Fenugreek: Interactions. Contraindications. Pregnancy Use. Practice Points. FAQ

Toxicity Safety studies indicate that fenugreek is extremely safe. When consumed as 20% of the diet, it did not produce toxic effects in animal tests. Adverse Reactions One clinical study found that a dose of 50 g taken twice daily produced mild gastrointestinal symptoms, such as diarrhea and flatulence, which subsided after 3-4 days. Allergic reactions have been reported, but are rare. Significant Interactions Where controlled studies are not available, interactions are speculative and based on evidence of pharmacological activity and case reports. HYPOGLYCAEMIC AGENTS Additive effects are theoretically possible in diabetes — monitor concomitant use and monitor serum glucose levels closely — potentially beneficial interaction. IRON Frequent use of fenugreek can inhibit iron absorption — separate doses by 2 hours. WARFARIN Although there is a theoretical concern that concomitant use could increase bleeding risk due to the herb’s coumarin content, this is unlikely. A placebo-controlled study found that fenugreek does not affect platelet aggregation, fibrinolytic activity or fibrinogen. Contraindications and Precautions Fenugreek is contraindicated in people with allergy to the herb, which has been Read more […]

Fenugreek: Uses. Dosage

Clinical Use DYSPEPSIA AND LOSS OF APPETITE Although controlled studies are unavailable, the increased activity of pancreatic and intestinal lipase seen in animal studies provides a theoretical basis for its use in dyspepsia. Commission E approved the internal use of fenugreek seed for loss of appetite. ELEVATED LIPID LEVELS Several clinical studies conducted in people with and without diabetes have identified significant lipid-lowering activity with different fenugreek preparations, such as defatted fenugreek, germinated seed and hydro-alcoholic extracts. As can be expected, the dose used and type of preparation tested has an influence over results. An open study using a daily dose of 18.0 g germinated fenugreek seed in healthy volunteers demonstrated significant reductions in total cholesterol and LDL-choles-terol levels. A placebo-controlled study found no effect after 3 months with a lower dose of 5 g seed daily, suggesting that higher intakes may be required for lipid-lowering activity to become significant. DIABETES Fenugreek is a popular natural treatment used to aid blood sugar regulation in diabetes. Overall, results from clinical studies have produced positive results however trials have used diverse Read more […]

Fenugreek: Background. Actions

Historical Note Fenugreek’s seeds and leaves are used not only as food but also as an ingredient in traditional medicine. It is indigenous to Western Asia and Southern Europe, but is now mainly cultivated in India, Pakistan, France, Argentina and North African countries. In ancient times it was used as an aphrodisiac by the Egyptians and, together with honey, for the treatment of rickets, diabetes, dyspepsia, rheumatism, anaemia and constipation. It has also been described in early Greek and Latin pharmacopoeias for hyperglycaemia and was used by Yemenite Jews for type 2 diabetes. In India and China it is still widely used as a therapeutic agent. In the United States, it has been used since the 19th century for postmenopausal vaginal dryness and dysmenorrhea. Common Name Fenugreek Other Names Trigonella seeds, bird’s foot, Greek hay, hu lu ba, methi, trigonella Botanical Name / Family Trigonella foenum graecum (family Leguminosae) Plant Parts Used Dried mature seed, although leaves are used less commonly. Chemical Components The main chemical constituents are fibre, tannicacid, fixed and volatile oils and a bitter extractive, steroidal saponins, flavonoids, polysaccharides, alkaloids, trigonelline, trigocoumarin, Read more […]

