St. John's Wort (hypericum) for HIV?

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Can St. John's Wort boost mood? -St. John's Wort(Hypericum)for HIV/AIDS?St. John's Wort -LATIN NAME: Hypericum perforatum FAMILY NAME:

Clusiaceaehttp://www.mothernature.com/Library/bookshelf/Books/54/13.cfm

St. John's wort is a happy plant. Just looking at its yellow,star-shaped flowers is enough to lift my spirits. But in the winter of1998, I reached for this weedy perennial for more than its aesthetic

qualities.Knowing the herb is a proven antidepressant as well as a potentialtreatment for a variety of ailments, I supplemented with St. John's wortcapsules four times a day to shake my winter doldrums.

Optimistic and energetic by nature, I typically work 12-hour days at mycomputer, walk daily in and around my six-acre herbal vineyard, andtravel the world to forage for plants or talk about them. One of my

associates jokes that she hardly has the energy to keep up with me, eventhough her years tally far fewer than my 70.Thankfully, I have never suffered from debilitating, down-and-outdepression. But every fall, as the daylight hours wane, my mood fades

too. I lose my usual enthusiasm. I feel out of sorts.Looking back, I think I've always been less motivated in fall andwinter. As a boy living in the South, where sunlight is plentiful, atleast in summer, this was not a problem for me. As an adult living in

Maryland, farther from the equator, my annual dose of sun is not aspotent. And I sense the subtle effects.In recent years, science has given a name to this common humanexperience: seasonal affective disorder, or SAD. While it is a form of

depression--affecting 10 million people in the United States, theNational Institute of Mental Health reports--it usually is mild andshort lived. When there is less daytime, our brains don't get as muchlight by way of our eyes.

That translates into fewer nourishing " neurochemicals " that fuel oursense of well-being.Annual jaunts to Peru and other South American climes are my favorite " antidote " for the winter blues. But in 1998, I had no trip planned. So,

instead, I took standardized hypericum capsules for the first time.After all, years of research and conversations with colleagues andfriends had convinced me hypericum was not to be ignored. Now, I

consider it part of my herbal arsenal, a kind of vacation in a bottle,when a trip to the Amazon is out of the question.What St. John's Wort Is and What It Can DoYou've probably heard something about St. John's wort & shy; & shy; or St. Joan's

wort, as my herbalist friend Susun Weed, author of Breast Cancer? BreastHealth! The Wise Woman Way, dubs it. Maybe you know of someone whoclaims this herb--in capsule form, tincture, or tea--has helped her ward

off SAD or full-blown depression.Hypericum's been much more popular in the United States since 1997 whena national television program aired a report on the herb's reputedantidepressant properties. The plant & shy; & shy;and products made from it

& shy; & shy;became downright hard to find.Now, it's available everywhere & shy; & shy;in health food stores, pharmacies, andsupermarkets and in products from well-known vitamin manufacturers. Even

in potato chips.Its reputation is growing beyond that of an antidepressant. Some of thephytochemicals in St. John's wort are believed to be helpful in stavingoff HIV, the virus that causes AIDS, and in the topical treatment of

herpes viruses and first-degree burns, cuts, and wounds.They show promise, too, in easing the pain and swelling of arthritis andfibromyalgia and the discomfort associated with menopause andperimenopause as well as other medical conditions.

That's why St. John's wort is among Duke's Dozen.This pretty perennial is native to Europe, where its use dates back2,000 years. In their book, Rational Therapy--A Physician's Guide toHerbal Medicine, Volker Schulz, Rudolf Hansel, and Varro E. Tyler say it

grows wild as a weed in Asia and North and South America. I find itgrows in most temperate climates, especially in dry sunny locations.Some people claim the herb gets its name from St. John's Day (June 24),

when it typically blooms, although there are other explanations. Wort,incidentally, has no relation to the unsightly skin growth (spelledwarts) that toads are infamous & shy; & shy; incorrectly--for passing along. It

simply is old English for " plant. " In earlier times, the herb was saidto expel evil spirits in those who ingested it. The Latin name,Hypericum, is based on the Greek word for " over an apparition. "

