Botanical Interventions for Toxicities and Negative Effects

George M. Carter

DRAFT COPY

NOTES REGARDING BOTANICALS:

The properties of botanical medicines have been studied for hundreds, sometimes thousands of years, so even if there is little scientific research on an "herb", there is likely to be much traditional knowledge about it. Traditional knowledge often as a great deal of validity, however the practices of the past are not an absolute guarantee of success. Also, whether some of these interventions are suitable or effective with conditions related to antiviral toxicities has, for the most part, not been evaluated.

Over the past century, a great deal more has been learned about the chemistry of many botanical interventions. When used appropriately, herbs can have powerful healing properties, but just because something is natural, that doesn’t mean it’s necessarily non-toxic. ALWAYS read the recommended dosages and suggestions for use! If possible, consult an herbalist, licensed acupuncturist or naturopathic practitioner.

The practice of using plants to treat illness is a branch of medicine called phytomedicine or phytotherapy. The root word "phyto-" is derived from the Greek word phyton for plants or that which grows. Many botanical medicines have been studied to find out what makes them work and about 25% of modern-day drugs owe their existence to these botanicals. Very often, these synthetic drugs may be more powerful and often more effective than their herbal ancestor; for example, digitalis is probably a better bet for managing heart problems than using foxglove. However, there are other times when the herb may work as well or better, although sometimes it may be a slower process (e.g., salicin compounds found in willow bark; see the section on Pain).

The chemicals that can make up an herb come in different families that include things like flavonoids, alkaloids, mucopolysaccharides, sterodal compounds, vitamins, minerals, polyphenols, glucans, glycosides, saponins, anthocyanidins and others. Sometimes it may be the balance of these many chemicals that can exert their effects rather than just one particular extracted drug. But because plants are made up of chemicals, some may carry risks of toxicity.

There are three basic ways in which herbs can cause problems: 1) Some herbs can be toxic, and are meant to be used only in very small quantities, for a brief time, or highly diluted; 2) Some herbs may interact badly with drug medications; 3) The person using it may be allergic to the herb, or to some chemical used in its growing or manufacturing process. That's why it is important in many cases to discuss the use of plant medicines with your physician and other healthcare providers.

Please also note that almost any herb or food may cause rare allergic reactions in some people. Even though allergic reactions are rare, they can also be very severe. Add new herbs carefully—preferably with the oversight of a healthcare provider—and watch in particular for any rashes, headaches, or shortness of breath. Forewarned is forearmed!

Botanicals can be used in a variety of forms and may be taken internally or applied externaly. Externally, one can use compresses, salves and poultices as well as in baths or in feet soaks. Botanicals can be taken internally when taken as teas, powdered, extracts, and capsules or pills. Plant products may come as tinctures of volatile oils (sometimes in an alcohol-base if that is an issue for you). Except for a few RARE exceptions, the pure oils must be used with great care, whether used externally or internally. If used incorrectly, the consequences can range from mild discomfort to killing you (for example, swallowing a concentrated oil that is meant to be used externally). Many oils can be used externally; always test them first on a little patch of skin to make sure you don't have an allergic reaction (like a rash). They may be used in ointments, massage oils, inhaled in steams or as suppositories.

Infusing herbs means steeping them in hot (not boiling) water for 5-10 minutes. Harder parts of the plant like the root may be boiled for a time in water; this is called a decoction. Make sure you know the source of any raw botanicals is reliable and they have been picked accurately and tested, if possible. For stronger tea, use more herb rather than steeping for a longer time, as a general rule. Some plants that have a lot of mucilage may be macerated in cold water. Mucilage is a thick liquid, sometimes containing gum, that is often used to soothe inflamed tissues. If using whole or cut/sifted herbs, consult an herbalist, licensed acupuncturist or naturopath for the best and most appropriate use.

Anemia

Clearly, anemia is a case of needing an accurate diagnosis as there are many underlying conditions that can cause a variety of types of anemia. Generally speaking, red blood cells may be lost through bleeding (from trauma, hemmorhoids, intestinal problems, etc.), from increased destruction or from a failure of the body to produce enough. Nutrient interventions may include iron (if serum ferritin is low), zinc, B complex (not just B12 but thaimin and riboflavin as well) and folic acid. Be sure you are not suffering from a low stomach acid content (hypochlorhydria). The botanicals listed below may be helpful for mild cases or as adjunctive therapy to nutritional therapy and/or use of drugs such as erythropoietin.

Alfalfa (Medicago sativa, L.) - is high in chlorophyll, minerals and other nutrients, vitamin K, phytoestrogens, falvonoids, etc. Tincture, tea (leaves, petals, flowers—steep 5 minutes), or whole, tasty sprouts may be used. It alkalizes and detoxifies the body, especially the liver; also has antifungal properties. It has been used for a variety of problems including colon disorders, anemia, hemorrhaging, diabetes, ulcers, and arthritis. Do not use long term if pregnant. This warning is speculative based on high-dose effect on uterine contraction in animal studies. High vitamin K content may result in interference with blood thinning medication. Avoid if you have a diagnosis of lupus erythematosus. Used before a meal, it can assist in digestion by aiding gastric secretions. During or after a meal, it may promote nutrient absorption; others suggest it may be taken throughout pregnancy.

Chinese herbs - Certain herbs such as white peony and rehmannia root have a tradition of treating what the west diagnoses as anemia; some benefit has been shown that corroborate this in animal studies. Please consult a professional. Consider also the Marrow Plus product, discussed under White Blood Cells.

Gentian - This is the "bitter" against which all others are measured. It may help stimulate gastric secretions when taken about half an hour before meals which may improve absorption of nutrients needed to offset anemia. See Gas/Bloating.

Greens - Particularly dandelion root, beet greens and nettles may be helpful in offsetting anemia. Partially, this may be due to their higher content of iron. Other higher-iron content greens include lamb's quarters and yellow dock. Watercress eaten in tasty salads may also be nutritionally helpful. Yellow dock may be helpful because it also contains a lower level of calcium. Calcium can block iron uptake which is why diets high in milk, cheese or other calcium may worsen iron-deficiency anemia, as can a strict vegetarian diet that relies heavily on soy products as a dairy/meat replacement and also eschews (avoids) red meat or chicken. (High calcium intake may also result in zinc or magnesium deficiency.) Check your serum ferritin levels if you are suffering from fatigue, pale tongue, skin, fingernail beds.

Nettle (Urtica dioica) - The herb (leaves) or seeds may be used. It may have a variety of benefits, including for liver function, endocrine function (such as deficiencies in adrenocortical, thyroid or gonadal function), chronic, degenerative disorders, and heavy metal detoxification. The herb part is used more for its decongestant properties, as well as for benign prostate hyerplasia (enlarged prostate gland). The seeds have traditional use for underactive thyroid or as an immune stimulant against insect bites or poisonous plant ingestion. See the sections on Hypoglycemia, Diuretics, Sexual Dysfunction and Thyroid.

Appetite Loss

Bitters: With certain plants, their bitter quality is key to their appetite-stimulating action. Some debate has erupted over the years as to whether and how they do this, but the bulk of the data suggest that they do indeed stimulate both production of saliva and gastric juices (in the stomach). Bitters include bitter orange, bogbean, dandelion, devil's claw, gentian, hops, horehound and yarrow. Gentian is probably the strongest. It may be that their best effect is achieved when taken by mouth in a drink form (like a tea). Do not use if you have an ulcer or other conditions (like reflux) of excess acid. However, some bitters may actually help with esophageal reflux disorders as they can help improve the tone of the doorway (sphincter) that separates the esophagus (the tube on the way down from swallowing) and the stomach; but this should only be done under careful supervision. Some data suggest that capsules can help too, but the dosage is higher (e.g., 300-600 mg of gentian root right before a meal).

Alfalfa - May stimulate appetite; see the discussion under Anemia.

Angelica (Angelica archangelica, not Angelica polymorpha/dong quai) - Only the root has value as an appetite stimulant, also relieving gas, stomach cramps, bloating. May cause sunburn or severe rash; not for long-term use. 1 tsp of powdered root per cup of water, simmered for 2 minutes and taken 1-2 times per day.

Aromatherapy - Essential oils of basil, coriander, fennel, lemon may help stimulate appetite.

Bay, sweet - Bay leaf infusion may stimulate appetite and prevent gas; avoid if pregnant. Infuse 1-2 tsp of crushed leaves per cup of water; take up to 3 times per day. Or add 1-2 drops of oil to tea or honey.

Bee pollen - German health authorities approve bee pollen as an appetite stimulant. Do not use if you have hay fever or other pollen allergies. Three 500 mg capsules three times per day is a typical suggested dose. Start with a lower dose and guard against rare but potentially dangerous allergic responses.

Marijuana (Cannabis sativa) - For many, this is a powerful appetite stimulant, but marijuana is illegal, even for such medicinal uses. Many states have had referenda to make medicinal marijuana an option, and even despite overwhelming support, the federal government has foolishly superceded these efforts. As needed.

OTHER HERBS

Other important appetite-stimulating herbs include cinnamon and cassia, coriander, fenugreek, Iceland moss and rosemary.

BLOOD SUGAR PROBLEMS

Problems with the way the body handles dietary glucose can affect anyone. Two forms are recognized. Type I diabetes is usually more severe and requires insulin to be managed. Type II is more prevalent in older adults. Some people develop glucose tolerance problems when taking ARV, and the risk profile appears to parallel the same folks who are HIV negative. That is, more often than not, those who are overweight (or obese) and approaching middle age. This condition must be carefully evaluated by your physician and treatment carefully evaluated. ONLY consider using the following described botanicals with the full knowledge of your primary care physician. It may be that adjustments to your insulin dosage (should insulin be prescribed) may be necessary.

Some botanicals have had a long history of use in gently regulating blood sugar levels. These include Asian ginseng (Panax ginseng and Panax quinquefolius), fenugreek (Trigonella foenum-graecum), gymnema (Gymnema sylvestre), bitter melon (Momordica charantia) and aloe (Aloe vera).

Diet and the glycemic index

Certain foods have greater ability to increase the level of blood sugar. Foods are rated by comparing the effect they have on blood sugar levels using as a baseline the amount of glucose in a slice of white bread, set at 100. For example: instant rice (boiled for six minutes) has a GI of 128; canned soy beans have a GI of 20. The lower the glycemic index number, the less the effect on blood sugar. So one way to address this issue is to eat foods that have a lower glycemic index. Eating more frequent, small meals that contain foods low on the glycemic index is a way to lower the glycemic response. Having a good balance of (good) fats, protein and a lower carbohydrate diet can help. A 10-year study of a large cohort of women aged 38-63 showed that the more simple sugars they consumed, the higher the likelihood of having coronary heart disease. And of course, all of this works MUCH better with exercise.

Increases in Insulin Resistance

Bitter melon (Momordica charantia) - Dr. Qincai Zhang notes that bitter melon has insulin-like activity, helps stimulate insulin production and prolongs insulin effects without inducing hypoglycemia. If taking insulin, the dose may need to be lowered. Bitter melon may have an additive effect with chlorpropamide (one case report); studies also show effect on reducing serum glucose and improving glucose tolerance test. Dose is usually 5 tablets twice per day.

Chinese herbs - various herbs have been used in traditional Chinese medicine to treat diabetes, including Rhus chinensis, Sanguisorba officinale, Myrica rubra, Allanthus altissima, Psidium guajava and Hibiscus syriacus. Please discuss this approach with a qualified practitioner of Chinese medicine, and, if possible, one experienced in HIV disease.

Fenugreek (Trigonella foenum-graecum) - Something like 50-100 grams of defatted seeds may help with reducing glucose and improve insulin sensitivity. This may have the concurrent benefit of reducing problems associated with a fatty liver (steatosis). (Naturally, one should adopt other strategies to address a fatty liver, including, where appropriate, weight reduction if obese, eating many small meals and improving one's overall diet).

Milk thistle/silymarin (Silybum marianum) - known for its ability to sustain liver function, it also has been shown to be useful in improving insulin sensitivity; 600 mg/day has also been investigated. See DAAIR Treatment Information Sheet, Silymarin. One test tube study raised concerns regarding the effect of milk thistle in possibly elevating plasma level of some drugs. These include any that interact with cytochrome P450 3A4--in short, similar to those ritonavir interferes with. According to a presentation by Steve Piscitelli, no effect was seen on protease inhibitor drugs, with the exception of a small increase in plasma levels. Given how poorly protease inhibitors are absorbed, this may be an advantage. The suggested dose is 3-6 capsules per day.

