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PubMed2001

The methodological quality of randomized controlled trials of homeopathy, herbal medicines and acupuncture.

BACKGROUND: To investigate the methodological quality of randomized controlled trials in three areas of complementary medicine. METHODS: The methodological quality of 207 randomized trials collected for five previously published systematic reviews on homeopathy, herbal medicine (Hypericum for depression, Echinacea for common cold), and acupuncture (for asthma and chronic headache) was assessed using a validated scale (the Jadad scale) and single quality items. RESULTS: While the methodological quality of the trials was highly variable, the majority had important shortcomings in reporting and/or methodology. Major problems in most trials were the description of allocation concealment and the reporting of drop-outs and withdrawals. There were relevant differences in single quality components between the different complementary therapies: For example, acupuncture trials reported adequate allocation concealment less often (6% versus 32% of homeopathy and 26% of herb trials), and trials on herbal extracts had better summary scores (mean score 3.12 versus 2.33 for homeopathy and 2.19 for acupuncture trials). Larger trials published more recently in journals listed in Medline and in English language scored significantly higher than trials not meeting these criteria. CONCLUSION: Trials of complementary therapies often have relevant methodological weaknesses. The type of weaknesses varies considerably across interventions.

Acupuncture Therapy↗

PubMed2000

Alternative medicine use in presurgical patients.

BACKGROUND: A dramatic increase in the use of complementary and alternative medicines has been observed. The use of such remedies in the presurgical population has implications for the anesthesiologist because of the potential for drug interactions, side effects, and medical liability. This study was undertaken to quantify the use of herbal remedies and vitamins in the presurgical population of a large tertiary care center. METHODS: A one-page questionnaire was distributed to all patients presenting for evaluation in the preoperative clinic over an 11-week period. Patients answered questions regarding use of prescription and nonprescription medications, herbal remedies, and vitamins. RESULTS: Twenty-two percent of presurgical patients reported the use of herbal remedies, and 51% used vitamins. Women and patients aged 40-60 yr were more likely to use herbal medicines. Over-the-counter medication use was strongly associated with herbal preparation use. The most commonly used compounds, from highest to lowest, included echinacea, gingko biloba, St. John's wort, garlic, and ginseng. CONCLUSIONS: Alternative medicine use is common in the preoperative period.

Adult↗

PubMed2001

Interactions of herbal remedies with prescription cardiovascular medications.

Herbal medicinal use has increased dramatically in recent years. The increasing use of these products is of concern, and their use may not be recognized by the treating physicians. Many of these remedies have potential for adverse interactions with medications commonly prescribed for various cardiovascular disorders. Despite their widespread use, limited data exists regarding the efficacy of herbs such as echinacea, garlic, ginseng, gingko, ephedra, and St. John's wort. Of special concern is the ability of herbal remedies to potentiate effects of prescription drugs with a narrow margin of safety. An increasing awareness of the potential for harmful effects of herbal remedies has given the impetus for aggressive interventions to inquire about the use of these agents and systematic reporting of adverse events emanating from their use. This review briefly summarizes important adverse interactions of commonly used herbal remedies with prescription cardiovascular medications.

Cardiovascular Agents↗

PubMedDate not supplied

Botanical dietary supplement use in peri- and postmenopausal women.

OBJECTIVE: To determine use of botanical dietary supplements (BDS) in women between the ages of 40 and 60 years at the University of Illinois at Chicago (UIC) clinics, including information about commonly used BDS, the reason for use, information resources used, and the overall perception of safety and efficacy of BDS. DESIGN: Five hundred female outpatients at UIC clinics were interviewed by healthcare practitioners using a botanical/drug history questionnaire. Respondents were 46.8% African American, 39.6% Caucasian, 11.7% Hispanic, and 1.5% Asian, with a mean age of 50.34 years. RESULTS: BDS were used by 79% of respondents ( = 395), of which 36.5% used BDS daily. Of the positive respondents, 51.7% used one or two BDS, whereas 48.4% used three or more. Commonly used botanicals included soy (42%), green tea (34.68%), chamomile (20.76%), gingko (20.51%), ginseng (17.97%), Echinacea (15.44%), and St. John's wort (7.34%). Black cohosh, garlic, red clover, kava, valerian, evening primrose, and ephedra were used by less than 15% of respondents. Efficacy ratings were high for BDS, and 68% claimed to have no side effects. Only 3% of respondents obtained BDS information from healthcare professionals, and 70% of respondents were not informing their physician of BDS use. CONCLUSIONS: A high percentage of women at UIC clinics were using multiple BDS. The respondents believed that these products were both safe and effective for the treatment of common ailments. Concomitant BDS use with prescription and over-the-counter medications was commonplace, often without a physician's knowledge. Consumer education about the possible benefits and risks associated with BDS use is urgently needed.

