CHAPTER 23 Herbal Medicine OBJECTIVES This chapter should enable you to • Discuss the actions of a tonic, an adaptogen, and an immune stimulant • List at least eight forms in which an herb can be used • Describe three precautions to observe when wildcrafting herbs • Discuss precautions when using herbs with children • Describe the common use and cautions of at least five popular herbs Advances in medical technology have given us antibiotics, laser surgery, and organ transplants that have changed the face of health care; however, this mushrooming of technology has come at a cost, including new risks and the insidious belief that health-care professionals and technology are the only sources of health and healing. We have not always looked to technology for solutions to health problems. There was a time when our ancestors were very aware of and connected to the healing power of nature. It was a natural part of human existence. Unfortunately, much of this information has been lost or ignored. Throughout the last century, in our quest for modern technology, we thought that we might be able to improve on nature. A change is taking place, however, in which we are rediscovering that one needs to venture no further than the kitchen spice cabinet, backyard garden, or nearest woods to discover the abundance of herbs that can be readily used to influence human health and well-being. Indeed, we are literally surrounded by a bounty of medicinally charged leaves, flowers, seeds, barks, and roots. We are learning of the healing power of nature. Common garden weeds, such as St. John’s wort, and garden perennials, such as echinacea, are offering natural ways to improve health and treat illnesses. Many benefits can be found in developing a relationship with plants. Employing the use of herbs from a holistic perspective is the best way to maximize their healing potential. This means using herbs in a way that addresses the whole person—mind, body, and spirit—within the dynamic environment as opposed to just trying to control, suppress, or alleviate symptoms. It is important to incorporate the appropriate herbs into a larger effort of care that includes other lifestyle decisions and factors, such as nutrition, exercise, and stress reduction (much of which has been addressed in other chapters of this book). KEY POINT Rather than control specific symptoms, herbal therapy, when used holistically, considers the needs of the whole person—mind, Historical Uses of Herbs and Folklore Let us take a quick look at where herbs have fit into the history of medicine. In the United States, an untold amount of information from millennia of cultural plant medicine use by indigenous people has been lost in just a few generations (see Exhibit 23-1). Fortunately, other countries and cultures have, to varying degrees, protected centuries of experiential data and records of plant use and effectiveness. EXHIBIT 23-1 WISDOM OF THE ANCIENTS One particularly interesting remnant of an ancient system of herbal use is referred to as the Doctrine of Signatures. This system suggested tha plant signified how it could be used. For example, a plant with a thick yellow root would indicate use for liver problems or red stems for bloo survived to make it relevant or safe for use today; however, it is evidence of the tremendous depth of understanding and relationship people t What remains quite valid about our history with plants is the fact that we have coevolved with them through the ages, creating a very special and unique relationship. Plants contain most of the substances that are vital to our health, but not only in the form of vitamins, minerals, and enzymes. They also contain hormones and compounds that stimulate our body to produce chemical messengers known as neurotransmitters that are responsible for major communication systems within our bodies. There is a myriad of materials known as phytochemicals (plant chemicals), and science seems to be uncovering, on a daily basis, new active ingredients and information regarding our health connections with plants. These phytochemicals occur in plants in mind-boggling numbers and combinations. They exist in delicate balances, buffering, strengthening each other, and creating synergy within the plants. KEY POINT Synergy is the combined and/or cooperative action of individual parts that allows the total effect to be greater than the sum of th have three, four, or more times the effects of either of them alone. Phytochemicals are stored by the plants in concert with the sun, soil, air, and water, and they exist as a product and service of the plants’ own healthy growth, function, and reproduction. Because of our coevolution, they also occur in forms that our bodies can, for the most part, readily digest, assimilate, and use for maintaining vital and healthy function. Yes, there is still a lot of research to be done, but while science continues to unravel the mysteries, we can begin to reacquaint ourselves with and take advantage of the wealth of knowledge handed down to us by our ancestors. Today, 80% of the world’s population still relies on plants as part of their primary health care. This percentage is not just a reflection of less developed countries—it includes those with advanced concepts of health care such as Germany and China where the systems recognize the undeniable benefits of integrating both modern conventional technology and traditional wisdom. (The scope of this subject extends far beyond what can be addressed in this chapter. For those interested in learning more about the history of herbal medicine, please refer to the “Suggested Readings” list at the end of the chapter.) REFLECTION What has been your attitude about the medicinal use of plants? Have you believed herbal medicine to be quaint folklore or legit products? Phytochemicals’ Actions on the Body Now that we know that individual plants contain hundreds, maybe thousands, of different phytochemicals in varying combinations, it is important to also develop a sense of how they work in our bodies and how those actions differ from synthetic pharmaceuticals. Foremost, the very reason most of our modern drugs came to be was to provide a particular action—to do one thing and do it with authority. This is generally achieved through potent blocking, suppressing, and overriding mechanisms in the body. As a result, we have many very powerful and effective drugs at our disposal; however, along with their power comes a ponderous incidence of side effects even when properly taken. Recently published research documents complications from improperly prescribed and used pharmaceuticals as the fourth leading cause of death in the United States. Herbs, on the other hand, with their warehouse of constituents, often do a variety of things at once on different levels (see Exhibit 23-2); they support, strengthen, and balance our systems. EXHIBIT 23-2 ACTION OF HERBS ACTION Adaptogen: helps body maintain and regain normal function in presence of stress Analgesic: reduces pain Antibacterial: inhibits growth of bacteria Anticatarrhal: reduces mucus and phlegm Antiemetic: reduces nausea, prevents vomiting Anti-inflammatory: reduces inflammation Antispasmodic: prevents or decreases spasms and cramps Astringent: contracts tissues to protect skin Carminative: eases digestion, assists eliminating gas from gastrointestinal system EXHIBIT 23-2 ACTION OF HERBS Diuretic: increases urine elimination Emetic: promotes vomiting Hepatic: strengthens liver, stimulates bile flow Hypnotic: induces sleep Hypotensive: reduces blood pressure Laxative: stimulates bowel elimination Nervine: strengthens nervous system, reduces anxiety Rubefacient: stimulates circulation to surface of skin when applied topically Sedative: promotes relaxation Stimulant: increases body’s activities Tonic: strengthens body or specific organs Herbs provide as important a role in helping to maintain good health as they do treating the symptoms and underlying causes of disease. In addition, many herbalists feel the range of influence on specific situations can be increased by combining a number of herbs and creating a formula or compound. The goal is to address different body tissues, thereby strengthening the overall effect of the remedy. For example, someone with premenstrual syndrome could use a formula that may include dandelion leaf to relieve symptoms of fluid retention, black cohosh to ease cramping, and chaste tree to help rebalance hormones and alleviate anxiety. Thus, depending on how deep a relationship you would like, becoming familiar with some of the known plant phytochemicals and their actions would give you an added advantage in choosing the herbs that would be most effective in a given situation and avoid possible side effects or conflicts with other herbs or treatments. Different Forms of Herbs In getting started, it is important to familiarize yourself with the different forms in which herbs are available and their advantages and disadvantages. From the holistic perspective, the form of herb is just as important a consideration as the type of herb. If it is a tea and the person does not “do teas,” it is not of much use. Most of us are used to taking our medicines in the form of a pill; however, this is not the only way, nor is it always the best or most effective method. Remember that a pill is a form that must first be digested before the medicine it contains can be absorbed, assimilated, and used. This is a process that is often compromised when someone is dealing with an illness. Teas and tinctures are in liquid form, and thus, they are more readily available to the body to absorb. Also, there is an entire science involving the solubility of phytochemicals in different solutions, some releasing their properties more readily in alcohol, others in water. Most herbal remedies at some point in their creation, unless you just eat them fresh or dried in an unaltered state, involve an extraction process. Extracts are made by separating the active constituents (phytochemicals) from the inactive ones (which may include sugars, starch, etc.) with the use of a solvent. This concentrates the active ingredients, which can then be kept as fluid (known as a liquid extract) or condensed and dried into a powder (referred to as powdered extract, which can then be put into capsules or made into tablets). A more potent form of the herb is created by these processes and is generally more effective for dealing with health imbalances than simply eating fresh or raw dried herbs. Tea is a liquid extract, with water being the solvent. This a great way to get your daily medicine, particularly tonic herbs, that nourish the body’s various tissues and systems, especially when taken over a period of weeks or months—it also does not seem much like medicine. A cup of tea is a thoughtful thing to do for yourself or someone else, providing you the opportunity to add your own caring intention to the preparation. Relatively speaking, it is often the least expensive way to take your medicine. KEY POINT Herbal remedies can be used in many forms, such as extracts, teas, infusions, decoctions, tinctures, capsules, compresses, poult There are two methods of tea making: infusion and decoction. An infusion is a gentle form of preparation designed to preserve the valuable nutrients and essential oils and is used to prepare the more delicate parts of plants—leaves, flowers, and fresh berries. Generally speaking, the herbs are placed in a covered container and steeped in freshly boiled water for 10–30 minutes. The proportions used will vary depending whether the herbs are fresh or dried; usually 1 teaspoon dried or 2 teaspoons fresh to 1 cup of water or 1 ounce of dried herb (roughly 2 ounces of fresh) to 1 quart of water is used. The second method, decoction, is used for harder parts of the plant (roots, bark, and seeds), which are gently simmered for 15 minutes to an hour. There are some wonderful books that extol the virtues of medicinal teas that include tried and true recipes to make it easy. Supplies are readily available at most health food stores in ready-to-steep bags or as loose bulk herbs to custom blend to your needs and desires. For those who are interested, there is little that can be more gratifying than growing, picking, and using some