Today, there are at least 120 distinct chemical substances derived from plants that are considered important drugs and are currently in use in one or more countries in the world. Some of these drugs are simply a chemical or chemicals extracted from plant materials and put into a capsule, tablet, or liquid. One such example is the plant chemical called cynarin, which occurs naturally in the common artichoke plant. In Germany, a cynarin drug is manufactured and sold to treat hypertension, liver disorders, and high cholesterol levels. The drug is simply this single chemical, or an artichoke liquid extract, that has been concentrated and chemically manipulated to contain a specific amount of this one chemical; such a preparation is called a standardized extract. This drug is manufactured by pharmaceutical companies and sold in pharmacies in Germany with a doctor's prescription.
However, in the United States, artichoke extracts are available as natural products and sold in health food stores as "dietary supplements." Some U.S. artichoke products are even standardized to contain a specific amount of cynarin, yet they can still be purchased here as a natural product without a prescription (and for a lot less money than in Germany). There may be little to no difference between the cynarin drug produced in Germany and the artichoke standardized herbal supplement made in the United States considering that the same amount of cynarin is being delivered, dose for dose.
NEED FOR CONSUMER EDUCATION
ABOUT HERBAL SUPPLEMENTS AND DRUGS
While American consumers do have more access to less-expensive natural products, such as cynarin-standardized artichoke products, regulations here prohibit the manufacturers to make any claims as to what the products might treat or even be good for, since they must be sold as "foods," not "medicines." Unfortunately, someone looking through the shelves in a health food store for something to help them manage their high blood pressure or high cholesterol might pass by an artichoke extract totally unaware of its status, the research about it, and its uses in Germany and other European countries. Therefore, even though American consumers may have freer access to these less-expensive natural products, they must make an effort to educate themselves about the properties and uses of these herbal substances in order to find the most appropriate natural remedy to meet their needs.
Many American consumers find it very frustrating to sort through a lot of ambiguous information put out by natural product manufacturers who cannot legally label their goods with condition-specific information (and stop them in their tracks in the aisles at the health food store saying, 'Hey, look at me, if you have high cholesterol!'). But, there is another way to look at it. Would you rather pay the much higher price to go to the doctor for the convenience of being told what to take and then spend more money on a prescription, as in Germany? Or would you rather do a little research yourself, skip the doctor's visit (and cost), and purchase a less-expensive natural product at the health food store that the German physician writes a prescription for anyway? Unfortunately, you can not have it both ways-not unless you find a highly knowledgeable naturopath, herbalist, or natural health practitioner who will just tell you (for free) what to buy at the health food store (and finding such a practitioner might take some research effort too!). So get prepared to do some research, take responsibility for your own health and wellness, and educate yourself about which natural remedies and products might be helpful for you.
Another well-known example of how similar a plant and drug can be (but a bit different) is quinine. For well over 100 years, the quinine chemical (an alkaloid) was extracted from the natural bark of Cinchona trees and sold as a prescription drug to treat malaria. American scientists were motivated to try to copy this chemical in the laboratory during World War II when the world's main tropical tree farms fell into the hands of the Japanese and the natural bark was in short supply-during which time American troops in the tropics were dropping like flies to malaria. Scientists were able to make an exact copy of the chemical in the laboratory without using any natural bark to start with, and a synthesized drug was created. Because it was a chemical occurring in nature and not a new one, it could not be patented by any one drug company. Several pharmaceutical companies worldwide began producing and selling synthesized quinine drugs, as they still do today.
While natural quinine-containing bark can be sold in the United States as a natural product, quinine drugs still require a prescription here. In many European countries, even the natural bark is regulated as a drug since it contains naturally occurring and very active quinine alkaloids that are regulated as drugs. This also means that Americans using the bark as a natural remedy should treat it with knowledge and respect due to its very powerful and active ingredient - quinine, which is not without well-documented acute toxicity and side effects. This is yet another reason American consumers need to educate themselves on the properties and actions of plants and their naturally occurring chemicals prior to using them. (Or find a qualified professional to guide them.)
