Controversy is no stranger to vitamins and herbs, albeit there are periods of more and of less attention. Popular news sources recently have been making much of a couple of issues: To start, there has been a regular drumbeat regarding the uselessness of vitamins, either alone or in combination, for either preserving or improving health. Multi-vitamin/mineral supplements are common targets, but so are vitamins such as vitamin D and a number of popular herbs. Next, we are warned routinely of possible interactions between various supplements, especially herbal extracts, and prescription drugs. In particular, blood-thinning medications and certain immuno-suppressants used to treat HIV have been emphasized as being incompatible with a number of popular plant products, including St. John's wort and Chinese ginseng. Both sets of issues are real, to be sure, and need to be considered for safety's sake. Nevertheless, the ensuing controversy over supplements is perhaps just as important for what it reveals about American dietary and other habits as for what it reveals about the safety of vitamins and herbs.

In point of fact, many common foods have as great or greater an impact upon numerous medical conditions as do the vitamins and herbs that have been singled out. Examples of this will be given shortly. In considering these examples, the reader should be aware they are not exhaustive. They are being offered as evidence for a number of points worth pondering. First, what is revealed by the current focus upon the medical interactions of popular supplements? Second, if quite a number of foods pose the threat of similar interactions, does a lack of focus on or concern with dietary factors suggest that the diet of the average American is highly restricted in terms of food choices? Third, is it the case that many conditions for which drugs are readily prescribed for chronic use in this culture might be better treated by simple changes in the diet and/or the use, as first choice, of vitamins, herbs and other supplements which have negligible side effects?

Vitamin D One More Time
TotalHealth magazine over the past few years has been vigilant in examining controversial attacks on vitamin supplements and it is disappointing to many of us that wrong-headed analyses continue to be picked up and presented uncritically by both professional journals and the popular press. USA Today (January 23, 2014) is a good example of this as it states unambiguously that studies and reviews of vitamin D have found no "significant benefits for heart health, cancer prevention or even bone health in healthy people." The journal article that prompted these comments, large meta-analysis just published in the British medical journal Lancet is blunt in its assessment of vitamin D:¹ "Available evidence does not lend support to vitamin D supplementation and it is very unlikely that the results of a future single randomized clinical trial will materially alter the results from current meta-analyses."

The response from a number of primary vitamin D researchers to this and other recent meta-analyses has been withering. This includes the remarks of Dr. Michael Hollick, the scientist responsible for identifying the major circulating form of vitamin D in serum —25-hydroxyvitamin D3—which is the form of vitamin D measured medically to assess vitamin D status. Dr. Hollick terms the recent papers flawed and "silly." Dr. Hollick's views are reported by Dr. Mercola at his website (http://articles.mercola.com/sites/articles/archive/2014/02/17/vitamin-d-supplements.aspx) which provides an elaborate critique of the recent vitamin D papers. Another researcher who roundly dismisses the recent studies is Dr. Cedric Garland of the University of California at San Diego Moores Cancer Center. His comments cover both the Lancet paper already mentioned and another recent meta-analysis:

This meta-analysis is nothing new and is already obsolete since it is mainly based on old papers that used too little vitamin D to expect any effect. A New Zealand study saying we should only supplement people with vitamin D deficiency and evidence of bone loss is equally wrong. Virtually everyone in New Zealand, and most adults in the U.S., are vitamin D deficient by modern criteria, being below 32 ng/ml.

The reality is that we now know that they are deficient with regard to extraskeletal effects of 25(OH)D if their serum level is below 40 ng/ml. These papers should be disregarded as obsolete work. We are moving into a new era of using vitamin D3 in doses no less that 4,000 IU/day for people aged 9 years and older... Studies using less than 4,000 IU/day are on the verge of obsolescence.

In other words, the studies culled and used as the basis of the recent meta-analyses of vitamin D were themselves inadequate because designed around totally inadequate vitamin D daily dosages. Moreover, one does not need to look far for at least one very major review that disagrees with the conclusions of the negative meta-analyses in the most fundamental way. A Cochrane review published just this year on vitamin D and mortality gives an answer that seems more than sufficient to warrant another look at vitamin D, at least in its D3 form:²

Vitamin D3 seemed to decrease mortality in elderly people living independently or in institutional care. Vitamin D2, alfacalcidol and calcitriol had no statistically significant beneficial effects on mortality.

