Herbal Medicine in HIV/AIDS
When we hear people refer to "herbal" or "botanical" medicine, we know that they are talking about plants used for healing purposes. Some other terms that are frequently used, however, can create some confusion. To clarify:
Herbal medicine involves the use of whole plants or parts of whole plants to obtain the active ingredients or chemicals that have a pharmacological effect. It is also referred to as herbology.
Phytomedicine includes extracts from whole plants.
Botanical medicine is the term preferred by the United States Food and Drug Administration and many plant experts to refer to herbal or phytomedicine.
Homeopathy uses herbs in the preparation of homeopathic remedies, but is very different from herbal medicine. Homeopathic treatments are based on the theory that "like heals like"; itching, for example, would be treated with something known to cause rather than stop it. Homeopathy uses tiny amounts of a plant, so it is almost impossible to measure the active ingredients present, and its healing mechanism is not based on the active compounds of plants.
Nutraceuticals may be derived or synthesized from plants and include other nutrients such as vitamins, minerals, and amino acids as main ingredients. These compounds are sold separately, in combinations, and in various concentrations.
Phytopharmaceuticals are plant medicines that have standardized concentrations of active ingredients only, not concentrations of whole plants.
The History of Herbal Medicine
Herbs have been used for spiritual and medicinal purposes for thousands of years. Archeologists and anthropologists have found cave carvings depicting healing plants dating back as far as the Stone Age. There are records of over 700 medicinal plants used by the Egyptians around 1500 B.C. The practice of herbal medicine has also been recorded from Medieval times to the present in Greece, Rome, and other parts of Europe. India and China are good examples of places where herbs were used thousands of years ago and continue to be used today in hospitals and medical care centers as well as in people's homes.
Throughout history, it was usually women who grew and practiced healing with herbs, but it was men who recorded and assembled all the information to document it. This explains why all the early herbalists were men.
The World Health Organization has estimated that about eighty percent of the world's population uses plants for healing purposes to some extent. Over fifty percent of drugs today are derived from plants, directly or indirectly. Digitalis, for example, comes from foxglove, and aspirin from white willow. Some herbalists believe that the world has a plant for every illness but that most plants are not yet known. There are an estimated 250,000 to 300,000 species of plants, but only about 5,000 of them have been studied for their constituents and medicinal properties.
Risks and Dangers of Medicinal Herbs
Like medicinal drugs, herbs can be very potent and toxic, and they can have adverse side effects. While plants have been used as healing agents for thousands of years all over the world, there is little documentation of the safety and efficacy of most herbals. There are only a limited number of clinical studies on some plants, even fewer clinical trials in humans. Most studies have been done overseas outside the United States.
Many herbalists believe that using the whole plant or part of the plant has a different effect from using just an extracted active ingredient, and possibly poses less risk of toxicity. Constituents in plants other than the active ingredients often appear to counteract or balance possible negative effects. Dandelion, for example, is used medicinally as a diuretic, and increased urination can lead to potassium depletion. But dandelion is also rich in potassium, so there may be enough to compensate for the possible loss. The healing property of herbs may be due to a combination of components found in the whole plant working together, and not just to one active ingredient acting alone.
Harmful side effects can be caused by an herb-medication interaction, from an overdose, from a mislabeled or adulterated product, or from any other inappropriate use. Adverse reaction to herbs is usually quick, with symptoms such as nausea, vomiting, cramps, diarrhea, dizziness, itching, or rashes coming on shortly after the herb is taken. Anyone experiencing any of these symptoms persistently should immediately discontinue taking the herb and seek medical help. Children and pregnant women should be particularly careful about taking herbals without professional supervision. In fact, they should avoid taking them in general.
In the United States, herbs are not controlled or regulated by the government as they are in European countries. In fact, some herbal products have been found to contain small amounts of lead, arsenic, antibiotics, coumarins (which act as blood thinners), and other harmful or unwanted fillers.
If you are taking both herbs and medicinal drugs, make sure your healthcare providers know what you are taking. To minimize possible drug-herb interactions, do not take the two together; In general, take herbs one hour before or two hours after medications to avoid interference with the absorption of medicinal drugs. Become an educated consumer and inform yourself about herbals. Never self-prescribe or take something because it worked for someone else. Not only may it not work for you, it might actually harm you. Learn to recognize which herbs are which, and remember, more is NOT better in taking herbs.
