Medicines, Herbal and Beyond  (June 28, 2016)

The last time we met, I was talking about St. John’s Wort, a fabulous herb with few side effects and as much, or more, evidence supporting its use for treating depression as many of the prescription antidepressants in common use. I did not go into any detail as to its proper use, however. .

That wasn't an oversight. That was because the use of St. John’s Wort was not the point of that article. The point I wished to make was this -- effective measures can fall out of common use for reasons, like trendiness or the lack thereof, that have nothing to do with how well they work.

Prescription medications do not have this issue. That is because THEY have multi-million advertising budgets, plus panels of men with doctory-sounding credentials and bales of stock options, all dedicated to reminding us continually about the drug in question. That's tough competition for an innocent plant.
 
Since I was talking about an herbal medicine, though, this seems like a good time to say a little about their proper use, and I'm going to stick with St. John's Wort as an example.

The correct method for selecting and using an herbal medicine is simple. It is the SAME APPROACH YOU SHOULD ALREADY BE USING WHENEVER YOU INTEND TO START USING ANY MEDICINE. Because of course you would never take anything the doctor gives you without checking it out first. 

What IS a medicine, you ask? (Ok, I know you didn’t ask that. But the cat did, right after inquiring as to where the tuna might be, so I will answer it.) The ultimate authority on these matters (Google) tells us that a medicine is “a compound or preparation used for the treatment or prevention of disease, especially a drug or drugs taken by mouth.” That’s a pretty good definition, so let’s go with it.

"Disease" is the key concept here, and even the cat knows what that is. The reason that is important is that when you are using something for a disease, you are on an entirely different playing field than when you are taking something to support or generally improve your health. The first is like badminton, and the second is like professional hockey. Which brings us again to the conflict between natural medicines and man-made ones.

As the haters of nutritional supplements are constantly informing us, prescription medications and nutritional supplements are regulated differently, the latter much less strictly. These less restrictive regulations for supplements supposedly Endanger The Public. This is so much hogwash. 

Returning to St. John's Wort -- it has been used in European folk medicine for many centuries. CENTURIES. Thousands of doctors and hundreds of thousands of patients have used it and no one has anything bad to say about it. That means that it's a safe thing to take.

Now, "safe" does not mean "harmless". And it doesn't mean that you can swallow any quantity of it any time you want, with obedience to naught but your own whims and the wild wind. It just means that if you follow the rules, you won't get into any trouble. 

It is a far different kettle of fish when Merck chemically tweaks a random generic medication, tests it in about 15 rats and then tries to market it to all and sundry. Just because a few lab animals lived to see another dawn doesn't prove that something is safe, so we make them test it some more. They bitterly resent this. They will tell you it's unfair to treat their wonderful new drug Crapex differently from St. John's Wort. Then they try to get the government to make St. John's Wort jump through the same regulatory hoops that Crapex must. 

There are different rules for natural substances and for medications. And that is as it should be. 

We can't simply leave it at that, though. Because herbal medicines are in a kind of no man's land between food and pharmaceuticals. Their centuries of wide use prove they are not dangerous substances. However, that is not enough to say whether they are useful as medicines. Do they actually improve symptoms, or disease conditions? That requires evidence. And if they are strong enough to fix a problem, they are strong enough to cause one as well.

And so that is where it can get a bit tricky with herbal medicines. They are classified as dietary supplements, and treated for purposes of safety like they are foods. But if you want to treat a disorder with them, you have to ask medicine-y questions about them. You have to check them out first. Just like you do your medications, right? RIGHT? 

Questions like:

What do I want to take this for?  Have a clear purpose in mind for any medicine that you are taking. St. John's Wort has very good evidence supporting its use in mild and moderate depression. Although it has anti-viral and anti-inflammatory effects as well, if that is what you are looking for, use something else besides St. John's Wort.  

Does this thing actually work?  ConsumerLab and PubMed are two places you can check to see if there is any real evidence that a natural substance has a useful medicinal action. Little doubt here about St. John's Wort.

How does it work?  We don’t know exactly how a lot of herbs work, and St. John's Wort is one of them. But that is ok. We used aspirin for over a hundred years without knowing how it worked. We still knew that it did work, and how to use it properly. Same deal for St. John's Wort, and many other herbs as well.

Are there side effects, risks, interactions with foods or other medicines?  Anything pharmacologically active is going to do things to your body other than what you are using it for, so find out what those things are. St. John's Wort has a bunch of potential side effects, most of which are avoidable. minor or rare. It does lower the blood levels of as much as 50% of the medications out there, which you certainly should know if you want to use it. 

Like I said, you should be asking these about your prescription medications as well. It's even more important for them, because a pharmaceutical is a whole lot more likely to kill you than an herb. For example, the internet constantly makes a big hairy deal about the fact that St. John’s Wort may interfere with birth control pills. I don’t remember one of those smug self-satisfied articles also mentioning that anti-seizure medications, barbiturates, Lamictal, Provigil, anti-fungals, anti-retrovirals (for HIV) and antibiotics can mess up birth control pills as well. 

How do I take it?  St. John's Wort supplements should be extracts, standardized to contain 0.3% hypericin, maybe 1-3% hyperforin as well, and taken three times a day, 300 mg at a dose. The root shouldn't be included. And it can take several weeks to start working. See what I mean? Ya gotta READ.

What does it cost? Is it worth it?   If it doesn’t have good evidence for it, you could still try it, but I wouldn't spend a lot of money on it.

Would a lifestyle change work just as well as this medicine?  You would not BELIEVE how many times the answer to that is “yes”. And I would go with the lifestyle change every time. Healthy living is never going to steer you wrong.

I think you see by now where I am going with this. Anything strong enough to help you needs to be understood and treated properly, whether it comes from Mother Nature or from Pfizer. And Mother Nature has been at this a LOT longer than Pfizer. Give her a chance.

--dr. diane holmes
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