Overview

Note: Over-the-counter supplements containing ephedra were banned by the U.S. Food and Drug Administration (FDA) in May 2004. See below for additional information.

Ephedra (Ephedra sinica), also called ma huang, is an herb that has been used in Traditional Chinese Medicine (TCM) for more than 5,000 years, primarily to treat asthma, bronchitis, and hay fever. Ephedra is also prescribed for symptoms of cold and flu, including nasal congestion, cough, fever, and chills.

While ephedra is a naturally-occurring herb, its main active ingredient ephedrine can also be synthesized as a medication. Synthetic ephedrine compounds, such as pseudoephedrine, are widely used in over-the-counter cold remedies and are regulated as a drug. This is unlike the regulation of ephedrine alkaloids derived from the herb itself. These are regulated as dietary supplements.

Until May 2004, ephedra was sold commercially as an energy booster, weight-loss supplement, and athletic performance enhancer. Although some scientific evidence suggests that this herbal supplement may improve weight, the information overall regarding its effectiveness for weight loss, energy, or athletic performance has been inconclusive and controversial. In addition, ephedra-containing products sold for these purposes have been linked to many cases of stroke, heart arrhythmia (irregular heart rhythm), and even death. Several of these products also contain caffeine; the combination of ephedra with caffeine dramatically increases the chances of adverse side effects.

It is important to note that ephedrine-containing products are banned from amateur sporting events, and evidence of ephedra on drug testing will likely disqualify athletes from competition.

The FDA ban on this substance includes any dietary supplements that contain ephedra, ephedrine, norephedrine, ma huang, Sida cordifolia, or pinellia. This does not pertain to teas (which are regulated as a conventional food) or to traditional Chinese herbal remedies prescribed by a traditional Chinese physician.

Plant Description

Ephedra is a shrub that is native to Pakistan, China, and northwestern India. Some ephedra species grow in the Southwest desert of the United States. The ephedra plant is a perennial evergreen that stands 1 foot high, on average. But it may grow up to 4 feet. Nearly leafless, the plant has slender, cylindrical, yellow-green branches and underground runners. In August, the flowers bear poisonous, fleshy, red cones resembling berries. The 3 ephedra species, ephedra sinica, ephedra equisetina, and ephedra intermedia, are collectively known by their Chinese name ma huang.

Parts Used

The young stems and branchlets are the parts used for medicinal preparations.

Medicinal Uses and Indications

Ephedra is primarily used to treat:

• Asthma
• Cough
• Bronchitis
• Allergic rhinitis
• Sinusitis
• Nasal congestion

Available Forms

Ephedra can come in dried or liquid form. It can be taken as a tablet, capsule, or as a tea to drink.

How to Take It

Ephedra should be used only on a short-term basis because prolonged use may lead to addiction. The amount of time considered safe, however, is not clear. Use of ephedra should take place only under the guidance and supervision of an appropriately-trained specialist. Ephedra should be taken between meals, without food.

Pediatric

The American Botanical Council warns that anyone under the age of 18 should not use ephedra without strict medical supervision.

Adult

Ephedra supplements have been banned from the U.S. market. People living outside of the U.S. should use caution, and work with a highly trained practioner when considering the use of ephedra.

Precautions

Herbs contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs only under the supervision of a health care provider knowledgeable in the field of botanical medicine.

Ephedra can produce side effects, such as irritability, restlessness, anxiety, insomnia, headaches, nausea, vomiting, and urinary problems. More serious side effects include high blood pressure, rapid or irregular heartbeat, stroke, seizures, addiction, and even death. If you experience any of these adverse effects, discontinue using ephedra and contact your provider immediately.

You should not take ephedra if you have the following health conditions: anxiety, depression, high blood pressure, glaucoma, heart disease, prostate enlargement, difficulty urinating, seizure disorder, impaired circulation to the brain, psychiatric disorders, thyroid disorders, or diabetes. Anyone taking medications for high blood pressure or depression, and women who are pregnant or breastfeeding, should avoid ephedra and ephedra alkaloids such as ephedrine. To determine whether ephedra is safe and appropriate for you, consult a knowledgeable provider.

Possible Interactions

While no specific interactions (positive or negative) between the herb ephedra and conventional medications have been reported, the active ingredients of ephedra, ephedrine, and pseudoephedrine have been associated with several serious drug interactions. We may assume, for safety's sake, that drugs that interact with ephedra's active ingredients may also interact with the herb ephedra. Medications for which there are well documented interactions with ephedra's active ingredients include, but are not limited to:

• Amphetamine and amphetamine derivatives. Amphetamine and amphetamine derivatives (such as dextroamphetamine, sometimes used for attention deficit hyperactivity disorder and narcolepsy) should not be used with ephedra. Ephedra may cause increased effects of amphetamines on the body, such as increased heart rate and blood pressure.
• Antidepressants. Ephedra may interact with antidepressants, namely those in the class of tricyclics (such as clomipramine, desipramine, doxepin, imipramine, and nortriptyline) and monoamine oxidase inhibitors (MAOIs, including phenelzine and trancylcypromine).
• Aspirinand blood-thinning medications. Ephedra may increase bleeding in sensitive individuals, such as those taking aspirin or other blood-thinning medications.
• Blood pressure medications. Ephedra may interact with blood pressure lowering medications, particularly clonidine.
• Caffeine and guarana (a caffeine containing herb)
• Narcotics. Ephedra may interact with narcotics prescribed for pain, such as morphine and codeine; codeine may also be prescribed for cough.
• Theophylline. Ephedra may interact with theophylline (used for asthma).

Supporting Research

Auerbach. Auerbach: Wilderness Medicine. 5th ed. Philadelphia, PA: Elsevier Mosby; 2007.

Ang-Lee MK, Moss J, Yuan C-S. Herbal medicines and perioperative care [review]. JAMA. 2001;286(2):208-16.

Blanck HM, Khan LK, Serdula MK. Use of nonprescription weight loss products: results from a multistate survey. JAMA. 2001;286:930-5.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Boston, MA: Integrative Medicine Communications; 2000:111-7.

Boozer CN, Nasser JA, Hemsfield SB, Wang V, Chen G, Solomon JL. An herbal supplement containing Ma Huang-Guarana for weight loss: a randomized, double-blind trial. Int J Obes. 2001;25(3):316-24.

Bucci LR. Selected herbals and human exercise performance. Am J Clin Nutr. 2000;72(2):624S-36S.

Cohen PA, Ernst E. Safety of herbal supplements: a guide for cardiologists. Cardiovasc Ther. 2010;28(4):246-53.

Council for Responsible Nutrition. Cantox Health Sciences International Safety Assessment and Determination of a Tolerable Upper Limit for Ephedra. Accessed on October 25, 2001.

Federal Register. Department of Health and Human Services. Food and Drug Administration. Dietary supplements containing ephedrine alkaloids. April 3, 2000;65(64):17509-12.

Food and Drug Administration. Consumer Alert: FDA plans regulation prohibiting sale of ephedra-containing dietary supplements and advises consumers to stop using these products. December 30, 2003. Accessed on May 5, 2004.

Gurley BJ, Gardner SF, Hubbard MA. Content versus label claims in ephedra-containing dietary supplements [see comments]. Am J Health Syst Pharm. 2000;57(10):963-9.

Hallas J, Bjerrum L, Stovring H, Andersen M. Use of a prescribed ephedrine/caffeine combination and the risk of serious cardiovascular events: a registry-based case-crossover study. Am J Epidemiol. 2008;168(8):966-73.

Haller CA and Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. NEJM. 2000;343:1833-8.

Health Canada. Advisory not to use products containing Ephedra or ephedrine. June 14, 2001. Accessed on 10/25/01.

Jalili J, Askeroglu U, Alleyne B, Guyuron B. Herbal products that may contribute to hypertension. Plast Reconstr Surg. 2013;131(1):168-73.

Lee MR. The history of Ephedra (ma-huang). J R Coll Physicians Edinb. 2011;41(1):78-84.

Miller. Miller's Anesthesia. 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009.

Miller SC. Psychiatric effects of ephedra: addiction. Am J Psychiatry. 2005 Nov;162(11):2198.

Palamar J. How ephedrine escaped regulation in the United States: a historical review of misuse and associated policy. [Review]. Health Policy. 2011;99(1):1-9.

Seamon MJ, Clauson KA. Ephedra: yesterday, DSHEA, and tomorrow -- a ten year perspective on the Dietary Supplement Health and Education Act of 1994. J Herb Pharmacother. 2005;5(3):67-86.

Vahedi K, Domigo V, Amarenco P, Bousser MG. Ischaemic stroke in sportsman who consumed MaHuang extract and creatine monohydrate for body building. J Neurol Neurosurg Psychiatry. 2000;68(1):112-3.

Wang J, van der Heijden R, Spruit S, Hankermeier T, Chan K, van der Greef J, Xu G, Wang M. Quality and safety of Chinese herbal medicines guided by a systems biology perspective. J Ethnopharmacol. 2009;126(1):31-41.

Woolf AD, Watson WA, Smolinske S, Litovitz T. The severity of toxic reactions to ephedra: comparisons to other botanical products and national trends from 1993-2002. Clin Toxicol (Phila). 2005;43(5):347-55.

Overview

Today, oil from the eucalyptus tree (Eucalyptus globulus) appears in many over-the-counter cough and cold products to relieve congestion. Eucalyptus oil is also used in creams and ointments to relieve muscle and joint pain, and in some mouthwashes.

In its native Australia, the eucalyptus tree is the main food for koalas. It has been used in the past as an antiseptic to kill germs. The oil was used in traditional Aboriginal medicines to heal wounds and fungal infections. Teas made of eucalyptus leaves were also used to reduce fevers. Eucalyptus was soon used in other traditional medicine systems, including Chinese, Indian (Ayurvedic), and Greek and European.

In 19^th century England, eucalyptus oil was used in hospitals to clean urinary catheters. Laboratory studies later showed that eucalyptus oil contains substances that kill bacteria. It also may kill some viruses and fungi. Studies in animals and test tubes show that eucalyptus oil acts as an expectorant, meaning it helps coughs by loosening phlegm.

Plant Description

There are many species of eucalyptus. Some are the size of an ornamental shrub, and some grow to be giant trees. The kind most often used as medicine is called blue gum or Australian fever tree. It can grow as high as 230 feet. Its 4 to 12 inch leaves are dark green and shiny. Its blue-gray bark peels to reveal a cream-colored inner bark.

Medicinal Uses and Indications

DO NOT take eucalyptus oil by mouth unless your doctor tells you to. Ingesting eucalyptus oil can be dangerous.

Cough and cold

Many medicines to treat coughs and the common cold contain eucalyptus. It is found in many lozenges, cough syrups, rubs, and vapor baths throughout the United States and Europe. Herbalists often recommend using fresh leaves in gargles to soothe sore throats and treat bronchitis and sinusitis.

Eucalyptus ointments are also used on the nose and chest to relieve congestion. Eucalyptus oil helps loosen phlegm, so many people breathe in eucalyptus steam to help treat bronchitis, coughs, and the flu.

Plaque and gum disease

Eucalyptus oil is rich in cineole, an antiseptic that kills the bacteria that can cause bad breath. Some antiseptic mouthwashes use eucalyptus along with other oils, and have been shown to help prevent plaque and gingivitis.

Other uses

On the skin, eucalyptus oil has been used to treat arthritis, boils, sores, and wounds. The oil is also used in some insect repellents. Preliminary studies have also shown that oil of lemon eucalyptus may also keep ticks away.

What is it Made of?

The leaves and oil of the eucalyptus plant are used as medicine. Eucalyptus oil is made from the fresh leaves and branch tops of the eucalyptus plant. Eucalyptus leaves contain flavonoids (plant-based antioxidants), volatile oils, and tannins. Researchers think tannins may help reduce inflammation.

Available Forms

Eucalyptus oil is available in many products, including liquids and ointments. The leaves are available fresh, dried (to be used in teas), and in liquid extracts. Cough drops, syrups, vaporizer fluids, liniments, toothpastes, and mouthwashes may contain eucalyptus oil or cineole, the active ingredient in eucalyptus oil. Some familiar, over-the-counter remedies that have eucalyptus oil include Listerine, Mentholatum Cherry Chest Rub, and Vicks VapoRub.

How to Take it

Pediatric

DO NOT give a child eucalyptus orally (by mouth) because it is toxic. DO NOT give cough drops containing eucalyptus to children under 6.

For a cold, DO NOT put eucalyptus oil, salve, or chest rub on the face or nose of a child under 2. Ask your doctor before using preparations that contain eucalyptus oil as a chest rub for your child or to inhale steam for congestion.

Adult

DO NOT take eucalyptus oil orally (by mouth) except under your doctor's supervision due to toxicity.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects, and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs under the supervision of a health care provider qualified in the field of botanical medicine.

For adults, eucalyptus oil is generally safe when applied to the skin. DO NOT put eucalyptus oil, salve, or chest rub on the face or nose of a child under 2.

People with asthma, seizures, liver disease, kidney disease, or low blood pressure should not use eucalyptus without first talking to their doctors.

Pregnant and breastfeeding women should not use eucalyptus.

Eucalyptus oil is toxic when taken by mouth. DO NOT ingest eucalyptus oil except under your doctor's supervision.

Possible Interactions

You should never take eucalyptus orally. It is toxic if consumed by mouth, and may interact with several medications. If you are currently taking medications that are processed by the liver, speak with your physician before using eucalyptus preparations. Eucalyptus may act on the liver, and thus impact how a wide variety of medications are metabolized. You should not take eucalptus without talking to your doctor first if you are being treated with the following medication:

5-Fluorouracil (5-FU): In an animal study, using eucalyptus oil on the skin caused more absorption of topical 5-FU, a medication used to treat cancer.

Supporting Research

Abdullah D, Ping QN, Liu GJ TI. Enhancing effect of essential oils on the penetration of 5-fluorouracil through rat skin. Yao Hsueh Hsueh Pao. 1996;31(3):214-221.

Ashour HM. Antibacterial, antifungal, and anticancer activities of volatile oils and extracts from stems, leaves, and flowers of Eucalyptus sideroxylon and Eucalyptus torquata. Cancer Biol Ther. 2008 Mar;7(3):399-403.

Biruss B, Kahlig H, Valenta C. Evaluation of a eucalyptus oil containing topical drug delivery system for selected steroil hormones. Int J Pharm. 2007;328(2);142-51.

Cermelli C, Fabio A, Fabio G, Quaglio P. Effect of eucalyptus oil on respiratory bacteria and viruses. Curr Microbiol. 2008;56(1):89-92.

Chen ZZ, Ho CK, Ahn IS, Chiang VL. Eucalyptus. Methods Mol Biol. 2006;344:125-34.

George J, Hegde S, Rajesh KS, Kumar A. The efficacy of a herbal-based toothpaste in the control of plaque and gingivitis: a clinico-biochemical study. Indian J Dent Res. 2009 Oct-Dec;20(4):480-2.

Jaenson TG, Garboui S, Palsson K. Repellency of oils of lemon eucalyptus, geranium, and lavender and the mosquito repellent MyggA natural to Ixodes ricinus (Acari: Ixodidae) in the laboratory and field. J Med Entomol. 2006 Jul;43(4):731-6.

Kehrl W, Sonnemann U, Dethlefsen U. Therapy for acute nonpurulent rhinosinusitis with cineole: results of a double-blind, randomized, placebo-controlled trial. Laryngoscope. 2004;114:738-742.

Kumar A, et al. Antibacterial properties of some Eucalyptus oils. Fitoterapia. 1988;59:141-144.

Osawa K, Yasuda H, Morita H, Takeya K, Itokawa H. Macrocarpals H, I, and J from the Leaves of Eucalyptus globulus. J Nat Prod. 1996;59:823-827.

Rehman JU, Ali A, Khan IA. Plant based products: use and development as repellents against mosquitoes: A review. Fitoterapia. 2014;95:65-74.

Sadlon AE, Lamson DW. Immune-modifying and antimicrobial effects of Eucalyptus oil and simple inhalation devices. Altern Med Rev. 2010 Apr;15(1):33-47. Review.

Salari MH, Amine G, Shirazi MH, Hafezi R, Mohammadypour M. Antibacterial effects of eucaluyptus globulus leaf extract on pathogenic bacteria isolated from specimens of patients with respiratory tract disorders. Clin Microbiol Infect. 2006;12(2):194-6.

Sartorelli P, Marquioreto AD, Amaral-Baroli A, et al., Chemical composition and antimicrobial activity of the essential oils from two species of Eucalyptus. Phytother Res. 2006;[Epub ahead of print].

Serafino A, et al. Stimulatory effect of eucalyptus essential oil on innate cell-mediated immune response. BMC Immunol. 2008;9:117.

Swanston-Flatt SK, Day C, Bailye CJ, Flatt PR. Traditional plant treatments for diabetes. Studies in normal and streptozotocin diabetic mice. Diabetologia. 1990;33(8):462-464.

Tesche S, Metternich F, Sonnemann U, et al. The value of herbal medicines in the treatment of acute non-purulent rhinosinusitis : Results of a double-blind, randomised, controlled trial. Eur Arch Otorhinolaryngol. 2008 Apr 25.

Thorsell W, Mikiver A, Tunón H. Repelling properties of some plant materials on the tick Ixodes ricinus L. Phytomedicine. 2006 Jan;13(1-2):132-4.

Webb NJ, Pitt WR. Eucalyptus oil poisoning in childhood: 41 cases in south-east Queensland. J Paediatr Child Health. 1993;29(5):368-371.

Woolf A. Essential oil poisoning. Clin Toxicol. 1999;37(6):721-727.

Overview

Evening primrose is a wildflower that grows throughout the United States. Although Native Americans used the seeds for food and made poultices from the whole plant to heal bruises, evening primrose oil (EPO) has only recently been used as medicine. European settlers took the root back to England and Germany where it was eaten as food.

EPO is found in the plant's seeds, and is high in the essential fatty acid gamma-linolenic acid (GLA). Essential fatty acids, such as omega-6s found in EPO and omega-3s found in fish oil, are used as building blocks for a number of molecules in the body. Your body needs a balance of omega-6 and omega-3 fatty acids for good health. GLA is also found in borage oil and black currant oil.

Today, EPO is used to relieve PMS symptoms and some arthritis-related conditions, although scientific evidence to support these uses is lacking. The strongest evidence for EPO use is for treating eczema.

This article focuses on the seed from which EPO is extracted.

Plant Description

A circle of leaves grows close to the ground around evening primrose stems after the first year it is planted. Flowers bloom after sunset, June through September, or on overcast days during the second year. The leaves grow on both sides of the stem at alternating levels.

What is it Made of?

Oil is extracted from the seeds and prepared as medicine using a chemical called hexane. The seeds contain up to 25% essential fatty acids, including linoleic acid (LA) and gamma-linolenic acid (GLA). Both LA and GLA are omega-6 fatty acids. The body needs a balance of omega-6s and omega-3s (found in fish oil) to stay healthy. Most North Americans get too much omega-6 fatty acids in their diet. However, there are different types of omega-6 fatty acids. Some are healthier than others, such as those found in EPO.

Other sources of GLA include spirulina (a blue-green algae), borage, hemp, and black currant oils.

Medicinal Uses and Indications

EPO is used mostly to relieve the itchiness caused by skin conditions, such as eczema and dermatitis. It is also used to ease breast tenderness from premenstrual syndrome (PMS) or other causes, and to help manage menopausal symptoms.

Eczema

Eczema symptoms include redness and scaling in addition to itching. More than 30 human studies report the benefits of EPO for eczema and dermatitis. A study of 1,207 people found that EPO helped relieve symptoms from skin conditions, including itching, crusting, edema (fluid retention and swelling), and redness. EPO can be used in children and adults with skin conditions.

Premenstrual syndrome (PMS)

Many women throughout the world take EPO to reduce PMS symptoms, although scientific evidence is lacking. In one review of 10 studies that used EPO to treat PMS, only two were well designed. Both of those studies found that EPO had no effect on PMS symptoms. More research is needed.

Rheumatoid arthritis (RA)

Although a few studies have found that people with RA who took EPO felt better, the studies were hampered by poor design and high drop-out rates. Also, there wasn't any evidence that taking EPO actually helped slow down the joint damage that occurs with RA. People with RA should be treated with conventional medications to slow down or stop permanent joint damage.

Raynaud's phenomenon

One small study suggests that taking EPO may help reduce symptoms in some people with Raynaud's phenomenon. But the study found no difference in hand temperature between people who took EPO and those who took placebo. More studies are needed.

Diabetic peripheral neuropathy

Diabetic peripheral neuropathy is a nerve condition where people with diabetes have numbness, tingling, pain, burning, or a lack of sensation in their feet and legs. Two studies have found that GLA may help reduce symptoms of diabetic neuropathy.

Breast pain

Although there is not a lot of scientific evidence, EPO is widely used to treat breast pain (mastalgia) in a number of European countries. A few studies have found that EPO seemed to help. But they were not well-designed studies. Other studies showed no benefit. More research is needed.

Menopausal symptoms

Preliminary studies suggest EPO may help alleviate the hot flashes that often accompany menopause. More research is needed.

Available Forms

EPO is available as an oil or in capsules. EPO products should be kept in the refrigerator and out of direct sunlight to prevent the oil from becoming rancid. Generally, high-quality EPO will be certified as organic by a reputable third party, packaged in light-resistant containers, refrigerated, and marked with a freshness date.

EPO should be standardized to contain 8% gamma-linolenic acid.

How to Take it

Pediatric

Ask your doctor before giving EPO to a child.

Adult

Speak to your doctor regarding dosing instructions.

Precautions

EPO is generally safe when used in recommended dosages. Reported side effects are rare and mild, and include nausea, stomach pain, and headache. Stomach pain and loose stools may mean that the dose is too high.

DO NOT use omega-6 supplements, including GLA and EPO, if you have epilepsy or another seizure disorder because there have been reports of these supplements bringing on seizures.

DO NOT take EPO if you have bleeding problems or a blood disorder.

Pregnant and breastfeeding women should ask their doctors before taking EPO.

Possible Interactions

If you are currently being treated with any of the following medications, you should not use EPO without first talking to your doctor.

Blood-thinning medications (anticoagulants): EPO may raise the risk of bleeding, especially if you take blood thinners such as aspirin, warfarin (Coumadin), and clopidogrel (Plavix).

Blood pressure medications: EPO may lower blood pressure in some people, although researchers have not confirmed this link. If you take medications to treat high blood pressure, ask your doctor before taking EPO.

Phenothizines: People who take a class of medications called phenothiazines to treat schizophrenia should not take EPO because it may increase the risk of seizures.

Medications to control seizures: EPO may lower the threshold for seizures, so people who are prone to seizures should not take it.

Antidepressants: EPO may interact with some antidepressants, including selective serotonin uptake inhibitors, such as:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Supporting Research

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Simon D, Eng PA, Borelli S, et al. Gamma-linolenic acid levels correlate with clinical efficacy of evening primrose oil in patients with atopic dermatitis. Adv Ther. 2014;31(2):180-8.

Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr. 1999;70(3 suppl):560S-569S.

Stonemetz D. A review of the clinical efficacy of evening primrose. Holist Nurs Pract. 2008;22(3):171-4.

Thompson L, Cockayne A, Spiller RC. Inhibitory effect of polyunsaturated fatty acids on the growth of Helicobacter pylori: a possible explanation of the effect of diet on peptic ulceration. Gut. 1994;35(11):1557-1561.

Whitaker DK, Cilliers J, de Beer C. Evening primrose oil (Epogam) in the treatment of chronic hand dermatitis: disappointing therapeutic results. Dermatology. 1996;193(2):115-120.

Whelan AM, Jurgens TM, Naylor H. Herbs, vitamins and minerals in the treatment of premenstrual syndrome: a systematic review. Can J Clin Pharmacol. 2009 Fall;16(3):e407-29. Epub 2009 Oct 29. Review.

Williams HC. Evening primrose oil for atopic dermatitis. BMJ. 2003;327(7428):1358-9.

Worm M, Henz BM. Novel unconventional therapeutic approaches to atopic eczema. Dermatology. 2000;201(3):191-195.

Yoon S, Lee J, Lee S. The therapeutic effect of evening primrose oil in atopic dermatitis patients with dry scaly skin lesions is associated with the normalization of serum gamma-interferon levels. Skin Pharmacol Appl Skin Physiol. 2002;15(1):20-5.

Overview

Feverfew has an interesting history. This member of the daisy family has been used for centuries to treat headaches, arthritis, and problems with labor and childbirth. Ancient Greek physicians used it to reduce inflammation and treat menstrual cramps. Although it was once used to treat fevers, as its name suggests, it was not very effective. It is now used to prevent migraine headaches, and several scientific studies suggest that it works well for that purpose.

Plant Description

Native to southeastern Europe, feverfew is now widespread throughout Europe, North America, and Australia. Feverfew is a short perennial that blooms between July and October, and gives off a strong and bitter odor. Its yellow-green leaves are alternate (the leaves grow on both sides of the stem at alternating levels), and turn downward with short hairs. The small, daisy-like yellow flowers are arranged in a dense flat-topped cluster.

What is it Made Of?

Feverfew products usually contain dried feverfew leaves, but all parts of the plant that grow above ground may be used. Researchers thought a substance called parthenolide, which helps relieve spasms in smooth muscle tissue, was what made feverfew effective against migraines. However, after more studies researchers are not sure which part of the herb may best treat or prevent migraines.

Parthenolide may also reduce inflammation and may stop cancer cells from growing.

Medicinal Uses and Indications

Feverfew is used mostly to treat and prevent headaches.

Migraine Headaches

Feverfew was popular in the 1980s as a treatment for migraines. A survey of 270 people with migraines in Great Britain found that more than 70% of them felt much better after taking an average of 2 to 3 fresh feverfew leaves daily. Several human studies have used feverfew to prevent and treat migraines. Overall, these studies suggest that taking dried leaf capsules of feverfew every day may reduce the number of migraines in people who have chronic migraines.

One study used a combination of feverfew and white willow (Salix alba), which has chemicals like aspirin. People who took the combination twice a day for 12 weeks had fewer migraines and the pain did not last as long or hurt as much.

Another study found that people who took a special extract of feverfew had fewer migraine attacks per month compared to people who took placebo. A 3-month study with 49 people found that a combination of feverfew, magnesium, and vitamin B2 led to a 50% decrease in migraines.

Not all studies have found that feverfew works for migraines, however. Whether it reduces migraine pain and frequency may depend on which supplement you take. Ask your doctor to help you find out the right formula and dose for your needs.

Rheumatoid Arthritis

Some laboratory tests show that feverfew can reduce inflammation, so researchers thought it might help treat rheumatoid arthritis (RA). However, a human study found that feverfew did not work any better than placebo in improving RA symptoms.

Dermatitis

Preliminary studies suggest that feverfew may help reduce damaged skin cells and inflammation. Other studies show feverfew may help relieve dermatitis and improve the appearance of the skin.

Available Forms

Feverfew supplements are available fresh, freeze-dried, or dried. They can be purchased as capsules, tablets, or liquid extracts. Feverfew supplements used in clinical studies contain a standardized dose of parthenolide. Feverfew supplements should be standardized to contain at least 0.2% parthenolide.

How to Take It

Pediatric

DO NOT give feverfew to children under 2.

For older children, ask your doctor whether feverfew is safe for your child. Your doctor will determine the right dose.

