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A Few Words About Over-The-Counter Herbs

The following information, about 3 popular over-the-counter herbs, is given as a way of illustrating the differences between using herbs in a holistic way or otherwise.

Saint John's Wort

Whilst medical herbalists may not have so much use for St John's Wort as a wound herb as they did in the past, it is still used a lot for inflammation and bleeding in the digestive tract. Its application to the nervous system is much wider than just for stress and depression. It is employed in neuralgias, and herbalists apply its anodyne qualities to treating shingles - internally as a tea or tincture and externally as oil. It also has regenerative effects on nervous tissue. Whilst nervous tissue normally recovers only very slowly from damage, lesions from operations and accidents may be helped in their healing by St John's Wort. Hypericum also has a mild tonic action on the liver.

The focus upon St John's Wort as the herb for depression not only diverts attention away from other herbs such as Lemon Balm but also assumes that depression is an illness that can be treated with a medicine. Whilst there are some depressive states that can be seen as a result of chemical imbalance in the body and which respond well to medication, herbal or pharmaceutical, most of us recognise that "depression" is to do with our interactions with the world around us. Whilst uplifting nervine herbs may be a source of support during hard times, they are not going to remake a broken marriage, remedy someone's poverty or redundancy from work or heal the pain of an abusive childhood. The attitude that says we can sort our lives out by taking a tablet is the one that stops us listening to the messages and the learning that illness can bring.

Standardisation

Another general issue about the marketing of herbs by the over - the counter (OTC) industry that is highlighted by St John's Wort is that of "standardisation". Whilst people and plants are variable in their makeup, industry requires a standardised product. It is reasonable, if buying a product, to want to know that what I buy this month is of the same quality as that I purchased before. The way that the OTC industry reassures us is to calibrate levels of certain chemical constituents of a herb and to make sure that these are maintained in its products. Usually one key active constituent is taken as the marker - in the case of St John's Wort this has been the red pigment, hypericin. The implication here is that hypericin is the essence of Hypericum, and that the anti-depressive activity of the plant is generated by this compound.

Chemists have determined what they think is the optimum level of hypericin that a plant sample should contain. As a crop of St John's Wort is processed its hypericin content is assessed. If the amount is too high then some is removed. If there is not enough then more hypericin is added. The label on the finished product will then proclaim "standardised for hypericin content" and will give a percentage figure to indicate its content.

In some ways this is a modern version of what the pharmaceutical industry has done with plants for over a hundred years - identifying the "active constituent" and taking it out to turn it into a drug. Only now it is taken out and then put back into a processed sample of the same plant. We have seen that extraction and synthesis of plant chemicals has led to an increase of potency but also of unwanted side effects. There is beginning to be a suspicion that a similar charge could be levelled at standardised extracts.

There is a humorous footnote to add here. There have been many clinical trials to assess the antidepressant activity of St John's Wort, most of them with standardised extracts. More recently a trial was done with St John's Wort which had had the hypericin removed. It was found to be efficacious in relieving depression!

Side Effects

Historically the main unwanted side effect that has been noted with the use of St John's Wort has been increased sensitivity to light. Some individuals using the plant may develop a skin reaction in strong sunshine. Actually this is an effect that has been noted in livestock far more frequently than in people and it is assumed that this reaction is relatively unusual in humans.

Near the beginning of the year 2000 the Medicines Control Agency in Britain published information concerning dangerous potential interactions between St John's Wort and pharmaceutical medication. These fell into two categories: 1 Some medicines that act on the central nervous system are potentiated 2 Some medicines that are cleared from the body by the liver are cleared more quickly than usual resulting in lower amounts of the medication in the bloodstream. Those medicines in the first category included Prozac and similar antidepressive drugs. Those in the second category included drugs used to treat epilepsy and clotting disorders, those used to stop the body rejecting transplants and the contraceptive pill.

Several points can be made about this. People taking herbal medication and orthodox medicines need to be aware that there are potential interactions between them. In the marketing of Hypericum's anti-depressive action its liver function enhancing effects have been neglected, but since many herbs act on the liver it is to be expected that more herb/drug interactions will come to light. It is recommended that people taking OTC herbal remedies inform their doctors of the fact. To be on the safe side, many doctors have reacted by advising people to cease taking St John's Wort, whereas monitoring blood levels of crucial drugs would be another course of action.

The effects of St John's Wort in lowering the effectiveness of the contraceptive pill are theoretical. Given the huge OTC sales of St John's Wort (£6 billion reported in 1999) and that more women purchase the herb than men, one would expect problems to be reported. It is, however, worth bearing in mind.

All reported actual and potential drug/herb interactions with St John's Wort all relate to standardised extracts. Medical herbalists tend to regard teas and tinctures as safer products.

It is also worth noting that problems with a particular herb or a sample of a particular herb still often result in an outcry against herbal medication in general, compared to problems with individual pharmaceutical drugs being perceived as just concerning that particular medication.

Echinacea

Echinacea has achieved immense popularity as an anti-infective remedy. Its use increases white blood cell count and activity, and also production of interferon, an anti-viral protein. This means that it is active against all sorts of infective illnesses. Traditionally its use was in suppurating skin conditions and it was seen as a heat clearing, detoxicant remedy applicable to inflammation and discharge as well as to infection.

Whereas a doctor might prescribe an antibiotic to treat a bacterial infection, a herbalist may use Echinacea. The intention of employing an antibiotic is to kill the organism responsible for the illness. Using a remedy such as Echinacea, which is seemingly much broader in its remit, actually allows the body to mediate its own specific response to a particular infective organism. This is a good example of the way in which herbal treatment supports the body's natural course of action rather than acting in its place.

It is the contention of many practising herbalists, however, that Echinacea is being very much overused.

We are only likely to catch an infective illness when our bodies are already feeling tired or stressed. We are exposed to all sorts of infective organisms all of the time but only go down with an illness when we are unable to fight it off. This means that when we do get an illness we need to get some rest, take time off from work and think about our diets. We also need to see if there are things we have been doing too much or too little of and see what generally in our lives needs readjusting to keep us well. It may well be that nervine herbs and a better diet are much more useful responses to an infection than dosing with Echinacea.

Echinacea is a very valuable remedy, but it is one that boosts our last line of defence when our bodies have already been weakened. Thus it can be seen that the mass consumption of Echinacea is perhaps the antithesis of holistic treatment.

It is also worth remembering that Echinacea is only one of a number of herbs useful in fighting infective illness. Traditionally herbs that support specific tissues were used for infections in that area - for example thyme for chest infections.

Milk Thistle

Traditionally the leaves have been used as food and the plant was used as a galactogogue. It had, however, fallen out of popular use until modern research showed the plant to be useful for treating a whole range of liver complaints. As well as stimulating bile flow, it is also useful in fatty liver, hepatitis and cirrhosis. Commercial extracts are often standardised for silymarin content - this being seen as the main active constituent. Silymarin acts on cell membranes in the liver helping to prevent damage from infective organisms and harmful chemicals (including pharmaceutical drugs). It is seen as a liver trophorestorative by herbalists, that is, a herb that helps restore an organ to an undamaged state. As such it is immensely valuable.

Whilst many people will benefit from the use of a herb which aids their liver, Milk thistle is probably most useful in complaints where professional supervision is needed. Many of the people who are buying Milk thistle supplements might be better off getting to know a little more about the lowly dandelion!


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