CM-IMAM 313-week 7- HDS & Aromatherapy.pptx

Complementary Medicine (CM) IMAM 313 week 7: Herbal medicines and Dietary Supplements (HDS) Aromatherapy By Dr. Saud Alsanad Definitions  There are different terms used to express the usage of herbs and dietary supplements.  Herbal Medicine (HM): “Herbal medicines include herbs, herbal material...

Complementary Medicine (CM) IMAM 313 week 7: Herbal medicines and Dietary Supplements (HDS) Aromatherapy By Dr. Saud Alsanad Definitions  There are different terms used to express the usage of herbs and dietary supplements.  Herbal Medicine (HM): “Herbal medicines include herbs, herbal materials, herbal preparations and finished herbal products that contain as active ingredients parts of plants, or other plant materials, or combinations”.  Herbs: “Herbs include crude plant material such as leaves, flowers, fruit, seed, stems, wood, bark, roots, rhizomes or other plant parts, which may be entire, fragmented or powdered”.  Dietary supplements (DS): “the purpose of which is to supplement the normal diet and which are concentrated sources of nutrients or other substances with a nutritional or physiological effect, alone or in combination, marketed in dose form”. Prevalence and patterns of use  It is difficult to accurately measure the extent of HDS use especially in the unregulated and internet markets of HDS products. This might be because of the unreliability of methods used and particularly survey-based studies.  However, most studies of CAM use clearly show that herbal medicines are the most popular treatment in CAM practice as well as in traditional medicine systems. Prevalence and patterns of use  WHO estimated that 80% of people worldwide rely on herbal medicines for some part of their primary health care.  In the US ,an estimated 40.6 million adults reported they had used HDS.  About 50% of surveyed consumers in Germany reported that they use HDS regularly.  Younger people, females, and highly educated people are more likely to use HDS.  By analyzing 24 studies, the use of herbal medicine in Saudi Arabia Systems (approaches) of herbal medicine  There are, of course, as many types of herbal medicine as there are ethnic groups in a society.  Herbal and nutritional medicine in any region now encompasses many different traditions, from indigenous folklore of the region and other imported systems.  Although having historical basis, herbal medicine is continually evolving and now also extends to include modern dietary considerations.  It is necessary for healthcare professionals to review herbal medicine systems for two main reasons:  To be able to advise patients who may wish to use herbs or consult a herbalist (herbal medicine practitioner).  Because traditional use is usually a common starting point in the ongoing search for new drugs.  Most practitioners will use an array of herbal and nutritional supplements depending on their experiences and preferences. Systems (approaches) of herbal medicine  The most important systems (approaches) of herbal medicine include:  Traditional Chinese Medicine (TCM).  Ayurveda.  Islamic Medicine.  Traditional (Western) medical herbalism.  Phytotherapy.  Nutraceuticals (functional foods): the term “nutraceutical” was created by Stephen DeFelice. It was coined from “nutrition” and “pharmaceutical” and according to DeFelice, nutraceutical defined as “a food (or part of a food) that provides medical or health benefits, including the prevention and/or treatment of a disease’’. Legal status and regulations In general, the regulation of HDS is complex because of the different ways in which countries define and categorize HDS. For example, ‘’echinacea’’, in UK, may be classed as a registered traditional herbal medicinal product or as a food supplement, whereas it is a dietary supplement in the USA and a medicine in Germany. Therefore, countries have implemented different policies for licensing, dispensing, manufacturing, and marketing HDS products. The ease of access to internet markets for HDS products, which are commonly accompanied by commercial advertisements, make the issue more complicated, especially as the issue of patients who taking HDS concurrently with their conventional medicines is well documented. Legal status and regulations  Accordingly, healthcare organizations in different parts of world are making significant progress in implementing and regulating HDS. For instance, there were only 65 of WHO Member States regulating herbal medicines in 1999, whereas there are now about 124.  The WHO has published a series of guidelines to share information and experiences of Member States on regulating and registration HDS products.  In Saudi Arabia, The Saudi Food and Drug Authority (SFDA) is the regulatory authority for registration, listing and licensing HDS products. Concerns about HDS use  With such a lack of regulation of HDS, the quality, safety, and efficacy of HDS has become a great concern for the patient as well as healthcare organizations and authorities.  There are few quality standards for HDS products and this issue is exacerbated because the lack of regulation.  