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UK Dept of Health report on herbal medicine regulations

The UK Department of Health just released a report entitled Advice on regulating herbal medicines and practitioners for the purpose of advising the government on the regulation of herbal practice. The Herbal Medicines Working Group, the responsible party, seems to not have included all stakeholders (with the exception of a few Ayurvedic practitioners). None of the NIMH herbalists are listed as having any participation in the discussions.

One of the conclusions of this report: there is insufficient evidence to allow herbalists to self-regulate. Ergo they must be regulated. The situation in the UK is complex, and I leave my seasoned English colleagues to offer more insightful commentary. But this is clearly one more step among many that is stilfing and suffocating herbal practice. Read more

The Sustainable Herbs Project

As an herbalist who helps formulate and develop herbal supplements, sourcing, supply chain and quality control are paramount. I want to help educate others on what constitutes good quality products and maintain quality standards in the industry.

Anthropologist Ann Armbrecht (who brought us the Numen film) is creating a new documentary called the Sustainable Herbs Project, which explores these facets of herbal trade and product development. They want to make it available for free. To do so, they’ve launched a Kickstarter campaign to fund the project. Please consider making a pledge (I did!) to make this documentary a reality and raise awareness about what goes into herbal supplements.

A Double-take on Herbal Adulteration

As an herbalist who works in the herbal product industry, I care about quality and adulteration in herbal trade. But what happened earlier this week just bugs me. Issues of herbal adulteration are good reasons to use local herbs and develop relationships with suppliers. My problem with this is that adulteration is not even confirmed in this case–it’s findings from only one lab, using methods that aren’t even considered acceptable for validation of herbal extracts.

James Schulte was commissioned to perform DNA barcoding on supplements from 4 retailers across NY state. The samples were sent to one lab and many failed DNA testing, leading to conclusions of herbal adulteration. The New York Attorney General subsequently issued cease and desist letters to Walmart, Target, GNC, and Walgreens to remove herbal products from their shelves that failed DNA authentication. Read more

Whole Artemisia plant overcomes Artemisin-resistant malaria in mice: the whole is greater than the sum of its parts

Whole plant medicine is the territory of herbalists. Based in the wisdom of our ancestors, many herbalists utilize whole-plant synergy in the form of powdered herbs, tinctures, and teas. This contrasts the practice of isolation and purification of plant compounds. Isolated compounds are have stronger monotherapeutic action, and are more conducive to current clinical research models. How do they stack up to whole herbs? The research is shedding more light on this.

Artemisinin is isolated from Artemisia annua, and has some unique chemical features not commonly seen in other natural compounds. Since its discovery in the 1970’s it has shown promising activity against Plasmodium falciparum malaria (and, increasingly, other parasitic infections) after chloroquine drug exhausted its utility as the drug of choice. As with many single compounds, Artemisinin-resistant strains of malaria have begun to emerge. Read more

Reishi-Green Tea Chai

I’m cutting back on caffeine and stimulants this Winter to really rest and restore. Caffeine and specifically coffee has numerous health benefits. But when consumed in excess (points finger to self), it can promote sympathetic dominance and affect cortisol and other adrenal hormones. Like all substances that affect our physiology, it’s best to keep our habits in check and cut back every now and then.

So I’ve ditched coffee for now and rekindling my love for tea recipes. My favorite is chais. If you’ve only had store bought or prepared chais, this recipe will change your mind about chai teas. When brewed for a long period of time, these warming spices infuse beautifully and give you a natural energy boost. And Reishi is a medicinal mushroom that supports systemic immunity, as well as adrenal function and cortisol regulation.

Green tea has potent antioxidant fractions due to its polyphenol content (EGCG) and supports Th2-mediated immunity. Reishi supports the Th1 arm, so the two together are a terrific match for supporting deep immune function.

Reishi-Green Tea Chai

  • 1 quart water
  • 2-3 Reishi mushroom slices (harvest your own or get through an organic source like Moutain Rose Herbs)
  • 1 cinnamon stick
  • sliver of nutmeg
  • 3 allspice berries
  • 3 whole cloves
  • 1 star anise
  • 3-4 peppercorns (red, white or black)
  • 3-4 cardamom pods
  • 1T organic Green tea (added at the last 5 minutes)

Decoct the Reishi along with the spices for 30 minutes. The longer it decocts, the stronger it will get. Turn off the heat and add the Green tea. (You can also substitute black tea, puerh, lapsang souchong, white tea, or yerba maté.) Let it steep for 5 minutes, then strain. Add sweetener or milk/milk substitute to taste. This will make 2-3 cups. If you have some leftover, I suggest straining it and storing in the refrigerator–the tea will become very bitter if left to steep.