Garlic: Contraindications. Practice Points. FAQ

Contraindications and Precautions Patients with bleeding abnormalities should avoid therapeutic doses of garlic. Although usual dietary intakes are likely to be safe prior to major surgery, suspend the use of high-dose garlic supplements 1 week before, as garlic may increase bleeding risk. If being used as part of a topical application, a test patch is advised before more widespread application. Pregnancy Use Garlic is not recommended at doses greater than usual dietary intakes. Practice Points / Patient Counselling • Garlic is both a food and a therapeutic medicine capable of significant and varied pharmacological activity. • It has antioxidant, antimicrobial, antiplatelet, antithrombotic, antihypertensive, lipid-lowering, anti-atherosclerotic and vasoprotective activity. • It also enhances microcirculation and may have hypoglycaemic, anti-inflammatory and immunostimulant activity. • Garlic is used as a treatment for many common infections, to reduce the incidence of colds, improve peripheral circulation and manage hyperlipidaemia and hypertension. • Increased consumption of garlic has been associated with a decreased risk of stomach and colorectal cancer, according to a review of the Read more […]

Garlic: Dosage. Adverse Reactions. Interactions.

Dosage Range GENERAL GUIDE • Fresh garlic: 2-5 g/day (ensure it is bruised, crushed or chewed). • Dried powder: 0.4-1.2 g/day. • Aged-garlic extracts have been studied in amounts ranging from 2.4 to 7.2 g/day. • Oil: 2-5 mg/day. • Garlic preparations that will provide 4-12 mg alliin daily. • Fluid extract (1:1): 0.5-2 mL three times daily. ACCORDING TO CLINICAL STUDIES • Hypertension: 600-900 mg/day in divided doses (delivering approximately 5000-6000 µg allicin potential). • Hyperlipidaemia: 600-9000 mg/day. • Fungal infection: topical 0.4-0.6% ajoene cream applied twice daily. • Occlusive arterial disease: 600-800 mg/day. It is important to be aware of the thiosulfinate content, in particular allicin-releasing ability, of any commercial product to ensure efficacy. Adverse Reactions INTERNAL USE Breath and body odour, allergic reactions, nausea, heartburn, flatulence, abdominal discomfort and diarrhea have been reported. Headache, myalgia and fatigue were reported in one study using a dose of 900 mg garlic powder (standardised to 1.3% alliin). TOPICAL USE An ajoene 0.6% gel produces a transient burning sensation after application, according to one study. Contact Read more […]

Garlic: Uses

Clinical Use Most studies have used a non-enteric coated dehydrated garlic powder preparation standardised to 1.3% alliin content (Kwai, Lichtwer Pharma) or an aged garlic extract (Kyolic, Wakunaga of America). CARDIOVASCULAR DISEASE Epidemiologic studies show an inverse correlation between garlic consumption and progression of CVD in general. This review will consider the evidence for garlic in the management of specific risk factors such as hypertension and hyperlipidaemia. Additionally, investigation into the effects of garlic directly on the atherosclerotic and arteriosclerotic processes is presented. Hypertension A meta-analysis of seven clinical trials using a garlic preparation, produced commercially as Kwai, found that three showed a significant reduction in SBP and four in DBP. Kwai was used in these studies in the dosage of 600-900 mg daily. Garlic treatment resulted in a mean reduction in SBP of 7.7 mmHg and 5.0 mmHg in DBP compared with placebo. In 2000, the Agency for Health Care Research and Quality analysed results from 27 randomised, placebo-controlled trials and reported that results were mixed. When significant reductions in blood pressure were observed, these were small. Several newer Read more […]

Garlic: Background. Actions

Historical Note Garlic has been used as both a food and a medicine since antiquity. Legend has it that garlic was used in ancient Egypt to increase workers’ resistance to infection and later used externallyto prevent wound infection. Other ancient civilizations have also used it medicinally. Sanskrit records document the use of garlic approximately 5000 years ago and the Chinese have been using it for over 3000 years. One of the uses of garlic was as a treatment for tumours, a use which extends back to the Egyptian Codex Ebers of 1550 BC. Louis Pasteur was one of the first scientists to confirm that garlic had antimicrobial properties. Garlic was used to prevent gangrene and treat infection in both world wars. Traditionally, garlic has been used as a warming and blood cleansing herb to prevent and treat colds and flu, coughs, menstrual pain and expel worms and other parasites. Common Name Garlic Other Names Ail, ajo, allium, camphor of the poor, da-suan, knoblauch, la-juan, poor man’s treacle, rustic treacle, stinking rose Botanical Name / Family Allium sativum (family Liliaceae) Plant Part Used Bulb, and oil from the bulb Chemical Components Garlic bulbs contain organosulfur compounds, protein (mainly alliinase), Read more […]

