Saw palmetto extract

American Indians used saw palmetto fruit for food and to treat various conditions, including urinary and reproductive system problems. It’s widely used in alternative medicine today for urogenital problems, especially benign prostatic hyperplasia (BPH). Given its history, is there any evidence to support this usage?

Unfortunately, no. While writers in the 19th century made, or repeated, grand claims for the efficacy of this herbal treatment, these have not been borne out. Its possible that its main indication, for treating enlarged prostate, comes and goes, so the limited studies with saw palmetto simply captured the process whereby some get better for a time, some get worse, and the evidence can look slightly positive. More recent and much larger studies indicate that it has no effect on urinary tract symptoms when compared to a placebo, and the gold-standard Cochrane review agrees: "Serenoa repens was not more effective than placebo for treatment of urinary symptoms consistent with BPH."

In 2012, the Journal of Family Practice released practice change guidelines regarding saw palmetto, based on a high quality randomised controlled trial and the 2009 Cochrane meta-analysis. They recommend that doctors should no longer advise men to use it for urinary symptoms, because “it has not been found to alleviate symptoms, even at triple the standard dose.“

If there’s any positive news, its that the same study did not find evidence of toxicity. Nonetheless, there’s no benefit to using saw palmetto for urinary symptoms, so give this one a pass.

Milk of Magnesia or Calamine for Poison Ivy

Can milk of magnesia or Calamine Lotion be used to treat poison ivy?

Poison ivy is a wicked plant. Just brushing against it can leave a hapless gardener or innocent passer by with itching and rash. The plant produces urushiol, a clear liquid compound found in the sap that binds to the skin on contact. Repeated exposure can lower sensitivity, as the immune system learns how to respond, but that’s a painful approach.

Treatment takes two forms. The first step is stop the urushiol from reacting with the skin – there isn’t much time for this – and the second step is to reduce the itching and blistering.

Urushiol is an oil, so it can be removed from the skin with soap and water. To reduce the itching, antihistamines can be taken orally or as a cream. Hydrocortisone creams will also alleviate symptoms.

As the itching is a symptom of a systemic reaction of the immune system, there’s not much that can be done to relieve it. Ice or cold water can reduce inflammation and itching, but evidence for other remedies is scant or negative.

Calamine lotion is useless for relieving pain and itching. Its active ingredients, zinc oxide and ferric oxide, do not help – although it may provide a soothing, cooling sensation while it dries to a white residue on the skin, and could help protect moist lesions. The same goes for Milk of Magnesia; it may feel good for a few minutes, but it won’t really help.

Treatment for poison ivy remains straightforward and unsatisfactory: as soon as possible, wash with soap and water. Let the blisters alone to heal; don’t break them. Cold water or creams may reduce inflammation and soothe itching.

By all means, reach for Milk of Magnesia or Calamine lotion if those sores are weeping. Just don’t expect miracles.

In the end, the best treatment for poison ivy is avoidance. Learn to spot it and then keep away.


Horny Goat Weed or Barrenwort?

Photograph of Epimedium grandiflorum(a compoun...
Image via Wikipedia

Introducing Epimedium

Epimedium is a genus of plants comprising some 50 or more species. Two species are found around the mediterranean, where they are known by names such as Bishop’s Hat, Fairy Wings or, less poetically, Barrenwort. The genus is far more abundant in Asia, where the majority of the species are found. In China, Epimedium was long ago given the name Horny Goat Weed (Yin Yang Hao). As the legend has it, a goatherd noticed that eating the plant caused his male goats to become very excitable; Epimedium entered the Chinese pharmacopeia as a male libido enhancer, and remains popular as such to this day.

Dandelion sap for warts

John Wesley was an 18th Century Anglican priest who foundedMethodism in England, Ireland and North America. He was a leader in the issues of social justice, and took a keen interest in the health of the poor. This interest led to him publishing a book of inexpensive and traditional remedies.

It is from this book that we read of a cure for warts that remains popular to this day. To whit,


Rub them daily with a Radish;

Or, with Juice of Dandelion;

Or, of Marigold Flowers;

Or, water in which Sal Ammoniac is dissolved.

In 1761, when Wesley recorded this remedy, dandelion sap was already a traditional treatment for warts and likely had been for some time – but how long, I don’t know.

Warts are caused by a papillomavirus, and are contagious with skin contact or through sharing items such as towels. An awareness of its transmissibility may have been the foundation of some of the more unusual remedies for wart removal. For example,

“Rub a white bean on the warts, wrap it in paper, and throw it on the road; whoever picks it up will get the warts.” (2)

It is, in fact, quite possible, albeit unlikely, that one could transfer warts to another person this way. What won’t happen is that by doing so, one’s own warts would thereby be cured; all that would happen is that both individuals would have warts. Besides, we know now that warm, humid surfaces are good vectors of transmission, and probably better than white beans. Here’s another old remedy:

“If you find an old bone in the field, rub the wart with it, then lay it down exactly as you found it. The wart will be cured.” (2)

Again, we have the notion that a wart can be magically transferred to something else. In this case, an old bone. It isn’t stated whether the cure is effected instantaneously, or if it takes weeks or months. If the latter, well, there’s a good reason for that.

