Hepatitis C Support Project • www.hcvadvocate.org
western medicine due to the lack of evidence-based research to
support safety and efficacy. Couple this with the potential harm
these substances can inflict and it is easy to see why physicians
are reluctant to endorse herb use. Some patients are interestedin alternative methods to use with or instead of the treatmenttheir physicians have prescribed. This is particularly true forpatients living with chronic hepatitis C virus (HCV). Although hugeprogress has been made in the HCV treatment arena, current
antiviral therapy has many side effects and is not always effective.
Add these elements to the symptoms some people experience
from HCV and it is no wonder that herbs seem attractive.
Although herbs and other supplements may seem appealing, a
2nd Edition number of herbs can cause harm. Some herbs are known to have
potentially carcinogenic properties and to cause neurologicaldamage. There are herbs that can be particularly harmful to the
liver and can cause damage and death. It is because of thepotential for hepatotoxicity (poisoning of the liver) that HCVpatients are advised to avoid herbs or to use them cautiously.
The Food and Drug Administration (FDA) is the federal agencyresponsible for drug and food safety. Drugs undergo years of
Interest in herbs and supplements seems to be on rigorous testing on animals and humans before the FDA allowsthe rise. When I first wrote this article, it was
them to be marketed. Herbs and supplements, on the other hand,
difficult to find reliable sources of information
are considered to be dietary supplements. This means that theyare regulated by different standards, called the Dietary
Supplement Health and Education Act of 1994 (DSHEA). Under
available, it became clear it was time to update
this act, it is the manufacturer that ensures the safety of the
“Herbs and Hepatitis C.“ This article is not meant
dietary supplement. In general, the supplement manufacturers do
to be the final stop on the information highway. I
not need FDA approval and do not need to register their product.
They are required, however, to label the supplement in a truthful
hope the reader will use this as a tool towards
gaining more insight and knowledge about theworld of herbs. Of course, this information is not
The point at which the FDA may become involved with herbs is
meant to be used for medical care. Always talk to
after marketing. The FDA may monitor product labeling,information, and safety. Adverse event reporting is voluntary.
your primary healthcare provider before using
Whether the FDA should regulate supplements is a hotly debated
issue. The FDA has been criticized both for regulating and underregulating dietary supplements. For a variety of reasons, the
The use of herbs for medicinal purposes has a long and
FDA's involvement with herb use has been minimal. To date, the
interesting history. The origins of some modern
notable exception to this is the sale of dietary supplements
medications are actually plants, such as aspirin from
containing ephedrine alkaloids. Ephedra, also called Ma Huang, is
white willow bark, digitalis from foxglove, morphine from
one of the plants that are a source of ephedrine alkaloids. Its use
poppies and warfarin (Coumadin) from sweet clover. Many
has been associated with an increase in blood pressure, a
cultures use indigenous plants for healing purposes. The
condition which will increase the risk of heart attack, stroke, and
use of herbs, however, is controversial in contemporary
There is very little independent research involving the use of
manufacturer complies with particular standards. A seal of
herbs. The gold standard randomized, controlled, double
approval from ConsumerLab.com (CL) also carries some
blind placebo controlled studies are few in the area of
distinction. Another standard is that of the world's leading
botanical remedies, let alone the use of herbs and HCV. In
authority on herbs, the German Commission E. This agency is
1991, the U.S. Congress established the Office of
the German equivalent of the Food and Drug Administration
Alternative Medicine (OAM) within the National Institutes of
(FDA). The American Herbal Pharmacopoeia is also developing
Health (NIH). In 1998 the National Center for
standardization guidelines for the American marketplace.
