The role of your cancer health professional is to create an environment of openness and trust, and to help in making informed decisions about alternative/ complementary therapies. Collaboration will improve the safe integration of all therapies during your experience with cancer. The "Summary" and "Professional Evaluation/ Critique" sections of this Unconventional Therapies manual are cited directly from the medical literature, and are intended to help in the objective evaluation of alternative/ complementary therapies.
Summary
Consumers should be aware that some herbal products in "the form of teas, powders, tablets, and capsules, are not regulated by federal or state agencies, and neither safe nor efficacy studies have been performed." (Koff)
"The public should be aware that all herbal products have the potential to be mis-identified when collected, mislabelled, contaminated, or adulterated." Persons who use herbal products need to report any adverse reactions immediately to health authorities. (MMWR)
"If you want to try a supplement despite the uncertainties, don't rely on what's printed on the package or in pamphlets. Do your best to seek out independent sources of information about what the herbs and other supplements are supposed to do." (Herbal roulette)
Some herbal teas have caused serious, even fatal, toxicity (see below under Toxicity).
SEE ALSO sections under Chaparral Tea, Comfrey, Ginseng, Green Tea, and Sassafras Tea.
Description/ Source/ Components
"Herbs may be obtained in various forms ranging from the plants themselves grown in gardens or harvested in the wild to processed herbal products such as pills." (Hafner)
"Herbal medications are said to work by causing neurochemical responses in the body. Herbal formulas can be taken orally in raw form or as capsules, tablets, teas, drops and syrups." (Ontario)
"Each herb may hold active chemical ingredients, and a single herb may harbor some helpful and some dangerous chemicals at the same time. Further, a particular chemical may be therapeutic in one amount and deadly in a slightly larger amount."(Cassileth)
"Herbal remedies differ from prescribed pharmaceuticals in several ways. Typically, they include the entire herb or an entire part of the herb, such as the leaf. In contrast, pharmaceuticals, including those made from herbs, contain only the isolated and purified chemicals found to be the active ingredients, plus an inert liquid for tinctures or a binding substance for pills... Herbs are much more dilute than the concentrated products we purchase in the local pharmacy, and they contain many more ingredients than do pharmaceuticals." (Cassileth)
History
"Every culture throughout history has used plants to treat medical problems. Originally, the specific utility of herbs was assumed to be based on their shape or color. With this primitive Doctrine of Signatures approach, heart shaped leaves were used against heart problems, plant with red flowers were applied to treat bleeding disorders, and so on."(Cassileth)
"Plant products have been used for centuries as medicines. Today in most of the developing world, plant remedies are the most prevalent treatments, with recipes handed down from generation to generation. They are available and are less costly than allopathic medicine, practitioners are available, and there is generally a more culturally sensitive attitude on the part of these practitioners."(Spencer)
"Approximately 114,000 plant extracts from 35,000 species were screened for anticancer activity between 1960 and 1981 in a mouse leukemia model. None proved effective in clinical trials during that time; therefore interest diminished. Other countries, notably Japan, France, and China, continue to screen new plant materials."(Spencer)
Proponent/ Advocate Claims
"Some proponents of medicinal herbs believe that a major benefit of natural herbs over manufactured pharmaceuticals is the collection of ingredients contained in medicinal herbs. Problems caused by one ingredient, they say, can be counterbalanced or neutralized by another."(Cassileth)
Proponents claim that herbal teas may be used both for preventative as well as for treatment purposes. (Hafner)
"You may be able to ward off nausea from chemotherapy by sipping ginger tea or eating a piece of crystallized ginger before or after your treatment... To soothe irritation of the esophagus due to chemotherapy, drink a thin gruel made from slippery elm powder." (Weil)
Proponents believe that "aloe may shrink tumours and reduce the rate at which cancer cells spread." (Ontario)
Aloe vera gel extract supplementation was found to reduce the severity of chemical hepatocarcinogenesis in rats. (Shamaan)
Some laboratory studies "have demonstrated inhibitory effects of tea preparations and tea polyphenols against tumor formation and growth." (Yang)
