Download The Impact of Herbal Medicine on Clinical Dentistry

The Impact of Herbal Medicine on Clinical Dentistry
Karen A. Baker, M.S., R.Ph.
Associate Professor
Dept. Oral Pathology, Radiology and Medicine - U of Iowa College of Dentistry
Dept. Clinical and Administrative Pharmacy - U of Iowa College of Pharmacy
I. DEFINITIONS & PATIENT UTILIZATION
Alternative Medicine (as defined by the Office of Alternative Medicine (NIH))
♦ Those treatments & health care practices not taught widely in medical schools
♦ Not generally used in hospitals
♦ Not usually reimbursed by medical insurance companies
Definitions of popular alternative therapies
♦
Holistic medicine: As the term implies, deals with a being as a "whole" and integrated system rather
than individual parts and advocates the synergistic use of herbs to heal the being. Also referred to as
alternative or complementary medicine, it is composed of a series of disciplines including chiropractics,
naturopathy, reflexology, acupuncture, massage, and the following.
♦
Homeopathy: Based on the principle of "like cures like”--very small doses of naturally derived botanical,
mineral, or animal compounds are diluted to treat a condition. The same substance in larger doses in a
healthy subject would cause symptoms similar to those of the disease being treated.
♦
Herbal medicine: Rests on the usage of preparations and medications derived from botanical
components such as roots, leaves, and flowers to promote healing.
♦
Naturopathy: Adopts a non-invasive approach emphasizing natural remedies, a healthy diet, and
exercise to heal rather than surgery or synthetic drugs. N.D. is “Doctor of Naturopathy”
Common Viewpoint Among Traditional Healthcare Providers: “Either Worthless or Dangerous!!”
♦
Until the 1940s much of the U.S. Pharmacopoeia was composed of drugs of herbal origin
♦
25% of common Rx drugs contain at least one active ingredient derived from plants
aspirin, atropine, belladonna, capsaicin, cocaine, colchicine, digoxin, ephedrine, ergotamine, opium,
physostigmine, pilocarpine, quinidine, scopolamine, taxol, vincristine, vinblastine
♦
80% of the world’s population (4 billion people) use herbal medicine for some aspect of primary health
care according to the World Health Organization…. What are the reasons???
1) Patient dissatisfaction with conventional treatments because of lack of effect, adverse effects, or
perceptions that treatments are too impersonal, highly technical, or costly;
2) The need for personal control is met because patient becomes a “co-therapist”;
3) Alternative therapies are more attractive because patients view them as more compatible with their
value systems.
♦
70% of patients will not tell health care providers they are taking herbal products
♦
U.S. Market for dietary supplements was almost 21 billion in 2006
♦
Top 10 herbal products account for 60% of the total herbal medicine market
MOST COMMON CONDITIONS TREATED AND THE SPECIFIC OTC SUPPLEMENTS SOLD
2005
growth
1%
5%
14%
6%
4%
7%
2%
17%
8%
1%
16%
13%
12%
12%
5%
1%
5%
% of total
in 2005
27%
22%
6%
6%
5%
5%
5%
3%
3%
1%
1%
1%
1%
1%
86%
14%
100%
Condition Specific Supps ($mil)
Sports/Energy/Weight-Loss
General Health
Cold/Flu-Immune
Joint health
Anti-cancer
Heart health
Bone health
Gastrointestinal health
Diabetes
Menopause
Brain Mental
Sexual Health
Mood
Insomnia
Sum of top 14 Conditions
Others
Total Supplements
2005
5,802
4,674
1,364
1,226
1,073
1,016
986
694
532
314
264
239
220
126
18,529
2,786
21,315
US Minerals
2003
2004
2004
2005
2005 growth growth
Calcium
1,046
993
1,010
-5%
2%
Magnesium
161
175
202
9%
15%
Chromium
106
119
125
13%
5%
Zinc
80
75
79
-6%
5%
Selenium
62
62
68
1%
8%
Potassium
71
70
74
-1%
6%
203
209
219
3%
5%
37
34
36
-7%
5%
1,765
1,738
1,812
-2%
4%
Iron
Others
Total
II.