If you want to increase your intake of healthy fats, you can include a little coconut oil, ghee, or grass fed butter.

You can also add your favorite herbs to this base recipe. Ashwaganda or Eleuthro root made wonderful additions, as does Astragalus, Hawthorn berries, Burdock, or Marshmallow root. Good mushroom substitutes include Turkey Tails, Chaga, and Maitake. Be creative!

Research Methods in Biomedicine and Applications to Botanicals

In my last post, I gave an overview on the basics of botanical research. To compile meaningful information you frame your question, structure your inquiry, search the appropriate databases, store and organize your information for easy access, and understand that you have to interpret the information. This last step is the hardest part.

After you’ve completed your literature search, you’ll want to look at the quality and nature of the information in front of you. The best way to assess the strength of the evidence is to know the research methods that were used–and their limitations.

In vitro studies

In vitro means ‘in glass’, and describes laboratory research conducted on cells or molecules outside of their biological environment. It is the least expensive and easiest type of research to conduct in comparison to other methods. It’s therefore used in bioprospecting and pharmaceutical screenings. Often, a group of researchers hear of a traditional use of a particular plant and that’s their clue to investigate its biological activity starting in vitro or in animals. These are also known as mechanism of action studies, as studying those cells up close can shed light on how particular herbs or compound are affecting certain cells.

In vitro studies usually test isolates or purified extracts. Sometimes, as in the case of oncology bioprospecting at the National Cancer Institute, important compounds like tannins are removed (Mills & Bone 2013). Tannins bind nonspecifically to many proteins and enzymes, and the removal of them drastically changes their biological activity. These purified extracts or compounds are added to a culture medium and incubated with cells, and changes are noted and documented. This brings us to a serious drawback of in vitro data: the difficulty of extrapolation.

For example, a 1999 in vitro study tested the effects of several botanical extracts (Echinacea, Ginkgo biloba, Saw palmetto, and St. John’s wort) on fertility. To do this, they cultured hamster oocytes (eggs) with pretty high concentrations of these extracts (upwards of 0.6mg/mL) and then tested sperm penetration (Ondrizek et al 1999). When you’re reading a study or abstract, try to envision what’s actually going on. Is it relevant? For reference, concentrations above 0.1mg/mL are unlikely to be achieved in people taking herbs orally.

Furthermore, and more troubling, is that you can’t get product preparation or extraction details from an abstract or even a full text sometimes. I’m consistently surprised to see how often authors neglect to describe the extract type (aqueous or ethanolic? Crude herb?). This is especially prolific in the mushroom literature, where extraction methods are crucial yet strangely absent from the abstracts.

In vitro data should be carefully examined before conclusions are made. Again, this is usually Step 1 in the process of seeing if a particular herb merits further study. Read more

Narrative medicine in the practitioner-client interaction

Nature abhors a vacuum. The less defined or understood a particular condition or disease is by the medical establishment, the more it exposes the explanatory frameworks of the individual practitioner or client. This goes especially for complex issues like chronic infections, metabolic or endocrine imbalances, inflammatory conditions, and degenerative diseases. When there aren’t agreed upon explanations for causes, treatment, or prognosis, it becomes a hazy blank canvas for individuals to paint a story. Is that a helpful story? Narrative medicine is not just a tool in the toolbox. It’s an entire dimension of the healing process that is either working with you or against you.

Addressing narrative is a missing piece in many medical or healing practices, including herbal medicine. Health and illness narratives affect our entire operational framework of a particular health issue. And these are huge blind spots in the practitioner and client relationship. Read more

Basics of Botanical Research

The research process is beautiful. And fun! You get to navigate and interact with the landscape of information about a subject, and figure out where the strengths, weaknesses, and opportunities exist in our knowledge base. In the process of digging into research, you can see the origins of the rumors spread about herbs, gain some clarity about it and weed through misinformation. Certainly, botanical preclinical and clinic research is an incremental way of building undertanding, much like an ant procuring crumbs of food to bring back to the colony. And it doesn’t tell us everything: there are many rich sources of information to draw from in botanical medicine, with traditional use chief among them. The skilled herbalist exercises good judgment and critical thinking by achieving fluency in these different areas, and knows how to apply them to help people.