Warts are, or can be, self limiting. That is, they won’t necessarily stay around for ever. A recent study on modern wart treatments concluded that no method was more than 73% effective. Just using a placebo had a 27% success rate (3). That 27% placebo effect has probably been behind a great deal of  these traditional wart remedies. Look at it this way: if 100 people rub their warts with an old bone, 27 of them will be ‘cured’, if those numbers for placebo hold true. But it won’t be the bone that did it. They would have gotten better anyway.

So what about our dandelion sap? It so happens that there are no clinical trial data. There are several centuries of reports of it being used as a wart treatment, but there is just as much proof of its effectiveness as there is for that old bone, or the trick with the white bean. Researchers haven’t taken enough interest in dandelion sap as a wart cure to really put it to the test. That isn’t to say that it won’t work, but there really isn’t any evidence that it will.

What does work is over the counter salicylic acid, followed, in efficacy, by freezing.  When it comes down to it, dandelion sap might be  just as effective for warts as rubbing an old bone.


(1)Primitive Physick, Or, An Easy and Natural Method of Curing Most Diseases. By John Wesley, John Benjamin Wesley, William Strahan, Frank Baker Collection of Wesleyana and British Methodism. Published by printed by W. Strahan, and sold by the booksellers of London and Westminster, 1761

(2) Memoirs of the American Folk-lore Society. American Folklore Society. Published for the American Folk-Lore Society by Houghton, Mifflin and Co., 1896

(3) Gibbs S, Harvey I. Topical treatments for cutaneous warts. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD001781. DOI: 10.1002/14651858.CD001781.pub2.

Peppermint oil and irritable bowel syndrome

Peppermint oil has long been well regarded for its stomach soothing properties. So much so that In 1833, oil of peppermint was even thought be “a more or less advantageous remedy for cholera.” An enormous quantity, some 700 pounds of it, was imported to Germany from France in just one month alone (1).

But it wasn’t the case that physicians of the time were convinced that peppermint could save people from the cholera. Far from it. As one doctor wrote,

“Fear being a great exciter of cholera, the inhabitants have been advised to carry about them different odoriferous substances, such as peppermint oil… but in fact the physicians do not really believe in the repelling power of these ingredients; they merely look upon them as a species of amulet, fit for tranquilizing the minds of the timid.”

Peppermint oil may have offered a modicum of relief for cholera sufferers, but it wouldn’t have saved them. As we now know, water and electrolyte replacement therapy, with antibiotics to kill the cholera bacteria, are the most effective treatments for this disease. Still, peppermint oil was also widely used for its therapeutic benefits in other indications.

In pharmacy manuals of the time, peppermint oil was recommended for spasmodic and flatulent pains of the stomach and bowels, as well as for cramp, faintness and nausea (2). The earliest reference for this indication that I could find dated as far back as 1778 (3); it also mentioned that peppermint was employed by the Edinburgh College in their aqua mirabilis, or “miracle water”, a popular health tonic.

The old has become new again, with reports that peppermint oil, which has antispasmodic properties, outperformed placebo in treating irritable bowel syndrome (IBS). A recent meta-analysis compared the effects of peppermint oil, pharmaceutical antispasmodics and fiber on IBS (4). The analysis considered four trials that used peppermint oil, three of which scored more than 4 on the Jadad scale, a measure of study quality. A score of 4 out of 5 indicates that these three studies fulfilled a majority of quality criteria.

The results? The NNT, or ‘number needed to treat’ with peppermint oil to prevent one patient having persistent symptoms, was between 2.5-3.0. By comparison, the same meta-analysis found that the NNT for the antispasmodic medications reviewed was 5, and 11 for fiber.

This meta analysis provides good evidence that even simple remedies like peppermint oil do have tangible benefits for IBS sufferers.

And please, if you are reading this because you have cholera, go see a physician instead. Fast.


(1) Oil of Ocymum basilicum, M. Bonastre. Journal of the Philadelphia College of Pharmacy. Published by Philadelphia college of pharmacy, 1833

(2) A Manual of Pharmacy By William Thomas Brande Published by Underwood, 1825

(3) The New Dispensatory: Elements of Pharmacy By William Lewis Published by J. Potts, 1778

(4) BMJ 2008;337:a2313

ADD / ADHD: Where the country is the remedy

ADHD is a funny diagnosis. There is a lot of agreement on the symptoms, as used in, for example, the DSM-IV and ICD-10 diagnostic criteria. The causes of the condition, however, are not a matter of agreement. Wikipedia has a good overview of the competing theories.

