Herbs high in mucilage, such as marshmallow or slippery elm, may help reduce the irritation to the walls of the intestinal tract that can occur with diarrhoea. A usual amount taken is 1,000 mg of marshmallow extract, capsules, or tablets three times per day. Marshmallow may also be taken as a tincture in the amount of 5–15 ml three times daily. Sweet annie has been used traditionally to treat infectious diarrhoea and malaria. However, more modern studies have used the isolated constituent artemisinin and it is unclear how effective the herb is in managing diarrhoea.
Holistic approaches that may be helpful
Other integrative approaches that may be helpful: Acupuncture may be useful for the treatment of diarrhoea, particularly in infants. A preliminary study of acupuncture treatment in 1,050 cases of infantile diarrhoea found 95% were relieved with one to three treatments. Similar results have been reported in other preliminary trials and case reports. A controlled trial of acupuncture for the treatment of infantile diarrhoea compared scalp acupuncture or traditional body acupuncture with drug therapy, primarily antibiotics. The cure rate for scalp and body acupuncture was significantly higher (90% and 89%) than that of drug treatment (46%).
Ear Infections
Many children suffer recurrent infections of the middle ear, a condition also known as otitis media (OM).
What are the symptoms of recurrent ear infections?
Ear infections can cause irritability, difficulty sleeping, runny nose, fever, fluid draining from the ear, loss of balance, mild to severe ear pain, and hearing difficulty. Untreated infections can cause permanent hearing impairment and can also spread to other parts of the head, including the brain. Frequent or persistent ear infections in children can reduce their hearing when normal hearing is critical for speech and language development.
Dietary changes that may be helpful
The incidence of allergy among children with recurrent ear infections is much higher than among the general public. In one study, more than half of all children with recurrent ear infections were found to be allergic to foods. Removing those foods led to significant improvement in 86% of the allergic children tested. Other reports show similar results. In one preliminary study, children who were allergic to cow’s milk were almost twice as likely to have recurrent ear infections as were children without the allergy. People with recurrent ear infections should discuss allergy diagnosis and elimination with a doctor.
Although sugar intake has not been studied in relation to recurrent ear infections, eating sugar is known to impair immune function. Therefore, some doctors recommend that children with recurrent ear infections reduce or eliminate sugar from their diets.
Xylitol, a natural sugar found in some fruits, interferes with the growth of some bacteria that may cause ear infections. In double-blind research, children who chewed gum sweetened with xylitol had a reduced risk of ear infections.
Lifestyle changes that may be helpful
When parents smoke, their children are more likely to have recurrent ear infections. It is important that children are not exposed to passive smoke.
Humidifiers are sometimes used to help children with recurrent ear infections, and animal research has supported this approach. Nonetheless, human research studying the effect of humidity on recurrent ear infections has yet to conclusively show that use of humidifiers is of significant benefit.
Use of pacifiers in infants increases the risk of ear infections.
Nutritional supplements that may be helpful
Vitamin C supplementation has been reported to stimulate immune function. As a result, some doctors recommend between 500 mg and 1,000 mg of vitamin C per day for people with ear infections. Nonetheless, vitamin C supplementation has not been studied by itself in people with ear infections.
Zinc supplements have also been reported to increase immune function. As a result, some doctors recommend zinc supplements for people with recurrent ear infections, suggesting 25 mg per day for adults and lower amounts for children. For example, a 30- pound child might be given 5 mg of zinc per day while suffering from OM. Nonetheless, zinc supplementation has not been studied in people with ear infections.
Herbs that may be helpful
Echinacea has been reported to support healthy short-term immune response. As a result, it has been suggested that some children with recurrent ear infections may benefit from 1–2 ml (depending on age) of Echinacea tincture taken three times per day or more. Doctors who use Echinacea suggest that supplementation be started as soon as symptoms start to appear and continued until a few days after they are gone. Nonetheless, research has not been done to determine whether Echinacea supplementation either reduces symptoms or prevents recurrence of ear infections.