US Vitamins
MultiVitamins
2003
2004
2004
2005
2005 growth growth
3,678
3,833
4,157
4%
8%
Vitamin C
770
808
836
5%
3%
Vitamin E
706
654
440
-7%
-33%
B Vitamins
817
880
937
8%
6%
Vitamin A/Carotenoids
237
248
258
5%
4%
Others
449
468
536
4%
14%
6,658
6,892
7,163
4%
4%
Total
Specialty Supplements
Melatonin
Probiotics
DHEA
Fish/Animal Oils
Plant Oils*
Glucosamine/Chondroitin
Bee Products
CoQ10
5 HTP
SAMe
MSM
Gelatin
Digestive Enzymes
Homeopathics
Others
2003
62
174
47
183
140
761
74
258
53
92
115
58
130
460
122
2004
67
204
48
262
177
762
81
283
59
93
111
52
147
532
134
2005
2005 growth
73
10%
243
19%
50
3%
359
37%
197
11%
810
6%
91
11%
339
20%
68
15%
96
3%
107
-3%
48
-8%
166
13%
619
16%
148
10%
Total
2,728
3,013
3,414
Effectiveness of Popular Vitamins and Herbal Medicines
1. Effect of Vitamin and Mineral Supplementation on Chronic Diseases
a. B vitamins and Heart Disease
b. Retinoids (Vitamin A)
c. Vitamin D
d. Antioxidants (lycopene, lutein, zeaxanthine)
e. Vitamin C (ascorbic acid)
f. Calcium Supplements
13%
3
2. Glucosamine Sulfate +/- Chondroitin
3. SamE or MSM
4. Coenzyme Q10
5. Fish Oils (Omega-3 Fatty Acids)
-DHA/EPA doses required to reduce triglycerides and total cholesterol
-Flaxseed Oil??
6. Melatonin (Pineal Gland Hormone)
7. Probiotics (Culturelle, etc.)
8. Bee Products (Royal Jelly)
9. 5-HTP (5-Hydroxytryptophan)
10. SamE
11. MSM
12. Gelatin
13. Digestive Enzymes (Pancreatin, etc.)
14. Ginkgo Biloba
15. Garlic
16. Echinacea
17. Ginseng
18. Saw Palmetto
19. St. John’s Wort (Goat Weed)
20. Topical Zinc for the Common Cold
4
III. REGULATORY ISSUES & SAFETY
A. Federal Trade Commission (FTC)
♦ OTC Drug Regulation
♦
FTC is responsible for all over-the-counter advertising
♦
Currently herbal medicines can only be marketed in the U.S. as dietary supplements
♦
Manufacturers/distributors cannot make specific health claims without FDA approval?
♦
Structure/function claims versus disease claims
B. Legislation
™ Dietary Supplements Health & Education Act (DSHEA) 1994
™ Congress “freed” the population to pursue self-medication with herbal and alternative products
vitamins, minerals, essential fatty acids, enzymes, coenzymes, plant derived (herbs), animal-derived
(glucosamine), bacteria, glandular products (adrenal extracts), hormonal (melatonin)
™ Act limits FDA’s regulation of “dietary supplements” to superficial labeling features because the act was not
fully funded. New legislative initiatives may change this very soon.
C. Problems with DSHEA
™ Products are not required to:
Gain prior marketing approval by the FDA
Be Monitored for identity or potency of chemicals in the supplement
Be backed by company data supporting safety or efficacy
™ Natural = Safe ???
Paradox – public is more afraid of tested drugs than of untested dietary supplements
15-20% of adults in US have used herbals within the past year according to USDHHS
D. Problems with Herbals
™ Intentional fraudulent adulteration with another active drug
™ Accidental substitution of a more toxic species for the intended plant material
™ Contaminants – chemicals, toxins, biologic pathogens
™ Inappropriate amounts of chemical ⇑ or ⇓
™ Adverse herb-drug or herb-disease interactions
™ Intrinsic toxicity, low margin of safety
– From Drug Topics April 16, 2001
E. Testing for Active Ingredient and Labeling –Consumer Lab gives a CL approved seal
-USP dietary supplement verified seal
-NSF International certifies products
F. Examples of Reliable Herb Companies
Nature's Way, Nature's Herbs, Phytopharmica, and Frontier Herbs
Large Pharmaceutical Companies – Bayer, American Home Products, Warner Lambert, Knoll
G. Patient History: Screening Questions on Dental Health Questionnaire
♦ Do you regularly take dietary supplements or herbal medicines?
