Root Rage

stressed? impotent? sleepless? herbal medicine has a cure for you--maybe

A Merica is getting back to its roots. To say nothing of its leaves, bark and flowers. In the pursuit of health and well-being, we shelled out close to $4 billion last year for plant preparations prized for their medicinal properties. In other words, we bought a lot of herbs.

People who a few years ago might have thought St. John's wort was a skin condition are now convinced it's nature's answer to Prozac, making an extract of the yellow-flowered plant the fastest-growing herbal remedy in the land.

Trolling health food stores, supermarket shelves and drugstores for ginkgo, ginseng, echinacea and saw palmetto, about one third of Americans opt for the botanical solution to wellness.

Why the excitement? Many people are driven by dissatisfaction with traditional doctors and toxic drugs, and the desire to take responsibility for their own health. And many herbs promise to do more than just cure disease; they promise to make good health better.

But with more than 20,000 herbal and related products on the shelves, there's a lot of confusion. "Patients come in with bags full of herbs, clueless about why they're taking them," says Dr. David Edelberg, founder of American WholeHealth, a Chicago-based chain of clinics that blend conventional and alternative medicines. One survey found that only three percent of herb users feel confident in what they're doing.

"Most people's knowledge of herbs comes from ads," says Dr. Edelberg. Those who seek to know more risk information overload from books, TV specials and hundreds of websites that offer a mix of science, traditional lore and just plain balderdash. How to separate the hype from the hard data?

The use of plants for good health goes way back--through 3 million years of human history, according to James Duke, a retired USDA ethnobotanist who has studied herbs for more than 50 years. The remedies that worked were passed along, and virtually all those in current use derive from the folk medicine of cultures around the world. In fact, more than one fourth of today's prescription and over-the-counter drugs were found by following up such leads (the most common example is aspirin, which came from willow bark--a traditional pain remedy).

Unlike drugs, which are generally single chemicals, herbs are complex combinations of compounds that often work synergistically. "The active principles are diluted by other plant material, which makes them milder than conventional drugs," says Varro Tyler, distinguished professor emeritus of pharmacognosy (the study of drugs from natural sources) at Purdue University. This means fewer side effects but less dramatic benefits. You often must take herbs for weeks, if not months, to realize their full effect, and they're best for chronic conditions rather than acute diseases.

Many of today's herbs have science as well as tradition behind them. But you can't tell from the label. Because the FDA regards herbs as dietary supplements and leaves them virtually unregulated, just about anyone can call just about any nontoxic plant product an herbal remedy. And because herbs haven't been subjected to the rigorous tests demanded for drug approval (which can cost half a billion dollars), no claims can be made about their effectiveness--even if the data are there.

The picture is different in Europe and Asia, where a lot of research has been conducted and herbs are widely prescribed instead of conventional drugs. In Germany, a government agency (Commission E) subjects herbs to systematic evaluation. After weighing traditional experience and scientific data, the commission has approved more than 300 herbs for use as medicines sold in German pharmacies. It has turned down 108 that haven't stood up to scrutiny. Tyler calls the commission's findings "the most accurate body of scientific knowledge on the subject available today."

The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines, published here last year, is the closest thing we have to an authoritative guide on herbs. But this isn't to throw softer data out the window. Science has always lagged behind folk wisdom in this department, and knowledgeable people such as herbalists, botanists and folklorists often have useful information to contribute.

So what can herbs offer you? Besides keeping you healthy, can they help you play harder, longer, stronger? Here's a rundown on some of the most popular remedies.

If you don't have much use for saw palmetto extract now, check back in a decade or two. Many men in their 50s develop an enlarged prostate, making urination more difficult and frequent. Urinary tract infections and kidney damage can follow. Seven years ago the drug finasteride (Proscar) was approved for the condition, but its side effects include sexual dysfunction.

Saw palmetto, a low-lying palm that grows in the southeastern U.S., has been used in Europe for generations and seems to work as well as Proscar. An analysis of 18 controlled trials involving nearly 3000 men, published in The Journal of the American Medical Association last year, found improvement equal to Proscar with virtually no side effects (other than occasional headaches and stomach upsets) and no impact on sexual function.

Scientists have speculated that saw palmetto, like Proscar, prevents the transformation of testosterone into a brother compound that works on the prostate.

"Saw palmetto extract could be considered a treatment option for men with symptoms of prostate enlargement but no complications," says Dr. Leonard Marks, clinical associate professor of urology at UCLA. But he suggests that men see a doctor first, because symptoms such as urinary frequency could indicate an infection or even cancer.

At any age, you have to contend with colds and flu, which explains why echinacea has become a top-selling herb. (continued on page 162)Root Rage(continued from page 96) Echinacea was a prized medicine among Plains Indians and has been approved by the German government as a treatment for upper respiratory and urinary tract infections.