Adult↗

PubMed2005

Differences in herbal and dietary supplement use in the Hispanic and non-Hispanic pediatric populations.

BACKGROUND: Complementary and alternative medical therapies are becoming increasingly popular in the general population. OBJECTIVE: To describe the cultural differences in the use of herbal and dietary supplements in the Hispanic and non-Hispanic-Caucasian outpatient pediatric populations. METHODS: Questionnaires were administered over a 2-month period to a convenience sample of adolescents and parents of patients younger than 12 years, presenting to an emergency department, an urban private pediatric practice, and a community-based clinic. RESULTS: There were 643 surveys completed. Ethnic distribution was 65% Caucasian, 27% Hispanic, 2% Pacific Islander, and 1% each Asian, African American and Native American. Mean respondent age was 30.8 years. Mean child age was 4.6 years; 51% were male. Use of nonprescribed dietary supplements was significantly greater in Hispanic (33%) versus Caucasian children (9%) (P < 0.01); most commonly used supplements were herbal teas (56%) and echinacea (14%). More Hispanic respondents reported receiving information on herbal preparations from a family member compared with non-Hispanic patients (56.0% vs. 18.7%). Complementary and alternative medicine use had not been discussed with a health care provider by 38% of the total users and 47% of those thought it not important to do so. CONCLUSIONS: There is significant use of complementary and alternative medicine in the pediatric population, and herbal and dietary supplement use varies between Hispanic and Caucasian children. In addition, this dietary supplement use is often not discussed with health care providers. These factors should be taken into consideration by all health care providers.

Child↗

PubMed2025

Combination of cycling hyperthermia and echinacoside creates a synergistic curing effect on pancreatic cancer PANC-1 cells.

Therapy targeting the suppression of human MutT homolog 1 (MTH1) has been gaining ground in recent years, thanks to its resulting significant increase of 8-hydroxy-2'-deoxyguanosine triphosphate (8-oxo-dGTP) accumulation in genomic DNA, causing DNA damage and apoptotic cell death. Echinacoside (Ech), a natural phenylethanoid glycoside first extracted from Echinacea angustifolia or desert plant Cistanches, is one of a few natural products that are capable of inhibiting the MTH1 function. It, however, is difficult to apply it in clinical trials, due to high cost for effective dosage in need. In this study, we show that the integration of Ech with thermal cycling-hyperthermia (TC-HT), a novel physical treatment, significantly augments its anticancer efficacy while simultaneously decreasing the necessary dosage. Specifically, 20 μM Ech with TC-HT reduced human pancreatic carcinoma cell line PANC-1 viability to 29.6% of the control, comparable to 28.7% of the control by 100 μM Ech alone. The combined treatment reduced MTH1 expression to 0.42-fold, initiating oxidative damage and apoptosis. Notably, 8-oxo-dGTP increased to 3.67-fold of the control, indicating enhanced oxidative DNA damage and 31.8% apoptosis. This oxidative stress further influenced critical signaling pathways, as p-ERK and p-JNK shifted to 0.59- and 5.55-fold, respectively, indicating a switch from survival to apoptotic signaling. Concurrently, mitochondrial apoptotic markers Bax/Bcl-2 and cleaved poly (ADP-ribose) polymerase increased to 4.22- and 7.12-fold, respectively. These results indicate that its effect is expected to be comparable to the treatment strategy containing MTH1, Bcl-2, and extracellular signal-regulated kinase inhibitors, posing as new promising approach in cancer treatment.

DNA damage↗

PubMed2005

Impact of socio-demographic factors, knowledge and attitude on the use of herbal drugs in pregnancy.

BACKGROUND: Herbal drugs are often promoted as 'natural' and 'safe'. These claims may especially attract pregnant women who are often concerned about their unborn child's well-being. Few studies have assessed the use of herbal drugs in pregnancy and the factors related to this use. OBJECTIVE: To investigate the impact of socio-demographic factors, knowledge and attitude on the use of herbal drugs in pregnancy. METHODS: A total of 400 postpartum women at Ulleval University Hospital in Oslo, Norway were interviewed within 3 days after giving birth by using a structured questionnaire in the period from February to June 2001. RESULTS: In all, 36% of the women reported herbal use during their pregnancy. Both women who had used herbal drugs in pregnancy and those not, had a positive attitude toward the use of herbal drugs in pregnancy. Echinacea was the most well known herb among both groups of women. The factors associated with the use of herbal drugs in pregnancy were: prior use of herbs, high knowledge about herbal drugs and age between 26 and 35 years. There was a non-significant higher frequency of herbal drugs use in pregnancy among women with a higher education level. CONCLUSION: The widespread use and positive attitude toward herbal drugs in pregnancy indicates an increased need for documentation about both the efficacy and safety of herbal drugs in pregnancy. Women between 26 and 35 years with a prior history of herbal drug use and high knowledge about herbs, are more prone to using herbal drugs in pregnancy.

