Modern Maturity

10 MEDICINAL HERBS TO
ENHANCE LIFE AFTER 50

“The fruit of the tree shall be for food, and the leaves for medicine.”
Ezekiel, 47:12.

James Duke of Fulton, Maryland, is betting his prostate on the medicinal herb saw palmetto--and winning. During a 27-year career with the U.S. Department of Agriculture, including five years as chief of the Medicinal Plant Resources Laboratory in Beltsville, Maryland, Duke, now 72, earned the moniker, Uncle Sam’s herbalist. Since retiring in 1995, he has lectured worldwide and written books about medicinal herbs. He has also transformed part of his six acres into a terraced herb garden containing some 300 medicinal plants arranged by the conditions they help prevent or treat. On the top terrace by a stone marker that says Prostate Problems, the most prominent herb is saw palmetto (Serenoa repens), a small palm native to Florida, whose berry-like fruits have been shown to shrink overgrown prostate tissue.

“During warm weather, I keep it in the garden,” he explains in a drawl that recalls his Southern youth, “but when it gets cold, I move it into my greenhouse.”

Ten years ago, when Duke first experienced prostate symptoms--decreased urine flow and nightly wake-ups to urinate--the standard treatment was surgery, snipping away overgrown prostate tissue to restore normal urination. “I wasn’t interested,” he recalls. “In addition to the risks of anesthesia, the surgery sometimes causes impotence.”

Then the first drug was introduced--Proscar. It shrinks prostate tissue by interfering with an enzyme that spurs overgrowth (5-alpha-reductase). “Proscar works,” Duke explains, “but saw palmetto is a natural 5-alpha-reductase inhibitor and it’s just as effective.”

An herb as effective as a drug? Duke’s claim was tested in 1998 when European researchers compared a daily 320 mg of saw palmetto extract head-to-head against a standard dose of Proscar in 1,098 men. After 26 weeks, both treatments produced statistically equivalent benefit. Proscar reduced prostate symptoms 39 percent, saw palmetto, 37 percent. But the herb caused fewer side effects, notably less impotence and libido loss. “I take the same dose as they did in that study,” Duke says, “a daily 320 mg of a standardized extract.” (For more on standardized extracts, see the Dose Control sidebar)

Several recent studies corroborate saw palmetto’s safety and effectiveness in treating prostate enlargement. UCLA researchers concluded: “Saw palmetto appears to be a safe, highly desirable option.”

When Duke decided to treat his prostate symptoms herbally, his doctor was taken aback. “He was open to alternative therapies, but despite the studies I showed him, he had difficulty believing that a herb could compete with a pharmaceutical. Well, it has. My prostate is the same size as it was five years ago, and my symptoms are no worse. At my last checkup, my doctor said, ‘Just keep doing what you’ve been doing.’ Every time I walk past the saw palmetto in my garden, I say thanks.”

MEDICINAL HERBS HIDE IN PLAIN SIGHT

The media and some doctors treat herbal medicine as something new, untested, and possibly sinister. “Ironically,” says Mark Blumenthal, an adjunct associate professor of medicinal chemistry at the University of Texas College of Pharmacy in Austin, and executive director of the American Botanical Council, a nonprofit herb educuation organization there, “even vocal critics use medicinal herbs all the time--usually without realizing it.”

Do you start your day with coffee? Caffeine is herbal medicine. In addition to being America’s favorite pick-me-up, “coffee opens the bronchial passages,” says pharmacologist Jerry Cott, Ph.D., of College Park, Maryland, formerly with the Food and Drug Administration. “It can help treat the common cold and asthma.” Tea is also medicinal. It’s high in antioxidants. Several studies have shown that as tea consumption increases, risk of heart disease and several cancers decreases. Do you get sea sick? Try the traditional herbal remedy, ginger--1,000 mg 30 minutes before embarking. In two recent studies on Italian cruise ships, ginger was compared head-to-head against the standard over-the-counter drug, Dramamine. The herb prevented seasickness more effectively with fewer side effects. Even our word “drug” harkens back to herbal medicine. It comes from the Dutch “droog,” meaning to dry, as in drying herbs, the first step in processing them into medicines.

