tag:theconversation.com,2011:/africa/topics/herbal-medicine-1322/articlesHerbal medicine – The Conversation2023-06-02T04:00:31Ztag:theconversation.com,2011:article/2068552023-06-02T04:00:31Z2023-06-02T04:00:31Z‘Nature’s own Ozempic’ or berberine is all over social media. But does it really help you lose weight?<figure><img src="https://images.theconversation.com/files/529537/original/file-20230601-21-p2u12n.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C992%2C580&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-berberine-supplement-capsules-1892500327">Shutterstock</a></span></figcaption></figure><p>The latest health trend on TikTok <a href="https://news.yahoo.com/tiktokers-supplement-nature-ozempic-safe-181600187.html">has been dubbed</a> “nature’s own Ozempic”. It’s the herbal preparation berberine. </p>
<p>Influencers have been enthusiastically claiming its success in helping them lose weight, with their posts <a href="https://www.tiktok.com/@daphnunez/video/7226399667154701610?q=berberine&t=1685677631980">viewed by millions</a>.</p>
<p>But what actually is berberine? How is it related to the drug Ozempic?
Does it help people lose weight? And is it safe?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-who-says-we-shouldnt-bother-with-artificial-sweeteners-for-weight-loss-or-health-is-sugar-better-205827">The WHO says we shouldn't bother with artificial sweeteners for weight loss or health. Is sugar better?</a>
</strong>
</em>
</p>
<hr>
<h2>Why berberine? What is it anyway?</h2>
<p>Many people who cannot lose weight through diet and exercise turn to medication. That includes the high-profile prescription medicine Ozempic, a diabetes drug that also leads to weight loss.</p>
<p>World-wide <a href="https://www1.racgp.org.au/newsgp/clinical/intermittent-semaglutide-availability-until-at-lea#:%7E:text='Ozempic%20stocks%20are%20available%20in,over%20coming%20weeks%20and%20months%20%E2%80%A6">supply shortages</a> of the drug and the need to get a prescription for it have likely driven people to look for alternatives available online or in pharmacies, such as berberine.</p>
<p>Berberine is a bitter tasting <a href="https://www.webmd.com/vitamins/ai/ingredientmono-1126/berberine#:%7E:text=Berberine%20is%20a%20chemical%20found,people%20with%20certain%20heart%20conditions.">chemical</a> extracted from the roots of plants, such as goldenseal and barberry. </p>
<p>It belongs to the class of plant chemicals called <a href="https://www.sciencedirect.com/topics/neuroscience/isoquinoline-alkaloid#:%7E:text=The%20isoquinoline%20alkaloids%20include%2C%20most,commercial%20source%20of%20the%20alkaloids.">isoquinoline alkaloids</a>. Other well known chemicals in this class include the pain-relieving medicines morphine and codeine. </p>
<p>Berberine extracts have been used in traditional medicines for disorders of the gut and to treat infections. It is mostly taken orally as a powder, capsule or tablet.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weekly-dose-taxol-the-anticancer-drug-discovered-in-the-bark-of-a-tree-56508">Weekly dose: Taxol, the anticancer drug discovered in the bark of a tree</a>
</strong>
</em>
</p>
<hr>
<h2>Is it the same as Ozempic?</h2>
<p>Berberine is not the same as Ozempic. Ozempic is the brand name of the drug semaglutide, which is used to treat people with type 2 diabetes. </p>
<p>Ozempic works by imitating a natural hormone called <a href="https://www.yourhormones.info/hormones/glucagon-like-peptide-1/#:%7E:text=Glucagon%2Dlike%20peptide%201%20is,and%20the%20release%20of%20insulin.">glucagon-like peptide-1</a> (GLP-1). This hormone is important because it helps the body produce insulin to regulate blood sugar levels. </p>
<p>More recently, Ozempic has been shown to be effective for <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">weight loss</a> in people who are overweight or obese. By mimicking GLP-1, Ozempic makes you feel full and less hungry.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ozempic-helps-weight-loss-by-making-you-feel-full-but-certain-foods-can-do-the-same-thing-without-the-side-effects-201870">Ozempic helps weight loss by making you feel full. But certain foods can do the same thing – without the side-effects</a>
</strong>
</em>
</p>
<hr>
<h2>Does berberine help you lose weight?</h2>
<p>In clinical studies, berberine leads to modest weight loss in people who are obese. But the data are not conclusive as most published studies are small and of varying quality.</p>
<p>The strongest evidence we have comes from two meta-analyses, types of studies that pool together and analyse the results of other studies.</p>
<p>These show that taking a 300-3,000mg berberine a day orally is associated with <a href="https://pubmed.ncbi.nlm.nih.gov/32690176/">modest reductions</a> in body mass index (BMI), waist circumference and body weight (around 3kg). These results were <a href="https://pubmed.ncbi.nlm.nih.gov/32379652/">most significant</a> in women with a BMI great than 30, taking at least 1,000mg daily for at least three months. </p>
<p>Studies have only been conducted with people who are overweight or obese. So we don’t know whether berberine leads to weight loss in others.</p>
<p>We also don’t yet have the data to say what happens when people stop taking berberine. </p>
<p>We don’t exactly know how berberine works to help people lose weight. But a recent <a href="https://www.sciencedirect.com/science/article/pii/S0753332220303292?via%3Dihub">systematic review</a> (when researchers pool together evidence) gives some clues.</p>
<p>It influences GLP-1 levels like Ozempic, but probably results in weight loss in other ways too. It decreases blood sugar levels, stimulates insulin release, influences how the body absorbs cholesterol, and changes the way fat is processed in the body.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fatblaster-max-has-just-been-banned-why-heres-everything-you-need-to-know-about-diet-supplements-183347">FatBlaster Max has just been banned. Why? Here’s everything you need to know about diet supplements</a>
</strong>
</em>
</p>
<hr>
<h2>Is berberine safe?</h2>
<p>Just because berberine is sold over the counter, doesn’t mean it’s safe. It can have side effects and interfere with other drugs you may be taking.</p>
<p><a href="https://health.clevelandclinic.org/berberine-for-insulin-resistance-weight-loss/">Common side effects</a> include diarrhoea, constipation, gas and an upset stomach. Large quantities may be fatal. </p>
<p>Berberine is not recommended for people who are pregnant as it is thought it can cross the placenta and may harm the fetus. It may also stimulate contractions of the uterus, which can inappropriately trigger birth. Because it can be transferred to <a href="http://www.ncbi.nlm.nih.gov/pubmed/8513024?dopt=Abstract">breast milk</a> it is not appropriate if breastfeeding.</p>
<p>Berberine can also interact with many other drugs and supplements. These include the immune-system drug ciclosporin, cough suppressants like dextromethorphan, and herbal remedies and medicines used to lower blood pressure, lower blood sugar levels, reduce blood clotting, and help with relaxation and sleep.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/science-or-snake-oil-do-skinny-teas-boost-weight-loss-87353">Science or Snake Oil: do skinny teas boost weight loss?</a>
</strong>
</em>
</p>
<hr>
<h2>So what to do?</h2>
<p>If you are obese or overweight and are having trouble losing weight through diet and exercise alone then berberine may be of some help.</p>
<p>However, before buying berberine, discuss it with your doctor or pharmacist to see if it will be safe for you, or if other medications might be more appropriate.</p><img src="https://counter.theconversation.com/content/206855/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Tina Hinton has previously received funding from the Schizophrenia Research Institute (formerly Neuroscience Institute of Schizophrenia and Allied Disorders). She is currently a Board member of the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists.</span></em></p><p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vairea Skincare LLC, a director of SetDose Pty Ltd a medical device company, and a Standards Australia panel member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Dr Roubin in the past had received funding from ARC Linkage, AusIndustry Biotechnology Innovation Fund, Clive & Vera Ramaciotti Foundation, Pharmacy Research Trust of NSW . She is a member of International Pharmaceutical Federation, a member of the Australasian Pharmaceutical Science Association, a member of the Australian & New Zealand Association for Health Professional Educators. Rebecca in the past was a research assistant for ADP Pharmaceuticals Pty Ltd a complementary medicines company.</span></em></p>Influencers have been enthusiastically claiming its success in helping them lose weight, with their posts viewed by millions. You might be surprised what the evidence shows.Tina Hinton, Associate Professor of Pharmacology, University of SydneyNial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyRebecca Roubin, Lecturer of the Sydney Pharmacy School, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1064842018-12-07T11:40:46Z2018-12-07T11:40:46ZBeware of natural supplements for sex gain and weight loss<figure><img src="https://images.theconversation.com/files/249343/original/file-20181206-128190-hd2cwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Natural supplements may be popular, but they can have dangerous side effects when they include prescription drugs.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/muscular-man-protein-drink-shaker-over-548586616?src=dZrpQEpAprfLrAJaUdrkmQ-1-64">Oleksandr Zamuruiev/Shutterstock.com</a></span></figcaption></figure><p>Many consumers consider dietary supplements to be natural and, therefore, safe. In fact, the Council for Responsible Nutrition reported in 2017 that 87 percent of U.S. <a href="https://www.crnusa.org/newsroom/dietary-supplement-usage-increases-says-new-survey">consumers have confidence</a> that dietary supplements, such as vitamins, minerals, herbs, botanicals, oils, microbiome bacteria and amino acids, are safe and effective. Unfortunately, their confidence may be misplaced when it comes to supplements for male sexual dysfunction and weight loss.</p>
<p>According to the Food and Drug Administration, 776 dietary supplement products from 146 different manufacturers sold between 2007 and 2016 contained <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2706496">synthetic/prescription drugs</a>. Most of these products are marketed for just <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2706496">two conditions</a>, sexual enhancement (45.5 percent) or weight loss (40.9 percent). </p>
<p>Why does this matter?</p>
<p>As a pharmacist and dietary supplement researcher, I’m concerned about the <a href="https://www.ncbi.nlm.nih.gov/pubmed/14722148">hidden inclusion</a> of these prescription drugs in supplements. It increases the risk of patient harm, and it allows people to attribute the benefits and harms they experience to an herb rather than to the true culprit – the added drug. This makes it harder for doctors and pharmacists to decipher in what types of patients these natural therapies could be used and in whom they should be avoided.</p>
<h2>Risky sex enhancement pills</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/249344/original/file-20181206-128217-5cg3bo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/249344/original/file-20181206-128217-5cg3bo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/249344/original/file-20181206-128217-5cg3bo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/249344/original/file-20181206-128217-5cg3bo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/249344/original/file-20181206-128217-5cg3bo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/249344/original/file-20181206-128217-5cg3bo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/249344/original/file-20181206-128217-5cg3bo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Packaging for Viagra in a Madrid pharmacy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/madrid-spain-july-4-viagra-drug-1127047736?src=RPw803JCOEcrMa-Apr6VWw-1-6">Enriscapes/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>It is considered malpractice for pharmacists to fill prescriptions for erectile dysfunction (ED) drugs like Viagra, Levitra or Cialis if patients are taking nitrate drugs, such as nitroglycerin pills or spray or isosorbide mono/dinitrate. These nitrate drugs are often used to treat chest pain or heart failure. Combining them with a drug to treat ED; as the FDA said the makers of Willy Go Wild did, can cause a patient’s blood pressure to drop precipitously. This in turn can lead to <a href="https://www.medscape.com/viewarticle/556235_7">hospitalization or death</a>. </p>