Herbs and HIV/AIDS
It has been estimated that at least a third of persons infected with HIV in the United States use medicinal herbs in some way or are interested in trying them. In some countries where conventional drugs are not an option, people with HIV disease rely heavily on herbal medicine and nutrition.
No herb and no combination of herbs will "cure" HIV/AIDS. Herbs can be of significant help, however, in alleviating the symptoms associated with HIV/AIDS, strengthening the immune system, helping the body to fight the virus, helping to speed up recovery from certain ailments, and helping to eliminate toxins from the body in order to maintain health. It is important to remember that herbal therapies are not quick-acting. They are not "magic bullets." In most cases, it may take several days or weeks for any effect to be noticeable.
Only some herbs commonly used in HIV/AIDS and only some of their most frequent uses are covered in this article. Many foods and nutritional supplements can also be helpful with these common HIV/AIDS symptoms and drug side effects:
Nausea. This is usually caused by medications, food intolerance, food poisoning, pregnancy, motion sickness, or strong smells from foods, perfumes, cleaning products, or fumes. Herbs that can help include ginger, peppermint, St. John's wort and chamomile. Ginger may have a mild blood-thinning property; avoid large quantities if taking blood-thinning medication or experiencing difficulty with blood clotting. A cup of ginger tea a day or a couple of slices in cooking is not a problem. Thyme oil, goldenseal. or a high dose of eucalyptus may aggravate nausea. Some people are allergic to chamomile.
Diarrhea. This can be caused by HIV itself and by some antiviral medications, food poisoning, antibiotics, and intolerance to milk. Herbs used to treat it include psyllium, slippery elm, oat bran, marshmallow root, blackberry leaf, ladies' mantle, meadowsweet, cinnamon, black walnut hull, fenugreek, carob, and oak bark. The first four can delay absorption of drugs that are taken at the same time; this interaction can be reduced by taking the herbs at a different time. Oak bark is a strong astringent and is best used only as a last resort. It is important to drink plenty of fluids with any of the herbs to maintain electrolyte balance and avoid dehydration. Avoid thyme oil and high doses of eucalyptus, as they will aggravate diarrhea.
Constipation. Binding foods such as rice, black tea, bananas, and cheese can trigger constipation, as can a lack of dietary fiber and fluids, lack of exercise, and some medications or iron supplements. Besides correcting food intake, increasing fluids, and exercising, taking cat's claw, cascara sagrada, aloe, psyllium, licorice, oats, flax seeds, flax oil, fenugreek, or dandelion root may help. Another herb used against constipation is senna, but it is very strong and may be irritating; it should not be used for more than three or four days in a row. It is important to drink at least 12 ounces of liquid each time any of these laxative herbs are taken.
Irritable bowel syndrome. This is a combination of episodes of diarrhea, constipation, and normal bowels, sometimes accompanied by bloating. Herbs that have been shown to have a calming and soothing effect are chamomile, peppermint (see discussion of individual herbs, below), psyllium (preferably the black psyllium, as it is milder than the blonde variety, and take with plenty of liquid), slippery elm, and garlic tea.
Lack of appetite. Medications, depression, fatigue, constipation, and sickness can take away appetite. Treating those conditions and making one's favorite foods can help to improve it. Food enters our system first through our eyes and nose before our mouths. Make foods look colorful and appetizing, and add herbs and seasonings to produce delicious aromas that stimulate appetite. Cooking herbs that contribute flavors, many nutrients, and phytochemicals to a dish include garlic, oregano, cilantro, thyme, turmeric, parsley, basil, etc. Other herbs that may help stimulate appetite are dandelion root, fenugreek seed, orange peel, fennel, cayenne, astragalus, burdock root, coriander seed, cinnamon, reishi mushrooms, and chicory. Bitter herbs increase the production of saliva, which stimulates appetite.
