also known as the ‘Fossil tree’ in the Far East,
where most of its fossils are found. A specimen
ofG. bilobawas the only living thing to survive at
ground zero, Hiroshima, recovering its stature
from the surviving root within about 10 years.
The product is used for memory loss and mental
alertness, without good clinical trial evidence, but
it has enjoyed this reputation for centuries in Asia,
and now worldwide. Ginkaloids are antioxidants,
but how this mechanism relates to its proposed
neurological and cardiovascular effects is unclear.
SomeG. bilobaextracts increase both the antipla-
telet properties of aspirin and the anticoagulant
properties of warfarin, perhaps suggesting that
the interaction takes place at the level of plasma
protein binding; which flavanoid or terpene lactone
is responsible for this is unknown, and perhaps it is
due to some other unidentified component of these
particular formulations. Hydrolyzed amino acids
from cow brain are recommended for the same
indications in Central Europe (e.g. Cerebrolyticu
in Romania).
Black cohosh(Cimicifuga racemosaor ‘Bugbane’)
is native to the eastern United States and was first
identified by the Algonquin tribes as an aid to
inducing labor, and treating peri- and postmeno-
pausal symptoms. Separation scientists have found
no factors with known estragenic activity. It would
therefore be illogical to impute beneficial effects of
this material on prevention of coronary heart dis-
ease or osteoporosis.
Glucosamine/chondroitincombinations are pro-
moted as ‘optimal support for joint health’, and to
‘repair joint cartilage’ in the United States. Both
materials may be prepared either from bovine or
ovine sources, which reputable manufacturers
usually obtain from herds that are free from scra-
pie or bovine spongiform encephalopathy prions.
Glucosamines are also found in chitin (the mate-
rial giving strength to insect exoskeletons and
the shells of marine arthropods) and some plant
cell walls. Patients with allergies to crabs and
lobsters are also liable to be allergic to glucosa-
mine formulations derived from these sources.
Chondroitin is a sulfated mucopolysaccharide
found in mammalian cartilage or tendons. Glu-
cosamine, in large doses, can increase insulin
requirements in diabetics. Chondroitin increa-
ses the likelihood of relative overdose with
warfarin, probably by competition for plasma
protein binding sites and increase in free warfarin
concentrations.
SAM-erecently became popular in North America,
although it has been used for much longer in
Europe. It is recommended for the kindred syn-
dromes of fibromyalgia and chronic fatigue syn-
drome, as well as unrelated diseases such as
osteoarthitis and Parkinson disease. SAM-e is also
recommended for depression and anxiety, which
can obviously be either primary or secondary to
the other indications. Pure SAM-e is (usually) the
S- isomer of adenosyl (L-) methionine, but it is
often formulated with B vitamins; endogenous
adenosyl methionine is found in the mammalian
liver, and thus swallowing 200 mg per day(a typical
dose) may not be able to materially change the
biological economy of this substance. Perhaps by
extrapolation from the known detoxicating proper-
ties of sulfydryl-containing amino acids, it pro-
posed that SAM-e removes ‘harmful metabolites’
and that these, in turn, are responsible for the dis-
eases for which the drug is indicated. It is also
proposed that SAM-e can ‘optimize the synthesis
of neurotransmitters, glutathione and cartilage’; as
glutathione is synthesized in many mammalian tis-
sues at high concentration, always from glutamate,
cysteine and glycine, these claims cannot be
entirely correct. One manufacturer’s trade mark
for SAM-e is ‘Nature’s Wonder’ and sells SAM-e
formulated with unidentified ‘methylation factors’
as a ‘complete methylation support formula’.
Ephedra spp.(known as ‘ma huang’ in Chinese
medicine) are a large genus of woody, jointed,
desert shrubs. These shrubs appear to be leafless
from a distance but, on close inspection, possess
scale-like leaf structures at the nodes. Ephedrine,
pseudoephedrine and related alkaloids are the
active principles. Ephedra is marketed for many
logical purposes, for example as decongestants,
bronchodilation and so on. Less appropriate uses
are to heighten awareness, remain awake when
studying for examinations and a street-sold alter-
native to illegal amphetamines. The predictable
adverse events are hypertensive episodes, stroke,
cardiac arrhythmias, malignant hyperthermia and
seizures, many of which occur in young people390 CH30 COMPLEMENTARY MEDICINES