Trend and pattern of herb and supplement use in the United States: results from the 2002, 2007, and 2012 national health interview surveys

Explore the Status of Communication Between Nursing Staff and Patients on Complementary Therapy Issues

This study investigates the state of communication between nursing staff and patients concerning complementary and alternative medicine (CAM) in a university hospital in Taiwan. The study employed a validated cross-sectional survey to gather data from 90 nurses in the internal medicine ward. The results indicate a notable need for more initiation and documentation of CAM discussions by nurses, with less than a quarter recording patients' CAM usage. Barriers such as limited time, access to evidence-based information, and workplace culture were identified as significant obstacles. Additionally, nurse characteristics like age, experience, and seniority also played a role in the extent of CAM communication. The study underscores the urgent need for health care institutions to prioritize CAM communication as a vital component of patient-centered care. It suggests the development of strategies to facilitate proactive discussions and referrals.

Effect of bitter orange blossom distillate on anxiety and sleep disorder in mothers with infants admitted to neonatal intensive care unit: A Randomized controlled clinical trial

OBJECTIVE

Mothers of neonates admitted to the intensive care unit are prone to sleep disorders due to stress and anxiety. Some herbs have anti-anxiety and sedative properties. This study aimed to investigate the effect of bitter orange blossom distillate on anxiety and sleep disorders in mothers with infants admitted to the neonatal intensive care unit.

METHODS

This randomized controlled clinical trial was conducted from 2021 May 15 to 2022 February 2, on 60 mothers with NICU-admitted infants in one of the medical teaching centers affiliated with Babol University of Medical Sciences, Iran. Permuted block randomization was used to assign the mothers to the experimental (bitter orange blossom distillate syrup) and control groups (syrup prepared from water and sugar). Given the impossibility of blinding the participants, allocation concealment was used to prevent the researcher from predicting the future allocation of the samples to the groups. In addition, the statistical consultant received coded data pertaining to the type of intervention in each group. A demographic questionnaire, the Spielberger State and Trait Anxiety Inventory (STAI), and the General Sleep Disorder Scale were employed to collect data. We assessed the level of anxiety and sleep disorder (in both groups before the intervention and again after the last day of the intervention). Data were analyzed using SPSS V22 software. A P-value less than 0.05 were considered significant.

RESULTS

The mean and standard deviation of the sleep disorder score in the intervention group from (50.26±5.81) to (44.70±6.94) and in the control group from (50.46±6.95) to (48.53±8.62) changed. The covariance test showed that bitter orange blossom distillate syrup has a significant effect on the improvement of sleep disorders (P = 0.01, Effect size = 0.09), but there was no significant difference in the State and Trait anxiety level of mothers (P = 0.122, 0.144 and Effect size = 0.04, 0.03) respectively.

CONCLUSIONS

Due to the positive effect of bitter orange blossom distillate syrup on sleep disorders of mothers with hospitalized babies, this low-cost and low-risk intervention is recommended.

TRIAL REGISTRATION

This study is registered at clinicaltrials.gov as Trial ID = IRCT20201209049666N1.

Herbal Supplement Use for Evidence-Based Indications in US Adults: An Analysis of National Survey Data

Objective: Understanding the changes in consumer use of herbal products and what has influenced these changes is key in the promotion of evidence informed use. The last analysis of evidence informed herbal supplement use involved the 2002 National Health Interview Survey (NHIS) analysis. This study reproduces and expands upon that earlier analysis, with the most recent NHIS dataset to report herb use patterns. It also explores the guiding resources consulted by consumers in their decision to use. Methods: Secondary analysis of cross-sectional data from the NHIS identified the 10 herbal supplements with the most reported use in 2012. The reasons reported by the NHIS for taking herbal supplements were compared with the 2019 Natural Medicines Comprehensive Database (NMCD) to determine whether reasons cited in consumption were supported by evidence. Logistic regression models were fit according to NHIS sampling weights to examine the relationship between evidence-based use and user characteristics, guiding resources, and health care professional engagement surrounding use. Results: Of the 181 reported uses of herb supplements for a specific health condition, 62.5% were for reasons supported by evidence-based indications (EBIs). The odds of herb use consistent with evidence significantly increased for those reporting higher education status (odds ratio [OR] = 3.01, 95% confidence interval [CI] [1.70-5.34]). Herbal supplement use consistent with EBIs was more likely among those who disclosed their herb use to a health care professional (OR = 1.77, 95% CI [1.26-2.49]). Evidence-based herb use was also less frequently informed by Media sources (OR = 0.43, 95% CI [0.28-0.66]) compared with non-EBI use. Conclusion: Approximately 62% of the reasons cited for taking the most consumed herbs in 2012 were in alignment with 2019 EBIs. This increase may be due to improved awareness of health care professionals and/or an increase of evidence for traditional uses of herbal products. Future research should explore the role of each of these stakeholders in improving evidence-based herb use in the general population.

Commercial probiotic products in public health: current status and potential limitations

Consumption of commercial probiotics for health improvement and disease treatment has increased in popularity among the public in recent years. The local shops and pharmacies are brimming with various probiotic products such as probiotic food, dietary supplement and pharmaceuticals that herald a range of health benefits, from nutraceutical benefits to pharmaceutical effects. However, although the probiotic market is expanding rapidly, there is increasing evidence challenging it. Emerging insights from microbiome research and public health demonstrate several potential limitations of the natural properties, regulatory frameworks, and market consequences of commercial probiotics. In this review, we highlight the potential safety and performance issues of the natural properties of commercial probiotics, from the genetic level to trait characteristics and probiotic properties and further to the probiotic-host interaction. Besides, the diverse regulatory frameworks and confusing probiotic guidelines worldwide have led to product consequences such as pathogenic contamination, overstated claims, inaccurate labeling and counterfeit trademarks for probiotic products. Here, we propose a plethora of available methods and strategies related to strain selection and modification, safety and efficacy assessment, and some recommendations for regulatory agencies to address these limitations to guarantee sustainability and progress in the probiotic industry and improve long-term public health and development.