Adult

For migraine headaches: Studies have used 50 to 100 mg daily, standardized to contain 0.2 to 0.35% parthenolides. Feverfew may be used to prevent or stop a migraine headache. Feverfew supplements may also be carbon dioxide extracted. For these, one study used 6.25 mg, 3 times daily, for up to 16 weeks.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider qualified in the field of botanical medicine.

Side effects from feverfew can include abdominal pain, indigestion, gas, diarrhea, nausea, vomiting, and nervousness. Some people who chew raw feverfew leaves may have mouth sores, loss of taste, and swelling of the lips, tongue, and mouth.

Rarely, allergic reactions to feverfew have been reported. People with allergies to chamomile, ragweed, or yarrow may be allergic to feverfew and should not take it.

Feverfew may increase the risk of bleeding, especially if you take blood-thinning medications, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Ask your doctor before taking feverfew if you take blood thinners.

Pregnant and nursing women, as well as children under 2, should not take feverfew.

If you are scheduled for surgery, tell your doctor if you are taking feverfew. It may interact with anesthesia.

DO NOT abruptly stop taking feverfew if you have used it for more than 1 week. Stopping feverfew too quickly may cause rebound headache, anxiety, fatigue, muscle stiffness, and joint pain.

Possible Interactions

Feverfew may change how prescription and nonprescription medications work. If you take any of the following medications, you should not use feverfew without first talking to your health care provider.

Blood-thinning medications: Feverfew may increase the risk of bleeding. Ask your doctor before taking feverfew if you take blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.

Medications broken down by the liver: Feverfew can interact with many medications that are broken down by the liver. To be safe, ask your doctor before taking feverfew if you take any prescription medications.

Supporting Research

Bowe WP. Cosmetic benefits of natural ingredients: mushrooms, feverfew, tea and wheat complex. J Drugs Dermatol. 2013;12(9 Suppl):s133-6.

Cady RK, Goldstein J, Nett R, Mitchell R, Beach ME, Browning R. A double-blind placebo-controlled pilot study of sublingual feverfew and ginger (LipiGesic™ M) in the treatment of migraine. Headache. 2011 Jul-Aug;51(7):1078-86. doi: 10.1111/j.1526-4610.2011.01910.x.

Chen CF, Leung AY. Gene response of human monocytic cells for the detection of antimigraine activity of feverfew extracts. Can J Physiol Pharmacol. 2007;85(11):1108-15.

Curry EA 3rd, Murry DJ, Yoder C, et al., Phase I dose escalation trial of feverfew with standardized doses of parthenolide in patients with cancer. Invest New Drugs. 2004;22(3):299-305.

De Weerdt CJ, Bootsma HPR, Hendriks H. Herbal Medicines in migraine prevention. Randomized double-blind placebo controlled crossover trial of a feverfew preparation. Phytomedicine. 1996;3:22-230.

Diener HC, Pfaffenrath V, Schnitker J, Friede M, Henneicke-von Zepelin HH. Efficacy and safety of 6.25 mg t.i.d. feverfew CO2-extract (MIG-99) in migraine prevention -- a randomized, double-blind, multicentre, placebo-controlled study. Cephalalgia. 2005;25(11):1031-41.

Ernst E, Pittler MH. The efficacy and safety of feverfew (Tanacetum parthenium L.): an update of a systematic review. [Review] Public Health Nutr. 2000;3(4A):509-514.

Evans RW, Taylor FR. "Natural" or alternative medications for migraine prevention. Headache. 2006;46(6):1012-8.

Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-1227.

Henneicke-von Zepelin HH. Feverfew for migraine prophylaxis. Headache. 2006;46(3):531

Johnson ES, Kadam NP, Hylands DM, Hylands PJ. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J. 1985;291:569-573.

Lesiak K, Koprowska K, Zalesna I, Nejc D, Düchler M, Czyz M. Parthenolide, a sesquiterpene lactone from the medical herb feverfew, shows anticancer activity against human melanoma cells in vitro. Melanoma Res. 2010 Feb;20(1):21-34.

Maizels M, Blumenfeld A, Burchette R. A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: a randomized trial. Headache. 2004;44(9):885-90.

Martin K, et al. Parthenolide-depleted Feverfew (Tanacetum parthenium) protects skin from UV irradiation and external aggression. Arch Dermatol Res. 2008;300(2):69-80.

Miller L. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;158(20):2200-2211.

Murphy JJ, Heptinstall S, Mitchell JR. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet. 1988;2:189-192.

Palevitch D, Earon G, Carasso R. Feverfew (Tanacetum parthenium) as a prophylactic treatment for migraine: a double-blind controlled study. Phytotherapy Res. 1997;11:508-511.

Pareek A, Suthar M, Rathore GS, Bansal V. Feverfew (Tanacetum parthenium L.): A systematic review. Pharmacogn Rev. 2011 Jan;5(9):103-10. doi: 10.4103/0973-7847.79105.

Pattrick M, Heptinstall S, Doherty M. Feverfew in rheumatoid arthritis: a double-blind, placebo controlled study. Ann Rheum Dis. 1989;48:547-549.

Pfaffenrath V, Diener HC, Fischer M, et al. The efficacy and safety of Tanacetum parthenium (feverfew) in migraine prophylaxis--a double-blind, multicentre, randomized placebo-controlled dose-response study. Cephalalgia. 2002;22(7):523-532.

Pittler MH, Vogler BK, Ernst E. Feverfew for preventing migraine. [Review] Cochrane Database Syst Rev. 2000;(3):CD002286.

Rodriguez KJ, Wong HK, Oddos T, Southall M, Frei B, Kaur S. A purified feverfew extract protects from oxidative damage by inducing DNA repair in skin cells via a P13-kinase-dependent Nrf2/ARE pathway. J Dermatol Sci. 2013;72(3):304-10.

Schiapparelli P, Allais G, Castagnoli Gabellari I, Rolando S, Terzi MG, Benedetto C. Non-pharmacological approach to migraine prophylaxis: part II. Neurol Sci. 2010 Jun;31 Suppl 1:S137-9. Review.

Shrivastava R, Pechadre JC, John GW. Tanacetum parthenium and Salix alba (Mig-RL) combination in migraine prophylaxis: a prospective, open-label study. Clin Drug Investig. 2006;26(5):287-96.

Silberstein SD. Preventive treatment of headaches. Curr Opin Neurol. 2005;18(3):289-92.

Won YK, Ong CN, Shi X, Shen HM. Chemopreventive activity of parthenolide against UVB-induced skin cancer and its mechanisms. Carcinogenesis. 2004;25(8):1449-58.

Wu C, Chen F, Rushing JW, Wang X, Kim HJ, Huang G, Haley-Zitlin V, He G. Antiproliferative activities of parthenolide and golden feverfew extract against three human cancer cell lines. J Med Food. 2006;9(1):55-61.

Yao M, Ritchie HE, Brown-Woodman. A reproductive screening test of feverfew: is a full reproductive study warranted? Reprod Toxicol. 2006;22(4):688-93.

Zhang S, Lin ZN, Yang CF, Shi X, Ong CN, Shen HM. Suppressed NF-kappaB and sustained JNK activation contribute to the sensitization effect of parthenolide to TNF-alpha-induced apoptosis in human cancer cells. Carcinogenesis. 2004;25(11):2191-9.

Overview

Flaxseed, or linseed (Linum usitatissimum L.), comes from the flax plant, which is an annual herb. The ancient Egyptians used flaxseed as both food and medicine. In the past, flaxseed was used mostly as a laxative. It is high in fiber and contains a gummy material called mucilage, both of which expand when they come in contact with water. They add bulk to stool and help it move more quickly through the intestines.

Flaxseed and flaxseed oil are rich in alpha-linolenic acid (ALA), an omega-3 fatty acid that may be helpful for heart disease, inflammatory bowel disease (IBD), arthritis, and other health problems. Other omega-3 fatty acids include those found in fish oil, which are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Mackerel, salmon, and walnuts are good sources of omega-3 fatty acids.

Flaxseed oil contains only ALA, not the fiber or lignans found in the flaxseed. Other plants that contain ALA include canola (rapeseed), soybean oil, walnuts, and pumpkin seed. Studies suggest that flaxseed may help prevent and treat of the following health conditions.

High cholesterol

People who eat a Mediterranean diet tend to have higher HDL (good) cholesterol levels. The Mediterranean diet includes whole grains, root and green vegetables, fruits, fish and poultry, olive and canola oils, and ALA from flaxseed, flaxseed oil, and walnuts. It limits the amount of red meat, butter, and cream you eat.

In lab tests and animal studies, flaxseed and flaxseed oil have been reported to lower cholesterol. Human studies show mixed results. One human study found that people who added flaxseed to a low-cholesterol diet lowered their LDL (bad) cholesterol and triglyceride levels (fats in the blood).

Heart disease

A diet rich in fruits, vegetables, whole grains, nuts or legumes, and foods with ALA may reduce the risk of heart attack and stroke, both for people who have never had either problem and for those who have already had a heart attack or a stroke.

One of the best ways to help prevent and treat heart disease is to eat a diet low in saturated fat and trans fat, and eat foods that are rich in monounsaturated and polyunsaturated fats, including omega-3 fatty acids from flaxseed. Evidence suggests that people who eat an ALA-rich diet are less likely to have a fatal heart attack.

Several human studies suggest that a diet rich in omega-3 fatty acids (including ALA) may lower blood pressure in people with hypertension.

Menopausal symptoms

One small study compared flaxseed to hormone replacement therapy (HRT) in menopausal women. It reported that 40 g of flaxseed worked as well as HRT for mild menopausal symptoms (hot flashes, mood disturbances, and vaginal dryness). But the study was not well designed, and another, larger study found that flaxseed did not improve symptoms like hot flashes, nor did it protect against bone loss.

Breast cancer

Flaxseed contains phytoestrogens, which are plant chemicals called lignans. Because lignans may act like estrogen in the body, scientists aren't sure whether flaxseed would be harmful or helpful for breast cancer. Studies have reported that flaxseed reduced breast tumor growth and metastasis (spreading) in rats.

There has been only one clinical study in humans. In that study, postmenopausal women who were newly diagnosed with breast cancer ate a muffin with 25 grams dietary flaxseed every day for 40 days. The study found that adding flaxseed to the diet may have the potential to reduce tumor growth in women with breast cancer. More research is needed.

Colon cancer

Animal studies show that lignans may slow the growth of colon tumor cells. Population studies suggest that flaxseed may reduce the number of abnormal cell growths, which are early markers of colon cancer. Clinical trials in people are needed, however.

Prostate cancer

Results from studies are confusing when it comes to prostate cancer and flaxseed. A few studies seemed to show that ALA intake was associated with an increased risk for prostate cancer. But other studies have found that flaxseed may benefit men at risk for prostate cancer. In one study, men with a precancerous prostate condition called PIN had lower PSA levels (a marker of prostate cancer) when they ate 30 g of flaxseed daily along with a low-fat diet. In men who had prostate cancer, 30 g of flaxseed daily and a low-fat diet did not lower PSA levels. But it did appear to lower levels of testosterone and slow down the rate of tissue growth. More studies are needed to understand how flaxseed may affect prostate cancer.

Other uses

Researchers are investigating whether omega-3 fatty acids may help protect against certain infections and in treating conditions including ulcers, migraine headaches, attention deficit/hyperactivity disorder (ADHD), addiction, eating disorders, preterm labor, emphysema, psoriasis, glaucoma, Lyme disease, lupus, and panic attacks.

Plant Description

Flax is an annual plant that thrives in deep moist soils rich in sand, silt, and clay. The small, oval-shaped seeds of the flax plant contain oil, sometimes called linseed oil.

What is it Made of?

Flaxseed has several plant chemicals that may be healthy, including:

• Fiber, both soluble and insoluble
• Protein
• Essential fatty acids (ALA)
• Lignans

Flaxseed acts like a laxative because of its fiber and mucilage content.

The health benefits of flaxseed, such as protection from heart disease and arthritis, are probably due to a high concentration of the omega-3 fatty acid ALA.

In addition to the important omega-3 fatty acid ALA, flaxseed, NOT the oil, also contains phytoestrogens, which are plant chemicals called lignans. Phytoestrogens act like the hormone estrogen and may help protect against some kinds of cancer.

Available Forms

Flaxseed oil should be refrigerated. Use whole flaxseeds within 24 hours of grinding, otherwise the ingredients lose their activity. Flaxseeds are also available ground in a special mylar package so that the components in the flaxseeds stay active. Ripe seeds, linseed cakes, powder, capsules, and flaxseed oil are all available at health food and grocery stores.

How to Take it

Pediatric

Flaxseed oil may be added to a child's diet to help balance fatty acids.

Children (2 to 12 years old): Ask your doctor to help you determine the right dose.

Adult

Grind before eating and take with lots of water.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can have side effects, and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider qualified in the field of botanical medicine.

Although studies have found that eating fish, which includes omega-3 fatty acids, regularly may reduce the risk of macular degeneration, a recent study of two large groups of men and women found that diets rich in ALA may increase the risk of macular degeneration. Talk to your health care provider.

DO NOT eat raw or unripe flaxseeds, they may be poisonous.

Women with breast, uterine, and ovarian cancer or endometriosis should ask their doctor before taking flaxseed, because it may act like estrogen in the body.

Some researchers think pregnant women should not take flaxseed, because it may act like estrogen in the body. Ask your doctor before taking flaxseed if you are pregnant or breastfeeding.

Men with prostate cancer should ask their doctor before taking flaxseed.

People with a bowel obstruction, inflamed bowel, or narrowed esophagus should not take flaxseed. It is high in fiber and could make the condition worse.

If you take ground flaxseed, be sure to take it with a lot of water.

Possible Interactions

Flaxseed supplements may alter the effects of some prescription and nonprescription medications. If you are currently being treated with any of the following medications, you should not use flaxseed without first talking to your doctor.

Blood-thinning medications: Omega-3 fatty acids may increase the risk of bleeding, especially if you also take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. In some cases, the combination of aspirin and omega-3 fatty acids may be helpful. But they should not be taken together except under a doctor's supervision.

Medications for diabetes: Flaxseed may lower blood sugar levels. If you are taking medicines for diabetes, including insulin, you should use flaxseed (ALA) only under your doctor's supervision.

Birth control pills or hormonal replacement therapy (HRT): Flaxseed may change hormone levels and change the effects of oral contraceptives or HRT. If you are taking an oral contraceptive or HRT, ask your doctor before taking flaxseed.

Supporting Research

Angerer P, von Schacky C. n-3 polyunsaturated fatty acids and the cardiovascular system. Curr Opin Lipidol. 2000;11(1):57-63.

Arnold LE, Kleykamp D, Votolato N, Gibson RA, Horrocks L. Potential link between dietary intake of fatty acid and behavior: pilot exploration of serum lipids in attention-deficit hyperactivity disorder. J Child Adolesc Psychopharmacol. 1994;4(3):171-182.

Boelsma E, Hendriks HF. Roza L. Nutritional skin care: health effects of micronutrients and fatty acids. Am J Clin Nutr. 2001;73(5):853-864.

Bommareddy A, Arasada BL, Mathees DP, Dwivedi C. Chemopreventive effects of dietary flaxseed on colon tumor development. Nutr Cancer. 2006;54(2):216-22.

Bruinsma KA, Taren DL. Dieting, essential fatty acid intake, and depression. Nutrition Rev. 2000;58(4):98-108.

Caligiuri SP, Aukema HM, Ravandi A, Guzman R, Dibrov E, Pierce GN. Flaxseed consumption reduces blood pressure in patients with hypertension by altering circulating oxylipins via an a-linolenic acid-induced inhibition of soluble epoxide hydrolase. Hypertension. 2014;64(1):53-9.

Caron MF, White CM. Evaluation of the antihyperlipidemic properties of dietary supplements. Pharmacotherapy. 2001;21(4):481-487.

Cellini M, Caramazzu N, Mangiafico P, Possati GL, Caramazza R. Fatty acid use in glaucomatous optic neuropathy treatment. Acta Ophthalmol Scand Suppl. 1998;227:41-42.

Cho E, Hung S, Willet WC, Spiegelman D, Rimm EB, Seddon JM, et al. Prospective study of dietary fat and the risk of age-related macular degeneration. Am J Clin Nutr. 2001;73(2):209-218.

Clark WF, Kortas C, Heidenheim AP, Garland J, Spanner E, Parbtani A. Flaxseed in lupus nephritis: a two–year nonplacebo-controlled crossover study. J Am Coll Nutr. 2001;20(2 Suppl):143-148.

Curtis CL, Hughes CE, Flannery CR, Little CB, Harwood JL, Caterson B. N-3 fatty acids specifically modulate catabolic factors involved in articular cartilage degradation. J Biol Chem. 2000;275(2):721-724.

Dahl WJ, Lockert EA, Cammer AL, Whiting SJ. Effects of flax fiber on laxation and glycemic response in healthy volunteers. J Med Food. 2005;8(4):508-11.

de Logeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99(6):779-785.

Demark-Wahnefried W, Price DT, Polascik TJ, et al. Pilot study of dietary fat restriction and flaxseed supplementation in men with prostate cancer before surgery: exploring the effects on hormonal levels, prostate-specific antigen, and histopathologic features. Urology. 2001;58(1):47-52.

Deutch B. Menstrual pain in Danish women correlated with low n-3 polyunsaturated fatty acid intake. Eur J Clin Nutr. 1995;49(7):508-516.

Dew TP, Williamson G. Controlled flax interventions for the improvement of menopausal symptoms and postmenopausal bone health: a systematic review. Menopause. 2013;20(11):1207-15.

Dodin S et al. Flaxseed on cardiovascular disease markers in healthy menopausal women: a randomized, double-blind, placebo-controlled trial. Nutrition. 2008;24(1):23-30.

Dodin S, Lemay A, Jacques H, Legare F, Forest JC, Masse B. The effects of flaxseed dietary supplement on lipid profile, bone mineral density, and symptoms in menopausal women: a randomized, double-blind, wheat germ placebo-controlled clinical trial. J Clin Endocrinol Metab. 2005;90(3):1390-7.

Edwards R, Peet M, Shay J, Horrobin D. Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients. J Affect Disord. 1998;48(2-3):149-155.

Freeman VL, Meydani M, Yong S, Pyle J, Flanigan RC, Waters WB, Wojcik EM. Prostatic levels of fatty acids and the histopathology of localized prostate cancer. J Urol. 2000;164(6):2168-2172.

Frieri G, Pimpo MT, Palombieri A, Melideo D, Marcheggiano A, Caprilli R, et al. Polyunsaturated fatty acid dietary supplementation: an adjuvant approach to treatment of Helicobacter pylori infection. Nut Res. 2000;20(7):907-916.

Geerling BJ, Badart-Smook A, van Deursen C, van Houwelingen AC, Russel MG, Stockbrugger RW, et al. Nutritional supplementation with N-3 fatty acids and antioxidants in patients iwth Crohn's disease in remission: effects on antioxidant status and fatty acid profile. IBD. 2000;6(2):77-84.

GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet. 1999;354:447-455.

Griel AE, Kris-Etherton PM, Hilpert KF, Zhao G, West SG, Corwin RL. An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans. Nutr J. 2007;6(1):2 [Epub ahead of print].

Hall C 3rd, Tulbek MC, Xu Y. Flaxseed. Adv Food Nutr Res. 2006;51:1-97.

Hallund J, Tetens I, Bugel S, Tholstrup T, Ferrari M, Teerlink T, Kjaer A, Wiinberg N. Daily consumption for six weeks of a lignan complex isolated from flaxseed does not affect endothelial function in healthy postmenopausal women. J Nutr. 2006;136(9):2314-8.

Haggans CJ, Hutchins AM, Olson BA, Thomas W, Martini MC, Slavin JL. Effect of flaxseed consumption on urinary estrogen metabolites in postmenopausal women. Nutr Canc. 1999;33(2):188-195.

Harper CR, Edwards MJ, DeFilipis AP, Jacobson TA. Flaxseed oil increases the plasma concentrations of cardioprotective (n-3) fatty acids in humans. J Nutr. 2006;136(1):83-7.

Harris WS. N-3 fatty acids and serum lipoproteins: human studies. Am J Clin Nutr. 1997;65(5):1645S (10).

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Holman RT, Adams CE, Nelson RA, Grater SJ, Jaskiewicz JA, Johnson SB, et al. Patients with anorexia nervosa demonstrate deficiencies of selected essential fatty acids, compensatory changes in nonessential fatty acids and decreased fluidity of plasma lipids. J Nutr. 1995;125:901-907.

Hu FB, Stampfer MJ, Manson JE et al. Dietary intake of alpha-linolenic acid and risk of fatal ischemic heart disease among women. Am J Clin Nutr. 1999;69:890-897.

Hutchins AM, Martini MC, Olson BA, Thomas W, Slavin JL. Flaxseed consumption influences endogenous hormone concentrations in postmenopausal women. Nutr Cancer. 2001;39(1):58-65.

Jenab M, Thompson LU. The influence of flaxseed and lignans on colon carcinogenesis and ß-glucuronidase activity. Carcinogenesis. 1996;17(6):1343-1348.

Klurfeld DM, Bull AW. Fatty acids and colon cancer in experimental models. Am J Clin Nut. 1997;66(6 Suppl):1530S-1538S.

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Lewis JE, Nickell LA, Thompson LU, Szalai JP, Kiss A, Hilditch JR. A randomized controlled trial of the effect of dietary soy and flaxseed muffins on quality of life and hot flashes during menopause. Menopause. 2006;13(4):631-42.

Lockwood K, Moesgaard S, Hanioka T, Folkers K. Apparent partial remission of breast cancer in 'high risk' patients supplemented with nutritional antioxidants, essential fatty acids, and coenzyme Q10. Mol Aspects Med. 1994;15Suppl:s231-s240.

Lorenz-Meyer H, Bauer P, Nicolay C, Schulz B, Purrmann J, Fleig WE, et al. Omega-3 fatty acids and low carbohydrate diet for maintenance of remission in Crohn's disease. A randomized controlled multicenter trial. Study Group Members (German Crohn's Disease Study Group). Scan J Gastroenterol. 1996;31(8):778-785.

Lowcock EC, Cotterchio M, Boucher BA. Consumption of flaxseed, a rich source of lignans, is associated with reduced breast cancer risk. Cancer Causes Control. 2013 Apr;24(4):813-6. doi: 10.1007/s10552-013-0155-7. Epub 2013 Jan 25.

Lucas EA, Wild RD, Hammond LJ, Khalil DA, Juma S, Daggy BP, Stoecker BJ, Arjmandi BH. Flaxseed improves lipid profile without altering biomarkers of bone metabolism in postmenopausal women. J Clin Endocrinol Metab. 2002;87(4):1527-32.

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Overview

Garlic has been used as both food and medicine for thousands of years, dating back to when the Egyptian pyramids were built. In early 18th century France, gravediggers drank crushed garlic in wine believing it would protect them from the plague. During both World War I and II, soldiers were given garlic to prevent gangrene. It was also used as an antiseptic and applied to wounds to prevent infection.

Today garlic is used to help prevent heart disease, including atherosclerosis or hardening of the arteries (plaque buildup in the arteries that can block the flow of blood and may lead to heart attack or stroke), high cholesterol, high blood pressure, and to boost the immune system. Eating garlic regularly may also help protect against cancer.

Garlic is rich in antioxidants. In your body, harmful particles called free radicals build up as you age and may contribute to heart disease, cancer, and Alzheimer disease. Antioxidants like those found in garlic fight off free radicals, and may reduce or even help prevent some of the damage they cause over time.

The conditions for which garlic is showing the most promise include the following:

Heart disease

Garlic is most often mentioned as an herb for heart disease and atherosclerosis (hardening of the arteries). But evidence is mixed. Some studies suggest that garlic may help prevent heart disease. It may slow down atherosclerosis and lower blood pressure a little, between 5% and 8%. Most of the studies on high blood pressure use a specific formulation called Kwai. One study that lasted 4 years found that people who took 900 mg daily of standardized garlic powder slowed the development of atherosclerosis. Garlic also seems to act as a blood thinner, which may help prevent heart attacks and strokes.

Earlier studies found that garlic lowered high cholesterol. But almost all recent studies that are high quality have found that garlic didn't lower cholesterol.

Common cold

Early evidence suggests garlic may help prevent colds. In one study, people took either garlic supplements or placebo for 12 weeks during cold season, between November and February. Those who took garlic had fewer colds than those who took placebo. And when they did get a cold, the people taking garlic saw their symptoms go away faster than those who took placebo.

Cancer

Garlic may strengthen the immune system, helping the body fight diseases such as cancer. In test tubes, garlic seems to kill cancer cells. And population studies, ones that follow groups of people over time, suggest that people who eat more raw or cooked garlic are less likely to get colon and stomach cancers and cancer of the esophagus. In fact, researchers who reviewed 7 studies found a 30% reduction in risk of colorectal cancer among people who ate a lot of raw or cooked garlic. Garlic supplements do not seem to have the same effect.

• A large-scale study, called the Iowa Women's Health Study, looked at how much garlic, fruit, and vegetables were in the diets of 41,000 middle-aged women. Results showed that women who regularly ate garlic, fruits, and vegetables had a 35% lower risk of developing colon cancer.
• Garlic may help the immune system function better during times of need such as in cancer. In a study of 50 people with inoperable colorectal, liver, or pancreatic cancer, immune activity improved after they took aged garlic extract for 6 months.

Other uses

• In test tubes, garlic killed roundworms, Ascaris lumbricoides, the most common type of intestinal parasite. But it has not been tested in humans, so researchers do not know if it works in people.
• One study found that men with benign prostatic hyperplasia (enlarged prostate) had fewer urinary symptoms when they took garlic, compared to men who took placebo. The garlic also reduced prostate size. More research is needed to see if garlic really helps men with enlarged prostate.
• Several studies report that a garlic gel applied to the skin may treat ringworm, jock itch, and athlete's foot.

Plant Description

Garlic is a perennial that originally came from central Asia, and is now grown throughout the world. It can grow 2 feet high or more. The compound bulb is the part used for medicine. Each bulb is made up of 4 to 20 cloves, and each clove weighs about 1 gram. Garlic supplements can either be made from fresh, dried, aged, or garlic oil. Each may have different effects on the body.

What is it Made of?

Researchers once thought that a chemical called allicin was responsible for garlic's benefits, as well as its distinctive smell. But there are other chemicals in garlic, including some sulfur-containing compounds, that may help fight heart disease and prevent some cancers.

Available Forms

Garlic supplements are made from whole fresh garlic, dried, or freeze-dried garlic, garlic oil, and aged garlic extracts.

Not all garlic contains the same amount of active ingredients. It is important to read the label carefully. To get the most benefit, use standardized garlic products. Also, follow the directions of a health care provider who is experienced in herbal medicine.

How to Take it

Pediatric

Ask your doctor before giving garlic supplements to a child. Research has not yet found what an effective and safe dose might be for children.

Adult

Ask your doctor for dosing instructions.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects, and interact with other herbs, supplements, or medications. For these reasons, you should take herbs under the supervision of a health care provider qualified in the field of botanical medicine.

Garlic is listed as Generally Recognized as Safe (GRAS) by the U.S. Food and Drug Administration (FDA).

Side effects include upset stomach, bloating, bad breath, body odor, and a stinging sensation on the skin from handling too much fresh or dried garlic. Handling garlic may also cause skin lesions. Other, more rare side effects that have been reported by those taking garlic supplements include headache, fatigue, loss of appetite, muscle aches, dizziness described as vertigo, and allergies such as an asthmatic reaction or skin rash.

