Herb Info - Astragalus

by Anthony Thompson

Names Common: astragalus, milkvetch root; Chinese (pinyin): Huang Qi; Botanical: Astragalus membranceus, variants - Astragalus mongholicus (1), Astragalus propinquus (2), Astragalus gummifer (3).

Description

Astragalus is one of the herbs that I often get questions about. Astragalus is in a category of herbs in Chinese medicine that boost immunity. It is not as strong as the more famous ginseng but it is more versatile. It is part of the pea family (Fabaceae) and its root is the part that is used in herbal formulas.

Usage

Traditionally, Astragalus is used to build more energy (Qi) in the body. This is useful in many circumstances. When someone becomes sick easily because their immune system is weak, Astragalus can be used over time to strengthen their immunity. When someone is weak after a serious illness or stroke, Astragalus is used to strengthen the body and promote healing. In such cases, Astragalus is usually used in high doses with other herbs that promote healing. These herbs combine and make the overall effectiveness stronger (4). Research in China has shown that Astragalus stimulates the production of blood cells (both red and white blood cells), decreases blood pressure and protects the liver from damage (5).

Modern research in the West has focused on the immune building properties of Astragalus, where it is being used in cancer research and for treatment in HIV/AIDS (6). In the West, awareness of this herb is gradually growing and therefore, more and more research is being done. In the next few years, we should have a more complete understanding of the effectiveness of this herb.

Safety

The relative safety rating is safest (7). In traditional usage the maximum dosage was 120g, which is quite high. There is no standard dose and dosage recommendations vary widely.

There a few drug interaction concerns that you need to be aware of. Astragalus may affect the peripheral circulation, so if you are taking anti-hypertensive medications, consult your physician. Also, there is a possibility that Astragalus may affect immunosuppressant drugs and those with autoimmune diseases. This possibility is only theoretical but you will want to consult a professional if you are taking these drugs or if you have an autoimmune disease (8).

The Word on the Street

I feel that Astragalus mostly lives up to its advertising. I see it being advertised as an energy tonic or immune booster, which are its main uses. Since it is a relatively safe herb and it is being used for what it is meant to be used for I have few concerns. My only concern is that in cases where someone has an autoimmune disease or someone is recovering from a serious illness or accident, Astragalus needs to be taken under supervision so that it is administered properly and effectively.

Sources

1. Chen J, Chen T. Chinese Medical Herbology and Pharmacology. City of Industry: Art of Medicine Press; 2004: 847.
2. Astragalus membranaceus. Wikipedia web site. accessed April 27, 2009. available at http://en.wikipedia.org/wiki/Astragalus_membranaceus.
3. Skidmore-Roth L. Mosby’s Handbook of Herbs and Natural Supplements: Third Edition. St. Louis: Elsevier Mosby; 2006: 67.
4. Chen J, Chen T. Chinese Medical Herbology and Pharmacology. City of Industry: Art of Medicine Press; 2004: 848-850.
5. Ibid: 850-851.
6. Skidmore-Roth L. Mosby’s Handbook of Herbs and Natural Supplements: Third Edition. St. Louis: Elsevier Mosby; 2006: 68.
7. Chen J, Chen T. Chinese Medical Herbology and Pharmacology. City of Industry: Art of Medicine Press; 2004: 852. [tested in mice with intraperitoneal injection: LD50 40 g/kg]
8. Skidmore-Roth L. Mosby’s Handbook of Herbs and Natural Supplements: Third Edition. St. Louis: Elsevier Mosby; 2006: 69.

Herb Info - Safety Ratings

by Anthony Thompson

This post is information that will support future posts on specific herbs. One problem with most information I find about herbs is that there is little relevant discussion on the safety of herbs. Most web sites, blogs or books talk a lot about the benefits of herbs or about the possible dangers of herbs but none of this discussion is framed in a context that gives consumers an easy way to compare various claims. While therapeutic effectiveness and dangerous side effects are important, there is a way that we can look at the safety of different herbs in relation to each other and in relation to other substances, including pharmaceuticals. There is an internationally recognized system of testing for toxicity (hence relative safety) of any substance. This system is called LD50 testing.

LD50 Testing

LD50 is a form of testing, usually performed on rats or mice, that determines the relative toxicity of a substance. The animals are given varying high doses of the test substance. The LD50 level is the dose that is lethal for 50% of the population. (Wikipedia 2009) Though this is certainly cruel for the rats and mice, it provides researchers with a valuable tool. They can look at these numbers and see how toxic different substances are in relation to each other. We can use these same numbers to compare the safety of various herbs in relation to each other and other substances.

A Relative Safety Rating

I am going to use these numbers to set up a rating system in simple English to show how safe substances are relative to all others. First, let's look at some of the details. An LD50 rating is expressed as number of grams or milligrams per kilogram. This is the dosage amount of a substance required per kilogram of body weight to produce death in 50% of the population. Here's an example; caffeine when tested in rats has LD50 rating of 192 mg/kg. (Wikipedia 2009) That means that if you give a dose of 192 mg/kg of caffeine to any population of rats, half (50%) will die. So how do we translate these numbers into a meaningful rating system, below I have broken down the LD50 ratings into five broad categories with a descriptive title for its relative safety.

