For most of human history herbal medicines were the number one remedy used by people worldwide. All that gradually changed with the advent of chemistry and pharmacology. Instead of using herbal teas or pastes people started to use standardized drugs produced by pharmaceutical companies, prescribed by medical professionals, and dispensed by pharmacies. Many of these drugs were naturally occurring substances or derivates that had been used as part of herbal medicines for a long time. Aspirin or acetylsalicylic acid (ASA), for example, is a derivative of salicylate, which can be found in such plants as willow tree and myrtle. It was first mentioned as a remedy for pain, fever, and inflammation in an Egyptian papyrus more than 3500 years ago.
Scientists, especially ethnobotanists, went all over the planet in search of other substances from plants, fungi, and lichen that could be tested for their medicinal properties. Over time, however, chemists took over and more and more pharmaceuticals were created in the lab. That made the process more controlled and made it easier for companies to claim patents on newly synthesized drugs. Yet, approximately 95% of tested components fail in clinical trials and for those few that pass the whole process from start to finish takes about 12 years and costs up to $800 million or more.
That kind of investment is a lot of money for developed countries, but almost too much for most developing countries, which explains why there are no new drugs coming out of developing countries. It also explains why there are only few and often no recently introduced drugs for rare disorders or disorders that mainly occur in poorer countries. Malaria is a typical example for that. Although there are an estimated 200 million cases of malaria every year and about half a million deaths related to malaria, there hasn’t been a new drug to treat malaria since artemisinin-based combination therapy (ACT) was introduced in the 1990s. One of the reasons for companies not investing into the development of new antimalarial drugs is that about 85% of all cases occur in Africa, where people can only afford to get the drug if governments or international non-governmental organizations (NGOs) subsidize the costs of treatment.
Starting in the mid-1990s a new approach developed that looked into traditional herbal medicines and their efficacy in treating certain diseases. For example, researchers in India conducted a nationwide survey of Ayurvedic physicians to take inventory of herbs used to treat conditions such as arthritis, diabetes, and hepatitis. After they had identified certain herbs for treatment of arthritis they started observational studies in a clinical setting as well as animal studies. Because this approach reverses the order in which traditional pharmacology works it is usually called reverse pharmacology.
In the case of malaria reverse pharmacology pointed to the benefits of Mexican prickly poppy (Argemone Mexicana) for the treatment of milder cases of malaria. Although the poppy was native to Mexico, it somehow made its way to Africa sometime in the 1800s and soon became a part of herbal remedies. When researchers talked to traditional healers in Mali in West Africa they learned about the beneficial effect of Argemone tea on patients with mild malaria. That led to a first prospective study that compared using Argemone tea for half of the patients and a standard artemisinin-based combination therapy (ACT) for the other half. Surprisingly Argemone tea did almost as well as ACT therapy in patients with non-life threatening malaria, although it hadn’t been refined and patients just drank as much tea as they liked.
But, there are still a lot of scientists, especially in pharmacology, that are skeptical or outright opposed to this approach. They prefer to use well defined compounds and point to the fact that herbal remedies often contain a mix of many active substances that may cancel each other out or cause uncontrollable side effects. Teas and infusions are almost impossible to standardize, which makes it difficult to give exact doses of active ingredients to the patients. They also point to unknown toxicities of plants or parts of plants. When we look at Mexican poppy, for example, then we find that the poppy seeds contain the poison sanguinarine, which was implicated in a mass poisoning of 3000 people in India in 1998 that lead to the death of 65 people. The leaves, however, are nonpoisonous and tea is safe to consume.
Another success story for reverse pharmacology and herbal remedies is happening in the western Pacific. Palau is an island nation of more than 500 islands that is a paradise for scuba diving and snorkeling. However, Palau also has the seventh highest obesity rate on the planet and may inhabitants suffer from high blood pressure (hypertension) and diabetes. Instead of trying the tried and tested methods that failed to stop the obesity epidemic in western developed countries, doctors tried to find herbal remedies to help treat hypertension and diabetes. After analyzing traditional herbal medicines they were able to draw up a list of herbs that showed potential. In the end two plants, Morinda citrifolica (a tree from the coffee family), and Phaleria nisidai, were associated with weight loss (M. citrifolica) and lowering of high blood pressure (P. nisidai).
Finding scientific proof that traditional herbal remedies are almost as good for the treatment of a variety of diseases as modern drugs while often having far fewer side effects is a boost to many who look for a more holistic approach to medicine. Many people in developed and developing countries are trying to live a more healthy life by eating local and often organic produce, by cutting down on animal protein, and by using traditional remedies when possible and available. The more their number grows the more companies will try to cater to their needs and demands, and the more herbal remedies will be used to treat physical and mental health disorders.