herbs of your own, and it is fairly easy; however, teas may not be for everyone. They do take time and space, can be cumbersome to travel with, and may not appeal to some taste buds, although most herbalists will tell you that the tasting of the herb can be a very important part of the healing relationship. Additionally, there are some phytochemicals that are not water soluble (meaning that they are not amenable to water extraction). There are health situations when forms other than teas are more appropriate. In these cases, other liquid extracts such as tinctures can be used, which will vary depending on the solvent used— generally alcohol, vinegar, or glycerin. Again, these preparations are made by the active ingredients literally being pulled out of the plant into the solution; the solvent then acts as a preservative. Of the three types of solvents, food-grade alcohol is most often used as it is the strongest and provides the longest shelf life (3 years or longer); however, regardless of the type of solvent used, all tinctures are easy to carry and are readily absorbed by the body’s digestive process. Some people object to the taste of alcohol tinctures (even though most can be concealed in juice or tea), and there are situations when even small amounts of alcohol are undesirable. The extracts made with glycerin are nonalcoholic and sweet tasting (and thus child friendly), but are considerably weaker in potency than the alcohol extracts. Likewise, vinegar extracts are not as potent as alcohol tinctures and not readily available commercially, but there are those who feel that vinegar, especially apple cider vinegar, adds healing properties of its own. When using tinctures, one should follow specific manufacturers’ recommendations for dosage. Capsules may contain crushed, dried herbs or the more concentrated powdered extract. The size of the capsule will determine the dose of the unaltered dried herb, with the standard double 00 capsules holding 500 mg. If the contents are powdered extract, the strength will be higher. This is one compelling reason why it is so important to develop the habit of reading labels so you know as much as possible what exactly you are getting (see Table 23-1). TABLE 23-1 POINTS TO CONSIDER IN REGARD TO STANDARDIZED EXTRACTS AND WHOLE PLA STANDARDIZED EXTRACT • Highly purified standard amount of specific constituents • Nonsynthetic powerful medicine • Some herbs have organ-specific activities and indications • Insures proper identification of plants • Promotes more allopathic approach of treating symptoms • Clinical testing and research data are available • Evidence of increased incidence of side effects • May lose all other activity, but targeted effect • Solvents such as hexane are involved in the extraction process; solvent residues can be liver toxins • Takes plant constituents out of context; perpetuates the idea that we can outsmart or improve on nature Note: It stands to (holistic) reason to determine what will serve the individual best in each situation. Perhaps employing standardized extract tonification (tonics). The important issue is having access to and being able to use what works best for the individual in a given scenario. External forms of herbal medicines also are extremely effective, and with many possible variations in form and content, they can be useful in a wide array of situations. For example, an infusion or decoction of echinacea or goldenseal can be used as a gargle to ease the inflammation of a sore throat. A compress is made by soaking a soft cloth in a warm or cool tea made with the appropriate herb and applied to an injury, sore, or wound to speed healing. A poultice is similar, but the herb itself is applied to the skin. This could be as quick and simple as crushing a fresh plantain leaf and pressing it to a bug bite or sting to bring relief, or as specific as mixing a combination of herbs, say garlic, mustard, and onions, wrapping them in gauze and securing them over the chest to break up the congestion of a cold. Herbal tea bags make a handy poultice (wet thoroughly and bandage where needed). Yet another very effective way to use a tea is as an herbal steam inhalation, breathing in the medicinal steam to lessen the inflammation, irritation, and discomfort of sinus infections or head colds. This also is a great idea to add to your routine to prevent illness, as many herbs that are used this way are antiviral and antibacterial, with the steam helping to keep the mucous membranes in top condition to fend off infectioncausing bugs. Liniments are tinctures that are used only externally. Because the alcohol that they contain is usually the isopropyl (rubbing) type, a liniment absorbs quickly on the skin, carrying the medicine into the tissues. Salves and ointments are semisolid preparations designed for application to the skin using oil-based substances or beeswax with dried herbs. They are not meant to blend into the skin but to form a protective outer layer that holds the medicine in place and prolongs the time that the herbs remain moist. (Included in the “Suggested Reading” list are books that go into great detail about making your own remedies, some providing extremely helpful illustrations of each step and pictures of commonly used herbs.) Cultivating Herbal Wisdom After you have made the decision to incorporate herbal medicine as part of your holistic health approach, some general guidelines and tips can help make your relationship with plants rewarding and safe. Become familiar with a few herbs. A single herb can offer multiple health benefits, and thus, you may find most of your herbal needs can be met from a few plants. Attend one of the increasingly available classes and workshops. To locate courses and events, check with local health food stores, wellness centers, and universities. Also, the American Herbalists Guild and the American Botanical Council (listed in the “Resources” section) are great organizations to check with regarding educational programs. When deciding where to buy herbs, try to purchase locally and organically grown produce when possible. Become attuned to looking for sustainably harvested products (plants that are collected in an ecologically and environmentally conscious manner). This may require a little investigation but is well worth the effort. Search for reputable companies, particularly those with the reputation of being in the business for more reasons than just making a profit. The quality of the medicine will be enhanced by the social consciousness and good intentions of the company producing it. Some precautions are needed when gathering your own herbs from the wild (wildcrafting). First, be absolutely sure that you properly identify the plant, as there are many examples of different plants that resemble each other very closely, some of them being very toxic. Be aware of the potential for chemical/pesticide contamination where you pick. For instance, do not pick along busy roads where the plants are exposed to many different pollutants from auto exhaust to detergent-laden runoff. Also, know plants well enough to avoid picking them if they are endangered species. All of these precautions can be disregarded if you are in a position to grow some herbs on your own. There are some books listed at the end of this chapter to help you do that. For best results when using herbs, be consistent and take them in the recommended amounts and with the recommended frequency. If taking something long term (as a tonic), it is a good idea to omit the herb at regular intervals; for instance, 5 days on/2 days off or 1 month on/1 week off— the individual situation and the herb used will help determine the schedule. When treating a specific condition, avoid starting herbs that are generally promoted as good for the condition without some assessment. Consider how you feel and what may have contributed to or precipitated the situation. Do not ignore symptoms or delay seeking the most appropriate care or therapy. If you have a known problem, consult with a health-care practitioner, especially if you are taking other medications. The ideal approach in these situations is to work with an experienced professional herbalist. If you do not know of one, try contacting the American Herbalists Guild to see whether there is a member in your area. In lieu of an herb-savvy healthcare professional, the safest way to proceed is with one herb at a time. KEY POINT Remember that the term natural does not necessarily mean safe! You will do well to remember that herbs are medicines and need to be used appropriately and correctly. It is important to know the dosage range and understand that a higher dose does not necessarily mean greater effectiveness. Also, in regard to safety, you must consider individual allergies and sensitivities, particularly if taking an herb for the first time, start with a low dose (perhaps half the recommended dose) and work up to a standard dose over a couple days. A considerable number of people are seen in hospital emergency departments each year with adverse events related to dietary supplements; most problems treated are related to (Geller et al., 2015): • unsupervised ingestion by children • cardiac symptoms associated with weight loss products • choking and pill-induced dysphagia in older adults This reinforces the need to use these products correctly and carefully. TIP FOR PRACTITIONERS When using herbs with children, particular attention must be paid to dose. A general rule is to use half the adult dose for childre of safety must be applied, as are considerations for the specific situation and individual child. Using herbs with infants should o Be aware that there are definitely situations when the use of specific herbs is inappropriate and contraindicated (should be avoided), as they may give rise to side effects or complicate the situation. This is particularly true during pregnancy and breastfeeding. There seems to be information released daily regarding drug–drug and food–drug interactions. To date, relatively little is known about interactions between synthetic pharmaceuticals and herbs. Until more research is available, use common sense and check several reliable resources, including the practitioner who prescribed the medication. Health-care providers need to be kept aware of all medicines, herbs, remedies, and supplements that are being taken by their patients. A growing number of pharmacists are becoming more knowledgeable about herbs, and many have access to computer databases that can help alert people to possible undesirable interactions to avoid side effects. The literature shows that most problems related to using herbs arise from misuse, allergic reactions, or improper combining with pharmaceuticals, all of which can be avoided by taking the responsibility to use herbs wisely, thoughtfully, and with respect for the abundance of health benefits that they offer. The following pages list some of the more popular and useful herbs readily available, along with a combination of information gathered from time-tested experience and what modern science has validated. This information is by no means all encompassing but is offered as a place to begin. Review of Some Popular Herbs Aloe Vera • Family: Aloaceae • Other names: A. barbadensis Mill., Aloe indica Royle, Aloe perfoliata L. var vera • Habitat: Warm, dry climate. • Parts used: Leaf extract • Common uses: Soothing skin irritation; healing minor burns, psoriasis, and general skin conditions. • Cautions: Ingestion is not advised as it could cause abdominal cramps and diarrhea. Black Cohosh (Cimicifuga racemosa) • Family: Ranunculaceae • Other names: Black snake root, fairy candles, bugbane • Habitat: Densely shaded, deciduous woods • Parts used: Dried root and rhizome • Common uses: Relief of menopausal symptoms • Cautions: Large doses (over 2 teaspoons) may cause headache. Do not use during pregnancy or while nursing. Take with food to avoid stomach irritation with long-term use. Black cohosh is a perennial plant that often reaches 6 feet in height and produces a rather showy spike of white flowers in midsummer. It is a spectacular sight when the sunlight filters down though the woodland canopy and strikes individual “candles,” setting them aglow. This herb was greatly