Aristolochia serpentaria is one of many in this genus carrying a toxic compound that may cause kidney damage.
Many of you may consider surfing the Internet as an experience akin to picking nettles. But, being on the cutting edge of herb information, especially on medicinal uses of herbs, has required not one good book, but an entire library of herbal information. I have such a library with about 4,000 volumes, on which I have spent thousands of dollars in the past twenty-five years. And while using computers to find and manage information will never be as seamless and pleasant as curling up with a book, the Internet offers more current information than you could possibly wade through in a day, much of it both up-to-date and cutting-edge.
Recently, a friend asked me for information on Parkinson’s disease, with which he had just been diagnosed. I did a PubMed (www.ncbi.nlm.nih.gov/PubMed/) search and found more than 12,000 references. I downloaded the references and abstracts for the 3,000 most current references, and handed him a printout of about 1,000 pages. That’s a little more than most of us want to know, but it illustrates how rich this source of information can be.
Getting started with your search
Make sure you have the latest Internet browser (compatible with your computer and operating system) to take full advantage of a site’s capabilities. Many of us get complacent in our browsing habits. If you get a lot of “site failed to load” messages, it might be because you don’t have the latest browser software, which is free and can be downloaded directly to your computer. You must have an up-to-date operating system and a CPU (central processing unit—i.e. your computer’s brain) to make it all work.
Get a fast Internet connection. The bigger the “pipeline,” the less time you will sit there waiting, and waiting, and waiting for your computer to respond. The ol’ 56 K modem connection doesn’t get you anywhere very fast. Check with your phone or cable TV company to see what’s available in your area. Digital Subscriber Line (DSL) service is available in most metropolitan areas. Integrated Services Digital Network (ISDN) lines can go twice as fast as most modems. Cable TV (especially digital cable) will make you feel like you’re driving an Internet sports car. Even direct home satellite Internet service is widely available. Connect as fast as you can.
Remember that there’s more than one search engine! Don’t rely on the same search engine all the time. If you use America Online, its browser engine works great for searching companies and organizations that have some kind of arrangement with the company. You’ll find more than you can plow through, but maybe not exactly what you’re looking for. The same is true for Excite, Yahoo, Hotbot, Lycos, AltaVista, and dozens of others. To learn more about search engines, I did an Internet search on “search engines.” It led me to a site called searchengine.com, which lists all sorts of search engines—general, world, topical, and reference. It explains what they are and what they do. My favorite search engine, the one that seems to give me the most hits relevant to my search, is www.google.com. I have it bookmarked as my home page in Internet Explorer and Netscape Navigator and use it many times each day.
Limit your search by entering specific information into the search field. I did a search on google.com for “herbs.” In .19 seconds, the search gave me 1,510,000 hits. “Herbal medicine” took .06 seconds to led me to a mere 113,000 sites. “Herbs for Health” took .50 seconds and led me to only 41,800 sites. “Herb Companion” took .34 seconds and led me to 2,030 hits. “Herb Companion Steven Foster” led me to, well, zero sites. Hmmm. Arm yourself with the information you need to conduct an Internet search. Let’s say you want to find out more about saw palmetto. You should know not only the common name of the plant, but the scientific name as well. If you know other, older synonyms for the scientific name, even better. For example, in the case of saw palmetto, it has been known botanically for more than 100 years as Serenoa repens. However, for whatever reason, non-botanical scientists in Europe often still use the more than century-old scientific name Sabal serrulata for saw palmetto. Therefore, if you do a search of scientific articles with “Serenoa repens” as a title or subject phrase, you will miss the several articles (including clinical studies) which use the obsolete name Sabal serrulata in their title. You are in control of your search. The more you know what you’re looking for, the better your results.
Once you’ve found it
One has to be selective with how he or she goes about choosing information. When it comes to information on medicinal plants or healthful herbs, “www” could be translated to “world-wide wasteland”. What I mean by that is simply don’t believe everything you read. The Internet, in all its vast glory, is the place where anyone can “publish” what they wish without the benefit of an editor. Consider the source of the information. How recent is the information and who is presenting it? Watch out for commercial sites with non-authoritative information geared to selling something. You should also consider the date that the information was posted onto the site. Many sites have the year indicated somewhere on the page.
When you find what you want, respect the creator’s intellectual property. Occasionally web users have an attitude “if it’s on the web, it’s free, it’s mine, and I can do whatever I please with what I find.” If you “capture” something on the web for your own personal, transient use, you probably don’t cross a line. But if you take an article, website content, photographs, illustrations, or whatever else you find out there and then stick them on your own website, you’re inviting trouble. Wearing my photographer’s hat, I frequent various professional photographers’ newsgroups and chatrooms. One photographer recently reported that he was deriving more income from prosecuting people who took his copyrighted work and used it without permission than he was from licensing new images! The “what’s yours is mine” Internet mentality is numbered. Respect the property of others.
It’s an Internet jungle out there, but with some judicious searching, you can find out just about anything you want to know. And remember not to get sucked in beyond the time you actually need to be in front of the computer. After all, you could be gardening.
C a p s u l e s
Aristolochia associated with kidney toxicity
Plant enthusiasts among you will recognize Aristolochia as the genus name for Dutchman’s pipe. A member of the birthwort family (Aristolochiaceae), the genus Aristolochia includes about 120 species of temperate and tropical herbaceous plants and vines. The unusual, calabash pipe-shaped calyx on the flower, giving it the name Dutchman’s pipe, is a unique flytrap, meant to attract insects, who slide down the tube and pollinate the flowers. Some Dutchman’s Pipe species even trap insects until the stamens have expanded and the anthers deposited pollen on the insect. Then they let the prisoner escape to pollinate other flowers.