1. Safest - these substances have an LD50 of greater than 10,000 mg/kg (10g/kg). In this category are water, table sugar and vitamin C. It would be very difficult to maintain doses high enough to be lethal with these substances. It is possible but highly improbable because most of these substances can be quickly broken down and excreted from the body.
2. Safe with proper use - these substances have an LD50 of greater than 500 mg/kg (0.5 g/kg) but less than 10,000 mg/kg (10/kg). Ethanol (grain alcohol), table salt, many pharmaceuticals and most medicinal herbs fall into this category. With these substances you need to know what dosage is safe and stick to it. If you are not sure what is safe, consult a professional.
3. Safe with supervision - these substances have an LD50 of greater than 100 mg/kg (0.1 g/kg) but less than 500 mg/kg (0.5g/kg). These are generally pharmaceutical substances that require a prescription. You will want professional supervision to determine dosing.
4. Dangerous - these substances have an LD50 rating of greater than 1 mg/kg (0.001 g/kg) but less than 100 mg/kg (0.1 g/kg). Many of these are poisons but some pharmaceutical drugs also fall into this category. They should only ever be used under strict supervision.
5. Extremely dangerous - these substances have an LD50 of less than 1 mg/kg (0.001 g/kg). Most of us will never have access to anything this toxic. These substances are strictly regulated in most countries. The one that everyone seems to know these days is Botulinum toxin (Botox), which is so toxic that its LD50 level can only be estimated. (Wikipedia 2009)

This rating will appear only to give readers a general idea of the safety of a particular herb. There are, of course, specific safety considerations for each herb that should also be taken into account. Examples are possible drug interactions and possible side effects of the herbs themselves. These must be weighed along with the relative safety rating when considering if an herb might be helpful for you.

Source
Median Lethal Dose. Wikipedia web site (English version): 2009. Available at: http://en.wikipedia.org/wiki/LD50. accessed April 24, 2009.

Supplements: know what you are taking

Dietary and herbal supplements are widely used in the U.S. and poorly regulated. This poses some serious risks to consumers. As an herbalist with many years of training, I find that there are few in the general public, including MD’s, nurses and other health-care professional, that have even a fundamental understanding of what herbal medicine is; its potential and its dangers. The gamut of opinion seems to rest around two misguided extremes. One is that herbs are generally safe and can therefore be taken without professional guidance. The other is that herbs are completely unsafe because we don’t know how they work from a scientific point of view. Both opinions are wrong because research on herbs has been ongoing for many years, although the U.S. lags behind much of Europe in this respect. Also, herbs are therapeutically effective, so just like pharmaceuticals we should have at least some basic information available to all health care providers. With so many people consuming these supplements it is unacceptable that there is not at least a rudimentary course offered to all health care providers. So how did we end up with this problem and how can you as the consumer avoid its pitfalls?


Regulation History

First, just a brief history of regulation in the U.S. In 1938 the congress passed a law (the Federal Food, Drug and Cosmetic Act) that required animal testing for drugs, placed cosmetics and medical devices under FDA regulation and added many more layers of safety regulation to the U.S. food industry. Dietary supplements were defined under this act and were regulated as food. This meant that they could not be misleading in their labeling and that they had to meet standard safety requirements (FDA 2009 [1]). In 1994, a new law, the Dietary Supplement Health and Education Act was passed. This law took some small steps to “legitimize” the claims of dietary supplements and changed the safety regulations slightly. The manufacturers could now make general claims about the product’s affect on health if they are substantiated but could not make any claims that it could be used to “diagnose, prevent, mitigate, treat or cure a specific disease” (FDA 2009 [2]) This is the reason that we are in a sort of limbo when it comes to herbal and dietary supplements. It also explains the scarcity of good information that is available to us as consumers because there is little basic research being done on dietary supplements. There is little incentive to prove therapeutic value when no claims can be made.

How to be an Informed Consumer

As consumers we need to know some basic facts when taking dietary supplements or herbal medicines. These facts are the same as those for drugs; how much do we take, how often, what are the possible side effects, are there any dangers when taking the supplements while taking other supplements or drugs? Many of these questions are difficult to answer because the basic research that is needed to answer those questions has not been done. However, there are some good resources out there that can fill in some of the gaps. The following resources are intended to give you some idea of the potential benefits and hazards when taking supplements, so that you can some background information before discussing with your health care providers what supplements will work for you.


http://www.naturalherbsguide.com/

This web site offers good information on the individual herbs, the active compounds in the herbs, common ways of taking the herbs and standard dosages. I also like that it allows you to search through several different pathways, including Ayurvedic (traditional Indian medicine) and Chinese herbs.