Blood Thinning Drugs
Another point of current controversy involves both vitamins/ vitamin-like compounds and various herbs. Many aging individuals are treated with anti-coagulants or "blood thinners" to reduce the risks of stroke and blood clots. One popularly prescribed such drug is Coumadin (warfarin). Drug interactions with any of the anticoagulants are quite common, including with such everyday items as alcohol and aspirin. The usual side effects involve too free bleeding and show up as such things as easy bruising, frequent nosebleeds, dark urine and tarry stools. Needless to say, excessive bleeding can be life-threatening under certain conditions. Interactions with anticoagulants are so common that some pharmaceutical experts caution against taking any new drug, including overthe- counter items such as aspirin, without first speaking with a doctor or pharmacist.

Ginkgo biloba extracts, particular examples of which in a number of clinical trials currently are being reaffirmed for cognitive health (but only in the case of certain extracts)3, possibly present a problem for those taking anticoagulant drugs largely because these extracts perform many of the same tasks as those drugs and much more. Ginkgo extracts improve the blood flow through the artery which serves the heart, improve circulation in the brain and more generally throughout the body, increase the clearance of toxins from the system, and protect the body against what is known as platelet-activating factor (PAF). PAF was only discovered in 1972, and since that time scientists have come to realize that it is involved in disturbances ranging from internal blood clots (often leading to heart attacks and strokes) to allergic reactions and asthma.⁴

Problems with excessively "sticky" blood are much more common in the United States than they are in many other countries around the world, such as in Japan. Diet appears to be by far and away the most significant factor in this. A quite large number of foods "thin" the blood. Food sources of omega-3 fatty acids, which include many coldwater ocean fish as well as walnuts and a few other items, all tend to increase clotting time. All members of the onion and garlic families act as blood thinners, especially if eaten regularly and in quantity. The same is true of the mo-er (black tree fungus) and reishi mushrooms, both of which can be purchased in markets, which carry specialty mushroom and Asian vegetables. Another natural blood thinner is hawthorn. Hawthorne, which is found primarily as an extract in this country, is the basis for some popular beverages in Asia and often taken as a tea in Europe. Red wine, especially if it is high in the antioxidant resveratrol, may increase coagulation time. The quinine found in tonic water will increase or prolong the actions of Coumadin and may have its own blood thinning effects. Grapefruit is notorious for reducing the clearance of warfarin-like compounds and therefore increasing the risk of hemorrhage.^5,6

A great many herbs, spices and digestive aids can exercise significant anticoagulant effects. These include cayenne pepper, bromelain from eating pineapple fruit and stem, papain from papaya, and likely paprika and most chili peppers. Ginger root, which is eaten in quantity in Indian and Oriental cuisines, can strongly inhibit clotting. So can its relative, tumeric, which is used widely in curries and a source for purified curcumin. Vitamins and vitamin-like compounds, as mentioned above, can lead to similar problems. These compounds include vitamin E, tocotrienols, omega-3 fatty acids, lipoic acid and many more.

Both Chinese and Indian (Ayurvedic) medicine would greatly expand these lists of foods and herbs which can increase clotting time, but, even as things stand, it should be clear that diet likely is the predominant factor by far in determining the activity of several elements in the blood which control clotting time. Of course, there are at least as many dietary factors which can influence blood coagulation in opposition to Coumadin as those which are additive.

Changing the Rate of Drug Clearance
Many drugs (including some protease inhibitors, calcium channel blockers, and oral contraceptives) are metabolized by the cytochrome P450 3A4 (CYP3A4) metabolic pathway, which is active in the liver. Grapefruit has already been mentioned as influencing this pathway; it contains the compound naringenin, which is one of the most powerful of common compounds in affecting CYP3A4. The herbal supplements, which presently are the most strongly implicated are goldenseal (Hydrastis canadensis), St. John's wort (Hypericum perforatum), and cat's claw (Uncaria tomentosa).⁷ Black pepper extracts, similarly, influence cytochrome P450 and other elements involved in drug clearance.

The ability to zero-in on this enzyme system through special research techniques, unfortunately, in many ways is a bit misleading. How much difference does it make in practice whether the clearance of a drug is delayed as opposed to its absorption being greatly enhanced? Black pepper, cayenne pepper, ginger and long pepper all either strongly increase absorption of other compounds and/or influence cytochrome P450. Some sources of lecithin, such as eggs, may similarly increase the uptake of certain drugs. Alcohol typically enhances the effects of many drugs, whether by increasing absorption, producing its own additive effects, or delaying clearance.

Quite a remarkable number of items in the diet can interfere with many drugs. Some interfere directly with absorption, as do the tannins and fibers found in many fruits and vegetables. Others do so indirectly by activating overall metabolism, liver and/or kidney functions.

