Version 4.2 August 2007
Dietary supplements are very popular in the U.S., with herbal blends being the top-selling supplements in 2004. Being healthy includes making wise choices. This means knowing what goes into your body. If you take an herb or herbal blend, do you know what you are taking? The following offers information on some popular herbal supplements.
This information is not intended as medical advice or endorsement of the use of dietary supplements. Always talk to your medical provider before taking any herbs or supplements. All herbs, drugs, and other substances can cause allergies. Allergic reactions have been reported for nearly every herb, sometimes with life-threatening consequences. If you suspect you are having an allergic reaction, stop the substance and seek immediate medical advice. If you have trouble breathing or feel faint, call 911.
Alfalfa (Medicago sativa )
This botanical has been used medicinally for many centuries. Purported to reduce diabetes, cholesterol and risk of atherosclerosis, although no research supports this. May lower cholesterol levels.
Attention for Liver Disease: May bind with iron, so iron overload and HCV patients should use cautiously.
Safety Information: Only use a product that is from a reputable source. There have been reports, including two deaths, from alfalfa contaminated with bacteria, arsenic and other unsafe substances. Is generally safe for up to 8 weeks. No safety data past 8 weeks. Mild gastrointestinal side effects are the most common complaints. Rashes, itching, skin redness and more sensitivity to sun have been reported. Use cautiously with history of diabetes and hypoglycemia. May increase thyroid levels and lower potassium levels. Use cautiously if taking blood thinners, such as warfarin. May exacerbate gout. Lupus-like symptoms have been reported by people taking alfalfa. Should be avoided by people with personal or family history of lupus. Alfalfa has estrogen-like properties, which may raise safety issues, particularly for those with hormone-sensitive cancers. Although traditionally, alfalfa has been used to increase lactation, no data supports this. Safety has not been established for children, pregnant or nursing mothers.
Interactions: May interact with the following: blood-thinners, cholesterol-lowering agents, potassium, diabetes and thyroid medications. Alcoholics and those taking metronidazole (Flagyl) or disulfiram (Antabuse) should avoid alcohol-based tinctures and extracts.
Lab Notes: May increase thyroid levels and lower potassium levels. May interfere with coagulation results. May cause abnormal blood cell counts and increase urea levels.
Dosage: Alfalfa has not been standardized and dosages are not established.
Back to top
Aloe (Aloe vera)
Topically, the gel-like juice from aloe vera leaves has been used for thousands of years. Aloe is purported to improve a number of skin disorders, including eczema, psoriasis, and genital herpes. Although most often used for burns and wound healing, research has not supported this application. In fact, aloe may delay healing in surgical and other wounds. Aloe has been approved by Germany ’s Commission E for use as a laxative, while the U.S. Food and Drug Administration warns that aloe as a laxative is not safe.
Attention for Liver Disease: Internal use of aloe may cause hepatitis (inflammation of the liver) and increase liver enzymes.
Safety Information: Most likely safe if used topically. Minor redness and rash have been reported with topical use. When used orally as a laxative, may cause abdominal cramping and should be used very cautiously. Do not use if history of intestinal obstruction or intestinal diseases, e.g., Crohn's, colitis, appendicitis, abdominal pain. Internal use of aloe may interfere with nutrient absorption. Use cautiously with patients who have diabetic, cardiac, renal, or gastrointestinal conditions. Use cautiously with history of diabetes and hypoglycemia. Use cautiously if history of heart disease, since oral use of aloe may cause electrolyte imbalance. Not recommended for prolonged use or for injection. Deaths have occurred after aloe was injected in humans. Topical use of aloe is probably safe for children, pregnant and nursing women, but oral use is not recommended.
Interactions: Do not use with AZT. Internal use may interfere with loop diuretics, such as furosemide (Lasix). Do not use with other laxatives, cardiac medications, oral corticosteroids, or hypoglycemic drugs. Avoid topical use of aloe if using topical steroid medications.
Lab Notes: May alter potassium, liver enzymes and blood glucose lab tests.
Dosage: Standardized aloe products are not widely available. Typical dosage recommendations to treat constipation are 0.04-0.17g of dried juice (10-30mg hydroxyanthraquinones).
Back to top
Alpha-Lipoic Acid (ALA)
Small studies suggest that ALA may improve blood glucose levels in patients with type 2 diabetes. ALA may be useful for treatment of diabetic or cancer chemotherapy-induced neuropathy. May provide relieve for Burning Mouth Syndrome. Research is being conducted using ALA for other purposes. Claims regarding benefit for HCV, HIV, liver disease and depression are unproven.
Attention for Liver Disease: May interact with drugs metabolized by liver.
Safety Information: Very few side effects have been reported. They are: allergic reaction, nausea, and vomiting. Diabetics need to watch blood sugar levels. Some experts discourage use of ALA in patients with hypothyroidism and thiamine deficiency. Insufficient safety data to make recommendations for children, pregnant or nursing mothers.
Interactions: May provide cardiac benefit when used with doxorubicin and adriamycin, but may alter therapeutic levels. May interact with drugs metabolized by liver.
Lab Notes: May lower blood glucose and thyroid levels.
Dosage: For general use and an antioxidant, 20 to 50 mg daily is commonly recommended. For diabetes and neuropathy, Natural Standard and Harvard Medical School suggest 800 to 1800 mg per day in divided oral doses.
Back to top
Artichoke (Cynara scolymus)
This herb is approved by Germany’s Commission E for indigestion. Artichoke is a frequent ingredient in “liver support” formulations. There is no evidence to support or refute artichoke’s hepatoprotective potential. Is being researched for possible bile secretion stimulation and lipid-lowering capacity, but no well-proven uses for artichoke.
Attention for Liver Disease: Avoid with bile duct obstruction. Use cautiously in liver patients with clotting problems as artichoke may increase risk of bleeding.
Safety Information: Likely safe for short term use. Use cautiously with history of allergy or asthma. Avoid with bile duct obstruction and kidney disease. Do not use with gallstones unless under strict medical supervision. May increase risk of bleeding. The following have been reported: itching, rash, asthma, shortness of breath, cough, runny nose, flatulence, diarrhea, hunger, nausea, kidney failure. No safety data available regarding children, pregnant or nursing mothers.
Interactions: Use cautiously if taking medications that affect blood clotting.
Lab Notes: May alter blood-clotting results.
Dosage: Not standardized. The German Commission E has recommended 6 grams of dried herb given as a single daily or divided into 3 oral daily doses.
Back to top
Astragalus (Astragalus membranaceus)
This herb is commonly used in Chinese Medicine, often in combination with other herbs. Approved by the FDA as “generally recognized as safe (GRAS) when used as a food additive. Astragalus is used for many health conditions and is purported to have immune stimulating and antiviral properties. In Chinese medicine, used strictly for chronic or recurrent infections, not for acute ones. Research has not proved or disproved any claims relating to astragalus; efficacy and safety remain unknown.
Attention for Liver Disease: May increase bleeding risk. Avoid if taking colchicine, diuretics or immune suppressants, such as steroids and anti-rejection drugs for liver transplantation. Do not take during interferon treatment unless advised otherwise. Those with autoimmune hepatitis, primary biliary cirrhosis or other autoimmune diseases should avoid.