Garlic acts like a blood thinner. Too much garlic can increase your risk for bleeding during or after surgery. It may also interact with blood-thinning medications.

People with ulcers or thyroid problems should ask their doctors before taking garlic.

Possible Interactions

Garlic may interact with a number of medications. Some of these medications are listed below. To be safe, if you take any prescription medicines, ask your doctor before taking garlic supplements.

Isoniazid (Nydrazid): This medication is used to treat tuberculosis. Garlic may interfere with the absorption of isoniazid, meaning the drug might not work as well.

Birth control pills: Garlic may make birth control pills less effective.

Cyclosporine: Garlic may interact with cyclosporine, a medication taken after organ transplant, and make it less effective.

Blood-thinning medications: Garlic may make the actions of blood-thinning medications including warfarin (Coumadin), clopidogrel (Plavix), and aspirin stronger, increasing the risk of bleeding.

Medications for HIV/AIDS: Garlic may lower blood levels of protease inhibitors, medications used to treat people with HIV. Protease inhibitors include:

• Amprenavir (Agenerase)
• Fosamprenavir (Lexiva)
• Indinavir (Crixivan)
• Nelfinavir (Viracept)
• Ritonavir (Norvir)
• Saquinavir (Fortovase)

Nonsteroidal anti-inflammatory drugs (NSAIDs): Both NSAIDs and garlic may increase the risk of bleeding. NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve), as well as prescription medications.

Supporting Research

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Berthold HK, Sudhop T, von Bergmann K. Effect of a garlic oil preparation on serum lipoproteins and cholesterol metabolism. JAMA. 1998;279.

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Fugh-Berman A. Herbs and dietary supplements in the prevention and treatment of cardiovascular disease. Prev Cardiol. 2000;3:24-32.

Garlic supplements can impede HIV medication. J Am Coll Surg. 2002;194(2):251.

Gallicano K, Foster B, Choudhri S. Effect of short-term administration of garlic supplements on single-dose ritonavir pharmacokinetics in healthy volunteers. Br J Clin Pharmacol. 2003;55(2):199-202.

Gullett NP, Ruhul Amin AR, Bayraktar S, Pezzuto JM, Shin DM, Khuri FR, Aggarwal BB, Surh YJ, Kucuk O. Cancer prevention with natural compounds. Semin Oncol. 2010 Jun;37(3):258-81. Review.

Hassan ZM, Yaraee R, Zare N, et al. Immunomodulatory affect of R10 fraction of garlic extract on natural killer activity. Int Immunopharmacol. 2003;3(10-11):1483-1489.

Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-1227.

Heron S, Yarnell E. Treating parasitic infections with botanical medicines. Altern Complement Ther. 1999;8:214-224.

Isaacsohn JL, Moser M, Stein EA, et al. Garlic powder and plasma lipids and lipoproteins: a multicenter, randomized, placebo-controlled trial. Arch Intern Med. 1998;158(11):1189-1194.

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Kendler BS. Recent nutritional approaches to the prevention and therapy of cardiovascular disease. Prog Cardiovasc Nurs. 1997;12(3):3-23.

Khatua TN, Adela R, Banerjee SK. Garlic and cardioprotection: insights into the molecular mechanisms. Can J Physiol Pharmacol. 2013;91(6):448-58.

Koscielny J, Klubendorf D, Latza R, Schmitt R, Radtke H, Siegel G, Kiesewetter H. The antiatherosclerotic effect of Allium sativum. Atherosclerosis. 1999;144:237-249.

Levi F, Pasche C, La Vecchia C, Lucchini F, Franceschi S. Food groups and colorectal cancer risk. Br J Cancer. 1999;79(7-8):1283-1287.

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Loy MH, Rivlin RS. Garlic and cardiovascular disease. Nutr Clin Care. 2000;3(3):146-151.

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Markowitz JS, Devane CL, Chavin KD, et al. Effects of garlic (Allium sativum L.) supplementation on cytochrome P450 2D6 and 3A4 activity in healthy volunteers. Clin Pharmacol Ther. 2003;74(2):170-177.

Mashour NH, Lin GI, Frishman WH. Herbal medicine for the treatment of cardiovascular disease. Arch Intern Med. 1998;158:2225-2234.

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Overview

Chamomile is one of the most popular herbs in the Western world. There are two plants known as chamomile: the more popular German chamomile (Matricaria recutita) and Roman, or English, chamomile (Chamaemelum nobile). Although they belong to different species, they are used to treat the same health problems. Both are used to calm frayed nerves, to treat stomach problems, to relieve muscle spasms, and to treat skin conditions and mild infections.

Chamomile has been used as a medicine for thousands of years, dating back to the ancient Egyptians, Romans, and Greeks. Historically, it has been used to treat many conditions, including:

• Chest colds
• Sore throats
• Abscesses
• Gum inflammation (gingivitis)
• Anxiety
• Insomnia
• Psoriasis
• Acne
• Eczema
• Minor first-degree burns
• Inflammatory bowel disease (ulcerative colitis)
• Stomach ulcers
• Children's conditions such as chickenpox, diaper rash, and colic

Although chamomile is popular, there are not many studies that look at whether it works to treat these conditions. Animal studies have shown that German chamomile reduces inflammation, speeds wound healing, reduces muscle spasms, and serves as a mild sedative to help with sleep. Few studies have investigated whether the same is true in people. Test tube studies have shown that chamomile can kill bacteria, fungus, and viruses.

Anxiety, insomnia

Most people in the U.S. who take chamomile use it to relieve anxiety or help them sleep. So far there has been only one controlled, randomized clinical trial using chamomile to treat anxiety in people. It found that chamomile capsules reduced symptoms of anxiety in people with mild to moderate generalized anxiety disorder (GAD). Animal studies have found that low doses of chamomile may relieve anxiety, while higher doses help sleep.

Digestive problems

Chamomile has been used traditionally to treat stomach cramps, irritable bowel syndrome (IBS), indigestion, diarrhea, gas, and colic. It helps relax muscle contractions, particularly in the smooth muscles that make up the intestines. But there are no good human studies on any of these conditions. One analysis of several studies found that a product with a combination of the herb iberis, peppermint, and chamomile helped relieve symptoms of indigestion.

Gingivitis, mouth sores

Some people use chamomile for these mouth problems, but so far there is no evidence that it works. When used as a mouthwash, there is some evidence that chamomile may help prevent mouth sores from radiation and chemotherapy, but results from studies are mixed.

Skin irritations, eczema

Chamomile is often used in a cream or ointment to soothe irritated skin, especially in Europe. Most evidence comes from animal studies, not studies with people. Two studies in people found that a chamomile cream helped relieve symptoms of eczema.

Plant Description

The tiny daisy-like flowers of German chamomile have white collars circling raised, cone-shaped, yellow centers and are less than an inch wide, growing on long, thin, light green stems. Sometimes chamomile grows wild and close to the ground, but you can also find it bordering herb gardens. It can reach up to 3 feet high. German chamomile is native to Europe, north Africa, and some parts of Asia. It is closely related to Roman chamomile (Chamaemelum nobile), which, although less commonly used, has many of the same medicinal properties.

What is it Made Of?

Chamomile teas, ointments, and extracts all start with the white and yellow flower head. The flower heads may be dried and used in teas or capsules, or crushed and steamed to produce a blue oil, which is used as medicine. The oil contains ingredients that reduce swelling and may stop the growth of bacteria, viruses, and fungi.

Available Forms

German chamomile is available as dried flower heads, tea, liquid extract, capsules, and topical ointment.

How to Take It

Pediatric

Ask your doctor before giving chamomile tea to a child. Children under 5 should not take more than half a cup of tea per day.

To relieve colic: Some doctors suggest 1 to 2 oz. of tea per day. Your doctor may recommend other doses.

Adult

• Tea: Pour 1 cup of boiling water over 2 to 3 heaping tsp. (2 to 4 g) of dried herb, steep 10 to 15 minutes. Drink 3 to 4 times per day between meals.
• Tincture (1:5, 45% alcohol): 30 to 60 drops of tincture, 3 times per day in hot water.
• Capsules: 300 to 400 mg taken 3 times per day.
• Gargle or mouthwash: Make a tea as above, then let it cool. Gargle as often as desired. You may also make an oral rinse with 10 to 15 drops of German chamomile liquid extract in 100 ml warm water, and use 3 times per day.
• Inhalation: Add a few drops of essential oil of chamomile to hot water (or use tea) and breathe in the steam to calm a cough.
• Bath: Use 1/4 lb. of dried flowers per bath, or add 5 to 10 drops of essential oil to a full tub of water to soothe hemorrhoids, cuts, eczema, or insect bites.
• Poultice: Make a paste by mixing powdered herb with water and apply to inflamed skin.
• Cream: Use a cream with a 3 to 10% chamomile content for psoriasis, eczema, or dry and flaky skin.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.

German chamomile is considered generally safe.

Chamomile may make asthma worse, so people with asthma should not take it.

Pregnant women should avoid chamomile because of the risk of miscarriage.

Chamomile may act like estrogen in the body, so women with a history of hormone-sensitive cancers, such as breast or uterine cancer, should ask their doctors before taking it.

If you are allergic to asters, daisies, chrysanthemums, or ragweed, you may also be allergic to chamomile.

Drinking large amounts of highly concentrated chamomile tea may cause vomiting.

Chamomile may cause drowsiness, so DO NOT take it and drive.

Stop taking chamomile at least 2 weeks before surgery or dental surgery, because of the risk of bleeding.

Possible Interactions

If you take any of the following drugs, you should not use German chamomile without first talking to your health care provider:

Blood-thinning medications (anticoagulants and antiplatelets): Chamomile may increase the risk of bleeding when taken with blood-thinners such as warfarin (Coumadin), clopidogrel (Plavix), and aspirin.

Sedatives: Use caution with sedatives since chamomile can make these drugs stronger, including:

• Anti-seizure medications, such as phenytoin (Dilantin) and valproic acid (Depakote)
• Barbiturates
• Benzodiazepines, such as alprazolam (Xanax) and diazepam (Valium)
• Drugs to treat insomnia, such as zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta), and ramelteon (Rozerem)
• Tricyclic antidepressants, such as amitriptyline (Elavil)
• Alcohol

The same is true of sedative herbs, such as valerian, kava, and catnip.

Blood pressure medications: Chamomile may lower blood pressure slightly. Taking it with drugs for high blood pressure could cause blood pressure to drop too low.

Diabetes medications: Chamomile may lower blood sugar. Taking it with diabetes drugs could raise the risk of hypoglycemia or low blood sugar.

Hormonal therapies: Due to its similarity to estrogen, chamomile may potentially interfere with drugs such as nolvadex (Tamoxifen) among others.

Other drugs: Because chamomile is broken down by the liver, it may interact with other drugs that are broken down the same way. Those drugs may include:

• Fexofenadine (Seldane)
• Statins (drugs that can lower cholesterol)
• Birth control pills
• Some antifungal drugs

Supporting Research

Ali-Shtayeh MS, Yaniv Z, Mahajna J. Ethnobotanical survey in the Palestinian area: a classification of the healing potential of medicinal plants. J Ethnopharmacol. 2000;73(1-2):221-232.

Amsterdam JD, Shults J, Soeller I, Mao JJ, Rockwell K, Newberg AB. Chamomile (Matricaria recutita) may provide antidepressant activity in anxious, depressed humans: an exploratory study. Altern Ther Health Med. 2012 Sep-Oct;18(5):44-9.

Amsterdam JD, Yimei L, Soeller I, et al. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. 2009;29(4):378-382.

Avallone R, Zanoli P, Puia G, et al. Pharmacological profile of apigenin, a flavonoid isolated from Matricaria chamomilla. Biochem Pharmacol. 2000;59(11):1387-1394.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:57-61.

de la Torre Morin F, Sanchez Machin I, Garcia Robaina JC, et al. Clinical cross-reactivity between Artemisia vulgaris and Matricaria chamomilla (chamomile). J Investig Allergol Clin Immunol. 2001;11(2):118-122.

Foti C, Nettis E, Panebianco R, et al. Contact urticaria from Matricaria chamomilla. Contact Dermatitis. 2000;42(6):360-361.

Gyllenhaal C. Efficacy and safety of herbal stimulants and sedatives in sleep disorders. Sleep Med Rev. 2000;4(2).

Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-1227.

Khayyal MT, el-Ghazaly MA, Kenawy SA, et al. Antiulcerogenic effect of some gastrointestinally acting plant extracts and their combination. Arzneimittelforschung. 2001;51(7):545-553.

Martins MD, Marques MM, Bussadori SK, Martins MA, Pavesi VC, Mesquita-Ferrari RA, Fernandes KP. Comparative analysis between Chamomilla recutita and corticosteroids on wound healing. An in vitro and in vivo study. Phytother Res. 2009 Feb;23(2):274-8.

Mazokopakis EE, Vrentzos GE, Papadakis JA, et al. Wild chamomile (Matricaria recutita L.) mouthwashes in methotrexate-induced oral mucositis. Phytomedicine. 2005 Jan;12(1-2):25-7.

McKay DL, Blumberg JB. A review of the bioactivity and potential health benefits of chamomile tea (Matricaria recutita L.). Phytother Res. [Review]. 2006 Jul;20(7):519-30.

Miller L. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;158(20):2200-2211.

O'Hara M, Kiefer D, Farrell K, et al. A review of 12 commonly used medicinal herbs. Arch Fam Med. 1998:7(6):523-536.

Roberts RE, Allen S, Chang AP, et al. Distinct mechanisms of relaxation to bioactive components from chamomile species in porcine isolated blood vessels. Toxicol Appl Pharmacol. 2013;272(3):797-805.

Singh O, Khanam Z, Misra N, Srivastava MK. Chamomile (Matricaria chamomilla L.): An overview. Pharmacogn Rev. 2011 Jan;5(9):82-95. doi: 10.4103/0973-7847.79103.

Srivastava JK, Shankar E, Gupta S. Chamomile: A herbal medicine of the past with bright future. Mol Med Report. 2010 Nov 1;3(6):895-901.

Subiza J, Subiza JL, Hinojosa M, et al. Anaphylactic reaction after the ingestion of chamomile tea: a study of cross-reactivity with other composite pollens. J Allergy Clin Immunol. 1989;84(3):353-358.

Viola H, Wasowski C, Levi de Stein M, et al. Apigenin, a component of Matricaria recutita flowers, is a central benzodiazepine receptors-ligand with anxiolytic effects. Planta Med. 1995;61(3):213-216.

Zick SM, Wright BD, Sen A, Arnedt JT. Preliminary examination of the efficacy and safety of a standardized chamomile extract for chronic primary insomnia: a randomized placebo-controlled pilot study. BMC Complement Altern Med. 2011 Sep 22;11:78. doi: 10.1186/1472-6882-11-78.

Overview

Ginger, the "root" or the rhizome, of the plant Zingiber officinale, has been a popular spice and herbal medicine for thousands of years. It has a long history of use in Asian, Indian, and Arabic herbal traditions. In China, for example, ginger has been used to help digestion and treat stomach upset, diarrhea, and nausea for more than 2,000 years. Ginger has also been used to help treat arthritis, colic, diarrhea, and heart conditions.

It has been used to help treat the common cold, flu-like symptoms, headaches, and painful menstrual periods.

Ginger is native to Asia where it has been used as a cooking spice for at least 4,400 years.

Plant Description

Ginger is a knotted, thick, beige underground stem, called a rhizome. The stem sticks up about 12 inches above ground with long, narrow, ribbed, green leaves, and white or yellowish-green flowers.

What is it Made of?

Researchers think the active components of the ginger root are volatile oils and pungent phenol compounds, such as gingerols and shogaols.

Medicinal Uses and Indications

Today, health care professionals may recommend ginger to help prevent or treat nausea and vomiting from motion sickness, pregnancy, and cancer chemotherapy. It is also used to treat mild stomach upset, to reduce pain of osteoarthritis, and may even be used in heart disease.

Motion sickness

Several studies, but not all, suggest that ginger may work better than placebo in reducing some symptoms of motion sickness. In one trial of 80 new sailors who were prone to motion sickness, those who took powdered ginger had less vomiting and cold sweats compared to those who took placebo. Ginger did not reduce their nausea, however. A study with healthy volunteers found the same thing.

However, other studies found that ginger does not work as well as medications for motion sickness. In one small study, people were given either fresh root or powdered ginger, scopolamine, a medication commonly prescribed for motion sickness, or a placebo. Those who took scopolamine had fewer symptoms than those who took ginger. Conventional prescription and over-the-counter medicines for nausea may also have side effects that ginger does not, such as dry mouth and drowsiness.

Pregnancy-related nausea and vomiting

Human studies suggest that 1g daily of ginger may reduce nausea and vomiting in pregnant women when used for short periods (no longer than 4 days). Several studies have found that ginger is better than placebo in relieving morning sickness.

In a small study of 30 pregnant women with severe vomiting, those who took 1 gram of ginger every day for 4 days reported more relief from vomiting than those who took placebo. In a larger study of 70 pregnant women with nausea and vomiting, those who got a similar dose of ginger felt less nauseous and did not vomit as much as those who got placebo. Pregnant women should ask their doctors before taking ginger and not take more than 1g per day.

Chemotherapy nausea

A few studies suggest that ginger reduces the severity and duration of nausea, but not vomiting, during chemotherapy. However, one of the studies used ginger combined with another anti-nausea drug. So it is hard to say whether ginger had any effect. More studies are needed.

Nausea and vomiting after surgery

Research is mixed as to whether ginger can help reduce nausea and vomiting following surgery. Two studies found that 1g of ginger root before surgery reduced nausea as well as a leading medication. In one of these studies, women who took ginger also needed fewer medications for nausea after surgery. But other studies have found that ginger did not help reduce nausea. In fact, one study found that ginger may actually increase vomiting following surgery. More research is needed.

Osteoarthritis

Traditional medicine has used ginger for centuries to reduce inflammation. And there is some evidence that ginger may help reduce pain from osteoarthritis (OA). In a study of 261 people with OA of the knee, those who took a ginger extract twice daily had less pain and needed fewer pain-killing medications than those who received placebo. Another study found that ginger was no better than ibuprofen (Motrin, Advil) or placebo in reducing symptoms of OA. It may take several weeks for ginger to work.

Other uses

Preliminary studies suggest that ginger may lower cholesterol and help prevent blood from clotting. That can help treat heart disease where blood vessels can become blocked and lead to heart attack or stroke. Other studies suggest that ginger may help improve blood sugar control among people with type 2 diabetes. More research is needed to determine whether ginger is safe or effective for heart disease and diabetes.

Available Forms

Ginger products are made from fresh or dried ginger root, or from steam distillation of the oil in the root. You can find ginger extracts, tinctures, capsules, and oils. You can also buy fresh ginger root and make a tea. Ginger is a common cooking spice and can be found in a variety of foods and drinks, including ginger bread, ginger snaps, ginger sticks, and ginger ale.

How to Take it

Pediatric

DO NOT give ginger to children under 2.

Children over 2 may take ginger to treat nausea, stomach cramping, and headaches. Ask your doctor to find the right dose.

Adult

In general, DO NOT take more than 4 g of ginger per day, including food sources. Pregnant women should not take more than 1 g per day.

• For nausea, gas, or indigestion: Some studies have used 1 g of ginger daily, in divided doses. Ask your doctor to help you find the right dose for you.
• For pregnancy-induced vomiting: Some studies have used 650 mg to 1 g per day. DO NOT take ginger without talking to your doctor first.
• For arthritis pain: One study used 250 mg, 4 times daily.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken under the supervision of a health care provider, qualified in the field of botanical medicine.

It is rare to have side effects from ginger. In high doses it may cause mild heartburn, diarrhea, and irritation of the mouth. You may be able to avoid some of the mild stomach side effects, such as belching, heartburn, or stomach upset, by taking ginger supplements in capsules or taking ginger with meals.

People with gallstones should talk to their doctors before taking ginger. Be sure to tell your doctor if you are taking ginger before having surgery or being placed under anesthesia.

Pregnant or breastfeeding women, people with heart conditions, and people with diabetes should not take ginger without talking to their doctors.

DO NOT take ginger if you have a bleeding disorder or if you are taking blood-thinning medications, including aspirin.

Possible Interactions

Ginger may interact with prescription and over-the-counter medicines. If you take any of the following medicines, you should not use ginger without talking to your health care provider first.

Blood-thinning medications: Ginger may increase the risk of bleeding. Talk to your doctor before taking ginger if you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.

Diabetes medications: Ginger may lower blood sugar. That can raise the risk of developing hypoglycemia or low blood sugar.

High blood pressure medications: Ginger may lower blood pressure, raising the risk of low blood pressure or irregular heartbeat.

Supporting Research

Ali BH, Blunden G, Tanira MO, Nemmar A. Some phytochemical, pharmacological and toxicological properties of ginger (Zingiber officinale Roscoe): a review of recent research. Food Chem Toxicol. 2008;46(2):409-20.

Altman RD, Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum. 2001;44(11):2531-2538.

Apariman S, Ratchanon S, Wiriyasirivej B. Effectiveness of ginger for prevention of nausea and vomiting after gynecological laparoscopy. J Med Assoc Thai. 2006;89(12):2003-9.

Bliddal H, Rosetzsky A, Schlichting P, et al. A randomized, placebo-controlled, cross-over study of ginger extracts and ibuprofen in osteoarthritis. Osteoarthritis Cartilage. 2000;8:9-12.

Bone ME, Wilkinson DJ, Young JR, McNeil J, Charlton S. Ginger root -- a new antiemetic. The effect of ginger root on postoperative nausea and vomiting after major gynaecological surgery. Anaesthesia. 1990;45(8):669-71.

Bordia A, Verma SK, Srivastava KC. Effect of ginger (Zingiber officinale Rosc.) and fenugreek (Trigonella foenumgraecum L.) on blood lipids, blood sugar, and platelet aggregation ion patients with coronary heart disease. Prostaglandins Leukot Essent Fatty Acids. 1997;56(5):379-384.

Chaiyakunapruk N. The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. Am J Obstet Gynecol. 2006;194(1):95-9.

Eberhart LH, Mayer R, Betz O, et al. Ginger does not prevent postoperative nausea and vomiting after laparoscopic surgery. Anesth Analg. 2003;96(4):995-8, table.

Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. B J Anaesth. 2000;84(3):367-371.

Fischer-Rasmussen W, Kjaer SK, Dahl C, Asping U. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol. 1991 Jan 4;38(1):19-24.

Fuhrman B, Rosenblat M, Hayek T, Coleman R, Aviram M. Ginger extract consumption reduces plasma cholesterol, inhibits LDL oxidation, and attenuates development of atherosclerosis in atherosclerotic, apolipoprotein E-deficient mice. J Nutr. 2000;130(5):1124-1131.

Gonlachanvit S, Chen YH, Hasler WL, et al. Ginger reduces hyperglycemia-evoked gastric dysrhythmias in healthy humans: possible role of endogenous prostaglandins. J Pharmacol Exp Ther. 2003;307(3):1098-1103.

Gregory PJ, Sperry M, Wilson AF. Dietary supplements for osteoarthritis. Am Fam Physician. 2008 Jan 15;77(2):177-84. Review.

Grontved A, Brask T, Kambskard J, Hentzer E. Ginger root against seasickness: a controlled trial on the open sea. Acta Otolaryngol. 1988;105:45-49.

Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-1227.

Kalava A, Darji SJ, Kalstein A, Yarmush JM, SchianodiCola J, Weinberg J. Efficacy of ginger on intraoperative and postoperative nausea and vomiting in elective cesarean section patients. Eur J Obstet Gynecol Reprod Biol. 2013;169(2):184-8.

Langner E, Greifenberg S, Gruenwald J. Ginger: history and use. Adv Ther. 1998;15(1):25-44.

Larkin M. Surgery patients at risk for herb-anaesthesia interactions. Lancet. 1999;354(9187):1362.

Lee SH, Cekanova M, Baek SJ. Multiple mechanisms are involved in 6-gingerol-induced cell growth arrest and apoptosis in human colorectal cancer cells. Mol Carcinog. 2008;47(3):197-208.

Mahady GB, Pendland SL, Yun GS, et al. Ginger (Zingiber officinale Roscoe) and the gingerols inhibit the growth of Cag A+ strains of Helicobacter pylori. Anticancer Res. 2003;23(5A):3699-3702.

Nurtjahja-Tjendraputra E, Ammit AJ, Roufogalis BD, et al. Effective anti-platelet and COX-1 enzyme inhibitors from pungent constituents of ginger. Thromb Res. 2003;111(4-5):259-265.

Phillips S, Ruggier R, Hutchinson SE. Zingiber officinale (ginger) -- an antiemetic for day case surgery. Anaesthesia. 1993;48(8):715-717.

Pongrojpaw D, Somprasit C, Chanthasenanont A. A randomized comparison of ginger and dimenhydrinate in the treatment of nausea and vomiting in pregnancy. J Med Assoc Thai. 2007 Sep;90(9):1703-9.

Portnoi G, Chng LA, Karimi-Tabesh L, et al. Prospective comparative study of the safety and effectiveness of ginger for the treatment of nausea and vomiting in pregnancy. Am J Obstet Gynecol. 2003;189(5):1374-1377.

Sripramote M, Lekhyananda N. A randomized comparison of ginger and vitamin B6 in the treatment of nausea and vomiting of pregnancy. J Med Assoc Thai. 2003;86(9):846-853.

Thomson M, Al Qattan KK, Al Sawan SM, et al. The use of ginger (Zingiber officinale Rosc.) as a potential anti-inflammatory and antithrombotic agent. Prostaglandins Leukot Essent Fatty Acids. 2002;67(6):475-478.

Vaes LP, Chyka PA. Interactions of warfarin with garlic, ginger, ginkgo, or ginseng: nature of the evidence. Ann Pharmacother. 2000;34(12):1478-1482.

Viljoen E, Visser J, Koen N, Musekiwa A. A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting. Nutr J. 2014; 13:20.

Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol. 2001;97(4):577-582.

Wang CC, Chen LG, Lee LT, et al. Effects of 6-gingerol, an antioxidant from ginger, on inducing apoptosis in human leukemic HL-60 cells. In Vivo. 2003;17(6):641-645.

White B. Ginger: an overview. Am Fam Physician. 2007;75(11):1689-91.

Wigler I, Grotto I, Caspi D, et al. The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis. Osteoarthritis Cartilage. 2003;11(11):783-789.

Willetts KE, Ekangaki A, Eden JA. Effect of a ginger extract on pregnancy-induced nausea: a randomised controlled trial. Aust N Z J Obstet Gynaecol. 2003;43(2):139-144.

Overview

Ginkgo (Ginkgo biloba) is one of the oldest living tree species. It is also one of the best-selling herbal supplements in the United States and Europe.

Ginkgo has a long history of use in treating blood disorders and memory issues. It is best known today as way to potentially keep your memory sharp. Laboratory studies have shown that ginkgo improves blood circulation by opening up blood vessels and making blood less sticky. It is also an antioxidant.

For those reasons, ginkgo may improve vein and eye health. Although not all studies agree, ginkgo may help treat dementia (including Alzheimer disease) and intermittent claudication, or poor circulation in the legs. It may also protect memory in older adults.

