David Baxter PhD
Late Founder
Nature's cure: how safe is it?
Thu 6 Apr 2006
by JOAN McFADDEN, The Scotsman
AN AMERICAN study which suggests that one in four medications may not work properly if taken in conjunction with the homoeopathic treatments, St John's wort or echinacea, has caused alarm this week - and not simply because of the revelation that they cause the drugs to be moved out of the body too quickly.
The greater concern is that, despite years of research, the general public and some sections of the media still fail to recognise that self-medication can be very dangerous.
"The problem lies not in the herbs, but in the drug," says Non Owen, researcher in herbal medicine with the National Institute of Medical Herbalism. "This is not new information, but we're still having to urge people to be sensible and seek the right advice."
For centuries, herbs have been used to treat illnesses, injuries and chronic conditions throughout the world, and many common drugs are made from herbal extracts. The belief that there are healing powers in plants is a well-documented one as the natural chemical properties of certain herbs have been shown to contain medicinal value. The most common misconception about herbalism, and the use of natural products in general, is that natural equals safe, irrespective of which other drugs, drink or foods are consumed at the same time.
However, nature is not automatically benign and many plants, such as hemlock or nightshade, have chemical defence mechanisms against predators that can have adverse, even fatal, effects on humans. Herbs can also have undesirable side-effects in the same way as pharmaceutical products can, and these problems are exacerbated by lack of control over dosage and purity. In addition, if given in conjunction with clinical drugs, there is a danger that the herb and the drug could have similar actions, resulting in an overdose.
In recent years, the use of and search for drugs and dietary supplements derived from plants has accelerated greatly, with the current trends indicating a return to the concept of natural remedies.
St John's wort has developed a reputation of being nature's Prozac, a benevolent remedy for conditions such as depression and Seasonal Affective Disorder (SAD). Unfortunately, this image - of a substance far removed from chemical medication - gives the false impression that side-effects are non-existent. In reality, when taken with other prescribed medication, it can cause medicines to be metabolised too slowly or too quickly, which can lead to drug toxicity and loss of therapeutic function. Drugs known to be affected include oral contraceptives, blood-pressure pills and medicines designed to prevent the rejection of transplanted organs.
Christopher Gorski, of the Indiana University School of Medicine, says that more attention to metabolic considerations in the action of herbal medicines is needed.
His research found that both St John's wort and echinacea increased the activity of a specific enzyme found in the liver and intestine. He told a conference in San Francisco, organised by the American Society for Pharmacology and Experimental Therapeutics, that his team was also studying the impact of St John's wort on antihistamines and other pharmaceutical drugs. He said that patients and clinicians should be aware of possible reductions in the therapeutic efficacy of prescription and over-the-counter drugs when taken at the same time as St John's wort, echinacea and possibly other herbal preparations. According to Owen, all medical personnel and herbalists in Britain should already be aware of most of this research, as it replicates earlier findings.
"The first big wave of research on this took place about five years ago," says Owen. "I haven't yet read Dr Gorski's research, but would reiterate what he says about being aware of the results of mixing different preparations, which has been emphasised for [several] years. Some of the conventional drugs mentioned are affected by broccoli, grapefruit or cranberry, which serves to illustrate my earlier statement that this is a drug problem. The National Institute of Medical Herbalism liaised heavily with the Medicines and Healthcare products Regulatory Agency (MHRA) immediately after the results of the research five years ago and sent a warning to all GPs about the possible effects of mixing St John's wort with a variety of drugs."
The British National Formulary, a drugs book for doctors and consultants listing preparations and possible side-effects which is updated every six months, has had St John's wort clearly listed for a number of years.
But the US study does shed new light on some herbal remedies.
"The echinacea research is new to me, but if it proves to be the case, it too will be listed," says Owen. "However, I have to keep saying this: be sensible and seek the right advice, unless it's a very minor condition [for which] you feel competent self-medicating. Feeling a little down or jaded and taking St John's wort for a few weeks is completely different from trying to treat a major depression by yourself."
Owen stops short of suggesting that herbal products should be licensed or available on prescription only, although she is concerned that their free availability over the counter in pharmacies and supermarkets enhances their essentially harmless image.
Helen Speed, a herbalist working with Napiers Herbal Health Care in Glasgow, also feels that a change of perception would be useful.
"There's a vast difference between a trained herbalist and someone who has just read all the information on particular herb," Speed says. "Although St John's wort is extremely well known, many people don't realise that there are other herbs which can help depression, which their herbalist might well recommend.
"A herbalist is treating the individual in the same way that a doctor treats a patient, and we need to work towards people recognising this rather than making the assumption that there's a one-size-suits-all remedy."
