Medicinal herbal extracts - renal friend or foe? Part one: The toxicities of medicinal herbs

In recent years, an increasing percentage of people from industrialized countries have been using complementary and alternative medicines (CAM). This, combined with numerous warnings regarding the potential toxicity of these therapies, suggests the need for practitioners to keep abreast of the reported incidence of renal toxicity caused by the ingestion of medicinal herbs. The goal of the present two-part series, on the toxic or beneficial effects of medicinal herbs on renal health, is to provide practitioners with a summary of the most recent information as well as the means by which evidence for benefit or toxicity has been found. In this first article, we explore in vivo evidence of toxicity. Included are nephrotoxicity from aristolochic acid and other components within herbs, herb-drug interactions resulting in adverse renal effects, and renal toxicity from contaminants within the extracts. The review aims to provide a guide to encourage future toxicity studies and rigorous clinical trials.

Health characteristics of older Australian dietary supplement users compared to non-supplement users

The aim of this study was to measure the prevalence of dietary and health supplement use among Australians aged 65 years and over, and to contrast the health differences between supplement users and non-supplement users. Data was obtained from 1,263 randomly selected older Australians, who provided general demographic data, in addition to information related to their health, symptoms experienced and uses of medication, including dietary supplements. Supplement use was reported by 43% of the sample (52% of females and 35% of males). This investigation has revealed distinct differences in the health profile of older supplement users compared to non-users. Although there was no difference in the number of visits to medical doctors or self-rated health status between supplement users and non-supplement users, supplement users were more likely to report arthritis and osteoporosis, and experience more symptoms and consume more medication than non-supplement users. In contrast, there was a reduced likelihood of taking a supplement for those with hypertension and by those using blood pressure medication and heart tablets. These results suggest that older dietary supplement users may benefit from education and professional advice to assist them make appropriate and informed choices, particularly if they expect these preparations to attenuate their health concerns.

Wading through the quagmire: Making sense of dietary supplement utilization

Since the 1980s, numerous studies conducted in the United States have attempted to estimate the prevalence of supplement use among the population (e.g., the National Health and Nutrition Survey and the National Health Interview Surveys). Despite these efforts, the true extent of supplement use is unclear. The literature pertaining to the prevalence of supplement use refers to a confusing array of ambiguous terms. Forming accurate conclusions about supplement use is confounded by differences in terminology and methodology between studies. Direct comparisons between studies are therefore inherently problematic. The emphasis in future investigations should be on standardizing the study design; recording data on daily, weekly, or even monthly use in order to establish the safety and efficacy of supplement use; and adopting a consistent, uniform definition of the term supplement.

A profile of middle-aged women who consult a chiropractor or osteopath: Findings from a survey of 11,143 Australian women

Purpose: The aim of this study is to examine the prevalence of chiropractic and osteopathy use and the profile of chiropractor/osteopath users among middle-aged Australian women. Methods: This article reports on research conducted as part of the Australian Longitudinal Study on Women's Health. The focus of this article is the middle-aged women who responded to Survey 3 in 2001 when they were between the ages of 50 and 55 years. The demographic characteristics, health status, and health service use of chiropractic/osteopathy users and nonusers were compared using chi(2) tests for categorical variables and t tests for continuous variables. Results: We estimate that 16% of middle-aged women consult with a chiropractor or osteopath (after adjustment for the oversampling of rural women). Area of residence, education, and employment status were all statistically significantly associated with chiropractic and osteopath use. Specifically, women who live in nonurban areas were more likely to consult a chiropractor or osteopath, compared with women who live in urban areas. Women are significantly more likely to consult with a chiropractor/osteopath if they have had a major personal injury in the previous year, and women who use chiropractic/osteopathy are also high users of 'conventional' health services. Conclusions: Chiropractic/osteopathy use among women in Australia is substantial and cannot be ignored by those providing or managing primary health care services for women. It is essential that the interface and communication between chiropractors/osteopaths and other health care providers be highlighted and maximized to establish and maintain effective overall patient coordination and management.

Ethical issues in social research

There are numerous ethical issues that one must consider when developing a research project; however, much discussion about ethics in health research has focused on experimental studies such as clinical trials. As a result, there remains some ambiguity as to the ethical issues that need to be considered in health-related social research. This paper outlines a number of important ethical issues that CAM researchers should be aware of when developing, running and writing up social research. Maintaining high ethical standards is extremely important in social research as it protects participants and researchers, improves the quality of the data retrieved and ensures that future researchers will have access to participants within the community. (C) 2005 Elsevier Ltd. All rights reserved.

Inhibition of COXs and 5-LOX and activation of PPARs by Australian Clematis species (Ranunculaceae)

The species of Clematis (Ranunculaceae) have been traditionally used for inflammatory conditions by indigenous Australians. We have previously reported that the ethanol extract of Clematis pickeringii inhibited COX-1. In this study, we examined the ethanol extracts and fractions of three Clematis species, Clematis pickeringii, Clematis glycinoides and Clematis microphylla, on cyclooxygenase-1 (COX-1), cyclooxygenase-2 (COX-2) and 5-lipoxygenase (5-LOX). We further examined the activating effects on the protein expression of peroxisome proliferator-activated receptor alpha (PPAR alpha) and gamma (PPAR-gamma) in HepG2 cells. The ethanol extracts of three Clematis species inhibited the activities of COX-1, COX-2 and 5-LOX in the different extents. The stem extract of Clematis pickeringii showed the highest inhibitory activities among the three species on COX-1, COX-2 and 5-LOX with the IC50 values of 73.5, 101.2 and 29.3 mu g/mL. One of its fractions also significantly elevated PPAR gamma expression by 173, 280 and 435% and PPAR gamma expression by 140, 228 and 296% at 4, 8 and 16 mu g/mL, respectively. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

The effect of St John's wort extracts on CYP3A: a systematic review of prospective clinical trials

Aim The aim of this systematic review was to assess the quality and outcomes of clinical trials investigating the effect of St John's wort extracts on the metabolism of drugs by CYP3A. Methods Prospective clinical trials assessing the effect of St John's wort (SJW) extracts on metabolism by CYP3A were identified through computer-based searches (from their inception to May 2005) of Medline, Cinahl, PsycINFO, AMED, Current Contents and Embase, hand-searches of bibliographies of relevant papers and consultation with manufacturers and researchers in the field. Two reviewers selected trials for inclusion, independently extracted data and recorded details on study design. Results Thirty-one studies met the eligibility criteria. More than two-thirds of the studies employed a before-and-after design, less than one-third of the studies used a crossover design, and only three studies were double-blind and placebo controlled. In 12 studies the SJW extract had been assayed, and 14 studies stated the specific SJW extract used. Results from 26 studies, including all of the 19 studies that used high-dose hyperforin extracts (> 10 mg day(-1)), had outcomes consistent with CYP3A induction. The three studies using low-dose hyperforin extracts (< 4 mg day(-1)) demonstrated no significant effect on CYP3A. Conclusion There is reasonable evidence to suggest that high-dose hyperforin SJW extracts induce CYP3A. More studies are required to determine whether decreased CYP3A induction occurs after low-dose hyperforin extracts. Future studies should adopt study designs with a control phase or control group, identify the specific SJW extract employed and provide quantitative analyses of key constituents.