ARE MEDICINAL HERBS SAFE?

Herbal medicine has become big business. Acccording to Nutrition Business Journal in San Diego, U.S. sales were $4.12 billion in 2000, up from $3.96 billion in 1998. But as herbs have become more popular, concerns about their safety have made headlines. Herbs are not regulated as stictly as drugs, and critics contend that consumers are flying blind. “Just because they’re natural does’t mean they’re safe,” Cott says. Some of the world’s most toxic substances are herbal, for example, poison hemlock.

However, critics have exaggerated herbs’ hazards, says Mary Hardy, M.D., medical director of integrative medicine at Cedars Sinai Medical Center in Los Angeles. (“Integrative medicine” means a combination of mainstream and alternative.) “Most popular medicinal herbs are reasonably safe for most people most of the time when taken in recommended amounts. But medicinal herbs have drug effects on the body, and all drugs have the potential to cause harm--allergic reactions, side effects, and possible interactions with other herbs and drugs. So, like drugs, herbs should be used cautiously and responsibly, and in consultation with your physician or another medical professional knowledgeable about herbs, especially if you have a chronic condition and take other drugs regularly.” (For more on herbal safety, see sidebar.)

10 GOOD HERBS FOR PEOPLE OVER 50

Dr. Duke and the other experts interviewed for this article recommend the following herbs to help maintain health and vitality in later life:

1. Bilberry (Vaccinium myrillus). Aging often brings serious eye diseases, among them, glaucoma and macular degeneration. This herb, a relative of blueberry, helps treat both, thanks to the pigments it contains (anthocyanosides). In a 1985 study, Italian researchers tested the vision of glaucoma sufferers before and after a single 200 mg dose of bilberry extract. The herb improved their vision. A German study shows that bilberry helps treat macular degeneration. Duke says it also helps prevent these conditions. “Bilberries are nontoxic,” says Golden, Colorado, physician Linda B. White, M.D., coauthor (with Steven Foster) of The Herbal Drugstore. “I’ve never seen a report of problems.” Buy a standardized extract containing 25 percent anthocyanosides, and take the dose the label recommends. “Or,” Duke says, “just eat more dark colored fruits: blueberries, blackberries, cranberries, red grapes, raisins, plums, and purnes. They all contain anthocyanosides and provide similar benefits.”

2. Black cohosh (Actaea recemosa, formerly Cimicifuga recemosa). If you’re a woman with menopausal complaints who can’t or would rather not take estrogen, this herb can help. Since the 1950s, a black cohosh preparation, Remifemin, has been marketed in Germany for menopausal complaints. In a 1998 review of eight studies, a Univeristy of Bridgeport (CT) researcher called it “a safe, effective alternative to estrogen replacement.” “My wife takes black cohosh for menopausal symptoms,” Cott says. Most black cohosh studies have used Reminfemin, which is now available in the U.S. at some health food stores and pharmacies. If you can’t find it, try another black cohosh preparation. Follow label directions.

3. Echinacea (Echinacea, various species). Grandparents often catch colds from thier grandchildren. You can speed healing with echinacea (eh-kin-AY-sha), an herbal immune stimulant. In a 1999 review, researchers at the University of Wisconsin analyzed nine studies of echinacea as a cold remedy. Eight showed significant benefit. More recently, researchers at York College in Pennsylvania gave 95 adults with early cold or flu symptoms either echinacea or a placebo. After five days, the herb group reported significantly speedier recovery. However, echinacea does not prevent colds and flu. “I stock it in my medicine cabinet,” White says, “and take it at the first sign of colds, flu, and other illnesses. I take it every two hours the first day, then three or four times a day after than until I’m better.” Echinacea is safe for most people, but recipients of transplanted organs should avoid it because immune stimulation can trigger organ rejection. Those with auto-immune diseases (lupus, rhematoid arthritis) should also steer clear because immune stimulation might exacerbate auto-immune diseases. Echinacea is available in tinctures (alcohol extracts), teas, tablets, and capsules. Follow the label directions.

