Alfalfa is a legume that has a long history of dietary and medicinal uses. A small number of animal and preliminary human studies report that alfalfa supplements may lower blood levels of cholesterol and glucose. However, most research has not been well-designed. Therefore, there is not enough reliable evidence available to form clear conclusions in these areas.
Alfalfa supplements taken by mouth appear to be generally well tolerated. However, ingestion of alfalfa tablets has been associated with reports of a lupus-like syndrome or lupus flares. These reactions may be due to the amino acid L-canavanine, which appears to be present in alfalfa seeds and sprouts, but not in the leaves. There are also rare cases of pancytopenia (low blood counts), dermatitis (skin inflammation), and gastrointestinal upset.
SynonymsReturn to top
Al-fac-facah, alfalfa weevil, arc, buffalo herb, California clover, Chilean clover, Fabaceae (family), feuille de luzerne (French), isoflavone, jatt, kaba yonca, Leguminosae (family), lucerne, medicago, mielga, mu su, phytoestrogen, purple medic, purple medick, purple medicle, sai pi li ka, saranac, Spanish clover, team, weevelchek, yonja.
EvidenceReturn to top
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Uses based on scientific evidence Grade*
Atherosclerosis (cholesterol plaques in heart arteries)
Several studies in animals report reductions in cholesterol plaques of the arteries after use of alfalfa. Well-designed research in humans is necessary before a firm conclusion can be drawn. C
Diabetes
A small number of animal studies report reductions in blood sugar levels following ingestion of alfalfa. Human data are limited, and it remains unclear if alfalfa can aid in the control of sugars in patients with diabetes or hyperglycemia. C
High cholesterol
Reductions in blood levels of total cholesterol and low-density lipoprotein ("bad cholesterol") have been reported in animal studies and in a small number of human cases. High-density lipoprotein ("good cholesterol") has not been altered in these cases. Although this evidence is promising, better research is needed before a firm conclusion can be reached. C
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Grading rationale
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Allergies, antifungal, antimicrobial, antioxidant, appetite stimulant, asthma, bladder disorders, blood clotting disorders, boils, breast cancer, cervical cancer, cough, diuresis (increased urination), estrogen replacement, gastrointestinal tract disorders, gum healing after dental procedures, increasing breast milk, indigestion, inflammation, insect bites, jaundice, kidney disorders, menopausal symptoms, nutritional support, peptic ulcer disease, prostate disorders, radiotherapy induced skin damage, rheumatoid arthritis, scurvy, skin damage from radiation, stomach ulcers, thrombocytopenic purpura, uterine stimulant, vitamin supplementation (vitamins A,C,E,K), wound healing.
DosingReturn to top
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
A dose of 5-10 grams of dried herb three times daily has been taken by mouth.
Two tablets (1 gram each) of Cholestaid® (esterin processed alfalfa) taken by mouth three times daily for up to two months, then 1 tablet three times daily, has been recommended by the manufacturer.
A dose of 5 to 10 milliliters (one to two teaspoonfuls) of a 1:1 solution in 25% alcohol three times daily has been taken by mouth.
For treating high cholesterol, 40 grams of heated seeds prepared three times daily with food has been taken by mouth.
Children (younger than 18 years)
Alfalfa supplements in children are not recommended due to potential side effects.
SafetyReturn to top
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
Alfalfa should be avoided in people with allergies to members of the Fabaceae or Leguminosae plant families. Caution is warranted in individuals with grass allergies.
Side Effects and Warnings
Alfalfa appears to be well tolerated by most individuals, although rare serious adverse effects have been reported.
Mild gastrointestinal symptoms may occur, such as stomach discomfort, diarrhea, gas, or larger/more frequent stools. Dermatitis (skin inflammation/redness) has been reported and may be due to alfalfa allergy.
Blood sugar levels may be reduced. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary.
Lupus-like effects have been associated with alfalfa use, including antinuclear antibodies in the blood, muscle pains, fatigue, abnormal immune system function, and kidney abnormalities. Therefore, people with a history of lupus (systemic lupus erythematosus) or a family history of lupus should avoid alfalfa supplements.
Other rarely reported adverse effects include abnormal blood cell counts (pancytopenia) and lowered potassium levels (hypokalemia). In theory, thyroid hormone levels may be increased, gout flares may be stimulated, and estrogen-like effects may occur.
Contamination of alfalfa products with potentially dangerous bacteria (including Escherichia coli 0157 : H7 , Salmonella , and Listeria monocytogenes ) has been reported. In one case report, vomiting occurring after the consumption of seaweed and organic alfalfa was attributed to contamination of the capsules with high amounts of entospore forming and streptomyces-like bacteria. Copper, arsenic, and antimony have been found in alfalfa plants.
Many tinctures/liquid extracts contain high levels of alcohol and should be avoided when driving or operating heavy machinery.
Pregnancy and Breastfeeding
Alfalfa supplements are not recommended during pregnancy and breastfeeding due to insufficient evidence and a theoretical risk of birth defects or spontaneous abortion. Amounts found in food are generally believed to be safe. Traditionally, alfalfa is believed to stimulate breast milk production, although this has not been well studied.
Tinctures/liquid extracts may contain high levels of alcohol and should be avoided during pregnancy.
InteractionsReturn to top
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Blood sugar levels may be reduced. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.
Alfalfa contains vitamin K, and therefore may reduce the "blood thinning" effects of the drug warfarin (Coumadin®). Alfalfa may add to the effects of cholesterol-lowering medications such as atorvastatin (Lipitor®) or simvastatin (Zocor®).
Alfalfa may increase the risk of severe sunburns when used with drugs that increase sun sensitivity, such as chlorpromazine (Thorazine®). Due to estrogen-like chemicals in alfalfa, the side effects of drugs that contain estrogens may be increased (such as birth control pills or hormone replacement therapy). In theory, alfalfa may increase thyroid hormone levels and may alter the effects of thyroid drugs such as thyroxine (Synthroid®, Levoxyl®).
Alfalfa may alter potassium and calcium levels like other drugs.
Many tinctures/liquid extracts contain high levels of alcohol and may cause nausea or vomiting when taken with metronidazole (Flagyl®) or disulfiram (Antabuse®).
Alfalfa may also interact with drugs that alter the immune system.
Interactions with Herbs and Dietary Supplements
Blood sugar levels may be reduced. Caution is advised when using herbs or supplements that may also lower blood sugar such as aloe or bitter melon. Blood glucose levels may require monitoring, and doses may need adjustment.
Alfalfa may add to the effects of cholesterol-lowering agents such as fish oil, garlic, guggul, red yeast, and niacin.
Alfalfa has been reported to contain vitamin K, and therefore may reduce the effects of herbs and supplements that have blood-thinning effects that rely on depletion of vitamin K.
Because alfalfa contains estrogen-like chemicals, the effects of other agents believed to have estrogen-like properties, such as black cohosh, may be altered. Alfalfa may also alter thyroid levels in herbs such as bladderwrack.
Alfalfa may alter potassium and calcium levels. It may also interact with iron, vitamin E, and vitamin K.
Alfalfa may interact with therapies that alter the immune system or cause sun sensitivity.
Alfalfa may contain significant levels of zinc, copper, manganese, and selenium.
Methodology Return to top
This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
ALEO VERA
loe (Aloe vera)
Contents of this page:
Background
Synonyms
Evidence
Dosing
Safety
Interactions
Methodology
Selected references
Aloe
Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Dried latex from the inner lining of the leaf has traditionally been used as an oral laxative.
There is strong scientific evidence in support of the laxative properties of aloe latex, based on the well-established cathartic properties of anthroquinone glycosides (found in aloe latex). However, aloe's therapeutic value compared with other approaches to constipation remains unclear.
There is promising preliminary support from laboratory, animal, and human studies that topical aloe gel has immunomodulatory properties that may improve wound healing and skin inflammation.
SynonymsReturn to top
Acemannan, Aloe africana , Aloe arborescens Miller, Aloe barbadensis , Aloe barbadesis , Aloe capensis , aloe-coated gloves, Aloe ferox , aloe latex, aloe mucilage, Aloe perfoliata , Aloe perryi Baker, Aloe saponaria , Aloe spicata , Aloe vulgari , Barbados aloe, bitter aloe, burn plant, Cape aloe, Carrisyn, Curaçao aloe, elephant's gall, first-aid plant, Ghai kunwar, Ghikumar, hirukattali, Hsiang-Dan, jelly leek, kumari, lahoi, laloi, lily of the desert, Lu-Hui, medicine plant, Mediterranean aloe, miracle plant, mocha aloes, musabbar, natal aloes, nohwa, plant of immortality, plant of life, rokai, sabilla, Savila, Socotrine aloe, subr, true aloe, Venezuela aloe, Za'bila, Zanzibar aloe.
EvidenceReturn to top
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Uses based on scientific evidence Grade*
Constipation (laxative)
Dried latex from the inner lining of aloe leaves has been used traditionally as a laxative taken by mouth. Although few studies have been conducted to assess this effect of aloe in humans, the laxative properties of aloe components such as aloin are well supported by scientific evidence. A combination herbal remedy containing aloe was found to be an effective laxative, although it is not clear if this effect was due to aloe or to other ingredients in the product. Further study is needed to establish dosing and to compare the effectiveness and safety of aloe with other commonly used laxatives. B
Genital herpes
Limited evidence from human studies suggests that extract from Aloe vera in a hydrophilic cream may be an effective treatment of genital herpes in men (better than aloe gel or placebo). Additional research is needed in this area before a strong recommendation can be made. B
Psoriasis vulgaris
Early evidence suggests that an extract from aloe in a hydrophilic cream may be an effective treatment of psoriasis vulgaris. Additional research is needed in this area before a strong recommendation can be made. B
Seborrheic dermatitis (seborrhea, dandruff)
Early study of aloe lotion suggests effectiveness for treating seborrheic dermatitis when applied to the skin. Further study is needed in this area before a strong recommendation can be made. B
Cancer prevention
There is early evidence that oral aloe may reduce the risk of developing lung cancer. Further study is needed in this area to clarify if it is aloe itself or other factors that may cause this benefit. C
Canker sores (aphthous stomatitis)
There is weak evidence that treatment of recurrent aphthous ulcers of the mouth with aloe gel may reduce pain and increase the amount of time between the appearance of new ulcers. Further study is needed before a firm recommendation can be made. C
Diabetes (type 2)
Study results are mixed. More research is needed to explore the effectiveness and safety of aloe in diabetics. C
Dry skin
Traditionally, aloe has been used as a moisturizer. Early low-quality studies suggest aloe may effectively reduce skin dryness. Higher quality studies are needed in this area. C
HIV infection
Without further human trials, the evidence cannot be considered convincing either in favor or against this use of aloe. C
Lichen planus
Limited study suggests that aloe may be a helpful, safe treatment for lichen planus, which is a chronic inflammatory disease that affects the lining of the mouth. Additional study is needed. C
Skin burns
Early evidence suggests that aloe may aid healing of mild to moderate skin burns. Further study is needed in this area. C
Skin ulcers
Early studies suggest aloe may help heal skin ulcers. High-quality studies comparing aloe alone with placebo are needed. C
Ulcerative colitis (including inflammatory bowel disease)
There is limited but promising research of the use of oral aloe vera in ulcerative colitis (UC), compared to placebo. It is not clear how aloe vera compares to other treatments used for UC. C
Wound healing
Study results of aloe on wound healing are mixed with some studies reporting positive results and others showing no benefit or potential worsening of the condition. Further study is needed, since wound healing is a popular use of topical aloe. C
Mucositis
There is early evidence that oral aloe vera does not prevent or improve mucositis (mouth sores) associated with radiation therapy. D
Pressure ulcers
Early well-designed studies in humans found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers. D
Radiation dermatitis
Reports in the 1930s of topical aloe's beneficial effects on skin after radiation exposure lead to widespread use in skin products. Currently, aloe gel is sometimes recommended for skin irritation caused by prolonged exposure to radiation, although scientific evidence suggests a lack of benefit in this area. D
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Grading rationale
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Alzheimer's disease, antifungal, antimicrobial, antioxidant, antitumor, antiviral, arthritis (osteoarthritis, rheumatoid arthritis), asthma, bacterial skin infections, birth control, blood vessel disorders, bowel disorders, chronic fatigue syndrome, congestive heart failure, frostbite, gingivitis, hair loss, heart disease prevention, hepatitis, high cholesterol, human papilloma virus (HPV), itchiness (skin), kidney or bladder stones, leukemia, lichen planus (a skin condition), parasitic worm infections, Parkinson's disease, periodontal surgical rinse, scratches or superficial wounds of the eye, stomach acid reduction, sunburn, systemic lupus erythematosus (SLE), tic douloureux (trigeminal neuralgia, severe facial pain), untreatable tumors, vaginal contraceptive, yeast infections of the skin.