HYPOGLYCEMIA (low blood sugar)

Fiber - Eat more foods with fiber like whole apples, broccoli, raw spinach, squash, string beans, brown rice, lentils, apricots, avocados, lemons and bananas. Honey is a better sweet to use than sugar. Stevia is a better substitute to use than other "sugar alternatives." Eat a bunch of ice cream to offset hypoglycemia--it'll work; but then you'll crash when the carb rush wears off.

Herbs - Other herbs that have shown some modest effect on increasing glucose (hyperglycemic effects include Cocoa bean (Theobroma cacao), Nettle (Urtica dioica) and Rosemary (Rosmarinus officinalis).

HYPERGLYCEMIA

Aloe vera - One study showed an effect on reducing blood sugar (so do not use if you are taking a drug like glyburide). Another form, "drug aloe" or aloe latex derived from the rind, acts as a laxative. Juice: 1 tablespoon up to 3 times per day.

Bitter melon (Momordica charantia, L.) -See Increases in Insulin Resistance above. Various data show benefits for reducing blood sugar levels.

Fenugreek (Trigonella foenum-graecum) - See section on Insulin Resistance above.

Ginseng, American (Panax quinquefolius) - A small study using a 3-gram dose investigated the effects on 10 normal subjects and nine with type II diabetes. Given 40 minutes before a meal with a fair amount of glucose, the usual rise in blood sugar level was prevented in both groups. This was also seen to be true when the ginseng was given with the meal--at least among diabetic subjects; interestingly, no such effect was observe among non-diabetic subjects.

Ginseng, Panax - used in traditional Chinese medicine as a treatment for diabetes. Probably better to avoid use with estrogens or corticosteroids. May raise corticosterone levels. One animal study, where diabetes was artificially induced, resulted in improvement in Type I diabetes. Its value may be as an anti-diuretic (prevents excessive urination); however, watch your potassium level. Huang reports it can used to lower blood sugar levels in mild hyperglycemia to 40-50 mg/dl after 2 weeks' continuous use (but we're not clear how to translate that mg/dl into a mg dosage of capsules). The root may be sliced for chewing; a decoction in wine to form a 3% or 10% tincture is common; often used in soups. 10% 2 ml ampules are sometimes used by injection. Available in capsules.

Glycyrrhizin/ licorice (Glycyrrhiza glabra) - to support adrenal function. Avoid if you have high blood pressure. Do not use for more than 4-6 weeks at a time. Carefully watch blood level of potassium! Use with insulin may hasten potassium loss. Eat more bananas, potatoes and carrots as they have more potassium than are allowed in supplements (which is a maximum of 99 mg). Maximum 40-200 mg/day of GL.

Gymnema (Gymnema sylvestre) - Used in the Indian Ayurvedic tradition to lower blood sugar, there have been numerous test tube and animal studies along with a few human studies. Gymnemic acid is one of the active constituents but is just one of at least 9 other similar acidic glycosides. It appears to work by stimulating insulin production (like sulfonylurea drugs). Rat studies showed it worked as well as the drug tolbutamide. While overdosing could be dangerous, proper use does not appear to be associated with toxicity.

Milk thistle (Silybum marianum) - known for its ability to sustain liver function, it also has been shown to be useful in improving insulin sensitivity. Contains silymarin. See DAAIR Treatment Information Sheet. See Insulin Resistance above.

Rosavin (Rhodiola rosea) - may be helpful as an adaptogenic herb that, with exercise, may help to reduce fat weight. One mouse/rat study showed that those with diabetes induced by alloxan had a significant reduction in glucose and increased glycogen production in the liver when given a Rhodiola extract. The relevance to humans, let alone those with ARV-related problems is unknown.

Stevia (Stevia rebaudiana) - This is a relatively newly available sweetener in the United States that some people are turning to instead of saccharin or aspartame/Equal-type products. It's been used for years in Paraguay, Brazil and other locales as a sweetener. Politically, saccharine and other sweetener manufacturers dislike this hitherto cheaper alternative. Part of managing diabetes, of course, is watching sugar intake; this provides a safe and sweet substitute.

Bone Loss/Osteopenia, Osteoporosis, Osteonecrosis, Avascular Necrosis

Exercise - Again with the exercise. Is there a pattern here? Anyway, the less you move around and get exercise, the more calcium loss is likely, the more deterioration of the bones. And exercise is important for maintaining strong bones. "Shake, rattle and roll dem bones" — and we don't mean in Atlantic City! But don't neglect your minerals since exercise seems to increase the excretion of minerals like magnesium and zinc.

Minerals - Calcium, boron, magnesium are all important, as well as manganese, zinc, copper and silicon. While, these can be found in supplements, diet plays a major role in how much of these minerals you get. Some botanicals have higher contents of different minerals. Also, if you are a vegetarian, you may not get as much of some minerals as your body might need. Timing is also critical. Taking calcium is good, but too much over the course of a day will not be helpful as it can wipe out your body's ability to absorb needed magnesium, iron and zinc.

Botanicals - Basically, this consists of getting enough of the minerals you need from foods. Oranges can provide lots of calcium; green leafy vegetables have many important minerals; bananas and potatoes have plenty of potassium. Otherwise, there aren't a lot of specific botanical supplements that might help much more than diet and exercise.

BODY DISTORTION

Fat accumulation/buffalo hump/lipoma

Botanicals? - Unfortunately, it is not yet clear what causes the central adiposity (belly), enlarged breasts, dorsocervical fat pads (buffalo humps) or other distortions. Some combination of effects such as the influence of HIV disease itself, intesinal permeability, liver dysfunction, and mitochondrial toxicity may work in tandem, with a healthy helping from various antiretrovirals, to create the conditions that foster and accelerate the development of this syndrome. As such, it's not clear what botanicals might help to manage this build up of fat around the organs (central adiposity).

Indeed, to the contrary, some "weight reducing" herbs that have been (often) misused may only make things worse. Use of compounds containing ephedra or caffeine probably won't help and may indeed hurt. More on this in the future.

Fat depletion

Botanicals - None we're aware of at this time. Use of some adaptogens like Siberian "ginseng" (Eleuthero senticosus) and Rhodiola rosea may provide some body support theoretically. Some older Soviet data suggest that Rhodiola my enhance ATP production (a function of the mitochondria). Whether this would work in people with mitochondria lost due to the use of antiretrovirals is unknown.

Cardiac Concerns

The following list of botanicals may be helpful in various ways for assuring good heart health. Much of the time, we think of the increasing amount of LDL-cholesterol and triglycerides as being the big threat to heart health--as well we should! However, there is more to a good functioning heart than just keeping the veins and arteries clear, such as keeping muscle tissue healthy and sustaining a steady rhythm. See also Varicose Veins and Vasculature.

Astragalus (Astragalus membranaceus) - Research studies in humans suggest a value as an antioxidant, and specifically for reducing angina pain, improving heart function (particularly left ventricular function) and EKG readings. Avoid taking with immune-suppressive drugs such as methotrexate, azathioprine and cyclosporine. 1-4 grams of dried root, 3-4 times/day.

Butcher’s broom (Ruscus aculeatus) - Various alkaloid chemicals, such as sparteine, may cause its heart effects, including correcting abnormally low blood pressure. It also relieves inflammation. Also good for kidney and bladder; can act as a diuretic. Use under healthcare provider supervision only: FDA says it’s too toxic, but the Germans say it's safe only used as directed. Warnings include to avoid it if you have high blood pressure, if using MAO inhibitors, if pregnant or if you have absolute arrhythmia.

Ginseng (Tienchi, Panax notoginseng) - Contains 7-10.8% crude saponins (found in other forms of ginseng) which can lower blood pressure and in animal studies has been shown to protect against heart injury and improve heart rhythm. Helps to stop bleeding and increases blood coagulating. Side effects of excessive use may include nausea, vomiting, dry mouth, flushed skin, nervousness, insomnia. 1-3 grams of powdered root used daily, upon rising.

Hawthorn berries (Crataegus oxyacantha) - The leaves and blossoms are also used. Hawthorn has been intensively studied; can help the heart in numerous ways, including dilating blood vessels (like gingko; this helps assure that heart tissue is well-perfused with blood and limbs have good blood supply), restoring heart muscle wall, lower blood pressure and lowering cholesterol. Its action is probably due to oligomeric proanthocyanidins (also found in grape seed extract). Don't take with other heart meds. At least not without physician oversight; German studies show it enhances effects of cardiac glycosides, (like digitalis) and thus may reduce the toxic effects of those drugs. May help with heart arrhythmia; best for milder conditions/preventive. One rat study suggested some benefit on lowering LDL, helping to corroborate anecdotal evidence. Don't overdose. "The dosage for hwathorn extracts standardized to contain 1.8% vitexin-4-rhamnoside or 10% procyaniins is 120-240 mg three times aily; for extracts standardized to contain 18% procyanidolic oligomers, the dosage is 240 to 480 mg per day."

Skullcap (Scutellaria lateriflora) - Two species exist, but Scutellaria baicalensis is commonly used (and may have anti-HIV properties). Improves circulation and strengthens the heart muscle. Traditionally used for nervous disorders, hysteria; relieves pain, stress, muscle cramps and spasms.

High LDL cholesterol

Intervention

Dose

Inositol hexaniacinate

800 mg 3-4 times per day

Guggul lipids (guggulins)

2 capsules 2-3 times per day

Carnitine

3-5 grams per day

Pantethine 20% powder

5 grams of powder = 1 gram pantethine

Garlic

Use fresh cloves

Curcumin

1-3 grams per day

Omega 3 fatty acids

1,200 mg three times per day

Fiber

2-3 grams per day, usually in the form of psyllium

Note: Garlic and curcumin may be problematic for those on blood thinning drugs or with low platelets.

Diet and Dietary Interventions

Almond, sweet (Amygdalus communis, L. var. dulcis) - substituting the "good" fats found in almonds (as well as olives, deep sea fish) may help lower "bad" cholesterol (LDL, VLDL). As a laxative, usually 30 milliliters (about an ounce).

Barley (Hordeum distichon, L.) - Barley bran as a high fiber food is helpful in an overall program to reduce cholesterol. Beta-glucan fibers in it may also help. Consume in cereals, breads and soups, if possible; or follow label instructions.

Charcoal, activated – Can work pretty well. One study over 4 weeks in 7 people saw 41% reduction in LDL, using 8 g three times a day, while HDL increased. This is substantial, considering statin drugs usually only drop LDL around 25%. Large doses will interfere with absorption of other nutrients from both food and supplements as well as drugs, so take large doses on an empty stomach. For digestive problems, take half a gram at onset, using 0.5-1.0 gram every two hours; do not exceed 25 g per day.

Fiber - a scoop a day of your favorite brand, and/or eat oat bran, bran muffins, etc. There are five types of fiber (cellulose in bran; hemicellulose in unrefined cereals; lignins in the woody part of vegetables; pectin in fruits and the gums found in dried beans and oats). Some are water-soluble (oat bran, psyllium, soy; pectins, gums, mucilages); others aren't (cereals; cellulose, hemicellulose). Some are not digestible (celluclose and lignins) and others are (hemicellulose, pectins and gums). Cellulose and hemicellulose (found in unrefined cereals, bran, some fruits and vegetables, whole wheat) can have a good effect both on stool bulk and some also can help to lower cholesterol (those found in lignins, pectins and gums). Oats, for example, contain digestible, water-soluble and mucilaginous gums, for examples, that can affect how fast the stomach empties out food, sugar uptake and cholesterol levels in serum. However, oats contain gluten which people with celiac disease must avoid. Psyllium is found commonly in products like Sonne and Metamucil and may also help. Try to avoid using them at the same time as your other vitamins/herbs or with drugs (particularly indinavir/Crixivan) as they may interfere with absorption. Don't take too much or for too long! Psyllium has laxative action, so take extra fluids. Do not use if you are diabetic or have an intestinal tract blockage. Fiber may impair the absorption of drugs; take an hour after HIV meds, perhaps in the evening before bed. Take about 3-4 grams/day. Be sure to drink enough water or other healthful fluids (not sugar-laden, crappy soft drinks).

Salvia (Salvia miltiorrhiza) - Some promising results in heart ailments, such as counteracting artery stenosis (narrowing) and improving circulation, possibly due to substances called tanshinones. Chinese studies suggest a value in treating lupus and stroke (cerebral infarction) as well as for treating liver damage. Don't take with warfarin (coumadin). 6-15 grams of dried root.

