Pregnancy Use Contraindicated in pregnancy and lactation. In addition to the preceding concerns about bilirubin, berberine has caused uterine contractions in pregnant and non-pregnant experimental models. A recent in vivo study using 65-fold the average human oral dose of goldenseal investigated effects on gestation and birth and found no increase in implantation loss or malformation. The authors conclude that the low bioavailability of goldenseal from the gastrointestinal tract was likely to explain the differences between in vitro and in vivo effects in pregnancy. Hydrastine (0.5 g) has also been found to induce labour in pregnant women. Until more pharmacokinetic studies are done, goldenseal is best avoided in pregnancy. Practice Points / Patient Counselling • Goldenseal has been used traditionally as an antidiarrheal agent and digestive stimulant. • It has been used topically as a wash for sore or infected eyes and as a mouth rinse. • Goldenseal is a bitter digestive stimulant that improves bile flow and improves liver function. • Most clinical evidence has been conducted using the chemical constituent berberine. This data has shown effectiveness against diarrhea, congestive heart failure, Read more […]
Clinical note — Berberine absorption Berberine is poorly absorbed, with up to 5% bioavailability. In vitro data has clearly demonstrated that berberine is a potent antibacterial; however, in vivo data has established low bioavailability. Berberine has been shown to upregulate the expression and function of the drug transporter P-glycoprotein (Pgp). Pgp belongs to the super family of ATP-binding cassette transporters that are responsible for the removal of unwanted toxins and metabolites from the cell. It appears that Pgp in normal intestinal epithelia greatly reduces the absorption of berberine in the gut. In vivo and in vitro methods have been used to determine the role of Pgp in berberine absorption by using the known Pgp inhibitor cyclosporin A. Co-administration increased berberine absorption six-fold and clearly demonstrated the role of Pgp in absorption. Increased expression of Pgp can lead to cells displaying multi-drug resistance. As previously reported a certain flavonolignan in many Berberis spp. has the ability to inhibit the expression of multi-drug resistant efflux pumps allowing berberine and certain antibiotics to be more effective. Adverse Reactions Goldenseal is generally regarded as safe Read more […]
Clinical Use Goldenseal has not been significantly investigated under clinical trial conditions, so evidence is derived from traditional, in vitro and animal studies. Many of these have been conducted on the primary alkaloids. All results are for the isolated compound berberine, and although this compound appears to havevarious demonstrable therapeutic effects, extrapolation of these results to crude extracts of goldenseal is premature. It should also be noted that equivalent doses of the whole extract of goldenseal are exceptionally high. DIARRHOEA A double-blind, placebo-controlled, randomised trial examined the effect of berberine alone (100 mg four times daily) and in combination with tetracycline for acute watery diarrhea in 400 patients. Patients were divided into four groups and given tetracycline, tetracycline plus berberine, berberine or placebo; 185 patients tested positive for cholera and those in the tetracycline and tetracycline plus berberine groups achieved a significant reduction in diarrhea after 16 hours and up to 24 hours. The group given berberine alone showed a significant reduction in diarrhea volume (1 L) and a 77% reduction in cAMP in stools. Noticeably fewer patients in the tetracycline and Read more […]
Historical Note Goldenseal is indigenous to North America and was traditionally used by the Cherokees and then by early American pioneers. Preparations of the root and rhizome were used for gastritis, diarrhea, vaginitis, dropsy, menstrual abnormalities, eye and mouth inflammation, and general ulceration. In addition to this, the plant was used for dyeing fabric and weapons. Practitioners of the eclectic school created a high demand for goldenseal around 1847. This ensured the herb’s ongoing popularity in Western herbal medicine, but unfortunately led to it being named a threatened species in 1997. Today, most high-quality goldenseal is from cultivated sources. Common Name Goldenseal Other Names Eye root, jaundice root, orange root, yellow root Botanical Name / Family Hydrastis canadensis (family Ranunculaceae) Plant Parts Used Root and rhizome Chemical Components Isoquinoline alkaloids, including hydrastine (1.5-5%), berberine (0.5-6%) and canadine (tetrahydroberberine, 0.5-1.0%). Other related alkaloids include canadaline, hydrastidine, corypalmineand isohydrastidine. Clinical note — Isoquinoline alkaloids Isoquinoline alkaloids are derived from phenylalanine or tyrosine and are most frequently found Read more […]
• There is good clinical evidence that probiotics may be beneficial in the treatment of infant diarrhea, travellers’ diarrhea, acute diarrhea, antibiotic-induced diarrhea, urogenital infections, irritable bowel syndrome, inflammatory bowel diseases, H. pylori infections, food intolerances and allergies, leaky gut and eczema. • There is also some evidence that probiotics are essential for both the development and maintenance of a healthy immune system. • There is some evidence that probiotics have a modest effect improving the LDLHDL-cholesterol ratio. • Probiotics can be administered orally or intravaginally. They can also be taken as yoghurt or other cultured dairy products. It should be noted that only products containing actual probiotic strains will be beneficial. The so-called starter cultures do not necessarily have the same beneficial effects. • Although probiotics may improve the long-term bowel flora, probiotic supplementation has other benefits not associated with direct colonisation of the gastrointestinal tract. Answers to Patients’ Frequently Asked Questions What can probiotics do for me? Probiotics are beneficial in the treatment of digestive disorders such as diarrhea and Read more […]
Adverse Reactions There have only been two documented adverse reactions. In a 74-year-old diabetic patient with hypertension, and in a 67-year-old patient with endocarditis undergoing tooth extraction, L. rhamnosus preparations caused adverse reaction. The causality was not established and details are scant. Significant Interactions No adverse drug interactions have been reported. ANTIBIOTICS Concomitant administration of probiotics (lactobacilli and Saccharomyces boulardii) reduces gastrointestinal and genitourinary side effects according to clinical studies — combination can be safely used together and a beneficial interaction is likely. Contraindications and Precautions Specific strains of probiotics are appropriated for different disorders. Certain strains are suitable for children. Probiotics are contraindicated in those people who are hypersensitive to any component of the probiotics-containing product. Pregnancy Use Likely to be safe in pregnancy; however, use of concentrated forms should be supervised by a healthcare professional.