DosingReturn to top
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
Pure Aloe vera gel is often used liberally on the skin three to four times per day for the treatment of sunburn and other minor burns. Creams and lotions are also available. There are no reports that using aloe on the skin causes absorption of chemicals into the body that may cause significant side effects. Skin products are available that contain aloe alone or aloe combined with other active ingredients.
The dose often recommended for constipation is the minimum amount to maintain a soft stool, typically 0.04-0.17 gram of dried juice (corresponds to 10-30 milligrams hydroxyanthraquinones) by mouth. As an alternative, in combination with celandine (300 milligrams) and psyllium (50 milligrams), 150 milligrams of the dried juice per day of aloe has been found effective as a laxative in research.
Cases of death have been associated with Aloe vera injections under unclear circumstances. Injected use is not recommended due to a lack of safety data.
Other uses of aloe from scientific studies include the treatment of genital herpes (cream applied to lesions for five consecutive days per week for up to two weeks) and psoriasis (cream applied to skin three times per day for five consecutive days per week for up to four weeks).
Children (younger than 18 years)
Topical (skin) use of aloe gel in children is common and appears to be well tolerated. However a dermatologist and pharmacist should be consulted before starting therapy. Aloe taken by mouth has not been studied in children and theoretically may have harmful effects, such as lowering blood sugar levels. Therefore, it is not recommended.
SafetyReturn to top
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
People with known allergy to garlic, onions, tulips, or other plants of the Liliaceae family may have allergic reactions to aloe. Individuals using aloe gel for prolonged times have developed allergic reactions including hives and eczema-like rash. Aloe injections have caused severe reactions and should be avoided.
Side Effects and Warnings
The use of aloe on surgical wounds has been reported to slow healing; redness and burning has been reported after aloe juice was applied to the face after a skin-peeling procedure (dermabrasion). Application of aloe prior to sun exposure may lead to rash in sun-exposed areas.
The use of aloe or aloe latex by mouth for laxative effects can cause cramping or diarrhea. Use for over seven days may cause dependency or worsening of constipation after the aloe is stopped. Ingestion of aloe for over one year has been reported to increase the risk of colorectal cancer. Individuals with severe abdominal pain, appendicitis, ileus (temporary paralysis of the bowel), or a prolonged period without bowel movements should not take aloe. There is a report of hepatitis (liver inflammation) with the use of oral aloe.
Electrolyte imbalances in the blood, including low potassium levels, may be caused by the laxative effect of aloe. This effect may be greater in people with diabetes or kidney disease. Low potassium levels can lead to abnormal heart rhythms or muscle weakness. People with heart disease, kidney disease, or electrolyte abnormalities should not take aloe by mouth. Healthcare professionals should watch for changes in potassium and other electrolytes in individuals who take aloe by mouth for more than a few days.
Aloe taken by mouth may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare professional, and medication adjustments may be necessary. People with thyroid disorders, kidney disease, heart disease, or electrolyte abnormalities should also use oral aloe only under medical supervision.
Avoid Aloe vera injections, which have been associated with cases of death under unclear circumstances.
Pregnancy and Breastfeeding
Although topical (skin) use of aloe is unlikely to be harmful during pregnancy or breastfeeding, oral (by mouth) use is not recommended due to theoretical stimulation of uterine contractions. It is not known whether active ingredients of aloe may be present in breast milk. The dried juice of aloe leaves should not be consumed by breastfeeding mothers.
InteractionsReturn to top
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Aloe taken by mouth may lower blood sugar levels. Caution is advised when taken with medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or injection should be monitored closely by a qualified healthcare professional. Medication adjustments may be necessary. In addition, insulin may add to the decrease in blood potassium levels that can occur with aloe.
Due to the lowering of potassium levels that may occur when aloe is taken by mouth, the effectiveness of heart medications such as digoxin and digitoxin, and of other medications used for heart rhythm disturbances, may be reduced. The risk of adverse effects may be increased with these medications due to low potassium levels.
Caution should be used in patients taking loop diuretics, such as Lasix® (furosemide), or thiazide diuretics, such as hydrochlorothiazide (HCTZ), that increase the elimination of both fluid and potassium in the urine. Combined use may increase the risk of potassium depletion and of dehydration.
Use of aloe with laxative drugs may increase the risk of dehydration, potassium depletion, electrolyte imbalance, and changes in blood pH. Due to its laxative effect, aloe may also reduce the absorption of some drugs.
Application of aloe to skin may increase the absorption of steroid creams such as hydrocortisone. In addition, oral use of aloe and steroids such as prednisone may increase the risk of potassium depletion.
There is one report of excess bleeding in a patient undergoing surgery receiving the anesthetic drug sevoflurane, who was also taking aloe by mouth. It is not clear that aloe or this specific interaction was the cause of bleeding.
Preliminary reports suggest that levels of AZT, a drug prescribed in HIV infection, may be increased by intake of aloe.
Drugs used for cancer and for hormone activity (hormone replacement therapy, birth control pills) may also interact with aloe.
Interactions with Herbs and Dietary Supplements
Based on the laxative properties of oral aloe, prolonged use may result in potassium depletion. Aloe may increase the potassium-lowering effects of other herbs such as licorice ( Glycyrrhiza glabra ). Theoretically, use of oral aloe and other laxative herbs such as senna may increase the risk of dehydration, potassium depletion, electrolyte imbalance, and changes in blood pH.
Oral aloe can reduce blood sugar. Caution is advised when using herbs or supplements such as bitter melon that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
Herbs and supplements used for cancer or the heart may interact with aloe. Phytoestrogens such as soy, as well as antivirals may also interact with aloe. Aloe may increase the absorption of vitamin C and vitamin E.
Methodology Return to top
This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Methodology details
American pennyroyal (Hedeoma pulegioides L.), European pennyroyal (Mentha pulegium L.)
Contents of this page:
Background
Synonyms
Evidence
Dosing
Safety
Interactions
Methodology
Selected references
American pennyroyal, European pennyroyal
BackgroundReturn to top
The essential oil of pennyroyal is considered toxic. Death has been reported after the consumption of small amounts. A characteristic noted in most cases of pennyroyal overdose is a strong minty smell on the patient's breath.
A possible role for N-acetylcysteine (NAC) in the management of pennyroyal overdose has been suggested. However, this application has not been confirmed by animal or human studies.
The essential oil of pennyroyal may act as an emmenagogue (menstrual flow stimulant) and induce abortion. However, it may do so at lethal or near-lethal doses, making this action unpredictable and dangerous. Future research to determine the safety and efficacy of the less toxic parts of the pennyroyal plant on the menstrual cycle is needed before a recommendation can be made.
SynonymsReturn to top
Aloe herbal horse spray, brotherwort, chasse-puces, churchwort, Cunila pulegioides , dictamne de Virginie, European pennyroyal, flea mint, fleabane, fretillet, Hedeoma phlebitides , herbal horsespray, herbe aux puces, herbe de Saint-Laurent, Labiatae (family), la menthe pouliot (French), Lamiacea (family), Lurk-in-the-Ditch, Melissa pulegioides , mentha pouillot, Miracle Coat spray-on dog shampoo, mock pennyroyal, mosquito plant, Old World pennyroyal, pennyroyal essential oil, petit baume, piliolerial, poley, pouliot royal, pudding herb, pudding grass, pulegium, pulegium oil, Pulegium regium , Pulegium vulgare , pulioll-royall, run-by-the-ground, squaw balm, squawmint, stinking balm, tickweed.
EvidenceReturn to top
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Uses based on scientific evidence Grade*
Abortifacient (uterus contraction stimulant/abortion inducer)
Folkloric use and several human case reports describe the use of the essential oil of pennyroyal to cause abortion. However, it may do so at deadly or toxic doses, making this an unpredictable and dangerous use. C
Menstrual flow stimulant (emmenagogue)
Folkloric use and several human case reports describe the use of the essential oil of pennyroyal as an emmenagogue (menstrual flow stimulant). However, it may do so at lethal or near-lethal doses, making this action unpredictable and dangerous. C
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Grading rationale
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Acaricidal (lethal to mites), acne, antiseptic, anti-spasm, anxiety, asthma, bruises and burns, cancer, chest congestion, colds, colic, cough, cramps, diarrhea, digestion, diuretic (increasing urine flow), dizziness, dysentery, fever, flavoring agent, flea control, flu, fragrance (detergents, perfumes, soaps), fumigant, gallbladder disorders, gas, gout, hallucinations, headache, hysteria, immortality, indigestion, insect repellant, intestinal disorders, itchy eyes, joint problems, kidney disease, leprosy, liver disease, mouth sores, muscle pain, nosebleeds, pneumonia, potpourri, pregnancy, premenstrual syndrome, preparing the uterus for labor, purifier (water, blood), refrigerant, respiratory ailments, sedative, skin ailments (itching, burning, bruising), snake bites (venomous), stimulant, stomach pain, sunstroke, sweating, syncope, toothache, uterine fibroids, whooping cough.
DosingReturn to top
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (over 18 years old)
No safe dose of pennyroyal has been established. Extracts, oils, teas, and infusions have been taken by mouth, but may be toxic. Topical preparations have also been applied to the skin. Pennyroyal has been used as an herbal flea collar for animals by hanging a bag of pennyroyal from a regular collar or using a pennyroyal garland. Safety and effectiveness of these preparations have not been proven.
Children (under 18 years old)
Pennyroyal is not recommended in children due to a lack of scientific study and potential toxicity.
SafetyReturn to top
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
Allergic reactions, such as rash, to pennyroyal or to its components, including pulegone, may occur.
Side Effects and Warnings
Pennyroyal herb and volatile oils have been associated with multiple reports of toxicity and adverse effects, including seizures, loss of consciousness, and death. In animals, pennyroyal (taken by mouth or placed on the skin) has been associated with liver, lung, and brain toxicity. Even small amounts of pennyroyal may be associated with death. Cases of human overdose and death have been reported in infants, children, and adults.
Pennyroyal oil toxicity may cause nausea, vomiting, abdominal pain, burning in the throat, difficulty swallowing, diarrhea, excessive sweating, chills, fever, headache, ringing in the ears, dizziness, extreme thirst, muscle spasms, restlessness, tremor, excessive talkativeness, hallucinations, agitation, drowsiness, fatigue, confusion, mania, seizures, organ failure (brain, liver, lung, kidney, heart), altered (low or high) heart rate, altered (low or high) blood pressure, slow breathing, coma, loss of consciousness, and death. Symptoms in pennyroyal overdose may mimic that of acetaminophen (Tylenol®) overdose, and the use of N-acetylcysteine (an antidote used for acetaminophen toxicity) treatment may prove beneficial, although this is not well proven.
Other side effects may include contact dermatitis, rash (when placed on the skin), malaise, lethargy, agitation, abnormal sensations, or change (increase or decrease) in pupil size. There are reports that pennyroyal may cause abortion. Pennyroyal has been used historically as an emmenagogue (menstrual stimulant) and may cause menstrual bleeding. There are reports that large amounts of pennyroyal may be irritating to the urinary tract. Pennyroyal may cause hypoglycemia (low blood sugar), hemolytic anemia (low red blood cell count due to destruction of cells), disseminated intravascular coagulation (widespread abnormal clotting and/or bleeding), and metabolic acidosis.
Pregnancy and Breastfeeding
Pennyroyal should be avoided during pregnancy or breastfeeding, due to the risk of uterine contractions, stimulation of menstruation, and abortion.
Many tinctures contain high levels of alcohol, and should be avoided during pregnancy.
InteractionsReturn to top
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Pennyroyal may interact with hormonal drugs and decrease the effectiveness of fertility agents. Pennyroyal has been reported to cause uterine contractions, stimulation of menstruation, and abortion.
