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Botanical (Herbal) Medicine

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Is the use of plants for their therapeutic or medicinal value.



Herbs Preparation vs Purpose
Standardized vs. Whole Herb
Interaction between Herbs, Foods and Drugs
Drug Interaction and Food


Herbal Medicine, sometimes referred to as Herbalism or Botanical Medicine is the oldest form of healthcare known to
mankind. Dates back to the beginnings of civilization and is the foundation of modern pharmacology.
An herb is a plant or plant part valued for its medicinal, aromatic or savory qualities. Herb plants produce and contain a
variety of chemical substances that act upon the body.

The medicinal use of plants seems to have been developed  by trial and error. Much of the pharmacopoeia of scientific
medicine was derived from the herbal lore of native peoples. They methodically collected information on herbs and
developed well-defined herbal pharmacopoeias.  Many drugs commonly used today are of herbal origin. Indeed, about
25 percent of the prescription drugs dispensed in the United States contain at least one active ingredient derived from
plant material. Some are made from plant extracts; others are synthesized to mimic a natural plant compound.

The World Health Organization (WHO) estimates that 4 billion people, 80 percent of the world population,
presently use herbal medicine for some aspect of primary health care.  WHO notes that of 119 plant-derived pharmaceutical medicines, about 74 percent are used in modern medicine in ways that correlated directly with their traditional uses as plant medicines by native cultures. Major pharmaceutical companies are currently conducting extensive research on plant materials gathered from the rain forests and other places for their potential medicinal value.

Substances derived from the plants remain the basis for a large proportion of the commercial medications used today
for the treatment of heart disease, high blood pressure, pain, asthma, and other problems. For example, ephedra is a herb
used in Traditional Chinese Medicine for more than two thousand years to treat asthma and other respiratory problems.
Ephedrine, the active ingredient in ephedra, is used in the commercial pharmaceutical preparations for the relief of asthma 
and other respiratory problems. It helps the patient to breathe more easily.

Interest in herbal medicine  had been growing in the recent years from the reported success stories from the use of herbs.
For example, St. John's Wort is widely used in the treatment of mild depression without the need for Prozac.
St. John's Wort does not have the side effects such as that of Prozac. 
Similarly the popularity of Ginseng and Ginkgo biloba (ginkgo) is rising due to its beneficial effects.

Today's naturopath bases an herbal prescription on the traditional uses as well as the ever increasing scientific research
and literature available on herbs. The use of herbs may be in the form of teas, tinctures, fluid extracts or tablets.
Herbal preparation may contain one or a combination of herbs to address the individual patients' needs.

Herbs Preparation vs Purpose.

Herbs can be prepared in a variety of forms depending on their purpose. Such techniques include:

Juice squeezed from herbs.
Mashing herbs into a paste.
Decoction or extracting the active ingredients by boiling down the herb in water.
Hot infusion (like hot tea)- Herb is steeped in hot water.
Cold infusion (like sun tea) - Herb is steeped in cold water.
Herbs ground into a powder and used as such or as compressed into a pill.
Herbal wine made by adding the herb to water and sugar and letting it ferment.
Tincture, made by combining ground herbs with alcohol, glycerin or vinegar and used internally.
Liniment - Made like a tincture except it is used externally.
Salves and ointments made by adding herbs to a medium such as petroleum jelly.
Syrups - Made by adding herb to a medium such as honey, sugar or glycerin.
Poultice - Herb is applied directly to a wound or body part and held in place with a cloth.
Herbal Oil - Usually made with common base oil, such as olive, almond, grape seed, or sesame oils.
The herb is allowed to sit in the oil for a week. It is strained and bottled.

In general, delicate leaves and flowers are best infused. Boiling may cause them to lose the volatile essential oils.
Roots, barks, and seeds are best made into decoctions.

