tag:theconversation.com,2011:/nz/topics/natural-medicine-19818/articlesNatural medicine – The Conversation2020-07-09T04:02:08Ztag:theconversation.com,2011:article/1410422020-07-09T04:02:08Z2020-07-09T04:02:08Z‘Living fossils’: we mapped half a billion years of horseshoe crabs to save them from blood harvests<figure><img src="https://images.theconversation.com/files/345986/original/file-20200707-27858-x1kgcv.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C5160%2C3445&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>If you ventured to the New York seaside in summer, you might see a large dome-shaped animal with a spiky tail, slowly moving towards the water. These are horseshoe crabs – the animals time forgot.</p>
<p>Fossil records for horseshoe crabs extend back about 480 million years. This is well over 200 million years before the dinosaurs. </p>
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Read more:
<a href="https://theconversation.com/a-giant-species-of-trilobite-inhabited-australian-waters-half-a-billion-years-ago-118452">A giant species of trilobite inhabited Australian waters half a billion years ago</a>
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<p>More recently, horseshoe crabs have greatly helped advance modern medicine. Their blood is used to identify <a href="https://www.sciencedirect.com/topics/chemistry/endotoxin">endotoxins</a> in solutions. These are toxins found in bacteria, so anyone who has had an injection or surgery has been kept safe from dangerous toxins thanks to these creatures.</p>
<p>Unfortunately, the harvesting of their blood for this purpose is one reason horseshoe crabs are becoming an <a href="https://science.howstuffworks.com/life/biology-fields/horseshoe-crabs-endangered-biomedical-bloodletting.htm">endangered group</a>. Our <a href="https://www.frontiersin.org/articles/10.3389/feart.2020.00098/abstract">research</a> published today in Frontiers in Earth Science will hopefully aid conservation efforts to protect these enigmatic creatures.</p>
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<img alt="" src="https://images.theconversation.com/files/342637/original/file-20200618-41200-1grm5ca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/342637/original/file-20200618-41200-1grm5ca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/342637/original/file-20200618-41200-1grm5ca.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/342637/original/file-20200618-41200-1grm5ca.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/342637/original/file-20200618-41200-1grm5ca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/342637/original/file-20200618-41200-1grm5ca.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/342637/original/file-20200618-41200-1grm5ca.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The American horseshoe crab <em>Limulus polyphemus</em>.</span>
<span class="attribution"><span class="source">WikiCommons.</span></span>
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<h2>A modern medical marvel</h2>
<p>Completely harmless, but spiky like a cactus, horseshoe crabs are not actually crabs. They don’t have the antennae or jaws their crustacean cousins do, and have additional pairs of legs (13 in total). In fact, they’re more closely related to spiders and scorpions than crabs. </p>
<p>Defined within their own order, <a href="https://ucmp.berkeley.edu/arthropoda/chelicerata/xiphosura.html">Xiphosura</a>, these animals are characterised by a horseshoe-shaped head section, a roundish hexagonal backside and a long tail. They are, in essence, a spider in a suit of armour that can swim upside down. </p>
<p>Horseshoe crabs have been used in medicine for at least the <a href="https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.2006607">past 40 years</a>. Their endotoxin-revealing blood is blue and copper-based (unlike our red, iron-based blood). </p>
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Read more:
<a href="https://theconversation.com/blood-in-your-veins-is-not-blue-heres-why-its-always-red-97064">Blood in your veins is not blue – here's why it's always red</a>
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<p>A chemical refined from their blood can be used to identify contaminants in medical equipment that is inserted into <a href="https://www.iflscience.com/plants-and-animals/how-horseshoe-crab-blood-saves-millions-lives/">humans</a>. </p>
<p>Blue blood is used to make sure injections, IV drips, and any implanted medical devices are safe for human use.</p>
<h2>Blue bloodletting</h2>
<p>However, to access this natural medicinal miracle, humans must collect horseshoe crabs and harvest their blood. While blood loss itself may not be the main cause of death, other factors such as capture and transport can impact group survival. </p>
<p>At present, with improved practices, between <a href="https://www.frontiersin.org/articles/10.3389/fmars.2018.00185/full?utm_source=FWEB&utm_medium=NBLOG&utm_campaign=ECO_FMARS_horseshoe-crab-blood#h11">6-15.4% </a> of horseshoe crabs die from harvesting.</p>
<p>This process represents one of the main threats to them today, even though a <a href="https://www.theatlantic.com/science/archive/2018/05/blood-in-the-water/559229/">synthetic substitute</a> for blue blood has been available for nearly two decades. However, there is uncertainty around the efficacy of this alternative, so horseshoe crabs are <a href="https://blogs.unimelb.edu.au/sciencecommunication/2019/10/22/horseshoe-crab-the-blue-blood-that-saves-millions-of-lives/">still harvested</a>.</p>
<p>As a result, two of the four living species – the Chinese horseshoe crab and American horseshoe crab (also called the Atlantic horseshoe crab) – have been placed on the <a href="https://www.iucnredlist.org/search?taxonomies=101493&searchType=species">International Union for Conservation of Nature’s</a> vulnerable and endangered species list.</p>
<p>Apart from bloodletting for biomedical use, <a href="https://www.nwf.org/Educational-Resources/Wildlife-Guide/Invertebrates/Horseshoe-Crab">other threats</a> facing horseshoe crabs include overharvesting, <a href="https://www.sciencedirect.com/science/article/pii/S2351989419306997">human interaction and serious habitat modification</a>.</p>
<h2>Fantastic beasts, and where to find them (online)</h2>
<p>To help raise awareness about the challenges horseshoe crabs face, we created an <a href="https://www.frontiersin.org/articles/10.3389/feart.2020.00098/abstract">atlas of all fossil and living Xiphosura</a>. This free, open access collection contains photos of every horseshoe crab species ever described in the group’s 480-million-year history. </p>
<p>Alongside the photos, we provide outlines of how the four living species survived until now. </p>
<p>Building this atlas took three years. It involved emailing more than 100 researchers and museum managers, and even travelling from Australia to England, Germany, Russia, Slovenia and the United States to collect photographs.</p>
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<a href="https://images.theconversation.com/files/342937/original/file-20200619-70381-16myyr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/342937/original/file-20200619-70381-16myyr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/342937/original/file-20200619-70381-16myyr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=241&fit=crop&dpr=1 600w, https://images.theconversation.com/files/342937/original/file-20200619-70381-16myyr1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=241&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/342937/original/file-20200619-70381-16myyr1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=241&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/342937/original/file-20200619-70381-16myyr1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=302&fit=crop&dpr=1 754w, https://images.theconversation.com/files/342937/original/file-20200619-70381-16myyr1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=302&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/342937/original/file-20200619-70381-16myyr1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=302&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Examples of fossil horseshoe crabs. Left to right: <em>Pickettia carteri</em>, <em>Albalimulus bottoni</em>, <em>Sloveniolimulus rudkini</em>, and <em>Tasmaniolimulus patersoni</em>.</span>
<span class="attribution"><span class="source">Reconstructions by Elissa Johnson and Katrina Kenny</span>, <span class="license">Author provided</span></span>
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<p>The result is an example of every single horseshoe crab species ever documented, living or extinct – more than 110 in total.</p>
<h2>The ‘living fossil’ that roamed with dinosaurs</h2>
<p>Our atlas can help highlight the unique and complex evolutionary history of horseshoe crabs. </p>
<p>These arthropods (invertebrates with an exoskeleton and jointed legs) survived all mass extinctions. Some have changed in appearance through time. For example, we have completely bizarre fossil forms, such as <em>Austrolimulus</em> – essentially a pick-axe in horseshoe crab form.</p>
