Bitter Orange

Introduction
This fact sheet provides basic information about bitter orange—common names, uses, potential side effects, and resources for more information. The bitter orange tree is native to eastern Africa and tropical Asia. Today, it is grown throughout the Mediterranean region and elsewhere, including California and Florida. Bitter orange oil is used in foods, cosmetics, and aromatherapyA therapy in which the scent of essential oils from flowers, herbs, and trees is inhaled to promote health and well-being. products. Bitter orange oil from the tree's leaves is called petitgrain, and oil from the flowers is called neroli.
Common Names—bitter orange, Seville orange, sour orange, Zhi shi
Latin Names—Citrus aurantium

What It Is Used For
Bitter orange has been used in traditional Chinese medicineA whole medical system that originated in China. It is based on the concept that disease results from disruption in the flow of qi and imbalance in the forces of yin and yang. Practices such as herbs, meditation, massage, and acupuncture seek to aid healing by restoring the yin-yang balance and the flow of qi. and by indigenous people of the Amazon rainforest for nausea, indigestion, and constipation. Current uses of bitter orange are for heartburn, loss of appetite, nasal congestion, and weight loss. It is also applied to the skin for fungal infections such as ringworm and athlete's foot.

How It Is Used
The dried fruit and peel (and sometimes flowers and leaves) are taken by mouth in extracts, tablets, and capsules. Bitter orange oil can be applied to the skin.

What the Science Says
There is not enough scientific evidence to support the use of bitter orange for health purposes. Many herbal weight-loss products now use bitter orange peel in place of ephedra. However, bitter orange contains the chemical synephrine, which is similar to the main chemical in ephedra. The U.S. Food and Drug Administration banned ephedra because it raises blood pressure and is linked to heart attacks and strokes; it is unclear whether bitter orange has similar effects. There is currently little evidence that bitter orange is safer to use than ephedra.

Side Effects and Cautions
Because bitter orange contains chemicals that may speed up the heart rate and raise blood pressure, it may not be safe to use as a dietary supplementA product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. The U.S. Food and Drug Administration has special labeling requirements for dietary supplements.. There have been reports of fainting, heart attack, and stroke in healthy people after taking bitter orange supplements alone or combined with caffeine. People should avoid taking bitter orange if they have a heart condition or high blood pressure, or if they are taking medications (such as MAO inhibitors), caffeine, or other herbs/supplements that speed up the heart rate. Due to lack of safety evidence, pregnant women should avoid products that contain bitter orange. Bitter orange oil used on the skin may increase the risk of sunburn, particularly in light-skinned people. Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Bilberry

Introduction
This fact sheet provides basic information about bilberry—common names, uses, potential side effects, and resources for more information. Bilberry is a relative of the blueberry, and its fruit is commonly used to make pies and jams. It has been used for nearly 1,000 years in traditional European medicine. Bilberry grows in North America, Europe, and northern Asia.
Common Names—bilberry, European blueberry, whortleberry, huckleberry
Latin Names—Vaccinium myrtillus

What It Is Used For
Historically, bilberry fruit was used to treat diarrhea, scurvy, and other conditions. Today, the fruit is used to treat diarrhea, menstrual cramps, eye problems, varicose veins, venous insufficiency (a condition in which the veins do not efficiently return blood from the legs to the heart), and other circulatory problems. Bilberry leaf is used for entirely different conditions, including diabetes.

How It Is Used
The fruit of the bilberry plant can be eaten or made into extracts. Similarly, the leaves of the bilberry plant can be made into extracts or used to make teas

What the Science Says
Some claim that bilberry fruit improves night vision, but clinical studies have not shown this to be true. There is not enough scientific evidence to support the use of bilberry fruit or leaf for any health conditions.

Side Effects and Cautions
Bilberry fruit is considered safe. However, high doses of bilberry leaf or leaf extract are considered unsafe due to possible toxic side effects. Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Astragalus

Introduction
This fact sheet provides basic information about the herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. astragalus—common names, uses, potential side effects, and resources for more information. Native to China, astragalus has been used for centuries in traditional Chinese medicineA whole medical system that originated in China. It is based on the concept that disease results from disruption in the flow of qi and imbalance in the forces of yin and yang. Practices such as herbs, meditation, massage, and acupuncture seek to aid healing by restoring the yin-yang balance and the flow of qi.. In the United States, the herb gained popularity in the 1980s. There are actually over 2,000 species of astragalus; however, the two related species Astragalus membranaceus and Astragalus mongholicus are the ones primarily used for health purposes.
Common Name—astragalus, bei qi, huang qi, ogi, hwanggi, milk vetch
Latin Name—Astragalus membranaceus, Astragalus mongholicus

What It Is Used For
Historically, astragalus has been used in traditional Chinese medicine, usually in combination with other herbs, to support and enhance the immune system. It is still widely used in China for chronic hepatitis and as an adjunctive therapy in cancer. It is also used to prevent and treat common colds and upper respiratory infections. Astragalus has also been used for heart disease.

How It Is Used
The root of the astragalus plant is typically used in soups, teas, extracts, or capsules. Astragalus is generally used with other herbs, such as ginseng, angelica, and licorice.