Yogurt - daily use may help lower cholesterol levels. Can be part of a diet-improving program. Make your own! Some people find that this is the best way to get adequate amounts and it's much less expensive.

Botanicals

Curcumin (Curcuma longa) - Some of the problems with cholesterol develop when it is oxidized. Curcumin may help not so much to lower LDL levels as to act as an antioxidant. May also have modest effects against HIV itself. It acts as a choleretic (stimulating bile production which helps digestion), reducing the liver's synthesis of cholesterol. This is well-documented according to the German Commission E. One study used 500 mg to achieve substantial reduction of lipid peroxides (33%) with a 29% increase in "good" HDL cholesterol and overall 11% decrease in total cholesterol. Please keep an eye on your platelet count as we have one report at DAAIR of decreased platelets. Anywhere from 300 (3 pills per day) to 500 mg per day.

Garlic (Allium sativum) - Data are somewhat mixed. Best results may be with 15% allicin (Tai He); studies have shown a drop of 5-10% for LDL cholesterol and decline in triglyceride numbers ranging from 10-20%. Other studies indicate HDL rises with use. By contrast, a study that used 300 mg three times per day of Kwai garlic powder over 12 weeks found no benefit in LDL, HDL or other parameters. There are many chemicals in garlic that are thought to confer its benefits; allicin, alliin and S-allylcysteine quantities should be marked on the bottle. One dose should contain the equivalent of 1-2 cloves of fresh garlic (4,000 mg) including a minimum of 10,000 mcg of alliin or 4,000 mcg of allicin. Alliin is converted to allicin in the body and has the advantage of not causing the odor problems. Aged garlic may be taken at 10-20 g/day; but it may not have much alliin or allicin. Consider four Garlicin Pro or 20-40 PGF500 per day (which is equivalent to Kyolic's aged garlic) or try 2 ampules allicin from Tai He's Dr. Qincai Zhang. You might also use the equivalent of 1.5 cloves (or 2.5 mg of allicin) per day; use fresh garlic fast as oils don't keep long. The German Commission E only approves fresh, raw garlic since they note that aged forms do not have sufficient levels of the beneficial compounds. While a couple of anecdotal reports noted in Project Inform Perspective #30 suggest that use of garlic may increase ritonavir (Norvir) levels, a study found no such adverse effect on the blood level of ritonavir (Norvir). Also, avoid excessive garlic intake or supplementation if using a protease inhibitor, particularly saquinavir (Invirase or Fortovase).

Guggul lipids (Commiphora mukul) –Should be standardized to 5% guggulsterone content (the product DAAIR carries is below 5%: 3.5% guggulsterones). It is also known as gum guggulu and has been used to treat allergies and to reduce VLDL and LDL cholesterol and triglycerides. In 40 people administered 4.5 grams in two divided doses over a 16-week period, such reductions in lipid profiles were noted. (That's 9 tablets per day.) It may be helpful for blood lipid problems related to lipodystrophy. It also may stimulate thyroid activity. Do not use if pregnant (may induce menstruation or abortion).

Psyllium (Plantago ovata) - There's blonde seed and black seed forms. Take extra fluids. Don't take at the same time as your vitamins or other drugs since this may wipe out absorption. Do not use if you are diabetic or have an intestinal tract blockage. See discussion in Fiber above. Need about 3.4 grams/day.

Rhubarbine and cordyceps - Dr. Qincai Zhang suggests Rhubarbine (6 tablets/day) and cordyceps (9 capsules/day). With long-term use, Rheum officinale (rhubarb root) may, like corticosteroids, licorice and thiazide diuretics, result in a loss of potassium; may also reduce aborption of orally administered drugs.

Tea, green (Camilla sinensis) - minor effects only, but switch to this instead of coffee. Or use green tea polyphenols. Drink 1-2 cups (1 cup has 20-30 mg of polyphenols) per day instead of colas/coffee, etc. However, one would need up to 9 cups per day to have small impact on cholesterol (no effect on HDL or triglycerides). So just consider this as part of an overall strategy, using green tea as a beverage of choice over coffee or soft drinks whenever possible.

Essential Fatty Acids

Lecithin - Phosphatidylcholine, a major component of lecithin, is widely used in Europe for the treatment of liver disease and elevated cholesterol levels. With high cholesterol, one suggested mechanism is that it helps the transport of cholesterol to the liver where it can be broken down. In the United States, phosphatidylcholine is regarded as a food supplement because no therapeutic claims are made by manufacturers. May need up to 20 grams/day of lecithin to treat cholesterol but as part of complete program, it may work as well; also good for the liver and for mental function/memory. 5-10 grams of 20% phosphatidylcholine (DAAIR's Triple Lecithin from NOW is 35%/1000mg).

Evening primrose oil (Oenothera biennis, Linn.) - One study achieved a 31.5% reduction in serum cholesterol in 179 people who used it for 3 months. This is not inexpensive! Up to 1-2 grams (that is, 1,000-2,000 mg) of GLA (the NOW Foods' Super EPA contains 135 mg of GLA) may be needed for inflammatory/cardiac disorders (which would be 10-15 capsules per day). Probably won't hurt as part of a regimen but not really realistic on its own due to the cost.

Omega-3 fatty acids - These are important as a source of good fats in the diet, rather than saturated or trans-fatty acids. Eat more deep sea fish (e.g., tuna, mackerel, sardines)—consuming such meals 3 times per week is recommended. If not, consider taking a high quality fish oil supplement or other supplement with omega-3 fatty acids. However, cholesterol lowering effects only seem to occur at high doses. Use as directed. Fish oil supplements, for example, usually 1-2 softgels of MAX DHA, which contains 500 mg of fish oil. Suggest 1-2 capsules with each meal. Take with vitamin E. Remember: If you are taking Agenerase, it is not advisable to take extra vitamin E (beyond that in your multivitamin).

Other interventions that may help include acidophilus, alfalfa, artichoke and dandelion root.

Low HDL

Various studies of things like activated charcoal (use with care), garlic, curcumin, and inositol hexaniacinate have shown benefit in not only reducing the "bad" LDL cholesterol, but also in improving "good" HDL counts. Guggul lipids, green tea, carnitine and niacin may all be helpful in lowering triglycerides. It might be a good idea to figure out what your budget can cover, start with a modest regimen (increasing dosages slowly) and follow your blood work. Don't forget that while activated charcoal can be very effective, it will also clear out your medications if you take it at the same time. So, while this is a powerful intervention, it has to be used with care and attention to scheduling your meds; consider it only if your cholesterol is really through the roof.

High triglycerides

Carnitine is probably the best bet as it can be prescribed as Carnitor. Other botanicals can act as helpful and healthful adjunctive therapy.

Essential fatty acids - Intake of the good fats that the body needs is important. This includes omega-3 fattty acids fund in deep sea fish, flax and hemp seed oil. Omega-6 fatty acids, found in evening primrose oil is also important. Evening primrose oil is particularly useful, 2 capsules 3 times daily; and/or linseed oil, 1,000 mg in capsules or in liquid form; consider 3-9 capsules of Essential Balance per day.

Garlic (Allium sativum) - Data are somewhat mixed. Best results is with 15% Allicin (Tai He); studies have shown a drop of 5-10% for LDL cholesterol and decline in triglyceride numbers ranging from 10-20%. Another study saw HDL rise. See the entry on LDL Cholesterol above.

Wild yam (Dioscorea bulbifera, L.) - Can act as an antioxidant; one study showed benefit in lowering triglycerides and increasing "good" cholesterol (HDL). Also, has effects in lowering blood sugar in a rabbit model. There are different species that have different effects (such as D. villosa, D. dumetorum and D. mexicana). About a gram of root in capsules or 2-4 ml of liquid extract is commonly used.

Constipation

Fiber - See the section under diarrhea. The aloe plant's leaves are sometimes use to provide relief from constipation. Also cascara sagrada, psyllium.

Depression, Stress Management

Clearly, there are many causes and types of depression. The DSM-IV "bible of psychological disorders" lists three major varieties. These include depressive disorders, bipolar disorders ("manic-depressive") and disorders based on etiology (like those caused by substances you consume, diseases, etc.) The first category, depressive disorders, can be further broken down into major depressive disorder, dysthymic disorder and "other." Dysthymic disorders are diagnosed in people who have had more depressed days than not over the past two years and have additional symptoms that do not permit a classification as a major depressive episode. [LARK/FRED: SAMe caveats re bipolar.]

If you are suffering from severe depression, some of these botanicals may have some small benefit, but you should seek more rigorous help. Unfortunately, even many mainstream medications may have limited benefit against some of the more profound forms of depression. Utilizing a range of stress management strategies is likely to be more effective than relying on any one herb! Try meditation, massage, carrying for a pet or plants and other approaches as well.

Many botanicals can operate on more than one mechanism. Some can help an underactive thyroid (see Gotu Kola discussion below). Others may work by improving blood flow to the brain (e.g., ginger, gingko). Botanicals may be prescribed based on whether there are signs such as nervousness or anxiety (e.g., kava kava, scullcap, valerian). They may often be blended, depending on your situation. Still others, like St. John's wort, may operate on different neurological pathways, such as serotonin-reuptake inhibition or MAO inhibitors. A consultation with an appropriately trained naturopath may help you to identify the best program for depression management.

Black Cohosh (Cimicifuga racemosa) - Roots and rhizomes (underground stems) are generally used. The general use is for women undergoing menopause; can be used for painful or delayed menstruation (see Menstrual problems). Do not take in high doses or if pregnant. Reduces spasms and may help relax a person (nervine action). It's traditional use is for those with a dark, brooding hopelessness; three case reports of women using 30 drops of a homeopathic tincture suggest dramatic improvement. Of course, more clinical studies will be helpful in establishing the truth of these observations.

Chamomile (Matricaria chamomilla) - A nice cup of tea will provide your body with some soothing compounds called apigenins which may help to alleviate stress and mild depression. (For a little extra, throw in a teaspoon of catnip to steep per cup of tea.) Chamomile tea may be given to kids as well; may help to manage colicky conditions byrelaxing the gutt wall. May help to offsetorreduce histamine-induced reacions (as found in allergy, hay fever, etc.).

Gingko (Gingko biloba) - opens blood vessels and can help cognitive (thinking) function. Can help for various arterial disorders, in addition to depression. Std. extract of 24% gingko flavone glycosides and 6% terpenes. 60 mg three times per day with meals of caps standardized to 24% gingko flavone glycosides and 6% terpenes.

Gotu Kola (Centella asiatica) - Don't use if you're hyperthyroid, but if your depression arises from a reduced thyroid output, this "Indian ginseng" may well help. Other herbs that may help due to diminished thyroid output include bladderwrack, damiana, nettle, oats and wormwood.

Kava kava (Piper methysticum) - A South Pacific plant that, unfortunately, has generated several recent reports of liver problems arising from some users. Is this due to a problem in the processing of the herb? It is not yet known. May help to relax and individual and has been used for urinary tract infections. Some serious concerns about liver toxicities have been raised about widely available formulae in the U.S. 1-4 grams (1-1.5 teaspoons) of rhizome decocted in a 1 cup of water three times a day.

Melatonin - this hormone is important for regulating the circadian rhythm; studies suggest it can indeed help with insomnia using anywhere from 1 to 3 mg at night (before sleeping). It may also have value as an antioxidant. Consider use with lavender (Lavandula officinalis). Use as directed.

Passion flower (Passiflora incarnata) - Used by Northeastern North American autochthons (I'm just seeing if you're reading this), it is used for a variety of health problems (including earaches, boils and inflammation). Excessive doses may be toxic. Europeans use it for its mildly sedative and analgesic qualities; it may also lower blood pressure. Effective dosage is a half teaspoon (1 gram) of dried leaves infused in a cup of water three times a day; can make a stronger tea at night.

Rosemary (Rosemarinus officinalis) - This is one that has traditional use only to support its use as an antidepressant. It may also help to alleviate flatulent dyspepsia, headache and nervous tension. It can be used with scullcap and oats. Use 2-4 teaspoons of dried herbs infused in 1 cup of water; use over a period of three weeks.