Ear drops with mullein, St. John’s Wort, and garlic in an oil or glycerine base are traditional remedies used to alleviate symptoms, particularly pain, during acute ear infections. No clinical trials have investigated the effects of these herbs in people with ear infections. Moreover, oil preparations may obscure a physician’s view of the ear drum and should only be used with a healthcare professional’s directions.
An unpublished clinical trial of children with colds found that linden tea, aspirin, and bed rest were more effective than antibiotics at speeding recovery and reducing complications such as ear infection. (Aspirin is no longer given to children due to the threat of Reye’s syndrome.) However, no research has yet confirmed the use of linden for preventing ear infections.
Eczema
Eczema is a common inflammatory condition of the skin.
Many skin diseases cause symptoms similar to those of eczema, so it is important to have the disease properly diagnosed before it is treated.
What are the symptoms of eczema?
Eczema is characterized by scaling, thickened patches of skin that can become red and fissured. It may also appear as tiny blisters (called vesicles) that rupture, weep, and crust over. The most troublesome and prevalent symptom of eczema is itching, which may be constant.
Dietary changes that may be helpful
Eczema can be triggered by allergies. Most children with eczema have food allergies, according to data from double-blind research. A doctor should be consulted to determine whether allergies are a factor. Once the trigger for the allergy has been identified, avoidance of the allergen can lead to significant improvement. However, “classical” food allergens (e.g., cows’ milk, egg, wheat, soy, and nuts) are often not the cause of eczema in adults. A variety of substances have been shown, in a controlled trial, to trigger eczema reactions in susceptible individuals; avoidance of these substances has similarly been shown to improve the eczema. Triggers included food additives, histamine, salicylates, benzoates, and other compounds (such as aromatic compounds) found in fruits, vegetables, and spices. These reactions do not represent true food allergies but are instead a type of food sensitivity reaction. The authors of this study did not identify which substances are the most common triggers.
It has been reported that when heavy coffee drinkers with eczema avoided coffee, eczema symptoms improved. In this study, the reaction was to coffee, not caffeine, indicating that some people with eczema may be allergic to coffee. People with eczema who are using a hypoallergenic diet to investigate food allergies should avoid coffee as part of this trial.
Nutritional supplements that may be helpful
Researchers have reported that people with eczema do not have the normal ability to process fatty acids, which can result in a deficiency of gamma-linolenic acid (GLA).7 GLA is found in evening primrose oil (EPO), borage oil, and black currant seed oil. Some, but not all, double-blind trials have shown that EPO is useful in the treatment of eczema. An analysis of nine trials reported that the effects for reduced itching were most striking. Much of the research uses 12 pills per day; each pill contains 500 mg of EPO, of which 45 mg is GLA. Smaller amounts have been shown to lack efficacy. Supplementation with borage oil, another source of GLA, has led to reductions in skin inflammation, dryness, scaliness, and itch in eczema patients in some, but not all, preliminary or double-blind trials.
Many years ago, use of large amounts of vegetable oil (containing precursors to GLA) was reported to help treat people with eczema, but these studies were not controlled and do not meet modern standards of research.
Ten grams of fish oil providing 1.8 grams of EPA (eicosapentaenoic acid) per day were given to a group of eczema sufferers in a double-blind trial. After 12 weeks, those using the fish oil experienced significant improvement. According to the researchers, fish oil may be effective because it reduces levels of leukotriene B4, a substance that has been linked to eczema. The eczema-relieving effects of fish oil may require taking ten pills per day for at least 12 weeks. Smaller amounts of fish oil have been shown to lack efficacy. One trial using vegetable oil as the placebo reported that fish oil was barely more effective than the placebo (30% vs. 24% improvement). As vegetable oil had previously been reported to have potential therapeutic activity, the apparent negative outcome of this trial should not dissuade people with eczema from considering fish oil.
Although supplementation with 400 IU of vitamin E per day has been reported in anecdotal accounts to alleviate eczema, research has not supported this effect. Moreover, rare cases of topical vitamin E potentially causing eczema have appeared. People with eczema should not expect vitamin E to be helpful with their condition.