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<img alt="" src="https://images.theconversation.com/files/342654/original/file-20200618-41221-18cmqhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/342654/original/file-20200618-41221-18cmqhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=440&fit=crop&dpr=1 600w, https://images.theconversation.com/files/342654/original/file-20200618-41221-18cmqhd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=440&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/342654/original/file-20200618-41221-18cmqhd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=440&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/342654/original/file-20200618-41221-18cmqhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/342654/original/file-20200618-41221-18cmqhd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/342654/original/file-20200618-41221-18cmqhd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"><em>Austrolimulus fletcheri</em> lived in the New South Wales area during the Triassic. They’re a truly unique species.</span>
<span class="attribution"><span class="source">Patrick Smith.</span></span>
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<p>However, some fossil species look very similar to modern ones. </p>
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<img alt="" src="https://images.theconversation.com/files/342656/original/file-20200618-41242-hdtdm7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/342656/original/file-20200618-41242-hdtdm7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=973&fit=crop&dpr=1 600w, https://images.theconversation.com/files/342656/original/file-20200618-41242-hdtdm7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=973&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/342656/original/file-20200618-41242-hdtdm7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=973&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/342656/original/file-20200618-41242-hdtdm7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1223&fit=crop&dpr=1 754w, https://images.theconversation.com/files/342656/original/file-20200618-41242-hdtdm7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1223&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/342656/original/file-20200618-41242-hdtdm7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1223&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"><em>Mesolimulus walchi</em>, from the Solnhofen Limestone in Germany.</span>
<span class="attribution"><span class="source">Russell Bicknell/Paläontologisches Museum, München specimen.</span></span>
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<p>Compare the Jurassic-aged fossil <em>Mesolimulus</em>, found in <a href="https://en.wikipedia.org/wiki/Solnhofen_Limestone">Solnhofen Limestone</a> in Germany, to American horseshoe crabs walking along the North American coast today. They are practically the same. </p>
<p>Apart from size differences, horseshoes crabs have changed very little over the past 150 million years or so, earning them the moniker “living fossils”. But while specimens in the fossil record are between 3-30cm long, horseshoe crabs today can grow to more than 80cm.</p>
<p>Unfortunately, horseshoe crab populations have been decreasing significantly due to blood harvesting. There’s now <a href="https://www.theguardian.com/environment/2018/nov/03/horseshoe-crab-population-at-risk-blood-big-pharma">genuine concern</a> humans will drive these organisms to extinction.</p>
<p>Expanding our collective knowledge could help fuel future conservation efforts. Let’s prevent these unique icons of a bygone era from passing into the annals of history. </p>
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Read more:
<a href="https://theconversation.com/giant-sea-scorpions-were-the-underwater-titans-of-prehistoric-australia-141290">Giant sea scorpions were the underwater titans of prehistoric Australia</a>
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<img src="https://counter.theconversation.com/content/141042/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Russell Dean Christopher Bicknell received funding for this project in the following forms: a University of New England Post Doctoral Fellowship, Betty Mayne Scientific Research Fund, James R Welch Scholarship, and a Schuchert and Dunbar Grants in Aid Program. He is also a member of the International Union for the Conservation of Nature Horseshoe Crab Species Specialist Group.
</span></em></p><p class="fine-print"><em><span>Stephen Pates is a postdoctoral fellow funded by the Museum of Comparative Zoology, Harvard University.</span></em></p>A chemical refined from the blue, copper-based blood of horseshoe crabs helps identify contaminants in medical equipment inserted into humans.Russell Dean Christopher Bicknell, Post-doctoral researcher in Palaeobiology , University of New EnglandStephen Pates, Postdoctoral fellow, Harvard UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1251562019-11-14T12:02:34Z2019-11-14T12:02:34ZSnail slime: the science behind molluscs as medicine<figure><img src="https://images.theconversation.com/files/301510/original/file-20191113-77331-bdof4y.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/helix-pomatia-roman-snail-burgundy-edible-1026233269?src=2f042cc6-d094-4696-86a6-33a4e03b72c1-1-12">Shutterstock/Andrey Armyagov</a></span></figcaption></figure><p>Snails are well known for their lack of speed and their ability to upset gardeners. But there is growing scientific interest in the familiar sticky trail of slime they leave behind – and the medicinal value it may contain. </p>
<p>For centuries <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1062150/">it has been thought</a> that eating snails is good for you – and not just because they are a good source of protein and considered by some to be a delicacy. </p>
<p>Both the ancient Greeks and Romans advocated eating snails to cure a wide variety of ailments. These included fainting, stomach pains and coughing up blood, as well as general pain relief. The snails could either be eaten whole after boiling or crushed (shells included) into a crunchy pulp. </p>
<p>The idea of munching on these molluscs for their medicinal properties <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1062150/">continued</a>. In the 18th century it was recommended as a treatment for anthrax, and in the 19th century for tuberculosis. “Snail broth” made from the mucus was said to encourage the regeneration of wounded skin, reduce redness and make skin smoother. </p>
<p>Since publishing <a href="https://research.brighton.ac.uk/en/publications/identification-and-characterisation-of-anti-pseudomonas-aeruginos">my own work</a> on the chemical properties of snail mucus, I have been contacted by people who reported how this natural product has been used to treat skin inflammation and wounds well into the 20th century.</p>
<p>These treatments would have mostly involved the Burgundy or edible snail, <em>Helix pomatia</em>, and its close relative the brown garden snail, <em>Helix aspera</em>, which are both found across Europe. </p>
<p>And in recent years, creams, gels and face masks containing slime collected from Helix snails have become <a href="http://nymag.com/strategist/article/best-snail-mucin-skincare-products.html">popular beauty treatments</a>. But can any of the claims be substantiated by scientific evidence? </p>
<p>Interest in snail slime as a skin treatment was <a href="https://www.prnewswire.com/news-releases/revolutionary-elicina-snail-cream-scores-cnn-money-feature-300558597.html">rekindled recently</a> from observations made by workers farming edible snails in Chile. After their skin came into contact with the slime during handling, they reported that cuts and scars tended to heal easily and rapidly. This led to the development of the creams and gels which can now be found on chemist and health food shop shelves. </p>
<p>Mucus is a very sticky and biologically complicated substance. The snail uses it to aid locomotion, stick to hard surfaces (when resting or hibernating) and to defend itself against predators by creating a viscous environment around themselves and blocking the entrance to the shell.</p>
<h2>Snail secrets</h2>
<p>It is over 90% water, but it contains a lot of other compounds. The manufacturers of snail slime creams and gels claim that the key ingredients are allantoin (which is incorporated into a range of cosmetic products as well as toothpaste and shampoo) and glycolic acid (again commonly found in skincare products). </p>
<p>A research team in Italy <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281574/">recently investigated this</a>. They found that a preparation made from the mucus produced by the snail did indeed show significant effects in laboratory tests which would explain the observed skin healing properties. </p>
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<img alt="" src="https://images.theconversation.com/files/301559/original/file-20191113-77315-18e3cfx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/301559/original/file-20191113-77315-18e3cfx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301559/original/file-20191113-77315-18e3cfx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301559/original/file-20191113-77315-18e3cfx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301559/original/file-20191113-77315-18e3cfx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301559/original/file-20191113-77315-18e3cfx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301559/original/file-20191113-77315-18e3cfx.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">
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<span class="caption">Beauty snail.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-up-snail-streaking-towards-jar-1139881079?src=f6bc48c5-fdc0-4830-bbd7-5501cbb88f07-1-2">Shutterstock/Andy Shell</a></span>
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<p>So there appears to be something in this. Yet the allantoin and glycolic acid were present in very low concentrations. This suggests that either they are not as important as previously thought in skin healing or that they are only effective when working with other components within the mucus. </p>