More is Not Always Better: Be Careful About Dosage Amounts
Too many Americans today buy into the idea that herbal products and medicinal plants are like food and are more or less benign and/or safe at any dosage. This is partly a result of legal restrictions stating that these products must be sold as "food supplements" in the United States. Also at play is that old American philosophy of excess: "if some is good, more is better." This idea is also somewhat prevalent in the food and dietary supplements market. While this may be true for some foods and dietary supplements, it is certainly not true for many of the biologically active medicinal plants that are sold here as herbal supplements. It is also not true for many of the rainforest plants discussed in this book. Traditional dosage amounts for herbal remedies have been included in the plant information provided in Part Three of this book for a reason. These dosage amounts are based on the long history of the plant's use and should be followed within reason. They have been calculated for an average-weight adult person of 120 to 150 pounds and should be generally adjusted up or down based on body weight. Take less if you weigh under 120 pounds, and more if you weigh more than 150 pounds (up to double the recommended dosage if you weigh 300 pounds or more). If you plan on taking more than one and one-half times the dosage that is indicated for your weight, it is best to check with a qualified herbalist, naturopath, or physician who has experience with the particular plant you are choosingto take at higher dosages.
Possible Contraindications and Interactions
Another good reason to learn more about an herbal product or medicinal plant before taking it is possible contraindications and drug interactions. An excellent example of this possible problem is a very active chemical-coumarin-found in many plants and herbal supplements. Unfortunately, there is not enough consumer awareness of this potential interaction yet. Coumarin is a natural plant chemical found in many species of plants in varying amounts-from trace amounts to highly significant amounts. One coumarin-containing plant is the rainforest plant called guaco. It can contain up to 10 percent coumarin.
In the 1940s, scientists discovered that coumarin was a highly effective blood thinner and went into the laboratory to synthesize or copy the plant chemical and turn it into a prescription drug. They changed the chemical just enough to patent it (basically by adding a type of salt molecule to the natural plant chemical) and renamed it coumadin. Today, coumadin is the eleventh most-prescribed medication in the United States, with annual sales of approximately $500 million in the United States alone. Even though the patent on this blood-thinning drug ran out years ago, it is still produced by just one company (a bit of a controversy) and sold in the United States under the brand name, Warfarin. (It is manufactured by other companies in other countries and sold at a much cheaper price as coumadin or "generic warfarin.")
The coumadin and coumarin chemicals are very similar in structure, so much so that they are often tested in the laboratory as being the same chemical. When Americans began taking many types of herbal supplements over the last decade, conventional practitioners and surgeons began telling their patients to discontinue any and all herbal supplements prior to and following surgical procedures because of the prevalence of natural coumarin in plants. Since so many plants contained natural coumarin (and it was such an effective blood thinner), the solution was to just tell patients to discontinue everything. No one was really sure which plants contained enough coumarin to increase the risk of bleeding problems during or after a surgical procedure.
This example illustrates yet another reason consumers should be knowledgeable about what type of medicinal plants and herbal products they choose to take and should obtain information and facts from practitioners before launching any self-treatment program with medicinal plants, especially if they routinely take prescription drugs. Someone already taking the prescription drug Warfarin should be informed that the blood-thinning effects of the drug must be carefully monitored (using blood tests), as excessive thinning of the blood is sometimes associated with fatal bleeding complications, including strokes and hemorrhages in the gastrointestinal tract. More importantly, they should be informed that taking plants high in natural coumarin may increase the blood-thinning effects of the drug and complications could be much more likely. As there are not enough research dollars available to document herb and drug interactions, many common plants that contain natural coumarin have never been officially studied as "blood thinners" in human studies or documented "to potentiate Warfarin drugs." No warnings are officially published for many of these plants.
So when an interaction between Warfarin and some herbal product happens, who's at fault? Is it the herbal supplement manufacturer who can not legally make a statement on the label of guaco (or other coumarin-containing plants) that the plant can thin the blood or label the product that it is contraindicated in someone taking Warfarin in the absence of proven clinical research for that particular plant? Or is it the fault of the drug company that produces Warfarin since it didn't do research on all the possible interactions between the drug and natural plants (not a legal requirement today)? The doctor who prescribed the Warfarin drug and didn't ask the patient what herbal supplements he or she was taking or tell the patient which ones to avoid (because the doctor didn't know either)? Or, does the fault lie with the consumer who begins taking herbal supplements without knowing what natural chemicals the supplement contains and fails to check with his or her doctor first? This will probably be a question fought over by trial lawyers for years to come, but it will ultimately be the consumer who always pays the price.
