Note: many words and phrases are linked to their definitions in the Glossary at the bottom of the page.Standard treatments for chronic hepatitis such as interferon or ursodiol may not produce lasting improvement and can cause undesirable side effects. Many people therefore look to alternative medical treatments such as milk thistle (silymarin) for help.This topic is controversial. Indeed, you may find that your doctor is unwilling to talk about it. Most doctors are not educated about alternative medical treatments and feel uncomfortable discussing them for fear they will give inaccurate or dangerous advice. Thus, their usual recommendation is to avoid them altogether.However, many standard drugs used by doctors were first recognized as herbal remedies. Many other drugs are undoubtedly waiting to be discovered. Even after a drug is discovered, it may take many years before it is available in prescription form. This page provides information to help you decide whether the benefits of herbal remedies are worth the risk.What are herbal remedies?Unlike animals, plants and fungi cannot run away from danger. Instead, many protect themselves from being eaten by insects and other browsing animals by producing toxic chemicals in their leaves and other tissues (also known as toxins). These chemicals sicken or kill the animal consuming them, thus discouraging further damage. These toxins may be divided into four categories.
Toxins with no known medical value: Some of these plant chemicals are deadly (for example, certain mushrooms contain a chemical called alpha-amanitin that can produce death from liver failure within a few days, while aflatoxins can produce liver cancer in doses too small to be visible to the human eye). The common names of many plants reflect this danger (e.g., deadly nightshade, death cap mushrooms, poison ivy) These toxins have no known beneficial uses, and should be avoided.
Toxins with proven medical value. While toxic, some of these chemicals can be useful for treating certain medical conditions when given in doses below the toxic threshold. For example, digitoxin in the leaves of the digitalis plant (found in many flower gardens) can stop a human heart from beating with a single dose of less than 1/1000 ounce (30 mg). Yet daily doses of less than 1/10,000 ounce (0.3 mg) can help patients with heart failure or irregular heart beats. Other examples of medically useful toxins include taxol (found in the bark of the Pacific Yew, used for treating certain cancers) and opium (found in poppy plants and used for treating severe pain). The difference between helpful and toxic levels of these toxins can be very small. Doctors often measure the blood level of these chemicals to make sure they are in the therapeutic range.
Toxins with social or recreational uses. Some plant tissues contain toxins that can produce pleasurable side effects in low doses. These include coffee beans (caffeine), tea leaves (caffeine and theophylline), tobacco leaves (nicotine), psychedelic mushrooms (psylocibin), cannabis leaves (marijuana), cocoa leaves (cocaine) and poppy buds (morphine). At higher doses, these same toxins produce unpleasant or even dangerous side effects. Some may also produce addiction or chronic toxicity.
Toxins with unknown medical value: The vast majority of plant and fungal toxins have not yet been tested for their potential for treating human diseases. Thus, we do not know to which of the above categories they belong. These include many herbal remedies available through natural food outlets. As long as they are sold as nutritional supplements rather than as drugs, they are not regulated by the US Government and do not need to be tested for safety or effectiveness.
Medical scientists will eventually test most of these chemicals. Some will undoubtedly lead to important new drugs. Others will be discarded because they don't work or are too dangerous. Until then, what should you do?
Suggestions For The Use Of Herbal Remedies:
Don't try remedies that are not already in wide use. You don't want to be the 'guinea pig' that proves that a particular treatment is dangerous. Many examples of liver damage due to herbal teas have been reported. If you already have liver damage, you don't want to make it worse! Some herbal remedies such as silymarin appear to be reasonably safe, and may have some value in treating liver disease.
Let your doctor know if you are using an herbal remedy. She may not approve, but at least she should be able to detect any possible toxicity before it becomes too severe.
Stick to the usual dose. Don't take "megadoses" of herbs, vitamins, or other nutritional supplements. Herbs that might be beneficial at low doses are much more likely to harm you at high doses. Even some vitamins can kill you if you take too much of them. This is doubly important if you have liver disease. A major job of the liver is to clear drugs and toxins from the blood. A sick liver may not remove the chemicals in herbal remedies from your blood rapidly enough to prevent toxic levels from accumulating.
Don't assume that herbal remedies can replace traditional medicines. When an herbal remedy is proven safe and effective, it becomes a drug. Don't miss out on effective treatments that may exist for your problem just because your doctor is not sympathetic to herbal treatments. Find a more sympathetic doctor instead!
Learn as much as you can. What is known about the herbal remedy? Is a natural hormone or related to one (i.e., melatonin, DHEA)? If so, it may have effects similar or identical to the natural hormone. Read about the hormone, including its undesirable effects. Is it an antioxidant? Oxidation can damage human cells, so antioxidants are generally helpful unless they have their own toxicity. Is it an essential mineral or vitamin? If so, both the minimal daily requirement and toxic levels have probably been established. The optimum level is somewhere in between.
Myths About Herbal Remedies.
Because herbal remedies are natural, they must be good for you. Many natural plant products are frankly poisonous. Even beneficial plant products can be dangerous at higher doses. There are no intrinsically good chemicals. All chemicals are potentially hazardous regardless of their origin.
Doctors are suppressing herbal remedies. Doctors want to help their patients. More importantly, however, they don't want to hurt them (this is part of the Hippocratic Oath many take when finishing medical school). Thus, doctors will almost never recommend a herbal treatment until it has been adequately studied (in which case it becomes a true drug). You may find this caution frustrating, but that is how doctors are trained to practice.
