Natural Medicines Comprehensive Database Research Articles

Herbal Supplement Use for Evidence-Based Indications in US Adults: An Analysis of National Survey Data.

Objective: Understanding the changes in consumer use of herbal products and what has influenced these changes is key in the promotion of evidence informed use. The last analysis of evidence informed herbal supplement use involved the 2002 National Health Interview Survey (NHIS) analysis. This study reproduces and expands upon that earlier analysis, with the most recent NHIS dataset to report herb use patterns. It also explores the guiding resources consulted by consumers in their decision to use. Methods: Secondary analysis of cross-sectional data from the NHIS identified the 10 herbal supplements with the most reported use in 2012. The reasons reported by the NHIS for taking herbal supplements were compared with the 2019 Natural Medicines Comprehensive Database (NMCD) to determine whether reasons cited in consumption were supported by evidence. Logistic regression models were fit according to NHIS sampling weights to examine the relationship between evidence-based use and user characteristics, guiding resources, and health care professional engagement surrounding use. Results: Of the 181 reported uses of herb supplements for a specific health condition, 62.5% were for reasons supported by evidence-based indications (EBIs). The odds of herb use consistent with evidence significantly increased for those reporting higher education status (odds ratio [OR] = 3.01, 95% confidence interval [CI] [1.70-5.34]). Herbal supplement use consistent with EBIs was more likely among those who disclosed their herb use to a health care professional (OR = 1.77, 95% CI [1.26-2.49]). Evidence-based herb use was also less frequently informed by Media sources (OR = 0.43, 95% CI [0.28-0.66]) compared with non-EBI use. Conclusion: Approximately 62% of the reasons cited for taking the most consumed herbs in 2012 were in alignment with 2019 EBIs. This increase may be due to improved awareness of health care professionals and/or an increase of evidence for traditional uses of herbal products. Future research should explore the role of each of these stakeholders in improving evidence-based herb use in the general population.

A review of available herbal medicine options for the treatment of chronic insomnia

Background: Insomnia is a universal health problem that affects the health and quality of life of people worldwide. During the last decade treatment of insomnia with herbal has been introduced to be effective but unfortunately, the safety and efficacy of these medicines are currently uncertain. However, the administration of various herbal medicines for insomnia is increasing mainly due to the diversity of various adverse effects of western medication. Objective: The present study is aimed to investigate available herbal medicine options for the treatment of chronic insomnia. Method: All demanded data were retrieved from electronic databases, Natural Medicines, TCMID, Natural Medicines Comprehensive Database, MedlinePlus, PubMed, EMBASE, and Google Scholar. Among them, randomized clinical trials were chosen precisely to be investigated more for seeking any additional information related to the treatment of chronic insomnia. All related papers in English and Persian languages included in the study criteria. At first, 162 articles were chosen to be investigated, then after screening all articles based on the PRISMA method, 83 qualified articles remained to be investigated carefully. Results: Herbal plants with medical properties as sedative agents are obtaining more and more attention because they contain various types of natural bioactive metabolites with the lowest rate of adverse effects. Moreover, these novel medicines are highly economic, with high efficacy while could be available easily. Conclusion: The data from this study demonstrated that medical plants could yield sedative activity and some of them are effective for insomnia, but we must not forget that further clinical trials are demanded to approve this. Keywords: Sleep disorders, Chronic insomnia, Herbal medicine, Alternative medication, Treatment.

Prevalence of potential interactions of medications, including herbs and supplements, before, during, and after chemotherapy in patients with breast and prostate cancer.