<p>Some patients taking nitrate drugs, who cannot safely take one of the ED drugs, have turned instead to so-called natural products. Had they bought one of the 353 tainted products, they would have gotten the <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2706496">same active ingredients</a> nonetheless. </p>
<p>In addition, prescription erectile dysfunction drugs can cause <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236300/">priapism</a>, a medical emergency where the penis can be irreparably damaged. The higher the dose consumed, the greater the risk. So imagine you want to enhance your prescription erectile dysfunction drug with an herbal remedy only to find out you were getting a prescription drug’s active ingredient instead. There are <a href="https://www.ncbi.nlm.nih.gov/pubmed/23386071">cases of priapism</a> with herbal sexual dysfunction medications. </p>
<h2>ED drugs and antidepressants</h2>
<p>Some other dietary supplement products for male enhancement added a drug called <a href="https://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/medicationhealthfraud/ucm479105.htm">daptoxetine</a>. The FDA has not approved it for any reason, including sexual dysfunction. People on other serotonin-enhancing drugs for depression or intestinal issues are more likely to end up with a condition called <a href="https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758">serotonin syndrome</a> when inadvertently exposed to this undisclosed drug. Serotonin syndrome is a life-threatening problem with high body temperatures, muscle stiffness, seizures and kidney damage.</p>
<p><a href="https://www.everydayhealth.com/drugs/sibutramine">Sibutramine</a>, an appetite suppressant, was removed from the U.S. market by the FDA in 2010 because its use increases the risk of heart attacks and strokes. However, 269 dietary supplement products touted for weight loss <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2706496">contained sibutramine</a>, and others contained the stimulants ephedrine and fenfluramine. </p>
<p><a href="https://www.rxlist.com/ephedrine-side-effects-drug-center.htm">Ephedrine</a>, a stimulant, was banned in the U.S. because it also <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2706496">increased cardiovascular risk</a>. <a href="https://pubchem.ncbi.nlm.nih.gov/compound/fenfluramine#section=Top">Fenfluramine</a>, an amphetamine derivative, was combined with phentermine in the popular “fen-phen” <a href="https://www.webmd.com/heart-disease/news/20081105/lasting-heart-damage-from-fen-phen#1">diet that was banned</a> after numerous cases of pulmonary hypertension, heart valve damage and heart failure occurred. </p>
<p>Still other dietary supplement products for weight loss contained the laxative phenolphthalein or prescription diuretics. <a href="https://pubchem.ncbi.nlm.nih.gov/compound/phenolphthalein#section=Health-Hazard">Phenolphthalein</a> is no longer used as a laxative in the U.S. because it may cause cancer and hurt fetuses. Laxatives and diuretics only cause weight loss through diarrhea or loss of water weight. They do not result in fat loss. They can cause <a href="https://ccforum.biomedcentral.com/articles/10.1186/s13054-015-1017-3">dangerously low blood pressure</a> and low blood potassium concentrations.</p>
<p>A study in the New England Journal of Medicine in 2015 estimated that dietary supplements led to 23,000 emergency department visits and over <a href="https://www.nejm.org/doi/full/10.1056/nejmsa1504267">2,000 hospitalizations</a> a year. Weight loss products or those related to increased energy also caused <a href="https://www.nejm.org/doi/full/10.1056/nejmsa1504267">72 percent of supplement-related adverse events</a>, including palpitations, chest pain or racing heart rate. I suspect the predominance of deliberate synthetic drug tainting of these dietary supplements might explain some of these findings.</p>
<h2>How can you protect yourself?</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/249346/original/file-20181206-128196-19mwbcj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/249346/original/file-20181206-128196-19mwbcj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/249346/original/file-20181206-128196-19mwbcj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/249346/original/file-20181206-128196-19mwbcj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/249346/original/file-20181206-128196-19mwbcj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/249346/original/file-20181206-128196-19mwbcj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/249346/original/file-20181206-128196-19mwbcj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If a package claims to be magic or to provide a miracle cure, don’t buy it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/medicine-packet-named-magic-pills-medical-1092206453?src=fe-3-I4DB_EUukoawP7P2w-1-7">Peter Hermes Furian/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>The FDA does not approve dietary supplements, and in many ways you are on your own. The Dietary Supplement Health and Education Act (DSHEA) of 1994 created a <a href="https://www.fda.gov/Food/DietarySupplements/">new category of health product</a>. As long as the product contains natural ingredients intended to promote or support health and not to diagnose, cure, treat, or prevent any disease, it qualifies as a dietary supplement. Under DSHEA, the FDA has to prove risk to human health before removing these products from the U.S. market.</p>
<p>The FDA, however, does have an <a href="https://www.accessdata.fda.gov/scripts/sda/sdNavigation.cfm?sd=tainted_supplements_cder">ongoing list</a> of products in which they have detected synthetic or prescription drugs, and you can check that out. If the product you have purchased is on that list, don’t use it. On Nov. 20, 2018, two dietary supplements for pain or drug addiction were found to be <a href="https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm626349.htm">tainted with tianeptine</a>, an antidepressant drug that is not FDA-approved for use in the U.S. market. If your product is not on that list, however, it doesn’t guarantee lack of tainting. The FDA simply does not have the resources to check the tens of thousands of dietary supplements on U.S. shelves. </p>
<p>Independent laboratory verification from the United States Pharmacopeia (USP) can help assure that the vitamin or herb specified on the label is in the bottle and that the product has a <a href="https://qualitymatters.usp.org/sites/default/files/user-uploaded-files/when-food-is-not-enough-download_0.pdf">low risk</a> of microbe, heavy metal or PCB contamination. Unfortunately, USP does not routinely test dietary supplements for synthetic or prescription drug tainting. </p>
<p><a href="https://www.consumerlab.com/methods_index.asp">ConsumerLab.com</a> does not usually test for prescription drug tainting during their product verification either. However, for <a href="https://www.consumerlab.com/reviews/review-of-sexual-enhancement-supplements-yohimbe-horny-goat-weed-arginine/sexenhancers/">sexual dysfunction drugs</a>, ConsumerLab.com did test for prescription drug tainting.</p>
<p>Beware of dietary supplements manufactured in Asia, because they are more likely to be contaminated and tainted according to the FDA. Also, ethnically diverse, non-English speaking and poor people are more likely to come across <a href="https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm466588.htm">tainted dietary supplements</a> because they shop for these products at ethnic stores, flea markets, swap meets or online. Buying from reputable brands in reputable stores or websites might reduce the risk. Finally, don’t believe miraculous claims of effectiveness, especially if the only data to back it up comes from testimonials.</p><img src="https://counter.theconversation.com/content/106484/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C. Michael White does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Men who can’t take drugs for erectile dysfunction and overweight people who can’t lose weight sometimes turn to natural supplements, thinking they are safe. Many times, they are not.C. Michael White, Professor and Head of the Department of Pharmacy Practice, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/947842018-04-16T09:00:24Z2018-04-16T09:00:24ZChamomile tea may help control diabetes – as my research into 19th century dyes revealed<figure><img src="https://images.theconversation.com/files/214733/original/file-20180413-587-9zyay1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cups-chamomile-tea-flowers-on-wooden-276983174?src=vVC5iBBz8-VRwT2LMZwJKA-1-51">ConstantinosZ/Shutterstock.com</a></span></figcaption></figure><p>Chamomile – that yellow flower so often made into a tea, enjoyed before bed – is a very interesting plant. It was recently discovered that the humble flower may control or even prevent diabetes – and now <a href="https://www.nature.com/articles/s41598-018-23736-1">my research</a> into historical textile dyes has helped to identify the specific compounds involved. That bedtime herbal tea may be doing many people a lot of good.</p>
<p>I’ve been working with Chris Rayner for over 15 years to develop new techniques to identify the chemistry of natural colourants used throughout history to dye textiles. Before William Perkin’s serendipitous 1856 <a href="http://www.rsc.org/Chemsoc/Activities/Perkin/2006/minisite_perkin_mauveine_non_flash.html">discovery of mauveine</a>, the first synthetic dye, textile fibres were dyed with coloured extracts of plants and animals. </p>
<p>Nature makes a complex cocktail of different compounds in these dye plants, and many of these are transferred to textiles during dyeing. We analyse historical artefacts to see if these compounds are present to try to determine when, where and how they were dyed and with what plant. The chemistry and ratio of these molecules can provide significant information about which plant species was used to dye the fibres or the technique used for the dye process. In the context of historical textiles, this information is of paramount importance for conservation and restoration purposes, as well as the generation of information on the ethnographic origins of the artefacts.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/214741/original/file-20180413-127631-1hmy9iu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/214741/original/file-20180413-127631-1hmy9iu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=653&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214741/original/file-20180413-127631-1hmy9iu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=653&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214741/original/file-20180413-127631-1hmy9iu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=653&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214741/original/file-20180413-127631-1hmy9iu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=821&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214741/original/file-20180413-127631-1hmy9iu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=821&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214741/original/file-20180413-127631-1hmy9iu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=821&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dyeing wool cloth, 1482.</span>
<span class="attribution"><span class="source">British Library Royal MS 15.E.iii, folio 269</span></span>
</figcaption>
</figure>
<p>So what does this have to do with diabetes? Well, many of the techniques that have been used to extract the dyes from textile samples cause damage to the dye molecule, resulting in a loss of information about the chemical fingerprint potentially available to conservators. But we have developed <a href="https://www.sciencedirect.com/science/article/pii/S0021967317301383">new “soft” extraction methods using glucose</a>, which can preserve the dye molecule during extraction and analysis, and have used these new techniques to investigate dyes that were commonly used prior to the mid-19th century.</p>
<p>One such plant used throughout history was chamomile, which gives a bright yellow colour on wool, cotton and other natural fibres. There is <a href="http://pubs.rsc.org/en/content/articlelanding/2004/cs/b305697j">evidence</a> of its use in Europe and Asia to dye textiles dating back many hundreds of years. We identified the colourants and other natural components present in several species of chamomile in our attempts to understand their coloration properties and their identification in historical textiles, in the process significantly developing our knowledge of their complex chemistry.</p>
<p>This would have been interesting from a pure conservation and dye chemistry perspective. But then members of our team had a chat with another research group, led by Professor Gary Williamson in the School of Food Science and Nutrition, and it became apparent that we had a mutual interest in the chemistry of chamomile. </p>