Safety Information: Safety is not established. Other varieties of astragalus are known to be toxic to livestock, so only use Astragalus membranaceus. According to Traditional Chinese Medicine, avoid during acute infections. Those with autoimmune conditions should avoid unless advised otherwise. Until safety is well established, avoid if taking beta-blockers and immune suppressants, such as steroids and anti-rejection drugs. Use cautiously in patients with bleeding or blood clotting disorders, and/or decreased clotting ability, such as those taking NSAIDs or anticoagulants. Use cautiously if diabetic or if taking growth hormones. May act as a diuretic. May interact with colchicine, procarbazine, sedatives, stimulants, and dopamine antagonists, such as Haldol. May interact with a long list of other supplements. Safety for children is not established, probably should avoid since astragalus may increase growth hormone. Pregnant and breastfeeding women should avoid.
Interactions: Tragacanth, a derivative found in astragalus, may interfere with absorption of other substances. Therefore, do not take astragalus with any other medications or supplements.
Lab Notes: May lower blood pressure and blood glucose levels. May increase growth hormone levels and coagulation times.
Dosage: Not established. Andrew Weil, M.D. recommends choosing astragalus that is standardized to 15% polysaccharides. Recommendations range from 500 to 1000 mg of root capsules by mouth two to four times daily to 250 to 500 mg of extract taken two to four times daily. Extract and tincture dosages vary according to strengths.
Back to top
Black Cohosh (Cimicifuga racemosa)
This herb has been approved by Germany’s Commission E for premenstrual complaints, painful periods, and management of menopause symptoms. Blue cohosh is not the same as black cohosh – do not substitute one for the other.
Attention for Liver Disease: There have been at least 5 reports of severe hepatitis linked to black cohosh use. Two of these cases resulted in liver failure requiring transplant surgery. These cases involved the use of herbal blends mixed with other ingredients besides cohosh. Experts do not know if the problem was due solely to black cohosh or the combination of ingredients.
Safety Information: Gastric discomfort is the most common side effect. Safety is unknown for women with endometriosis, breast or uterine cancer. Those with history of stroke or thromboembolism should avoid black cohosh. Cardiovascular and neurological (seizures) adverse events were reported by a very small number of patients taking black cohosh, although the link between the two is not solidly established. Black cohosh should not be taken by women who are pregnant or breastfeeding. No safety information is available for children.
Interactions: Black cohosh may interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450 below). Anyone with hormone-sensitive malignancies or those taking drugs, such as tamoxifen or HRT may want to avoid or use cautiously. May interact with hormones, NSAIDs, anti-androgenic, and anticoagulant drugs.
Lab Notes: May lower blood pressure.
Dosage: No established universal dose recommendations. The British Herbal Compendium recommends 40-200 mg of dried rhizome daily in divided doses. Take black cohosh with a full glass of water.
Back to top
Capsicum (Cayenne, hot pepper) (Capsicum frutescens and C. annuum)
Capsaicin, the active ingredient in this common pepper, is believed to have anti-inflammatory properties. It is purported to relieve ulcer pain. Germany’s Commission E has approved capsicum for pain control in a variety of conditions, such as shingles, arthritis, and nerve pain.
Attention for Liver Disease: May lower liver enzymes.
Safety Information: May cause intense burning if the eyes are exposed to capsicum. Other side effects include the usual reactions to hot peppers – mouth and nose burning, sweating, gastrointestinal complaints, etc. May cause a rash. The safety for children, pregnant and nursing mothers is not established.
Interactions: May interact with acetaminophen, ACE inhibitors, MAO inhibitors, theophylline, and anti-hypertensive medications.
Lab Notes: May alter liver function tests.
Dosage: Capsicum is used internally and topically. Universal dosages have not been established. When used topically, the Commission E guidelines recommend applying capsicum for 2 days and then waiting 14 days before another application, since more frequent use may cause nerve damage.
Back to top
Chamomile (Matricaria recutita, Chamaemelum nobile)
Germany’s Commission E approved the internal use of chamomile for “gastrointestinal spasms and inflammatory diseases of the gastrointestinal tract” and external use for “skin and mucous membrane inflammations including those of the oral cavity and gums.” It is also approved for various respiratory problems and anal-genital inflammation. The Commission E did not approve it as a sedative or sleep aid as evidence to support these indications was weak.
Attention for Liver Disease: Chamomile may reduce clotting ability.
Safety Information: Rashes and allergic reactions are the most common side effects of chamomile. May increase bleeding risk. The safety for children, pregnant and nursing mothers is not established.
Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450). Use cautiously if taken with other sedating drugs.
Lab Notes: May interfere with coagulation labs, such as PT and INR.
Dosage: No established universal dose recommendations. Chamomile comes in many forms. Ingested or applied as a tea are the most popular forms of administration.
Back to top
Chondroitin Sulfate
This supplement has been heavily researched and consistently showed improvement for osteoarthritis. It is often combined with glucosamine but can be taken alone. It can be derived from algae, cow trachea, shark, pig, chicken or beef cartilage. There is also a synthetic form. Although unlikely to be an issue, those concerned about “Mad Cow” disease should avoid chondroitin made from bovine sources.
Attention for Liver Disease: May reduce clotting ability.
Safety Information: Appears to be well tolerated. Stomach upset is the most common complaint. Men with risk of prostate cancer should avoid. May increase bleeding risk. The safety for children is not established. Pregnant and breastfeeding women should avoid.
Interactions: None reported.
Lab Notes: May interfere with coagulation labs, such as PT and INR.
Dosage: No established universal dose recommendations. One common dose recommendation is 400mg 3 times daily. Typical doses used in studies ranged from 200-400mg 2 to 3 times daily and 800-1200mg once daily. Be patient. Chondroitin may take over 3 months before there are noticeable benefits.
Back to top
Cranberry (Vaccinium macrocarpon)
Research supports the efficacy of cranberry juice for prevention of urinary infections. Purportedly, cranberry juice has been used for a variety of kidney and urinary problems, particularly for urinary tract infections. However, the evidence is weak regarding these applications.
Attention for Liver Disease: None reported.
Safety Information: Most likely safe for everyone 2 years and older. Diarrhea and gastric distress are the most common complaints. High acid content may be a problem for those prone to acid reflux. Diabetic patients need to use sugar-free juice. Patients with oxalate kidney stones should not exceed 1 L/day. The safety for infants, pregnant and nursing mothers is not established.
Interactions: None reported.
Lab Notes: None reported.
Dosage: 2 glasses (8 oz.) of cranberry juice cocktail (at least 25% cranberry juice), one glass in the morning and one in the evening. May use white cranberry juice cocktail. To avoid unnecessary sugar, use artificially sweetened juice. Sucrolose seems to be the safest artificial sweetener currently on the market.
Back to top
Coenzyme Q10 (CoQ10)
CoQ10 is produced naturally in the body, but levels may decrease with age and chronic disease. Many purported uses but insufficient data to support efficacy. Preliminary data suggest possible benefit for angina and other cardiac conditions, high blood pressure, Alzheimer’s, migraine headache prevention, breast cancer and HIV. Insufficient information is available to establish the efficacy of CoQ10 for relief of fatigue.
Attention for Liver Disease: Rare reports of increased liver enzymes. May lower platelets.
Safety Information: Side effects include fatigue, nausea, vomiting and GI distress, itching, rash, insomnia, loss of appetite, headache, dizziness, irritability, light sensitivity, and flu-like symptoms. A small study reported organ damage in heart patients using CoQ10 during intense exercise. Vigorous exercise is discouraged with simultaneous use of CoQ10. Use cautiously if there is a history of diabetes, low blood pressure, thyroid disease or use of anticoagulants (warfarin, aspirin, ibuprofen, etc.) No safety data available regarding children, pregnant or nursing mothers.
