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Oahu Health Talk Herbal Safety Guide

Herbal Safety Guide

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HERBS A-Z

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A

ANISE (Pimpinella Anisum)

Safety:Tell your doctor if you are taking medicine or are allergic to any medicine (prescription or over-the-counter (OTC) or dietary supplement), are pregnant or plan to become pregnant while using this medicine, are breastfeeding or have any other health problems, such as high blood pressure or heart or blood vessel disease.

Dosage: There are many doses for this medicine. The most common doses for Anise Seed are listed. Ask your doctor if your health problem is not on the list or if the dose is not given for a product you want to use. General Use, dried herb: 3 grams, or as a tea, three times daily, by mouth. General Use, essential oil: 0.3 grams three times daily, by mouth.

Contraindications: Do not take Anise Seed without talking to your doctor first if you are taking Iron or iron-containing products, Anise Seed may increase the amount that your body absorbs.Before taking Anise Seed, tell your doctor if you are pregnant or breastfeeding. Pure Anise Seed oil should not be taken by mouth without consulting your health care professional. Seizures (uncontrolled shaking) and pulmonary edema (water in the lungs) have occurred with as little as 1 to 5 milliliters of Anise Seed Oil.
If you are pregnant or breastfeeding, you should not take Anise Seed Oil. Stop taking your medicine right away and talk to your doctor if you have any of the following side effects. Your medicine may be causing these symptoms which may mean you are allergic to it.
Breathing problems or tightness in your throat or chest, Chest pain, Skin hives, rash, or itchy or swollen skin. You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine. Upset stomach and throwing up have occurred when the essential oil is taken by mouth.
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ALFALFA (Medicago sativa)

Safety: Alfalfa in its various forms may present some health risks. Powdered alfalfa herb, alfalfa sprouts, and alfalfa seeds all contain L-cavanine, a substance that may cause abnormal blood cell counts, spleen enlargement, or recurrence of lupus in patients with controlled disease. However, heating alfalfa may correct this problem.
Researchers investigating alfalfa seeds' ability to lower cholesterol levels discovered that it had another effect on the lab animals used for testing. In some of the monkeys, it caused a disease very similar to lupus. Further research on this effect revealed that monkeys that had abnormal blood cell counts when eating either alfalfa seeds or sprouts, and then recovered when alfalfa was no longer part of their diet, developed the symptoms again when given an isolated component of alfalfa called L-canavanine. Alfalfa seeds and sprouts have a higher concentration of L-canavanine than the leaves or roots.
In a clinical trial of alfalfa seeds for lowering cholesterol involving only three human volunteers, one man who participated developed pancytopenia (an abnormally low number of all of the various types of blood cells) and enlargement of the spleen. Additionally, there are two published case reports of patients who had lupus which was controlled with drug therapy, suffering relapses after consuming alfalfa tablets. Again, L-canavanine is thought responsible for these effects.
When alfalfa seeds were autoclaved (heated to extremely high temperatures) and fed to monkeys for a year, no ill effects were seen, and the monkeys' cholesterol levels decreased. It may be that the L-canavanine can be destroyed by extreme heat, while the saponins that seem to be responsible for the beneficial effects of alfalfa remain intact. If so a heat-treated product might prove safe; however, much research remains to be done before we can know this for certain.
At present, it seems prudent that people who have been diagnosed with lupus, or those who suspect a predisposition to it based on family history, should probably avoid alfalfa. This includes the tablets used for supplements and the sprouts on the salad bar (go for the lettuce or the spinach instead).
Because of the estrogenic effects of some of alfalfa's components, alfalfa is not recommended for pregnant or nursing women or young children. In addition, the high vitamin K content in alfalfa could, in theory, make the drug warfarin (Coumadin) less effective.
Finally, a number of cases of food poisoning have been documented from fresh sprouts infected with bacteria that was present on the seeds prior to germination. Unfortunately, sprouts can appear fresh and yet host enough bacteria to cause illness in people who eat them. Some health care workers recommend that those at higher risk for such infections�young children, those with chronic diseases, and the elderly�avoid eating sprouts altogether.

Dosage:A typical dose of alfalfa for tea is 1 to 2 teaspoons per cup, steeped in boiling water for 10 to 20 minutes. Tablets and capsules of whole alfalfa or alfalfa extracts should be taken according to the manufacturer's recommendations. Certain products are said to be free of canavanine and other potentially harmful constituents, and may be preferable.

Contraindications: If you are taking warfarin (Coumadin), the high vitamin K content of alfalfa might make it less effective.
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ASTRAGALUS (Astragalus membranaceus)

Safety: Astragalus appears to be relatively nontoxic. High one-time doses, as well as long-term administration, have not caused significant harmful effects. Side effects are rare and generally limited to the usual mild gastrointestinal distress or allergic reactions. However, some Chinese herb manuals suggest that astragalus at 15 g or lower per day can raise blood pressure, while doses above 30 g may lower blood pressure.
As mentioned above, traditional Chinese medicine warns against using astragalus in cases of acute infections. Other traditional contraindications include "deficient yin patterns with heat signs" and "exterior excess heat patterns." Because understanding what these mean would require an extensive education in Chinese medicine, we recommend using astragalus only under the supervision of a qualified Chinese herbalist.
Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease has not been established.