<p>As a food, most people will be familiar with chamomile’s use as a herbal tea, often associated with aiding sleep. Indeed recognition of its medicinal properties as a relaxant and sedative is exemplified by its listing as an <a href="https://journals.lww.com/hnpjournal/Citation/2008/01000/Chamomile__A_Spoonful_of_Medicine.10.aspx">official drug</a> in the pharmacopoeias of 26 countries, including the UK. But we didn’t realise that it potentially has other dietary benefits. German chamomile has been taken for digestive problems <a href="http://www.rjb.csic.es/jardinbotanico/ficheros/documentos/pdf/pubinv/RMV/354Chapter14book.pdf">since at least the first century CE</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/214739/original/file-20180413-584-enbg0b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/214739/original/file-20180413-584-enbg0b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214739/original/file-20180413-584-enbg0b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214739/original/file-20180413-584-enbg0b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214739/original/file-20180413-584-enbg0b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214739/original/file-20180413-584-enbg0b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214739/original/file-20180413-584-enbg0b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">German chamomile.</span>
<span class="attribution"><span class="source">JSOBHATIS16899/Shutterstock.com</span></span>
</figcaption>
</figure>
<p>This team has spent the last few years studying the link between dietary components and carbohydrate digestion: specifically, how certain natural compounds can help to control blood glucose levels. They had screened several plant extracts and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/mnfr.201700566">identified</a> German chamomile (<em>Matricaria chamomilla</em>) as very effective in controlling diabetes in 2017. But what was really important was to understand which compounds in particular were responsible for this activity. We wondered if our research on natural dyes in chamomile could help with this.</p>
<p>We applied the techniques that we had developed for extraction of historical textiles to extraction and analysis of chamomile flowers. Working together, we identified four specific compounds that are active in chamomile and able to control carbohydrate digestion, drawing on our experience of dyestuff analysis. </p>
<p>Two of these compounds, apigenin-7-<em>O</em>-glucoside and apigenin, are yellow colourants that we had previously seen in wool textiles dyed with chamomile. The other two compounds had been previously misidentified by other researchers, but we correctly identified them as (<em>Z</em>) and (<em>E</em>)−2-hydroxy-4-methoxycinnamic acid glucosides. We studied the contribution of these four compounds to the overall bioactivity of chamomile, and found that, taken together, they were able to modulate carbohydrate digestion and absorption. There is also the potential to extract and concentrate these components from chamomile for medicinal application.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/214742/original/file-20180413-587-tc0oxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/214742/original/file-20180413-587-tc0oxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214742/original/file-20180413-587-tc0oxx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214742/original/file-20180413-587-tc0oxx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214742/original/file-20180413-587-tc0oxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214742/original/file-20180413-587-tc0oxx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214742/original/file-20180413-587-tc0oxx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chamomile chemical structures.</span>
<span class="attribution"><span class="source">Richard Blackburn</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>So simply put, drinking chamomile tea may be helpful in controlling or even preventing diabetes. And excitingly, it seems that understanding the chemistry of plant dyes in common use prior to the mid-19th century could unlock new treatments for modern day medicine.</p><img src="https://counter.theconversation.com/content/94784/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Blackburn receives funding from BBSRC, Clothworkers’ Foundation, DEFRA, EPSRC, Innovate UK and National Institute for Health Research. He is affiliated with The Society of Dyers and Colourists and The American Chemical Society. </span></em></p>That pre-sleep herbal tea may be doing many people a lot of good.Richard Blackburn, Associate Professor and Head of The Sustainable Materials Research Group, University of LeedsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/750282017-04-21T10:27:56Z2017-04-21T10:27:56ZWhy Mexican immigrants are healthier than their US-born peers<figure><img src="https://images.theconversation.com/files/166120/original/file-20170420-20054-5jvulh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Making tortillas.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/92998261?src=eYXU6VLTRH2GeqL_rzDIyw-1-22&size=medium_jpg">karamysh/Shutterstock</a></span></figcaption></figure><p>Supporters of Donald Trump’s wall might have us believe that Mexicans who enter the US illegally <a href="https://www.theguardian.com/us-news/2015/jul/06/donald-trump-mexican-immigrants-tremendous-infectious-disease">carry disease</a> and take advantage of America’s healthcare system. But <a href="https://www.cdc.gov/nchs/nhanes/nhanes3.htm">several large public health surveys</a> suggest that most Mexican immigrants are healthier than the average American citizen. So what can Americans learn about health from their Mexican neighbours? </p>
<p>The “Hispanic health paradox” was first identified in 1980, in the <a href="https://www.cdc.gov/nchs/nhanes/hhanes.htm">Hispanic health and nutrition examination survey</a>. Results of the survey were compared with a second part of the survey, which looks at all Americans. Of all Hispanic groups, people from Mexico have some of the best health compared with the rest of Americans. For example, Mexicans have lower rates of high blood pressure, cardiovascular disease and most cancers than the general US population. </p>
<p>But, by the second or third generation, people of Mexican descent do not seem to have any health advantage over other Americans. This suggests that the paradox depends on cultural factors, such as physical activity, eating habits and family support. </p>
<p>I conducted research for my PhD thesis in “Los Duplex,” one of the first Mexican immigrant neighbourhoods in the city of Athens, in Georgia. I wanted to know if traditional medical practices migrated with people from Mexico to the US. </p>
<p>The World Health Organisation (WHO) defines traditional medicine as “the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness”. Traditional medicine is <a href="http://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf?ua=1">recognised and promoted by the WHO</a> as an important healthcare resource. </p>
<p>At the time of my study, about 75% of the 131 homes in Los Duplex were occupied by Mexican tenants. Most were recent immigrants who worked in a nearby poultry processing plant. As part of my research, I collected family health histories and self-assessments of health, which were generally positive. I also found that Mexicans in Los Duplex approached health and healing by drawing on both traditional and mainstream medicine. </p>
<h2>Living well in Los Duplex</h2>
<p>Mexican immigrants in Los Duplex cared for and supported each other physically, emotionally and financially. Strong social networks help migrants cross the border and find jobs in the US. They also help spread knowledge of medical resources and traditional practices, which together form a holistic system of healthcare.</p>
<p>The Mexican families in my study had a relatively easy time accessing the mainstream medical system of Athens. But mainstream medicine was seen as a last resort. Immigrants reported that traditional Mexican health practices can often prevent or resolve problems before they require medical attention. Such practices promoted keeping calm, staying active and maintaining a positive attitude, to consuming traditional foods and herbal remedies.</p>
<p>Most Mexican women routinely cooked meals for their families made with beans and corn tortillas (the traditional Mexican staple foods), as well as meat and vegetables. Food was prepared fresh with a variety of seasonings, like onion, garlic, mint, chillies, cumin, and oregano. These add <a href="http://www.tandfonline.com/doi/abs/10.1080/10408398.2011.585525?journalCode=bfsn20">micronutrients and antioxidants</a>, as well as flavour. Although children consumed sweets and fizzy drinks, which could be bought in the neighbourhood, meals were usually served with homemade drinks made from fresh fruit. </p>
<p>Mexican migrants in Los Duplex also used a variety of medicinal plants, as well as other home remedies. They generally used these medicines for the health problems they experienced most frequently in Georgia: respiratory tract infections and digestive disorders. And there is some evidence for these traditional remedies. For example, the herb gordolobo (<em>Gnaphalium spp.</em>), which is used in Los Duplex for coughs and chest congestion, has been shown to have <a href="http://www.sciencedirect.com/science/article/pii/S1756464616303310">anti-inflammatory</a> and <a href="http://www.sciencedirect.com/science/article/pii/S0378874100003494">antimicrobial</a> properties that are useful in preventing and treating respiratory disease. And manzanilla (<em>Matricaria recutita</em>), which is used to relieve stomachache and menstrual cramps, has <a href="http://www.tandfonline.com/doi/abs/10.1080/10942912.2014.939660?journalCode=ljfp20">antimicrobial</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410481/">antispasmodic</a> properties. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/166121/original/file-20170420-20075-15gqcib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/166121/original/file-20170420-20075-15gqcib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/166121/original/file-20170420-20075-15gqcib.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/166121/original/file-20170420-20075-15gqcib.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/166121/original/file-20170420-20075-15gqcib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/166121/original/file-20170420-20075-15gqcib.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/166121/original/file-20170420-20075-15gqcib.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mexican immigrants use a variety of medicinal plants, but also eat well.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/538734118?src=L4tZrdzVbZBMhT-kRUt4SA-1-2&size=medium_jpg">13Smile/Shutterstock</a></span>
</figcaption>
</figure>
<p>Mexican women described herbal remedies as inexpensive, natural and safe. But they were wary of most pharmaceuticals, even though they sometimes used them. Reasons for mistrusting pharmaceuticals related to their side effects. Drugs to counteract the side effects of other drugs were seen as especially problematic. </p>
<h2>Too much, too little, just right</h2>
<p>I asked people in Los Duplex why they thought Mexican immigrants were healthier than Americans. They attributed this to Americans’ overconsumption of fast foods, as well as the consumption of too many “pastillas” (pills). Most Americans do indeed rely heavily on pharmaceutical drugs, even for relatively minor conditions. Overmedication may in fact be <a href="http://health.usnews.com/health-news/managing-your-healthcare/diabetes/articles/2010/10/07/overmedication-are-americans-taking-too-many-drugs">undermining the health of many Americans</a>.</p>
<p>Of course, <a href="http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/#footnote-198942-20">under-medication</a> is also a problem for uninsured Americans and other groups with limited access to medical care, including some Mexican migrants. For example, undocumented Mexican farm workers earn so little they can lack the means to see a doctor or pay for medicine. This is particularly problematic as these migrants often live in makeshift housing, with limited facilities for cooking or making herbal remedies. For these and other reasons (such as pesticide exposure), Mexican migrant farm workers <a href="https://www.ncbi.nlm.nih.gov/pubmed/11783860">have worse health</a> than Americans. </p>
