(Dr. Steven Bratman's Second visit to Power Surge) Dearest: DR. STEVEN BRATMAN is a physician who integrates conventional and alternative medicine. He believes that alternative medicine has both strengths and weaknesses, just like conventional medicine. Dearest: Dr. Bratman is the author of "Beat Depression with St. John's Wort," and "The Alternative Medicine Sourcebook:A Realistic Evaluation of Alternative Medicine, and the upcoming Alternative Medicine Ratings Guide:An Expert Panel Ranks the Best Alternative Treatments for Over 90 Conditions Dearest: He lectures, consults for medical boards on issues of alternative medicine, and publishes essays in national magazines and is currently focusing his attention on writing. Dearest: Welcome back to Power Surge, Dr. Bratman. Before we get to the questions, let me ask, with so little monitoring, how can we be sure that the "natural" remedies sold almost everywhere these days are pure, safe and actually contain what their labels claim? Dr. Steven Bratman: Honestly, we can't! This is a serious problem in alternative medicine, and one that hasn't proven easy to remedy. PianoMary: When a bottle of herbs says it's standardized, who has set those standards? Dr. Steven Bratman: In Germany, a governmental organization known as Commission E sets the standards for herb production. However, in the US, there is no one overseeing the industry. Some companies have deliberately set out to match the European standards, but others, I'm afraid to say, simply pretend to do so. To make the matter even more difficult, it is actually very difficult to verify label accuracy. DERM LPN: Are you an MD or Ph.D.? I dont believe in herbs. Dr. Steven Bratman: I am an MD. To me, the question of belief or disbelief is not appropriate to medicine. What matters is the facts. For quite a number of herbs, the state of scientific evidence is fairly strong. Most of the good studies have been done in Europe, where herbs are approved as medical treatments. For example, in Germany, the herb saw palmetto is the gold standard treatment for prostate disease; new drugs must be compared against it to be approved! Dearest: Dr. Bratman, I'm amazed at the efficacy of St. John's Wort. Why are doctors still prescribing things like Prozac, Zoloft, Paxil, etc. when SJW is so effective? Dr. Steven Bratman: Actually, SJW is only effective for mild to moderate depression. It is not effective for severe depression. Furthermore, SJW is only effective for about 60% of the people who use it. The same may be said of drugs like Prozac, but sometimes when one treatment doesn't work, another one does. You have to be practical in medicine. Trial and error is always part of the process. NRM08: What is the correct dose & strength for SJW? Dr. Steven Bratman: There is only one type of SJW that has been proven effective. It is a preparation called LI160, which is standardized to hypericin content. The proper dose is 300mg 3x daily. LI160 is available in the US under the brand name Kira. There are many other SJW products too. However, none of them have been put through double blind studies, and therefore we really don't known whether they work. However, in practice, quite a few brands of SJW appear to work, when taken at the dose listed above. TogaGirl4U: Do you have to watch your diet with St. John's Wort? Dr. Steven Bratman: No, contrary to early reports, SJW is not an MAO inhibitor. There are no foods that must be avoided while taking SJW. MarSea249: What are your feelings about a meno woman wishes to take nothing during meno? Dearest: By nothing do you mean HRT, Marsea? MarSea249: As I wish to take nothing but perhaps natural herbs Or nothing Dearest: You want to know if women can treat menopause with only herbs? MarSea249: And herbs and/or supplements. Dr. Steven Bratman: It is quite possible to control menopausal symptoms with regarding osteoporosis. We know that calcium and vitamin D help osteoporosis somewhat, but estrogen appears to help more. However, estrogen has its problems, of course. There is no obligation to do anything at all -- in fact, the only natural treatment for menopause is no treatment! Menopause of course is completely natural. Dearest: Dr. Bratman, isn't it important for the absorption of calcium to take vitamin D with it? Dr. Steven Bratman: Yes. Isn't that what I said? Without adequate vitamin D calcium will not be taken up. Sunlight provides vitamin D of course, but these days we are all being told to stay out of the sun, or to wear sun screen. DizzHead: Can I switch from Prozac to St. John's Wort without problems, I've been on Prozac for a year and severe anxiety I take Klonopin is there anything natural that I can take during these perimenopausal years? Dr. Steven Bratman: There are really two parts to your question. About changing over from Prozac to SJW, you probably can do it if you weren't severely depressed prior to taking Prozac. SJW is not for severe depression. I recommend stopping Prozac for a week or so before starting SJW. You might try taking ginkgo too. Regarding severe anxiety, Klonapin is a very strong drug. There is not natural treatment that is equally effective. Kava is somewhat effective for anxiety, but it doesn't approach the strength of Klonapin. Also, you have to be very careful about getting off Klonapin. Dearest: Dr. Bratman, what motivated you to write your new book, "Alternative Medicine Ratings Dr. Steven Bratman: Thank you for asking! Alternative medicine is a huge field filled with a lot of junk. It isn't always easy to find which