Trend and pattern of using herbal medicines among people who are aware of their diabetes mellitus: results from National STEPs Surveys in 2005 to 2011 in Iran

Objectives

Use of traditional herbal medicines especially by those affected by chronic diseases, such as diabetes mellitus is important. The objective of this study was to assess trend and Pattern of using traditional herbal medicines by diabetic population in Iran.

Methods

The results of this study are extracted from the National Stepwise approach to chronic disease risk factor surveillance (STEPs), conducted in 2005- 2016 in Iran. A total of 3095 Iranian diabetic individuals, aged more than 25 years in 2005, 1470 diabetics in 2006, 1633 diabetics in 2007, 1652 diabetics in 2008, 1563 diabetics in 2009, and 1005 diabetics in 2011 were included in this study. We couldn't use data in 2016 because in 2016, traditional herbal use has not been questioned. First, a descriptive analysis of the study variables and prevalence of herbal use for each year, was performed. Thereafter, to determine which variables were independent predictors of adherence to herbal use, we performed multivariate logistic regression.

Results

Using traditional herbal medicines among Iranian adult population was increased from 11.1 (9.98-12.20) in 2005 to 23.5 (20.87-26.25) in 2011. The results show increase in herbal medicine use in all age groups, both urban and rural areas, and both male and female over time. Also, we found that using traditional herbal medicines was more common among female compared with male (24.2% versus 21.8%), older than middle-aged people (24.4% versus 15.9%), and people living in urban areas compared with rural area (24.13% versus 20.95%) in 2011.

Conclusion

The use of traditional herbs for treatment, alone or in combination with other therapies by the patients who have diabetes has increased over the time. Considering the high level of using traditional herbal medicines in treatment of diabetes and because of the possible herb-drug interactions, policymakers need to take appropriate interventions to control herb store and increase people's knowledge about the herbal usage.

Authentication of garlic (Allium sativum L.) supplements using a trnLUAA mini-barcode

Garlic (Allium sativum), a widely distributed plant with great cultural and medicinal significance, is one of the most popular herbal dietary supplements in Europe and North America. Garlic supplements are consumed for a variety of reasons, including for their purported antihypertensive, antibacterial, and anticarcinogenic effects. The steady increase in the global herbal dietary supplement market paired with a global patchwork of regulatory frameworks makes the development of assays for authentication of these products increasingly important. A DNA mini-barcode assay was developed using the P6 loop of the plastid trnL^UAA intron to positively identify A. sativum products. Analysis of 43 commercially available garlic herbal dietary supplements produced mini-barcode sequences for 33 supplements, all of which contained detectable amounts of A. sativum. The trnL^UAA P6 mini-barcode can be highly useful for specimen identification, particularly for samples that may contain degraded DNA.

A Health Risk Assessment of Lead and Other Metals in Pharmaceutical Herbal Products and Dietary Supplements Containing Ginkgo biloba in the Mexico City Metropolitan Area

The use of the medicinal plant Ginkgo biloba has increased worldwide. However, G. biloba is capable of assimilating both essential and toxic metals, and the ingestion of contaminated products can cause damage to health. The aim of this study was to investigate the safety of manganese (Mn), copper (Cu), lead (Pb), arsenic (As), and cadmium (Cd) in 26 items containing Ginkgo biloba (pharmaceutical herbal products, dietary supplements, and traditional herbal remedies) purchased in the metropolitan area of Mexico City. Metal analysis was performed using a graphite furnace atomic absorption spectrometer. All of the products were contaminated with Pb, 54% of them with As, and 81% with Cd. The lowest values of Pb, As, and Cd were detected in pharmaceutical herbal products > dietary supplements > traditional herbal remedies. The daily intake dose (DID) of pharmaceutical herbal products was within the established limits for the five metals. Dietary supplements and traditional herbal remedies exceeded the DID limits for Pb. The hazard quotients estimation and non-carcinogenic cumulative hazard estimation index for Mn, As, and Cd indicated no human health risk. Our results suggest that products containing G. biloba for sale in Mexico are not a health risk.

Community-Based Survey Exploring Use of the Dietary Supplement Creatine by Adult Non-Athletes

Creatine is classified as a “sports supplement”, but it also has health benefits. The purpose of this study was to assess use of creatine as a dietary supplement in adult non-athletes. Three hundred ninety-nine adults (19–89 years) completed an online survey. Among the respondents, 77% (n = 307) were regularly active, including participation in weightlifting (34%), running (34%), and cycling (21%). Twenty-eight percent (n = 111) reported use of creatine with an average dose of 6.4 ± 4.5 g. Daily creatine use was reported by 45%, and 38% reported using creatine 2–6 times weekly. Primary sources of information about creatine were trainers/coaches (29%), friends/family (32%), and internet (28%). Forty percent (n = 44) of creatine users were female. When compared by age, 46% of young, 32% of midlife, and 6% of old respondents reported creatine use with no differences in dose or frequency. Young and midlife respondents reported primarily trainers/coaches, friends/family, and internet as sources of information about creatine, but old respondents limited their sources to friends/family and fitness magazines. Although creatine is widely used by adult non-athletes who regularly exercise, dietitians and other healthcare providers are not the primary source of information. Fitness trainers can appropriately provide guidance and education regarding safe and effective use of creatine.

Acute Severe Hyponatremia Following Use of "Detox Tea"

A previously healthy 51-year-old woman presented to the ED with a one-week history of malaise, myalgia, unsteadiness, and an intermittent mild headache. Physical examination revealed neurological signs including a broad-based gait and bilateral low amplitude tremor. Laboratory testing of electrolytes revealed acute severe hyponatremia (115 mmol/L). Further, history-taking revealed increased urinary frequency following regular consumption of an over-the-counter detoxification tea product. The patient made a good recovery following admission to the intensive care unit. We identify similar cases in the literature and explore potential causal mechanisms. This case highlights the importance of enquiring about the use of supplementary health products when taking a history, and specifically identifies a growing number of reports of acute severe hyponatremia following the use of “detox teas”.