DR. DUKE'S NOTESIn some parts of the country, St. John's wort is better known by itscommon name, klamath weed. In California, where cattle have becomephotosensitive after grazing on large amounts of klamath, a movement has

sprung up to eradicate the wild weed. There is even a monument, erectedby the U.S. Department of Agriculture, to indicate success in biologicalcontrol of the klamath weed in California. And, in 1998, California was

having trouble supplying the demand for St. John's wort.Emotional HealthSchulz, Hansel, and Tyler suggest that Paracelsus, the sixteenth-centurySwiss physician and alchemist, knew of hypericum's effectiveness in

treating psychiatric conditions and that German poet-physician JustinusKerner reported its use in mood disorders in the early nineteenthcentury.In more recent years, though, the herb was pushed aside in favor of

synthetic antidepressants. Then, in the late twentieth century, reportsof its usefulness began to pour in once again.Most came from Germany, where the value of herbal medicines has beenmore readily embraced.

In 1984, Commission E (a German panel of experts roughly equivalent tothe U.S. Food and Drug Administration) approved hypericum for relief ofmild to moderate depression and anxiety associated with it.

As study after study cited its effectiveness, St. John's wort became theleading antidepressant in Germany.There, it outsells even Prozac, the synthetic pill Americans begangobbling up in the late 1980s.

We're slow to catch on in America. Most of the studies showinghypericum's value as an antidepressant have been done abroad. In 1996,the British Medical Journal published an overview of 23 clinical

studies, involving more than 1,700 patients.It concluded that hypericum has antidepressant properties, particularlyin mild to moderate cases. And it said the herb was more effective thana placebo and just as potent as prescription antidepressants, without

their side effects.I'm almost positive I'm improving my emotional health by keeping St.John's wort on hand and using it when I feel the need.Oddly, this herb has gained so much attention overseas, Americans often

are surprised when I tell them hypericum grows on its own in each of the50 states. Early colonists likely brought it with them, eitherintentionally or by accident. Perhaps the tiny seeds hitched a ride on

some food or other supply the settlers carried to the New World.Thanks to our ancestors, you might have your own supply of thiswonderful herb just down the road a bit or on your own soil, as I do.Although I never purposely cultivated St. John's wort until I

established my Green Farmacy Garden in 1998, I suppose you could say itgrew on me. The weed has a mind of its own in my garden, popping upwherever it likes, to heights of one to two feet, or three feet in an

organic garden.HERB LORE AND MORENative Americans also turned to the healing qualities of St. John'swort, which early colonists brought to the New World. Interestingly,their uses are not the ones considered most effective today.

The Menominees compounded it with blackcap raspberry root and used itfor kidney troubles. A compound containing the root was used to treattuberculosis.The Meskwakis applied a powder of the boiled root of St. John's wort to

draw poison from the bite of the water moccasin. The Cherokees, too,chewed on the root, swallowing a portion and applying the rest as apoultice for snakebites.The Cherokees took infusions of hypericum for fever and sniffed the

crushed plant as a remedy for nosebleeds. Infusions also were used forbloody flux and bowel complaints. A compound decoction was taken topromote menstruation.The Seminoles used infusion of roots for rat sickness and blocked

urination and bowels. The Choctaw relied on a decoction of root forcolic and as a wash for sore eyes.The Miwok Indians depended on a decoction of the plant as a wash forrunning sores. It was thought to be a dermatological aid, perhaps

because of its anti-inflammatory and antiviral properties, and it wasused to break fevers and counteract venereal disease.A Bountiful Garden and a Beautiful BouquetMy wild-but-welcome St. John's wort includes Hypericum perforatum and

Hypericum punctatum, 2 of about 400 species of the plant. My two happento be among seven I studied in my years with the U.S. Department ofAgriculture. All proved rich in at least one major active ingredient,

hypericin, the focus of many studies.Each year, around the third week of June, my plants bloom on scheduleand continue to flower sporadically through first frost. (They may lapseinto quiescence during droughts, only to liven up after the rains

return.) It's as if they know I expect them. Their yellow petals arespeckled with orange and reddish dots that ooze a purplish oil whenpinched. Some herbalists liken the dots--where the active ingredientsreside--to the pores of St. John's skin. When the flowers are steeped in

oil, the " blood " in the pores moves into the oil. My Hypericum punctatumseems to have more of the purplish compounds. Just crushing it stains myfingers.Sometimes, on summer strolls around my home, I gather the plants'

flowering tops--so rich in phytochemicals. I could use them to make myown extract but generally prefer to take standardized capsules. Thatway, I know I'm getting the same amount of active ingredients with every