4. Garlic (Allium sativum). For Americans over 50, the top two causes of death are heart disease and cancer. Garlic helps prevent both. Many studies show that garlic reduces cholesterol, a key risk factor for heart disease. In 1993, researchers at New York Medical College in Valhalla analyzed five studies and found that one clove a day reduces cholesterol about 9 percent. Garlic also helps prevent the internal blood clots that trigger heart attack, and appears to lower blood pressure, another heart-disease risk factor. In 2000, German researchers published a four-year study showing that large doses of garlic powder open narrowed arteries, suggesting “a curative role” in heart disease. “There’s no question in my mind that garlic helps prevent and treat heart disease,” Duke says. Garlic also helps prevent several cancers. Last year, University of North Carolina researchers analyzed 18 studies and found that compared with participants who consumed no garlic, those who ate the most (more than 12 cloves a week) were 31 percent less likely to develop colon cancer and 47 percent less likely to suffer stomach cancer. Corroborating evidence comes from a University of Minnesota study of 42,000 Iowa women. Compared with those who ate the least garlic, participants who consumed the most saw their risk of colon cancer plummet 32 percent. “Garlic is a wonder herb,” Duke says. “I used lots of it in cooking, and I roast the bulbs and squeeze the contents on crackers as a spread.” In addition to garlic breath, the herb’s main side effect is impaired blood clotting. In people with heart disease, this can help prevent heart attack. But it can also increase risk of bruising (bleeding beneath the skin), and hemorrhage during surgery. Stop taking garlic two weeks before scheduled surgery.

5. Ginkgo (Ginkgo biloba). Who over 50 isn’t worried about Alzheimer’s disease? Ginkgo slows its progression. Many studies have shown this, including an influential 1997 report in the Journal of the Americal Medical Association by researchers at the New York Institute for Medical Research in Tarrytown. Participants in the Alzheimer’s studies have taken 120 to 240 mg a day. “Ginkgo is almost as effective as current pharmaceuticals,” Cott says, “but it causes fewer side effects so people are more likely to stick with it.” Ginkgo also enhances memory in healthy individuals. A British study from 1999 studied various ginkgo dosages on the memories of 31 subjects, aged 30 to 59. The greatest memory enhancement occurred in those over 50 taking 120 mg once a day. “I take it when I’m feeling mentally slow or fuzzy,” White says. Ginkgo may also help treat chronic ringing in the ears (tinnitus), Dr. Hardy says. Ginkgo leaves contian only trace amounts of the medicinal compounds. Commercial preparations concentrate these compounds. Look for standardized extracts that contain 24 percent flavonoid glycosides. Ginkgo has an ananticoagulant effect. Stop taking it before surgery or if you notice bruising. Otherwise, it causes very few side effects.

6. Hawthorn (Crataegus oxyacantha). Congestive heart failure (CHF) gets less press than heart attack, but 4.8 million Americans have it, and deaths have soared 70 percent since 1980, the vast majority in older adults. CHF develops when the heart becomes weak. Hawthorn strengthens the heart. In a 1994 German study, 78 CHF sufferers were given either a placebo or hawthorn (600 mg/day). After eight weeks, the herb group showed significantly stronger hearts with no major side effects. “Hawthorn is gentle and effective, and safe enough to take long-term,” White says. “But it takes a month or so to notice any benefit, so be patient.” However, Hardy cautions, those who use hawthorn to treat heart problems should do so in consultation with a physician or another medical professional knowledgeable about herbs.