Trends and factors of botanical dietary supplement use among US adults with COPD from 1999 to 2016

BACKGROUND

The potential effects of botanical dietary supplements (BDS) in the treatment of asthma have been proposed. However, the evidence of the effects of BDS use among patients with COPD is limited. The objective of our study was to exam the trends and effects of BDS use among US adults with COPD.

METHODS

A serial, cross-sectional study was conducted by using data of the NHANSE from 1999 to 2016 (n = 53,348). COPD (n = 2,580) was identified by using self-reported diagnosis history, and any BDS use was identified in the past 30 days. The prevalence of BDS use was calculated for respondents with and without COPD. Simple linear regression models were applied to test for trends in BDS use. Multiple logistic regression models were used to identify the factors of BDS use and patients' clinical outcomes, including all-cause hospitalization and abnormal hemoglobin levels, associated with BDS use. The results were weighted to represent national estimates.

RESULTS

The prevalence of BDS use was greater among participants who had COPD compared to the referent group (mean 16.77% vs. 15.11%, p = 0.044). The trend of BDS use decreased from 1999 through 2016 in COPD group (p = 0.0023), but the trend remained stable in the non-COPD group (P>0.05). Results of multivariate logistic regression models showed that patients with higher family income (≥100% FPL) and graduated from college were more likely to use BDS compared with non-users. BDS use was associated with a lower likelihood of having all-cause hospitalization (adjusted odds ratio = 0.64; 95% CI 0.45-0.92) and abnormal levels of hemoglobin (adjusted odds ratio = 0.67; 95% CI 0.49-0.92) among adult COPD patients, after adjusting for covariates.

CONCLUSIONS

The overall use of BDS decreased during 1999 through 2016 for US adults with COPD. The potential benefit of these supplemental medications use for clinical outcomes might exist for adult COPD patients.

A Review of Medicinal Plants in Cardiovascular Disorders: Benefits and Risks

Many cultivated and wild plants are used for the management of various diseases, specifically renal and hepatic diseases and those of the immune and cardiovascular systems. In China, medicinal plants from ancient to modern history have been used in patients with angina pectoris, congestive heart failure (CHF), systolic hypertension, arrhythmia, and venous insufficiency for centuries. The latest increase in the fame of natural products and alternative medicine has revived interest in conventional remedies that have been consumed in the management of CVD. The cardio-protective properties of the various herbs are possibly due to their anti-oxidative, antihypercholesterolemic, anti-ischemic activities, and inhibition of platelet aggregation that reduce the risk of CVD. Ethno-pharmacological and biological properties of these plants are explored, based upon published scientific literature. Although a majority of medicinal plants having a biological mechanism that linked with CVD management, to date, published literature pertaining to their promising scientific properties are still poorly understood. Compared with synthetic medicines, alternative medicines do not need scientific studies before their formal approval from the government sector and due to this purpose; their safety, as well as efficacy, still remain elusive. Taken together, we addressed all accessible evidence on alternative medicines commonly consumed in CVD management. Our comprehensive analysis of the scientific literature indicated that many TCMs are available and valuable herbal medication would be the best alternative for the management of CVD as a complementary therapy. Furthermore, practitioners should always discuss possible benefits-risks of alternative medicines with patients so that they are aware of the consumption of alternative medications.

Practical Application of "About Herbs" Website: Herbs and Dietary Supplement Use in Oncology Settings

The Integrative Medicine Service at Memorial Sloan Kettering Cancer Center developed and maintains About Herbs (www.aboutherbs.com), which provides summaries of research data including purported uses, adverse effects, and herb-drug interactions for about 284 dietary supplements. Using Google Analytics, we found the website registered more than 26,317,000 hits since November 2002. The 10 most searched-for herbs/supplements of 2018 are chaga mushroom, turmeric, ashwagandha, reishi mushroom, graviola, Active Hexose-Correlated Compound, boswellia, dandelion, green tea, and Coriolus versicolor. Here we discuss their safety, herb-drug interactions, and appropriate uses in the oncology setting, based on literature searches in PubMed. Over the past 16 years, the evidence for use of these supplements is based mostly on preclinical findings, with few well-designed studies and limited trials conducted in cancer patients. It is important to familiarize health care professionals about popular supplements, so patients can be informed to make decisions that maximize benefits and minimize risks.

Herbal Medicinal Product Use During Pregnancy and the Postnatal Period: A Systematic Review

Synthesis of pooled data on herbal medicinal products used during and after pregnancy highlights the need for robust safety studies.

OBJECTIVE:

To report the incidence and nature of herbal medicinal products' adverse events and herb–drug interactions used by some pregnant and postnatal women.

DATA SOURCES:

The Allied and Complementary Medicine Database, the Cumulative Index to Nursing and Allied Health Literature, EMBASE, the Cochrane Library, MEDLINE, Scopus, Web of Science, and ClinicalTrials.gov were searched from inception until August 2018.

METHODS OF STUDY SELECTION:

Any studies reporting adverse events, herb–drug interactions or absence thereof associated with herbal medicinal products used during pregnancy or the postnatal period were included. Conference abstracts, pilot studies, and nonhuman studies were excluded. All included studies were critically appraised by two independent reviewers.

TABULATION, INTEGRATION AND RESULTS:

Database searches retrieved 3,487 citations. After duplicate removal and review of titles, abstracts, and full-text, 115 articles were critically appraised. After excluding irrelevant and low-quality articles, 74 articles were included for data extraction and synthesis. Adverse drug reactions, congenital malformations, fetal growth retardation or herb–drug interactions were the primary study objective reported by 19 of the 74 included studies, 16 cohort studies, one cross-sectional survey, and two randomized controlled trials. A total of 47 herbal medicinal products and 1,067,071 women were included in this review. Use of almond oil was associated with preterm birth (odds ratio 2.09, 95% CI 1.07–4.08), oral raspberry leaf was associated with cesarean delivery (adjusted odds ratio [AOR] 3.47, 95% CI 1.45–8.28); heavy licorice use was associated with early preterm birth by 3.07-fold (95% CI 1.17–8.05). African herbal medicine mwanaphepo was associated with maternal morbidity (AOR 1.28; 95% CI 1.09–1.50), and neonatal death or morbidity. Fourteen studies reported absence of adverse events. Four studies reported herb–drug interactions, but none studied adverse events arising from them.

