Herbalism A Tradition of Healing

1. HerbalismA Tradition of Healing Linda Diane Feldt RPP, NCTMB, NC, RPE Holistic Health Practitioner and Herbalist

2. Outline of this presentation • Why herbology matters to conventional practitioners • Certification of • Herbs • Practitioners • Developing studies and evidence • Problems in design and standardizing plants • Parts of the plant, Harvesting, Preparations • Effects of herbs • Nourishing • Medicinal • The plants • Popular • Local • Case Studies

3. Herbology and Conventional Medicine • Herbs are one of the most popular forms of CAM • Consumers both self treat and don’t report use to medical professionals • Big money marketing is becoming a larger influence • The history of herbal use is greater than 10,000 years - we have a lot to learn from experience

4. Certification Confusing to everyone

5. Certification of Herbs • Contents are unadulterated and properly labeled • Manufacturing process is acceptable • Does not address potency, preparation, or if the active plant part is harvested in the right season. • Standards vary, may be random, samples may be submitted, most agencies charge for certification

6. The bad Prone to consumer confusion Does not ensure potency Does not address processing or preparation Does not address safety of the herb Expense may prohibit good companies from using certification The good Helpful to ensure WYSIWYG Raising awareness of importance of herbal quality Important to ensure Good Manufacturing Practices (GMP) are used Can address the real problem of contamination Herbal certification

7. Reputable companies • Harvest ethically • Employ herbalists and support professional associations • Provide access to information on • where plants are harvested - avoid non US unless using TCM • company philosophy - focus on herbs or marketing? • control of product - don’t just repackage or rebottle from suppliers • Multi-level marketing deserves special scrutiny • Certification is helpful, but is only part of the whole picture. Smaller companies will not be able to afford the process, less popular herbs are less likely to be certified.

8. HerbPharm Frontier Pacific Botanicals Trout Lake Botanicals Scientific Botanicals Phytopharmica Naturopathic Formulary Thorne Research Eclectic Institute MediHerb Bezweken Women's Transition Wise Women Herbals And ?? Examples of companies

9. Certification of Herbalists • Traditional Healers • Native American, Ayurvedic, Tibb, Unani, Tibetan, etc • Traditional Chinese • Western Folkloric • Western Scientific • Earth-centered • Ethno-botanical example categories from the American Herbalist Guild

10. Herbalism Training and Education • College and University courses • Electives within schools that teach wellness, holistic health, bodywork or somatic practices • Apprenticeship programs both formal and informal • Correspondence courses

11. Herbalism Training and Education (cont.) • Traditional initiation and training often combined with religious/spiritual practices • Self taught • Promotional material and workshops provided by manufacturers • Multi level marketing materials • Certification provided by herb manufacturers

12. Western Folkloric Tradition • Promotes ethical harvesting of plants • Uses whole parts of plant, in season • Encourages consumer involvement

13. Western Folkloric Tradition • Emphasis is on nutritive value of herbs • Priority given to local plants, and what is readily available • Uses a holistic approach to support the individual and systems of the body

14. Western Folkloric Tradition • Encourages sharing of information, stories, experiences, and methods • Can easily work in a supportive role with conventional Western Medicine

15. The Big Questions Dangers, concerns, and evidence

16. Are Herbs Dangerous? • Adulteration and contamination • Misuse, use in place of more effective therapies • Ineffective preparations • Self medication, misinformation, • Drug, surgery and therapy interactions • Minimal reporting of adverse events from herbs • Misdirection of resources esp. time and money • Poisonous plants • Combination herbal formulas difficult to track, learn what is effective, what may create reactions • Long term use may mask disease serious illness

17. Common Concerns • Dose and strength may vary with plant and preparation method • No government control/approval • Anecdotal evidence lack of studies • Significant focus on using herbs for cleansing and purifying, often based on faulty information and myths

18. Research Research on herbs is different than typical drug research • The most extensively used herbs and formulas are not patentable • Standardization can be difficult with many preparations • Blinding is difficult when herbs have strong tastes or odors • When used holistically, different herbs might be suggested for the same symptoms, or combined in different ways on a case by case basis • Potency is affected by preparation, harvesting, and other factors researchers may not be aware of

19. Herbal Basics What to use when and how

20. Herbal Basics - what part to use • Roots - alkaloids concentrated, more toxic (esp. perennials) • Leaves - nutrient rich, less toxic • Bark - nutrient rich, less toxic • Seeds - often toxic, (annuals and biennials less so), varied components • Flowers - rarely toxic, often used topically --Please note these are guidelines only, there are always exceptions.

