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St. John's Wort
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St. John's Wort
Common Name: Klamath weed
Botanical name: Hypericum perforatum

St. John's Wort grows in both the United States and Europe. In America, it is most abundant in Northern California and Southern Oregon.

St. John's Wort is alternative medicine's success and its failure - it's a symbol of why alternative medicines can help people, but also why it is dangerous to people's health and lives. St. John's Wort is a "food supplement" which is used to treat depression. It is not regulated by the FDA or any government agency. St. John's Wort works - it does indeed seem to help with mild forms of depression, but only with the very mild forms. Studies performed at Duke University have demonstrated that with moderate to severe depression, St. John's Wort does no good at all.

St. John's Wort can also kill you, if you aren't careful - it is a drug, and drugs can be dangerous. It's common for ads for "natural remedies" to give the impression that, being "natural," they are inherently safe, perhaps safer than laboratory-created medicines. Then again, arsenic is also "natural."

Lurking Dangers
Why is St. John's Wort dangerous? The active ingredient in St. John's Wort is a monoamine oxidase inhibitor (MAOI). These substances were among first used to treat depression, and they are still used today when the condition is in a mild form. MAOIs inhibit the actions of a protein in the brain called monoamine oxidase. This protein "cleans up" in the brain by destroying neurotransmitters. You can't have neurotransmitters sitting around forever after they have done their job, so they have to be eliminated; yet if too many are eliminated, depression can result. MAOIs, then, keep the levels of neurotransmitters a bit higher and help keep you feeling better.

MAOIs do something else, however: they also "clean up" tyramine, a molecule that affects blood pressure. When monoamine oxidase is blocked, the levels of tyramine increase quickly. You feel better, emotionally and psychologically, but your blood pressure can rise so much and so quickly that the blood vessels in your brain can burst. When MAOIs were first introduced in the 1960s, the country was swept by a wave of deaths from inexplicable brain hemorrhages.

Foods to Avoid
Eventually, the link between MAOIs and tyramine was discovered, so the banned drugs could be reintroduced along with a warning for patients to restrict their diets. Foods high in tyramine and which are forbidden include:

  • alcoholic beverages (especially chianti, sherry, liqueurs, and beer)
  • alcohol-free or reduced-alcohol beer or wine
  • aged foods, especially aged meats and cheeses
  • smoked or pickled meat, poultry, or fish
  • bologna, pepperoni, salami, summer sausage, or any fermented sausage
  • meat with tenderizers, unfresh meat, meat extracts, canned meats
  • dried and pickled fish, including caviar, anchovies and pickled herring
  • liver, especially chicken livers.
  • cheeses (especially strong or aged varieties), except for cottage and cream cheese
  • fermented foods and homemade breads with a lot of yeast
  • fruit: raisins, bananas, canned figs, red plums, avocados, or any overripe fruit
  • vegetable products: green bean pods, eggplant, Italian broad beans, soy sauce

There are additional foods which can only be eaten in moderation. All of this information is given to patients who are prescribed MAOIs by their doctor. As you can see, the list is very extensive and includes a lot of popular foods; because of this, many people find taking MAOIs to be very difficult.

Drug Interactions
And that isn't all. It is a simply phramaceutical fact that drugs sometimes interact with each other - there is no way around this. Does St. John's Wort interact with anything? As a matter of fact, yes - it can interfere with the chemotherapy drug irinotecan, reducing its ability to kill cancer. The FDA has issued a long list of additional medications which St. John's Wort can interfere with - medications used to treat conditions like HIV infection, heart disease, seizure, and cancer. It even affects drugs used to prevent transplant rejection and pregnancy.

The next time you see St. John's Wort in a store, however, take a look at the package and see if it contains health warnings or a list of foods which you shouldn't eat or drugs which it can interact with. You will probably search in vain. The best I have every seen tells people not to take the product if they are taking other MAO inhibitors and not to take it with "high tyramine foods like red wine" - a warning so inadequate as to actually cause depression in the reader. Others are even worse, giving no warning whatsoever.

But Does it Work?
The "success" here is the fact that a popular alternative treatment to a medical condition can indeed work - people have been helped. The failure, however, is the fact your health is needlessly put in danger because you are not given enough information to make an informed choice when such dangerous drugs are marketed without sufficient warning. The only saving grace is that doses of St. John's Wort may not contain enough active ingredient to cause a negative reaction - but in that case, it may also not contain enough to actually work.

If herbal remedies and alternative medicines work, then they must affect your body's chemistry and biology. In such a situation, it is possible to have negative reactions - side effects brought about by your own body, by other drugs, by foods, etc. On the other hand, if there are no possible side effects, then there is no effect on your body's chemistry and biology - which means that the drug can't actually work. You should think about that the next time you look at an alternative medicine and fail to see any warnings about side effects or reactions with other drugs or food.

Also Known As: none

Alternate Spellings: none

Common Misspellings: none

Related Resources:

What is Alternative Medicine?
There's an awful lot in the news and in society about "alternative medicines" these days. By some estimates, it's an industry doing between $15 and $20 billion annually - and growing! But what is alternative medicine - how does it differ from scientific medicine and why do people use it?

Skepticism & Critical Thinking
This is the main index for issues dealing with skepticism, critical thinking, logic and arguments. The first section is Critical Thinking itself - how to think about claims and arguments you hear, how to critique arguments, and how to formulate your own arguments such that they are more likely to be sound and valid. The second section is about Skeptical Investigations - the practical application of the critical thinking skills covered in the first section. Here you will find critiques of things like astrology, alternative medicine, parapsychology, the New Age and more.

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