7. Horse Chestnut (Aesculus hippocastanum). Aging often means varicose veins and hemorrhoids. This herb can help, Blumenthal says. Varicose veins and hemorrhoids develop when the small blood vesseld (capillaries) in the legs or anal area become weak and develop distended pouches where blood pools and tissue swells. Horse chestnut extract strengthens capillary walls preventing this pooling and swelling. In a 1996 German study, 240 people with varicose veins were given a placebo, compression stockings (a standard mainstream medical therapy), or horse chestnut extract. Leg swelling increased in the placebo group but decreased equally in the stocking and herb groups. The herb caused no significant side effects. “My wife takes it to treat varicose veins,” Cott says. In addition, horse chestnut extract has some anti-inflammatory action, which can also help soothe varicose veins and hemorrhoids. “Older people often notice that they bruise more easily because their capillaries become more fragile,” Dr. White explains. “Horse chestnut can help that, too.” Off the tree, horse chestnut seeds are poisonous. Commercial preparations are detoxified and safe. Follow label directions.

8. Milk Thistle (Silybum marianum). “Most people take more drugs as they get older,” Duke explains. “Drugs get metabolized through the liver, and many drugs cause liver damage, including cholesterol-lowering medications. Milk thistle minimizes the liver damage drugs cause.” In a 1994 study, Italian researchers studied 60 people taking psychiatric medication linked to liver damage. Some also took milk thistle (800 mg/day). After 90 days, the herb group showed less liver damage. The most widely used drug that damages the liver is alcohol. “If you drink regularly,” White says, “I’d recommend milk thistle.” A relative of artichoke, milk thistle also stimulates regeneration of liver cells, which explains other studies showing that it speeds recovery from hepatitis, and helps treat cirrhosis. Milk thistle, also known as silymarin, is safe, though allergic reactions are possible. The recommended dose is 200 mg three times a day of a standardized extract containing 70 percent silymarin.

9. Saw Palmetto. Discussed earlier. “I prescribe it for men with prostate enlargement,” Dr. Hardy says. “I’m impressed with it.”

10. Turmeric (Curcuma longa). After 50, aches and pains become common, and arthritis becomes a leading chronic condition. The newest arthritis drugs are COX-2 inhibitors (Celebrex, Vioxx), which provide the same relief as older medications with less abdominal distress. Turmeric, a spice used in curry, gets its yellow color from the pigment, curcumin, a natural COX-2 inhibitor. In a 1999 study, British researchers noted its “potent anti-inflammatory action.” “When I feel achy,” Duke says, “I often reach for curcumin instead of aspirin or ibuprofen.” Curcumin capsules and tablets are available at health food stores and supplement centers. In preliminary studies, curcumin has also been shown to reduce risk of several cancers: breast, prostate, colon, and stomach. It’s too early to tout turmeric for cancer prevention, but the tasty spice is safe, so if you like it, why not use more of it? “I often use turmeric and curries in cooking,” Duke says.

Some doctors remain skeptical of herbal medicine and other alternative therapies. But increasingly, physicians are becoming more comfortable with them. A 1998 survey of physicians in Minneapolis found that two-thirds called alternative therapies “promising,” and only 13 percent were “unfamiliar” with herbal medicine. The public recognizes this change in medical opinion. As recently as 1997, only 39 percent of patients felt comfortable telling their doctors they used alternative therapies. Today, according to a survey of 46,000 Consumer Reports readers, the figure is 60 percent.

Some doctors are even open to using herbs themselves, among them, Duke’s physician: “I’ve been seeing him for six years, giving him my books, and showing him various studies. He’s seen saw palmetto work for me. He’s now in his late 50s, and starting to experience prostate symptoms. During my last visit, he said he might try saw palmetto himself.”

Sidebar:
Dose Control

Critics contend that herbs are hazardous because typical preparation directions--1 to 2 teaspoons of plant material per cup of boiling water steeped for 10 to 20 minutes--yield teas with highly variable doses of the medicinally active compounds. In contrast, with pharmaceuticals, the label declares the dose precisely.

Critics have a point. Herb potency depends on plant genetics, growing conditions, maturity at harvest, time in storage, and preparation. On the other hand, one need look no farther than the poisoning statistics (see safety sidebar) to know that precise dose control is no guarantee of safety.