Depression/anxiety. Some medications may cause depression and anxiety, and they may also be part of the disease process due to emotional stress and isolation. If depression is not severe, some herbs may help, but it may take a month or two before seeing any results. St. John's wort, kava, and gingko biloba are among the most popular. If taking antidepressants such as Paxil, Prozac, Elavil, etc., these herbs should be avoided. Recent reports and reviews of past literature, however, indicate that these herbs can be taken along with the mentioned medications when properly supervised by a medical doctor who can adjust the drug dose. On the other hand, antidepressants that are considered MAOIs (monoamine oxidase inhibitors), such as Marplan, Nardil, Eldepryl, and Parnate, appear to interfere with some herbs, such as licorice and St. John's wort, possibly causing serious interactions. Avoid them in such a case. Lately, some relief from depression has been anecdotally reported from the use of whole lemon and olive oil blended into a juice. Lemons are packed with phytochemicals and antioxidants in the peel, rind, and seeds, and the rest of the fruit is rich in vitamin C.
Abnormal lipid (fat) levels. Elevated levels of cholesterol and triglycerides have been associated with the use of protease inhibitors, although not everyone has this reaction. In addition to nutrition and exercise intervention, cayenne, seaweeds, garlic, mushrooms (shiitake, maitake, and reishi), soy products, onions, psyllium, guggul or guggulipid, fenugreek, oats, and green tea may help to control fat abnormalities.
Hyperglycemia. High levels of sugar in the blood may be caused by some antiviral medications. Nutrition intervention is essential to control high blood sugar. Some helpful herbs are bitter melon, astragalus, pau d'arco, aloe, dandelion root, burdock, garlic, reishi mushrooms, fenugreek, sage, and ginger. If a person is on insulin or medication to lower blood sugar, herbs can drop sugar levels too low, causing dizziness, blurred vision, mood changes, shaking, or fainting.
Liver problems. Elevated liver enzymes are frequently seen due to current or past liver disorders and the use of certain drugs. The liver acts as a detoxifier or filter for the body. Chemicals ingested, environmental and dietary factors, alcohol consumption and viruses can cause liver damage. Some animal and human case studies have shown some herbs to be beneficial to liver function: milk thistle, bitter melon, licorice, aloe, garlic, turmeric, astragalus, and dandelion root. Silymarin, an active ingredient in milk thistle, helps the body regenerate liver cells as well as ridding the liver of toxins. No toxicity has been found when taken in recommended doses.
Excess mucus production. Try eliminating dairy products (eat other calcium-rich foods and supplement with calcium), substituting with soy products, increasing liquids, taking vitamin C, and avoiding high-sugar and high-starch foods. Poor stomach emptying also contributes to mucus formation and accumulation. Some herbs that may help are stinging nettles, grapeseed extract, curcumin, ginger, sage, fenugreek, and mullein.
Fatigue/lack of energy. These may be due to anemia, lack of exercise, depression, wasting, chronic fatigue syndrome, or a weak immune system. Besides a well-balanced diet, exercise and nutritional supplements, some herbs can help to boost the immune system and contribute to increasing energy levels. Some of these are garlic, astragalus, ginseng, echinacea, burdock root, cayenne, St. John's wort, ginger, ginseng, and red clover blossom.
Difficulty sleeping. The cause can vary enormously: Caffeine-rich foods and beverages, stress, depression, and some medicines can promote wakefulness. Medications could be taken earlier instead of at bedtime. Herbs that will help include valerian, catnip, hops, mint, chamomile tea, chamomile (in tea form, accompanied by massage), passion flower, lemon balm, scullcap (recent reports of toxicity were due to a scullcap product tainted with germander, an herb that causes liver damage).
Aloe vera. Laxative, antiseptic, and anti-inflammatory, aloe is also known by its trade name, Carrisyn, or by the extract name Acemannan. The gel from inside fresh leaves is very good for sunburn and minor burns, and when applied externally it may have antifungal and antibacterial activity. For severe, blistering burns, medical care is necessary; aloe should not be used as it may aggravate the condition by slowing the healing process. Acemannan is the latex, also known as aloe juice, left from the gel once the liquid evaporates. It may have antiviral and laxative properties. It is the latex, or aloe juice, that may cause cramps, or diarrhea, and may aggravate ulcers and other gastrointestinal conditions. Aloe should not be taken with other laxatives or diuretics.