In theory, the toxicity of pennyroyal may be increased when combined with acetaminophen (Tylenol®). Pennyroyal may lower glutathione (a liver substance), which may increase the risk of acetaminophen toxicity. Pennyroyal may increase the risk of liver damage caused by other drugs.
Pennyroyal may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood, and may cause increased effects or potentially serious adverse reactions. Patients using any medications should check the package insert and speak with a healthcare provider, including a pharmacist, about possible interactions.
Pennyroyal may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.
Pennyroyal may have antihistamine effects and may cause increased effects if combined with drugs that have antihistamine action, such as diphenhydramine (Benadryl®), fexofenadine (Allegra®), or loratidine (Claritin®).
Many tinctures contain high levels of alcohol and may cause nausea or vomiting when taken with metronidazole (Flagyl®) or disulfiram (Antabuse®).
Pennyroyal may interact with drugs that lower the seizure threshold; use cautiously.
Interactions with Herbs and Dietary Supplements
Pennyroyal may increase the risk of liver damage when combined with some herbs or supplements, such as kava.
Pennyroyal has been found to inhibit the absorption of iron in meals.
Pennyroyal may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of these herbs or supplements may be increased in the blood and may cause increased effects or potentially serious adverse reactions. It may also alter the effects that other herbs or supplements possibly have on the P450 system, such as St. John's wort.
Pennyroyal may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar, such as American ginseng.
Pennyroyal and black cohosh have been taken together to induce abortion, and this combination has been associated with toxicity and death.
Pennyroyal and blue cohosh have traditionally been taken together to normalize the menstrual cycle in women. In theory, the combination of the two herbs may act together to increase menstrual flow. Notably, blue cohosh has been associated with multiple dangerous effects including stroke.
Severe psychotic episodes and seizures have been reported in a young pregnant woman after ingesting an unknown dose of pennyroyal and "Widow Welch's Female Pills," a combination of ferrous sulfate, sulfur, licorice ( Glycyrrhiza glabra ), and turmeric ( Curcuma longa ). The exact cause is unknown.
Arginine (L-arginine)
Contents of this page:
Background
Synonyms
Evidence
Dosing
Safety
Interactions
Methodology
Selected references
Arginine
BackgroundReturn to top
L-arginine was first isolated in 1886. In 1932, scientists learned that L-arginine is needed to create urea, a waste product that is necessary for toxic ammonia to be removed from the body. In 1939, researchers discovered that L-arginine is also needed to make creatine. Creatine breaks down into creatinine at a constant rate, and it is cleared from the body by the kidneys.
Arginine is considered a semi-essential amino acid because even though the body normally makes enough of it, supplementation is sometimes needed. For example, people with protein malnutrition, excessive ammonia production, excessive lysine intake, burns, infections, peritoneal dialysis, rapid growth, urea synthesis disorders, or sepsis may not have enough arginine. Symptoms of arginine deficiency include poor wound healing, hair loss, skin rash, constipation, and fatty liver.
Arginine changes into nitric oxide, which causes blood vessel relaxation (vasodilation). Early evidence suggests that arginine may help treat medical conditions that improve with vasodilation, such as chest pain, clogged arteries (called atherosclerosis), coronary artery disease, erectile dysfunction, heart failure, intermittent claudication/peripheral vascular disease, and blood vessel swelling that causes headaches (vascular headaches). Arginine also triggers the body to make protein and has been studied for wound healing, bodybuilding, enhancement of sperm production (spermatogenesis), and prevention of wasting in people with critical illnesses.
Arginine hydrochloride has a high chloride content and has been used to treat metabolic alkalosis. This use should be under the supervision of a qualified healthcare professional.
In general, most people do not need to take arginine supplements because the body usually produces enough.
SynonymsReturn to top
2-amino-5-guanidinopentanoic acid, Arg, arginine, arginine hydrochloride (intravenous formulation), dipeptide arginyl aspartate, HeartBars, ibuprofen-arginate, L-arg, L-arginine, NG-monomethyl-L-arginine, Sargenor, Spedifen®.
Note: Arginine vasopressin is different from arginine/L-arginine, with an entirely different mechanism. NG-monomethyl-L-arginine is different from arginine/L-arginine, and functions as an inhibitor of nitric oxide synthesis.
EvidenceReturn to top
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Uses based on scientific evidence Grade*
Growth hormone reserve test / pituitary disorder diagnosis
Arginine can be injected to measure growth hormone levels in people who might have growth hormone deficiencies, such as panhypopituitarism, gigantism, acromegaly, or pituitary adenoma. The U.S. Food and Drug Administration (FDA) has approved this use. A
Inborn errors of urea synthesis
In patients with inborn errors of urea synthesis, high ammonia levels in the blood and metabolic alkalosis may occur, particularly among patients with ornithine carbamoyl transferase (OCT) deficiencies or carbamoyl phosphate synthetase (CPS) deficiencies. Arginine may help treatment by shifting the way the body processes nitrogen. Arginine should be avoided in patients with hyperargininemia (high arginine levels). Other drugs, such as citrulline, sodium benzoate, or sodium phenylbutyrate, may have similar benefits. However, dialysis may be needed at first. This use of arginine should be supervised by a qualified healthcare professional. A
Coronary artery disease / angina
Early evidence from several studies suggests that arginine taken by mouth or by injection may improve exercise tolerance and blood flow in arteries of the heart. Benefits have been shown in some patients with coronary artery disease and chest pain (called angina). However, more research is needed to confirm these findings and to develop safe and effective doses. B
Critical illness
Some studies suggest that arginine may be beneficial for people with critical or life-threatening illnesses when it is added to nutritional supplements. However, it is unclear what the specific role of arginine is in recovery. Because of the potential for harm, large doses of arginine should be avoided. B
Heart failure
Studies of arginine in patients with chronic heart failure have shown mixed results. Some studies report improved exercise tolerance. Additional studies are needed to confirm these findings. B
Migraine headache
Early studies suggest that adding arginine to ibuprofen (e.g., Motrin® or Advil®) therapy may decrease migraine headache pain. B
Peripheral vascular disease / claudication
Intermittent claudication causes leg pain and tiredness because cholesterol plaques or clots develop in leg arteries and block blood flow. A small number of studies report that arginine therapy may improve walking distance in patients with claudication. Further research is needed. B
Adrenoleukodystrophy (ALD)
Adrenoleukodystrophy (ALD) is a rare inherited metabolic disorder that is characterized by the loss of fatty coverings (myelin sheaths) on nerve fibers in the brain and progressive destruction of the adrenal glands. This condition results in dementia and adrenal failure. Injections of arginine may help manage this disorder, although most study results are inconclusive. Further research is needed to evaluate the use of arginine in ALD. C
Anal fissures
Early studies suggest that arginine may help treat chronic anal fissures, which are small tears that develop in the anus. Additional studies are needed. C
Autonomic failure
Arginine has been studied in autonomic failure, a condition that may include low blood pressure, but the effect is unclear. Well-designed studies will help clarify this relationship. C
Breast cancer
It is unclear if arginine can help treat breast cancer patients. Results from early human studies are mixed. High-quality studies are needed. C
Burns
Arginine may improve immune function and protein function in burn patients. Further research is needed before a conclusion can be drawn. C
Chemotherapy adjuvant
Early human studies suggest that arginine supplements may be beneficial for patients undergoing chemotherapy. Larger, high-quality studies are needed. C
Chest pain (non-cardiac)
Small studies in humans suggest that arginine taken by mouth (not injected) may improve non-cardiac chest pain associated with esophageal motor disorders. Large, well-designed studies are needed. C
Circulation problems (critical limb ischemia)
Early human studies suggest that intravenous arginine may increase blood flow in patients with critical limb ischemia. This condition occurs when blood flow to the arms and/or legs is blocked. Large, well-designed trials are needed. C
Dental pain (ibuprofen arginate)
Some research suggests that ibuprofen-arginate (Spedifen®) may reduce pain after dental surgery faster or more effectively than ibuprofen (e.g., Motrin® or Advil®) alone. More research is needed in this area. C
Diabetes (Type 1/Type 2)
Early studies in humans suggest that arginine supplements may decrease the severity of diabetes. Large, well-designed studies are needed to understand this relationship. C
Diabetic complications
Early studies in humans suggest that arginine supplements may help the body fight some long-term complications of diabetes, including heart disease and nerve damage. Well-designed studies are needed. C
Erectile dysfunction
Early studies have shown that arginine supplements may help treat erectile dysfunction (ED) in men with low nitrate levels in their blood or urine. A combination of L-arginine, glutamate, and yohimbine hydrochloride has been used to treat ED. However, because a combination product was used, and yohimbine hydrochloride is an FDA-approved therapy for this condition, the effects of arginine alone are unknown. More research is needed with arginine alone. C
Gastrointestinal cancer surgery
A combination of arginine and omega-3 fatty acids may reduce the length of hospital stays and infections after surgery in gastrointestinal cancer patients. Other research suggests that arginine, omega-3 fatty acids, and glutamine may boost the immune system and reduce inflammation after surgery. More research with arginine alone is needed. C
Heart protection during coronary artery bypass grafting (CABG)
Arginine-supplemented "blood cardioplegic solution" may help protect the heart. Further research is needed before a firm conclusion can be drawn. C
High blood pressure
Early study in humans suggests that arginine taken by mouth may help widen the arteries and temporarily reduce blood pressure in patients with high blood pressure and type 2 diabetes. Larger, high-quality studies are needed before a recommendation can be made. C
High cholesterol
Some research suggests that arginine may help treat or prevent high cholesterol. More research is needed. C
Immunomodulator
Early study results suggest that arginine supplementation may boost the immune response elicited by the pneumonia vaccine in older people. More studies are needed to confirm these results. C
Intrauterine growth retardation
Early studies in pregnant mothers suggest that arginine supplements may improve growth in fetuses that are smaller than average. Additional studies are needed. C
Kidney disease or failure
Study results are mixed as to whether arginine as a therapy by itself directly helps certain kidney diseases or failure. Arginine may be a helpful adjunct for kidney disease related conditions such as anemia in the elderly. Additional research is needed in this area. C
MELAS syndrome
Early studies have found that long-term supplementation with L-arginine significantly improved endothelial function in patients with MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke). Further research is merited in this area. C
Myocardial infarction (heart attack)
Study results of arginine supplementation after myocardial infarction (heart attack) are mixed. Further research is needed before a recommendation can be made. A cardiologist and pharmacist should be consulted before arginine supplements are taken. C
Pre-eclampsia (high blood pressure in pregnancy)
Early study suggests that long-term supplementation with L-arginine may decrease blood pressure that is too high in pregnant women. Arginine may also improve fetal health and growth during pre-eclampsia . Further research is needed to confirm these results. C
Pressure ulcers
Studies of arginine for pressure ulcers show mixed results. Further research is needed before a conclusion can be drawn. C
Prevention of restenosis after coronary angioplasty (PTCA)
Arginine has been injected in patients who had stents surgically inserted into arteries in order to widen them. Early research suggests that this therapy may help prevent the arteries from becoming narrow again (called restenosis). Additional studies are needed. C
Raynaud's phenomenon
Early study in humans has looked at the effect of arginine on blood vessel activity in Reynaud's phenomenon, a condition that causes the blood vessels in the fingers, toes, nose, and ears to narrow in response to cold temperatures or stress. However, the effects of arginine are not clear. Large, well-designed trials are needed. C
Recovery after surgery
Early study suggests that arginine may provide benefits when used as a supplement after surgery. However, the role of arginine in this condition is unclear. More research is needed to determine if this is safe and effective. C
Respiratory infections
Early study suggests that arginine supplements may decrease the risk of respiratory (lung) infections. Large, well-controlled studies are needed to clarify this relationship. C
Senile dementia
There is not enough information available to make a strong recommendation about the use of arginine in senile dementia. C
Transplants
Dietary supplementation with L-arginine and canola oil has been associated with decreased rejection rates after the first month in kidney transplant patients. Because it may reduce the risk of heart problems, long-term benefits for patient survival may be particularly important. Further research is needed to confirm these results. C
Wound healing
Arginine has been suggested to improve the rate of wound healing in the elderly. Research has shown that an enteral diet supplemented with arginine and fiber improved wound healing after surgery in patients with head and neck cancer. Arginine has also been applied to the skin in order to improve wound healing. Further research is necessary in this area before a firm conclusion can be drawn. C
Altitude sickness
Based on early research, L-arginine supplementation is not an effective therapy to prevent acute mountain sickness (AMS). D
Cyclosporine toxicity
Animal studies report that arginine blocks the poisonous (toxic) effects of cyclosporine, a drug used to prevent organ transplant rejection. However, results from studies in humans have not found that arginine offers any protection from cyclosporine-induced toxicity. D
Exercise performance
Overall, currently available study results conclude that arginine supplementation does not improve exercise performance. D
Infertility
Although there are several studies in this area, it is not clear what effects arginine has on improving the likelihood of getting pregnant. Early evidence does not support the use of arginine as a fertility treatment in women who are undergoing in vitro fertilization or in men with abnormal sperm. D
Interstitial cystitis
Arginine has been proposed as a treatment for interstitial cystitis or inflammation of the bladder. However, most human studies have not found that arginine improves symptoms, such as urinary frequency or urgency. D
Kidney protection during angiography
The contrast media, or dye, used during angiography to map a patient's arteries (or during some CT scans) can be poisonous (toxic) to the kidneys, especially among people with kidney disease. Researchers have studied L-arginine as a way to protect the kidneys in patients with long-term kidney failure who were undergoing angiography. The authors found no evidence that injections of L-arginine protect the kidney from damage due to contrast. D
Asthma
Although it has been suggested that arginine may treat asthma, studies in humans have actually found that arginine worsens inflammation in the lungs and contributes to asthma symptoms. Therefore, taking arginine by mouth or by inhalation is not recommended in people with asthma. F
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Grading rationale
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
AIDS/HIV (prevention of wasting), ammonia toxicity, anti-aging, anti-inflammatory, anti-platelet agent, anxiety, beta-hemoglobinopathies, cancer, chronic pain, cirrhosis, cold prevention, cystic fibrosis, endocrine disorders (metabolic syndrome), glaucoma, hemolytic uremic syndrome (HUS), hepatic encephalopathy, increased muscle mass, infantile necrotizing enterocolitis, infection, inflammatory bowel disease (IBD), ischemic stroke, liver disease, lower esophageal sphincter relaxation, metabolic acidosis, obesity, osteoporosis, pain, peritonitis, pre-term labor contractions, sepsis, sexual arousal, sexual function in women, sickle cell anemia, stress, stomach motility disorders, stomach ulcers, supplementation to a low protein diet, thrombotic thrombocytopenic purpura (TTP), trauma (recovery), tumors, ulcerative colitis.
