Hepato Detox by Pacific BioLogic

POSSIBLY EFFECTIVE

• Upper respiratory tract infection (URTI). Oral American ginseng seems to prevent the incidence of URTIs in some people. Details: Some evidence shows that taking a specific American ginseng extract called CVT-E002 (Cold-FX, Afexa Life Sciences) 200-400 mg twice daily over a 3-64 month period during influenza season might modestly decrease the risk of developing symptoms of a URTI such as the common cold or flu in adults (11351,13192,14345,91275). This extract also seems to reduce symptom severity and duration of symptoms when infections do occur (13192,14345,91275). The extract might not reduce the chance of getting the first cold of a season, but it seems to reduce the risk of getting repeat colds in a season (13192). Additional evidence shows that, in people aged 65 years and older, treatment with the extract for 3-4 months, in addition to influenza vaccination at 4 weeks, is necessary before there is any significant reduction in the risk of developing a respiratory tract infection (14345). One small clinical study shows that taking the extract 200 mg twice daily orally over a 12-week period during influenza season reduces the risk of laboratory confirmed influenza or influenza and respiratory syncytial virus (RSV) infections. However, it does not seem to reduce the appearance of influenza symptoms, symptom severity, or symptom duration in these patients (11351). This same extract does not appear to prevent respiratory infections in patients who are immunocompromised. In one clinical trial, taking this extract 200 mg twice daily for 3 months did not reduce the risk of developing an acute respiratory infection, the number of days of cold symptoms, or the need for use of antibiotics when compared with placebo in patients with chronic lymphocytic leukemia (29998). Preliminary clinical research in children 3-12 years of age shows that taking the same extract 13-26 mg/kg once on the day of URTI onset, then 8.5-17 mg/kg once on the next day, then 4.5-9 mg/kg once on day three does not reduce the severity or duration of symptoms when compared with placebo. However, this study was designed to evaluate the safety and tolerability of this extract in children; therefore, it was not adequately powered to evaluate effectiveness (22365).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Anemia of chronic disease. Although there has been interest in using oral American ginseng for anemia of chronic disease, there is insufficient reliable information about the clinical effects of American ginseng for this condition.
• Antiretroviral-induced insulin resistance. It is unclear if oral American ginseng is beneficial for antiretroviral-induced insulin resistance. Details: Preliminary clinical research in healthy volunteers shows that taking capsules containing ground American ginseng root 1 gram three times daily for 14 days along with the HIV protease inhibitor indinavir does not reduce indinavir-induced insulin resistance when compared to baseline (89401).
• Athletic performance. Early research shows that oral American ginseng does not seem to be beneficial for athletic performance. Details: Preliminary clinical research shows that taking American ginseng extract 8 mg/kg or 16 mg/kg daily (average daily dose 618-1235 mg) for one week does not improve exertion, time to exhaustion, heart rate, or maximal oxygen consumption during bicycle testing when compared with placebo (4236). Other preliminary clinical research in physically active male college students shows that taking American ginseng 1600 mg daily for 4 weeks does not enhance workout capacity when compared with placebo (14804).
• Attention deficit-hyperactivity disorder (ADHD). Oral American ginseng has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that taking a specific combination product (AD-fX, Afexa Life Sciences) containing American ginseng extract plus ginkgo leaf extract may modestly improve ADHD symptoms such as anxiety, hyperactivity, and impulsivity in children aged 3-17 years when compared with baseline (8235). It is not clear if this effect is due to American ginseng, ginkgo, or the combination. Additionally, the validity of this finding is limited by the lack of a comparator group.
• Breast cancer. It is unclear if oral American ginseng is beneficial for breast cancer survival. Details: Population research in China suggests that breast cancer patients who regularly take any form of ginseng, including either American ginseng or Panax ginseng, have higher quality of life scores and have a lower risk of overall mortality, breast cancer-related mortality, and breast cancer recurrence compared to patients who do not take ginseng (14466). However, ginseng users were also significantly more likely to have been treated with tamoxifen.