Complementary and Alternative Medicine (NCCAM) became
ConsumerLab.com has provided a much-needed service by
a new center of the NIH. Responding to the need for more
testing popular supplements. This company has discovered that
research about the safety and efficacy of herbs and
many products do not contain the levels of key ingredients that
supplements, NCCAM and the NIH Office of Dietary
are on the products' labels. A product that passes their
Supplements established the first Dietary Supplements
inspection may carry the triangular label with the
Research Centers with an emphasis on botanicals. The
ConsumerLab.com quality of approval. The use of this service
specific subject of herbs and viral hepatitis was included in
does have a fee associated with it. Companies that belong to the
the Complementary and Alternative Medicine in Chronic
American Herbal Products Association and submit to this
Liver Disease conference in 1999 and a few clinical trials
organization's code of ethics are another good choice.
are being conducted in this area. Unfortunately funding islimited and evidence-based data about herbs and HCV is
Suggested Guidelines for Herbal Use
• Assess your overall health. If you smoke, drink alcohol, and
The insufficiency of independent research does not mean
have other unhealthy habits, do not expect herbs to offset the
that there is no value in herbs. Herbs have made a
potential damage these habits can cause. Adopting healthy
significant contribution to medicine. Herbal practice has
habits will provide far more benefit than any herb can possibly
been around for centuries and has produced some sound
observations. Indigenous practitioners relied on botanicals
• Discuss herb and supplement use with your healthcare
for medicine. In these modern times it is common for
provider. Identify all the herbs and supplements you take, even if
people to self-treat mild sunburns with aloe vera, mild
you think your doctor might disapprove. Drugs and supplements
stomach aches with ginger, or mild colds with peppermint
can interact with each other as well as with other health
or chamomile tea. Generally these are assumed to be safe
alternatives. However, the use of herbs for treatment of
• Apply the same commonsense approach and standards to
more serious conditions such as HCV is more complicated
herbs as you would to any drug. If you are reluctant to take any
and raises a number of questions. For example, when
prescription or over-the counter drug, be equally as reluctant to
choosing an herb, which part of plant is used, when is it
harvested, and how is it processed? Botanicals are not
• Be informed and be sure your information is current.
made in a lab setting. This means that the consistency of
• Before you take an herb or supplement, find out if it is
the product is at risk. Is the herbal product safe, which
compatible with other drugs or supplements you are taking.
brands are the best, and what is the recommended dose?
Verify that the supplement is not contraindicated for any othercondition you may have (see “A Warning about Milk Thistle and
To answer these questions, start with the label. Herbs can
vary in strength and purity, so it may be wise to take a
• Take extra precautions if you have a history of allergies.
standardized and certified form. Certification and
Botanical products can cause allergic reactions.
standardization is voluntary. The goal of the United States
• Follow the label's dosage recommendations. More is not
Pharmacopeia (USP) is to set industry standards for drugs
and dietary supplements in the U.S. The label of a
• Know your source. Herbs may be contaminated. Before
supplement that displays the USP seal is worth considering.
ingesting anything, ask yourself what you know about what you
A product that is certified by NSF International (formerly the
National Sanitation Foundation) is another indicator that the
• Choose herbs and supplements that are standardized.
• Comfrey (Symphytum officinale and S. uplandicum)
• Buy products that submit to voluntary self-regulation.
• Natural does not equal healthy or safe. Snake venom is
natural but not healthy.
• Do not be swayed by bargain prices. Herbs are not all equal.
• Check the expiration date on the container.
• Do not rely on the health food store staff for health care
• Mistletoe (Phoradendron leucarpum and viscum album)
information. Although they may be helpful, remember that
salespeople are usually not licensed to practice medicine. Donot treat your condition on the advice of a salesperson.
• Be skeptical. Claims made by the product manufacturer or
seller may vastly differ from independent evidence-based
• Skullcap (Scutellaria lateriflora) Valerian
• Do not be swayed by personal testimonies. Although
individuals may benefit from botanical use, the notion that "one
Although not specifically associated with liver toxicity,
size fits all" does not apply in medicine.