Consumers are the ones experiencing the side effects and health problems, and they ultimately pay the price for litigation through higher insurance and product liability rates. This is also the reason why so many conventional doctors refuse to advise their patients about herbal supplements and many just discourage their use altogether. They simply don't know enough about them, don't have the time to educate themselves properly, and don't want to be in the legal-liability loop for any negative side effect or drug interaction with the drugs they do prescribe and the many herbal supplements available to patients today. For these reasons, in Part Three, information about contraindications and drug interaction is provided for each plant; this information may, or may not, be officially substantiated by human clinical research. The guaco plant is still a great example. No one has funded any human clinical research to prove that the plant can thin the blood, or that it will potentiate Warfarin or coumadin drugs, but it has regularly been tested and found to contain highly significant amounts of coumarin. Programs in Brazil are even underway to extract the natural coumarin from this particular plant for the manufacture of Brazilian-made coumadin drugs.
Therefore, warnings about contraindications and possible drug interactions with Warfarin and other coumadin drugs have been provided in the guaco plant data (and for other rainforest plants that contain natural coumarin) in Part Three, based solely on the chemical contents of the plant. While many nonprofessionals may just skim over the chemical information that has been provided for each plant, the information has been recorded and provided to help explain not only why a plant might have a specific biological activity, but also to help you-and your healthcare provider-determine if there may be possible contraindications or drug interactions.
In fact, much of the data provided in this book on contraindications and drug interactions are based on the plants' chemistry or traditional uses in herbal medicine, rather than on funded human clinical studies proving a drug interaction or a medical contraindication. Human studies of this nature are very expensive and just aren't performed on most medicinal plants anywhere. There are too many plants, too many drugs, and not enough money to study all the possible interactions. This also means that the data that is provided in this book should not be considered all-inclusive or complete. It's important to note that much of the history of the medicinal uses of the plants discussed in this book is mainly recorded in tropical Third World countries where the plants grow. The populations of people using plant-based herbal remedies don't regularly take the amount or types of prescription drugs Americans do, and the history of side effects or contraindications when combining the plants with the drugs we use is virtually nonexistent. If you are taking prescription drugs, please always check with your doctor before taking any herbal supplements or medicinal plants, including those you learn about in this book.
This brings us to yet another common and growing problem in what has been termed the "self-medicating herbal product industry" in the United States. What about the person who is tired of paying the high price for Warfarin at the pharmacy and wants to try a plant like guaco to replace it? The majority of patients making up the $500 million-a-year market for this particular drug is over 60 years old and lives on a fixed income, so ideas such as this are not so uncommon. Unfortunately, this practice is also fraught with problems, especially in this particular instance. Warfarin should be taken in very specific dosages, which have been tested to be effective and safe for each patient (dosages can vary from patient to patient) and an individual patient's needs can change over time as his or her medical condition improves or deteriorates. Taking too much or too little can have drastic results. Regular blood tests are administered to ensure the dosage is correct and continues to be correct for each patient.
The coumarin content in guaco (and any plant) can change and fluctuate due to where it was grown, how and when it was harvested, climate changes in the growing environment/season, and other natural phenomena. The coumarin content can be 10 percent in one harvest of guaco plants, and as low as 5 percent the following year, even when the same plants are harvested again only a year later. So, in this case, it just would not be a good idea to try to replace the drug with an herbal supplement. Even if one found a "standardized" herbal guaco supplement with a guaranteed potency or content of coumarin, it should only be used under a doctor's supervision, in order to establish the correct dosage for the particular patient (with an obvious medical need) and would require the doctor's ongoing supervision and periodic testing. In most instances, ideally, conventional medicine and traditional medicine should play complementary roles in health care, and one should not replace the other.
PROBLEM OF ONE VS SEVERAL CHEMICALS
While many drugs have originated from biologically active plant chemicals, and many plants' medicinal uses can be attributed to various active chemicals found in them, there is a distinct difference between using a medicinal plant and a chemical drug. The difference is one that scares most conventionally trained doctors with no training in plants. Drugs usually consist of a single chemical, whereas medicinal plants can contain 400 or more chemicals. It's relatively easy to figure out the activity and side effects of a single chemical, but there is just no way scientists can map all the complex interactions and synergies that might be taking place between all the various chemicals found in a plant, or a traditionally prepared crude plant extract, containing all these chemicals. It is not unusual for a plant to contain a single documented cancer-causing chemical and also maybe five other chemicals that are anticancerous and which may counteract the one "bad" chemical. Overall, the plant extract may even provide some type of anticancerous effect.