Standardized vs. Whole Herb

A standardized extract means that the manufacturer has verified that the active ingredient believed to be present in the herb
is present in the preparation and that the potency and the amount of the active ingredient is assured in the preparation.
The problem is that, the action of the herb may be from a number of constituents and not from just one or two ingredients.
Thus, the standardized preparation may omit some of the ingredients and we will lose out on the effect from the complex combination of the constituents.

When Herbs and Foods are taken  with Drugs

Many people have the mistaken notion that, being natural, all herbs and foods are safe. This is not so.
Very often, herbs and foods may interact with medications resulting in serious side reactions.
It is always a good practice to tell your health practitioner what you are taking so that they can advise you of possible complications, if there is any. You should also keep an eye for unusual symptoms. Very often, this may foretell the symptoms
of a drug interaction.

Experts suggest that natural does not mean it is completely safe. Everything you put in your mouth has the potential to interact
with something else. The medication that is taken by mouth travels through the digestive system in much the same way as food
and herbs taken orally do. So, when a drug is mixed with food or another herb, each can alter the way the body metabolizes
the other. Some drugs interfere with the body's ability to absorb nutrients.
Similarly, some herbs and foods can lessen or increase the impact of a drug.

For example, alcohol is a drug that interacts with almost every medication, especially antidepressants and other drugs
that affect the brain and nervous system.
Some dietary components increase the risk of side effects. Theophylline, a medication administered to treat asthma,
contains xanthines, which are also found in tea, coffee, chocolate, and other sources of caffeine.
Consuming large amounts of these substances while taking theophylline increases the risk of drug toxicity.
Certain vitamins and minerals impact on medications too. Large amounts of broccoli, spinach, and other green leafy vegetables
high in vitamin K, which promotes the formation of blood clots, can counteract the effects of heparin, warfarin, and other drugs given to prevent clotting.
Dietary fiber also affects drug absorption. Pectin and other soluble fibers slow down the absorption of acetaminophen,
a popular painkiller. Bran and other insoluble fibers have a similar effect on digoxin, a major heart medication.

High-risk patients, such as the elderly, patients taking three or more medications for chronic conditions,
patients suffering from diabetes, hypertension, depression, high cholesterol or congestive heart failure,
should be especially on the lookout for side reactions.

Interaction between Herbs, Foods and Drugs

The following are the examples of known interaction between popular herbs, foods, and prescription and
over-the-counter drugs.

Hawthorn, touted as effective in reducing angina attacks by lowering blood pressure and cholesterol levels,
should never be taken with Lanoxin (digoxin), the medication prescribed for most for heart ailments.
The mix can lower your heart rate too much, causing blood to pool, bringing on possible heart failure.

Ginseng, according to research, can increase blood pressure, making it dangerous for those trying to keep
their blood pressure under control. Ginseng, garlic or supplements containing ginger, when taken with the blood-thinning drug, Coumadin, can cause bleeding episodes. Coumadin is a very powerful drug that leaves little room for error, and patients taking it should never take any medication or otherwise before consulting a qualified health professional.
In rare cases, ginseng may overstimulate resulting in insomnia. Consuming caffeine with ginseng increases the risk of
overstimulation and gastrointestinal upset. Long tern use of ginseng may cause menstrual abnormalities and breast tenderness
in some women. Ginseng is not recommended for pregnant or lactating women.

Garlic capsules, combined with diabetes medication can cause a dangerous decrease in blood sugars.
Some people who are sensitive to garlic may experience heartburn and flatulence. Garlic has anti-clotting properties.

Goldenseal is used for coughs, stomach upsets, and even arthritis. However, the plant's active ingredient will raise blood pressure, complicating treatment for those taking antihypertensive medications, especially beta-blockers.
For patients taking medication to control diabetes or kidney disease, this herb can cause dangerous electrolyte imbalance.
High amount of consumption can lead to gastrointestinal distress and possible nervous system effects.
Not recommended for pregnant or lactating women.

Feverfew, believed to be the natural remedy for migraine headaches, should never be taken with Imitrex or other migraine medications. It can result in the patient's heart rate and blood pressure to rise dangerous levels.