Many species are used medicinally. The elusive Virginia snakeroot (Aristolochia serpentaria), a small woodland herb with a very fragrant root, was once widely used as an herbal medicine, often for digestive problems. Others such as the eastern Dutchman’s pipe (A. tomentosa), are woody vines and are used similarly. In the mid-1990s several papers were published in kidney-related scientific journals associating toxicity with several Chinese species of Aristolochia. One paper in Nephrology Dialysis Transplantation (1995) attributed kidney failure and pelvic cancer to a product containing, among other ingredients, the Chinese herb Aristolochia fangchi (known in Chinese as guang fang ji). This paper was widely quoted in the media and in professional herbal and toxicity publications. Most reports have involved inadvertent substitution of another Chinese herb, Stephania tetrandra (known in Chinese as han fang ji). These cases of substitution have occurred because of the similarity of the Chinese names of the two different herbs. Various Aristolochia species and other plants containing the toxic compound aristolochic acid are identified as the source of the kidney toxicity cases reported in various medical journals (1). As a result, the FDA issued a “Consumer Advisory” on April 11, 2001, warning consumers to immediately discontinue use of any botanical products containing aristolochic acid. The FDA warns, “consumption of products containing aristolochic acid has been associated with
permanent kidney damage, sometimes resulting in kidney failure that has required kidney dialysis or kidney transplantation. In addition, some patients have developed certain types of cancers, most often occurring in the urinary tract.”
The FDA issued the warning after it received reports of two patients in the United States who developed serious kidney disease after using products containing aristolochic acid. The FDA has been testing botanicals for the presence of aristolochic acid. Another herb familiar to many herb enthusiasts, wild ginger (Asarum canadense), which has long been considered a ginger substitute by virtue of its spicy flavor, also contains aristolochic acid. Use of this and other aristolochic acid-containing ingredients should cease. A little nibble in the garden once in a while, is okay, but long-term or regular consumption of aristolochic acid in any form should be avoided. The FDA is working closely with health professionals and the herb industry to resolve this potential problem. (2) For more information visit the following FDA web link: www.cfsan.fda.gov/~dms/ds-bot2.html.
St. John’s wort bashed by AMA
The April 18, 2001, issue of the Journal of the American Medical Association (JAMA) contained a new study entitled “Effectiveness of St. John’s wort in Major Depression.” The randomized, placebo-controlled, double-blind clinical study was conducted in eleven academic medical centers in the United States between November 1998 and January 2000. It assessed the effectiveness and safety of St. John’s wort versus a placebo in 200 adult outpatients diagnosed with major depression. The trial lasted eight weeks. All patients received a one-week, single-blind, run-in period of the placebo. In other words, they were all given placebo for the first week. Single-blind means the doctors knew it, but the participants didn’t. This controversial procedure was followed in order to eliminate any participants who might experience dramatic improvements from the placebo alone. Then patients received either the placebo or a dose of 900 mg per day of a St. John’s wort extract. If those taking St. John’s wort did not respond to treatment after four weeks, the dose was increased to 1,200 mg per day for the following four weeks. The study showed that St. John’s wort was safe and well-tolerated, with headache the only side effect experienced more in the treatment group than the placebo group. However, while St. John’s wort produced a significantly higher remission of illness than the placebo group, the statistical analysis of the data deemed that the St. John’s wort treatment was not significantly better than the placebo treatment. The authors concluded that “St. John’s wort was not effective for treatment of major depression.” (3)
In the final analysis, more questions have been raised about the intent of the study than about the effects of St. John’s wort itself. According to an April 18, 2001, press release from the American Herbal Products Association (AHPA), the study was designed and funded by Pfizer, Inc., which markets sertraline (Zoloft), a leading antidepressant drug for major depression. While JAMA states that Pfizer did not manufacture St. John’s wort when the study was conducted and designed, Pfizer did recently acquire Warner-Lambert, which had a St. John’s wort product that was discontinued shortly after the acquisition was made.
“In spite of the authors’ dismissal of virtually all previous research, this report does not invalidate the many recent clinical studies that have demonstrated that St. John’s wort is effective for mild to moderate depression,” states Joseph Betz, Ph.D., vice president of scientific and technical affairs for AHPA and a former FDA official. According to Betz, “This study evaluates St. John’s wort for the treatment of a condition (major depression) for which it is not used. It’s ironic that the study’s authors cited three recent published St. John’s wort clinical trials which demonstrate conclusively that St. John’s wort is superior to placebo, and equivalent to existing antidepressants for treatment of mild to moderate depression but dismissed these studies merely because they were designed to determine the effects on mild to moderate depression.” An April 13, 2001, press release from the American Botanical Council raises similar concerns. According to the council’s Executive Director Mark Blumenthal, most of the previous clinical studies conducted in Europe on St. John’s wort targeted only mild to moderate cases of depression.
“There is a significant body of research and clinical experience that documents the safety and efficacy of St. John’s wort to treat mild and moderate cases of depression,” Blumenthal notes.
The German Commission E monographs, the regulatory basis of St. John’s wort labeling in Germany, notes that the herb is contraindicated in cases of major depression.
The bottom line is that the JAMA study shows what was already known—use of St. John’s wort is appropriate for mild to moderate cases of depression. It should not be used in cases of severe depression.
(1) Chen, J. K. “Nephropathy associated with the use of aristolochia.” HerbalGram 2000, 48: 44–45.
(2) Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration. “FDA warns consumers to discontinue use of botanical products that contain aristolochic acid.” Consumer Advisory, April 11, 2001: http://www.cfsan.fda.gov/~dms/ds-bot2.html.
(3) Shelton, R. C., et al. “Effectiveness of St. John’s wort in major depression: A randomized controlled trial.” Journal of the American Medical Association 2001, 285(15): 1978–1986.