In some instances, a particular plant chemical's activity is enhanced or increased when it is combined with another chemical or chemicals that occur naturally in the plant. An example of this is the rainforest plant cat's claw. First, the crude extract of cat's claw was shown to boost immune function. Then, specific alkaloid chemicals in the plant were scientifically documented (and patented) to be the "active constituents" that provided this effect. However, scientists discovered much later that if they extracted just the alkaloids, these alkaloids were less potent at stimulating immune cells than they were when combined with other chemicals (called catechin tannins) that the plant contains. Adding the tannin chemicals to the alkaloids increased the immune-stimulating effect of the alkaloids by almost 40 percent. In this instance, a drug made using only the alkaloids would probably be less effective than a crude extract of the plant that contained both alkaloids and tannins.
The drug industry often misses the boat in this regard. However, their motivations are different. Crude plant extracts cannot be patented or approved as drugs. The drug researcher's goal is to come up with a single chemical with good biological activity-one that can be changed in some way (without losing activity) so that it can be patented as a novel chemical and then be synthetically manufactured into a new patented drug (like adding a salt molecule to the plant chemical coumarin and patenting it as coumadin). Sometimes the isolated chemical might not be quite as effective as the crude extract in which it was found, but the researchers have the ability to deliver more of the chemical therapeutically by increasing the dosage of the single chemical. Sometimes, they can even improve on the activity of the plant chemical by modifying it in some way, which also makes it patentable. Even if patents were not an issue, the drug company still would not be able to provide enough scientific data on how so many naturally occurring plant chemicals work individually, much less in combination with one another, to get a crude plant extract approved as a drug under our current drug regulations.
The quinine tree and its quinine alkaloid are again a wonderful example of some of the limitations in this regard. Scientists selected just one single alkaloid from the crude bark extract, the chemical that evidenced the highest antimalarial effect, to turn into a drug. But the crude extract actually had at least fifteen unique chemicals which were individually found to be antimalarial. The crude extract also contained other chemicals that had a different activity: they reduced fever (one of the main symptoms of malaria). Yet even other chemicals were found to be effective regulators of the heart and could be used to treat arrhythmia. (Sometimes very high fevers cause irregular heartbeat or increase the heart rate.) No wonder the crude bark extract was used for hundreds, if not thousands, of years by the indigenous people to treat malaria. It killed the bug that caused the disease, and in the meantime, it treated the symptoms the disease was causing! But similar to the guaco vine, the content of the active chemicals in the quinine tree can fluctuate. Some species of quinine trees can have 1 percent of the main antimalarial alkaloids, while others have up to 7 percent. How would a doctor know if a crude extract contained enough of these main chemicals to be therapeutic or how to prescribe proper dosages if these chemicals varied from extract to extract? For years, this alone has justified the use of the synthesized drug over the natural crude bark extract.
POSSIBLE ANSWER TO DRUG RESISTANCE
Something really interesting has happened with the quinine tree, the quinine drug, and malaria, however. Since we've used this single synthesized drug against malaria for so many years, the malaria-causing organism (a Plasmodium protozoa) has mutated to create a defense mechanism against it. Today, we have several different strains of malaria that are completely resistant to our time-honored synthetic quinine drug. Back to the drawing board? Nope. . . back to the crude extract! Even the World Health Organization (WHO) is now revisiting the idea of going back to treating malaria in Third World countries with quinine bark extracts. Preliminary test-tube and animal studies (funded by WHO) indicate that natural bark extracts can effectively treat the new drug-resistant strains of malaria. Remember those other fourteen antimalarial chemicals in the crude bark extract? Do we know which one is doing the trick - or does it matter?
Another very interesting concept is that many disease-causing organisms can easily adapt and mutate to become resistant to a single chemical, but it would be much harder and take much more time for the organisms to create a defense mechanism against fifteen different chemicals simultaneously. Even more interesting: will throwing fifteen different active chemicals against the disease simultaneously speed up the treatment process? Only time will tell, and only if we somehow come up with the money to fund expensive large-scale human studies on unpatentable crude extracts. The pharmaceutical companies can't justify spending these research dollars on a crude plant-based medicine they cannot patent or sell. In this particular case, the WHO and/or large government public health agencies are more likely candidates to come up with the needed research dollars. Worldwide, more than one million people still die every year from malaria, and, unfortunately, this trend is likely to increase as more resistance to our main synthetic quinine drug develops.
The organism causing malaria is not the only evolving disease-causing bug we need to worry about. Bacteria can readily develop defense mechanisms against antibacterial drugs and become drug resistant. Many already have. The common staph bacteria (Staphylococcus) has gone through so many mutations over the last thirty years that many different strains have evolved that are now completely resistant to the eight major antibiotic drugs that were once effective against it. Could plants again hold the answer? Very possibly!