If a little bit is good, more is better. The Greeks had the right ideas when they called for "everything in moderation". Even essential dietary nutrients like iron, copper and selenium are toxic at high doses. Nothing is without some toxicity. People have even been known to die from drinking too much water (really!).
If you read something it must be true. Examine the source of the article. Ask yourself:
Does the publisher have a bias for or against alternative medicine? If the magazine accepts advertisements promoting natural remedies, it may be more inclined to accept articles favoring its advertiser's products.
Will the author gain financially by promoting the product? Testimonials written by the same person that is selling the product are often worthless.
Is there evidence that a remedy actually works?Anecdotal evidence is the weakest form of support. The best evidence is usually a controlled trial, in which the effect of the treatment is compared to that of an alternative treatment or placebo. Controlled trials may be open label or double-blind. Blinded trials offer the best assurance that the authors' beliefs have not influenced the results. If you are not an expert, look for articles that have been carefully examined by experts in the field before they were published. This process, which is known as peer review, helps assure that substandard papers are not published until any problems are corrected.
Anecdotal evidence. Evidence based on a single observation, such as the result of a certain treatment on a disease in one person. It is usually impossible to know if the given result would occur again under similar circumstances, or was a chance event. For this reason, anecdotal evidence should rarely form the basis of treatment recommendations.
Controlled trial. A method for testing therapies in which the results of a proposed treatment are compared with a standard treatment or with a placebo. In general, two similar groups of patients are used, and both favorable and unfavorable results (i.e., toxicity) are recorded. Unlike anecdotal evidence, controlled trials often form the basis for treatment recommendations.
Chemical. Two or more atoms united by chemical bonds to form a molecule. Over four million chemicals are known to man. When chemicals interfere with normal chemical processes in living cells, they are referred to as toxins. Plants and fungi often produce toxins to discourage browsing by insects and larger animals. A man-made toxin has properties identical to the same toxin produced by a plant.
Double-blind trial. Persons testing a new therapy for safety and effectiveness can be influenced by their preconceived ideas or desires. Similarly, patients often report improvement from treatments if they expect the treatment to work, a phenomenon known as the placebo effect. To prevent these biases from influencing results, controlled trials often use codes that hide knowledge of which treatment is being given from both the investigator and the patient until after the study is complete.
Hippocratic oath. The Hippocratic oath has been the guiding ethical code for physicians since ancient Greece. The oath contains two parts. The first specifies the duties of the physician to his teachers and his obligations in transmitting medical knowledge. The second contains rules to be observed in the treatment of diseases. One of these rules is that the physician should do should do no harm while trying to help the patient.
Open-label trial. The opposite of a double-blind trial. In open label trials, the effectiveness of a treatment is determined with full knowledge of whether or not the patient is taking the medication. Because the expectations of the investigator and patient can subtlely influence the results of such trails, they are considered less useful than double blind trials.
Peer review. The process by which a medical article is evaluated by experts before it is published. Although this process is effective in preventing flawed studies from being published before the flaws are corrected, it can occasionally stifle new ideas. The best traditional medical journals have rigorous peer review processes to ensure that only the most carefully conducted studies are published.
Placebo. A drug or treatment designed to appear identical to the actual treatment being tested, but lacking the active chemical. Placebos are sometimes referred to as sugar pills.
Side effects. Drugs and herbal therapies may produce both desirable and undesirable effects. The undesirable effects are referred to as side effects. They can often be reduced by reducing the dosage of the drug or using a purer formulation.
Testing for safety and effectiveness. New drugs approved by the US Government must not only be shown to be safe to use, but also to be effective at producing the desired effect. All candidate drugs must go through multiple phases of testing before they are approved. Early testing shows safety in animals and humans, while the later phases test for effectiveness and further confirm safety. This process is very expensive and may take many years. For this reason, many potential drugs remain untested.
Therapeutic range. Maximum effectiveness of a drug is generally found only for a narrow range of dosages. Below that range, the amount of drug in the body is too low to have the desired effect. Above that range, undesirable side effects or toxicity are produced. Drugs with a narrow therapeutic range (e.g., digitoxin), are more dangerous than drugs with a large therapeutic range (e.g., vitamin C).
Toxin. Any chemical that interferes with normal cell function. Toxins may be man-made (such as DDT), or made by plants (phytotoxins), fungi (mycotoxins), or bacteria. Many herbal remedies obtain their effect from low levels of phytotoxins
Toxic Threshold. The minimum dose of a medication or herbal remedy required to produce toxicity. This level is not always well-defined, as it may depend on the individual taking the treatment.
Ursodiol. A water-soluble bile acid found in high concentrations in the bile of bears. When administered to humans, it tends to replace less water-soluble bile acids in the bile. Ursodiol has been shown to reduce liver inflammation associated with a variety of chronic liver diseases, although whether is prevents progression to cirrhosis and liver failure is still under investigation. Also known as ursodeoxycholic acid.
Vitamin toxicity. Certain vitamins and minerals can accumulate in the body when taken at doses above their toxic threshold. This is particularly likely with vitamins A and D, as these tend to accumulate in body fat where they cannot be cleared by the kidneys.