dose--something I can't be sure of with the plants. Just like humans,each one of them is chemically unique.St. John's wort also makes a beautiful bouquet. You probably can findthe plants in summer at your local greenhouse. Although these

commercially grown plants won't be as medicinally active, all St. John'swort seems to contain an aromatic called cineole.In studies, large quantities of cineole enabled rats to zip through amaze more rapidly, whether the compound was inhaled, applied to their

skins, or force-fed to them.Maybe a mere whiff of these mildly scented blooms can help us get happy.Why not place a pretty bouquet on a dining table or nightstand?DR. DUKE'S NOTESYou can buy potato chips and other snack foods sprinkled with St. John's

wort. They may taste good and likely won't hurt you. Unfortunately, theyprobably don't have therapeutic value, because they don't contain enoughof the herb to make a difference.How St. John's Wort Can Help

St. John's wort contains dozens of active ingredients, such ashypericin, pseudohypericin, protohypericin, and hyperforin. Throughouthistory, myriad external and internal uses have been reported. Here are

the ones I believe are the most scientifically sound:Burns, cuts, and other wounds. Modern science backs up some of thefolklore surrounding hypericum, including its ability to promote healingon our skin, not just underneath it.

Commission E has approved the topical use of St. John's wort oil forprimary and secondary blunt and sharp injuries and for burns, skindamage caused by heat, caustics, electricity, or radiation. Hypericum is

both an anti-inflammatory and antibiotic, which may help preventinfection. One study in Germany showed hypericum ointment speededhealing and lessened the severity of scarring.Weed says the oil also reduces skin damage from radiation treatments.

Women who applied the oil before and after treatments report their skinstayed healthy and flexible, even after dozens of exposures. Somesuggest it may quicken healing from sunburn.Depression. According to the World Health Organization, depression

affects 3 to 5 percent of people. It's characterized by flagging mood,lack of interest in normally pleasurable activities, disturbed eatingand sleeping patterns, low self-esteem, indecisiveness, irritability,

fatigue, and hopelessness.In recent years, science has begun to shed light on depression--that itscauses are environmental and biochemical, and that often it runs infamilies.We also have a new understanding of how depression occurs: through an

imbalance in neurotransmitters, or feel-good chemicals such asserotonin, dopamine, and norepinephrine, which regulate mood.A CASE IN POINTKimberly's StoryCan St. John's wort boost mood when combined with synthetic

antidepressants?The major pharmaceutical makers may not want to know.But plenty of folks who suffer from depression tell me they do--and someforward-thinking physicians are helping their patients find combinations

that work.Kimberly B., a fortysomething career woman in Virginia, who asked thather real name not be used, has fought mild but chronic depression sinceshe was a teenager. " I thought I was lazy, until I learned in my late

twenties what depression was, " she says.Kimberly says talk therapy helped her to " see differently, " to viewlife's glass as half-full and not half-empty. She learned thatdepression could be hereditary. " A couple of my cousins have bipolar

disorder, " she says. " I think a couple of relatives struggled withalcoholism. They drank to deal with their depression. " Kimberly asked her doctor about synthetic antidepressants. " I wanted to

know if I could feel better, the way normal people feel, " she says. Shetried commonly prescribed dosages of Prozac, then Zoloft, and thenPaxil. But the side effects--nervousness, agitation, and

irritability--wouldn't pass. Finally, with her doctor's help Kimberlysettled on a " baby dose " of Luvox, a selective serotonin reuptakeinhibitor (SSRI) used to treat obsessive-compulsive disorder and

depression. Still, she says, the benefits seemed small.Then, in 1997, Kimberly read the news reports about St. John's wort, andwith her doctor's okay, began taking 300 milligrams containing 0.3percent hypericin three times a day, in addition to the Luvox. (Note: I

do not recommend combining hypericum with synthetic antidepressantswithout your doctor's approval.)Kimberly says she noticed the effect almost right away. " In fact, byabout the third day of using both, I felt overstimulated, so I cut back

on the Luvox to every other day. Sometimes, I skip a dose or two of theSt. John's wort. Otherwise, I haven't had any problems. I don't avoidany particular foods and, generally, I feel good. " This newfound knowledge has led to pharmaceuticals that target specific

brain chemicals. One class of antidepressants called monoamine-oxidaseinhibitors, or MAOIs, help raise the brain's supply of norepinephrineand dopamine. A newer class, selective serotonin reuptake inhibitors, or

SSRIs, such as Prozac and Zoloft, ensure an abundance of serotonin.While studies show these Food and Drug Administration (FDA) approveddrugs are effective for many, there is a price to pay--not only in

dollars at the pharmacy but in side effects including dizziness,fatigue, dry mouth, constipation, and sexual dysfunction. Further,people taking the MAOIs must avoid certain foods and medications thatinteract with the drugs.