Two controlled double-blind studies linked echinacea to less frequent colds and a reduction in the length and severity of flu-like symptoms. Other studies suggest that echinacea stimulates the immune system, helping your body fight off nasty bugs.

Despite echinacea's widespread use, no serious side effects have been reported, but the German Commission E advises that people take it for no more than eight weeks at a time.

Heart disease remains the number one killer of American men, and there's reason to believe garlic can offer protection. Active chemicals in this pungent herb make it a lot more than just a cooking ingredient: It has been shown to kill bacteria and fungi, and evidence suggests it can lower cancer risk.

Most studies show that sustained garlic consumption can also lower cholesterol by six to 11 percent (particularly LDL, which has been linked to heart disease) and reduce triglycerides as well.

Similar research indicates that garlic lowers blood pressure (another coronary risk factor) by five to seven percent, and studies on animals show that it makes blood less likely to clot, which would further reduce the chance of a heart attack or stroke. New data imply it makes blood vessels more elastic and thus less likely to plug up.

Side effects? It depends on who you hang out with.

You can get a sufficient amount of garlic eating a raw clove daily (cooking may inactivate allicin, the chemical that appears to do the work) or taking the equivalent in capsules (about 300 mg, two or three times a day).

Even if you're healthy, it's unlikely you can escape stress. What you need is an herb, such as ginseng, to help you cope. Ginseng is considered an adaptogen-- that is, it improves the body's ability to adapt to both physical and mental demands.

Studies suggest that ginseng helps normalize the pituitary and adrenal hormones that stress can send out of whack. The Commission E report approves the herb "as a tonic for invigoration and fortification at times of fatigue" and for "declining capacity for work and concentration." Side effects are rare, though insomnia and nervousness can come with excessive doses. Some experts advise a week off ginseng after two or three weeks on.

It's important to know that several herbs go under the name ginseng. Most research has been done on Panax ginseng (also known as Korean or Asian ginseng). Siberian ginseng (a.k.a. eleuthero) is actually a distantly related (and somewhat less potent) plant that also seems to have adaptogen properties.

When the demands of work and home life have you anxious and off the wall, consider kava. This herb, prepared from the root of a tropical plant, is "the most powerful anti-anxiety preparation available without a prescription," says Jerry Cott, a pharmacologist with the National Institutes of Health. Several studies have shown significant reductions in nervousness, though less than with drugs such as Valium. By the same token, kava doesn't dull your mind and memory like heavy meds do.

Save kava for occasional use when the stress gets you, Cott suggests. If you need it all the time, there's probably something in your life (job? a relationship?) that should be changed.

If you're too stressed to sleep, valerian may do you good. This nasty-smelling root extract has been calming insomniacs for centuries. Two small random trials (and a number of other studies) found that valerian helped people nod off faster and sleep more soundly--and left them refreshed, not logy, in the morning.

Unlike prescription sleeping pills, valerian doesn't lose any of its effect with continued use. In fact, it seems to work better after you have taken it for several weeks.

Too much stress can take its toll on your mood. The effectiveness of St. John's wort against mild depression led to a 20-fold increase in U.S. sales last year. The herb has been used for thousands of years and is widely prescribed in Europe (in Germany it outsells all other antidepressants combined). A major study in the British Medical Journal analyzed results from 23 controlled trials and called St. John's wort effective in mild to moderate depression; several of these trials found it works just as well as do prescription drugs. So great is the interest in the herb that the National Institute of Mental Health and other U.S. agencies have started a $4.3 million study of it.

While prescription antidepressants come with a host of distressing side effects--including sexual problems--St. John's wort appears to have few, though it can make fair-skinned people sensitive to the sun. And it may be six to eight weeks before you're feeling better.

Note: If your mood is dark enough to interfere with work, or your personal life, don't treat it on your own. Ask a doctor about St. John's wort--or something stronger.

There's a category of herbs that is directed not at negative conditions but rather at increasing your health potential. In this area, ergogenic herbs promise to enhance athletic performance. But do they deliver?

Ephedra has gotten a lot of press in recent years, most of it bad. Serious side effects--irregular pulse, increased blood pressure, shakiness--and some deaths have been associated with its unwise use.

But ephedra apparently works--on the mental side of sports, anyway, suggests Luke Bucci, vice president for research at Weider Nutrition International. "It's more for concentration, alertness, confidence. Weight lifters use it to motivate themselves."

If you take ephedra, limit it to 24 mg of the active ingredient, ephedrine, per day. And don't combine it with other stimulants, such as caffeine (which many ephedra products contain).

Speaking of which, coffee has similar effects and is a far safer (if less sexy) natural product. Caffeine revs you up and gets your muscles to burn fat instead of stored glycogen, for an endurance boost.