21. Herbal Basics - when to harvest • Roots - spring and fall when alkaloids are concentrated in root • Leaves - best before flowering begins • Bark - spring, fall harvest may damage tree • Seeds - when fully developed • Flowers - when fully developed --Please note these are guidelines only, there are always exceptions.

22. Herbal Basics - the preparations • Capsules and pills are most common, and least effective unless made with extracts • Infusion and decoction especially for nourishing effects • Tincture, vinegar, and oil • Poultice, compress • Salve, bolis, • Inhaled by smoking, smudge, vapor, essential oil

23. Nourishing and Medicinal Herbs Two different ways herbs can be used

24. Medicine or Food? • In traditional herbalism plants are used for both • Substantial healing can occur by nourishing the body or systems of the body • Many herbs occupy both roles • The nourishing herbs are far less likely to have unwanted side effects • Weeds in Michigan are often higher in available nutrients than conventional foods

25. Nourishing herbs • Nutrient rich • Bio-available • Generally considered safe, side effects uncommon • Dosage and strength less important • Tend to be local, whole, and common • Large amounts used, in contrast to medicinal plants • Includes tonics • Supportive to body systems • Long term use is usually beneficial

26. Nourishing Herbs cont. • Infusions provide readily absorbable nutrients, vary with herb used. • Nettle urtica provides protein, calcium and iron. Esp. helpful for anemia, pregnancy (3rd trimester) • Red Clover mineral rich • Oatstraw appears to provide trace minerals helpful for endocrine system, some evidence affects fertility • Anecdotal information is very positive for using specific infusions to help with allergies, infertility, poor nutrition, blood sugaring balancing, and many other problems.

27. Nourishing Herbs cont. • Internal use • Infusions • Water based • Vinegar based • Whole plant • Cooked • Raw (salad) • External use • Compress • Poultice • Salve • Oils - essential oils and infused oils

28. Medicinal Herbs • Dosage and strength important or critical • Tend to utilize more toxic parts of plant • Stimulate or sedate • More likely to have side effects • Are often plants that are less common, or rare • Long term use is generally discouraged • More extensive knowledge is needed to use safely and effectively

29. Medicinal Herbs cont. • Internal Use • Tinctures • Extracts provided in capsules or other • Standardized components of plants • Drug preparations derived from plants • Injections of extracts • Capsules (not necessarily effective) • External Use • Poultice, compress, bolis • Salves • Oils

30. Popular Herbs

31. Ginkgo biloba St. John’s wort Garlic Echinacea Goldenseal Saw palmetto Milk thistle Black cohosh Ginger Valerian The Herbs

32. Most ancient tree known Uses: cerebral insufficiency, Alzheimer’s Ds, intermittent claudication, tinnitis Powdered leaves Tincture or infusion Ginkgo biloba

33. Ginkgo • Increases vascular flow • diabetic peripheral vascular disease • Raynauds syndrome • Other circulatory benefits fro varicose veins, hemorrhoids, eye disorders • Affinity for cerebral circulation • Inhibits platelet activity factor

34. Ginkgo • Used to relieve tension, anxiety, elevate mood • Contains flavanoids, terpene lactones, ginkgolides A, B, and C, bilobalide, quercetin, and kaempferol. • ginkgolides control allergic inflammation, anaphylactic shock and asthma • antioxidant

35. What to watch for • Can increase blood flow • Discontinue before surgery • Do not use with menstrual flooding • Do not use with other bleeding problems (ulcer, bruising, etc.) • Not suggested with blood thinners, aspirin, etc.