Adult↗

PubMed1990

Porcine granulocyte functions: evaluation and modulation.

Functions of porcine polymorphonuclear neutrophils are evaluated with in vitro test systems. Results are compared with those from human PMN and the relevance for in vivo conditions is discussed. Ethanol was inhibitory to all porcine PMN functions investigated here. Influex, a combination product, containing extracts of Echinacea, Aconitum, Apis and Lachesis stimulated adherence, chemotaxis, and phagocytosis, but inhibited chemiluminescence. These results suggest an effect of the product in the generation of reactive oxygen species.

Animals↗

PubMed2004

Herbal medicine use by children presenting for ambulatory anesthesia and surgery.

BACKGROUND: Herbal medicine use has become increasingly popular throughout the world. Some of these agents may have serious interactions with anesthetic drugs. Children may potentially be more vulnerable to such interactions because of altered drug handling. While the prevalence of herbal medicine use by children with some chronic illnesses has been estimated, the incidence of this in a population of otherwise healthy children admitted for minor ambulatory anesthesia and surgery is currently unknown. METHODS: Parents of 601 children presenting consecutively for ambulatory surgery were asked to complete a questionnaire detailing administration of herbal medicines to their child. RESULTS: This study identified that 6.4% of children were currently taking an herbal preparation; while a further 10.1% had taken an herbal medicine in the past. Echinacea and arnica were the commonest used herbal remedies. A significant number of children had taken agents which may interact with anesthesia and surgery: St John's Wort, valerian, garlic and gingko. Information on herbal medicines was mostly obtained by parents from nonmedical sources. CONCLUSIONS: A total of 16.6% of children had a current or past history of ingestion of herbal medicines. This finding may have implications for the perioperative management of children presenting for day-case surgery.

Adolescent↗

PubMed2005

Herbal and homeopathic medication use in pediatric surgical patients.

BACKGROUND: Patients who present for surgery may be using herbal or homeopathic preparations; adverse effects of some of these substances include bleeding, cardiovascular changes, and liver dysfunction. Little information is available on the frequency of use in the pediatric surgical population. METHODS: With institutional approval, a survey was conducted to assess the use of vitamins, nutritional supplements, or herbal or homeopathic preparations in children presenting for surgery in five geographically diverse centers in the USA. RESULTS: A total of 894 completed surveys showed that overall, 3.5% of pediatric surgical patients had been given herbal or homeopathic medications in the 2 weeks prior to surgery. Most substances were prescribed by parents. The use of these medications did not differ between children with coexisting diseases and those without; use was also not different among ethnic groups or by residence setting (city, suburban, rural). There was a significant difference between the west coast centers in the study compared with the rest of the country (7.5% of patients in Palo Alto, CA; 5.5% of patients in Seattle, WA; 1.5% of patients in Chicago, IL; and 1.9% in Virginia and Delaware used herbal or homeopathic remedies). The most prevalent substance given to children presenting for elective surgery was Echinacea. CONCLUSIONS: Herbal and homeopathic medications are used by a small percentage of pediatric patients presenting for elective pediatric surgery patients. Use of these substances should be addressed in the preoperative history.

Adolescent↗

PubMed2007

The induction of CYP1A2, CYP2D6 and CYP3A4 by six trade herbal products in cultured primary human hepatocytes.