The use of herbs and supplements (HS) is common among patients with cancer, yet limited information exists about potential medication interactions (PMIs) with HS use around chemotherapy. Patients with breast or prostate cancer who had recently finished chemotherapy at 2 academic medical centers were surveyed by telephone. Interviewers inquired about all medications, including HS, before, during, and after chemotherapy. Micromedex, Lexicomp, and Natural Medicines Comprehensive Database interaction software programs were used to determine PMIs. A total of 67 subjects (age range, 39-77 years) were evaluated in this study. Participants were primarily White patients (73%) with breast cancer (87%). The median number of medications was 11 (range, 2-28) during the entire study and was highest during chemotherapy (7; range, 2-22). Approximately four-fifths (84%) used HS. A total of 1747 PMIs were identified, and they represented 635 unique PMIs across all 3 timeframes, with most occurring during chemotherapy. Prescription-related PMIs (70%) were the most common type, and they were followed by HS-related (56%) and anticancer treatment-related PMIs (22%). Approximately half of the PMIs (54%) were categorized as moderate interactions, and more than one-third (38%) were categorized as major interactions. Patient use of HS increased from 51% during chemotherapy to 66% after chemotherapy, and this correlated with an increased prevalence of HS PMIs (46% to 60%). HS users were more likely to be at risk for a major PMI than non-HS users (92% vs 70%; P = .038). The use of HS remains prevalent among patients with cancer and may place them at risk for PMIs both during chemotherapy and after the completion of treatment. This study evaluates the risk of potential medication interactions for patients with breast or prostate cancer undergoing chemotherapy. The results show that patients often use herbs and supplements during treatment. Prescription medications are most often associated with medication interactions, which are followed by herb and supplement-related interactions. More than one-third of potential medication interactions are considered major. Patients should be educated about the risk of herb and supplement-related medication interactions during treatment.

IDISK: the integrated DIetary Supplements Knowledge base.

To build a knowledge base of dietary supplement (DS) information, called the integrated DIetary Supplement Knowledge base (iDISK), which integrates and standardizes DS-related information from 4 existing resources. iDISK was built through an iterative process comprising 3 phases: 1) establishment of the content scope, 2) development of the data model, and 3) integration of existing resources. Four well-regarded DS resources were integrated into iDISK: The Natural Medicines Comprehensive Database, the "About Herbs" page on the Memorial Sloan Kettering Cancer Center website, the Dietary Supplement Label Database, and the Natural Health Products Database. We evaluated the iDISK build process by manually checking that the data elements associated with 50 randomly selected ingredients were correctly extracted and integrated from their respective sources. iDISK encompasses a terminology of 4208 DS ingredient concepts, which are linked via 6 relationship types to 495 drugs, 776 diseases, 985 symptoms, 605 therapeutic classes, 17 system organ classes, and 137568 DS products. iDISK also contains 7 concept attribute types and 3 relationship attribute types. Evaluation of the data extraction and integration process showed average errors of 0.3%, 2.6%, and 0.4% for concepts, relationships and attributes, respectively. We developed iDISK, a publicly available standardized DS knowledge base that can facilitate more efficient and meaningful dissemination of DS knowledge.

Effects of Carotenoids on Health: Are All the Same? Results from Clinical Trials.

Oxidative stress is implicated in the pathogenesis of a lot of age-related pathologies and some types of cancers. Carotenoids have shown antioxidant properties, due to the ability to quench singlet oxygen and to scavenge free radicals that may prevent and treat a wide range of chronic diseases. The aim of this review is to discuss the clinical evidence present in literature about the effects of carotenoids on human health and to evaluate their effectiveness in the prevention and treatment of many chronic diseases. We reviewed studies on carotenoids claiming to show an effect in the prevention and treatment of many chronic diseases. In particular, we focused our attention on clinical trials published on Natural Medicine Comprehensive Database and PubMed. A great number of clinical trials reported the beneficial effects of carotenoids on human health, in particular against skin, eye, hepatic, cardiovascular diseases and some types of cancer. Nevertheless, a few study evaluated the intake of carotenoids alone and sometimes the results are discording. Furthermore, irrational or excessive use of antioxidants may produce risk of potential toxicity. The antioxidant activity of carotenoids, taken with the diet or through nutritional supplements, seems to benefit human health. Therefore, it is necessary to test them alone and to evaluate their safety in longterm clinical trials on a large and heterogeneous sample of people.