♦
If YES, do you regularly take any of the following:
♦
Diet or Energy supplements
Echinacea
Garlic
♦
Kava
Valerian
Vitamin E >400I.U. Fish Oil >3 grams/day
St. John’s Wort
Ginger Ginkgo
♦
Do you regularly use natural or herbal oral health products?
♦
Have you recently stopped taking any herbs?
♦ Have you substituted herbs for prescription or over-the-counter drugs?
H. Drug Interactions with Herbal Products:
Ginseng
♦
5
Why are herb-drug interactions difficult to assess?(see interactions table at end of handout)
o Actual doses may differ from label and herbals may contain adulterants
o Potency varies by crop year
o Collection, storage and marketing methods promote contamination
IV. Dental Impact of Herbal Supplements
What are we worried about in clinical dental practice??
• Increased bleeding or effects on hemostasis
• Delayed wound healing
• Effects on the immune system
• Sedation and other CNS effects
• Interactions with dental medications
A. Surgical Considerations for Patients Taking Selected Herbal Supplements______
HERB
Black
Cohosh
USE (S)
•
•
treatment of PMS and
dysmenhorrhea
alleviate menopausal
symptoms
PROPOSED
MECHANISM OF
ACTION/EFFECTS
•
•
Chamomile
•
•
•
anxiolytic/sedative
treatment of GI spasm
or irritation
treatment of menstrual
disorders
•
•
•
DRUG
INTERACTIONS
active
components
are triterpene
glycosides and
formononetin
(an
isoflavanoid),
which may
have estrogenlike hormonal
activity
suppresses
leutenizing
hormone
secretion in
menopausal
women
•
also contains
bioflavinoids
which are
considered to
be active
apigenin
competitively
inhibits binding
of several
benzodiazepin
es
contains
coumarin,
which exerts
an
antispasmotic
effect
•
caution when
administered
with other
drugs that
can reduce
BP
OTHER
CONSIDERATIONS
•
•
•
•
no reports of
coagulation
disorders, but
effects on
coagulation
system have
not been
studied; avoid
concurrent
administration
of (or closely
monitor)
warfarin
may make
other drugs
less effective
when
administered
concurrently
•
•
•
•
may lower BP
side effects
are generally
mild (GI,
headache,
weight gain,
dizziness)
limit use to 3
months
sedative
effects noted
from 6oz.
cup of strong
tea
can cause
skin irritation,
allergic
conjunctivitis,
and/or severe
allergic rx.
long-term
consumption
may have
cumulative
effects
consider
discontinuin
g 2 weeks
prior to
surgery
6
Echinacea
antiinfective
•
•
Evening
Primrose Oil
•
•
•
•
treatment of PMS
lowers serum
cholesterol
allergic/inflammatory
conditions (eczema,
psoriasis)
autoimmune disease
(MS, lupus)
•
•
Feverfew
•
•
prevention and
treatment of migraines
anti-inflammatory agent
(used to treat fever,
menstrual problems,
arthritis)
•
•
•
enhances
"nonspecific"
cell immunity
by enhancing
release of
cytokines and
phagocytic
activity
stimulates
autoimmune
processes
•
extract
contains 6080% linoleic
acid and 814% - linolenic
acid (an
omega-6 fatty
acid formed by
desatruration
of linoleic acid)
lowers
platelet
aggregation
•
suggested to
be serotonin
release during
aggregation of
platelets;
inhibits
platelet
aggregation
antagonizes
actions of
autocoids and
vascular
agonists
potentially
involved in
migraines and
chronic
inflammation
antipyretic and
antiplatelet
effect may be
due to
•
may
counteract
immunosuppr
esant drugs
(e.g.
corticosteroid
s); do not
administer
together
•
•
•
•
may interact
with
anticoagulant
c or
antiplatelet d
drugs to raise
risk of
bleeding
use caution
when
administered
with drugs
that lower
seizure
threshold
(e.g.
phenothiazine
s, tricyclics)
•
may interact
with
anticoagulant
or antiplatelet
drugs to raise
risk of
bleeding
use caution
when
administering
with drugs
that raise
serotonin
(fluoxetine,
sumatriptan,
etc.)
