Herbal Supplements,
which ones work?
Jim Painter PhD, RD
Professor, Eastern Illinois University
Top 10 Herbal Supplements By Sales
Supplement
Sales
1
Soy
$25,600,000
2
Cranberry
$24,000,000
3
Garlic
$20,500,000
4
Ginkgo
$18,000,000
5
Saw Palmetto
$17,000,000
6
Echinacea
$14,400,00
7
Black Cohosh
$8,600,000
8
Milk Thistle
$8,600,000
9
Ginseng
$8,400,000
19
St. John’s Wort
$8,000,000
Cavaliere, C., et al.(2008).Herbal Supplement Sales in United States
Basic Four Food Groups
Everything that
is bad for you
tastes good
Was good for
you but not
any more
Everything that is
good for you
tastes bad
If you eat
that it you
will kill you
Popular Herbal Supplements
1.
2.
3.
4.
5.
6.
7.
8.
Garlic
Rosemary
Ginger
Soy, isoflavones
Grapes, Resveratrol
Black Cohosh
Saw Palmetto
Kava
9. St Johns Wort
10. Valerian
11. Cinnamon
12. Turmeric
13. Ginseng
14. Cranberry
15. Ginkgo
16. Glucosamine &
Condroitin
I. Ginger
Zingiber officinale
Ginger
• Contains powerful antioxidants
– Gingerols, Shogaols, zingerones
• Use - prevent or ease nausea
- Reduce motion sickness
- Reduce morning sickness
- Reduce post surgery nausea
Nausea Score
N/V in Motion Sickness
N/V in Pregnancy
Nausea Intensity
Study by Ozgoli, Goli & Simbar, 2009
N/V Post-surgery
80
70
60
Percentage
reporting POV
symptoms
50
40
30
20
10
0
Ginger
Placebo
Study by Bone, et al., 1990.
II. Soy/ legumes
• Low in saturated fat
• Contains protein and other compounds that
help lower blood cholesterol
Effect = reduced risk of heart disease
Effects: Meta-analysis of Soy protein
on Serum Lipids
• 38 clinical studies; 730 people over 2 decades:
- 20 studies used soy protein isolate
- 15 used textured vegetable protein
• Lowering of serum cholesterol in 34/38 studies
• No effect in 4 studies
•In all studies, cholesterol averaged <185 mg./dl.
James W. Anderson, M.D., Bryan M. Johnstone, Ph.D., and Margaret E. Cook-Newell, M.S., R.D. N Engl J Med 1995; 333:276-282
Reduction of Total Cholesterol by Soy
Initial Cholesterol
(mg/dl)
>335
259-332
201-255
127-198
0
20
40
60
Average Total Cholesterol Reduction
(mg/dl)
Reduction in Blood
Cholesterol mg.
Reduction of Blood Cholesterol
with Soy Consumption
30
25
20
15
10
5
0
25
50
Soy Intake (grams)
75
Sources: Soy Protein
Soy Food
Amount
Soy Protein
Soy milk, plain
1 cup
8g
Tofu
½ cup
10 g
Soy flour, defatted
¼ cup
8g
Soybeans, cooked
½ cup
13 g
Roasted soynuts
¼ cup
12 g
Tempeh
½ cup
16 g
Source: United Soybean Board
III. Garlic
• Garlic has been used in traditional and folk
medicine for over 4,000 years
• Garlic contains sulfur compounds
• Eating one clove of garlic per day may help
decrease blood cholesterol levels
Effects: Garlic
• Prevents platelet “stickiness”
• Inhibits constriction of arteries
• Reduces LDL oxidation (leads to clotting)
• Prevents high blood pressure
• Reduces blood lipids
Ackermann et al., 2001, Arch Intern Med, 161: 813-24.
Butt et al., 2009, Crit Rev Food Sci Nutr, 49(6): 538-51
Component Responsible for
Lipid Lowering
• Allicin, a sulfur compound
• Volatile sulfur compounds are not present in intact
cells
• Release by:
– chopping
– steaming
– crushing
Garlic Compounds and the Effect on
HMG-CoA Reductase
Liu & Yeh, 2002, J Nutr 132: 1129-1134
Recommendations: Garlic
• Experts still researching optimal dose
• Conservative estimate = 1-3 cloves per day
IV. Cinnamon
Cinnamon
• Source of Manganese, iron, calcium, and
fiber
– Cinnamaldehyde (Reduces stickiness of
platelets)
– Cinnamyl acetate (Antioxidant)
– Cinnamyl alcohol (Antioxidant)
Cinnamon – True Ceylon Cinnamon
• Arthritis – Reduces uric acid production
• Heart Health – reduce lipids/platelet
adhesion
• Type 2 Diabetes – lower blood glucose
• Blood Pressure – Reduced blood pressure
Meta-analysis: Cinnamon & A1C
Allen, R. W., Schwartzman, E., Baker, W. L., Coleman, C. I., & Phung, O. J. (2013). Cinnamon Use in Type 2 Diabetes: An Updated Systematic Review and MetaAnalysis. Annals Of Family Medicine, 11(5), 452-459. doi:10.1370/afm.1517
V. Black Cohosh
Actaea racemosa L.