36. 52 week RCT, double blind, multi-center Outcomes in 309 pts (ITT): Pt cognition: tx no change, placebo worse (p=0.04) Caregiver assess: tx slight improve, placebo worse (p=.004) Dose: 120 mg/d of EGb 761 Safety: side effects equal Problems: high dropout rate (50% tx, 62% placebo) Gingko biloba & Dementia

37. Ginkgo & Claudication • Meta-analysis of Egb 761 • 5 placebo controlled trials • Moderate to large effect (0.75 Cohen’s d) on pain-free treadmill walking distance Schneider B. Arzneimforsch 1992;42(4):428-436

38. Ginkgo - Toxicology • Adverse events • GI complaints • bruising & spontaneous bleeding • Avoid if taking warfarin, heparin, or NSAIDs • Can increase insulin levels • May increase sedation with trazodone

39. St. John’s Wort Hypericum Perforatum Used as tincture, extract in pill form, topically as oil or salve Popular as anti-depressant. Also used for muscle aches, nerve pain, nerve regeneration, for herpes outbreaks, bruising

40. St. John’s Wort • Utilizes P450 Cytochrome system • Can interfere with effectiveness of other medications • Possible rash from exposure to sun (sheep and cows) • Use with other mood altering drugs of concern • Use by people with manic depressive and other psychological conditions of concern

41. St. John’s Wort & Depression • Meta-analysis: 23 studies, 1757 pts • Mild-mod depression • Superior to placebo, rrr =2.67 (1.78-4.01) • As effective as TCA’s , rrr=1.10 (0.93-1.31) • Fewer side effects than TCA’s • Dose: 0.4-2.7 mg Hypericin (standardized extract) • Multi-center trial vs. SSRI’s at Duke Linde K, et al. BMJ 1996;313:253-8

42. St. John’s Wort - Toxicology • Side effects • Theoretical risk - sunburn • Herb-drug interactions • Studies - digoxin, protease inhibitors, TCAs • Case reports - cyclosporine, warfarin, oral contraceptives, theophylline, SSRIs • Theoretical - iron Facts & Comparisons Review of Natural Products, Dec 2000.

43. Garlic (Allium sativum) • Uses • Lower cholesterol • anti-thrombotic • lower blood pressure • anti-microbial agent • Strengthen heart muscle • Reduce platelet clumping and clotting • Stabilize blood sugar levels

44. Garlic • Some caution about use if bleeding is of concern • Odor • Large amounts can great gas • Potential decreased platelet aggregation

45. Garlic • Contains alliin in intact garlic bulb • Alliin  allicin (crushed) • 600 – 900 mg of dried powder (1.3% allicin)

46. Garlic - Evidence • German Commission E • elevated blood lipids • prevention of age-related vascular changes • 25 studies between 1979-1998 with 2,920 people • Mixed results highly dependent on type of garlic preparation

47. Garlic - Evidence • 2 Meta-analyses • garlic lowered total cholesterol between 9-12% • Meta-analysis • Anti-hypertensive - 10% reduction • Double blind RCT - 152 subjects for 4 years • garlic reduced development of atherosclerosis

48. Echinacea spp. • E. pallida purpurea angustifolia • Use: prevention and treatment of colds, flu,immune system support • One of most popular herbs in US • German Commission E • supportive for colds, chronic URI, UTI • UK - GSL

49. Echinacea • Stimulating dose not advised with autoimmune and some systemic diseases • Can interfere with immune suppression during chemotherapy treatment • Stimulating dose should be short term (3-4 days) only • No known side effects • Concern with steroid treatment - depends on use

50. Echinacea - Human Evidence • 26 controlled trials (many open label) • 3 blinded RCT’s on URI • 1 showed dose dependent decrease in symptoms and duration of “flu” • 2 showed 13-20% relative risk reduction of acquiring URI • Dose: 30-60 gtts 1:5 (g/ml) tincture TID • Species, method of preparation and dose of concern with recent trials