Anxiety, stress, and insomnia are some of the most troublesome problems to treat with conventional medicine. The drugs used have many side effects, and most are habit-forming. Natural remedies provide safe alternatives and are becoming the first treatment choice.
—ROB MCCALEB, HERB RESEARCH FOUNDATION
When reading the label on an herbal preparation, keep in mind that manufacturers are prevented by current law from stating that herbs can help treat or prevent diseases or symptoms. According to the 1994 Dietary Supplement Health and Education Act (DSHEA), herbs are considered supplements, not drugs. Manufacturers are able to claim that their products can enhance general well-being or that they can support or help improve body functions, such as circulation or digestion, so long as the claim is supported by scientific evidence.
A few unscrupulous companies are making inappropriate claims regarding poor-quality or unproven herbal products that the DSHEA had made it difficult for the Food and Drug Administration (FDA) to regulate. A 1997 presidential commission on dietary supplements proposed that a new set of regulations be instituted to ensure good manufacturing practices for herbal medicines and to help weed out unethical companies. Consumers are urged to buy products only from reputable manufacturers. To find out which companies are the most respected, check with your physician, health food store, or pharmacy.
The ideal policy for medicinal herbs in the United States would be to adopt the German standard for sanctioning herbs as drugs: absolute proof of safety and reasonable proof of efficacy (see “Germany’s Commission E,” below). This would allow the best medically proven herbs to be approved as over-the-counter (OTC) drugs. The American Herbal Products Association, the Utah Natural Products Alliance, the European-American Phytomedicines Coalition, the National Nutritional Foods Association, and the Council for Responsible Nutrition are all lobbying for OTC drug status for herbal medicines. In Germany and in much of Europe, OTC herbs are already regulated as drugs, ensuring that standards of quality are high.
In any case, it is important to educate yourself about any herbal remedy or synthetic drug that you consider taking. Don’t use any substance without being familiar with therapeutic indications, dosages, side effects, and contraindications (factors that render the administration of a drug or herb inadvisable). Do not self-diagnose for potentially serious medical conditions or use a clerk at a health food store as a surrogate doctor or pharmacist. It is always best to consult a physician for a diagnostic checkup and a discussion of therapeutic options.
In addition to the herbal medicines for healing anxiety and stress discussed in this book, there are other herbs that have been scientifically studied and proven effective to treat many diseases and promote health. Based on scientific studies from around the world, the following herbs are recommended for the conditions listed. Adequate medical scrutiny has shown that they consistently offer therapeutic value, efficacy, and safety.
Herb: Saw palmetto berry
Condition: Benign prostatic hyperplasia
Standardization: 85–95% fatty acids and sterols
Herb: Garlic
Condition: High cholesterol; viral, fungal, bacterial conditions
Standardization: 3.4% alliin
Herb: Pygeum Africanum
Condition: Benign prostatic hyperplasia
Standardization: 13% total sterols
Herb: Feverfew
Condition: Migraine headaches
Standardization: 0.6% parthenolide
Herb: Cranberry
Condition: Urinary tract infection
Standardization: 5% anthocyanidins, 30% organic acids, 20% arbutin
Herb: Black cohosh
Condition: Menopausal symptoms
Standardization: 1 mg of triterpene glycosides calculated as 27-deoxyactein
Herb: Grape seed
Condition: Inflammation, athrosclerosis, bruising, oxidation, vascular disease, varicose veins
Standardization: 95% procyanidolic oligomers
Herb: Bilberry
Condition: Cataracts, myopia, night blindness, diabetic retinopathy, macular degeneration
Standardization: 25% anthocyanosides calculated as anthocyanidins
Herb: Ginger
Condition: Nausea, motion sickness
Standardization: 20% pungent compounds, calculated as 6-gingerol and 6-shogaol
If you already have a known medical disease or take prescription drugs, discuss with your doctor whether herbs are safe for you. Do not discontinue medically approved conventional treatments without medical supervision. If you have any unusual side effects from an herb, stop taking it and call your physician immediately.
If you are pregnant, consult with your obstetrician or other health care provider before taking any herb. Some herbs contain substances that can cause a miscarriage or premature labor or damage the fetus. Little research has been done on using herbs during pregnancy or breast-feeding, so caution is strongly recommended.
Just because an herb is natural doesn’t mean it is always safe. Ephedra, or mahuang, for example, should be avoided by anyone with anxiety, hypertension, diabetes, glaucoma, or elevated thyroid. Comfrey and coltsfoot contain toxins that can damage the liver. Some plants, like water hemlock and belladonna, can be deadly and are therefore prohibited by the FDA.
No substance is perfectly safe. Among the few people who have become ill after taking medicinal herbs, some had the mistaken notion that if something is natural, it is safe in any dosage. Others may have unusual allergic reactions to herbs that are safe for most people, just as some people have food allergies. Although side effects are few and generally mild, you should consider them carefully before taking any herb and take only the recommended dosage.
The herbal remedies recommended in this book enjoy an excellent safety record over thousands of years of folk medicine. These herbs generally are less toxic and have fewer side effects than their synthetic counterparts. The last decade has seen an explosion of scientific research on these herbal medicines, including their therapeutic uses, contraindications, dosage recommendations, and other pertinent safety considerations.