http://altmedicine.about.com/

This is one of the best sites I have seen for information on supplements. It is moderated by Cathy Wong, an author and naturopathic doctor. This is the most extensive list of supplements that I have seen online. It offers good information on potential uses and potential dangers of using various supplements. The only downside is I wasn’t able to find much information on recommended dosages.

http://nccam.nih.gov/health/herbsataglance.htm

This site offers basic information on several herbs, including some background information on what research has been done. I found that this site is heavy on the side effects/caution side but doesn’t offer a lot of other relevant information.

http://www.nutrametrix.com/balanceaom

This is a link from my web site, balanceaom.com to nutraMetrix, a nutraceutical line that we carry in our clinic. I like this site as an information site because they offer extensive information about ingredients, dosage, what it used for, what are the risks and what scientific research has been done (both in the U.S. and Europe). It is also easy to find the type of supplement that you want because the products are listed by general categories (e.g. heart health).

I know many of my readers may have other valuable resources, if so please send a comment. Also, I would love to hear from readers if you have a specific herb or supplement that you want more information on. You can go to my website and submit a question, I will happily include it in my future blog posts on specific herbs/supplements.


Sources

1. U.S Food and Drug Administration (FDA). The Story of the Laws Behind the Labels. USFDA Center for Food Safety and Applied Nutrition web site. 2009. Available at: http://www.cfsan.fda.gov/~lrd/histor1a.html. Accessed April 14, 2009.
2. U.S Food and Drug Administration (FDA). Dietary Supplement Health and Education Act. USFDA Center for Food Safety and Applied Nutrition web site. 2009. Available at: http://www.cfsan.fda.gov/~dms/dietsupp.html. Accessed April 14, 2009.

The Foundation of Health: Conclusion

When I ask my patients about their diet and exercise routines, I often get a long list of all the healthy things they are doing to stay in shape. Of course, like a boss hiring new employees, I realize that this "resume" is only part of the story. Obviously, though we don't exercise nearly as often as we should or eat as well as we would like to, we are reluctant to admit it. However, this can be a big obstacle to our improving our health because we hide our own bad habits, even from ourselves. So in this final entry on the foundation of health, I would like to take some of the mental aspects of how we deal with our health habits and flip them over, so we can have a more positive approach.

Bill Moyers had an interview on PBS this past year with Michael Pollan. Mr. Pollan is the author of An Omnivore's Dilemma and recently, In Defense of Food. In his interview, he had two main recommendations for people who wanted to improve the food they were eating and the national food system, learn to cook and grow a garden. I was amazed at the Zen nature of his recommendations. For though it sounds simple, it would be a tremendous shift if we were all to start cooking for ourselves and to start growing some of our own food. His biggest rationale behind these recommendations is that it would give people an opportunity to compare quality, home-grown, home-cooked meals with what we normally eat now, which is not nearly of the same quality. It is a good idea, but a difficult one to implement. Cooking and gardening can take some time, especially if you have never done it before. It is a good starting point, though. These are just some ideas for adventures in healthier living.

In a previous post, I gave some ideas for improving your general diet plan. Now I would like to look at some longer-term "lifestyle adventures". First of all, I think we should all remember that the most successfull long term plans often start out with little baby steps. Why? Because those little baby steps add up over time and pretty soon we can see that we are making real progress. So before we all plant victory gardens and start planning our daily menus for the next year, I would like to recommend a few baby steps.

• Grow a few potted vegetables and herbs to use in your cooking. Roma tomatoes can be grown indoors if you have enough light and they make a great addition to many dishes. In addition, you get to taste a real tomato!
  
• Find four healthy meals that you can make at home and become an "expert" at preparing them. Make one meal per week.

Making little changes like this can motivate you to make bigger changes down the road. One last note here. Let's not beat ourselves up when we don't eat well. We should simply note that we could have eaten something better. On the other hand, when we eat a delicious and nutritious meal we should pause for moment of thanks and congratulate ourselves for doing the right thing. I know this sounds hokey, but try it for a month and see if you don't notice what your eating that is good and what is not.

Exercise, which was discussed in the last post, is much the same way. Before we set out to climb Mount Everest, we should probably get a few day hikes under our belts. The flip-side of that coin is that if you start doing a day hike here and there, pretty soon you are looking for bigger adventures. As we improve our physical health, our mind starts to dream of greater challenges and this is a good thing. It is what truly keeps us young.

What exercise is the best for you? I think it is the exercise that motivates you to do more, to dream of bigger challenges. That will be different things for everyone, whether that is running in the next marathon or taking that long hiking trip or playing basketball with your friends, doesn't really matter. What does matter is that it is an activity that you love and one that motivates you to stay active. If you wake up and tell yourself grumpily "I have to go running today so I can stay in shape", then I would say that running isn't the activity for you. On the other hand if you wake up excited about taking your morning run because you know it makes you feel so much better throughout the day, bravo! Activities, of course, may change over the course of our lives, but we can stay active throughout our lives if we are careful to maintain the three-legged stool I mentioned in the last blog. Always include cardiovascular training, strength training and stretching in your overall exercise routine. Remember, good health is the foundation of a happy life!