Glossary of Herbal Supplements

Learn about Natural and Organic Nutrients

Thanks to HCV Advocate

Dietary supplements are often part of people’s health regimen. Being healthy includes making wise choices.  This means knowing what goes into your body.  If you take an herb or herbal blend, do you know what you are taking?  This glossary provides information on some popular supplements.

This information is not intended as medical advice or endorsement of the use of dietary supplements.  Always talk to your medical provider before taking any herbs or supplements. All herbs, drugs, and other substances have potential side effects.  Allergic reactions have been reported for nearly every herb, sometimes with life-threatening consequences.  If you suspect you are having an allergic reaction or other serious side effect, stop the substance and seek immediate medical advice.

If you are scheduled for a medical or surgical procedure, particularly if anesthesia will be used, or plan to undergo chemotherapy, report supplement use to your medical provider.  You may need to stop supplement use for a week or more since many supplements interfere with anesthesia and/or blood clotting.

A

Alfalfa (Medicago sativa)

This botanical has been used medicinally formany centuries.  Unproven but purported to ease allergies, asthma, arthritis, diabetes, peptic ulcers, and thyroid problems.  Small, uncontrolled studies reported that alfalfa may lower cholesterol levels.

Safety Information: Only use a product that is from a reputable source.  There have been reports, including two deaths, from alfalfa contaminated with bacteria, arsenic and other unsafe substances.  Is generally safe for up to 8 weeks.  No safety data past 8 weeks.  Mild gastrointestinal side effects are the most common complaints.  Rashes, itching, skin redness and more sensitivity to sun have been reported.  Use cautiously with history of diabetes and hypoglycemia.  May increase thyroid levels and lower potassium levels.  Use cautiously if taking blood thinners, such as warfarin.  May exacerbate gout.  Lupus-like symptoms have been reported by people taking alfalfa.  Should be avoided by people with personal or family history of lupus.  Alfalfa has estrogen-like properties, which may raise safety issues, particularly for those with hormone-sensitive cancers.  Although traditionally, alfalfa has been used to increase lactation, no data supports this.  Safety has not been established for children, pregnant or nursing mothers.

Interactions: May interact with the following: blood-thinners, cholesterol-lowering agents, potassium, diabetes and thyroid medications.  Alcoholics and those taking metronidazole (Flagyl) or disulfiram (Antabuse) should avoid alcohol-based tinctures and extracts.

Lab Notes: May increase thyroid levels and lower potassium levels.  May interfere with coagulation results.  May cause abnormal blood cell counts and increase urea levels.

Aloe (Aloe vera, Aloe barbadensis, Aloe capensis)

Topically, the gel-like juice from aloe vera leaves has been used for thousands of years.  Aloe is purported to improve a number of skin disorders, including eczema, psoriasis, and genital herpes.  Although most often used for burns and wound healing, research has not supported this application.  In fact, aloe may delay healing in surgical and other wounds.  Aloe was approved for use as a laxative by Germany ’s Commission E, which no longer exists.  The U.S.  Food and Drug Administration warns against the use of aloe as a laxative.

Safety Information: Most likely safe if used topically.  Minor redness and rash have been reported with topical use.  When used orally as a laxative, may cause abdominal cramping and should be used very cautiously.  Do not use if history of intestinal obstruction or intestinal diseases, e.g., Crohn's, colitis, appendicitis, abdominal pain.  Internal use of aloe may interfere with nutrient absorption.  Use cautiously with patients who have diabetic, cardiac, renal, or gastrointestinal conditions.  Use cautiously with history of diabetes and hypoglycemia.  Use cautiously if history of heart disease, since oral use of aloe may cause electrolyte imbalance.  Not recommended for prolonged use or for injection.  Deaths have occurred after aloe was injected in humans.  Topical use of aloe is probably safe for children, pregnant and nursing women, but oral use is not recommended.

Interactions: Do not use with AZT.  Internal use may interfere with loop diuretics, such as furosemide (Lasix).  Do not use with other laxatives, cardiac medications, oral corticosteroids, or hypoglycemic drugs.  Avoid topical use of aloe if using topical steroid medications.

Lab Notes: May alter potassium, liver enzymes and blood glucose lab tests.