<p>My research on Mexican immigrants suggests that both too much and too little mainstream medicine is a potential threat to health. Because of their traditional medical knowledge, the Mexicans of Los Duplex were able to achieve the right balance between complementary and mainstream medicine. Their holistic approach to health and healing provides a valuable lesson for American citizens.</p><img src="https://counter.theconversation.com/content/75028/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Waldstein received funding for this research from the (United States) National Science Foundation. </span></em></p>Could holistic medicine partly explain the ‘Hispanic health paradox’?Anna Waldstein, Lecturer in Medical Anthropology, University of KentLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/744982017-03-16T10:46:57Z2017-03-16T10:46:57ZWhich is deadlier – herbal remedies or conventional medicines?<figure><img src="https://images.theconversation.com/files/160964/original/image-20170315-5324-1dacp9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/eugene-birchall/25793725050/in/photolist-4yznGS-4yv6T2-4yzoqo-4yznmj-7Zw7PW-8sth5f-azfSnv-9tjkkx-2EStD-5ubDsx-5ubD6D-fg3wrW-8mf3je-tkc8b-ffNiz8-82piY8-fg3wAW-ffNicz-FiizPq-iP9kVR-d91rRs-iRH5eT-d91qcs-d91rzL-8SdTv-6euiBF-c9LZhW-qM2oUL-9a69Ne-be8wbe-nQSsUN-fA4tsd-gphdqL-e9G3jw-e9Aobp-5JTv6m-k8NqsB-qQP6pW-8SdC2-d91syq-8SdQj-d91rhQ-d91ses-d91qtA-DtXCjt-kGEzvo-e3ooBH-buitN1-9UyM8C-gjTrn7">Eugene Birchall/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Two people in San Francisco ended up in intensive care after taking a <a href="https://medicalxpress.com/news/2017-03-critically-ill-san-francisco-toxic.html">herbal remedy</a>, it was reported last week. The incident is likely to raise questions about the safety of herbal medicines. But are they any more dangerous than the drugs dispensed by your doctor or those sold over the counter without a prescription? </p>
<p>It is a common belief that herbal medicines are safe and research suggests that they are used by at least a third of people in some countries, such as <a href="https://www.ipsos-mori.com/researchpublications/researcharchive/2307/Public-Perceptions-of-Herbal-Medicines.aspx">the UK</a>. </p>
<p>To better understand the relative risks involved, it is helpful to put herbal medicines and pharmaceutical drugs into context. It is generally accepted that <a href="https://www.drugwatch.com/side-effects/">pharmaceuticals cause side effects</a>. But, as part of licensing requirements, a risk-benefit analysis is undertaken to determine whether the benefits outweigh the potential harms. In other words, is the possible harm caused by the drug acceptable? If it is, the drug may be granted a marketing authorisation (product licence) by a regulatory authority, such as the <a href="https://www.fda.gov/">Food and Drug Administration</a> in the US or the <a href="http://www.ema.europa.eu/ema/">European Medicines Agency</a> in Europe.</p>
<p>Undeniably, pharmaceutical drugs kill people. In the US, it is estimated that pharmaceuticals kill around <a href="http://health.usnews.com/health-news/patient-advice/articles/2016-09-27/the-danger-in-taking-prescribed-medications">100,000 people every year</a>. For certain conditions, however, there may be no alternative to drug therapy and certain medicines can prolong life, such as drugs used to treat diabetes, heart disease and cancer. </p>
<p>By contrast, herbal medicines are considered by many to be a <a href="https://www.ipsos-mori.com/researchpublications/researcharchive/2307/Public-Perceptions-of-Herbal-Medicines.aspx">safer alternative</a> and are preferred by a sizeable section of the public for treating <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068720/">non-life-threatening conditions</a>. And there is some evidence to support the idea that herbal medicines are safer for minor ailments. For example, drugs to treat mild to moderate pain, such as paracetamol and aspirin, are known to cause side effects, including some that – although rare – can be serious, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3086018/">gastric bleeds</a>. Whereas with herbal equivalents, such as devil’s claw, the risks of side effects are <a href="http://umm.edu/health/medical/altmed/herb/devils-claw">reportedly lower</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/160948/original/image-20170315-5321-3lalyr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/160948/original/image-20170315-5321-3lalyr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/160948/original/image-20170315-5321-3lalyr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/160948/original/image-20170315-5321-3lalyr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/160948/original/image-20170315-5321-3lalyr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/160948/original/image-20170315-5321-3lalyr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/160948/original/image-20170315-5321-3lalyr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Despite its fearsome name, devil’s claw (Physoplexis comosa) is a relatively safe treatment for headaches.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/devils-claw-physoplexis-comosa-alpine-plant-458741860?src=KJJmk3QGuBg2okKJN1dcrA-1-2">Mario Saccomano/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>A tricky comparison</h2>
<p>Adverse events associated with herbal remedies are reported far less often than those associated with pharmaceuticals. For example, in the UK, between 2006 and 2008, there were only <a href="https://www.gov.uk/drug-safety-update/herbal-products-safety-update">284</a> such reports for herbal medicines compared with <a href="https://www.ncbi.nlm.nih.gov/pubmed/20701410">26,129</a> for pharmaceuticals in a similar two-year period.</p>
<p>The reasons for this vast difference are complex, and it has been suggested that adverse events of herbal medicines are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2700706/">unrecognised or underreported</a>. Also, there are many more drugs <a href="https://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm">consumed</a> than herbal remedies so it is to be expected that the figures for pharmaceuticals are higher. However, the enormous difference does suggest that adverse events are far more common with pharmaceuticals than herbal remedies.</p>
<p>When serious side effects are triggered by herbal remedies it is often due to poor quality products, products containing newly discovered plant ingredients, or products that have been adulterated – <a href="http://www.nhs.uk/conditions/herbal-medicines/Pages/Introduction.aspx#online">including with pharmaceutical drugs</a>.</p>
<p>For the public, buying herbal products that are regulated offers some assurance that the medicines are both safe and of acceptable quality. For instance, in the UK, traditional herbal remedies are <a href="https://assets.publishing.service.gov.uk/media/547307ff40f0b6130e000038/con060025.pdf">manufactured to a high standard</a> and include a patient information leaflet, which lists known side effects and, importantly, warns of possible interactions with pharmaceuticals, another cause of adverse reactions. </p>
<p>For example, St John’s wort – a herbal remedy used to treat mild depression – is <a href="http://umm.edu/health/medical/altmed/herb-interaction/possible-interactions-with-st-johns-wort">known to have side effects</a> when taken alongside fluoxetine (Prozac). The makers of these products also have a legal obligation to monitor any adverse reactions and report them to the regulators.</p>
<h2>Voluntary regulation</h2>
<p>Another way to help avoid adverse reactions, especially when dealing with conditions that are not always suitable for self-treatment with over-the-counter drugs, is to visit a qualified herbalist. The training and regulation of herbalists varies widely from country to country and without government regulation of these practitioners, it is difficult for the public to assess who is legitimate. </p>
<p>However, voluntary regulation by professional associations does exist and is effective in many countries, including the US, Canada, the UK and Australia. This regulation helps to ensure that practitioners are appropriately educated and safe. </p>
<p>Herbal medicines are relatively safe compared with pharmaceuticals provided that they are regulated products or that they are prescribed by herbal practitioners who are registered with an appropriate governing body. But consumers need to be better informed about the dangers of obtaining herbs from unregulated sources if further cases of serious side effects are to be avoided.</p><img src="https://counter.theconversation.com/content/74498/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Booker receives funding from Dr. Willmar Schwabe GmbH & Co. Germany and
Comisión Nacional de Investigación Científica y Tecnológica, Chile. He is affiliated with The British Herbal Medicine Association's Herbal Practitioner Suppliers Section and The Register of Chinese Herbal Medicine (UK). </span></em></p>Herbal remedies can be dangerous, but so can drugs approved by the FDA.Anthony Booker, Senior Lecturer in Chinese Herbal Medicine and Medicinal Plant Science, University of WestminsterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/733122017-02-22T19:31:16Z2017-02-22T19:31:16ZMulberry leaf extract could reduce the risk of type 2 diabetes<figure><img src="https://images.theconversation.com/files/157855/original/image-20170222-1323-qstx55.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The humble mulberry leaf contains medicinally useful compounds. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/420370693?src=oNPe6RElgTILURSKTSKIrw-1-22&size=medium_jpg">FemPat/Shutterstock.com</a></span></figcaption></figure><p>Consuming refined carbohydrates is linked to a heightened risk of developing <a href="http://www.bmj.com/content/346/bmj.e7492">type 2 diabetes</a>, not to mention <a href="https://www.ncbi.nlm.nih.gov/pubmed/24493081">heart disease</a>. But what if a supplement could decrease the breakdown of carbohydrates into simple sugars? That might reduce a person’s risk of developing type 2 diabetes. <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0172239">Our latest study</a>, published in PLOS ONE, shows that an extract made from mulberry leaves might do just that. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/16611383">Previous research</a> shows that herbal medicines could be effective in regulating blood glucose levels. Indeed, the history of the commonly used diabetic drug metformin can be traced back to the use of a herbal medicine, <a href="http://bit.ly/2kLlHaq"><em>Galega officinalis</em></a> (goat’s rue or French lilac) in medieval Europe. <em>G. officinalis</em> was found to be rich in guanidine, a substance with blood glucose-lowering activity that formed the chemical basis of metformin (biguanide). This insulin sensitising drug was introduced in 1957. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/157858/original/image-20170222-1344-10j55of.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/157858/original/image-20170222-1344-10j55of.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/157858/original/image-20170222-1344-10j55of.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/157858/original/image-20170222-1344-10j55of.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/157858/original/image-20170222-1344-10j55of.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/157858/original/image-20170222-1344-10j55of.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/157858/original/image-20170222-1344-10j55of.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Metformin, the first-line drug used to treat diabetes was also developed from a herb.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/171253349?src=nkNw5NHxJSqlxEuZ_3MosA-1-5&size=medium_jpg">Thinglass/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Mulberry leaves have been used in traditional Chinese medicine for several millennia and its use was first recorded in around 500AD. In the Grand Materia Medica, it states that “if the juice (of the herb) is decocted and used as a tea substitute it can stop wasting and thirsting disorder”. Wasting (weight loss) and excessive thirst along with increased urination and tiredness are symptoms associated with diabetes. We aimed to investigate the effects of mulberry extract on blood glucose and insulin responses in healthy volunteers with a randomised, double-blind, placebo-controlled clinical trial – the gold standard for a clinical trial.</p>
<h2>Promising results</h2>
<p>We took blood samples from 37 healthy volunteers after they had consumed a carbohydrate rich drink (containing maltodextrin, a dietary starch with a high glycaemic index that is commonly added to many foods and beverages). Each participant took either a placebo or one of three doses of the extract along with the drink on four separate days. We measured each person’s glucose and insulin levels over the following two hours. </p>
<p>Our analysis showed that the standard strength mulberry extract (250mg) reduced the total glucose and insulin rises by 22% and 24% respectively compared to a placebo. These results were both statistically significant (unlikely to be due to chance) and clinically significant, and thus could have meaningful health benefits. The extract effectively reduced the total amount of sugar being absorbed into the bloodstream by over 20%. </p>