Guarana, an alternative remedy being used as a stimulant and diet aid, contains 3 percent to 5 percent more caffeine than
a cup of coffee. So, if you are taking any medication that advises you against taking any drink with caffeine,
you should avoid taking this stimulant. It may cause insomnia, trembling, anxiety, palpitations, urinary frequency,
and hyperactivity. Avoid during pregnancy and lactation period.
Long term use of Guarana may lead to decreased fertility, cardiovascular disease, and several forms of cancer.

Kava, a herb that has antianxiety, pain relieving, muscle relaxing and anticonvulsant effects, should not be taken together
with substances that also act on the central nervous system, such as alcohol, barbiturates, anti depressants, and antipsychotics.

St. John's Wort is a popular herb used for the treatment of mild depression.
The active ingredient of St. John's Wort is hypericin. Hypericin is believed to exert a similar influence on the brain as
the monoamine oxidase (MAO) inhibitors such as the one in major antidepressants.
Mixing MAO inhibitors with foods high in tyramine, an amino acid, produces one of the most dramatic and dangerous
food-drug interactions. Symptoms, which can occur within minutes of ingesting such foods while taking an MAO inhibitor,
include rapid rise in blood pressure, a severe headache, and perhaps collapse and even death.
Foods high in tyramine include aged cheese, chicken liver, Chianti (and certain other red wines), yeast extracts,
bologna (and other processed meats), dried or pickled fish, legumes, soy sauce, ale, and beer.

White Willow, an herb traditionally used for fever, headache, pain, and rheumatic complaints may lead to
gastrointestinal irritation, if used for a long time. It exhibits similar reactions as aspirin (aspirin is derived from white willow).
Long term use may lead to stomach ulcers.

Drug Interaction and Food

Drug interaction risk isn't limited to herbal supplements. Certain foods can interact with medications.

People taking digoxin should avoid Black licorice (which contains the ingredient glycyrhizin).
Together, they can produce irregular heart rhythms and cardiac arrest; licorice and diuretics will produce dangerously low potassium levels, putting a patient at risk for numbing weakness, muscle pain and even paralysis.
Licorice can also interact with blood pressure medication or any calcium channel blockers.

Aged cheese (brie, parmesan, cheddar and Roquefort), fava beans, sauerkraut, Italian green beans, some beers, red wine, pepperoni and overly ripe avocados should be avoided by people taking MAO antidepressants.
The interaction can cause a potentially fatal rise in blood pressure.

And because Saint Johns Wort contains the same properties as these MAO antidepressants, it stands to reason that people ingesting the herb should avoid these same foods.

Grapefruit juice interacts with calcium channel blockers (including Calan, Procardia, Nifedipine, and Verapamil),
cholesterol control medications, some psychiatric medications, estrogen, oral contraceptives and many allergy medications (Seldane, Hismanal). The juice modifies the body's way of metabolizing the medication, affecting the liver's ability to work
the drug through a person's system.

Orange juice shouldn't be consumed with antacids containing aluminum. 'The juice increases the absorption of the aluminum. Orange Juice and milk should be avoided when taking antibiotics. The juice's acidity decreases the effectiveness of antibiotics,
as does milk.

Milk also doesn't mix with laxatives containing bisacodyl (Correctol and Dulcolax).
You might find the laxative works a little "too well" in the morning.

Large amounts of oatmeal and other high-fiber cereals should not be eaten when taking digoxin. The fiber can interfere with the absorption of the drug, making the act of swallowing the pill a waste of time.

However, don't stop eating your cereal right away, because that could cause digoxin levels in your system to soar to toxic levels.
A professional should make the dietary changes after carefully examining the digoxin levels.

Leafy green vegetables, high in vitamin K, should not be taken in great quantities while taking Coumadin.
These vegetables could totally negate the affects of the drug and cause blood clotting.