© Peter Reuter 2015
It has been known for a long time that there are many bacteria that grow on the body membranes that cover our outer (skin) and inner body surfaces (mouth, gastrointestinal tract, vagina). Many of them will cause disease when they overgrow an area, while others will never harm us or can even help protects us from disease causing microbes (so-called pathogens). We knew that some pathogens can cause severe diseases when introduced into our gastrointestinal system, such as food poisoning. It has also been known for quite some time that some of these bacteria help us break down certain food we eat, which can be beneficial, but also cause irritation and embarrassment (beans, beans the magic fruit…). However, there were also indications that at least some bacteria have an even greater and more beneficial influence on what is going on inside our body, such as strengthening our immune system.
Over the last 10 years or so our understanding of and appreciation for the bacterial garden, especially inside our mouth and the large intestine has grown a lot. We now estimate that for each cell in our whole body we have 10 bacteria colonizing our large intestine. Researchers have found that there are many different bacteria that together form a so-called microbiome. Which bacteria are dominant in a person’s microbiome is of great importance for how their body processes food, how many calories they extract from the food they eat and how their body weight develops.
Over the last few decades almost all developed countries experienced an ever increasing weight problem. Although no one really knows what a “normal” weight is, long-term research has shown that overweight people are at a higher risk to develop certain diseases. The Body Mass Index (BMI) or Quetelet index is used to classify people based on body weight and height into normal body weight (BMI below 25), overweight (BMI between 25 and 30) and obese (BMI above 30). Even though those ranges aren’t a law of nature and may be changed depending on future research, we still know that the heavier people get the more likely they are to develop diseases of the cardiovascular system, diabetes mellitus type II, and osteoarthritis. Currently approximately 1/3 of Americans are of normal weight, 1/3 is overweight, and 1/3 is considered obese.
Because of the negative long-term effects for overweight and obese people themselves as well as the enormous financial burden treatment of their obesity-related diseases puts on society as a whole, there have been many attempts at educating people about the dangers of obesity and the benefits of weight loss. Still, the percentage of overweight and obese adult and children keeps rising steadily. Researchers looking into these issues kept coming across people who seemed to do everything right, they ate healthy food in recommended amounts and exercised, but couldn’t lose weight or even gained some more, whereas others seemed to do everything wrong, from eating too much unhealthy food to not exercising at all, and yet didn’t gain any weight. We couldn’t find any reason for these differences when we measured how much energy they burnt at rest (basal metabolic rate, BMR) or when active (total metabolic rate, TMR), which indicated that there had to be something to the way how these different people digested food and absorbed nutrients.
The first hints about the importance of our gut bacteria for our body weight came from twin studies. They showed that “lean” twins and “obese” twins had different bacterial floras. When they ate the same kind and amount of food the lean twins would stay lean, while the obese twins gained more weight. We also saw the importance of a healthy microbiome when we looked at the reasons for severe bacterial infections of the large intestine caused by antibiotics given for the treatment of bacterial infections. One of the most surprising findings, however, was the importance of natural birth and breast feeding on the long-term body weight of babies and children. Babies born via C section and babies raised on formula instead breast milk have a much higher chance of becoming overweight or obese. Looking into that we realized that babies pick up a healthy bacterial flora on their way through the birth canal of the mother. These bacteria colonize the skin, the mouth and the large intestine of the newborn and establish a healthy environment. Breastfeeding encourages further growth of this healthy microbiome. Babies delivered via C section don’t pick up bacteria on their way out of the womb and babies fed on formula grow bacteria that breast-fed babies start growing once they transition to solid food. As their immune system had time to develop first they are more likely to being able to resist and suppress unhealthy microbes.
Based on these findings some researchers in Europe are experimenting with transferring healthy gut bacteria from lean patients to overweight patients to help them lose weight. Most doctors, however, want to wait and find out first which bacteria really are the good guys so we can isolate them and then introduce them into the body of people with weight issues. But, there are situations where a transfer of gut flora is a potentially life-saving procedure. Some patients on antibiotics or after gastroenteritis develop a Clostridium difficile infection in their bowels, which can cause vomiting, diarrhea and abdominal pain, and even be fatal in severe cases. One way to treat this disorder is to perform a fecal microbiota transplant – sometimes jokingly referred to as transpoosion. In this procedure a fecal sample of a healthy donor is introduced into the rectum of the patient. In a recently reported case from the United Kingdom a mother suffering from this condition was given a fecal transplant from her overweight daughter. The transplant did its job, the bowel infection healed, but the mother gained 36 lbs of weight over the next sixteen months going from a BMI of 26 (just above normal weight) to a BMI of 34.5, which is classified as obese, under the same diet as before.
There is still a lot to be learned about how bacteria influence our body as a whole and how we can use them to treat and prevent acute and chronic disorders. But, we can already say that bacteria, not dogs, should be considered men’s best friend.
© Peter Reuter 2015