<p>The extract didn’t cause any side effects in the volunteers, such as nausea and flatulence – side effects which are common with many diabetic medications. An active component in the extract, 1-deoxynojirimycin (DNJ), blocks the breakdown of carbohydrates into simple sugars, preventing the absorption of sugar, lowering blood-glucose rises. Although mulberry leaves can be used to make tea, the particular extract we used had undergone strict quality control processes in order to guarantee consistency of its DNJ content.</p>
<p>In order to draw definitive conclusions about the long-term health benefits of mulberry leaf extract, longer, more pragmatic trials reflecting real-life dietary habits are needed to show if this herbal supplement could prevent the development of type 2 diabetes. The initial results are certainly promising.</p><img src="https://counter.theconversation.com/content/73312/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Lown received funding from a Technology Strategy Board grant</span></em></p><p class="fine-print"><em><span>George Lewith receives funding the
Technology strategy board for this project. </span></em></p>Traditional Chinese medicine suggests that mulberry leaves may be useful for treating diabetes. A new clinical trial supports that suggestion.Mark Lown, Clinical Lecturer and General Practitioner, University of SouthamptonGeorge Lewith, Prof of Health Research, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/632092016-08-16T19:39:37Z2016-08-16T19:39:37ZStronger oversight may protect South Africans from misleading advertising<figure><img src="https://images.theconversation.com/files/134396/original/image-20160817-3608-gs3ed.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Self-regulation of advertisements in South Africa is facing a rethink.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>South Africa has an effective and functioning advertising self-regulator. But it doesn’t always work as it should. The self-regulatory regime in place cannot do enough to protect consumers because it is based on the willing cooperation of advertisers. </p>
<p>The Advertising Standards Authority of South Africa’s (ASASA) <a href="http://www.asasa.org.za/codes/advertising-code-of-practice">Advertising Code of Practice</a> requires advertisements to be legal, decent, honest and truthful. It is based on an <a href="http://www.easa-alliance.org/">international code</a> and is similar to advertising codes in most developed and developing countries, such as the UK, Australia and Malaysia. But ASASA is not a statutory body and it does not have the teeth to enforce its rulings on non-members. It cannot impose penalties on advertisers and media owners who do not comply. </p>
<p>There are some reforms on the horizon that promise to change this by making ASASA an ombudsman with increased powers. South Africa currently has the only functioning self-regulatory advertising system on the continent and this may provide even more protection for consumers. </p>
<h2>How the self-regulatory system works</h2>
<p>The aim of ASASA is to protect consumers, ensure fair play between competitors and make sure that the advertising profession is not brought into disrepute.</p>
<p>There are an agreed set of rules and procedures to resolve disputes about advertising. ASASA does not initiate its own investigations. It only reacts to complaints from the public or from competing marketers. Its website makes it easy for a consumer to lodge an online complaint without costs.</p>
<p>It is an independent, nonprofit company that is funded by the marketing communications industry. </p>
<p>ASASA considers valid complaints, allows the relevant advertiser to respond and gets expert opinion if required. It then issues a ruling and publishes the result on its website. Decisions are based on its code and supporting appendices that cover specialist industries, such as <a href="http://www.asasa.org.za/codes/advertising-code-of-practice/appendix-a-alcohol-advertising-ara">alcohol</a>, <a href="http://www.asasa.org.za/codes/advertising-code-of-practice/appendix-d-advertising-for-slimming">slimming</a> and <a href="http://www.asasa.org.za/codes/advertising-code-of-practice/appendix-b-code-of-cosmetics">cosmetics</a>. </p>
<p>A complainant or the advertiser can appeal a ruling. </p>
<p>The success of South Africa’s advertising self-regulatory process depends on an active citizenry, and on the compliance of the advertiser. It is up to them to withdraw or amend an advertisement after an adverse ruling. The regulator has a range of sanctioning processes that even allow it to instruct media owners not to publish an advertisement from a repeat offender.</p>
<h2>Regulator on the defensive</h2>
<p>Two recent landmark court cases – one in <a href="http://www.camcheck.co.za/power-report-watchdog-in-chains-as-advertiser-fights-back/">2015</a> and another in <a href="http://www.camcheck.co.za/court-action-herbex-vs-asa/">2016</a> – set an important precedent for the future of advertising self-regulation in South Africa. </p>
<p>ASASA, before the court cases, ruled against the companies on the grounds that their advertisements were misleading and lacking substantiation. The companies then went on to challenge the authority of the regulator in <a href="http://www.camcheck.co.za/usn-herbex-antagolin-solal-and-vigro-nativa-go-to-court-to-block-asa/">court</a>.</p>
<p>The companies – <a href="http://www.herbexhealth.com/">Herbex</a>, a marketer of foodstuffs and complimentary medicines, and the <a href="http://mnilifestyle.co.za/">Medical Nutrition Institute</a>, a company that markets a <a href="http://mnilifestyle.co.za/products/antagolin/">product</a> to combat insulin resistance – argued that they were not bound by the regulator’s codes and processes because they were not members of the association. </p>
<p>The Medical Nutrition Institute also argued that its products and advertisements were regulated by the <a href="http://www.saflii.org/za/legis/hist_reg/marsa101o1965rangnr510723/marsa101o1965rangnr510a2m2003796.html">Medicines and Related Substances Control Act</a>, the <a href="http://www.mccza.com/">Medicines Control Council</a> and the <a href="http://www.gov.za/documents/consumer-protection-act">Consumer Protection Act</a>.</p>
<p>The problem is that neither the <a href="http://www.mccza.com/">Medicines Control Council</a> nor the <a href="http://www.thencc.gov.za/">National Consumer Commission</a> are equipped to assess whether an advertising claim is misleading, unsubstantiated or exaggerated. </p>
<p>Both companies won their cases. The court ruled that the regulator did not have jurisdiction over non-members, and that non-members did not have to participate in its processes. In the Medical Nutrition Institute case, the court even issued an interdict against the regulator for interfering with its advertising.</p>
<p>As it currently stands, an advertiser can sidestep the regulator by choosing not to be a member and therefore simply electing not to uphold the advertising code. </p>
<p>But this may be about to change.</p>
<h2>Teeth for the regulator</h2>
<p>The Department of Trade and Industry has released a <a href="http://www.gpwonline.co.za/Gazettes/Gazettes/40159_26-07_TradeIndustry.pdf">notice</a> that could strengthen the regulator’s hand. </p>
<p>The idea is to introduce an industry code and ombudsman scheme that has been proposed by the advertising and marketing industry. </p>
<p>The notice makes provision for the Minister of Trade and Industry to recognise the regulator as an ombudsman – someone appointed by the government to look after the interest of the public. The organisation will no longer be a not-for-profit company, but an entity that has the backing of a statutory body.</p>
<p>The code would apply to all marketing and advertising participants. This would mean that advertisers could no longer get around regulations by simply choosing not to subscribe to an advertising code, or by electing not to be a member of the association.</p>
<p>Advertisements that are illegal, that create serious offence, are dishonest and untrue, and that aim to deceive and exploit consumers deliberately, will have less manoeuvring space.</p><img src="https://counter.theconversation.com/content/63209/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rudi de Lange does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The current system for regulating advertising in South Africa is dependent on the buy-in of the advertiser. But this may be about to change.Rudi de Lange, Associate Professor in Visual Communication, Tshwane University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/563442016-05-12T20:05:09Z2016-05-12T20:05:09ZScience or Snake Oil: can a detox actually cleanse your liver?<figure><img src="https://images.theconversation.com/files/119596/original/image-20160421-8017-p1z3ew.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Can the liver actually be cleansed?</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This is the first article in our new ongoing series Science or Snake Oil. Articles will look at the claims for a product and decide whether they are supported by science or lacking in evidence.</em> </p>
<hr>
<p>The human adult liver weighs about <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072577/">one-and-a-half kilograms</a>, making it one of the largest organs in the body. It is responsible for a range of functions. It helps break down fats, carbohydrates and proteins into substances the body can utilise. </p>
<p>The liver acts as a storage unit for these substances (including vitamins and minerals) and supplies the body with them when they need it. For example, when your blood sugar level drops, the liver will release stored carbohydrate (glycogen) to rectify the problem. </p>
<p>It also acts by metabolising toxins into harmless substances or by eliminating toxic substances from the body. Clever marketing has led us to believe it is the food that contains toxins and, hence, following a diet that eliminates certain foods and taking over-the-counter products that “cleanse” your liver of “toxins” will detoxify the liver.</p>
<h2>Can the liver be ‘cleansed’?</h2>
<p>We have a misconception we can “cleanse” the body by following a “detox” diet.</p>
<p>This is a complete fallacy. To explain this process one must first understand exactly what a toxin is. A toxin is a harmful substance that enters your body from the environment. Examples include carbon monoxide from motor vehicles, bisphenol A (BPA) from consumer plastics, and heavy metals such as lead and mercury. Toxins can also include drugs and poisons. </p>
<p>However, substances are only toxic based on the quantities in which we ingest them. The situation in which “detoxification” is required is when someone is being treated in a hospital for a dangerous level of a substance that is life-threatening. </p>
<p>The liver is otherwise working to eliminate unwanted substances in the body through our faeces and urine. These are the toxic byproducts from the metabolization of foods. For example, excessive amounts of <a href="http://www.ncbi.nlm.nih.gov/pubmed/16779921">protein</a> can be dangerous to the liver.</p>
<p>Many over-the-counter products claim to “clean” your liver of “toxins”. But does the liver really respond to an over-the-counter product that claims to “detoxify” or “heal” its function? </p>
<p>Most of these products contain the active ingredients from <em>Silybum marianum</em> (known as milk thistle) and <em>Taraxacum officinale</em> (known as dandelion). Many of the formulations also contain <a href="https://www.google.com/patents/US20030044512">other ingredients</a> such as selenium, phosphatidylcholine, amino acids, artichoke leaf, green tea leaf and turmeric root, to name a few.</p>
<p>Several companies produce a range of liver detox or liver cleanse products with varying quantities and ingredient compositions. But how strong is the evidence to show these active ingredients actually help with liver repair?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/119582/original/image-20160421-8023-1p3ufbx.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/119582/original/image-20160421-8023-1p3ufbx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/119582/original/image-20160421-8023-1p3ufbx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=483&fit=crop&dpr=1 600w, https://images.theconversation.com/files/119582/original/image-20160421-8023-1p3ufbx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=483&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/119582/original/image-20160421-8023-1p3ufbx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=483&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/119582/original/image-20160421-8023-1p3ufbx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=607&fit=crop&dpr=1 754w, https://images.theconversation.com/files/119582/original/image-20160421-8023-1p3ufbx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=607&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/119582/original/image-20160421-8023-1p3ufbx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=607&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some popular liver detox brands.</span>