<p>In <a href="https://tandfonline.com/doi/abs/10.1080/09674845.2015.11665749">our work</a>,
we have found that mucus from brown garden snails kills one particular species of bacteria in laboratory experiments. This is an organism called <em>Pseudomonas aeruginosa</em>, which can cause bloodstream infections, pneumonia, chronic wound infections and respiratory infections in people with cystic fibrosis. </p>
<p>We have tried 20 different strains of this bacteria and the mucus has stopped all of them from growing. But we have not seen the mucus work convincingly against any other type of bacteria. </p>
<p>We are also trying to find the key active ingredient. The viscosity of mucus makes it hard to work with, but so far we have identified three new proteins that we want to investigate, and we hope this could lead to the creation of a new antibiotic. </p>
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<img alt="" src="https://images.theconversation.com/files/301557/original/file-20191113-77320-17z2lb6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/301557/original/file-20191113-77320-17z2lb6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301557/original/file-20191113-77320-17z2lb6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301557/original/file-20191113-77320-17z2lb6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301557/original/file-20191113-77320-17z2lb6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=494&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301557/original/file-20191113-77320-17z2lb6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=494&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301557/original/file-20191113-77320-17z2lb6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=494&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The author with her lab companions.</span>
<span class="attribution"><span class="source">University of Brighton</span>, <span class="license">Author provided</span></span>
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</figure>
<p>At the moment, though, we do not know whether extracting them from the snail’s mucus and making them artificially will work. It is (perhaps appropriately for a snail product) a slow process – but given time, we might be able to explain why the Romans and Greeks gave snails the credit they may well be due.</p><img src="https://counter.theconversation.com/content/125156/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Pitt has received funding from Institute of Biomedical Science Research Fund. </span></em></p>A historical trail through its medicinal properties.Sarah Pitt, Principal Lecturer, Microbiology and Biomedical Science Practice, Fellow of the Institute of Biomedical Science, University of BrightonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1074712018-12-13T13:26:43Z2018-12-13T13:26:43ZNature is a rich source of medicine – if we can protect it<figure><img src="https://images.theconversation.com/files/250203/original/file-20181212-76962-1gh995f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Gila monster.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/gilamonster-heloderma-suspectum-122625310?src=CfOjhjgYFlhhHlFiLecNPg-1-2">Reptiles4all/Shutterstock</a></span></figcaption></figure><p>The Pacific yew tree is a fairly small and slow growing conifer native to the Pacific Northwest. The Gila monster is a lizard with striking orange and black markings from the drylands of the Southwestern US and Mexico. Two very different organisms, but with a fascinating connection.</p>
<p>They’ve both given us drugs that have saved and improved the lives of millions of people. Paclitaxel, originally isolated in 1971 from the bark of the Pacific Yew tree, is so important for treating various cancers that it is one of the <a href="http://apps.who.int/iris/bitstream/handle/10665/273826/EML-20-eng.pdf?ua=1">World Health Organisation’s “Essential Medicines”</a>. This compound has been studied in <a href="https://clinicaltrials.gov/ct2/results?cond=&term=paclitaxel&cntry=&state=&city=&dist=&Search=Search">more than 3,000 clinical trials</a>. It’s safe and effective and it generates sales of around <a href="https://www.sciencedirect.com/science/article/pii/S0169409X17300303?via%3Dihub">US$80-100m per year</a>.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/250058/original/file-20181211-76959-1i8j21j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/250058/original/file-20181211-76959-1i8j21j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/250058/original/file-20181211-76959-1i8j21j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=750&fit=crop&dpr=1 600w, https://images.theconversation.com/files/250058/original/file-20181211-76959-1i8j21j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=750&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/250058/original/file-20181211-76959-1i8j21j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=750&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/250058/original/file-20181211-76959-1i8j21j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=943&fit=crop&dpr=1 754w, https://images.theconversation.com/files/250058/original/file-20181211-76959-1i8j21j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=943&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/250058/original/file-20181211-76959-1i8j21j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=943&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Pacific yew tree (<em>Taxus brevifolia</em>) foliage and fruit.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Taxus_brevifolia#/media/File:Taxus_brevifolia_Blue_Mts_WA.jpg">Jason Hollinger/Wikimedia Commons.</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Nature’s medicinal marvels</h2>
<p>Exenatide, a synthetic version of a compound found in the saliva of the Gila monster, is an injected treatment used by as many as <a href="https://www.astrazeneca-us.com/media/blogs/2015/Celebrating-10-Years-of-Exenatide-The-First-GLP-1-RA-Treatment-Option-08271015.html">two million people with type 2 diabetes</a>. In 2014, exenatide products <a href="https://www.astrazeneca.com/content/dam/az/our-company/our-company-052017/investor-relations/presentations-and-webcast/Press-release-amp-development-pipeline-Q4-and-full-year-results-2014.pdf">generated sales of US$767m</a>. Not only that, but exenatide has also been shown to have potential in the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2817%2931585-4/fulltext">treatment of Parkinson’s Disease</a>.</p>
<p>These two examples illustrate how significantly compounds sourced from nature can benefit public health, but they also tell a deeper story of how we fail to protect nature. Up until fairly recently, paclitaxel had to be isolated from the bark of wild Pacific yew trees, which meant stripping the bark and killing these <a href="https://www.nytimes.com/1991/05/13/us/tree-yields-a-cancer-treatment-but-ecological-cost-may-be-high.html">rare and slow growing trees</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/250061/original/file-20181211-76983-3pr3xs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/250061/original/file-20181211-76983-3pr3xs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/250061/original/file-20181211-76983-3pr3xs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=811&fit=crop&dpr=1 600w, https://images.theconversation.com/files/250061/original/file-20181211-76983-3pr3xs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=811&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/250061/original/file-20181211-76983-3pr3xs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=811&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/250061/original/file-20181211-76983-3pr3xs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1020&fit=crop&dpr=1 754w, https://images.theconversation.com/files/250061/original/file-20181211-76983-3pr3xs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1020&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/250061/original/file-20181211-76983-3pr3xs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1020&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Gila monster (Heloderma suspectum) at home in the Mojave Desert, USA.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/gila-monster-lizard-saguaro-sundown-646092688?src=CfOjhjgYFlhhHlFiLecNPg-1-3">Jay Pierstorff/Shutterstock</a></span>
</figcaption>
</figure>
<p>In 1977, demand for the drug generated an order for 7,000lbs (3,175kg) of bark, which yielded a mere <a href="https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/camptothecintaxol.html">132 grams of paclitaxel</a>. This demand <a href="https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/camptothecintaxol.html">destroyed 1,500 trees</a>, damaging the native environments in which they grow. This destruction continued until 1994 when chemists came up with a way of <a href="http://web.missouri.edu/%7Eglaserr/210w97/taxol_bodypage.htm">synthesising paclitaxel</a>.</p>
<p>The production of exenatide does not require the maceration of thousands of Gila monsters, thankfully. However, despite the huge sums generated by the sale of the compound, the delicate habitats where this lizard and countless other species live are <a href="https://news.nationalgeographic.com/2016/07/gila-monsters-threatened-climate-change/">threatened by development and climate change</a>.</p>
<h2>The cost of environmental destruction</h2>
<p>When it comes to discovering medicinal products found in nature, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1847427/">we’ve barely scratched the surface</a>. With every habitat that falls to the chainsaw or disappears under the plough or concrete, we impoverish nature and deprive ourselves of potential medicines. </p>