Skullcap (Scutellaria lateriflora) - The aerial parts of this plant have long been used to act as a nervine tonic (to relax nerves), sedative and to ease muscle spasms (an antispasmodic). It can also help to manage seizures, ease premenstrual tension and for those in an exhausted, debilitated or depressed condition. Often used with valerian, passion flower or black cohosh. It also is a vasodilator so caution is probably advised if you are taking blood thinners like coumadin. Used for insomnia and anxiety as well. Effective dosages are 2-4 teaspoons (4-8 grams) infused in a cup of water three times a day.

St. John's wort (Hypericum perforatum) - Very well-studied and proven for mild to moderate depression; make sure it is a standardized extract of 0.3% hypericin. However, it appears that hypercin is, at least on its own, not the element that confers the anti-depressant activity, but rather a substance known as hyperforat. Jarsin 300 is a German, pharmaceutical-grade product which was included in controlled studies of mild-to-moderate depression and mood stabilization and showed significant benefit, even when compared with antidepressant drugs like sertraline (Zoloft), amitriptyline (Elavil), diazepam (Valium), imipramine (the papa of the tricyclic antidepressants) and fluoxetine (Prozac). Recent press reports that "it doesn't work" are misleading. In the study in question, it did not work well for severe depression--nor did the antidepressant sertraline work! (Of course, the study also showed that the placebo actually worked better than either intervention!!) It is not indicated for really severe depression, but there are scads of studies supporting its use for for mild-to-moderate depression. Take 3-6 per day (not more than 6). Note: One small study in HIV-negative volunteers showed a substantial decrease in the level of indinavir (Crixivan) in the blood when these people added St. John's wort. Further research is needed.

Valerian (Valeriana officinalis) - Used for thousands of years in disparate traditions (India to China and Europe), it acts as a mild and effective sedative, with both animal and human clinical studies to support this use. Contains a variety of alkaloids an iridoid compounds; which is the active ingredient (if there is "one") is under scrutiny.

Vervain (Verbena officinalis) - may help when used for depression related to anxiety, abdominal distress or following recovery from flu.

Diarrhea

Of course, obtaining an accurate diagnosis as to the cause of the diarrhea is the FIRST essential step. Some of the following botanically-based interventions may be helfpul in reducing the frequency and volume of stools, as well as their consistency. (Please see the Nausea section for remedies that will help after reading that last bit.) Please also see the discussion under Gas/Bloating that expands, pardon the expression, on these concepts a bit.

Acidophilus - Those "good" bacteria your gut needs and which may be lost during bouts of diarrhea and/or when using antibiotics. Take 20-30 minutes before eating.

Apple (Pyrus malus ) - Part of a good BRAT diet (bananas, rice, apples and tea or toast). Anti-diarrheal effects probably due to pectin content. Avoid eating the seeds. Have at least one apple a day!

Aromatherapy - Essential oils of black pepper, chamomile, camphor, cypress, eucalyptus, geranium, lavender, myrrh, neroli, peppermint, rosemary, sandalwood.

Barberry (Berberis vulgaris) - The berberine it contains may help offset cholera-related diarrhea but there are few studies. Do not exceed dose. Stimulates macrophages, so may help fight infections but may be bad for people with HIV. Golden seal (Hydrastis canadensis) also contains berberine, but it is being harvested out of existence and in any case, barberry is cheaper. ½ tsp of powdered root bark in a cup of water taken once per day.

Biocidin - An extremely powerful Chinese herbal preparation for parasites, bacteria and candida. May prove particularly useful for someone with a low grade candida infection or constant reoccurrence of blastocystis hominus. Dose for acute (intense) treatment is 3-4 tablets, 3 times per day for at least three weeks. For ongoing prophylactic/low grade problems, 2 tablets, 3 times per day. Always take with food. Please Note: There is an even stronger double strength liquid preparation known as BioRadiance which may be needed. Please read the DAAIR catalog or get a BioRadiance Information Sheet from the DAAIR office or website for further important instructions.

Fennel (Foeniculum vulgare) - Good also for stomach upset, indigestion, bloating and gas. Probably best to not use it for more than a couple of weeks. Very rarely, may cause skin reactions or sun sensitivity. Women who cannot take the "Pill" should probably avoid it. 1-2 teaspoon of seeds per cup of water.

Hydrochloric acid - For gas/bloating, you might also consider getting checked for the amount of acid that is in your stomach. Sometimes the level can get very low, making digestion difficult (a condition known as hypochlorhydria). You can take a supplement of hydrochloric acid that helps replace the acid your stomach is missing.

Innerfresh Pro - This product contains a good deal of chlorophyll. It has been used to "deodorize" the situation for people with colostomy bags. Use as directed/needed.

Lactaid/lactase - If you still eat dairy but have a lactose intolerance, supplementing this enzyme may make up for the lactase deficiency.

Oat bran (Avena sativum, L.) - See the Fiber entry under Cardiac Concerns/LDL Cholesterol. Any fiber containing fruits and vegetables, especially oat bran, fruit pectin, psyllium (Plantago spp.) can help to reduce diarrhea by absorbing water. The seeds also have a reputation for helping to break addictions and to calm an overactive mind.

Quiet Digestion - Chinese herbal blend, Quiet Digestion, which can be helpful for cramps, gas, bloating and diarrhea. Quiet Digestion from Health Concerns is traditionally used to reduce gastric distress including pain, cramping, nausea, vomiting, diarrhea, regurgitation, poor appetite; it treats viral or bacterial gastroenteritis as well as motion sickness, hangover and the effects of jet lag! Suggested use is 2 tablets taken after meals, 3 times per day; also may be taken between meals or as needed. Chew for best results.

Saccharomyces boulardii - others have also found to be helpful in controlling diarrhea, particularly for helping to control C. difficile as well as from other types of bacteria. Dose escalates from 2 capsules taken 3 times per day up to 6 capsules, 3 times per day.

SB-Normal Stool Formulaä - This is a product intended for the treatment of watery (secretory) diarrhea. It is derived from the sap of a tree found in the Amazon rainforest known as Croton lechleri. It is used by locals as a treatment for diarrhea, dysentery, gastritis and stomach ulcers. The product contains anthocyanidins (a class of chemicals found in grape seed extract), however, this product is not absorbed into the bloodstream. It is most helpful for secretory diarrhea, which involves an excessive secretion of electrolytes. Secretory diarrhea causes a watery diarrhea that can persist with fasting and is associated with dehydration. The resin and anthocyanidins found in SB Normal Stool Formula help to slow the secretion of electrolytes and substantially reduce watery diarrhea. It works but it is ridiculously expensive. Suggested use is 1-2 tablets, two to four times a day as need or as directed by your healthcare provider.

Tamarind (Tamarindus indica, L.) - May be helpful against diarrhea induced by certain bacteria (including E. coli, Staph. aureus and Bacillus subtilus) as well as some fungi like candida and Aspergillus and parasites like Schistosoma mansoni according to lab tests (but not human clinical studies; they haven't been done yet). No adverse events/side effects reported from its use. 4-8 grams of fruit per day.

Tannin-containing Herbs - Many herbs, listed below, contain substances called tannins which can help control diarrhea. These include bilberry, blackberry, black currant leaves, blueberry, meadowsweet, raspberry leaves, Chinese rhubarb, savory, and yellow dock.

Tea, black or green (Camilla sinensis) - Tea contains tannins. Green and black teas are from the same plant, but prepared in a variety of ways. Black tea is fermented. Green tea has more antioxidants (flavonoids and polyphenols) that taken daily may help reduce certain cancer risks. Drink 1-2 cups (1 cup has 20-30 mg of polyphenols) per day instead of colas/coffee.

Fatigue

Bee pollen - Can dramatically improve energy in some cases. Some may have allergic reaction; discontinue if you have rash, wheezing or discomfort. Start with a few grains and over a few days, increase dose to 2 tsp.

Ginseng (Panax ginseng) - Panax and Siberian ginseng (Eleutherococcus senticosus) varieties are both noted for their ability to offset fatigue and improve stamina. See the DAAIR paper on Adaptogens for more information and cites. The German Commission E notes its use for fatigue and debility as well as for convalescence. 20-40 drops of Maxim-L or 3-6 capsules per day.

Gotu kola (Centella asiatica) - The "longevity" herb of south Asia (Centella asiatica) and Africa. Ayurvedic tradition (where it is known as Mandookaparni) uses it as a sedative; other traditions use it as an energizer when taken with ginseng. Salves can help heal wounds and treat psoriasis. May help treat cirrhosis of the liver. May elevate blood sugar. Make an infusion with ½ tsp per cup of water and take twice a day; or follow suggested dosing instructions.

Olive leaf tea (Olea europea, L.) - an inexpensive and effective way of improving energy. It's a very natural stimulant and liver booster that doesn't cause a crash afterwards like coffee. The cost is about $10 per month. If money is not an issue for you and/or making the tea is difficult to manage, then you might consider using 8-16 capsules a day of the DAAIR or NOW Foods olive leaf extract. The DAAIR Catalog has directions on how best to prepare the loose tea.

Omega-3 fatty acids/DHA (fish oil) – One variety, containing a good amount of GLA to EPA (types of "good" fatty acids) was shown to statistically significantly reduce fatigue in a study of 18 HIV+ people while other data suggest lower levels in people with HIV. Another study showed improvements in fatigue, myalgia and depression. Use as directed. Or eat at least 3 servings weekly of fish (see above.)

Seacure fish proteins - Jackie Haught, a widely recognized and respected NYC acupuncturist, has found this product very successful in eliminating HIV-related fatigue. Especially helpful for those on chemotherapy. This is a very easily digested form of protein. Use as directed.

Siberian ginseng (Eleutherococcus senticosus) - Various studies underscore its value as an adaptogen (see DAAIR Treatment Information Sheet on Adaptogens). Other studies suggest value for high blood pressure, rheumatic heart disease, atherosclerosis and diabetes. (Other suggest you avoid it if you have high blood pressure or heart trouble or hypoglycemia.) May improve efficacy of antibiotics like monomycin and kanamycin. 250-500 mg caps 1-2 times per day.

Gas/Bloating

Don't forget to address dietary issues; drink lots of water/fluids. Eat small meals more frequently. Get an intestinal permeability test (urine test) to evaluate gut function. [LARK?] Avoid dairy if you have a lactose intolerance (which may cause lots of gas); or use lactase. Certain foods, such as beans, beer, Brussels sprouts, cabbage, carbonated drinks, cucumbers, fatty fried or greasy foods, green peppers, onions, peas, too much fiber, and even chewing gum, can all produce gas. Don't go to sleep right after eating; exercise!

One way to look at the list of herbs that follows is to divide them into their (primary) mechanism of action. (Some may work at more than one level.) So to simplify things, it may be best to try combinations of herbs with the following actions:

Bitters: These are herbs that stimulate the gut to produce more bile, increase appetite and improve digestion. They include gentian, barberry root (Berberis vulgaris), dandelion and artichoke. Don't use if you have an ulcer! See the discussion and caution under Appetite Loss. Some suggest consuming some bitter greens, like dandelion, or rinking a bitters formula about 30 minutes before a meal to prevent gas buildup.

Demulcents: These soothe the gut and may help in healing of ulcers. Comfrey root, marshmallow root, slippery elm and liquorice all fall into this category.

Carminatives: These herbs help to reduce gas build-up in the intestines. They can include fennel seeds (Foeniculum vulgare), cardamom, dill, cumin seeds, caraway seeds (Carum carvi), chamomile and lemon balm. Teas can be made from these ingredients. Peppermint oil in enteric-coated caps may also be very helpful.

Fiber: Fiber comes in different varieties; some can help offset diarrhea by absorbing water. Psyllium is a common bulk fiber laxative; mucilage contained in it helps to soothe the intestinal tract, particularly helpful for people with irritable bowel syndrome. Soluble fibers include fruit pectin, flaxseed, chia seed and oat bran. See the Fiber entry under Cardiac Concerns/LDL Cholesterol.

Mucilage: This is a substance that is found in a variety of botanicals and which helps to coat the inside of the intestines to keep stool moist and flowing smoothly. These include marshmallow root (Althaea officinales), slippery elmbark (Ulmus rubra), and mullein leaf (Verbascum spp.). A tablespoon per meal of powdered bulk herb can be added to a spoonful of applesauce and consumed.

Stimulant laxatives: These help the peristalsis or wave-like motion that moves material along the digestive tract. They include senna leaf (Senna alexandrina), cascara sagrada (Rhamnus purshiana) an aloe leaf (Aloe vera). These are best used for a couple of weeks at most uring period of acute constipation.