Why Look to Dietary Choices Last?
Herbs, of course, do have many powerful effects upon the body and should not be treated as if they are innocuous merely because they are "natural." However, also missing in American culture at large is an awareness that it is relatively easy to intervene in many common conditions without resorting to prescription drugs. In point of fact, other than a quite narrow range public health messages regarding primarily fats and fiber in the diet, we do not tend to think of diet as having much of an impact upon health at all. There is no reservoir of knowledge in everyday American culture regarding the health uses of foods and herbs, unlike the cultures of Asia and even Europe. Moreover, the U.S. heavily subsidizes the growth and production of many foodstuffs used in "fast foods" (corn, wheat, sugar beets, etc.) while doing nothing to reduce the cost to consumers for fresh fruit and vegetables, i.e., items that are healthful rather than being merely sources of calories.

Indeed, there are entire classes of medications sold extremely widely in the United States for which there appears to be no need in many other cultures. One class which immediately comes to mind is that of the acid reflux / heartburn /antacid medications, whether over-the-counter or prescription. The entire notion that there are health problems stemming from the production of excess stomach acid is surely an odd one given the fact that we typically have no such problems when we are young and produce plenty of stomach acid, yet such problems in this culture are common in middle age and later, i.e., at the point at which the ability to produce stomach acid has already begun to decline markedly. What has really happened is that the muscle that closes off the top of the stomach and prevents its contents from flowing back up the esophagus has weakened. Items that reduce the production of stomach acid at the same time prevent the complete digestion of proteins in the stomach, but, again, do nothing to strengthen the muscle that controls acid reflux. Interestingly enough, acid reflux is virtually unknown in much of Asia where ginger is commonly used as a part of meals. Ginger just happens to strengthen the esophageal sphincter.

This returns us to our starting point. Were the average American consuming a truly varied diet, the American medical profession likely would be more aware of the impact of foods upon health. Likewise, there is the curiously dichotomous thinking of many of those who are medically trained to the effect that herbs are either without any benefit, on the one hand, or likely to be a threat to prescribed pharmaceutical drugs, on the other hand. According to this way of thinking, items are either foods or drugs. Foods support the structure and functions of the body, whereas drugs intervene. As long as herbs could be seen as being without effect, they could be relegated largely to the foods category, i.e., at best innocuous and a waste of money in terms of health benefits. Once it is admitted that herbs might have benefits, they must be treated like drugs and viewed as possessing a host of powerful side effects and drug interactions.

The problem is that even everyday foods can have quite powerful effects upon the body. So why not make use of these food effects as a first line of treatment, herbs as a second line, and drugs only when all else fails?

References

1. Reid IR, Bolland MJ, Grey A. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet. 2014 Jan 11;383(9912):146-55.
2. Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, Bjelakovic M, Gluud C. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev. 2014 Jan 10;1:CD007470.
3. Lewis JE, Melillo AB, Tiozzo E, Chen L, Leonard S, Howell M, Diaz J, Gonzalez K, Woolger JM, Konefal J, Paterson E, Barnes D. A double-blind, randomized clinical trial of dietary supplementation on cognitive and immune functioning in healthy older adults. BMC Complement Altern Med. 2014 Feb 4;14(1):43.
4. Murray, Michael T. "The Healing Power of Herbs," 2nd edition (Prima Publishing, Rocklin, California: 1995.)
5. Brinker, Francis. "Herb Contraindications and Drug Interactions." Revised 2nd edition. (Eclectic Medical Publications, 1998.)
6. Mindell, Earl and Hopkins, Virginia. "Prescription Alternatives." (Keats Publishing, 1998.)
7. Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine. 2000;7(4):273-82.
8. Yeshi Donden. "Health Through Balance." Snow Lion Publications, 1986.)

Four humble herbs with an impressive history for helping people to improve their health and overcome disease include burdock root (Arctium lappa L.), sheep sorrel herb (Rumex acetosella L.), Indian rhubarb root (Rheum officinale L.) and slippery elm bark (Ulmus rubra Muhl.). A traditional herbal formulation made with these four herbs is gaining recognition as a good remedy for treating a wide range of health problems. The below information covers some of the impressive research on these four herbs and helps to shed light on how this synergist blend can afford so many profound health benefits.

BURDOCK ROOT(Arctium lappa L.) Not far from your doorstep, if you look, you can usually find the soft green leaves of burdock, common in most neighborhoods— and based on much scientific and historical data, the root of this plant can dramatically enhance your health by boosting your immune system, improving digestion and thwarting cancer in many different ways. Regularly incorporating burdock root in your daily regime may even be able to increase your lifespan based on anti-aging results found with animals. There are many other documented and accepted health benefits of regularly drinking burdock root tea based on the German Pharmacopoeia, including the relief of gastrointestinal complaints and bone and joint conditions.