• Cancer-related fatigue. Evidence for the use of oral American ginseng for cancer-related fatigue is conflicting. Details: Two clinical trials show that taking American ginseng 750-2000 mg in 1-2 divided doses daily for 8 weeks does not reduce cancer-related fatigue when compared with placebo (22370,104131). However, another clinical trial shows that taking American ginseng 2000 mg in two divided doses daily for 8 weeks reduces cancer-related fatigue scores by 51% after 8 weeks, compared to only 25% in those taking placebo (29996). These differing findings may be due to the instrument used to measure fatigue. The initial studies used the Brief Fatigue Inventory, whereas the positive study used the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). Additionally, treatment for a shorter duration of only 4 weeks does not appear to be effective (22370,29996,104131).
• Cardiovascular disease (CVD). Although there has been interest in using oral American ginseng for CVD, there is insufficient reliable information about the clinical effects of American ginseng for this condition.
• Cognitive function. It is unclear if oral American ginseng is beneficial for cognitive function. Details: Clinical research shows that a single dose of a specific American ginseng extract (Cereboost, Naturex) 100-400 mg, taken 1-6 hours prior to cognitive testing, improves short-term working memory performance and may improve reaction time accuracy when compared with placebo in healthy young adults (22367). Other clinical research in healthy adults shows that taking the same specific American ginseng extract, standardized to contain 10% to 12% ginsenosides, as 200 mg orally daily for 14 days modestly improves memory and mental fatigue scores when compared with placebo (109518). American ginseng has also been studied in combination with other ingredients. Taking a single dose of a product containing American ginseng (Cereboost) 100 mg, bacopa 300 mg, and coffee fruit extract 100 mg modestly improves some, but not all, measures of working memory and attention after 45 minutes when compared with placebo (103375).
• Diabetes. It is unclear if oral American ginseng is beneficial for diabetes. Details: Two small clinical trials show that taking American ginseng 3 grams orally, up to two hours before a meal, can significantly reduce postprandial glucose levels in patients with type 2 diabetes when compared with placebo (1018,6461). However, doses greater than 3 grams do not seem to offer any additional benefit (6461). In addition, the postprandial glucose lowering effect of American ginseng may differ among preparations due to variations in the concentration of ginsenosides (9732). American ginseng has also been studied in combination with other ingredients. Clinical research in patients with type 2 diabetes shows that taking American ginseng 1500 mg and Panax ginseng 750 mg, enriched to contain 30% total ginsenosides, orally daily for 12 weeks reduces glycated hemoglobin by 0.35% when compared with placebo. Taking this combination also reduces systolic, but not diastolic, blood pressure by about 4 mmHg when compared with placebo (107745). It is unclear if this effect is due American ginseng, Panax ginseng, or the combination.
• Epilepsy. Although there has been interest in using oral American ginseng for epilepsy, there is insufficient reliable information about the clinical effects of American ginseng for this condition.
• Headache. Although there has been interest in using oral American ginseng for headaches, there is insufficient reliable information about the clinical effects of American ginseng for this purpose.
• HIV/AIDS. Although there has been interest in using oral American ginseng for HIV/AIDS, there is insufficient reliable information about the clinical effects of American ginseng for this condition.
• Hypertension. Evidence on the use of oral American ginseng for hypertension is conflicting. Details: Some clinical research shows that taking American ginseng 1500 mg twice daily for 12 weeks does not reduce blood pressure when compared with placebo in patients with hypertension (22368,22369). However, other clinical research shows that taking American ginseng extract 1000 mg three times daily for 12 weeks lowers systolic blood pressure by 12% when compared with baseline in patients with type 2 diabetes and hypertension (29999). In a similar study in patients with type 2 diabetes and hypertension, American ginseng extract 500 mg in combination with Panax ginseng extract 250 mg three times daily for 12 weeks, providing 30% total ginsenosides daily, reduces central systolic blood pressure by about 5 mmHg, but not diastolic blood pressure, when compared with placebo (103046). These differing results may be due to the higher amount of total ginsenosides provided in the latter study.