Botanicals

Acidophilus/bifidus - may take a few days, but can help assure digestive integrity. Up to 25-50% of the dry volume of healthy stools consists of the variety of flauna that co-exist in our guts, including Lactobacilus acidophilus, E. coli (the good kind), Bifidus species and so forth.

Allspice (Pimento officinales, Lindl.) - 4% is a volatile oil that may be the primary element helping with gas and griping (cramp-like abdominal pain), along with a substance called eugenol. Test tube studies show it can fight some viruses, fungi, parasites and bacteria (when used topically). It may help if rubbed on sore gums since it is mildly analgesic. The herb is rich in antioxidants. 1-2 teaspoons in a cup of water take up to 3 times/day (from the berry). Never use concentrated oil alone if using a tincture.

Aromatherapy - Essential oils of coriander, fennel, peppermint, bergamot, marjoram, rosemary, cardamom.

Betaine HCl - People with HIV sometimes have reduced amounts of acid in the stomach, necessary for digesting food. This compound can help to replenish lost stores. As directed, with food.

Catnip (Nepeta cataria) - A tea can be made from the leaves and flowers to relieve gas build up. Don't take near cats. Make tea with a teaspoon or 2, maybe with some fresh cut and sifted peppermint.

Dandelion (Taraxacum officinale) - Bitter chemical "taraxacin" boosts salivation/gastric juice production and should stimulate appetite. Also good for the liver/bile production. Very safe but don't use if you have gall stones. Also acts as diuretic so be sure to get enough fluids. Take supplement as directed. Or ½ ounce of dried leaves per cup of water; 1-3 tsp chopped or powdered root.

Devil's claw (Harpagophytum procumbens) - Highly recommended by S. African folk healers and others as a bitter, appetite stimulant and improving small intestine and pancreas function. Products vary a lot in quality and its popularity is placing it at risk for extinction. Avoid or take under professional guidance if you have heart problems, ulcers or gall stones. German tests showed an unacceptable variability in quality; is this still the case? See also the entry on Pain. Capsules commonly contain 4.5 grams. However, taking it as a tea or tincture is suggested for its digestive benefits.

Evening primrose oil (Oenothera biennis, Linn.) - According to some studies, useful for a wide array of problems, including arthritis, hastening liver healing and diabetes, and, topically, for atopic eczema (allergic inflammatory skin condition). Internally, 200-750 mg of GLA (gamma linoleic acid) are recommended.

Fennel (Foeniculum vulgare) - Excellent for stomach upset/gas and reducing cramp-like stomach pains, colon disorders. Promotes spleen, liver, kidney and lung function (also good as a cough medicine). Acts as an appetite suppressant, so only use if this effect is desired. Probably best to not use it for more than a couple of weeks. Very rarely, may cause skin reactions or sun sensitivity. An extract may be best. Women who cannot take the "Pill" should probably avoid it. 1-2 tsp of seeds per cup of water.

Gentian (Gentiana lutea) - The classic bitter. German approved for appetite loss, bloating and flatulence. Some people may not tolerate it so well, and in a few, you might have nausea/vomiting or headache. Avoid if you have an ulcer, high blood pressure or are pregnant. 1 teaspoon of dried root/rhizome in 3 cups water; then take 1 tablespoon of the decoction one half hour before meals.

Ginger root (Zingiber officinale) - a long established remedy for nausea and indigestion, may also help for gas. Very safe to use. High doses may cause blood thinning. Avoid if pregnant; may be best not to use it long term. May help with menstrual cramps. 3-10 grams of fresh ginger or 2-4 grams of dried ginger used daily; or 1-2 500 mg capsules. For digestion, 2 tsp powdered or grated root per cup of water.

Licorice (Glycyrrhiza glabra) - Chewing tablets of the variety without the glycyrrhizin can help to soothe the stomach by protecting against stomach acid and other juices.

Oregano (Origani vulgaris) - A common household herb and remedy both to stimulate appetite and relieve gas.

Peppermint (Mentha piperita) - The menthol in peppermint is widely recognized as a cold remedy; the oils can help with irritable bowel syndrome, abdominal pain, bloating and disturbed bowel habits, according to German authorities. Can use 1 tablespoon (1.5 g) of leaves per cup of water, 3-4 times per day. 2 enteric-coated capsules (0.2 milliliters) of oil may be used for gas, gallstones or other GI problems.

Quiet Digestion - Each tablet 750 mg of poria, coix, shen chu, magnolia, angelica, pueraria, red atractylodes, saussurea, pogostemon, oryza, trichosanthes root, chrysanthemum, halloysite, citrus, mentha and malt. Used to reduce gastric distress including pain, cramping, nausea, vomiting, diarrhea, regurgitation, poor appetite; treats viral or bacterial gastroenteritis as well as motion sickness, hangover and jet lag effects. Suggested use is 2 tablets taken after meals, 3 times per day; also may be taken between meals or as needed. Chew for best results.

Rosemary (Rosmarinus officinalis) - Strong antioxidant; may fight bacteria and fungi. Leaves are used to treat dyspepsia, according to the German Commission E. Avoid consuming the essential oil; avoid if pregnant. Used to good effect in aromatherapy. Good for massaging into arthritic joints. 1 teaspoon of chopped leaves per cup of water. Take this 2-3 times per day.

SPV-30 (boxwood leaves; Buxus sempervirens) - May cause cramping, in which case drink additional water.

Thyme (Thymus vulgaris, L.) - Eliminates gas and reduces fever, headache, and mucus. Lowers cholesterol levels.

Hair Loss

For as long as men (and women) have existed and held some cherishing of their vanity via the sprouts on the tops of our heads, there have been as many remedies to cure, prevent or offset hair loss. While it may seem merely to be an homage to that vanity to discuss it here, there is more to it when that hair loss arises from illness or chemotherapy. Hair loss can have a variety of causes, aside from the genes you get. HIV medications such as 3TC (Epivir) have been also linked to hair loss in some individuals. In addition, another major cause of hair loss, and one that may be related to HIV disease, is the loss of testosterone. Hair follicles tend to contain a fair amount of the hormone, dihydrotestosterone (DHT). When there is too much DHT in the follicles where the hair is rooted (often the case in hair at the front of men's scalps) the hair dies.

The following seem like they may be worth trying, especially since many of them may address other problems. Also, it might not hurt to eat some extra toasted sesame seeds, which are used in Chinese traditions to treat hair loss.

Lark/Fred; some stuff on thymus glandulars as helpful. Thoughts? Included already, Lark? Other stuff on shampoos??

Licorice (Glycyrrhiza glabra) - Licorice contains a compounds that helps to prevent the conversion of testoserone to DHT. A shampoo is suggested as one remedy to slow hair loss.

Nettle (Urtica dioica) - Dr. Duke refers to the work of a German physician, Rudolf Fritz Weiss, MD, who uses a tincture of nettle to treat thinning hair.

Rosemary (Rosmarinus officinalis) - Using an oil to massage into the scalp has been popular among women to maintain lush hair. (Note that you can use the oil internally and this may help; but ONLY do this with good advice from a naturopath; large doses taken internally can be toxic and even fatal.) If it works, it may simply be due to the massage. (Along these lines, you may want to try massaging safflower oil into the scalp, which can help open blood vessels. This method is used in Chinese traditional medicine as well.) Indeed, one study of aromatherapy had 86 patients randomized to receive either a massage of carrier oils or a treatment with essential oils containing thyme, rosemary, lavender and cedarwood; 19 of 43 in the active group (44%) showed improvement compared to only 15% in the control group.

Salvia (Salvia miltiorrhiza) or sage (Salvia officinalis) - This is a folk remedy used in Asian and western traditions. A few teaspoons of sage tincture added to your shampoo may help--and it won't hurt. But don't take it with warfarin (coumadin).

Saw palmetto (Serenoa repens) - Aside from its benefits in helping with an enlarged prostate in men, this herb may have some modest benefit in preventing hair loss. Saw palmetto works in part by preventing the conversion of testosterone to the super-powerful DHT that can contribute to hair loss.

Kidney (renal trouble)

There are some basic uses for botanicals in kidney function that relate to either clearing of stones or offsetting or inflammation. However, botanicals that may improve kidney tissue are few; DAAIR needs to research this area more.

Artichoke (Cynara scolymus, L.) - Cynarin is the main ingredient: it has been used to treat nephritis (kidney inflammation) and may have a modest effect on cholesterol. Also good for the liver. 2-3 caps/day, each with 15 mg of caffeoylquinic acids is commonly used.

Barberry (Berberis vulgaris, L.) - The fruits have been used for kidney complaints. Berries don't contain berberine like the bark/root/root bark, so it is much safer. However, it is less well studied. Used also for liver problems, gallbladder and to reduce fever. May act as a laxative as well. Be sure to use preparations containing the fruit only.

Cordyceps (Cordyceps sinensis) - Studies have shown value in offsetting kidney damage from drugs like aminoglycosides and cyclosporin; other studies show value for improving red blood cell count and hemoglobin; may help with asthma; however, there is concern that it may increase some inflammatory cytokines like TNF and IL-1. Use as directed.

Cranberry - Well known for its benefit in urinary tract infections; anecdotally it also appears to help with kidney infections (pyelonephritis). Seems to work better curing bacterial infections than preventing them. 12-32 fluid ounces per day (360 to 1,080 ml) of cranberry juice to treat infections.

Glycyrrhizin (Glycyrrhiza glabra) - this is listed in the accompanying literature as excellent for improving kidney function. Again, pay attention to your blood pressure (which it can increase) and potassium (which can be decreased). Eat more bananas along with this therapy! If using the Jarrow brand, do not exceed 3 capsules per day.

Avoid - barberry leaves (fruits may be helpful), liverwort herb, marsh tea, parsley seed, Pasque flower, rue, tansy—these are listed by the German Commission E as potentially damaging to the kidneys.

Diuretics/Herbs That Increase Urine Flow

Diuretics/herbal - Often, herbs used to treat kidney troubles are intended to "irrigate" or flush the kidney to help alleviate or prevent the formation of stones. Thus, they tend to be diuretics, increasing the flow of urine, so it is always important to drink more fluids during the day when using these herbs. A few of the more potent ones for kidney function are listed below. Avoid diuretics if you have fluid retention from kidney or heart problems. Intake of extra fluid, however, won't always improve kidney function; the need may be to reduce inflammation. B-vitamins are extremely important if problems arise from dialysis. Asparagus - kidney benefit comes from its action as a diuretic (makes you pee more) which helps prevent kidney stones. Drink more fluids. Eat the stalks or powdered seed, 1 tsp in juice. Nettle- Diuretic, so drink more fluids; may help lower TNF. Modest benefit for hay fever. Used as irrigation to prevent stones. 8-12 grams daily.

Check this list against any herbs you're taking. Be careful if using more than one herb on this list. They help increase urine flow; you must consume more fluids if using these! Agropyron repens (rhizomes), alfalfa, artichoke, asparagus, birch, boldo, buchu, celery seed, cleavers, corn silk, couch grass, dandelion, dong quai, Equisetum arvense (whole plant), goldenrod, hibiscus, horsetail, hydrangea, juniper fruits, roots of Levisticum officinale, lovage, mate, meadowsweet, nettle, onion, parsley, whole herb and root of Petroselinum crispum, sarsaparilla, squill, tea, black, uva ursi. See note under Kidney. Note that Panax ginseng counters the diuretic effect.

Lactic acidosis

Hawthorn (Crataegus oxyacantha) - There is some evidence that one way that hawthorn exerts its heart benefits is by helping to decrease accumulated levels of lactic acid. It improves oxygen utilization which in turn reduces lactic acid build-up which can be otherwise be a serious problem for the heart. This seems to be a more important mechanism of action (of the several it has) and indeed, one study suggested that hawthorn doesn't necessarily improve coronary blood flow. See also Cardiac Concerns.

Liver Problems

Liver problems can be divided, broadly speaking, into those relating to damage to secretion of bile into the gall bladder and damage to the parenchyma. Clearly, stressing the liver with a bad diet, excessive alcohol intake, and other stuff that's hard on the liver makes it hard for your body both to digest the food you take in and for the liver to handle what winds up getting into it.

Drugs/Herbs Bad for the Liver

Avoid - The following herbs are listed by the German Commission E as dangerous to the liver/hepatotoxic: Borage (the seed oil is OK), coltsfoot, hound's tongue, madder root, Petasites leaf, rue, senecio herb, tansy.

