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Created: July 2001
Diane Manhattan


You are here: IC Network > Patient Handbook > Herbal Supplements

Herbal Supplements

The use of herbs as a treatment for IC remains one of the most controversial subjects to date. Some patients claim that their symptoms have improved using a variety of herbs & alternatives, while others report that their IC has worsened and that herbs have caused an increase in frequency and urgency.

Dr. Robert Moldwin, author of "The IC Survival Guide," appeared as a guest speaker in the ICN Guest Lecture Series in early 2001. He was asked his thoughts on alternatives. His response was outstanding.

"I think that the best advice in the area of alternative medicine is to be skeptical. There are a lot of products out there with all sorts of unsubstantiated claims. It's actually a multibillion dollar business! Perhaps some of those products do work, but until those products are held to the same scrutiny as standard medications, we'll never know. My biggest concern is that some of these "natural" alternatives can have harmful properties as well. As you mentioned, some of the herbal teas have been found to cause flares in IC symptoms. Fortunately, there's recently been a big push by consumer groups and even the National Institutes of Health to get these agents evaluated appropriately."

So, as we begin this discussion of herbs and IC, we'd like to remind our readers that herbs are untested and should be approached with caution. You'll likely hear many claims about herbs and IC on the internet from patients and companies. Please remember that the least reliable source of information to base a medical decision on is the advice of a single patient or someone who has a financial benefit if you buy something from them. Beware of anyone who claims that herbs, or alternatives or vitamins can "cure" IC. One great web site to check out is Quackwatch (http://www.quackwatch.com) which documents the latest health scams on the web. Until further research is found, we urge extreme caution when trying any herbal products.

This section of the ICN Patient Handbook is intended to be an informational tool only. Because the methods described in this chapter are Alternative methods, they may not have been approved or investigated by any regulatory or government agency. The content is not to be intended in any way to be a substitute for professional medical advise.



A Brief History of Herbs

There are two major divisions of medicine, "modern medicine" (i.e., herbal medicine, botanical medicine), and "traditional medicine." In China, however, neither applies. The terms "western Medicine" and "chinese Medicine" are most commonly used and are actually very specialized. Western medicine uses pure chemicals or synthetics, while chinese medicine uses herbs and natural products. Modern/Herbal medicine is the term used throughout the world with the exception of China.

Herbs have been used for centuries dating back to the beginning of Chinese history. Prior to the discovery of penicillin, they were used extensively to treat or cure most ailments. In some countries today, herbal medicine is still the only form of treatment available.

In the United States, herbal products are marketed under the provisions of the Dietary Supplement Act of 1994, which prohibits their sale for diagnosis, treatment, cure or prevention of any disease. As a result, little research has been performed through the FDA. Instead researchers "screen" plants for their biological properties and their active constitutes or components.

The German Regulatory Authority-Herbal Watch Dog Agency (Commission E) is the closest available analog to the FDA-approved labeling system. The agency has conducted and reviewed research and literature on over 300 herbals, weighing the clinical evidence and identifying their uses. Their results appear to be the best informational source available and represent the best professional consensus on medicinal herbs.

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Are there different forms of herbal supplements?

Herbs come in all different forms, tablets, capsules, liquids beverages, powders, extracts, tinctures, creams, lotions salves and oils.

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What are the different ways that herbs are used?

Herbs are used in various ways and are also found in many of our food sources that are consumed through our normal diets (i.e., onions, garlic, ginger, turmeric etc.). Some of the most common ways that herbs are used today, mostly for the sake of convenience, include: compresses, teas, extracts, capsulated powders and tablets. There are many other ways that herbs can be used, which are less common due the process of preparation, and compounding, these include: Essential Oils, Ointments & Salves, Syrups and Tinctures

A. Compresses:

Compresses are cloths that are soaked in a herbal solution that are applied directly to injured or inflamed areas to help promote healing. According to Sant's text book, Interstitial Cystitis, two types of hot compresses may help women with pelvic pain increasing circulation and causing relaxation.

