Friday 26 April 2019

Herb-Drug Interactions and St John’s Wort

Article & Photo by Ann Walker
According to media reports, interactions between herbs and drugs are common and threaten anyone taking prescription drugs. In reality, drug interactions with foods are more prevalent, having led to several deaths (in particular, cranberry juice with warfarin and grapefruit with blood pressure drugs). Whilst no herb-drug deaths are recorded, non-fatal herb-drug interactions occur at around four cases a year and mostly involve the drug warfarin taken with St John’s wort. Despite the rarity of records, interaction ‘lists’ are padded with speculative claims based on test-tube or animal studies.

Often the quantities of herbs used in these studies are far higher than used in clinical practice or in over-the-counter products. Actually, the likelihood of herb-drug interaction is low with normal use of most herbs taken at recommended doses. Unfounded comments and prejudices expressed by scientists often mislead journalists into publishing damaging misinformation on herbal medicine. In particular, surveys of the use of herbs do not equate with drug interactions, despite scientists’ conclusions often pointing that way.

In the case of St John’s wort, we do have clinical (human) evidence of interactions with prescribed drugs. The herb’s use for depression is well supported by clinical trials (well over 30 to date). So much so that the herb provides a very viable alternative to modern antidepressants in many situations and the side effects are much lower. However, a study published in the Lancet in 2000 gave the first indication of how the concurrent use of St John’s wort with certain drugs could lower the level of the drug in the bloodstream (PMID: 10683007).

It was later found that the herb increases particular detoxication pathways in the liver (where there are many such pathways) and thus increases the rate of elimination of drugs which are disposed of by these same pathways. Not all drugs are affected by any means, but there are some important ones that are: cyclosporin, digoxin, warfarin and the contraceptive pill. Despite these known interactions, St John’s wort is a success story. Its use for depression is well founded and quality extract are on sale to the general public, with Traditional Herbal Registration (look for THR on the pack). Each pack containing a comprehensive leaflet stating clearly when it should be not used. As long as you follow these guidelines, St John’s wort remains a very useful herb – not only is it antidepressant, but it is anti-viral, anti-inflammatory and can (alongside other herbs) help with back pain, shingles, anxiety, low vitality and insomnia. I use it a lot in my practice.

PMID = PubMed identifier

Ann Walker PhD, FCPP, MNIMH, RNutr
Course Director DHM
Herbal Practitioner

Friday 19 April 2019

Olive Leaf Shortens the Duration of Colds

Article & Photo by Ann Walker

Olive tree leaves have long been used in the Mediterranean region as traditional medicine. The leaves contain higher amounts of polyphenols (healthful plant chemicals) than even extra virgin olive oil or the olives themselves. Clinical and laboratory evidence already supports the cardio-protective, anti-oxidant and anti-inflammatory properties of these compounds, which are thought to confer the health-giving properties to olive oil. More recently, research attention has turned to the immune-supporting properties of olive leaf. In one study, white cells were taken from blood samples of 25 healthy volunteers and cultured in the laboratory with extracts of olive leaf. The extracts favourably modified the immune biochemicals from these cells (compounds such as interferon and cytokines) so as to support the notion of olive leaf as potential treatment for infections and chronic inflammatory diseases.   PMID: 29149822

This hypothesis was put to the test in a two-month, double-blind, randomized controlled trial in New Zealand on young elite athletes (PMID: 30744092). In this study, olive leaf extract was used to study the incidence and duration of colds to which athletes are particularly prone. The intervention group received extract tablets equivalent to 20 g per day of olive leaf. Whilst there was no difference in the incidence of colds between the active and control groups, there were 28% fewer sick days in the olive leaf group. This was because the average duration of illnesses was 9.7 days in the olive leaf group compared to 12.3 days in the placebo group.

It is good to see evidence coming through for herbal remedies to combat upper respiratory viral infections, even though the study in this case was small (29 people completed the study). There is little that modern medicine can offer against these common viruses that we all suffer – or indeed, viral infections in general. Other natural remedies studied in clinical trials showing benefit for common viral infections include pelargonium and andrographis, but results of trials are equivocal for vitamin C and echinacea, despite their popular use by the public and herbal practitioners. New angles like this on olive leaf provide further natural solutions for viral infections and are always very welcome.