Regulatory roulette

Regulatory roulette

Dietary supplement interactions with antiretrovirals: a systematic review.

Many patients who take antiretroviral drugs also take alternative therapies including dietary supplements. Some drug-supplement combinations may result in clinically meaningful interactions. We aimed to investigate the evidence for dietary supplement interactions with antiretrovirals. A systematic review was conducted using multiple resources including PubMed, Natural Medicine Comprehensive Database, The Review of Natural Products, and Google Scholar. All human studies or case reports evaluating an interaction between a dietary supplement and an antiretroviral were selected for inclusion. Twenty-eight pharmacokinetic studies and case-series/case reports were selected for inclusion. Calcium carbonate, ferrous fumarate, some forms of ginkgo, some forms of garlic, some forms of milk thistle, St. John's wort, vitamin C, zinc sulfate, and multivitamins were all found to significantly decrease the levels of selected antiretrovirals and should be avoided in patients taking these antiretrovirals. Cat's claw and evening primrose oil were found to significantly increase the levels of antiretrovirals and patients should be monitored for adverse effects while taking these dietary supplements with antiretrovirals. This systematic review shows the importance of screening all human immunodeficiency virus patients for dietary supplement use to prevent treatment failure or adverse effects related to an interaction.

Characterization of Complementary and Alternative Medicine-Related Consultations in an Academic Drug Information Service

Purpose: To characterize requests received through an academic drug information consultation service related to complementary and alternative medicines. Methods: A retrospective review and descriptive analysis of drug information consultations was conducted. Results: A total of 195 consultations related to complementary and alternative medicine were evaluated. All consultation requests involved questions about dietary supplements. The most common request types were related to safety and tolerability (39%), effectiveness (38%), and therapeutic use (34%). Sixty-eight percent of the requests were from pharmacists. The most frequent consultation requests from pharmacists were questions related to drug interactions (37%), therapeutic use (37%), or stability/compatibility/storage (34%). Nearly 60% of complementary and alternative medicine-related consultation requests were able to be completely addressed using available resources. Among review sources, Natural Medicines Comprehensive Database, Clinical Pharmacology, Micromedex, and Pharmacist’s Letter were the most common resources used to address consultations. Conclusion: Utilization of a drug information service may be a viable option for health care professionals to help answer a complementary and alternative medicine-related question. Additionally, pharmacists and other health care professionals may consider acquiring resources identified to consistently answering these questions.

Reduction of Fasting Blood Glucose and Hemoglobin A1c Using Oral Aloe Vera: A Meta-Analysis.

Diabetes mellitus is a global epidemic and one of the leading causes of morbidity and mortality. Additional medications that are novel, affordable, and efficacious are needed to treat this rampant disease. This meta-analysis was performed to ascertain the effectiveness of oral aloe vera consumption on the reduction of fasting blood glucose (FBG) and hemoglobin A1c (HbA1c). PubMed, CINAHL, Natural Medicines Comprehensive Database, and Natural Standard databases were searched. Studies of aloe vera's effect on FBG, HbA1c, homeostasis model assessment-estimated insulin resistance (HOMA-IR), fasting serum insulin, fructosamine, and oral glucose tolerance test (OGTT) in prediabetic and diabetic populations were examined. After data extraction, the parameters of FBG and HbA1c had appropriate data for meta-analyses. Extracted data were verified and then analyzed by StatsDirect Statistical Software. Reductions of FBG and HbA1c were reported as the weighted mean differences from baseline, calculated by a random-effects model with 95% confidence intervals. Subgroup analyses to determine clinical and statistical heterogeneity were also performed. Publication bias was assessed by using the Egger bias statistic. Nine studies were included in the FBG parameter (n = 283); 5 of these studies included HbA1c data (n = 89). Aloe vera decreased FBG by 46.6 mg/dL (p < 0.0001) and HbA1c by 1.05% (p = 0.004). Significant reductions of both endpoints were maintained in all subgroup analyses. Additionally, the data suggest that patients with an FBG ≥200 mg/dL may see a greater benefit. A mean FBG reduction of 109.9 mg/dL was observed in this population (p ≤ 0.0001). The Egger statistic showed publication bias with FBG but not with HbA1c (p = 0.010 and p = 0.602, respectively). These results support the use of oral aloe vera for significantly reducing FBG (46.6 mg/dL) and HbA1c (1.05%). Further clinical studies that are more robust and better controlled are warranted to further explore these findings.