<span class="attribution"><span class="source">Screenshot, Chemist Warehouse</span></span>
</figcaption>
</figure>
<h2>Milk thistle</h2>
<p>Milk thistle extract (standardised to 80% silymarin) is the most commonly marketed herb claimed to “detoxify” the liver. Silymarin is the active ingredient in milk thistle. The use of milk thistle for treatment of various diseases dates back to <a href="http://ovidsp.tx.ovid.com/sp-3.19.0a/ovidweb.cgi?QS2=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">Dioscorides</a>, the first-century Greek physician. </p>
<p>In more recent times, it has been used to treat <a href="http://www.cochrane.org/CD003620/LIVER_no-evidence-supporting-or-refuting-milk-thistle-for-alcoholic-andor-hepatitis-b-or-c-virus-liver-diseases">liver disease</a>. However the majority of studies that have been conducted are of low-quality study design, so its purported efficacy is <a href="http://www.amjmed.com/article/S0002-9343(02)01244-5/abstract?cc=y=">still questioned</a>.</p>
<p>There is <a href="http://www.ncbi.nlm.nih.gov/pubmed/24152839">some evidence</a> to suggest <a href="http://www.ncbi.nlm.nih.gov/pubmed/25765835">milk thistle</a> (usually accompanied by other substances) is beneficial for improving blood cholesterol, insulin resistance and inflammatory markers in the body. There is no evidence, however, to suggest milk thistle “detoxifies” the liver – which <a href="https://www.carusosnaturalhealth.com.au/product/114/liver-detox">many</a> of these <a href="https://www.swisse.com/en-au/products/vitamins-supplements/digestion-detox/swisse-ultiboost-liver-detox">products</a> claim.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/119583/original/image-20160421-8026-1cg6ew.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/119583/original/image-20160421-8026-1cg6ew.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/119583/original/image-20160421-8026-1cg6ew.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=364&fit=crop&dpr=1 600w, https://images.theconversation.com/files/119583/original/image-20160421-8026-1cg6ew.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=364&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/119583/original/image-20160421-8026-1cg6ew.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=364&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/119583/original/image-20160421-8026-1cg6ew.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=457&fit=crop&dpr=1 754w, https://images.theconversation.com/files/119583/original/image-20160421-8026-1cg6ew.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=457&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/119583/original/image-20160421-8026-1cg6ew.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=457&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Caruso’s liver detox active ingredients as per their website.</span>
<span class="attribution"><a class="source" href="https://www.carusosnaturalhealth.com.au/product/114/liver-detox">Screenshot, Caruso's</a></span>
</figcaption>
</figure>
<h2>Dandelion</h2>
<p>Dandelion’s therapeutic use <a href="http://www.ncbi.nlm.nih.gov/pubmed/16093238">dates back to the tenth century</a> for liver and spleen disorders. </p>
<p>Since then, the medicinal use of the plant has been tested for a range of diseases. But the evidence is <a href="http://www.tandfonline.com/doi/abs/10.1080/J157v05n01_09?journalCode=iher20#.VxRPwjZJldg">contradictory</a>, or based on <a href="http://www.ncbi.nlm.nih.gov/pubmed/25858507">poor study design</a> with incomparable results.</p>
<p>Of greater relevance is that the majority of research investigating the efficacy of this flower extract has <a href="http://online.liebertpub.com/doi/abs/10.1089/jmf.2011.0282">been tested only in animals</a>. Similar to milk thistle extract, there is no evidence to suggest it helps to eliminate toxins or detoxify the liver, and hence serves no benefit for such a proposed indication. </p>
<h2>A healthy liver</h2>
<p>To have a well-functioning liver you simply have to eat healthy foods and limit your consumption of substances, such as <a href="http://europepmc.org/abstract/med/10677787">alcohol</a>, that cause it to work harder. Excessive consumption of any one particular food may contribute to an <a href="http://www.ncbi.nlm.nih.gov/pubmed/16779921">increased load on the liver</a>. </p>
<p>Therefore, a healthy, well-balanced diet based on <a href="https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">national guidelines</a> is the best liver “cleanse” available, rather than spending disposable income on over-the-counter products that are not backed by scientific literature supporting such claims. </p>
<p>Complementary medicines are one of the largest growing markets in the world. Governing bodies must continue to incentivise companies to conduct innovative research to support the specific claims accompanying their products. It’s imperative companies are transparent in their advertising claims so consumers know what they are spending their money on from both an efficacy and safety point of view. </p>
<p>Evidence for approved ingredients should not be generalised from product to product. This is because the evidence supporting one such product is made up of a unique combination of ingredients and dosages. The most recent review of the regulatory framework for complementary medicines is available on the <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/Expert-Review-of-Medicines-and-Medical-Devices-Regulation">Department of Health website</a>.</p><img src="https://counter.theconversation.com/content/56344/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Nicholas Fuller has received research grants for other clinical trials funded by Australian Egg Corporation, Weight Watchers International, SOHO Flordis International, Arnotts Biscuits, Sanofi-Aventis, Novo Nordisk, Allergan, Roche products, MSD, and GlaxoSmithKline. </span></em></p>Does the liver really respond to an over-the-counter product that claims to ‘detoxify’ or ‘heal’ its function?Nick Fuller, Research Fellow, Clinical Trials Development and Assessment, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/255622014-04-24T12:01:08Z2014-04-24T12:01:08ZGinseng could be an effective way to prevent the flu<figure><img src="https://images.theconversation.com/files/46936/original/nwcmjm6q-1398264742.jpg?ixlib=rb-1.1.0&rect=0%2C515%2C683%2C437&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Flavour is another thing.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/53766310@N02/6139690868/sizes/l">Florina_Presse</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Ginseng, the root of the plant <em>Panax ginseng</em>, is one of the most commonly used herbal medicines and is often sold as an over-the-counter remedy for fatigue. Although it has been used by humans for thousands of years, more recent research has begun to investigate therapeutic and pharmacological uses including <a href="http://www.ncbi.nlm.nih.gov/pubmed/22360884">anti-allergy</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/21494373">anti-inflammatory properties</a>. It is also known to act on the immune system and to affect viral replication. And it may also be a very effective way of preventing the flu.</p>
<p>The findings of a recent study we carried out suggest that normal consumption of Korean red ginseng extract by healthy individuals could prevent infections by different flu virus strains. And studies in mice suggest that long-term ginseng intake could confer and prepare immune systems with better resistance to fight future pathogens. </p>
<p>The effect that ginseng has on flu virus infections regardless of strain makes it different from the <a href="https://theconversation.com/a-universal-flu-vaccine-is-still-some-time-off-18525">strain-specific protection</a> from annual vaccinations (often given to those most at risk such as the elderly and pregnant women, and <a href="http://www.nhs.uk/Conditions/vaccinations/Pages/how-flu-vaccine-works.aspx">determined by the strains in most circulation</a> in a given year) and prescribed antiviral drugs such as Tamiflu – which <a href="http://www.nhs.uk/news/2014/04April/Pages/questions-over-tamiflu-relenza-effectiveness.aspx">recently came under fire</a> over its effectiveness as a treatment against severe flu.</p>
<h2>Rooting around</h2>
<p>Korean red ginseng extracts are produced by steaming and drying the fresh roots of six-year-old <em>Panax ginseng</em> plants. These are then boiled in water and the supernatants – or liquids above the settled material – are concentrated. It is this preparation that can be designated as “red ginseng extract.” Because of its prominent biological effects, extracts from this particular plant have been used in animal studies. Despite known beneficial effects on human health and its action on viral infection, the mechanism for how it does this remains largely unknown. </p>
<p>In <a href="http://www.ncbi.nlm.nih.gov/pubmed/22856395">previous studies</a>, we investigated the effects of ginseng given orally in mice – the most common way that healthy people take ginseng as a supplement. We found that this gave the mice a moderate but significant resistance to infection with the 2009 pandemic flu virus strain – on the whole it didn’t prevent illness, which was shown by them losing weight, but it did result in better survival.</p>
<p>Protection from ginseng given before infection wasn’t strong because the mice still became ill but we also found that treating them with ginseng after infection gave even less protection.</p>
<h2>Cross-protection</h2>
<p>However most human adults who consume ginseng already have some immunity to the flu, either through previous contact with the virus or vaccination. So we tried giving ginseng instead to vaccinated mice instead through oral doses and found that it significantly improved how well the mice were able to fight different strains of flu viruses through cross-protection.</p>
<p>Infection of mice with a mixture of influenza virus and ginseng extract resulted in better clearance of lung viral levels and lower levels of inflammatory cytokines, the small proteins that are important in helping cells to send signals. But it also led to higher levels of antiviral cytokines. From these lab tests we know that Korean red ginseng extract may inhibit the flu virus growing. The extract appears to have multiple mechanisms against fighting infectious diseases, which might be beneficial if taken in healthy mice with previous exposure and prior to infections.</p>
<p>Our more recent study, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3942714/">published in Nutrients</a> found that ginseng improved the survival of human lung epithelial cells (tissue cells that line cavities in the lung) when someone is infected with the flu virus. Also, ginseng treatment reduced the expression of pro-inflammatory genes, probably in part by interfering with chemically reactive molecules that contain oxygen and which are formed by the flu virus.</p>
<p>Taking ginseng for a longer term (around 60 days) showed multiple effects on the immune system of mice such as stimulating anti-viral protein production after flu virus infection. Ginseng also inhibited the infiltration of inflammatory cells into the lungs in mice. So ginseng might have potential beneficial effects in preventing flu virus infections by acting on the immune system in multiple ways. </p>
<p>Small doses of ginseng has been taken in humans for many years with no major side effects. But while ginseng looks like a promising way to help prevent flu, results only relate to healthy individuals taking normal doses. Based on animal studies it also has shown no or only minimal protective beneficial effects if treated after the onset of symptoms. </p><img src="https://counter.theconversation.com/content/25562/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sang-Moo Kang has received funding from NIH/NIAID grants and the Korean Ginseng Corporation for his research</span></em></p>Ginseng, the root of the plant Panax ginseng, is one of the most commonly used herbal medicines and is often sold as an over-the-counter remedy for fatigue. Although it has been used by humans for thousands…Sang-Moo Kang, Associate Professor, Institute for Biomedical Sciences, Georgia State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/228822014-02-13T19:42:01Z2014-02-13T19:42:01ZWhy we can’t have reliable evidence for herbal therapies<figure><img src="https://images.theconversation.com/files/41454/original/h2pzz3vf-1392267635.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In their "natural" form herbal medicines are so variable from batch to batch and across brands that gathering reliable evidence of effectiveness is unlikely ever to be possible.</span> <span class="attribution"><span class="source">Mickey_Liaw/Flickr</span></span></figcaption></figure><p><em>TESTING ALTERNATIVE THERAPIES - La Trobe University’s decision to accept funding from Swisse for a new centre to research alternative medicines has sparked controversy. This series looks at how the evidence behind alternative medicines can be assessed, and the ethics of such links between industry and research institutions.</em></p>