•
•
•
•
•
hepatotoxic
effects may
be associated
with
prolonged
use or if
administered
with other
hepatotoyjc
agents
immune
suppression
can result
from
prolonged
use (> 10- 14
days)
side effects
are generally
infrequent
(GI,
headache)
may lower
seizure
threshold
abrupt
discontinuatio
n may cause
rebound
headache or
pain with stiff
joints and
muscles
can cause
mouth sores
and loss of
taste
do not take
for > 4
months
consider
discontinuin
g 2 weeks
prior to
surgery
7
phospholipase
inhibitor that
prevents the
release of
arachidonic
acid, a
precursor to
prostaglandins
and
leukotrines
Fish Oil
Supplements
(Omega-3
fatty acids)
•
management of severe
dyslipidemia, lowers
risk of coronary heart
disease, lowers BP
•
•
•
Garlic
•
•
lowers serum
cholesterol
lowers blood pressure
•
•
•
•
possibly via
effects on
prostaglandins
,
thromboxanes
and
leukotrines
decreases
platelet
aggregation,
decreases
thromboxane
A2 and
increases
bleeding
times
incorporated
in RBCs,
leading to
lower blood
viscosity
•
although no
drug
interactions
have been
reported, it
would be
prudent to
avoid
anticoagulant
and
antiplatelet
drugs
active
constituents
are sulfur
compounds
and the alliinsplitting
enzyme
alliinase
inhibits
cholesterol
synthesis
has
vasodilator
and
antioxidant
properties
effects on
coagulation
include
inhibition of
platelet
aggregation,
antithromboti
c activity,
mean plasma
viscosity and
•
may interact
with
anticoagulant
and
antiplatelet
drugs to
increase risk
of bleeding
may
potentiate
antihypertensi
ve drugs
•
•
•
•
•
•
report of
spontaneous
epidural
hematoma
and
postoperative
bleeding
may increase
INR
chronic or
excessive
doses may
decrease
production of
Hb
side effects
include GI
discomfort,
dizziness,
allergic
reactions,
headache,
sweating, and
garlic odor of
breath/skin
hypoglycemic
hematocrit
Ginger
•
•
•
prevention of nausea
and vomiting
digestive problems
muscle pain and
swelling
•
•
•
Ginkgo
Biloba
•
•
treatment of dementia
symptoms or other
conditions associated
with cerebral or
peripheral vascular
insufficiency
treatment of vertigo or
tinnitus of vascular of
involutional origin
•
•
•
•
•
potent agonist
at the
serotonin
receptor
exerts effect in
GI tract, not in
CNS
multiple
effects on
platelet
aggregation
(potent
inhibition of
thrombaxane
synthetase,
prostacyclin
agonist)
•
medicinal
extracts
contain 2227% flavanoid
glycosides, 57% terpene
lactones
(ginkgofides
A,B and C and
bilobalide) and
< 5 ppm
ginkgolic acids
several active
constituents
are potent
antioxidants
and freeradical
scavengers
inhibits agerelated decline
of muscarinic
cholinergic
receptors and
a2-adrenergic
receptors
ginkgolides,
especially
ginkgolide B,
inhibit
platelet
activating
factor,reduce
thrombus
•
•
•
•
may interact
with
anticoagulant
and
antiplatelet
drugs to
increase risk
of bleeding
increases
calcium
uptake by
heart; may
alter CCB
drug effects
•
may interact
with
anticoagulant
and
antiplatelet
drugs to
increase risk
of bleeding
ginkgo toxin
in Ginkgo leaf
and seed may
reduce
effectiveness
of
carbamazepin
e, phenytoin
and
phenobarbital
in epileptic
patients
do not use
with drugs
that lower
seizure
threshold
•
•
•
•
•
8
effects
consider
discontinuin
g 2 weeks
prior to
surgery
may increase
bleeding time
may effect
blood glucose
may effect BP
consider
discontinuin
g 2 weeks
prior to
surgery
several cases
of
spontaneous
bleeding
reported
(subdural and
subarachnoid
hematomas,
bleeding from
iris into
anterior
chamber of
the eye
consider
discontinuin
g 2 weeks
prior to
surgery
9
formation
Ginseng
•
•
•
•
heighten resistance to
stress
enhance physical and
mental performance
increase stamina