Caffeinated beverages and asthma drugs taken together can cause excessive excitability. Those taking Tagament (Simetidine), quinolone antibiotics (Cipro, Penetrex, Noroxin) and even oral contraceptives should be aware these drugs may cause
their cup of coffee to give them more of a Java jolt than they expected.

Grilled meat can lead to problems for those on asthma medications containing theophyllines.
The chemical compounds formed when meat is grilled somehow prevent this type of medication from working effectively,
increasing the possibility of an unmanageable asthma attack.

Regularly consuming a diet high in fat while taking anti-inflammatory and arthritis medications can cause kidney damage
and can leave the patient feeling, drowsy and sedated.

Alcoholic beverages tend to increase the depressive effects of medications such as benzodiazepines, antihistamines,
antidepressants, antipsychotics, muscle relaxants, narcotics, or any drug with sedative actions.

It's a good idea to not consume any alcoholic beverages, or at least scale way back, when taking prescription medications. Antioxidant and beta-carotene intensify alcohol's effect on the liver.

Other commonly used over-the-counter medications can cause interaction problems also.

Aspirin can modify the effectiveness of arthritis medications, strong prescription steroids and diuretics.
Combining aspirin with diabetic medications can drop blood sugars to dangerous levels.
Aspirin can also cause toxicity when taken with glaucoma and anticonvulsant (anti-seizure) drugs and cause
bleeding episodes when combined with a blood thinner, like Coumadin.

Acetaminophen can also cause interaction complications when overused. Heavy drinkers who take acetaminophen for hangover relief risk liver damage. Taking high doses of acetaminophen with Coumadin can cause bleeding episodes.

Antacids taken with antibiotics, heart and blood pressure or thyroid medications can decrease drug absorption
by up to 90 percent.

Over-the-counter antihistamines - sold under the names Actifed, Theraflu, Dimetapp, Benadryl and Comtrex should be avoided
if you are taking antianxiety or antidepressant medications.

Oral contraceptives are less effective when taken with barbiturates, antibiotics, anti-fungal or tuberculosis drugs.

Turnips contain two goitrogenic substances, progoitrin and gluconasturtin, which can interfere with the thyroid gland's ability to make its hormones. Although moderate consumption of goitrogens is not a hazard for healthy people, they can promote development of a goiter (an enlarged thyroid) in persons with thyroid disease.

Tomato contains small quantities of a toxic substance known as solanine that may trigger headaches in susceptible people.
They are also a relatively common cause of allergies. An unidentified substance in tomatoes and tomato-based products can
cause acid reflux, leading to indigestion and heartburn.
Individuals who often have digestive upsets should try eliminating tomatoes for 2 to 3 weeks to see if there is any improvement.

Strawberries, Raspberries, Spinach, and Rhubarb: These contain oxalic acid, which can aggravate kidney and bladder stones
in susceptible people, and reduce body's ability to absorb iron and calcium.

Raspberries contain a natural salicylate that can cause an allergic reaction in aspirin sensitive people.

The seeds from fruits such as Apple, apricot, and Quinces contain amygdalin, a compound that turns into
Hydrogen Cyanide in the stomach. Eating large amount of seeds can result in cyanide poisoning.

Potatoes: Avoid potatoes with a green tint to the skin, and remove any sprouts; they will taste bitter and may contain solanine,
a toxic substance that can cause diarrhea, cramps, and fatigue.

Plums, Peaches, Apricots, and Cherries: These fruits may produce allergic reaction in individuals with confirmed allergies to apricots, almonds, peaches, and cherries. People who are allergic to aspirin may also encounter problems after they
have eaten plums or peaches as they contain salicylates. The pits of plums, peaches and apricots contain a compound called amygdalin.  When consumed in large amounts, amygdalin breaks down into hydrogen cyanide, a poison.

Horseradish: Very high doses of horseradish can cause vomiting or excessive sweating. Avoid if you have hypothyroidism.

Turmeric: Should be avoided by persons with symptoms from gallstones.


To discuss your situation in more detail:
Contact Dr. Comas
tel: (416) 515-8493

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