products containing ephedrine alkaloids (ephedra) should be
• Do not be influenced by the latest supplement to make
avoided. Reports of heart attacks, strokes, seizures,
headlines. Dietary supplements can be compared to cars. When
psychosis, and death have been linked to the use of
new models are introduced, sometimes it takes time before
ephedrine alkaloids. The FDA has banned the sale of dietary
problems develop. A product that really has value will be around
supplements containing ephedrine alkaloids, including
• Herbs and supplements should not be given to children ortaken by pregnant or nursing women without a physician's
approval. Older adults and those with various health conditions
Milk thistle, Silybum marianum, is the most commonly used
should also exercise extra caution before taking non-prescribed
herb for liver problems. A frequently asked question
supplements. Herbs should never be used with decompensated
regarding chronic hepatitis C viral (HCV) infection concerns
the use of this herb. If you are considering taking a milk
• Some herbs prolong bleeding times or interfere with
thistle product, talk to your doctor and find out if it is
anesthetics. Stop all herb use at least a week prior to any
compatible with other drugs or supplements you are taking.
surgery or procedure that uses anesthesia. Tell your attending
Verify that the supplement is not contraindicated for any
physician and anesthesiologist about any herbs you are using,
other condition you may have (see “A Warning about Milk
particularly if the procedure occurs before you have sufficient
Thistle and Drug Interactions” below). Do not use milk
time to observe this "wash-out" period.
thistle if you have decompensated cirrhosis.
• Report any suspected adverse reactions to an herb orsupplement to the FDA's monitoring program, Medwatch. Call
Medical consultants for the Consumers Union
800-322-1088 or www.fda.gov/medwatch.
recommended the following in the April 2001 issue ofConsumer Reports On Health:
Some Herbs Associated with Liver Toxicity
• Patients should not use milk thistle to replace a
This list is primarily liver specific and by no means exhaustive.
conventional treatment for viral hepatitis;
The substances on this list are referred to in their oral form only.
• Patients should not take milk thistle while on aconventional treatment for viral hepatitis;
• Milk thistle is probably safe and no one should bediscouraged from taking it if there are no other options;
• Choose a brand that contains silibin and phosphotidyl
choline, which may be better absorbed.
There is insufficient research to establish a suggested daily
• transplant drugs - cyclosporine (Neoral, Sandimmune),
dose of milk thistle. Typical dosages are in the range of
140-420 mg in divided doses, 2-3 times a day of 70-80%silymarin. See the section "Suggested Guidelines for Herbal
Milk thistle also has the potential to lower levels of the
Use" (above) for more information on choosing milk thistle
• anti-parasite drugs - Mepron (atovaquone)• sedatives/sleeping pills - Ativan (lorazepam)
A Warning About Milk Thistle and Drug
Raman Venkataramanan and colleagues1 at the Universityof Pittsburg reported observations about silymarin, a
There is virtually no research on the safety of herbs and
compound found in milk thistle. In short, this report raised
supplements co-administered with peginterferon/ribavirin
concerns that silymarin may impair the metabolism of
therapy. Because of this, it is common for patients to abstain
certain drugs when taken together. Further, the potential
from milk thistle and herb use while undergoing antiviral
exists for increased toxicity of co-administered drugs in the
therapy. Even commonly used botanicals need to be used with
caution. Some herbs and supplements can hinder the ability ofthe blood to clot. For instance, ginger is widely used to relieve
The medications levels of the following may
nausea. However, patients with gallstones should talk to their
taken by people who are also using milk thistle. The source
health care provider prior to using ginger. Additionally, ginger
for this list is the Community AIDS Treatment Information
has an anticlotting action and should not be taken if you have
Exchange (CATIE) and is not meant to be complete.
reduced blood clotting ability. Interferon therapy and/or cirrhosis
can also interfere with blood clotting, so there may be an
increased risk if some herbs are used simultaneously under
these conditions. Other commonly used herbs, such as
• heart drugs - Tambocor (flecainide), Rythmol
chamomile and St. John's Wort carry a warning of potential
drug interactions. The rule of thumb is to be informed and talk
to your healthcare provider prior to using any botanical product.
• anti-seizure drugs - carbamazepine (Tegretol)• antidepressants - St. John's wort, Zyban/Wellbutrin
Warning: Bupleurum is a popular herb used in a variety of
(bupropion), Paxil (paroxetine), Prozac (fluoxetine), Luvox
Traditional Chinese and Japanese Medicine Mixtures for liver
(fluvoxetine) Serzone (nefazodone), Zoloft (sertraline),
conditions. At least 16 deaths have been reported in Japan for
HCV patients being treated simultaneously with alpha interferon
• antihistamines - Hismanal (astemizole), Seldane
and Xiao Chai Hu Tang (Minor Bupleurum).