elevate mood
•
•
•
•
•
Hops
•
sedative-hypnotic,
digestive aid
•
•
Horse
Chestnut
•
•
reduce leg edema
improve symptoms of
chronic venous
•
active
ingredients
thought to be
ginsenosides
increases
activity of CNS
neurotransmitt
ers by
lowering their
removal from
neuronal
synapse;
increase in
serotonin
useful when
treating
anxiety and
depressive
disorders
may potentiate
activity of
GABA
steroidal
mechanism of
action has
been
suggested;
possibility of
hormone-like
or hormoneinducing
effects cannot
be ruled out
ginsenosides
inhibit
platelet
aggregation
and enhance
fibrinolysis
•
acts as a mild
depressant on
higher nerve
centers
contains
substances
with estrogenic
activity
•
main active
constituent is
aescin
•
•
•
may interact
with
anticoagulant
and
antiplatelet
drugs to
increase risk
of bleeding
avoid
concurrent
administration
of
hypoglycemic
drugs
avoid
concurrent
administration
of MAO I
•
•
•
•
•
•
varying
effects on
blood
pressure
hypoglycemic
effect; caution
in diabetics
avoid in
patients with
manicdepressive
disorders or
psychosis
(due to
steroid
effects)
may
potentiate
action of
MAO
inhibitors
limit use to 3
months
may have
additive
effects with
other CNS
depressants
drugs
metabolized
by the
cytochrome
P450 liver
enzyme
system
•
avoid in
depressive
states
may interact
with
anticoagulant
•
side effects
include
nausea,
insufficiency
•
and
antiplatelet
drugs to
increase risk
of bleeding
contains
coumarin
constituents
•
•
•
•
Kava Kava
•
•
sedative
anxiolysis
•
•
•
•
active
constituents
are the
kavalactones
(kawain,
dihydrokawain,
methysticin,
and
dihydromethys
ticin)
kavalactones
may act on
central GABA
and BZD
binding sites;
may decrease
excitability of
the limbic
system
may
antagonize
dopamine and
inhibit MAO
uptake
kawain (a
kavalactone)
has been
shown to
have
antiplatelet
effects due to
lowering
platelet
aggregation
secondary to
inhibition of
cycloxygenas
•
•
•
•
kavalactones
potentiate
effects of
other CNS
depressants,
including
opioids,
barbiturates
and BZDs
decreases
effectiveness
of levodopa
(due to
dopamine
antagonism)
theoretical
additive
effects with
other
anticoagulant
and
antiplatelet
drugs to
increase risk
of bleeding
use caution
with MAO
inhibitor and
other
psychopharm
acologic
agents
•
•
•
•
•
•
10
stomach
discomfort,
allergic skin
reactions,
itching and
muscle
spasms
turn urine red
can cause
kidney or liver
damage
can cause
severe
bleeding or
bruising
consider
discontinuin
g 2 weeks
prior to
surgery
avoid in
depression;
may increase
suicide risk
due to its
CNS
depressant
effects
can impair
motor
function
continuous
heavy use
can cause
changes in
blood
chemistry,
pulmonary
hypertension,
exaggerated
kneecap
reflex,
reddened
eyes,
shortness of
breath, weight
loss and dry,
flaking,
discolored
skin
limit use to 3
months
no evidence
of potential
for
dependency
consider
discontinuin
11
g 1-2 weeks
prior to
surgery
e
Passion
Flower
•
•
•
relaxation
sleep
•
Saw
Palmetto
St. John's
Wort
•
•
treatment of benign
prostatic enlargement
treatment
of mildmoderate
depressio
n, anxiety
•
•
•
•
•
active
constituents
may be
glycosides
(harmala
compounds),
maltone and
ethyl-maltone,
and flavanoids
chrysin
(component;
a flavanoid)
has BZD
receptor
activity
•
like finasteride
(antiandrogeni
c activity);
antiestrogenic
activity
•
hypericin
(presumed active
ingredient) shows
affinity for
serotonin, GABA,
and BZD
receptors
inhibits MAO A &
B (MAO inhibitor
effects are
thought to be
minor)
primary
mechanism of
action of
hypericin is
thought to be
inhibition of
serotonin
reuptake, as well
as downregulation of
serotonin
receptors and
neurohormonal
mechanisms