parts really work. The best way is solid research. However, there simply isn't enough solid research to guide one completely. The next best thing is expert advice -- we even use this in conventional medicine where studies are incomplete. So what I did was convene a panel of expert alternative practitioners, selected for their hard headed, pragmatic style. In other words, I wanted people who were realistic, not true believers. Then, I queried them on what alt treatments they found most effective for about 80 conditions. The Alternative Medicine Ratings Guide gives the expert panel consensus. It ranks treatments as slightly effective, moderately effective, and strongly effective. It's only a rule of thumb, of course, but it provides a starting point. Dearest: Sounds like an excellent reference book, what with all the confusion out there. Is it now available in book stores, at amazon, etc? Dr. Steven Bratman: It is being released even as we speak. It should be in all the stores within a week. Dearest: Thanks. I can't wait to read it, Dr. Buchermj: Why are American doctors so slow in recognizing herbs as medical treatments? Dearest: Excellent question, Bucher :) Dr. Steven Bratman: There are a few reasons. Perhaps the most reasonable objection is that it is impossible to be sure that one batch of herbs is identical to another. Unlike drugs like tylenol, where there is only one substance, herbs contain thousands of ingredients. We usually don't know which ones are active. Each years batch is different, so are batches grown in different soils, weather, etc. Furthermore, the method of storage and processing can completely change the effect. This is a real problem for doctors who would like to feel that one pill of SJW is as good as another. In fact, it might not be. A company called PharmaPrint Inc believes that it has found a solution. The FDA has been impressed enough that they have granted an new drug application to two herbs standardized by the PharmaPrint process. But I'm not sure the method is as good as it sounds on paper. There are many other reasons for doctor's non acceptance too -- but I should stop. Catalina5: Do any of your books name companies likely to produce a reliable product? Dr. Steven Bratman: At the present time, the only herb products known to be reliable are those produced in Europe and run through double blind trials. Many of these are available in the US. Ironically, their manufacturers are pharmaceutical companies! If we call those herbs the A list, the B list consists of herbs made in imitation of the European standards. Enzymatic Therapy is one company that tries to do so (or so they say). Dearest: Excellent answers, Dr. B. Thank you! Rosemcur, go ahead. ROSEMCUR7: Are there any side effects from SJW? Dr. Steven Bratman: Practically none. A few people have mild stomach upset, and if you give yourself a huge overdose you might sunburn more easily. Curiously, the very lack of side-effects can be a problem. Some people say "I don't fell anything at all -- this can't be working" and quit too soon. SJW does work it just is very smooth. Dearest: Dr. Bratman, I was completely taken aback during a chat with Dr. Theodosakis of Glucosamine/Chondroitin fame, who said that many of the products out there contain only about 39% of what the labeling claims. How do they get away with that? Isn't that misrepresentation? Dr. Steven Bratman: In fact, studies show that many products contain none of the substance on the label! The supplement industry has been very effective in keeping the FDA out of regulating them. However, the industry has not taken any serious steps to regulate itself. This leaves the consumer in the lurch. This is why I recommend European products -- European regulatory agencies do screen those products. Dearest: What are your feelings about FDA intervention/ regulation of herbs? Dr. Steven Bratman: Unfortunately, the FDA has traditionally taken a very combative stance toward herbs. It has made highly prejudicial decisions, and has not made itself out to be a likely candidate for fair regulation of herbs. However, the FDA does seem to be improving its attitude recently. The industry, too, is just starting to recognize that it better clean up its act. Dearest: Thank you, Dr. B. WINDOCK1: How long has St Johns Wort been on the market & studied? Dr. Steven Bratman: St. John's wort has been an approved treatment for depression in Germany since about 1989, and over 1800 people have been involved in double-blind studies. LJones1027: I have a lots of allergies and asthma , any problems with taking SJW ? Dr. Steven Bratman: No problems, unless you happen to be allergic to SJW. It's possible to be allergic to anything. THRV Coll: Dr. Bratman, what is your opinion about the use of herbs (or herbal supplements) for weight loss. Dearest: Great question :) Dr. Steven Bratman: Unfortunately, I don't know of any great alternative treatments for weight loss. By now, probably everyone knows about the danger of using ephedra (ma huang) for weight loss. There are claims about many other substances, but in my experience, none of them seem to work. Sorry! Dearest: Dr. B, if herbs often don't contain what they say they do, how can we be sure of our vitamins? Dr. Steven Bratman: Vitamins are somewhat better regulated. There are official standards, and it is much easier to verify compliance, since vitamins, like drugs, are single chemicals. Still, there are some problems with vitamins too. Sports supplements have been evaluated in a recent book, and there the accuracy of