• Menopausal symptoms. Oral American ginseng has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research during pre- and post-menopause shows that taking a specific combination product (Phyto-Female Complex, SupHerb) containing black cohosh root extract 100 mg, dong quai root extract 75 mg, milk thistle extract 75 mg, red clover flower extract 50 mg, American ginseng root extract 50 mg, and vitex agnus-castus fruit extract 50 mg twice daily for 12 weeks improves sleep quality and reduces menopausal symptoms, including the number and intensity of hot flashes and the number of night sweats, when compared with placebo (19552). However, it is unclear whether these effects are due to American ginseng, other ingredients, or the combination.
• Schizophrenia. It is unclear if oral American ginseng is beneficial for schizophrenia. Details: Preliminary clinical research in adults with schizophrenia who are taking antipsychotics shows that taking a specific American ginseng extract (HT1001, Afexa Life Sciences) 100 mg twice daily for 4 weeks modestly increases visual working memory score when compared with placebo. This treatment also reduces physical symptoms associated with antipsychotic use, such as abnormal gait or muscle rigidity. However, it does not appear to improve other clinical symptoms or parameters related to cognitive function, such as verbal working memory, sustained attention, verbal function, or immediate or delayed auditory memory, when compared with placebo (29997).
• Ulcerative colitis. Although there has been interest in using oral American ginseng for ulcerative colitis, there is insufficient reliable information about the clinical effects of American ginseng for this condition. More evidence is needed to rate American ginseng for these uses.

(Read more about AMERICAN GINSENG)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Abdominal pain. Although there has been interest in using oral atractylodes for abdominal pain, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Anorexia nervosa. Although there has been interest in using oral atractylodes for anorexia nervosa, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Cachexia. It is unclear if oral atractylodes is beneficial in patients with cachexia. Details: Preliminary clinical research in people with gastric cancer-related cachexia shows that taking an isolated constituent of atractylodes, atractylenolide I, 1.32 grams orally daily for 7 weeks moderately improves appetite scores and functional ability scores when compared with fish oil 0.45 grams (15706).
• Common cold. Although there has been interest in using oral atractylodes for the common cold, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Diarrhea. Although there has been interest in using oral atractylodes for diarrhea, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Gastroesophageal reflux disease (GERD). Although there has been interest in using oral atractylodes for GERD, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Influenza. Although there has been interest in using oral atractylodes for Influenza, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Lung cancer. Although there has been interest in using oral atractylodes for lung cancer, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Obesity. Although there has been interest in using oral atractylodes for obesity, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Peritoneal dialysis. Although there has been interest in using oral atractylodes for peritoneal dialysis, there is insufficient reliable information about the clinical effects of atractylodes for this purpose.
• Rheumatoid arthritis (RA). Although there has been interest in using oral atractylodes for RA, there is insufficient reliable information about the clinical effects of atractylodes for this purpose. More evidence is needed to rate atractylodes for these uses.

(Read more about ATRACTYLODES)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Asthma. Although there is interest in using oral Codonopsis lanceolata for asthma, there is insufficient reliable information about the clinical effects of codonopsis for this condition.
• Cancer. Although there is interest in using oral Codonopsis lanceolata for cancer, there is insufficient reliable information about the clinical effects of codonopsis for this condition.
• Dyspepsia. Although there is interest in using oral Codonopsis lanceolata for dyspepsia, there is insufficient reliable information about the clinical effects of codonopsis for this condition.
• Hyperlipidemia. Although there is interest in using oral Codonopsis lanceolata for hyperlipidemia, there is insufficient reliable information about the clinical effects of codonopsis for this condition.