Dosage: A typical daily dosage of astragalus involves boiling 9 to 30 g of dried root to make tea. Newer products use an alcohol-and-water extraction method to produce an extract standardized to astragaloside content, although there is no consensus on the proper percentage.

Contraindications:
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B

BILBERRY (Vaccinium myrtillus)

Safety: Bilberry fruit is a food and as such is quite safe. Enormous quantities have been administered to rats without toxic effects. One study of 2,295 people given bilberry extract found a 4% incidence of side effects such as mild digestive distress, skin rashes, and drowsiness. Although safety in pregnancy has not been proven, clinical trials have enrolled pregnant women. Safety in young children, nursing women, or those with severe liver or kidney disease is not known. There are no known drug interactions. Bilberry does not appear to interfere with blood clotting.
Little is known about the safety of bilberry leaf. Based on animal evidence that it can reduce blood sugar levels in people with diabetes, it is possible that use of bilberry leaf by diabetics could require a reduction in drug dosage.

Dosage: The standard dosage of bilberry is 120 to 240 mg twice daily of an extract standardized to contain 25% anthocyanosides.

Contraindications: If you are taking medications to reduce blood sugar, bilberry leaf (not fruit) might amplify the effect, and you may need to reduce your dose of medication.
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BURDOCK ROOT (Arctium lappa)

Safety: As a food commonly eaten in Japan (it is often found in sukiyaki), burdock root is believed to be safe. However, in 1978, the Journal of the American Medical Association caused a brief scare by publishing a report of burdock poisoning. Subsequent investigation showed that the herbal product involved was actually contaminated with the poisonous chemical atropine from an unknown source. Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease is not established.

Dosage: A typical dosage of burdock is 1 to 2 g of powdered dry root 3 times per day.

Contraindications: If you are taking insulin or oral medications to reduce blood sugar, it is possible that burdock will increase its effect.
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BUTCHER'S BROOM (Ruscus aculeatus)

Safety: Butcher's broom is believed to be safe when used as directed, although detailed studies have not been performed. Noticeable side effects appear to be rare. Safety in young children, pregnant or nursing women, or those with liver or kidney disease has not been established.

Dosage: Butcher's broom is sometimes standardized to its ruscogenine (or ruscogenin) content, but due to varying manufacturing methods we suggest following the label instructions. For hemorrhoids, butcher's broom can also be applied as an ointment or in the form of a suppository.

Contraindications:
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C

*CHAMOMILE German (Matricaria recutita), Roman (Chamaemelum nobile)

Safety: Chamomile is listed on the FDA's GRAS (generally recognized as safe) list. Reports that chamomile can cause severe reactions in people allergic to ragweed have received significant media attention. However, when all the evidence is examined, it does not appear that chamomile is actually more allergenic than any other plant. The cause of these reports may be products contaminated with "dog chamomile," a highly allergenic and bad-tasting plant of similar appearance.
Chamomile also contains naturally occurring coumarin compounds that might act as "blood thinners" under certain circumstances. Excessive use of chamomile is therefore not recommended when taking prescription anticoagulants. Some evidence suggests that chamomile might interact with other medications as well, but the extent of this effect has not been fully determined.
Safety in young children, pregnant or nursing women, or those with liver or kidney disease has not been established, although there have not been any credible reports of toxicity caused by this common beverage tea.

Dosage: Chamomile cream is applied to the affected area 1 to 4 times daily. Chamomile tea can be made by pouring boiling water over 2 to 3 heaping teaspoons of flowers and steeping for 5 minutes. Chamomile tinctures and pills should be taken according to the directions on the label. Alcoholic tincture may be the most potent form for internal use.

Contraindications: If you are taking blood-thinning medications such as Coumadin (warfarin), heparin, Plavix (clopidogrel), or Trental (pentoxifylline), you should avoid using chamomile as it might increase their effect. This could potentially cause problems.
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CINNAMON (Cinnamomae zeylanicum/cassesiae)

Safety: As a widely used food, cinnamon is believed to be safe. However, cinnamon's essential oil is much more concentrated than the powdered bark commonly used for baking. There is some evidence that high doses of cinnamon oil might depress the central nervous system. Germany's Commission E recommends that pregnant women should avoid taking cinnamon oil or high doses of the bark. Maximum safe doses in young children, nursing women, or individuals with severe liver or kidney disease have not been determined.
When used topically, cinnamon bark oil may cause flushing and a burning sensation. Some people have reported strong burning sensations or mouth ulcers after chewing cinnamon-flavored gum or candy. However, these reactions disappeared within days of discontinuing the gum.

Dosage: Typical recommended dosages of cinnamon are 2 to 4 g daily of cinnamon bark or 0.05 to 0.2 g daily of essential oil.