hypericin and
psuedohypericin
may induce
hepatic enzymes
•
•
possible
additive
effects with
other CNS
depressants
avoid MAO I
•
potential
additive
effects with
otherhormone
s ad
•
although no
drug-drug or
drug-food
interactions
have been
reported, it
may be
prudent to
avoid
concomitant
use with MAO
inhibitor,
meperidine
and
sympathomim
etics, as well
as traditional
antidepressan
ts
•
•
•
•
•
reports of
hepatotoxicity
and
pancreatic
toxicity
no evidence
of potential
for
dependency
can cause
HTN and GI
disturbances
considered
an atypical
antidepressa
nt
can cause
photosensitivi
ty in fairskinned
people (doserelated)
potentially
can cause
serotonin
syndrome
may prolong
effects of
anesthesia
12
Valerian
•
•
sedative
anxiolysis
•
•
•
•
•
•
interacts and
binds with
GABA; valerenic
acid component
may inhibit
breakdown of
GABA, thereby
enhancing activity
Japanese
valerian contains
kessyl gycol
diacetat which
has BZD-like
anxiolyfic effects
and
antidepressant
effects (possibly
due to blockage
of MAO uptake)
high
concentration of
glutamine in
valerian extracts
could explain
sedative
properties;
glutamine is
metabolized to
GABA once it
crosses BBB
possible direct
relaxing effect on
smooth muscle
(thought to be
due to GABA
present in
valerian)
may also weakly
antagonize BZD
receptors
too high initial
dose can cause
excitability
•
•
•
may have
additive
effects with
other CNS
depressants,
including
barbiturates,
benzodiazepin
es , and
opioids
will likely
potentiate
effects from
barbiturates
Antabuse;
there is
alcohol in
many of the
extract
products
•
•
•
•
•
•
does not
appear to
affect driving
ability,
potentiate
effects of
alcohol or
result in
morning
hangover
side effects
include
headache
and morning
grogginess
can cause
cardiac
disturbances
can cause
liver damage
effects are
not
immediate (24 weeks)
does not
seem to
cause
dependence
a Herbs are classified as dietary supplements and not approved by the FDA to be used as drugs. The uses, proposed
mechanism of action, effects, drug interactions and other considerations are based on reports in the literature. The
body of literature does not always agree on each herbs specific properties, effects and uses.
b This is a very conservative recommendation for discontinuing these herbs prior to surgery, thereby allowing normal
hematologic function to return. Gingko biloba is believed to be the herbal product with the most serious side effects,
with several case reports in the literature of spontaneous bleeding. In two cases, the patient was also taking chronic
aspirin or warfarin.
c Anticoagulant drugs include warfarin, heparin and low molecular weight heparin
d Antiplatelet drugs include aspirin, nonsteroidal antinflammatory agents, dipyridamole, ticlopidine, and sulfinpyrazone
13
B. DIETARY SUPPLEMENTS WITH ANTI- OR PRO-COAGULANT ACTIVITY
Irreversible platelet effects: Feverfew, garlic, panax ginseng. D/C 7-10 days prior to surgery.
Reversible platelet effects: Ginkgo, Vitamin E. D/C 3 days prior to surgery.
14
V. TWELVE DIETARY SUPPLEMENTS NO ONE SHOULD TAKE!!!
Name
Dangers
(Also known as)
DEFINITELY HAZARDOUS
Documented organ failure and known carcinogenic properties
Aristolochic acid (Aristolochia, birthwort, snakeroot,
Potent human carcinogen;
snakeweed, sangree root, sangrel, serpentary, serpentaria; kidney failure, sometimes
asarum canadense, wild ginger). Can be an ingredient in requiring transplant; deaths
Chinese herbal products labeled fang ji, mu tong, ma dou reported.
ling, and mu xiang. Can be an unlabeled substitute for
other herbs, including akebia, asarum, clematis, cocculus,
stephania, and vladimiria species.