FOOD ALLERGIES High-level antigen exposure during the first few months of life is suspected of predisposing individuals to allergic sensitisation and, therefore, various atopic conditions such as skin reactions and even systemic or respiratory manifestations. Intestinal inflammation seems to be a predisposing factor in increased sensitisation of a subject, which in turn promotes further inflammation when antigen exposure occurs. Considering that the gut microflora is an important factor in regulating both the intestinal and systemic immune system, probiotics are used to promote endogenous barrier mechanisms, reduce gut permeability and alleviate intestinal inflammation in patients with atopic dermatitis and food. A 1 -month study of 10 breastfed infants who had atopic eczema and cow’s milk allergy found that L. GG reduced certain faecal inflammatory markers. Clinical note — The hygiene hypothesis The intestinal tract is the largest immune organ of the body. It produces more antibodies than any other part of the body and contains 80% of all antibody-producing cells. The intestinal mucosa functions as a barrier against infections, but it also provides communication between the different mucosal surfaces of the Read more […]
It is generally agreed that a probiotic must be capable of colonising the intestinal tract to influence human health. Currently, one of the most extensively studied probiotics is Lactobacillus GG. Probiotic supplements are usually standardised in terms of the amount of living organisms per unit of volume and dosages range from 1 billion colonies to as high as 450 billion daily. DIARRHOEA Infectious diarrhea A Cochrane review analysed results from 23 RCTs that compared a specified probiotic agent with placebo or no probiotic in people with acute diarrhea proven or presumed to be caused by an infectious agent. Overall, 1917 volunteers were involved, of whom 1449 were infants or children (age <18 years). The review concluded that probiotics reduced the risk of diarrhea at 3 days and the mean duration of diarrhea by 30.5 hours and supplementation was a useful adjunct to rehydration therapy in treating acute, infectious diarrhea in adults and children. Several different probiotics were tested: all were lactic acid bacilli, except in two studies that tested the yeast Saccharomyces boulardii. With the exception of a trial of live Streptococcus thermophilus and Lactobacillus bulgaricus, a beneficial effect in the probiotic Read more […]
Background and Relevant Pharmacokinetics The generally accepted definition of a probiotic is ‘a live microbial food supplement which beneficially affects the host animal by improving its intestinal microbial balance’. This definition is, however, rather limited as some probiotics are transient and do not take up residence in the intestinal tract. A better definition may be ‘[a] microbial dietary supplement that beneficially affect the host physiology by modulating mucosal and systemic immunity, as well as improving nutritional and microbial balance of the intestinal tract’. The gastrointestinal tract is sterile at birth. Normal gut flora develops gradually over time and is influenced by factors such as composition of the maternal gut microflora, diet, degree of hygiene, use of antibiotics or other medication, the environment and possibly genetic aspects. Once established, a person’s individual gut flora remains surprisingly constant throughout life. This is likely to be due to the fact that the gut immune system learns to recognise and tolerate those bacterial species acquired during early infancy. It is therefore very difficult to alter the composition of the gut flora after this time. Successful colonisation with Read more […]
Answers to Patients’ Frequently Asked Questions What will this herb do for me? Raspberry leaf preparations have been used since ancient times to prepare the uterus for birth in an attempt to facilitate a complication-free labour. It is also used to treat diarrhea and dyspeptic complaints, and incorporated into a mouthwash to reduce inflammation of the mouth and throat. When will it start to work? Currently, there is insufficient research to answer this question. However, it is used in increasing doses during the last few weeks of pregnancy. Symptomatic relief of diarrhea and inflammation of the oral cavity is likely to occur within the first few doses. Are there any safety issues? Considering raspberry leaf has uterine activity, it is recommended that pregnant women wanting to use it do so under the careful supervision of an experienced healthcare professional.