CONCLUSION:

The use of herbal medicinal products during pregnancy and the postnatal period should be discouraged until robust evidence of safety is available.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42017081058.

Prevalence of complementary and alternative medicine (CAM) use in Brazil

Background

The use of medicinal plants or other alternative practices can be the only therapeutic resources for many communities and ethnic groups, especially in developing countries. In Brazil, the Ministry of Health incorporated Complementary and Alternative Medicine (CAM) as a public health policy since 2006. The aim of this study was to evaluate the prevalence of CAM use in Brazil.

Methods

This was a cross-sectional study performed as an epidemiological survey, with data from the National Health Survey, 2013 that evaluated a sample of adult Brazilians (18+ years old). The outcome was the use of CAM therapies, such as acupuncture, homeopathy, medicinal plants and herbal medicines in the last 12 months. We employed a logistic regression model (CI 95%) to evaluate the chances of CAM use.

Results

The prevalence of CAM use in Brazil was 4.5%. The subjects with higher chances to use CAM were: women (AOR = 1.42), aged > 40 years (AOR = 1.64), with higher educational levels (AOR = 2.35), and residents at North (AOR = 2.02) and South (AOR = 1.67) regions of Brazil, all with p-value < 0.001. According to the socioeconomic status, subjects from upper classes had higher chances to use acupuncture and homeopathy when compared to the other classes, and individuals from lower classes had higher chances to use medicinal plants and herbal medicines. Almost half of all individuals reporting CAM use did so outside the health care system. The Brazilian Unified Health System (SUS) was the least used funding for CAM when compared to other types of funding.

Conclusions

We recommend that the Ministry of Health invests in capacity building for health professionals who work with CAM, providing structure for those practices in health services, increasing the access of CAM therapies for SUS users, and improving the registering of information about those therapies, encouraging the use of CAM by the Brazilian population.

Associations of Herbs and Nonvitamin Dietary Supplements Use with Clinical Outcomes Among Adult and Pediatric Patients with Asthma in the United States

BACKGROUND

Herbs and nonvitamin dietary supplements (NVDS) have been commonly used among patients with asthma, yet evidence of their impact on patients' clinical outcomes is limited.

OBJECTIVE

This study examined the associations of herbs and NVDS use with asthma episodes and asthma-related emergency department (ED) visits among US adults and pediatric patients with asthma.

METHODS

A cross-sectional analysis of the 2012 National Health Interview Survey data included 2,930 US adults and 1923 children with self-reported asthma. We estimated the prevalence and type of herbs and/or NVDS use and identified factors associated with their use. We then used multivariable logistic regression models to examine the associations between these supplemental medications use and asthma outcomes, controlling for patient-related covariates. All results were weighted to represent national estimates.

RESULTS

Approximately 7.20% of American children and 21.17% of adults with asthma used herbs and/or NVDS in 2012. Herb and/or NVDS users were more likely to be female, non-Hispanic white, living in the West region, having higher family income, and having comorbidities compared with nonusers. Herbs and/or NVDS use was associated with lower likelihood of having asthma-related ED visit (adjusted odds ratio = 0.48; 95% confidence interval: 0.31, 0.75) among adult patients with asthma, but not for pediatric patients with asthma. No association between herbs and/or NVDS use and having an asthma episode was observed in either adults or children.

CONCLUSIONS

This study found high prevalence of herbs and/or NVDS use among US patients with asthma. Potential benefit of these supplemental medications use on asthma-related ED visits might exist for adult patients with asthma.

Selection and characterization of botanical natural products for research studies: a NaPDI center recommended approach

Covering: up to the end of 2018 Dietary supplements, which include botanical (plant-based) natural products, constitute a multi-billion-dollar industry in the US. Regulation and quality control for this industry is an ongoing challenge. While there is general agreement that rigorous scientific studies are needed to evaluate the safety and efficacy of botanical natural products used by consumers, researchers conducting such studies face a unique set of challenges. Botanical natural products are inherently complex mixtures, with composition that differs depending on myriad factors including variability in genetics, cultivation conditions, and processing methods. Unfortunately, many studies of botanical natural products are carried out with poorly characterized study material, such that the results are irreproducible and difficult to interpret. This review provides recommended approaches for addressing the critical questions that researchers must address prior to in vitro or in vivo (including clinical) evaluation of botanical natural products. We describe selection and authentication of botanical material and identification of key biologically active compounds, and compare state-of-the-art methodologies such as untargeted metabolomics with more traditional targeted methods of characterization. The topics are chosen to be of maximal relevance to researchers, and are reviewed critically with commentary as to which approaches are most practical and useful and what common pitfalls should be avoided.

Factors Related to Disclosure and Nondisclosure of Dietary Supplements in Primary Care, Integrative Medicine, and Naturopathic Medicine

Background:

Patients infrequently disclose use of dietary supplements to providers. Little is known about factors that motivate patients to disclose supplement use. The study aimed to identify reported factors motivating patients’ disclosure and nondisclosure of dietary supplement use and explore differences based on type of supplement and provider practice.

Methods:

Mixed methods study combining qualitative content analysis of semi-structured interviews with statistical analyses to assess differences in identified factors by provider practice type and supplement type. Seventy-eight English-speaking patients who reported taking 466 dietary supplements in the previous 30 days were recruited from primary care and Complementary and Alternative Medicine (CAM), and Integrative Medicine (IM) offices in Southern California.