Contraindications:
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COMFREY (Symphytum)

Safety: Before taking Comfrey, tell your doctor if you are pregnant or breastfeeding. Comfrey should not be taken internally (by mouth). Eating or drinking Comfrey may cause liver damage. Do not use Comfrey if you have a history of liver disease.Do not apply Comfrey to broken skin. Do not exceed the recommended dose of Comfrey. Stop taking your medicine right away and talk to your doctor if you have any of the following side effects. Your medicine may be causing these symptoms which may mean you are allergic to it. Breathing problems or tightness in your throat or chest, Chest pain, Skin hives, rash, or itchy or swollen skin. You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine. Liver damage can occur if Comfrey is taken orally (by mouth).

Dosage: Oral (by mouth) use of Comfrey is not recommended. Ointment (10 to 15% root extract): apply three times daily to the affected area of the skin. Wounds, external use: apply fresh leaves or a cloth soaked in tea (made from 100 grams Comfrey root in 250 milliliters water and simmered for 10 to 15 minutes) three times daily for 1 hour to affected area of skin.

Contraindications:
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D

DAMAIANA (Turnera diffusa)

Safety: Damiana appears to be safe at the recommended dosages. It appears on the FDA's GRAS (generally recognized as safe) list and is widely used as a food flavoring. However, because damiana contains low levels of cyanide-like compounds, excessive doses may be dangerous. Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease is not established. The only common side effect of damiana is occasional mild gastrointestinal distress.

Dosage: The proper dosage of damiana is 2 to 4 g taken 2 to 3 times daily, or as directed on the label.

Contraindications:
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DANDELION (Taraxacum officinale)

Safety: Dandelion root and leaves are believed to be quite safe, with no side effects or likely risks other than rare allergic reactions. It is on the FDA's GRAS (generally recognized as safe) list and approved for use as a food flavoring by the Council of Europe. However, based on dandelion root's effect on bile secretion, Germany's Commission E has recommended that it not be used at all by individuals with obstruction of the bile ducts or other serious diseases of the gallbladder, and only under physician supervision by those with gallstones. Some references state that dandelion root can cause hyperacidity and thereby increase ulcer pain, but this concern has been disputed.
Because the leaves contain so much potassium, they probably resupply any potassium lost due to dandelion's mild diuretic effect, although this has not been proven. People with known allergies to related plants, such as chamomile and yarrow, should use dandelion with caution. Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease has not been established.

Dosage: A typical dosage of dandelion root is 2 to 8 g ~ 3 times daily of dried root; 250 mg 3 to 4 times daily of a 5:1 extract; or 5 to 10 ml 3 times daily of a 1:5 tincture in 45% alcohol. The leaves may be eaten in salad or cooked.

Contraindications: There are no known drug interactions with dandelion. However, based on what we know about dandelion root's effects, there might be some risk when combining it with pharmaceutical diuretics or drugs that reduce blood sugar levels. If you are taking diuretic drugs or insulin and oral medications that reduce blood sugar levels, use dandelion only under doctor's supervision.
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DON QUAI (Angelica sinensis)

Safety: Dong quai is believed to be generally nontoxic. Very large amounts have been given to rats without causing harm. Side effects are rare and primarily consist of mild gastrointestinal distress and occasional allergic reactions (such as rash). Certain constituents of dong quai can cause increased sensitivity to the sun, but this has not been observed to occur in people using the whole herb.
According to traditional beliefs, inappropriate long-term use of dong quai (such as taking it as a single herb rather than in a combination) can damage the digestive tract and cause other disturbances in overall health. Dong quai is also generally contraindicated during the first 3 months of pregnancy and during acute respiratory infections, and in women with excessively heavy menstruation. However, there is no scientific evidence for these concerns. Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease has not been established. One case report suggests that dong quai usage by a nursing mother caused elevated blood pressure in both the mother and child.

Dosage: We recommend using dong quai under the supervision of a qualified Chinese herbalist, not because the herb is dangerous, but because it is difficult to self-prescribe Chinese herbal formulas. If you wish to self-treat with dong quai, a typical dosage is 10 to 40 drops of dong quai tincture 1 to 3 times daily, or 1 standard 00 gelatin capsule 3 times daily.