<p>The molecular diversity of life on Earth is <a href="https://www.ncbi.nlm.nih.gov/pubmed/15729362">effectively limitless</a>, but it is under threat. Conservative estimates suggest that we are <a href="http://science.sciencemag.org/content/269/5222/347">losing one important drug every two years</a> because of our onslaught on the natural world. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/250451/original/file-20181213-178570-m5oaop.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/250451/original/file-20181213-178570-m5oaop.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/250451/original/file-20181213-178570-m5oaop.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/250451/original/file-20181213-178570-m5oaop.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/250451/original/file-20181213-178570-m5oaop.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/250451/original/file-20181213-178570-m5oaop.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/250451/original/file-20181213-178570-m5oaop.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">Nature is our most dependable resource for medical breakthroughs – but for how much longer?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/white-pills-spilling-out-toppled-bright-549397639?src=hUJIwA63gpjyIayuaFJZrg-1-0">Video_Creative/Shutterstock</a></span>
</figcaption>
</figure>
<p>Perversely, this onslaught comes amid a new golden age of discovery. Tools, such as DNA sequencing, can reveal <a href="http://science.sciencemag.org/content/325/5937/161">“new” species hiding in plain sight</a>, while advances in mass spectrometry, genomics and genetic engineering have allowed us to harness their molecular diversity without excessive harvesting of wild specimens.</p>
<p>Although the potential of natural products is undisputed, the enormous amount of effort and resources required to bring a promising molecule to market <a href="https://journals.sagepub.com/doi/10.1177/1740774515625964">is offputting</a>. Not only that, but unscrupulous “bioprospectors” have illegally collected living material, <a href="https://theconversation.com/biopiracy-when-indigenous-knowledge-is-patented-for-profit-55589">often from developing countries</a>. These predatory practices prompted legislation that now hinders legitimate natural products research that <a href="http://www.sciencepolicyjournal.org/uploads/5/4/3/4/5434385/rourke.pdf">seeks to protect biodiversity</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drugs-from-bugs-the-next-blockbuster-medicine-could-be-lurking-inside-an-insect-71831">Drugs from bugs: the next blockbuster medicine could be lurking inside an insect</a>
</strong>
</em>
</p>
<hr>
<h2>Unlocking nature’s potential</h2>
<p>Magainin was the first anti-microbial protein discovered in an organism, isolated from the skin secretions of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC298875/pdf/pnas00330-0371.pdf">African clawed frog</a>. The discovery stems from the observation that surgical wounds on these frogs rarely become infected despite non-sterile procedures and conditions. Efforts to commercialise this molecule were mired in difficulties and today, despite the promise of a potentially transformative drug to treat infections, no magainin products are available.</p>
<p>Natural products give us a compelling angle for the protection of overlooked species and their habitats, but we need an ethical and transparent approach for developing them. To some extent, this is the goal of the Convention on Biological Diversity and the <a href="https://academic.oup.com/bioscience/article/67/4/400/3065742">Nagoya Protocol</a> – international agreements on sharing the benefits derived from biodiversity fairly. </p>
<p>But as a result of these treaties, the academics working to find new drugs in nature must meet the same regulatory requirements as companies with commercial intent. Extensive permitting requirements mean many academic scientists are avoiding international collaborations to <a href="http://www.sciencepolicyjournal.org/uploads/5/4/3/4/5434385/rourke.pdf">study biodiversity altogether</a> – hampering the discovery of new molecules. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/250234/original/file-20181212-110249-l074v4.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/250234/original/file-20181212-110249-l074v4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/250234/original/file-20181212-110249-l074v4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=213&fit=crop&dpr=1 600w, https://images.theconversation.com/files/250234/original/file-20181212-110249-l074v4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=213&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/250234/original/file-20181212-110249-l074v4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=213&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/250234/original/file-20181212-110249-l074v4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=268&fit=crop&dpr=1 754w, https://images.theconversation.com/files/250234/original/file-20181212-110249-l074v4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=268&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/250234/original/file-20181212-110249-l074v4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=268&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The author’s take on how humans presently exploit biodiversity.</span>
<span class="attribution"><span class="source">Rob Jenkins</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Governments need to support research efforts and collaboration between scientific disciplines such as ecology and biochemistry, with investment and infrastructure. Building trust with communities that live where natural products are sourced is also critical.</p>
<p>These steps could create a system of natural product research and development with a greater appreciation of nature’s value. Ultimately, the equal sharing of benefits derived from drug discoveries will help conserve nature. However, the clock is ticking and with every day that passes species and their unique chemistry are lost forever.</p>
<p>Nature is a public library of information waiting to be accessed. The science, technology and political will to read this library is being ignored while destruction continues and companies hoard resources that have been harnessed from nature for profit. We are destroying the best library in the world in order to build a writer’s workshop, open only to the few.</p><img src="https://counter.theconversation.com/content/107471/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Gila monster gave humans a treatment for diabetes. What other medical miracles are we losing by failing to protect wildlife and ecosystems?Ross Piper, Entomologist, Zoologist and Visiting Research Fellow, University of LeedsAlexander Kagansky, Reader in Molecular Biology, The University of EdinburghJohn Malone, Assistant Professor of Molecular and Cell Biology, University of ConnecticutNils Bunnefeld, Professor in Biological and Environmental Sciences, University of StirlingRob Jenkins, Reader in Psychology, University of YorkLicensed 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/703392017-04-16T19:34:58Z2017-04-16T19:34:58ZScience or Snake Oil: do meds like Remifemin ease hot flushes and night sweats in menopausal women?<figure><img src="https://images.theconversation.com/files/155404/original/image-20170203-1650-17xmyqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hot flushes and night sweats are the most common symptom of a female reproductive milestone known as the menopause.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>If you see a female friend or colleague sitting in front of a desk fan in winter while everyone else is shivering in sweaters, chances are she is having a hot flush, courtesy of the menopause. </p>
<p>Hot flushes and night sweats are the most common symptoms of the female reproductive milestone. The menopause is often blamed for a host of other symptoms such as insomnia, joint pains, depression and mood swings, vaginal dryness and difficulty concentrating. </p>
<p>Hot flushes can last for years and <a href="https://theconversation.com/a-shift-in-social-attitudes-can-make-menopause-a-positive-experience-46742">be debilitating</a>, and conventional treatments such as hormone replacement therapy (HRT) and antidepressants come with risks. HRT <a href="https://www.menopause.org.au/images/stories/education/docs/Revised_global_consensus_statement_MHT.pdf">increases the chance</a> of developing potentially deadly clots in the leg veins; a small increase in breast cancer risk has also been reported. </p>
<p>Because of these risks, women may turn to herbal products that are purportedly safer and have fewer side effects. A native American root called black cohosh (<em>Actaea racemosa</em>) is included in many such treatments used for hot flushes.</p>
<p>The root has a <a href="http://umm.edu/health/medical/altmed/herb/black-cohosh">long history of use in Europe</a> and became popular around the world after <a href="https://www.ncbi.nlm.nih.gov/pubmed/20085176">receiving German approval</a> as a non-prescription drug for hot flushes in 2000. In Australia, it is sold in various formulations <a href="http://au.iherb.com/Natural-Factors-WomenSense-Menopause-Black-Cohosh-Extract-40-mg-90-Veggie-Caps/2525?gclid=Cj0KEQiA1b7CBRDjmIPL4u-Zy6gBEiQAsJhTMHDICUYCseOD2oSt13kQGl5I2t9QQp438Pj-aBne9H4aAn6B8P8HAQ">and promoted as:</a></p>
<blockquote>
<p>a safe and natural way to help reduce symptoms such as hot flashes and night sweats. </p>