A double-blind trial reported that use of a hypoallergenic infant formula plus probiotics (500 million organisms of Lactobacillus GG bacteria per gram of formula, taken for one month) initially led to improvement in eczema symptoms in infants with suspected allergy to cows’ milk. However, by the end of two months, both the group receiving Lactobacillus GG and the placebo group had improved approximately the same amount. In the same report, a preliminary trial giving 20 billion Lactobacilli twice per day to breast-feeding mothers led to significant improvement of their allergic infants’ eczema after one month. Probiotics may reduce allergic reactions by improving digestion, by helping the intestinal tract control the absorption of food allergens, and/or by changing immune system responses.
In 1989, Medical World News reported that researchers from the University of Texas found that vitamin C, at 50–75 mg per 2.2 pounds of body weight, reduced symptoms of eczema in a double-blind trial. In theory, vitamin C might be beneficial in treating eczema by affecting the immune system, but further research has yet to investigate any role for this vitamin in people with eczema.
Herbs that may be helpful
The table below summarizes the three categories of herbs used for people with eczema: anti-inflammatories and herbs that affect the immune system (immunomodulators), astringents (herbs that bind fluids and exudates), and herbs that affect the liver (also called alternatives). Alterative herbs are poorly researched. Astringents are only helpful if applied topically when weeping eczema is present; they will not help people with dry eczema.
Zemaphyte®, a traditional Chinese herbal preparation that includes liquorice as well as nine other herbs, has been successful in treating childhood and adult eczema in double- blind trials. One or two packets of the combination is mixed in hot water and taken once per day. Because one study included the same amount of liquorice in both the placebo and the active medicine, it is unlikely that liquorice is the main active component of Zemaphyte®.
Several Chinese herbal creams for eczema have been found to be adulterated with steroids. The authors of one study found that 8 of 11 Chinese herbal creams purchased without prescription in England contained a powerful steroid drug used to treat inflammatory skin conditions.
A cream prepared with witch hazel and phosphatidylcholine has been reported to be as effective as 1% hydrocortisone in the topical management of eczema, according to one double-blind trial.
Topical applications of chamomile have been shown to be moderately effective in the treatment of eczema. One trial found it to be about 60% as effective as 0.25% hydrocortisone cream.
Onion injections into the skin and topical onion applications have been shown to inhibit skin inflammation in people with eczema, according to one double-blind trial. The quantity or form of onion that might be most effective is unknown.
A Japanese topical ointment called Shiunko has been reported to help improve symptoms of eczema, according to preliminary research. The ointment contains sesame oil and four herbs (Lithospermum radix, Angelica radix, Cera alba and Adeps suillus) and was applied twice daily along with petrolatum and 3.5% salt water for three weeks. Clinical improvement was seen in four of the seven people using Shiunko.
Topical preparations containing calendula, chickweed, or oak bark have been used traditionally to treat people with eczema but none of these has been studied in scientific research focusing on people with eczema.
Burdock, sarsaparilla, red clover, and wild oats have been used historically to treat people with eczema, but without scientific investigation.
Holistic approaches that may be helpful
Numerous trials have reported that hypnosis improves eczema in children and adults.44 A preliminary trial emphasizing relaxation, stress management, and direct suggestion in hypnosis showed reduced itching, scratching, and sleep disturbance, as well as reduced requirements for topical corticosteroids. All of the patients studied had been resistant to conventional treatment.
Erectile Dysfunction
Erectile dysfunction (ED) is the inability of a male to attain or sustain an erection sufficient for sexual intercourse.
It can be a persistent condition; however, almost half of all men experience ED only occasionally. ED can have physical, psychological, or drug-induced causes. Although some doctors used to believe differently, most researchers and doctors now believe that physical factors are responsible for the majority of ED cases. Several conditions may contribute to ED by impairing blood flow to the penis. These include atherosclerosis, diabetes, hypothyroidism, multiple sclerosis, and chronic alcohol abuse.
What are the symptoms of erectile dysfunction?
ED is defined by the symptoms listed above. Symptoms may also include loss of sexual desire (libido), premature ejaculation, or inability to achieve orgasm.
Lifestyle changes that may be helpful
Men who smoke have been shown to have an increased incidence of ED.
