Are Herbal Medicines Safe By Evangeline Amor

Are Herbal Medicines Safe? Evangeline C. Amor Associate Professor Institute of Chemistry, University of the Philippines Diliman, Quezon City 1101 [email protected]

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History of Medicine • 8000 BC (Prehistoric medicine)

Trepanning: an ancient human skull viewed from above. Science, Technology and Society Lecture

History of Medicine • 2000 BC (Egyptian medicine)

Medical papyrus.

Egyptian heiroglyphs, like this one, show medical procedures.

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History of Medicine • 450 BC – 300 AD (Greeks and Romans) Blood gave a person a lively personality and lots of energy. They would enjoy life and the arts. Phlegm made a person feel lethargic or have a dull personality. Black bile caused depression and sadness. Yellow bile influenced a person's temperament. It caused anger and a fiery temper. Science, Technology and Society Lecture

Imagine that you are a Greek doctor. For each of these people, decide which of the humours are not in balance. a. Suffering from depression b. Really tired and slow all the time c. Disruptive and always getting into fights

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History of Medicine • 450 BC – 300 AD (Greeks and Romans)

Galen. One of the first physicians to use dissections to understand how the body works.

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History of Medicine • 500 – 1400 AD (The Middle Ages)

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History of Medicine • 700 – 1500 AD (Arabic Medicines)

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History of Medicine • 1400 – 1700 AD (The Renaissance)

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History of Medicine • 1700 – 1900 AD (18th and 19th century)

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History of Medicine • 1900 – 2000 AD (The 20th century)

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R A P I S T 

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History of Medicine • 2000 – 2100 AD (21st century medicine)

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Cause of Death (1900)

1– 3– 5– 7– 9–

Pneumonia (all forms) and Influenza Diarrhea, enteritis & ulcer of the int. Intracranial lesions of vascular origin All Accidents Senility

2 – Tuberculosis (all forms) 4 – Diseases of the Heart 6 – Nephritis 8 – Cancer and tumors 10 - Diphtheria

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Cause of Death (1992)

1– 3– 5– 7– 9–

Diseases of the heart Stroke All accidents Diabetes Mellitus Suicide

2 – Cancer and other malignant tumors 4 – Chronic obstructive lung diseases 6 – Pneumonia (all forms) 8 – HIV infections including AIDS 10 – Homicide (and legal intervention)

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Some questions…. • Are all medicines drugs and vice versa? – Medicines are agents that is used to treat disease or injury – Drugs are substances used in the treatment or prevention of disease or as a component of medication

• How is the safety of a medicine/drug determined?

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Clinical trials • • • •

• • •

"The drug must be free from any extraneous accidental quality." "It must be used on a simple, not a composite, disease." "The drug must be tested with two contrary types of diseases, because sometimes a drug cures one disease by its essential qualities and another by its accidental ones." "The quality of the drug must correspond to the strength of the disease. For example, there are some drugs whose heat is less than the coldness of certain diseases, so that they would have no effect on them." "The time of action must be observed, so that essence and accident are not confused." "The effect of the drug must be seen to occur constantly or in many cases, for if this did not happen, it was an accidental effect." "The experimentation must be done with the human body, for testing a drug on a lion or a horse might not prove anything about its effect on man."

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Folk Medicine = Alternative Medicine • Every approach to healing that does not fall within the realm of conventional medicine • Unconventional, unorthodox, unproven,

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5 Domains from NCCAM Alternative Medical Systems

Ayurveda, Chinese, Native American, Aboriginal, African, Middle Eastern, Tibetan, Central and South American cultures, Homeopathy, Naturopathy

Mind-Body Interventions

cognitive-behavioral approaches, meditation, hypnosis, dance, music, art therapy, prayer, mental healing

Biological Based Therapies

dietary supplements, herbs, orthomolecular (varying concentrations of chemicals, such as, magnesium, melatonin, and mega-doses of vitamins), individual biological therapies (use of laetrile, shark cartilage, bee pollen).

Manipulative And BodyBased Methods

chiropractic, osteopathic, manipulation, massage

Energy Therapies

Qi gong, Reiki, therapeutic touch, bioelectromagnetic-based therapies (pulsed fields, magnetic fields, or alternating current or direct current fields) Science, Technology and Society Lecture

Types of CAM Acupuncture Aromatherapy Biofeedback Chiropractic Diets Exercise Folk remedies

Imagery Magnets Massage Prayer Reflexology Relaxation Self-help/support groups

Herbal/botanical therapy

Spiritual healing (by others)

Homeopathy Hypnosis

Vitamins Yoga Science, Technology and Society Lecture

Who uses CAM?