Ginkgo leaves contain flavonoids and terpenoids, which are both antioxidants. In your body, harmful particles called free radicals build up as you age, and may contribute to heart disease, cancer, and Alzheimer disease. Antioxidants like those found in ginkgo fight off free radicals, and stop them from damaging DNA and other cells.

Plant Description

Ginkgo biloba is the oldest living tree species. A single tree can live as long as 1,000 years and grow to a height of 120 feet. It has short branches with fan-shaped leaves and inedible fruits that smell bad. The fruit has an inner seed, which may be poisonous. Ginkgos are tough, hardy trees and are sometimes planted along urban streets in the United States. The leaves turn brilliant colors in the fall.

Although Chinese herbal medicine has used both the ginkgo leaf and seed for thousands of years, modern research has focused on the standardized Ginkgo biloba extract (GBE) made from the dried green leaves. This standardized extract is highly concentrated and seems to treat health problems (particularly circulatory problems) better than the non-standardized leaf alone.

What is it Made of?

Scientists have found more than 40 components in ginkgo. Only two are believed to act as medicine: flavonoids and terpenoids. Flavonoids are plant-based antioxidants. Laboratory and animal studies show that flavonoids protect the nerves, heart muscle, blood vessels, and retina from damage. Terpenoids (such as ginkgolides) improve blood flow by dilating blood vessels and reducing the stickiness of platelets.

Medicinal Uses and Indications

Based on studies conducted in laboratories, animals, and people, ginkgo is used for the following:

Dementia and Alzheimer disease

Ginkgo is widely used in Europe for treating dementia. At first, doctors thought it helped because it improves blood flow to the brain. Now research suggests it may protect nerve cells that are damaged in Alzheimer disease. Several studies show that ginkgo has a positive effect on memory and thinking in people with Alzheimer disease or vascular dementia.

Studies suggest that ginkgo may help people with Alzheimer disease:

• Improve thinking, learning, and memory (cognitive function)
• Have an easier time performing daily activities
• Improve social behavior
• Have fewer feelings of depression

Several studies have found that ginkgo may work as well as some prescription Alzheimer disease medications to delay the symptoms of dementia. It has not been tested against all of the drugs prescribed to treat Alzheimer disease.

In 2008, a well-designed study with more than 3,000 elderly people found that ginkgo was no better than placebo in preventing dementia or Alzheimer disease.

Intermittent claudication

Because ginkgo improves blood flow, it has been studied in people with intermittent claudication, or pain caused by reduced blood flow to the legs. People with intermittent claudication have a hard time walking without feeling extreme pain. An analysis of 8 studies showed that people taking ginkgo tended to walk about 34 meters farther than those taking placebo. In fact, ginkgo has been shown to work as well as a prescription medication in improving pain-free walking distance. However, regular walking exercises work better than ginkgo in improving walking distance.

Anxiety

One preliminary study found that a special formulation of ginkgo extract called EGB 761 might help relieve anxiety. People with generalized anxiety disorder and adjustment disorder who took this specific extract had fewer anxiety symptoms than those who took placebo.

Glaucoma

One small study found that people with glaucoma who took 120 mg of ginkgo daily for 8 weeks had improvements in their vision.

Memory and thinking

Ginkgo is widely touted as a "brain herb." Some studies show that it does help improve memory in people with dementia. It is not as clear whether ginkgo helps memory in healthy people who have normal, age-related memory loss. Some studies have found slight benefits, while other studies have found no effect. Some studies have found that ginkgo helps improve memory and thinking in young and middle-aged people who are healthy. And preliminary studies suggest it may be useful in the treatment of Attention Deficit Hyperactivity Disorder (ADHD). The dose that works best seems to be 240 mg per day. Ginkgo is often added to nutrition bars, soft drinks, and fruit smoothies to boost memory and enhance mental performance, although such small amounts probably do not help.

Macular degeneration

The flavonoids found in ginkgo may help stop or reduce some problems with the retina, the back part of the eye. Macular degeneration, often called age-related macular degeneration or AMD, is an eye disease that affects the retina. The number one cause of blindness in the Unites States, AMD is a degenerative eye disease that gets worse as time goes on. Some studies suggest that ginkgo may help preserve vision in those with AMD.

Premenstrual syndrome (PMS)

Two studies with a somewhat complicated dosing schedule found that ginkgo helped reduce PMS symptoms. Women in the studies took a special extract of ginkgo beginning on day 16 of their menstrual cycle and stopped taking it after day 5 of their next cycle, then took it again on day 16.

Raynaud's phenomenon

One well-designed study found that people with Raynaud's phenomenon who took ginkgo over a 10-week period had fewer symptoms than those who took placebo. More studies are needed.

Available Forms

• Standardized extracts containing 24 to 32% flavonoids (also known as flavone glycosides or heterosides) and 6 to 12% terpenoids (triterpene lactones)
• Capsules
• Tablets
• Liquid extracts (tinctures, fluid extracts, and glycerites)
• Dried leaf for teas

How to Take it

Pediatric

Ginkgo should not be given to children.

Adult

Memory problems and Alzheimer disease: Many studies have used 120 to 240 mg daily in divided doses, standardized to contain 24 to 32% flavone glycosides (flavonoids or heterosides) and 6 to 12% triterpene lactones (terpenoids).

Intermittent claudication: Studies have used 120 to 240 mg per day.

It can take 4 to 6 weeks to see any effects from ginkgo. Ask your doctor to help you find the right dose.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider qualified in the field of botanical medicine.

Ginkgo usually has few side effects. In a few cases, people have reported stomach upset, headaches, skin reactions, and dizziness.

There have been reports of internal bleeding in people who take ginkgo. It is not clear whether the bleeding was due to ginkgo or some other reason, such as a combination of ginkgo and blood-thinning drugs. Ask your doctor before taking ginkgo if you also take blood-thinning drugs.

Stop taking ginkgo 1 to 2 weeks before surgery or dental procedures due to the risk of bleeding. Always alert your doctor or dentist that you take ginkgo.

People who have epilepsy should not take ginkgo, because it might cause seizures.

Pregnant and breastfeeding women should not take ginkgo.

People who have diabetes should ask their doctor before taking ginkgo.

DO NOT eat Ginkgo biloba fruit or seed.

Possible Interactions

Ginkgo may interact with prescription and non-prescription medications. If you are taking any of the following medications, you should not use ginkgo without talking to your doctor first.

Medications broken down by the liver: Ginkgo can interact with medications that are processed through the liver. Because many medications are broken down by the liver, if you take any prescription medications ask your doctor before taking ginkgo.

Seizure medications (anticonvulsants): High doses of ginkgo could interfere with the effectiveness of anti-seizure drugs. These drugs include carbamazepine (Tegretol) and valproic acid (Depakote).

Antidepressants: Taking ginkgo along with a kind of antidepressant called selective serotonin reuptake inhibitors (SSRIs) may increase the risk of serotonin syndrome, a life-threatening condition. Also, ginkgo may strengthen both the good and bad effects of antidepressants known as MAOIs, such as phenelzine (Nardil). SSRIs include:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Medications for high blood pressure: Ginkgo may lower blood pressure, so taking it with blood pressure medications may cause blood pressure to drop too low. There has been a report of an interaction between ginkgo and nifedipine (Procardia), a calcium channel blocker used for blood pressure and heart rhythm problems.

Blood-thinning medications: Ginkgo may raise the risk of bleeding, especially if you take blood-thinners, such as warfarin (Coumadin), clopidogrel (Plavix), and aspirin.

Alprazolam (Xanax): Ginkgo may make Xanax less effective, and interfere with the effectiveness of other drugs taken to treat anxiety.

Ibuprofen (Advil, Motrin): Like ginkgo, the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen also raises the risk of bleeding. Bleeding in the brain has been reported when using a ginkgo product and ibuprofen.

Medications to lower blood sugar: Ginkgo may raise or lower insulin levels and blood sugar levels. If you have diabetes, you should not use ginkgo without first talking to your doctor.

Cylosporine:Ginkgo biloba may help protect the cells of the body during treatment with the drug cyclosporine, which suppresses the immune system.

Thiazide diuretics (water pills): There is one report of a person who took a thiazide diuretic and ginkgo developing high blood pressure. If you take thiazide diuretics, ask your doctor before taking ginkgo.

Trazodone: There is one report of an elderly person with Alzheimer disease going into a coma after taking ginkgo and trazodone (Desyrel), an antidepressant medication.

Supporting Research

Amieva H, Meillon C, Helmer C, Barberger-Gateau P, Dartigues JF. Ginkgo biloba extract and long-term cognitive decline: a 20-year follow-up population-based study. PLoS One. 2013;8(1):e52755. doi: 10.1371/journal.pone.0052755. Epub 2013 Jan 11.

Aruna D, Naidu MU.Pharmacodynamic interaction studies of Ginkgo biloba with cilostazol and clopidogrel in healthy human subjects. Br J Clin Pharmacol. 2006 Sep 29; [Epub ahead of print].

Ashton, A. K., Ahrens, K., Gupta, S., and Masand, P. S. Antidepressant-induced sexual dysfunction and Ginkgo Biloba. Am J Psychiatry. 2000;157(5):836-837.

Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD003120. Review.

Cheuvront, S. N. and Carter, R., III. Ginkgo and memory. JAMA. 2-5-2003;289(5):547-548.

Choi WS, Choi CJ, Kim KS, Lee JH, Song CH, Chung JH, et al. To compare the efficacy and safety of nifedipine sustained release with Ginkgo biloba extract to treat patients with primary Raynaud's phenomenon in South Korea; Korean Raynaud study (KOARA study). Clin Rheumatol. 2009 Jan 22. [Epub ahead of print]

Cieza, A., Maier, P., and Poppel, E. Effects of Ginkgo biloba on mental functioning in healthy volunteers. Arch Med Res. 2003;34(5):373-381.

DeKosky ST, Williamson JD, Fitzpatrick AL, Kronmal RA, Ives DG, Saxton JA, et al; Ginkgo Evaluation of Memory (GEM) Study Investigators. Ginkgo biloba for prevention of dementia: a randomized controlled trial. JAMA. 2008 Nov 19;300(19):2253-62. Erratum in: JAMA. 2008 Dec 17;300(23):2730.

Drew S, Davies E. Effectiveness of Ginkgo biloba in treating tinnitus: double blind, placebo controlled trial. BMJ. 2001;322(7278):73.

Engelsen, J., Nielsen, J. D., and Hansen, K. F. [Effect of Coenzyme Q10 and Ginkgo biloba on warfarin dosage in patients on long-term warfarin treatment. A randomized, double-blind, placebo-controlled cross-over trial]. Ugeskr.Laeger. 4-28-2003;165(18):1868-1871.

Evans JR. Ginkgo biloba extract for age-related macular degeneration. Cochrane Database Syst Rev. 2013 Jan 31;1:CD001775. doi: 10.1002/14651858.CD001775.pub2. Review.

Hartley, D. E., Elsabagh, S., and File, S. E. Gincosan (a combination of Ginkgo biloba and Panax ginseng): the effects on mood and cognition of 6 and 12 weeks' treatment in post-menopausal women. Nutr Neurosci. 2004;7(5-6):325-333.

Hilton, M. and Stuart, E. Ginkgo biloba for tinnitus. Cochrane Database Syst Rev. 2004;(2):CD003852.

Horsch, S. and Walther, C. Ginkgo biloba special extract EGb 761 in the treatment of peripheral arterial occlusive disease (PAOD)--a review based on randomized, controlled studies. Int.J Clin Pharmacol Ther. 2004;42(2):63-72.

Huang, S. Y., Jeng, C., Kao, S. C., Yu, J. J., and Liu, D. Z. Improved haemorrheological properties by Ginkgo biloba extract (Egb 761) in type 2 diabetes mellitus complicated with retinopathy. Clin.Nutr. 2004;23(4):615-621.

Ihl R. Effects of Ginkgo biloba extract EGb 761 in dementia with neuropsychiatric features: review of recently completed randomised, controlled trials. Int J Psychiatry Clin Pract. 2013; 17 Suppl 1:8-14.

Ihl R, Tribanek M, Bachinskaya N; GOTADAY Study Group. Efficacy and tolerability of a once daily formulation of Ginkgo biloba extract EGb761 in Alzheimer's disease and vascular dementia: results from a randomised controlled trial. Pharmacopsychiatry. 2012;45:41-6.

Johnson SK, Diamond BJ, Rausch S, Kaufman M, Shiflett SC, Graves L. The effect of Ginkgo biloba on functional measures in multiple sclerosis: a pilot randomized controlled trial. Explore (NY). 2006;2(1):19-24.

Kenney C, Norman M, Jacobson M, and et al. A double-blind, placebo-controlled, modified crossover pilot study of the effects of Ginkgo biloba on cognitive and functional abilities in multiple sclerosis. American Academy of Neurology 54th Annual Meeting. April 13-20 2002;P06.081.

Kohler, S., Funk, P., and Kieser, M. Influence of a 7-day treatment with Ginkgo biloba special extract EGb 761 on bleeding time and coagulation: a randomized, placebo-controlled, double-blind study in healthy volunteers. Blood Coagul.Fibrinolysis. 2004;15(4):303-309.

Le Bars PL, Kieser M, Itil KZ. A 26-week analysis of a double-blind, placebo-controlled trial of the Ginkgo biloba extract EGb761 in dementia. Dement Geriatr Cogn Disord. 2000;11:230-237.

Mantle D, Pickering AT, Perry AK. Medicinal plant extracts for the treatment of dementia: a review of their pharmacology, efficacy and tolerability. CNS Drugs. 2000;13:201-213.

Mauro, V. F., Mauro, L. S., Kleshinski, J. F., Khuder, S. A., Wang, Y., and Erhardt, P. W. Impact of ginkgo biloba on the pharmacokinetics of digoxin. Am.J Ther. 2003;10(4):247-251.

May BH, Lit M, Xue CC, Yang AW, Zhang AL, Owens MD, et al. Herbal medicine for dementia: a systematic review. Phytother Res. 2008 Dec 11;23(4):447-459.

May BH, Yang AW, Zhang AL, Owens MD, Bennett L, Head R, et al. Chinese herbal medicine for Mild Cognitive Impairment and Age Associated Memory Impairment: a review of randomised controlled trials. Biogerontology. 2009 Apr;10(2):109-23. Epub 2008 Aug 21.

Mazza M, Capuano A, Bria P, Mazza S. Ginkgo biloba and donepezil: a comparison in the treatment of Alzheimer's dementia in a randomized placebo-controlled double-blind study. Eur J Neurol. 2006;13(9):981-5.

McCarney R, Fisher P, Iliffe S, van Haselen R, Griffin M, van der Meulen J, Warner J. Ginkgo biloba for mild to moderate dementia in a community setting: a pragmatic, randomised, parallel-group, double-blind, placebo-controlled trial. Int J Geriatr Psychiatry. 2008 Dec;23(12):1222-30.

Moher D, Pham B, Ausejo M, Saenz A, Hood S, Barber GG. Pharmacological management of intermittent claudication: a meta-analysis of randomised trials. Drugs. 2000;59(5):1057-1070.

Nathan, P. J., Harrison, B. J., and Bartholomeusz, C. Ginkgo and memory. JAMA. 2-5-2003;289(5):546-548.

Oh SM, Chung KH. Antiestrogenic activities of Ginkgo biloba extracts. J Steroid Biochem Mol Biol. 2006;100(4-5):167-76.

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Ozgoli G, Selselei EA, Mojab F, et al. A randomized, placebo-controlled trial of Ginkgo biloba L. in treatment of premenstrual syndrome. J Altern Complement Med. 2009;15:845-51.

Persson, J., Bringlov, E., Nilsson, L. G., and Nyberg, L. The memory-enhancing effects of Ginseng and Ginkgo biloba in healthy volunteers. Psychopharmacology (Berl). 2004;172(4):430-434.

Pittler MH, Ernst E. Ginkgo biloba extract for the treatment of intermittent claudication: a meta-analysis of randomized trials. Am J Med. 2000;108(4):276-281.

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Overview

Goldenseal (Hydrastis canadensis) is one of the most popular herbs in the United States, often combined with echinacea and sold to treat or prevent colds. But there is no evidence that it works. In fact, there is very little scientific evidence that goldenseal works to treat any condition.

Nevertheless, goldenseal is often said to kill bacteria and is sometimes used to treat eye infections, diarrhea, urinary tract infections, canker sores, and vaginitis. A substance in goldenseal, called berberine, does kill some kinds of bacteria and fungus in test tube studies. But scientists do not know if goldenseal would kill any germs in people.

Goldenseal is also popular because of a rumor that taking the herb can help block a positive test for illegal drugs. There is no evidence that it works, and several studies have reported that taking goldenseal does not change the results of a drug test.

Plant Description

Goldenseal is a small plant with a single hairy stem. It has two jagged 5 lobed leaves, small flowers, and raspberry-like fruit. The bitter tasting rhizome, or root, is bright yellow or brown, twisted, and wrinkled. Goldenseal can be found growing wild in rich, shady soil in the northern United States, but it is now grown mostly on farms.

What is it Made Of?

Goldenseal contains a compound called berberine that kills many types of bacteria in test tubes, including the ones that cause diarrhea. Berberine also kills a wide range of other types of germs in test tubes, such as those that cause candida (yeast) infections and parasites such as tapeworms and Giardia. Berberine may also activate white blood cells, making them better at fighting infection and strengthening the immune system.

Berberine is sometimes used as an antibiotic, although studies have not shown whether it works or not in people. It has been studied to treat H. pylori infection (the bacterium that causes ulcers) and infectious diarrhea. It is sometimes recommended to treat urinary tract infections (UTIs). Berberine may also be useful in heart failure. However, some experts think the berberine in goldenseal is not absorbed very well when it is taken by mouth.

Medicinal Uses and Indications

ANTIBIOTIC OR IMMUNE BOOSTER

Today, goldenseal is sold to help with digestion, soothe an upset stomach, and to kill bacteria. It is considered a natural antibiotic and is often combined with echinacea and promoted as strengthening the immune system. However, only one study found that goldenseal might help boost white blood cells (a measure of the infection-fighting ability of the immune system), and the study was not well designed.

UPPER RESPIRATORY PROBLEMS

Goldenseal is often found in herbal remedies for hay fever (allergic rhinitis), colds, and the flu. There is no real evidence that it works to treat upper respiratory infections or allergies in humans, however. It may help ease a sore throat, which often accompanies cold or flu.

MINOR WOUNDS

Because goldenseal seems to have antiseptic properties in test tubes, it is sometimes used to disinfect cuts and scrapes.

OTHER USES

It is commonly used to treat several skin, eye, and mucous membrane problems, such as sinusitis, pink eye, and urinary tract infections. It is also available in mouthwashes for sore throats and canker sores.

Not many scientific studies have looked at goldenseal. Some have looked at berberine, one of the active compounds in goldenseal. Berberine is widely used in Traditional Chinese Medicine (TCM) to treat dysentery and infectious diarrhea. Berberine may work in humans to treat malaria, heart failure, and some types of infections, including upper respiratory problems. It may also dilate blood vessels and help treat heart failure. However, oral goldenseal has only very small amounts of berberine, so it is impossible to say whether or not goldenseal would work to treat these conditions.

Available Forms

Goldenseal is available in tablets and capsules (containing the powdered root), liquid extracts, and glycerites (low alcohol extracts). Goldenseal is often combined with echinacea.

How to Take It

Goldenseal is not recommended for children unless your doctor says so. Never give goldenseal to an infant.

For adult use, goldenseal can be taken by mouth. It is often mixed with water and other liquids to create different skin washes, mouthwash, and even as a vaginal douche. Ask your health care provider to find the right kind and dose for you.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider qualified in the field of botanical medicine.

Pregnant or breastfeeding women should not use goldenseal.

People with high blood pressure, liver disease, or heart disease should ask their provider before taking goldenseal.

Goldenseal can irritate the skin, mouth, throat, and vagina. It may also cause an increased sensitivity to sunlight.

Goldenseal may interfere with some medications. If you are taking prescription or over-the-counter medications, ask your doctor before taking goldenseal.

Possible Interactions

It is possible that berberine (a major component of goldenseal) and goldenseal itself may interact with many medications, including some that are broken down by the liver and some that are affected by a cell protein. For that reason, anyone who takes any prescription or over-the-counter medication should check with their doctor before taking goldenseal.

Cyclosporine: Goldenseal may cause levels of cyclosporine in the body to get too high.

Digoxin: Goldenseal may raise blood levels of digoxin, a medication used to treat heart conditions. This can increase the risk of side effects.

Tetracycline: One study reported that berberine may cause tetracycline antibiotics to not work as well.

Anticoagulants (blood thinners): Theoretically, goldenseal and berberine could increase the risk of bleeding, especially if you take blood thinners. Some blood thinners include:

• Warfarin (Coumadin)
• Plavix (Clopidogrel)
• Aspirin

Other drugs: Goldenseal may interact with many medications, including:

• Some chemotherapy drugs
• Some drugs to treat HIV
• Amitriptyline (Elavil)
• Cimetidine (Tagamet)
• Cisapride (Propulsid)
• Clarithromycin (Biaxin)
• Diltiazem (Cardizem)
• Donepezil (Aricept)
• Erythromycin
• Fexofenadine (Allegra)
• Fluoxetine (Prozac)
• Indinavir (Crixivan)
• Loperamide (Imodium)
• Lovastatin (Mevacor)
• Metoprolol (Lopressor, Toprol XL)
• Olanzapine (Zyprexa)
• Ranitidine (Zantac)
• Sildenafil (Viagra)
• Tramadol (Ultram)
• Trazodone (Desyrel)
• Triazolam (Halcion)

Supporting Research

Abidi P, Chen W, Kraemer FB, et al. The medicinal plant goldenseal is a natural LDL-lowering agent with multiple bioactive components and new action mechanisms. J Lipid Res. 2006;47(10):2134-47.

Ang ES, Lee ST, Gan CS, et al. Evaluating the role of alternative therapy in burn wound management: randomized trial comparing moist exposed burn ointment with conventional methods in the management of patients with second-degree burns. Med Gen Med. 2001;3:3.

Cech NB, Junio HA, Ackermann LW, Kavanaugh JS, Horswill AR. Quorum quenching and antimicrobial activity of goldenseal (Hydrastis canadensis) against methicillin-resistant Staphylococcus aureus (MRSA). Planta Med. 2012 Sep;78(14):1556-61.

Chen S, Wan L, Couch L, et al. Mechanism study of goldenseal-associated DNA damage. Toxicol Lett. 2013;221(1):64-72.

Clement-Kruzel S, Hwang SA, Kruzel MC, Dasgupta A, Actor JK. Immune modulation of macrophage pro-inflammatory response by goldenseal and Astragalus extracts. J Med Food. 2008 Sep;11(3):493-8.

Hwang BY, Roberts SK, Chadwick LR, et al. Antimicrobial constituents from goldenseal (the Rhizomes of Hydrastis canadensis) against selected oral pathogens. Planta Med. 2003;69(7):623-7.

Inbaraj JJ, Kukielczak BM, Bilski P, et al. Photochemistry and photocytotoxicity of alkaloids from Goldenseal (Hydrastis canadensis L.). 2. Palmatine, hydrastine, canadine, and hydrastinine. Chem Res Toxicol. 2006;19(6):739-44.

Janbaz KH, Gilani AH. Studies on preventive and curative effects of berberine on chemical-induced hepatotoxicity in rodents. Fitoterapia. 2000;71:25-33.

Lau CW, Yao XQ, Chen ZY, et al. Cardiovascular actions of berberine. [review]. Cardiovasc Drug Rev. 2001;19(3):234-244.

Li H, Miyahara T, Tezuka Y, et al. Effect of berberine on bone mineral density in SAMP6 as a senile osteoporosis model. Biol Pharm Bull. 2003;26(1):110-1.

Mahady GB, Pendland SL, Stoia A, et al. In vitro susceptibility of Helicobacter pylori to isoquinoline alkaloids from Sanguinaria canadensis and Hydrastis canadensis. Phytother Res. 2003;17(3):217-21.

Palanisamy A, Haller C, Olson KR. Photosensitivity reaction in a woman using an herbal supplement containing ginseng, goldenseal, and bee pollen. J Toxicol Clin Toxicol. 2003;41(6):865-7.

Periera da Silva A, Rocha R, Silva CM, et al. Antioxidants in medicinal plant extracts. A research study of the antioxidant capacity of Crataegus, Hamamelis and Hydrastis. Phytother Res. 2000;14(8):612-616.

Sandhu RS, Prescilla RP, Simonelli TM, et al. Influence of goldenseal root on the pharmacokinetics of indinavir. J Clin Pharmacol. 2003;43(11):1283-8.

Scazzocchio F, Cometa MF, Tomassini L, et al. Antibacterial activity of Hydrastis canadensis extract and its major isolated alkaloids. Planta Med. 2001;67(6):561-564.

Weber HA, Zart MK, Hodges AE, et al., Chemical comparison of goldenseal (Hydrastis canadensis L.) root powder from three commercial suppliers. J Agric Food Chem. 2003;51(25):7352-8.

Overview

Gotu kola (Centella asiatica) has been used to treat many conditions for thousands of years in India, China, and Indonesia. It was used to heal wounds, improve mental clarity, and treat skin conditions such as leprosy and psoriasis.

Some people use it to treat respiratory infections, such as colds, and in the past it was used for that in China. It has been called "the fountain of life" because legend has it that an ancient Chinese herbalist lived for more than 200 years as a result of taking gotu kola.

Historically, gotu kola has also been used to treat syphilis, hepatitis, stomach ulcers, mental fatigue, epilepsy, diarrhea, fever, and asthma. Today, in the U.S. and Europe gotu kola is most often used to treat varicose veins and chronic venous insufficiency, a condition where blood pools in the legs. It is also used in ointments to treat psoriasis and help heal minor wounds.

Gotu kola is not the same as kola nut (Cola nitida). Unlike kola nut, gotu kola does not have caffeine, and is not a stimulant.

Plant Description

Gotu kola is a perennial plant native to India, Japan, China, Indonesia, South Africa, Sri Lanka, and the South Pacific. A member of the parsley family, it has no taste or smell. It thrives in and around water. It has small fan-shaped green leaves with white or light purple-to-pink flowers, and small oval fruit. The leaves and stems of the gotu kola plant are used as medicine.

Medicinal Uses and Indications

Treatment

Venous insufficiency and varicose veins

When blood vessels lose their elasticity, blood pools in the legs and fluid leaks out of the blood vessels. That causes the legs to swell (venous insufficiency). Several small studies suggest gotu kola may help reduce swelling and improve blood flow. In a study of 94 people with venous insufficiency, those who took gotu kola saw their symptoms improve compared to those who took placebo. In another study of people with varicose veins, ultrasound tests showed that people who took gotu kola had less leakage of fluid.

One study also found that people who took gotu kola before flying had less ankle and leg swelling than those who did not take it.

Wound healing and skin lesions

Gotu kola has chemicals called triterpenoids. In animal and lab studies, these compounds seem to help heal wounds. For example, some studies suggest that triterpenoids strengthen the skin, boost antioxidants in wounds, and increase blood supply to the area. Based on these findings, gotu kola has been applied to the skin, or used topically, for minor burns, psoriasis, preventing scars after surgery, and preventing or reducing stretch marks.

You can find gotu kola in many creams for wound healing. Ask your health care provider if one is right for you.