Another possibility if you're into long runs or bike rides is eleuthero (a.k.a. Siberian ginseng). Several studies have shown it can improve aerobic capacity--your muscles burn more oxygen, which (according to a few reports) enables users to run faster and farther.

Real (Asian or Korean) ginseng could be most helpful for long-term training. As an adaptogen, it helps your body bounce back after a heavy workout. Besides that, Asian ginseng seems to sharpen mental performance--concentration and reaction time--and not just in sports. One controlled study found that college students who took it for 12 weeks performed math calculations faster.

Again, note that Siberian and Asian ginseng require time to work. "If you want to see things happen, allow at least two months," says Bucci.

Ginkgo biloba is also used to enhance mental performance. Ginkgo improves blood flow to the brain and throughout the body and is approved in Germany for a host of circulatory problems. Here, a yearlong study of patients with Alzheimer's disease found that the herb improved thinking ability about as much as drug treatment.

Does ginkgo help the healthy? In his clinical experience, "it improves attention, concentration and memory," says Dr. Dharma Singh Khalsa, president and medical director of the Alzheimer's Prevention Foundation in Tucson, Arizona. Because it gobbles up free radicals--high-energy molecules that damage cells slowly but steadily--gingko is said to protect the brain against the toll of time.

Deciding which herbs to use may be easier than choosing a brand. "There are some good products out there, and lousy forms of the same herbs," says Tyler. "The trouble is that there are no official standards for quality. You're at the mercy of the manufacturer."

While experts are loath to endorse particular brands, most suggest going with the bigger and better-known, on the theory that they have more to lose by selling faulty goods. Herbs marketed by pharmaceutical companies (a growing trend) can be assumed to have undergone reasonable quality control.

Look for products that are standardized--the label will tell you how much of the herb is in every capsule, plus the amount of a key ingredient. If the product has the same formulation that was used in scientific trials--the best-case scenario--the label should say so. (For example: the ginkgo extract used in research is EGb 761; the tested form of St. John's wort extract has 300 mg of the herb, containing 0.3 percent hypericin.)

Combinations of herbs are rarely tested as thoroughly as single ones--you're likely to get useless crap along with the good stuff. "Products containing a lot of different herbs often have too little of any to do much," says Tyler.

Don't bother with such cute ideas as ginkgo-flavored potato chips, kava candy bars or ginseng tea bags. These socalled fortified foods are more likely gimmicks than meaningful sources of herbs, says James Duke.

As for safety, don't fall prey to two common misconceptions: that because something is "natural" it can do you no harm, and that if one pill is good, two or three are better. Take no more than the recommended dose.

Herbs that will ordinarily cause you no trouble may become toxic when used along with drugs (ginkgo and garlic, for example, can cause bleeding for someone who is on a blood thinner). If you're taking any medication--prescription or over-the-counter--ask your doctor or pharmacist about possible interactions.

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Better Sex, Botanically

sometimes you just can't beat mother nature

The search for a safe and natural product to make men harder has gone on for centuries, all around the world, without unearthing a botanical Viagra. But there are some herbs that deserve more than a second look.

The bark of the African yohimbe tree has the strongest claim--its active ingredient, yohimbine, is an approved drug for erectile dysfunction. But the modest benefits from yohimbine are a lot less impressive than its possible side effects, which include high pulse and blood pressure, nausea, vomiting and anxiety--hardly the recipe for a romantic evening. The German Commission E refused to approve yohimbe, citing its poor risk-to-benefit ratio. In this case the drug is safer and more effective than the herb: If it's yohimbine you want, get a prescription.

A lot more promising is ginkgo biloba, which may well raise more than your IQ. The herb improves blood flow throughout the body--including the penis. In one trial involving 60 men with erectile dysfunction, six months of ginkgo restored potency to half. Recent research strongly suggests that ginkgo can redress the sexual damage (impotence, delayed ejaculation) wreaked by antidepressant drugs, and a controlled study is under way to evaluate the effect.

Ginseng has been described by James Duke as "North America's most famous unproved aphrodisiac." The herb's "tonic" properties have been shown to accelerate sexual behavior in mice and to increase testosterone and sperm production in human subjects.

Garlic may sound like an unlikely sex enhancer, but Duke swears by it. The theory is intriguing: The herb is a rich source of arginine, an amino acid that aids the manufacture of nitric oxide. Nitric oxide activates an enzyme that allows the penis to swell with blood. (Viagra works by enhancing the effect of nitric oxide.)

There are more--many more--herbal helpers whose value remains unproved. Ashwaganda, India's answer to ginseng, hasn't undergone much study in this country. The sexual reputation of muira puama has followed it all the way from the Amazon rain forest, but research doesn't justify its nickname of "potency wood": Commission E left muira puama on its unapproved list. The same goes for avena sativa, whence comes the phrase "sow one's wild oats."