What the Science Says
The evidence for using astragalus for any health condition is limited. Results from small or preliminary studies suggest that astragalus may benefit heart function and help the immune system fight infections. A few studies have shown potential benefits for using astragalus—in combination with another herb, glossy privet (Ligustrum lucidum)—as an adjunctive therapy for cancer. In general, however, these studies were not well designed. NCCAM-funded investigators are studying the effects of astragalus on the body, particularly on the immune system.

Side Effects and Cautions
Astragalus is considered safe for most adults. Its possible side effects are not well known because astragalus is generally used in combination with other herbs. Astragalus may interact with medications that suppress the immune system, such as the drug cyclophosphamide taken by cancer patients and similar drugs taken by organ transplant recipients. People should avoid using astragalus species such as "locoweed" that grow in the United States, as these other species may have different effects and side effects. Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Aloe Vera

Introduction

This fact sheet provides basic information about aloe vera—common names, uses, potential side effects, and resources for more information. Aloe vera's use can be traced back 6,000 years to early Egypt, where the plant was depicted on stone carvings. Known as the "plant of immortality," aloe was presented as a burial gift to deceased pharaohs.
Common Names—aloe vera, aloe, burn plant, lily of the desert, elephant's gall
Latin Names—Aloe vera, Aloe barbadensis

What It Is Used For

Traditionally, aloe was used topically to heal wounds and for various skin conditions, and orally as a laxative. Today, in addition to traditional uses, people take aloe orally to treat a variety of conditions, including diabetes, asthma, epilepsy, and osteoarthritis. People use aloe topically for osteoarthritis, burns, and sunburns. Aloe vera gel can be found in hundreds of skin products, including lotions and sunblocks. The Food and Drug Administration (FDA) has approved aloe vera as a natural food flavoring

How It Is Used

Aloe leaves contain a clear gel that is often used as a topical ointment. The green part of the leaf that surrounds the gel can be used to produce a juice or a dried substance (called latex) that is taken by mouth.

What the Science Says

Aloe latex contains strong laxative compounds. Products made with various components of aloe (aloin, aloe-emodin, and barbaloin) were at one time regulated by the FDA as oral over-the-counter (OTC) laxatives. In 2002, the FDA required that all OTC aloe laxative products be removed from the U.S. market or reformulated because the companies that manufactured them did not provide the necessary safety data. Early studies show that topical aloe gel may help heal burns and abrasions. One study, however, showed that aloe gel inhibits healing of deep surgical wounds. Aloe gel does not prevent burns from radiation therapy. There is not enough scientific evidence to support aloe vera for any of its other uses.

Side Effects and Cautions

Use of topical aloe vera is not associated with significant side effects. Abdominal cramps and diarrhea have been reported with oral use of aloe vera. Diarrhea, caused by the laxative effect of oral aloe vera, can decrease the absorption of many drugs. People with diabetes who use glucose-lowering medication should be cautious if also taking aloe by mouth because preliminary studies suggest aloe may lower blood glucose levels. Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Asian Ginseng

Introduction

This fact sheet provides basic information about the herbA plant or part of a plant used for its flavor, scent, or potential therapeutic properties. Includes flowers, leaves, bark, fruit, seeds, stems, and roots. Asian ginseng—common names, uses, potential side effects, and resources for more information. Asian ginseng is native to China and Korea and has been used in various systems of medicine for many centuries. Asian ginseng is one of several types of true ginseng (another is American ginseng, Panax quinquefolius). An herb called Siberian ginseng or eleuthero (Eleutherococcus senticosus) is not a true ginseng.
Common Names—Asian ginseng, ginseng, Chinese ginseng, Korean ginseng, Asiatic ginseng
Latin Name—Panax ginseng

What It Is Used For

Treatment claims for Asian ginseng are numerous and include the use of the herb to support overall health and boost the immune system. Traditional and modern uses of ginseng include

Improving the health of people recovering from illness Increasing a sense of well-being and stamina, and improving both mental and physical performance Treating erectile dysfunction, hepatitis C, and symptoms related to menopause Lowering blood glucose and controlling blood pressure How It Is UsedThe root of Asian ginseng contains active chemical components called ginsenosides (or panaxosides) that are thought to be responsible for the herb's medicinal properties. The root is dried and used to make tablets or capsules, extracts, and teas, as well as creams or other preparations for external use.