valued by Native Americans as a remedy for joint pain. It is often used as part of a formula (in combination with other herbs) to reduce inflammation of joints and soft tissues. It has been thought to have a role in normalizing to the female reproductive system, providing relief of menstrual cramps and menopausal symptoms, such as hot flashes and anxiety; however, research has not supported this. Burdock (Arctium lappa) • Family: Compositae • Other names: Beggar’s buttons, cockle buttons, cocklebur, burr seed • Habitat: Open fields, roadsides, and waste places • Parts used: Root and seed • Common uses: Blood cleanser/purifier (alternative) • Cautions: Do not take during pregnancy. It may cause dermatitis in sensitive individuals. It can affect blood sugar in people with diabetes and produces a diuretic effect and bladder irritation in some people. Antibiotics and medications taken to treat gout, cancer, or HIV may interact with burdock. Burdock is a large biannual plant growing up to 6 feet tall with huge leaves and a deep taproot that can reach 30 feet in length. Small purple flowers appear at the top of a single stalk in late spring of the second year and mature into seed heads, which readily stick to almost anything they touch. These are also known as beggar’s buttons because they were once used to fasten clothing together. The concept of hook and loop fasteners is based on the sticky nature of burdock seed heads. In Japan, the long taproot is known as gobo and is used for food. Fresh, young roots can be sliced and added to a stir-fry or soup to make a nutritious meal. In general, it is an important tonic herb, which is considered gentle and nourishing. Traditionally, burdock root has been used as a blood purifier because of its ability to support the body’s function in elimination of waste products via the liver. It also is considered a tonic that can improve the body’s overall health. Herbalists use the root as a mild diuretic (increasing fluid elimination through the kidneys) and to support kidney function. A decoction of the root or tincture of the seeds can be used for dry skin disorders, such as eczema and psoriasis. Additionally, some cases of acne respond to treatment with burdock; it can take 4–6 weeks of consistent use for results to be seen. A root poultice or oil infusion of leaves can be applied to skin sores and leg ulcers. A compress made with a strong decoction will help treat topical fungal infections. Because it is a bitter herb it can help digestive organs work better, which can aid in reducing indigestion. Its ability to stimulate digestive activity can worsen chronic diarrhea. Calendula (Calendula offcinalis) • Family: Compositae • Other names: Marigold • Habitat: Mediterranean area; however, it can be cultivated in any good garden soil. • Parts used: Flower petals • Common uses: Topically for healing injuries and infections of the skin and mucous membranes, internally for stomach ulcers, fevers, and menstrual cramps • Cautions: Do not take during pregnancy or when breastfeeding. This bright yellow member of the marigold family is native to the Mediterranean region and lacks the strong smell of its more familiar nonmedicinal cousin. Almost anyone can easily grow calendula in a sunny location. Calendula’s anti-inflammatory and wound-healing properties make it a very useful herb. As an ointment, it can be applied to bruises, cuts, and scrapes. In the form of a tincture, it is a wonderful mouth rinse for red, irritated gums, gingivitis, and pyorrhea. A tea can be used as an aid in healing mouth tissues after oral surgery, as well as treating a sore throat or mouth ulcers. Just gargle and rinse. A poultice or compress can be applied to varicose veins and bruises. A tea or glycerite tincture used topically can help with healing bedsores. Although calendula is considered a mild remedy, it is effective as a tea to soothe unpleasant conditions like stomach ulcers. Externally, it can often reduce the effects of eruptions, such as measles or shingles. For day-to-day use, calendula cream makes skin feel soft and silky. In the form of a lotion, it is an excellent beauty aid for cleansing and soothing the skin. Cayenne (Capsicum annum) • Family: Solanaceae • Other names: Hot pepper, red pepper • Habitat: Tender annual can be cultivated in any good garden soil • Common uses: Stimulate circulation, aid in nerve pain, anti-inflammatory • Parts used: Dry, ground pods without seeds • Cautions: Do not use the seeds (as they can be too irritating). Use with caution during pregnancy. Do not use on broken or injured skin. Avoid getting capsicum in the eyes. Some individuals may develop sensitivity to both internal and external applications. It is not recommended to take capsicum for more than 2 days at a time. Cayenne is popular as a condiment for food, especially in Asian, Mexican, and Indian cuisines. Recently, it has gained popularity in contemporary medicine as a topical cream to reduce nerve pain and to reduce itching and inflammation associated with psoriasis. It has been shown to be effective in relieving joint and muscle pain due to its ability to block the neurotransmitter substance P, which blocks the transmission of pain signals to the skin and spinal cord. Internal uses include stimulating the appetite and the prevention of atherosclerosis (plaque buildup in the arteries). Cayenne is available in capsule form, which helps in avoiding its hot, spicy sensation. Many topical ointments are available over the counter. Always follow the manufacturer’s directions. Chamomile (Matricaria recutica) • Family: Asteraceae • Other names: Mayweed, whig plant • Parts used: Flowers • Common uses: Heartburn, nausea, vomiting, skin irritation, stress, insomnia • Cautions: Can cause allergic reactions in persons with an allergy to ragweed. It can cause drowsiness so caution is needed if alertness for performing an activity is needed. Should not be used during pregnancy or by nursing mothers. Two types of chamomile—German chamomile and Roman chamomile—exist, with the German variety being the most common used in the United States. Chamomile is consumed in tea, tablet, and capsule form and can be applied as a cream or ointment. Chamomile has a calming, sedative effect, which makes it useful in treating anxiety and insomnia. It can relieve heartburn and symptoms associated with irritable bowel syndrome. Due to its anti-inflammatory action, chamomile can be used as an ointment to reduce skin irritation and itching. When applied as a compress it can aid in healing skin lesions and hemorrhoids. Chasteberry (Vitex agnus-castus) • Family: Verbenaceae • Other names: Chaste tree, monk’s pepper, hemp tree • Habitat: Mediterranean region of Asia • Parts used: Fruit • Common uses: Female tonic, kidney tonic, and thyroid tonic • Cautions: Chasteberry may affect certain hormone levels. Women who are pregnant or taking birth control pills or who have a hormone-sensitive condition (such as breast cancer) should not use chasteberry. Do not take while breastfeeding, either. It may cause urticaria (itching). Because chasteberry may affect the dopamine system in the brain, people taking dopamine-related medications, such as selegiline, amantadine, and levodopa should avoid using chasteberry. This herb can cause gastrointestinal problems, rashes, and dizziness. Chasteberry is a deciduous shrub growing up to 10 feet high with flower spikes made up of dense, showy clusters of pale, lilac blue flowers. In folklore, the plant was given the name of monk’s pepper because of the alleged use of the fruit in monasteries for its ability to reduce male libido. As a female tonic, chasteberry has been used to reduce common symptoms associated with imbalances of the menstrual cycle and menopause. It is believed to work through the female pituitary gland, which is responsible for the secretion of the hormones that regulate the ovaries. Because of this mechanism of action, it is a primary herb in helping menopausal symptoms, such as hot flashes and mood swings. Although some small studies support the benefit of this herb, additional scientific studies are needed to draw conclusive results. Chasteberry can be safely taken for months at a time with intermittent breaks to check if it is still needed. Chasteberry can be used as a tea or a tincture. Cinnamon (Cinnamomum zeylanicum) • Family: Lauraceae • Other names: Cassia • Habitat: Tropical Asia • Common uses: Antiviral, antibacterial, analgesic (pain relieving), mild digestive disorders and intestinal cramping in children and adults, flatulence, circulatory stimulant • Parts used: Bark • Cautions: Do not use with active stomach ulcers or during pregnancy or when breast feeding. Some individuals may be sensitive and develop contact irritation. Because cinnamon can reduce blood glucose levels, persons with diabetes should use with caution. Cinnamon is an evergreen with dense, leathery leaves that grows 30–40 feet tall. It is a tropical tree native to China. Cinnamon is used as both a food and a medicine. Although widely known for adding a pleasing, mellow flavor to desserts and ethnic foods, it is very safe as a medicine for children and adults. As a tea for nausea, vomiting, and motion sickness, it is pleasant and soothing. Ground cinnamon can reduce diarrhea, especially if mixed in applesauce, because applesauce contains pectin, which helps bind the bowels. Cinnamon also possesses antibacterial properties. Cinnamon can be ingested as a fresh spice with foods or in capsules. It can be taken for amounts up to 6 grams daily for 6 weeks or less. Dandelion (Taraxacum offcinale) • Family: Compositae • Other names: Piss-a-bed, teeth of the lion, Dent de’ Leon • Habitat: Lawns, meadows, and roadsides • Parts used: Whole plant, leaves, flowers, roots, stem • Common uses: Blood tonic, diuretic, gout, digestive bitter, appetite stimulant, stimulates the liver • Cautions: Do not collect from sprayed lawns or roadsides. Should not be used when diarrhea is present or when there is bile obstruction, gallstones, inflammation of the gall bladder, or intestinal blockage. This ubiquitous little weed, which is the bane of many homeowners, is indeed a wonderful tonic and medicine, with every part having uses. The leaves are a rich source of calcium, magnesium, sodium, zinc, manganese, copper, iron, phosphorus, and vitamins C and D. It is so nutritious that it made the top of the list in a Japanese vegetable survey of the world’s most nutrient-dense plants! The golden yellow flowers are high in flavonoids and antioxidants, and a good way to use them is in savory spring biscuits or salads. The tender young leaves are also good steamed, sautéed, or raw in salads. The leaves as a medicine are a gentle, potassium-sparing (will not deplete the body of vital potassium) diuretic, making it useful in some types of congestive heart failure, high blood pressure, and water retention related to premenstrual syndrome. It is believed to support and strengthen liver function while reducing liver congestion and enhancing the flow of bile and that dandelion’s bitter action stimulates digestion, absorption of nutrients, and elimination of wastes. These are some of the reasons that the dandelion was usually one of the plants used to make traditional spring tonics. Despite the long-term use of the herb, there is limited evidence supporting this. Seek the advice of your practitioner or medical doctor if your symptoms include pain or the whites of your eyes are yellow. Dong Quai (Angelica sinensis) • Family: Umbelliferae • Other names: Tang kwei (there are a variety of spellings and pronunciations) • Habitat: China • Common uses: Premenstrual syndrome, menopause, balancing female hormones, anemia, heart and circulatory tonic, antispasmodic • Part used: Root • Cautions: Women who have midcycle spotting or menstrual flooding should not take dong quai. Do not take during pregnancy. It can increase skin sensitivity to the sun. Can delay blood clotting. This is a small, fern-leafed, aromatic plant that is native to China. Dong quai is a much revered traditional Chinese tonic herb and can be found in many Asian grocery stores. The roots, which are the parts used, are often sliced and incorporated in soups and stews. In the West, it is used as a circulatory stimulant