Herbal Remedies & Your Prescriptions: Talk to Your Pharmacist First (Women's Health Matters article) (Web resource; WHM resource) Author: Poonam Khanna Organization: Women's College Hospital, Women's Health Matters If you’re taking herbal remedies, make sure you let your health-care providers know — especially if they are prescribing you drugs, says University of Toronto’s Dr. Heather Boon. Herbal remedies might interact with the medicines your doctors prescribe for you, so it’s essential that your physician understand what you’re taking, said Boon, an associate professor in the Leslie Dan Faculty of Pharmacy at the university. A rose is not always a rose Although many people wouldn’t let their kids eat berries they find on a bush for fear they might be poisonous, they don’t take the same kind of precautions with herbal remedies. They think because something is in a bottle, it means it’s safe. Although many herbal remedies are safe, not all are, Boon said in a presentation at the 2008 Women’s Health Matters Form & Expo in Toronto. However, patients are often reluctant to discuss herbal medicines with their doctors ― either because no one asked them about it, or they’re afraid their doctor might scorn them. Some patients don’t think of herbs as medicine, or they think their doctor won’t know anything about them anyway. Although medical professionals should always ask patients about herbal remedies, ultimately it’s your health and your body, so tell your health-care providers about any herbs you are taking. Echinacea Echinacea, the purple cornflower, is one of the most popular herbal remedies available. There are three different types available for purchase in Canada ― echinacea angustifolia, echinacea pallida and echinacea purpurea. There is no scientific evidence that one type is better than another and many products use a combination. Though we still don’t know how echinacea works, it is thought to increase the number of cells in the immune system. It doesn’t work like an antibiotic, however. The Cochrane Collaboration, an international not-for-profit organization that provides information about the effects of health care, did a review of 16 double blind studies on echinacea. Nine of those found echinacea helped, one found only a slight improvement and six reported no difference. Part of the problem was that the studies were looking at different products that use different species and parts of the flower. Though Boon personally doesn’t think echinacea works, she recommends people who want to use it buy a product that is standardized to the active ingredients ― cichoric acid and polysaccharides. Echinacea is also not meant to be taken for long periods and shouldn’t be taken for more than a month. And though it’s not an absolute contraindication, Boon said anyone with chronic immune dysfunction should not take it since we still don’t understand what it’s doing. Black cohosh Black cohosh is another popular herbal remedy that is used to treat the symptoms associated with menopause. The Cochrane Collaboration looked at 19 clinical studies, but found that only four of the trials were well done, and only two of those were blinded (where the testers didn't know if they were using the real product or a placebo). Three of the trials showed positive results, but there isn’t strong evidence overall for the benefits of black cohosh, she said. Women with estrogen positive tumors and who are pregnant or breastfeeding should not take it. It has an additive estrogen-like effect, so for those already on hormone therapy, there is little point in taking it then. Ginkgo Ginkgo comes from the oldest tree on earth, but there is no scientific evidence that it will make you live longer. Boon recommends products that are standardized to about 20 percent of the active ingredients, ginkgo flavone glycosides and terpenoids. Though ginkgo is best known as an aid against cognitive disabilities such as dementia and Alzheimer disease, there is actually more evidence to support its ability to increase vascular circulation. Ginkgo has been shown to help people with circulatory conditions. One study on its ability to help cognition indicated it had some effect at 12 weeks, but not at 24 weeks. In other words, the study found it had short-term effects. Because ginkgo makes your blood less likely to clot, those on anticoagulants should avoid it. Ginkgo is also not recommended for those taking the calcium channel blocker nifedipine. Red clover Like black cohosh, red clover is used to treat the symptoms of menopause. Studies done on its effectiveness weren’t well done, so there is no scientific evidence that it works, Boon said. But this doesn’t mean it doesn’t work ― and women who take it say it works. Red clover should not be taken by those on estrogen. St. John’s Wort St. John’s Wort is another common herbal remedy used to treat mild or moderate depression. It appears to work as a serotonin reuptake inhibitor (SRI). A Cochrane review of 37 trials found it was more effective than placebos but that it doesn’t work for severe depression. It also had fewer adverse effects than those experienced by people taking traditional depression medications, but side effects include stomach upsets, skin reactions, fatigue, restlessness and anxiety. It could increase adverse symptoms if taken with traditional medications for depression. Garlic Garlic is used by people with cardiovascular conditions to decrease cholesterol levels and blood pressure. There is some evidence to support that it works, Boon said. It has also been shown that people who eat more garlic have a lower incidence of stomach and colon cancer ― though this doesn’t mean eating it will help you avoid those cancers. Garlic can cause post-operative bleeding so isn’t recommended to people who are preparing to go into surgery. Other cautions include women who are pregnant or lactating. Studies of odourless garlic indicate it has the same effect. Ginseng Ginseng is the last popular herb Boon spoke about. She said there are a few different types of ginseng. The Asian and American varieties are used to improve concentration and mental performance. Studies on ginseng were not well done, and some were actually negative, she said. Editor’s Note: Written by Poonam Khanna, a Toronto-based freelance writer specializing in science, health and technology issues. Coverage of a session at the 2008 Women’s Health Matters Forum & Expo. Related Resources: More coverage of the 2008 Women’s Health Matters Forum & Expo can be found here. Version française :  Cliquez ici pour voir la description en français Purpose:  Consumer information/support; Health information Information Source:  Hospital/Clinic Geographic Origin:  Canada Language of Resource:  English Last Reviewed by Women's Health Matters:  May 08, 2008