PMID = PubMed identifier

Ann Walker PhD, FCPP, MNIMH, RNutr
Course Director DHM
Herbal Practitioner

Friday 12 April 2019

Valerian and Insomnia

Article and Photo by Ann Walker
The documented use of Valerian for sleep problems goes as far back as Galen, the physician/philosopher of the Roman Empire, who recommended the herb for insomnia in the 2nd century AD. Despite this long history of use, modern research findings have been equivocal as to the herb’s benefit for sleep. Indeed, some studies have shown no benefit at all (e.g. PMID: 18482867). These ‘no effect’ findings are likely to be due to the dose being too low, as, given at a realistic level, even one dose can markedly reduce nerve excitability in the cortex region of the brain (PMID: 29035887). The cortex plays a key role in memory, thought, language and consciousness: characteristics which relate to sleep patterns.

Contradictory study results seem to afflict valerian. Although one study showed that nearly a month of regular daily consumption was necessary to combat insomnia, another study found a more immediate effect. In a large study, of 128 subjects, valerian extract given before bedtime, worked immediately to improve sleep compared with placebo, which is more in keeping with how the herb is used in practice (PMID: 7122669).

Ambivalent responses to valerian are well known to herbal practitioners: while most patients respond well to valerian taken before bedtime, it does nothing for a minority. Nevertheless, if insomnia is a problem, it is well worth giving it a try and, based on the research mentioned above, perhaps for up to a month before discarding it as ineffective. Fortunately, if valerian proves ineffective for insomnia, all is not lost, as there are several other herbs, mostly taken in combination, which can combat insomnia.

PMID = PubMed identifier

Ann Walker PhD, FCPP, MNIMH, RNutr
Course Director DHM
Herbal Practitioner

Friday 5 April 2019

Nicholas Culpeper Part 3 - Culpeper's Last Legacy

Photo and Article ⓒ Debs Cook
Shortly after Culpeper’s death Alice Culpeper remarried the astrologer John Heyden who Culpeper knew when they were both members of the Society of Astrologers, and according to Benjamin Woolley in his book 'The Herbalist', Heyden was actually living in Culpeper’s house prior to Culpeper’s demise. Woolley seems to think that Alice and Nicholas became estranged, and uses the odd entry on Wormwood found in older editions of the ‘English Physician’ to present a man bitter towards his wife, and the wife accusing Culpeper of abuse. What the truth is one can only speculate, however after Culpeper died, Alice seems to have done her best to cash in on her late husband’s previous works and reputation, and claimed that he had left behind over 70 books or manuscripts that he had left for her to publish.

Alice joined forces with Heyden and a Dr. Freeman to sell an alchemical potion called ‘Aurum Potabile’ a remedy in the 17th century that was believed to be a universal remedy for all diseases, the remedy was made from a herbal suspension in which trace amounts of gold were added. In a hand bill that was circulated around London, it was claimed by camp Alice that Culpeper and Dr. Freeman had discovered the wonders of this remedy during his studies and she gave Culpeper the title of Dr. Culpeper, the first time he was known as Nicholas Culpeper M.D. he never referred to himself as such, one feels he would have been turning in his grave being labelled as part of the establishment he fought against all his life.

Keeping a monopoly of the Culpeper ‘brand’ was of the utmost importance and to do this, Alice teamed up with Culpeper’s publisher Peter Cole who had already begun printing books that he claimed were penned by Culpeper, including translations of seven European herbals from the 16th century written in Latin. Cole offered to help Alice promote her cure-all potion in exchange for her endorsement on the works he published in Culpeper’s name.

By 1655 just 1 year after Culpeper’s death, Alice’s monopoly began to waiver, another publisher of Culpeper’s work, a Nathaniel Brooke published a book called 'Culpeper’s Last Legacy', which he claimed had been written by Culpeper and left for his wife to publish. To add insult to injury, Brooke published a letter akin to an endorsement allegedly written by Alice which stated that “the copy of what is here printed… was delivered to my trust among [Nicholas’s] choicest secrets upon his death bed.” Alice vehemently denied that she had written the letter published and denied that the book was written by Culpeper. So much so several months after the Last Legacy was published, Alice published a pamphlet entitled ‘Mr Culpeper’s Treatise of Aurum Potabile’ which began with an assault on Brooke, accusing him of publishing “a hodge-podge of ingested collections and observations.