and as a laxative in older people. It has been promoted to help nourish women with long menstrual cycles, bloating, and heavy bleeding with associated weakness, mild anemia (because of its significant iron content), and menopausal symptoms of hot flashes, skin crawling, and vaginal dryness. Although dong quai has many historical and theoretical uses based on animal studies, there is little human evidence supporting the effects of it for any condition. Most of the available clinical studies have either been poorly designed or reported insignificant results. Also, most have examined combination formulas containing multiple ingredients in addition to dong quai, making it difficult to determine which ingredient may cause certain effects. Dong quai can be added to any soup by placing the roots in a cheesecloth bag and removing it before serving. This herb can also be taken as a tea or tincture. Echinacea (Echinacea angustifolia, purpurea, or pallida) • Family: Compositae • Other names: Purple coneflower • Habitat: Prairies, meadows; is easily cultivated • Parts used: Root, whole flowering head • Common uses: Immune system stimulant, anti-inflammatory, antibacterial • Cautions: Do not use with autoimmune diseases, such as lupus, or AIDS. Because it stimulates the immune system, it has the potential of causing a flare-up. People with allergies to ragweed, chrysanthemums, marigolds, and daisies are at high risk for allergic reactions to echinacea. Echinacea once grew in abundance on the Great Plains. Native Americans used this plant for medicinal purposes long before White settlers arrived on the shores of North America. It is now grown commercially with tons being exported to Europe annually. It has also become a common garden perennial, growing well in most sunny, dry locations and attracting butterflies. Many people know echinacea as the immune herb. It has been used to prevent a cold or flu or shorten the duration and severity of symptoms, although research supporting this has yielded mixed views. A tincture is an effective way to take this herb for this purpose. Be aware that a good quality preparation will make the inside of the mouth tingle for a short period of time. The most appropriate and effective use is on exposure to a bacterial or viral infection or at the first signs of the same. The strategy most people find effective is to use the tincture, taking one or two droppers full every 2–3 hours as long as symptoms exist (or a couple of days), four times a day for another 2–3 days. A less well-known use for echinacea is as a topical treatment for skin infections, such as boils, carbuncles, and bug bites. It also can be useful for wounds and burns. For these purposes, a strong tea or tincture can be applied as a compress. Garlic (Allium sativum) • Family: Allium • Other names: Stinking rose • Habitat: Any good garden soil • Parts used: Individual cloves from the bulb • Common uses: Heart tonic, blood thinner, to lower cholesterol, to lower blood pressure • Cautions: Garlic should be avoided if you are on blood thinners (such as warfarin). Discontinue at least 1 week before any surgical procedure, to avoid prolonged bleeding. Caution during breastfeeding is advised as it can travel through the breast milk and cause irritation of the infant’s gastrointestinal system. Garlic has been found to interfere with the effectiveness of saquinavir, a drug used to treat HIV infection. Its effect on other drugs has not been well studied. Garlic was cultivated over 5,000 years ago. It is sometimes known as the stinking rose because of its acrid smell when sliced or chopped. Garlic is rich in germanium, which is a powerful antioxidant, and sulfur, which can reduce the risk of stomach, lung, and bowel cancers. In World War I and World War II, garlic was used as a wound dressing because of its strong antibacterial and antiviral properties. Garlic is both a food and a medicine as many herbs are—adding to the wisdom, “Let your medicine be your food and your food be your medicine.” The activity of garlic makes it good for preventing atherosclerosis (buildup of plaque in the veins and arteries); although some evidence indicates that taking garlic can slightly lower blood cholesterol levels, studies done by the National Center for Complementary and Integrative Health have not drawn the same conclusions. It also acts as a mild blood thinner and can help lower blood lipids (cholesterol). Garlic possesses potent antimicrobial (antibacterial, antiviral, and antifungal) activity, but it is best used fresh and uncooked for this purpose. Because the medicinal volatile oils are excreted through the lungs, it is useful for respiratory infections, such as colds and bronchitis. The suggested dose is two to three raw, crushed cloves (the small sections of the garlic bulb) four times a day. Because garlic can be unpleasant if taken straight, mixing it with a little honey, yogurt, or applesauce is very helpful. Try chopping the clove and placing it on a spoon. Do not chew it, but wash it down with water (like a pill). This method can help reduce the taste and residual odor. Also, raw garlic can be delicious and medicinal eaten in the form of pesto or grated over pasta. Because of the high levels of volatile oil compounds, garlic can be irritating to the stomach lining despite taking it with food. If irritation occurs, discontinue use for a period of time and then restart at a small dose. A great variety of commercial products are available, manufactured to minimize the odor and other less desirable effects. Some of these have been the subject of research for their effects on cholesterol and blood pressure and are quite effective; however, for the antimicrobial action and cost effectiveness, fresh organically grown garlic is still the best bet. Ginger (Zingiber officinale) • Family: Zingiberaceae • Other names: Ginger root • Common uses: Nausea, vomiting, bloating, flatus • Parts used: Root • Cautions: Ginger can delay clotting and should be avoided by persons using anticoagulants (e.g., warfarin). Because ginger can cause blood sugar to decrease caution is needed by persons with diabetes. Ginger can reduce blood pressure; persons taking antihypertensive medications may have excessive drops in blood pressure. This herb can interact with calcium channel blockers. Powdered ginger can cause gas, bloating, and indigestion. • Ginger has been shown to control pregnancy-related nausea and vomiting and is recommended by the American College of Obstetricians and Gynecologists as a nonpharmacologic means to control nausea during pregnancy (Goodwin & Ramin, 2015). Research is mixed regarding the benefit of ginger in controlling nausea related to motion sickness, chemotherapy, or surgery. Some people claim it is useful for joint and muscle pain, but research supporting this is weak. Ginkgo (Ginkgo biloba) • Family: Ginkgoaceae • Other names: Maidenhair tree • Habitat: Native to China • Common uses: Improve circulation, to improve memory • Parts used: Leaves • Cautions: Some individuals will have allergic reactions. Ginkgo dilates blood vessels; therefore, individuals who have fragile blood vessels and a tendency to bleed easily should not take ginkgo. Those with a history of stroke-related aneurysm (bleeding as opposed to blood clot) should avoid ginkgo as should those on blood-thinning therapies, such as warfarin. Uncooked ginkgo seeds contain a chemical known as ginkgotoxin, which can cause seizures. Ginkgo trees are among the oldest living plants in the world. Their survival is partly explained by the fact that they were considered sacred trees by the Chinese and therefore protected. Recently, cultivated trees have proven to be one of the finest specimen trees for inner cities, thriving undeterred by pests and pollution. These are usually the trees you see growing out of cracks in the sidewalk. Ginkgo is one of the most researched herbs in the world. It has many uses, but most people became familiar with ginkgo as an herb that potentially could boost memory. Research has shown ginkgo to improve cognition in persons with dementia (Gauthier & Schlaeke, 2014). The National Center for Complementary and Integrative Health is funding research that includes studies on ginkgo for other conditions for which it has been used, including asthma, symptoms of multiple sclerosis, vascular function (intermittent claudication), cognitive decline, sexual dysfunction caused by antidepressants, and insulin resistance. Take tinctures as recommended by the manufacturer for up to 3 months before evaluating improvement. Because of the blood-thinning potential of ginkgo, consult your practitioner or herbalist before self-treatment. Ginseng (American ginseng [Panax quinquefolius L], Asian/Chinese/Korean Ginseng [Panax ginseng], Siberian Ginseng [Eleutherococcus senticosus]) • Family: Araliaceae • Other names: Ginseng • Habitat: Siberia, China, Northern Korea • Part used: Root bark • Common uses: Normalize body systems, help in adapting to stress (adaptogen), lower blood glucose, improve energy level, support immune system • Cautions: Breast tenderness in some normally menstruating women. Some individuals may develop high blood pressure and should discontinue use; individuals with hypertension should not use. Occasionally, headaches, insomnia, and nervousness have been reported with ginseng use. Should not be used by pregnant or nursing women, or by persons with bipolar or manic disorder. There is some thought that ginseng could interfere with anticoagulant, antihypertensive, and antidiabetic medications although the evidence is conflicting at this time. Siberian ginseng is a relative of American and Chinese ginsengs. It was first studied in Russia for its effects on productivity of factory workers and was shown to increase productivity and reduce the incidence of disease. In studies among athletes, endurance, speed, and stamina were increased, and recovery time was shorter. Siberian ginseng is used as a tonic remedy for people who are stressed out, overworked, and burning the candle at both ends. It is milder and less stimulating than American ginseng and greatly valued for its ability to help the body adapt to and handle stress. Ginseng appears to have antioxidant effects that may benefit people with heart disorders. Although additional research is needed in this area, some studies suggest that ginseng also reduces oxidation of low-density lipoprotein (LDL or bad) cholesterol and brain tissue. Several studies suggest ginseng may lower blood sugar levels in patients with type 2 diabetes before and after meals. It can be taken as a tea or tincture for up to 3 months at a time. Then one should take a break and reevaluate how he or she is feeling. Goldenseal (Hydrastis canadensis) • Family: Ranunculaceae • Other names: Yellow root • Habitat: Deciduous woodlands (endangered species) • Common uses: Antibacterial, anti-inflammatory, antifungal • Parts used: Rhizome and root • Cautions: Should not be used by women who are pregnant or breastfeeding or with infants and small children. Do not exceed the recommended dose. It is not meant for long-term use. Taking over a long period or in high doses can cause a drying of the mucous membranes and irritation of the digestive tract. Goldenseal is native to deciduous woodlands of North America. Overcollection and misuse have made it an endangered species. Although it can be cultivated, it is a slow and tricky process. Fortunately, there are other herbs that contain some of the same powerful constituents as goldenseal. Clinical studies on a compound found in goldenseal, berberine, suggest that the compound may be beneficial for certain infections—such as those that cause some types of diarrhea, as well as some eye infections; however, goldenseal preparations contain only a small amount of berberine, and thus, it is difficult to extend the evidence about the effectiveness of berberine to goldenseal. Goldenseal may be wasted on systemic (distributed by the bloodstream) diseases. It will not help with general malaise, fever, or aches and pains. Other herbs, such as echinacea, are better suited for helping to fight the flu or a cold. Suggested and appropriate uses for goldenseal include urinary tract infections, gastritis, and athlete’s foot. It is a very