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Why are people using CAM? (Stephen Strauss) • PUSH – Dissatisfaction with health care providers and medical outcomes – Side effects of drugs and treatments – High health costs – Technology – Lack of control in their own health care practices – Time spent with practitioner

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PULL Factors • • • •

Looking for “cures” Want to use “natural” products Patient feels empowered Focus on spirituality and emotional wellbeing • Health Care Provider provides the 3 T’s (Dr. Strauss): touch, talk, time

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The Case For Herbal Medicine • Tradition: used throughout history • Natural: perceived as gentler and safer • Cost: often less expensive than prescription medicine • Access: patient maintains control & no prescription necessary • Synergism: a view that multiple ingredients working together yield better results Science, Technology and Society Lecture

The Case Against Herbal Medicine • Lack of Regulation and Oversight – Lack of Dosage Standardization – Potential for adulteration

• Potential for toxicity and drug interactions: natural is not always safer • More effective therapy may be delayed • Many herbs are not superior to prescription medicines Science, Technology and Society Lecture

Regulatory Issues • Dietary Supplement Health Education Act (DSHEA) of 1994 – Herbal products are legally food supplements – Manufacturer may state usage and safety, but not make curative claims – Manufacturer alone is responsible for product safety – FDA must prove product unsafe to remove it from the market

• Europe: Herbs regulated as pharmaceuticals

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Herbal medicine in the Philippines • Traditional and Alternative Medicine Act (TAMA) of 1997 • Philippine Institute of Traditional and Alternative Health Care (PITAHC) under the DOH • National Integrated Research Program on Medicinal Plants (NIRPROMP) funded by DOST • Bureau of Food and Drug (BFAD) Science, Technology and Society Lecture

Agriculture (raw material)

Pharmacy (formulation)

Clinical Trials

Technology Transfer (Herbal Drug)

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Pharmacology (bioassay, toxicity, mutagenicity)

• 1996: Herbal products lagundi (AscofTM) and sambong (Re-leafTM) were introduced to the market by Pascual Laboratories.

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Medicinal Chemistry Research  Plant, Marine, Microbial Origin  Extraction  Fractionation  Isolation  Bioassays  Structure Elucidation  Further Studies

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What plant to study? Ethnobotanical Phytochemical Taxonomic Random

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Where and what to sample? Accessibility and availability Plant part – root, flower, leaves, stem, bark, fruit

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Where and what to sample? Choose healthy samples – microbial and other infections may change the metabolites produced by the specimen.

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Where and what to sample? Variations in collection site (altitude, plant age, climate soil type) – may change the concentration levels of secondary metabolites and even the kinds of compounds synthesized.

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Where and what to sample? EO 247 (18 May 1995) : Proper compensation of indigenous people Prior informed consent Research agreement with the Philippine government (Academic or Commercial)

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Identification and Authentication of the sample Deposit voucher specimen to a herbarium (place, altitude, environment, characteristics, etc.)

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Validation (Bioassay)

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Acetic Acid Induced Writhing Test ICR strain, 14 – 18 g

% reduction in squirms no. of squirms for (acetic acid + solvent control) no. of squirms for (acetic acid + test sample) X 100 no. of squirms for (acetic acid + solvent control)

after 30 min

Oral gavage of sample

after 5 min

count squirms for 15 min

i.p administration of 0.7% acetic acid

Guevara B.Q. and B.V. Recto. 1985. Phytochemical, Microbiological, and Pharmacological Screening of Medicinal Plants. UST, Manila.

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Herbal Remedies for Pain • Cayenne (Capsicum annuum) • Active component is capsaicin, which when applied to the skin acts as a local analgesic because it desensitizes nerve endings • Believed to stimulate production of Substance P

http://www.herbalremediesinfo.com

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Herbal Remedies for Pain

http://www.herbalremediesinfo.com

• Echinacea (angustifolia/purpurea) • Caffeic acid derivatives, polyacetylenes, alkylamides polysaccharides essential oils, flavonoids, and glycoproteins. • Stimulate immune response and reduce inflammation

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Herbal Remedies for Pain • Kava (Piper methysticum) • Analgesic, sedative and euphoriant • Long term use associated with liver and skin damage http://www.herbalremediesinfo.com

http://www.kava.co.uk

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Herbal Remedies for Pain • Turmeric (Curcuma longa) • High in antioxidants, has anticancer and anti-inflammatory properties • Long term use cause stomach distress http://www.herbalremediesinfo.com

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Herbal Remedies for Pain • Kataka-taka leaves (Kalanchoe pinnata (Lam.) Pers.) • Used for toothache http://www.livinginthephilippines.com/ herbalmedicine/herbal_remedies.html

http://www.filipinoherbshealingwonders.filipinovegetarianrecipe.com/ herbs_pics/katakataka.jpg

