Yellow Oleander Seed, or "Codo de Fraile" (Thevetia spp.): A Review of Its Potential Toxicity as a Purported Weight-Loss Supplement.

The Dietary Supplements and Health Education Act (DSHEA), passed by the United States Congress in October of 1994, defines herbal products as nutritional supplements, not medications. This opened the market for diverse products made from plants, including teas, extracts, essential oils, and syrups. Mexico and the United States share an extensive border, where diverse herbal products are available to the public without a medical prescription. Research undertaken in the neighboring cities of Ciudad Juarez, Mexico, and El Paso, Texas, USA, shows the use of herbs is higher in this border area compared to the rest of the United States. A portion of the population is still under the erroneous impression that "natural" products are completely safe to use and therefore lack side effects. We review the dangers of ingesting the toxic seed of Thevetia spp. (family Apocynaceae), commonly known as "yellow oleander" or "codo de fraile," misleadingly advertised on the Internet as an effective and safe dietary supplement for weight loss. Lack of proper quality control regarding herbs generates a great variability in the quantity and quality of the products' content. Herb-drug interactions occur between some herbal products and certain prescription pharmaceuticals. Certain herbs recently introduced into the U.S. market may not have been previously tested adequately for purity, safety, and efficacy. Due to the lack of reliable clinical data regarding the safe use of various herbal products currently available, the public should be made aware regarding the possible health hazards of using certain herbs for therapeutic purposes. The potentially fatal toxicity of yellow oleander seed is confirmed by cases reported from various countries, while the purported benefits of using it for weight loss have not been evaluated by any known clinical trials. For this reason, the use of yellow oleander seed as a dietary supplement should be avoided.

Herbal product use by older adults.

In the past two decades, there has been an exponential increase in the use of medicinal herbal products around the world. In various countries, these products are classified and promoted as foods, not pharmaceuticals, which facilitate their availability on the international market without requiring a medical prescription. Since older adults (OAs) are an important and growing sector of the population in many countries, it is important to know the prevalence of their herbal product use, since many OA take herbs along with diverse quantities of prescription and over the counter medications. For this reason, it is important to be aware of the possibilities of health complications due to the concomitant use of diverse medications and herbs. OA are an especially vulnerable population, since many of the human body's physiological activities, such as renal and hepatic detoxification and clearance usually decrease with age. Additionally, information on certain herbal products is either misleading, or simply unavailable. These products may indeed be a therapeutic option, but some can be used properly only under the guidance of a health professional. Those OA taking combinations of various medications and herbal supplements are also more at risk to experience some sort of herb-drug interactions. This publication reviews selected articles related to the use of herbal products by OAs and mentions the various patterns of use and health implications of the concomitant use of herbal products and prescription medications. This topic is currently not fully understood and further research is warranted.

Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States-Mexico border: a descriptive, questionnaire-based study.

BACKGROUND AND OBJECTIVE: The use of multiple medications, herbs or nutritional supplements can lead to adverse consequences, particularly in the elderly. A significant consequence resulting from polypharmacy, polyherbacy and nutritional supplement use is the potential for interactions to occur among the various products. The primary objective of this study was to estimate the prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the US-Mexico border. METHODS: This was a descriptive study that involved the administration of a bilingual (English/Spanish) questionnaire to a convenience sample of adults aged >or=60 years recruited from senior centres located within the most populated US-Mexico border region from June 2005 to March 2006. Participant demographics were collected in addition to information about current use of prescription medications, over-the-counter (OTC) medications, herbal products and nutritional supplements (i.e. nutraceuticals and vitamins or minerals). The outcomes measured were the number of prescription medications, OTC medications, herbal products, vitamins/minerals and nutraceuticals per participant. Furthermore, the number of potential interactions and major interactions between drugs, herbal products and nutritional supplements were identified for each participant. Additionally, product use patterns between men and women and among locations within the border region were compared. RESULTS: One-hundred-and-thirty participants (mean age 71.4 years) were recruited to complete the questionnaire. The prevalence of polypharmacy among all participants was 72.3% (n = 94), with 38.5% (n = 50) taking five or more concomitant medications (major polypharmacy). Twenty-one participants (16.2%) in the study sample reported taking two or more herbal products (polyherbacy). Thirty-four participants (26.2%) reported taking two or more vitamin/mineral supplements and nine (6.9%) reported using two or more nutraceuticals. Participants living on the US side of the border had higher rates of major polypharmacy, polyherbacy and use of nutritional supplements than those living on the Mexican side of the border. Overall, there were no significant differences in medication, herbal product and nutritional supplement use patterns between men and women. Evaluation of potential interactions revealed that 46.2% (n = 60) of participants were at risk of having at least one potential drug-drug interaction. Regarding drug and herbal product-supplement interactions, 31.5% (n = 41) of participants were at risk of having at least one possible interaction. CONCLUSIONS: The prevalence of polypharmacy among older adults living on the US side of the border was similar to national trends (estimates suggest that one-quarter to one-half of US adults aged >or=65 years take five or more medications). However, polypharmacy was less common in older adults living on the Mexican side of the border. Additionally, herb use was higher in older adults living on the US-Mexico border than has been reported in national surveys of US adults, which indicate that less than one-quarter of adults have used a herbal product within the previous 12 months. Furthermore, this study demonstrated that older adults living on the US side of the border consumed more herbs and nutritional supplements than their Mexican counterparts. In addition to describing product use patterns on the border, these findings suggest that almost half of the older adult participants were at risk for a potential drug-drug interaction, with approximately one-third having a potential interaction between their medications, herbs or nutritional supplements.

Case study of Bell's palsy applying complementary treatment within an occupational therapy model.