DosingReturn to top
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Dietary Sources of Arginine
Walnuts, filberts (hazelnuts), pecans, Brazil nuts, sesame and sunflower seeds, brown rice, raisins, coconut, gelatin, buckwheat, almonds, barley, cashews, cereals, chicken, chocolate, corn, dairy products, meats, oats, peanuts.
Adults (18 years and older)
There is a lack of standard or well-established doses of arginine, and many different doses have been used and studied. A common dose is 2-3 grams taken by mouth three times daily. In studies, 0.5-16 grams of arginine has been taken daily by mouth for up to six months. Arginine has been applied to the skin in order to improve wound healing.
Doses of arginine used intravenously depend on specific institutional dosing guidelines and should be given under the supervision of a healthcare provider.
Children (younger than 18 years)
Arginine supplements are not recommended in children because there is not enough scientific information available and because of potential side effects.
SafetyReturn to top
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
A severe allergic reaction, called anaphylaxis, has occurred after arginine injections. People with known allergies should avoid arginine. Signs of allergy may include rash, itching, or shortness of breath.
Side Effects and Warnings
Arginine has been well tolerated by most people in studies lasting for up to six months, although there is a possibility of serious side effects in some people.
Stomach discomfort, including nausea, stomach cramps, or an increased number of stools, may occur. People with asthma may experience a worsening of symptoms, which may be related to allergy, if arginine is inhaled.
Other potential side effects include low blood pressure and changes in numerous chemicals and electrolytes in the blood. Examples include high potassium, high chloride, low sodium, low phosphate, high blood urea nitrogen, and high creatinine levels. People with liver or kidney diseases may be especially sensitive to these complications and should avoid using arginine except under medical supervision. After injections of arginine, low back pain, flushing, headache, numbness, restless legs, venous irritation, and death of surrounding tissues have been reported.
In theory, arginine may increase the risk of bleeding. Patients using anticoagulants (blood thinners) or antiplatelet drugs, or with underlying bleeding disorders, should speak with their qualified healthcare providers before using arginine and should be monitored.
Arginine may increase blood sugar levels. Caution is advised in patients taking prescription drugs to control sugar levels.
Arginine may increase potassium levels, especially in patients with liver disease.
L-arginine may worsen symptoms of sickle cell disease.
Pregnancy and Breastfeeding
Arginine cannot be recommended as a supplement during pregnancy or breastfeeding because there is not enough scientific information available.
L-arginine has been used in pregnant women with high blood pressure (pre-eclampsia) until 10 days after birth, but it should not be used without supervision of an OB/GYN and pharmacist.
InteractionsReturn to top
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Because arginine can increase the activity of some hormones in the body, many possible drug interactions may occur. The prescription drugs aminophylline and the sweetening agent xylitol may decrease the effect that arginine has on glucagon.
Estrogens (found in birth control pills and hormone replacement therapies) may increase the effects of arginine on growth hormone, glucagon, and insulin. In contrast, progestins (also found in birth control pills and some hormone replacement therapies) may decrease the responsiveness of growth hormone to arginine.
When used with arginine, some diuretics, such as spironolactone (Aldactone®), or ACE-inhibitor blood pressure drugs, such as enalapril (Vasotec®), may cause potassium levels in the blood to get too high. Monitoring of blood potassium levels may be required.
Arginine should be used carefully with drugs, such as nitroglycerin or sildenafil (Viagra®), because blood pressure may fall too low. Other side effects, such as headache and flushing, may occur when arginine is used with these drugs.
Because arginine may cause the stomach to make more acid, it may reduce the effectiveness of drugs that block stomach acid such as ranitidine (Zantac®) or esomeprazole (Nexium®).
In theory, arginine may increase the risk of bleeding when used with anticoagulants (blood thinners) or antiplatelet drugs. Examples include warfarin (Coumadin®), heparin, and clopidogrel (Plavix®). Some pain relievers may also increase the risk of bleeding if used with arginine. Examples include aspirin, ibuprofen (Motrin®, Advil®), and naproxen (Naprosyn®, Aleve®, Anaprox®).
It is also possible that arginine may raise blood sugar levels. Patients taking oral or injected drugs for diabetes should be monitored closely by their healthcare providers while using arginine. Dosing adjustments may be necessary.
Studies suggest that a combination of ibuprofen and arginine (ibuprofen-arginate/Spedifen®) has a faster onset of pain relief than ibuprofen alone. Use of other ibuprofen-based pain relievers, such as Motrin® or Advil®, with ibuprofen-arginate may increase the risk of toxic effects. Patients should consult their healthcare providers before combining these medications.
Interactions with Herbs and Dietary Supplements
Arginine may block the benefits of lysine in treating cold sores. It may increase the activity of growth hormone if used with ornithine.
In theory, arginine may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba , and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
Arginine may raise blood sugar levels. People using other herbs or supplements that may raise blood sugar levels should be monitored closely by their healthcare providers while using arginine. Dosing adjustments may be necessary.
Arginine should be used cautiously in patients taking potassium supplements because of the possible additive effect.
Belladonna (Atropa belladonna L. or its variety acuminata Royle ex Lindl)
Contents of this page:
Background
Synonyms
Evidence
Dosing
Safety
Interactions
Methodology
Selected references
Belladonna
BackgroundReturn to top
Belladonna is an herb that has been used for centuries for a variety of indications, including headache, menstrual symptoms, peptic ulcer disease, inflammation, and motion sickness. Belladonna is known to contain active agents with anticholinergic properties, such as the tropane alkaloids atropine, hyoscine (scopolamine), and hyoscyamine.
There are few available studies of belladonna alone for any indication. Most research has evaluated belladonna in combination with other agents, such as ergot alkaloids or barbiturates, or in homeopathic (diluted) preparations. Preliminary evidence suggests possible efficacy in combination with barbiturates for the management of symptoms associated with irritable bowel syndrome. However, there is currently insufficient scientific evidence regarding the use of belladonna for this or any other indication.
Common adverse effects include dry mouth, urinary retention, flushing, pupillary dilation, constipation, confusion, and delirium. Many of these effects may occur at therapeutic doses.
SynonymsReturn to top
Atropa belladonna , atropa belladonna-AE, beladona, belladone, belladonnae herbae pulvis standardisatus, belladonna herbum, Belladonna Homaccord, Belladonna Injeel, Belladonna Injeel Forte, belladonna leaf, belladonna pulvis normatus, belladonnae folium, belladonna radix, belladonne, deadly nightshade, deadly nightshade leaf, devil's cherries, devil's herb, die belladonna, die tollkirsche, divale, dwale, dwayberry, galnebaer, great morel, herba belladonna, hoja de belladonna, naughty man's cherries, poison black cherries, powdered belladonna, Solanaceae (family), solanum mortale, solanum somniferum, strygium, stryshon, tollekirsche, tollkirschenblatter.
EvidenceReturn to top
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Uses based on scientific evidence Grade*
Airway obstruction
Belladonna can cause relaxation of the airway and reduce the amount of mucus produced. However, due to a lack of high-quality human research in this area, there is not enough evidence to form a clear conclusion. C
Ear infection
Little reliable research is available on the use of belladonna for ear infections. Other therapies have been shown to be effective and are recommended for this condition. C
Headache
The available studies of belladonna in the treatment of headache are not well designed and do not show a clear benefit. More studies are needed to test the ability of belladonna alone (not in multi-ingredient products) to treat or prevent headache. C
Irritable bowel syndrome
Belladonna has been used historically for the treatment of irritable bowel, and in theory its mechanism of action should be effective for some of the symptoms. However, of the few studies that are available, none clearly show that belladonna alone (not as part of a mixed product) provides this effect. C
Menopausal symptoms
Bellergal® (a combination of phenobarbital, ergot, and belladonna) has been used historically to treat hot flashes. However, in human studies belladonna supplements have not shown effectiveness. C
Nervous system disorders
The autonomic nervous system, which helps control basic body functions like sweating and blood flow, is affected in several disorders. To date, human studies have shown no benefit from belladonna in treating these disorders. C
Premenstrual syndrome (PMS)
Bellergal® (a combination of phenobarbital, ergot, and belladonna) has been used to treat PMS symptoms. More studies are needed before a strong recommendation can be made. C
Radiation therapy rash (radiation burn)
There is a lack of reliable scientific evidence available for the effectiveness of belladonna for rash after radiation therapy. Further study is needed before a strong recommendation can be made. C
Sweating (excessive)
There is a lack of reliable scientific evidence available for the effectiveness of belladonna to treat excessive sweating (hyperhidrosis). More research is needed in this area. C
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Grading rationale
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Abnormal menstrual periods, acute infections, acute inflammation, anesthetic, antispasmodic, anxiety, arthritis, asthma, bedwetting, bowel disorders, chicken pox, colds, colitis, conjunctivitis (inflamed eyes), dental conditions, diarrhea, diuretic (use as a "water pill"), diverticulitis, earache, encephalitis (inflammation of the brain), eye disorders (dilation of the pupils), fever, flu, glaucoma, gout, hay fever, hemorrhoids, hyperkinesis (excessive motor function), inflammation, kidney stones, measles, motion sickness, mumps, muscle and joint pain, muscle spasms (excessive unintentional muscle movements), nausea and vomiting during pregnancy, organophosphate poisoning, pain from nerve disorders, Parkinson's disease, pancreatitis, peritonitis, rash, scarlet fever, sciatica (back and leg pain), sedative, sore throat, stomach ulcers, teething, toothache, ulcerative colitis, urinary tract disorders (difficulty passing urine), warts, whooping cough.