Nutritional supplements that may be helpful
Low blood levels of the hormone dehydroepiandrosterone (DHEA) have been reported in some men with ED. In one double-blind trial, 40 men with low DHEA levels and ED were given 50 mg DHEA per day for six months. Significant improvement in both erectile function and interest in sex occurred in the men assigned to take DHEA, but not in those assigned to take placebo. No significant change occurred in testosterone levels or in factors that could affect the prostate gland. Experts have concerns about the safe use of DHEA, particularly because long-term safety data do not exist.
Dilation of blood vessels necessary for a normal erection depends on a substance called nitric oxide, and nitric oxide formation depends on the amino acid arginine. In a preliminary trial, men with ED were given 2,800 mg of arginine per day for two weeks. Six of the 15 men in the trial were helped, though none improved while taking placebo. In a larger double-blind trial, men with ED were given 1,670 mg of arginine per day or a matching placebo for six weeks. Arginine supplementation was found to be particularly effective at improving ED in men with abnormal nitric oxide metabolism. Although little is known about how effective arginine will be for men with ED or which subset of these men would be helped, available research looks promising and suggests that at least some men are likely to benefit.
In a double-blind study of men with erectile dysfunction, supplementation with 120 mg per day of Pycnogenol®, an extract of the bark of a certain tree (Pinus pinaster), improved erectile function, whereas placebo treatment had no effect.
Herbs that may be helpful
Yohimbine (the primary active constituent in Yohimbe) has been shown in several double-blind trials to help treat men with ED; negative results have also been reported,
however. Yohimbe dilates blood vessels and may help, regardless of the cause of ED. A tincture of Yohimbe bark is often used in the amount of 5 to 10 drops three times per day. Standardized Yohimbe extracts are also available. A typical daily amount of Yohimbine is 15 to 30 mg. It is best to use Yohimbe and Yohimbine under the supervision of a physician.
Asian ginseng (Panax ginseng) has traditionally been used as a supportive herb for male potency. A double-blind trial found that 1,800 mg per day of Asian ginseng extract for three months helped improve libido and the ability to maintain an erection in men with ED. The benefit of Asian ginseng confirmed in another double-blind study, in which 900 mg three times a day was given for eight weeks.
Ginkgo Biloba may help some men with ED by increasing blood flow to the penis. One double-blind trial found improvement in men taking 240 mg per day of a standardized Ginkgo Biloba extract (GBE) for nine months. A preliminary trial, involving 30 men who were experiencing ED as a result of medication use (selective serotonin reuptake inhibitors and other medications), found that approximately 200 mg per day of GBE had a positive effect on sexual function in 76% of the men.
Damiana (Turnera diffusa) is a traditional herbal treatment for men with ED. However, no modern clinical trials have confirmed its effectiveness.
Holistic approaches that may be helpful
ED that cannot be linked to physical causes has been successfully treated by hypnosis. In one trial, three hypnosis sessions per week, later decreased to one per month, over a six-month period led to improvement in 75% of men in the trial.
Acupuncture might be of some benefit for men with ED. Electroacupuncture, which is acupuncture accompanied by electrical stimulation, was performed on various acupuncture points in men with ED in a preliminary trial of men with this condition. Two treatments were administered every week for one month. An improvement in quality of erection was observed in 15% of the participants and an increase in sexual activity was reported by 31% of the men. Another preliminary trial found good results in over half of the men treated, but the only controlled trial of electroacupuncture for ED found that placebo also produced a large improvement in sexual function—an effect similar to that of acupuncture. Controlled trials with larger groups of men are necessary to better test the efficacy of acupuncture therapy for men suffering from ED.
Fatigue
Chronic fatigue syndrome (CFS) is disabling fatigue lasting more than six months that reduces activity by more than half. CFS is a poorly understood disease involving many body systems. No single cause of CFS has been identified, therefore, it is diagnosed by symptoms and by ruling out other known causes of fatigue by a healthcare practitioner. Suggested causes include chronic viral infections, food allergy, adrenal gland dysfunction, and many others. None of these have been convincingly documented in more than a minority of sufferers. In some people there is also difficulty sleeping, swollen lymph nodes, and/or mild fever. When there is muscle soreness, fibromyalgia may be the actual problem. Although CFS is considered a modern diagnosis, it may have existed for centuries under other names, such as “the vapours,” neurasthenia, “effort syndrome” (diagnosed in World War I veterans), hypoglycaemia, and chronic mononucleosis.