Regulatory actions
FDA warning to consumers and industry
and import alert, in April 2001. Banned in
7 European countries and Egypt, Japan,
and Venezuela.
VERY LIKELY HAZARDOUS
Banned in other countries, FDA warning, or adverse effects in studies
Comfrey (Symphytum officinale, ass ear, black root,
Abnormal liver function or FDA advised industry to remove from
blackwort, bruisewort, consolidae radix, consound, gum damage, often irreversible; market in July 2001.
plant, healing herb, knitback, knitbone, salsify, slippery deaths reported.
root, symphytum radix, wallwort)
Androstenedione
(4-androstene-3, 17-dione, andro, androstene)
Increased cancer risk,
decrease in HDL
cholesterol.
FDA warned 23 companies to stop
manufacturing, marketing, and
distributing in March 2004. Banned by
athletic associations.
Chaparral (Larrea divaricata, creosote bush, greasewood, Abnormal liver function or FDA warning to consumers in December
hediondilla, jarilla, larreastat)
damage, often irreversible; 1992.
deaths reported.
Germander (Teucrium chamaedrys, wall germander, wild Abnormal liver function or Banned in France and Germany.
germander)
damage, often irreversible;
deaths reported.
15
Kava (Piper methysticum, ava, awa, gea, gi, intoxicating Abnormal liver function or FDA warning to consumers in March
pepper, kao, kavain, kawa-pfeffer, kew, long pepper,
damage, occasionally
2002. Banned in Canada, Germany,
malohu, maluk, meruk, milik, rauschpfeffer, sakau, tonga, irreversible; deaths reported. Singapore, South Africa, and Switzerland.
wurzelstock, yagona, yangona)
LIKELY HAZARDOUS Adverse-event reports or theoretical risks
Bitter orange (Citrus aurantium, green orange, kijitsu,
High blood pressure;
neroli oil, Seville orange, shangzhou zhiqiao, sour orange, increased risk of heart
zhi oiao, zhi xhi)
arrythmias, heart attack,
stroke.
Organ/glandular extracts(brain/adrenal/pituitary/
placenta/other gland “substance” or “concentrate”)
Theoretical risk of mad
cow disease, particularly
from brain extracts.
None
FDA banned high-risk bovine materials
from older cows in foods and
supplements in January 2004. (High-risk
parts from cows under 30 months still
permitted.) Banned in France and
Switzerland.
Lobelia (Lobelia inflata, asthma weed, bladderpod,
Breathing difficulty, rapid Banned in Bangladesh and Italy.
emetic herb, gagroot, lobelie, indian tobacco, pukeweed, heartbeat, low blood
vomit wort, wild tobacco)
pressure, diarrhea, dizziness,
tremors; possible deaths
reported.
Pennyroyal oil(Hedeoma pulegioides, lurk-in-the-ditch,
mosquito plant, piliolerial, pudding grass, pulegium, runby-the-ground, squaw balm, squawmint, stinking balm,
tickweed)
Liver and kidney failure,
None
nerve damage, convulsions,
abdominal tenderness,
burning of the throat; deaths
reported.
Scullcap (Scutellaria lateriflora, blue pimpernel, helmet
flower, hoodwort, mad weed, mad-dog herb, mad-dog
weed, quaker bonnet, scutelluria, skullcap)
Abnormal liver function or None
damage.
Yohimbe (Pausinystalia yohimbe, johimbi, yohimbehe,
yohimbine)
Change in blood pressure, None
heart arrythmias, respiratory
depression, heart attack;
deaths reported.
According to product labels.
Sources: Natural Medicines Comprehensive Database 2004 and
Consumers Union's medical and research consultants.
VI. Advice For the Patient
♦
If it seems too good to be true it probably is!