DosingReturn to top
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
A traditional dose of belladonna leaf powder is 50 to 100 milligrams taken by mouth, with a maximum single dose of 200 milligrams (0.6 milligrams of total alkaloids, calculated as the ingredient hyoscyamine) and a maximum daily dose of 600 milligrams. A traditional dose of belladonna root is 50 milligrams, with a maximum single dose of 100 milligrams (0.5 milligrams of total alkaloids, calculated as hyoscyamine) and a maximum daily dose of 300 milligrams. A traditional dose of belladonna extract is 10 milligrams, with a maximum single dose of 100 milligrams (0.5 milligrams of total alkaloids, calculated as hyoscyamine) and a maximum daily dose of 150 milligrams. The expert German panel, the Commission E, suggests these doses mainly for the treatment of "gastrointestinal spasm." For tincture of belladonna (composed of 27 to 33 milligrams of belladonna leaf alkaloids in 100 milliliters of alcohol), informal reports suggest either a total dose of 1.5 milligrams daily (divided into three doses daily with a double dose at bedtime) or a dose of 0.6 to 1 milliliters (0.18 to 0.3 milligrams of belladonna leaf alkaloids) taken 3-4 times daily.
For headache, studies have used the combination product Bellergal® (40 milligrams phenobarbital, 0.6 milligrams ergotamine tartrate, 0.2 milligrams levorotatory alkaloids of belladonna), taken by mouth twice daily.
Homeopathic doses often depend on the symptom being treated and the style of the prescribing provider. Dosing practices may therefore vary widely. Usually, a homeopathic product is diluted several times. For example, belladonna may be diluted by 100 (one teaspoon belladonna added to 99 teaspoons water) in the first round, and this new, dilute mixture may be diluted 30-fold (1 teaspoon of the dilute mixture added to 29 teaspoons water).
A belladonna plaster produced by Cuxson Gerrard (England) containing 0.25% belladonna alkaloids (hyoscine 2%, atropine 1%) has been used topically (applied to the skin) for muscle and bone aches. Long-term use may cause a rash at the site of the plaster.
Children (younger than 18 years)
Informal reports describe a typical dose of 0.03 milliliter for each kilogram of weight, taken by mouth three times daily. Another dose that has been used is 0.8 milliliter for each square meter of body surface area, taken by mouth three times daily (27 to 33 milligrams of belladonna leaf alkaloids in 100 milliliters). The maximum dose is reported as 3.5 milliliters in a day. Safety and effectiveness have not been proven.
Death in children may occur at 0.2 milligram of atropine for each kilogram of a child's weight. Since 2 milligrams of atropine are often found in a fruit, just two fruits may be deadly for a small child.
Homeopathic doses often depend on the symptom being treated and the style of the prescribing provider. Dosing practices may therefore vary widely. Usually, a homeopathic product is diluted several times.
SafetyReturn to top
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
Belladonna should be avoided in people who have had significant reactions to belladonna or anticholinergic drugs, or who are allergic to belladonna or other members of the Solanaceae (nightshade) family such as bell peppers, potatoes, and eggplants. Long-term use of belladonna on the skin can lead to allergic rashes.
Side Effects and Warnings
In smaller doses, belladonna is traditionally thought to be safe, but may cause frequent side effects such as dilated pupils, blushing of the skin, dry mouth, rapid heartbeat, confusion, nervousness, and hallucinations. Based on animal study, belladonna alkaloids may inhibit cognitive function and gastrointestinal motility. High doses can cause death.
In children, death can be caused by a small amount of belladonna. Several reports of accidental belladonna overdose and death are reported. Belladonna overdose can also occur when it is applied to the skin. Belladonna overdose is highly dangerous and should be treated by qualified medical professionals. Because belladonna can slow the movement of food and drugs through the stomach and gut, the side effects may go on long after the belladonna is swallowed.
Belladonna may cause redness of the skin, flushing, dry skin, sun sensitivity, hives, and allergic rashes, even at dilute concentrations. A very serious, potentially life-threatening rash called Stevens-Johnson syndrome has been reported. Other side effects reported are headache, hyperactivity, nervousness, dizziness, lightheadedness, drowsiness or sedation, unsteady walking, confusion, slurred speech, exaggerated reflexes, or convulsions. The eyes may be sensitive to light and vision may be blurry. If pieces of belladonna are put into the eye, the pupils may be dilated permanently.
Cases report hyperventilation, coma with the loss of breathing, and severe high blood pressure. Others report abdominal fullness, difficult urination, decreased perspiration, slow release of breast milk while nursing, muscle cramps or spasms, and tremors. Belladonna should be avoided in those with difficulty passing urine, enlarged prostate, kidney stones, dry mouth, Sjögren syndrome, dry eyes, or glaucoma. Belladonna should be used cautiously with a fever. People with myasthenia gravis (a disorder of nerves and muscles) or Down's syndrome may be especially sensitive to belladonna.
Older adults and children should avoid belladonna, as there are many reports of serious effects in these age groups. Belladonna should not be combined with prescribed anticholinergic agents. People with heart disease, who have had a heart attack, fluid in the lungs, high blood pressure, or abnormal heart rhythms, should avoid belladonna. Because belladonna can affect the activity of the stomach and intestines, people who have had ulcers, reflux, hiatal hernia, obstruction of the bowel, poor movement of the intestines, constipation, colitis, or an ileostomy or colostomy after surgery should avoid belladonna.
Pregnancy and Breastfeeding
Belladonna is not recommended in pregnancy and breastfeeding because of the risks of side effects and poisoning. Belladonna is listed under category C according to the U.S. Food and Drug Administration (FDA) (category C includes drugs for which no thorough studies have been published). In nursing women who use belladonna, belladonna ingredients are found in breast milk, therefore endangering infants.
InteractionsReturn to top
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Belladonna may slow the movement of food and medication through the gut, and therefore some medications may be absorbed more slowly. Many prescribed medications can interact with anticholinergic drugs that have similar effects to belladonna. A qualified healthcare professional, including a pharmacist, should be consulted prior to taking belladonna.
Atropine is an ingredient in belladonna. Theoretically, drugs that interact with atropine may also interact with belladonna. Some antidepressant medications (tricyclic drugs) can interact with belladonna. The effects of the drug cisapride, used to increase the movement of food through the stomach, may be blocked. Medications that can increase heart rate, especially procainamide, can cause an exaggerated increase in heart rate if given with belladonna. The use of alcohol with belladonna can cause extreme slowing of brain function.
Belladonna may also interact with alkaloids, atropine, ergot derivatives, hormonal agents, drugs that increase sun sensitivity, drugs cleared by the kidney, scopolamine, and tacrine (Cognex®).
Interactions with Herbs and Dietary Supplements
Belladonna may slow the movement of food and medication through the gut, and therefore some supplements may be absorbed more slowly. The use of belladonna with supplements that have anticholinergic activity, such as Jimson weed ( Datura stramonium ), may increase its effects and worsen its side effects.
Belladonna may also interact with alcohol, alkaloids, ergot derivatives, hormonal agents, and herbs and supplements that increase sun sensitivity or are cleared by the kidneys.
Beta-carotene
Contents of this page:
Background
Synonyms
Evidence
Dosing
Safety
Interactions
Methodology
Selected references
Beta-carotene
BackgroundReturn to top
The name "carotene" was first coined in the early 19th Century by the scientist Wachenroder after he crystallized this compound from carrot roots. Beta-carotene is a member of the carotenoids, which are highly pigmented (red, orange, yellow), fat-soluble compounds naturally present in many fruits, grains, oils, and vegetables (green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers). Alpha, beta, and gamma carotene are considered provitamins because they can be converted to active vitamin A.
The carotenes possess antioxidant properties. Vitamin A serves several biological functions including involvement in the synthesis of certain glycoproteins. Vitamin A deficiency leads to abnormal bone development, disorders of the reproductive system, xerophthalmia (a drying condition of the cornea of the eye), and ultimately death.
Commercially available beta-carotene is produced synthetically or from palm oil, algae, or fungi. Beta-carotene is converted to retinol, which is essential for vision and is subsequently converted to retinoic acid, which is used for processes involving growth and cell differentiation.
SynonymsReturn to top
A-beta-carotene, alpha carotene, beta carotene, beta-cryptoxanthin, carotene, carotenoids, dry beta carotene, eyebright, gamma carotene, green leafy vegetables, palm oil, provitamin A, red palm oil, sunflower oil, synthetic all-trans beta-carotene, retinol.
EvidenceReturn to top
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Uses based on scientific evidence Grade*
Erythropoietic protoporphyria
Erythropoietic protoporphyria is a rare inherited genetic disorder of porphyrin-heme metabolism that has skin and systemic manifestations, including photosensitivity (painful skin sensitivity to sunlight), as well as gallstones and liver dysfunction. It is usually recognized during childhood. The over-the-counter synthetic beta-carotene product Lumitene® is U.S. Food and Drug Administration (FDA)-approved for photoprotection in this disease. Antihistamines may also be used to reduce symptoms. A
Carotenoid deficiency
Although consumption of provitamin A carotenoids (alpha-carotene, beta-carotene, and beta-cryptoxanthin) can prevent vitamin A deficiency, no overt deficiency symptoms have been identified in people consuming low-carotenoid diets if they consume adequate vitamin A. After reviewing the published scientific research, the Food and Nutrition Board of the Institute of Medicine (IOM) concluded that the existing evidence in 2000 was insufficient to establish a recommended dietary allowance (RDA) or adequate intake (AI) for carotenoids. C
Cataract prevention
Study results of beta-carotene supplementation for cataract prevention are conflicting. Further well-designed clinical trials are needed before a conclusion can be drawn. C
Chemotherapy toxicity
Observational research suggests that greater dietary intake of beta-carotene may lower the incidence of adverse effects in children undergoing chemotherapy for lymphoblastic leukemia. However, in theory high-dose antioxidants may interfere with the activity of some chemotherapy drugs or radiation therapy. Therefore, individuals undergoing cancer treatment should speak with their oncologist if they are taking or considering the use of high dose antioxidants. Additional evidence is needed in this area before a clear conclusion can be drawn. C
Chronic obstructive pulmonary disease (COPD)
The prevalence of bronchitis and shortness of breath in male smokers with chronic obstructive pulmonary disorder (COPD) seems to be lower in those patients who consume a diet containing high amounts of beta-carotene. However, beta-carotene supplements have not been proven to benefit COPD and may actually increase cancer rates in smokers. C
Cognitive performance
Antioxidants such as beta-carotene may be helpful for increasing cognition and memory. Long term, but not short-term, beta-carotene supplementation appears to benefit cognition. C
Cystic fibrosis
Individuals with cystic fibrosis may be deficient in beta-carotene and vitamin E, and it has been suggested that they may be more susceptible to oxidative damage. Theoretically, these patients may benefit from beta-carotene supplementation. Further research is needed before a conclusion can be drawn. C
Exercise-induced asthma prevention
Based on preliminary evidence, taking a mixture of beta-carotene isomers orally may prevent exercise-induced asthma. However, because synthetic beta-carotene has not been well tested for this indication, the difference between the activities of the two supplements cannot be deduced. Further research is needed before a strong recommendation can be made. C
Immune system enhancement
Preliminary research of beta-carotene for immune system maintenance or stimulation shows mixed results. Further research is needed before a strong conclusion can be drawn. C
Oral leukoplakia
Taking beta-carotene orally seems to induce remission in patients with oral leukoplakia. Further research is needed to confirm these results. C
Osteoarthritis
Beta-carotene supplementation does not appear to prevent osteoarthritis, but it might slow progression of the disease. Well-designed clinical trials are needed before a conclusion can be drawn. C
Polymorphous light eruption (PLE)
Beta-carotene has been used for PLE. Additional study is needed in this area. C
Pregnancy-related complications