Complementary and alternative medicine use among cancer patients in Palestine with special reference to safety-related concerns

Ethnopharmacological relevanceThe use of CAM including herbal medicine as the most preferred CAM modality, among cancer patients who are taking prescription medications has shown to be highly prevalent worldwide as well as in several Middle Eastern countries, with a high percentage of the patients do not disclose their CAM use to treating physician. Aim of the studyThe current study aimed to evaluate the patterns of CAM use among two cohorts of cancer patients in Palestine over a three-year period, and to identify socio-demographic factors that are associated with CAM use. Materials and methodsAcross-sectional survey of patients attending outpatient cancer clinics. The method was based on a semi-structured questionnaire. In order to identify safety-related concerns associated with the products listed, a literature search was conducted using different databases (PubMed, Micromedex, AltMedDex, and the Natural Medicine Comprehensive Database). ResultsIn 472 cancer patients including 372 of the 2011 cohort; and 100 of the 2014 cohort, the overall prevalence of CAM use was 69.5%. CAM users were more likely to be ≤65 years old, village resident, being in the midst of chemotherapy, to have high interest spiritual quest, and to have no other chronic diseases. A significant number of CAM users reported using herbal preparations (98.3%, and 89.6% in the two study cohorts, respectively). In the current study, a total of 40 plant taxa belonging to 23 botanical families were reported by ≥3 cancer patients in the two cohort groups. The top most commonly used plant in the 2011 cohort group was Arum palaestinum (43.5%), while Ephedra foeminea emerged as the top most commonly utilized plant (from 0.0% in 2011 to 55.2% in the 2014 cohort), mainly due to a recent publicizing and portraying of the plant in the local media as an effective cancer herbal remedy. Safety-related concerns were associated with 33 (82.5%) herbs, including herb-drug interactions with altered pharmacokinetics (8, 20% herbs), direct toxic effects (16, 40% herbs), and increased in vitro response of cancer cells to chemotherapy (30, 75% herbs). ConclusionsCAM use, especially herbal medicine in cancer is highly prevalent in Palestine. This study has demonstrated the role of the media on the emergence of new CAM herbal therapies among cancer patients in Palestine, and discussed its potential implications on patients and for oncologists who are treating them. Some of the most widely used herbal medicines by cancer patients in the present work are known to interact with conventional anticancer drugs. Hence, the disclosure of the use of herbal remedies by patients to health professionals with sufficient training in CAM use is important for the later in order to assess whether there are any possible herbal drug interactions and/or harmful drug reactions.

Nutraceuticals with a clinically detectable blood pressure-lowering effect: a review of available randomized clinical trials and their meta-analyses.