Fast Facts
• Main use: ease menopausal
symptoms like hot flashes or
night sweats
• Most popular brand is
Remifemin- it is a standardized
extract
– Commonly given in 20 mg pills,
twice a day
Effect of Black Cohosh on
Menopausal Symptoms
50
40
Average
Kupperman
Menopausal
Index (KMI)
Score
30
20
10
0
Week 0 Week 4 Week 8
KMI score is out of 51 points and scores the
following symptoms: hot flushes, paraesthesia,
insomnia, nervousness, melancholia, vertigo,
weakness, arthralgia or myalgia, headache,
palpitations, and formication.
Week
12
Study by Vermes et al., 2005
Pilot Test of BC for hot flashes
100
90
80
Daily hot
70
flash scores
(mean of all 60
participants) 50
40
30
20
10
0
Baseline
Hot flash score is frequency of
hot flashes X severity
Week 1
Week 2
Week 3
Study by Pockaj et al., 2004.
Week 4
Summary:
• Black cohosh is probably effective but
may not work for everyone- try it for a few
months to see if it works for you!
VI. Turmeric:
• Long used as a yellow food coloring and
spice.
• A principal ingredient in curry
powder(28%).
• Contains three major curcuminoids, which
are responsible for the yellow color of the
herb.
• Curcumin (diferuloylmethane) is the most
significant curcuminoid.
Effect of Turmeric on lung cancer in Mice
Percentage that developed cancer
Curcumin
& Taxol
Curcumin
Taxol
Placebo
0
20
40
60
80
100
MD Anderson Study
VII. Saw Palmetto
Main use: relief from urinary
symptoms associated with BPH
BPH diagrams
BPH Prevalence in Males
Does it work?- Peak Urinary Flow
Rate
Peak Urinary Flow Rate
(mL/min)
12.4
12.2
12
11.8
Saw Palmetto
Placebo
11.6
11.4
11.2
11
Month 3
Month 6
Month 9
Month 12
Study by Bent et al., 2006.
SP effect on DHT
6000
5000
4000
Pg/g
Testosterone
DHT (dihydrostes
tosterone)
3000
2000
1000
0
Untreated
Permixon
Study by Di Silverio, et al., 1998.
Maximal Urinary Flow Rate
Maximal
Urinary Flow
Rate
(mL/sec)
VIII. Kava Kava
Piper Methysticum
Witte, D. Loew, D. & Gaus, W. (2005). Meta-analysis of the efficacy of the acetonic kava-kava extract WS 1490 in patients with
anxiety disorders. Phytotherapy Research. 19, p. 183-188.
non-psychotic
Drug Interactions-Effective
Uses
• Sedative
• Anxiolytic
• Muscle Relaxant
• Mood stabilization
• Reduce mild nervous anxiety
• Restlessness & Agitation
• Tension & Stress
• Mild anti-inflammatory actions
Dosage
• Oral Use
• Supplied by:
– Capsules: 100 500mg
– Liquid: 1:1, 1:2
– Tea
• Daily Dosage:
– Capsules: Root extract:
150mg-300mg twice daily,
with a daily dosage of
Kava pyrones 50mg240mg.
– Tincture: Taken as 30
drops with water 3 times
daily
– Infusion: Take ½ cup twice
daily
Study by Witte, D. Loew, D. & Gaus, W. (2005).
Results
Geier [3]
Kinzler [4]
Lehrl [5]
Malsch [7]
Volz [11]
Warnecke [12]
-15
-10
-5
0
5
HAMA Difference
10
15
20
25
30
Study by Witte, D. Loew, D. & Gaus, W. (2005).
Results
Younger
Older
Male
Female
All
0
-10
-5
0
5
10
HAMA Difference
15
20
25
30
IX. Valerian Root
Valeriana Officinalis
Dosage
• Daily dosage: 100mg-1800mg
• Total internal daily dose: 15g root powder,
for restlessness 220mg three times daily,
& for sleep aid 400mg-900mg of extract
YEAR
NUMBER OF
PARTICIPANT
DOSE
DURATION
SLEEP QUALITY
INPROVEMENT
LEATHWOOD 1997
128
400 mg qhs
1 Day
YES
BALDERER 1985
10
450 mg qhs
1 Day
NO
LEATHWOOD 1985
8
450 mg qhs
1 Day
NO
DIAPER 2004
16
300 mg qhs
1 Day
NO
FARAG 2003
25
320 mg
4 Days
NR
SCHULTZ 1994
14
405 mg tid
8 Days
NO
KAMM-KOHL 1984
80
90 mg tid
14 days
YES
KUHLMANN 1999
91
600 mg qhs
14 Days
NO
DONATH 2000
16
600 mg qhs
14 Days
NO
FRANCIS 2002
5
20 mg/kg
14 Days
NO
DELSIGNORE 1992
51
100 mg tid
21 Days
NR
COXETER 2003
21
225 mg qhs
21 Days
NO
JACOBS 2005
270
600 mg qhs
28 Days
NO
VORBACH 1996
121
600 mg qhs
28 Days
YES
CERNY 1999
98
360 mg qhs
30 Days
YES
JASEN 1977
150
100 mg tid
30 Day
YES
Dichotomous Outcomes for Sleep Quality (Sleep
improved or not)
Jansen
Leathwood (1982)
Vorbach
Cerny
Kamm-Kohl
Jacobs
0.1
1.0
10.0
Relative Risk
Study by Bent. S. et. Al. (2006).
