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 […]

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 […]