The aim of the present study was to review and comment on the available evidence on nutraceuticals with a clinically demonstrable blood pressure (BP)-lowering effect. We reviewed studies published in the English language from 1990 to 2015 on dietary supplements or nutraceuticals claiming to show an effect on human BP. An initial list of possibly effective agents and studies was obtained from the online reference, the Natural Medicine Comprehensive Database. Using PubMed, we searched agents identified from this list using the MeSH terms 'hypertension', 'blood pressure', 'dietary supplement' and 'nutraceuticals', alone and in combination. We then focused our attention on meta-analyses and randomized clinical trials. Beyond the well-known effects on BP of the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet, a large number of studies have investigated the possible BP-lowering effect of different dietary supplements and nutraceuticals, most of which are antioxidant agents with a high tolerability and safety profile. In particular, a relatively large body of evidence supports the use of potassium, magnesium, L-arginine, vitamin C, cocoa flavonoids, beetroot juice, coenzyme Q10, controlled-release melatonin and aged garlic extract. The antihypertensive effect of all these nutraceuticals seems to be dose related and the overall tolerability is good. Some nutraceuticals might have a positive impact on BP in humans. Further clinical research is needed, to identify from the available active nutraceuticals those with the best cost-effectiveness and risk-benefit ratio for widespread and long-term use in the general population with a low-added cardiovascular risk related to uncomplicated hypertension.

Evaluation of dietary supplement advertisements in popular Spanish, Chinese, and Korean media outlets: a cross sectional study

The prevalence of dietary supplement (DS) advertisements in non-English daily periodicals, weekly periodicals, and television in the United States is unknown. Additionally, it is unclear if the claims presented in these advertisements are validated. This study aims to compare the prevalence of DS advertisements and percent of validated claims in DS advertisements among popular English and non-English daily periodicals, weekly periodicals, and television. This is a cross-sectional study involving daily periodical, weekly periodical, and television advertisements for DS in English, Spanish, Chinese, and Korean in San Francisco Bay Area and Los Angeles Area, California, USA. Study outcomes are percent prevalence of DS advertisements, percent of claims in DS advertisements that made therapeutic claims, and percent of validated claims in DS advertisements. Claims in DS advertisements were validated by using the effectiveness rating of the Natural Medicines Comprehensive Database and/or identifying a supporting randomized controlled trial (RCT). The prevalence of DS advertisements across all three media outlets were 0 % in English, 0 % in Spanish, 14.8 % in Chinese, and 11.4 % in Korean. Across all three media outlets, DS advertisements were significantly more prevalent in both Asian languages than in English (p < 0.001). None of the products identified in English media outlets made a therapeutic claim whereas 18.6 % of products identified in non-English media outlets did. None of the claims in DS advertisements had an effective rating. Only one product identified in English media outlets had supporting data from an RCT. Our data suggest that DS advertisements are more common in Asian language media outlets than in English and Spanish language media outlets. Given the lack of validated claims in DS advertisements, rigorous evaluations of their claims should be carried out to guide and protect consumers.

Potential risks associated with traditional herbal medicine use in cancer care: A study of Middle Eastern oncology health care professionals.

The authors assessed the use of herbal medicine by Middle Eastern patients with cancer, as reported by their oncology health care professionals (HCPs). Herbal products identified by the study HCPs were evaluated for potential negative effects. Oncology HCPs from 16 Middle Eastern countries received a 17-item questionnaire asking them to list 5 herbal products in use by their patients with cancer. A literature search (PubMed, Micromedex, AltMedDex, and the Natural Medicine Comprehensive Database) was conducted to identify safety-related concerns associated with the products listed. A total of 339 HCPs completed the study questionnaire (response rate of 80.3%), identifying 44 herbal and 3 nonherbal nutritional supplements. Safety-related concerns were associated with 29 products, including herb-drug interactions with altered pharmacodynamics (15 herbs), direct toxic effects (18 herbs), and increased in vitro response of cancer cells to chemotherapy (7 herbs). Herbal medicine use, which is prevalent in Middle Eastern countries, has several potentially negative effects that include direct toxic effects, negative interactions with anticancer drugs, and increased chemosensitivity of cancer cells, requiring a reduction in dose-density. Oncology HCPs working in countries in which herbal medicine use is prevalent need to better understand the implications of this practice. The presence of integrative physicians with training in complementary and traditional medicine can help patients and their HCPs reach an informed decision regarding the safety and effective use of these products.