Exercise Caution - Chronic or long-term use of acetaminophen (Tylenol) may damage the liver by depleting its store of glutathione. DHEA may be hard on the liver. High dose niacin (over 1,000 mg or 1 gram) per day may cause jaundice and other problems. Others botanicals that can be hard on the liver, particularly depending on dose and duration of use, include senna, chapparal, comfrey, pennyroyal, sassafras. Excess iron intake (beyond what you get in the diet) may be very hard on the liver.

Botanicals

Aloe vera - Great for your skin and for cuts, it also can be taken internally as a juice or in capsules or pills (0.05 to 0.2 g). Contains a variety of compounds with different effects, including antiviral, antifungal and antibacterial. Another form, "drug aloe" or aloe latex derived from the rind, acts as a laxative (avoid if you have diarrhea). Juice: 1 tablespoon up to 3 times per day.

Artichoke (Cynara scolymus, L.) - Cynarin is the main ingredient that may have some modest effect on cholesterol levels as well as on liver function. Also good for the liver. 2-3 caps/day, each with 15 mg of caffeoylquinic acids is a common recommendation. However, studies showing effects on cholesterol lowering used 160-320 mg of caffeoylquinic acid.

Astragalus (Astragalus membranaceus) - Increases activity of different types of white blood cells in the test tube. Human studies suggest a value as an antioxidant as well as protecting against hepatitis-related liver damage (supported by lots of animal studies, mostly using mixtures of herbs). 1-4 grams of dried root, 3-4 times/day.

Beets, beet juice (Beta vulgaris, L.) - Long used as a remedy for improving liver function. (Be aware: when you wipe your butt after a good bowel movement it can appear like blood!) Nice in a mix of ginger and carrot juice. Often used with Chinese privet (Ligustrum lucidum).

Curcumin (Curcuma longa) - Substances found in the spice turmeric may help to the liver through its antioxidant action, improving bile secretion and helping to reduce inflammation and fibrosis; most clinical studies use 400-600 mg per day. May also help to lower cholesterol. Long used as a remedy in Chinese medicine for jaundice; some test tube studies indicate a potential mechanism.

Dandelion (Taraxacum officinale) - Bitter chemical "taraxacin" boosts salivation/gastric juice production and should stimulate appetite. It's also good for the liver's bile production (choleretic activity). Very safe. Also acts as diuretic so be sure to get enough fluids. Take supplement as directed; with the NOW Dandelion Root, 1 capsule 2-3 times a day is suggested. Or ½ ounce of dried leaves per cup of water; 1-3 tsp chopped or powdered root.

Ecliptex - Mixture of Chinese herbs by Health Concerns specifically formulated for the liver to help reduce liver enzymes. Includes a combination of herbs which includes Eclipta concentrate (Eclipta alba), milk thistle, curcuma, salvia, lycium fruit, ligustrum, bupleurum, schizandra, tienchi ginseng (Panax pseudoginseng), tang-kuei (Dang Gui; Angelica sinensis), plantago seed and licorice. Suggested use is 3 tablets, 2-3 times per day between meals.

Glycyrrhizin (Glycyrrhiza glabra) - a licorice extract. Caution: may increase blood pressure or deplete potassium levels. See DAAIR Treatment Information Sheet. Also may help fight bacteria and fungi (like thrush). Can help heal ulcers. May have some benefit against HIV (mostly studies done in Japan). Use periodically. Use as directed.

Hepato-C (Pacific Biologics proprietary blend) - Chinese Herbal Formula for Hepatitis C, including Astragalus membranaceus radix (root; huang qi), Artemisia capillaris herba (shoots and leaves, yin chen/mian & hao), Citrus aurantium seu poncirus fructus (bitter orange fruit, zhi ke), Codonopsis pilosula radix (high grade root, dang shen), Dryopteris crassi rhizoma (root, guan zhong), Heydyotidid diffusa herb (bai hua she she cao), Lycium barbarum fructus (lycium fruit, gou qi zi), Magnolia officinalis cortex (bark, hou po (reg), Paeoneae rubrae radix (red peony root, chi shao), Polygonum cuspidatum rhizoma (knotweed rhizome, hu zhang), Polygonum multiflorum radix (root, he shou wu), Polyporum umbellatum sclerotium (zhu ling), Rhodiola sachelanensis radix (root, hong jin tian), Salvia miltiorrhiza radix (root, dan shen) and Scutellaria barbata herb (barbat skullcap herb, ban zhi lan). This formulation has been specifically designed for hepatitis C infection. Suggested use is 2-3 capsules in the morning and evening for the first 3 months. Thereafter, reduce to 2 capsules in the morning and evening.

Hepato Detox (Pacific Biologics)—Herbal formula designed to strengthen liver function. Combination includes salvia, codonopsis, lycium, polygonatum rhizome, astragalus, reishi, privet fruit (ligustrum), ginseng root (red ji lin) and Cornelian Asiatic cherry. Suggested use is 2 daily before bed. For short-term use, 2 capsules before and after drinking alcoholic beverages.

Lecithin - 5-10 grams of 20% phosphatidylcholine (DAAIR's NOW is 35%); also good for the liver. May need up to 20 grams/day to treat cholesterol but as part of complete program.

Licorice - (see glycyrrhizin).

Milk thistle (Silybum marianum) - This is perhaps the premier liver herb. Very safe with many clinical studies; get a brand standardized to contain 70-80% silymarin. It may cause flatulence in some. See the DAAIR Treatment Information Sheet, Silymarin, for more information and cites. The chemicals found in milk thistle are known as flavanolignans, a set of which are known as silymarin. They help to protect liver cells (hepatocytes) by helping to remove toxic free radicals, modifying membrane turnover, inhibiting fatty membrane peroxidation, increasing liver glutathione levels, reducing inflammation and scarring (fibrosis) and increasing bile secretion. One test tube study suggests that Silymarin may increase blood levels of some antiretrovirals. According to a presentation by Steve Piscitelli, no effect was seen on protease inhibitor drugs, with the exception of a small increase in plasma levels. Given how poorly protease inhibitors are absorbed, this may be an advantage. Maybe milk thistle could be used as a healthy alternative to a ritonavir boost. At least 1 tablet/capsule, 3 times a day, each capsule containing at least 140 mg of silymarin (from a total standardized to 80% silymarin).

Stimuliv - A potent liver detoxifier containing a blend of 10 herbs, including Andrographis paniculata 8% (200 mg), Phyllanthus niruri 10:1 (100 mg), Eclipta alba 4% (100 mg), Picrorhiza kurroa 6% (100 mg), Boerhaavia diffusa 8:1 (50 mg), Berberis aristata 8% (25 mg), neem leaf 10:1 (50 mg), Solanum nigram 10:1 (25 mg), Tephrosia purpurea 9:1 (25 mg) and Ipomoea trupethum 30% (50 mg). Suggested use is to take 1-2 tablets twice per day with meals. Some PWHIVs might want to try a regimen that includes this product for 2-3 weeks every 3 months.

Whey - Milk is made of 2 fractions: casein and whey. The whey is found in higher proportions in human breast milk than in cow milk which has more casein. Whey also contains a fair amount of the amino acids glutamine and cysteine which are both important building blocks for glutathione which is very important for liver protection. It's a good and relatively inexpensive approach to liver care. If you are lactose intolerant, some brands have less than 1% lactose. See directions for use.

Loss of Internal Flora/Friendly Gut Bacteria

Acidophilus, bulgaricus and bifidus - Bacteria widely studied for its ability to restore natural flora in the intestines that can be wiped out with antibiotic use. Take as directed a couple hours after antibiotics.

Saccharomyces boulardii - An extremely important part of maintaining intestinal tract health. One small study showed help managing C. difficile infection. Dose escalates from 2 capsules taken 3 times per day up to 6 capsules, 3 times per day.

Memory (Cognitive) Problems

Aromatherapy - Essential oils of basil, fennel, cardamom, peppermint, rosemary.

Ginkgo biloba - Avoid if you are on blood thinners or have hemophilia. Opens blood vessels and can help cognitive (thinking) function. Can improve dizziness/vertigo related to inner ear problems. It contains lots of antioxidants and can help against allergies. Can help for various arterial disorders; also depression. 40 mg three times per day with meals of caps standardized to 24% gingko flavone glycosides and 6% terpenes.

Gotu kola (Centella asiatica) - The "longevity" herb of south Asia (Sri Lanka) and Africa; Ayurvedic tradition uses it as a sedative; other traditions use it as an energizer when taken with ginseng. Used with goldenseal as a "brain tonic." Salve can help heal wounds and treat psoriasis. Used to treat leprosy (which studies support) and may help treat cirrhosis of the liver. Elevates blood sugar? Make an infusion with ½ tsp per cup of water and take twice a day; or follow suggested dosing instructions.

Menstrual and Menopausal Problems

Black cohosh (Cimicifuga racemosa) - While FDA dismisses it, German authorities recognize its value for premenstrual and menstrual discomfort or pain as well as menopause associated nervousness. Some clinical studies support this, showing it reduces levels of luteinizing hormone. 40-200 mg is usual; or ½ tsp powdered root per cup of water; take 2 tablespoons every few hours, up to 1 cup a day.

Chasteberry (Vitex agnus-castus) - The berries are used traditionally for painful or absent menstrual cycles. May act by reducing prolactin levels, allowing for increase in luteinizing hormone (the second or "luteal" phase of menstruation). Can help minimize PMS symptoms (fluid on the knee, discomfort). May also have antimicrobial effects. Probably best to avoid using with drugs like haloperidol (Haldol), metoclopramide as well as hormone replacement therapies, contraceptives or if pregnant. 20 mg of crude fruit, usually taken as a tincture.

Cramp bark (Guelder rose, Viburnum opulus) - Used for muscular cramps and spasms related to nervous disorders. Specifically used for ovarian and uterine muscle problems. It may also help with migraines, to lower blood pressure and for colicky pains. Don’t take with blood thinning agents, if you have a heart condition or if you're pregnant. Take with fluids. Few clinical studies have been done so far. 1 tsp of tincture in water taken up to 3 times a day.

Passionflower (Passiflora incarnata) - Can help for menstrual discomfort and as a digestive aid. Some studies supporting the sedative and tranquilizing ability of this herb. May lower blood pressure. Good one for nervous unrest (approved in Germany). Not narcotic. Don't overdose (due to ability to slow down central nervous system). Probably best to avoid if pregnant. 1 tsp dried flowers per cup water before bed. Extracts in doses of 150-300 mg per day.

Mitochondrial Support

Adding Bioperine should help improve absorption. Bioperine is an extract of the fruit of the black pepper that has been shown to increase blood levels of different classes of nutrients. Avoid taking bioperine at the same time as your prescription drugs to prevent overdoses. To date, though, DAAIR hasn’t seen any problems (such as increased toxicities or viral load breakthrough) in people using Bioperine. This area needs further research.

Muscle Problem (Myopathy)

No botanicals appear to treat this problem, at least not with this diagnosis. DAAIR will research this further in the future.

Myelopathy (spinal cord problem)

No botanicals appear to treat this problem, at least not with this diagnosis. DAAIR will research this further in the future.

Nausea, vomiting

Artichoke (Cynara scolymus, L.) - Cynarin is the main ingredient that may have some modest effect on cholesterol. Also good for the liver. 2-3 caps/day, each with 15 mg of caffeoylquinic acids is a common recommendation.

Basil leaves - A tea made of 2 ounces of dried leaves in a quart of water brought to a boil then turn down the heat and simmer for 5 minutes results in a light green tea (after straining out the leaves). This is good, warm as possible, for kids with nausea. Refrigerate the rest. If nausea persists or grows worse, see a physician.

Ginger root (Zingiber officinale) - a long established remedy for nausea and indigestion. Very safe to use. A study comparing it to dramamine showed it worked better as a motion sickness remedy--and that's just using plain old ginger powder. The Chinese think the dried form, taken as a tea, is better for coughs and bronchial congestion. Either is good for stomach upsets. May help with menstrual cramps. Capsules should be taken half an hour before a trip to let the capsules dissolve (to prevent motion sickness). Active ingredients include volatile oils (gingerols and shoagol). Very high doses may cause blood thinning. Avoid if pregnant; may be best not to use it long term. 3-10 grams of grated, fresh ginger root (about a half a teaspoon) or 2-4 g of dried ginger used daily; or 1-2 500 mg capsules. For digestion, 2 tsp powdered or grated root per cup of water.

