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Herbal Medicines For Older Adults

Introduction

A few months ago, I gave a talk at a local "Y" to a group of seniors on the subject of herbal medicine. I opened the talk by asking how many of those in the room were taking Ginkgo biloba, an herb that may help slow memory loss in the elderly. Seventeen of the twenty-one people who were there raised their hands. No big surprise, given the amount of press Ginkgo has gotten in the last year or two. Then I asked how many of them had shared with their doctor the fact that they were using this herb. This time only one man raised his hand. People in the group had many answers when I asked them why they were not willing to discuss this with their doctors: "He wouldn’t be interested"; "She’d tell me to stop"; "He wouldn’t know anything about it anyway." It seems we have a long way to go in teaching our doctors how to talk to their patients about alternatives!
 

Ginkgo Biloba, For Your Memory

So what about Ginkgo? Does it work? Is it safe? Who should take it?

Benefits for people with dementia
Well, there is some good medical evidence that Ginkgo, taken at a dose of 120 mg per day, can slow down the progression of dementia in older adults. The effect is fairly modest—it’s not a miracle cure by any means—but it was significant enough to be recognized both by the patients themselves and their family members. The effect was shown both in those with Alzheimer’s and in those with dementia from other causes. A much larger study, to involve almost 2000 people at a cost of almost $15 million, has just been funded by the National Institutes of Health, and will be carried out over the next two years. Compared to the earlier study, which involved less than 200 people, this one should provide more conclusive answers about how well Ginkgo works and who should take it.

Benefits for those without dementia
What about older adults without dementia who just feel they have lost some of their edge and are looking for a way to get it back? And what about younger adults who want to improve their performance at work? Will they benefit from ginkgo? The answers are not yet in, though one recent study in younger adults did show an improvement in short-term memory in those taking ginkgo. This is just one study, though, and we need additional testing and larger tests before we can answer these questions.

Is gingko safe?
In general gingko is quite safe, though some people will experience upset stomach or nausea. The one concern has to do with ginkgo’s blood-thinning properties. Ginkgo can interfere with the action of platelets, a type of blood element which is crucial to blood clotting. There are a few (and only a few) case reports of patients on ginkgo having unusual or excessive bleeding. Given the huge numbers of people who have been taking ginkgo over the past few years, the number of cases of bleeding reported is actually very small. To be on the safe side, however, patients on strong blood-thinning medications like Coumadin should probably not take ginkgo. If you take aspirin or other blood thinners, you should discuss this issue with your doctor. And if you are preparing for a surgical procedure and you take gingko, you should probably stop a week or so before the surgery to reduce the chance of any bleeding complications.

Choosing the right product
Finally, it is important to get a ginkgo product that is at least similar to the extract used in the studies if you expect to get a similar effect. There are numerouse products on the market, many of which are not nearly concentrated enough to be effective. Yours should be an extract standardized to 24 percent flavone glycosides and 6 percent terpene lactones, the active ingredients in ginkgo products. Take the names of these components to your pharmacist and tell him to make sure the ginkgo he sells you includes each of them!

Herbs To Help You Sleep

There are some wonderful herbs that you should try if you share the sleep troubles that seem to plague many of my older patients.

Valerian
The first is valerian. This herbal medicine, made from the root of the plant Valeriana officianalis, has worked wonders for some of my patients. It smells and tastes terrible, so be prepared; but it is also extremely safe and rarely causes even a stomachache. It is not addictive. Contrary to the information in some sources, which claim it resembles the prescription medicine Valium, its effects are very gentle and not habit-forming. As with ginkgo—and every herbal medicine for that matter—it is important to get a good quality product. With valerian I usually recommend the tincture (herb in alcohol solution) because the recommended dose of this herb varies widely from one person to the next and it is much easier to adjust the dosage with a liquid formulation than with capsules. I start my patients on 10-15 drops of the tincture, usually given in an ounce or two of warm water. They take this 30-60 minutes before bedtime. If this dose is not completely effective, they can go up to 40 or even 50 drops. Valerian does seem to work better if you take it on a daily basis, rather than just now and then for sleep.

Additional sleep aids
A number of other herbs work nicely for sleep and can be taken in the form of an infusion or a tea. These include chamomile, oatstraw, skullcap, and spearmint. I usually ask my patients to mix several of these together and brew a strong cup of tea an hour or two before bedtime. These herbs are all extremely safe, and a hot cup of herbal tea in the evening can be wonderfully therapeutic. If you are using raw herbs or teabags, it is important to make sure you keep your supply fresh, since many of these will lose their potency if they sit too long on the shelf.
 