Whether you agree with the use of stimulant medications for ADD or not – which the science says are safe – people with ADD/ADHD often come up with their own coping mechanisms in addition to, or instead of, drugs.

Recent research offers another option for the attention challenged; one that is entirely non-pharmaceutical.

Echinacea for colds and flu

Echinacea. Its the first thing that many people take when they feel a cold coming on. Many people even take it throughout the winter months to prevent a cold from starting. So what evidence is there for the use of this popular herb as a cold remedy?

Chilli pepper: It works for chickens

Folk wisdom in countries like Mexico, where people love to eat hot and spicy food, is that chilli can ward off illness. There may be some truth to that, at least for chickens. Adding capsaicin, the spicy component of chilli peppers, to chicken feed increased resistance to Salmonella.

Apparently, the spice inflames the intestine, and this inflammation may be what prevents Salmonella binding to the intestinal cells. The chickens don’t seem to mind the heat, as they, along with most birds, don’t appear to taste the pepper. However, rodents do, so adding pepper to bird feed can also keep mice and rats away.

Preventing a cold

The idea that cold weather, and exposure to cold weather, has been around for centuries.

Celsus, in the 1st Century AD, wrote:

“Winter provokes headache, coughs, and all the affections which attack the throat, and the sides of the chest and lungs.”

We all know to wrap up warm before going outside in the cold, but can simply getting cold cause a cold?

The short answer is no. Colds are caused by a virus, to which one must be exposed. Cold weather won’t by itself cause a cold. So why are there more colds, headaches, coughs and flu in the winter than in other seasons? Here is a breakdown of the main explanations.

  • First, exposure to cold may impair the body’s immune system, so that one is more susceptible to any viruses to which one comes in contact. Wrapping up warm is good advice in so far as it gives the body a better chance at fighting off infections.
  • Secondly, cold, dry air may be better suited for the survival of cold virii. The chances of exposure to a cold virus are therefore increased.
  • Thirdly, when the body is cold, the blood vessels in the nose constrict and the temperature of the mucosal membrane falls. This reflex could decrease resistance to infection. A 2005 study found that chilling people’s feet led to a 10% increase in colds within a 4/5 day period, perhaps due to this effect.
  • Fourthly, people are more crowded together in the winter months, so the chances of exposure to a cold virus are greater.

To prevent a cold, there’s no harm in following your grandmother’s advice. Wrap up and stay warm. Perhaps try to keep that cold nose away from other people, as when you are warm and your nose is warm, you may be better able to fight off infection. Finally, if you can’t avoid people entirely, which would be a sure way of preventing a cold, then wash hands often. Colds can be picked up from touching contaminated surfaces like door handles. Soap doesn’t kill cold virii, but it will help to remove them from the skin.

Remedies for the common cold

Colds cannot be cured. The common cold is caused by a virus, and usually just needs to run its course. However, there are things one can do to treat the symptoms of a cold, and get through it as unscathed as possible. If you really can’t get, or don’t want, antihistamines (to treat the itching, watery eyes, runny noses or tickly throat), decongestants (to relieve a stuffy nose, blocked sinuses and sinus headaches), or cough suppressants (to relieve a cough that keeps you awake at night), here are some other things to try. These remedies are categorized from most likely to least likely to work.

Most effective cold treatments:

Drink plenty of fluids and get some rest. Your body is producing lots of fluid that need to be replenished. Take things easy and allow your body to heal itself.

Chicken soup. It’s an old standby, but one that has some good science behind it. A lot of people find that they crave hot soups when they have a cold; the steam from the soup, or indeed any hot beverage, can ease congestion and open the airways.

Spicy foods, like curry, horseradish, mustard and chillis can help clear the sinuses.

Possibly effective cold treatments:

Vitamin C in high doses has been a popular treatment for the cold, ever since Linus Pauling first popularised the idea in his book, Vitamin C and the Common Cold. However, since then, evidence to support its use for shortening or preventing a cold has been hard to find.

Zinc is another popular treatment for colds, but again, the evidence for it is limited.

Nasal washes: Inhaling liquid through the nose and out the mouth is a centuries old decongestant treatment. Home made preparations can be put together using a teaspoon of salt and a pinch of baking soda in warm water. So far, the evidence shows little effect on cold symptoms, but they may be useful for very temporary relief of congestion.

Ineffective cold treatments:

Echinacea. A benchmark study in 2005 found that this herb doesn’t treat or help colds, contrary to  received wisdom. While a few other studies have come up with positive results, there is nothing conclusive to indicate the use of Echinacea either prophylactically or to limit cold duration. You can read a long review here

So, just take care of yourself. Get lots of rest, eat and drink hot soups and spicy foods. Most colds just need time.



National Institutes of Health

Cough remedies