The aim of this study was to evaluate the in vitro inductive potential of six commonly used trade herbal products on CYP1A2, CYP2D6 and CYP3A4 metabolic activities. Herbal components were extracted from the trade products in a way that ensured a composition equal to that present in the original product. Primary human hepatocytes and specific CYP substrates were used. Classic inducers were used as positive controls and herbal extracts were added in in vivo-relevant concentrations. Metabolites were determined by high performance liquid chromatography (HPLC). St. John's wort and common valerian were the strongest inducing herbs. In addition to induction of CYP3A4 by St. John's wort, common valerian and Ginkgo biloba increased the activity of CYP3A4 and 2D6 and CYP1A2 and 2D6, respectively. A general inhibitory potential was observed for horse chestnut, Echinacea purpurea and common sage. St. John's wort inhibited CYP3A4 metabolism at the highest applied concentration. Horse chestnut might be a herb with high inhibition potentials in vivo and should be explored further at lower concentrations. We show for the first time that G. biloba may exert opposite and biphasic effects on CYP1A2 and CYP2D6 metabolism. Induction of CYP1A2 and inhibition of CYP2D6 were found at low concentrations; the opposite was observed at high concentrations. CYP2D6 activity, regarded generally as non-inducible, was increased by exposure to common valerian (linear to dose) and G. biloba (highest concentration). An allosteric activation is suggested. From the data obtained, G. biloba, common valerian and St. John's wort are suggested as candidates for clinically significant CYP interactions in vivo.

Adult↗

PubMed2006

Can nutrition limit exercise-induced immunodepression?

Prolonged exercise and heavy training are associated with depressed immune cell function. To maintain immune function, athletes should eat a well-balanced diet sufficient to meet their energy, carbohydrate, protein, and micronutrient requirements. Consuming carbohydrate during prolonged strenuous exercise attenuates rises in stress hormones and appears to limit the degree of exercise-induced immune depression. Recent evidence suggests that antioxidant vitamin supplementation may also reduce exercise stress and impairment of leukocyte functions. Further research is needed to evaluate the effects of other antioxidants and dietary immunostimulants such as probiotics and echinacea on exercise-induced immune impairment.

Antioxidants↗

PubMed2003

Use of dietary supplements by elite figure skaters.

The present study examined the prevalence of dietary supplement use among elite figure skaters, gender differences in supplement use, and differences in nutrient intake of supplement users versus non-users. Male (n = 46) and female (n = 59) figure skaters completed a supplement survey and 3-day food records. Descriptive analysis, chi-square test, and independent t tests were used to analyze the data. Sixty-five percent of male (n = 30) and 76% of female (n = 45) figure skaters reported use of supplements. Forty-seven percent of males and 55% of females reported daily use of supplements. Multivitamin-mineral supplements were the most popular dietary supplements consumed by figure skaters. Significant gender differences were observed in the use of multivitamin-mineral supplements (61% males vs. 83% females, p < .05). Echinacea and ginseng were popular herbal supplements used by these skaters. The 3 main reasons given by male figure skaters for taking supplements were: to provide more energy (41%), to prevent illness or disease (34%), and to enhance performance (21%). Among female figure skaters, the 3 main reasons given were: to prevent illness or disease (61%), to provide more energy (39%), and to make up for an inadequate diet (28%). Significant differences (p < .05) were observed in protein, total fat, saturated fat, polyunsaturated fat intakes, and % energy from carbohydrate and total fat of male supplement users versus non-users, with supplement users having higher intakes except for percent energy from carbohydrate. Sodium was the only nutrient significantly different (p < .05) among female supplement users versus non-users, with supplement users having lower intakes. Given the popularity of dietary supplements, it is important to understand the factors influencing athletes' use of supplements, their knowledge and attitudes regarding supplements, dosage of supplements used, and the effectiveness of these dietary supplements in meeting the goals of the athletes.

Adolescent↗

PubMed2006

Effects of herbal extracts on the function of human organic anion-transporting polypeptide OATP-B.

Most known interactions between herbal extracts and drugs involve the inhibition of drug-metabolizing enzymes, but little is yet known about the possible role of transporters in these interactions. In this study, we have examined the effects of herbal extracts used in dietary supplements on the function of organic anion-transporting polypeptide B (OATP-B; OATP2B1), which is expressed on human intestinal epithelial cells and is considered to be involved in the intestinal absorption of various drugs. Specifically, the effects of 15 herbal extracts on uptake of estrone-3-sulfate, a typical OATP-B substrate, by human embryonic kidney 293 cells stably expressing OATP-B were evaluated. At concentration levels considered likely to be attainable in the human intestine, extracts of bilberry, echinacea, green tea, banaba, grape seed, ginkgo, and soybean potently inhibited estrone-3-sulfate uptake by 75.5, 55.5, 82.1, 61.1, 64.5, 85.4, and 66.8%, respectively (P < 0.01). The inhibitory effect of ginkgo leaf extract was concentration-dependent (IC(50) = 11.2 +/- 3.3 microg/ml) and reversible. Moreover, flavonol glycosides and catechins significantly inhibited the function of OATP-B, suggesting that the inhibitory effects of the herbal extracts on OATP-B may be primarily attributable to flavonoids. The extracts of mulberry, black cohosh, and Siberian ginseng moderately (but significantly) inhibited estrone-3-sulfate uptake by 39.1, 47.2, and 49.2%, respectively (P < 0.05). Extracts of barley, Job's tears, rutin, rafuma, and passionflower were ineffective. These results suggest that coadministration of some dietary supplements may decrease the absorption of orally administered substrates of OATP-B.