Speed adds that, while she doesn't have GPs referring patients to her, some do recommend her.
"That's the way that conventional and alternative medicine should work together," she says.
Dr Jenny Bennison, a GP from Leith and Deputy Chair of the Royal College of General Practioners Scotland, is in complete agreement: "I wholeheartedly go along with the idea that we should be working together rather than in opposition to each other," she says. "Antidepressants are much less in favour now and I can understand a patient wanting to try something like St John's wort or hypnosis. While I don't refer direct to a herbalist, I would always encourage a patient to see a qualified herbalist rather than just popping into a chemist and picking something off the shelf without advice."
Bennison is also keen for patients to recognise that their family, friends or co-habitees and GP should be kept well informed. "It's particularly important if they're taking other drugs, such as warfarin, where the consequences of adding other preparations could be disastrous," she says. "We're not going to act as if they're naughty children, doing something they shouldn't. We quite understand why they're investigating other treatments, but our main priority is ensuring they do so safely."
What is St John's wort?
St John's wort, or hypericum, has been used for centuries to treat problems such as anxiety, tension, insomnia and depression. The medicinal herb, extracted from bright golden-yellow, star-shaped flowers, is often recommended for menopausal problems, stomach ulcers, chronic pain conditions and viral infections.
How can it help me?
Research shows that, in mild to moderate depression, St John's wort is as effective as modern synthetic antidepressant drugs, and it seems to have fewer side-effects. In some European countries, it's the most popular treatment for depression. <Admin note: More recent controlled studies in North America have disputed both the effectiveness and the absence of side-effects.>
St John's wort has also been shown to help Seasonal Affective Disorder, where depression is linked to lack of sunlight in autumn and winter. The usual treatment is sitting in front of a lightbox for several hours a day, but St John's wort may be as good a remedy. People involved in the research also said they felt less anxious and their sleep and sex drive improved after taking St John's wort.
What are the potential risks?
St John's wort can cause light sensitivity, and you should not take it if you are taking warfarin, cyclosporin, oral contraceptives, anticonvulsants, digoxin, theophylline or certain anti-HIV drugs, as it may reduce the effect of these medicines.
You should not take it at the same time as taking an SSRI antidepressant or triptan medicines, or if you are pregnant or breastfeeding.
This article: Latest Lifestyle News | The Scotsman
Thu 6 Apr 2006
by JOAN McFADDEN, The Scotsman
AN AMERICAN study which suggests that one in four medications may not work properly if taken in conjunction with the homoeopathic treatments, St John's wort or echinacea, has caused alarm this week - and not simply because of the revelation that they cause the drugs to be moved out of the body too quickly.
The greater concern is that, despite years of research, the general public and some sections of the media still fail to recognise that self-medication can be very dangerous.
"The problem lies not in the herbs, but in the drug," says Non Owen, researcher in herbal medicine with the National Institute of Medical Herbalism. "This is not new information, but we're still having to urge people to be sensible and seek the right advice."
For centuries, herbs have been used to treat illnesses, injuries and chronic conditions throughout the world, and many common drugs are made from herbal extracts. The belief that there are healing powers in plants is a well-documented one as the natural chemical properties of certain herbs have been shown to contain medicinal value. The most common misconception about herbalism, and the use of natural products in general, is that natural equals safe, irrespective of which other drugs, drink or foods are consumed at the same time.
However, nature is not automatically benign and many plants, such as hemlock or nightshade, have chemical defence mechanisms against predators that can have adverse, even fatal, effects on humans. Herbs can also have undesirable side-effects in the same way as pharmaceutical products can, and these problems are exacerbated by lack of control over dosage and purity. In addition, if given in conjunction with clinical drugs, there is a danger that the herb and the drug could have similar actions, resulting in an overdose.
In recent years, the use of and search for drugs and dietary supplements derived from plants has accelerated greatly, with the current trends indicating a return to the concept of natural remedies.
St John's wort has developed a reputation of being nature's Prozac, a benevolent remedy for conditions such as depression and Seasonal Affective Disorder (SAD). Unfortunately, this image - of a substance far removed from chemical medication - gives the false impression that side-effects are non-existent. In reality, when taken with other prescribed medication, it can cause medicines to be metabolised too slowly or too quickly, which can lead to drug toxicity and loss of therapeutic function. Drugs known to be affected include oral contraceptives, blood-pressure pills and medicines designed to prevent the rejection of transplanted organs.
Christopher Gorski, of the Indiana University School of Medicine, says that more attention to metabolic considerations in the action of herbal medicines is needed.