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Herbal Remedies for Pain • Yerba buena leaves (Mentha cordifolia) • Used for headache, tootache and arthritic pains • Tablet, capsule, teaform http://www.pcarrd.dost.gov.ph/prosea/proseaherbal/yerba_buena_doc.htm

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Hypoglycemic Assay (post-prandial)

Measure BGL (tail venipuncture method) Test Groups: - Glucose control group - Positive control group (euglocon) - Negative control group (solvent) - Plant extracts (methanol)

Feed 40% glucose Measure BGL (after 15 min) Feed sample

Measure BGL (15-min interval)

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Infant Mortality: Ten (10) Leading Causes Number & Rate/1000 Livebirths & Percentage Distribution Philippines, 2003

Number

Cause

Diarrhea statistics

Rate

Percent

1. Other perinatal conditions

9,695

5.8

42.4

2. Pneumonia

2,314

1.4

10.1

3. Bacterial sepsis of newborn

1,439

0.9

6.3

4. Congenital malformation of the heart

1,127

0.7

4.9

5. Diarrhea and gastroenteritis of presumed infectious origin

984

0.6

4.3

6. Congenital Pneumonia

783

0.5

3.4

7. Other congenital malformation

550

0.3

2.0

8. Respiratory distress of newborn

462

0.3

2.0

9. Neonatal aspiration syndromes

440

0.3

1.9

10. Disorders related to short gestation and low birth weight

433

0.3

1.9

Image courtesy of www.sandylevel.org/.../ img_photos_sept_02/

Source: The 2003 Philippine Health Statistics * percent share from total infant deaths, all causes, Philippines Last Update: January 11, 2007 www.doh.gov.ph

MORBIDITY TEN LEADING CAUSES OF MORBIDITY No. & Rate/100,000 Population PHILIPPINES, 2003

CAUSE

Source: 2003 FHSIS Annual Report **rate/100,000 of sex-specific pop. * Total population of regions with reports only Last Update: January 11, 2007 (www.doh.gov.ph)

MALE

FEMALE

Rate**

Rate**

BOTH SEXES Number

Rate*

1. Acute Lower RTI and Pneumonia

770.9

748.2

674,386

861.2

2. Diarrheas

695.0

655.0

615,692

786.2

3. Bronchitis/Bronchiolitis

639.6

677.0

604,107

771.4

4. Influenza

455.4

503.1

431,216

550.6

5. Hypertension

325.4

420.7

325,390

415.5

6. TB Respiratory

126.4

84.0

92,079

117.9

7. Heart Diseases

28.8

29.2

30,398

38.8

8. Malaria

41.1

30.4

28,549

36.5

9. Chickenpox

30.3

30.4

26,137

33.4

10. Measles

30.2

30.4

25,535

32.6

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Herbal Remedies for Diarrhea • Cymbopogon nardus • Anti-inflammatory, analgesic. • Used for treatment of headache, stomach ache, diarrhea, rheumatism. irregular menses, post partum edema. • Main source of citronella oil.

http://www.rimbundahan.org

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Herbal Remedies for Diarrhea • Cinnamomum verum (cinnamon) • Roots treat rheumatism and fever. Tree bark used in many medicinal powders and tinctures, tonics for diarrhea and colic. http://www.rimbundahan.org

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Herbal Remedies for Diarrhea • Piper betel • Leaves are eaten with gambir for treating diarrhea. Mild stimulant, applied in poultices for stomach pains, coughs and asthma. Leaf sap applied to soothe oral sores and ulcers.

http://www.rimbundahan.org

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Herbal Remedies for Diarrhea

http://www.rimbundahan.org

• Curcuma longa (Turmeric) • One of the oldest spice plants known, dried rhizomes ground for curries, dyes, used to relieve flatulence and diarrhea • High in antioxidants, has anticancer and antiinflammatory properties Long term use cause stomach distress

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Herbal Remedies for Diarrhea • Geranium maculatum • Common astringent, sore throat and canker sores, Antiinflammatory, used for diarrhea, hemorrhoids, ulcers, douche, excessive menstruation.

http://www.herbies-herbs.com

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Herbal Remedies for Diarrhea • Drimys piperita (sapal) • Used for symptomatic relief of diarrhea • 15-Nonacosanol and bis(tridecyl)phthalate as active constituents www.cls.zju.edu.cn

L.P Pladio and I.M. Villaseñor. PJS 133 (1), 2004.

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Charcoal Tracing Method ICR strain, 17 – 20 g after 20 min

after 1 hr

Oral gavage of sample

Oral gavage of charcoal meal

Measure distance traveled by charcoal meal from pylorus to caecum Noel, M. and Villaseñor, I. Bioassay and Phytochemical Techniques. NRCP, 1996

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Are Herbal Medicines Safe?

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