• Obesity. Although there is interest in using oral Codonopsis lanceolata for obesity, there is insufficient reliable information about the clinical effects of codonopsis for this condition.
• Respiratory tract infections. Although there is interest in using oral Codonopsis lanceolata for respiratory tract infections, including bronchitis and tuberculosis, there is insufficient reliable information about the clinical effects of codonopsis for these conditions. More evidence is needed to rate codonopsis for these uses.

(Read more about CODONOPSIS)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Age-related cognitive decline. Oral fo-ti has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with mild age-related cognitive decline shows that taking a combination product containing fo-ti root and Panax ginseng as five capsules three times daily for 3 months improves memory when compared to baseline (50720). The validity of these findings is limited by a lack of placebo control group.
• Aging. Although there has been interest in using oral fo-ti for aging, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.
• Alopecia areata. Although there has been interest in using oral fo-ti for alopecia areata, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.
• Alzheimer disease. Although there has been interest in using oral fo-ti for Alzheimer disease, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.
• Androgenic alopecia. Although there has been interest in using oral fo-ti for androgenic alopecia, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.
• Cardiovascular disease (CVD). Although there has been interest in using oral fo-ti for CVD, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.
• Dyslipidemia. Oral fo-ti has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults in China with dyslipidemia shows that taking four capsules of a specific combination product (Blood Fat Droplets, Vita Green Pharmaceutical Ltd.), containing extracts of fo-ti 43 mg, hawthorn 129 mg, Asian water plantain 86 mg, corn silk 86 mg, reishi mushroom 43 mg, and white mulberry 43 mg, twice daily for 12 weeks decreases low-density lipoprotein (LDL) cholesterol by 12 mg/dL, or around 9%, but does not improve total cholesterol, high-density lipoprotein (HDL) cholesterol, or triglyceride levels, when compared with placebo (99854).
• Insomnia. Although there has been interest in using oral fo-ti for insomnia, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.
• Osteoarthritis. Although there has been interest in using oral fo-ti for osteoarthritis, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.
• Osteoporosis. Although there has been interest in using oral fo-ti for osteoporosis, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.
• Parkinson disease. Although there has been interest in using oral fo-ti for Parkinson disease, there is insufficient reliable information about the clinical effects of fo-ti for this purpose.
• Wrinkled skin. Although there has been interest in using topical fo-ti for wrinkled skin, there is insufficient reliable information about the clinical effects of fo-ti for this purpose. More evidence is needed to rate fo-ti for these uses.

(Read more about FO-TI)

There is insufficient reliable information available about the effectiveness of glossy privet.

(Read more about GLOSSY PRIVET)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Age-related macular degeneration (AMD). It is unclear if oral goji berry reduces the risk of developing AMD. Details: A small, unblinded clinical study in healthy adults aged 45 to 65 years shows that consuming goji berries 28 grams five times a week for 90 days improves macular pigment optical density, which is a marker for AMD, when compared to baseline (110767). The validity of this finding is limited by the lack of statistical comparison to the other study group that received a supplement containing lutein and zeaxanthin.
• Cancer. Although there is interest in using oral goji for cancer, there is insufficient reliable information about the clinical effects of goji for this condition.
• Cardiovascular disease (CVD). It is unclear if oral goji improves risk factors for CVD. Details: A meta-analysis of 6 mostly small clinical studies of adults in China shows that consuming goji as polysaccharide extract or juice for 1-3 months modestly improves triglycerides, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and fasting blood glucose but does not impact total cholesterol when compared with no treatment or placebo (110765). Another meta-analysis of 4 small clinical studies in adults also shows that consuming goji polysaccharide extract or goji berries for 1-4 months modestly improves triglycerides and HDL but does not impact total or LDL cholesterol when compared with placebo or healthy eating. Goji also had no impact on systolic or diastolic blood pressure, or markers of oxidative stress (110768). However, the interpretation of the findings from these meta-analyses is limited by the use of variable goji forms and doses, as well as inclusion of studies in heterogeneous patients, including healthy people, patients with diabetes, and patients with metabolic syndrome. Furthermore, most studies were conducted in China; it is unclear if these benefits can be extrapolated to other geographic locations.