Anxiety

These same chemicals, triterpenoids, seem to reduce anxiety and increase mental function in mice. One human study found that people who took gotu kola were less likely to be startled by a new noise than those who took placebo. Since the "startle noise" response can be a way to tell if someone is anxious, researchers think that gotu kola might help reduce anxiety symptoms. But the dose used in this study was very high, so it is impossible to say how gotu kola might be used to treat anxiety.

Scleroderma

A single study of 13 women with scleroderma found that gotu kola decreased joint pain and skin hardening, and improved finger movement.

Insomnia

Gotu kola acts as a sedative when given to animals in tests. Because of that, it is sometimes suggested to help people with insomnia. But no human studies have been done to see whether it works or whether it is safe.

Dosage and Administration

Gotu kola is available in teas and as dried herbs, tinctures, capsules, tablets, and ointments. Products should be stored in a cool, dry place and used before the expiration date on the label.

Pediatric

Gotu kola is not recommended for children under 18 years old.

Adult

The standard dose of gotu kola (Centella asiatica) is different depending on what kind you use and what you use it for.  Your health care provider can help you choose the right dose for you. Most studies have used standardized extracts:

• Dried herb: You can make a tea of the dried leaf, 3 times daily.
• Powdered herb: available in capsules
• Tincture (1:2 w/v, 30% alcohol): 30 to 60 drops (equivalent to 1.5 to 3 mL, there are 5 mL in a tsp.), 3 times daily.
• Standardized extract: 50 to 250 mg, 2 to 3 times daily. Standardized extracts should contain 40% asiaticoside, 29 to 30% asiatic acid, 29 to 30 % madecassic acid, and 1 to 2% madecassoside. Doses used in studies mentioned in the Treatment section include 20 mg for scleroderma and up to 180 mg in one study for venous insufficiency, although most of the studies for this condition used 90 to 120 mg daily.

Precautions

Gotu kola has been used in some studies that lasted up to one year. However, gotu kola has the potential to be harmful to the liver. It is best not to use gotu kola for more than 6 weeks without talking to your doctor. You may need to take a 2-week break before taking the herb again.

Asiaticoside, a major part of gotu kola, has also been link with tumor growth in mice. Anyone with a history of precancerous or cancerous skin lesions, such as squamous cell, basal cell skin cancer, or melanoma, should not use gotu kola.

People with liver disease, or who take medications that affect the liver, should not take gotu kola. Ask your doctor if you take any prescription medications, or often take over-the-counter pain relievers.

Side Effects

Side effects are rare but may include skin allergy and burning sensations with external use, headache, stomach upset, nausea, dizziness, and extreme drowsiness. These tend to happen with high doses of gotu kola.

Pediatric Use

Gotu kola is not recommended for children.

Geriatric Use

People older than 65 should take a lower dose of gotu kola. Your health care provider can help you determine the right dose for you, which can be increased slowly over time.

Interactions and Depletions

Gotu kola may interact with the following medications:

Drugs that affect the liver: Gotu kola contains things that may hurt a person's liver, and taking it along with some other medications that also can harm the liver may cause liver damage.

Cholesterol-lowering drugs (including statins): In animal studies, gotu kola raised cholesterol levels. It may also raise cholesterol levels in humans, although no studies have been done.

Diabetes medications: In animal studies, gotu kola seems to increase blood sugar levels. People with diabetes should not take gotu kola without first talking to their doctor.

Diuretics (water pills): Gotu kola seems to act like a diuretic, meaning it helps the body get of excess fluid. Taking diuretic medications and gotu kola could cause your body to lose too much fluid, upsetting the balance of electrolytes you need. The same is true of taking gotu kola with herbs that have diuretic effects, such as green tea, astragalus, or gingko.

Sedatives: Because gotu kola acts like a sedative, it might make some drugs taken for anxiety or insomnia stronger. The same is true for herbs taken for anxiety or insomnia, such as valerian.

Supporting Research

Antani JA, Kulkarni RD, Antani NJ. Effect of abana on ventricular function in ischemic heart disease. Jpn Heart J. Nov 1990:829-835.

Anonymous. Centella asiatica (Gotu kola). Botanical Monograph. American Journal of Natural Medicine. 1996;3(6):22-26.

Ahshawat MS, Saraf S, Saraf S. Preparation and characterization of herbal creams for improvement of skin viscoelastic properties. Int J Cosmet Sci. 2008 Jun;30(3):183-93.

Belcaro GV, Rulo A, Grimaldi R. Capillary filtration and ankle edema in patients with venous hypertension treated with TTFCA. Angiology. 1990;41(1):12-18.

Biswas TK, Mukherjee B. Plant medicines of Indian origin for wound healing activity: a review. Int J Low Extrem Wounds. 2003;2(1):25-39.

Bradwejn J, Zhou Y, Koszycki D, Shlik J. A double-blind, placebo-controlled study on the effects of Gotu Kola (Centella asiatica) on acoustic startle response in healthy subjects. J Clin Psychopharmacol. 2000;20(6):680-684.

Brinkhaus B, Linder M, Schuppan D, Hahn EG. Chemical, pharmacological and clinical profile of the East Asian medical plant Centella asiatica. Phytomed. 2000;7(5):427-448.

Cauffield JS, Forbes HJM. Dietary supplements used in the treatment of depression, anxiety, and sleep disorders. Lippincotts Prim Care Pract. 1999:3(3):290-304.

Cesarone MR, Incandela L, De Sanctis MT, et al. Flight microangiopathy in medium- to long-distance flights: prevention of edema and microcirculation alterations with total triterpenic fraction of Centella asiatica. Angiology. 2001;52 Suppl 2:S33-7.

DerMarderosian A, ed. Gotu Kola. In: Facts and Comparisons The Review of Natural Products. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008.

Ivanov V, Ivanova S, Kalinovsky T, Niedzwiecki A, Rath M. Plant-derived micronutrients suppress monocyte adhesion to cultured human aortic endothelial cell layer by modulating its extracellular matrix composition. J Cardiovasc Pharmacol. 2008 Jul;52(1):55-65.

Jana U, Sur TK, Maity LN, Debnath PK, Bhattacharyya D. A clinical study on the management of generalized anxiety disorder with Centella asiatica. Nepal Med Coll J. 2010 Mar;12(1):8-11.

Kuhn M, Winston D. Herbal Therapy and Supplements: A Scientific and Traditional Approach. Philadelphia, PA: Lippincott; 2001.

Pittella F, Dutra RC, Junior DD, Lopes MT, Barbosa NR. Antioxidant and cytotoxic activities of Centella asiatica (L) Urb. Int J Mol Sci. 2009 Aug 26;10(9):3713-21.

Pointel JP, Boccalon H, Cloarec M, Ledevehat C, Joubert M. Titrated extract of centella asiatica (TECA) in the treatment of venous insufficiency of the lower limbs. Angiology. 1987;38(1 Pt 1):46-50.

Shukla A, Rasik AM, Dhawan BN. Asiaticoside-induced elevation of antioxidant levels in healing wounds. Phytother Res. 1999;13(1):50-54.

Singh RH, Narsimhamurthy K, Singh G. Neuronutrient impact of Ayurvedic Rasayana therapy in brain aging. Biogerontology. 2008 Dec;9(6):369-74.

Subathra M, Shila S, Devi MA, Panneerselvam C. Emerging role of Centella asiatica in improving age-related neurological antioxidant status. Exp Gerontol. 2005;40(8-9):707-15.

Wollina U, Abdel-Nasar MB, Mani R. A review of the microcirculation in skin in patients with chronic venous insufficiency: the problem and the evidence available for therapeutic options. Int J Low Extrem Wounds. 2006;5(3):169-80.

Wojcikowski K, Wohlmuth H, Johnson DW, Rolfe M, Gobe G. An in vitro investigation of herbs traditionally used for kidney and urinary system disorders: Potential therapeutic and toxic effects. Nephrology (Carlton). 2008 Sep 22. [Epub ahead of print].

Overview

Grapes (Vitis vinifera) have been heralded for their medicinal and nutritional value for thousands of years. Egyptians ate grapes at least 6,000 years ago, and several ancient Greek philosophers praised the healing power of grapes, usually in the form of wine. European folk healers made an ointment from the sap of grapevines to treat skin and eye diseases. Grape leaves were used to stop bleeding, inflammation, and pain, such as the kind brought on by hemorrhoids. Unripe grapes were used to treat sore throats, and dried grapes (raisins) were used for constipation and thirst. Round, ripe, sweet grapes were used to treat a range of health problems including cancer, cholera, smallpox, nausea, eye infections, and skin, kidney, and liver diseases.

But grapes, or the chemicals within them, especially oligomeric proanthocyanidin complexes (OPCs), have been touted as powerful antioxidants. Some people believe they could help treat a number of conditions, from heart disease to cancer to aging skin, although scientific evidence is mostly lacking for those conditions. However, there is good evidence that grape seed extract can help treat chronic venous insufficiency and edema.

A study of healthy volunteers found that taking grape seed extract substantially increased blood levels of antioxidants. Antioxidants are substances that destroy free radicals, which are harmful compounds in the body that damage DNA (genetic material) and even cause cell death. Scientists believe free radicals contribute to aging, as well as the development of a number of health problems, including heart disease and cancer.

Plant Description

Grapes are native to Asia near the Caspian Sea, but they were brought to North America and Europe. This plant's climbing vine has large, jagged leaves, and its stem bark tends to peel. The grapes may be green, red, or purple.

What is it Made Of?

Vitamin E, flavonoids, linoleic acid, and OPCs are highly concentrated in grape seeds. Lower concentrations of these compounds are also available in the skin of the grape, as well as grape juice and wine. Resveratrol is another compoud in grapes and grape skins that is related to OPCs. Resveratrol has become very popular as an antioxidant and is being studied in connection with a variety of diseases.

Medicinal Uses and Indications

Today, standardized extracts of grape seed may be used to treat a range of health problems related to free radical damage, including heart disease, diabetes, and cancer. Grape seed extract has also been shown to protect against bacterial infections, such as Staphylococcus aureus. Some studies, mostly in animals, support these uses.

Flavonoids found in red wine may help to protect the heart by lowering LDL ("bad") cholesterol. The so called "French paradox" is the belief that drinking wine protects people living in France from developing heart disease at the high rates seen in people living in the United States. So far, however, there is no clear evidence that taking grape seed extract helps reduce the risk of heart disease. Some researchers speculate that the alcohol in the wine, not the flavonoids, could be responsible for any healthful effects. Others think it could be the combination of alcohol and flavonoids.

Drinking alcohol to protect against heart disease is not advocated by the American Heart Association and other organizations because of the potential for addiction and other serious problems, such as car accidents and the increased risk of hypertension, liver disease, breast cancer, and weight gain. If you do drink red wine, you should have no more than 2 glasses (20 g ethanol) per day if you are a man, and no more than 1 glass per day if you are a woman.

Chronic venous insufficiency

In chronic venous insufficiency, blood pools in the legs, causing pain, swelling, fatigue, and visible veins. A number of high quality studies have shown that OPCs from grape seed can reduce symptoms.

Edema

Edema, swelling caused by surgery or an injury, seems to go away faster when people take grape seed extract. Edema is common after breast cancer surgery, and one double-blind, placebo-controlled study found that breast cancer patients who took 600 mg of grape seed extract daily after surgery for 6 months had less edema and pain than those who took placebo. Another study found that people who took grape seed extract after experiencing a sports injury had less swelling than those who took placebo.

High cholesterol

There is not enough evidence to say whether taking grape seed extract can lower cholesterol, although preliminary studies show promising results. A study of 40 people with high cholesterol looked at whether taking grape seed extract, chromium, a combination of both, or placebo for 2 months would lower cholesterol. The combination of grape seed extract and chromium was more effective than either grape seed alone or placebo in lowering total and LDL cholesterol.

Another study looked at the effects of a proprietary grape seed extract on lipid peroxidation (the breakdown of fats in the blood) in a group of heavy smokers. In the study, 24 healthy male smokers (aged 50 years or older) took either placebo or 2 capsules (75 mg of a grape procyanidin extracts and soy phosphatidalcholine), twice daily for 4 weeks. LDL cholesterol levels were lower in those taking the grape seed supplement than those taking placebo.

High blood pressure

Theoretically, grape seed extract might help treat hypertension or high blood pressure. Antioxidants, like the ones found in grape seed, help protect blood vessels from damage. Damaged blood vessels can lead to higher blood pressure. In several animal studies, grape seed extract substantially reduced blood pressure. More research is needed to determine whether grape seed extract helps people with high blood pressure.

Cancer

Studies have found that grape seed extracts may prevent the growth of breast, stomach, colon, prostate, and lung cancer cells in test tubes. However, there is no clear evidence whether it works in humans. Antioxidants, such as those found in grape seed extract, may help reduce the risk of developing cancer. Grape seed extract may also help prevent damage to human liver cells caused by chemotherapy medications. Talk to your doctor or pharmacist before combining antioxidants with any chemotherapy drugs to make sure they interact safely together, and that they do not interfere with effects of the chemotherapy medications.

Other conditions

Grape seed extract is sometimes suggested for the following, although evidence is slight:

• Alzheimer disease
• Diabetes (improving blood sugar control)
• Improving night vision
• Protecting collagen and elastin in skin (anti-aging)
• Treating hemorrhoids
• Protecting against oxidative rancidity and bacterial pathogens

Available Forms

Grape seed is available as a dietary supplement in capsules, tablets, and liquid extracts. Look for products that are standardized to 40 to 80% proanthocyanidins or an OPC content of not less than 95%.

How to Take It

Pediatric

Grape seed extracts are not recommended for children. Grapes, however, make a healthy and safe snack for children.

Adult

Grape seed often comes in standardized extracts with certain levels of proanthocyanidins. Speak to a knowledgeable provider to find the right dose for your issue.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider qualified in the field of botanical medicine. Common side effects include nausea, itching, dizziness, stomach upset, diarrhea, headache, sore throat, cough, and rash.

Pregnant or breastfeeding women should not take grape seed supplements.

Possible Interactions

Grape seed extract can potentially affect medications broken down by the liver. Numerous medications are broken down by the liver, so check with your physician. Also, OPCs in grape seed extract may interact with the following:

Anticoagulants (blood thinners): Grape seed extract may act as a blood thinner, and could increase the risk of bleeding if taken with other blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. If you are taking blood-thinning medications, or have bleeding disorders, ask your doctor before taking grape seed extract.

Phenacetin: Drinking grape juice may increase how quickly the body breaks down Phenacetin to get rid of it. This may decrease the effectiveness of the Phenacetin you are taking.

Supporting Research

Al-Habib A. Bactericidal effect of grape seed extract on methicillin resistant Staphylococcus aureus (MRSA). J Toxicol Sci. 2010;35(3):357-64.

Anastasiadi M, Chorianopoulos NG, Nychas GJ, Haroutounian SA. Antilisterial activities of polyphenol-rich extracts of grapes and vinification byproducts. J Agric Food Chem. 2009;57(2):457-63.

Bagchi D, Sen CK, Ray SD, et al. Molecular mechanisms of cardioprotection by a novel grape seed proanthocyanidin extract. Mutat Res. 2003;523-524:87-97.

Banerjee B, Bagchi D. Beneficial effects of a novel IH636 grape seed proanthocyanidin extract in the treatment of chronic pancreatitis. Digestion. 2001;63(3):203-206.

Belleville J. The French paradox: possible involvement of ethanol in the protective effect against cardiovascular diseases. Nutrition. 2002;18(2):173-177.

Bernstein BJ, Grasso T. Prevalence of complementary and alternative medicine use in cancer patients. Oncology. 2001;15(10):1267-1272; discussion 1272-1278, 1283.

Bielory L. Complementary and alternative interventions in asthma, allergy, and immunology. Ann Allergy Asthma Immunol. 2004;93(2 Suppl 1):S45-54.

Brooker S, Martin S, Pearson A, et al. Double-blind, placebo-controlled, randomised phase II trial of IH636 grape seed proanthocyanidin extract (GSPE) in patients with radiation-induced breast induration. Radiother Oncol. 2006;79(1):45-51.

Busserolles J, Gueux E, Balasinska B, et al. In vivo antioxidant activity of procyanidin-rich extracts from grape seed and pine (Pinus maritima) bark in rats. Int J Vitam Nutr Res. 2006;76(1):22-7.

Carlson S, Peng N, Prasain JK, Wyss JM. Effects of botanical dietary supplements on cardiovascular, cognitive, and metabolic function in males and females. Gend Med. 2008;5 Suppl A:S76-90. Review.

Chan MM, Mattiacci JA, Hwang HS, et al. Synergy between ethanol and grape polyphenols, quercetin, and resveratrol, in the inhibition of the inducible nitric oxide synthase pathway. Biochem Pharmacol. 2000;60(10):1539-1548.

Chou EJ, Keevil JG, Aeschlimann S, et al. Effect of ingestion of purple grape juice on endothelial function in patients with coronary heart disease. Am J Cardiol. 2001;88(5):553-555.

Décordé K, Teissèdre PL, Sutra T, Ventura E, Cristol JP, Rouanet JM. Chardonnay grape seed procyanidin extract supplementation prevents high-fat diet-induced obesity in hamsters by improving adipokine imbalance and oxidative stress markers. Mol Nutr Food Res. 2008 Nov 26. [Epub ahead of print]

Faria A, Calhau C, de Freitas V, et al. Procyanidins as antioxidants and tumor cell growth modulators. J Agric Food Chem. 2006;54(6):2392-7.

Fitzpatrick DF, Bing B, Maggi DA, et al. Vasodilating procyanidins derived from grape seeds. Ann NY Acad Sci. 2002;957:78-89.

Freedman JE, Parker C 3rd, Li L, et al. Select flavonoids and whole juice from purple grapes inhibit platelet function and enhance nitric oxide release. Circulation. 2001;103(23):2792-2798.

Gruenwalkd J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 4th ed. Montvale, NJ: Thomson Healthcare; 2007:405-410.

Hsu CP, Lin YH, Chou CC, Zhou SP, Hsu YC, Liu CL, Ku FM, Chung YC. Mechanisms of grape seed procyanidin-induced apoptosis in colorectal carcinoma cells. Anticancer Res. 2009;29(1):283-9.

Hu H, Qin YM. Grape seed proanthocyanidin extract induced mitochondria-associated apoptosis in human acute myeloid leukemia 14.3D10 cells. Chin Med J (Engl). 2006;119(5):417-21.

Hung LM, Chen JK, Huang SS, et al. Cardioprotective effect of resveratrol, a natural antioxidant derived from grapes. Cardiovasc Res. 2000;47(3):549-555.

Joshi SS, Kuszynski CA, Bagchi D. The cellular and molecular basis of health benefits of grape seed proanthocyanidin extract. Curr Pharm Biotechnol. 2001;2(2):187-200.

Kalin R, Righi A, Del Rosso A, et al., Activin, a grape seed-derived proanthocyanidin extract, reduces plasma levels of oxidative stress and adhesion molecules (ICAM-1, VCAM-1 and E-selectin) in systemic sclerosis. Free Radic Res. 2002;36(8):819-25.

Kar P, Laight D, Rooprai HK, Shaw KM, Cummings M. Effects of grape seed extract in Type 2 diabetic subjects at high cardiovascular risk: a double blind randomized placebo controlled trial examining metabolic markers, vascular tone, inflammation, oxidative stress, and insulin sensitivity. Diabet Med. 2009;26(5):526-31.

Kaur M, Agarwal R, Agarwal C. Grape seed extract induces anoikis and caspase-mediated apoptosis in human prostate carcinoma LNCaP cells: possible role of ataxia telangiectasia mutated-p53 activation. Mol Cancer Ther. 2006;5(5):1265-74.

Kaur M, Agarwal C, Argarwal R. Anticancer and cancer chemopreventive potential of grape seed extract and other grape-based products. J Nutr. 2009;139(9):1806S-12S.

Kaur M, Mandair R, Agarwal R, Agarwal C. Grape seed extract induces cell cycle arrest and apoptosis in human colon carcinoma cells. Nutr Cancer. 2008;60 Suppl 1:2-11.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp; 2000:451-452.

Nassiri-Asl M, Hosseinzadeh H. Review of the pharmacological effects of Vitis vinifera (Grape) and its bioactive compounds. Phytother Res. 2009 Jan 12. [Epub ahead of print]

Natella F, Belelli F, Gentili V, et al. Grape seed proanthocyanidins prevent plasma postprandial oxidative stress in humans. J Agric Food Chem. 2002;50(26):7720-5.

Preuss HG, Wallerstedt D, Talpur N, et al. Effects of niacin-bound chromium and grape seed proanthocyanidin extract on the lipid profile of hypercholesterolemic subjects: a pilot study. J Med. 2000;31(5-6):227-246.

Preuss HG, Bagchi D, Bagchi M. Protective effects of a novel niacin-bound chromium complex and a grape seed proanthocyanidin extract on advancing age and various aspects of syndrome X. Ann NY Acad Sci. 2002;957:250-9.

Ramchandani AG, Karibasappa GS, Pakhale SS. Antitumor-promoting effects of polyphenolic extracts from seedless and seeded Indian grapes. J Environ Pathol Toxicol Oncol. 2008;27(4):321-31.

Vigna GB, Costantini F, Aldini G, et al. Effect of a standardized grape seed extract on low-density lipoprotein susceptibility to oxidation in heavy smokers. Metabolism. 2003;52(10):1250-7.

Vitseva O, Varghese S, Chakrabarti S, et al. Grape seed and skin extracts inhibit platelet function and release of reactive oxygen intermediates. J Cardiovasc Pharmacol. 2005;46(4):445-51.

Waffo-Teguo P, Hawthorne ME, Cuendet M, et al. Potential cancer-chemopreventive activities of wine stilbenoids and flavans extracted from grape (Vitis vinifera) cell cultures. Nutr Cancer. 2001;40(2):173-179.

Wang YJ, Thomas P, Zhong JH, Bi FF, Kosaraju S, Pollard A, Fenech M, Zhou XF. Consumption of grape seed extract prevents amyloid-beta deposition and attenuates inflammation in the brain of an Alzheimer's disease mouse. Neurotox Res. 2009;15(1):3-14.

Yamakoshi J, Saito M, Kataoka S, et al. Safety evaluation of proanthocyanidin-rich extract from grape seeds. Food Chem Toxicol. 2002;40(5):599-607.

Zhang HJ, Ji BP, Chen G, Zhou F, Luo YC, Yu HQ, Gao FY, Zhang ZP, Li HY. A combination of grape seed derived procyanidins and gypenosides alleviates insulin resistance in mice and HepG2 cells. J Food Sci. 2009;74(1):H1-7.

Overview

Tea has been cultivated for centuries, beginning in India and China. Today, tea is the most widely-consumed beverage in the world, second only to water. Hundreds of millions of people drink tea, and studies suggest that green tea (Camellia sinesis) in particular has many health benefits.

There are 3 main varieties of tea, green, black, and oolong. The difference is in how the teas are processed. Green tea is made from unfermented leaves and reportedly contains the highest concentration of powerful antioxidants called polyphenols. Antioxidants are substances that fight free radicals, damaging compounds in the body that change cells, damage DNA, and even cause cell death. Many scientists believe that free radicals contribute to the aging process, as well as the development of a number of health problems, including cancer and heart disease. Antioxidants, such as polyphenols in green tea, can neutralize free radicals and may reduce or even help prevent some of the damage they cause.

In traditional Chinese and Indian medicine, practitioners used green tea as a stimulant, a diuretic (to help rid the body of excess fluid), an astringent (to control bleeding and help heal wounds), and to improve heart health. Other traditional uses of green tea include treating gas, regulating body temperature and blood sugar, promoting digestion, and improving mental processes.

Green tea has been extensively studied in people, animals, and laboratory experiments. Results from these studies suggest that green tea may help treat the following health conditions:

Atherosclerosis

Population-based studies indicate that the antioxidant properties of green tea may help prevent atherosclerosis, particularly coronary artery disease. Population-based studies are studies that follow large groups of people over time or studies that compare groups of people living in different cultures or with different diets.

Researchers believe green tea reduces the risk of heart disease by lowering cholesterol and triglyceride levels. Studies show that black tea has similar effects. In fact, researchers estimate that the rate of heart attack decreases by 11% with consumption of 3 cups of tea per day.

High cholesterol

Research shows that green tea lowers total cholesterol and raises HDL (good) cholesterol in both animals and people. One population-based study found that men who drink green tea are more likely to have lower total cholesterol than those who do not drink green tea.

Results from one animal study suggest that polyphenols in green tea may block cholesterol from being absorbed in the intestine and also help the body get rid of cholesterol. In another small study of male smokers, researchers found that green tea significantly reduced blood levels of harmful LDL (bad) cholesterol.

Cancer

Several population-based studies suggest that both green and black teas help protect against cancer. For example, cancer rates tend to be low in countries such as Japan where people regularly consume green tea. However, it is not possible to know for sure from these studies whether green tea actually prevents cancer in people.

Early clinical studies suggest that the polyphenols in tea, especially green tea, may play an important role in the prevention of cancer. Researchers also believe that polyphenols help kill cancerous cells and stop them from growing.

Bladder cancer. In one study that compared people with and without bladder cancer, researchers found that women who drank black tea and powdered green tea were less likely to develop bladder cancer. A follow-up clinical study by the same group of researchers revealed that people with bladder cancer, particularly men, who drank green tea had a better 5-year survival rate than those who did not drink green tea. People with cancer should consult with their doctor before adding tea to their regimen.

Breast cancer. Studies in animals and test tubes suggest that polyphenols in green tea inhibit the growth of breast cancer cells. In one study of 472 women with various stages of breast cancer, researchers found that women who drank the most green tea had the least spread of cancer. It was especially true in premenopausal women in the early stages of breast cancer. They also found that women with early stages of the disease who drank at least 5 cups of tea daily before being diagnosed with cancer were less likely to experience a recurrence after they finished treatment. However, women with late stages of breast cancer had little or no improvement from drinking green tea.

There is no clear evidence one way or the other about green tea and breast cancer prevention. In one very large study, researchers found that drinking tea, green or any other type, was not associated with a reduced risk of breast cancer. However, when the researchers broke down the sample by age, they found that women under the age of 50 who consumed 3 or more cups of tea per day were 37% less likely to develop breast cancer compared to women who did not drink tea.

Ovarian cancer. In a study done with ovarian cancer patients in China, researchers found that women who drank at least one cup of green tea per day lived longer with the disease than those who did not drink green tea. In fact, those who drank the most tea, lived the longest. But other studies found no beneficial effects.

Colorectal cancer. Studies on the effects of green tea on colon or rectal cancer have showed conflicting results. Some studies show decreased risk in those who drink the tea, while others show increased risk. In one study, women who drank 5 or more cups of green tea per day had a lower risk of colorectal cancer compared to non-tea-drinkers. However, there was no protective effect for men. Other studies show that drinking tea regularly may reduce the risk of colorectal cancer in women. More research is needed before researchers can recommend green tea for the prevention of colorectal cancer.

Esophageal cancer. Studies in laboratory animals have found that green tea polyphenols inhibit the growth of esophageal cancer cells. However, studies in people have produced conflicting findings. For example, one large-scale population-based study found that green tea offered protection against the development of esophageal cancer, particularly among women. Another population-based study found just the opposite, green tea consumption was associated with an increased risk of esophageal cancer. In fact, the stronger and hotter the tea, the greater the risk. Given these conflicting results, more research is needed before scientists can recommend green tea for the prevention of esophageal cancer.