"One specific Chinese herbal preparation deserves specific mention. PC SPES consists of reproducible extracts of seven different Chinese herbs and an American herb. This combination has been shown to have the ability to suppress tumor cell proliferation and to reduce the clonogenicity of a variety of human tumor cell lines, inducing apoptosis [programmed cell death](Halicka)." (Spencer)
"A recent in vitro [in an artificial environment] study found that biochanin A from red clover inhibited carcinogen activation in cell cultures, suggesting the need for further studies." (Tyler)
"Astragalus root is a well-known Chinese traditional medicine that may have use in the restoration of immune function after cancer chemotherapy. The active principles are primarily cycloartane saponins and polysaccharides." (Anonymous)
Professional Evaluation/ Critique
"Medicinal herbs are not reviewed by the [U.S.] Food and Drug Administration (FDA) for safety and effectiveness." (Cassileth)
"There are significant problems with any study of herbal products. There is generally a lack of standardization of dosage and formulation. The plant contains many potentially effective compounds with their inherent synergistic and competitive possibilities making it difficult to determine which products are beneficial and which are potentially harmful. Often, naturopaths employ several such plants simultaneously, poorly controlled, and scientific method is seldom employed. Biopsy proof of malignancy is often absent, as is direct clear measurement of end points. Careful, well-controlled statistical studies are needed." (Spencer)
"The ingredients of some teas may be labelled incorrectly, and errors can occur in identification of herbs by suppliers." (Herbert)
"Great differences in the presence of active substances have been found, depending on where the herbs were grown and how long (up to several months) they were allowed to stand." (Borins)
"McCutcheon who teaches pharmacognosy (the evaluation of herbal medicines) at the college and university levels, said: "I have yet to evaluate a batch of herbs where there weren't problems. Either they were contaminated with pesticides, or they were adulterated with other herbs, or they were an inferior species of herb, or they simply didn't have the active ingredients.'" (Sun)
"McCutcheon said that in addition to poor quality control, herbal products can cause problems because consumers don't know how to take them... When the label says, 'Six' and their friend says, 'Take 10,' they take 30 and they die of a heart attack.'" (Sun)
"Potential for future benefits pending further research is just that. This emphasizes one of the real dangers of self-medicating with ineffectual drugs. They themselves may not be harmful, but neglecting effective treatment for a serious disease may eventually prove disastrous... Exactly the same precaution applies to the local application of red clover flowers to treat 'cancerous growths.' This herb is also an ingredient in the 'internal formula' of the now discredited Hoxsey cancer treatment. Red clover is not effective in such conditions, and delay in obtaining proper therapy maybe fatal." (Tyler)
Tea consumption is "likely to have beneficial effects in reducing cancer risk in certain populations. However, possible harmful effects of the consumption of excessive amounts of tea, tea at very high temperature, or salted tea cannot be discounted... Additional studies on the chemical properties and biologic activities of tea and tea components are needed to provide a sound background for examining the effects of tea on health." (Yang)
Aloe gel (often incorrectly designated 'juice') is said to promote cell proliferation. (Tyler)
Preliminary studies suggest that the concomitant administration of aloe may enhance the therapeutic effects of MLT (pineal indole melatonin). This seems to be true, at least in terms of stabilization of disease and survival, for patients with advanced solid tumors for whom no other standard effective therapy is available. (Lissoni)
"To date, most animal and human studies have failed to demonstrate any significant anti-inflammatory effect of the devil's claw root extract or of harpagoside." (Lepik)
"Little is known about the human pharmacology of ginger." (Ginger)
"There is no evidence that Barley (green) juice nor clover juice cures cancer or prevents it." (Dunn)
Toxicity/ Risks
"Some herbs are toxic. Read about herbs before taking them." (Ontario)
"Because of underreporting, our present knowledge may well be just the 'tip of the iceberg'. Little is known about the relative safety of herbal remedies compared to synthetic drug treatments, although for some herbal remedies, the risks may be less than for conventional drugs." (Ernst)