Astragalus root. There are thousands of astragalus varieties grown all over the world. It is the Chinese type, however, that has been studied and tested for its medicinal properties. It contains many active ingredients that appear to help improve immune function, lower blood sugar, counteract the side effects of chemotherapy, increase appetite, alleviate night sweats, protect the liver from toxins and combat tiredness. It is considered a very important tonic herb in China. It can also lower blood pressure and cause dizziness or feelings of tiredness if taken in excess or in concentrated forms.
Bitter Melon. This is a common food in Asia, the Caribbean, and South America. Also known as Chinese cucumber, it has active ingredients that will lower blood sugar, stimulate appetite, and alleviate psoriasis. It has also been used for fighting viruses, parasites, and tumor cells, and for cleansing the liver. Two proteins have been identified in bitter melon that appear to inhibit HIV in lab tests. It is eaten fresh as a vegetable, as a juice extracted from the fresh plant, as a concentrated powdered extract, or as a tincture. As the name implies, its flavor is very bitter. The fresh extracted juice is used by some for a retention enema, but it should be avoided by people with hemorrhoids or anal injuries. It can lower blood sugar levels too much in people taking insulin or medication for diabetes. Avoid if having diarrhea, as it can be laxative.
Echinacea. There is much controversy regarding the use of echinacea in HIV infection. Some experts advise not to take it at all, while others say it is okay if the CD4 cell count is 200 and above, or to take with caution as it is an immune stimulant that can be too strong. Still others see no problem and consider it safe. Most studies have been conducted a while ago in Europe using concentrated active ingredients extracted from echinacea purpurea or pallida (not angustifolia), sometimes taken intravenously. A recent review of all the literature has led many reputable herbalists today to believe that it is safe for people with HIV/AIDS to take echinacea orally for certain conditions, such as at the start of flulike symptoms, or to boost the immune system against other infections.
Garlic. Garlic is known as a "natural antibiotic," "Russian penicillin," and "nectar of the gods." among other nicknames. It has been grown for more than 5,000 years and has been used for centuries for medicinal purposes as well as for religious and ritual ceremonies. Its healing properties include fighting fevers, colds, worms, high blood pressure, high cholesterol, stomach upsets, fungal infections, and blood-clotting problems, among other conditions. It is better to crush the fresh garlic to allow the allicin to be produced, rather than using the odorless capsule form. Allicin is one of the active compounds in garlic responsible for its healing property and for its strong smell. Cooking will destroy some of it, but some beneficial properties remain. Chewing fresh parsley helps to eliminate the strong smell coming from the body after eating raw garlic. A warm bath or shower will open up pores and help the body to eliminate the garlic odor faster.
Gingko Biloba. The leaves of the tree are used. The pulp of the fruit and the seeds are poisonous. Touching either can cause a rash similar to a poison ivy reaction. The seeds must be processed in a particular way before they become edible. Gingko extracts are usually taken instead of capsules or pills because large amounts of the active ingredients are needed to see any pharmacological effect. Gingko is a powerful antioxidant that has a blood-thinning effect. It is used for circulatory problems such as varicose veins and for vertigo, short-term memory loss, and inner-ear problems. It also appears to help asthma, kidney, and immune disorder sufferers. Gingko should be avoided by those taking anticoagulant medication or those with blood-clotting problems. It is wise to avoid if taking aspirin, large doses of vitamin E, or Amprenavir, because of their combined blood-thinning properties.
Ginseng. This has been used in the Orient for over 2,000 years as a tonic for gaining energy, increasing longevity and wisdom, and helping to cure almost anything. It is really meant to promote health, help balance the physical and mental stresses of the body, and build up resistance to illnesses. Chinese, Korean, and American ginseng are three species of the true ginseng. Siberian ginseng has similar effects on the body but is a different plant. Siberian ginseng is reported to help lower cholesterol, blood sugar, and blood pressure, as well as to strengthen the adrenal glands. It is less expensive than the true ginsengs.