<hr>
<p>Natural products can be a source of useful new medicines when the active ingredient is isolated, identified, standardised and subjected to appropriate clinical studies. But in their “natural” form herbal medicines are so variable from batch to batch and across brands that gathering reliable evidence of effectiveness is unlikely ever to be possible.</p>
<p>Indeed, for almost all herbal therapies, it’s likely there will never be anywhere near the standard of evidence that’s required for prescription medicines.</p>
<h2>Standardisation issues</h2>
<p>The <a href="http://www.tga.gov.au/about/tga.htm#.UvdIssvNvwo">Therapeutic Goods Administration</a> (TGA) is charged with regulating medicines in Australia, and this includes ensuring their quality and fitness for use. </p>
<p>A large amount of data is required to register new prescription medicines for use in Australia. In the not-too-recent past, a large truck delivered an application to register a new chemical compound. Technology now allows this information to be electronically compressed, but the quantity of data is the same or greater.</p>
<p>These applications to the TGA comprise results of testing for effectiveness and safety in humans and animals, what and whom the compound can treat, and the dose, frequency and duration of treatment. </p>
<p>Supporting these results is information about the chemical content of the batches of medicine used in testing (which chemical and how much), the pharmaceutical properties of the formulations (rate of drug release, for instance), and the stability of the product for the duration of its shelf life.</p>
<p>Without these guarantees of consistency, there’s no reasonable likelihood that future batches will lead to the same responses in patients. Indeed, without it the statistical results of clinical studies cannot be relied upon in the future.</p>
<p>But this kind of standardisation of herbal medicines is almost impossible. </p>
<p>Even confirming the identity of a herb is itself often a difficult task because each has multiple varieties, and sometimes the same name is used for different herbs in different countries. The <a href="http://scu.edu.au/scps/index.php/110">Chinese Pharmacopoeia</a> provides one means of identifying particular herbs but there’s little in its monographs to characterise the chemical composition of individual batches. </p>
<h2>Variable composition</h2>
<p>Like other government bodies, TGA has finite resources so these are allocated according to the <a href="http://www.tga.gov.au/about/tga-regulates-how.htm#.UsqUVjiIpDt">risk that medicines could pose</a> to consumers.</p>
<p>Alternative medicines are considered to incur the lowest risk to consumers, subject to defined criteria, and so receive little scrutiny compared with prescription medicines. In <a href="http://www.tga.gov.au/about/tga-regulates-how.htm#.Uvxhp8vNvwo">assessing the level of risk</a>, TGA considers factors such as side effects, potential harm through prolonged use, toxicity and the seriousness of the medical condition for which the product is intended to be used. But the registration or listing of a herbal medicine doesn’t imply that TGA has given its imprimatur to effectiveness or to the consistency of batches in the future.</p>
<p>Indeed, the TGA restricts its scrutiny of herbal medicines to ensuring that the product doesn’t cause harm when used to treat a restricted range of conditions. But even this is problematic because herbal and other “natural” medicines are of inherently variable composition. Unpredicted toxicity and interactions with other medicines are <a href="https://theconversation.com/herbal-medicines-toxic-side-effects-and-drug-interactions-23118">always possible</a>.</p>
<p>Consider St John’s Wort, which is a relatively well-studied herb. There have been a number of clinical studies about its efficacy and the Cochrane Collaboration has done <a href="http://summaries.cochrane.org/CD000448/st.-johns-wort-for-treating-depression">a review</a> that notes: </p>
<blockquote>
<p>St John’s Wort products available on the market vary to a great extent. </p>
</blockquote>
<p>And that’s the heart of the problem – the herb’s chemical composition (qualitative and quantitative) varies with its <a href="http://www.ncbi.nlm.nih.gov/pubmed/12099108">country of origin</a>, <a href="http://www.tandfonline.com/doi/abs/10.1300/J044v13n02_07#.Uvm9tmS1aRk">harvest time</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/12099108">method of processing</a>, the <a href="http://www.sciencedirect.com/science/article/pii/S0308814609004695">part of the plant</a> the sample is sourced from (stem, flowers, leaves, buds, or shoots), and how long the <a href="http://www.ist-world.net/ResultPublicationDetails.aspx?ResultPublicationId=12dd60e3538a4e818779dcfc689bd974">harvested plant was stored</a> before use in manufacture.</p>
<p>Its <a href="http://www.sciencedirect.com/science/article/pii/S0308814609004695">chemical composition has been studied</a> and it is complex. If more than one of its chemical components are active, what are their relative clinical potencies and what ratio of composition leads to an optimum and consistent outcome? </p>
<p>To register and market a new combination of mainstream prescription medicines (the equivalent of a two-component herb), another large dataset must be generated. To require such data for a herbal medicine would be to price it out of the market, even if TGA had the resources to review the submission. </p>
<p>Ultimately, there’s no problem with a thriving market for herbal products so long as they’re safe and consumers are not misled into using unproven medicines to treat serious conditions and so long as they know that TGA’s approval is limited to “do no [known] harm”. But because of the lack of standardisation, there will never be anywhere near the quality of clinical evidence for unrefined herbal medicines that’s required for prescription medicines. </p>
<p><strong><em>Read the opposite viewpoint:</em></strong></p>
<ul>
<li><a href="https://theconversation.com/quality-research-of-herbal-medicines-is-possible-23139">Quality research of herbal medicines is possible</a></li>
</ul>
<p><strong><em>This is the fourth article in our series about complementary and alternative therapies. Click on the links below to read the others:</em></strong></p>
<ul>
<li><p><a href="https://theconversation.com/heres-why-we-should-research-alternative-therapies-19436">Here’s why we should research alternative therapies</a></p></li>
<li><p><a href="https://theconversation.com/herbal-medicines-toxic-side-effects-and-drug-interactions-23118">Herbal medicines – toxic side effects and drug interactions</a> </p></li>
</ul><img src="https://counter.theconversation.com/content/22882/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Walters sometimes works part-time for a local pharmacy.</span></em></p>TESTING ALTERNATIVE THERAPIES - La Trobe University’s decision to accept funding from Swisse for a new centre to research alternative medicines has sparked controversy. This series looks at how the evidence…Susan Walters, Adjunct Associate Professor, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/74742012-11-07T03:48:47Z2012-11-07T03:48:47ZWestern herbal medicine – panacea or placebo?<figure><img src="https://images.theconversation.com/files/17312/original/gfjtknz7-1352247740.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Calendula (marigold), lavendar and rosemary are used by practitioners of Western herbal medicine.</span> <span class="attribution"><span class="source">Smoobs/Flickr</span></span></figcaption></figure><p><em>PANACEA OR PLACEBO – A weekly series assessing the evidence behind complementary and alternative medicines.</em></p>
<hr>
<p>Herbs have been used for therapeutic purposes in most cultures for hundreds and even thousands of years. The father of Western medicine, Hippocrates (460 BC - 377 BC) is known to have used many plants and herbs for medicinal purposes. Hippocrates’ use of up to 400 plants are well documented in a collection called the <em>Corpus Hippocraticum</em>.</p>
<p>Western herbal medicines have traditionally been used to help prevent and treat diseases. Many useful pharmaceuticals have been derived from such herbs, including:</p>
<ul>
<li><p>salicylic acid to make aspirin from the bark of the white willow tree (Salix alba);</p></li>
<li><p>morphine from the poppy plant (Papaver somniferum);</p></li>
<li><p>digitalin, digitoxin and digoxin from the plant foxglove (Digitalis purpurea);</p></li>
<li><p>atropine from the belladonna plant (Atropa belladonna) and;</p></li>
<li><p>quinine from the bark of the quinine tree (Cinchona ledgeriana).</p></li>
</ul>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/17314/original/k9phsn7g-1352248119.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/17314/original/k9phsn7g-1352248119.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/17314/original/k9phsn7g-1352248119.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/17314/original/k9phsn7g-1352248119.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/17314/original/k9phsn7g-1352248119.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/17314/original/k9phsn7g-1352248119.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/17314/original/k9phsn7g-1352248119.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Poppies.</span>
<span class="attribution"><span class="source">Rob van Hilten</span></span>
</figcaption>
</figure>
<p>In herbal medicine, the whole plant or parts of the plant (flowers, leaves, bark, fruit, seeds, stems and roots) are used for their <a href="http://nccam.nih.gov/health/whatiscam">potential therapeutic properties</a>.</p>
<p>Herbal medicines differ from pharmaceuticals as they contain complex multi-component substances, and like pharmaceuticals can exert biochemical and physiological effects on the body. There are natural variations of the active components in herbs, which is why there are differences in the profiles of batches of the same herbal ingredient. </p>
<p>This variation creates difficulties for research and analysis of systematic reviews of trials. Standardisation of extracts of herbs has improved over the years but remains an ongoing issue for both research and clinical use.</p>
<p>Safety is also an issue for herbs. As they contain active substances, herbs can cause adverse reactions as a result of <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Eur%20Clin%20Pharmacol%202006%3A%2062%20%283%29%3A225-233">interacting with pharmaceutical drugs</a>. A good example is St John’s wort, which is used for treating mild depression. The hyperforin levels found in this plant can result in reduced efficacy for drugs such as digoxin, the oral contraceptive pill and warfarin.</p>
<p>Western herbal medicines used by Hippocrates and still commonly used today include fennel, cinnamon, clove, chaste-berry, anise or licorice, coriander, garlic, St John’s wort, white willow bark, valerian, linseed, peppermint, chamomile, celery, clove (oil), Viscum album, elder-wood, sage and nettle.</p>
<h2>The evidence base</h2>
<p>Most of the evidence for herbal medicine stems from traditional use accumulated over hundreds of years and is documented in key monographs. Randomised control trials have also been conducted for some herbs but the majority vary in quality, lack methodological rigour, are often of short duration and have small numbers of participants. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/17315/original/z755xbyq-1352248262.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/17315/original/z755xbyq-1352248262.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=801&fit=crop&dpr=1 600w, https://images.theconversation.com/files/17315/original/z755xbyq-1352248262.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=801&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/17315/original/z755xbyq-1352248262.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=801&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/17315/original/z755xbyq-1352248262.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1007&fit=crop&dpr=1 754w, https://images.theconversation.com/files/17315/original/z755xbyq-1352248262.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1007&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/17315/original/z755xbyq-1352248262.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1007&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">St John’s wort.</span>