strong herb, and a little goes a long way. Use a tea for nasal wash, eyewash (sterile tea solution) for conjunctivitis, and as a mouth rinse for gum disease, infection, or sore throat. When preparing eyewash, carefully strain the tea through a coffee filter, then reheat to sterilize. Cool to room temperature for use. Lavender (Lavandula angustifolia) • Family: Lamiaceae • Other names: English lavender, garden lavender • Habitat: Originally found in France and the western Mediterranean region; now easily cultivated in any garden that has good sunlight • Common uses: Relaxant, sedative • Parts used: Flower, essential oil • Cautions: Lavender oil can be poisonous if taken by mouth. Sedative effects can be\compounded if taken with medications that have sedative effects. Applying lavender oil to the skin can cause irritation. Lavender’s most popular use is as an essential oil in aromatherapy to promote relaxation. Other health claims for the use of this herb have not been proven. The essential oil can be diluted with another oil to apply to the skin or placed in bath water. Lemon Balm (Melissa officinalis) • Family: Lamiaceae • Other names: Sweet Mary, honey plant, cure-all, dropsy plant, Melissa • Habitat: Native to the Mediterranean region and western Asia. Lemon balm will grow vigorously in average soil in temperate climates; it is a common garden herb. • Common uses: Antibacterial, antiviral, antidepressant, nervine (calms nervousness), insomnia • Parts used: Fresh leaves are preferred; dry leaves can be used. • Cautions: Few studies have investigated the safety and effectiveness of lemon balm alone, except for topical use. Lemon balm is a mild, aromatic, tasty, and effective remedy. It can be safely used to settle digestive problems. Several studies have found that lemon balm combined with other calming herbs (such as valerian, hops, and chamomile) helps reduce anxiety and promote sleep. It has been known for centuries as the gladdening herb. Just sniffing fresh lemon balm can lift one’s spirits. The crushed leaves, when rubbed on the skin, are used as a repellant for mosquitoes. A poultice or compress (made by soaking a cloth in a strong tea) can be used to ease the discomfort of herpes lesions or shingles. For cold sores, mix a few drops of lemon balm essential oil with 2–3 tablespoons of glycerin and dab on the sore. Licorice Root (Glycyrrhiza glabra) • Family: Leguminosae • Other names: Sweet root, deglycyrrhizinated licorice (DGL) • Habitat: Southeastern Europe and western Asia • Common uses: Gastric irritation and ulcers, tonic, cough suppressant, expectorant (helps remove secretions from the chest), anti-inflammatory • Part used: Root • Cautions: Licorice supplements should only be used on a short-term basis (4–5 weeks). Licorice should be avoided by individuals with high blood pressure, kidney disease, low potassium levels, and edema. Large amounts over time can cause sodium retention and potassium depletion. When taken in large amounts, licorice can affect the body’s level of the hormone cortisol and steroid drugs. Should not be taken with digitalis or diuretic medications. Pregnant women should avoid using licorice as a supplement or consuming large amounts of licorice as food, as some research suggests it could increase the risk of preterm labor. This perennial member of the pea family has long been cultivated for its flavorful root. Licorice has been a popular ingredient in candy and to disguise the unpleasant taste of other medicine. It is an integral part of traditional Chinese medicine and is used to balance other herbs used in a formula. Licorice root is believed not to have the adverse effects of licorice supplements although research supporting this use is inconclusive at this time. Milk Thistle (Silybum marianum) • Family: Compositae • Other names: Mary thistle, silymarin • Habitat: Originated in Europe but will grow in any temperate climate (can become a noxious weed) • Common uses: Liver tonic, liver protectant, stimulating breast milk production • Parts used: Leaves, seeds • Cautions: Do not take during pregnancy. In large doses, can cause mild diarrhea and allergic reactions, especially in persons with allergies to plants in the same family (e.g., ragweed, daisy, marigold) Milk thistle is a stout, hardy, invasive, annual plant. It can grow to up to 3 feet high, sporting dark green, scallop-edged spiny leaves with white streaks. The petals of the solitary purple flowers end in sharp spines. Although the leaves and seeds both have medicinal value, the seed contains the highest amount of the active component silybin, which is credited with the ability to protect the liver from the damage caused by many drugs, including chemotherapy. There have been some studies of milk thistle on liver disease in humans, but these have been small. Some promising data have been reported, but study results at this time are mixed. The National Center for Complementary and Integrative Health is studying milk thistle’s benefits for chronic hepatitis C and nonalcoholic steatohepatitis (liver disease that occurs in people who drink little or no alcohol). The National Cancer Institute and the National Institute of Nursing Research are also studying milk thistle for cancer prevention and to treat complications in HIV patients. • Silybum marianum was named milk thistle because of the traditional use of a tea from the leaves to stimulate milk production in nursing mothers. The leaves also enhance digestion. For therapeutic purposes, standardized extracts (tinctures and freeze-dried extracts) are probably most appropriate because of the high concentration of active constituents that are most soluble in alcohol. Plantain (Plantago major, P. lanceolata) • Family: Plantaginaceae • Other names: White man’s foot • Habitat: Common weed of lawns, gardens, and meadows • Common uses: Topical and internal antibacterial, anti-inflammatory, demulcent (soothing) coughs, wound healing, insect bites and stings; seed can be used as a bulk laxative • Parts used: Leaves, roots, seeds • Cautions: Do not collect plantain from contaminated areas or sprayed lawns. Some individuals may be allergic to plantain. The Native Americans named plantain White man’s foot because it appeared to sprout up in the footsteps of the white settlers as they moved west. It is now common throughout most of the United States. The dark green, glossy, ribbed leaves radiate from the ground. Beneath the earth are the short, dense, radiating, brown roots. The flowers and seeds form at the top of tall stalks. A poultice of the leaves of the plant has been used effectively for insect or spider bites and bee stings. In an emergency, plantain can be gathered from a lawn or meadow, chewed up, and applied directly onto the bite or sting; it is then covered and kept in place for 1–2 hours. The pain and swelling will quickly diminish. This remedy often works better than over-the-counter pharmaceuticals. A poultice can also be applied to cuts, scrapes, and burns to aid in healing. Plantain leaf tea or juice (combined with tomato, carrot, or vegetable juice) is an effective way to soothe the symptoms of gastritis, irritable bowel, or colitis and to relieve the discomfort from urinary tract infections. A tea of the leaf or root is also a mild, soothing expectorant (facilitates removal of secretions from the lungs), which makes it useful for treating bronchitis and lung congestion. The seeds are a rich source of zinc and psyllium, which is a popular bulk laxative. Rosemary (Rosmarinus officinalis) • Family: Labiatae • Other names: Dew of the sea • Habitat: Native to the Mediterranean region, will grow in any average garden soil. • Common uses: Antimicrobial, dyspepsia, rheumatism, moth repellant, some types of headache, memory aid, antioxidant, digestive aid • Parts used: Leaves • Cautions: Do not use in medicinal amounts during pregnancy. Rosemary leaves are quite safe, but the essential oil should be used with caution because of its potency. Rosemary is a native of the Middle East and around the Mediterranean Sea. From afar, it looks like green sea foam on the face of the cliffs by the sea, hence its name, dew of the sea. It is easy to grow in average garden soil but is not winter hardy. It can be grown indoors but it is temperamental and does not like to dry out. This herb is excellent on roasted potatoes and with lamb and other foods, but as a medicine, the crushed leaves possess potent antimicrobial activity (kills bacteria and virus), which is due to the high content of volatile oils. During World War II, rosemary leaves and juniper berries were burned in hospitals as a disinfectant. For gas, nausea, and biliousness, take as a tea or tincture. To stimulate circulation, soothe aches, and relieve rheumatic pain, make a strong tea and add it to bath water, or make a warm compress and apply over affected areas. This is a good herb to use in steam inhalations for prevention or treatment of colds. Saw Palmetto (Serenoa repens, Sabal serrulata) • Family: Palmaceae • Other names: Cabbage palm, American dwarf palm tree • Habitat: Subtropical sandy soil • Common uses: Tonic for male and female reproductive organs, respiratory system, irritable bladder, enlarged prostate gland • Part used: Berry • Cautions: Some people may experience mild stomach discomfort using this herb. It can increase the risk of bleeding if used by people taking anticoagulants. Pregnant women should not use this herb as it can harm the fetus due to its androgen activity. Saw palmetto is also known as Spanish sword because its long slender leaves, which radiate from the ground, have sharp, serrated edges that can rip clothing and skin. This can make collecting the berries a challenge. Writings suggest that the berries smell and taste like rotten cheese. Because of this and the added fact that many of its active components are not released in water, its use as a tea is undesirable. At this time, research does not support the benefit of saw palmetto for controlling urinary symptoms associated with benign prostatic hypertrophy. The National Center for Complementary and Integrative Health is studying the effects of the herb on prostate cancer. St. John’s Wort (Hypericum perforatum) • Family: Guttiferae • Other names: Hardhay, amber, goat weed, Klamath weed, Tipton weed • Habitat: Open fields, roadsides • Common uses: Antidepressant, antianxiety • Parts used: Flowers and buds • Cautions: The most common side effects of St. John’s wort include dry mouth, dizziness, diarrhea, nausea, restlessness, increased sensitivity to sunlight, sexual dysfunction, and drowsiness. Combining St. John’s wort with pharmaceutical antidepressants can lead to increased serotoninrelated side effects, which could potentially be serious. Can interfere with the effects of birth control pills, cyclosporine, digoxin, phenytoin, phenobarbital, protease inhibitors, and warfarin. A commonsense approach is to check with your health-care practitioner before combining any herb and drug. This stout little plant that was promoted as the depression herb has been the subject of substantial research and clinical trials. Studies suggest that St. John’s wort is of no greater benefit in treating major depression than a placebo (National Center for Complementary and Integrative Health, 2016). Sage (Salvia offcinalis, Salvia lavandulaefolia) • Family: Laminaceae • Other names: Black sage, common sage, broad-leafed sage • Habitat: Mediterranean region; can be grown in average garden soil • Common uses: Antiseptic, mouth and throat inflammation, indigestion, improve mood, boost memory or mental performance. • Parts used: Leaves • Caution: Do not take during pregnancy. This beautiful, woody perennial makes a nice addition to any herb garden. It likes a sheltered, sunny location and will withstand moderately cold, snowy winters. Historically, sage was associated with fertility. Native Americans used it topically for skin conditions and to stop wounds from bleeding. The astringent, antiseptic qualities of sage make it an ideal gargle in the form of a tea for sore throats, gingivitis, or bleeding gums. A tea is also a good way to make a digestive tonic and to relieve night sweats during menopause or reduce excessive perspiration. Some recent small studies have suggested that