For 7% of people with Bell's palsy, facial impairment is permanent. The case study patient was a 48-year-old female who had no recovery from paralysis 12 weeks after onset. Goals were to restore facial sensory-motor functions, functional abilities and reduce depression. Facial paralysis was assessed by clinical observations, the Facial Disability Index and Beck Depression Index. Complementary interventions of aromatherapy, reflexology and electro-acupuncture were used with common physical agent modalities in an intensive home activity and exercise programme. The patient had 100% return of function and resolution of depression after 10 days of intervention. The limitation of this study is that it was a retrospective case study and the investigators reconstructed the case from clinical notes. Further research using a prospective approach is recommended to replicate this study.

Bi-national evaluation of herbal product use on the United States/México border.

The study objective was to compare the prevalence of herbal product use between El Paso, Texas, and Ciudad Juárez, Chihuahua, the largest U.S./México border population. 500 households on each side of the border were randomly selected following a strict procedure for household and participant selection. 1001 adult residents of selected households participated. Trained bi-lingual interviewers conducted semistructured interviews using a bi-lingual questionnaire. A chi-square test was used to compare populations when considering discrete variables and a t test was used for continuous variables. There was no significant difference in the overall prevalence of herbal product (HP) use between the El Paso (68%) and Ciudad Juárez samples (65%). El Paso residents used a greater number of HPs compared to Ciudad Juárez residents (P = 0.001). The most common HPs used in El Paso were chamomile, aloe vera, garlic, peppermint and lime. In Ciudad Juárez, they were chamomile, eucalyptus, garlic, linden tree flower and peppermint. In addition, intra-city variation in the use of HPs was observed. On both sides of the border, relatives were the most common source of advice regarding HP use, and most HPs were reportedly used in raw form. While participants in both groups believed that the HPs were effective and safe, a large number of HPs that could potentially be responsible for drug interactions, and side effects were identified. Very low disclosure rates to physicians were reported (33% in El Paso and 14% in Ciudad Juárez). A high prevalence of HP use was documented on both sides of the U.S./México border. Some significant variations in HP use were also identified. The possibilities of HP-related problems combined with low disclosure rates are of significant concern.

Providers of herbal products in the largest US-Mexico border community.

We surveyed providers of herbal products in El Paso, Texas, and Ciudad Juárez, México, to find out which herbal products they used, the content and place of origin of the products, and the illnesses for which the products were recommended. Providers were selected randomly from Ciudad Juárez and El Paso. Most of the herbal products sold in El Paso (98%) are from the United States, whereas most sold in Ciudad Juárez (89.6%) are from México. People in El Paso tend to consume herbal or natural supplements for weight loss or muscle enhancement; those in Ciudad Juárez use herbal products (mostly crude plants) to treat specific illnesses. Ciudad Juárez and El Paso are bordering cities; however, the herbal products consumed by their respective populations are distinct, both in content and method of use.

Guide for herbal product use by Mexican Americans in the largest Texas-Mexico border community.

Use of herbal products is a very common practice among Mexican Americans living in the El Paso, Texas, region. Although medicinal plants are generally assumed to be a safe and natural alternative to conventional medications, some herbal products could pose a potential health risk to the consumer. Currently, only a few studies focus on herbal product use by Mexican Americans, and no studies have focused on its use by patients with human immunodeficiency virus (HN) living on the US-Mexico border. A prospective observational study was conducted in 439 non-HIV patients, as well as in 35 patients suffering from HIV Findings showed that 347 out of 439 (79%) of non-HIV patients and 25 out of 35 (71%) of HIV patients reported using herbal products.

Herbal product use by hispanic surgical patients.

We hypothesized that the use of herbal products is highly prevalent in Hispanic surgical patients on both sides of the U.S./México border. One hundred fifteen patients were interviewed in El Paso and 112 in Ciudad Juárez from December 2001 to June 2002. This prospective, randomized study evaluated patients aged 18 years or older that were scheduled for surgery. Sixty-two per cent of our sample in the United States and 81 per cent of patients in Mexico reported using herbal products in the past year. About 58 per cent of patients in the United States and 49 per cent in Mexico rated the products as "excellent" in treating their conditions. Ninety-two percent of U.S, and 93 per cent of Mexican patients did not inform their physician of their herbal use. Preoperative assessment of patients did not include inquiries about herbal products in either hospital. With the growing use of herbal products and because most users do not inform their physician, there is increasing concern related to the possible occurrence of herbal-related adverse events during and after surgery. The fact that health care personnel did not inquire about herbal product use before surgery is an added concern.

Herbal product use in non-HIV and HIV-positive Hispanic patients.

PURPOSE: The primary endpoint of this study was to determine the prevalence of herbal product use by a sample of Mexican-American patients in the El Paso, TX region. Even though medicinal plants are popularly assumed to be a safe and natural alternative to conventional medications, some herbal products may pose a potential health risk to the consumer. Currently, there are few studies related to herbal use by Mexican Americans and none in HIV patients living on the U.S./México border. METHODS: A prospective observational study was conducted in hospitals and clinics throughout the El Paso region area. A semistructured interview was conducted by trained bilingual interviewers. A 45-item bilingual questionnaire was used to collect the information. RESULTS: A total of 439 non-HIV patients as well as 35 patients afflicted with HIV participated in the study. Seventy-nine percent (347/439) of non-HIV and 71% (25/35) of HIV patients reported using herbal products. The percentages of herbal use among the two groups did not show any statistically significant differences (p=0.29), and both groups reflected that herbal products are commonly used. CONCLUSIONS: The use of herbal products was very common among non-HIV (79%) and HIV-positive (71%) Mexican-Americans patients in the El Paso region.