pubmed/18843608?dopt=Abstract

https://www.ncbi.nlm.nih.gov/pubmed/9798597?dopt=Abstract

https://www.ncbi.nlm.nih.gov/pubmed/9684948?dopt=Abstract

Prune

Scientific Name: Ameixa; Ciruela; Prunus; Prunus domestica

What is it used for?

Prune is a dried plum that has been used as a laxative and demulcent properties. It may also be used as an antioxidant for cardiovascular benefits.

How does it work?

The main mechanism of action attributed to prunes for constipation has been attributed to the high dietary fiber found in the fruit. Dried prunes contain about 6.1 g of dietary fiber per 100 g. prunes may also contain components that may contribute its effects within the GI tract. These components include sugar alcohol sorbitol and phenolic compounds, predominantly chlorogenic and neochlorogenic acids. These components are effective because they are poorly absorbed by the small intestine and pass undigested into the colon.

What are some side effects?

There are no adverse events reported.

Are there any trials that support its use/non-use (efficacy)? Provide details.

A systemic review was done to assess the effect of prunes, prune juice or prune extract on GI function in constipated and non-constipated patients through. The systemic review was of 4 randomized controlled trials. As for one of the studies that focused on constipation, 3 weeks of prune consumption or 100 g per day showed an improved stool frequency 3.5 vs. 2.8 CSBM per week, (P = 0.006). As for stool consistency, the prune patients had a value of 3.2 compared to psyllium of 22g per day value of 2.8 on Bristol stool form scale, (P = 0.02). In non-constipated subjects, prunes softened stool consistency in one trial and increased stool weight of 628 g vs. 514 g per 72 hour in wet weight, (P = 0.001) in another trial, compared with control.

Dried plums/prunes (DPs) have also been reported to provide health benefits in animal models for bones and cardiovascular health. Data from human studies suggest that prunes intake can increase lipid metabolism, anti-inflammatory, and oxidant defense systems, having an overall positive benefit on cardiovascular health. Twenty-seven healthy, postmenopausal women were randomly assigned to consume six dried prunes of about 42 g or about 14 g per day for 2 weeks, then a 2-week washout period, followed by a cross over. Serum C-telopeptide, beta-crosslinked (CTX) was used as a measure of bone resorption and peripheral artery tonometry (PAT) was used to assess microvascular function. The results suggested a trend in decreased bone resorption in those consuming 42g of prunes a day. No effects on vascular function were noted

Additional Considerations (Can include known drug interactions, special directions, etc.)

Although no studies have proven the efficacy of prunes for cardiovascular health, prunes are a good source of antioxidants.

https://onlinelibrary.wiley.com/doi/full/10.1111/apt.12913

https://www.ncbi.nlm.nih.gov/pubmed/11401245

https://www.liebertpub.com/doi/abs/10.1089/jmf.2018.0209?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=jmf

******

Common Name/Scientific Name:

Zingiber officinale

What is it used for?

****** can be used for motion sickness, pregnancy-induced nausea and vomiting, diarrhea, fatulences, IBS, UC, CINV, PONV, and loss of appetite. IT can also be used for RA, osteoarthritis, migraine headaches, and hypertension. Topically, the juice of ****** can help alleviate thermal burns.

Are there any trials that support its use/non-use (efficacy)? Provide details.

Clinical research mostly shows promising results regarding ****** and osteoarthritis. Taking ****** 500-1000 mg a day can improve pain. An analysis studies patients taking ****** extract 500-1000 mg a day for 3-12 weeks. Compared to the placebo, pain and disability reduced in knee or hip osteoarthritis patients. Some research has also compared ****** to conventional drug treatment such as ibuprofen 400 mg three times daily compared to ****** extract 500 mg twice a day for one month. Both of the medications provided similar effects.

What are some side effects?

Some common side effects include abdominal discomfort, heartburn, and diarrhea.

References:

Haghighi M, Khalva A, Toliat T, Jallaei S. Comparing the effects of ****** (Zingiber officinale) extract and ibuprofen on patients with osteoarthritis. Arch Iran Med 2005;8:267-71.