Results:

We identified nine themes related to disclosure and nine related to nondisclosure of dietary supplement use. Major themes were features of the office visit, circumstances in patient health and medical care, and provider/patient characteristics. The most commonly raised theme promoting disclosure of supplement use was provider inquiry. Patients associate disclosure with having concerns about a supplement but also with annual physical exams and some routine topics of discussion, including self-care, lab results, and new medication prescriptions. Themes related to nondisclosure included lack of provider inquiry, features of the office visit, such as supplements being unrelated to the visit purpose, and patients’ convictions that supplements are safe or not important to discuss. Themes did not vary by supplement type. Primary care patients were more likely than CAM/IM patients to attribute nondisclosure to convictions that supplements were beneficial, not worth mentioning, or equivalent to food (p ≤ 0.001).

Conclusions:

When providers fail to ask directly about dietary supplement use, disclosure is often an impromptu decision that is driven by the content of provider-patient interactions. Ensuring disclosure of dietary supplement use to prevent potential drug-supplement interactions or adverse health outcomes likely requires consistent, proactive provider queries about supplement use.

Conventional Western Treatment Associated With Chinese Herbal Medicine Ameliorates the Incidence of Head and Neck Cancer Among Patients With Esophageal Cancer

BACKGROUND

Because of advances in medical treatment, the survival of cancer patients is prolonged. In line with the prolonged survival time of cancer the incidence of second primary cancer has increased. There is currently no effective way to prevent the occurrence of secondary primary cancer (SPC).

OBJECTIVES

The aim of this study is to evaluate whether Chinese Herbal Medicine (CHM) is correlated with reduced occurrence of second primary cancer (SPC) of head and neck (H&N) in patients with esophageal cancer (EC).

METHOD

We identified 15,546 patients who were diagnosed with esophageal cancer between Jan 1, 2000, and Dec 31, 2010. The patients with H&N cancer before receiving CHM were excluded. After the selection and matching process, both CHM and non-CHM cohorts each contained 850 individuals. We compared the cumulative incidence of SPC of H&N with or without CHM treatment in patients with EC by the Kaplan-Meier method. NodeXL is used to run a network analysis of CHM to examine the association between herbs and formulas.

RESULTS

Compared with non-CHM users, CHM-users showed a reduced incidence rate of SPC of H&N among the patients with EC. Reduced cumulative incidence of SPC of H&N among patients with EC was noted in the CHM cohort compared to the non-CHM cohort. The most commonly used single herbs and formulas were associated with reducing SPC occurrence.

CONCLUSION

We propose that CHM as an adjuvant therapy may prevent the occurrence of SPC of H&N in patients with EC.

Diagnoses associated with dietary supplement use in a national dataset

OBJECTIVES

The purpose of this study was to determine if participant diagnosis, as determined by a health care provider, is associated with dietary supplement (DS) use.

DESIGN/SETTING

Surveys from 1255 study participants aged 34-84, part of the Midlife in the US Study (MIDUS 2 Survey) Biomarker Project, were reviewed. Participant data included pharmaceutical use (prescription and over-the-counter medications (OTC)), clinical symptoms and diagnosis, and laboratory results. Associations were calculated between the above participant characteristics and DS use.

MAIN OUTCOME MEASURES

Frequency of DS use for physician-reported diagnoses.

RESULTS

Overall prevalence of DS use was 32.4%. Participants taking DS were more often female (p = .048), white (p < 0.001), and older (mean age 57 years, p < 0.001). Participants taking DS reported taking more OTC (p < .001) and prescription medications (p = .024), and had an increased number of chronic conditions (p = .004). Participants reporting physician-diagnosed diabetes were significantly less likely to be taking DS (p = .0066), while participants with eye disease (p = .001), high cholesterol (p = 0.041), cancer (p = 0.042), and arthritis (p = 0.044) were more likely to be taking DS than those without those conditions. No difference in DS use was found between patients with and without other identified medical conditions. After adjusting for age, race/ethnicity, and gender, only diabetes remained a significant predictor of decreased DS use (OR 0.588, CI 0.388-0.873, p = .01).

CONCLUSIONS

Some physician-reported participant diagnoses were associated, positively or negatively, with DS use.

Health Information Discrepancies Between Internet Media and Scientific Papers Reporting on Omega-3 Supplement Research: Comparative Analysis

Background

Dietary supplements are the most used complementary and alternative health modality in the United States, and omega-3 supplements continue to be the most popularly used nonvitamin or nonmineral supplements by adults. Users of dietary supplements report that they obtain health guidance from internet media resources, but there is question as to whether or not these resources provide the necessary evidence to guide health decisions. Current evidence suggests that there is a mistranslation occurring somewhere between researchers and the media.

Objective

The aim of this study was to conduct a comparative cross-sectional analysis to identify areas of discordance created when science is translated from the laboratory to Web-based news media.

Methods

A Google news search provided our convenience sample of 40 omega-3 supplement–based media reports stratified by the years 2009 to 2012. Media reports (n=17) were compared with the corresponding scientific papers for content. Report and scientific paper content were extracted using commonly accepted reporting guideline domains, and domains were then compared for detecting underlying omissions or mistranslations in reporting. Mean scores for all of the scientific papers and media reports were assessed for each domain.

Results

Scientific papers (n=14) generally maintained a mean close to complete for each reporting domain. The only domain where there was not a significant difference between media and scientific reporting match was within the objectives domain (χ²₁= 0.8, P=.36). Media reports (n=17) more frequently reported potential caveats and warnings for consumers with a mean domain for caveat reporting of 0.88, with possible scores falling between 0 and 1.

Conclusions

There are inherent differences in the intended audience, structure, and goals in scientific and media communications. These differences should be explored further, and consumers should be made aware of them. Additional considerations for balanced reporting and reader accessibility are also necessary to take into account and are explored further in this analysis.