Natural Medicines: A Complementary and Alternative Medicines Tool Combining Natural Standard and the Natural Medicines Comprehensive Database

Natural Medicines is a subscription-based database of complementary and alternative medicine information, building on the information previously available within Natural Standard and the Natural Medicines Comprehensive Database. Natural Medicines offers several special features including an Interaction Checker and Effectiveness Checker, as well as tools focused on Nutrient Depletion, Pregnancy & Lactation, and Adverse Effects. This column features a sample search of Natural Medicines, along with descriptions of the special features and how they might be used in practice by health care providers and health sciences information professionals.

Weighing the Benefits of Fish Oil for Patients With Prostate Cancer: A Subcohort Review From the SELECT Trial.

© 2015 Harborside Press® Many individuals, both men and women, seek dietary supplements with the belief that they will protect them from developing certain chronic diseases and possibly even decrease their risk of developing cancer (National Cancer Institute, 2015). Fish oil is of the most popular dietary supplements, containing two of the most important omega-3 acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Humans cannot produce their own omega-3 fatty acids or make them from omega-6 fatty acids. Therefore, external intake of these acids is important to one’s health. Two external means of obtaining omega-3 fatty acids in diet are eating cold water fish such as salmon, sardines, herring, mackerel, tuna, or anchovy or taking fish oil supplements. Sometimes, oral fish oil supplements contain tiny amounts of vitamin E to prevent spoilage and other minerals such as calcium and iron, or they are orally mixed with vitamins A, B1, B2, B3, C, or D. It is necessary for patients and advanced practitioners to read supplement labels. Also, preparation of fish (broil or baked, not fried) is important to obtain the maximal benefit of the omega-3 fatty acids. Fish oil has long been taken for various conditions. Scientific evidence suggests that omega-3 fatty acids can reduce pain, swelling, and inflammation (Goldberg & Katz, 2007; Maroon & Bost, 2006). Strong evidence supports the idea that fish oil helps to lower high-density proteins and the risk of heart disease and stroke (Natural Medicines Comprehensive Database, 2015). There is ongoing research on the use of fish oil for other purposes.

Safety of Popular Herbal Supplements in Lactating Women.

The increasing popularity and use of dietary supplements has required health care professionals to become more knowledgeable of their properties, interactions, and adverse effects. The objectives of this review were to evaluate the safety of popular dietary supplements in breastfeeding mothers and the effects on the infants. Nine of the most popular herbal dietary supplements were identified based on the 2011 US market report of the top 10 selling botanicals and the most frequently received inquiries by the Ruth A. Lawrence Lactation Study Center at the University of Rochester Medical Center. Relevant publications were identified through June 2014 using PubMed and EMBASE; tertiary references, including the Drugs and Lactation Database and Natural Medicine Comprehensive Database, were also reviewed. These herbals include black cohosh, cranberry, echinacea, evening primrose, garlic, ginseng, melatonin, milk thistle, and St John's wort. Studies varied greatly with regard to study design, herbal intervention, and outcome measures. Findings suggested that dietary/herbal supplements have not been evaluated in high-quality clinical trials, and there is limited evidence supporting safety of use, particularly among lactating women. Therefore, it is essential for physicians to provide counseling for nursing mothers seeking information on dietary supplements, highlighting reliable safety profiles, inquiring about the potential benefits the patient is seeking, and assessing the patient's perception of this supplement during breastfeeding. More research and clinical trials are required in this area to guide the recommendations and expand our current knowledge of these products.

What Are n-7 Fatty Acids and Are There Health Benefits Associated with Them?

What Are n-7 Fatty Acids and Are There Health Benefits Associated with Them?

Echinacea and elderberry—should they be used against upper respiratory tract infections during pregnancy?