All-trans beta-carotene (synthetic beta-carotene) taken weekly before, during, and after pregnancy may reduce pregnancy-related mortality, night blindness, post partum diarrhea and fever. A regular intake of a micronutrient supplement at a nutritional dose may be sufficient to improve micronutrient status of apparently healthy pregnant women and could prevent low birth weight in newborns. However, further research is necessary to consolidate the evidence in this area before a clear recommendation can be made. C
UV-induced erythema prevention/sunburn
A combination of antioxidants may help protect the skin against irradiation. Long-term supplementation with beta-carotene may reduce UV-induced erythema, and appears to modestly reduce the risk of sunburn in individuals who are sensitive to sun exposure. However, beta-carotene is unlikely to have much effect on sunburn risk in most people. C
Abdominal aortic aneurysm (AAA) prevention
Long-term supplementation with alpha-tocopherol or beta-carotene has been shown not to have a protective or preventive effect in male smokers with large AAAs. D
Alzheimer's disease
Intake of dietary or supplemental beta-carotene has been shown not to have any effect on Alzheimer's disease risk. D
Angioplasty
There is some concern that when antioxidant vitamins, including beta-carotene, are used together they might have harmful effects in patients after angioplasty. Additional research is needed to determine the effect of beta-carotene specifically. Supplements containing these vitamins should be avoided immediately before and following angioplasty without the recommendation of a qualified healthcare professional. D
Birthmark/mole (dysplastic nevi) prevention
Beta-carotene has been shown not to reduce the development of new moles in patients with numerous atypical moles. D
Cancer
While diets high in fruits and vegetables rich in beta-carotene have been shown to potentially reduce the incidence of certain cancers, results from randomized controlled trials with oral supplements do not support this claim. There is some concern that beta-carotene metabolites with pharmacological activity can accumulate and potentially have cancer-causing (carcinogenic) effects. A higher, statistically significant incidence of lung cancer in male smokers who took beta-carotene supplements has been discovered. Beta-carotene/vitamin A supplements may have an adverse effect on the incidence of lung cancer and on the risk of death in smokers and asbestos exposed people or in those who ingest significant amounts of alcohol. In addition, high-dose antioxidants theoretically may interfere with the activity of some chemotherapy drugs or radiation therapy. Therefore, individuals undergoing cancer treatment should speak with their oncologist if they are taking or considering the use of high dose antioxidants. Beta-carotene in the amounts normally found in food does not appear to have this adverse effect. D
Cardiovascular disease
Although several studies suggest that diets high in fruits and vegetables containing beta-carotene appear to reduce the risk of cardiovascular disease, most randomized controlled trials with oral supplements of beta-carotene have not supported these claims. A Science Advisory from the American Heart Association states that the evidence does not justify the use of antioxidants such as beta-carotene for reducing the risk of cardiovascular disease. D
Helicobacter pylori bacteria eradication
Infection with Helicobacter pylori bacteria in the gut can lead to gastric ulcers. Dietary supplementation with beta-carotene has not been found to be effective for this indication. D
Macular degeneration
Taking beta-carotene and other antioxidants has been proposed to help prevent or delay progression of age-related macular degeneration. However, long-term studies have not shown strong evidence that beta-carotene supplementation can prevent age-related eye disorders. D
Mortality reduction
Patients given beta-carotene supplements show no reduction in relative mortality rates from all causes based on most available data. D
Postoperative tissue injury prevention
Study results conclude that peri-operative supplementation with antioxidant micronutrients has limited effects on strength and physical function following major elective surgery. D
Stroke
Taking all-trans beta-carotene (synthetic beta-carotene) orally has been reported to have no effect on the overall incidence of stroke in male smokers. Additionally, there is some evidence that beta-carotene actually increases the risk of intracerebral hemorrhage by 62% in patients who also drink alcohol. D
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Grading rationale
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Acute respiratory infections, anemia, angina pectoris (chest pain), asbestosis (chronic lung disease), benign breast diseases, bone marrow transplantation, bronchial asthma, bronchopulmonary dysplasia in premature infants, diabetes, gastritis, glioblastoma, Graves' disease, high cholesterol, HIV, infections (sepsis), iron deficiency (prevention), leukemia (chronic myeloid), low birth weight (prevention), lung function (improving), nasal polyposis, nutrition supplementation (during alcohol rehabilitation), Streptococcal infections (group A), weight loss (HIV, post-partum).
DosingReturn to top
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
General
Formulations: Beta-carotene supplements are available in both oil matrix gelatin capsules and water-miscible forms. Some clinical trials have used water-miscible beta-carotene (10%) beadlets. The water miscible form seems to produce a significantly higher response in plasma beta-carotene (approximately 47% to 50%) than oil matrix gelatin capsules. Oral dosage is available in capsules (United States and Canada), tablets (United States and Canada), and chewable tablets (Canada).
Dietary intake: Consuming 5 servings of fruit and vegetables daily provides 6-8 milligrams of beta-carotene. Beta-carotene requires some dietary fat for absorption, but supplemental beta-carotene is similarly absorbed when taken with high-fat or low-fat meals. 1,800 micrograms of beta-carotene has been reported to maintain adequate vitamin A levels.
Consensus recommendations: The American Heart Association recommends obtaining antioxidants, including beta-carotene, from a diet high in fruits, vegetables, and whole grains rather than through supplements, until more information is available from randomized clinical trials. Similar statements have been released by the American Cancer Society, the World Cancer Research Institute in association with the American Institute for Cancer Research, and the World Health Organization's International Agency for Research on Cancer. The Institute of Medicine has reviewed beta-carotene, but has not make recommendations for daily intake, citing lack of sufficient evidence. Routine use of beta-carotene supplements is not considered necessary in the general population.
Adults (18 years and older)
15-180 milligrams taken by mouth of supplemental beta-carotene has been studied for various indications.
Children (younger than 18 years)
There is insufficient available data to recommend high-dose oral (by mouth) supplementation in children.
SafetyReturn to top
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
People who are sensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products should avoid supplemental use.
Side Effects and Warnings
Supplemental beta-carotene in children should be limited to specific medical indications. There is insufficient reliable information available about the safety of large doses of beta-carotene in pregnant or breastfeeding women.
Supplemental beta-carotene may increase the risk of lung cancer, prostate cancer, intracerebral hemorrhage, and cardiovascular and total mortality in people who smoke cigarettes or have a history of high-level exposure to asbestos. Beta-carotene from foods does not seem to have this effect.
In people who smoke, beta-carotene may increase cardiovascular mortality. In men who smoke and have had a prior myocardial infarction (MI or heart attack), the risk of fatal coronary heart disease increases by as much as 43% with low doses of beta-carotene. There is some evidence that beta-carotene in combination with selenium, vitamin C, and vitamin E might lower high-density lipoprotein 2 (HDL2) cholesterol levels. HDL levels are protective so this is considered to be a negative effect. Dizziness, reversible yellowing of palms, hands, or soles of feet and to a lesser extent the face (called carotenoderma) can occur with high doses of beta-carotene. Loose stools, diarrhea, unusual bleeding or bruising, and joint pain have been reported.
Pregnancy and Breastfeeding
U.S. Food and Drug Administration (FDA) Pregnancy Risk Factor C.
Insufficient data are available on larger oral doses of beta-carotene in pregnant and breastfeeding woman.
InteractionsReturn to top
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Preliminary studies in animals indicate that beta-carotene supplementation, when combined with heavy alcohol consumption, may increase liver toxicity and promote cancer.
Cigarette smoking decreases serum concentrations of beta-carotene and other carotenoids and depletes body stores of beta-carotene. However, oral beta-carotene supplementation should not be recommended in smokers because supplemental beta-carotene in certain doses is associated with a significantly higher risk of lung and prostate cancer in smokers. Smokers and people with a history of asbestos exposure should avoid taking beta-carotene supplements.
Cholestyramine (Questran®) and colestipol (Colestid®) can reduce the absorption of fat-soluble vitamins, including beta-carotene. Serum levels of beta-carotene can be reduced, but this is probably only in proportion to the lowering of cholesterol (on which beta-carotene is transported). Supplements are not usually necessary.
Colchicine can cause disruption of intestinal mucosal function, resulting in malabsorption of beta-carotene.
Taking beta-carotene in combination with selenium, vitamin C, and vitamin E appears to decrease the effectiveness of the combination of simvastatin (Zocor®) and niacin. Theoretically, beta-carotene could reduce the effectiveness of other HMG-CoA reductase inhibitors ("statins") such as atorvastatin (Lipitor®), fluvastatin (Lescol®), lovastatin (Mevacor®), and pravastatin (Pravachol®).
Mineral oil reduces absorption of fat-soluble vitamins, including beta-carotene.
Oral neomycin sulfate can reduce beta-carotene absorption, but short-term use is unlikely to have a significant effect.
Orlistat (Xenical®) can decrease the absorption of beta-carotene and other fat-soluble vitamins. It is recommended that patients take a multivitamin supplement, and separate the dosing time by at least two hours from orlistat.
Loss of stomach acid can reduce the absorption of a single dose of beta-carotene. Examples of proton pump inhibitors (PPIs) include esomeprazole (Nexium®), lansoprazole (Prevacid®), omeprazole (Prilosec®, Losec®), rabeprazole (Aciphex®), and pantoprazole (Protonix®, Pantoloc®).
Interactions with Herbs and Dietary Supplements
Consumption of a natural carotenoid mixture has been shown to lower the increase in oxidative stress induced by the fish oil. This carotenoid mixture may also enhance the plasma triglyceride-lowering effect of the fish oil.
Iron supplementation in infants with marginal vitamin A status has led to lower plasma vitamin A concentrations and greater vitamin A liver stores. Some researchers recommend that iron supplementation in infants should be accompanied by measures to improve vitamin A status.
Beta-carotene supplementation has been shown to lower serum lutein concentrations. Lutein from food sources does not seem to result in the decrease in beta-carotene concentrations that accompanies administration of lutein supplements.
Plant sterols have been shown to reduce beta-carotene bioavailability in some studies and not to have a significant effect in others. The effects on cholesterol levels are also unproven.
Supplementation of beta-carotene may decrease the vitamin E concentration in tissues.
Betel nut (Areca catechu L.)
Contents of this page:
Background
Synonyms
Evidence
Dosing
Safety
Interactions
Methodology
Selected references
Betel nut
BackgroundReturn to top
Betel nut use refers to a combination of three ingredients: the nut of the betel palm ( Areca catechu ), part of the Piper betel vine, and lime. Anecdotal reports have indicated that small doses generally lead to euphoria and increased flow of energy while large doses often result in sedation. Although all three ingredients may contribute to these effects, most experts attribute the psychoactive effects to the alkaloids found in betel nuts.
Betel nut is reportedly used by a substantial portion of the world's population as a recreational drug due to its stimulant activity. Found originally in tropical southern Asia, betel nut has been introduced to the communities of east Africa, Madagascar, and the West Indies. There is little evidence to support the clinical use of betel nut, but the constituents have demonstrated pharmacological actions. The main active component, the alkaloid arecoline, has potent cholinergic activity.
Constituents of betel nut are potentially carcinogenic. Long-term use has been associated with oral submucous fibrosis (OSF), pre-cancerous oral lesions (mouth wounds), and squamous cell carcinoma (cancer). Acute effects of betel chewing include worsening of asthma, low blood pressure, and rapid heart beat.
SynonymsReturn to top
Amaska, Areca catechu , areca quid, areca nut, arecoline, arequier, betal, betel quid, betelnusspalme, chavica etal, gutkha, hmarg, maag, marg, mava, mawa, paan, Palmaceae (family), pan, pan masala, pan parag, pinang, pinlang, Piper betel Linn. (leaf of vine used to wrap betel nuts), pugua, ripe areca nut without husk, quid, Sting® (Tantric Corporation), supai, ugam.
