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Heathtwise: Herbs & Hepatitis C
By Lucinda K Porter, RN
The use of herbs is controversial in the medical community largely because of the lack of evidence-based research supporting efficacy. Couple this fact with the potential harm these substances might inflict, and its easy to see why physi-cians are reluctant to endorse the use of herbs. On the other hand, many patients are interested in alternative therapies to use with, or in place of, a standard treatment their doctors have prescribed.Since many herbs can cause liver damage, this review with list of apparently safe and potentially toxic herbs is to help the hepatitis patient make informed choices. Many herbs can be harmful in other ways, such as by having potentially carcinogenic properties or by causing neurological damage. The list of herbs reviewed below is primarily specific to patients with liver disease and by no means exhaustive. The substances on this list are referred to in their oral form only.
Herbs and supplements can be powerful. As with any medication, be certain your healthcare practitioner is aware of what you are taking or plan to take. Do this even if you feel that your healthcare provider is not supportive of the use of supplements or herbs. Healthcare practitioners are becoming increasingly aware of the use of herbs and the potential for interac-tions with other drugs and supplements. Herbs and supplements are considered to be dietary supplements. This means that they are virtually unregulated by any federal agency. Since herbs can vary in strength and purity, it is wise to take a standardized and certified form. Certification and standardization is voluntary.
The goal of the United States Pharmacopeia (USP) is to set industry standards for drugs and dietary supplements in the U.S. The label of a supplement that states it meets the standards of the USP is worth considering. If it meets the USP standards, the product is allowed to display a National Formulary (NF) seal. Another standard is that of the world’s leading authority on herbs, the German Commission E. This agency is the German equivalent of the Food and Drug Administration (FDA). The American Herbal Pharmacopoeia is also developing standardiza-tion guidelines for the American marketplace.
Recently, a company named ConsumerLab.com has provided a much-needed service by testing popular supplements. This company has discovered that many products do not contain the levels of key ingredients that are on the products’ labels. A product that passes their inspection may carry the triangular label with the ConsumerLab.com quality of ap-proval. This service is in its infancy and at the time of this article only a few products have been tested. Companies that belong to the American Herbal Products Association and who submit to this organization’s code of ethics are another good choice. These are listed at www.ahpa.org/links2.html
Herb Tips
- Tell your doctor all the herbs and supplements you take, even if you think your doctor might disapprove. Drugs and supplements can interact with each other as well as affect other health conditions.
- Follow the label’s dosage recommendations; more is not better.
- Know your source; herbs may be contaminated. Before ingesting anything, ask yourself what you know about what you are about to take.
- Buy products that submit to voluntary self-regulation.
- Natural does not equal healthy or safe. Dirt is natural, but would you eat it?
- Do not be swayed by bargain prices; not all herbs are equal.
- Check the expiration date on the container.
- Do not rely on the health food store staff for health care information. Although they may be helpful, remember that they are not licensed to practice medicine. Do not treat your condition on the advice of a salesperson.
- Apply the same commonsense approach to herbs as you would to any drug. Consider that if you are reluctant to take acetaminophen, why would you take an herb?
- Herbs and supplements should not be given to children or taken by pregnant or nursing women without a physician’s approval. Older adults and those with various health conditions should also exercise extra caution before taking non-prescribed supplements.
- Report any suspected adverse reactions to an herb or supplement to the FDA’s monitoring program, Medwatch. Call 800-322-1088 or www.fda.gov/ medwatch.
Milk Thistle (Silybum marianum), is the most commonly used herb for liver disease. The use of milk thistle for chronic hepatitis C virus (HCV) infection has not been well researched. Milk thistle may interact with other drugs. If you take milk thistle, look for a standardized dose. A product label that states it meets more stringent manufacturing requirements is even better. Tell your all your doctors you take milk thistle, especially if you are taking other medications. Interferon
Warning: Although Chinese herbs are sometimes used successfully to treat symptoms, these also need to be used with great caution. This article does not cover most of the Chinese herbs. One exception is worth noting.
Xiao Chai Hu Tang (Minor Bupleurum) is a popular herb used in Traditional Chinese Medicine for liver conditions. At least 16 deaths have been reported in Japan for HCV patients being treated simultaneously with alpha interferon and Xiao Chai Hu Tang (Minor Bupleurum).
Herbs with Known Toxicity
Alkanna (Alkanna tinctoria) *
Borage (Borago officianalis) *
Chaparral (Larrea tridentata)*
Colt’s Foot (Tussilago farfara)*
Comfrey (Symphytum officinale and S. uplandicum)*
Dong Quai (Angelica polymorpha) Dusty Miller (Senecio cineraria)
Ephedra aka Ma Huang (Ephedra Sinica) Forget-Me-Not (Myosotis arvensis)*
Germander (Teucrium chamaedrys)*
Groundsel (Senecio vulgaris)*
Hemp Agrimony (Eupatorium cannabinum)*
Hops (Humulus lupulus)
Jin Bu Huan (Lycopodium serratum)
Life Root (Senecio aureus and S.nemorensis)*
Mistletoe (Phoradendron leucarpum and viscum album)
Mormon Tea (Ephedra nevadensis)
Pennyroyal (Mentha pulegium)*
Petasites (Petasites hybridus) *
Pokeroot (Phytolacca americana)
Ragwort (Senecio jacoboea)*
Rue (Ruta graveolens)
Sassafrass (Sassafrass albidum)
Skullcap (Scutellaria lateriflora)*
Yohimbe (Pausinystalia yohimbe)
*Signifies Potential Hepatotoxicity
Herbs with Known Toxicity if taken at High Doses (also possibly toxic at low doses)
Alpine Cranberry (Vaccinium vitis-idaea)
Cayenne (Capiscum annum)
Mercury Herb (Mercurialis annua)
Schisandra (Schisandra chinensis)
Sweet Clover (Melilotus officianalis)
Tonka Beans (Dipteryx odorata)
Trailing Arbutus (Epigae repens)
Witch Hazel (Hamamelis virginiana)
Woodruff (Galium oderata)
Uva Ursi (Uva Ursi srcostaphylos)
Herbs that May be Safe (Unproven health benefits)
Artichoke (Cynara scolymus)
California Poppy (Eschcholtzia californica)
Chamomile (Matricaria chamomilla)
Dandelion (Taraxacum officinale)
Licorice (Glycyrrhiza glabra) (not recommended for long-term use,
especially for people with high blood pressure)
Maitake (Grifloa frondosa)
Milk Thistle (Silybum marianum)
Peppermint (Mentha piperita)
Rosemary (Rosemarinus officinalis)
Soybean (Glycine soja)
Resources: The American Pharmaceutical
Association Practical Guide to Natural Medicines by Andrea Peirce The
Green Pharmacy by James A. Duke
Herbs of Choice by Varro E. Tyler The Honest Herbal by Varro Tyler
PDR for Herbal Medications published by the Medical Economics Company
American Botanical Council 512-926-4900 www.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 - This is a very comprehensive website that provides a wide
variety of information on herbs, including evidence-based information
www.herbmed.org
The United States Pharmacopeia 800-822-8772 www.usp.org
Copyright 2001, Lucinda K. Porter, RN All Rights Reserved
Lucinda K. Porter, RN is a research nurse and patient educator at Stanford
in the area of hepatology. She co-facilitates a support group and is
active in many aspects of hepatitis C education. In addition to being HCV
positive, she has a life which include her husband and teenaged daughter.