Bartels EM, Folmer VN, Bliddal H, et al. Efficacy and safety of ****** in osteoarthritis patients: a meta-analysis of randomized placebo-controlled trials. Osteoarthritis Cartilage. 2015;23(1):13-21

Aloe

Scientific Name: Aloe barbadensis, Aloe Ferox, Aloe perryi, Aloe Vera, Aloe vulgaris

What is it used for?

Widely used in cosmetics for its moisturizing and revitalizing effects. Aloe should only be used topically and appears to inhibit infection and promote healing of minor burns and wounds, frostbite, and skin affected by diseases such as psoriasis and seborrhea dermatitis.

How does it work?

Believed to have antibacterial effects as well as help relieve skin irritation. No clinical data supports the antibacterial effect, however it is believed that using aloe will divert microorganisms from the site of irritation. Additionally, it is believed that the reason aloe works to relieve skin irritations such as burns is due to its advanced moisturizing effects.

What are some side effects?

Aloe is well tolerated for topical use only. Patients may experience minimal itching, and rarely mild pain. Ingestion of aloe can be extremely toxic and will result in bloody diarrhea, potassium depletion, albuminuria, hematuria, muscle weakness, weight loss, and cardiac effects.

Are there any trials that support its use/non-use (efficacy)? Provide details.

There are many clinical trials that support the use of aloe in burns and skin irritation, but not antibacterial effects, anticancer effects, and anti-inflammatory effects. For burn and skin irritation, a study of 27 patients treated with aloe vera gel, the primary outcome was for the time it took for partial thickness burn wounds to heal. Patient with aloe healed in an average of 12 days as opposed to the Vaseline-gauze-treated area of the same burn, which healed in an average of 18 days. Another systematic review was carried out in 2007 to determine the efficacy of aloe vera in burn wound healing. Only 4 studies with 371 patients of burns were identified in humans. Two of these studies used time to wound healing as an outcome measure. Based on a meta-analysis of these 2 studies, the summary-weighted mean difference in healing time of the aloe vera group was 8.79 days shorter than of those in the control group (P = 0.006). The other 2 studies showed that treatment in the aloe vera group was better than that of the control group. One study reported a success rate with aloe vera of 95% compared with 83% with silver sulfadiazine. The other showed that the epithelialization rate measured by the healing size of the aloe wound was higher than that of the Vaseline gauze group on both day 5 and day 8 following skin grafting. The findings also suggest that aloe vera products are safe for topical use.

Additional Considerations (Can include known drug interactions, special directions, etc.)

Though there are no relative contraindications or extra precautions with topical use of aloe, there once was a time that aloe was ingested to be used as a laxative. This was contraindicated for the use of those who were pregnant, children under 12 years of age, and the elderly population. Additionally, the use of oral aloe increased risk of congenital malformations. The US FDA removed all OTC oral aloe products from the market in 2002.

- Online. Lexi.com

- Visuthikosol V, Chowchuen B, Sukwanarat Y, Sriurairatana S, Boonpucknavig V. Effect of aloe vera gel to healing of burn wound: a clinical and histologic study. J Med Assoc Thai. 1995;78(8):403-409.

- Maenthaisong R, Chaiyakunapruk N, Niruntraporn S, Kongkaew C. The efficacy of aloe vera used for burn wound healing: a systematic review. Burns. 2007;33(6):713-718

Saw Palmetto

Scientific Name: Brahea serrulata, Chamaerops serrulata Michx, Corypha repens, Sabal serrulata, Sabal serrulatum, Serenoa repens.

Common Name: American dwarf palm tree, Cabbage palm, Sabal palm, Saw palmetto, Saw palmetto berry.

What is it used for?

Saw Palmetto is a type of palm tree that grows in southeastern states in the United States. In history, many native tribes in Florida depended on the berries of the plant for food. It is currently used to treat symptoms associated with benign prostatic hyperplasia (BPH), chronic pelvic pain, decreased sex drive, migraine and hair loss.

How does it work?

The exact mechanism of action is not well understood but it is thought that saw palmetto’s activity in treating BPH is due to its antiandrogenic and anti-inflammatory properties.

What are some side effects?

• Abdominal pain

• Diarrhea

• Nausea

• Fatigue

• Headache

• Decreased libido

Are there any trials that support its use/non-use (efficacy)? Provide details.