EvidenceReturn to top
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Uses based on scientific evidence Grade*
Anemia
Early poor-quality research reports that betel nut chewing may lessen anemia in pregnant women. Reasons for this finding are not clear, and betel nut chewing may be unsafe during pregnancy. C
Dental cavities
Due to the known toxicities of betel nut use and the availability of other proven products for dental hygiene, the risks of betel nut may outweigh potential benefits. C
Saliva stimulant
Betel nut chewing may increase salivation. However, it is not clear if this is helpful for any specific health condition. Due to known toxicities from betel nut use, the risks may outweigh any potential benefits. C
Schizophrenia
Preliminary poor-quality studies in humans suggest improvements in symptoms of schizophrenia with betel nut chewing. However, side effects such as tremors and stiffness have been reported. More research is necessary before a firm conclusion can be drawn. C
Stimulant
Betel nut use refers to a combination of three ingredients: the nut of the betel palm ( Areca catechu ), part of the Piper betel vine, and lime. It is believed that small doses can lead to stimulant and euphoric effects, and betel nut chewing is popular due to these effects. Chronic use of betel nuts may increase the risk of some cancers, and immediate effects can include worsening of asthma, high or low blood pressure, and abnormal heart rate. Based on the known toxicities of betel nut use, the risks may outweigh any potential benefits. C
Stroke recovery
Several poor-quality studies report the use of betel nut taken by mouth in patients recovering from stroke. In light of the potential toxicities of betel nut, additional evidence is needed in this area before a recommendation can be made. C
Ulcerative colitis
Currently, there is a lack of satisfactory evidence to recommend the use of betel nut for ulcerative colitis. Based on the known toxicities of betel nut use, the risks may outweigh any potential benefits. C
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Grading rationale
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Alcoholism, aphrodisiac, appetite stimulant, appetite suppressant, asthma, blindness from methanol poisoning, cough, dermatitis (used on the skin), digestive aid, diphtheria, diuretic, ear infection, excessive menstrual flow, excessive thirst, fainting, gas, glaucoma, impotence, intestinal worms, joint pain/swelling, leprosy, respiratory stimulant, toothache, veterinary uses (intestinal worms).
DosingReturn to top
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
Betel nut can be chewed alone, but it is often chewed in combination with other ingredients (called a "quid") including calcium hydroxide, water, catechu gum, cardamom, cloves, anise seeds, cinnamon, tobacco, nutmeg, and gold or silver metal. These ingredients may be wrapped in a betel leaf, followed by sucking the combination in the side of the mouth. It is reported that ingestion of 8-30 grams of areca nut may be deadly.
Children (younger than 18 years)
Betel is not recommended in children due to risks of toxicity, including worsening symptoms of asthma, effects on the heart, and cancer.
SafetyReturn to top
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
Breathing problems with betel nut use have been reported, although no allergic reactions are noted in the available scientific literature. Caution is warranted in people with allergies to other members of the Palmaceae family.
Side Effects and Warnings
Betel nut cannot be considered safe for human use by mouth. This is due to toxic effects associated with short or long-term chewing or eating of betel nut.
Betel nut and chemicals in betel leaves may cause skin color changes, dilated pupils, blurred vision, wheezing/difficulty breathing, and increased breathing rate. Tremors, slow movements, and stiffness have been reported in people also taking anti-psychotic medications. Worsening of spasmodic movements has occurred in patients with Huntington's disease. Seizure has been reported with high doses.
"Cholinergic" toxicity symptoms from betel use may include salivation, increased tearing, lack of urinary control (incontinence), sweating, diarrhea, and fever. Other problems may include confusion, problems with eye movement, psychosis, amnesia, stimulant effects, and a feeling of euphoria. Long-term users may form a dependence on the effects of betel, and discontinuing use may cause signs of withdrawal, such as anxiety or memory lapse.
Chewing betel nuts can also cause nausea, vomiting, diarrhea, stomach cramps, chest pain, high or low blood pressure, and irregular heart beats. A heart attack occurred in a man immediately after chewing betel nut. It is not clear if betel was the cause.
Betel chewing has been shown to have a harmful effect on the gums. The nut may cause the teeth, mouth, lips, and stool to become red stained. Burning and dryness of mouth may occur.
Studies of Asian populations have linked pre-cancer conditions of the mouth and esophagus to betel use ("oral submucous fibrosis"). There may be a higher risk of cancers of the liver, mouth, stomach, prostate, cervix, and lung with regular betel use.
In animals, a chemical in betel nut alters blood sugar levels. Although human study is lacking in this area, caution is advised in people with diabetes or glucose intolerance, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary. Betel nut chewers may have a higher risk of developing type 2 diabetes. Animal studies show mixed effects on thyroid function and increased skin temperature. Other problems can include increased blood calcium levels and kidney disease ("milk alkali syndrome"), possibly due to calcium carbonate paste sometimes used for preparing betel nuts for chewing.
Some betel nuts may be contaminated with harmful substances, including aflatoxin (a toxin produced by mold) or lead. Betel nut may cause metabolic syndrome, immunosuppression, and liver toxicity.
Pregnancy and Breastfeeding
Betel nut is not recommended during pregnancy and breastfeeding due to the risk of birth defects or spontaneous abortion.
InteractionsReturn to top
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
The effects of anticholinergic drugs may decrease when used in combination with betel nut or its constituent arecoline. Use with cholinergic drugs may cause toxicity (salivation, increased tearing, incontinence, sweating, diarrhea, vomiting, or fever). Betel nut may slow or raise the heart rate and could alter the effects of drugs that slow the heart, such as beta-blockers, calcium channel blockers, or digoxin.
Betel nut may alter blood sugar levels. Caution is advised when using medications that may also alter blood sugar. Patients taking drugs for diabetes by mouth or using insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.
Betel nut may increase the effects of monoamine oxidase inhibitors (MAOIs), angiotensin-converting enzyme (ACE) inhibitors, phenothiazines, cholesterol-lowering drugs, stimulant drugs, and thyroid drugs. Betel may increase or decrease the effects of anti-glaucoma eye drops. Reliable human study is lacking in these areas.
Other medications that betel nut may interact with include: antibiotics, medications that alter blood pressure, anti-inflammatory medications, or medications taken for cancer or immunosuppression. Patients taking anti-psychotic drugs should use cautiously due to reports of increased side effects. Based on the way betel nut is processed in the body, there may be interactions when taken with muscarinic antagonists. Furthermore, chronic use of betel nut and alcohol may lead to an increased risk of oral cancer.
Interactions with Herbs and Dietary Supplements
Taking betel with other cholinergic herbs may cause toxicity (salivation, tearing, urinary incontinence, sweating, diarrhea, vomiting, facial flushing, and fever) due to the chemical arecoline. Examples of cholinergic herbs include: American hellebore, jaborandi, lobelia, pulsatilla, and snakeroot. Betel may reduce the effects of herbs with possible anticholinergic properties, such as belladonna, henbane , hyoscyamine, and Swertia japonica Makino.
Betel may alter blood sugar levels. Caution is advised when using herbs or supplements that may also alter blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
Betel may inhibit monoamine oxidase and therefore may increase the effects of herbs and supplements that may also inhibit monoamine oxidase. Betel nut may also interact with cardioactive agents, such as hawthorn or oleander, or agents that effect thyroid levels, such as bladderwrack.
Betel nut extracts may lower blood cholesterol levels and may increase the effects of agents that lower cholesterol levels, such as fish oil, garlic, guggul, and niacin.
Betel may cause stimulant and euphoric effects and add to the effects of stimulants such as caffeine, guarana, or ephedra (ma huang).
Betel has been reported to deplete an essential vitamin (thiamine) and theoretically may cause neurologic damage including Wernicke-Korsakoff syndrome (confusion, poor muscle coordination, eye movement problems, and amnesia). Based on human study, chewing betel nut may aggravate the effects of vitamin D deficiency. Theoretically, simultaneous long-term use of betel and alcohol may lead to an increased risk of mouth cancer.
Other herbs or supplements that betel nut may interact with include antibacterials, agents that alter blood pressure, anti-inflammatory agents, or agents taken for cancer or immunosuppression. Patients taking herbs with antipsychotic effects should use cautiously due to reports of increased side effects. Based on the way betel nut is processed in the body, there may be interactions when taken with herbs with muscarinic antagonists effects as well.
Bilberry (Vaccinium myrtillus)
Contents of this page:
Background
Synonyms
Evidence
Dosing
Safety
Interactions
Methodology
Selected references
Bilberry
BackgroundReturn to top
Bilberry, a close relative of blueberry, has a long history of medicinal use. The dried fruit has been popular for the symptomatic treatment of diarrhea, for topical relief of minor mucus membrane inflammation, and for a variety of eye disorders, including poor night vision, eyestrain, and myopia.
Bilberry fruit and its extracts contain a number of biologically active components, including a class of compounds called anthocyanosides. These have been the focus of recent research in Europe.
Bilberry extract has been evaluated for efficacy as an antioxidant, mucostimulant, hypoglycemic, anti-inflammatory, "vasoprotectant," and lipid-lowering agent. Although pre-clinical studies have been promising, human data are limited and largely of poor quality. At this time, there is not sufficient evidence in support of (or against) the use of bilberry for most indications. Notably, the evidence suggests a lack of benefit of bilberry for the improvement of night vision.
Bilberry is commonly used to make jams, pies, cobblers, syrups, and alcoholic/non-alcoholic beverages. Fruit extracts are used as a coloring agent in wines.
SynonymsReturn to top
Airelle, anthocyanins, Bickbeere (German), bilberry leaf, black whortle, Blaubeere (Dutch), blaubessen, bleaberry, blueberry, bogberry, bog bilberry, burren myrtle, cranberry, dwarf bilberry, dyeberry, Ericaceae (family), European blueberry, Heidelbeere (Dutch), Heidelbeereblatter, heidelberry, huckleberry, hurtleberry, lingonberry, lowbush blueberry, Mirtillo nero (Italian), Myrtilli folium , Myrtilli fructus , Myrtilus niger Gilib., Optiberry, resveratrol, sambubiosides, trackleberry, Vaccinium angulosum Dulac, Vaccinium montanum Salibs., Vaccinium myrtillus anthocyanoside extract, VMA extract, VME, whortleberry, wineberry.
EvidenceReturn to top
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Uses based on scientific evidence Grade*
Atherosclerosis ("hardening" of the arteries), peripheral vascular disease
Bilberry has sometimes been used traditionally to treat heart disease and atherosclerosis. There is some laboratory research in this area, but there is a lack of clear information in humans. C
Cataracts
Bilberry extract has been used for a number of eye problems, including the prevention of cataract worsening. At this time, there is limited scientific information in this area. C
Chronic venous insufficiency
Chronic venous insufficiency is a condition that is more commonly diagnosed in Europe than in the United States, and it may include leg swelling, varicose veins, leg pain, itching, and skin ulcers. A standardized extract of bilberry called Vaccinium myrtillius anthocyanoside (VMA) is popular in Europe for the treatment chronic venous insufficiency. However, there is only preliminary research in this area, and more studies are needed before a recommendation can be made. C
Diabetes mellitus
Bilberry has been used traditionally in the treatment of diabetes, and animal research suggests that bilberry leaf extract can lower blood sugar levels. Human research is needed in this area before a recommendation can be made. C
Diarrhea
Bilberry is used traditionally to treat diarrhea, but there is a lack of reliable research in this area. C
Fibrocystic breast disease
There is limited research suggesting a possible benefit of bilberry in the treatment of fibrocystic disease of the breast. More study is needed before a strong recommendation can be made. C
Glaucoma
High intraocular pressure is considered a risk factor for developing glaucoma. Products containing bilberry may reduce the risk for developing glaucoma. Additional study is needed. C
Painful menstruation (dysmenorrhea)
Preliminary evidence suggests that bilberry may be helpful for the relief of menstrual pain, although more research is necessary before a firm conclusion can be drawn. C
Retinopathy
Based on animal research and several small human studies, bilberry may be useful in the treatment of retinopathy in patients with diabetes or high blood pressure. However, this research is early, and it is still unclear if bilberry is beneficial for this condition. C
Stomach ulcers (peptic ulcer disease)
Bilberry extract has been suggested as a treatment to help stomach ulcer healing. There is some support for this use from laboratory and animal studies, but there is a lack of reliable human evidence in this area. C
Night vision
Traditional use and several unclear studies from the 1960s and 1970s suggest possible benefits of bilberry on night vision. However, more recent well-designed studies report no benefits. Based on this evidence, it does not appear that bilberry is helpful for improving night vision. D
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Grading rationale
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Age-related macular degeneration, angina (chest pain), angiogenesis (blood vessel formation), antifungal, antimicrobial, antioxidant, antiseptic, antiviral, arthritis, bleeding gums, burns, cancer, cardiovascular disease, chemoprotectant, chronic fatigue syndrome, common cold, cough, dermatitis, dysentery (severe diarrhea), edema (swelling), encephalitis (tick-borne), eye disorders, fevers, gout (painful inflammation), heart disease, hematuria (blood in the urine), hemorrhoids, high blood pressure, high cholesterol, kidney disease, lactation suppression, laxative (fresh berries), leukemia, liver disease, macular degeneration, oral ulcers, pharyngitis, poor circulation, retinitis pigmentosa, scurvy, skin infections, sore throat, stomach upset, tonic, urine blood, urinary tract infection, varicose veins of pregnancy, vision improvement.