SHOTGUN APPROACH, NOT SINGLE BULLET?
A few years back, scientists evaluated a jungle shaman's "dysentery remedy." It was a crude plant extract that contained seven plants. Now, one must remember, dysentery in the Amazon can be attributed to any number of different bacteria, amebas, and parasites common in the area (and commonly shared in the close communal living environments of indigenous groups). The Indian shaman doesn't have the ability to send blood or stool samples to a laboratory to find out which specific organism is causing the dysentery in his village, but he must still select the appropriate plants to treat his patients. Maybe this is why a shaman usually selects a handful of plants (about four to seven) to brew into a remedy, instead of just one.
When the seven different plants in the dysentery remedy were analyzed, at least twelve different known antibiotic chemicals, five anti-amebic chemicals, and seven antiparasitic chemicals were found between all the plants in the shaman's formula. The twelve different antibiotic chemicals in the extract were found to kill bacteria in at least five different ways; these ways are called biological pathways of action. The shaman didn't really need to know which "bad bug" was the culprit, in what mainstream medicine would call his "shotgun" approach. But does this really matter either? This particular remedy, containing a total of several thousand individual plant chemicals, had at least thirty-one active chemicals that hit the top ten or so main bugs that might cause dysentery. (And, yes, you'd think your doctor was completely nuts if he sent you home with thirty-one prescriptions, so maybe "shotgun" is an appropriate analogy within your doctor's limitations.)
But let's go back to the interesting concept mentioned earlier. If the dysentery bug was an easily-mutating bacteria like staph, how likely would it be that this one organism could survive long enough to create a defense against twelve different antibacterial chemicals coming at it in at least five different ways simultaneously? These drug-resistant strains of bacteria are certainly more prevalent in First World nations in which single-chemical antibiotics are regularly employed than in poor tropical countries in which mainly plant-based remedies are used. Maybe it will take a broadly scattering shotgun to fight these tricky and quickly mutating organisms, instead of a single chemical bullet. Food for thought, for sure!
As more of our gold-standard single-bullet drugs become less effective against newly developing strains of drug-resistant bacteria, viruses, fungi, and parasites, we will probably see more interest and research on medicinal plants, herb-based drugs, and traditional remedies. The rainforests of the world are, and will continue to be, of great importance and one of the main areas where this research will likely take place. Rainforests hold the highest biodiversity and sheer number of novel chemicals on the planet. Acre for acre, they contain more species of plants and animals, and yes, even bacteria, mold, fungi, and virus species than anywhere else on earth.
It's also very important to note that all living things have inbred survival instincts. It is literally part of the cellular makeup of all species on earth. In highly mobile species like humans and other animals, the main survival instinct and mechanism is "flee, fight, or hide." Even bacteria and virus species have learned to flee or hide from immune cells and chemical agents attacking them, as well as to fight them by mutating or changing their own physical structure to defend against them. With stationary plants rooted to the ground and incapable of physically fleeing from danger, their survival instinct is controlled by wonderfully complex and rich chemical defense mechanisms that have evolved over eons. Plants have either created a defense mechanism against what might harm them, or they have succumbed and become extinct.
In the species-rich rainforest, there are many species of fungi, mold, bacteria, viruses, parasites, and insects that attack and kill plants. It is of little wonder that rainforest plants contain so many potent and active chemicals: the plants are in a constant battle for survival in an environment literally teeming with life that is constantly evolving. From soil-borne root rot (a virus) that attacks tender herbaceous plants, to the fungi and mold smothering the life out of huge canopy trees, or to the incredible number of insects devouring any defenseless leaf in the forest, rainforest plants have learned to adapt, create chemical defenses against attack, and survive. Within this rich arsenal of defensive chemicals are antibacterial, antiviral, antifungal, antiparasitic, anti-mold, and insecticidal chemicals with tested potent actions. This is the mechanism the plants use to survive, grow, and flourish as well as to fight the many disease-causing organisms that attack them. It is likely that within these diverse chemicals created to protect the plants from disease, at least a handful or more will be harvested and put to use protecting humans and animals from the same types of disease-causing organisms.
This is yet another reason to respect and value rainforest plants as very active potent herbal remedies and to protect them against humankind's destruction (against which the plants have no defense mechanism). Please respect them-and please help to protect them.
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