In the United States, Prozac is the best-selling antidepressant. But inGermany, about 200,000 prescriptions a month are filled for just onebrand of St. John's wort, compared to about 30,000 a month for Prozac,

says Varro E. Tyler, Ph.D., Sc.D., professor emeritus of pharmacognosyat Purdue University.In German studies involving 3,250 people, 80 percent found partial orcomplete freedom from depressive symptoms, Dr. Tyler says in " The Honest

Herbalist--The Secrets of Saint-John's-Wort, " published in Preventionmagazine.DR. DUKE'S NOTESWhile St. John's wort has been proven effective against unipolardepressions, evidence does not support its use in treating bipolar

disorder, a condition in which sufferers " cycle " between depression andeuphoria.In the United States, researchers are only beginning to study the herb'smedicinal value. A three-year National Institute of Mental Health study

at Duke University in North Carolina is comparing St. John's wort withZoloft, or sertraline, the silver bullet in pharmaceutical treatment ofdepression in this country. I am, like many, eager to see the results.

These university trials satisfy something I have been urging for adecade: that new studies on pharmaceuticals compare them not only withplacebo but also with a more promising herbal alternative. I'd like to

see the FDA require that for every pharmaceutical so that we can see howthe herbal remedy compares with the synthetic drug. But the FDA doesn'toversee herbal products, and there's little financial incentive for big

drug manufacturers to test herbs, because they can't patent them. So myplea for mandatory comparisons with herbal alternatives as well asplacebo remains unanswered. But the studies at Duke (no relation tomyself) are at least one start in the right direction.

You'll most often see hypericin touted on St. John's wort product labelsin the United States. But look for hyperforin, too. In Germany, newerstudies are focusing on that chemical's action in the treatment of

depression.Herpes. St. John's wort may have antiviral benefits when appliedtopically to the oozing, painful blisters of genital herpes. Thecontagious viral infection affects about 45 million Americans, according

to the National Institute of Allergy and Infectious Diseases (NIAID).Herpes simplex II typically causes genital herpes, which is spreadmainly through sexual contact with someone who has the virus. It lies

dormant in the body between outbreaks. While oral and topical treatmentscan help reduce the number of outbreaks and their severity, there is nocure.St. John's wort contains proven antivirals that can help speed healing

when applied topically. It also can help heal cold sores and feverblisters caused by herpes simplex I, as well as the blisters of itscousins, chickenpox and shingles (varicella-zoster).Shingles afflicts about 20 percent of adults who suffered a nasty, itchy

bout of chickenpox in their earlier years. It is most common in peopleover 50. This virus, too, hides out in the body. When it erupts--oftenas the result of illness or stress--it causes pain and a blistering

rash. The pain may linger for years after the visible sores have healed.Hypericum contains analgesic properties that may help to quell the pain.If I had shingles, I would add a bit of capsaicin topically to my St.

John's wort--but only after any open sores had healed.Studies in the early 1990s showed hypericin is active against herpessimplex I and II. Herbalist Susun Weed also believes hypericum'santiviral powers pass through the skin and into the nerve endings,

preventing and checking a variety of problems. She suggests hypericuminternally (25 drops tincture) and externally, maybe every four hours,for shingles, cold sores, and genital herpes.FROM MY SCIENCE NOTEBOOK

In Europe, hypericum has a long history as a treatment for depression,anxiety, and unrest. Research shows it boosts feel-good brain chemicalssuch as serotonin, dopamine, and norepinephrine.For many years, it was believed hypericum acted primarily as a

monoamine-oxidase inhibitor, or MAOI, enhancing dopamine andnorepinephrine. The warning was given to avoid alcohol, smoked orpickled foods, and certain medications for allergies and colds, which

might interact with hypericum, as with synthetic MAOIs.Now, it appears the hypericum link was overplayed. My friend Jerry Cott,Ph.D., chief of the Pharmacologic Treatment Program at the NationalInstitute of Mental Health, says the MAOI role is minor. It is more

likely, as so often found in the plant world, that the compounds in St.John's wort work in synergy. They attack their opponent together, like adisciplined basketball team headed for the championship.