Burdock root, also known as gobo or Poor-man’s potatoes, is an important food in Japan known for its many healing properties. Burdock root can safely be eaten as a root vegetable and is popularly eaten by Japanese people and sushi lovers of all nationalities. When grown in loamy soil, the root grows into a very long, creamy colored tap root similar in appearance to a carrot but much longer. It can grow deeper than most root veggies and is known as a good source of trace elements and minerals accessed from deeper soil layers. Unlike carrots and potatoes, burdock root does not contain starch it contains complex carbohydrates called fructo-oligosaccharides (FOS) including 27–45 percent inulin. When people eat starchy roots, this causes a sharp rise in blood sugar and blood insulin levels. But burdock root provides the body with soluble fibers that do not affect blood sugar or blood insulin levels. This makes burdock root and FOS particularly beneficial for diabetics. FOS and inulin have many scientifically documented health benefits including acting as a beneficial prebiotic by feeding beneficial intestinal microflora (BIM) while also eliminating potential gut pathogens, optimizing colonic pH, boosting bone strength through increasing calcium and mineral absorption from food, supporting serum enterolactone and enterodiol concentrations, helping to control blood sugar levels and reducing cholesterol. Other foods that contain inulin include chicory root, onions, Jerusalem artichokes and bananas.

According to Bengmark (2005), researching out of the Institute of Hepatology, University College, London Medical School, U.K., inulin has prebiotic qualities and can affect intestinal immune cells and potentially repair the gut wall and thereby improve overall immune function. Several recent scientific studies have documented significant immune-enhancing effects of inulin and oligofructose.

Taking herbal formulas that contains burdock root, rich in natural oligofructose and inulin, have been found to afford many digestive benefits and favorable results have been shown with a number of digestive disorders according to Tamayo and colleagues (2000).

SHEEP SORREL (Rumex acetosella L.) Sheep sorrel is a common herb found abundantly at roadsides and is otherwise known as sour grass because of its tart leaves. The leaves are popularly used in herbal teas for rejuvenating health and cleansing toxins from the body. Sheep sorrel has powerful phytoestrogen activity (phytoestrogen means plant-estrogen) based on in vitro studies conducted by U.S. hormone researcher, Dr. David Zava in 1998. Sheep sorrel came in tenth out of 150 herbs tested for phytoestrogen activity; the list was headed by soy beans, licorice root and red clover herb, all legumes wellknown for their phytoestrogen activity.

Sheep sorrel is an important component of ESSIAC® tea and products, together with three other herbs, burdock root, slippery elm bark and Indian rhubarb root. Early research on sheep sorrel herb by famed Canadian nurse Rene M. Caisse and R.O. Fisher, M.D., in Ontario in the 1920s and 30s, found that sheep sorrel liquid extract given to mice with artificially induced tumors caused cancerous tumors to markedly regress and disappear. The other herbs in ESSIAC were said to help with cleansing and eliminating the dead cancer cells and other toxins from the system. Nurse Rene Caisse also reputedly had success with treating cancer patients with ESSIAC together with sheep sorrel extract—including one case cured and two cases improved accepted by a Cancer Commission set up by the Canadian Government in the 1939. There are many more anecdotal reports and some well documented cases of success with ESSIAC for dramatically improving people’s health very quickly.

Human clinical studies with other phytoestrogen-rich foods and herbs, such as flaxseed and red clover, have also produced profound anti-cancer results. For instance, clinical studies with breast cancer patients given muffins containing 50 grams of ground flaxseed daily (flaxseed contains phytoestrogens called lignans in its seed coat) versus placebo muffins (without flaxseed) conducted by Dr. Paul Goss, Dr. Lilian Thompson and colleagues in 2000 at the Princess Margaret Hospital in Toronto, Canada, and a further clinical study conducted by these same researchers with post-menopausal breast cancer patients taking 25 grams of flaxseed daily documented significant anti-cancer effects within 30 to 40 days. A study done with a prostate cancer patient in Australia reported by Dr. Fredrick O. Stevens (1997) and a further randomized, placebo-controlled clinical study with prostate cancer patients conducted by Dr. Jarred and colleagues in England (2002) using red clover isoflavonoid extracts (160 mg/daily for only seven days in the case study and for 30–40 days in the clinical trial) have documented strong anti-cancer effects for red clover isoflavonoid phytoestrogens within days/weeks based on tumorectomies. There were no serious negative side effects noted in any of these studies.

