Last week, the Journal of the American Medical Association (JAMA) published an article warning of the dangers of using herbal remedies around the time of surgery. The study draws attention to the fact that herbs do have real biochemical and physiological effects in the body, and there is a need for individuals taking them to disclose this to their doctors. There is a considerable amount of scientific research which demonstrates that therapeutic herbs can offer considerable health benefits, and are generally very safe. However, they are not entirely without risk. What follows is a guide to the safe use of our favourite herbal remedies.
One herbal remedy which has grown massively in popularity over the last few years is Echinacea. Studies show that Echinacea (mainly the angustifolia and purpurea species) has the ability to stimulate the immune system and is effective in treating viral infections such as cold and flu. The normal recommended dose is 3 – 4 ml of tincture (alcoholic extract) or 300 mg of powdered herb (in tablet or capsule form) taken three times a day at the first sign of an infection. Treatment normally lasts for 10 ” 14 days. Echinacea is generally safe, but can very occasionally give rise to an allergic reaction. Because of its immune-stimulating effects, there has been some question over whether echinacea can be used in conditions where the immune system is reacting against the body’s own tissues (autoimmune illness) such as rheumatoid arthritis. However, this risk is theoretical, and there is actually no evidence for problems here. Echinacea is safe to use around the time of surgery, and can be used during pregnancy and breast-feeding.
Another popular herb for helping to stave off infection is garlic, which has proven antibacterial and antiviral properties. Regular garlic consumption has also been linked with a reduced risk of heart disease and certain cancers. A raw clove of garlic, or 600 ” 900 mg of a standardised garlic preparation each day seems to be a safe and effective dose for most people. The main concern over garlic comes from the fact that it is known to have blood-thinning properties and may therefore increase the risk of bleeding. For this reason, it should be used with caution by individuals taking blood-thinning medication such as warfarin or dipyridamole. To reduce the risk of unwanted bleeding, garlic should be discontinued a week prior to surgery. Garlic is safe to use during pregnancy and breast-feeding.
Another herb which is gaining increasing recognition for it’s beneficial effects is Ginkgo biloba. Ginkgo has circulation enhancing activity in the body, and has been used for a wide variety of conditions including poor memory, peripheral vascular disease (narrowed arteries in the legs), macular degeneration (a common cause of visual deterioration), vertigo, tinnitus (ringing in the ears) and impotence. The normal recommended daily dose is 120 ” 240 mg of standardised Ginkgo extract containing 6 p.c. terpene lactones and 24 p.c. flavone glycosides (believed to be the main active ingredients). Ginkgo is generally safe, but does have a mild blood-thinning effect. Although experimental studies have not shown any increase in bleeding risk, should be used with caution in individuals taking blood-thinning medication. It is also prudent to discontinue Ginkgo two days prior to any surgery. Ginkgo is safe to take during pregnancy and breast-feeding.
In today’s fast-paced culture, stress and fatigue can be perennial problems for many of us. Panax ginseng is one natural ‘tonic’ which has become popular for combating these problems. The normal recommended daily dose is 100 ” 200 mg of ginseng containing 5 ” 7 p.c. ginsenosides (believed to be the main active ingredients). It is generally recommended that Panax ginseng is taken for two to three weeks, followed by a 1 or 2 week ‘rest’ period before resuming. Panax ginseng has some blood-thinning properties and should be used with caution in individuals taking anti-clotting medication such as warfarin. Panax ginseng is thought to have a mild hormone-like effect and may cause breast tenderness and menstrual irregularity in some women. It is not recommended for use during pregnancy and breast-feeding.
Stress is also well known to increase the risk of sleeplessness. Valerian (Valeriana officinalis) is most commonly used herbal treatment for this problem. The normal recommended dose is 300 – 500 mg of concentrated valerian root extract taken ½ – 1 hour before bedtime. Valerian is a very safe herb which does not lead to addiction or appear to impair ability to drive or operate machinery. However, it is generally advised that it is not used with other conventional sleep-inducing medication or tranquillisers. It is safe to use around the time of surgery and during pregnancy or breast-feeding.
Another useful sedative herb is Kava kava. This herb can reduce the symptoms of anxiety, an effect which is supported by several scientific studies. Kava kava is also known to have muscle-relaxant and pain-relieving properties. The chief active ingredient in Kava kava is a group of substances known as the kavalactones. The normal recommended dose is 100 mg of Kava kava (standardised to contain 70 p.c. kavalactones), taken three times a day. Kava kava exerts a biochemical effect on the brain, and its use should therefore be avoided in individuals taking other ‘psychoactive’ agents such as tranquillisers (e.g. diazepam) and antidepressants. Because Kava kava can theoretically affect sedatives used around the time of an operation, it is recommended that it is stopped a day before surgery. For everyday use, Kava kava is very safe, and does not appear to impair function or cause addiction at the recommended dose. It is not, however, recommended for use during pregnancy and breast-feeding.
Another natural substance which can help with mood-related issues is St John’s Wort (Hypericum perforatum). This herb has been shown to be as effective as some commonly used antidepressants in treating depression, but with far fewer side-effects. The normal recommended dose is 300 mg of the herb, taken three times a day. Theoretically, St John’s Wort can make the skin more sensitive to sunlight, though this does not appear to be a concern in practice. St John’s Wort can reduce the level of some conventional drugs including cyclosporine (a drug used to help prevent rejection after transplant), digoxin, amitriptyline (an antidepressant), theophylline (used to treat respiratory disorders), indinavir (used in the treatment of HIV) and warfarin. Individuals taking these drugs should avoid using St John’s Wort. It is believed that St John’s Wort may reduce levels of oestrogen in the body, which can very rarely cause bleeding between periods. A reduction of oestrogen levels may also, theoretically, reduce the effectiveness of the oral contraceptive pill. There have been five reports of women who have fallen pregnant while taking the Pill and St John’s Wort. However, the Pill is not 100 p.c. effective and there is therefore no assurance that these unplanned pregnancies were caused by St John’s Wort. Nevertheless, women taking the Pill should consult their doctor before taking St John’s Wort. St John’s Wort should not be taken with other antidepressant or tranquillising medication unless under the supervision of a doctor. Because it is not know whether St John’s Wort is safe for use during pregnancy or breast-feeding, it should be avoided at these times.