Contraindications: Dong quai may interact with the blood-thinning drug Coumadin (warfarin), increasing the risk of bleeding, according to one case report. Dong quai might also conceivably interact with other blood-thinning drugs, such as heparin, aspirin, Plavix (clopidogrel), or Trental (pentoxifylline). Additionally, dong quai could conceivably interact with natural products with blood-thinning properties, such as garlic, ginkgo, or high-dose vitamin E.
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E

*ECHINACEA (Echinacea purpurea, E. angustifolia, E. pallida)

Safety: Echinacea appears to be safe. Even when taken in very high doses, it has not been found to cause any toxic effects. Reported side effects are also uncommon and usually limited to minor gastrointestinal symptoms, increased urination, and mild allergic reactions.26 However, severe allergic reactions have occurred occasionally, some of them life threatening. Germany's Commission E warns against using echinacea in cases of autoimmune disorders such as multiple sclerosis, lupus, and rheumatoid arthritis, as well as tuberculosis or leukocytosis. There are also rumors that echinacea should not be used by people with AIDS. These warnings are theoretical, based on fears that echinacea might actually activate immunity in the wrong way. But there is no evidence that echinacea use has actually harmed anyone with these diseases. The Commission E monograph also recommends against using echinacea for more than 8 weeks.
One study raised questions about possible antifertility effects of echinacea. When high concentrations of echinacea were placed in a test tube with hamster sperm and ova, the sperm were less able to penetrate the ova. However, since we have no idea whether this much echinacea can actually come in contact with sperm and ova when they are in the body rather than a test tube, these results may not be meaningful in real life.
One study found evidence that use of echinacea during pregnancy does not increase risk of birth defects. Furthermore, studies dating back to the 1950s suggest that echinacea is safe in children. Nonetheless, the safety of echinacea in young children or pregnant or nursing women cannot be regarded as established. In addition, safety in those with severe liver or kidney disease has also not been established.

Dosage: Echinacea is usually taken at the first sign of a cold and continued for 7 to 14 days. The three species of echinacea are used interchangeably. The typical dosage of echinacea powdered extract is 300 mg 3 times a day. Alcohol tincture (1:5) is usually taken at a dosage of 3 to 4 ml~ 3 times daily, echinacea juice at a dosage of 2 to 3 ml 3 times daily, and whole dried root at 1 to 2 g 3 times daily. There is no broad agreement on what ingredients should be standardized in echinacea tinctures and solid extracts.
Many herbalists feel that liquid forms of echinacea are more effective than tablets or capsules, because they feel part of echinacea's benefit is due to activation of the tonsils through direct contact. Echinacea should only be used as a short term "boost" to your immunity. It does not appear to strengthen your immunity when taken for months. See the articles on ginseng and vitamin E for treatments that might strengthen immunity. Goldenseal is frequently combined with echinacea in cold preparations.

Contraindications: Some evidence suggests that echinacea might interact with various medications, but the extent of this effect has not been fully determined.
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EUCALYPTUS (Eucalyptus globulus)

Safety: Before taking Eucalyptus, tell your doctor if you are pregnant or breastfeeding. Eucalyptus oil or eucalyptol should not be taken by mouth or put on the skin without diluting. Do not take if you have liver disease. Do not take if you have inflammation (soreness) in your intestinal tract (colon). Less than a teaspoonful of the undiluted oil may cause death. Do not use on the face on children or infants, especially around the nose. Stop taking your medicine right away and talk to your doctor if you have any of the following side effects. Your medicine may be causing these symptoms which may mean you are allergic to it. Breathing problems or tightness in your throat or chest, Chest pain, Skin hives, rash, or itchy or swollen skin. You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine. Undiluted eucalyptus oil (or oil that has not been diluted enough) may cause stomach upset, vomiting (throwing up), dizziness, muscle weakness, confusion, and convulsions (uncontrolled shaking).

Dosage: Eucalyptol (also called cineole): 0.05 to 0.2 milliliters (this is less than one drop) by mouth. If using eucalyptol do not take it undiluted, mix 10 teaspoons of water with one of eucalyptol, then use between 10 to 40 drops of this mixture. Eucalyptus Oil: use the same dose and instructions as with eucalyptol for use by mouth. For use on the skin, 6 teaspoons of eucalyptus oil may be mixed with 16 ounces of water, and then some of the mixture is applied to the skin. Fluid Extract, leaf: 2 to 4 grams, by mouth.

Contraindications: Do not take Eucalyptus without talking to your doctor first if you are taking High blood sugar medicine (examples: insulin, Glucophage(R) metformin, DiaBeta(R) Glynase(R) glyburide).
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F

FENNEL (Foeniculum vulgare)

Safety: Before taking Fennel Seed, tell your doctor if you are pregnant or breastfeeding. Do not use Fennel Seed for a long time, or in large amounts. Do not take if you have an allergy to members of the Umbelliferae family, like carrots, celery, or mugwort. Stop taking your medicine right away and talk to your doctor if you have any of the following side effects. Your medicine may be causing these symptoms which may mean you are allergic to it. Breathing problems or tightness in your throat or chest, Chest pain, Skin hives, rash, or itchy or swollen skin. You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine. Throwing up and upset stomach have been reported. Using too much Fennel Seed may cause your skin to become sensitive to the sun and burn easy.

Dosage: General Use, dried herb: 5 to 7 grams, or as a tea, daily, by mouth. General Use, tincture: 5 to 7.5 grams daily, by mouth. Cough, fennel honey or syrup: 10 to 20 grams daily, by mouth.