100.0
X. St John’s Wort
Hypericum Perforatum
Quick Facts
• Main Use: treatment for mild to
moderate depression,
• Extract is standardized to 0.3%
hypericin; 300-600mg 3x/day
• Treatment of depression
requires 2-6 weeks of
treatment, and for full
therapeutic dose use up to
6months
Total Score HAM-D (mean)
SJW & Mild to Moderate Depression
Kasper,S. et al, 2006
Total Score HAM-D (mean)
SJW vs. Standardized Depression
Medication
Phillip,M. et al, 1999
XI. Ginkgo Biloba
What is Ginkgo biloba?
• Dietary Supplement
• Composition
– Extract, flavonoid glycosides (composition?),
terpene lactones and ginkgolic acid
– Main Uses: Improves cognitive function, antiinflammatory effects, and vascular effects
Speed of Attention (total Msec)
Time
Kennedy, DO, Scholey, AB, Wesnes, KA. Psychopharmacology. 2000
Kennedy, DO, Scholey, AB, Wesnes, KA. Physiol Behav. 2002. Based on Bond-Lader Visual Analog Scales.
Summary of effectiveness of
Ginkgo and Ginkgo/Ginseng
combination on cognition
• Enhanced speed of attention at 240 and 360
mg but not at 120 mg
• Quality of memory was enhanced at 120 mg
and 240 mg of Ginkgo
• Working memory was enhanced with
Ginkgo/Ginseng combo vs. Ginkgo alone
XII. Glucosamine & Chondroitin
• Meta-analysis found that supplements used
together narrowed joint space.
• Improved pain and mobility
• More than 500 studies were evaluated
• 1,775 patients
Richy, F., & Bruyere O., 2003
55
• Largest clinical trial:
Glucosamine/chondroitin
Arthritis Intervention Trial (GAIT)
• GAIT has produced two sets of
negative results.
• Glucosamine and chondroitin,
alone or together, did not
reduce osteoarthritis knee pain
more than a placebo.
56
• Glucosamine & chondroitin may reverse
osteoarthritis and decrease inflammation
• Both may relieve arthritis pain and stiffness
with fewer side effects than conventional
drugs.
• Although positive reports outnumbered
negative ones, the negative ones have been
larger and better designed.
57
• Only for use with
moderate-to-severe • Do not use with:
– Warfarin
arthritis
– Asthma
• Give supplement
– Allergic reactions
three months to
– Constipation
– Ulcers
work
– Liver disease
• Buy from researched
– Inflammatory bowl
supplier
disease
58
XIII. Chocolate
• Cocoa processed with alkali is not beneficial
• High fat chocolate is not beneficial
• High sugar chocolate is not beneficial
• Cocoa is beneficial
Effects: Cocoa
Comparison of Antioxidant Content
• Black tea (2gm bag) 1000 C for 2 min.
• Green tea (2gm bag) 1000 C for 2 min.
• Wine 140 ml. California Merlot.
• 2 tbs. commercial Cocoa pwd. 200 ml H20
Total Flavonoid and Phenolic
Content of Tea, Wine and Cocoa
(per serving)
700
600
500
400
mg
300
200
100
0
GAE
ECE
Black Tea
Green Tea
Wine
cocoa
Gallic acid equivalents (GAE), phenolic
Epicatechin equivalents (ECE), flavonoid
Lee et al. (2003). Cocoa Has More Phenolic Phytochemicals and Higher Antioxidant Capacity the Teas and Red Wine.
Journal of Agriculture and Food Chemistry, 51, 7292-7295.
Cocoa Inhibits Blood flow and Vessel
Dilation
• Subjects 20 individuals at risk of CHD
• Consumed a cocoa drink
• 2 groups high and low flavanol
• Brachial artery flow and dilation were measured
Sies, et al. 2005. Cocoa Polyphenols and Inflammatory Mediators. American Journal of Clinical Nutrition, 81, 304s-12s.
Vaso-dilation with Cocoa Flavanols
7
6
5
% FMD 4
Before
2 hr After
3
2
1
0
Low flavanol
cocoa
High flavanol
cocoa
FMD (Flow-mediated Dilation)
Sies, et al. 2005. Cocoa Polyphenols and Inflammatory Mediators. American Journal of Clinical Nutrition, 81, 304s-12s.
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