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All that is green is not always good.

As previous articles have noted, herbs are complex mixtures of chemicals. We outlined some benefits of herbs for MS symptoms in the Fall 2008 Momentum. However, herbs may produce harmful as well as beneficial effects. There are multiple ways in which this could happen. Something in an herb may worsen the underlying process of MS or worsen MS symptoms, such as fatigue or bladder difficulties. Something in an herb may produce a potentially harmful interaction with another medication. And some herbs known to be dangerous are sometimes recommended for MS.


First, learn as much as you can

The adverse effects of herbs for people with MS are not widely known. The truth is, many MS health professionals are not knowledgeable about herbs and many herbal medicine practitioners are not familiar with the complexities of MS. Moreover, labels and written information accompanying herbal products rarely if ever address disease-specific issues, particularly MS-specific precautions.


People with MS who are considering herbal therapy need to educate themselves. Despite the fact that their health-care provider may not have much information, they should openly discuss their use of herbs and other dietary supplements with their provider.


Then try to calm, not stimulate

Some books on herbal therapies state that since MS is an immune-system disease, people with MS should take herbs that activate the immune system. This is erroneous and potentially dangerous. Yes, MS is an immune-system disease, but it is characterized by excessive immune-system activity. Thus therapies for MS should decrease or calm down the immune system--not stimulate it.


Many different herbs activate components of the immune system, including T-cells and macrophages, the very cells that are known to be excessively active in MS. One of the best known immune-stimulating herbs is echinacea, which is sometimes used in the hope of preventing or decreasing the severity of a common cold. In traditional Chinese medicine, many herbs activate the immune system, including Asian and Siberian ginseng, astragalus, licorice, and maitake, reishi and shiitake mushrooms.

Other common immune-stimulating herbs in the Western tradition include alfalfa, cat's claw and garlic. Ashwagandha, which is used in Ayurvedic medicine, is sometimes specifically recommended for MS in spite of the fact that it activates T-cells. There are no studies showing that this produces beneficial effects in MS.

Herbal side effects

Herbs, like conventional pharmaceuticals, can have side effects that may worsen MS symptoms. Two common MS symptoms to keep in mind when considering herbal therapy are fatigue and bladder difficulties. Fatigue may be increased by many herbs, including ashwagandha, ginseng (Asian and Siberian), passion-flower, St. John's wort, sage, chamomile and valerian (which is why these last two are used at bedtime to improve sleep). Bladder problems may be provoked by coffee and other caffeine-containing herbs including tea, cola nut, guarana and mate. Other herbs that may irritate the urinary tract include eucalyptus, parsley, sassafras and thyme.

Interactions with other drugs?

Just as drugs may adversely interact with each other, certain herbs may adversely interact with specific drugs. The disease-modifying drugs, such as glatiramer acetate (Copaxone), interferons (Avonex, Betaseron, Rebif), mitoxantrone (Novantrone), and natalizumab (Tysabri), all produce their therapeutic effects by modulating or slowing down immune system processes. Thus, any "immune-stimulating" herbs (listed above) may decrease their beneficial effects.


There are also potential interactions between herbs and medications used to control MS symptoms. Some of the more common are:

* Steroids such as methylprednisolone (Solu-Medrol) or dexamethasone (Decadron) and Asian ginseng, ephedra (ma huang), licorice and senna

* Tricyclic antidepressant medications such as amitriptyline (Elavil) and nortriptyline (Pamelor) and St. John's wort, belladonna, henbane, Jimson weed, mandrake and scopolia

* SSRI antidepressant medications such as fluoxetine (Prozac) and St. John's wort

* Methotrexate and aspen, meadowsweet, poplar, sweet birch, willow and wintergreen.


Dangerous herbs

There are some herbs that have been associated with severe toxic effects, including death. For unclear reasons, some of them are sometimes recommended for MS. Herbs that should be avoided include chaparral, comfrey, ephedra (ma huang), lobelia and skullcap. In addition, kava kava, sometimes recommended for anxiety, has been associated with more than 50 cases of severe liver toxicity or death. Kava kava is banned in Europe and Canada but is still available in the U.S.

Know before you go

Use caution when considering herbal therapy not because herbs don't work but because they may have powerful effects. Although some information is available about herbs and MS, much more remains to be learned. The message for herbs and MS is similar to that for unconventional medicine and MS as a whole--some therapies may be beneficial, others may be harmful, and nearly all are not fully understood.

To learn more, see the Society's booklet Clear Thinking About Alternative Therapy at thinking or call 1-800-344-4867 and ask for a copy. Pages 20-24 contain a comprehensive list of Web sites, technical and non-technical reference books, and a handy checklist to guide personal reviews of unconventional therapies.

Dr. Allen Bowling is affiliated with the rocky Mountain MS Center in Colorado and is the author of the highly recommended complementary and Alternative Medicine and Multiple sclerosis, 2nd edition, from Demos Medical Publishing.
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Title Annotation:CAM: HERBS AND MS, PART 3
Author:Bowling, Allen C.
Article Type:Report
Date:Dec 22, 2008
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