Lung cancer. While green tea polyphenols have been shown to inhibit the growth of human lung cancer cells in test tubes, few clinical studies have looked at the link between drinking green tea and lung cancer in people, and the studies that have been done show conflicting results. One population-based study found that Okinawan tea, similar to green tea but partially fermented, was associated with lower lung cancer risk, particularly among women. But a second study found that green tea and black tea increased the risk of lung cancer. More studies are needed before researchers can draw any conclusions about green tea and lung cancer. Green tea should not be used by patients on bortezomib therapy.

Pancreatic cancer. In one large-scale clinical study researchers compared green tea drinkers with nondrinkers and found that those who drank the most tea were less likely to develop pancreatic cancer. This was particularly true for women, those who drank the most green tea were half as likely to develop pancreatic cancer as those who drank less tea. Men who drank the most tea were 37% less likely to develop pancreatic cancer.

However, it is not clear from this population-based study whether green tea is solely responsible for lowering pancreatic cancer risk. More studies are needed before researchers can recommend green tea for the prevention of pancreatic cancer.

Prostate cancer. Laboratory studies have found that green tea extracts prevent the growth of prostate cancer cells in test tubes. A large clinical study in Southeast China found that the risk of prostate cancer went down with increasing frequency, duration, and quantity of green tea consumption. However, both green and black tea extracts also stimulated genes that cause cells to be less sensitive to chemotherapy drugs. People who are undergoing chemotherapy should ask their doctors before drinking green or black tea, or taking tea supplements.

Skin cancer. The main polyphenol in green tea is epigallocatechin gallate (EGCG). Scientific studies suggest that EGCG and green tea polyphenols have anti-inflammatory and anticancer properties that may help prevent the development and growth of skin tumors.

Stomach cancer. Laboratory studies have found that green tea polyphenols inhibit the growth of stomach cancer cells in test tubes, however, studies in people have been less conclusive. In two studies that compared green tea drinkers with nondrinkers, researchers found that people who drank tea were about half as likely to develop stomach cancer and stomach inflammation as those who did not drink green tea. However, a clinical study with more than 26,000 men and women in Japan found no association between green tea and stomach cancer risk. Some studies even suggest that green tea may increase the risk of stomach cancer.

More studies are underway to see whether green tea helps reduce the risk of stomach cancer.

Inflammatory Bowel Disease (IBD)

Green tea may help reduce inflammation associated with Crohn disease and ulcerative colitis, the two types of IBD. If green tea proves to help prevent colon cancer, it would also help those with IBD because they are at higher risk for colon cancer.

Diabetes

Green tea has been used traditionally to control blood sugar levels. Animal studies suggest that green tea may help prevent the development of type 1 diabetes and slow the progression once it has developed. In people with type 1 diabetes, their bodies make little or no insulin, which helps convert glucose or sugar into energy. Green tea may help regulate glucose in the body. Research also suggests that regular consumption of green tea may help manage type 2 diabetes.

Liver disease

Population-based studies have shown that men who drink more than 10 cups of green tea per day are less likely to develop liver problems. Green tea also seems to protect the liver from the damaging effects of toxic substances such as alcohol. Animal studies have shown that green tea helps protect against liver tumors in mice.

Results from several animal and human studies suggest that plant chemicals in green tea called catechins, may help treat viral hepatitis, an inflammation of the liver. In these studies, catechin was used by itself in very high amounts. It is not clear whether green tea, which has a lower concentration of catechins, would have the same benefits. It is important to note that 10 cups of green tea a day could cause problems due to high levels of caffeine. Ask your doctor about the best way to include green tea in your treatment.

Weight loss

Clinical studies suggest that green tea extract may boost metabolism and help burn fat. One study found that the combination of green tea and caffeine improved weight loss and maintenance in people who were overweight and moderately obese. However, other studies show no benefit.

Other uses

Preliminary studies suggest that drinking green tea can help prevent dental cavities. More research is needed. Green tea may also be useful in inflammatory diseases, such as arthritis. Research suggests that green tea may help arthritis by reducing inflammation and slowing the breakdown of cartilage. Chemicals in green tea may help treat genital warts, treat dermatologic conditions, and prevent symptoms of colds and flu. Green tea may play a role in preventing Parkinson disease, cognitive decline, and osteoporosis. Studies also show that drinking green tea is associated with reduced risk of dying from any cause.

Plant Description

Green, black, and oolong tea are all derived from the leaves of the Camellia sinensis plant. Originally cultivated in East Asia, this plant grows as large as a shrub or tree. Today, Camellia sinensis grows throughout Asia and parts of the Middle East and Africa.

People in Asian countries more commonly consume green and oolong tea while black tea is most popular in the United States. Green tea is prepared from unfermented leaves, the leaves of oolong tea are partially fermented, and black tea is fully fermented. The more the leaves are fermented, the lower the polyphenol content and the higher the caffeine content. Green tea has the highest polyphenol content while black tea has roughly 2 to 3 times the caffeine content of green tea.

What's It Made Of?

Researchers think the health properties of green tea are mostly due to polyphenols, chemicals with potent antioxidant potential. In fact, the antioxidant effects of polyphenols seem to be greater than vitamin C. The polyphenols in green tea also give it a somewhat bitter flavor.

Polyphenols contained in teas are classified as catechins. Green tea contains six primary catechin compounds: catechin, gallaogatechin, epicatechin, epigallocatechin, epicatechin gallate, and apigallocatechin gallate (also known as EGCG). EGCG is the most studied polyphenol component in green tea and the most active.

Green tea also contains alkaloids including caffeine, theobromine, and theophylline. They provide green tea's stimulant effects. L-theanine, an amino acid compound found in green tea, has been studied for its calming effects on the nervous system.

Available Forms

Most green tea dietary supplements are sold as dried leaf tea in capsule form. Look for standardized extracts of green tea. There are also liquid extracts made from the leaves and leaf buds. The average cup of green tea contains 50 to 150 mg polyphenols (antioxidants). Decaffeinated green tea products contain concentrated polyphenols. Caffeine-free supplements are available.

How to Take It

Pediatric

Green tea has not been studied in children, so it is not recommended for pediatric use.

Adult

Depending on the brand, 2 to 3 cups of green tea per day (for a total of 240 to 320 mg polyphenols) or 100 to 750 mg per day of standardized green tea extract is recommended. Caffeine-free products are available and recommended.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, people should take herbs with care, under the supervision of a practitioner knowledgeable in the field of botanical medicine.

People with heart problems or high blood pressure, kidney problems, liver problems, stomach ulcers, and psychological disorders, particularly anxiety, should not take green tea. Pregnant and breastfeeding women should also avoid green tea.

People with anemia, diabetes, glaucoma, or osteoporosis should ask their health care provider before drinking green tea or taking an extract.

People who drink large amounts of caffeine, including caffeine from green tea, for long periods of time may experience irritability, insomnia, heart palpitations, and dizziness. Caffeine overdose can cause nausea, vomiting, diarrhea, headaches, and loss of appetite. If you are drinking a lot of tea and start to vomit or have abdominal spasms, you may have caffeine poisoning. If your symptoms are severe, lower your caffeine intake and see your health care provider.

Possible Interactions

If you are being treated with any of the following medications, you should not drink green tea or take green tea extract without first talking to your health care provider:

Adenosine. Green tea may inhibit the actions of adenosine, a medication given in the hospital for an irregular and usually unstable heart rhythm.

Beta-lactam. Green tea may increase the effectiveness of beta-lactam antibiotics by making bacteria less resistant to treatment.

Benzodiazepines. Caffeine, including caffeine from green tea, may reduce the sedative effects of these medications commonly used to treat anxiety, such as diazepam (Valium) and lorazepam (Ativan).

Beta-blockers, Propranolol, and Metoprolol. Caffeine, including caffeine from green tea, may increase blood pressure in people taking propranolol (Inderal) and metoprolol (Lopressor, Toprol XL). These medications are used to treat high blood pressure and heart disease.

Blood-Thinning Medications. People who take warfarin (Coudamin) should not drink green tea. Since green tea contains vitamin K, it can make this medication ineffective. Other compounds in green tea may slow blood clotting and therefore increase the blood-thinning effect of these medications. You should not mix green tea and aspirin because they both prevent blood from clotting. Using the two together may increase your risk of bleeding. If you are taking medications that promote blood thinning, discuss green tea consumption with your physician.

Chemotherapy. The combination of green tea and chemotherapy medications, specifically doxorubicin and tamoxifen, increased the effectiveness of these medications in laboratory tests. However, the same results have not been found in studies on people. On the other hand, there have been reports of both green and black tea extracts affecting a gene in prostate cancer cells that may make them less sensitive to chemotherapy drugs. For that reason, people should talk to their doctors before drinking black and green tea or taking tea extracts while undergoing chemotherapy.

Clozapine (Clozaril). The effects of the clozapine may be reduced if taken within 40 minutes after drinking green tea.

Ephedrine. When taken with ephedrine, green tea may cause agitation, tremors, insomnia, and weight loss.

Lithium. Green tea has been shown to reduce blood levels of lithium, a medication used to treat bipolar disorder. That can make lithium less effective.

Monoamine Oxidase Inhibitors (MAOIs). Green tea may cause a severe increase in blood pressure, called a "hypertensive crisis," when taken together with these drugs used to treat depression. Examples of MAOIs include:

• Isocarboxazid (Marplan)
• Moclobemide (Manerix)
• Phenelzine (Nardil)
• Tranylcypromine (Parnate)

Birth control pills. Oral contraceptives can prolong the amount of time caffeine stays in the body, which may increase its stimulating effects.

Phenylpropanolamine. A combination of caffeine, including caffeine from green tea, and phenylpropanolamine, used in many over-the-counter and prescription cough and cold medications and weight loss products, may cause mania and a severe increase in blood pressure. The FDA issued a public health advisory in November 2000 to warn people of the risk of bleeding in the brain from use of this medication and urged all manufacturers of this drug to remove it from the market. Most drugs that contained phenylpropanolamine have been reformulated without it.

Quinolone antibiotics. Green tea may make these medications more effective and also increase the risk of side effects. These medications include:

• Ciprofloxacin (Cipro)
• Enoxacin (Penetrex)
• Grepafloxacin (Raxar)
• Norfloxacin (Chibroxin, Noroxin)
• Sparfloxacin (Zagam)
• Trovafloxacin (Trovan)

Other medications. Green tea, especially caffeinated green tea, may interact with a number for medications, including:

• Acetaminophen (Tylenol)
• Carbamazepine (Tegretol)
• Dipyridamole (Persatine)
• Estrogen
• Fluvoxamine (Luvox)
• Methotrexate
• Mexiletine (Mexitil)
• Phenobarbital
• Theophylline
• Verapamil (Bosoptin, Calan, Covera- HS, Verelan, Verelan PM)

To be safe, check with your health care provider before drinking or taking green tea if you also take other medications.

Supporting Research

Baladia E, Basulto J, Manera M, Martinez R, Calbet D. Effect of green tea or green tea extract consumption on body weight and body composition: systematic review and meta-analysis. Nutr Hosp. 2014; 2993):479-90.

Belza A, Toubro S, Astrup A. The effect of caffeine, green tea and tyrosine on thermogenesis and energy intake. Eur J Clin Nutr. 2007; [Epub ahead of print].

Bettuzzi S, Brausi M, Rizzi F, Castagnetti G, Peracchia G, Corti A. Chemoprevention of human prostate cancer by oral administration of green tea catechins in volunteers with high-grade prostate intraepithelial neoplasia: a preliminary report from a one-year proof-of-principle study. Cancer Res. 2006;66(2):1234-40.

Borrelli F, Capasso R, Russo A, Ernst E. Systematic review: green tea and gastrointestinal cancer risk. Aliment Pharmacol Ther. Mar 1, 2004;19(5):497-510.

Boschmann M, Thielecke F. The effects of epigallocatechin-3-gallate on thermogenesis and fat oxidation in obese men: a pilot study. J Am Coll Nutr. 2007;26(4):389S-95S.

Brown AL, Lane J, Holyoak C, Nicol B, Mayes AE, Dadd T. Health effects of green tea catechins in overweight and obese men: a randomised controlled cross-over trial. Br J Nutr. 2011 Jun 7:1-10. [Epub ahead of print]

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Overview

Hawthorn (Crataegus species) has been used to treat heart disease as far back as the 1st century. By the early 1800s, American doctors were using it to treat circulatory disorders and respiratory illnesses. Traditionally, the berries were used to treat heart problems ranging from irregular heartbeat, high blood pressure, chest pain, hardening of the arteries, and heart failure. Today, the leaves and flowers are used medicinally. There is even research to suggest that hawthorn might be effective when used in the treatment of mild-to-moderate heart failure.

Animal and laboratory studies report hawthorn contains antioxidants, including oligomeric procyandins (OPCs, also found in grapes) and quercetin. Antioxidants are substances that destroy free radicals, which are compounds in the body that damage cell membranes, tamper with DNA, and even cause cell death. Free radicals occur naturally in the body and grow in number as we age. Environmental toxins (including ultraviolet light, radiation, smoking, some medicines, and air pollution) can also increase the number of these damaging particles. Scientists believe free radicals contribute to the aging process (such as wrinkling), as well as the development of a number of health problems, including cancer and heart disease. Antioxidants in hawthorn may help stop some of the damage from free radicals, especially when it comes to heart disease.

Plant Description

Hawthorn is a common thorny shrub in the rose family that grows up to 5 feet tall on hillsides and in sunny wooded areas throughout the world. Its flowers bloom in May. They grow in small white, red, or pink clusters. Small berries, called haws, sprout after the flowers. They are usually red when ripe, but they may also be black. Hawthorn leaves are shiny and grow in a variety of shapes and sizes.

What is it Made Of?

Hawthorn contains many substances that may benefit the heart. These antioxidant flavonoids, including OPCs, may help dilate blood vessels, improve blood flow, and protect blood vessels from damage.

The berries, leaves, and flowers of the hawthorn plant have been used for medicinal purposes. Most modern preparations use the leaves and flowers, which are believed to contain more flavonoids than the berries.

Medicinal Uses and Indications

Hawthorn is used to help protect against heart disease and help control high blood pressure and high cholesterol. Both animal and human studies suggest hawthorn increases coronary artery blood flow, improves circulation, and lowers blood pressure. It has also been used on the skin to treat boils and skin sores.

Heart failure

Hawthorn has been studied in people with heart failure (a condition in which the heart is unable to pump enough blood to other organs in the body). More studies are needed to understand how effective it may be. A number of studies conclude that hawthorn significantly improved heart function. Studies also suggest that the herb can enhance a person's ability to exercise following heart failure. Participants in studies have reported that hawthorn significantly improved symptoms of the disease (such as shortness of breath and fatigue). One study found that hawthorn extract (900 mg/day) taken for 2 months was as effective as low doses of captopril (a prescription heart medication) in improving symptoms of heart failure.

A large study found that a standardized hawthorn supplement was effective in 952 people with heart failure. The study compared conventional methods of treating heart failure (with different medications) with hawthorn alone and in addition to the drugs. After 2 years, the clinical symptoms of heart failure (palpitations, breathing problems, and fatigue) decreased significantly in people taking the hawthorn supplement. People taking hawthorn also took less medication for their condition.

Heart failure is a serious condition, and you should never try to self treat with hawthorn. Ask your doctor if hawthorn is right for you.

Chest pain (Angina)

Preliminary evidence suggests hawthorn may help combat chest pain (angina), which is caused by low blood flow to the heart. In one early study, 60 people with angina were given either 180 mg/day of hawthorn berry leaf flower extract or placebo for 3 weeks. Those who received hawthorn experienced improved blood flow to the heart and were also able to exercise for longer periods of time without suffering from chest pain. However, more studies are needed to say for sure whether hawthorn is effective.

High blood pressure

Although hawthorn has not been studied specifically in people with high blood pressure, some people think its benefits in treating heart disease may carry over to treating high blood pressure (hypertension). However, there is not enough research to conclude whether hawthorn is effective at lowering blood pressure, and if so, by how much.

In one study, hawthorn extract was found to be effective for hypertension in people with type 2 diabetes who were also taking prescribed medicines. Participants took 1,200 mg hawthorn extract daily or placebo for 16 weeks. Those taking hawthorn had lower blood pressure than those taking the placebo.

You should talk with your doctor before taking hawthorn if you have high blood pressure.

Available Forms

Hawthorn is available in nonstandardized and standardized capsules and liquid extracts, along with tinctures and solid extracts. A bitter-tasting tea can also be made from dried hawthorn leaves, flowers, and berries.

How to Take It

Pediatric

Hawthorn should not be given to children.

Adult

Speak to a knowledgeable health care provider to find the right dose for you.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that may trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider qualified in the field of botanical medicine.

Side effects of Hawthorn are rare, but may include headache, nausea, and palpitations (a feeling of a racing heart). One review of 29 clinical studies with more than 5,500 people found that hawthorn was safe when used in recommended dosages. Doses found to be safe were from 160 to 1,800 mg daily, and from 3 to 24 weeks in length. You may not notice any improvement for 6 to 12 weeks.

Heart disease is a serious condition. DO NOT self treat heart conditions without telling your doctor. You should use hawthorn only under your doctor's supervision.

DO NOT use hawthorn if you are pregnant or breastfeeding.

It is important to note any changes you feel while you are taking hawthorn. People experiencing more pain, more angina attacks, or more exhaustion while walking or exercising should stop taking hawthorn and seek emergency medical attention. Even if you do not experience any of these symptoms, see your provider if your condition has not improved after 6 weeks of hawthorn treatment. Your progress should always be monitored by your doctor. Side effects may include dizziness, vertigo, headaches, migraines, and palpitations.

Possible Interactions

If you are taking prescription or nonprescription medicines, talk to your health care provider before taking herbal supplements. If you are currently being treated with any of the following medications, you should not use hawthorn without first talking to your provider:

Digoxin: Hawthorn may enhance the activity of digoxin, a medication used for irregular heart rhythms.

Beta-blockers: These drugs are used to treat heart disease by lowering blood pressure and dilating blood vessels. Hawthorn can make the effects of these drugs stronger. They include:

• Atenolol (Tenormin)
• Metoprolol (Lopressor, Toprol-XL)
• Propranolol (Inderal, Inderal LA)

Calcium channel blockers (CCBs): These drugs are used to treat high blood pressure and angina by dilating blood vessels. Hawthorn can make the effects of these drugs stronger. They include:

• Norvasc (amlodipine)
• Cardizem (diltiazem)
• Procardia (nifedipine)

Phenylephrine: In a laboratory study, an alcoholic extract of hawthorn fruit reduced the effects of phenylephrine, a medication that constricts blood vessels and is commonly found in nasal decongestant products. Natural remedies, including cat's claw, coenzyme Q10 (CoQ10), fenugreek, fish oil, ginger, and other herbs.

Medications for male sexual dysfunction (Phosphodiesterase-5 inhibitors): When used together with Hawthorn, it may result in blood pressure dropping too low.

Nitrates: These medications increase blood flow to the heart and taking Hawthorn together with them might increase the chance of dizziness or light headedness.

Supporting Research

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:182-192.

Brixius K, Willms S, Napp A, et al. Crataegus special extract WS 1442 induces an endothelium-dependent, NO-mediated vasorelaxation via eNOS-phosphorylation at serine 1177. Cardiovasc Drugs Ther. 2006;20(3):177-84.

Daniele C, Mazzanti G, Pittler MH, et al. Adverse-event profile of Crataegus spp.: a systematic review. Drug Saf. 2006;29(6):523-35.

Dasgupta A, Kidd L, Poindexter BJ, Bick RJ. Interference of hawthorn on serum digoxin measurements by immunoassays and pharmacodynamic interaction with digoxin. Arch Pathol Lab Med. 2010;134(8):1188-92.

Degenring FH, Suter A, Weber M, et al. A randomised double blind placebo controlled clinical trial of a standardised extract of fresh Crataegus berries (Crataegisan) in the treatment of patients with congestive heart failure NYHA II. Phytomedicine. 2003;10(5):363-369.

Fugh-Berman A. Herbs and dietary supplements in the prevention and treatment of cardiovascular disease. Prev Cardiol. 2000;3(1):24-32.

Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 4th ed. Montvale, NJ: Thomson Healthcare; 2007;279-284.

Habs M. Prospective, comparative cohort studies and their contribution to the benefit assessments of therapeutic options: heart failure treatment with and without Hawthorn special extract WS 1442. Forsch Komplementarmed Klass Naturheilkd. 2004;11 Suppl 1:36-9.

Holubarsch CJ, Colucci WS, Meinertz T, Gaus W, Tendera M; Survival and Prognosis: Investigation of Crataegus Extract WS 1442 in CHF (SPICE) trial study group. The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial. Eur J Heart Fail. 2008 Dec;10(12):1255-63.

Hwang HS, Boluyt MO, Converso K, Russell MW, Bleske BE. Effects of hawthorn on the progression of heart failure in a rat model of aortic constriction. Pharmacotherapy. 2009;29(6):639-48.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp; 2000:456-457.

Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2007.

Miller L. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;158(20):2200-2211.

Morelli V, Zoorob RJ. Alternative therapies: Part II. Congestive heart failure and hypercholesterolemia. [Review]. Am Fam Physician. 2000;62(6):1325-1330.

Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med. 2003;114(8):665-674.

Rakel: Integrative Medicine. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012.

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Rigelsky JM, Sweet BV. Hawthorn: pharmacology and therapeutic uses. Am J Health Syst Pharm. 2002;59(5):417-422.

Schandry R, Duschek S. The effect of Camphor-Crataegus berry extract combination on blood pressure and mental functions in chronic hypotension - a randomized placebo controlled double blind design. Phytomedicine. 2008 Oct 15. [Epub ahead of print]

Schmidt U, Albrecht M, Schmidt S. [Effects of an herbal crataegus-camphor combination on the symptoms of cardiovascular diseases]. Arzneimittelforschung. 2000;50(7):613-619.

Tadic VM, Dobric S, Markovic GM, Dordevic SM, Arsic IA, Menkovic NR, Stevic T. Anti-inflammatory, gastroprotective, free-radical-scavenging, and antimicrobial activities of hawthorn berries ethanol extract. J Agric Food Chem. 2008 Sep 10;56(17):7700-9.

Tankanow R, Tamer HR, Streetman DS, et al. Interaction study between digoxin and a preparation of hawthorn (Crataegus oxyacantha). J Clin Pharmacol. 2003;43(6):637-642.

Walker AF, Marakis G, Simpson E, et al. Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial. Br J Gen Pract. 2006;56(527):437-43.

Zapfe JG. Clinical efficacy of crataegus extract WS 1442 in congestive heart failure NYHA class II. Phytomedicine. 2001;8(4):262-266.

Overview

Horsetail (Equisetum arvense) is an herbal remedy that dates back to ancient Roman and Greek times. It was used traditionally to stop bleeding, heal ulcers and wounds, and treat tuberculosis and kidney problems. The name Equisetum is derived from the Latin roots equus, meaning "horse," and seta, meaning "bristle."

Horsetail contains silicon, which helps strengthen bone. For that reason, some practitioners recommend horsetail as a treatment for osteoporosis. It is also used as a diuretic, and as an ingredient in some cosmetics. However, few studies have investigated horsetail's effect in humans.

Plant Description

Horsetail is derived from huge, tree-like plants that thrived 400 million years ago during the Paleozoic era. A close relative of the fern, horsetail is a nonflowering weed found throughout parts of Europe, Asia, the Middle East, and North America. The plant is a perennial (returns each year) with hollow stems and shoots that look like asparagus at first. As the plant dries, silica crystals that form in the stems and branches look like feathery tails and give the plant a scratching effect. That accounts for its historic use in polishing metal, particularly pewter.

Parts Used

The aboveground parts of horsetail (fresh or dried) are used for medicinal purposes.

Medicinal Uses and Indications

Horsetail has traditionally been used as a diuretic (helps rid the body of excess fluid by increasing urine output). One study examined the use of horsetail by people who had a history of uric acid kidney stones. The people who took horsetail experienced an increase in diuresis (urine output). Other studies suggest horsetail has antioxidant properties and may inhibit cancer cell growth.

Osteoporosis

Horsetail has been suggested as a treatment for osteoporosis (thinning bone), because it contains silicon, a mineral needed for bone health. In one study, 122 Italian women took horsetail dry extract or Osteosil calcium 270 mg twice daily (a horsetail/calcium combination used in Italy for osteoporosis and fractures). Both groups who took horsetail experienced improved bone density, however the study was poorly designed. More research is needed to determine whether horsetail has any effect on bone density.

Other

Horsetail is sometimes suggested for the following conditions, although scientific evidence is lacking:

• Kidney stones
• Urinary tract infections
• Brittle nails
• Minor wounds and burns (applied topically; you should never apply herbal supplements to open wounds).

Available Forms

Horsetail is available in the following forms:

• Dried herb
• Liquid preparations

Horsetail preparations should be stored in sealed containers to ensure protection from light.

How to Take It

Pediatric

Because horsetail contains traces of nicotine, it is not recommended for young children.

Adult

• Capsule: use a standardized dose that contains 10 to 15% silica
• Herbal infusion (tea): 2 to 3 tsp., 3 times daily. Pour hot water onto herb and steep for 5 to 10 minutes. Drink as directed.
• Tincture (1:5): Speak to a physician for the proper dose for your condition
• External (compresses): 10 g of herb per 1 liter water daily

Be sure to drink enough fluids when taking horsetail preparations by mouth.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a qualified health care provider trained in the field of botanical medicine.

Horsetail remedies prepared from Equisetum arvense are generally considered safe when used properly. Another species of horsetail, however, called Equisetum palustre is poisonous to horses. To be safe, never take that form of horsetail. Be sure to buy products made by an established company with a good reputation. When possible, select products with guaranteed potency or standardized extracts.

Prolonged use of even the safe form of horsetail (E. arvense) is also not advised.

Taking horsetail by mouth may cause levels of vitamin B1 (thiamin) in the body to drop. If you take horsetail on a regular basis, you should also take a quality multivitamin or at least a B complex supplement daily.

People with heart or kidney disorders, diabetes, or gout should not use horsetail.

DO NOT drink alcohol regularly while taking horsetail because horsetail may cause levels of thiamin to drop.

Horsetail may flush potassium out of the body so people who are at risk for low potassium levels should not take Horsetail.

Women who are pregnant or breastfeeding should not take horsetail.

Possible Interactions

The effects of horsetail may enhance the effects of certain medications. For this reason, people taking prescription medications should not take horsetail without first consulting a health care provider.

Alcohol: People who are chronic drinkers may have low levels of vitamin B1 (thiamin). Because horsetail can also cause low levels of thiamin, you should not take horsetail if you drink heavily.

Nicotine patches or gum: Horsetail contains some nicotine, and should not be used if you are also using nicotine replacement patches or chewing gum.

Digoxin (Lanoxin): Horsetail may cause low levels of potassium (hypokalemia) in the body. People with heart arrhythmias and those taking digoxin should not use horsetail.

Diuretics (water pills): Horsetail may have weak diuretic properties, meaning it helps rid the body of excess fluid. People who take diuretics should not take horsetail due to the risk of dehydration or low potassium (hypokalemia).

Lithium: By interfering with the body's ability to eliminate Lithium, taking Horsetail with Lithium may result in a dangerous build up of Lithium in the body.

Supporting Research

Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:208-211.

Bradley P, ed. British Herbal Compendium. Vol. I. Dorset (Great Britain): British Herbal Medicine Association; 1992:92-94.

Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical; 1998:85.