What the Science Says

Some studies have shown that Asian ginseng may lower blood glucose. Other studies indicate possible beneficial effects on immune function. To date, research results on Asian ginseng are not conclusive enough to prove health claims associated with the herb. Only a handful of large clinical trials on Asian ginseng have been conducted. Most studies have been small or have had flaws in design and reporting. Some claims for health benefits have been based only on studies conducted in animals. NCCAM supports studies to better understand the use of Asian ginseng. Areas of recent NCCAM-funded research include Asian ginseng's interactions with other herbs and drugs and the herb's potential to treat chronic lung infection, impaired glucose tolerance, and Alzheimer's disease. Side Effects and CautionsWhen taken by mouth, ginseng is usually well tolerated. Some sources suggest that its use be limited to 3 months because of concerns about the development of side effects. The most common side effects are headaches and sleep and gastrointestinal problems. Asian ginseng can cause allergic reactions. There have been reports of breast tenderness, menstrual irregularities, and high blood pressure associated with Asian ginseng products, but these products' components were not analyzed, so effects may have been due to another herb or drug in the product. Asian ginseng may lower levels of blood sugar; this effect may be seen more in people with diabetes. Therefore, people with diabetes should use extra caution with Asian ginseng, especially if they are using medicines to lower blood sugar or taking other herbs, such as bitter melon and fenugreek, that are also thought to lower blood sugar. Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Side Effects and Cautions

When taken by mouth, ginseng is usually well tolerated. Some sources suggest that its use be limited to 3 months because of concerns about the development of side effects. The most common side effects are headaches and sleep and gastrointestinal problems. Asian ginseng can cause allergic reactions. There have been reports of breast tenderness, menstrual irregularities, and high blood pressure associated with Asian ginseng products, but these products' components were not analyzed, so effects may have been due to another herb or drug in the product. Asian ginseng may lower levels of blood sugar; this effect may be seen more in people with diabetes. Therefore, people with diabetes should use extra caution with Asian ginseng, especially if they are using medicines to lower blood sugar or taking other herbs, such as bitter melon and fenugreek, that are also thought to lower blood sugar. Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Can herbal health products and supplements cause other problems?

Yes. Herbal products and supplements may have other effects that aren’t listed in the box above. A few examples include the following:

* Glucosamine products may contain sodium. If you’re on a low-sodium diet, talk to your doctor before taking glucosamine.
* People who are allergic to shellfish may also be allergic to glucosamine. If you have a shellfish allergy, check with your doctor before taking glucosamine.
* Don’t drink alcohol if you take kava products. Kava can increase the effects of alcohol.
* The phytoestrogen black cohosh contains salicylates, so avoid it if you are sensitive to aspirin or other salicylates.

Also, you shouldn’t take more than the recommended dose of any herbal health product or supplement. The problems that these products can cause are much more likely to occur if you take too much or take them for too long.

Can herbal health products or supplements change the way prescription or OTC drugs work?

Yes. Herbal health products or supplements can affect the way the body processes drugs. When this happens, your medicine may not work the way it should. For example, St. John’s wort reduces the amount of certain drugs absorbed by the body. This may mean the drugs aren’t absorbed at high enough levels to help the conditions for which they are prescribed. This can cause serious problems.

You should be especially cautious about using herbal health products or supplements if you take a drug in one of the following categories:

* Drugs to treat depression, anxiety or other psychiatric problems
* Anti-seizure drugs
* Blood thinners
* Blood pressure medicine
* Heart medicine
* Drugs to treat diabetes
* Cancer drugs

If you take any of these drugs, talk to your doctor before taking any type of herbal product or supplement.

Do any health problems increase the danger of taking herbal products and supplements?

Yes. Herbal products and supplements may not be safe if you have certain health problems. You also may be at increased risk of problems from these products if you are elderly. Talk to your doctor before taking herbal products if you have any of the following health problems:

* Blood clotting problems
* Cancer
* Diabetes
* An enlarged prostate gland
* Epilepsy
* Glaucoma
* Heart disease
* High blood pressure
* Immune system problems
* Psychiatric problems
* Parkinson’s disease
* Liver problems
* Stroke
* Thyroid problems

If you are going to have surgery, be sure to tell your doctor if you use herbal products. Herbal products can cause problems with surgery, including bleeding and problems with anesthesia. Stop using herbal products at least 2 weeks before surgery, or sooner if your doctor recommends it.

What types of herbal products and supplements are available?

Hundreds of herbal products and supplements are available. They are advertised to treat just about any symptom. However, trustworthy evidence usually doesn’t exist to support these advertising claims.

Some of the most popular herbal products and supplements include chondroitin sulfate, echinacea, ephedra (also called ma huang), garlic, ginkgo biloba, ginseng, glucosamine, kava, melatonin, phytoestrogens (such as black cohosh, dong quai and soy), saw palmetto and St. John’s wort.

Herbal Products and Supplements: What You Should Know

This information was developed as part of an educational program made possible by an unrestricted educational grant from McNeil Consumer & Specialty Pharmaceuticals.
Are herbal health products and supplements safe because they’re natural?
Not necessarily. Don’t think that herbal health products and supplements are safer than medicines just because they occur in nature or come from plants. After all, many plants are poisonous! Although herbal products and supplements are advertised as “natural,” they aren’t necessarily natural to the human body.

Unlike prescription and over-the-counter (OTC) medicines, herbal products and supplements don’t have to be tested to prove they work well and are safe before they’re sold. Also, they may not be pure. They might contain other ingredients, such as plant pollen, that could make you sick. Sometimes they contain drugs that aren’t listed on the label, such as steroids or estrogens. Some of these products may even contain toxic (poisonous) substances, such as arsenic, mercury, lead and pesticides.