Contraindications:
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FENUGREEK (Trigonella foenumgraecum)

Safety: As a commonly eaten food, fenugreek is generally regarded as safe. The only common side effect is mild gastrointestinal distress when it is taken in high doses. Because fenugreek can lower blood sugar levels, it is advisable to seek medical supervision before combining it with diabetes medications. Extracts made from fenugreek have been shown to stimulate uterine contractions in guinea pigs. For this reason, pregnant women should not take fenugreek in dosages higher than is commonly used as a spice, perhaps 5 g daily. Besides concerns over pregnant women, safety in young children, nursing women, or those with severe liver or kidney disease has also not been established.

Dosage: Because the seeds of fenugreek are somewhat bitter, they are best taken in capsule form. The typical dosage is 5 to 30 g of defatted fenugreek taken 3 times a day with meals.

Contraindications: If you are taking diabetes medications such as insulin or oral hypoglycemics, fenugreek may enhance their effect. This may cause excessively low blood sugar, and you may need to reduce your dose of medication.
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*FEVERFEW (Tanacetum parthenium)

Safety: Among the many thousands of people who use feverfew as a folk medicine in England, there have been no reports of serious toxicity. Animal studies suggest that feverfew is essentially nontoxic. In the 8-month Nottingham trial, there were no significant differences in side effects between the treated and control groups. There were also no changes in measurements on blood tests and urinalysis.
In a survey involving 300 people, 11.3% reported mouth sores from chewing feverfew leaf, occasionally accompanied by general inflammation of tissues in the mouth.15 A smaller percentage reported mild gastrointestinal distress. However, mouth sores do not seem to occur in people who use encapsulated feverfew leaf powder, the usual form. In view of its use as a folk remedy to promote abortions, feverfew should probably not be taken during pregnancy.
Because feverfew might slightly inhibit the activity of blood-clotting cells known as platelets, it should not be combined with strong anticoagulants, such as Coumadin (warfarin) or heparin, except on medical advice. Feverfew might also increase the risk of stomach problems if combined with anti-inflammatory drugs such as aspirin. Safety in young children, pregnant or nursing women, or those with severe kidney or liver disease has not been established.

Dosage: Given the recent confusion surrounding parthenolide, previous dosage recommendations for feverfew based on parthenolide content have been cast in doubt. At the present time, the best recommendation is probably to take 80 to 100 mg of powdered whole feverfew leaf daily. When taken at the onset of a migraine headache, higher amounts of feverfew are often used. However, the optimum dosage has not been determined.

Contraindications: If you are taking Coumadin (warfarin), heparin, aspirin or other nonsteroidal anti-inflammatory drugs: Do not use feverfew except on medical advice.
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FO-TI (He Shou Wu),(Polygonum multiflorum)

Safety: Detailed modern safety studies have not been performed on this herb. Immediate side effects are infrequent, primarily limited to mild diarrhea and the rare allergic reaction. Safety for young children, pregnant or nursing women, or those with severe kidney or liver disease has not been established.

Dosage: He Shou Wu should be taken at a dosage of 9 to 15 g of raw herb per day, or according to the label for processed extracts. For most purposes, the processed or "red" fo ti is said to be superior. However, the raw herb is believed to be more effective for relieving constipation.

Contraindications:
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G

*GARLIC (Allium sativum)

Safety: As a commonly used food, garlic is on the FDA's GRAS (generally recognized as safe) list. Rats have been fed gigantic doses of aged garlic (2,000 mg per kilogram body weight) for 6 months without any signs of negative effects. Unfortunately, there does not appear to be any animal toxicity studies on the most commonly used form of garlic�powdered garlic standardized to alliin content. The only common side effect of garlic is unpleasant breath odor. Even "odorless garlic" produces an offensive smell in up to 50% of those who use it.
Other side effects occur only rarely. For example, a study that followed 1,997 people who were given a normal dose of deodorized garlic daily over a 16-week period showed a 6% incidence of nausea, a 1.3% incidence of dizziness on standing (perhaps a sign of low blood pressure), and a 1.1% incidence of allergic reactions. These are very low percentages in comparison to those usually reported in drug studies. There were also a few reports of bloating, headaches, sweating, and dizziness.
When raw garlic is taken in excessive doses, it can cause numerous symptoms, such as stomach upset, heartburn, nausea, vomiting, diarrhea, flatulence, facial flushing, rapid pulse, and insomnia. Topical garlic can cause skin irritation, blistering, and even third-degree burns, so be very careful about applying garlic directly to the skin.
Since garlic "thins" the blood, it is not a good idea to take high-potency garlic pills immediately prior to or after surgery or labor and delivery, due to the risk of excessive bleeding. Similarly, garlic should not be combined with blood-thinning drugs, such as Coumadin (warfarin), heparin, aspirin, Plavix (clopidogrel), or Trental (pentoxifylline). In addition, garlic could conceivably interact with natural products with blood-thinning properties, such as ginkgo, policosanol, or high-dose vitamin E. Garlic may also combine poorly with certain HIV medications. Two people with HIV experienced severe gastrointestinal toxicity from the HIV drug ritonavir after taking garlic supplements. Garlic might also reduce the effectiveness of some drugs used for HIV. Garlic is presumed to be safe for pregnant women (except just before and immediately after delivery) and nursing mothers, although this has not been proven.