</blockquote>
<p>Apart from menopausal symptoms, black cohosh is <a href="http://umm.edu/health/medical/altmed/herb/black-cohosh">also used to treat</a> arthritis and premenstrual syndrome. It is the main ingredient in the product sold in many pharmacies called Remifemin, which claims to be “one of Germany’s foremost herbal products and is used in more than 25 countries.” But does this herb live up to the marketing? </p>
<h2>How is black cohosh used?</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/155402/original/image-20170203-1652-1hqc7xl.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/155402/original/image-20170203-1652-1hqc7xl.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/155402/original/image-20170203-1652-1hqc7xl.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=897&fit=crop&dpr=1 600w, https://images.theconversation.com/files/155402/original/image-20170203-1652-1hqc7xl.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=897&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/155402/original/image-20170203-1652-1hqc7xl.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=897&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/155402/original/image-20170203-1652-1hqc7xl.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1127&fit=crop&dpr=1 754w, https://images.theconversation.com/files/155402/original/image-20170203-1652-1hqc7xl.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1127&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/155402/original/image-20170203-1652-1hqc7xl.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"></a>
<figcaption>
<span class="caption">Remifemin’s main ingredient is black cohosh.</span>
</figcaption>
</figure>
<p>Native Americans didn’t only use black cohosh to <a href="https://ods.od.nih.gov/attachments/nt2000027_betz.pdf">treat female reproductive problems</a> such as “menstrual irregularities”, they <a href="https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/">also used it</a> for pain, fever and cough. </p>
<p>The root is most commonly sold as an extract in capsule form, but can also be taken as a liquid tincture or tea. Commercial formulations vary in dose and form.</p>
<p>Although the root and rhizome (the stalk of the root) of the black cohosh plant contain a number of active ingredients, its <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=black+cohosh+natural+standard">mechanism of action</a> when it comes to menopausal symptoms remains unclear. </p>
<p>It may work by <a href="http://www.cochrane.org/CD007244/MENSTR_black-cohosh-cimicifuga-spp.-for-menopausal-symptoms">affecting chemical compounds</a> related to female hormone levels (such as oestrogen), but evidence on this is still vague. </p>
<h2>Does it work?</h2>
<p>The evidence for whether or not black cohosh eases hot flushes is unfortunately inconclusive. Some studies show it works, while others don’t. It is important to note that there is often a high placebo effect with hot flush treatments. </p>
<p>In 2012, a <a href="http://www.cochrane.org/CD007244/MENSTR_black-cohosh-cimicifuga-spp.-for-menopausal-symptoms">Cochrane review</a> pulled together results from 16 studies evaluating the effectiveness of black cohosh. There was no difference in the number of weekly, or daily, hot flushes between women who received black cohosh and women who received a placebo.</p>
<p>There was also a similar side effect profile between placebo and treatment. However, only three trials were suitable for the side effect analysis. </p>
<p>The Cochrane authors were unable to make a definitive conclusion about how effective black cohosh was for menopausal symptoms for a number of reasons. These included design flaws in many of the trials evaluated, differences in the types of herbal extract used, and variation in the way symptoms were reported. </p>
<p>Some trials did not report a dose for black cohosh, while the duration of treatment ranged from eight weeks to 12 months.</p>
<p>A more <a href="https://www.ncbi.nlm.nih.gov/pubmed/25276716">recent and well-designed trial</a> of 84 menopausal women in Iran showed those allocated to take a standardised extract of black cohosh (“<a href="http://www.goldaru-co.com/fa/products/group-therapy/gynecology-and-sterility/508-cimifugol">Cimifugol</a>”) reported an 82% reduction in daily hot flushes, compared to 24% in the placebo group after eight weeks. </p>
<p>But when these results were combined with those from previous similar trials in a <a href="http://jamanetwork.com/journals/jama/fullarticle/2529629">2016 meta-analysis</a>, no difference between groups was found.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/161279/original/image-20170317-6100-1v4zosv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/161279/original/image-20170317-6100-1v4zosv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/161279/original/image-20170317-6100-1v4zosv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/161279/original/image-20170317-6100-1v4zosv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/161279/original/image-20170317-6100-1v4zosv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/161279/original/image-20170317-6100-1v4zosv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/161279/original/image-20170317-6100-1v4zosv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/161279/original/image-20170317-6100-1v4zosv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Native Americans used black cohosh to treat female reproductive symptoms.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/thumb/8/8e/Cimicifuga_simplex3.jpg/1280px-Cimicifuga_simplex3.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>A subsequent <a href="https://www.ncbi.nlm.nih.gov/pubmed/24941138">2015 trial in 54 Thai women</a> did not find black cohosh to be effective for menopausal symptoms. However, <a href="https://www.ncbi.nlm.nih.gov/pubmed/26000551">another small trial</a> reported both subjective and objective improvements in sleep disturbance. </p>
<h2>Is it safe?</h2>
<p>A 2008 review was conducted by a <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/18340277/?i=2&from=/25093128/related">US dietary supplements expert committee</a> after around 30 reports of liver failure in patients from the European Union, Canada and Australia (<a href="https://ods.od.nih.gov/attachments/nt2000027_betz.pdf">one death was reported</a>), were “potentially associated” with black cohosh. It found the liver toxicity was <em>possibly</em> (but not probably) linked to black cohosh. </p>
<p>This means there is a very small risk of liver failure, which is potentially fatal, for those taking black cohosh. Women should seek urgent medical attention if they develop abdominal pain, fatigue, have dark urine or jaundice.</p>
<p>It should be noted clinical trials have not reported a link between black cohosh and liver failure, and that the association may be due to other factors affecting liver health (such as alcohol consumption) or lack of quality control in commercial preparations. That is to say, black cohosh has not been proven to <em>cause</em> liver failure. </p>
<p>Also, overall <a href="https://ods.od.nih.gov/attachments/nt2000027_betz.pdf">side effects from black cohosh</a> are considered rare (one in 14,000 to one in 100,000). </p>
<h2>Other remedies</h2>
<p>In 2015, a <a href="https://www.mja.com.au/system/files/issues/203_03/10.5694mja14.01723.pdf">large Australian survey</a> of women aged 40 to 65 reported 13% of survey respondents took a complementary medicine for hot flushes. Phytoestrogens (such as red clover and soy isoflavones) were the most popular. There is <a href="http://jamanetwork.com/journals/jama/fullarticle/2529629">evidence these may reduce the number</a> of hot flushes by a modest 1.3 flushes a day. </p>
<p>Phytoestrogens are considered a relatively safe supplement. Yoga, mindfulness meditation and cognitive behavioural therapies <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031101/">also show promise</a>. Although black cohosh was the fourth most popular complementary therapy used by survey respondents, it was only used by 1.5% of women.</p>
<p>Acupuncture was initially thought to be effective for hot flushes, but a <a href="http://annals.org/aim/article/2481811/acupuncture-menopausal-hot-flashes-randomized-trial">large 2016 Australian study</a> reported no difference between real and sham acupuncture. </p>
<p>While results on whether black cohosh improves menopausal symptoms are mixed, this is not to say we know for sure black cohosh <em>doesn’t</em> work. Rather, the inconclusive findings reflect some of the problems with complementary medicine research, including the use of varying doses and formulations leading to difficulties making conclusions. </p>