Korean ginseng: Practice Points – Patient Counselling. FAQ

Contraindications and Precautions Korean ginseng is generally contraindicated in acute infections with fever, and in persons who are very hot, tense and overly stimulated. Overuse may result in headache, insomnia and palpitation. Ginseng should not be taken concurrently with other stimulants including caffeine and should be discontinued 1 week before major surgery. Use in hypertension should be supervised however it may prove beneficial for this indication. Pregnancy Use Ginseng is traditionally used in Korea as a tonic during pregnancy. The Commission E does not list any restrictions. However, due to the potential teratogenicity of some compounds (ginsenoside Rb1) observed under experimental conditions, ginseng should be used cautiously during the first trimester of pregnancy. In a two-generation rat study, a ginseng extract fed at doses as high as 1 5 mg/kg/day did not produce adverse effects on reproductive performance, including embryo development and lactation. Practice Points / Patient Counselling TRADITIONAL USE Ginseng is traditionally used for deficiency of Qi (energy/life force) manifested by shallow respiration, shortness of breath, cold limbs, profuse sweating and a weak pulse (such as may occur Read more […]

Korean ginseng: Adverse Reactions. Significant Interactions

Adverse Reactions Ginseng abuse syndrome (hypertension, nervousness, insomnia, morning diarrhea, inability to concentrate and skin reactions) has been reported and there has been a report of a 28-year-old woman who had a severe headache after ingesting a large quantity of ethanol-extracted ginseng. Cerebral angiograms showed ‘beading’ appearance in the anterior and posterior cerebral and superior cerebellar arteries, consistent with cerebral arteritis. High doses (1 5 g/day) have been associated with confusion, depression and depersonalisation in four patients. However, the majority of the scientific data suggest that ginseng is rarely associated with adverse events or drug interactions. A systematic review found that the most commonly experienced adverse events are headache, sleep and gastrointestinal disorders. Data from clinical trials suggest that the incidence of adverse events with ginseng mono-preparations is similar to that of placebo. Any documented effects are usually mild and transient. Combined preparations are more often associated with adverse events, but causal attribution is usually not possible. A case of suspected ginseng allergy has recently been reported in the scientific literature. The case Read more […]

Korean ginseng: Other Uses. Dosage

Other Uses GASTROPROTECTION DURING HEART SURGERY In a trial of 24 children undergoing heart surgery for congenital heart defects, 12 children received 1.35 mg/kg ginsenoside compound or placebo intravenously before and throughout the course of cardiopulmonary bypass surgery. Ginseng administration resulted in attenuation of gastrointestinal injury and inflammation. RESPIRA TORY DISEASE Ginseng extract (G115) has been shown significantly (P < 0.05) to improve pulmonary function test, maximum voluntary ventilation, maximum inspiratory pressure and maximal oxygen consumption (VO2max) in a study of 92 patients suffering moderately severe chronic obstructive pulmonary disease (n = 49, G115 100 mg twice daily for 3 months). HEUCOBACTER PYLORI Helicobacter pylori can provoke gastric inflammation, ulceration and DNA damage, resulting in an increased risk of carcinogenesis. As preliminary evidence suggests that Panax ginseng inhibits the growth of Helicobacter pylori and can inhibit adhesion it may be useful as a gastroprotective agent against Helicobacter pylori-associated gastric mucosal cell damage. HIV INFECTION Long-term intake of Korean ginseng slows the depletion of CD4+ T cells and may delay disease progression Read more […]