This review evaluates the safety of echinacea and elderberry in pregnancy. Both herbs are commonly used to prevent or treat upper respiratory tract infections (URTIs) and surveys have shown that they are also used by pregnant women. The electronic databases PubMed, ISI Web of Science, AMED, EMBASE, Natural Medicines Comprehensive Database, and Cochrane Library were searched from inception to November 2013. Relevant references from the acquired articles were included. No clinical trials concerning safety of either herb in pregnancy were identified. One prospective human study and two small animal studies of safety of echinacea in pregnancy were identified. No animal- or human studies of safety of elderberry in pregnancy were identified. Twenty clinical trials concerning efficacy of various echinacea preparations in various groups of the population were identified between 1995 and 2013. Three clinical trials concerning efficacy of two different elderberry preparations were identified between 1995 and 2013. The results from the human and animal studies of Echinacea sp. are not sufficient to conclude on the safety in pregnancy. The prospective, controlled study in humans found no increase in risk of major malformations. The efficacy of Echinacea sp. is dubious based on the identified studies. Over 2000 persons were given the treatment, but equal amounts of studies of good quality found positive and negative results. All three clinical trials of Elderberry concluded that it is effective against influenza, but only 77 persons were given the treatment. Due to lack of evidence of efficacy and safety, health care personnel should not advice pregnant women to use echinacea or elderberry against upper respiratory tract infection.

Natural Products for the Treatment of Type 2 Diabetes Mellitus

In the past decade, there has been an increase in the use of natural products in type 2 diabetes mellitus (T2DM). Several agents, such as guar gum, magnesium, oat bran, blond psyllium, and soy, have shown efficacy for treatment of T2DM. Objective: To review the scientific literature to identify effects of natural products (i.e., dietary supplements) for the treatment of T2DM. Methods: A search of Natural Medicines Comprehensive Database was performed to identify natural products advocated for the treatment of T2DM. Natural products categorized as both “possibly effective” and “likely safe” (guar gum, magnesium, oat bran, blond psyllium, and soy) were selected for review. A MEDLINE (1950-March 2013) literature review was performed. Articles published within the last ten years (January 2003-March 2013) and pertinent articles published prior to 2003 were included in this review. Diabetes prevention studies were not selected for this review. Conclusions: Based on the published information, there is little evidence to support the use of herbal products for the treatment of T2DM. Some agents may be useful as adjunctive therapy; however, patients should be encouraged to speak with their health care practitioner before starting or stopping any herbal products.

Anxiety-Inducing Dietary Supplements: A Review of Herbs and Other Supplements with Anxiogenic Properties

Anxiety disorders comprise the most common group of mental disorders to affect the general population in the United States. These disorders are heterogeneous in nature, highly comorbid with one another, and pose a degree of difficulty regarding diagnosis and management. The exact etiology and pathophysiology of anxiety remains to be elucidated; however, it is likely that it is multifactorial, and all potential causes of anxiety must be investigated, including substance-induced anxiety. Among substances that may induce anxiety are dietary supplements. As utilization of these products appears to be high in the US population, it is important to identify which of available supplements may cause anxiety. Objective: To review the scientific literature to identify dietary supplements associated with induction of anxiety and related symptoms. Methods: A search of Natural Medicines Comprehensive Database, MedlinePlus Herbs and Supplements, and Natural Standard was performed to identify dietary supplements with anxiogenic properties. Dietary supplements were included based on product availability, utilization trends, and if there was sufficient evidence that the substance could elicit anxiety via direct pharmacologic effects. Agents were excluded from the review if anxiety was solely due to withdrawal from the substance or only occurred in the setting of intoxication. A search of MEDLINE and PUBMED was performed to identify relevant peer reviewed publications concerning induction of anxiety and/or its associated symptoms by those dietary supplements chosen for review. Conclusions: Dietary supplements can contribute to and cause anxiety and its related symptoms via overstimulation of the Central Nervous System. Healthcare professionals should screen all patients presenting with symptoms consistent with anxiety for recent or current use of all products capable of inducing anxiety, including dietary supplements.