"Many herbal products are collected in their plant form, which may be contaminated with toxic insecticides, fertilizers, or infectious agents. Herbal remedies may contain lead, arsenic, mercury, tin, zinc, or arsenic, which can be toxic in their own right." (Spencer)
"Many, if not most, medicinal plants contain flavonoids; over 100 such herbal preparations are on the European market. This family of compounds has been associated with several beneficial effects, such as antioxidative activity or reduction in vascular permeability. However, recent reports suggest that adverse reactions such as hemolytic anemia, chronic diarrhea, severe nephropathy, and colitis can be associated with their use." (Ernst)
"A caution was raised by one scientist, who suggested that since ginger is a thromboxane synthetase inhibitor, it could theoretically affect sex steroid differentiation of the fetal brain. (Fisher-Rasmussen) ...some problems may be too subtle to be explored, especially as it relates to dosage of ginger." (Spencer)
"Aloe is a potent purgative that may cause abdominal pains, gastro-intestinal irritation leading to pelvic congestion and, in large doses, may result in nephritis [inflammation of the kidney], bloody diarrhea, and haemorrhagic gastritis [inflammation of the stomach with bleeding]. Like all stimulant purgatives, prolonged use of aloes may produce watery diarrhea with excessive loss of water and electrolytes (particularly potassium), muscular weakness, and weight loss." (Newall)
"Anthroid laxatives such as aloe, cascara, frangula, and rhubarb senna are commonly used and generally considered to be safe. However, the long-term use (10-30 years) of these drugs may be a risk factor for colorectal cancer."(Ernst)
Persons with gallstones should consult a practitioner prior to using ginger root for therapeutic use. (McGuffin)
"Any herb that is an emmenagogue [an agent that induces menstruation] or menstrual regulator can potentially be an abortifacient [an agent which causes abortion]." (Borins)
"In 1990-91, some 100 women were diagnosed with total destruction of their kidneys through irreversible interstitial fibrosis. Their medical conditions were all traced to a group practice of 'alternative' doctors who had prescribed the women medicinal cocktails containing Chinese herbs. The prescriptions contained Stephania tetranda, Magnolia officinalis, and possibly phen-fen... St tetranda is call Fan Ji in Chinese. In some batches, the Chinese had replaced Fan Ji with Fangchi, also known as Aristolochia. Aristolochic acid was identified in the preparations that the victims took. There are many species of Aristolochia used for medical purposes on all continents. Aristolochic (Calico Flower, Dutchman's pipe) contains acid that is nephrotoxic [toxic or destructive to kidney cells] and carcinogenic." (Betz)
"Inadvertent anticholinergic poisoning can result from consumption of foods contaminated with plants that contain belladonna alkaloids." In 1994, seven cases of anticholinergic poisoning were reported by the New York City Department of Health. The patients drank a commercially labelled tea called Paraguay tea, which was derived from the plant Ilex paraguariensis that is native to South America. Symptoms included fever, dilated and nonreactive pupils, dry skin and oral mucosa, and absent bowel sounds. (MMWR)
"Recently, short term use of the Chinese herb Jin bu huan has been found to produce life-threatening neurologic and cardiovascular effects requiring intubation [the introduction of a tube into a hollow organ] in children. Long-term treatment causes liver injury of poorly defined hepatotoxic mechanism. (Woolf) (Horowitz)" (Spencer)
A Chinese herbal product called Jin Bu Huan, "which has been used for more than 1000 years as a sedative and analgesic" has recently been implicated in clinically recognized hepatitis in seven patients. (Koff) (Woolf)
"Several case-control studies showed no association between drinking of tea at normal temperature (35-47º C) and esophageal cancer, but ingestion of very hot tea (55-67º C) was associated with twofold to threefold increases in risk for esophageal cancer." (Yang)
"A few unusual herbal teas can cause gastrointestinal, hepatic, hematologic and nervous system abnormalities." Some herbal tea preparations such as burdock, thorn apple or jimson weed, may cause blurred vision, dry mouth, dilated pupils, disorientation and delirium. (Ridker)
A 25-year-old woman consulted her gynecologist because of menometrorrhagia (excessive uterine bleeding). She was found to have an abnormally high blood clotting time. The patient strongly denied taking coumarin drugs but she had been accustomed to eating only natural foods for several years and had been drinking large amounts of an herbal tea. Natural coumarins are found in tonka beans, melilot, and sweet woodruff, three ingredients of the patient's "Seasonal Tonic". (Hogan)
