May 14, 2001 -- The results of a recent Vanderbilt University study showing that St. John's wort does not help people with deep depression has dealt a blow to proponents of herbal remedies.
The study, published last month in The Journal of the American Medical Association, tested 200 people suffering from serious depression. At the end of the eight-week trial, doctors concluded that St. John's wort was basically useless in helping them.
But, counter proponents of herbal remedies, no one ever said the mood-boosting herb would be of benefit to people with deepdepression.
"Nobody is out there making claims that St. John's wort is for people with major or severe depression," says Mark Blumenthal, founder and executive director of the American Botanical Council (ABC), a nonprofit research and education organization based in Austin, Texas. "You can't take the results of that study and extrapolate it to people with mild to moderate depression."
And you would be wrong if you did, according to the results of several earlier studies that found the herbal product to be effective in people milder forms of depression.
Confused by such seemingly conflicting reports, consumers aren't sure what to do. In the case of St. John's wort they've apparently decided to back off for a while. In just the past year, sales of the herb have fallen by almost half.
Mainstream Medicine Taking Note
And it's not just St. John's wort that's hurting. Overall sales of herbal remedies declined last year, according to the ABC. The organization cites negative media coverage over the past two years as being behind the 15% decline in sales.
Still, herbal remedies are wildly popular. Americans spent $591 million out of pocket for herbal remedies in 2000, ABC reports. And the number of people using complementary therapies -- including herbal medicine, massage, megavitamins, folk remedies, and homeopathy -- jumped from 33% in 1990 to more than 42% in 1997, according to the NIH's National Center for Complementary and Alternative Medicine (NCCAM).
What's more important is that mainstream medicine is beginning to take the industry seriously. For instance, according to NCCAM, 75 out of 117 American medical schools now offer courses in alternative remedies.
Courses in herbal medicine didn't exist when Michael Cirigliano, MD, was in medical school. But over the past nine years Cirigliano, assistant professor at the University of Pennsylvania School of Medicine and a specialist in internal medicine, has become an expert on the subject and lectures on the topic at least once a week.
"The main reason I got interested was that my patients were taking herbal supplements and I had to know what they were taking," Cirigliano says. "The government is pumping millions of dollars into studying complementary medicine to see if it does or doesn't work. There is a lot of interest in research and a lot of people doing research."
NCCAM, the agency directing that research, was created by Congress in 1998 specifically to explore and support work in alternative and complementary medicine. In its short lifetime NCCAM's budget has jumped from $2 million in 1998 to more than $68 million last year. Much of that money is given out in grants and to research centers across the country studying the efficacy of complementary and alternative medical treatments.
Keep Your Doctor in the Loop
But many physicians still question if herbals have any real role in medicine.
"It depends on whom you talk to," Cirigliano says. "There are plenty of physicians who feel there is a role and plenty who feel it's baloney. In my opinion that is unfortunate. The healing process is not just what is written in TheNew England Journal of Medicine, despite what some people think."
Cirigliano is quick to add that there are limits to the role herbal remedies can play. St. John's wort, he says, is a perfect example.
"For mild depression, a fair number of studies show it works," Cirigliano says. "But the study also shows that there is no role for herbals in serious illness."
Cirigliano recommends that patients get a medical diagnosis of their ailment and talk to their doctor before taking any herbal remedies.
"If it's a serious condition there probably is not a role for an herbal remedy," he says. "You should never take herbals if you are pregnant or lactating. You shouldn't really take them without supervision if you are very young or very old. And you should never mix herbals with pharmaceuticals without supervision. Don't use them in higher doses than recommended, and don't take them for long periods of time unsupervised by a knowledgeable healthcare provider."
Still, some herbal treatments have shown some medical possibilities. Here are some of the most promising:
- Black cohosh -- Said to reduce the incidents of hot flashes in menopausal women.
- Echinacea -- An immune stimulant and an anti-infective. A number of studies, Cirigliano says, have shown that it can reduce the length of flu-like illnesses if taken at the first sign of illness.
- Garlic -- Studies show that it lowers cholesterol. "I think there is a role for garlic ingestion for people who want to lower their cholesterol," Cirigliano says.
- Ginkgo biloba -- Shown to increase cerebral blood flow and relieve vertigo. A 1997 study found that ginkgo significantly improved cognitive functioning in some patients with Alzheimer's disease -- a larger study is under way.
- Ginger -- An antinauseant, it works well for people with motion sickness.
- Ginseng root -- Russian studies have found that it increases the ability to handle both physical and emotional stress. There are more than 400 species, some of which can lead to an elevation in blood pressure. "I don't recommend the use of ginseng in women with a history of estrogen-driven tumors," Cirigliano says.
- Feverfew -- For migraine headaches and menstrual irregularities. "There is a fair amount of data showing that it works and a fair amount of data showing that it doesn't," says Cirigliano. "There might also be a withdrawal problem with feverfew."
- Kava -- A natural Valium-like sedative. If used too long, it can lead to yellow discoloration of the skin.
- Milk thistle -- It may help people with liver problems, including hepatitis B and C and cirrhosis. It is used in Europe for mushroom toxicity. "There is a lot of data showing that it works," he says.
- Saw palmetto -- Helps men with a benign enlargement of the prostate. An ongoing study at Columbia-Presbyterian Hospital in New York City shows that saw palmetto -- an ingredient in PC-SPES -- may actually improve the quality of life for men with prostate cancer.
- Soy -- The sale of soy products jumped 115% last year. "It has estrogenic properties and has been shown to reduce hot flashes" in menopausal women, Cirigliano says. "It's very interesting."
- Valerian - A sedative and muscle relaxant, it has been shown to help people with insomnia.
Bob Calandra is a freelance writer whose work has appeared in several magazines including People and Life. He lives in Glenside, Pa.