What are the symptoms of chronic fatigue syndrome?
In addition to fatigue, there may also be muscle pain, joint pain not associated with redness or swelling, short-term memory loss, and an inability to concentrate. Some people with chronic fatigue syndrome also experience difficulty sleeping, swollen lymph nodes, and/or mild fever.
Dietary changes that may be helpful
Some doctors believe that people with CFS who have low blood pressure should not restrict their salt intake. Among CFS sufferers who have a form of low blood pressure triggered by changes in position (orthostatic hypotension), some have been reported in a preliminary study to be helped by additional salt intake.1 People with CFS considering increasing salt intake should consult a doctor before making such a change. (See the Herb information, below, for more information on blood pressure and CFS.)
Lifestyle changes that may be helpful
Exercise is important to prevent the worsening of fatigue. Many people report feeling better after undertaking a moderate exercise plan. However, most people with CFS are sensitive to overexertion, and excessive exercise may lead to consistently worsening fatigue and mental functioning. Exercise should be attempted gradually, starting with very small efforts. One small study found that intermittent exercise, in which patients walked for three minutes followed by three minutes of rest for a total of 30 minutes, did not exacerbate their CFS symptoms.
Nutritional supplements that may be helpful
The combination of potassium aspartate and magnesium aspartate has shown benefits for chronically fatigued people in double-blind trials. However, these trials were performed before the criteria for diagnosing CFS was established, so whether these people were suffering from CFS is unclear. Usually 1 gram of aspartates is taken twice per day, and results have been reported within one to two weeks.
Vitamin B12 deficiency may cause fatigue. However, some reports, even double-blind ones, have shown that people who are not deficient in B12 have increased energy following a series of vitamin B12 injections. Some sources in conventional medicine have discouraged such people from taking B12 shots despite this evidence. Nonetheless, some doctors have continued to take the limited scientific support for B12 seriously. In one preliminary trial, 2,500 to 5,000 mcg of vitamin B12 given by injection every two to three days led to improvement in 50 to 80% of a group of people with CFS; most improvement appeared after several weeks of B12 shots.16 While the research in this area remains preliminary, people with CFS considering a trial of vitamin B12 injections should consult a doctor. Oral or sublingual B12 supplements are unlikely to obtain the same results as injectable B12, because the body’s ability to absorb large amounts is relatively poor.
A preliminary trial has shown that people with CFS have reduced functional B-vitamin status when compared to people without the condition. The functional vitamin deficiency seen in this study was most pronounced for vitamin B6. Double-blind trials are needed to establish whether B-vitamin supplementation is effective in people with chronic fatigue syndrome.
L-carnitine is required for energy production in the powerhouses of cells (the mitochondria). There may be a problem in the mitochondria in people with CFS. Deficiency of carnitine has been seen in some CFS sufferers. One gram of carnitine taken three times daily for eight weeks led to improvement in CFS symptoms in one preliminary trial.
NADH (nicotinamide adenine dinucleotide) helps make ATP, the energy source the body runs on. In a double-blind trial, people with CFS received 10 mg of NADH or a placebo each day for four weeks. Of those receiving NADH, 31% reported improvements in fatigue, decreases in other symptoms, and improved overall quality of life, compared with only 8% of those in the placebo group. Further double-blind research is needed to confirm these findings.
Magnesium levels have been reported to be low in CFS sufferers. In a double-blind trial, injections with magnesium improved symptoms for most people. Oral magnesium supplementation has improved symptoms in those people with CFS who previously had low magnesium levels, according to a preliminary report, although magnesium injections were sometimes necessary. These researchers report that magnesium deficiency appears to be very common in people with CFS. Nonetheless, several other researchers report no evidence of magnesium deficiency in people with CFS. The reason for this discrepancy remains unclear. If people