Dosage: A typical dosage of garlic is 900 mg daily of a garlic powder extract standardized to contain 1.3% alliin, providing about 12,000 mcg of alliin daily. However, a great deal of controversy exists over the proper dosage and form of garlic. Most everyone agrees that 1 or 2 raw garlic cloves per day are adequate for most purposes, but virtual trade wars have taken place over the potency and effectiveness of various dried, aged, or deodorized garlic preparations. The problem has to do with the way garlic is naturally constructed. A relatively odorless substance, alliin, is one of the most important compounds in garlic. When garlic is crushed or cut, an enzyme called allinase is brought in contact with alliin, turning it into allicin. The allicin itself then rapidly breaks down into entirely different compounds. Allicin is most responsible for garlic's strong odor. It can also blister the skin and kill bacteria, viruses, and fungi. Presumably the garlic plant uses allicin as a form of protection from pests and parasites. It also may provide much of the medicinal benefits of garlic.
When you powder garlic to put it in a capsule, it acts like cutting the bulb. The chain reaction starts: Alliin contacts allinase, yielding allicin, which then breaks down. Unless something is done to prevent this process, garlic powder won't have any alliin or allicin left by the time you buy it. Some garlic producers declare that alliin and allicin have nothing to do with garlic's effectiveness and simply sell products without it. This is particularly true of aged powdered garlic and garlic oil. But others feel certain that allicin is absolutely essential. However, in order to make garlic relatively odorless, they must prevent the alliin from turning into allicin until the product is consumed. To accomplish this feat, they engage in marvelously complex manufacturing processes, each unique and proprietary. How well each of these methods work is a matter of finger-pointing controversy.
The best that can be said at this point is that in most of the clinical studies of garlic, the daily dosage supplied at least 10 mg of alliin. This is sometimes stated in terms of how much allicin will be created from that alliin. The number you should look for is 4 to 5 mg of "allicin potential." Alliin-free aged garlic also appears to be effective when taken at a dose of 1 to 7.2 g daily.

Contraindications: Blood-thinning drugs such as Coumadin (warfarin), heparin, aspirin, Plavix (clopidogrel), or Trental (pentoxifylline): Do not use garlic except on medical advice. Ginkgo, policosanol, or high-dose vitamin E: Taking garlic at the same time might conceivably cause a risk of bleeding problems. Medications for HIV: Do not use garlic.
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GENTIAN ROOT (Gentiana lutea)

Safety: Gentian is somewhat mutagenic, meaning that it can cause changes in the DNA of bacteria. For this reason, gentian should not be taken during pregnancy. Safety in young children, nursing women, or those with severe liver or kidney disease is also not established. In the short term, gentian rarely causes any side effects, except for occasional worsening of ulcer pain and heartburn. (For some people, it relieves stomach problems.)

Dosage: A typical dosage of gentian is 20 drops of tincture 15 minutes before meals. To make the intensely bitter taste more tolerable, you can mix the tincture in juice or water.

Contraindications:
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*GINGER (Zingiber officinale recen)

Safety: Ginger is on the FDA's GRAS (generally recognized as safe) list as a food, and the treatment dosages of ginger are comparable to dietary usages. No significant side effects have been observed. Like onions and garlic, extracts of ginger inhibit blood coagulation in test tube experiments. This has led to a theoretical concern that ginger should not be combined with drugs such as Coumadin (warfarin), heparin, Plavix (clopidogrel), Trental (pentoxifylline), or even aspirin. European studies with actual oral ginger taken alone in normal quantities have not found any significant effect on blood coagulation but it is still possible that combination treatment could cause problems. Safety in pregnant or nursing women, young children, or individuals with severe liver or kidney disease has not been established.

Dosage: For most purposes, the standard dosage of powdered ginger is 1 to 4 g daily, divided up into 2 to 4 doses per day. To prevent motion sickness, it may be best to begin treatment 1 or 2 days before the trip and continue it throughout the period of travel.

Contraindications: If you are taking strong blood-thinning drugs such as Coumadin (warfarin) heparin, Plavix (clopidogrel), Trental (pentoxifylline), or even aspirin, ginger might possibly increase the risk of bleeding problems.
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*GINKGO BILOBA (Ginkgo biloba)

