Picking Herbal Remedies

Herbal medicine is big business. Last year, Americans spent about $4 billion on a variety of natural remedies with names like St. John's wort and gingko biloba. Today, the Food and Drug Administration is giving a nod of approval for the use of a dietary supplement (though not an herb) to treat chronic fatigue syndrome. CBS This Morning Health Correspondent Dr. Emily Senay sorts through the claims and the facts on some of the most popular remedies on the store shelves, and offers some general guidance on buying herbs.

GINGKO BILOBA

• Health Claims:
  This is the top selling herb. It's an antioxidant sometimes referred to as a "smart pill" or "memory pill" because there has been evidence that it helps older adults retain their short-term memory. It appears to increase blood circulation and oxygenation in the brain, which helps slow memory loss and the symptoms of Alzheimer's disease.
• Evidence:
  Studies have shown that it's effective in aiding memory in adults who are around 50 years old or older. There hasn't been any evidence that it's effective in younger adults, say someone who is 35 and just has a bad memory. A large study reported in the Journal of the American Medical Association in 1997 confirmed its effectiveness in slowing down the development of cognitive deficiencies and in improving concentration in Alzheimer's patients.
• Side effects:
  Not many. A mild upset stomach and minor headaches were observed in fewer than one percent of the people who were in clinical studies. You can reduce the chances of that if you take it with food.
• Precautions:
  It thins the blood. So, heart patients on blood thinners like Coumadin (the generic name is warfarin) should not take gingko biloba. It should also not be taken with aspirin. No studies have been done on the effects of the leaf extracts in pregnant and lactating women, so they should avoid it. Touching or eating the small oval fruits of the female tree has caused severe allergic skin reactions (edema, erythema, blisters, itching).
• Price range:
  From $6 for a gingko extract in liquid form, and from $15 to $35 for tablets or capsules. The price depends on the quality, size and form of the product.

ECHINACEA

• Health claims:
  Studies have indicated that it shortens the intensity and length of colds and flu when it is used at the first sign of symptoms. It appears to work by stimulating the immune system.
• Evidence:
  Several European studies, particularly in Germany where there have been many studies on herbs, have confirmed its usefulness.
• Side effects:
  Mild stomach upset has been reprted. Long term use is not recommended for people with auto-immune disorders such as lupus or rheumatoid arthritis.
• Precautions:
  It should not be used by people with progressive disorders like multiple sclerosis, AIDS, HIV infection and tuberculosis. Because it's in the daisy family, people who have hay fever may be allergic to it.
• Price range:
  You can buy a box of tea bags for around $5 or tablets and capsules in the $10 to $30 range, depending on the size and the quality.

ST. JOHN'S WORT

• Health claims:
  St. John's wort is used to relieve mild to moderate depression.
• Evidence:
  Several studies in Europe have indicated the effectiveness of St. John's wort in treating depression. However, in the United States, the scientific and medical communities feel that more clinical trials are needed to determine long-term safety and theraputic guidelines. A three-year study by the National Institutes of Health is now underway.
• Side effects:
  High doses can cause extreme sensitivity to the sun.
• Precautions:
  Because it's an anti-depressant, St. John's wort should generally not be taken with other anti-depressants, like Prozac. Pregnant and lactating women should not use it. It can enhance the sleeping time of narcotics and antagonizes the effects of reserpine.
• Price range:
  You can pay about $2.50 for tea bags or spend in the $20 to $30 range for tablets and capsules.

GINSENG

• Health claims:
  It reduces stress. It increases stamina, and some believe that it may increase sex drive.
• Evidence:
  There is no proof that ginseng increases sexual activity. That could be a result of stress reduction, for which ginseng has been documented to be helpful.
• Side Effects:
  Ginseng acts as a stimulant so it could inhibit sleep. When taken in high doses, it could cause breast tenderness in women.
• Precautions:
  People with hypertension should not take it.

These remedies come in different forms. Which is the most effective?

It doesn't make a lot of difference in most cases. In general a dry dosage will keep longer than a liquid because chemicals tend to decompose more rapidly in solutions. Some people think the liquid extract acts more quickly, but there is very little evidence of this.

How do I know how much to take?

In general, follow the instructions on the label for the proper dose or "serving," as some herbal brands term it.

How do I choose among the many different brands?

Herbal supplements are not regulated by the government. The FDA has control only over the labeling. That means maufacturers aren't allowed to make health claims about effectiveness.

You should check the label to see if it says the product is a "standardized herbal extract." The standard is the quality and amount of active ingredients that researchers found effective in clinical trials. Many companies voluntarily do this. But consumers really have no way of knowing if the product meets the standard or not.

It's important to educate yourself about what research has been done. Buy a product made by a quality manufacturer and check the expiration date.

But keep in mind that just because a company is large doesn't mean that its products are the best. There are good small manufacturers, too.

Ask your doctor, pharmacist and local health food store owner for advice.

There is some good news just out about a nutritional dietary supplement that is not an herb. What is it?

It's a nutritional supplement for energy enhancement called ENADA, and it's been available in stores for several years.

On Tuesday, researchers from Georgetown University Medical Center announced that ENADA has been found to help patients with chronic fatigue syndrome in an FDA-approved trial.

Patients with chronic fatigue syndrome suffer from a severe lack of energy. About half a million Americans have CFS, and 14 million others are estimated to have its symptoms.

This is one of the first dietary supplements to voluntarily undergo rigourous FDA-approved testing.

ENADA, manufactured by Menuco Corporation, is the brand name for stabilized, absorbable NADH. A natural coenzyme in our diet, NADH helps the body produce energy. It is found in fish, poultry, cattle and yeast products but our bodies absorb only a small amount of the coenzyme.

ENADA is the first and only NADH supplement that is effectively absorbed by the body.

Find out more about ENADA from the Menuco Corp.

See also: Drug-Herb Interactions of Commonly Used Drugs from the Journal of the American Medical Association.

A Review of 12 Commonly Used Medicinal Herbs from the Journal of the American Medical Association.

International bibliographic information on dietary supplements, including herbal products from the National Institutes of Health.

By Dr. Emily Senay
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