Marijuana (Cannabis sativa) or Marinol - Several studies have proven the benefits of marijuana for treating nausea, especially related to chemotherapy. Stupid and hypocritical laws make it illegal in many places. Marinol may be prescribed specifically for nausea (but contains only one type of THC). For some though, pot seems to work better—and it is less expensive. Smoking a joint can allow for more controlled administration of the drug in terms of timing the effect (for appetite before you know you're going to eat) and obtaining an effective dose (that will enhance appetite or offset nausea). It may possibly be better to eat pot in brownies than to smoke. As directed.

Patchouli (Pogostemon cablin) - A traditional remedy in India and China for digestive problems and nausea. Animal studies tend to support the benefits in preventing nausea and vomiting. Other similar therapies include fennel oil, tisanes of chamomile, peppermint, limeblossom; infusions of tarragon; blends of coriander, clove, nutmeg and cinnamon.

Quiet Digestion - Chinese herbal blend from Health Concerns is traditionally used to reduce gastric distress including pain, cramping, nausea, vomiting, diarrhea, regurgitation, poor appetite. See discussions under Diarrhea andGas/Bloating.

Neuropathy (Nerve Problems): Peripheral and Autonomic

Acupuncture/acupressure/massage/reflexology - these techniques may be helpful, if done by a trained practitioner, to alleviate the pain. Other complementary therapies, described in some detail in Senneff's book, include acupuncture; physical therapy; relaxation and meditation training; massage and other bodywork, such as therapeutic touch; and magnets.

Botanicals: A variety of herbs are also suggested in Senneff's book for peripheral neuropathy, including ginkgo biloba, St. John's wort, bioflavonoids, and hops. Of the anecdotal reports noted in the book, hops and St. John's wort seemed to have the most impact. One report on ginkgo stated they saw no benefit. People not using any drugs but experiencing some relief mentioned St. John's wort and hops with 400 IU of vitamin E; two using valerian tablets and hops tincture (10 drops tid); and a couple using grape seed extract or pycnogenol. They were often use with other mainstream interventions.

Pain

As with all other symptoms, pain is what drives one to seek a diagnosis. Is it acute (sudden onset) or chronic (been with you a while)? What's the diagnosis? Injury? Bursitis or arthritis? Carpal tunnel? Cancer? Opiates are perhaps the most powerful pain killers such as morphine and heroin. Opium clearly is beneficial. Marijuana also may help allevaite some pain. Some dietary changes may help; for example, if your problem is arthritis-related, some suggest avoiding members of the nightshade family (potatoes, tomatos, etc.) By contrast, adding cherries, berries and other fruits rich in antioxidants may help.

Botanicals may help with pain that arises from inflammation. Some that have anti-inflammatory properties include green tea, barberry, turmeric, holy basil, oregano, devil's claw and stinging netle as well as the bromelain found in pineapple. Foods high in omega-3 fatty acids may also help to slow inflammatory processes, as well as those that contain tryptophan. Treating the emotional aspects of pain can help as well.

Acupuncture/acupressure - See a qualified practitioner. Many painful conditions can be alleviated by using acupuncture and acupressure as well as by massage and biofeedback techniques. See also the sections on Neuropathy and Menstrual and Menopausal Problems.

Bupleurum (Bupleurum falcatum or B. chinensis) - These are the two most common species used, although the B. falcatum has a higher percentage (2.8%) of active compounds (a steroidal chemical called a triterpenoid saponin, specifically known as saikosaponins). Several of these saikosaponins have been discovered. These may work in part as anti-inflammatories by activating the body's ability to secrete corticosteroids. Most of the studies are in rats and mice, often using injections. Other data suggest that these compounds may operate by blocking the production of inflammatory prostaglandins. Bupleurum may have effects in increasing blood glucose levels as well as in improving liver function in people with chronic, active disease and lower cholesterol. Human data are somewhat limited and indeed one study of oral dosing suggested no benefit in liver disease. By contrast, a couple of studies using an injectable form saw some benefits in liver disease; one of those studies also injected Salvia miltiorrhiza and gave vitamins B and C. Oral doses may thus have to be very high in order to be effective and indeed, one study showed a rate of 10 times the IM dose were needed to achieve similar antiinflammatory effects as an injection. Suggested dosages are 1.5 to 6 grams per day of the dried root.

Arnica (Arnica montana) - A homeopathic remedy (meaning its been diluted substantially) is popular in Europe for wound healing and pain. May also increase sweating and urinary frequence, expectorant and as a mild sedative. Doses of as little as 60 ml of tincture can be fatal! 30ml of 20% solution can cause serious GI problems. This is one better taken as a homeopathic remedy where the dilutions and shaking that produce the product essentially result in a product with nothing in it -- yet it does seem to be of benefit!

Devil's Claw (Harpagophytum procumbens) - One study, double-blind, randomized and controlled compared people with osteoarthritis who received 6 capsules (each with 435 mg of herb) or 100 mg/day of an arthritis drug, diacerhein. Each group had similar responses to reduced pain by the end of the 4-month study. A scale of 1-100 was used and the Devil's claw recipients went from 63.6 to 31.3 while the drug group went from 61.6 to 35.8. Herb recipients had fewer side effects, although diarrhea as a side effect was seen in both groups. Probably should be standardized to an active constituent, harpagoside. Unfortunately, this botanical is facing extinction due to its popularity. Suggested dose is 300-400 mg/day, preferably from enterically-coated tablets. Other botanicals that may help include boswellia and yucca. LARK/FRED: other negative studies, two in animals, one in humans (altho the endpoint was simply effects on arachidonic acid metabolism--but it is thought there may be a different mech.)--still, given the extinction issue, I'd say no. Leaving it in for your review.

External Use: Red Pepper (Capsicum sp.) and Clove oil (Syzygium aromaticum) - These are often used topically as ointments for the skin. Discussed more under Neuropathy. Clove oil can be very helpful for tooth pain. Other oils that can be mixed with a little vegetable oil include peppermint, rosemary, eucalyptus and lavender oils that have some anecdotal use to support their efficacy. Cat's claw has also been used to ease pain related to herpes zoster sores and fibromyalgia.

Fish oil - Omega-3 fatty acids in fish oil may have some benefit in reducing inflammatory responses. However, one study that showed benefit only saw it when people took 6 grams each day! Better to simply eat more fish in the diet and not overdo the meat, peanuts, corn, cottonseed and sunflower oil-containing products.

Ginger (Zingiber officinales) - A study of 56 people with different conditions (rheumatoid arthritis, osteoarthritis and fibromyalgia) showed 75% with "significant pain relief" after three months of use. They used 2-4 tsp of powdered ginger a day. Externally, it can be used in hot compresses for headach, abdominal cramps and joint stiffness. Maybe add some hot peppers to the compress.

Valerian (Valeriana officinale) - This, along with other herbs, can act as a sedative that may help to alleviate pain and help induce a restful sleep. Consider using with Passionflower, Scullcap and Chamomile.

Willow Bark (Salix spp.) - This contains the precursor, salicin, to the main ingredient in aspirin, salicylic acid. One double-blind, placebo-controlled study using 240 mg daily dose of willow bark extract showed significant superiority over placebo for lower back pain relief. The study also showed that the higher dose worked better than 120 mg/day. No side effects were reported, however, one person experienced swollen eyes and itching believed to be related to an allergic reaction to the willow bark. As with aspirin, this is not for kids who have pain from a virally-related flu as it may result in Reye's syndrome, which may damage liver, brain--and may even be fatal.

Pancreatic Problems

Chlorophyll-a - May help reduce problems related to pancreatitis (see above).

Glycyrrhizin (Glycyrrhiza glabra) - A licorice extract. Caution: may increase blood pressure or deplete potassium levels. Taking one or two a day may prevent pancreatitis from developing at all, according to DAAIR director Fred Bingham. For treatment of the pancreatitis, the injectable form may be extremely helpful. See other entries. Few data to suport this indication.

Pancreatic enzymes - take with food. This is to help offset the loss of these important enzymes during a period when pancreas function is compromised.

Sexual dysfunction

A whole slew of aphrodisiacs have been tried and recommended in every culture on the planet. A lot of them are probably crap, enhanced by the placebo effect. Others do seem to help, depending on the need--whether to overcome a problem of getting it hard (or otherwise enhancing local blood flow to tissues), getting aroused (improving libido), or enhancing the pleasurable sensations derived from the nerves. Many foods have been suggested--chocolate may have a measurable effect due to the presence of a form of L-phenylalanine (an amino acid) called phenylethylamine. This compound is found in higher amounts in "romantically" aroused individuals. We review a few of the possibilities that have some research behind them. And of course, many scents are associated with arousal, such as jasmine.

By contrast, lots of things can play havoc with sexual drive. HIV first of all can do this, resulting in lowered testosterone over time in both men and women. But you can make things worse by smoking, drinking, doing some recreational drugs, consuming a high-fat, high cholesterol diet, using antihistamines (or drugs that can "cause drowsiness") and so forth.

There is more to sex life than a few herbs. Indeed, most of these should only be used occasionally. Exercise is one key. It stimulates the body, helps you to look better, possibly to help you feel better about your body image and thus more interested in enjoying sex. A good diet helps. Quitting smoking, la-di-da…you know the routine. It's your choices! But if you're feeling naughty, one study showed that the odor that most strongly induced a hard-on was hot cinnamon buns!

Ashwagandha (Withania somnifera) - A long use in the traditional medicinal system of India, Ayurveda. The root is often used for general debility and nervous exhaustion as well as for impotence an seminal debiity. Usually take as a powder mixed with ghee (clarified butter) and honey, taken in the evening with a little warm milk.

Black Cohosh (Cimicifuga racemosa) - Long known and being clinically evaluated for post-menopausal women (to help reduce symptoms like hot flashes), this herb may have other uses. It acts as an anti-inflammatory and may aid in uterine contraction. It is believed to have weak estrogenic action and may lower luteinizing hormone (which plays a role in regulating menstruation). But see Chasteberry below.

Chasteberry (Vitex agnus-castus) - Centuries ago, priests used it because it was thought to reduce sex drive…hmmmm….in women, it appears to modulate the hormonal milieu. It may reduce prolactin which, when high, can diminish sexual function in men and women. It may also stimulate the pituitary to produce luteinizing hormone, leading to higher progesterone levels. Might help in managing pre-menstrual syndrome. See Black Cohosh.

Damiana (Turnera diffusa) - A Mexican tradition, this herb can help to increase the sensitivity of the clitoris and penis. This could be a problem for guys who struggle with premature ejaculation, tho! Which may be why it is more often used by women.

Ginger (Zingiber officinale) - As a digestive aid, this is an herb long recognized in Chinese medicine for its adaptogenic properties. May help to stimulate a "rush of blood" to the genitals. It's very safe to use. Often used as a heart stimulant in that tradition when combined with other herbs such as poria, sage, aconite, licorice and angelica.

Ginkgo biloba - Opens blood vessels and can help cognitive (thinking) function. May possible help with impotence (erectile dysfunction). One study suggested as little as 50 mg a day could offset erectile dysfunction. 60 mg three times per day with meals of caps standardized to 24% gingko flavone glycosides and 6% terpenes.

Horny Goat weed (Epimedium koreanum) - Used in Chinese traditional medicine and may have some benefit in increasing testosterone; but it may also increase cortisol or other adrenal hormones and this may not be such a good idea for people with HIV. (Suggest we leave this in as caution.)

Maca (Lepidium meyenii, Walp.) - (Note that some feel this is the wrong name and it should be referred to as Lepidium peruvianum Chacon after its more recent discoverer.) The tuber (like a turnip) has been used as a staple food among inhabitants of the high Peruvian mountains for thousands of years. It has effects upon the endocrine system and may help balance hormonal function. One way this was noted was that horses at high elevations lose their fertility. Give them some maca and they bear foals. While some suggest it may be helpful for men, other data suggest that it may reduce fertility and act as an "anti-aphrodisiac" in men, similar to another Peruvian plant that contains similar chemicals known as the anu. It contains a specific chemical called a mustard oil (after the flavor) called isothiocyanate. This may help enhance women's fertility. It also has some preliminary evidece of being helpful for post-menopausal symptoms. Some bodybuilders use it due to its high sterol content; whether this has any benefit is doubtful. Do not use if you have an elevated level of prostate surface antigens (PSA).

Muira puama (Ptychopetalum sp.) - Also known as Potency Wood, this remedy has been used in traditional medicine in South America and recently garnered some attention in the supplement industry. One small study suggested that It has a benefit for enhancing libido and/or offsetting impotency in about over half of 262 users.