Alpha-Lipoic Acid (ALA)

Purported, but unproven uses include liver disease, cancer prevention, artherosclerosis and treatment, HIV and AIDS.  Small studies suggest that ALA may improve blood glucose levels in patients with type 2 diabetes.  ALA may be useful for treatment of diabetic or cancer chemotherapy-induced neuropathy.  May provide relief for Burning Mouth Syndrome.  Research is being conducted using ALA for a variety of other purposes.

Safety Information: Very few side effects have been reported.  They are: allergic reaction, nausea, and vomiting.  Diabetics need to watch blood sugar levels.  Some experts discourage use of ALA in patients with hypothyroidism and thiamine deficiency.  Insufficient safety data to make recommendations for children, pregnant or nursing mothers.

Interactions: May interact with drugs metabolized by liver.

Lab Notes: May lower blood glucose and thyroid levels.

Artichoke (Cynara scolymus)

Artichoke is a frequent ingredient in “liver support” formulations.  There is no scientific evidence to support or refute artichoke’s hepatoprotective potential.  Some evidence supports the use of artichoke to lower cholesterol and stimulate bile secretion to improve digestion.

Safety Information: Likely safe for short term use.  Use cautiously with history of allergy or asthma.  Avoid with bile duct obstruction and kidney disease.  Do not use with gallstones unless under strict medical supervision.  May increase risk of bleeding.  The following have been reported: itching, rash, asthma, shortness of breath, cough, runny nose, flatulence, diarrhea, hunger, nausea, kidney failure.  No safety data available regarding children, pregnant or nursing mothers.

Interactions: Use cautiously if taking medications that affect blood clotting.

Lab Notes: May alter blood-clotting results.

Astragalus (Astragalus membranaceus)

In Chinese Medicine, this herb is commonly used for chronic or recurrent infections, not for acute ones and often in combination with other herbs.  Astragalus is used for many health conditions and is purported to have immune stimulating and antiviral properties.  Research is weak, but astragalus has shown enough promise that the National Center for Complementary and Alternative Medicine is conducting studies.  May have cardiac and immune system benefits.  Likely safe for most adults.  Efficacy for treatment of hepatitis has not been established.

Safety Information: Some varieties of astragalus are known to be toxic to livestock, so only use Astragalus membranaceus.  According to Traditional Chinese Medicine, avoid during acute infections.  Those with autoimmune conditions should avoid unless advised otherwise.  Avoid if taking beta-blockers and immune suppressants, such as steroids and anti-rejection drugs.  Use cautiously in patients with bleeding or blood clotting disorders, and/or decreased clotting ability, such as those taking NSAIDs or anticoagulants.  Use cautiously if diabetic or if taking growth hormones.  May act as a diuretic.  May interact with colchicine, procarbazine, sedatives, stimulants, and dopamine antagonists, such as Haldol.  May interact with a long list of other supplements.  Safety for children is not established, probably should avoid since astragalus may increase growth hormone.  Pregnant and breastfeeding women should avoid.

Interactions: Do not take with immune suppression medications.  Tragacanth, a derivative found in astragalus, may interfere with absorption of other substances.  Therefore, do not take astragalus with any other medications or supplements.

Lab Notes: May lower blood pressure and blood glucose levels.  May increase growth hormone levels and coagulation times.

B

Black Cohosh (Cimicifuga racemosa)

This herb is best known for alleviation of menopause symptoms.  Studies have yielded mixed results on black cohosh’s efficacy.

Safety Information: Hepatotoxicity is the biggest safety concern.  Black cohosh has estogenic properties but only weakly so.  Researchers are concerned about the possibility of cancer or use of cancer drugs interacting with this herb.  Gastric discomfort is the most common side effect.  Those with history of stroke or thromboembolism should avoid black cohosh.  Cardiovascular and neurological (seizures) adverse events were reported by a very small number of patients taking black cohosh, although the link between the two is not solidly established.  Black cohosh should not be taken by women who are pregnant or breastfeeding.  No safety information is available for children.

Interactions: Black cohosh may interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450 below).  Anyone with hormone-sensitive malignancies or those taking drugs, such as tamoxifen or HRT may want to avoid or use cautiously.  May interact with hormones, NSAIDs, anti-androgenic, and anticoagulant drugs.