The quality of HDS products is a crucial issue and many difficulties have been identified: for example purity, standardization, identity, compatibility, and stability.  Aspects such as environmental conditions of planting, growth and harvesting, storage, identification of species and collecting the relevant parts of the plant will all affect the chemical constituents of the HDS products. Concerns about HDS use  Contamination is a major issue: in India, 126 samples of commonly used herbs were analyzed for ochratoxin A (a nephrotoxic and carcinogenic mycotoxin). 14/26 samples of black pepper, 20/50 samples of coriander, 2/25 sample of ginger, and 9/25 samples of turmeric were contaminated with ochratoxin A greater than 10µg/kg.  Another example is the nephrotoxicity case linked to ‘bladderwrack’ herb due to high level of its arsenic content. Concerns about HDS use  The possibility of interactions occurring between herbs and drugs may be higher than between conventional drugs due to the large number of components in the herb, compared to the single active substance of a conventional medicine.  The large number of HDS products containing a wide variety of chemical constituents, and used to treat the same illness, make interactions difficult to interpret accurately. For example, there are more than 100 different HDS treatments that are claimed to treat asthma, however, scientifically, researchers could not reach consensus regarding any single HDS treatment for this condition. Examples of most common traditional herbs used in Saudi Arabia Black seeds (Nigella sativa) Ancient Egyptians and Greeks prescribed black seeds or black cumin for some ailments such as headache and to increase milk production. It was traditionally used in the Middle East for asthma and hypertension. In Arabian Gulf countries, black seeds are prescribed for a variety of ailments including diabetes. Black seeds in therapeutic doses had a wide safety margin. Fenugreek (Trigonella foenum-graecum) It is a traditional herb used for thousands of years by various traditional medical systems such as Ayurveda to treat diabetes mellitus. Fenugreek may have positive effects by promotion of insulin secretion effects and enhancement of peripheral utilization of glucose. Various studies reported the benefits and the wide safety margin of fenugreek. Examples of most common traditional herbs used in Saudi Arabia Myrrh (Commiphora myrrha) It is an old traditional medicinal herb. Myrrh was used by ancient Egyptians. The word “myrrh” from the Arabic word “mur” which means “bitter”. Myrrh may have an antiglycemic and antioxidant effect on animals. It may also be used locally with or without honey for wounds treatment but for short periods (less than two weeks) and low concentration as its seemed to have harmful adverse events if it used in high concentrations or long periods. Helteet (Ferula assa-foetida) It is a traditional spice and a medicinal herb. Helteet is used traditionally as an anthelmintic, antispasmodic, and antidiabetic herb. In animal studies, there is preliminary evidence suggesting the potential antihyperglycemic effect of helteet. It had a confirmed toxicity profile for a dose of 250mg/kg for a short period on animals. Examples of most common traditional herbs used in Saudi Arabia Harmel (Rhazya stricta) It is cultivated in the Arabic region and used as a folk medicine. Harmel is used traditionally in the treatment of diabetes mellitus, sore throat, and inflammatory conditions. Animal studies showed controversial results. However, other study reported a significant decrease in the blood glucose level and an increase of insulin when using harmel and glibenclamide. Adverse events of harmel were reported in animals leading to death. Harmel may interact with antidiabetic drugs. Aloe (Aloe vera) It is cultivated in North Africa and Turkey. It is used traditionally as a laxative, anti-inflammatory agent and in wounds and burns treatment. However, controversial results of antidiabetic effects of aloe were reported which may be due to the use of different parts of the plant. Aloe showed antioxidant and antihyperlipidemia effects in animal studies. Oral administration of aloe may cause numerous adverse events such as diarrhea, and kidney dysfunction, while adverse events of local application of aloe may include dermatitis, photo-irritation, and erythema. Examples of most common traditional herbs used in Saudi Arabia Ginger (Zingiber officinale) It is a traditional medicinal herb and a popular spice. Ginger is used for more than 2500 years. A study suggested that the use of 3 grams of ginger for eight weeks may be beneficial for diabetic patients and may lower both fasting blood sugar and glycosylated hemoglobin. Ginger was also considered relatively safe. Cinnamon (Cinnamomum zeylanicum) Cinnamon was used for more than 4000 years and it is popular worldwide flavoring herbs. A study suggested that the use of 1 to 6 grams/day of cinnamon could significantly reduce blood glucose, tri-glycerides, LDL and total cholesterol. Cinnamon is seemed to be relative safe and a well-tolerated herb. Allergy