Nettle (Urtica dioica) - May help to enhance energy loss due to autoimmune imbalances, allergies, liver problems and other fatigue-inducing stresses; which in turn can make for better energy and hence that "headache" goes away!

Saw palmetto (Serenoa repens) - This may be a helpful adjunct for people suffering from an enlarged prostate. It acts as a mild diuretic. May have effects similar to finasteride (Proscar) on male hormones. Traditional use in the Caribbean as an aphrodisiac may be a rationale also for further study. May work better with other herbs such as ginger or gingko.

Tribulus terrestris - This herb has a long history of use and may have some small effect on increasing testosterone level. But use it intermittently. For PWAs with profound testosterone depletion, it may not help. No clinical data yet in people with HIV.

Yohimbe (Pausinystalia johimbe) - Numerous studies show benefits for men using yohimbe (from Corynanthe yohimbe) to enhance sexual performance by opening up blood vessels (like Viagra and gingko do, but they have not been compared in studies). Avoid if you have low blood pressure or inflammation of liver, heart, prostate or kidneys. May help prevent or offset orthostatic hypertension caused by tricyclic antidepressants. Unfortunately, many over-the-counter products have none of the active yohimbine, which is also found as a pure extract (and otherwise known as a prescribable drug). The drug form, yohimbine, or excessive use of the whole herb may cause anxiety, hypertension, tachycarida, insomnia; take under medical supervision. Do not exceed 500 mg of whole herb; more than that doesn't improve the situation and just risks increasing toxicities. Don't use with wine, cheese, meat, ir drugs (like nasal decongestants) that contain phenylpropanolamine which contain tyramine since yohimbine is an MAO inhibitor. The drug has been shown to help about one-third to two-thirds of impotent men when using about 18 or 42 mg dosages over at least two months.

Sleep Problems (Insomnia)

Eliminate diagnoses like candidiasis, chronic hepatitis C, tonsillar hypertrophy, low NK cells, depression, B vitamin, biotin or magnesium deficiency, premature menopause, alcohol or other folate deficiency.

Acupuncture - While studies show a benefit for pain, there are fewer on the value for insomnia. Acupressure, hypnotherapy, various "energy" therapies and massage therapy may also help.

Ashwagandha (Withania somnifera or winter cherry) - used in India (Ayurvedic medicine); animal studies show sedative effects. Root bark (or sometimes leaves) are used. May help against some tumors. Acts as an "adaptogen" (and is also known as Indian ginseng). A DAAIR friend who studies Siddha and Ayurvedic medicine uses Ashwagandha to increase his testosterone level, using 1 tsp. twice a day in warm milk/ovaltine. Note: "Because Ashwaganda is a heavy herb and somewhat hard to digest it can be taken with ginger, warm milk, meals, honey or hot water. It is good for weakness during pregnancy." Get standardized to 2-5 mg of withanolides; use 150-300 mg per day.

Balm (lemon balm; Melissa officinales, L.) - Has tranquilizing, sedative and anti-muscle spasm properties. Bitter principle may control digestive upset and gas. Ointments can speed healing, reduce cold sore recurrence. Contains tannins and polyphenols. Use under doctor supervision if you have a thyroid disorder (like Grave's disease). 1-3 teaspoons of crushed leaves per cup of water.

Lavender (Lavandula officinale) - The tea (or oil dripped on a sugar cube) is used for restlessness or difficulty sleeping (probably due to its volatile oil). To a lesser extent, it may help with gas/stomach upset and may also lower blood sugar (seen in rat studies). Make tea with 1-2 tsp of flowers per cup of water, take several times per day (especially before bedtime). Or 1-4 drops of oil on a sugar cube.

Marijuana (Cannabis sativa) - Eating it is probably the best bet. It can induce drowsiness as well as help alleviate nausea and appetite loss. Stupidly, though, it's illegal. Even in states where it is legal to use medicinally, there are bizarre restrictions.

Passionflower (Passiflora incarnata) - Long tradition with some studies supporting the sedative and tranquilizing ability of this herb. May lower blood pressure. Good one for nervous unrest (approved in Germany). Can also help as digestive aid and for menstrual discomfort. Not narcotic. Don't overdose (due to ability to slow down central nervous system). May wish to avoid if pregnant. One tsp. dried flowers per cup water before bed. Extracts in doses of 150-300 mg per day.

Schizandra (Schizandra chinensis) - An adaptogen (see DAAIR Treatment Info Sheet). Various studies show value for a variety of conditions, including improving athletic endurance and animal studies showing tranquilizing, antidepressant effects and stimulation of the uterus. Avoid if you have liver trouble. Contains antioxidants. 1.5-9 grams of dried herb; use 5 grams of crushed berries per 100 ml of water; divide into doses 3 times per day.

Valerian (Valeriana officinalis) - Can help you fall asleep; may not help you get a full night though. The root has a long tradition and a few human studies to back its effects against insomnia. Not studied in pregnant people but no adverse effects known. Not addictive (as opposed to valium/drugs). 1 tsp of root per cup of water; 2-3 grams taken 1-3 times per day or couple of caps of 475 mg root.

Thyroid

Hyperthyroidism

Hyperthyroidism - Increased thyroid hormone output is often related to weight loss and increased metabolism. Generally, the problem in HIV is reduced thyroid hormone output. However, some may experience this problem and it may eventually lead to hypothyroidism if it wears out the thyroid gland. If you have this condition, do not use alpha interferon! This condition may arise after ARV treatment since in people around 40 years of age (men mostly?), there may be a risk that as immune function improves, an autoimmune condition may arise where the body attacks the thyroid with its own antibodies (known as Graves' disease).

Diet - avoid dairy for at least 3 months, as well as stimulants such as coffee, colas, nicotine, etc. Avoid excessive iodine intake (including detoxifying herbs like bladderwrack, kelp or other seaweeds). More than 150 micrograms of iodine can exacerbate this disease.

Virginia bugleweed (Lycopus virginicus) - Commercial preparations are available; usually made from the aerial parts of the plant. It may act as a sedative and diuretic (make you pee); it's been used specifically for overactive thyroid function that include symptoms of palpitations and tightness of breathing. Use under guidance of a qualified practitioner.

Motherwort (Leonurus cardiaca) - This also acts as a sedative, uterine and cardiac tonic and carminative (helps with gas). May help as a tonic for menopausal changes and to ease false labor pains. It's also been specifically used in heart conditions associated with anxiety and tension.

Hypothyrodism

Hypothyroidism - reduced thyroid output resulting in increased weight gain and sleepiness (somnolence). One issue this raises is that methadone is to be used cautiously or at lower doses in people with hypothyrodism. Somatropin (human growth hormone) is also not to be taken unless the condition is treated. One way to test is to keep a thermometer at your bedside. Upon waking, place the thermometer under your armpit and hold it there for 15 minutes (staying still—you can use this time as a good opportunity to do breathing or meditation practice). If it consistently reads below 97.6° F, you may have a problem. Avoid sulfa drugs or antihistamines. Make sure prescribing physician knows of your hypothyroid condition.

Several different botanicals have been suggested for enhancing thyroid function. Bayberry, black cohosh, goldenseal - A combination of these herbs may be helpful. Do not take goldenseal for more than 1-2 weeks at a time. Bladderwrack, kelp (Fucus vesiculosus, L.) - the various algae, possibly due to their high iodine content, may be helpful in managing this condition. Gotu kola (Centella asiatica) - May be helpful for hypothyroidism. Wild oats (Avena sativum, L.) - according to the German Commission E, wild oat combinations are used to manage hypothyroidism. However, this is a complex syndrome and a variety of articles suggest a range of interventions. LARK/FRED: I will update this further if time permits.

Varicose Veins and Vasculature

We bring this issue up because of the increased, sometimes painfully protruding veins associated with lipoatrophy. See also Cardiac Concerns.

Bilberry (Vaccinia myrtillus, L.) - Some evidence suggests bilberry is good for varicose veins and venous insufficiency in the lower limbs by protecting tiny blood vessels (capillaries). Hawthorne may also help due to its high content of oligomeric proanthocyanidins (OPC)s and other antioxidants. Two 500-mg caps taken twice per day is commonly recommended.

Butcher's broom (Ruscus aculeatus) - This is an evergreen, Mediterranean shrub (Ruscus acleatus) from which the fleshy root stock is used. It tends to constrict blood vessels. Improvements were seen in a double-blind study of 40 people that compared placebo (no benefit) against the use of an extract along with vitamin C and hesperidin. After two months, participants noted a reduction in swelling, numbness, tingling as well as the sensations of heaviness and cramping. In a second but shorter study, similar results were seen, but the results were not as dramatic--probably because it was only two weeks long. No adverse events were noted. Active ingredients include the glycoside triterpine saponins known as ruscosides A and B. It might help with hemorrhoids. Approved by German health authorities for the indication of chronic venous insufficiency. Dose should be the equivalent of 7-11 mg of total ruscogenin.

Gotu kola (Centella asiatica) - The "longevity" herb of south Asia (Sri Lanka) and Africa. Several studies indicate a value for treating varicose veins. Make an infusion with ½ tsp per cup of water and take twice a day; or follow suggested dosing instructions.

Hawthorne (Crataegus oxyacantha) - See the discussion under Cardiac Concerns above.

Horsechestnut (Aesculus hippocastanum, L.) - Horsechestnut has a long tradition of use in the management of varicose veins. The aescin component, a triterpene or saponin with a steroid-like molecular structure, has a fair amount of research showing that it improves circulation, especially in the lower extremities. Thus, it has benefit for varicose veins and hemorrhoids, with numerous studies to support this. Poorly prepared products could cause damage to the liver and kidneys. Rarely, use may result in itching or nausea. One study showed benefit after using 100-150 mg of aescin after 2 weeks (which would be 2-3 capsules per day). German Commission E reports that extracts should be 15-21% aescin in a slow-release form. Suggested use is one capsule twice daily with water at mealtimes. Do not exceed recommended dose.

White Blood Cells (WBC) or Bone Marrow Suppression (See also Anemia)

If you have low levels of white blood cells, see your physician first. Neutropenia should not be dealt with lightly and drugs like neupogen are your best bet. Some botanicals may help to stimulate white blood cell production (which includes all different sorts of cells). One type, the natural killer cell, may be depleted in numbers in HIV disease; and those that are left behind may not work as well. However, DAAIR has heard anecdotally of some people using MGN-3 to stimulate NK function had the unfortunate consequence of increasing HIV load and dropping CD4 count. Yet others found the opposite effect! So treat carefully when using botanicals to manage issues around white blood cell counts.

Astragalus (Astragalus membranaceus) - Increases activity of different types of white blood cells, at least in the test tube. Human studies suggest value as an antioxidant, and specifically for improving heart function/EKG readings. Injected along with ginseng, may slow loss of white blood cells in chemotherapy-treated cancer. Others suggest avoiding use with drugs like methotrexate and cyclosporine. 1-4 grams of dried root, 3-4 times/day.

Cordyceps (Cordyceps sinensis) - One mouse study saw improvements in numbers of cells that eventually develop into red blood cells (EFU/BFU). Take as directed; one tablet with lunch per day is typical.

Echinacea - some studies suggest it can stimulate production of certain white blood cells (polymorphonuclear granulocytes).

Glycyrrhizin (Glycyrrhiza glabra) - small study in six people with hemophilia suggests it may offset AZT bone marrow effects. Do not use if you have high blood pressure; monitor your blood potassium level. Take as directed.

Marrow Plus - contains milletia, ho-shou-wu, salvia, codonopsis, astragalus, ligusticum, raw and cooked rehmannia, lycium, tang-kuei, lotus seed, citrus, red date extract, oryza and gelatinum. A formula designed specifically to offset the bone marrow suppressive effects of drugs like AZT and DHPG (ganciclovir, an antiviral used to treat CMV). May also help to reverse anemia. This formula was derived by Misha Cohen. Suggested dose is 2-3 tablets taken 3-4 times per day, for a total of 6-8 tablets are taken each day.

Privet/glossy privet or Chinese privet (Ligustrum lucidum) - Used in Chinese medicine to increase the number of white blood cells. Tonic for heart function and has diuretic properties. Some antibacterial effect; may enhance activity of cells known as phagocytes and lymphokine-activated killer cells. Used traditionally for leukopenia, chronic bronchitis, and to improve kidneys and nourish the liver. Decoction of 60 g of bark or 90 g of leaf taken 3 times a day for 10 days.