Four young Chinese women with psoriasis imbibed an herbal tea brought into Hong Kong by an Indian man who had experienced remission of his psoriasis while drinking this tea. One patient discontinued the herbal tea when she developed a skin rash. The other three patients developed abdominal ascites (an accumulation of fluid) and hepatomegaly (enlargement of the liver) and were admitted to hospital. Two patients stopped drinking the tea and experienced clinical and biochemical remission. The third patient continued drinking the tea against medical advice and died from liver failure, hypertension and terminal gastrointestinal haemorrhage eight weeks later. All four patients had liver biopsies, which revealed hepatic veno-occlusive (obstruction of a vein) disease. Other findings included ascites, oozing, enlarged oesophageal veins and bloody mucus in the stomach. The herbal tea was examined and was found to contain chopped leaves, acorns, dates, seeds, sticks and cones. Analysis revealed unsaturated pyrrolizidine alkaloids in the leaves. The leaves were of the family Compositae. (Kumana)
"Numerous human and animal intoxications have been associated with naturally occurring components, including pyrrolizidine alkaloids [PA], tannins, and safrole... Preparation of infusion drinks prepared from plants appears to concentrate biologically active compounds and is a major source of PA poisoning."(Manteiga)
"A case is presented of fatal veno-occlusive disease of the liver in a patient undergoing treatment by whole abdomen irradiation for carcinoma of the ovary. She had also been exposed to herbal tea and chemotherapy, each of which may cause veno-occlusive disease in its own right. Interaction of these agents is postulated and should be considered before submitting patients to combination treatment." (Feigen)
About 10 hours after drinking tea made from leaves of Nerium oleander, a 30 year-old Los Angeles woman complained of nausea, a numb tongue and vomiting; she appeared confused. Upon admission to hospital, her pulse was weak, blood pressure was not palpable, respirations were 36/min., an electrocardiogram revealed an irregular heart beat. She later died; postmortem findings included pulmonary congestion and swelling and mild thickening of the arteries. The serum digoxin level was 6.4 mg [milligrams]/ml. Cause of death was reported as oleander intoxication. All parts of the oleander plant (leaves, stems, blossoms, seeds, sap, honey, and berries) contain cardiac glycosides including oleandrin, oleandroside, nerioside and digitoxigenin. Boiling or drying the plant does not inactivate the toxins. The plant also irritates mucus membranes in the mouth, causes a bitter taste, nausea, vomiting, increased salivation, abdominal pain, and diarrhea. Central nervous system reactions include altered mental status, visual disturbances, dilation of the pupil, painful, tender nerves and weakness. (Haynes)
The entire poke plant (pokeweed, inkberry) is toxic. Eating the uncooked plant can cause gastroenteritis, decreased breathing, and death. Children have died from eating the berries. (Medical Letter)
A 43-year-old woman drank one cup of tea made from powdered poke plant. She was admitted to hospital experiencing nausea, vomiting, cramping, and abdominal pain. Her blood pressure was low and her heart beat excessively rapid. (Dukes)
Goiter, staggering gait, nerve damage and blindness have all been linked to chronic cyanide poisoning caused by eating cassava. (Medical Letter)
The prolonged use of chamomile tea and peppermint tea can result in clinical water intoxication and subsequent seizures because of inadequate sodium content. (Lipsitz)
"Several studies have shown an increased risk of cancer associated with tea consumption under three conditions: (1) when tea is drunk at more than 75 degrees Celsius leading to cancer of the esophagus); (2) when tea is drunk in excessive quantities; or (3) when tea is mixed with butter, as it is in some localities, such as the Kashmir region of India." (Muir)
Costs
"Herbs are available at most health food stores. The cost may range from approximately $5 for a single herb to $500 for an entire program of herbal therapy." (Ontario, 1994)
References
Anonymous. Astragalus. Facts and Comparisons Review of Natural Products 1999 May.
Betz W. Epidemic of renal failure due to herbals. Sci Rev Alt Med 1998;2:12-13.
Borins M. The dangers of using herbs: what your patients need to know. Postgraduate Herb Medicine 1998;104:91-100.
Cassileth BR. The alternative medicine handbook: the complete reference guide to alternative and complementary therapies. New York: W. W. Norton & Co., 1998:86-98.
Dukes MNG. Remedies used in non-orthodox medicine. Side Eff Drug Ann 1981;5:430-435.