<p>Women who use black cohosh should be aware of these uncertainties and of the small risk of liver failure that has been reported.</p><img src="https://counter.theconversation.com/content/70339/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carolyn Ee has received funding from the National Health and Medical Research Council (Project Grant, Postgraduate Scholarship, Centre for Research Excellence in PCOS) and the RACGP Research Foundation. She is Senior Research Fellow at NICM (the National Institute of Complementary Medicine, Western Sydney University). As a medical research institute, NICM receives research grants and donations from foundations, universities, government agencies, individuals and industry. Sponsors and donors provide untied funding for work to advance the vision and mission of the Institute. This article was not undertaken as part of a contractual relationship with any organisation. Carolyn Ee has received honoraria as a Member of the GP Advisory Board of the Blackmores Research Institute, is the Chair of the RACGP Integrative Medicine Working Group, and is an integrative medicine practitioner. </span></em></p>The root of the black cohosh plant has a long history of use in Europe and became popular around the world after receiving German approval as a non-prescription drug for hot flushes in 2000.Carolyn Ee, Senior Research Fellow, NICM, Western Sydney University, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/727262017-02-23T19:23:34Z2017-02-23T19:23:34ZDo you know what’s in the herbal medicine you’re taking?<figure><img src="https://images.theconversation.com/files/157614/original/image-20170221-18640-1m65eoo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vitamins are often seen as benign since they're meant to be natural, but the list of ingredients isn't always accurate.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Complementary medicine has received a lot of attention in the past couple of weeks. First, <a href="https://www.mja.com.au/system/files/issues/206_02/10.5694mja16.00614.pdf">a study</a> focused on potential safety concerns about taking herbal products. Second, <a href="http://www.abc.net.au/4corners/stories/2017/02/13/4616948.htm">ABC’s Four Corners</a> looked at the need for better regulation of product claims, and questioned the credibility of the pharmacy industry for endorsing and selling these products.</p>
<p>Both of these are particularly relevant, <a href="https://www.ncbi.nlm.nih.gov/pubmed/12200102">considering complementary and alternative medicines</a> are <a href="https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm">widely used</a> by <a href="https://www.mja.com.au/journal/2006/184/1/continuing-use-complementary-and-alternative-medicine-south-australia-costs-and">different populations</a> and by more than <a href="http://www.nicm.edu.au/health_information/information_for_consumers/reports,_surveys,_audits">half of all people</a>. People like complementary medicines often because they find such natural alternatives to be more in line with their <a href="https://www.ncbi.nlm.nih.gov/pubmed/9605899">values and beliefs</a>, and desire to lead a more “natural” life.</p>
<p>However, in many instances complementary medicines have no added benefit when compared to placebo, or weak evidence. These include <a href="http://www.cochrane.org/CD000980/ARI_vitamin-c-for-preventing-and-treating-the-common-cold">dietary supplements such as vitamin C</a> and <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000530.pub3/abstract">echinacea</a> for the common cold, and <a href="http://www.metabolictrial.com">weight-loss</a> <a href="https://theconversation.com/do-over-the-counter-weight-loss-supplements-work-53167">supplements</a>. </p>
<p>On the other hand, there is evidence for complementary medicines in preventing or managing a range of conditions. Some examples include <a href="https://www.ncbi.nlm.nih.gov/pubmed/10759336">improvement</a> in <a href="https://www.ncbi.nlm.nih.gov/pubmed/23832433">mental health</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/17174460">conditions</a>, managing <a href="http://jamanetwork.com/journals/jama/fullarticle/2529629">menopausal symptoms</a>, and for <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1503734">healthy outcomes during pregnancy</a>.</p>
<h2>How complementary meds end up on our shelves</h2>
<p>In contrast to pharmaceuticals (otherwise known as conventional “Western” medicines), government typically does not subsidise complementary medicines. Therefore, the cost burden is shifted to consumers. While this is good news for government budgets, consumers need to have confidence the products they’re spending their money on are safe and effective.</p>
<p>All herbal medicines (these are products derived from plant sources and fall under the complementary medicines umbrella) must be listed on the Australian Registry of Therapeutic Goods before they are made available for sale. This <a href="https://www.tga.gov.au/listed-medicines">gives them an AUST-L number</a>. However, this still relies on the manufacturer’s honesty with respect to its effectiveness. </p>
<p>This stands in stark contrast to pharmaceuticals. These have high up-front development costs, go through rigorous registration processes and have no guarantee of approval. Once pharmaceuticals are approved they are given an AUST-R number, which is different to the AUST-L number.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=452&fit=crop&dpr=1 600w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=452&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=452&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=568&fit=crop&dpr=1 754w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=568&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=568&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Echinacea for colds has been found to have limited effectiveness.</span>
<span class="attribution"><a class="source" href="https://www.google.com.au/search?q=echinacea&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjE9YiLqKXSAhVljFQKHZGHBZ0Q_AUICCgB&biw=1960&bih=1118#tbm=isch&q=echinacea+supplements&*&imgrc=qD4fkLWUnoKduM:">Elaine Thompson/AP</a></span>
</figcaption>
</figure>
<p>Natural or herbal medicines do not face the same regulatory scrutiny as pharmaceutical drugs because of their origin from “natural” sources. </p>
<p>However, as the <a href="https://www.mja.com.au/system/files/issues/206_02/10.5694mja16.00614.pdf">recent piece in the Medical Journal of Australia</a> points out, some products (particularly traditional Chinese medicines) often inaccurately list ingredients and may contain undeclared products (including DNA from endangered animals such as the snow leopard) or <a href="http://www.nature.com/articles/srep17475#t1">toxic and pharmaceutical contaminants</a>. </p>
<p><a href="http://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1002657#s4">Similar findings</a> have been reported previously for traditional Chinese medicines.</p>
<p>If a complementary medicine product does not have an AUST-L number you should not buy it: you are putting yourself at risk. </p>
<h2>Not all bad eggs</h2>
<p>It’s often the poor compliance of a few companies tarnishing the industry as a whole. One example is “Hydroxycut”. Not only has the product been banned in the US several times, it has put <a href="http://www.ncbi.nlm.nih.gov/pubmed/20104221">consumers’ health</a> in <a href="http://www.ncbi.nlm.nih.gov/pubmed/19139478">serious jeopardy</a>. </p>
<p>Other dietary supplements have led to questions being asked of the industry due to case reports of liver damage from taking products containing, for example, <a href="http://link.springer.com/article/10.2165/00002018-200831060-00003">green tea extract</a>. It’s the concoction of different ingredients in these supplements that often makes it difficult to pinpoint the exact root of concern. Therefore, tighter regulation of the industry is needed. </p>
<p>But many companies are meeting regulatory requirements and performing good-quality research to support their product claims. One <a href="http://link.springer.com/article/10.1007/s00213-016-4471-y">recent example</a> is an extract from the green–lipped mussel for those with attention deficit hyperactivity disorder (ADHD) or learning difficulties. This supplement showed some benefits in reducing hyperactivity and inattention, and improving memory in children and adolescents. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4690059/">Similar studies</a> with other products are under way.</p>
<p>Regulatory reform is needed to protect those companies performing good-quality research from other companies “piggy-backing” off this evidence for their similarly marketed product, perhaps with the same or similar ingredients. The Therapeutic Goods Administration should require manufacturers to have independent testing performed on their products before marketing to ensure <a href="https://www.mja.com.au/system/files/issues/206_02/10.5694mja16.00614.pdf">the ingredients listed on the packet are accurate</a>. </p>
<p>However, this still doesn’t stop people purchasing complementary medicine over the internet, <a href="https://www.tga.gov.au/book-page/purchasing-complementary-medicines-over-internet">despite clear warnings</a> against this.</p>
<p>We need to encourage and better incentivise research and development of complementary medicines. And we need to give adequate resources to a relevant body capable of more closely regulating the listing of complementary medicines to ensure patient safety. </p>
<p>Until this happens, make sure you only purchase supplements with an AUST-L number to ensure it’s safe – and do some research into the efficacy to ensure you’re not wasting your money.</p><img src="https://counter.theconversation.com/content/72726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nick Fuller has received research grants for clinical trials funded by Australian Egg Corporation, Arnotts Biscuits, SOHO Flordis International Research, Sanofi-Aventis, Novo Nordisk, Allergan, Roche products, MSD, and GlaxoSmithKline.</span></em></p>In many instances complementary medicines have no added benefit when compared to a placebo, or weak evidence of effectiveness.Nick Fuller, Research Fellow, Clinical Trials Development & Analysis, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/495982015-11-10T03:40:04Z2015-11-10T03:40:04ZNatural cancer remedies: sorting fact from fiction<figure><img src="https://images.theconversation.com/files/101259/original/image-20151109-29341-1ec67lb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Different parts of the guayabano or soursop plant has cancer-fighting properties. </span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>When it comes to natural remedies for cancer therapy, many patients are given anecdotal advice about the usefulness of alternative traditional medicines. They are also often told to combine these with their conventional medication for added effect.</p>