Her pamphlet echoed previous claims that Culpeper had left “seventy-nine books of ‘his own making, or translating, in my hands” adding that there were also another 17 completed works that were ready to be published and would be published exclusively by herself and Culpeper’s “much honoured friend”, referring to Peter Cole. The rest of the pamphlet was a travesty, Culpeper in his lifetime had poured scorn and ridicule on charlatan’s who promoted cure-alls like aurum potabile, so promoting such a cure made no sense at all. The pamphlet is not written in Culpeper’s style nor did it match his medical beliefs. What happened next is of little consequence to this article on the life of Culpeper, so I’ll move on.

Suffice to say, and remember I said earlier that the contents of the 1652 edition of ‘The English Physician’ were important? After Brooke published his work it became open season for a good selection of people to cash in on Culpeper’s name by publishing books that became known as 'Culpeper’s Complete Herbal', my 1698 edition is the same as the 1652 edition, nothing added and nothing taken away and still known as 'The English Physician'. It wasn’t until around 1789 that editions of the ‘Complete Herbal’ began to appear with coloured plates when Ebenezer Sibly published his version of Brooke’s and Culpeper’s works across 2 volumes, adding his own words and additional herbs and including the coloured plates, as well as Medical references and illustrations.

1814 saw the publication of "Culpeper’s Complete Herbal, to which is now added, upwards of one hundred additional herbs, with a display of their Medicinal and Occult Qualities; physically applied to the cure of all disorders incident to mankind: to which are now first annexed, the English physician enlarged, and key to physic, with rules for compounding medicine according to the true system of nature. Forming a complete family dispensatory, and natural system of physic. To which is also added upwards of fifty choice receipts [recipes], selected from the author's last legacy to his wife. Embellished with engravings of upwards of four hundred different plants with other subjects to illustrate the work.” By Richard Evan’s of White Row, Spitalfields. Evans version was attributed to Culpeper, the only part of the book that is Culpeper’s is all that was in ‘The English Physician’, the rest is from Nathaniel Brooke’s 'Culpeper’s Last Legacy'.

The 1826 edition published by J. Gleave and Son of Deansgate in Manchester was different, the listing for herbs started with Agrimony an herb that doesn’t even feature in the original ‘English Physician’, after yarrow, yew and yucca were also included, and again neither featured in Culpeper’s original book. In 1835 Thomas Kelly publishers issued a reprint of the Complete Herbal which like the 1814 edition is Brooke’s work and not all Culpeper’s, Kelly’s edition followed the Brooke’s edition using herbs from Amara Dulcis to Yarrow, the extra herbs were listed in the back albeit briefly.

Throughout the 19th and 20th centuries Brooke’s book has been republished and always attributed to Culpeper, all of them containing only his original book 'The English Physician', although I believe that Silby referenced Culpeper’s ‘A Directory for Midwives’ and Brooke’s dipped in to Culpeper’s translation of the 'Pharmacopoeia Londonesis' for the remedies he published. If the reader wants to see examples of cures and remedies that Culpeper recommended they would be best suited finding a copy of 'Pharmacopoeia Londonesis' rather than modern day versions of what Culpeper was supposed to have written!

I started out this three part article as I said earlier with a different view of Nicholas Culpeper than I have now, from considering him nothing more than a plagiarist to discovering he was not only plagiarised, but also had words and entire books attributed to him that he never wrote, as well as having things published that totally went against his beliefs so that others could benefit from his name. With more time a more rounded story could be told of this man, and I intend to revisit 'The English Physician' in the future as well as take a closer look at the remedies in 'Pharmacopoeia Londonesis' and what Culpeper had to say about the College of Physicians. For now I will bring this missive on Culpeper to a close gentle reader and trust that you have learnt something new, and maybe like me now see Culpeper in a new light?

Debs Cook is the IT Media Manager for the DHM, she is a self confessed herbaholic who loves to write about the way herbs were once used and about the herbalists that used them. You can find out more about Debs over on her Herbal haven blog.