Castor Oil Packs: "Castor Oil (cold pressed) and four pieces of wool or cotton flannel, cut large enough to fit over the bladder/pelvic area. Layer the flannel and pour castor oil into the center until well saturated. Lay this directly onto the skin so that it covers the bladder area. Cover the cloth with a plastic bag and than with a heat source, such as a heating pad. Leave on as long as desired but at least 30 minutes. These compresses should not be used during menses. After removing the pack, wash the skin with a solution of 1 tsp. baking soda to 1 pt. water to wash off the oil. The flannel pack can be stored in refrigerator and reused up to 20 to 30 times."(1)

Ginger Compresses: "Ginger compresses can be made by grating a two inch piece of ginger root or 1 teaspoon of ginger powder (not as potent). Add ginger to 1 quart of boiled water. Remove from the heat and cover and steep for 15 to 20 minutes before straining out the ginger. Dip cloth or cotton towel into the ginger water and apply to the bladder area. Cover with plastic and heat source. Leave on as long as desired at a comfortable temperature. Ginger water can be refrigerated and warmed up for additional treatments.''(1)

B. Teas:

Herbal teas are classified into three categories: decoctions, infusions and herb teas. In herb teas, fresh herbs or tea bags are steeped in boiling water for 3-5 minutes. Infusions are made from the stems, leaves and flowers of herbs that are steeped in very hot water for 10-20 minutes. Decoctions are teas made from the root, bark, seed or berry of the plant. Decoctions and infusions contain stronger concentrations of herbs than regular herbal teas.

Herbal Teas - Patients with interstitial cystitis often ask "What hot drinks are IC friendly?" Even though some herbal teas can be irritating to the IC bladder; many IC patients find that peppermint or spearmint tea can be IC friendly if made properly. By using herbal teabags (caffeine free) or a tea ball and dunking the tea in hot water a few times you can have a IC friendly hot drink. Bev Laumann, author of a monthly column on diet & nutrition for IC patients, offers several suggestions for IC friendly teas in her January 2000 Fresh Tastes Column: Warm Beverages in Cold Weather. Andrew and Gaye Sandler, authors of "Patient to Patient: Managing Interstitial Cystitis & Overlapping Conditions," also share their insight into how herbal teas may benefit the IC patient in their April 2001 ICN column.

Chinese Herbs - Many acupuncturists also use herbs for pain relief and healing in conjunction with the acupuncture. Chinese herbs are also sometimes used alone. Ching Yao Shi, MD has formulated an herbal tea especially for IC patients. Sold by Green Healing Center, Inc., the tea is composed of many herbs. Patients drink one or two cups daily. The tea has been evaluated in one small formal study involving 25 IC patients, conducted by Dr. Kristene Whitmore (author of "Overcoming Bladder Disorders"), Dr. David Gordon, and Dr. Shi. Results over a period of several months were generally favorable, with 82% of IC patients showing at least some improvement. This was not a double-blind or placebo-controlled study. Dr. Shi's tea and copies of related research projects are available on the web at Green Healing Center, Inc. Please note that it appears to be somewhat expensive for patients on limited incomes.

C. Extracts:

Extracts are considered the most effective form of herbs because they are rapidly absorbed. Available in an alcohol or water base, IC patients should be very cautious when purchasing extracts. Alcohol can irritate an IC bladder. There are two methods in which extracts are commonly used. The first method is by placing a few drops (by use of an eye dropper) in a beverage such as water or juice. The second method that many people use for the purpose of faster absorption is placing a few drops under the tongue.

D. Capsulated Powders & Tablets

Capsulated powders are herbs that have been pulverized and blended into a dry powder and than are placed in capsules. Tablets are herbs that are pulverized into a fine powder, mixed with appropriate adjuvants and binders and made into pills. Tablets and capsulated powders have been one of the most favorable ways of purchasing herbs in the past few decades due to convenience and also because of the undesirable taste of herbs. One of benefits of using capsulated powders and tablets is that they can be purchased in different strengths therefore, allowing the consumer the ability to adjust dosages appropriately to their individual needs.

E. Essential Oils, Ointments & Salves, Syrups and Tinctures

Essential oils are made from herbs through the process of steam distillation or cold pressing and than mixed with either water or vegetable oil. Common uses of essential oils include, ear, eye and mouth washes, douches, inhalants, teas, massage therapy or for the use of treating burns and abrasions. Ointments and salves are made by adding herbs to oils, petroleum jelly and bees wax. Syrups are herbs that are added to a form of sugar, such as honey or glycerin, and than boiled. Tinctures are herbs that are similar to extracts, however, tinctures contain varying amounts of alcohol (70 to 80%).