Lab Notes: May lower blood pressure.

Note: Take black cohosh with a full glass of water.  Blue cohosh is not the same as black cohosh – do not substitute one for the other.

C

Capsicum (Cayenne, hot pepper) (Capsicum frutescens and C.  annuum)

Capsaicin, the activeingredient in this common pepper, is believed to have anti-inflammatory properties.  An FDA-approved cream using capsaicin is marketed under the name of Zostrix.  Capsaicin is used for pain control in a variety of conditions, such as shingles, arthritis, and nerve pain.

Safety Information: May cause intense burning if the eyes are exposed to capsicum.  Other side effects include the usual reactions to hot peppers – mouth and nose burning, sweating, gastrointestinal complaints, etc.  May cause a rash.  The safety for children, pregnant and nursing mothers is not established.

Interactions: May interact with acetaminophen, sedatives, ACE inhibitors, MAO inhibitors, theophylline, and anti-hypertensive medications.

Lab Notes: May alter liver function tests.

Note: Capsicum is used internally and topically.

Chamomile (Matricaria recutita, Chamaemelum nobile)

Used internally for gastrointestinal problems and externally for skin and mucous membrane inflammation.  It is alsoused for anxiety and sleeplessness.  Although research has not supported most of these claims, there is some weak evidence pointing to the efficacy of chamomile for alleviating mouth sores and certain skin conditions.  There are ongoing studies evaluating the use of chamomile for anxiety and chronic pain.

Safety Information: Rashes and allergic reactions are the most common side effects of chamomile.  May increase bleeding risk.  The safety for children, pregnant and nursing mothers is not established.

Interactions: Use cautiously if taken with other sedating drugs.

Lab Notes: May interfere with coagulation labs, such as PT and INR.

Note: Chamomile comes in many forms.  Ingested or applied as a tea are the most popular forms of administration.

Chondroitin Sulfate

This supplement has been heavily researched and consistently showed improvement for osteoarthritis.  These studies have been rigorously debated and to date the validity of the research remains in question.  Chondroitin is often combined with glucosamine but can be taken alone.  It can be derived from algae, cow trachea, shark, pig, chicken or beef cartilage.  There is also a synthetic form.  Although unlikely to be an issue, those concerned about “Mad Cow” disease should avoid chondroitin made from bovine sources.

Safety Information: Appears to be well tolerated.  Stomach upset is the most common complaint.  Men with risk of prostate cancer should avoid.  May increase bleeding risk.  The safety for children is not established.  Pregnant and breastfeeding women should avoid.

Interactions: Use cautiously if taking medications that affect blood clotting.

Lab Notes: May interfere with coagulation labs, such as PT and INR.

Note: Chondroitin may take over 3 months before there are noticeable benefits.

Coenzyme Q10 (CoQ10)

CoQ10 is produced naturally in the body, but levels may decrease with age and chronic disease.  Most compelling data points to possible benefit for congestive heart failure.  Other purported uses of CoQ10 suggest possible benefit for other cardiac conditions, high blood pressure, Parkinson’s, and diabetes.  CoQ10 is being studied for its effect on a variety of other medical conditions.

Safety Information: CoQ10 is fairly safe.  Side effects include fatigue, nausea, vomiting and GI distress, itching, rash, insomnia, loss of appetite, headache, dizziness, irritability, light sensitivity, and flu-like symptoms.  A small study reported organ damage in heart patients using CoQ10 during intense exercise, but the correlation was unclear.  Use cautiously if there is a history of diabetes, low blood pressure, thyroid disease or use of anticoagulants (warfarin, aspirin, ibuprofen, etc.) No safety data available regarding children, pregnant or nursing mothers.

Interactions: CoQ10 is known to interact with a long list of other drugs and supplements.  These interactions seem to create dosing problems but are not true interactions.  These include anticoagulants, blood pressure-lowering drugs, diuretics, cholesterol-lowering drugs, beta-blockers, oral diabetes drugs, antipsychotics, tricyclic antidepressants, clonidine, methyldopa,hydrochlorothiazide, hydralazine, thyroid medications, ginkgo and vitamin E.  Use cautiously if you have HIV-related peripheral neuropathy and are taking reverse-transcriptase inhibitors.