<span class="attribution"><span class="source">randomtruth/Flickr</span></span>
</figcaption>
</figure>
<p>Still, there are some Cochrane reviews and research worthy of mention that demonstrate the potential effectiveness of some herbs. Cranberry tablets (not the juice) for the prevention of recurrent <a href="http://summaries.cochrane.org/CD001321/cranberries-for-preventing-urinary-tract-infections">urinary tract infections</a> in young women, for instance, or <a href="http://summaries.cochrane.org/CD000448/st.-johns-wort-for-treating-depression.">St John’s wort</a> for mild, moderate and major depression, various herbs (STW 5 and STW 5-II) for <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004116.pub2/otherversions">irritable bowel syndrome</a>, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/18407528">rosehip</a> and avocado-soybean unsaponifiables for <a href="http://www.ncbi.nlm.nih.gov/pubmed/11279783">osteoarthritis</a>. </p>
<p>Also, hawthorne berries as an adjunct treatment for <a href="http://summaries.cochrane.org/CD005312/hawthorn-extract-may-be-used-as-an-oral-treatment-option-for-chronic-heart-failure">chronic heart failure</a>, and <a href="http://www.biomedcentral.com/1471-2261/8/13">garlic for hypertension</a>.</p>
<p>As the trials included in the systematic reviews are quite diverse, it’s difficult in some cases to know the type of extract, dosage or form of herbs that are most active and clinically effective. </p>
<p>Larger rigorous and high-quality trials are needed to help identify which herbs or standardised extracts of herbs are clinically useful. This would also help identify the safety profile of Western herbal medicines, especially with prolonged use.</p>
<p><em><strong>This is the sixth article in our series Panacea or Placebo. Click on the links below to read the other instalments:</strong></em></p>
<ul>
<li><p><a href="https://theconversation.com/aromatherapy-panacea-or-placebo-9270">Aromatherapy</a></p></li>
<li><p><a href="https://theconversation.com/chiropractic-therapy-placebo-or-panacea-8104">Chiropractic</a></p></li>
<li><p><a href="https://theconversation.com/colonic-therapy-panacea-or-placebo-9926">Colonic therapy</a></p></li>
<li><p><a href="https://theconversation.com/modern-acupuncture-panacea-or-placebo-8102">Modern acupuncture</a></p></li>
<li><p><a href="https://theconversation.com/myotherapy-panacea-or-placebo-9183">Myotherapy</a></p></li>
</ul><img src="https://counter.theconversation.com/content/7474/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Vicki Kotsirilos AM does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>PANACEA OR PLACEBO – A weekly series assessing the evidence behind complementary and alternative medicines. Herbs have been used for therapeutic purposes in most cultures for hundreds and even thousands…Associate Professor Vicki Kotsirilos AM, Adjunct Senior Lecturer in Epidemiology and Preventative Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/61662012-04-02T01:02:44Z2012-04-02T01:02:44ZDoes traditional Chinese medicine have a place in the health system?<figure><img src="https://images.theconversation.com/files/9183/original/frdgzv2p-1333327588.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Despite recent attempts to retain traditional healing practices in China, modern medicine is supplanting traditional medicine there.</span> <span class="attribution"><span class="source">Jean-François Chénier</span></span></figcaption></figure><p>Most of traditional healing practices are based on intuitive principles of diseases involving the imbalance of elemental qualities. </p>
<p>For the ancient Greeks and Romans, whose systems of traditional healing were accepted in Europe until the scientific revolution, these elements were the four bodily fluids or humours. Each corresponded to the four fundamental elements of the world – earth, water, air and fire. </p>
<p>In traditional Chinese medicine, the elements are wood, fire, earth, metal and water; for the ancient Unani medicine in India, the four humors (akhlaat) are air, earth, fire and water; for Indian Ayurveda medicine, health is the balance of three elemental energies in the universe: air, water and fire.</p>
<p>None of the ideas have any scientific basis. </p>
<p>With the advent of modern medicine, traditional European practices were relegated to a handful of surviving herbal remedies. Similarly <a href="http://www.nature.com/nature/journal/v480/n7378_supp/full/480S82a.html">in China</a>, despite <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.93.7.1082">recent attempts to retain</a> traditional healing practices, modern medicine is supplanting traditional medicine.</p>
<p>Paradoxically, in Australia and other developed countries there’s increased interest in complementary and alternative medicines, reverting to irrational approaches to health practice, despite people from such countries benefiting most from medicine’s advances.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=897&fit=crop&dpr=1 600w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=897&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=897&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1127&fit=crop&dpr=1 754w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1127&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1127&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chinese medicinal herbs.</span>
<span class="attribution"><span class="source">Jennifer Yin</span></span>
</figcaption>
</figure>
<p>The <a href="http://www.health.wa.gov.au/publications/documents/discussion%20paper%20-%20regulation%20of%20practitioners%20of%20chinese%20medicine%20in%20wa.pdf">resurgence of interest</a> in traditional Chinese healing in Australia, along with other alternative medicines, is due to rising discontent with conventional medicine; a preference for natural (or gentler) alternatives to pharmaceutical drugs or surgery; desire for greater control over personal health care and the relatively low success rate of conventional medicine in treating conditions, such as chronic pain, for some individuals.</p>
<p>This has led to the recent contentious decision to permit traditional Chinese medicine practitioners to be registered with the new national <a href="http://www.chinesemedicineboard.gov.au/">Chinese Medicine Board of Australia</a> from July this year. The board will be a new member of the <a href="http://www.ahpra.gov.au/">Australian Health Practitioner Regulation Agency</a>. </p>
<p>I have argued against the move, along with my colleague Associate Professor Hubertus Jersmann, in articles published today in <a href="http://www.mjainsight.com.au/view?post=marcello-costa-hubertus-jersmann-chinese-paradox&post_id=8680&cat=comment">MJA Insight</a> and the <a href="http://www.smh.com.au/national/health/alarm-bells-sound-on-registration-of-chinese-medicine-20120401-1w6mo.html">Sydney Morning Herald</a>.</p>
<p>The decision follows Victoria’s move (in 2000) to register traditional Chinese medicine practitioners, which has had a <a href="http://www.publish.csiro.au/paper/AH10869.htm">positive impact</a> on tightening standards and dealing with complaints. </p>
<p>Among traditional Chinese medicine practitioners to be registered are those who provide Chinese medical diagnosis, dispense Chinese herbs and perform acupuncture. All three components of this practice have serious flaws, being based on non-existent energies (Yin and Yang), non-existent bodily structures (meridiens) and on principles of disease diagnosis based on the imbalance of five non-existent elements. It is therefore doubtful whether such practitioners are able to make correct and safe diagnoses.</p>
<p>Proponents of traditional medical practices often point out that extracts from animals and plants have been the source of effective remedies in modern medicine. And while pharmacology and medicinal chemistry have enabled this revolution since mid-1800s, only a handful of the extracts used in traditional healing have been proven to contain active principles beneficial for fighting disease. These include about 120 chemical substances out of the thousands of <a href="http://www.hindawi.com/journals/ecam/2005/629537/abs/">herbal remedies</a> used in traditional medicines. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=713&fit=crop&dpr=1 600w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=713&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=713&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=896&fit=crop&dpr=1 754w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=896&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=896&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Artemisia annua or qing hao su became incorporated into medicine after it’s anti-malarial activity was proven through research.</span>
<span class="attribution"><span class="source">Scamperdale</span></span>
</figcaption>
</figure>
<p>Take, for instance, qing hao su, a herb used in China for treating fever for over 2,000 years. About 40 years ago, scientific research found that it had specific anti-malarial activity and its active compound, artemesin, was isolated. </p>
<p>In fact, it’s fortunate that most herbal remedies have little acute toxicity. This is due to empirical experience, which over time has selected out those proven to be overtly toxic. But the more subtle, chronic toxicity of herbal remedies remains a serious concern. </p>
<p>Only <a href="http://www.hindawi.com/journals/ecam/2005/629537/abs/">6% of plants species</a> have been screened chemically and pharmacologically to identify their active principles. This process, started by modern medicine just over 150 years ago, is continuing with investigations of potential benefits of new therapies often based on a long history of empirical evidence.</p>
<p>This is why research on active chemical principles in herbal remedies showing some potential beneficial effect is fully supported by the <a href="http://www.scienceinmedicine.org.au/">Friends of Science in Medicine (FSM)</a>, of which I am a founding member. </p>
<p>FSM represents a growing number of medical researchers, clinicians and members of the public concerned by the “current trend which sees government-funded tertiary institutions offering courses in the health care sciences that are not underpinned by sound scientific evidence”. We are worried that this gives unwarranted credibility given to their practitioners and practices, including traditional Chinese medicine. </p>
<p>Even though it falls within traditional Chinese medicine, acupuncture requires separate consideration because, despite being based on a flawed theory of non-existent “meridiens”, it has shown promising effectiveness in some ailments. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Acupuncture is based on the idea of “meridiens”.</span>
<span class="attribution"><span class="source">aloucha</span></span>
</figcaption>
</figure>
<p>But it’s important to remember that despite its popularity, acupuncture has only proven beneficial in alleviating some symptoms of pain and nausea. And the mechanisms by which it appears to work are similar to the physiological processes in the nervous system underlying the placebo effects on pain. Ultimately, research on acupuncture has enabled it to become incorporated in medicine in the few conditions for which it has proven to be effective.</p>
<p>My view, shared by many, is that there’s only one medicine and adjectives such as traditional and “Western” are irrelevant. Rather, medicine is about efficacy and safety, proven through scientific research. </p>
<p>Living in a modern society requires that in matters of health, we unapologetically only accept practices that have undergone the scrutiny of science. And once that criteria is fulfilled, we can accept it as effective medical treatment and teach it in our universities.</p>
<p>Sadly, this is not the case for most traditional Chinese medical practices and practitioners.</p><img src="https://counter.theconversation.com/content/6166/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marcello Costa does not work or consults for, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant undisclosed affiliations. Marcello as member of the Australian Academy of Science, is committed to support the highest scientific standard in education and tertiary institutions.
He is one of the five founding members of the Friends of Science in Medicine.</span></em></p>Most of traditional healing practices are based on intuitive principles of diseases involving the imbalance of elemental qualities. For the ancient Greeks and Romans, whose systems of traditional healing…Marcello Costa, Professor of Neurophysiology, Department of Physiology, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.