Dunn B. Memorandum on barley. Vancouver: BC Cancer Agency, 1991. (BCCA Cancer Information Centre search file 1961)
Ernst E. Harmless herbs? A review of the recent literature. Am J Med 1998;104:170-178.
Fisher-Rasmussen W, et al. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 1991;38:19.
Feigen M. Fatal veno-occlusive disease of the liver associated with herbal tea consumption and radiation. Aust NZ J Med 1984;14:61-62.
Ginger. Lawrence review of natural products. 1991 Nov.
Hafner AW, editor. Reader's guide to alternative health methods. Milwaukee, Wisconsin: American Medical Association, 1993:128-130.
Halicka HD, et al. Apoptosis and cell cycle effects induced by extracts of the Chinese herb preparation PC SPES (submitted for publication).
Haynes BE, et al. Oleander tea: herbal draught of death. Ann Emerg Med 1985;14(4):350-353.
Herbal roulette. Consumer Reports 1995 November:698-705.
Herbert V, Barrett S. Vitamins and health foods: the great American hustle. Philadelphia: George F. Stickley,1981;167-169.
Hogan RP. Hemorrhagic diathesis caused by drinking an herbal tea. JAMA 1983;249:2679-2680.
Horowitz RS, et al. The clinical spectrum of Jin Bu Huan toxicity. Arch Intern Med 1996;156:889.
Koff RS. Herbal hepatoxicity: revisiting a dangerous alternative. JAMA 1995 Feb 8;273(6):502.
Kumana CR, et al. Herbal tea induced hepatic veno-occlusive disease: quantification of toxic alkaloid exposure in adults. Gut 1985;26:101-104.
Lepik K. Back to our roots: what every pharmacist should know about common herbal remedies. BC Pharmacy 1995 Mar:6-12.
Lipsitz DJ. Herbal teas and water intoxication in a young child. J of Family Practice 1984;18(6):933-937.
Lissoni P, et al. Biotherapy with the pineal immunomodulating hormone melatonin versus melatonin plus aloe vera in untreatable advanced solid neoplasms. Natural Immunity 1998;16:27-33.
McGuffin M, et al. American herbal products association's botanical safety handbook. New York: CRC Press, 1997:125.
Manteiga R, et al. Risks associated with consumption of herbal teas. Reviews of Environmental Contamination & Toxicity 1997;150:1-30.
Medical Letter (Anonymous). Toxic reactions to plant products sold in health food stores. Medical Letter 1979;21(7):29-31.
MMWR (Anonymous). Anticholinergic poisoning associated with an herbal tea_New York City, 1994. MMWR_Morbidity and Mortality Weekly Report 1995 Mar 24;44(11):193-195.
Muir M. (Green) Tea time: Does it help prevent cancer? Alternative and complementary therapies 1998 Feb: 43-47.
Newall AN, et al. Herbal medicines: a guide for health-care professionals. London: Pharmaceutical press, 1996:27.
Ontario Breast Cancer Information Exchange Project. Guide to unconventional cancer therapies. 1st ed. Toronto: Ontario Breast Cancer Information Exchange Project, 1994:29-31.
Ridker PM. Health hazards of unusual herbal teas. American Family Physician 1989;39(5);153-156.
Shamaan NA, et al. Vitamin C and aloe vera supplementation protects from chemical hepatocarcinogenesis in the rat. Nutrition 1998;14:846-52.
Spencer JW, Jacobs JJ. Complementary/alternative medicine: an evidence based approach. Toronto: Mosby, 1999:143-148.
The Sun. Herbal remedies: you don't always get what you want. 1998 Feb 16:B10-11.
Tyler VE, Foster S. Tyler's honest herbal. New York: Haworth herbal press, 1999:27-31,315-17.
Weil A. Dr. Andrew Weil's self healing: creating natural health for your body and mind. (Newsletter) Jan 1998:1,6-7.
Woolf GM, et al. Acute hepatitis associated with the Chinese herbal product Jin Bu Huan. Annals of Internal Medicine 1994 Nov 15;121(10):729-735.
Yang, CS, Wang ZY. Tea and cancer. J Natl Cancer Inst 1993 July 7;85(13):1038-1049.
Revised February 2000