labeling was found to be terrible. Other food supplements, like glucosamine, seem to be frequently dishonestly labeled as well. Dearest: Sounds like Americans are being duped :( Dr. Steven Bratman: It's big business. Dearest: EFPHO: I used Kira and found that it made me very tired and had no other affect. Dr. Steven Bratman: Tiredness is a rare side-effect of SJW, but it does happen. As I said earlier, SJW only works for about 60% of people who try it. This is about the same track record as Prozac. You can also try 5-HTP, DL-phenylalanine, S-adenosylmethionine (although it's very expensive), ginkgo or phosphatidyl serine. TogaGirl4U: How long does it take until you notice the positive effects of SJW? Dr. Steven Bratman: Like most other antidepressants, SJW takes about 4 to 6 weeks to act. Interestingly, the supplement SAM (S-adenosylmethionine) works in about a week. But at present its price is nearly prohibitive (about $240 per month!). Dearest: Whew! Is SAM an Rx or OTC? Imagine... Sam and Herb :) Dr. Steven Bratman: SAM is a food supplement. It's widely used in Italy. The price should come down eventually. It's also a great treatment for osteoarthritis -- perhaps better than glucosamine. PTLdiane: Can you take both, prozac and SJW? And or Kava? What do you think helps shin splints ? :) Dr. Steven Bratman: There's no good reason to combine SJW and Prozac. Regarding Kava, many people combine it with antidepressants to add an anti-anxiety effect. There have not been any problems reported from such combinations, but we don't know for sure that it's safe to combine them. Dr. Steven Bratman: I didn't answer about the shin splints. Acupuncture is often quite effective. Kathrynbf: I'm 37 and on low dose birth control pills for lots of symptoms. Am happy with results except for one thing, a bad side effect - total loss of libido any herbs that can help, thanks, Dr. Steven Bratman: Birth control pills are powerful; it's hard to get herbs to make much of a difference on top of them. You might try adjusting the dosage of the pills. There are other possibilities too, but it's complicated. LDAC: I have lupus, always sleeping, is this part of the disease what can help? Dr. Steven Bratman: Lupus, as you know, is a very complex disease. It can manifest in many different ways. Sleepiness can be part of it, although sleepiness can also be caused by many other things. For reasons that no one understands, DHEA sometimes seems to help lupus quite a bit. But DHEA isn't really a natural treatment, and we don't know how safe it really is. LDAC: thank you Dearest: Dr. Bratman, what led you more into the direction of alternative medicine and away from traditional medicine? Dr. Steven Bratman: Actually, Dearest, I started out in alternative medicine over twenty years ago. I went to medical school later. So my path was the reverse of most alternative MDs. Dearest: Are you in favor of this new integrative medicine they're finally teaching med students? Dr. Steven Bratman: Yes, but they aren't really teaching it to medical students practically anywhere, contrary to reports you might read. Dearest: Not all, but some.. .like where Dr. Andrew Weil teaches. Dr. Steven Bratman: Actually, it's happening practically nowhere, except in Arizona! Dearest: You're kidding! I thought it had been incorporated into many medical schools curriculum. Dr. Steven Bratman: Harvard too, I believe. You'll read reports that say they are teaching alt medicine in nearly all medical schools, but they are counting informal lunch meetings arranged by two or three students. Sigh. Facts just aren't what they seem. Dearest: what are we to believe anymore. Dr. Steven Bratman: I don't think this is new -- rumor and misinformation have always been the way of things. The reason science was invented was to try to get things more accurate. This is very important in alternative medicine, because it's a field that has a huge history of fantasy and wishful thinking. But this is improving. WINDOCK1: Are there any alternative treatments similar to the new drug Viagra for men? Dr. Steven Bratman: Of course, we think that Viagra may work for women too -- that's been the big news for a while. There are quite a few herbs touted as sexual aids, but the evidence for all of them is weak. One that may be a bit better than others is the herb ashawaganda. O SEAPEARL: How effective is Black Cohash on menopause and uncontrolled periods and what is the the difference between black and blue cohash? Dr. Steven Bratman: Standardized extracts of black cohosh are quite effective for the symptoms of menopause, although it isn't known whether they help prevent osteoporosis. Blue cohosh is an entirely different herb. It is actually quite an endangered plant. I don't recommend using it. Dearest: Ask your question, SDamore. SDamore690: Coritc artery is blocked in my left side in the neck I need to know herbs that can be used Dr. Steven Bratman: Alternative medicine is generally better early in the game, rather than late. I'd recommend an extremely low fat diet, garlic supplements, aortic GAGs, antioxidants, . . .and close medical supervision. Dr. Steven Bratman: I hope this was helpful to you all. Steve B Dearest: Dr. Bratman, thank you for this very stimulating discussion. Anyone interested in buying Dr. Bratman's books: "Beat Depression With St. John's Wort" , , "The Alternative Medicine Sourcebook," , and his newest book, "The Alternative Medicine Ratings Guide:Top Experts Rate the Best Treatments and What They Can Do for You" by Power Surge. All Rights Reserved.