Friday, January 14, 2011

Goldenseal - Medicinal Uses, Interactions, Side Effects, Dosage

Goldenseal
Goldenseal, also called yellowroot or eyeroot, is a member of the buttercup family and is native to North America. It produces a golden-yellow dye. Goldenseal's popularity in the 1990s led to severe over-harvesting, causing concerns that it was becoming an endangered species in the U.S. this has stimulated increased cultivation.
Uses and Benefits:
Goldenseal is marketed as a tonic and natural antibiotic, and it is often combined with echinacea to help "strengthen the immune system." As a popular American folk medicine, goldenseal has been used as an antiseptic, astringent, or hemostatic to treat a wide variety of skin, eye, and mucous membrane inflammatory and infectious conditions. Thus, it has been employed as a mouthwash, for canker sores, and as a topical agent for dermatologic disorders. In tonic form, it has been ingested as a "bitter" to aid digestion and treat dyspepsia. Some herbalists also view goldenseal as a mucous membrane "alterative"-increasing and decreasing mucus secretion depending on the body's needs.
Pharmacology:
Goldenseal contains several active isoquinoline dlkaloids such as berberine (0.5-6%), hydrastine (1.5-4%), and canadine. Berberine provides the bitter taste and yellow color to the herb, and most of the scientific explanations for goldenseal's 115e have been attributed to the effects of berberine and related . Berberine is very poorly absorbed orally (probably . 1 %), although blood levels are measurable after large doses.
Extracts of the crude herb, and berberine in particular, have broad in vitro antimicrobial activity against grampositive and gramnegative bacteria, fungi, and protozoa and other parasites to Immunologic activity, such as enhanced macrophage, cytokintt , and antibody response, has been demonstrated in rodent and vitro studies. In contrast, anti-inflammatory and immunos pressive effects also have been demonstrated, High doses oral berberine reduced the colonic inflammation of drug-inducod colitis in rats. Berberine's use as an antidiarrheal agent may be partly explained by inhibition of ion transport secretory activity in intestinal epithelial cells.
Berberine and related alkaloids affect in vivo cardiovasculilf activity and cause contraction or relaxation of isolated smooll1 muscles; results vary depending on the alkaloid and the animnl model studied. In humans, very large intravenous doses 01 berberine (0.2 mg/kg/min for 30 min) to patients with severe conge.stive heart failure caused significant hemodynamic changes consistent with decreased vascular resistance and increased cardiac output, as well as ventricular tachycardia in some patients.
Clinical Trials:
There are no clinical trials in the medical or herbal literature using goldenseal or crude herbal extracts. The only clinical research has been with pure berberine, often isolated from other berberine-containing plants such as Berberis aristata. Berberine has been studied in countries such as India for acute diarrhea in children or adults, and for trachoma. It appears to have antimicrobial and clinical activity similar to other antibiotics in un­blinded, controlled trials for diarrhea due to enterotoxigenic Escherichia coli and giardia, with fewer benefits found for cholera. One randomized, double-blind, placebo-controlled trial found only minimal anti-secretory or antibacterial effects for cholera and noncholera diarrhea. Berberine oral doses usually ranged from 100 mg/day for children to 400 mg/day for adults. For trachoma, a 0.2% berberine eyedrop was found to be similar in efficacy to other standard ophthalmic antibiotics these old studies have not been replicated.
In the Russian literature, very small doses of berberine have been reported to be beneficial in the treatment of cholecystitis or hepa­titis (10-60 mg/day), and for thrombocytopenia (15 mg/day). However, it is doubtful that enough berberine is absorbed at these doses to have a substantial systemic effect. In uncontrolled Chinese studies, large doses of oral berberine have been found ben­eficial in patients with severe CHF (1200 mg/day) and diabetes (900-1500 mg/day).
Adverse Effects:
The herb appears safe and well tolerated based on traditional and common usage; there are no well-documented adverse effects with usual doses. A number of serious reactions have been previously described (e.g., gastrointestinal, toxicity, nephritis, ulcerations, convulsions, fatalities from cardiovascular collapse), but these appear to be inappropriately extrapolated from reports of toxicologic studies of berberine administered to animals, or from 19th century literature on homeopathic "provings."
Side Effects and Interactions:
Goldenseal can inhibit the hepatic cytochrome P450-3A4 drug-metabolizing system in vitro, but this has not been verified in vivo or clinically.Goldenseal is erroneously belived by drug users to act as a natural substance to mask the detection of illegal drugs in urine tests, This myth was originally based on an antiquated chemical reaction described in a novel by the herbalist John Lloyd, published in 1900.
Cautions:
Berberine-containing plants have been used as ingredients in abortifacient products and should be avoided during pregnancy. Similarly, use has been associated with cases of kernicterus in the newborn and should be avoided during breastfeeding of the very young. Because goldenseal is at risk of becoming an endangered species, some herbalists advocate the use of alternative berberine-containing plants in its place (e.g., barberry, Oregon grape, Chinese and American goldthread).
Preparations & Doses:
The usual oral dose of goldenseal is about 250-500 mg of solid extracts, or 500-1000 mg of dried root and rhizome, usually given t.i.d. Various tinctures and fluid extracts are also available. To provide 400 mg of berberine (the adult dose used in many clinical studies), one would have to ingest roughly 20-30 capsules containing 500 mg of goldenseal, an unreasonably large amount.
Summary Evaluation
Clinical trials have not been performed with goldenseal, and there is no evidence that this herb is effective for any clinical indica­tion. There appears to be no rationale for favoring its combina­tion with echinacea. Although the isolated alkaloid berberine is pharmacologically active, the small amount contained in usual oral doses of goldenseal is unlikely to be absorbed to a sufficient degree to provide systemic effects. Herbal extracts do have an­timicrobial and other pharmacologic activity; these properties may support some of the herb's traditional uses when applied topically to the skin or mucous membranes, or when used locally in the gastrointestinal tract. These indications, however, have yet to be clinically evaluated.

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