These days, herbal medicines are increasingly available as "standardized extracts," meaning the plant was grown from seeds or clones known to produce a certain concentration of its pharmacologically active compounds, and then grown, harvested, stored, and prepared under controlled conditions to produce dose uniformity. Standardized extracts are not quite as dose-controlled as laboratory-synthesized pharmaceuticals, but they’re close, and considerably more dose-controlled than bulk herbs. “I use the whole herbs in cooking--ginger, garlic, turmeric, rosemary,” White explains. “I also use whole herbs in beverage teas--chamomile, peppermint. But for the more drug-like herbs--among them, ginkgo and milk thistle, I choose standardized extracts.”

Sidebar:
Using Herbs Safely

Last fall, the Public Citizen Health Research Group in Washington, D.C., petitioned the Food and Drug Administration (FDA) to ban products containing Chinese ephedra (ma huang)--mostly diet aids--based on reports of more than 400 adverse reactions, including some deaths. “I wouldn’t recommend ephedra as a diet aid,” White says. And University of Chicago researchers warn that garlic, ginkgo, and ginseng should not be taken before surgery because they have anticoagulant action that might cause bleeding complications.

But pharmaceuticals are much more dangerous. In a report in the Journal of the American Medical Association, University of Toronto researchers estimated that pharmaceutical side effects kill an astonishing 106,000 American hospital patients each year. This makes drug side effects the nation’s fifth leading cause of death, accounting for more funerals than suicide, homicide, and motor vehicle accidents combined.

The American Association of Poison Control Centers tracks accidental poisonings around the country. Last year, pharmaceuticals prompted approximately 1 million calls and caused 1,400 deaths. Herbs accounted for only about 1 percent of that number--17,000 calls and 15 deaths. “People need to use herbs responsibly,” Dr. Duke says. “But when you look at the numbers, pharmaceuticals are the problem, not herbs.”

To use herbs safely:

* Read up on them. Don't just take friends' advice. (See Good Guides)

* When using commercial preparations (teas, tinctures, pills, capsules, etc.), follow the label directions. Don’t exceed recommended dosage.

* If you're over 60, start by taking a low dose, especially if you have kidney or liver problems. As people grow older, sensitivity to drugs increases, so a low dose might suffice. Starting with a low dose of medicinal herbs reduces the risk of adverse reactions. You can always increase the dose later.

* In medical consultations, tell your doctor which herbs you take and why. Forthrightness helps prevent potentially harmful interactions between herbs and pharmaceuticals. (It also encourages physicians to learn more about herbs.)

* If you’re scheduled for surgery, stop taking anticoagulant herbs at least two weeks beforehand, notably, garlic, ginkgo, ginseng, and white willow.

* Do not duplicate drug effects with herbs. If you take an antidepressant, don’t take St. John's wort, the herbal antidepressant. If you take a pharmaceutical anticoagulant, e.g. aspirin, don’t take large amounts of garlic, ginkgo, or ginseng. If you’re already taking a tranquilizer or anti-anxeity medication, steer clear of kava, an herbal tranquilzier.

* Do not substitute an herbal medicine for any prescribed medication.

* Stay alert for problems: abdominal upset, diarrhea, headache, itching, rash, or anything else out of the ordinary. If you notice unusual symptoms that appear to be linked to a medicinal herb--stop taking it and discuss your reaction(s) with your doctor.

Sidebar:
Good Guides to Herbal Medicine

* Duke, James. The Green Pharmacy. Rodale, 1997.
* White, Linda, M.D., and Steven Foster. The Herbal Drugstore. Rodale, 2000.
* McCaleb, Robert and the Herb Research Foundation. The Encyclopedia of Popular Herbs. Prima Publishing. 2000.
* HerbalGram, the journal of the American Botanical Council. P.O. Box 144345, Autin, TX 78714-4345; www.herbalgram.org
* Castleman, Michael. The New Healing Herbs. Rodale. 2001.