• Cognitive function. It is unclear if oral goji berry improves cognition in healthy young individuals. Details: A small clinical crossover study in healthy participants 14-24 years of age shows that taking goji berry fruit water extract (BIOMIX Company) 3600 mg in 3 divided doses daily for 4 weeks might improve certain cognitive measures such as verbal learning, short-term memory, and attention when compared with baseline (105488). The validity of these findings are limited due to incomplete outcome reporting and a lack of statistical comparisons between the treatment and placebo groups.
• Cough. Although there is interest in using oral goji for cough, there is insufficient reliable information about the clinical effects of goji for this purpose.
• Depression. It is unclear if oral goji berry polysaccharide is beneficial for adolescents with subthreshold depression. Details: A small clinical study in adolescents aged approximately 15 years with subthreshold depression in China shows that taking goji berry polysaccharide extract 300 mg daily for 6 weeks modestly improves clinician-assessed depression scores (i.e. Hamilton Depression Scale, HAMD-24) but does not improve self-reported depression scores (i.e. Beck Depression Inventory) or scores assessing sleep quality, psychological distress, or anxiety when compared with placebo (110769). However, these results are from an interim analysis, which limits the interpretation of these findings. Furthermore, it is unclear if results can be extrapolated to patients in other geographic locations.
• Diabetes. It is unclear if oral goji berry polysaccharides improve glycemic control in patients with diabetes. Details: One small clinical study in patients with type 2 diabetes shows that taking goji fruit polysaccharide powder 150 mg twice daily for 3 months results in a slightly lower postprandial glucose area under the curve (AUC), but does not seem to affect insulin levels or insulin resistance, when compared with placebo. A subgroup of patients who were not taking antidiabetes medications had a greater reduction in postprandial blood glucose (92117).
• Dry eye. Although there is interest in using oral goji for dry eye, there is insufficient reliable information about the clinical effects of goji for this purpose.
• Erectile dysfunction (ED). Although there is interest in using oral goji for ED, there is insufficient reliable information about the clinical effects of goji for this condition.
• Hypertension. Although there is interest in using oral goji root bark for hypertension, there is insufficient reliable information about the clinical effects of goji for this condition.
• Obesity. It is unclear if oral goji berry juice improves weight loss. Details: Preliminary clinical research in healthy, overweight adults shows that drinking a specific goji fruit juice (GoChi, FreeLife International LLC) 120 mL daily for 14 days while following a weight loss diet and participating in an exercise program decreases waist circumference by about 4.7 cm more than exercise and diet alone. However, drinking goji berry juice along with diet and exercise does not improve body weight, body mass index, or body fat when compared with diet and exercise alone (52536).
• Quality of life. Small clinical studies suggest that oral goji berry juice may modestly improve quality of life in healthy adults. Details: Small clinical studies in healthy adults suggest that taking a specific standardized goji fruit juice (GoChi, FreeLife International LLC) 120 mL daily for 14-30 days improves subjective measures of energy levels, athletic performance, sleep quality, mental acuity, calmness, feelings of well-being, and gastrointestinal regularity when compared with placebo (17082,52532,52542). These studies were funded by the juice manufacturer.
• Sunburn. It is unclear if oral goji extract can prevent sunburn. Details: A small clinical study in healthy Japanese adults shows that taking goji extract 900 mg daily for 8 weeks reduces and accelerates resolution of erythema after exposure to a standard dose of UVB irradiation when compared with placebo (110770). All study participants were highly UV-sensitive; it is unclear whether these results can be extrapolated to individuals less sensitive to UV irradiation.