Cetojevic-Simin DD. Antioxidative and antiproliferative activities of different horsetail (Equisetum arvense L.) extracts. J Med Food. 2010;13(2):452-9.

Corletto F. [Female climacteric osteoporosis therapy with titrated horsetail (Equisetum arvense) extract plus calcium (osteosil calcium): randomized double blind study]. Miner Ortoped Traumatol. 1999;50:201-206.

D'Agostino M, Dini A, Pizza C, et al. Sterols from Equisetum arvense. Boll Soc Ital Biol Sper. 1984;60(12):2241-2245.

Do Monte FH, dos Santos JG Jr, Russi M, et al. Antinociceptive and anti-inflammatory properties of the hydroalcoholic extract of stems from Equisetum arvense L. in mice. Pharmacol Res. 2004;49:239-43.

Dos Santos JG Jr, Blanco MM, Do Monte FH, et al. Sedative and anticonvulsant effects of hydroalcoholic extract of Equisetum arvense. Fitoterapia. 2005;76:508-13.

Foster S, Tyler VE. Tyler's Honest Herbal. 4th ed. New York, NY: The Haworth Herbal Press; 1999:219-220.

Gibelli C. The hemostatic action of Equisetum. Arch Intern Pharmacodynam. 1931;41:419-429.

Graefe EU, Veit M. Urinary metabolites of flavonoids and hydroxycinnamic acids in humans after application of a crude extract from Equisetum arvense. Phytomedicine. 1999;6(4):239-246.

Henderson JA, Evans EV, McIntosh RA. The antithiamine action of Equisetum. J Amer Vet Med Assoc. 1952;120:375-378.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp; 2000:459-460.

Maeda H, Miyamoto K, Sano T. Occurrence of dermatitis in rats fed a cholesterol diet containing field horsetail (Equisetum arvense L.). J Nutr Sci Vitaminol (Tokyo). 1997;43(5):553-563.

Mimica-Dukic N, Simin N, Cvejic J, Jovin E, Orcic D, Bozin B. Phenolic compounds in field horsetail (Equisetum arvense L.) as natural antioxidants. Molecules. 2008 Jul 17;13(7):1455-64.

Nitta A, Yoshida S, Tagaeto T. A comparative study of crude drugs in Southeast Asia. X. Crude drugs derived from Equisetum species. Chem Pharm Bull (Tokyo). 1977;25(5):1135-1139.

Perez Gutierrez RM, Laguna GY, Walkowski A. Diuretic activity of Mexican equisetum. J Ethnopharmacol. 1985;14(2-3):269-272.

Safiyeh S, Fathallah FB, Vahid N, Hossine N, Habib SS. Antidiabetic effect of Equisetum arvense L. (Equisetaceae) in streptozotocin-induced diabetes in male rats. Pak J Biol Sci. 2007 May 15;10(10):1661-6.

Sudan BJ. Seborrhoeic dermatitis induced by nicotine of horsetails (Equisetum arvense L.). Contact Dermatitis. 1985;13(3):201-202.

Tiktinskii OL, Bablumian IA. [Therapeutic action of Java tea and field horsetail in uric acid diathesis]. Urol Nefrol (Mosk). 1983;3(1):47-50.

Wright CI, Van-Buren L, Kroner CI, Koning MM. Herbal medicines as diuretics: a review of the scientific evidence. J Ethnopharmacol. 2007 Oct 8;114(1):1-31.

Overview

Jamaica (or Jamaican) dogwood (Piscidia erythrina or Piscidia piscipula) has been used as a traditional remedy for treating nerve pain, migraine, insomnia, anxiety, fear, and nervous tension. As early as 1844, Western scientists discovered that Jamaica dogwood had pain-relieving and sweat-promoting properties. More recent scientific studies have also shown that bark extracts of this plant have anti-inflammatory, sedative, and antispasmodic (helps relieve smooth muscle spasms along the digestive tract) effects in animals.

However, Jamaica dogwood is potentially toxic. It has been used throughout Central and South America as a fish poison. This herb also contains a substance known as rotenone that has been used in insecticides to control lice, fleas, and larvae. Rotenone is believed to be nontoxic to warm-blooded animals, including people (when taken orally). Because of the potential danger from Jamaica dogwood, you should never use it without a doctor's close supervision.

Plant Description

Jamaica dogwood is native to Central America, Florida, and the West Indies, and can now also be found in Texas, Mexico, and the northern part of South America. The plant's characteristic pods bear four projecting longitudinal wings. The bark is yellow or grayish brown on the outer surface, and lighter colored or white on the inner surface. Jamaica dogwood's distinctly acrid and bitter taste causes a burning sensation in the mouth, and the bark gives off an unpleasant odor.

Parts Used

The root bark is the medicinal part of Jamaica dogwood.

Medicinal Uses and Indications

Jamaica dogwood is not recommended for human use, and should never be taken without a doctor's close supervision. Animal studies have shown that Jamaica dogwood may promote sleep, relieve pain, reduce smooth muscle spasms, relieve cough, and reduce fever and inflammation. However, it is also potentially toxic.

Available Forms

The Jamaica dogwood root bark is sold in pieces about 1 to 2 inches in length and 1/8 inch in thickness. There is considerable variation in the chemical constituents of Jamaica dogwood from different geographic regions. Jamaica dogwood is also available in liquid extract and tincture forms.

How to Take It

Pediatric

Children should not use Jamaican dogwood.

Adult

DO NOT take Jamaican dogwood without first talking to your doctor. Typical forms include teas, fluid extract, and tincture.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a qualified health care provider.

Jamaica dogwood can be toxic. Symptoms of Jamaican dogwood overdose include numbness, tremors, salivation, and sweating. Seek immediate medical attention if you experience any of these symptoms after taking Jamaican dogwood. DO NOT take Jamaica dogwood on your own.

Pregnant and breastfeeding women should never use this herb. Elderly people should also avoid Jamaica dogwood.

Possible Interactions

Jamaica dogwood has rarely been studied in humans, so there are no known scientific reports of interactions between Jamaica dogwood and conventional medications. However, Jamaica dogwood has sedative effects, and may increase the effects of other drugs or herbs used for insomnia or anxiety (called central nervous system depressants).

DO NOT take Jamaica dogwood if you already take medications for anxiety or insomnia.

There is some concern that Jamaican Dogwood may combine poorly with anesthesia so discontinue use at least 2 weeks prior to scheduled surgery.

Supporting Research

Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications; 1998:86-87.

British Herbal Pharmacopoeia. 4th ed. Great Britain: Biddles Ltd, Guildford and King's Lynn; 1996:139-141.

Costello CH, Butler CL. An investigation of Piscidia erythrina (Jamaica dogwood). J Am Pharm Assoc Am Pharm Assoc. 1948 Mar;37(3):89-97.

Della Loggia R, Zilli C, Del Negro P, Redaelli C, Tubaro A. Isoflavones as spasmolytic principles of Piscidia erythrina. Prog Clin Biol Res. 1988;280:365-368.

Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 4th ed. Montvale, NJ: Thomson Healthcare; 2007:478.

Newall C, Anderson L, Phillipson J. Herbal Medicines: A Guide for Health-care Professionals. London, England: Pharmaceutical Press; 1996:174-175.

Overview

Kava kava (Piper methysticum) has been used as a ceremonial drink in the Pacific Islands for hundreds of years. Some people report its effects are similar to alcohol.

The roots are chewed or ground into a pulp and added to cold water. The resulting thick brew, which has been compared to the social equivalent of wine in France, is offered to guests and dignitaries visiting the Pacific Islands.

In addition to its ceremonial uses, kava is best known for its relaxing qualities. Kava is said to elevate mood, well being, and contentment, and produce a feeling of relaxation. Several studies have found that kava may be useful in the treatment of anxiety, insomnia, and related nervous disorders.

However, there is serious concern that kava may cause liver damage. More than 30 cases of liver damage have been reported in Europe. However, researchers have not been able to confirm that kava is toxic to the liver. It's not clear whether kava itself causes liver damage, or whether taking kava in combination with other drugs or herbs is responsible. It's also not clear whether kava is dangerous at previously recommended doses, or only at higher doses. Some countries have taken kava off the market. It remains available in the United States. But the Food and Drug Administration (FDA) issued a consumer advisory in March 2002 regarding the "rare" but potential risk of liver failure associated with kava-containing products.

It is impossible to say what, if any, dose of kava might be safe. You should not take kava unless you are under a doctor's close supervision.

Kava may cause liver damage. Do not take kava unless you are under a doctor's supervision. Evidence suggests kava may be helpful for the following health problems:

Anxiety

A number of clinical studies, though not all, have found kava to be effective in treating symptoms associated with anxiety. In a review of 7 scientific studies, researchers concluded that a standardized kava extract was significantly more effective than placebo in treating anxiety. Another study found that kava substantially improved symptoms after only 1 week of treatment. Other studies show that kava may be as effective as some prescription antianxiety medications. According to one study, kava and diazepam (Valium) cause similar changes in brain wave activity, suggesting they may work in the same ways to calm the mind.

Research on using kava for anxiety has decreased because of reports of liver toxicity.

A 2004 study found that 300 mg of kava may improve mood and cognitive performance. That is significant because some prescription drugs used to treat anxiety, such as benzodiazepines (like Valium and alprazolam or Xanax), tend to decrease cognitive function.

Insomnia

Preliminary evidence suggests that kava may help improve sleep quality and decrease the amount of time needed to fall asleep. Due to concerns about kava's safety and the fact that other herbs can treat sleeplessness, kava is not the best choice for treating insomnia.

Plant Description

Kava is a tall shrub that grows in the islands of the Pacific Ocean. This shrub produces large, green, heart-shaped leaves that grow thickly on the branches. Long, slender flowers grow where the branches meet the stems. The roots look like bundles of woody, hairy branches. The root is the part of the plant used medicinally.

In Fiji, the plant is called "yaquona." In Hawaii, it is known as " 'awa." In Aboriginal tribes, it is referred to as "grog."

What's It Made Of?

The main active ingredients in kava root are called kavalactones (kavapyrones). These chemicals (including kawain, dihydrokawain, and methysticum) have been extensively studied in laboratory and animal studies. They have been found to reduce convulsions, promote sleep, and relax muscles in animals. They also have pain relieving properties, which may explain why chewing kava root tends to cause a temporary numbness and tingling sensation on the tongue.

Available Forms

In some parts of the world, whole kava roots are chewed for their medicinal value. Kava is also available in liquid form, as tinctures or standardized extracts, and powdered in capsules or tablets.

How to Take It

Because some people have developed severe liver damage, even liver failure, after taking kava, you should only take it under a doctor's close supervision. If you have liver disease (such as cirrhosis or hepatitis), you should not take kava at all.

Kava comes in dried extracts, tablets, capsules, or liquid drops. You can also make a tea by simmering the roots of the plant in water.

Pediatric

Kava should not be given to children.

Adult

Given reports of liver damage, it is now impossible to say what dose of kava may be safe. You should take kava only under a doctor's supervision.

Do not take kava for more than 4 weeks.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider qualified in the field of botanical medicine. This is particularly true for kava, because there is evidence it may cause liver damage.

Reports in the United States and Europe have linked kava with severe liver problems. Kava-containing products have been associated with at least 25 reports of liver related injuries (including hepatitis, cirrhosis, liver failure, and death).

We don't know much about kava's effect on the liver. It may be that the kava supplements some people took were contaminated with other substances that caused liver damage. Or it is possible that some people already had liver problems before taking kava, or that they took a combination of kava and other prescription medications or herbs that damaged their livers. It is also possible that the doses generally recommended for kava affect people differently. So a dose that would cause liver damage in one person might have no effect on the liver in another person.

Because of the uncertainty around kava, you should take it only with your doctor's supervision. If you have taken kava and are having symptoms of liver damage, such as yellow skin (jaundice); fatigue; abdominal pain; loss of appetite; nausea; vomiting; and joint pain, seek immediate medical attention.

Do not take kava if you have depression, liver disease, such as hepatitis, or Parkinson's disease. Pregnant or breastfeeding women should not take kava.

Do not take kava if you are going to have surgery (and tell your surgeon if you have taken it in the past). Kava can prolong the effect of anesthesia.

Do not drink alcohol while taking kava.

Other side effects associated with kava include:

• Allergic skin reactions (such as contact dermatitis)
• Dizziness
• Drowsiness
• Restlessness
• Stomach upset
• Tremors

Long-term use at high doses may cause:

• Flaky, dry, and yellowish discoloration of the skin
• Hair loss (alopecia)
• Partial loss of hearing
• Loss of appetite

Like alcohol, kava may have intoxicating effects and should not be taken before operating a car or other machinery.

Possible Interactions

Do not take kava unless you are under the supervision of a doctor, especially if you are being treated for disease. Do not take kava with prescription or over-the-counter medications.

Kava may interact with the following:

Anticonvulsants -- Kava may increase the effects of medications, such as phenytoin (Dilantin), that are used to treat seizures.

Alcohol -- Do not use kava and alcohol together. The risk of impairment and the risk of liver damage are greatly increased.

Anti-anxiety agents -- Kava may increase the effects of CNS depressants such as benzodiazepines, used for sleep disturbances or anxiety (particularly alprazolam or Xanax), and barbiturates (such as pentobarbital), which are used for sleep disorders and seizures. Benzodiazepines include:

• Alprazolam (Xanax)
• Diazepam (Valium)
• Lorazepam (Ativan)
• Triazolam (Halcion)
• Chlordiazepoxide (Librium)

Diuretics (water pills) -- These drugs help rid the body of excess fluid. Kava can make the effects of these drugs stronger, raising the risk of dehydration.

Phenothiazine medications -- Kava may increase the risk of side effects associated with phenothiazine medications (often used for the treatment of schizophrenia), including chlorpromazine (Thorazine); and promethazine (Phenergan), which is used as an antihistamine.

Levodopa -- There has been at least one report that kava may reduce the effectiveness of levodopa, a medication used to treat Parkinson's disease. You should not take kava if you are taking any medications containing levodopa or if you have Parkinson's disease.

Medications metabolized by the liver -- Because it works on the liver, kava may affect medications that are metabolized by the liver. Speak to your doctor about any medication you are taking before taking kava.

Supporting Research

Ang-Lee M, Moss J, Yuan C. Herbal medicines and perioperative care. JAMA. 2001;286(2):208-216.

Anke J, Ramzan I. Pharmacokinetic and pharmacodynamic drug interactions with Kava (Piper methysticum Forst. f.). J Ethnopharmacol. 2004;93(2-3):153-60.

Attele AS, Xie JT, Yuan CS. Treatment of insomnia: an alternative approach. Altern Med Rev. 2000;5(3):249-259.

Basch E, Ulbricht C, Hammerness P, et al. Kava monograph. J Herbal Pharmacother. 2002;2(4):65-91.

Beaubrun G, Gray GE. A review of herbal medicines for psychiatric disorders. [review]. Psychiatr Serv. 2000;51(9):1130-1134.

Beckman SE, Sommi RW, Switzer J. Consumer use of St. John's wort: a survey on effectiveness, safety, and tolerability. Pharmacotherapy. 2000;20(5):568-574.

Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:221-225.

Boerner RJ, Klement S. Attenuation of neuroleptic-induced extrapyramidal side effects by Kava special extract WS 1490. Wien Med Wochenschr. 2004;154(21-22):508-510.

Boerner RJ, Sommer H, Berger W, et al. Kava-Kava extract LI 150 is as effective as Opipramol and Buspirone in Generalised Anxiety Disorder--an 8-week randomized, double-blind multi-centre clinical trial in 129 out-patients. Phytomedicine. 2003;10 Suppl 4:38-49.

Cagnacci A, Arangino S, Renzi A, et al. Kava-Kava administration reduces anxiety in perimenopausal women. Maturitas. 2003;44(2):103-109.

Christl SU, Seifert A, Seeler D. Toxic hepatitis after consumption of traditional kava preparation. J Travel Med. 2009 Jan-Feb;16(1):55-56.

Connor KM, Payne V, Davidson JR. Kava in generalized anxiety disorder: three placebo-controlled trials. Int Clin Psychopharmacol. 2006;21(5):249-253.

Cropley M, Cave Z, Ellis J, et al. Effect of Kava and Valerian on human physiological and psychological responses to mental stress assessed under laboratory conditions. Phytother Res. 2002;16(1):23-27.

De Smet PA. Safety concerns about kava not unique. Lancet 2002;360(9342):1336.

Ernst E. Safety concerns about kava. Lancet 2002;359(9320):1865.

Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. [Review]. Ann Intern Med. 2002;136(1):42-53.

Escher M, Desmeules J, Giostra E, et al. Hepatitis associated with kava, a herbal remedy for anxiety. BMJ. 2001;322:139.

Fu PP, Xia Q, Guo L, Yu H, Chan PC. Toxicity of kava kava. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 2008 Jan-Mar;26(1):89-112. Review.

Gastpar M, Klimm HD. Treatment of anxiety, tension and restlessness states with Kava special extract WS 1490 in general practice: a randomized placebo-controlled double-blind multicenter trial. Phytomedicine 2003;10(8):631-639.

Gyllenhaal C, Merritt SL, Peterson SD, et al. Efficacy and safety of herbal stimulants and sedatives in sleep disorders. Sleep Med Rev. 2000;4(2):1-24.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH:LexiComp; 2000: 466-467.

Lehrl S. Clinical efficacy of kava extract WS 1490 in sleep disturbances associated with anxiety disorders. Results of a multicenter, randomized, placebo-controlled, double-blind clinical trial. J Affect Disord 2004;78(2):101-110.

Li XZ, Ramzan I. Role of ethanol in kava hepatotoxicity. Phytother Res. 2010;24(4):475-480.

Maneze D, Speizer A, Dalton N, Dennis S. A descriptive study of kava use among Tongan men in Macarthur, Sydney South West. Aust N Z J Public Health. 2008 Aug;32(4):314-316.

Pittler MH, Ernst E. Kava extract for treating anxiety. Cochrane Database Syst Rev. 2002;(2):CD003383.

Rakel: Integrative Medicine, 3rd ed. Philadelphia, PA: Saunders, An Imprint of Elsevier; 2012.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:245-248.

Sarris J, Kavanagh DJ, Deed G, Bone KM. St. John's wort and Kava in treating major depressive disorder with comorbid anxiety: a randomised double-blind placebo-controlled pilot trial. Hum Psychopharmacol. 2009 Jan;24(1):41-48.

Teschke R, Gaus W, Loew D. Kava extracts: safety and risks including rare hepatotoxicity. Phytomedicine. 2003;10(5):440-446.

Teschke R, Sarris J, Lebot V. Contaminant hepatotoxins as culprits for kava hepatotoxicity--fact or fiction? Phytother Res. 2013; 27(3):472-474.

Teschke R, Schwarzenboeck A, Hennermann KH. Kava hepatotoxicity: a clinical survey and critical analysis of 26 suspected cases. Eur J Gastroenterol Hepatol. 2008 Dec;20(12):1182-1193.

Thompson R, Ruch W, Hasenohrl RU. Enhanced cognitive performance and cheerful mood by standardized extracts of Piper methysticum (Kava-kava). Hum Psychopharmacol. 2004;19(4):243-250.

van der Watt G, Laugharne J, Janca A. Complementary and alternative medicine in the treatment of anxiety and depression. Curr Opin Psychiatry. 2008 Jan;21(1):37-42. Review.

Wheatley D. Kava and valerian in the treatment of stress-induced insomnia. PhytotherRes. 2001;15(6):549-551.

Witte S, Loew D, Gaus W. Meta-analysis of the efficacy of the acetonic kava-kava extract WS1490 in patients with non-psychotic anxiety disorders. Phytother Res. 2005;19(3):183-188.

Overview

Many people appreciate lavender (Lavandula angustifolia or Lavandula officinalis) for its fragrance. Lavendar is a common ingredient in soaps, shampoos, and sachets for scenting clothes. The name lavender comes from the Latin root lavare, which means "to wash." Lavender may have earned this name because it was frequently used in baths to help purify the body and spirit. However, this herb has also been used as a remedy for a range of ailments from insomnia and anxiety to depression and fatigue. Research has confirmed that lavender produces slight calming, soothing, and sedative effects when its scent is inhaled.

Plant Description

Lavender is native to the mountainous zones of the Mediterranean where it grows in sunny, stony habitats. Today, it flourishes throughout southern Europe, Australia, and the United States. Lavender is a heavily branched short shrub that grows to a height of roughly 60 centimeters (about 24 inches). Its broad rootstock bears woody branches with upright, rod like, leafy, green shoots. A silvery down covers the gray green narrow leaves, which are oblong and tapered, attached directly at the base, and curled spirally.

The oil in lavender's small, blue violet flowers gives the herb its fragrant scent. The flowers are arranged in spirals of 6 to 10 blossoms, forming interrupted spikes above the foliage.

Parts Used

Essential oil is extracted from the fresh flowers of the lavender plant and used for medicinal purposes.

Medicinal Uses and Indications

A number of studies have reported that lavender essential oil may be beneficial in a variety of conditions, including insomnia, alopecia (hair loss), anxiety, stress, and postoperative pain. However, most of these studies have been small. Lavender is also being studied for antibacterial and antiviral properties. Lavender oil is often used in other forms of integrative medicine, such as massage, acupuncture, and chiropractic manipulation.

Insomnia or Agitation

In folklore, pillows were filled with lavender flowers to help restless people fall sleep. Scientific evidence suggests that aromatherapy with lavender may slow the activity of the nervous system, improve sleep quality, promote relaxation, and lift mood in people suffering from sleep disorders. Studies also suggest that massage with essential oils, particularly lavender, may result in improved sleep quality, more stable mood, better concentration, and reduced anxiety. In one study, people who received massage with lavender felt less anxious and more positive than those who received massage alone. Several small studies suggest that lavender aromatherapy may help reduce agitation in people with dementia. Lavender flowers have also been approved in Germany as a tea for insomnia, restlessness, and nervous stomach irritations.

Alopecia areata

In one study of 86 people with alopecia areata (an autoimmune disease that causes hair to fall out, often in patches), those who massaged their scalps with lavender and other essential oils daily for 7 months experienced significant hair regrowth compared to those who massaged their scalps without the essential oils. However, there is no way to tell whether it was one or the combination of oils that was effective. On the other hand, preliminary studies also show that lavendar may be effective in treating women with hirsuitism (excessive hair growth).

Other uses

Aromatherapists use lavender in inhalation therapy to treat headaches, nervous disorders, and exhaustion. Herbalists treat skin ailments, such as fungal infections (like candidiasis), wounds, eczema, and acne, with lavender oil. It is also used in a healing bath for joint and muscle pain. One study evaluating treatments for children with eczema founded it was therapeutic touch from the mother that improved symptoms; in other words, massage with and without essential oils (including lavender) both reduced the dry, scaly skin lesions.

Another study found that lavender oil may improve pain control after surgery. Fifty people undergoing breast biopsy surgery received either oxygen supplemented with lavender oil or oxygen alone. People in the lavender group reported better pain control than people in the control group.

Available Forms

Commercial preparations are made from dried flowers and essential oils of the lavender plant. These preparations are available in the following forms:

• Aromatherapy oil
• Bath gels
• Extracts
• Infusions
• Lotions
• Soaps
• Teas
• Tinctures
• Whole, dried flowers

How to Take It

Pediatric

• Oral use in children is not recommended.
• May be used topically in diluted concentrations to treat skin infections and injuries, such as minor cuts and scrapes. For proper dilutions speak with a knowledgeable health care provider. There are some aromatherapy formulas for children as well. Speak with a knowledgeable provider for dosing. Never use lavender on an open wound. Seek immediate medical attention.
• A study published in the New England Journal of Medicine concluded that lavender and tea oils in some shampoos, soaps, and lotions may cause gynecomastia, breast development in boys. If you have any concerns, ask your doctor about using lavender for a child.

Adult

The following are recommended adult doses for lavender:

• Internal use: Speak with a knowledgeable provider to find the right dose for you.
• Inhalation: 2 to 4 drops in 2 to 3 cups of boiling water. Inhale vapors for headache, depression, or insomnia. If you have asthma, talk to your doctor before using essential oil inhalations to see if they are right for you. There are some people who find essential oil used in inhalation form irritating to lungs and/or eyes.
• Topical external application: For ease of application, add 1 to 2 drops per tbsp. of base oil (such as almond or olive oil). Lavender oil is toxic if taken orally. Only use the oil externally or by inhalation. Also, avoid contact with eyes or mucous membranes, such as the lips and nostril.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider qualified in the field of botanical medicine.

Some people may develop an allergic reaction to lavender. Nausea, vomiting, headache, and chills have also been reported in some people after inhaling or absorbing lavender through the skin. Lavender applied to skin may cause irritation in some people. Oral use of Lavender may cause constipation, headache, and increased appetite. Lavender oil is toxic if taken orally.

Pregnant and breastfeeding women should avoid using lavender.

Possible Interactions

CNS Depressants: There are no known scientific reports of interactions between lavender and conventional medications. However, because lavender promotes relaxation, it may make the effects of central nervous (CNS) depressants stronger. These drugs include narcotics such as morphine or oxycodone (OxyContin) for pain, and sedative and anti-anxiety agents such as lorazepam (Ativan), diazepam (Valium), and alprazolam (Xanax). Ask your doctor before using lavender with these and other sedatives.

Supporting Research

Anderson C, Lis-Balchin M, Kifk-Smith M. Evaluation of massage with essential oils in childhood atopic eczema. Phyother Res. 2000;14(6):452-456.

Auerbach P. Auerbach: Wilderness Medicine. 5th ed. Philadelphia, PA: Elsevier Mosby; 2007.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:226-229.

Ernst E. The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach. Edinburgh: Mosby; 2001:130-132.

Fibler M, Quante A. A case series on the use of lavendula oil capsules in patients suffering from major depressive disorder and symptoms of psychomotor agitation, insomnia and anxiety. Complement Ther Med. 2014;22(1):63-9.

Graham PH, Browne L, Cox H, Graham J. Inhalation aromatherapy during radiotherapy: results of a placebo-controlled double-blind randomized trial. J Clin Oncol. 2003;21(12):2372-6.

Gyllenhaal C, Merrit SL, Peterson SD, Block KI, Gochenour T. Efficacy and safety of herbal stimulants and sedatives in sleep disorders. Sleep Medicine Reviews. 2000;4(2):1-24.

Han SH, Hur MH, Buckle J, Choi J, Lee MS. Effect of aromatherapy on symptoms of dysmenorrhea in college students: A randomized placebo-controlled clinical trial. J Altern Complement Med. 2006;12(6):535-41.

Henley DV, Lipson N, Korach KS, Bloch, CA. Prepubertal gynecomastia linked to lavender and tea tree oils. New England Journal of Medicine. 2007;5(365):479-485.

Howard S, Hughes BM. Expectancies, not aroma, explain impact of lavender aromatherapy on psychophysiological indices of relaxation in young healthy women. Br J Health Psychol. 2008 Nov;13(Pt 4):603-17.

Kim JT, Wajda M, Cuff G, et al., Evaluation of aromatherapy in treating postoperative pain: pilot study. Pain Pract. 2006;6(4):273-7.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp; 2000:468-469.

Lee IS, Lee GJ. [Effects of lavender aromatherapy on insomnia and depression in women college students] Taehan Kanho Hakhoe Chi. 2006;36(1):136-43.

