Herbal Medications Part Two

This represents a continuation of a previous article discussing some of the risks and benefits of herbal medication. As noted, herbal use has topped annual sales in of $1.5 billion. Many physicians have been reluctant to endorse them given their lack of FDA regulation and potential for possible adverse effects.
Kava: Kava is derived from a shrub found in the South Pacific and has been used in those cultures for over 3000 years. As a ceremonial beverage, it purportedly has relaxing and sleep enhancing effects. The downside, however, is the trend toward excessive sedation and its ability to potentiate other "sedative" type drugs i.e. alcohol, antidepressants and barbiturates, etc. Randomized studies have shown success with the short-term use of kava for the treatment of anxiety disorder, but caution must be taken when considering the use of this herbal preparation. Side effects include possible gastrointestinal distress, dermatitis and possible yellowing of the skin (which is fortunately reversible).
St. Johns Wort: Many are familiar with St. Johns wort, an herbal supplement indigenous to the United States that has been shown to improve the signs and symptoms of depression. Of all the herbal medications, St. Johns wort has received the most popularity and, therefore, the most clinical evaluation. Twenty three studies (over1750 patients) demonstrate efficacy in treating mild to moderate depression, thus it remains a reasonable initial choice for many patients. It should not be used in combination with over-the-counter decongestants, red wine, cheese, or smoked meats. I know that sounds odd and completely random, but it has to do with specific chemical interactions between the medicine and certain foodstuffs. At doses of 300 milligrams three times per day, side effects are minimal and include dry mouth, sedation and GI upset.
Saw Palmetto: Saw palmetto is used to treat the urinary symptoms of an enlarged prostate by decreasing the amount of prostatic fluid within the gland and acting as an anti-androgen to shrink the gland itself. Trials with 2939 men have shown that it is as effective as proscar, an established medication used for BPH (benign prostatic hyperplasia) that is available by prescription. Doses of 160 milligrams twice a day are recommended – side effects include headache and once again, gastrointestinal upset. It is critical for physicians to assess for herbal medications use given its increasing popularity. Estimates suggest that greater than sixty million Americans use herbal supplements. Many docs may not ask about supplements on a regular basis (myself included!) therefore I always suggest that patients alert their providers about such use.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.