• There have been a number of high quality trials conducted to determine the efficacy of saw palmetto in treating symptoms associated with BPH. In one trial, saw palmetto was compared to placebo in reducing lower urinary tract symptoms. The results showed that treatment with SP was not superior to placebo.

• A 72 week trial using the American Urological Association Symptom Score Index, reported that saw palmetto was not superior to placebo at double and triple doses.

• Similarly in another trial, there was no difference between saw palmetto and placebo in decreasing nightly urination on the AUA Nocturia scale.

• When comparing prostate size reduction there was also no significant difference between saw palmetto and placebo.

References

• https://www.nccih.nih.gov/health/saw-palmetto

• https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001423.pub3/full?highlightAbstract=saw%7Cpalmett%7Cpalmetto

• https://www.ncbi.nlm.nih.gov/pubmed/19591529

Garlic

Common Name/Scientific Name: Allium sativum L.

What is it used for?

garlic consumption has significant effects on lowering blood pressure, prevention of atherosclerosis, reduction of serum cholesterol and triglyceride, inhibition of platelet aggregation, and increasing fibrinolytic activity

How does it work?

It has been suggested that the mechanism of antihypertensive activity of garlic is due to its prostaglandin-like effects, which decrease peripheral vascular resistance

What are some side effects?

Garlic was highly tolerable in all trials and was associated with minimal side effects.

Are there any trials that support its use/non-use (efficacy)? Provide details.

In one trial, 47 hypertensive patients showed that garlic significantly decreased the mean systolic blood pressure by 12 mmHg and the mean supine diastolic blood pressure by 9 mmHg versus placebo.

In a meta-analysis study, author concluded that garlic should be considered as an alternative option with a higher safety profile than conventional cholesterol-lowering medications in patients with slightly elevated cholesterol

However, studies using garlic powder failed to show any lipid-lowering effects.

It has also been suggested that different people might have different responses to garlic, thus garlic may be more beneficial for some specific groups.

Bayan, L., Koulivand, P. H., & Gorji, A. (2014). Garlic: a review of potential therapeutic effects.Avicenna journal of phytomedicine,4(1), 1–14.

Auer W, Eiber A, Hertkorn E, Hoehfeld E, Koehrle U, Lorenz A, Mader F, Merx W, Otto G, Schmid-Otto B, et al. Hypertension and hyperlipidaemia: garlic helps in mild cases. Br J Clin Pract Suppl. 1990;69:3–6

Biotin

Common Name/Scientific Name:

Cis-hexahydro-2-oxo-1H-thieno[3,4-d]-imidazole-4-valeric acid

What is it used for?

Biotin is used for biotin deficiency symptoms. It is commonly used for hair loss and brittle nails, to strengthen both of them. It can be used for preventing or treating biotin deficiency associated with pregnancy, long term parenteral nutrition, malnutrition, rapid weight loss, and multiple carboxylase deficiency

What are some side effects?

Some drugs that can affect biotin levels are antibiotics. The interference with the gastrointestinal flora can reduce bacterial synthesis of biotin.

Are there any trials that support its use/non-use (efficacy)? Provide details.

Clinical research shows that taking a combination of biotic 2 mg and chromium 600 mcg as chromium picolinate can lower blood glucose and hemoglobin A1C levels in Type 2 DM patients who are poorly controlled while on oral hypoglycemic drugs. 36 moderately obese patients with Type 2 DM were evaluated and randomized to be given either the drug combination or a placebo in addition to their normal medications for 4 weeks. The measurements of blood lipids, glucose, insulin, and fructosamine were evaluated before and after 4 weeks and compared. A significant difference in TG level and LDL to HDL ratio was recorded. Biotin alone however did not seem to have a significant affect on glucose or insulin levels in patients.

Regarding brittle nails, evidence shows that biotin 2.5 mg daily taken for about 2 to 15 months increased the thickness and decreases splitting of fingernails and toenails by 25%

References:

https://www.ncbi.nlm.nih.gov/pubmed/17496732

https://www.ncbi.nlm.nih.gov/pubmed/8477615

Melatonin

Scientific Name: N-[2-(5-methoxy-1H-indol-3-yl)ethyl]

What is it used for?