“Scientific Breakthrough”
“Miraculous Cure”
“Exclusive Product”
“Secret Ingredient”
“Ancient Remedy”
How to Spot False Claims
Medical Conspiracy to Suppress Product
16
Undocumented Case Histories Claiming Amazing Results
Product Available from Only One Source
Money-Back Guarantee
Weight Loss is Easy and Fast
Key Issues For Consumers
“Natural” is not synonymous with “Safe”
Lack of standardization may result in great variation among products
Never use in pregnant women, the elderly, or in young children
Consumers must protect themselves in the current regulatory environment
VII. “Natural” Oral Health Products: Help or Hype?
A. Common “Alternative” Ingredients
-Loturbark, Neem, Tulsi, Myrrh
-Peelu (Miswak Chewing Stick)
-Melaleuca (Australian Tea Tree Oil)
-Propolis (Bee Product)
-Essential Oils
-Coenzyme Q10 (Ubiquinone)
-Green Tea Extract
-Antioxidants
-Vitamin C (Ascorbic Acid)
-Aloe Vera
-
17
B. Common Alternative Dental Products
Product/Manufacturer
Claims
“Active Ingredients”
Auromere (www.auromere.com)
Invigorates/purifies
Neem, Peelu, 24 herbal extracts
Dabur (Nature Care)
Astringent/cleaning
Tulsi, Loturbark, essential oils
DentiCare Tooth Polish (Melaleuca, Inc.)
Benefits bleeding gums
Melaleuca, propolis, myrrh
Dentaforce (Bioforce)
Astringent/stimulant
Echinacea, rosemary, essential oils
-
Eco-Dent (Eco-Dent 888.Eco.Dent)
Hardens enamel w/o F
BS, tartaric acid, CaCo3, myrrh
Cool Mint (Nature’s Gate)
Antiseptic/ “free” calcium
Sage, vitamin C, Calcium Carrot Pwd.
Herbal TP and Gum Therapy (Woodstock
800.615.6895)
Prevent cavities/fight gingivitis
MFP, aloe vera, echinacea, golden seal,
bloodroot, calendula, propolis
Homeodent (Boiron-Borneman)
No-mint,no effect on homeopathy
Calendula, plantain, witch hazel
Jason Toothpaste (www.jasonnatural.com)
Best Tasting Natural Toothpaste!
CoQ10, Aloe Vera, Sea Salt, Melaleuca,
Gum support/perio protection
Perilla Seed Extract
MouthFx (www.mouthrx.com)
97% effective in 41 countries
100% natural essential oils
Nutribiotic Dental Gel
(www.nutribiotic.com/dentalgel)
Supports teeth and gums
Grapefruit Seed Extract, Zinc citrate,
sanguinaria, aloe vera, stevia
Parodontax (Madaus)
To treat periodontal disease
Rhatany, chamomille, myrrh, echinacea,
Peelu (Peelu Products)
Miswak/Siwak chewing stick
Peelu fiber, natural sorbo fruit juice
Propolis TP (Beehive Botanicals)
Protects hive, benefits mankind
Propolis, xylitol, flavoring oils
Rembrandt “Naturals” (Den-Mat)
Antioxidant, vit. C, Calcium
Freshening/Invigorating/Soothing
Tea Tree Oil TP (Desert Essence)
Especially good for gingivitis/perio
Melaleuca, propolis, ginger
Tea Tree TP (Thursday Plantation)
Healthy gums, decrease tartar
0.4% melaleuca, chlorophyllin-copper
Tom’s of Maine (Tom’s of Maine)
No dyes, preservatives, sweetners
MFP, CaCo3, silica, zinc for TC
Tooth and Gum Paste (Dental Herb
Company 800.747.4372)
Substantive, no SLS, “natural
fluoride source” from tea
Echinacea, green tea, essential oils
No Fluoride which is toxic
VIII. Herbal and Nutritional Drug Product References
Natural Medicines Comprehensive Database
-“Gold Standard” for objectivity and comprehensive information
-patient handout option very useful and database can be searched by disease state
-updated daily and fully referenced with abstracts available for review
-priced at $75/year at www.naturaldatabase.com
Nutrition Action Health Letter
-10 issues per year. Subscribe at www.cspinet.org
- -nonprofit “food police” address dietary supplement controversies
-price $24/year or $42/24 months, to order fax 202.265.4954,
Useful Websites
-www.quackwatch.com
-www.consumerlab.com -analytical reports on specific products
-www.americanbotanicalsociety.com or www.herbalgram.org (Mark Blumenthal)
-www.nccam.nih.gov/health/
-www.ific.org/publications/other/driupdateom.cfm.
-www.mskcc.org/mskcc/html/11570.cfm.
-www.asahq.org-“Herbals and Anesthesia” brochure for sale