Interactions: CoQ10 is known to interact with a long list of other drugs and supplements, including anticoagulants, blood pressure-lowering, diuretics, cholesterol-lowering drugs, beta-blockers, antipsychotics, tricylclic antidepressants, clonidine, methyldopa, thyroid medications, ginkgo and vitamin E.
Lab Notes: Rare reports of increased liver enzymes. May lower platelet and blood glucose levels. May alter blood clotting and thyroid results.
Dosage: CoQ10 is sold in varying amounts and qualities. Typical recommended doses range from 30 to 300 mg daily, often divided into 2 or 3 doses. CoQ10 is fat-soluble and may be better absorbed when taken in an oil-based soft gel cap rather than in tablet or capsule form.
Back to top
Cordyceps (Cordyceps sinensis)
Very little is known about this fungus. In China, cordyceps traditionally is harvested from caterpillar larvae. Has been used for a variety of medical conditions, including fatigue, hepatitis, and bronchitis as well as to enhance athletic and sexual performance. There is virtually no research about cordyceps, so safety and efficacy are unknown.
Attention for Liver Disease: None known. If cordyceps is an immune stimulant, then theoretically, should be avoided by those with autoimmune hepatitis, primary biliary cirrhosis or other autoimmune diseases; those taking immune suppressants, such as steroids and anti-rejection drugs for liver transplantation; and those taking interferon.
Safety Information: To date there have been no reported adverse reactions. Diabetics should use cautiously as cordyceps may lower blood glucose.
Interactions: Use cautiously if taking medications to lower blood glucose levels.
Lab Notes: May lower blood glucose levels.
Dosage: Dosages are not established. On his website, Andrew Weil, M.D. recommends, “purchasing liquid or powdered extract not grown on caterpillars. For general weakness adults can take 1-2 capsules per day (or follow dosage advice on product)”. Cordyceps has not been tested on children, pregnant or nursing mothers. Andrew Weil advises against pediatric use.
Back to top
Dandelion (Taraxacum officinale)
This common plant is used in Europe for hepato-biliary disorders, as an appetite stimulant, a diuretic and for dyspepsia. The evidence supporting its efficacy has not been proven.
Attention for Liver Disease: Avoid if you have bile duct obstruction. Dandelion may decrease clotting ability.
Safety Information: Dandelion should be avoided by those with bile duct obstruction or gallbladder conditions. Most common side effects include itching, rash, acid reflux and sun sensitivity. May lower blood glucose levels, reduce clotting ability, and act as a potassium-sparing diuretic. The safety for children, pregnant and nursing mothers is not established, but likely safe when used as food.
Interactions: Avoid dandelion if taking ciprofloxin (Cipro).
Lab Notes: May interfere with electrolyte, blood glucose and coagulation labs.
Dosage: No established universal dose recommendations. One source suggested 3 to 4 grams of powdered dandelion root taken 3 times daily.
Back to top
DHEA (Dehydroepiandrosterone)
DHEA is a hormone, secreted by the adrenal glands and is normally found in humans. DHEA levels decrease as we age. DHEA is purported to have multiple uses, such as for management of lupus, osteoporosis, sexual dysfunction and adrenal insufficiency. There is not enough information to judge its efficacy. As a supplement, DHEA is made synthetically. Wild yam does not contain or convert to DHEA. DHEA use is banned by the Olympic committee and other athletic organizations.
Attention for Liver Disease: May cause liver damage and should be avoided if there is a history of liver disease.
Safety Information: DHEA has some serious risks and should be taken under the direction of a license health practitioner. May increase risk of blood clots and cause irregular heart rhythms. Since DHEA is a hormone, people with prostate, breast and other hormone-sensitive cancers should avoid it. Due to increased sex hormones, women taking DHEA may experience side effects such as voice deepening and excess facial hair. Men may have breast enlargement and other female sex hormone traits. High doses have been associated with Cushing’s Syndrome, which is a hormonal disorder. DHEA may interact with hormones and alter the production of insulin, cholesterol, thyroid, etc. Use cautiously in women with endometriosis uterine fibroids polycystic ovary syndrome, etc. Common side effects are fatigue, headache, acne and nasal congestion. Mania has been reported. Long-term effects of DHEA are unknown. Pregnant and nursing women should avoid DHEA. Not enough evidence to recommend safe use for children.
Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450). Women taking tamoxifen, birth control pills and other hormones may want to avoid. Anyone taking medication to regulate blood glucose levels or cholesterol may want to avoid.
Lab Notes: May alter blood-clotting times. May lower blood pressure, cholesterol and blood glucose levels.
Dosage: Common doses range from 50-200 mg daily.
Dong Quai (Angelica sinensis)
This herb is used commonly for medicinal purposes in Chinese medicine, usually blended with other herbs. In the U.S. and Europe, Dong Quai is used as a flavoring agent in food. Dong Quai has many purported uses, none of which have been researched conclusively. It is frequently used to treat symptoms related to PMS and menopause, but the evidence for its efficacy is weak. Sometimes used to offset fatigue, but again, the evidence for this is weak.
Attention for Liver Disease: May decrease clotting ability.
Safety Information: As a food additive, is considered to be safe. Safety has not been proven for higher doses when used medicinally, but Chinese safety studies do not report evidence of toxicity. May cause gastrointestinal symptoms and raise blood sugar levels. Also reported are headache, lightheadedness / dizziness, sedation/drowsiness, insomnia, irritability, fever, sweating, weakness, abnormal heart rhythms, blood pressure abnormalities, wheezing/asthma, hot flashes, worsening premenstrual symptoms, reduced menstrual flow, increased male breast size, kidney problems, and skin rash. An oil found in Dong Quai may be carcinogenic. Use cautiously in patients with bleeding or blood clotting disorders, and/or decreased clotting ability, such as those taking NSAIDs or anticoagulants. May cause photosensitivity (sun sensitivity). The safety for children is not established. Pregnant and breastfeeding women should avoid.
Interactions: Use very cautiously if taking anticoagulants, such as Coumadin. May interact with cardiac and blood pressure medications. There are disputes over whether Dong Quai shares some of the same properties of estrogen or how it interacts with estrogen, other hormones, or estrogen-sensitive medications and conditions. May also interact with other herbs and dietary substances. In particular, use cautiously with substances with similar anticoagulant properties, such as Ginkgo Biloba, and those with other estrogen-like properties, such as Black Cohosh.
Lab Notes: May raise blood sugar levels and alter coagulation labs, such as PT and INR.
Dosage: Standard dosing has not been established. Dong Quai is most often blended in combination with other herbs. The roots are used much more often than the leaves. A typical adult dosage is 3 to 8 milliliters of a fluid extract(1:2) or 10 to 40 drops (1:5 in 50-70% alcohol) of dong quai tincture 1 to 3 times daily by mouth. As a powdered or dried root, common adult dosages range from 1 to 2 grams taken 3 times daily by mouth.
Back to top
Echinacea (Echinacea purpurea and other varieties)
This popular herb comes in many forms. E. Purpurea is believed to be the most potent. Germany’s Commission E has approved echinacea orally as supportive therapy for colds, upper respiratory infections, urinary tract infections, and topically for poor wound healing. Echinacea leaves and roots are purported to have mild antiviral and antibacterial properties. Research has not proven any other effective uses for this herb.
Attention for Liver Disease: Increased risk of liver toxicity when used with other potentially hepatotoxic substances/drugs.
Safety Information: Probably safe when used as recommended. Avoid if diabetic. Theoretically can interfere with immune function. Patients with HIV, cancer, TB, low white blood count or autoimmune diseases (MS, Lupus, etc.) should avoid or use cautiously.
Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450 below). Avoid if taking immune suppression drugs, interferon, or Kava. The safety for children, pregnant and nursing mothers is not established.
Lab Notes: May lower white blood cell count.
Dosage: Germany’s Commission E set the dose at 6 – 9 ml juice or equivalent. Do not use for more than 8 consecutive weeks.
Back to top
Evening Primrose Oil (EPO) (Oenothera biennis)
EPO is a source of essential fatty acids (GLA). Research is not conclusive regarding its use for diabetic neuropathy, atopic dermatitis and eczema. Research is weak regarding the many other purported uses for EPO.
Attention for Liver Disease: May decrease clotting ability.
Safety Information: Headaches, nausea, and gastric upset were reported. Contraindicated for those with schizophrenia. Seizures have been reported by people taking EPO in conjunction with certain medications or anesthesia. EPO may interfere with clotting ability. Pregnant and nursing women should avoid EPO. Not enough evidence to recommend safe use for children except for medically supervised treatment of eczema and dermatitis.
Interactions: Reports of interactions with phenothiazines and anesthesia. Has the potential to interact with anticonvulsant and antihypertension medications.
Lab Notes: May alter coagulation results.
Dosage: Universal dosages are not established. An adult eczema study used 4 to 8 grams daily, taken orally in divided doses. No long-term safety data is available.
Back to top
Fennel (Foeniculum vulgare)
Fennel is used in cooking and is generally safe. As a supplement, fennel is commonly used for upset stomachs. Research supports the use of fennel for colicky babies. Fennel seed and oil are the part of the plant used for medicinal purposes. Fennel has been approved by Germany ’s Commission E for a variety of gastrointestinal disorders, including flatulence.
Attention for Liver Disease: May alter liver laboratory results.
Safety Information: Fennel is generally safe. Allergic reactions are common. Pregnant women should not supplement with fennel. Seizures have been associated with fennel oil use. Avoid if history of seizures. Diabetics should use cautiously fennel that is prepared in syrup or honey. Probably safe for children if taken in small doses. Safety for pregnant women is unknown.
Interactions: Avoid if taking Ciprofloxacin.
Lab Notes: May alter liver function tests and blood-clotting times. May lower blood pressure, cholesterol and blood glucose levels.
Dosage: Universal dosages are not well established. Germany ’s Commission E suggests 0.1 - 0.6 ml, equivalent to 0.1 - 0.6 g of herb. Do not use fennel supplementation for more than a few weeks. For flatulence, Andrew Weil, M.D. recommends chewing one-half to one teaspoon of fennel seeds.
Back to top
Feverfew (Tanacetum parthenium)
The leaf of this plant is purported to have a number of uses. Research supports the use of feverfew for prevention of migraine headaches. May have pain-relieving properties, but evidence for this is not strong.
Attention for Liver Disease: May decrease clotting ability.
Safety Information: Most side effects were mild. Inflammation of the lips, mouth, gum, and throat were the most common. Gastrointestinal distress and sun sensitivity were reported. There were withdrawal symptoms for those who stopped feverfew after long-term use. These were headache, anxiety, insomnia, and muscle and joint discomfort. Those with platelet or clotting problems should use cautiously. Safety of feverfew for children, pregnant and nursing mothers is not established.
Interactions: May interact with aspirin, NSAIDs, coumadin, and other anticoagulant drugs.
Lab Notes: May interfere with coagulation labs, such as PT and INR.
Dosage: The standardization of feverfew has been called into question. Capsules of powdered leaves were the form used in migraine headache studies. Dose ranges were between 50 and 110 mg daily.
Back to top
Fish Oil
The primary groups of essential fatty acids are omega-3s and omega-6s. Fish oils are high in omega-3s. Fish oils have attracted a great deal of interest and research. The evidence is strongly in favor of fish oil’s ability to lower triglycerides and protect against the occurrence of sudden heart attack. Fish oils may help with many other conditions, such as rheumatoid arthritis, depression, cognition, inflammation, and protection from cyclosporine toxicity in organ transplant patients. Much more research will need to be conducted in order to support these and the many other claims about the value of fish oils. Research has found that fish oils may raise both LDL and HDL cholesterol, making it an impractical choice for high cholesterol patients. Research also suggests that fish oil does not prevent organ transplant rejection.
Attention for Liver Disease: May increase liver function levels and interfere with blood clotting. May raise vitamin A level.
Safety Information: Most common reports were a fishy aftertaste, rash, and gastrointestinal complaints: indigestion, acid reflux, burping, bloating, loose stools and diarrhea. Use cautiously if diagnosed with bi-polar disease, diabetes, low blood pressure, or have reduced blood-clotting ability. Use of over 3 grams daily of fish oil may interfere with blood clotting. Fish can be high in mercury and other contaminants. Safety of omega-3 fatty acids has not been established for infants, children, pregnant and breastfeeding women. However, these groups should avoid fish as a source of omega-3s because of the high risk of mercury ingestion.
Interactions: Long-term use may lower vitamin E levels. May raise vitamins A and D, both of which can be toxic in high amounts.
Lab Notes: May raise blood glucose levels, LDL/HDL cholesterol and increase blood-clotting times. May lower triglycerides and blood pressure.
Dosage: Fish oil has many kinds of omega-3 fatty acids. Dosages are not based on the amount of fish oil, but on the amounts of DHA and EPA in the fish oil. DHA and EPA are most abundant in cold-water fish, especially salmon. DHA and EPA are also found in nuts, seeds, soy, and in trace amounts in dark green leafy vegetables. Dose suggestions are based on what condition you want to treat. The American Heart Association recommends 200mg to 400mg daily of EPA and DHA with a strong warning to do this with professional guidance, especially because of the bleeding risk. The WHO recommends 300mg to 500mg of EPA and DHA. It is suggested to start with low amounts of fish oil, gradually increasing the dose. Fish oils should be taken with meals and a full glass of water.
Back to top
Flaxseed and Flaxseed Oil (Linum usitatissimum)
There is not much research about flaxseed and its oil. It is high in an essential fatty acid, alpha-linolenic acid. Flaxseed is high in fiber and seems to be the form that is most often used in research. The oil has no fiber. Germany ’s Commission E has approved flaxseed for constipation and other gastrointestinal conditions. Other purported uses include cancer prevention, high cholesterol, menopausal symptoms, heart disease, diabetes and high blood pressure. Research does not support the use of flaxseed for prostate cancer and may actually cause it.
Attention for Liver Disease: May alter liver laboratory results and increase bleeding risk.
Safety Information: Most common side effects are increased bowel movements and flatulence.Constipation may occur if flaxseed is taken with insufficient water.Long-term effects are not known. Use cautiously if taking blood-thinning medications.
Raw flaxseed and unripe pods may be poisonous. Overdose of flaxseed may cause breathing difficulties, weakness, seizures, paralysis and difficulty walking. Avoid flaxseed use if bipolar. Because of its laxative effects, avoid when there are pre-existing bowel problems. Large amounts of flaxseed may cause bowel obstruction. Take the seed with large amounts of water, at least a 1:10 ratio. Diabetics should use cautiously. People with hormone sensitive conditions or cancers should avoid flaxseed. Pregnant and nursing women should probably avoid flaxseed. Not enough evidence to recommend safe use for children.
Interactions: Flaxseed may interfere with drug absorption. Do not take any drugs, herbs, or other supplements one hour before or two hours after taking flaxseed. May interfere with mood stabilizing medications. Women taking tamoxifen, birth control pills and other hormones may want to avoid. Use cautiously if taking blood-thinning medications.