Melatonin has been used for short-term management of insomnia inpatients 55 and older. Ot has also been studied in depressive disorders including seasonal affective disorder, and for its contraceptive activity, although at larger doses. Due to its effect on the circadian rhythm, melatonin has been used to treat jet lag.

How does it work?

Melatonin is a hormone naturally produced in the pineal gland from the amino acid tryptophan.

Melatonin increases the concentration of aminobutyric acid and serotonin in the midbrain and hypothalamus. This enhances the activity of pyridoxal-kinase, an enzyme used in the synthesis of aminobutyric acid, serotonin, and dopamine. It may also be used to protect from changes in skin coloration. Melatonin is secreted when you close your eyes and during hours of darkness, and may affect sleep patterns. Melatonin is given with doses ranging from 1 to 5mg, 1 to 2 hours before bedtime and after food, for insomnia. This dosage may be continued for up to 13 weeks.

What are some side effects?

· Headache,

· Nasopharyngitis

· Back pain

· Arthralgi

Are there any trials that support its use/non-use (efficacy)? Provide details.

There are numerous studies for use of melatonin in insomnia and jet lag. One meta-analysis searched through a number of biomedical databases for phase 1, 2 and 3 clinical studies to with melatonin as the primary intervention, and in a case of controlled trials compared to placebo. The results found that although melatonin was effective in helping patients fall asleep faster, the quality and efficiency of sleep was not increased. The results did show that melatonin is safe and is related to the cicardian rhytm.

Additional Considerations (Can include known drug interactions, special directions, etc.)

An increase in seizure activity was noted in children with severe neurological health problems while being treated with melatonin for sleep disorders. Seizure activity returned to baseline when the melatonin was stopped. The seizures returned when melatonin was rechallenged. CYP450 isoenzymes CYP1A1 and CYP1A2 are involved in the metabolism of melatonin. Melatonin may inhibit or induce these isoenzymes and should not be taken with fluvoxamine, methoxsalen, cimetidine, or oestrogens as these medications may increase melatonin concentrations. Tobacco smoking may decrease melatonin concentrations.

https://www.ncbi.nlm.nih.gov/books/NBK11941/

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)79321-1/fulltext

https://jamanetwork.com/journals/jama/article-abstract/408493

Valerian

Scientific Name: Centranthus ruber L., Valeriana officinalis L., Valeriana sambucifolia Mik., Valeriana wallichi DC.

Common Name: Valerian, Baldrian, Cat's love, Garden heliotrope, Kesso root, Radix valerianae, St. George's herb

What is it used for?

Valerian is a perennial plant native to Europe and Asia and naturalized in North America. It is commonly used to treat insomnia and anxiety. In history, it has been used in Unani, Ayurvedic, and traditional Chinese health systems to treat conditions such as hysteria and epilepsy.

How does it work?

The active compounds thought to be responsible for sedation in valerian are known as mono- and sesquiterpenes and iridoid triesters. While the exact mechanism of action is unclear, data suggests that the actions of valerian extracts can be linked to central activity on GABA, serotonin, and adenosine receptors.

What are some side effects?

• Headache

• Diarrhea

• Stomach upset

• Uneasiness

• Dizziness

Are there any trials that support its use/non-use (efficacy)? Provide details.

• There have been a few trials that have looked at the efficacy of valerian in treating anxiety. In one small study, patients received either valerian extract, placebo or diazepam for generalized anxiety disorder. The results showed that there was no significant difference between the different therapies when comparing HAM-A scores (a scale used to classify anxiety). Because this trial was small, and other trials are not very reliable a conclusion should not be made about the efficacy of valerian in treating anxiety. A randomized controlled trial (RCT) would need to be conducted before such conclusions can be made.

• A systematic review and meta-analysis involving 16 trials with a total of 1093 patients showed that in some trials, valerian had as significant benefit on sleep quality without causing side effects. In order to properly draw conclusions about efficacy, RCT should be done with standardized dosing and outcomes.

References

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394901/

• https://ods.od.nih.gov/factsheets/Valerian-HealthProfessional/

• https://www.ncbi.nlm.nih.gov/pubmed/17054208?dopt=Abstract

• https://www.ncbi.nlm.nih.gov/pubmed/16909441?dopt=Abstract