Consumers are likely to experience fewer side effects with the herbalremedy because of the shared actions of the compounds, says Varro E.Tyler, Ph.D., Sc.D., professor emeritus of pharmocognosy at PurdueUniversity. Newer research on hypericum, for example, shows it also acts

as a selective serotonin reuptake inhibitor (SSRI), increasing themood-enhancing brain chemical serotonin.I believe the empirically proven herbs are milder and safer because ofthis synergy. And their therapeutic effects may be more complete.

HIV/AIDS. The NIAID says as many as 900,000 Americans may be infectedwith human immunodeficiency virus, or HIV. It's the virus that causesAIDS, a major worldwide epidemic, first reported in the United States in

1981.The virus kills or cripples the immune system's T-cells--the goodguys--and leaves its victims unable to fight infection and certaincancers. They become susceptible to opportunistic infections, such as

cytomegalovirus and herpes. In healthy people, the microbes that carrysuch infections don't usually cause illness. For people with HIV, theycan be deadly.HIV is passed along most commonly by sexual contact with an infected

partner. The sharing of needles and syringes or contact with infectedblood also can spread it. Mothers can transmit the virus to their babiesduring pregnancy or birth, NIAID says.Some people have flu-like fever, headache, and fatigue a month or two

after exposure. Severe symptoms may not occur for a decade or more. Asthe immune system weakens, signs such as swollen glands and weight lossbegin to show. In advanced stages, HIV is categorized as AIDS. The virus

can be detected by blood tests.Standard treatments for HIV/AIDS include drugs such as AZT thatinterrupt an early stage of virus replication, slowing the virus in thebody and delaying the onset of infections. Other drugs called protease

inhibitors, such as saquinivir, interrupt the virus at later stages.Because HIV can become resistant to the drugs, often they are used incostly combinations, or drug " cocktails. " These cocktails can run as high as $18,000 a year. They require extreme

diligence on the part of the patient, and they are not without sideeffects--nausea, diarrhea, and gastrointestinal disturbances among them.Patients must also be alert to signs of interaction with other drugs

that can result in serious side effects, the NIAID acknowledges.DR. DUKE'S NOTESIs it a placebo or is it hypericum? Clinical studies show a strongrelationship between placebo pills and mood enhancement. In other words,

people who think they are receiving medication may feel better, even ifthe pill is a dud. I'd rather " fool " myself with an herb than a costlypharmaceutical and the side effects that go with it.

If I suffered from HIV/AIDS, I would also try the less expensive, saferherbal alternatives, including St. John's wort.I first became curious about its role against HIV in the early 1980s.Gordon Cragg, Ph.D

.., at the Natural Products Branch of the NationalCancer Institute (NCI), called and asked where we might be able to findhypericin. " In my garden, " I told him. But it was September, past theplant's flowering season.

Daniel Meruelo, Ph.D., professor of pathology at New York UniversitySchool of Medicine, wanted to examine the potential antiretroviralactivities of hypericin in clinical trials.The AIDS connection was new to me, and exciting. The following spring I

was able to supply them with hypericum.Dr. Meruelo was looking at hypericin in test tube studies, especiallywhen combined with ultraviolet light. As with certain cancer treatments,researchers direct the tiny flashlight-like rays to hot spots where the

virus is.Dr. Cragg says hypericin itself did not appear to be the silver bulletin the NCI AIDS screen, but the work continues. Hypericum contains manyingredients that may help slow HIV. Dennis V.C. Awang, of the American

Botanical Council Advisory board, has noted that pseudohypericin canreduce the spread of HIV, at least in the test tube. At my urging, JerryCott, Ph.D., of NIMH may look at Hypericum hypericoides, yet another

species. Hypericum also shows promise in fending off opportunisticinfections, such as cytomegalovirus.Hypericum might be doubly useful in treating AIDS because of itsantiviral and antidepressant properties, says a 1995 article in the

Psychiatric Times.The Journal of the American Medical Association reports that half ofall people with a medical illness also are depressed. Adding St. John'swort to the HIV/AIDS weaponry might boost patient morale and the immune

system, possibly slowing the virus.-- Diana Gonzalez Nothing wastes more energy than worrying - the longer a problem is carried, the heavier it gets. Don't take things too seriously - live a life of serenity, not a life of regrets.

-Unknown