Foods and herbs rich in phytoestrogens, such as flaxseed (lignans), burdock root (isoflavones), burdock seed (lignans), milk thistle seed (lignans), red clover (isoflavones), soybean (isoflaonves), kudzu root (isoflavones), etc., once eaten, are metabolized within the gut by beneficial intestinal bacteria and the isoflavonoids and lignans that they contain significantly increase serum enterolactone and enterodiol concentrations. According to research conducted by the Australian company, Novogen, certain phytoestrogen metabolites function to inhibit anti-apoptosis proteins in cancer cells thereby causing cancer cells to go through apoptosis or programmed cell death without harming normal cells. Simply put, phtoestrogen-rich foods and extracts can cause cancer cells to simply die and be cleansed from the body without causing terrible side effects. Many phytoestrogens have also been shown to stimulate beneficial anti-cancer enzymes. The powerful and safe anti-cancer activity of phytoestrogen-rich foods and herbs may help to explain the myriad anecdotal reports of spontaneous remissions in cancer patients and miracle cancer cures documented over the centuries with various herbs and herbal combinations. More research is needed in this area to clearly define the anti-cancer activity of different phytoestrogens.

Many foods, herbs and supplements contain beneficial phytoestrogens and other natural anti-cancer compounds that help to balance hormones in different ways. Sheep sorrel appears to be one that may have great promise for cancer patients. Further human clinical studies with sheep sorrel are needed to confirm the beneficial estrogen modulating and anti-cancer activity of its phytoestrogens and other active ingredients.

SLIPPERY ELM INNER BARK
(Ulmus fulva Michx. and U. rubra Muhl.) Slippery elm bark has a long history of use as a medicine and also as a food that can be eaten like gruel and is commonly made into lozenges for sore throats and coughs. The inner bark of this tree has been used as folk remedy for treating cancer and other conditions including: respiratory problems, throat irritation, fever, abscesses, dysentery, urinary and kidney inflammations.

Choi and colleagues (2002) at Pusan National University in Korea studied slippery elm bark and found that it exhibited dose-dependent peroxynitrite scavenging activities. According to Langmead and colleagues (2002) at the Academic Department of Adult and Paediatric Gastroenterology, London, U.K., slippery elm bark also exhibited potent antioxidant activity using in vitro tests based on chemiluminescence used to detect herbal effects on generation of oxygen radicals by mucosal biopsies from patients with active ulcerative colitis. These researchers concluded that slippery elm and other herbal extracts merit formal evaluation as novel therapies in inflammatory bowel disease.

Lans, Turner, Khan and Bauer (2007) report the use of Ulmus fulva Michx. in ethnoveterinary medicines used to treat endoparasites and stomach problems in pigs and pets in British Columbia, Canada. The authors note that Ulmus fulva, along with other plants used for this purpose, have mid- to high-level validity for their ethnoveterinary use as anthelmintics (deworming agents).

Five case studies of patients with psoriasis following a dietary regimen including a pinch of slippery elm bark taken daily with meals found relief of symptoms according to Brown and colleagues (2004) at the University of Hawaii at Manoa, Honolulu, U.S. The five psoriasis cases, ranging from mild to severe at the study onset, improved on all measured outcomes over a six-month period.

INDIAN RHUBARB ROOT
(Rheum officinale L.)
Michael Castleman in his book, Medicinal Herbs describes rhubarb (medicinal rhubarbs, Rheum officinale and R. palmatum; and garden rhubarb, R. rhaponticum noted as having similar but less powerful action) as an odd plant: its roots are medicinal; its stems make tasty pies but its leaves are poisonous. He also notes that Chinese physicians have used rhubarb root since ancient times prescribing it externally as a treatment for cuts and burns and internally in small amounts for dysentery while large amounts have powerful laxative action. Formerly, the root was an important drug in many army camps, said to stop dysentry in its tracks. The active ingredients of Indian rhubarb root include emodin and aloe-emodin, rhein and other anthracene derivatives.

Conclusion: According to many studies, adding a time-tested herbal formula with these humble herbs to your daily menu may bring a boon to your health resulting in many immediately noticeable benefits to your well-being.

Formal clinical trials are warranted to evaluate the real anticancer effects of formulas containing these four herbs. Such clinical studies need to be carefully designed, placebo controlled clinical trials with cancer patients scheduled for tumorectomies but not receiving chemo or radiation, in order to avoid confounding variables from these treatments (i.e. similar in design to studies assessing the anticancer effects of flaxseed and red clover).

For references send a S.A.S.E. to totalhealth.