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Are there any important factors in regarding the use of herbs?

As with all types of medications, there are important factors that we must all be aware of. Herbs must be used properly, not indiscriminately. Some of the most important factors that should be closely observed in the use of herbal products are as follows:

  1. When starting any herbal therapies, herbs should be taken in moderation. It is recommended that you always start with low doses. It is also as important that you introduce one herbal supplement at a time so that you can assess whether it will cause bladder irritation. Never exceed the recommended dosage as per manufacturing labeling, so that you will know if it is IC-friendly or a possible bladder trigger.

  2. Herbs can contain powerful ingredients that can be very potent. With long-term use some of these herbal remedies can become toxic to your system.

  3. Some of herbs may negatively interact with prescription medications.

  4. Always buy herbs from a reputable manufacturer. Don't trust often-biased informational pamphlets.

  5. If you experience any unwanted side effects stop taking immediately, (i.e., nausea, vomiting, intestinal upset, headache).

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What herbs have been commonly explored by the IC Patient?

Marshmallow Root:

It is believed that marshmallow root tea provides a soothing coating to the bladder because of the mucilage found in the plant.

Scientific Name: Althaea officinalis
Approved by Commission E: Yes
Description: The medicinal parts of the plant are mallow flowers, leaves, syrups and roots. However, the herbal supplement is made from the dried root and the dried leaves.
Actions & Pharmacology: Marshmallow root relieves local irritation, inhibits mucocilary activity, functions as an anti-inflammatory, good for bladder infections and is an immune stimulant.
General Precautions:There are no general precautions or side effects if the drug is used as per manufactures labeling on required dosages.
Drug Interactions: If other drugs are taken simultaneously the absorption of the other drugs may be delayed.
How Supplied: Marshmallow root can be purchased in capsules, tablets (coated and uncoated), as an extract, as a tea and in powder form.

For related research abstracts and additional information please refer to:
PubMed-National Library of Medicine
Holistic-online-Marshmallow root

Licorice Root

Licorice root is believed to act in a similar manner as marshmallow root by providing a soothing coating and calming effect to the bladder wall. Estrogen effects the integrity of the cells of the bladder and urethra, licorice root helps in balancing estrogen levels.

Scientific Name: Glycyrrhiza glabra
Approved by Commission E: Yes
Description: The medicinal parts of the plant that licorice root is derived from consist of the dried roots and runners (the primary root which subdivides into 3 to 5 subsidiary roots) which are unpeeled, the peeled dried roots and the rhizome (underground stem) with the root. However, the herbal supplement contains the peeled and unpeeled dried roots and the stolons (vine like stems).
Actions & Pharmacology: Has anti-inflammatory and anti-allergic properties, contains many anti-depressant compounds, inhibits the breakdown of certain prostaglandins related to cell reproduction, contains polysaccharides, mainly glucans, increases mucus secreting cells, stimulates the production of interferon, has estrogen and progesterone-like effects and helps in pain reduction.
General Precautions: One of the main hazards is the sodium content and the association with water retention. Patients that are currently on heart medication, have severe menstrual problems, are diabetic or pregnant should not use licorice root.
Taking licorice root for long periods of time and at high doses can lead to hypertension, and deficiency of potassium in the blood. Potassium deficiency due to the use of licorice root can also have an effect on many prescription medications, in which also can cause a decrease in potassium levels. Some of the prescription medications included are as follows:

  1. Corticosteriods: prednisone, inhaled cortisone
  2. Cardiotonic drugs: digoxin, digitals and related glycosides.
  3. Diuretics (non potassium sparing) Lasix and hydrochlorothiazade.
  4. grapefruit and grape fruit extract.
Drug Interactions:
  1. Because licorice root contains many anti-depressant compounds, IC patients should be very cautious, especially if they are currently taking antidepressants prescribed by a medical care provider.
  2. Licorice root can accelerate the excretion of acetaminophen (Tylenol). IC patients should also be cautious because many of the pain medications that are prescribed contain acetaminophen.
  3. Licorice root may decrease the effectiveness of prescription drugs prescribed for high blood pressure.
  4. Licorice root in combination with birth control pills and oral contraceptives increase the risk of high blood pressure.
How Supplied: Tea, capsules and extract

For related research abstracts and additional information please refer to:
PubMed-National Library of Medicine
Holistic-online-Licorice root