Drug-induced autoimmune hepatitis associated with turmeric dietary supplement use

Turmeric dietary supplement sales, which accounted for US$69 million in spending in 2016, have been increasing exponentially in the USA, making this one of the most popular botanical supplements sold in the USA. Herbal supplement use, which is generally regarded as safe by consumers, is not usually reported to healthcare providers. We reported here on a case of autoimmune hepatitis, occurring in a 71-year-old woman taking turmeric dietary supplements for the maintenance of cardiovascular health, which resolved rapidly following discontinuation of the turmeric supplements. Of particular note, turmeric use was not documented in the patient's medical records and the potential causative role of the turmeric supplementation was ultimately identified by the patient rather than the healthcare providers. To our knowledge, this is the first documented report of turmeric supplement-induced autoimmune hepatitis.

Herbal medicine use among Type 2 diabetes mellitus patients in Nigeria: understanding the magnitude and predictors of use

Background Patients with chronic diseases exploit complementary and alternative treatment options to manage their conditions better and improve well-being. Objective To determine the prevalence and predictors of herbal medicine use among Type 2 Diabetes patients in Lagos, Nigeria. Setting Secondary healthcare facilities in Lagos state, Nigeria. Method The study design was a cross sectional survey. A two-stage sampling approach was used to select the health facilities and patients were recruited consecutively to attain the sample size. Data was collected using a structured and standardized interviewer-administered questionnaire. Characteristics, prevalence and predictors of herbal medicine use were assessed using descriptive statistics and multivariate regression analyses. Main outcome measure Herbal medicine use among Type 2 diabetes mellitus patients. Results 453 patients were surveyed, 305 (67.3%) reported herbal medicine use, among whom 108 (35.4%) used herbal and conventional medicines concurrently; 206 (67.5%) did not disclose use to their physician. Herbal medicine use was significantly associated with age (p = 0.045), educational level (p = 0.044), occupation (p = 0.013), duration of diabetes disease (p = 0.007), mode of diabetes management (p = 0.02), a positive history of diabetes (p = 0.011) and presence of diabetes complication (p = 0.033). Formulations or whole herbs of Vernonia amygdalina, Moringa oleifera, Ocimum gratissimum, Picralima nitida, and herbal mixtures were the commonest herbal medicine. Beliefs and perceptions about herbal medicine varied between the users and non-users. Conclusion The use of herbal medicine among Type 2 diabetes mellitus patients in Lagos, Nigeria is high. There is dire need for health care practitioners to frequently probe patients for herbal medicine use and be aware of their health behaviour and choices, with a view to manage the disease better.

Trends in botanical dietary supplement use among US adults by cancer status: The National Health and Nutrition Examination Survey, 1999 to 2014

BACKGROUND

Patients with cancer may use botanical dietary supplements (BDS) in an attempt to manage the side effects of chemotherapy, yet evidence about BDS use among patients with cancer is limited. The authors examined trends in BDS use among US adults according to cancer status and patient characteristics.

METHODS

A serial, cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey from 1999 through 2014 (n = 43,644). Self-reported cancer diagnosis history and any BDS use in the preceding 30 days were determined. The prevalence of BDS use was calculated in each cycle for respondents with and without cancer, both overall and by patient characteristics. Simple linear regression models were applied to test for trends in BDS use at a 2-sided P value < .05. Multiple logistic regression models were performed to identify the patient factors associated with BDS use. The results were weighted to represent national estimates.

RESULTS

The prevalence of BDS use was greater among participants who had cancer compared with participants who did not have cancer, but trends remained stable during 1999 through 2014 for both groups. Trends in BDS use declined in patients with cancer who were older (P_trend  = .047), had a low annual family income (P_trend  = .028), and had a lower education level (P_trend  = .004). Among the respondents without cancer, trends in BDS use declined in those who were middle-aged (P_trend  = .025), non-Hispanic whites (P_trend  = .025), those with a lower education level (P_trend  = .011), and those who were not receiving prescription medication (P_trend  = .036). Patient age, sex, race/ethnicity, income, education, and health conditions were associated with BDS use.

CONCLUSIONS

The overall use of BDS remained stable during 1999 through 2014 for US adults with and without cancer, but it varied by individual characteristics. Cancer 2018;124:1207-15. © 2017 American Cancer Society.

Design and Implementation of an Elective on the Ethnopharmacology of Appalachia for the PharmD Curriculum

Objective. To create and implement a class in ethnopharmacology that would educate student pharmacists on folk medicine, including home remedies and native plants that are used as alternative medicinal sources; active components of medicinal plants including toxicity issues and the mechanism of action of beneficial compounds, such as catechins and other flavonoids; and nutraceuticals and poisonous plants. Methods. In this three-credit hour class, herbal remedies are investigated from the standpoints of medical efficacy, potential toxicities and drug interactions with prescribed medications. Class discussions are conducted on the usefulness of remedies, the attitudes of practitioners toward traditional remedy use and the risks of relying on herbal preparations. Each student prepares a 15-minute presentation on a disease state, which covers modern pharmaceuticals and herbal or folk remedy alternatives used in that disease. Special emphasis is given to drug-herb interactions. Results. The class has gained popularity among students and consistently fills within the first hour of computerized registration. Students agree that being educated in the benefits and potential toxicities of herbal products will better prepare them to counsel their patients who use these remedies. The elective has been offered 10 times since 2007. Anecdotal comments from our alumni indicate that they have found the information to be very useful in their practice environments. Conclusion. Providing our students with a greater understanding of herbal remedies is essential to prepare them for practice. By including both the uses and potential toxicities, the student pharmacist is able to counsel her patients from a standpoint of expertise on these self-administered remedies.

Yogi Detox Tea: A Potential Cause of Acute Liver Failure

We present a case of acute fulminant liver failure from a liver detoxification tea. We present a 60-year-old female with weakness, lethargy, scleral icterus, jaundice, and worsening mental status. She drank herbal tea three times a day for 14 days prior to symptom development. Liver tests were elevated. Remaining laboratory tests and imaging were negative for other etiologies. An ultrasound-guided liver biopsy showed submassive necrosis. A literature search on the ingredients shows six ingredients as having hepatotoxic effects and remaining ingredients as having very sparse hepatoprotective data. Healthcare professionals should discuss herbal medication and tea use and report adverse effects.

