March/April 2009

Herbs: Help or Harm?
By Carol M. Bareuther, RD
Aging Well
Vol. 2 No. 2

Herbal remedies have been used throughout the ages to treat a variety of ills. Today, affordability and apparent benefits without side effects entice consumers to use these readily available products. The paradox is that while some herbs can be helpful, others are harmful.

This is an especially important topic among older adults because this age group is among the largest users of herbal supplements. Forty-one percent of adults in the United States aged 60 to 69 use some form of complementary and alternative medicine, including the use of herbal therapy, according to the Centers for Disease Control and Prevention’s National Health Statistics Report “Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007.” Interestingly, a 2002 National Health Interview Survey revealed that one half of the adults questioned did not disclose their herb use to conventional medical professionals.

“There are many herb-drug, herb-herb, and herb-food interactions a senior should find out about before taking a long list of herbs,” says Christine Gerbstadt, MD, MPH, RD, LDN, an Altoona, PA-based spokesperson for the American Dietetic Association.
Ginkgo, St. John’s wort, ginseng, garlic, echinacea, saw palmetto, and kava are among the top-selling herbal supplements in the United States. Here’s the scoop on each of them and where they fit into a health prevention and/or health treatment plan:

Ginkgo biloba: Native to China, the ginkgo is one of the oldest types of trees in the world, and its seeds have been used in traditional Chinese medicine for thousands of years. Recently, the flavonoids found in the ginkgo’s green fan-shaped leaves have been employed therapeutically as a memory aid. However, according to a 2007 article published in in The Journal of the American Medical Association, ginkgo was judged to be ineffective for reducing the development of dementia and Alzheimer’s disease in older adults. The article reported on results of the Ginkgo Evaluation of Memory study, in which more than 3,000 participants aged 75 and older took twice-daily doses of 120 milligrams of ginkgo extract for an average of six years.

“Ginkgo is relatively safe,” says Gerbstadt. “But seniors taking blood thinners [anticoagulants], for example, such as ibuprofen or aspirin, should use caution as this can lead to excessive bleeding.” Ginkgo-drug interactions also include raised blood pressure when combined with a thiazide diuretic.

St John’s wort: Medicinal uses for this yellow-flowered plant were first recorded in ancient Greece. Today, says Gerbstadt, “It may be useful for relief of mild depression in place of a prescription antidepressant.”

There are herb-drug interactions involved with St. John’s wort. “Since this herb has mild MAOI [monoamine oxidase inhibitor], tricyclic, and atypical antidepressant drug effects, it should not be used at the same time as any prescription MAOI (e.g., Nardil, Parnate), any tricyclic antidepressant (e.g., Zoloft, Prozac), or newer generation antidepressants (e.g., Paxil, Effexor),” Gerbstadt says.

St. John’s wort may also lower blood concentrations of medications such as cyclosporin (immune system depressant), digoxin (heart medication), indinavir (HIV medication), warfarin (anticoagulant/blood thinner), phenprocoumon (anticoagulant/blood thinner), and theophylline (respiratory medication).

Ginseng: Used as a stress buster, stimulant, and aphrodisiac, this root has been credited with a host of benefits. “Ginseng may energize someone who has a low energy level and conversely may calm when someone is too hyper,” says Gerbstadt. “It’s relatively safe. But like ginkgo, caution is advised if someone is taking blood thinners.”

A study published last year in the European Journal of Neurology indicates that ginseng may be a promising adjuvant therapy to conventional antidementia medications for patients with Alzheimer’s disease. In this study, 15 patients with Alzheimer’s disease received 9 grams of Korean red ginseng per day for 12 weeks and showed significant improvement on the Alzheimer’s Disease Assessment Scale and the Clinical Dementia Rating Scale. The authors did caution that additional studies with larger numbers of subjects are warranted.

Garlic: This member of the lily family is prized for its pungent flavor, as well as its potential for lowering blood cholesterol levels. Some short-term studies lasting one to three months suggest that taking garlic supplements can lower blood cholesterol levels. However, a study funded by the National Center for Complementary and Alternative Medicine found no effect whether the garlic was fresh, dried powdered tablets, or aged garlic extract tablets.

Because garlic supplements can augment the blood sugar-lowering effect of chlorpropamide when the two are taken together, this should be avoided.

Echinacea: Also known as purple coneflower, this plant has traditionally been used to prevent and treat the common cold. “Used in four- to six-week intervals, this herb may help boost immune function. However, do not take it for extended periods of time because this isn’t the way echinacea works,” Gerbstadt says. Currently, there are no known drug-herb interactions for echinacea.

Saw palmetto: The Seminole Indians of Florida were the first to use the fruit of this small native palm tree for medicinal purposes. “Saw palmetto may benefit an enlarged prostate or benign prostate hyperplasia. However, senior men should always be checked for cancer first,” Gerbstadt says.

The jury is still out on saw palmetto’s effectiveness. Several small studies suggest a benefit. However, according to an article published in 2006 in The New England Journal of Medicine, saw palmetto did not improve symptoms or objective measures of benign prostate hyperplasia. The study involved 225 men over the age of 49 who had moderate to severe symptoms of benign prostate hyperplasia and took saw palmetto extract (160 milligrams twice per day) or placebo for one year. As with echinacea, there are currently no known drug-herb interactions for saw palmetto.

Kava: This native of the South Pacific islands and member of the pepper family has been used as a ceremonial beverage and fatigue fighter for centuries. No one, says Gerbstadt, “should use kava. This is a central nervous system depressant that can cause liver toxicity and failure.”

Putting it All Together
Older adults should consider two key points before deciding to embark on herbal therapy. First, says Gerbstadt, “Is it safe? The answer is usually yes unless the herb therapy is inadequately addressing a serious medical problem.”

For example, consider an elder who has mild depression and wants to try an alternative therapy rather than use prescription antidepressants. The individual decides with a primary care physician to start a program with group or individual counseling, exercise therapy, and herbal therapy using St. John’s wort. The older adult would check in with his or her physician in four to six weeks to assess the effects.

“If the senior reports back that the depression seems to be better and the therapy and exercise are also helping,” says Gerbstadt, “Then this is an appropriate use of herbal treatment.”

 On the other hand, if an older adult with mild depression tries the same treatment plan and in six weeks has lost five pounds, is sleeping poorly, is less engaged in activities, and has avoided therapy or exercise class for the past few weeks, then the treatment has not helped.

In this case, says Gerbstadt, “Herbal therapy should be discontinued and more conventional treatment begun. A trial of herbal therapy was not unreasonable, but continuing it would be a poor choice.”

 Secondly, is the cost of herbal supplements using up precious resources that could be better spent on healthful food, group exercise, or a hobby?

 “Herbal treatments can use up much of a limited budget when this money could benefit the senior’s health with more impact when spent elsewhere. I see this all the time and with many supplements,” says Gerbstadt. “A healthy diet with good habits like not smoking, daily activity, maintaining a reasonable body weight, responsible alcohol use, and good sleep practices cures many ailments that people think they need herbs to treat. Living healthy is the best revenge.”