Some experts prefer the use of the American ginseng for people with HIV/AIDS, as it is a milder variety. There is great difference in products available; some contain little or no ginseng and as much as 55 percent alcohol. Ginseng can cause diarrhea, insomnia, and rashes in rare cases. Avoid it in heart disease, diabetes, high blood pressure, or if taking anticoagulants, steroids, or tranquilizers.
Guggul or Guggulipid. This is a sticky, yellowish substance from a tree native to India. Guggul is found in standardized or purified extract form, which is known as guggulipid. This is widely available and used in India to treat arthritis and to lower high cholesterol and high triglycerides. It appears to lower LDL, the bad cholesterol, but raise HDL, the good cholesterol. It also appears to prevent or reduce the platelets from sticking to each other, lowering the risk for coronary artery disease.
Guggulipid is better tolerated and more effective than guggul, the crude resin form available in capsules or tablets. It is considered safe; only in a few rare cases, diarrhea, restlessness, hiccups, and mild nausea have been reported when taking guggul, the unpurified form. Those with inflammatory bowel syndrome, diarrhea, or liver problems, should avoid it.
Licorice. One of the most studied herbs, licorice is also one of the most frequently used in Asia to stop smoking and for a large number of conditions, including fungal infections, gastric ulcers, heartburn, sore throats, coughs, colds, and many others besides HIV infection. One of the side effects, especially when taking licorice on an empty stomach or in high doses or for a long period of time, is swelling of the face and ankles, which indicates potassium loss and sodium retention. A cup of licorice tea a day would not be a problem. Taking over three cups a day is not recommended for someone with elevated blood pressure, low potassium levels, kidney or gall bladder disease, arrhythmias, anorexia ,or bulimia. Potassium loss could be compensated by taking licorice with no glycyrrhizin.
Mushrooms. Shiitake and reishi mushrooms have both been used for medicinal purposes throughout Asia for centuries. They have antioxidant activity. Studies show both mushrooms to be very safe to take, but allergic reactions are possible. Shiitake mushrooms are reported to have antiviral, antimicrobial, immune-stimulating, tumor-fighting, and cholesterol-/blood sugar-/blood pressure-lowering properties. They have many nutrients and are widely used in Oriental cooking. They are available fresh or dried to be added to foods. Capsules, tablets, and tinctures are also available.
Reishi mushrooms, also known as Ganoderma mushrooms, are considered the "elixir of life" and were used by Chinese emperors for longevity, energy, and the ability to fight stress and illness. They are used, among many other things, to lower cholesterol and triglycerides, stimulate the immune system, lower blood sugar, control allergies, slow cancer growth, prevent blood clots, reduce inflammation, and protect the liver from environmental toxins. Reishi mushrooms are available mostly in a dried form that can be soaked and used in soups, but they are not as popular in cooking as shiitakes. Reishi mushrooms are mainly found in capsules, liquid extracts, tablets, tinctures, or teabags.
Peppermint. It contains many flavonoids and volatile oils that help with indigestion and other gastrointestinal problems. It soothes and calms smooth muscles. For irritable bowel syndrome in particular, it is recommended to take the enteric-coated peppermint capsules so the active ingredients can reach the large intestine directly. Peppermint tea will also work, but for faster action the enteric-coated capsules may be preferable.
Slippery Elm. The inner bark of the slippery elm tree has been used extensively by Native Americans as a laxative and for coughs, upset stomach, ulcers, diarrhea, etc. During the American Revolution, doctors used it as a poultice to treat gunshot wounds. It has also been used as food in times of hunger or food shortages. Today it is used to soothe irritated mucous membranes of the throat and the digestive system and for diarrhea and constipation. Because the gastrointestinal tract is so adversely affected in HIV infection, some experts believe slippery elm powder should be taken by everyone with the virus to prevent gastrointestinal damage.
St. John's wort. A recent study in England showed that this herb significantly reduced fatigue as well as depression. Two active ingredients, hypericin and hyperforin, are responsible for its healing properties; make sure both are listed in the ingredients of any St. John's wort you buy. Hyperforin may be more responsible for the herb's healing properties. There are no clinical human trials to show that it may help HIV-related depression, but some case reports indicate that it can. Studies using standardized hypericin extract available in Germany suggest that using this herb as an antiviral for HIV/AIDS can have good results. Products found here, however, do not appear to be concentrated enough. Besides increasing sensitivity to sunlight, St. John's wort may act as a diuretic, causing possible loss of potassium and dehydration. It should not be taken with other diuretic or cardiac medications. It can also reduce the effect of chemotherapy and can reverse its effect, so it should not be taken if undergoing this treatment.