(terfenadine)•antifungals - itraconazole (Sporanox), Ketoconazole
(Nizoral)• gastrointestinal motility agents - Prepulsid (Cisapride)
Herbs have been part of the healing arts for centuries. Clearly
• ergot drugs - Ergonovine, Ergomar (ergotamine)
more information and research needs to be conducted in this
• anti-psychotics - Clozaril (clozapine), Orap (pimozide)
area in order to better understand and incorporate the use of
• sedatives/sleeping pills - Ambien (zolpidem), Halcion
botanical products into current health practices. In the
meantime, make informed decisions regarding your health. Your
• lipid-lowering drugs (statins) - Lescol (fluvastatin),
Mevacor (lovastatin), Pravachol (pravastatin) and Zocor(simvastatin), Baycol (cerivastatin)
1 Venkataramanan R, Ramachandran V, Komoroski BJ, et al. Milk thistle, aherbal supplement, decreases the activity of CYP3A4 and uridine
diphosphoglucuronosyl transferase in human hepatocyte cultures. Drug
Metabolism and Disposition 2000;28(11):1270-1273.
• The American Pharmaceutical Association Practical Guide toNatural Medicines by Andrea Peirce.
• The ABC Clinical Guide to Herbs edited by Mark Blumenthal,et al at the American Botanical Council.
• ConsumerLab.com's Guide to Buying Vitamins &Supplements: What's Really in the Bottle by Tod Cooperman,M.D., William Obermeyer, Ph.D., Denise Webb, R.D., Ph.D.
• The Green Pharmacy by James A. Duke.
• Herbs of Choice by James E. Robbers and Varro E. TylerPDR for Herbal Medicines published by the Medical EconomicsCompany.
• Tyler's Honest Herbal: A Sensible Guide to the Use of Herbsand Related Remedies by Stephen Foster and Varro E. Tyler,Ph.D.
• American Botanical Council - 512-926-4900www.herbalgram.org• American Herbal Products Association - www.ahpa.org• ConsumerLab.com - www.consumerlab.com• FDA Dietary Supplement website - vm.cfsan.fda.gov/~dms/supplmnt.html• HerbMed - www.herbmed.org• Memorial Sloan-Kettering Cancer Center - www.mskcc.org/aboutherbs• National Center for Complementary and Alternative Medicine -888-644-6226 http://nccam.nih.gov• National Institutes of Health Clincal Trial Information -www.clinicaltrials.gov
• National Sanitation Foundation - http://www.nsf.org
A publication of the Hepatitis C Support Project
• NSF International - www.nsf.org• The United States Pharmacopeia - 800-822-8772
E x e c u t i v e D i r e c t o r
Editor-in-Chief, HCSP Publications
• UC Berkeley Wellness Letter - www.wellnessletter.com
• United States Pharmacopeia - www.usp.org
should consult a medical practitioner fordiagnosis and treatment of HCV.
C.D. Mazoff, PhD
This information is provided by theHepatitis C Support Project • a nonprofit
Support Project • Reprint permission is
granted and encouraged with credit tothe Hepatitis C Support Project.
Referat Nr. 1 Die drei Seinsebenen des Menschen sowie Definition und Maßstab der Gesundheit aus homöopathischer Betrachtungsweise! – Was ist klassische Homöopathie? Betrachten wir zunächst einige Tatsachen: Phantastisch muten die derzeitig medizinischen Fortschritte an, mit deren Hilfe heute sorgfältig angewandte Unfallchirurgie und Intensivpflege schwerstgeschädigte Akutkra
ad 209: color / mo + we 1:00–3:40 / room 2400d fall 2012 20 oliver oroeger @ uic.edu Novel Synopsis Strange Case of Dr Jekyll and Mr Hyde is a novella written by the Scottish author Robert LouisStevenson and first published in 1886. It is about a London lawyer who investigates strange occurrences between his old friend, Dr Henry Jekyll, and the misanthropic Edward Hyde. The work