Lin PW, Chan W, Ng BF, Lam LC. Efficacy of aromatherapy (Lavandula angustifolia) as an intervention for agitated behaviors in Chinese older persons with dementia: a cross-over randomized trial. Int J Geriatr Psychiatry. 2007;22:405-10.

Lytle J, Mwatha C, Davis KK. Effect of lavender aromatherapy on vital signs and perceived quality of sleep in the intermediate care unit: a pilot study. Am J Crit Care. 2014;23(1):24-9.

Moon T, Wilkinson JM, Cavanagh HM. Antiparasitic activity of two Lavandula essential oils against Giardia duodenalis, Trichomonas vaginalis and Hexamita inflata. Parasitol Res. 2006;99(6):722-8.

Motomura N, Sakurai A, Yotsuya Y. Reduction of mental stress with lavender odorant.Percept Mot Skills. 2001;93(3):713-718.

Pemberton E, Turpin PG. The effect of essential oils on work-related stress in intensive care unit nurses. Holist Nurs Pract. 2008 Mar-Apr;22(2):97-102.

Rho KH, Han SH, Kim KS, Lee MS. Effects of aromatherapy massage on anxiety and self-esteem in Korean elderly women: a pilot study. Int J Neurosci. 2006;116(12):1447-55.

Shimizu K, Gyokusen M, Kitamura S, Kawabe T, Kozaki T, Ishibashi K, et al. Essential oil of lavender inhibited the decreased attention during a long-term task in humans. Biosci Biotechnol Biochem. 2008 Jul;72(7):1944-7.

Soden K, Vincent K, Craske S, Lucas C, Ashley S. A randomized controlled trial of aromatherapy massage in a hospice setting. Palliat Med. 2004;18(2):87-92.

Soltani R, Soheilipour S, Hajhashemi V, Asghari G, Bagheri M, Molavi M. Evaluation of the effect of aromatherapy with lavender essential oil on post-tonsillectomy pain in pediatric patients: a randomized controlled trial. Int J Pediatr Otorhinolaryngol. 2013;77(9):1579-81.

Tirabassi G, Giovannini L, Paggi F, et al. Possible efficacy of Lavender and Tea tree oils in the treatment of young women affected by mild idiopathic hirsutism. J Endocrinol Invest. 2013;36(1):50-4.

Williams TI. Evaluating effects of aromatherapy massage on sleep in children with autism: a pilot study. Evid Based Complement Alternat Med. 2006;3(3):373-7.

Yip YB, Tse SH. An experimental study on the effectiveness of acupressure with aromatic lavender essential oil for sub-acute, non-specific neck pain in Hong Kong. Complement Ther Clin Pract. 2006;12(1):18-26.

Overview

Lemon balm (Melissa officinalis), a member of the mint family, is considered a calming herb. It was used as far back as the Middle Ages to reduce stress and anxiety, promote sleep, improve appetite, and ease pain and discomfort from indigestion (including gas and bloating, as well as colic). Even before the Middle Ages, lemon balm was steeped in wine to lift the spirits, help heal wounds, and treat venomous insect bites and stings. Today, lemon balm is often combined with other calming, soothing herbs, such as valerian, chamomile, and hops, to promote relaxation. It is also used in creams to treat cold sores (oral herpes).

Plant Description

Native to Europe, lemon balm is grown all over the world. It is grown not only in herb gardens or to attract bees, but also in crops for medicine, cosmetics, and furniture polish manufacturing. The plant grows up to 2 feet high, sometimes higher if not maintained. In the spring and summer, clusters of small, light yellow flowers grow where the leaves meet the stem. The leaves are very deeply wrinkled and range from dark green to yellowish green in color, depending on the soil and climate. If you rub the leaves, your fingers will smell tart and sweet, like lemons. The leaves are similar in shape to mint leaves, and come from the same plant family.

Medicinal Uses and Indications

Insomnia and anxiety

Several studies show that lemon balm combined with other calming herbs (such as valerian, hops, and chamomile) helps reduce anxiety and promote sleep. Few studies have examined lemon balm by itself, except for topical use. For example, in one study of people with minor sleep problems, 81% of those who took an herbal combination of valerian and lemon balm reported sleeping much better than those who took a placebo. It is not clear from this and other studies whether lemon balm or valerian (or the combination) is responsible for the result.

The same is true of several studies for anxiety, which used a combination of herbs to reduce symptoms.

In another double-blind, placebo-controlled study, 18 healthy volunteers received 2 separate single doses of a standardized lemon balm extract (300 mg and 600 mg) or placebo for 7 days. The 600 mg dose of lemon balm increased mood and significantly increased calmness and alertness.

Herpes

Some studies suggest that topical ointments containing lemon balm may help heal cold sores caused by the herpes simplex virus (HSV). In one study of 116 people with HSV, those who applied lemon balm cream to their lip sores experienced significant improvement in redness and swelling after only 2 days. Other symptoms, such as pain and scabbing, did not improve. Both the people and their doctors reported that lemon balm ointment was highly effective. Another large study involving three German hospitals and one dermatology clinic showed that when lemon balm was used to treat the primary infection of HSV I, not a single recurrence was noted. The cream has also been found to reduce the healing time of both genital and oral herpes. Several animal studies also support the value of topical lemon balm for herpes lesions. And preliminary studies show that lemon balm exhibited a high, concentration-dependent activity against HIV infection.

Other uses

Some evidence suggests that lemon balm, in combination with other herbs, may help treat indigestion. Others reveal that lemon balm oil has a high degree of antibacterial activity. In one study, lemon balm showed adequate activity against Listeria monocytogenes and Staphylococcus auerus. And a few studies have found that lemon balm may help improve cognitive function and decrease agitation in people with Alzheimer disease.

What is It Made Of?

Lemon balm supplements are made from the leaves of the plant. Essential oils made from lemon balm leaves contain plant chemicals called terpenes, which play at least some role in the herb's relaxing and antiviral effects. Lemon balm contains substances called tannins, which may be responsible for many of the herb's antiviral effects. Lemon balm also contains eugenol, which calms muscle spasms, numbs tissues, and kills bacteria.

Available Forms

Lemon balm is available as a dried leaf that can be bought in bulk. It is also sold as tea, and in capsules, extracts, tinctures, and oil. Some creams used in Europe, which contain high levels of lemon balm, are not available in the United States. On the other hand, teas can be applied to the skin with cotton balls. Lemon balm is also available in homeopathic remedies and as aromatherapy (essential oil).

How to Take It

Pediatric

Lemon balm may be used topically in children to treat cold sores. Speak to your health care provider for appropriate dosage for the child's age.

Adult

For difficulty sleeping, or to reduce indigestion, flatulence, or bloating, consult a knowledgeable provider for the specific dose to best fit your needs. Possible doses may be as follows:

• Capsules: Take 300 to 500 mg dried lemon balm, 3 times daily or as needed.
• Tea: 1.5 to 4.5 grams (1/4 to 1 tsp.) of dried lemon balm herb in hot water. Steep and drink up to 4 times daily.
• Tincture: 60 drops of lemon balm daily
• Topical: Apply topical cream to affected area, 3 times daily or as directed.

For cold sores or herpes sores, steep 2 to 4 tsp. of crushed leaf in 1 cup boiling water for 10 to 15 minutes. Cool. Apply tea with cotton balls to the sores throughout the day.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider qualified in the field of botanical medicine.

Pregnant and breastfeeding women should not take lemon balm.

Possible Interactions

Lemon balm may potentially interact with the following medications:

Sedatives and thyroid medications: Lemon balm may interact with sedatives and thyroid medications. If you are taking sedatives (for insomnia or anxiety) or medications to regulate your thyroid, ask your doctor before taking lemon balm.

HIV medications: It is not clear whether lemon balm interacts with antiretroviral agents. At this time, avoid use of lemon balm if you are taking medication for HIV.

Supporting Research

Awad R, Levac D, Cybulska P, Merali Z, Trudeau VL, Arnason JT. Effects of traditionally used anxiolytic botanicals on enzymes of the gamma-aminobutyric acid (GABA) system. Can J Physiol Pharmacol. 2007 Sep;85(9):933-42.

Ballard CG, O'Brien JT, Reichelt K, Perry EK. Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo-controlled trial with Melissa. J Clin Psychiatry. 2002;63(7):553-8.

Berdonces JL. Attention deficit and infantile hyperactivity. [Spanish]. Rev Enferm. 2001;24(1):11-14.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:230-232.

de Sousa AC, Alviano DS, Blank AF, Alves PB, Alviano CS, Gattass CR. Melissa officinalis L. essential oil: antitumoral and antioxidant activities. J Pharm Pharmacol. 2004;56(5):677-81.

Dos Santos-Neto LL, de Vilhena Toledo MA, Medeiros-Souza P, de Souza GA. The use of herbal medicine in Alzheimer's disease-a systematic review. Evid Based Complement Alternat Med. 2006 Dec;3(4):441-5.

Ernst E. The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach. Edinburgh: Mosby; 2001:169.

Gaby AR. Natural remedies for Herpes simplex. Altern Med Rev. 2006;11(2):93-101.

Geuenich S, Goffinet C, Venzke S, Nolkemper S, Baumann I, Plinkert P, Reichling J, Keppler OT. Aqueous extracts from peppermint, sage and lemon balm leaves display potent anti-HIV-1 activity by increasing the virion density. Retrovirology. 2008;5:27.

Ghaffariyan S, Mohammadi SA, Aharizad S. DNA isolation protocol for the medicinal plant lemon balm (Melissa ofiicinalis, Lamiaceae). Genet Mol Res. 2012;11(2):1049-57.

Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 4th ed. Montvalie, NJ: Thomson Healthcare; 2007:514-515.

Gutierrez J, Rodriguez G, Barry-Ryan C, Bourke P. Efficacy of plant essential oils against foodborne pathogens and spoilage bacteria associated with ready to eat vegetables: antimicrobial and sensory screening. J Food Proct. 2008;71(9):1846-54.

Hncianu M, Aprotosoaie AC, Gille E, Poiat A, Tuchilu C, Spac A, Stnescu U. Chemical composition and in vitro antimicrobial activity of essential oil Melissa officinalis L. from Romania. Rev Med Chir Soc Med Nat Iasi. 2008;112(3):843-7.

Kennedy DO, Little W, Haskell CF, Scholey AB. Anxiolytic effects of a combination of Melissa officinalis and Valeriana officinalis during laboratory induced stress. Phytother Res. 2006;20(2):96-102.

Kennedy DO, Scholey AB, Tildesley NT, Perry EK, Wesnes KA. Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (Lemon Balm). Psychosom Med. 2004 Jul-Aug;66(4):607-13.

Kennedy DO, Wake G, Savelev S, et al., Modulation of mood and cognitive performance following acute administration of single doses of Melissa officinalis (Lemon balm) with human CNS nicotinic and muscarinic receptor-binding properties. Neuropsychopharmacology. 2003;28(10):1871-81.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp; 2000:469.

Madisch A, Melderis H, Mayr G, Sassin I, Hotz J. A plant extract and its modified preparation in functional dyspepsia. Results of a double-blind placebo controlled comparative study. [German]. Z Gastroenterol. 2001;39(7):511-517.

Mantle D, Pickering AT, Perry AK. Medicinal plant extracts for the treatment of dementia: a review of their pharmacology, efficacy and tolerability. CNS Drugs. 2000;13:201-213.

Mazzanti G, Battinelli L, Pompeo C, Serrilli AM, Rossi R, Sauzullo I, et al. Inhibitory activity of Melissa officinalis L. extract on Herpes simplex virus type 2 replication. Nat Prod Res. 2008;22(16):1433-40.

Muller SF, Klement S. A combination of valerian and lemon balm is effective in the treatment of restlessness and dyssomnia in children. Phytomedicine. 2006;13(6):383-7.

Nolkemper S, Reichling J, Stintzing FC, Carle R, Schnitzler P. Antiviral Effect of Aqueous Extracts from Species of the Lamiaceae Family against Herpes simplex Virus Type 1 and Type 2 in vitro. Planta Med. 2006;72(15):1378-82.

Patora J, Klimek B. Flavonoids from lemon balm (Melissa officinalis L., Lamiaceae). Acta Pol Pharm. 2002;59(2):139-43.

Rakel: Integrative Medicine. 3rd ed. Philadelphia, PA. Elsevier Saunders; 2012.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:249-251.

Schnitzler P, Schuhmacher A, Astani A, Reichling J. Melissa officinalis oil affects infectivity of enveloped herpes viruses. Phytomedicine. 2008;15(9):734-40.

Taavoni S, Mazem Ekbatani N, Haghani H. Valerian/lemon balm use for sleep disorders during menopause. Complement Ther Clin Pract. 2013;19(4):193-6.

Triantaphyllou K, Blekas G, Boskou D. Antioxidative properties of water extracts obtained from herbs of the species Lamiaceae. Int J Food Sci Nutr. 2001;52(4):313-317.

Overview

Licorice (Glycyrrhiza glabra) has been used in food and as medicine for thousands of years. Also known as "sweet root," licorice root contains a compound that is about 50 times sweeter than sugar. Licorice root has been used in both Eastern and Western medicine to treat a variety of illnesses ranging from the common cold to liver disease. It acts as a demulcent, a soothing, coating agent, and as an expectorant, meaning it helps get rid of phlegm. It is still used today for several conditions, although not all of its uses are supported by scientific evidence.

Licorice that has the active ingredient of glycyrrhiza can have serious side effects. Another type of licorice, called DGL or deglycyrrhizinated licorice, does not seem to have the same side effects and is sometimes used to treat peptic ulcers, canker sores, and reflux (GERD). Practitioners still sometimes suggest whole licorice for cough, asthma, and other breathing problems. Topical preparations are used for eczema and other skin problems.

Plant Description

Licorice grows wild in some parts of Europe and Asia. A perennial that grows 3 to 7 feet high, licorice has an extensive branching root system. The roots are straight pieces of wrinkled, fibrous wood, which are long and cylindrical (round) and grow horizontally underground. Licorice roots are brown on the outside and yellow on the inside. Licorice supplements are made from the roots and underground stems of the plant.

Medicinal Uses and Indications

Licorice root is used for a variety of conditions.

Peptic ulcers

DGL is often suggested as a treatment for stomach ulcers, although it is not clear whether it works. A few studies have found that DGL and antacids helped treat ulcers as well as some prescription drugs. However, since antacids were combined with DGL, it is not possible to know how much of the benefit came from DGL alone.

One animal study found that aspirin coated with licorice reduced the number of ulcers in rats by 50%. (High doses of aspirin often cause ulcers in rats.) In one study, licorice root fluid extract was used to treat 100 people with stomach ulcers, 86 of whom had not improved with conventional medication, for 6 weeks. Ulcers disappeared in 22 people; 90% of participants got better. Other studies have found that DGL had no effect on peptic ulcers in humans.

Canker sores (Apthous ulcers)

One small study suggested that gargling with DGL dissolved in warm water 4 times per day helped reduce pain among people with canker sores.

Eczema

In one study, licorice gel, applied to the skin, helped relieve symptoms of itching, swelling, and redness. A gel with 2% licorice worked better than a gel with 1% licorice.

Dyspepsia (indigestion, GERD)

Preliminary studies suggest that a specific herbal formula containing licorice, called Iberogast or STW 5, may help relieve symptoms of indigestion or gastroesophageal reflux disease (GERD). This herbal formula also contains peppermint and chamomile, two herbs often used for indigestion.

Upper respiratory infections (cold, cough)

Licorice is a traditional treatment for cough, asthma, and sore throat. One study found that gargling with licorice before getting anesthesia cut the incidence of postoperative sore throat by half.

Weight loss

One study found that a preparation of licorice may reduce body fat. Fifteen people of normal weight consumed 3.5 g of licorice each day for 2 months. Body fat was measured before and after treatment. Licorice appeared to reduce body fat mass and to suppress the hormone aldosterone; however, the people in the study retained more water.

Another study found that a topical preparation of glycyrrhetinic acid (a component of licorice) reduced the thickness of fat on the thigh in human subjects. A third study found that people who took 900 mg of licorice flavonoid oil daily for 8 weeks experienced reductions in body fat, body weight, body mass index, and LDL cholesterol levels. More studies are needed to say if licorice really helps reduce fat. In addition, taking licorice long term has a number of health risks.

Menopause

Preliminary research suggests licorice may be effective at reducing hot flashes. One study found that licoricee seems more effective than HRT in improving hot flash duration.

Other

People who regularly take large amounts of licorice, more than 20 g/day, may raise blood levels of the hormone aldosterone, which can cause serious side effects, including headache, high blood pressure, and heart problems. For people who already have high blood pressure or heart or kidney disease, as little as 5 g/day can cause these side effects. More research is needed.

Available Forms

Licorice products are made from peeled and unpeeled, dried root. There are powdered and finely cut root preparations made for teas, tablets, and capsules, as well as liquid extracts. Some licorice extracts do not contain glycyrrhizin. These extracts are known as deglycyrrhizinated licorice (DGL), and do not seem to have the undesired side effects of other forms of licorice. Some studies suggest DGL may be better for stomach or duodenal ulcers. DGL may offer protection against ulcer formation when taken with aspirin.

How to Take It

Pediatric

Older children who have a sore throat can chew a piece of licorice root or drink licorice tea. Ask your doctor to help you determine the right dose for your child. DO NOT give a child licorice tea for more than a day without talking to your doctor. Never give licorice tea to an infant or toddler.

Adult

Your health care provider should determine the dose of licorice that's right for you.

DO NOT use licorice for longer than a week without talking to your doctor due to the risk of potentially dangerous side effects.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and that can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider in the field of botanical medicine.

Licorice with glycyrrhizin may cause serious side effects. Too much glycyrrhizin causes a condition called pseudoaldosteronism, which can cause a person to become overly sensitive to a hormone in the adrenal cortex. This condition can lead to headaches, fatigue, high blood pressure, and even heart attacks. It may also cause water retention, which can lead to leg swelling and other problems.

Although the dangerous effects mostly happen with high doses of licorice or glycyrrhizin, smaller amounts of licorice may cause side effects. Some people have muscle pain or numbness in the arms and legs. To be safe, ask your provider to monitor your use of licorice.

People with the following conditions should not take licorice:

• Heart failure
• Heart disease
• Hormone-sensitive cancers, such as breast, ovarian, uterine, or prostate cancer
• Fluid retention
• High blood pressure (hypertension)
• Diabetes
• Kidney disease
• Liver disease
• Low potassium (hypokalemia)
• Erectile dysfunction

Pregnant or breastfeeding women should not take licorice. Some studies suggest that taking licorice during pregnancy can increase the risk of stillbirth.

DO NOT use any licorice product for longer than 4 to 6 weeks.

Possible Interactions

Licorice may interfere with several medications, including the ones listed below. If you are taking any medication, ask your doctor before taking licorice.

ACE inhibitors and diuretics. If you are taking angiotensin converting enzyme (ACE) inhibitors or diuretics for high blood pressure, you should not use licorice products. Licorice could cause these medications to not work as well, or could make side effects worse, including a build up of potassium in the body. ACE inhibitors include:

• Captopril (Capoten)
• Benazepril (Lotensin)
• Enalapril (Vasotec)
• Lisinopril (Prinivil, Zestril)
• Gosinopril (Monopril)
• Ramipril (Altace)
• Perindopril (Aceon)
• Quinapril (Accupril)
• Moexipril (Univasc)
• Trandolapril (Mavik)

Digoxin. Because licorice may dangerously increase the risk of toxic effects from digoxin, do not take this herb with this medication.

Corticosteroids. Licorice may increase the effects of corticosteroid medications. Talk to your doctor before using licorice with any corticosteroids.

Insulin or drugs for diabetes. Licorice may have an effect on blood sugar levels.

Laxatives. Licorice may cause potassium loss in people taking stimulant laxatives.

MAO inhibitors. Licorice may make the effects of this class of antidepressant stronger.

Oral contraceptives. There have been reports of women developing high blood pressure and low potassium levels when they took licorice while on oral contraceptives.

Warfarin (Coumadin). Licorice may decrease the levels of this blood thinner in the body, meaning it may not work as well.

Medications processed by the liver. Licorice may interfere with several medications processed by the liver, including celecoxib (Celebrex), diclofenac (Voltaren), fluvastatin (Lescol), glipizide (Glucotrol), ibuprofen (Advil, Motrin), phenytoin (Dilantin), piroxicam (Feldene), phenobarbital, and secobarbital (Seconal).

Diuretics, hormonal medications, and many other medications interact with licorice.

Supporting Research

Armanini D, De Palo CB, Mattarello MJ, et al. Effect of licorice on reduction of body fat mass in healthy subjects. J Endocrinol Invest. 2003;26:646-50.

Armanini D, Nacamulli D, Francini-Pesenti F, Battagin G, Ragazzi E, Fiore C. Glycyrrhetinic acid, the active principle of licorice, can reduce the thickness of subcutaneous thigh fat through topical application. Steroids. 2005 Jul;70(8):538-42.

Borrelli F, Izzo AA. The plant kingdom as a source of anti-ulcer remedies. [Review]. Phytother Res. 2000;14(8):581-91.

Choi JS, Han JY, Ahn HK, et al. Fetal and neonatal outcomes in women reporting ingestion of licorice (Glycyrrhiza uralensis) during pregnancy. Planta Med. 2013;79(2):97-101.

Cinatl J, Morgenstern B, Bauer G, et al. Glycyrrhizin, an active component of liquorice roots, and replication of SARS-associated coronavirus. Lancet. 2003;361(9374):2045-6.

Dhingra D, Parle M, Kulkarni SK. Memory enhancing activity of Glycyrrhiza glabra in mice. J Ethnopharmacol. 2004;91(2-3):361-5.

Dhingra D, Sharma A. Antidepressant-like activity of Glycyrrhiza glabra L. in mouse models of immobility tests. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30(3):449-54.

Fatima A, Gupta VK, Luqman S, Negi AS, Kumar JK, Shanker K, et al. Antifungal activity of Glycyrrhiza glabra extracts and its active constituent glabridin. Phytother Res. 2009 Jan 23. [Epub ahead of print]

Fiore C, Eisenhut M, Ragazzi E, Zanchin G, Armanini D. A history of the therapeutic use of liquorice in Europe. J Ethnopharmacol. 2005;99(3):317-24.

Fuhrman B, Volkova N, Kaplan M, et al. Antiatherosclerotic effects of licorice extract supplementation on hypercholesterolemic patients: increased resistance of LDL to atherogenic modifications, reduced plasma lipid levels, and decreased systolic blood pressure. Nutrition. 2002;18(3):268-73.

Fujioka T, Kondou T, Fukuhara A, et al. Efficacy of a glycyrrhizin suppository for the treatment of chronic hepatitis C: a pilot study. Hepatol Res. 2003;26(1):10-14.

Fukai T, Marumo A, Kaitou K, Kanda T, Terada S, Nomura T. Anti-Helicobacter pylori flavonoids from licorice extract. Life Sci. 2002;71(12):1449-63.

Furusawa J, Funakoshi-Tago M, Mashino T, et al. Glycyrrhiza inflata-derived chalcones, Licochalcone A, Licochalcone B and Licochalcone D, inhibit phosphorylation of NF-kappaB p65 in LPS signaling pathway. Int Immunopharmacol. 2009;9(4):499-507.

Kamisoyama H, Honda K, Tominaga Y, Yokota S, Hasegawa S. Investigation of the anti-obesity action of licorice flavonoid oil in diet-induced obese rats. Biosci Biotechnol Biochem. 2008 Dec;72(12):3225-31.

Kao TC, Wu CH, Yen GC. Bioactivity and potential health benefits of licorice. J Agric Food Chem. 2014;62(3):542-53.

Kaye AD, Clarke RC, Sabar R, et al. Herbal medicines: current trends in anesthesiology practice -- a hospital survey. J Clin Anesth. 2000;12(6):468-71.

Krausse R, Bielenberg J, Blaschek W, Ullmann U. In vitro anti-Helicobacter pylori activity of Extractum liquiritiae, glycyrrhizin and its metabolites. J Antimicrob Chemother. 2004;54(1):243-6.

Langmead L, Rampton DS. Review article: herbal treatment in gastrointestinal and liver disease -- benefits and dangers. [Review]. Aliment Pharmacol Ther. 2001;15(9):1239-52.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH:LexiComp; 2000:470-1.

Lee JW, Ji YJ, Yu MH, Bo MH, Seo HJ, Lee SP, Lee IS. Antimicrobial effect and resistant regulation of Glycyrrhiza uralensis on methicillin-resistant Staphylococcus aureus. Nat Prod Res. 2009;23(2):101-11.

Madisch A, Holtmann G, Mayr G, et al. Treatment of functional dyspepsia with a herbal preparation. A double-blind, randomized, placebo-controlled, multicenter trial. Digestion. 2004;69:45-52.

Melzer J, Rosch W, Reichling J, et al. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther. 2004;20:1279-87.

Menati L, Khaleghinezhad K, Tadayon M, Siahpoosh A. Evaluation of contextual and demographic factors on licorice effects on reducing hot flashes in postmenopause women. Health Care Women Int. 2014;35(1):87-99.

Messier C, Epifano F, Genovese S, Grenier D. Licorice and its potential beneficial effects in common oro-dental diseases. Oral Dis. 2012;18(1):32-9.

Ofir R, Tamir S, Khatib S, Vaya J. Inhibition of serotonin re-uptake by licorice constituents. J Mol Neurosci. 2003;20(2):135-40.

Olukoga A, Donaldson D. Liquorice and its health implications. J R Soc Health. 2000;120(2):83-9.

Rakel: Integrative Medicine. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012.

Ruetzler K, Fleck M, Nabecker S, et al. A randomized, double-blind comparison of licorice versus sugar-water gargle for the prevention of postoperative sore throat and postextubation coughing. Anesth Analg. 2013;117(3):614-21.

Shibata S. A drug over the millennia: pharmacognosy, chemistry, and pharmacology of licorice. [review]. Yakugaku Zasshi. 2000;120(10):849-62.

Sigurjonsdottir HA, Franzson L, Manhem K, et al. Liquorice-induced rise in blood pressure: a linear dose-response relationship. J Hum Hypertens. 2001;15:549-52.

Somjen D, Knoll E, Vaya J, Stern N, Tamir S. Estrogen-like activity of licorice root constituents: glabridin and glabrene, in vascular tissues in vitro and in vivo. J Steroid Biochem Mol Biol. 2004;91(3):147-55.

Strandberg TE, Jarvenpaa AL, Vanhanen H, McKeigue PM. Birth outcome in relation to licorice consumption during pregnancy. Am J Epidemiol. 2001 Jun 1;153(11):1085-8.

Tamir S, Eizenberg M, Somjen D, et al. Estrogenic and antiproliferative properties of glabridin from licorice in human breast cancer cells. Cancer Res. 2000;60(20):5704-9.

Tamir S, Eizenberg M, Somjen D, Izrael S, Vaya J. Estrogen-like activity of glabrene and other constituents isolated from licorice root. J Steroid Biochem Mol Biol. 2001;78(3):291-8.

Tominaga Y, Nakagawa K, Mae T, et al. Licorice flavonoid oil reduces total body fat an visceral fat in overweight subjects: A randomized, double-blind, placebo-controlled study. Obesity Research & Clinical Practice. 2009;3(3).

van Rossum TG, Vulto AG, Hop WC, Schalm SW. Glycyrrhizin-induced reduction of ALT in European patients with chronic hepatitis C. Am J Gastroenterol. 2001;96(8):2432-7.