His research found that both St John's wort and echinacea increased the activity of a specific enzyme found in the liver and intestine. He told a conference in San Francisco, organised by the American Society for Pharmacology and Experimental Therapeutics, that his team was also studying the impact of St John's wort on antihistamines and other pharmaceutical drugs. He said that patients and clinicians should be aware of possible reductions in the therapeutic efficacy of prescription and over-the-counter drugs when taken at the same time as St John's wort, echinacea and possibly other herbal preparations. According to Owen, all medical personnel and herbalists in Britain should already be aware of most of this research, as it replicates earlier findings.
"The first big wave of research on this took place about five years ago," says Owen. "I haven't yet read Dr Gorski's research, but would reiterate what he says about being aware of the results of mixing different preparations, which has been emphasised for [several] years. Some of the conventional drugs mentioned are affected by broccoli, grapefruit or cranberry, which serves to illustrate my earlier statement that this is a drug problem. The National Institute of Medical Herbalism liaised heavily with the Medicines and Healthcare products Regulatory Agency (MHRA) immediately after the results of the research five years ago and sent a warning to all GPs about the possible effects of mixing St John's wort with a variety of drugs."
The British National Formulary, a drugs book for doctors and consultants listing preparations and possible side-effects which is updated every six months, has had St John's wort clearly listed for a number of years.
But the US study does shed new light on some herbal remedies.
"The echinacea research is new to me, but if it proves to be the case, it too will be listed," says Owen. "However, I have to keep saying this: be sensible and seek the right advice, unless it's a very minor condition [for which] you feel competent self-medicating. Feeling a little down or jaded and taking St John's wort for a few weeks is completely different from trying to treat a major depression by yourself."
Owen stops short of suggesting that herbal products should be licensed or available on prescription only, although she is concerned that their free availability over the counter in pharmacies and supermarkets enhances their essentially harmless image.
Helen Speed, a herbalist working with Napiers Herbal Health Care in Glasgow, also feels that a change of perception would be useful.
"There's a vast difference between a trained herbalist and someone who has just read all the information on particular herb," Speed says. "Although St John's wort is extremely well known, many people don't realise that there are other herbs which can help depression, which their herbalist might well recommend.
"A herbalist is treating the individual in the same way that a doctor treats a patient, and we need to work towards people recognising this rather than making the assumption that there's a one-size-suits-all remedy."
Speed adds that, while she doesn't have GPs referring patients to her, some do recommend her.
"That's the way that conventional and alternative medicine should work together," she says.
Dr Jenny Bennison, a GP from Leith and Deputy Chair of the Royal College of General Practioners Scotland, is in complete agreement: "I wholeheartedly go along with the idea that we should be working together rather than in opposition to each other," she says. "Antidepressants are much less in favour now and I can understand a patient wanting to try something like St John's wort or hypnosis. While I don't refer direct to a herbalist, I would always encourage a patient to see a qualified herbalist rather than just popping into a chemist and picking something off the shelf without advice."
Bennison is also keen for patients to recognise that their family, friends or co-habitees and GP should be kept well informed. "It's particularly important if they're taking other drugs, such as warfarin, where the consequences of adding other preparations could be disastrous," she says. "We're not going to act as if they're naughty children, doing something they shouldn't. We quite understand why they're investigating other treatments, but our main priority is ensuring they do so safely."
What is St John's wort?
St John's wort, or hypericum, has been used for centuries to treat problems such as anxiety, tension, insomnia and depression. The medicinal herb, extracted from bright golden-yellow, star-shaped flowers, is often recommended for menopausal problems, stomach ulcers, chronic pain conditions and viral infections.
How can it help me?
Research shows that, in mild to moderate depression, St John's wort is as effective as modern synthetic antidepressant drugs, and it seems to have fewer side-effects. In some European countries, it's the most popular treatment for depression. <Admin note: More recent controlled studies in North America have disputed both the effectiveness and the absence of side-effects.>
St John's wort has also been shown to help Seasonal Affective Disorder, where depression is linked to lack of sunlight in autumn and winter. The usual treatment is sitting in front of a lightbox for several hours a day, but St John's wort may be as good a remedy. People involved in the research also said they felt less anxious and their sleep and sex drive improved after taking St John's wort.
What are the potential risks?
St John's wort can cause light sensitivity, and you should not take it if you are taking warfarin, cyclosporin, oral contraceptives, anticonvulsants, digoxin, theophylline or certain anti-HIV drugs, as it may reduce the effect of these medicines.
You should not take it at the same time as taking an SSRI antidepressant or triptan medicines, or if you are pregnant or breastfeeding.
This article: Latest Lifestyle News | The Scotsman