Concealed use of herbal and dietary supplements among Thai patients with type 2 diabetes mellitus

Background

Diabetes mellitus (DM) has been one of the most common chronic diseases that create great impacts on both morbidities and mortalities. Many patients who suffering from this disease seek for complementary and alternative medicine. The aim of this study was to determine the prevalence and related factors of herbal and dietary supplement (HDS) use in patients with DM type 2 at a single university hospital in Thailand.

Methods

A cross-sectional study was performed in 200 type 2 DM patients via face-to-face structured interviews using developed questionnaires comprised of demographic data, diabetes-specific information, details on HDS use, and medical adherence.

Results

From the endocrinology clinic, 61% of total patients reported HDS exposure and 28% were currently consuming. More than two-thirds of HDS users did not notify their physicians, mainly because of a lack of doctor concern; 73% of cases had no awareness of potential drug-herb interaction. The use of drumstick tree, turmeric and bitter gourd and holy mushroom were most frequently reported. The main reasons for HDS use were friend and relative suggestions and social media. Comparisons of demographic characteristics, medical adherence, and hemoglobin A1c among these non-HDS users, as well as current and former users, were not statistically significantly different.

Conclusions

This study revealed a great number of DM patients interested in HDS use. The use of HDS for glycemic control is an emerging public health concern given the potential adverse effects, drug interactions and benefits associated with its use. Health care professionals should aware of HDS use and hence incorporate this aspect into the clinical practice.

Electronic supplementary material

The online version of this article (doi:10.1186/s40200-017-0317-3) contains supplementary material, which is available to authorized users.

Utilization and perceived benefits of homeopathy and herbal therapies in U.S. adults: Implications of patient-centered care

We evaluated reasons for and perceived benefits of using homeopathic and herbal therapies in U.S. adults. Data were collected from the 2012 National Health Interview Survey, which represents non-institutionalized U.S. adults (n = 33,167 unweighted). In the past 12 months, 18.6% (41.95 million) of U.S. adults reported using either homeopathy and/or herbal therapies. Among these users, 34.8% and 5.1% used them for wellness only and treatment only, respectively. 60.1% reported using homeopathic and herbal therapies for a combination of both treatment and wellness. In four out of seven self-reported perceived benefit measures, users for wellness only and for a combination of both treatment and wellness had higher likelihood of reporting benefits, compared to those who used CAM for treatment only (p < 0.001). Overall, homeopathic and herbal therapies maybe a promising lifestyle approach to enhance health-related quality of life in U.S. adults, but future research is needed to establish safety and efficacy issues.

Herbal Medications in Cardiovascular Medicine

Herbal medications are commonly used for clinical purposes, including the treatment of cardiovascular conditions. Compared with conventional medications, herbal medications do not require clinical studies before their marketing or formal approval from regulatory agencies, and for this reason their efficacy and safety are rarely proven. In this review, we summarize available evidence on herbal medications mostly used in cardiovascular medicine. We show that the use of these medications for the treatment of cardiovascular diseases is often not supported by scientific evidence. Despite most of these herbs showing an effect on biological mechanisms related to the cardiovascular system, data on their clinical effects are lacking. Potential relevant side effects, including increased risk of drug interactions, are described, and the possibility of contamination or substitution with other medications represents a concern. Physicians should always assess the use of herbal medications with patients and discuss the possible benefits and side effects with them.

Self-reported use of natural health products among rheumatology patients: A cross-sectional survey

OBJECTIVES

To describe the self-reported use of natural health products (NHPs) and identify characteristics that predict selected NHP use in rheumatology patients.

METHODS

We conducted a cross-sectional survey of consecutive rheumatology patients in two major clinics in Edmonton, Alberta. Survey items included demographic data, rheumatologic diagnoses, prescribed medications, NHPs, and information regarding patients' use of NHPs. Selected NHPs of interest - defined to include joint-specific products, oils with putative joint benefits, and other non-vitamin, non-mineral products - were classified by 2 reviewers. The characteristics of selected NHP users and non-users were compared using chi-squared and ANOVA tests, followed by multivariable-adjusted logistic regression.

RESULTS

1063 patients completed the survey (response rate = 36%, mean age 53 [sd 15], 70% female). 36% of respondents reported using one or more of a wide range of selected NHPs (mean 1.8, range 1-9). The most common source of NHP recommendations for selected NHP users were physicians (42%). Significant predictors of selected NHP use were: being female (aOR 1.41, 95%CI [1.05-1.90], p = 0.02), having a post-secondary degree (aOR 1.60 [1.15-2.22], p = 0.005), and the number of non-rheumatic medications (aOR 1.08 [ 1.00-1.15], p = 0.03) and NSAIDs (aOR 1.32 [1.06, 1.63], p = 0.01). Similar findings were observed among only inflammatory arthritis patients.

CONCLUSIONS

Our study confirms the frequent use of selected NHPs, possibly to mitigate persistent symptoms of rheumatologic illness. Rheumatologists appear to be trusted sources of advice and recommendations on NHP use and should provide balanced counselling for their patients.

Mind the gap: Disclosure of dietary supplement use to hospital and family physicians

OBJECTIVE

We aim to compare patients' perspectives on communication with their hospital physicians (HPs) and primary care physicians (PCPs) on patients' dietary and herbal supplements (DHS) use.

METHODS

We conducted a cross-sectional prospective study among in-patients using structured questionnaires on DHS use. Multivariate logistic regression models assessed variables influencing doctor-related reasons for patients' nondisclosure of supplement use.

RESULTS

Of 452 DHS users identified, 133 (29.4%) used herbs and 319 (70.6%) used non-herbal supplements. DHS users reported that PCPs were more aware of DHS consumption than HPs (70.1% vs. 34.1%, P<0.0001). PCPs initiative to detect supplement use was higher compared with HPs (P<0.0001). Doctor-related reasons for non-disclosure of DHS use were more prominent in a hospital setting. Multivariate logistic regression model suggested association between older patient age and doctor-related non-disclosure (p=0.03). DHS use was recorded in only 33 patients medical files.