Herbs For Anxiety And Depression

There are a number of herbs I recommend to relieve anxiety and depression.

Valerian
Valerian is indispensable for sleep problems, and it can also be very helpful if you are suffering from anxiety. The dose is usually about half the dose required for sleep problems, although again this will vary from person to person.

Kava kava
Another herb that has become quite popular recently for anxiety is kava kava. This herb, extracted from the plant Piper methysticum, has been used for many years in the islands of the South Pacific. You can find kava in either tincture or capsule form; as with ginkgo, you should look for a standardized extract, this time with 70% kavalactones. The proper dose is roughly 100 mg two to three times per day; it is fine to use it less if it is needed only occasionally.

There are a few cautions to be aware of regarding the use of kava. First, it may potentiate or increase the sedative effects of other substances or medications, like alcohol or other tranquilizers; second, you should not use it if you are suffering from moderate to severe depression; and third, it is not recommended to be used daily for more than three months at a stretch, simply because we do not know enough yet about its long-term effects. I use kava often in my practice and consider it quite safe, so don’t let these cautions scare you if it seems like the right choice for you.

St. John’s Wort
I have many patients, both old and young, who have used St. John’s Wort over the past few years for depression. Although it doesn’t work for everyone, and is not for those with severe depression, I have found it to be very helpful for some of my patients. The proper dose of this herb is 300 mg three times per day, and again it should be a standardized extract. Generally people choose to take St. John’s Wort in capsule form, though it is also available in liquid formulations. It is milder than conventional antidepressants and takes longer to work—up to six to eight weeks in some people—but it is also much easier to tolerate in terms of side effects. There are quite a number of studies from Europe finding that St. John’s Wort, if used properly, works just as well as many conventional antidepressants.

One caution with this herb: if you are currently taking a medication from the group of antidepressants called SSRI’s—Paxil, Prozac, Zoloft and the like—and you are looking to switch to St. John’s Wort, you should probably stop the medication before starting the herb, as there is some question as to whether it is safe to take both the herb and these medications at the same time.

Herbs For Your Heart

It is hard to think of an herb more versatile than garlic, which has been used all around the world as both a food and medicine. I find in my practice that the people garlic most benefits are those with high cholesterol. In study after study, one clove of garlic per day—or the equivalent in capsule form—has been shown to reduce cholesterol by an average of 10 percent. Although this does not sound like much, when you combine garlic with proper diet and exercise regimens, that 10 percent extra may be the difference between needing a medication and being able to avoid it!

There are only a couple potential downsides to garlic. First is the odor—which, if it bothers you (or your spouse) you can avoid by choosing the de-odorized capsule form. Second, there is a possible increase in bleeding tendency similar to that seen with ginkgo.

Cooked garlic is not quite as good as raw, because the cooking process causes some of the medicinal properties to be lost; however, putting your garlic into a dish for the last two to three minutes of cooking is probably fine.

Garlic has also been touted for its ability to lower blood pressure, and many of my patients tell me they use it for this reason. In my experience, though, I have not seen it work well for blood pressure problems, and when you investigate the research, it turns out that, although garlic does have an effect on blood pressure, this effect only lasts about 30-60 minutes after ingesting the garlic. So unless you want to eat a clove of garlic every one to two hours, don’t count on it as treatment for your high blood pressure.
 

Herbs For The Prostate

One final herb, which my patients would never forgive me for leaving out of this article, is saw palmetto. A common problem in men over the age of 50 is a benign enlargement of the prostate. This can create a difficulty with urination, and for this problem, saw palmetto can be a real blessing.

It is taken twice a day in a dose of 160mg each time and has no significant side effects. Many urologists are now recommending saw palmetto routinely for treatment of BPH (benign prostatic hypertrophy) because there is so much evidence that it works just as well in most people as the conventional medications, with a much lower rate of side effects. If you are on one of the standard medications and it is working for you, but you are experiencing side effects, it is also fine to combine saw palmetto with conventional treatment. This will enable you to lower the dose of the regular medicine and reduce the side effects. One caution: contrary to the claims made in some sources, saw palmetto is not a treatment for cancer of the prostate.
 

Summary

Hopefully this discussion has given you some ideas about herbs that might suit your needs, and how to use them. Now we just have to encourage the doctors to be as informed as their patients are!