Pipsissawa

Scientific Name: Chimaphila umbellata
Approved by Commission E: unknown
Description: The medicinal parts of the plant include the dried leaves and on occasion the twigs and flowers. The Pipsissawa plant also is comprised of the aeronautical parts, which are combined with the flowers and dried plant. The Herbal preparation consists of the aerial parts of the plant.
Actions & Pharmacology: The main purpose of using Pipsissawa as an herbal supplement is due to its main properties, quinine, which is a urinary antiseptic. Pipsissawa also is considered to have antimicrobial properties. The American Indians also use it for regulation of menstruation.
General Precautions: Pipsissawa has a weak sensitizing effect. Pipsissawa is not suitable for long term use.
Drug Interactions: May interfere with oral contraceptives due to its phytoestrogenic properties.
How Supplied: Tincture, Extract, Tablet and Tea (In Homeopathic medicine it is used in injection form)

*Note: Interstitial Cystitits; by Grannum R. Sant, Chapter 25:210, refers to an herbal remedy that includes pipsissawa and cornsilk (by Wind River Herbs) that may be helpful to IC patients by soothing the urinary tract.

Cornsilk

Scientific Name:
Zae mays
Approved by Commission E: unknown
Description: The medicinal parts of the plant include the seed, flower, fruit, leaves, stems and roots. The herbal supplement is produced from the stamen of the female flower, which is picked prior to full bloom.
Actions & Pharmacology: Although, approval from Commission E, is unknown cornsilk has been used for disorders of the urinary track, kidneys and liver disorders for centuries. As an herbal supplement for the bladder it works as a diuretic, anti-inflammatory and also aids in relieving pain of inflamed or irritated mucous surfaces.
General Precautions: No health hazards are known when taken in conjunction with manufacturing labeling instructions.
Drug Interactions: Unknown
How Supplied: Extract, Capsule

For related research abstracts and additional information please refer to:
Holistic-online-Cornsilk

Uva Ursi

Uva-Ursi has been a commonly mentioned herbal supplement in the IC community; However, IC patients should take extra precautions in the use of this herbal supplement.

Scientific Name: Arctostaphylos uva-ursi
Approved by Commission E: Yes
Description: The medicinal parts of the Uva-Ursi plant are the dried leaves and the preparation of the fresh leaves. Even though the Uva-Ursi plant consists of flowers, fruit, leaves, stems and roots the herbal supplement is comprised merely of the leaves
Actions & Pharmacology: One of the main properties of Uva-Ursi is "arbutin", one of the most active ingredients found in the leaves. Arbutin works as an antiseptic, diuretic (an agent that increases the flow of urine) and antibiotic/antibacterial. However, depending on the alkaline of the urine, determines the activity of arbutin as an antibiotic.

American Indians have used Uva-Ursi as an herbal remedy for irritation and inflammation of the urinary tract for conditions such as urethritis, cystitis and nephritis. In addition Uva-Ursi has also been used as an herbal remedy to reduce the pain of menstrual cramping by gently constricting the blood vessels in the lining of the uterus.

General Precautions:

  1. Uva-Ursi is contradicted during pregnancy
  2. Individuals with gastric sensitivity may experience nausea and vomiting.
  3. Liver damage can occur if taken for long periods of time especially in children.
  4. If designated therapeutic dosages are exceeded Uva-Ursi can cause inflammation and irritation of the bladder and urinary tract mucous membrane.
Drug Interactions:
  1. Should not be taken with medications that increase acidity of the urine.
  2. Should not be taken with thiazide and loop diuretics.
  3. Should not be used if taking NSAID's.
How Supplied: Capsules, Teas and Extracts

For related research abstracts and additional information please refer to:
PubMed-National Library of Medicine
Holistic-online-Uva Ursi

Black cohosh

Scientific Name:
Cimicifuga racemosa
Approved by Commission E: Yes
Description: The medicinal parts of the black cohosh plant include the fresh and dried leaves, flowers, fruit, stems and roots. The underground stems, called the rhizome and the attached roots are the medicinally parts that are the makeup of the herbal supplement.
Actions & Pharmacology: In research studies there have been contradictory results in the estrogen-like action of black cohosh. One study suggests that black cohosh has estrogenic effects that decreases symptoms such as hot flashes, perfuse perspiration and psychological disturbances. Another study suggests there is no estrogenic-like actions of black cohosh. However, both studies and clinical trials have demonstrated that improvement of PMS, painful menstruation and menopausal symptoms may be alleviated due to the possibility of the action and properties of black cohosh relaxing the uterine tissue.
General Precautions: No general precautions or side effects are known, except for occasional stomach upset. Another precaution is that black cohosh is not recommended for treatment longer than six months and during pregnancy it should be avoided due to the risk of spontaneous abortions.
Drug Interactions: Black cohosh can have an effect on antihypertensive medications.
How Supplied: Capsules, Drops (extracts) and Tablets.