Lab Notes: May alter blood-clotting tests. May lower blood pressure. May increase blood sugar levels. Flaxseed increased the red blood cell count in animal studies.
Dosage: Flaxseed breaks down when cooked or exposed to high heat. Flaxseed needs careful storage. Dry flaxseed may be stored in a cool dry location for up to one year. Flaxseed oil should be kept refrigerated in a dark opaque bottle. Flaxseed has not been standardized. Suggested dosages vary tremendously. Germany ’s Commission E recommends 1 tablespoon of whole seed with 150 mls of water, 2 to 3 times daily or 2 to 3 tablespoons of ground flaxseed.
Back to top
Garlic (Allium sativum)
Garlic has a long history and may have many health benefits. There is quite a bit of garlic research, but to date the studies don’t substantiate most of the claims. Garlic does seem to lower triglycerides and low-density lipoproteins (LDL). Germany’s Commission E has approved the use of garlic for high blood lipids and prevention of age-related vascular changes.
Attention for Liver Disease: May decrease clotting ability.
Safety Information: Garlic is probably safe at recommended doses. Garlic may cause bad breath, body odor, gastric complaints and allergies. Garlic may increase bleeding risk. Avoid topical application and ingesting large amounts. A myocardial infarction was reported in a 23 year-old man who took excessive amounts of garlic. May be safe for children, pregnant or nursing mothers, but may alter the flavor of breast milk.
Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450 below). May interact with fish oils, EPA, pycnogenol, NSAIDs, protease inhibitors, hypoglycemic, anti-hypertensive, thyroid, lipid-lowering, anticoagulant drugs.
Lab Notes: May cause abnormal insulin and thyroid levels, increase clotting times, and lower cholesterol and blood pressure.
Dosage: Garlic is not standardized, so dose recommendation is not practical. The Commission E set the dose at 4g fresh garlic (or equivalent) per day. Fresh or odorless enteric-coated garlic are probably the best forms to use.
Back to top
Ginger (Zingiber officinale)
Ginger is a good example of how a plant can be used as a food, spice or medicine. Ginger has a long history. The Commission E has approved it for digestive upset and motion sickness. There is no solid evidence supporting or opposing the use of ginger for nausea related to chemotherapy, surgery, or morning sickness.
Attention for Liver Disease: Theoretically could decrease clotting ability.
Safety Information: Should be avoided by those with gallstones, inflammatory bowel disease or bowel obstruction. Although there are no human studies to support this, ginger may interfere with normal clotting, may lower blood glucose levels, and may cause cardiac arrhythmias, especially if taken with high amounts of calcium. It has been reported to both increase and relieve stomach acid stimulation. Likely to be safe for pregnant and nursing women if used in moderate doses for no more than five consecutive days. Safety not established for children.
Interactions: Use cautiously with high doses of calcium.
Lab Notes: May alter coagulation labs, such as PT and INR.
Dosage: When used as a food, the typical amount of ginger is 1 gram daily. There is no universal standardization of ginger. Recommended doses range from 1 to 4 grams daily of fresh or dried ginger. Should not be used at excessive doses or for more than five consecutive days if used for morning sickness.
Back to top
Ginkgo Biloba (Ginkgo biloba)
This herb has been used for centuries and has been studied extensively. Ginkgo is purported to have anticoagulant properties. Germany’s Commission E approved ginkgo for peripheral intermittent claudication (lameness), certain forms of organic brain syndromes, vertigo and tinnitus. Ginkgo is used for many other conditions, but there is not enough evidence to draw firm conclusions. Ginkgo fruit pulp and seeds are toxic.
Attention for Liver Disease: May decrease clotting ability.
Safety Information: Generally, ginkgo has a good safety record when used as recommended. Ginkgo fruit pulp and seeds are toxic. There have been more than 70 reports of toxicity, including seizures, loss of consciousness, and death. May increase bleeding risk. Use cautiously in patients with bleeding or blood clotting disorders, and/or decreased clotting ability, such as those taking NSAIDs or anticoagulants. Use cautiously if diabetic. May lower seizure threshold. Reports of dermatological, neurological, cardiovascular and gastrointestinal side effects. Theoretically may reduce male and female fertility. Unsafe for infants. No safety data for children. Not recommended for pregnant or nursing women.
Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450 below). Ginkgo is known to interact with a very long list of drugs, herbs and supplements, such as many types of antidepressants, insulin, erectile dysfunction drugs and Yohimbe. May increase colchicine levels.
Lab Notes: May alter coagulation labs, such as PT and INR. May increase concentrations of insulin and C-peptides in the blood.
Dosage: 40 – 240 mg standardized dry extract in liquid or solid pharmaceutical grade taken orally in 2-3 divided doses. Only use standardized ginkgo.
Commission E used 50:1 standardized leaf extract (standardized to 24% to 25% ginkgo flavone glycosides and 6% terpine lactones). Never take high doses or extracts with gingkolic acid.
Back to top
Ginseng (many varieties)
This herb has been widely studied and has earned a prominent reputation in Chinese medicine. Purported to improve mental ability and fatigue along with many other uses. Some uses are supported by clinical data and earned the approval of a number of worldwide organizations, including the World Health Organization (WHO) and Germany’s Commission E. Small studies show possible benefit for those with liver disease.
Attention for Liver Disease: May alter liver function tests. May decrease blood clotting.
Safety Information: Contraindicated for those with hypertension. Multiple side effects and warnings, including cardiac, bleeding, and manic symptoms. May cause menstrual irregularities and breast tenderness. Not enough evidence to recommend safe use for children. Pregnant and nursing women and those with history of breast or uterine cancer should avoid ginseng.
Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450 below). May interact with many drugs including warfarin, aspirin, ibuprofen, naproxen, MAO inhibitors, calcium channel blockers, digoxin, and opioids. Should not be used with other stimulants, including excessive caffeine.
Lab Notes: May alter blood pressure, blood glucose levels and liver function tests. May alter coagulation labs, such as PT and INR.
Dosage: The common “recommended dose” is 100 mg of standardized ginseng extract 1 to 2 times a day. Should not be taken continuously. If taken continuously for 2 weeks, discontinue for 2 weeks before restarting. Andrew Weil, MD suggests using American ginseng since the Asian variety is associated with insomnia, irritability, and increase blood pressure. He also states that “real ginseng” contains ginsenosides.
Back to top
Glucosamine
This supplement has been well-researched and consistently shows improvement for osteoarthritis. It is often combined with chondroitin but can be taken alone. Made from corn or shellfish.
Attention for Liver Disease: None reported.
Safety Information: Avoid if allergic to shellfish or take corn version. Side effects include gastric discomfort, headache, itching, leg pain, edema, drowsiness, insomnia, sun sensitivity, and toughening of the nails. Increased blood pressure, heart rate and palpitations also reported. Use cautiously if there is history of asthma or diabetes. Cataracts were reported in animal studies, but not in humans. The safety for children is not established. Pregnant and breastfeeding women should avoid.
Interactions: May interact with diuretics, insulin and recombinant erythropoietin.
Lab Notes: May lower blood glucose levels and increase blood pressure.
Dosage: Universal dosages have not been established. Common dose recommendation is 500mg 3 times daily. Be patient. Chondroitin may take over 3 months before there are noticeable benefits.