sage may improve memory and mental performance (Natural Medicines Comprehensive Database, 2016; Scholey et al., 2008). Brew a strong tea for making a compress to soothe slow-healing wounds. Add honey to an infusion for sore throat or cough and take over 1–3 days. For colds and sinus congestion, use a steam inhalation to dry up excessive secretions and postnasal drip. Thyme (Thymus vulgaris) • Family: Laminaceae • Other names: Garden thyme • Habitat: Native to the Mediterranean region, northern Africa, and parts of Asia. It can be grown in average garden soil in a sunny location. • Common uses: Antibacterial, antiviral, expectorant (helping to remove secretions) of colds and bronchitis, antifungal • Parts used: Leaves • Caution: Avoid large amounts with hypothyroidism. Although research on its therapeutic value is scant, thyme has been widely used for centuries as both a culinary and medicinal herb. This perennial shrub can be easily grown in a sheltered spot in the garden. A strong tea of thyme is thought to help eliminate mucus congestion, coughs, or sore throat associated with a cold or flu. A soothing cough medicine can be made by steeping dried thyme in honey. Tea can also be used as a gargle to ease or prevent a sore throat. Add a strong tea to bath water to soothe and deodorize the skin. A steam inhalation is effective for sinus congestion. Yarrow (Achillea millefolium) • Family: Compositae • Other names: Soldier’s wound wort, thousand weed, staunchweed, sanguinary, milfoil • Habitat: Temperate regions of North America and Europe • Common uses: Styptic, anti-inflammatory • Parts used: Flower heads • Cautions: Some individuals’ skin may be sensitive; avoid during pregnancy. Yarrow is a hardy, rampant grower and easily crowds out more delicate plants. Thus, you may want to confine it to its own section of the garden. It likes a hot, sunny location and is not fussy about rich soil, but will not tolerate wet roots. Archeologists have identified fossils of yarrow pollen in Neanderthal burial caves of 60,000 years ago. It was used as a styptic 3,000 years ago to stop bleeding from wounds suffered in the Trojan War. Native American tribes used this herb for skin sores and wounds, and it was included in the medical supplies issued during the American Civil War. Yarrow, applied as a poultice, has been used for its ability to stop bleeding and to reduce inflammation; however, there is no research supporting this claim to date. Summary Phytochemicals are chemicals that occur in plants. Herbs can have a variety of therapeutic effects in the body, some of which include tonics, which are nourishing; adaptogens, which help the body regain normal function in the presence of stress; and nervines, which strengthen the nervous system. Herbal remedies can be used in the form of an extract, tea, infusion, decoction, tincture, capsule, compress, poultice, liniment, salve, or ointment. When wildcrafting herbs, caution must be taken to identify the plant properly, assure that there is no contamination from pesticides or other chemicals, and avoid picking endangered species. Children require lower doses of herbs. Herbs should not be used with infants unless guided by a health-care practitioner. Each herb has unique uses and cautions. Safe use of herbs requires that one become knowledgeable of herbs intended to use to determine appropriateness for the given condition, dosage, and safety issues. It is important to assure research supports claims of an herb’s therapeutic value. References 1. Gauthier, S., & Schlaelke, S. (2014). Efficacy and tolerability of Gingko biloba extract EGb 761(r) in dementia: A systematic review and meta-analysis of randomized placebo-controlled trials. Clinical Interventions in Aging, 9(11):2065– 2077. 2. Geller, A. I., Shehab, N., Weidle, N. J., Lovegrove, M. C., Wolpert, B. J., Timbo, B. B., . . . Budnitz, D. S. (2015). Emergency department visits for adverse events related to dietary supplements. New England Journal of Medicine, 373(16):1531– 1540. 3. Goodwin, T. M., & Ramin, S. M. (2015). Practice bulletin summary no. 153. Nausea and vomiting of pregnancy. Obstetrics and Gynecology, 126(3):687–688. 4. National Center for Complementary and Integrative Health. (2016). St. John’s wort. Retrieved from https://nccih.nih.gov/health/stjohnswort/ataglance.htm 5. Natural Medicines Comprehensive Database. (2016). Sage. Retrieved from http://naturaldatabase.therapeuticresearch.com/nd/Search.aspx?cs=&s=N D&pt=100&id=504&ds=&name=SAGE&searchid=56886473 6. Scholey, A. B., Tildesley, N. T., Ballard, C. G., Wesnes, K. A., Tasker, A., Perry, E. K., & Kennedy, D. O. (2008). An extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers. Psychopharmacology, 198(1):127–139. Suggested Readings 1. Althea Press. (2014). The practical medicine handbook: Your quick reference guide to healing herbs and remedies. Berkeley, CA: Althea Press. 2. Coates, P., Blackman, M., Cragg, G., Levine, M., Moss, J., & White, J. (Eds.). (2010). Encyclopedia of dietary supplements (pp. 550–561). New York, NY: Marcel Dekker. 3. Dog, T. L., Johnson, R., Foster, S., & Kiefer, D. (2012). National Geographic guide to medicinal herbs: The world’s most effective healing plants. Margate, FL: National Geographic Books. 4. Easley, T., & Home, S. (2016). The modern herbal dispensatory: A medicine-making guide. Berkeley, CA: North Atlantic Books. 5. Gruenwald, J., Brendler, T., & Jaenicke, C. (Eds.). (2007). PDR for herbal medicines. Montvale, NJ: Medical Economics Company. 6. Kains, M. G., & Frank, R. A. (2015). Culinary herbs: Their cultivation, harvesting, curing, and uses. Seattle, WA: CreateSpace. 7. Lill, S. (2015). Depression in older adults in primary care: An integrative approach to care. Journal of Holistic Nursing, 33(3):260–268. 8. Pursell, J. J. (2015). The herbal apothecary: 100 medicinal herbs and how to use them. Portland, OR: Timber Press. Resources • American Botanical Council • • www.herbalgram.org American Herbalists Guild • • www.americanherbalistsguild.com Herb Research Foundation • • www.herbs.org Natural Medicines Comprehensive Database • • www.naturaldatabase.com Office of Dietary Supplements, National Institutes of Health CHAPTER 22 Nutritional Supplements OBJECTIVES This chapter should enable you to • Describe the components of dietary reference intakes • Discuss the development of the nutritional supplement industry • List factors to consider in assessing the need for supplements • Describe facts that are listed on supplement labels • List the antioxidants and their sources • Define the term phytochemical • Discuss health conditions for which nutritional supplements can be beneficial The importance of proper and sensible nutrition, as stated in a previous chapter, cannot be emphasized enough. In its Healthy People 2020 report, the U.S. government’s Office of Disease Prevention and Health Promotion states that what people eat, especially when they exercise regularly and do not smoke and/or drink excessively, is the most significant controllable risk factor affecting their long-term health (U.S. Department of Health and Human Services, 2016). Basic dietary principles supporting optimum health include the following: • Eating a wide variety of foods that provide adequate nutrients, including plenty of fresh fruits and vegetables, complex carbohydrates, plant protein, and fiber. • Keeping consumption of sugary foods, caffeinated beverages, and alcohol to a minimum. • Eating only a small amount of animal protein and fat. • Matching calories consumed with energy expenditure to assure the amount of energy derived from consumed food is sufficient to support biological and physiological activities • Drinking plenty of water. It was once thought that anyone who followed these principles was considered properly nourished and did not need supplementation; however, the dietary habits of most Americans lead them to be overweight and undernourished. Views on Nutritional Supplements There has been much debate regarding vitamins and minerals as nutritional supplements and how (or if) they should be taken daily. The early 1900s focused largely on deficiencies of vitamins and minerals that caused diseases such as scurvy and beriberi. Vitamins began to be added to food—a process called fortification. Through the 1950s and 1960s, a number of foods were fortified, such as breads, cereals, and milk. The addition of calcium has been among the recent fortification of many food products. By the mid-1970s, however, the focus was less on vitamin deficiency and more on the value of vitamin and mineral supplementation for the prevention of illness and disease. Vitamin C was thought to prevent and alleviate symptoms of the common cold. Vitamin E was said to help keep the heart healthy. A low-fat, high-fiber diet was the order of the decade. The late 1970s saw the response of the U.S. Senate Select Committee on Nutrition (1977) that listed the number one public health problem in this country as poor nutrition. Experts believed Americans consumed too much food of too little nutritive value and that this was a contributing factor to poor quality of life and increased disease. KEY POINT In 1994, an office was created within the National Institutes of Health (NIH) for overseeing research on dietary supplements th supplements to include the words dietary supplement on product labels. How the Government Is Involved Recommended Dietary Allowances Since the 1940s, the Food and Nutrition Board of the National Academy of Sciences has made recommendations for nutrient intake. These recommendations have been termed recommended dietary allowances (RDAs) and represent the minimum standards that should meet the needs of most healthy people in the United States. In the 1990s the Food and Nutrition Board determined that a different approach to guidelines was needed to address the growing use of dietary supplements, food fortification, and awareness of the role of higher intakes of some nutrients in disease prevention. Because RDAs did not provide guidelines that addressed the needs of specific groups (e.g., nursing homes, schools, prisons), Dietary Reference Intakes (DRIs) were developed by the Institute of Medicine to provide recommendations for different settings (U.S. Department of Agriculture, 2016). DRIs include several reference values: • RDAs: the average daily intake of a nutrient to meet the needs of nearly all healthy people • Adequate Intake (AI): an alternative when RDAs cannot be determined which is based on the observed intakes of a nutrient by healthy people • Tolerable Upper Intake Level (UL): the highest level of daily intake of a nutrient that is likely to be safe for most people • Estimated Average Requirement (EAR): the amount of a nutrient estimated to meet the requirement of half of all healthy people in a population Each of the values considers differences in life stages and gender. KEY POINT RDAs, AIs, and ULs offer dietary guidelines for individuals; EARs provide guidelines for groups and populations. EARs would satisfy 50% of requirements for men and women for specific age groups and are intended for use by nutritional professionals. If calculations of EARs are not available, adequate intakes are used instead of RDAs. RDAs continue to be considered as sufficient amounts of nutrients to meet nearly all needs. Tolerable upper intake levels indicate the largest amount of a nutrient that someone can ingest without adverse effect. The Food and Drug Administration (FDA) describes acceptable claims that can be made for relationships between a nutrient and the risk of a disease or health-related condition. These claims must be clear as to the relationship of the nutrient to the disease and be understandable by the general public. The claims can be made in several ways—through third-party references (such as the National Cancer Institute), symbols (such as a heart), and vignettes or descriptions (see Exhibit 22-1). EXHIBIT 22-1 STATUS OF HEALTH CLAIMS APPROVED HEALTH CLAIMS FOR DIETARY SUPPLEMENTS AND CONVENTIONAL FOODS • Calcium and osteoporosis • Folate and neural tube defects • Soluble fiber from whole oats and coronary heart disease • Soluble fiber from psyllium husks and coronary heart disease • Sugar alcohols and dental caries APPROVED HEALTH CLAIMS FOR CONVENTIONAL