Other herbs used in HIV/AIDS. Cat's claw, grown mainly in the rainforest of Peru, has been used there for centuries for rheumatism, gastric ulcers, tumors, and many other ailments. In Europe and the U.S., it became known for its use against cancer and HIV infection. It is not recommended for autoimmune diseases such as lupus and arthritis and tuberculosis.
Fennel seed tea is used for intestinal gas, cramps, coughs, lack of appetite, and poor digestion. Some people may get skin irritations if allergic or sensitive to its volatile oil content.
Pau d'arco is used for fungal infections and to strengthen the immune system. It is also used to lower blood sugar. It can cause hypoglycemia if used improperly.
Sage is used for coughs, phlegm, sore throats, and elevated blood sugar.
The above is intended to be a general overview and guideline, not a prescription for treating any condition. Each case must be treated individually, and always in consultation with a doctor and/or nutritionist.
What to Look for When Buying
Because there is no regulation of herbal products, there can be no assurance that what you intend to buy is what you get. Standardization is the mechanism used in Europe to guarantee that a product contains a certain amount of a properly identified herb and, mainly, that it contains a certain amount of its active ingredient. In this country, however, there is no tight control of this mechanism. Some standardized products here have been found to have less than the concentrations specified on their labels. At least, standardized products assure that the plant has been properly identified. So, buyer beware!
Buy only from reliable sources you trust. Contact the manufacturers and ask how they assure quality control. Ask for a listing of all the ingredients in a product. Check that the manufacturer belongs to the American Herbal Products Association.
Dried herbs should look fresh, clean, and free of bugs. They should retain the strong smell typical of the plant.
Buy whole leaves and flowers, rather than crushed or powdered product.
Keep herbs in dark, covered containers in a cool and dry place, away from sunlight.
Be sure you can identify dried herbs before buying them. Lids with labels can be switched between containers at a store.
If buying capsules or pills, be sure the labels indicate the ingredients and that they list the amount of active ingredients. Look for expiration dates and how to contact the manufacturer.
Freeze-dried herbs keep their potency longer than powdered herbs.
Tinctures are easier to take, but check their label carefully too.
"Wildcrafted" means that the herbs are not cultivated but are grown wild. They usually cost more, but be aware that properties and potency of an herb change due to soil, geographic, and growing conditions. You may be paying more for less potency and properties.
For sound, reliable information on herbal medicine:
The Herb Research Foundation, 1007 Pearl Street, Suite 200, Boulder, Colorado 80302; (303) 449-2265.
The American Botanical Council, P.O. Box 201660, Austin, Texas 78720
The American Herbalists Guild, P.O. Box 70, Roosevelt, Utah 84066
For information on Chinese Herbs and Medicine:
Quan Yin Healing Arts Center, 1748 Market Street, San Francisco, California 94102
Oriental Healing Arts Institute, 945 Palo Verde Boulevard, Long Beach, California 90815
Referrals to qualified herbalists in the United States are available from the above organizations. They can also provide listings of places where herbal products can be purchased. Most products are also available by mail order. Most centers providing HIV/AIDS services, particularly nutrition services, can also provide information and/or referrals on herbal medicine.
There are enormous numbers of publications on herbs. The following books can be good starters and are readily available in most bookstores and in public libraries:
The Complete Medicinal Herbal, by Penelope Ody, has colorful pictures of plants.
Herbal Remedies for Dummies, by Christopher Hobbs.
The Green Pharmacy, by James Duke, also in paperback
The Way of Herbs, by Michael Tierra (1998 edition)
Herbs for Your Health, by Steven Foster
Rosa J. Donohue is a nutrition consultant with Iris House, Inc., St. Vincent's Hospital's Air Bridge Program, Mt. Sinai's HIV Adherence Network Development Program, Community Food Resources Center, and Gay Men's Health Crisis. She divides her time between New York City and Geneva, Switzerland.