Integrative Medicine:
Dietary Supplements 2002, Part 1

When it comes to herbal supplements, what are patients taking?  Here is a review of some of the most popular ones, from the annual meeting of the American College of Physicians.  I’ve tried to “weed through” the data – note that most studies are short term, with few patients.  And watch out! Problems with purity and potency abound – especially with “quick buck” artists.

St. John’s Wort:

Also known as Hypericum perforatum, it has a 2000 year history of use for depression.  The German Commission E (one of the most complete reviews of supplements) gave it early support for “depressive moods, anxiety and/or nervous unrest.”  In a review of 17 double-blind randomized placebo controlled trials (the best studies that can be done) with 1168 patients, 56% of those on SJW improved versus 25% on placebo. In a 6 week trial, 400 mg twice a day worked about as well as 20 mg Prozac. Side effects include dry mouth, stomach upset, restlessness and increased sun sensitivity, but less than 1% of patients dropped out.  There can be interactions with drugs for depression, contraception, epilepsy and AIDS.

Ginkgo biloba:

Used to try to improve brain function, particularly memory.  It comes from a 200 million year old species of trees, and is the top selling  herbal therapy in the US and Germany.  Most studies to date have been poorly done; of 56 studies only 4 could be used for meta-analysis in a review in Archives of Neurology.  With 120-240 mg/day for 3-6 months there was modest improvement in some measures of thinking.  Side effects are mostly uncommon and mild: headache, rash, and stomach upset. There are occasional reports of spontaneous bleeding, such as in the eye or brain.

Kava: (Piper methysticum)

Called the “intoxicating pepper” and first reported in English by Captain James Cook in1768, it’s used for anxiety in the Kava ceremony in the South Pacific.  The active ingredient in kavapyrones.  In 2 double-blind controlled trials (58 patients for 4 weeks and 101 for 25 weeks) using 100 mg (70% kavapyrones) 3x/day, there was improvement in anxiety scores.  Side effects include low weight and skin disorder from long term use, involuntary muscle movements and coma when combined with Xanax.  Watch out for the dose!  The percentage of kavalactone is important.  Commission E recommends 60-120 mg kavalactone per day.

Valerian: (Valeriana officinalis)

This root is used for insomnia.  In a study of 121 patients, valerian 600 mg nightly was compared to placebo for 28 days, with continuing improvement.  There is one report of severe withdrawal after long-term high dose use, and it is metabolized by the liver with occasional toxicity (we have seen this).

Ginseng: (Panax ginseng)

Used as a general tonic.  It is thought to have effects on nerves involved in serotonin and GABA.  Studies have had mixed results; commercial preparations vary widely in content and purity, and in some  no ginseng was found at all.  Side effects include jitteriness, diarrhea, hypertension, and
insomnia.