<p>While conventional treatments are subjected to rigorous research before they can be recommended for clinical use, alternative treatments are not. These “natural” remedies are either turned into over-the-counter medicines or can be taken in their natural forms. </p>
<p>It is important to note that alternative methods labelled “natural” are not necessarily “good”. Nor do they necessarily translate into healing. The use of traditional remedies should always be discussed with a physician or an oncologist. They may have adverse effects or may reduce the efficacy of conventional treatment.</p>
<p>Many alternative or traditional medicines <a href="http://www.cancer.org/acs/groups/cid/documents/webcontent/acspc-041660-pdf.pdf">claim</a> to have the ability to heal but there is <a href="http://www.cancer.org/acs/groups/cid/documents/webcontent/acspc-041660-pdf.pdf">no scientific evidence</a> to support this. In some cases scientific evidence may even <a href="http://www.cancer.org/acs/groups/cid/documents/webcontent/acspc-041660-pdf.pdf">contradict</a> the claims.</p>
<p>Here are some of the myths and facts about natural products that purportedly have anti-cancer properties.</p>
<h2>Fruit and vegetable pits</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/101264/original/image-20151109-29309-eul8jf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/101264/original/image-20151109-29309-eul8jf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/101264/original/image-20151109-29309-eul8jf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/101264/original/image-20151109-29309-eul8jf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/101264/original/image-20151109-29309-eul8jf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/101264/original/image-20151109-29309-eul8jf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/101264/original/image-20151109-29309-eul8jf.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">Chewing apricot pits were considered to have anti-cancer properties but this is not true.</span>
<span class="attribution"><span class="source">shutterstock</span></span>
</figcaption>
</figure>
<p>For generations the pits of many fruits, particularly apricots or kernels, have been promoted anecdotally to treat cancer. Traditionally the pits were chewed in their natural form. <a href="https://www.mskcc.org/cancer-care/integrative-medicine/herbs/amygdalin">Amygdalin</a> found inside apricot pits was thought to be the active ingredient linked to tales of its powerful anti-cancer properties. </p>
<p>But after nearly four decades of research, scientists cannot find any proof of its elusive chemotherapeutic effects. </p>
<p>What has been <a href="http://journals.lww.com/euro-emergencymed/Abstract/2005/10000/Severe_cyanide_toxicity_from__vitamin_supplements_.14.aspx">reported</a> and is nearly guaranteed is that a person who uses this remedy will suffer the adverse effects of chronic poisoning caused by the cyanide found in some of these pits.</p>
<h2>Overripe bananas</h2>
<p>In 2009, an <a href="https://www.jstage.jst.go.jp/article/fstr/15/3/15_3_275/_article">article</a> investigating cancer-related biological activity in ripened bananas was published. The study could not make any direct link to the fruit as an anti-cancer remedy but included the following statement:</p>
<blockquote>
<p>Due to the association between immunostimulatory and anti-oxidative effects, oral banana intake has the potential to help prevent lifestyle-related diseases and carcinogenesis. </p>
</blockquote>
<p>The statement went viral in the media with many memes posted on Facebook suggesting ripened bananas could reduce cancer risk. While <a href="http://libir.tmu.edu.tw/bitstream/987654321/50848/2/JECM_(2012)">studies</a> have demonstrated that antioxidants play an important role in protecting body cells against potential cancer agents, the article does not say bananas have an active ingredient that can combat cancer.</p>
<p>There are, however, remedies that have seen more positive results. </p>
<h2>The tropical guayabano fruit</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/101263/original/image-20151109-29326-flr22d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/101263/original/image-20151109-29326-flr22d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/101263/original/image-20151109-29326-flr22d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/101263/original/image-20151109-29326-flr22d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/101263/original/image-20151109-29326-flr22d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/101263/original/image-20151109-29326-flr22d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/101263/original/image-20151109-29326-flr22d.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">Different part of the soursop plant have anti-cancer properties.</span>
<span class="attribution"><span class="source">shutterstock</span></span>
</figcaption>
</figure>
<p>A member of the custard apple family fruit tree, <a href="http://dx.doi.org/10.3390%2Fijms160715625"><em>Annona muricata</em></a>, which is more commonly known as soursop, graviola or guayabano, is extensively eaten by indigenous communities in the tropical parts of northern Africa and South America. It is an oval-shaped, dark green, prickly fruit with a mildly acidic, whitish flesh. </p>
<p>When the plant was put through scientific tests, <a href="http://dx.doi.org/10.3390%2Fijms160715625">studies</a> found that several parts had potentially potent anti-cancer properties. This was particularly shown to be the case when used as an adjunct treatment.</p>
<p>Research showed that the leaves have active ingredients that possess anti-cancer properties that kill lung, prostate, colon, breast, and pancreatic cancer cells. Its seeds display properties that perform the same task that chemotherapy treatment would, killing breast, oral and lung cancer cells. And its fruit component has anti-prostate cancer potential. </p>
<p>Traditionally, the leaves and or roots would have been brewed or crushed for consumption, and the fruit eaten. But extracts of the active ingredients from the leaves have been made into tablets and sold <a href="http://ajouronline.com/index.php?journal=AJAS&page=article&op=view&path%5B%5D=1251&path%5B%5D=668">commercially</a>. These are taken in conjunction with conventional chemotherapy.</p>
<h2>South African rooibos herbal tea</h2>
<p>Rooibos, which is only found in the Cederberg region of the Western Cape, South Africa, is known for its aromatic flavour. The plant has been <a href="http://www.sciencedirect.com/science/article/pii/S1383571803003516">found</a> to have anti-cancer properties in <em>in vitro</em> and <em>in vivo</em> animal models. </p>
<p>Additional <a href="http://www.sciencedirect.com/science/article/pii/S0304383504008687">research</a> shows that the herbal tea possesses ingredients that reduce oesophageal and liver cancer and skin tumours. Clinical trials in humans are being planned. </p>
<p>The Cancer Association of South Africa has endorsed the herbal tea’s potential as a form of natural chemoprevention. This means it can aid in preventing cancer and even possibly reduce the growth of cancer cells. And it has funded <a href="http://www.cansa.org.za/rooibos-research-around-the-world/">research projects</a> aimed at identifying the active ingredients.</p>
<h2>The <em>Sutherlandia frutescens</em> plant</h2>
<p><em>Sutherlandia frutescens</em> is indigenous to South Africa, Lesotho, southern Namibia and southeastern Botswana. It is commonly used in traditional medicine. This shrub-like plant has bitter, aromatic leaves and is known for its red-orange flowers during spring to mid-summer.</p>
<p>Studies show that it has anti-cancer properties against <a href="http://www.sciencedirect.com/science/article/pii/S0378874111005307">oesophageal</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/26377232">prostate</a>, liver, <a href="http://www.sciencedirect.com/science/article/pii/S0378874111009238">breast</a> and lung cancer cells. Recent <a href="http://www.sciencedirect.com/science/article/pii/S0378874108004431">studies</a> proposed that cancer bush, the name it is commonly known by, may be a promising adjunctive therapy because of its potent anti-oxidative properties. </p>
<p>Preliminary <a href="http://www.ncbi.nlm.nih.gov/pubmed/25070435">clinical studies</a> proved that it had no negative effects. And the indications are that it may act as an immune stimulant to support the cancer patient. It has been made into tablet form and commercialised but studies are continuing to produce more definitive evidence of its benefits. </p>
<p>It is currently being marketed as a natural remedy that can be used alongside conventional treatment.</p>
<h2>Coix seed</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/101262/original/image-20151109-29317-fk5nk8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/101262/original/image-20151109-29317-fk5nk8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/101262/original/image-20151109-29317-fk5nk8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/101262/original/image-20151109-29317-fk5nk8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/101262/original/image-20151109-29317-fk5nk8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/101262/original/image-20151109-29317-fk5nk8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/101262/original/image-20151109-29317-fk5nk8.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">Extracts from coix seeds has anti-cancer effects.</span>
