Herbal Weight Loss Supplement Review

Herbal Medicine Introduced Into the Basic Science Curriculum for 2 nd Year Medical Students DJ Smith, Ph.D. WVU-HSC Coordinator Medical Pharmacology

Does instruction in herbal medicine have a place in a US medical school?

The Need for Instruction in Herbal Medicine
Herbal Remedies and Dietary Supplements are used extensively
Herbal products have medicinal value & toxicities & interactions with other herbs and drugs
Physicians need to be prepared to interact with patients using or requesting herbals

Introduction of Herbal Instruction at WVU-HSC
Early in the Medical Pharmacology lecture series
Final 8 weeks of the Basic Science curriculum
Began in 2000
Students’ first formal exposure to herbal products

Objectives of the Learning Experience
Learn indications, side effects and contraindications for herbal remedies
Appreciate herb-herb and herb-drug interactions
Understand the regulatory climate for dietary supplements and herbal remedies
Begin to understand unique barriers to effective physician-patient interaction

Instructional Method
75 minutes of lecture
delivered non-judgmentally, but factually
Small group discussion (2hrs)
faculty facilitator & 8 students
Students prepared in advance of group discussions
reviewing clinical cases
using on-line and hard copy resources
visiting herbal retail store

Evaluation of the Impact of the Instruction
Questionnaire given before and repeated after the instruction
Instrument was designed to evaluate students’ awareness, attitudes and content knowledge of herbal remedies
Also asked the extent to which they recommend future students be exposed to the material

The Case For Herbal Medicine
Tradition: used throughout history
Natural: perceived as gentler and safer
Cost: often less expensive than prescription medicine
Access: patient maintains control & no prescription necessary
Synergism: a view that multiple ingredients working together yield better results

The Case Against Herbal Medicine
Lack of FDA Regulation and Oversight
Lack of Dosage Standardization
Potential for adulteration
Potential for toxicity and drug interactions: natural is not always safer
More effective therapy may be delayed
Many herbs are not superior to prescription medicines

Regulatory Issues
Dietary Supplement Health Education Act (DSHEA) of 1994
Herbal products are legally food supplements
Manufacturer may state usage and safety, but not make curative claims
Manufacturer alone is responsible for product safety
FDA must prove product unsafe to remove it from the market
Europe: Herbs regulated as pharmaceuticals

Saw Palmetto ( Serenoa repens )
Used for prostatic obstructive symptoms
Dose: lipidosterolic extract 100mg (bid) or 1 g dried berries (tid) with food
Side effects: include nausea, diarrhea, headache impotence
Cautions: include false negative PSA
Effectiveness: equal to finasteride, but alpha-1 antagonists appear better

Introduction to Case Discussion (edited for brevity)
Athlete presents with SVT. Reluctantly admits drinking flavored beverage containing Ma Huang ( Ephedra sinica ) to enhance weight-lifting performance. Used two scoops for good measure. Observed till tachycardia resolved.
Initial Questions
What may account for his reluctance to admit using the product?
How do health care providers perpetuate the propensity to withhold this information? & How do we change?

Facts and Assignment (discussion continues)
Active ingredients of Ma Haung is ephedra… Used extensively in Chinese herbal medicine…. Alkaloids are used in FDA approved meds… Life threatening CVS complications occur
At a local herb store see what products contain ephedra, and evaluate the label information
Questions:
Is the label information adequate?
What medical conditions preclude ephedra use?
What herb-herb-drug interactions concern you?

Additional Questions
Many herbalists and patients believe that medical establishment has a prejudiced view of herbals. This creates a rift between patient and physician that is a barrier to effective communication.
Questions:
Are US physicians prejudiced, and if so why?
Are US physicians competent to make judgments about herbals and to guide their patients, and if not how do we improve?

Further Consideration
The regulatory climate in the US is described…. In Europe herbs are regulated as phytopharmaceuticals, and they are widely prescribed in Europe and Asia… About 1/3 of the US population regularly take herbals
Questions
Advantages and disadvantages of US approach?
Would you change the regulatory environment, how?
How can patients be encouraged to share their use of herbals with physicians?

Awareness of Herbal Remedies
60% did not have personal exposure
Gained knowledge of the extent of herb use in the US
Q. What % of the US population uses herbal remedies

Students significantly improved their recognition of herbal medicine
Q. The contemporary definition of herbal medicine is?

Students discovered that there are credible sources for information on herbal medicine which are available in print form and on-line.
Professional’s Handbook of Complementary and Alternative Medicine, Fetro and Avila, Springhouse, 1999.
Herbal Research Foundation: www.herbs.org
Herb Med www. herbmed .org
Medline Plus http://www.nlm.nih.gov/medlineplus/herbalmedicine.html
ConsumerLab.com: http://www. ConsumerLab .com

Attitudes Toward Herbal Remedies
Students had strong opinions that changed very little with the learning experience
70% were skeptical of the reliance on herbals to the exclusion of Rx meds
Overwhelmingly, herbals are to be used with caution
Nearly all students accepted that their responsibility is to counsel patients regarding herbals

Physicians should take a non-judgmental approach when counseling patients
Q. I believe that it is _____ to take the position that herbal remedies are “bad medicine”

Physicians should take a non-judgmental approach when counseling patients
Q. If a patient mentions the decision to take St John’s Wort for depression, the physician should

Knowledge of Herbal Remedies
8 Content questions dealing with the regulatory climate, and therapeutic effects of specific herbals were asked.
Examined knowledge in a low impact manner, since performance on the questionnaire did not influence grade, nor were the students “asked” to study
Students gained appreciably

Q. FDA regulates the manufacture, sale and therapeutic claims of herbal medicine as they do for prescription and non-prescription drugs

Q. The herbal product used most frequently to treat migraine headache is:

General Observations and Conclusions
Our students have a high tolerance of the use of herbals, and are willing to counsel patients in a non-judgmental manner
They express a cautious view, but accept that there may be medical value when patients use some products appropriately
They report that exposure to this material is important and should be in the Medical Curriculum

Herbal Weight Loss Supplement Review

by MizaMX on Jan 01, 2010

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Herbal Weight Loss Supplement Review — Presentation Transcript