Safety: Ginkgo appears to be relatively safe. Extremely high doses have been given to animals for long periods of time without serious consequences. Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease, however, has not been established. In all the clinical trials of ginkgo up through 1991 combined, involving a total of almost 10,000 participants, the incidence of side effects produced by ginkgo extract was extremely small. There were 21 cases of gastrointestinal discomfort, and even fewer cases of headaches, dizziness, and allergic skin reactions. ***Ginkgo is most effective when combined with Hawthorne Berry and Gotu Kola in order to obtain the most beneficial aspects of it memory enhancing properties.***
However, ginkgo is a blood thinner, and there have been two case reports in highly regarded journals of subdural hematoma (bleeding in the skull) and hyphema (spontaneous bleeding into the iris chamber) in association with ginkgo use. Contact with live ginkgo plants can cause severe allergic reactions, and ingestion of ginkgo seeds can be dangerous. In addition, the ginkgo extracts approved for use in Germany are processed to remove alkylphenols, including ginkgolic acids, which have been found to be toxic. The same ginkgo extracts are available in the United States. However, other ginkgo extracts and whole ginkgo leaf might contain appreciable levels of these dangerous constituents. German medical authorities do not believe that ginkgo possesses any serious drug interactions. However, because of ginkgo's "blood-thinning" effects, some experts warn that it should not be combined with blood-thinning drugs such as Coumadin (warfarin), heparin, aspirin, Plavix (clopidogrel), and Trental (pentoxifylline), and use of such drugs was prohibited in most of the double-blind trials of ginkgo. It is also possible that ginkgo could cause bleeding problems if combined with natural blood thinners, such as garlic, policosanol, and high-dose vitamin E.

Dosage: The standard dosage of ginkgo is 40 to 80 mg 3 times daily of a 50:1 extract standardized to contain 24% ginkgo-flavone glycosides. Levels of toxic ginkgolic acid and related alkylphenol constituents should be kept under 5 ppm.

Contraindications: Blood-thinning drugs such as Coumadin (warfarin), heparin, aspirin, Plavix (clopidogrel), or Trental (pentoxifylline): Simultaneous use of ginkgo might cause bleeding problems. Natural substances with blood-thinning properties, such as garlic, phosphatidylserine, or high-dose vitamin E: It is possible that, again, simultaneous use of ginkgo might cause bleeding problems. Antidepressant drugs, especially in the SSRI family: Ginkgo might remedy sexual side effects such as impotence or inability to achieve orgasm. Antipsychotics: Ginkgo might help them work better with fewer side effects.
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*GINSENG (Panax ginseng, Panax quinquefolius, Eleutherococcus senticosus)

Safety: The various forms of ginseng appear to be nontoxic, both in the short and long term, according to the results of studies in mice, rats, chickens, and dwarf pigs. Ginseng also does not seem to be carcinogenic. Side effects are rare. Occasionally women report menstrual abnormalities and/or breast tenderness when they take ginseng. However, a large double-blind trial found no estrogen-like effects. Another double-blind trial found no effects on estrogen or testosterone.
Unconfirmed reports suggest that highly excessive doses of ginseng can cause insomnia, raise blood pressure, increase heart rate, and possibly cause other significant effects. Whether some of these cases were actually caused by caffeine mixed in with ginseng remains unclear. Ginseng allergy can also occur, as can allergy to any other substance. In 1979, an article was published in the Journal of the American Medical Association claiming that people can become addicted to ginseng and develop blood pressure elevation, nervousness, sleeplessness, diarrhea, and hypersexuality. This report has since been thoroughly discredited and should no longer be taken seriously.
However, there is some evidence that ginseng can interfere with drug metabolism, specifically drugs processed by an enzyme called "CYP 3A4." Ask your physician or pharmacist whether you are taking any medications of this type. There have also been specific reports of ginseng interacting with MAO inhibitor drugs and also with a test for digitalis, although again it is not clear whether it was the ginseng or a contaminant that caused the problem. There has also been one report of ginseng reducing the anticoagulant effects of Coumadin (warfarin). Safety in young children, pregnant or nursing women, or people with severe liver or kidney disease has not been established. Interestingly, Chinese tradition suggests that ginseng should not be used by pregnant or nursing mothers.

Dosage: The typical recommended daily dosage of Panax ginseng is 1 to 2 g of raw herb, or 200 mg daily of an extract standardized to contain 4 to 7% ginsenosides. In one study of American ginseng (Panax quinquefolius) for diabetes, the dose used was 3 g. Eleutherococcus is taken at a dosage of 2 to 3 g whole herb or 300 to 400 mg of extract daily. Ordinarily, a 2- to 3-week period of using ginseng is recommended, followed by a 1- to 2-week "rest" period. Both Russian and Chinese tradition suggests that ginseng should not be used by those under 40. Because Panax ginseng is so expensive, some products actually contain very little of it. Adulteration of ginseng supplements with other herbs and even caffeine is not unusual.