and contact reactions were the most reported adverse events. Aromatherapy Development and general principles Aromatherapy, in principle, is the topical use of essential (volatile) oils to provide therapeutic effects. Although it is often said that aromatherapy originated with the ancient Egyptians, there is no real evidence for this. The development of aromatherapy is attributed to Rene-Maurice Gattefosse, a French perfumer and chemist, in 1928. Gattefosse is said to have burnt his hand while working in a laboratory and finding the lavender oil nearby, he plunged the injured hand into the flask. The burn healed more quickly than would be expected, and with little scarring. During the Second World War. Jean Valnet pioneered Gattefosse’s ideas using essential oils in wound healing, and progressed to using them more widely for other medical disorders. Development and general principles Aromatherapy is a very popular form of CAM, with much overlap with the beauty and cosmetics industry, to the extent that much of what is sold as ‘aromatherapy’ is merely having a massage (or even bathing or showering) with fragrant oil. This has contributed to the view of aromatherapy as useless but harmless; however, it is increasingly being shown in clinical studies to have therapeutic benefits. Development and general principles Aromatherapy is divided into three separate parts: Aromatherapy: the effect of essential oils on physical and psychological conditions. Aromachology: the effect of aromas on emotions and feelings. Aromatology: the internal use of essential oils, which can include vaginal or rectal administration as well as oral ingestion. Therapeutic indications The pharmacological properties of essential oils are well documented and it has now been demonstrated that essential oil components are absorbed through the skin and can be measured in the breath around 20 minutes after topical administration. However, it is not necessarily the case that topical application of essential oils mirrors exactly the effects of ingestion, since the different constituents may be differently absorbed. Therapeutic indications The effects of odor are probably as important as systemic absorption, as odors can affect mood and other psychological parameters via the limbic system of the brain. Absorption through the skin is the usual method of administration in aromatherapy as it combines the therapeutic effects of the oils with the benefits of massage. When applied in the form of massage, the oils will be inhaled and will also stimulate the olfactory system with an aroma. Inhalation of an essential oil, perhaps in steam or otherwise, will lead to absorption into the bloodstream via the lung. This is not quite the same as olfaction (perception of an odor). Olfaction is an area where gender differences are important regarding pain perception and mood. It is known there are gender differences in sensitivity to smell and the effect of odor on the brain, which is particularly relevant to aromatherapy. Therefore, it seems to be the case that women are more susceptible to the effect of odors and may therefore benefit more from aromatherapy, although this remains pure speculation. Therapeutic indications  Although the evidence for efficacy limited, aromatherapy has been reported to be used for variety of health conditions, for examples: Safety considerations Most essential oils are composed of up to 200 constituents, many of which are present in minor amounts, and of course, a minor component in one particular type of oil may be a major component in another, even from the same species of plant. Variation is commonplace even in natural oils and depends on chemotype, source, extraction method and storage. There is a great price difference according to quality, and this can lead to adulteration or falsification. Poor storage of essential oils lead to chemical degradation, oxidation and polymerization, which change the chemistry and hence the pharmacology. The odor of essential oils changes and the color darkens as the oil degrade; this is a good indication of deterioration. Drug interactions are non known or expected but some oils may enhance penetration of topical preparations. Safety considerations “safety advice” No major complications have been reported from aromatherapy treatment as long as certain cautions are observed: Only fresh essential oils, carefully stored in a cool dark place with minimum exposure to air, must be used for aromatherapy. Essential oils must always be diluted before use. Essential oils should be applied externally or by inhalation only. Do not use for long periods as they may cause irritation. Avoid excessive inhalation of vapour as this may cause headache, fatigue and bronchial spasm. Consult a healthcare professional before using aromatherapy if you have a respiratory disorder. Pregnant women must consult their healthcare professional before using aromatherapy since some essential oils should be avoided in pregnancy such as benzoin, bergamot, laurel, clove. Essential oils, especially those with stimulant effects, should be avoided by patients with epilepsy.