Back to top
Green Tea (Camellia sinensis)
Green tea has been used for centuries. It is a source of antioxidants. It also contains caffeine and tannins. It is purported to prevent cancer and to help many medical conditions, but there is no clear evidence to support or dispute this. Caffeine may help to relieve headaches and fatigue.
Attention for Liver Disease: Those with advanced liver disease should use decaffeinated green tea because of reduced ability to metabolize caffeine. May decrease clotting ability.
Safety Information: The majority of warnings are associated with green tea’s caffeine content. Caffeine acts as a stimulant and diuretic. The primary complaints were frequent urination, nervousness, insomnia, and gastric discomfort. Anyone needing to avoid or reduce caffeine should use decaffeinated green tea. This includes those with anxiety, high blood pressure, cardiac, kidney and hyperthyroid disease. May delay blood-clotting ability, especially if high amounts are used. May stimulate stomach acid production. Classified by the FDA as “generally regarded as safe.” Pregnant and breastfeeding women should avoid caffeine. High caffeine use during pregnancy is associated with risk of birth defects and SIDS. Caffeine can cause sleeplessness in infants. Safety in children is not established.
Interactions: Theoretically may interact with any cytochrome p-450 metabolized substances, but this has not been proven in humans (see About Cytochrome P-450 below). May interact with MAO-inhibitors, codeine, stimulants and other herbs. Can reduce iron’s bioavailability, so do not drink green tea two hours before or 4 hours after taking iron supplementation.
Lab Notes: May increase blood-clotting times and blood glucose levels. May lower electrolyte levels.
Dosage: No established universal dose recommendations. One cup of average strength green tea has approximately 50 mg of caffeine.
Back to top
Hoodia (Hoodia gordonii)
This succulent plant has attracted a great deal of interest because of its supposed weight-loss properties. However, none of this is evidence-based. One never-published “study” of 18 obese people supposedly showed weight loss, but this research was not well-constructed or scientifically reviewed. The biggest problem with Hoodia is that it is scarce and much of what is being sold to consumers actually has little or no hoodia.
Attention for Liver Disease: None known.
Safety Information: Not known.
Interactions: None known.
Lab Notes: None known.
Dosage: Not established.
Back to top
Licorice Root (Glycyrrhiza glabra and G. uralensis)
Glycyrrhizin is the primary active substance in licorice root. This root has been used for centuries in many parts of the world. Approved by Germany’s Commission E for upper respiratory congestion, gastric and duodenal ulcers. Not approved for any use by WHO. An NCCAM review of randomized, controlled studies reports possible benefits for improvement of liver tissue for hepatitis patients and may reduce HCV complications for non-responders to interferon treatment. Thought to prevent liver cancer in those with HCV, although this has not been proven. Glycyrrhizin may lower liver enzymes but does not seem to lower HCV viral loads. Licorice root may prevent ulcers related to aspirin or NSAID use. Purported to stimulate the adrenal glands, but the evidence is insufficient.
Attention for Liver Disease: In spite of the NCCAM review, those with liver disease should avoid or use cautiously until safety and efficacy have been well established. Should be avoided by anyone with cirrhosis or cholestatic liver disorders. May worsen ascites. May lower liver enzymes.
Safety Information: Likely safe when used in moderate amounts. Prolonged or excessive use can lead to potentially serious side effects including, potassium depletion, high blood pressure, lethargy, hypertensive encephalopathy, sodium and water retention and swelling. Should be avoided by anyone with kidney disease, diabetes, and hormone-sensitive cancer. Other potential side effects include nausea, vomiting, headache, and decreased libido in men. Should be avoided by pregnant and nursing women. Safety in children is not established.
Interactions: May interact with diuretics, digitalis, antiarrhythmics, corticosteroids, heart and blood pressure medications, MAO inhibitors, antidiabetes drugs, anti-rejection agents, hormones, birth-control pills and anti-cancer dugs such as tamoxifen.
Lab Notes: May decrease liver enzymes, potassium and testosterone levels. May increase sodium levels and blood pressure. May alter blood glucose levels.
Dosage: No universally established dosages. Licorice root should not be used for more than 4 to 6 weeks. Prolonged use increases risk of serious side effects. Some sources recommend use of deglycyrrhizanated (DGL), since glycyrrhizic acid may be responsible for most of the side effects. However, some argue that this reduces overall effectiveness. Germany’s Commission E dosage uses DGL.
Back to top
Maitake (Grifola frondosa)
Maitake is a mushroom, making it both a food and a supplement. Has been found to be safe as a food source. Very little is known about its safety and efficacy as a higher dose supplement. Some purported uses include immune stimulation, antihypertensive, antidiabetes, cancer, HIV, hepatitis and fatigue management.
Attention for Liver Disease: None known. If maitake stimulates the immune system, then theoretically, should be avoided by those with autoimmune hepatitis, primary biliary cirrhosis or other autoimmune diseases; those taking immune suppressants, such as steroids and anti-rejection drugs for liver transplantation; and those using interferon.
Safety Information: Maitake may lower blood pressure and blood glucose levels. Safety for children, pregnant or breastfeeding women has not been established.
Interactions: Use cautiously if taking medications to treat blood pressure or blood glucose levels. Use cautiously if taking other herbs or supplements that are known to also lower blood pressure or blood glucose levels.
Lab Notes: May lower blood pressure and blood glucose tests.
Dosage: Standard dosing has not been established.
Melatonin (N-acetyl-methoxytryptamine)
Melatonin is a hormone produced by the body’s pineal gland. Melatonin responds to the presence and absence of light, which affect sleep-wake cycles. As a supplement, melatonin is not well absorbed by the body and is rapidly metabolized by the liver. Research supports the efficacy of melatonin for sleep disorders, such as jet lag and insomnia. Less is known about many other purported uses, such as Alzheimer’s, ADHD, cancer, etc.
Attention for Liver Disease: Melatonin has been linked to autoimmune hepatitis.
Safety Information: Melatonin has few side effects when used short-term. Common side effects include fatigue, dizziness, irritability, headache, mood changes, disorientation, eye problems and gastrointestinal complaints. There may be an increased risk of blood clotting, particularly those taking blood-thinning drugs. Use cautiously if there is a history of seizures, major psychiatric problems, heart disease, blood pressure problems, and diabetes. Hormonal side effects have been reported, so use cautiously with any condition or medication that may be influenced by hormones. Long-term effects are unknown. Pregnant and nursing women should avoid melatonin. Not enough evidence to recommend safe use for children.
Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450). Use cautiously with alcohol, caffeine, blood-thinning, anti-depressant, anti-seizure, blood pressure, diabetic and any sedating medications and supplements. Avoid if taking Haldol.
Lab Notes: May affect blood pressure, blood sugar levels and blood-clotting tests.
Dosage: Melatonin is used to manage many conditions, so dosages vary. Typical dosages range from 0.5 to 5 mg daily. Natural Standard suggests the following for jet lag: On your travel day, start melatonin (0.5 to 5 mg) close to what is your usual bedtime for time zone you to which you will be adjusting. Continue to take every 24 hours for several days. Do not use slow-release melatonin. Taking melatonin too early in the daytime may cause daytime drowsiness.
Back to top
Milk Thistle (Silybum marianum)
A great deal of research has been conducted using this herb for a variety of liver diseases. There has been very little done specifically targeting HCV. Currently there is no solid evidence for or against the use of milk thistle for liver disease. It has been approved by Germany’s Commission E for liver inflammatory diseases and cirrhosis. It is important to note that the Commission E denied approval for “maintaining health, for stimulation and functional disorders of liver.” Three ingredients in milk thistle are of scientific interest because of their potential therapeutic value and capacity to protect the liver. These ingredients are silibinin, silychristin, and silydianin, collectively known as silymarin.