Lab Notes: Rare reports of increased liver enzymes.  May lower platelet and blood glucose levels.  May alter blood clotting and thyroid results.

Note: CoQ10 is fat-soluble and may be better absorbed when taken in an oil-based soft gel cap rather than in tablet or capsule form.

Cordyceps (Cordyceps sinensis)

Very little is known about this fungus.  In China, cordyceps traditionally is harvested from caterpillar larvae.  Has been used for a variety of medical conditions, including fatigue, hepatitis, and bronchitis as well as to enhance athletic and sexual performance.  There is virtually no research about cordyceps, so safety and efficacy are unknown.

Safety Information: To date there have been no reported adverse reactions.  Diabetics should use cautiously as cordyceps may lower blood glucose.

Interactions: Use cautiously if taking medications to lower blood glucose levels.

Lab Notes: May lower blood glucose levels.

Note: On his website, Andrew Weil, M.D. recommends, “purchasing liquid or powdered extract not grown on caterpillars.  Cordyceps has not been tested on children, pregnant or nursing mothers.  Andrew Weil advises against pediatric use.

Cranberry (Vaccinium macrocarpon)

Research supports the efficacy of cranberry juice for prevention of urinary infections.  Purportedly, cranberry juice has been used for a variety of kidney and urinary problems, particularly for urinary tract infections.  However, the evidence is weak regarding these applications.

Safety Information: Most likely safe for everyone 2 years and older.  Diarrhea and gastric distress are the most common complaints.  High acid content may be a problem for those prone to acid reflux.  Diabetic patients need to use sugar-free juice.  Patients with oxalate kidney stones should not exceed 1 L/day.  May increase bleeding risk.  The safety for infants, pregnant and nursing mothers is not established.

Interactions: Use cautiously if taking medications that affect blood clotting.

Lab Notes: May interfere with coagulation labs, such as PT and INR.

Note: May use white cranberry juice cocktail.  To avoid unnecessary sugar, use artificially sweetened juice.  Sucralose seems to be the safest artificial sweetener currently on the market.

D

Dandelion (Taraxacum officinale)

This common plant is used in Europe for hepato-biliary disorders, as an appetite stimulant, a diuretic and for dyspepsia.  The evidence supporting its efficacy has not been proven.

Safety Information: Dandelion should be avoided by those with bile duct obstruction or gallbladder conditions.  Most common side effects include itching and gastrointestinal complaints.  May lower blood glucose levels, reduce clotting ability, and act as a potassium-sparing diuretic.  The safety for children, pregnant and nursing mothers is not established, but likely safe when used as food.

Interactions: Avoid dandelion if taking lithium.  Use cautiously if taking medications to lower blood sugar.  

Lab Notes: May interfere with electrolyte, blood glucose and coagulation labs.

DHEA (Dehydroepiandrosterone)

DHEA is a hormone, secreted by the adrenal glands and is normally found in humans.  DHEA levels decrease as we age.  DHEA is purported to have multiple uses, such as for management of lupus, osteoporosis, sexual dysfunction and adrenal insufficiency.  There is not enough information to judge its efficacy.  As a supplement, DHEA is made synthetically.  Wild yam does not contain or convert to DHEA.  DHEA use is banned by the Olympic committee and other athletic organizations.

Safety Information: Side effects include nausea, gastrointestinal discomfort, fatigue, headache, nasal congestion, acne, insomnia, and abnormal menses.  Avoid if there is a history of abnormal heart rhythms, blood clots, Cushing’s Syndrome and liver disease.  May cause irregular heart rhythms.  Since DHEA is a hormone, people with prostate, breast and other hormone-sensitive cancers should avoid it.  Due to increased sex hormones, women taking DHEA may experience side effects such as voice deepening and excess facial hair.  Men may have breast enlargement and other female sex hormone traits. DHEA may interact with hormones and alter the production of insulin, cholesterol, thyroid, etc.  Use cautiously in women with endometriosis uterine fibroids polycystic ovary syndrome, etc.  Use cautiously in patients with diabetes or hyperglycemia, high cholesterol, thyroid disorders, or other endocrine (hormonal) abnormalities.  Serum glucose, cholesterol and thyroid levels may need to be monitored by a healthcare professional, and medication adjustments may be necessary.  Insomnia, agitation, delusions, mania, nervousness, and irritability have been reported.  Long-term effects of DHEA are unknown.  Pregnant and nursing women should avoid DHEA.  Not enough evidence to recommend safe use for children.

Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450 below).  Women taking tamoxifen, birth control pills and other hormones may want to avoid.  Anyone taking medication to regulate blood glucose levels or cholesterol may want to avoid.  May cause dosing interferences with alprazolam, amlodipine, diltiazem, metformin, insulin, and morphine.

Lab Notes: May alter blood-clotting times.  May lower blood pressure, cholesterol, hormone and blood glucose levels.

Dong Quai (Angelica sinensis)

This herb is usually blended with other herbs and commonly used for medicinal purposes in Chinese medicine. In the U.S. and Europe, Dong Quai is used as a flavoring agent in food.  Dong Quai has many purported uses, none of which have been proven by research..  It is frequently used to treat symptoms related to PMS and menopause, but the evidence for its efficacy is weak.  Sometimes used to offset fatigue, but again, the evidence for this is weak.

Safety Information: As a food additive, is considered to be safe.  Safety has not been proven for higher doses when used medicinally, but Chinese safety studies do not report evidence of toxicity.  May cause gastrointestinal symptoms and raise blood sugar levels.  Also reported are headache, light-headedness/dizziness, sedation/drowsiness, insomnia, irritability, fever, sweating, weakness, abnormal heart rhythms, blood pressure abnormalities, wheezing/asthma, hot flashes, worsening premenstrual symptoms, reduced menstrual flow, increased male breast size, kidney problems, and skin rash.  An oil found in Dong Quai may be carcinogenic.  Use cautiously in patients with bleeding or blood clotting disorders, and/or decreased clotting ability, such as those taking NSAIDs or anticoagulants.  May cause photosensitivity (sun sensitivity).  The safety for children is not established.  Pregnant and breastfeeding women should avoid.

Interactions: Use very cautiously if taking anticoagulants, such as Coumadin.  May interact with cardiac and blood pressure medications.  There are disputes over whether Dong Quai shares some of the same properties of estrogen or how it interacts with estrogen, other hormones, or estrogen-sensitive medications and conditions.  May also interact with other herbs and dietary substances.  In particular, use cautiously with substances with similar anticoagulant properties, such as Ginkgo Biloba, and those with other estrogen-like properties, such as Black Cohosh.

Lab Notes: May raise blood sugar levels and alter coagulation labs, such as PT and INR.

Note:  Dong Quai is most often blended in combination with other herbs.  The roots are used much more often than the leaves.

E

Echinacea (Echinacea purpurea and other varieties)

This popular herb comes in many forms.  E.  Purpurea is believed to be the most potent.  Echinacea leaves and roots are purported to have mild antiviral and antibacterial properties.  Research has not proven effective uses for this herb.

Safety Information: Probably safe when used as recommended.  Avoid if diabetic.  Theoretically can interfere with immune function.  Patients with HIV, cancer, TB, low white blood count or autoimmune diseases (MS, Lupus, etc.) should avoid or use cautiously.

Interactions: May interact with any cytochrome p-450 metabolized substances (see About Cytochrome P-450 below).  Avoid if taking immune suppression drugs, interferon, or Kava.  The safety for children, pregnant and nursing mothers is not established.

Lab Notes: May lower white blood cell count.

Note: Do not use for more than 8 consecutive weeks.

Evening Primrose Oil (EPO) (Oenothera biennis)

EPO is a source of essential fatty acids (GLA).  Purported to help a  number of conditions, but, except for eczema, research did not show any clear evidence.

Safety Information: Headaches, nausea, and gastric upset were reported.  Contraindicated for those with schizophrenia.  Seizures have been reported by people taking EPO in conjunction with certain medications or anesthesia.  EPO may interfere with clotting ability.  Pregnant and nursing women should avoid EPO.  Not enough evidence to recommend safe use for children except for medically supervised treatment of eczema and dermatitis.

Interactions: Reports of interactions with phenothiazines and anesthesia.  Has the potential to interact with anticonvulsant and antihypertension medications.

Lab Notes: May alter coagulation results.