<span class="attribution"><span class="source">shutterstock</span></span>
</figcaption>
</figure>
<p>Traditional Chinese Medicine is a significant component of <a href="https://nccih.nih.gov/sites/nccam.nih.gov/files/Backgrounder_Traditional_Chinese_Medicine_10-25-2013.pdf">alternative medicine</a>. Initially confined to Asian countries, big Western pharmaceutical companies have recently started sifting through the orient’s vast indigenous knowledge for natural cancer remedies. </p>
<p><a href="http://www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/what-is-kanglaite">Kanglaite</a> is an anti-tumour drug that was developed using modern technology. It contains extracts from coix seeds. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/25787906">Research</a> shows that Kanglaite has anti-cancer effects particularly in gastric, lung, and liver cancer. After passing the phase three clinical trials it was marketed along with conventional therapy to improve the patient’s quality of life.</p><img src="https://counter.theconversation.com/content/49598/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kareemah Gamieldien 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>There are several natural remedies that have can help reduce cancer cells.Kareemah Gamieldien, PhD (Human Physiology), Cape Peninsula University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/457272015-08-27T03:58:52Z2015-08-27T03:58:52ZWhy alternative medicine should be integrated into conventional health care<figure><img src="https://images.theconversation.com/files/93071/original/image-20150826-15407-1lxf8iy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Complementary and alternative medicine has been recognised in South Africa but is not yet fully integrated into the country's health care system.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>A proposal to restructure primary health care in South Africa provides the perfect opportunity for complementary and alternative medicine to be formally integrated into the country’s health system.</p>
<p>Complementary and alternative medicine is any practice of medicine that is outside mainstream conventional <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=10981">allopathic</a> medicine. Some of these medicines may be sourced from natural herbs and are referred to as herbal medicines. They are used, among others, as remedies for a variety of ailments like coughs and insomnia and as dietary supplements and weight loss.</p>
<p>In South Africa, as in many other countries, these alternative treatments are used alongside conventional medicines rather than exclusively. They are also chosen by patients rather than prescribed to them, which creates a complementary rather than an alternative practice. </p>
<p>In 2014 the government amended the Medicines and Related Substances <a href="http://www.saflii.org/za/legis/consol_reg/marsa101o1965rangnr510723/">Act</a>. Practitioners of complementary and alternative medicine are now officially recognised and are obliged to register with the Allied Health Professions <a href="http://www.ahpcsa.co.za/">Council</a>. </p>
<p>The amendment has been seen as the government acknowledging complementary and alternative medicines, but it has not translated into their inclusion into health policy. There is still much to be done before there’s symbiosis between these two systems.</p>
<h2>Filling a critical gap</h2>
<p>South Africa’s private health care system is rated among the best in Africa, with facilities said to be comparable to those in <a href="http://www.thesouthafrican.com/which-countries-have-the-best-healthcare-systems-and-where-does-sa-rank/">developed economies</a>.</p>
<p>Against this backdrop it may seem counter-productive to focus on the integration of conventional with complementary health approaches. But the reality is that the population’s health care demands are not being met. This is particularly true in the country’s rural areas, where access to basic conventional health care is extremely limited. </p>
<p>In these rural settings, complementary and alternative medicine practices are <a href="http://www.abpn.org.br/Revista/index.php/edicoes/article/viewFile/533/430">common</a>. The rich diversity of South Africa means there are a variety of alternative medicine approaches. However, current literature provides little information on its use. </p>
<p>Fully including these treatments into the health care programmes would ensure that safety, quality and efficacy studies are available and regulated. This is particularly important given the potential of side effects that the existing health care system may be unaware of or is ill-prepared to manage. </p>
<h2>A global picture</h2>
<p>Across the globe, only a few countries have achieved full integration. These include China, Korea and Vietnam.</p>
<p>But there is more to integrating complementary medicine than using one treatment with another. In an integrated system, complementary health care approaches are officially recognised and incorporated into all aspects of health as well as the national drug policy. Training and treatment measures are registered and properly regulated. Patients can access both conventional and complementary <a href="http://kamome.lib.ynu.ac.jp/dspace/bitstream/10131/6917/3/Payyappallimana.pdf">products and services</a>.</p>
<p>In Equatorial Guinea, Nigeria, Mali, Canada and India, complementary medicine practices are inclusive rather than integrated. This is because the practice is not fully incorporated into all aspects of health. In these countries, complementary medicines are extensively used but are not fully accepted for health care provision. They are also not fully included in the national drug policy. </p>
<p>Many other countries have a “tolerant” system of complementary medicine, which means that allopathy is the major system of care and some complementary approaches are allowed under law. South Africa falls in this subcategory.</p>
<h2>The challenges</h2>
<p>The popularity of complementary and alternative medicine in South Africa has resulted in calls for it to be integrated into the country’s health care and medical education <a href="http://www.biomedcentral.com/1472-6920/14/40">systems</a>. </p>
<p>But there are two problems. Firstly, integrative measures into medical and health schools in South Africa are almost non-existent. Linked to this is a scarcity of studies on the integration of these medicines with conventional ones and their effect on patients. </p>
<p>Secondly, there are challenges in deciding what student trainees should be taught. Adding the “selected content” to the intense schedule of medical, pharmacy, nursing and the allied health professions students will pose considerable challenges. </p>
<p>Valuable lessons could be learnt from countries like Cuba where complementary medicine is integrated into training and practice. Medical students are extensively trained in the theoretical and practical aspects of complementary and alternative medicine. Only duly qualified and certified health professionals are allowed to practice with complementary and <a href="http://www.ncbi.nlm.nih.gov/pubmed/17122478">alternative medicine</a>. This ensures that patients are not exposed to unsafe practices. </p>
<h2>Moving towards a single system</h2>
<p>South Africa’s diversity means there are a variety of complementary health approaches that may differ among different racial, ethnic and cultural groups. This may pose a challenge to inclusion.</p>
<p>As a start, South Africa can create inclusion strategies which will see integration happen over time. These would include quality and efficacy studies and scientific evidence supporting the use of complementary and alternative medicines. </p>
<p>Inclusion strategies may need to be initiated in a specific province, with the full support of government and advisory bodies sanctioned by regulatory authorities. This would focus attention on a smaller area and may limit associated errors.</p>
<p>The strategy would also need to incorporate alternative medicine practices into the training curriculum of medical and health care workers. This would raise awareness of complementary practices among students and expose conventional health practitioners to the benefits and disadvantages. </p>
<p>This strategy would have several benefits, such as successfully incorporating complementary practises into the health system. It would also mean that practitioners could advise patients about medicines and treatments accordingly. Most importantly, it would advance the agenda of health care for all in South Africa.</p><img src="https://counter.theconversation.com/content/45727/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gail Hughes receives funding from South African National Research Foundation and is an executive committee member for the Public Health Association of South Africa. She is also a member of the American Public Health Association and in the leadership of its integrative complementary and alternative practice group.
</span></em></p><p class="fine-print"><em><span>Ol N M 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>Complementary and alternative medicine could alleviate many of the access problems within primary health care in South Africa’s rural areas if it was fully integrated into the system.Gail Hughes, Professor and Director South African Herbal Science and Medicine Institute (SAHSMI), University of the Western CapeOl N M, Researcher at the School of Pharmacy, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.