GERMANY’S COMMISSION E
Germany is the world’s role model for high standards in herbal medicine. Much of the revolutionary scientific research on the effectiveness of medicinal herbs comes from Germany, a country with a continuous, highly respected tradition of herbal medicine. German physicians are trained in the use of these natural remedies while they are in medical school, and about 80 percent prescribe herbal medicines in their practices. In contrast, the United States has had a broken tradition of herb use because of social and economic factors. Unrealistic federal regulations have hampered research on herbal remedies by making such research unprofitable for American pharmaceutical companies. To get FDA approval of a natural remedy as a new drug can cost tens of millions of dollars and take seven or more years. And because a plant cannot be patented in the United States, there is little economic incentive for American companies to investigate and develop a botanical medicine as a new pharmaceutical drug.
In Germany, herbal medicines are approved as OTC drugs by a governmental agency similar to our FDA. Germany’s Commission E is a special scientific committee of the Bundes-gesundheitsamt (Federal Department of Health) that has actively collected research data on herbal medicines, evaluating their effectiveness and safety. The results are published as monographs, which are considered among the top scientific compendiums on herbs in the world. Commission E consists of a panel of consumers and experts including physicians, pharmacologists, toxicologists, and pharmaceutical industry representatives specializing in herbal medicine. The commission reviews studies of animal and pharmacological research, human clinical trials, medical practice, and quality control investigations of herbal cultivation and manufacturing.
Since 1978 Commission E has published 410 monographs covering 324 individual herbs and various herbal combinations. Each monograph describes the herb’s effectiveness, side effects, contraindications, and proper therapeutic dosage. Each monograph includes a positive or negative assessment. For an herb to gain Commission E approval, it must show strong evidence of safety and a reasonable assurance of effectiveness. The labeling of herbal products for OTC use is based on the commission’s assessment and includes a caution when a specific herb’s benefits may not be proven. The American Botanical Council, under the direction of Mark Blumenthal, in 1997 published an English translation of the German Commission E monographs.
STANDARDIZED HERBAL PRODUCTS
All natural products are not created equal. Some cost more, and some are always discounted. However, price tags provide no information about the health benefits contained inside a package. If price is the sole criterion by which a product is purchased, the goal of achieving good health will probably not be attained. There’s more to selecting an herbal product than price and knowing what condition it can help. Quality is essential. It is not the herb that provides the benefit but the active ingredients found in the herb. It is not the name on the label that ensures effective results but the quality and concentration of the active ingredients found in the herb. Because there is so much disparity among the multitude of products available, consumers should make their selections carefully.
The best way to ensure quality is to buy herbal products that are standardized. A standardized herbal product provides specific concentrations of an herb’s active ingredients dose after dose. Standardization guarantees consistency in herbal products for a predictable effect.1
Standardization is a manufacturing process that ensures that an herbal product contains agreed-upon levels of certain chemicals or compounds believed to be active ingredients of that herb or reliable markers for the presence of adequate amounts of herb in the product. Standardization is not a measure of the strength or potency of the herbal product, but it guarantees that it contains a consistent amount of the chosen compounds.
The reason for standardization is to assure consistency of therapeutic effect. Nonstandardized extracts may also be effective, but since most modern clinical research is performed using standardized extracts, less evidence exists to support the use of nonstandardized extracts. In addition, some herbal products are not standardized, because researchers have not yet identified which active ingredients are reliable markers for those plants.
The worldwide research performed on herbs does not ensure results unless standardization information is understood and used. For instance, there are many grades and qualities of the herb sold under the name of Hypericum (Saint-John’s-wort), and not all of these products are effective. The landmark studies on Hypericum for the treatment of depression call for the herb to be standardized at 0.3 percent hypericin. Using a Saint-John’s-wort product containing anything less than 0.3 percent hypericin will not guarantee results. On the other hand, when the level of potency matches the medical studies, the health benefits are uniform.
Choose products from a reputable manufacturer. Producing good natural products can be challenging because the quality of herbs and plants used varies greatly as a result of climate, growing conditions, and conditions of harvesting and storing. These variables can dramatically affect the nutritional and therapeutic benefits of the final product. Only the most advanced manufacturers combine nature and technology to create products that contain research-grade ingredients in amounts that have been scientifically validated. The best manufacturers have on-site laboratories, closely monitor processes, and standardize to ensure consistent potency from batch to batch. Enzymatic Therapy, Nature’s Herbs, and Nature’s Way are examples of leading herbal manufacturers whose quality products are found at fine health food stores. Sunsource and Murdock-Madaus-Schwabe, also dedicated to high-quality products, are distributed solely to pharmacies, supermarkets, and discount stores nationwide.
Large manufacturers in Europe and the United States are increasingly adhering to quality control methods that ensure that the herbal product you purchase is consistently pure and safe. Modern herb extraction processes integrate the age-old knowledge of folk remedies with scientific standards. Techniques of cultivation, drying, storage, grinding, extraction, and concentration are carefully controlled and tested to make sure that the final capsules, tablets, or liquid preparations are of consistent quality.
Some herbs are so mild in their effects that it is impractical to try to consume enough of the plants in bulk form or tablets to obtain their benefits. Therefore an extract is made, which concentrates the active ingredients by mixing the crude herb (the flowers, leaves, or roots) with alcohol or another solvent. A solid residue remains when all of the solvent is evaporated off. This solid extract, available in powdered form in either capsules or tablets, represents the most concentrated form of an herbal medicine. Herbal teas, which use water as the solvent, are relatively weak. These may be more suitable for children, elderly people, and others who are especially sensitive to the effects of herbs.