Attention for Liver Disease: May lower liver function tests.
Safety Information: If used as recommended, milk thistle is generally safe. Reported side effects are mild laxative, gastric complaints, itching and lowered blood sugar levels. Safety has not been established for children, pregnant or nursing mothers.
Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450 below). Silymarin has the potential to interact with many drugs, herbs and dietary supplements. A few are hormones, methadone, antibiotics, anti-seizure, antidepressants, antipsychotics, antihistamines, organ transplant-rejection, cardiac, lipid-lowering drugs and sleeping pills.
Lab Notes: May alter liver function tests and blood sugar levels.
Dosage: Commission E set doses at 200-400 mg total daily dose of 70 to 80% standardized silymarin. This herb should be taken in divided doses, 2-3 times a day.
Back to top
Peppermint (Mentha piperita)
This flowering plant has been used for centuries. It is used in gum, toothpaste, mouthwash, and tea. Research supports its effectiveness to relieve indigestion and irritable bowel syndrome. Note: Read the safety information as there is a significant difference between peppermint leaf and oil.
Attention for Liver Disease: Avoid peppermint oil if you have liver damage or bile duct obstruction. Use peppermint tea in moderate amounts and with caution.
Safety Information: As a tea, it is likely safe when used in moderate amounts. Peppermint oil can be deadly at high doses. Should be avoided by anyone with G6PD deficiency, gall bladder disease or bile duct obstruction. Side effects include skin, eye, and digestive tract irritation, mouth sores, burning of the mouth and anus, headache, dizziness, slow heart rate, and muscle tremor. Seizures and brain damage were reported in animal studies. Avoid using peppermint around the face, especially with infants and children. Infants, children, pregnant and breastfeeding women should avoid.
Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450 below). Do not use peppermint if taking cyclosporine, felodipine (Plendil®) or simvastatin (Zocor®). Do not use topical peppermint oil and topical 5FU (Efudix©).
Lab Notes: None reported.
Dosage: No established universal dosages. As a tea, some sources suggest 2 to 3 cups daily; leaf form – 2 grams, 2 to 3 times daily. Peppermint oil – adults should never exceed 1 gram per kilogram of body weight.
Back to top
Reishi (Ganoderma lucidum)
Reishi is a mushroom, making it both a food and a supplement. Has been found to be safe as a food source. Very little is known about its safety and efficacy as a higher dose supplement. Some purported but unproven uses include immune stimulation, high cholesterol, high blood pressure, inflammation, viral infections HIV, and fatigue management.
Attention for Liver Disease: May decrease clotting ability. If reishi stimulates the immune system, then theoretically, should be avoided by those with autoimmune hepatitis, primary biliary cirrhosis or other autoimmune diseases; those taking immune suppressants, such as steroids and anti-rejection drugs for liver transplantation; and those using interferon.
Safety Information: Very little available safety information. Reports of nausea, vomiting, GI upset, itching, dry nose and dry throat. No safety data available regarding children, pregnant or nursing mothers.
Interactions: May interact with immunosuppressants, anticoagulants and certain chemotherapy agents.
Lab Notes: May alter blood clotting tests results and lower blood pressure readings.
Dosage: None established.
Back to top
Rhodiola (Rhodiola rosea)
Commonly called rose root, very little is known about this herb. Purported to combat fatigue and depression among other uses.
Attention for Liver Disease: None reported.
Safety Information: Very little available safety information. Reports of irritability and insomnia. Use very cautiously with bipolar disease since rhodiola may act as an antidepressant. No safety data available regarding children, pregnant or nursing mothers.
Interactions: None reported.
Lab Notes: None reported.
Dosage: None established.
Back to top
SAMe(S-adenosylmethionine)
The human body produces the chemical SAMe. The body makes all it needs and is rarely deficient. There is not much known about SAMe supplementation. Its purported uses include depression, arthritis, fibromyalgia, osteoarthritis, Alzheimer’s, Parkinson’s and muscle pain. Research has not shown any efficacy of SAMe. It is very expensive and unstable.
Attention for Liver Disease: Purported to help liver conditions. More research is needed to prove this.
Safety Information: Headache, upset stomach, flatulence, nausea and diarrhea are common side effects. Anyone with bipolar disorder should avoid SAMe.
Interactions: There is a risk of serotonin syndrome if taken with antidepressant medications.
Lab Notes: None reported.
Dosage: Typical oral dosage is 200 to 1600 mg in divided daily doses. SAMe should be started slowly and increased over a period of one to two weeks. The dose can be reduced gradually when the patient is feeling better.
Back to top
Saw Palmetto (Serenoa repens)
In the U.S., this berry was listed as an official drug in the beginning of the 20th century. Saw palmetto has been studied extensively and evidence points strongly to its effectiveness for prostate problems, particularly for the relief of symptoms from benign prostatic hypertrophy (BPH).
Attention for Liver Disease: May alter liver function test results.
Safety Information: Saw Palmetto may increase bleeding risk. Not recommended for patients with hypertension. Most common side effects are gastric problems. There have been reports of insomnia, fatigue, respiratory, neurological, cardiovascular, psychiatric, and genito-urinary problems. These occurred in small numbers and were usually mild. There was a single report of cerebral hemorrhage, but not enough evidence to be certain that saw palmetto was the cause. Pregnant and nursing women should avoid. No conclusive safety information is available for children.
Interactions: May interact with hormones, NSAIDs, anti-androgenic, and anticoagulant drugs.
Lab Notes: May alter liver function test results. If taking blood thinners, such as warfarin, may interfere with coagulation results.
Dosage: Saw Palmetto comes in many forms. Most sources recommend 160 mg twice daily of standardized saw palmetto (80-90% sterols and fatty acids or lipidosterolic extract). 320 mg once daily is sometimes recommended, but both dosing strategies seem equally effective. Be patient – symptom relief may not occur for several months.
Back to top
Schisandra (Schisandra chinensi and S. sphenanthera)
Animal studies suggest possible benefit for liver disease. No significant human studies have been conducted and very little is known about schisandra.
Attention for Liver Disease: May alter liver function tests.
Safety Information: Probably safe for general use. May cause a variety of gastroenterological complaints or central nervous system depression. The safety for children, pregnant and nursing mothers is not established.
Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450 below).
Lab Notes: May alter liver function tests.
Dosage: Not universally established. Common daily doses range from 1.5 to 6 grams.
Back to top
Soy (Glycine max)
Soybeans have been used as a dietary staple for over 5000 years. Soy is purported to help many conditions, such as high cholesterol and symptom relief from hepatitis, menopause and a host of other maladies. Research supports soy’s effectiveness for lowering LDL cholesterol for people with LDLs greater than 160. Soy may be effective for other conditions, but research has not drawn any strong conclusions for or against the use of soy. Germany’s Commission E has approved soy phospholipids for use in hepatitis patients.
Attention for Liver Disease: Soy phytoestrogens occasionally appear on lists of supplements that people with liver disease should not take. No evidence was found to support this.
Safety Information: Soy has a good safety record. Gastrointestinal complaints, such as bloating and flatulence are the most common. Soy may lower thyroid levels, especially in infants. Safety has not been established for children, pregnant or nursing mothers.
Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450 below). There is still controversy about the phytoestogen properties in soy. For this reason, soy is not recommended for anyone with hormone-sensitive malignancies or those taking drugs, such as tamoxifen, to prevent disease recurrence. Soy may interfere with warfarin, ginseng, calcium, and phosphate.
