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 […]

Ginger: Practice Points – Patient Counselling. FAQ

Pregnancy Use Although Commission E suggests that ginger is contraindicated in pregnancy, more recent research suggests that ginger is not contraindicated in pregnancy — doses up to 2 g/day of dried ginger root have been used safely. No adverse effects on pregnancy were observed in multiple studies of ginger or nausea and vomiting. Practice Points / Patient Counselling • Ginger is most often used for its anti-emetic, anti-inflammatory and gastrointestinal effects. • There is clinical support for the use of ginger in the treatment of nausea and vomiting associated with motion sickness, the postoperative period, pregnancy and chemotherapy. • Ginger is traditionally used for gastrointestinal disorders including dyspepsia, poor appetite, flatulence, colic, vomiting, diarrhea and spasms, as well as a diaphoretic in the treatment of the common cold and influenza. • Ginger is also used as an anti-inflammatory agent for arthritis, although large controlled studies have yet to produce strong support for this use. • Although antiplatelet effects have been reported, this requires very large doses and is not likely to be significant in normal therapeutic doses or dietary intake levels. Answers to Read more […]

Ginger: Dosage. Interactions. Contraindications.

Dosage Range The recommended dose ranges widely from 500 mg to 9 g/day dried root or equivalent; however, as there are wide variations in the gingerol concentrations in commercial ginger supplements the effective dosage will depend on the preparation and the indication for use. • Liquid extract (1:2): 0.7-2.0 mL/day. • Dried root: 1-3 g daily in divided doses or 1-2 g taken as a single dose for nausea and vomiting. • Infusion: 4-6 slices of fresh ginger steeped in boiling water for 30 minutes. Adverse Reactions Gastric irritation, heartburn and bloating have been reported in clinical trials. Contact dermatitis of the fingertips has also been reported with topical use. Significant Interactions Controlled studies are not available for many interactions; therefore they are based on evidence of activity and are largely theoretical and speculative. WARFARIN Due to the herb’s antiplatelet effects there is a theoretical risk of increased bleeding at high doses (> 10 g) although this is not evident clinically. There is no evidence of an interaction with warfarin at the usual dietary and therapeutic intakes, and ginger has been shown not to alter prothrombin times in pooled human plasma collected from Read more […]

Ginger: Uses

Clinical Use Although ginger is used in many forms, including fresh ginger used in cooking or chai (Indian spicy tea), pickled or glazed ginger, ethanol extracts and concentrated powdered extracts, preparations made with the root are used medicinally. Depending on the specific solvent used, the resultant preparation will contain different concentrations of the active constituents and may differ markedly from crude ginger. Although the great majority of research refers specifically to the species Zingiber officinale, there is the potential for confusion with other species or even with other genera. Furthermore, there are reported to be wide variations in the quality of commercial ginger supplements with concentrations of gingerols ranging from 0.0 to 9.43 mg/g. As such, the results of specific research can not necessarily be extrapolated to different preparations. PREVENTION OF NAUSEA AND VOMITING Many clinical studies have investigated the effects of ginger in the prevention and treatment of nausea and vomiting associated with different circumstances, including pregnancy, the postoperative period, motion sickness and chemotherapy. A recent systematic review of 24 RCTs covering 1073 patients suggest that results Read more […]

Ginger: Background. Actions

Historical Note Ginger has been used as both a food and a medicine since ancient times. Confucius wrote about it in his Analects, the Greek physician, Dioscorides, listed ginger as an antidote to poisoning, as a digestive, and as being warming to the stomach in De Materia Medica, and the Koran, the Talmud and the Bible all mention ginger. Records suggest that ginger was highly valued as an article of trade and in 13th and 14th century England, one pound of ginger was worth the same as a sheep. Ginger is still extremely popular in the practice of phytotherapy, particularly in TCM, which distinguishes between the dried and fresh root. It is widely used to stimulate circulation, treat various gastrointestinal disorders and as a stimulant heating agent. Other Names African ginger, Indian ginger, Jamaica ginger, common ginger, rhizoma zingiberis, shokyo (Japanese) Botanical Name / Family Zingiber officinale Roscoe (family Zingiberaceae) Plant Part Used Rhizome Chemical Components The ginger rhizome contains an essential oil and resin known collectively as oleoresin. The composition of the essential oil varies according to the geographical origin, but the chief constituents, sesquiterpene hydrocarbons, which are 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 […]