CONCLUSIONS

Doctor-patient communication concerning DHS use is significantly poorer during hospitalization compared with primary-care settings. A significant barrier for in-hospital disclosure is doctor-related.

PRACTICE IMPLICATIONS

Continuity of care between community and hospital physicians regarding patients' DHS use should be improved due to the safety implications of such use. Educating physicians on DHS and improving communication could bridge this gap.

Significant inhibitory impact of dibenzyl trisulfide and extracts of Petiveria alliacea on the activities of major drug-metabolizing enzymes in vitro: An assessment of the potential for medicinal plant-drug interactions

Dibenzyl trisulfide (DTS) is the major active ingredient expressed in Petiveria alliacea L., a shrub widely used for a range of conditions, such as, arthritis, asthma and cancer. Given its use alone and concomitantly with prescription medicines, we undertook to investigate its impact on the activities of important drug metabolizing enzymes, the cytochromes P450 (CYP), a key family of enzymes involved in many adverse drug reactions. DTS and seven standardized extracts from the plant were assessed for their impact on the activities of CYPs 1A2, 2C19, 2C9, 2D6 and 3A4 on a fluorometric assay. DTS revealed significant impact against the activities of CYPs 1A2, 2C19 and 3A4 with IC50 values of 1.9, 4.0 and 3.2μM, respectively, which are equivalent to known standard inhibitors of these enzymes (furafylline, and tranylcypromine), and the most potent interaction with CYP1A2 displayed irreversible enzyme kinetics. The root extract, drawn with 96% ethanol (containing 2.4% DTS), displayed IC50 values of 5.6, 3.9 and 4.2μg/mL respectively, against the same isoforms, CYPs 1A2, 2C19 and 3A4. These investigations identify DTS as a valuable CYP inhibitor and P. alliacea as a candidate plant worthy of clinical trials to confirm the conclusions that extracts yielding high DTS may lead to clinically relevant drug interactions, whilst extracts yielding low levels of DTS, such as aqueous extracts, are unlikely to cause adverse herb-drug interactions.

Imbalance of the antioxidative system by plumbagin and Plumbago indica L. extract induces hepatotoxicity in mice

Background/Aim:

Plumbago indica (PI) L. and its active constituent, plumbagin, has been traditionally claimed for several pharmacological activities; however, there is little information regarding their toxicity. The present study aims to examine the effects of plumbagin and PI extract (PI) on hepatic histomorphology and antioxidative system in mice.

Materials and Methods:

Adult male intelligent character recognition mice were intragastrically administered plumbagin (1, 5, and 15 mg/kg/day) or PI (20, 200, and 1,000 mg/kg/day) consecutively for 14 days. Hepatic histomorphology was examined. Plasma alanine transaminase (ALT) and aspartate transaminase (AST) levels, hepatic lipid peroxidation, superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities, and the ratio of reduced to oxidized glutathione (GSH/GSSG) were determined.

Results:

Plumbagin and PI concentration-dependently induced hepatic injury based on histopathological changes via imbalance of antioxidative system. Plumbagin and PI significantly increased plasma ALT and AST levels, hepatic lipid peroxidation, and GPx activity but significantly decreased hepatic SOD and CAT activities. The GSH/GSSG ratio was significantly reduced by plumbagin.

Conclusion:

Plumbagin and PI caused hepatotoxic effects in the mice by unbalancing of the redox defense system. Therefore, plumbagin and PI-containing supplements should be used cautiously, especially when consumed in high quantities or for long periods.

In vitro exposure of Adhatoda zeylanica to human renal cells lacks acute toxicity

Adhatoda zeylanica is a dietary supplement ingredient present in several types of dietary supplements, including weight loss, respiratory relief, and immune regulating products. Due to its reported wide range of uses in folk medicine, it was hypothesized that it may have the potential to target multiple organs and lead to a range of toxicity features. As a preliminary evaluation of the safety of this herbal ingredient, an investigation into its effects on the kidney was sought. An in vitro study of its potential nephrotoxicity using the HK-2 human proximal tubule cell line in a variety of functional indicators was performed to capture both general forms of cellular toxicity as well as ones that are specific to proximal tubules. A. zeylanica was only capable of inducing detrimental short-term toxicity to HK-2 cells at relatively high treatment concentrations when exposed directly to the cells. The lack of acute and potent toxicity of A. zeylanica under our experimental conditions calls for further studies to better define its toxicant threshold and establish safe dosage levels.

Traditional Chinese Medicine Decreases the Stroke Risk of Systemic Corticosteroid Treatment in Dermatitis: A Nationwide Population-Based Study

Epidemiological studies have shown a strong association between dermatitis and stroke. Systemic corticosteroid, the mainstay treatment for dermatitis, could enhance the atherosclerotic process. Traditional Chinese Medicine (TCM) has been used for dermatitis to decrease the side effects of corticosteroid. However, the different stroke risk in dermatitis patients treated with systemic corticosteroid or TCM remains unclear. This study identified 235,220 dermatitis patients and same comorbidity matched subjects between 2000 and 2009 from database of NHRI in Taiwan. The two cohorts were followed until December 31, 2011. The primary outcome of interest was new diagnosis of stroke. The crude hazard ratio (HR) for future stroke among dermatitis patients treated with systemic corticosteroid was 1.40 (95% CI, 1.34–1.45; P < 0.0001) and TCM was 1.09 (95% CI, 1.05–1.13; P < 0.0001). The log-rank test showed a higher cumulative incidence of ischemic stroke in the patient treated with only systemic corticosteroid group than that treated with systemic corticosteroid and TCM, only TCM, and neither systemic corticosteroid nor TCM in the matched cohort during the follow-up period (P < 0.0001). We demonstrated that patients treated with systemic corticosteroid had an increased risk of stroke and that the risk probably decreased by TCM treatment.