For related research abstracts and additional information please refer to:
PubMed-National Library of Medicine
Holistic-Online Black Cohosh

Motherwort

Scientific Name: Leonurus cardiaca
Approved by Commission E: Yes
Description:The medicinal parts of the plant includes the fresh aerial part of the plant, the flower, fruit, leaves stems and roots. One of the characteristics of Motherwort is the displeasing smell. The herbal supplements consists of the above ground parts which are harvested and dried along with their additives and/or preparations.
Actions & Pharmacology: sedative, anti-spasmodic, influences and increases the rate of the heartbeat, regulates the pressure and circulation of the blood, helps with menstrual disorders , and has antibacterial effects and increases the flexibility of the uterine lining.
General Precautions: No health hazards or side effects are known. Not to be used during pregnancy.
Drug Interactions: None reported
How Supplied: Extract or Tablet

For related research abstracts and additional information please refer to:
PubMed-National Library of Medicine
Holistic-online - Motherwort

Garlic

Scientific Name: Allium sativum
Approved by Commission E: Yes
Description: The medicinal part of garlic is the whole fresh bulb and the oil of the garlic. The herbal supplement is comprised of either the fresh dried bulb with several secondary bulbs.
Actions & Pharmacology: Garlic is probably one of the most well recognized foods that date back to biblical times. It is known for many functions, including antibiotic, antifungul & antiviral activities. Garlic is also considered a very powerful immune system stimulant. It aids in digestion, dilates blood vessels, thins the blood, helps in the prevention of blood clots (anticoagulant), and lowers cholesterol

.As a natural antibiotic, garlic is effective against many strains of bacteria and parasites. It also stimulates the body's natural defenses against foreign invaders. It is believed that garlic achieves its antibiotic action through a by-product (produced by crushing or bruising the bulb) called allicin. Research shows that one medium garlic bulb is the equivalent to 1% penicillin. Research also shows that is has a broad-spectrum antibacterial action against gram-positive and gram-negative bacteria. Garlic was used as an antibiotic prior to the discovery of penicillin and sulfur drugs.

Garlic also has antifungul properties and has shown to inhibit the growth of Candida albicans. Garlic has been used in the treatment of systemic candidiasis and vaginal yeast (candida). William G. Crook, MD, author of The Yeast Connection, states "Garlic possesses a broad antifungul activity, both on apgar plates and broth. Nystatin nor amphotericin B displayed such a high activity as garlic juice."

General Precautions:

  1. Adverse reactions have been seen with therapeutic doses which include: headache, fatigue, myalgia and vertigo.
  2. Allergic reactions such as contact dermatitis and asthma can occur.
  3. If used as an external treatment (antimicrobial dressing), studies show that garlic can cause burns and necrosis.
  4. Abdominal discomfort, nausea, vomiting, diarrhea and feeling of fullness can occur.
  5. Not to used while nursing
Drug Interactions: The use of garlic with anticogulants such as coumadin and antiplatelets such as aspirin can increase the risk of bleeding.
How Supplied Dried powder, Capsules, Tablets, Extract (solid garlic, Aqeous).

For related research abstracts and additional information please refer to:
PubMed-National Library of Medicine



References:

  1. Sant, Grannum R. Interstitial Cystitis. Lippincott-Raven: 1997; Chapter 25: 205-213.
  2. Medical Economics Company. PDR For Herbal Medicines, Second Edition, 2000
  3. Balch, James F., Balch, Phyllis A., Prescription for Nutritional Healing:1997
  4. Murray, Michael T., The Healing Power of Herbs: 1992

The ICN follows the HonCode: Health Code of Conduct for Medical Web Sites. As such, we do not and cannot recommend any books or materials which offer herbal strategies, yet offer no research supporting those claims




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