Camellia sinensis↗

PubMed2001

Nutritional strategies to minimise exercise-induced immunosuppression in athletes.

Strenuous prolonged exertion and heavy training are associated with depressed immune function. Furthermore, improper nutrition can compound the negative influence of heavy exertion on immunocompetence. Dietary deficiencies of protein and specific micronutrients have long been associated with immune dysfunction. An adequate intake of iron, zinc, and vitamins A, E, B6 and B12 is particularly important but excess intakes can also impair immune function. Immune system impairment has also been associated with excess intake of fat. To maintain immune function, athletes should eat a well balanced diet sufficient to meet their energy requirements. An athlete exercising in a carbohydrate-depleted state experiences larger increases in circulating stress hormones and a greater perturbation of several immune function indices. Conversely, consuming carbohydrate during exercise attenuates rises in stress hormones such as cortisol and appears to limit the degree of exercise-induced immunosuppression, at least for non-fatiguing bouts of exercise. Strong evidence that high doses of antioxidant vitamins, glutamine supplementation or echinacea extracts can prevent exercise-induced immunosuppression is lacking.

Dietary Carbohydrates↗

PubMed2004

Preoperative use of herbal medicines and vitamin supplements.

There has been a definite increase in the popularity and use of complementary and alternative medicines, including herbal medicines, in the last ten years. The aim of this study was to determine the prevalence and patterns of use of herbal medicines and vitamin supplements by patients in the preoperative period. A questionnaire was offered to all patients attending the pre-admission clinics at St. Vincent's Hospital and Box Hill Hospital, Melbourne, over an eight-month period in 2002. In all, 1102 questionnaires were completed (91.8% response rate). The prevalence of herbal medicine use was 14.3%, with an average user age of 54.0 years and 61.4% female predominance. The five most popular herbs were Garlic, Evening Primrose, Gingko, St. John's Wort and Echinacea. The commonest reasons for herbal medicine use were acute and chronic medical conditions. 63.2% of patients had self-prescribed. 27.8% of herbal remedy users had informed the hospital doctors and 41.8% had notified their general practitioner The prevalence of vitamin supplement use was 20.4%, with an average user age of 54.8 years and 66.2% female predominance. The five most popular vitamins were multivitamins, followed by vitamin B, C, E and D. The commonest reasons for vitamin use were maintenance of general well-being and health. The use of herbal medicines and vitamin supplements preoperatively by patients is common. Clinicians should endeavour to familiarize themselves with the more popular and significant herbal medications and, as part of the routine preoperative assessment, ask all their patients about their consumption of herbal remedies.

Female↗

PubMedDate not supplied

The use of herbal therapies in pediatric oncology patients: treating symptoms of cancer and side effects of standard therapies.

Complementary and alternative medicine is increasing in use in the pediatric oncology population. Although there is a multitude of herbal therapies used, the focus of this article is a review of the literature addressing some herbal therapies used to treat the symptoms of cancer and side effects of traditional methods of treatment. Ginger is used in the treatment of nausea and vomiting. St. John's wort is successful in treating depression and anxiety. Echinacea is used as an immunostimulant. Herbal therapies in the pediatric oncology population are usually initiated and managed by parents. Many herbal therapies are beneficial, but some potential herb-drug interactions should be considered. This poses a challenge to the oncology nurse because herbal treatments are managed by the parents and pharmaceuticals are managed by the practitioner. Educating the patient, family, and practitioner is important in ensuring a thorough health history assessment and, subsequently, safe and effective herbal and pharmacological therapies.

Antineoplastic Agents↗

PubMed2000

An overview of herbal medications with implications for the school nurse.

Americans are increasingly using herbs and herbal preparations to treat a wide array of conditions ranging from colds to depression. Children and parents are ingesting herbs in greater quantities, as reflected by increased herb sales and telephone calls to poison information centers. Herbal preparations are being used for the management of insomnia, anxiety, and attention deficit hyperactivity disorders. This trend introduces interesting opportunities and dilemmas for the school nurse. This article provides an overview of the seven most common medicinal herbs (garlic, ginkgo, ginseng, Echinacea, chamomile, valerian, and feverfew). It provides a guide to choosing herbal supplements, a framework for developing school-based herbal policies, and a discussion of the issues faced by school nurses.

Humans↗