Lab Notes: Theoretically, may interfere with thyroid tests in children. If taking blood thinners, such as warfarin, may interfere with coagulation results.
Dosage: There is a great deal of variability in sources of soy and dose ranges between studies. The Japanese consume roughly 7 to 10 grams of soy in their daily diet. Isoflavones are key, whether you use soy in your diet or as a supplement. Recommended ranges of isoflavones seem to be approximately 30-50 mg daily. The Commission E used 1.5–2.7 g phospholipids from soybean with 73–79% (3-sn-phosphatidyl) choline in a single daily dose. To lower cholesterol, the Center for Science in the Public Interest suggests 25 grams of soy protein daily.
Back to top
St. John’s Wort (Hypericum perforatum)
This herb has been studied extensively. It is approved by Germany’s Commission E for mild depression. Commission E has classified St. John’s wort as an MAO inhibitor. No other purported uses for St. John’s wort have been proven. Note: Depression is a serious illness. Seek professional advice before using this or any herbal substance.
Attention for Liver Disease: May alter liver function tests. There have been case reports of organ transplant rejection in those using St John’s wort with cyclosporine.
Safety Information: Fatigue and gastric distress are the most common complaints. May cause sun sensitivity, especially at high doses. Bipolar patients should avoid. Safety has not been established for children, pregnant or nursing mothers.
Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450 below). The FDA has a specific warning about using St. John’s wort and indinavir, antiretrovirals, and other drugs. Do not take St. John’s wort if you are taking antidepressants, protease inhibitors, NRTI’s, or immunosuppressive medications. There have been case reports of organ transplant rejection by those taking cyclosporine.
Lab Interactions: May alter liver function test results.
Dosage: Germany’s Commission E recommends 300 mg three times daily of hypercin 0.3% extract or 2-5% hyperforin. Do not use for more than 3 months.
Back to top
Thymus Extract
The thymus gland plays an important role in our immune system. The “rationale” behind the use of thymus extract is that this will stimulate the immune system. There is no evidence to support this.
Attention for Liver Disease: There is no evidence supporting the use of thymus extract for treatment of HCV or HBV. Thymus extract may lower platelets.
Safety Information: There are a number of safety concerns about the use of thymus extract. The most major of these is that since thymus extract is a cow product, there is risk of contamination, particularly Mad Cow disease. Anyone with impaired immune function should avoid thymus extract.
Interactions: None known.
Lab Notes: May lower platelets.
Dosage: Not established.
Back to top
Turmeric/ Curcumin (Curcuma longa )
Curcumin is derived from turmeric which is sometimes used to flavor foods. In small amounts as a source of food, it is generally considered to be safe. The root or rhizome is the plant part that is used medicinally. Germany ’s Commission E has approved curcumin as an upset stomach remedy. In Chinese medicine it is used to alleviate stomach upset, arthritic pain and “low energy.” In lab and animal studies, curcumin has been found to have anti-inflammatory, antioxidant and anti-tumor properties. Whether this translates to humans is unknown. Research suggests curcumin may relieve heartburn. More research may reveal its value in treating other conditions.
Attention for Liver Disease: Some sourceswarn patients with liver disease to avoid curcumin. Curcumin may elevate liver function lab tests, but some sources disagree with this. May decrease clotting ability.
Safety Information: Patients withgallstones or any gall bladder obstruction should avoid curcumin. Should be avoided by patients undergoing chemotherapy. If taken in high doses or for prolonged time periods, curcumin may cause upset stomach. May cause hair loss and weaken the immune system. Pregnant and nursing women should avoid curcumin. Not enough evidence to recommend safe use for children.
Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450).
Lab Notes: May alter liver function tests and blood-clotting times. May lower blood pressure, cholesterol and blood glucose levels.
Dosage: Common doses for curcumin are 400 to 600 mg three times daily.
Back to top
Valerian (Valeriana officinalis)
The Commission E and WHO approved the use of valerian for restlessness and sleeping disorders. There is disagreement about the strength of this evidence.
Attention for Liver Disease: May be liver toxic, especially if taken long-term. Some doubts surround other claims of its hepatotoxic qualities, since all the reports used valerian in combination with other herbs. Until safety reports can be verified or disputed, it is recommended that people with liver disease avoid valerian.
Safety Information: May cause daytime sleepiness. Use cautiously when driving or operating machinery. May cause headaches, constipation, gastric complaints, nervousness, blurred vision, insomnia, lightheadedness, tightness in the chest, restlessness and slowing or irregular heartbeat. Symptoms of withdrawal may occur if stopping after long-term use of valerian. Safety has not been established for children, pregnant or nursing mothers.
Interactions: May interact with muscle relaxants, sleep, anxiety, pain, antiseizure, antidepressant, or other drugs or supplements that cause drowsiness.
Lab Notes: None reported.
Dosage: No established universal dose recommendations. For insomnia, a reputable source suggests 600 mg 1 hour before bedtime. Valerian may need to be taken on a regular basis for at least 4 weeks before results are evident.
Back to top
About Cytochrome P-450 (CYP-450)
CYP-450 refers to a group of enzymes that play an important role in drug metabolism. Enzymes are substances your body makes and metabolism refers to the conversion of chemicals into something your body can use. Certain diseases, particularly a poorly functioning liver, can interfere with drug metabolism that relies on CYP-450. This means that you could get too little or too much of any of the drugs that interact with each other.
Drugs and substances that are metabolized by the same enzymes can compete with one another for metabolism. This means drugs could be toxic rather than therapeutic. It is also possible that what substance or drug you are taking will not work. There are hundreds of drugs and dietary substances that can interact with any cytochrome p-450 metabolized substances.
Just because a substance has the potential to interact with another substance does not mean that you should not take it or that something bad will happen. It means the potential is there and you should talk about this with your medical provider. Your pharmacist is another resource to consult. There might be safer ways to take certain combinations of substances, such as taking one in the morning and another at night.
Here is a partial list of some drugs, foods, and dietary supplements that use CYP-450 for metabolism:
• NSAIDs, anesthesia, pain medications, protease inhibitors, non-nucleoside analogues, hormones, methadone, antibiotics, antifungals, antihistamines, anticonvulsants, antidepressants, antipsychotics, antianxiety, sedatives, sleeping medications, lipid-lowering agents(statins), transplant anti-rejection drugs, anti-parasite drugs, diabetic, cardiac, gastrointestinal drugs, chemotherapy agents, drugs containing ergot, methadone and Viagra
• Broccoli, brussel sprouts, cabbage, caffeine, cannabinoids (marijuana), cauliflower, charbroiled meats, garlic, grapefruit juice, green tea, star fruit and tobacco.
• Black cohosh, bloodroot, cat’s claw, chamomile, chaparral, chasteberry, echinacea, ginkgo, ginseng, goldenseal, hops, milk thistle, oregano, peppermint, red clover, schisandra, soy, St. John’s wort, wild cherry, and yucca.
References
• American Botanical Council
www.herbalgram.org
• Center for Science in the Public Interest: Nutrition Action Health Letter
http://cspinet.org
• ConsumerLab.com
www.consumerlab.com
• Drugs.com: Drug Information Online
www.drugs.com (You can use this website to check the interactions between all your medications and dietary supplements.)
• Memorial Sloan-Kettering Cancer Center
www.mskcc.org/aboutherbs
• National Institutes of Health National Center for Complementary and Alternative Medicine
http://nccam.nih.gov
• Natural Standard
www.naturalstandard.com
|