I’ve been in the research field for 6 years–first in anthropological research at the Center for World Indigenous Studies, then as a botanical research assistant and writer for several clinicians, and now in R&D for a medicinal mushroom company. And I’m passionate about supporting herbalists in navigating the scientific research about botanicals and supplements to improve decision-making.

Let’s use an example. Say you’ve been heard about Thyme Oil as a Powerful Natural Antibiotic on social media sites and want to dig further into it. When we’re looking for at the evidence base of a claim, we want to go to the primary research and see the studies that have actually been done. Not reviews, not news articles, but real studies.

Frame the question to structure the inquiry.

I usually make 2 columns: the first lists the substance I’m searching for. This can be a specific plant, phytochemical, or just plants in general. Use the latin name for plants (in this case Thymus vulgaris), and include potential misspellings. Then in the second column is the subject: the name of a condition, keyword, or associated biomarker (you can use the term antibiotic or antibacterial). In this case, there’s a MeSH term for anti infective agents, which would cover the territory nicely.

Get better at searching.

You can then use this basic format to search the databases. Searching MEDLINE via PubMed will be more helpful with complex searches, as you can specify which fields you’d like to search. I also like to search Google Scholar. It indexes MEDLINE as well as other databases. The search is wider and you get more results, but you can’t customize it as well as you can with PubMed. Below is the search builder on PubMed. As you can see, you can add lots of different criteria for more wheat and less chaff.

Screen Shot 2014-12-13 at 10.14.37 AMAnd get to know your journals–PLOS, PubMed Central, BioMed Central, and anything from the Hindawi Publishing Group is free full text. My favorite botanical/phytotherapy journals are Fitoterapia, Phytotherapy, Phytotherapy Research, and Planta Medica. The Journal of Ethnopharmacology is also a great one, but I get the feeling that it’s a bioprospecting publication.

Use reference management programs to store and organize citations.

Once you start generating citations, programs like EndNote, Papers, Mendeley (free), Zotero (free), and Sente (pictured below, my personal favorite) can store, track and organize your citations. With any software, each have their different strengths and weaknesses. For example, EndNote is great for formatting citations in a final publication, but not the best at organizing into folders, tagging, storing PDFs. Sente is my personal favorite because I can sync these libraries with research colleagues, store and annotate PDFs, and having standing searches to keep up on new search results as they come in. Mendeley is a nice free/open source program, and is a good place to start.

Sente screenshotI have several of these programs installed. I can import and export citations as needed, depending on the project.

Going from A to B: know how to extrapolate and interpret data relevant to your inquiry.

This is where the true skill lies in research. Investigators set up replicas of reality in their labs. I can’t stress enough that research findings are specific to that setting, model, and process. Assessing the relevance of a finding is crucial. How do we translate study A to real world situation B? This takes some understanding of human biology, test methods, and the strength of different types of research methodologies and evidence (which I’ll address in future posts).

Back to thyme oil: once you complete your search, you’ll see that there is some data on antibacterial effects. Great! You have something to work with. Then the researcher should consider:

  • Were these done in test tubes (in vitro), animals, or humans?

In vitro studies are done in test tubes, often by culturing cells with botanical extracts, concentrates or isolates. They’re done to investigate the mechanism by which something works, and/or to see if there’s enough of an effect for research efforts to progress to animal studies. As the body would metabolize these compounds differently than what’s done in petris, findings should be taken with a grain of salt as they’re difficult to extrapolate to real world situations.

  • What kind of bacteria? What exactly were the effects?

This is very important! Just because a substance has an effect on a particular genus, species, or class of bacteria doesn’t mean that it will be effective in others. This error in applying a finding to other non-related pathogens or conditions is rampant in discussions about herbal medicine (see my post on Herbs for Ebola). Remember: this information is for a certain preparation in a certain type of experimental model. A may not always translate to B.

  • Is the dose and preparation relevant to what people would actually use?

I can’t stress this enough. Many natural substances can have an effect in test tubes and animals, but getting those amounts in humans would not be feasible. If possible, a critical examination of study doses and concentrations should be part of your research toolkit.

This is the first of a series on botanical research. Please leave your questions and feedback in the comments!