FOODS ONLY • Dietary lipids and cancer • Dietary saturated fat and cholesterol and coronary heart disease • Fiber-containing grain products, fruits, and vegetables and cancer • Fruits and vegetables and cancer (for foods that are naturally a “good source” of vitamin A, vitamin C, or dietary fiber) • Fruits, vegetables, and grain products that contain fiber, particularly soluble fiber, and coronary heart disease • Sodium and hypertension HEALTH CLAIMS NOT AUTHORIZED • Antioxidant vitamins and cancer • Dietary fiber and cancer • Dietary fiber and cardiovascular disease • Omega-3 fatty acids and coronary heart disease • Zinc and immune function in older individuals EXHIBIT 22-1 STATUS OF HEALTH CLAIMS Data from U.S. Food and Drug Administration. (2016). Guidance for Industry: Substantiation for Dietary Supplement Claims Made Under S from http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/DietarySupplements/ucm073200.ht The FDA does not allow claims for healing, treatment, or cure of specific medical conditions on the labels or advertisements of nutritional supplements. This would put supplements in the category of drugs. The DSHEA allows only three types of claims to be used with supplements— nutrient content, disease, and nutrition support claims. The nutrient content explains how much of a nutrient is in a supplement. Claims regarding disease must have a basis in scientific evidence and refer to health-related conditions or diseases and a particular nutrient. Nutrition support claims (which may be used without FDA approval, but not without notification to that agency) are set up to explain how a deficiency could develop if the diet was deficient in that nutrient. These claims are accompanied by an FDA disclaimer on the label of the supplement and are therefore easy to determine. In March 1999, the DSHEA required that all nutritional supplements carry a supplement facts panel (see Figure 22-1). Figure 22-1 Supplement Label Reproduced from United States Pharmacopeial Convention. (2016). How to read a supplement label. Retrieved from http://qualitymatters.usp.org/how-read-supplement-label REFLECTION What motivates you to use supplements? Do you carefully evaluate claims about them? A Supplement Extravaganza Vitamins and minerals were what traditionally made up typical nutritional supplements. Today the definition of nutritional supplements is expanded to include vitamins, minerals, herbs, botanicals, and other plant-derived substances; and amino acids, concentrates, metabolites, constituents, and extracts of these substances (U.S. Food and Drug Administration, 2015). Consumers can easily become confused by the burgeoning of scientific studies on nutrients; the immediate release of single studies relating to nutrition, diet, and health; and supplement advertisements that use health claims to increase sales. In many cases, one report contradicts another—what was touted as good yesterday is considered harmful today. The following are some considerations when evaluating studies on supplements: • Who conducted the research? Was it an independent source or a person/company with a financial interest in the product? • Are the details of the studies provided or just the results? • How many people participated in the research and how were they selected? • Was the dose standardized? • Have the findings been replicated? • Has the research been published in a reputable journal and has it been included in the Cochrane Database of Systematic Reviews (http://www.cochranelibrary.com/), which evaluates health-care research? KEY POINT More than half of all adults in the United States use nutritional supplementation on a regular basis. The new millennium was accompanied by buzzwords, such as antioxidants, phytochemicals, functional foods, and nutriceuticals. It is yet to be determined whether these new compounds deserve the onslaught of press, print, and manufacture they so readily receive. When a new study has been completed that suggests a benefit from a nutrient, it is released immediately. Americans rush to purchase the latest combination of vitamins, minerals, and nutritive supplements—spending billions of dollars on dietary supplements annually. Are the supplements worth taking, and are the claims made by manufacturers true? Nutritional supplements may be helpful, but they may also be harmful. Taking supplements without knowledge of their actions and interactions could lead to imbalances of other nutrients and, potentially, toxicity; however, if taken properly and with forethought, supplements can increase general health and ward off some diseases. When making the decision to take nutritional supplements, evaluation of the information available should be done in a carefully planned manner as part of a total nutrition program. If people hear of studies that seem to relate to their circumstances, it is important for them to do some investigating on their own. Studies need to be assessed in the context they were performed and their relationship to a person’s particular situation. Health professionals can assist individuals in understanding what studies reveal. In any case, taking a supplement based on what has been read or heard in the news does not guarantee that a given person will have the same outcome. The nutritional supplement industry is still young and grows exponentially each day. There continues to be an increasing variety of supplements readily available, which can be bought over the Internet, by mail order, at supermarkets, in drug stores, and in other types of stores. Supplements are no longer the domain of natural food stores. The FDA regulates and oversees manufacturing, product information, and safety; and the Federal Trade Commission regulates advertising of supplements; however, decisions regarding whether supplements should be taken, in what form, and how much, still remain a personal choice. There is increasing interest among Americans to use nutritional supplements for optimum health. Some experts are also indicating a definite need for supplementation as part of a nutritional plan as relying solely on diet to meet the body’s needs for vitamins and minerals may not assure adequate intake. We no longer eat food picked fresh from the local garden and cooked within hours. Additionally, many food preparation practices decrease the nutritive value of food. Vitamins and minerals play an important role in optimum health and in reducing the risk of chronic diseases. Is the diet a person is consuming, however, giving him or her enough nutrients and meeting individual needs? If so, then all that may be needed is a good quality multivitamin and mineral; however, if a person has poor nutritional habits, is under a great deal of stress, is pregnant or planning a pregnancy, or has a health problem, supplementation is a must. The supplements that are needed, how much of each, and for how long they need to be taken then becomes the issue. The research is promising, but for many nutrients, the results are still not definite. KEY POINT Supplements can never substitute for a healthy, sensible nutrition program where whole foods, containing hundreds of substanc supplementation. Age, nutritional lifestyle, quality and quantity of food, gender, life stage, environment, family history, personal history, diet, exercise, and rest patterns should be considered in determining a person’s need for nutritional supplementation. As with all holistic approaches, knowledge, self-care, balance, and using what nature provides are the keys. Individual nutritional needs can be determined by looking at the responses made on your nutritional lifestyle survey (earlier in this book) and by considering several factors, which include the following: Age. There are factors that increase the need for nutrient supplementation with age. Some nutrients are not absorbed as well as a person ages, even if they are consumed in good quantity. Older adults may be affected by poor lifelong nutrition habits, social isolation, and chronic diseases that require special diets or affect food intake. Children need a balanced diet, along with a good quality multivitamin and limited sweets and fats to promote their growth and development. Chronic health problems. Some chronic conditions create special nutritional needs, whereas others produce symptoms that threaten a healthy nutritional status. If a person has a chronic health problem, is taking medication, and wants to take nutritional supplements, a thorough knowledge of drug–supplement interactions is necessary. Nurses and other health practitioners can help in this area. Female issues. Women who are pregnant, planning to become pregnant, breastfeeding, menopausal, or postmenopausal need added nutrients and/or supplementation. Different supplements are needed for different life cycles. Within the past decade, the National Academy of Sciences has addressed the unique DRIs for folate and calcium for women (National Institutes of Health, Office of Dietary Supplements, 2016a; National Institutes of Health, Office of Dietary Supplements, 2016b). Lifestyle choices. Cigarette and alcohol use reduces the levels of certain nutrients and predisposes the body to diseases for which added protection is helpful. A stressful lifestyle can deplete nutrients. Deficiencies also can arise from the high consumption of caffeine and sugar. If people presently take multivitamin/mineral supplements and believe that they may benefit from taking additional supplements, they should first examine the labels of their food and supplements. They need to check the DVs of each vitamin and mineral listed. They should be receiving at least 100% of all nutrients from all food and supplements. If they are lower than 100%, they first need to determine whether they can meet this need through a change in diet. If they cannot meet the requirements through diet, then supplements of specific nutrients may be necessary. If the DV is over 100% for some or all nutrients, they may want to cut back on that supplement. The guideline is to keep below 300% DV of any nutrient. A nutritional analysis can be used, also. A registered dietician, nutritionist, or nutrition-knowledgeable health-care professional can help with an analysis. TIP FOR PRACTITIONERS For every supplement they are taking, clients should be advised to know: the purpose, recommended dosage, side effects, adver Supplement Labels Supplements come in many forms—tablets, capsules, softgels, powders, and liquids. The USP is the agency that oversees drug products and sets the standards for dietary supplements. All supplements now require labels, which are regulated by the USP. The USP has certain standards that must be met for single vitamins and those in combination, as well as dietary supplements, and botanical and herbal preparations. Figure 22-1 shows the information that is contained on a supplement label. One facet of the dietary supplement label that is important to read is the DV column. The DV is the percentage of the recommended daily amount of the nutrient that a serving gives. According to the USP, intake should be between 50% and 100% of the DV of each nutrient. One nutrient that would not provide 100% of the DV is calcium. If 100% of calcium were added to any supplement, it would be too big to swallow. Calcium should be taken in divided doses throughout the day. The bioavailability of a particular nutrient is the amount of a nutrient that enters the bloodstream and actually reaches the various organs, tissues, and cells of the body. Nutrients have greater bioavailability when they are taken with compounds that help their absorption. Fruits and vegetables contain many compounds that, when eaten, allow for synergy to take place in the body, increasing bioavailability. Fruits and vegetables are especially affected by mode of storage and preparation. Those that have been exposed to heat, light, or air have lost some or all of their nutrients; their bioavailability is lowered. Two important factors when considering the bioavailability of a supplement are ease of absorption and the benefit of taking it in combination with another supplement. Disintegration (how quickly a tablet/supplement breaks apart) and dissolution (how fast the supplement dissolves in the intestinal tract) (U.S. Pharmacopeia, 