DosingReturn to top
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
Fresh berries 55 to 115 grams three times daily or 80 to 480 milligrams of aqueous extract three times daily by mouth (standardized to 25% anthocyanosides) have been used traditionally.
Dried fruit 4 to 8 grams by mouth with water two times per day has been used traditionally, or decoction of dried fruit by mouth three times per day (made by boiling 5 to 10 grams of crushed dried fruit in 150 milliliters of water for 10 minutes and straining while hot), or cold macerate of dried fruit by mouth three times per day (made by soaking dried crushed fruit in 150 milliliters of water for several hours). Experts have warned that patients should use dried bilberry preparations because the fresh fruit may actually worsen diarrhea.
Some experts recommend using a mouthwash gargle of 10% dried fruit decoction as needed for mucus membrane inflammation.
Children (younger than 18 years)
There is not enough scientific evidence to recommend the use of bilberry in children.
SafetyReturn to top
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
People with allergies to plants in the Ericaceae family or to anthocyanosides may have reactions to bilberry. However, there is a lack of reliable published cases of serious allergic reactions to bilberry.
Side Effects and Warnings
Bilberry is generally believed to be safe in recommended doses for short periods of time, based on its history as a foodstuff. There is a lack of known reports of serious toxicity or side effects, although if taken in large doses, there is an increased risk of bleeding, upset stomach, or hydroquinone poisoning.
Based on human use, bilberry fresh fruit may cause diarrhea or have a laxative effect. Based on animal studies, bilberry may cause low blood sugar levels. Caution is therefore advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider and medication adjustments may be necessary.
In theory, bilberry may decrease blood pressure, based on laboratory studies.
With the use of bilberry leaf extract, there is a theoretical increased bleeding risk, although there are no reliable published human reports of bleeding. Caution is advised in patients with bleeding disorders, taking drugs that may increase the risk of bleeding, or prior to some surgeries and dental procedures.
Pregnancy and Breastfeeding
There is not enough scientific evidence to recommend the safe use of bilberry in pregnancy or breastfeeding, although eating bilberry fruit is believed to be safe based on its history of use as a foodstuff. One study used bilberry extract to treat pregnancy-induced leg swelling (edema), and no adverse effects were reported.
InteractionsReturn to top
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Bilberry may lower blood sugar levels, although there is a lack of reliable human studies in this area. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.
Based on human use, bilberry may increase diarrhea when taken with drugs that cause or worsen diarrhea, such as laxatives or some antibiotics. Bilberry theoretically may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®). There are no reliable published human reports of bleeding with the use of bilberry. Based on theory, bilberry may further lower blood pressure when taken with drugs that decrease blood pressure.
Based on early laboratory study, berry extracts have been shown to inhibit H . pylori , an ulcer-producing bacteria and enhance the effects of the prescription drug clarithromycin (Biaxin®).
Bilberry may also interact with anticancer agents, liver-damaging agents, and estrogen-containing medications. Consult with a qualified healthcare professional, including a pharmacist, to check for interactions.
Interactions with Herbs and Dietary Supplements
Based on animal research, bilberry may lower blood sugar levels. Although there is a lack of reliable human study in this area, caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
Based on theory, bilberry may lower blood pressure further when taken with herbs or supplements that decrease blood pressure.
Based on theory, bilberry may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
Based on traditional use, bilberry may increase diarrhea or laxative effects when taken with herbs and supplements that are also believed to have laxative effects.
Consuming bilberry with quercetin supplements may result in additive effects. Cooking bilberries with water and sugar to make soup may decrease the amount of quercetin by 40%. Berries contain resveratrol, which has been studied as an antioxidant, for cardiovascular disease, and for cancer and may have additive effects when taken with supplements like grape seed.
Bilberry may also interact with anticancer agents, antioxidants, liver-damaging agents, and herbs or supplement with hormonal properties. Consult with a qualified healthcare professional, including a pharmacist, to check for interactions.
Biotin (vitamin H)
Contents of this page:
Background
Synonyms
Evidence
Dosing
Safety
Interactions
Methodology
Selected references
Biotin
BackgroundReturn to top
Biotin is an essential water-soluble B vitamin. The name biotin is taken from the Greek word bios meaning "life." Without biotin, certain enzymes do not work properly and various complications can occur involving the skin, intestinal tract, and nervous system. Metabolic problems including very low blood sugars between meals, high blood ammonia, or acidic blood (acidosis) can occur. Death is theoretically possible, although no clear cases have been reported. Recent studies suggest that biotin is also necessary for processes on the genetic level in cells (DNA replication and gene expression).
Biotin deficiency is extremely rare. This is because daily biotin requirements are relatively small, biotin is found in many foods, and the body is able to recycle much of the biotin it has already used. Significant toxicity has not been reported in the available literature with biotin intake.
SynonymsReturn to top
ARP [N-(Aminooxyacetyl)-N¡-(D-biotinoyl) hydrazine], biocytin, biotin-alkaline phosphate, biotin cadaverine, biotin nitrilotriacetic acid, biotin NTA , biotin-PEO4-amine, Biotin-PEO2-PPO2-amine, biotin-PEO3-maleimide, biotin-PEO4-propionate succinimidyl ester, biotinidase, coenzyme R, D-biotincis-hexahydro-2-oxo-1H-thieno[3,4-d]-imidazole-4-valeric acid, dUTP biotin, factor alpha, tripotassium salt (BNTA), vitamin Bw, vitamin H, W factor.
Note: This review does not cover the use of biotin in radioimmunotherapy (radioactive therapy) or radio-labeling for diagnostic procedures.
EvidenceReturn to top
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Uses based on scientific evidence Grade*
Biotin deficiency
Biotin deficiency is extremely rare. Some potential causes of biotin deficiency are: long-term use of certain anti-seizure medications; prolonged oral antibiotic use; intestinal malabsorption (for example short gut syndrome); intravenous feeding (total parenteral nutrition/TPN) without added biotin; and eating raw egg whites on a regular basis. Supplementing with biotin appears helpful for the treatment of this deficiency. A
Biotin-responsive inborn errors of metabolism
Disorders such as multiple carboxylase deficiency can cause inborn errors of metabolism that cause a "functional" biotin deficiency. High-dose biotin is used to treat these disorders. Management should be under strict medical supervision. A
Brittle fingernails
Biotin has been suggested as a treatment for brittle fingernails, particularly in women. There is not sufficient scientific evidence to form a clear conclusion. C
Cardiovascular disease risk (in diabetics)
A combination of biotin and chromium may help lower cholesterol and decrease the risk of developing clogged arteries (called atherosclerosis) in diabetics. However, other research of biotin alone found that biotin did not affect cholesterol, glucose, or insulin levels, but did decrease triglyceride levels. More research with biotin alone is needed. C
Diabetes mellitus (type 2)
In early research, biotin has been reported to decrease insulin resistance and improve glucose tolerance, which are both properties that may be beneficial in patients with types 2 (adult-onset) diabetes. Other research suggests that a combination of biotin and chromium may help improve blood sugar control. However, there is not enough human evidence to form a clear conclusion in this area. C
Hepatitis (in alcoholics)
Antioxidant therapy with biotin, vitamins A-E, selenium, zinc, manganese, copper, magnesium, folic acid, Coenzyme Q10 did not improve survival rates in alcoholics with hepatitis. More research with biotin alone is needed. C
Pregnancy supplementation
Marginal biotin deficiency has been found to commonly occur during pregnancy. Biotin supplementation during pregnancy is not currently standard practice, and prenatal vitamins generally do not contain biotin. However, individual patients may be considered for biotin supplementation by healthcare practitioners on a case-by-case basis. Additional study is needed in this area. C
Total parenteral nutrition (TPN)
Intravenous feeding solutions (TPN) should contain biotin, in order to avoid biotin deficiency in recipient patients. This applies for patients in whom TPN is the sole source of nutrition. More study is needed in this area to make a firm recommendation. C
*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.
Grading rationale
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Alopecia areata (hair loss), antioxidant, basal ganglia disease, cancer, Crohn's disease, exercise capacity improvement, hyperlipidemia, metabolic disorders (3-methylcrotonylglycinuria), Parkinson's disease, peripheral neuropathy, Rett syndrome, seborrheic dermatitis, uncombable hair syndrome, vaginal candidiasis, wound healing (periodontal).
DosingReturn to top
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
The U.S. Food and Nutrition Board of the National Academy of Science's Institute of Medicine recommends a daily Adequate Intake (AI) of 30 micrograms in adults 19 years and older (a daily AI of 25 micrograms is recommended in those ages 14-18 years old). In pregnant women older than 14 years, an AI of 30 micrograms is recommended. During breastfeeding, a daily AI of 35 micrograms is recommended. Most healthy non-pregnant individuals with regular diets obtain these amounts of biotin through dietary consumption.
The U.S. Recommended Dietary Allowance (RDA) for biotin is 300 micrograms daily. This is the dose used in many dietary supplements. Toxicity with biotin intake has not been reported in the available literature, and doses as high as 200 milligrams daily have been used in patients with inborn errors of metabolism without significant reported toxicity.
Biotin is available as capsules and tablets in various doses and as lozenges. Treatment for biotin deficiency should be under strict medical supervision. There is disagreement among experts about the proper dose. In adults, intramuscular (injected into the muscle) doses as low as 150-300 micrograms daily have been suggested. Higher doses between 10-40 milligrams of biotin daily have also been recommended (given by mouth, injected into the muscle, or injected into the veins).
Children (younger than 18 years)
The U.S. Food and Nutrition Board of the National Academy of Science's Institute of Medicine recommends a daily Adequate Intake (AI) of 5 micrograms daily (~0.7 micrograms per kilogram) in infants ages 0-6 months old; 6 micrograms daily (~0.7 micrograms per kilogram) in infants ages 7-12 months old; 8 micrograms daily in children ages 1-3 years old; 12 micrograms daily in children ages 4 8 years-old; 20 micrograms daily in children ages 9-13 years old; and 25 micrograms in adolescents ages 14-18 years old.
Treatment for biotin deficiency and biotin-responsive inborn errors of metabolism should be under strict medical supervision. There is disagreement among experts about the proper dose.
SafetyReturn to top
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
Individuals with hypersensitivity to constituents of biotin supplements should avoid these products.
Side Effects and Warnings
Significant toxicity with biotin intake has not been reported in the available literature, and very high doses have been used in patients with inborn errors of metabolism without reported toxicity. However, doses higher than the U.S. Food and Nutrition Board's recommended daily Adequate Intake (AI) should not be exceeded in healthy individuals unless under medical supervision.
Pregnancy and Breastfeeding
Marginal biotin deficiency has been found to commonly occur during pregnancy. Serious concern has been focused on this finding because biotin deficiency is teratogenic (causes birth defects) in many animals. It has been suggested by some experts that biotin supplements should be considered for widespread use in pregnant women, although there is not enough available scientific information to make this recommendation.
The recommended daily adequate intake (AI) by the U.S. Food and Nutrition Board should not be exceeded unless under medical supervision.
InteractionsReturn to top
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Anti-seizure medications, such as phenytoin (Dilantin®), primidone (Mysoline®), carbamazepine (Tegretol®), phenobarbital (Solfoton®), and possibly valproic acid, have been associated with reduced blood levels of biotin. Patients using these medications should consult with a qualified healthcare professional, including a pharmacist, to see if biotin supplementation may be necessary.
Broad-spectrum antibiotics such as sulfa drugs can alter the normal intestinal bacteria (flora) that make biotin. Biotin supplementation may be necessary if deficiency is found.
Isotretinoin (Accutane®) may reduce biotinidase activity. It is not clear if biotin supplementation may be warranted during long-term use.
Biotin may increase the effects of lipid-lowering medications.
Interactions with Herbs and Supplements
High-doses of pantothenic acid can lead to malabsorption of biotin in the gut and can lower levels of biotin in the body. Caution is advised.
Biotin may increase the effects of lipid-lowering herbs or supplements.
Eating raw egg whites on a regular basis increases the risk of biotin deficiency.
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