• Tinnitus. Although there is interest in using oral goji for tinnitus, there is insufficient reliable information about the clinical effects of goji for this purpose. More evidence is needed to rate goji for these uses.

(Read more about GOJI)

POSSIBLY INEFFECTIVE

• Hyperlipidemia. Preliminary clinical studies show that oral reishi mushroom does not improve lipid levels in patients with hyperlipidemia or type 2 diabetes. Details: Preliminary clinical research shows that taking reishi mushroom extract 1440 mg daily for 12 weeks does not significantly improve the lipid profile in patients with hyperlipidemia (70776). Also, a meta-analysis shows that taking reishi mushroom extract 1400-4000 mg daily for 12-16 weeks does not reduce total cholesterol or low-density lipoprotein (LDL) cholesterol in patients with type 2 diabetes (91435).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging. Although there has been interest in using oral reishi mushroom for aging, there is insufficient reliable information about the clinical effects of reishi mushroom for this purpose.
• Altitude sickness. Although there has been interest in using oral reishi mushroom for altitude sickness, there is insufficient reliable information about the clinical effects of reishi mushroom for this purpose.
• Alzheimer disease. A small clinical study suggests that oral reishi mushroom does not improve Alzheimer disease symptoms. Details: Preliminary clinical research in patients with Alzheimer disease shows that taking reishi mushroom powder 1000 mg three times daily for 6 weeks does not improve memory, language skills, or quality of life when compared with placebo (97942).
• Asthma. Although there has been interest in using oral reishi mushroom for asthma, there is insufficient reliable information about the clinical effects of reishi mushroom for this purpose.
• Benign prostatic hyperplasia (BPH). Preliminary clinical research suggests that oral reishi mushroom extract can help reduce some lower urinary tract symptoms in patients with BPH. Details: Clinical research in patients with mild to moderate lower urinary tract symptoms (LUTS) associated with BPH, urinary incontinence, overactive bladder, or other conditions, shows that taking reishi mushroom extract 6 mg orally once daily for up to 12 weeks moderately improves total symptom severity measured on the International Prostate Symptom Score (IPSS) scale, when compared with placebo (91436,91437). A higher dose of 60 mg daily is not more effective than the 6 mg dose, and a lower dose of 0.6 mg daily is not more effective than placebo (91437). Reishi mushroom extract does not improve peak urine flow rate, residual urine volume, prostate volume, or quality of life when compared with placebo (91436,91437). The relevance of these results is unclear since not all of the patients with LUTS had BPH.
• Bronchitis. Although there has been interest in using oral reishi mushroom for bronchitis, there is insufficient reliable information about the clinical effects of reishi mushroom for this purpose.
• Cancer. It is unclear if oral reishi mushroom is beneficial when used in conjunction with chemotherapy. Details: A meta-analysis of 9 clinical trials using various reishi mushroom products in combination with chemotherapy found that complete and partial responses increased by 30% with combination therapy when compared with chemotherapy alone. However, there was no difference in overall survival (102915). The reliability and applicability of these results are unclear since the trials looked at several different types of cancer, used varying doses and durations of therapy, and were all conducted in China or other Asian countries.
• Cancer-related fatigue. It is unclear if oral reishi mushroom is beneficial in patients with breast cancer and fatigue. Details: Results from a small clinical study in breast cancer patients show that taking reishi mushroom powder 1000 mg orally three times daily for 4 weeks can improve cancer-related fatigue when compared with placebo (91438). However, it is not clear if the improvement is clinically meaningful.
• Cardiovascular disease (CVD). It is unclear if oral reishi mushroom is beneficial for reducing CVD risk factors. Details: A meta-analysis of 5 low-quality studies in adults with diabetes shows that taking reishi mushroom 1400-3000 mg daily for 12-16 weeks does not reduce CVD risk factors, including total and low-density lipoprotein (LDL) cholesterol, triglycerides, blood pressure, and body mass index, when compared with placebo (91435).