Contraindications: Ginseng should not be used by pregnant or nursing mothers. Drugs processed by an enzyme called "CYP 3A4": Ginseng might interfere. Ask your physician or pharmacist whether you are taking any medications of this type. MAO inhibitor drugs or digitalis: It is possible that ginseng might cause problems. Insulin or oral hypoglycemics: Ginseng may reduce your dosage need. Coumadin (warfarin): Ginseng might decrease its effect. Influenza vaccine: Ginseng might help it work better.
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*GOLDENSEAL (Hydrastis canadensis)

Safety: Goldenseal appears to be safe when used as directed. One widespread rumor claims that goldenseal can disrupt the normal bacteria of the intestines. However, there is no scientific evidence that this occurs, and many herbalists believe that such concerns are unwarranted. Another fallacy is that small overdoses of goldenseal are toxic, causing ulcerations of the stomach and other mucous membranes. This idea is based on a misunderstanding of old literature.
However, because berberine has been reported to cause uterine contractions and to increase levels of bilirubin, goldenseal should not be used by pregnant women. Safety in young children, nursing women, or those with severe liver or kidney disease is also not established. Side effects of oral goldenseal are uncommon, although there have been reports of gastrointestinal distress and increased nervousness in people who take very high doses.

Dosage: When used as a topical for skin wounds, a sufficient quantity of goldenseal cream, ointment, or powder should be applied to cover the wound. Make sure to clean the wound at least once a day to prevent goldenseal particles from being trapped in the healing tissues. For mouth sores and sore throats, goldenseal tincture may be swished or gargled. Goldenseal may also be used as strong tea for this purpose, made by boiling 0.5 to 1 g in a cup of water. Goldenseal tea can also be used as a douche for vaginal candidiasis. For oral use, to aid the digestive tract or loosen clogged sinuses, a typical dosage of goldenseal is 250 to 500 mg 3 times daily. Goldenseal is generally only taken for a couple of weeks at most.

Contraindications:
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GOTU KOLA (Centella asiatica)

Safety: Orally, gotu kola appears to be nontoxic. It seldom causes any side effects other than the occasional allergic skin rash. However, there are some concerns that gotu kola may be carcinogenic if applied topically to the skin. Gotu kola has not been proven safe for pregnant or nursing women Safety in young children and those with severe liver or kidney disease has not been established.

Dosage: The usual dosage of gotu kola is 20 to 60 mg 3 times daily of an extract standardized to contain 40% asiaticoside, 29 to 30% asiatic acid, 29 to 30% madecassic acid, and 1 to 2% madecassoside. Be patient, because gotu kola takes at least 4 weeks to work. For the prevention of keloid scars, the herb is usually taken for 3 months prior to surgery, and for another 3 months afterwards.

Contraindications: Gotu kola has not been proven safe for pregnant or nursing women Safety in young children and those with severe liver or kidney disease has not been established.
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H

HAWTHORNE BERRIES (Fructus Crataegus oxyacantha)

Safety: Hawthorn appears to be safe. Germany's Commission E lists no known risks, contraindications, or drug interactions with hawthorn, and mice and rats have been given phenomenal doses without showing significant toxicity.11 However, since hawthorn affects the heart, it shouldn't be combined with other heart drugs without a doctor's supervision. People with especially low blood pressure should also exercise caution. Side effects are rare, mostly consisting of mild stomach upset and occasional allergic reactions (skin rash). Safety in young children, pregnant or nursing women, or those with severe liver, heart, or kidney disease has not been established.

Dosage: The standard dosage of hawthorn is 100 to 300 mg 3 times daily of an extract standardized to contain about 2 to 3% flavonoids or 18 to 20% procyanidins. Full effects appear to take several weeks or months to develop.

Contraindications: If you are taking any heart medications, it is possible that taking hawthorn could cause problems.
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K

KAVA (Piper methysticum)

Safety: When used appropriately, kava appears to be reasonably safe. Animal studies have shown that dosages of up to 4 times that of normal cause no problems at all, and 13 times the normal dosage causes only mild problems in rats. A study of 4,049 people who took a rather low dose of kava (70 mg of kavalactones daily) for 7 weeks found side effects in 1.5% of cases. These were mostly mild gastrointestinal complaints and allergic rashes. A 4-week study of 3,029 individuals given 240 mg of kavalactones daily showed a 2.3% incidence of basically the same side effects. However, long-term use (months to years) of kava in excess of 400 mg kavalactones per day can create a distinctive generalized dry, scaly rash called "kava dermopathy." It disappears promptly when the kava use stops.
Kava should not be used by individuals who have had "acute dystonic reactions." These consist of spasms in the muscles of the neck and movements of the eyes, and are believed related to effects on dopamine. They are typically caused by antipsychotic drugs, which affect dopamine. Kava might trigger such reactions too. Kava may very occasionally cause liver inflammation or damage. A 50-year-old man who had been taking a reasonable dose of a well-regarded kava product for 2 months experienced liver failure requiring liver transplant surgery. Due to the absence of any other cause of liver damage, it appears likely that kava was the source of the problem. Liver inflammation was also seen in another person using kava, but the cause-and-effect relationship in that case was not as clearly defined. Based on these reports, we recommend that individuals with any liver-related condition should avoid the use of kava.
Kava does not appear to produce mental cloudiness. Nonetheless, it is not recommended to drive after using kava until you discover how strongly it affects you. It makes some people quite drowsy. Contrary to many reports in the media, there is no evidence that kava actually improves mental function. Two studies are commonly cited as if to prove this, but actually there was only one study performed: It was simply described in two separate arti

 

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