2016) are two additional factors directly related to bioavailability. Vitamin C assists with the absorption of iron into the body. If taking iron as a supplement, people also should consider their vitamin C intake. Taking an iron supplement with a glass of orange juice would increase the bioavailability of the iron. On the other hand, calcium inhibits iron and magnesium absorption. This is important to remember when adding supplements to a nutritional plan, especially if iron, calcium, and vitamin C individually or in a multivitamin are being taken. More research is needed to determine and document supplement interactions. Birth Defects One of the first vitamins addressed by the advisory committee on dietary supplements was folic acid. The original aim was to reduce neural tube birth defects, especially spina bifida. The RDA for folic acid was doubled from 200 to 400 mcg/day. The Centers for Disease Control, the USP, the FDA, and the March of Dimes have all recommended that women of childbearing age consume 0.4 mg (400 mcg) per day of folic acid, either through diet or supplements (Centers for Disease Control and Prevention, 2016). Women who are planning to become pregnant and who are of childbearing age should eat a varied diet and also take folic acid through supplementation. Sufficient folate (folic acid) is critical from conception through the first 4 to 6 weeks of pregnancy when the neural tube is formed. This means adequate diet and supplement use should begin well before pregnancy occurs. Antioxidants Antioxidants are compounds that naturally protect the body from free radicals by reducing their oxidative damage and help to depress the effects of metabolic by-products that cause degenerative changes related to aging. Free radicals have a helpful function in the body, but in higher levels, they can damage cells and tissues. They are produced by the body’s own metabolism and are generated from exposure to environmental factors and toxins. Antioxidant nutrients are said to neutralize the harmful free radicals that occur in the body constantly and arise from improper nutrition, eating fatty foods; smoking; drinking alcohol; taking drugs; and exposure to environmental pollutants (such as herbicides and pesticides), toxins, carcinogens, iron, smog, and radiation. KEY POINT The neural tube is a type of membrane that grows into the spinal cord and brain in utero (during pregnancy). Neural tube defect be a result of folate deficiency of the mother in the weeks before and in the early weeks of pregnancy. It is estimated that nearly The body has natural antioxidant enzymes that regulate the effects of free radicals. These enzymes are catalase, superoxide dismutase, and glutathione peroxidase. Vitamins A (as betacarotene), C, and E and selenium assist the enzymes in the body to fight free radical damage. Although antioxidant supplements have been promoted as a means to prevent heart disease, cancer, and other conditions, research has not supported these claims (Harvard School of Public Health, 2016). Benefits Versus Risks of Antioxidant Supplementation A diet low in fats, sweets, and animal protein that includes at least five fruits and vegetables per day, in variety, is a much safer way to obtain antioxidant protection than through supplementation. A greater chance of imbalances and toxicity exists when supplements are being used (Tables 22-1 and 22-2 show guidelines for information on vitamins and minerals); however, there continues to be increased evidence supporting antioxidant supplements as part of a nutritional lifestyle. TABLE 22-1 VITAMINS VITAMIN DEFICIENCY MAY CAUSE HOW IT WORKS A Night blindness; skin problems; dry, inflamed eyes Bone and teeth growth; vision; keeps cells, skin, an working properly B-1 Tiredness, weakness, loss of appetite, emotional upset, nerve damage to legs (late sign) Helps release food nutrients and energy, appetite co nervous system and digestive tract B-2 Riboflavin Cracks at corners of mouth, sensitivity to light, eye problems, inflamed mouth Helps enzymes in releasing energy from cells, prom oxidation TABLE 22-1 VITAMINS VITAMIN DEFICIENCY MAY CAUSE HOW IT WORKS Niacin General fatigue, digestive disorders, irritability, loss of appetite, skin disorders Fat, carbohydrate, and protein metabolism; good sk digestive system; circulation B-6 Pyridoxine Dermatitis, weakness, convulsions in infants, insomnia, poor immune response, sore tongue, confusion, irritability Necessary protein metabolism, nervous system func of red blood cells, immune system function Biotin Rarely seen since it can be made in body if not consumed. Flaky skin, loss of appetite, nausea. Cofactor with enzymes for metabolism of macronut of fatty acids, helps other B vitamins be utilized Folic Acid Anemia, diarrhea, digestive upset, bleeding gums, Red blood cell formation, healthy pregnancy, metab proteins B12Cobalamin Elderly, vegetarians, or those with malabsorption disorder are at risk of deficiency-pernicious anemia, nerve damage Necessary to form blood cells, proper nerve functio carbohydrates and fats, builds genetic material Pantothenic Acid Not usually seen; vomiting, cramps, diarrhea, fatigue, tingling hands and feet, difficult coordination Needed for many processes in the body, converts nu energy, formation of some fats, vitamin utilization, hormones C Ascorbic Acid Bleeding gums, slow healing, poor immune response, aching joints, nose bleeds, anemia Helps heal wounds, collagen maintenance, resistanc formation of brain chemicals D Poor bone growth, rickets, osteoporosis, bone softening, muscle twitches Calcium and phosphorus, metabolism and absorptio teeth formation E Not usually seen, after prolonged impairment of fat absorption, neurological abnormalities Maintains cell membranes, assists as antioxidant, re formation K Tendency to hemorrhage, liver damage Needed for prothrombin, blood clotting, works with bone growth TABLE 22-2 MINERALS MINERALS DEFICIENCY MAY CAUSE HOW IT WORKS Calcium Rickets, soft bones, osteoporosis, cramps, numbness and tingling in arms and legs Strong bones, teeth, muscle and nerve function, bloo Phosphorus Weakness and bone pain, otherwise rare Works with calcium; helps with nerve, muscle, and Magnesium Muscle weakness, twitching, cardiac problems, tremors, confusion, formation of blood clots Needed for other minerals and enzymes to work, he contraction Potassium Lethargy, weakness, abnormal heart rhythm, nervous disorders Fluid balance; controls heart, muscle, nerve, and dig Iron Anemia, weakness, fatigue, pallor, poor immune response Forms of hemoglobin and myoglobinsupplies oxyge Iodine Goiter, weight gain, increased risk of breast cancer Helps metabolize fat, thyroid function Zinc Poor growth, poor wound healing, loss of taste, poor sexual development Works with many enzymes for metabolism and dige wound healing, reproductive development Manganese Nerve damage, dizziness, hearing problems Enzyme cofactor for metabolism; controls blood sug functions Copper Rare, but can cause anemia and growth problems in children Enzyme activation, skin pigment, needed to form ne blood cells Chromium Impaired glucose tolerance in low blood sugar and diabetes Glucose metabolism Selenium Heart muscle abnormalities, infections, digestive disturbances Antioxidant with vitamin E, protects against cancer, TABLE 22-2 MINERALS MINERALS DEFICIENCY MAY CAUSE HOW IT WORKS Molybdenium Unknown Element of enzymes needed for metabolism, helps s Vitamin A Vitamin A is necessary for good immune function, tissue repair, healthy skin and hair, bone formation, and vision. Fat-soluble vitamin A can cause toxicity and even be fatal in amounts higher than 10,000 IUs per day. Beta-carotene, one of the family of carotenoids and a precursor to vitamin A, is a natural antioxidant that enhances the immune system and may protect against certain cancers, cataracts, and heart disease. Beta-carotene is converted in the intestines and liver into preformed vitamin A; its sources are bright, orange-yellow fruits and vegetables. Lycopene is another carotenoid and powerful antioxidant shown to reduce the risk of prostate and other cancers. The sources are fruits and vegetables of deep red to pink color. Some orange fruits and vegetables, some green leafy vegetables, and broccoli contain lutein, another carotenoid that has been found to arrest the development of macular degeneration and help protect the eyes from other diseases (Saad & Washington, 2016). Vitamin C The Food and Nutrition Board at the Institute of Medicine recommends a daily intake of vitamin C of 75 mg for adult women and 90 mg for adult men (National Institutes of Health, Office of Dietary Supplements, 2016c). Despite this recommendation, vitamin C often is promoted at higher dosages, with tolerable intake levels being as high as 2,000 mg for adults (National Institutes of Health, Office of Dietary Supplements, 2016c). High doses have the risk of disrupting bowel function, causing diarrhea. Long-term high intakes of vitamin C can reduce vitamin B12 and copper levels, erode dental enamel, and heighten the metabolism or excretion of ascorbic acid. Vitamin E and Selenium Vitamin E, discovered in the early 1920s, has antioxidant proprieties. It has been shown to decrease the risk of cardiovascular disease and some cancers (e.g., prostate, colorectal) and may offer protection from Parkinson’s disease and slow the progression of Alzheimer’s disease. Vitamin E comes in two forms—natural and synthetic. The natural type is preferred and usually is listed on the label as d-alpha tocopherol (d-alpha tocopheryl) acetate. Synthetic vitamin E is listed on the label as dl-alpha tocopherol (tocopheryl) acetate. There is little evidence of vitamin E toxicity, but at high levels, it can increase the effect of anticoagulant (blood thinning) medications and may also interfere with vitamin K’s action in the body (blood clotting). Vitamin E has been shown to help immune response, keep low-density lipoprotein cholesterol levels in check, and assist other antioxidants to be more available for use against free radicals. A diet that includes whole grains, wheat germ, nuts, sunflower oil, and corn oil will meet vitamin E RDAs. If you wish to consume 400 to 800 IUs per day, supplementation is necessary. Vitamin E together with selenium offers powerful antioxidant properties. High selenium use has been shown to lower cancer incidence and cancer mortality (Vinceti et al., 2014). Phytochemicals Phytochemicals (plant chemicals) are compounds that exist naturally in all plant foods and give them their color, flavor, and scent. They are the nonnutritive substances of plants and are not vitamins or minerals; nevertheless, phytochemicals have been associated with assisting the immune system, working as antioxidants, and fighting cancer (Howes & Simmons, 2014). Foods that have been identified as having these health benefits are fruits, vegetables, legumes, grains, seeds, soy, licorice, and green tea. Researchers have discovered many classes of phytochemicals in food. Isoflavones (phytoestrogens) and lignins (soy), lycopene (tomatoes), anthocyanins and proanthocyanidins (grapes, blueberries, cherries, and other red crops), saponins (whole grains and legumes), flavonoids (cherries, tea, and parsley), and isothiocyanates and indoles (broccoli, cauliflower, and cabbage), have antioxidant properties that may lower LDL (bad cholesterol levels) and curb growth of tumors (Arumuggam, Bhowmick, & Rupasinghe, 2015). One example of a vegetable that has gotten much press over the last several years is broccoli. Broccoli is in the cruciferous family, which includes cauliflower, cabbage, kale, brussels sprouts, bok choy, and Swiss chard. Cruciferous vegetables are excellent sources of fiber, beta-carotene, vitamin C, and other vitamins and minerals. Their cross-shaped flowers give them their name. The phytochemicals that have been found in these vegetables are indoles, isothiocyanates, and sulforaphane, which assist the body in triggering the formation of enzymes that block hormones and may protect cells against damage from certain carcinogens. Research is promising with regard to these and other phytochemicals and cancer; however, more studies are needed. Benefits ...
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