HINI

Herbal Remedies: Cause or Cure of Ailments?
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I. M. Laquatra, PhD, RD
Nutrition Consultant
Pittsburn, PA

At a growth rate of 25% per year, herbal medicines are considered one of the fastest growing segments of the alternative health industry(1,2). In the United States, 250 firms produce herbal or botanical products, with sales reported at $2.5 billion in 1996(1,3). Pediatricians and other health care professionals face a growing trend of parents using herbal remedies for themselves and their children. Knowledge about herbs and how they are used is becoming more important in clinical practice.

Reasons for Taking Herbal Medicines

Parents turn to herbal remedies for a number of reasons, including

Fear or distrust of physicians. Health care is in a state of transition and consumers are not totally satisfied with their treatment. One marketing tactic that takes advantage of the current dissatisfaction port rays the patients as underdogs against the establishment.
Current interest in "natural products". Herbal cures are considered natural and somehow better and safer than traditional medicines. Promotional literature can recommend using herbs to treat ailments based on hearsay, folklore and tradition.
Disappointment with prescription drugs or traditional care. Sometimes parents become desperate to solve their child's chronic health problem. Traditional drugs may have had a limited impact, prompting parents to investigate herbal medicines. Parents feel they have more control when they can make some decisions and take action.
Cultural influences . Herbal remedies may have important cultural roles. As the North American market becomes increasingly influenced by globalization, heightened awareness of cultural traditions must be better understood by health care professionals to provide informed care.
Increased acceptance of alternative remedies . Benefits of alternative medicine are now appearing in the media, and there is a surge of interest among practitioners. If the remedies are proven to be beneficial, the cost savings in health care would be dramatic.

Documented Harm of Herb Usage During Pregnancy and Infancy

Reports have been published describing the effect of herbal medications in pregnancy. One case report described profound neonatal congestive heart failure as a result of maternal consumption of blue cohosh(5). Blue cohosh, also known as papoose root or squaw root, consists of the roots and rhizomes of a perennial herb found in rich moist woods in Canada from southeast Manitoba to New Brunswick, south to Alabama and west to Missouri(5). It is recommended as a uterine stimulant, inducer of menstruation and antispasmodic(4). Blue cohosh contains the alkaloid methylcytisine and the glycosides caulosaponin and caulophyllosaponin. Methylcytisine's actions resemble those of nicotine. It appears that caulosaponin and caulophyllosaponin produce the oxytocic effects. They also constricts coronary blood vessels, exerting a toxic effect on cardiac muscle. The extent of the use of this herbal treatment is not known, although it is widely available.

In the case report which occurred in Seattle, Washington, the mother was advised to take one tablet of blue cohosh daily beginning one month prior to delivery to help induce uterine contractions. The mother took three times the recommended dose for three weeks. Shortly after spontaneous vaginal delivery, the male infant was treated for respiratory distress, acidosis and cardiogenic shock caused by myocardial ischemia(5).

Herbal medicine ingestion during pregnancy is reported to be high in African countries; herbal ingestion rates of 45% have been documented(6). The most common medication taken by people of Nguni origin during pregnancy is known as isihlambezo (that which cleans), a concoction made from a variety of plants(6). In a recent study, 55% of 229 randomly selected patients presenting in early labor had a positive history of herbal ingestion, with 48% taking herbal medication less than 12 hours before admission to the hospital(6). A significantly greater number of women who took herbal medication had meconium-stained amniotic fluid which led to significantly higher caesarean section rates in the study group.

The American Academy of Pediatrics (AAP) currently discourages pregnant women from unlimited consumption of herbal teas because the composition and safety of most of them is unknown(7). Additionally, it is difficult to determine an exact dose in teas due to differences in brewing times(8). The AAP recommendation also advises pregnant women to choose only products in filtered tea bags and to limit herbal tea consumption to two 8-ounce servings per day.

Treating minor ailments in infants with herbs has also resulted in devastating effects. A report of two cases of hepatic and neurologic injury in two infants in the California area illustrated the injury associated with pennyroyal poisoning(9). In case one, an 8-week-old Hispanic boy was hospitalized 14 hours after his mother gave him approximately 120 mL of a tea brewed from the leaves of a home-grown mint plant which contained pennyroyal oil. Fulminant liver failure with cerebral edema and necrosis developed, and the infant died four days after admission.

The second case involved a 6-month-old Hispanic boy who had been given approximately 90 mL of tea three times a week since he was three months old. The tea was brewed from a home-grown mint plant found to contain pennyroyal oil. The mother thought that the tea soothed him and relieved his occasional colic and congestion. Hepatic dysfunction and a severe epileptic encephalopathy developed. Two months after admission, the infant was discharged.

Certain clinical manifestations characterize significant pennyroyal oil toxicity. These include: fulminant hepatic failure, acute renal failure, coagulopathy, metabolic acidosis, gastrointestinal hemorrhage, pulmonary congestion with consolidation, mental status changes, and seizures. The exact mechanism of pennyroyal oil toxicity is not clearly defined. It is hypothesized that rapid depletion of biotransformation and detoxification enzymes by the constituent pulegone leads to a buildup of toxic metabolites with subsequent tissue damage(9). Treatment for pennyroyal oil poisoning is early detoxification . The American Academy of Pediatrics does not advocate the medicinal use of herbs for infants or children. Given the current state of regulation and the lack of research, this conservative approach is required .

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