• Chronic fatigue syndrome (CFS). Although there has been interest in using oral reishi mushroom for CFS, there is insufficient reliable information about the clinical effects of reishi mushroom for this purpose.
• Chronic kidney disease (CKD). Although there has been interest in using oral reishi mushroom for CKD, there is insufficient reliable information about the clinical effects of reishi mushroom for this purpose.
• Colorectal adenoma. Limited clinical research suggests that oral reishi mushroom extract may be beneficial for reducing colorectal adenoma size. Details: Preliminary clinical research in patients with colorectal adenomas shows that taking reishi mushroom extract 1500 mg orally in two divided doses daily for 12 months reduces the number and size of adenomas when compared with no treatment (70774).
• Coronary heart disease (CHD). It is unclear if oral reishi mushroom is beneficial for CHD. Details: Preliminary clinical research shows that taking a specific reishi mushroom extract (Ganopoly, Encore International Co.) 1800 mg orally three times daily for 12 weeks reduces symptoms of CHD, such as chest pain, palpitations, and shortness of breath, in a greater percentage of patients when compared with placebo (70800).
• Diabetes. Evidence on the use of oral reishi mushroom in patients with type 2 diabetes is conflicting. Details: A meta-analysis of clinical research in patients with type 2 diabetes shows that taking reishi mushroom extract 1400-4000 mg daily for 12-16 weeks does not reduce glycated hemoglobin (HbA1c) or plasma lipids (91435). However, one preliminary clinical study in patients with type 2 diabetes shows that taking a specific reishi mushroom extract (Ganopoly, Encore International Co.) 1800 mg three times daily for 12 weeks reduces HbA1c, but not fasting blood glucose, when compared with placebo (70801).
• Fibromyalgia. It is unclear if oral reishi mushroom is beneficial for fibromyalgia. Details: A small clinical trial in patients with fibromyalgia shows that taking reishi mushroom (MundoReishi Salud S.L.) powder 3 grams twice daily for 6 weeks does not improve mood, quality of life, anthropometric measures, blood pressure, or glycemic or lipid parameters when compared with placebo (108309,108310). However, the study may have been underpowered to detect any differences between groups.
• Genital herpes. Oral reishi mushroom has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults with recurrent genital herpes shows that taking 4.4 grams of a mixture of hot water extracts of reishi mushroom, terminalia, Job's tears, Wisteria floribunda, Trapa natans, and Elfvingia applanata orally once daily for 2 days, then 2.2 grams daily thereafter until outbreak resolution, decreases the time to outbreak resolution by 6 days when compared with previous outbreaks (91434).
• Gulf war syndrome. It is unclear if oral reishi mushroom is beneficial for Gulf war syndrome. Details: A very small exploratory clinical trial in adults with Gulf war syndrome shows that taking reishi mushroom extract (JHS Natural Products, Mushroom Science) 1600 mg in two divided doses daily for 30 days does not improve symptoms when compared with placebo. Also, symptoms modestly worsened after an additional 30 days of treatment at a dose of 3200 mg daily (108311).
• Hepatitis B. One small clinical study suggests that a specific reishi mushroom extract may reduce hepatitis B activity and improve liver function. Details: Preliminary clinical research shows that taking a specific reishi mushroom extract (Ganopoly, Encore International Co.) 1800 mg orally three times daily for 12 weeks reduces levels of hepatitis B viral DNA and hepatitis B surface antigen, which are markers of hepatitis B activity, and normalizes aminotransferase levels in a greater percentage of patients when compared with placebo (70799).
• Herpes labialis (cold sores). Oral reishi mushroom has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults with recurrent herpes labialis shows that taking 4.4 grams of a mixture of hot water extracts of reishi mushroom, terminalia, Job's tears, Wisteria floribunda, Trapa natans, and Elfvingia applanata orally once daily for 2 days, then 2.2 grams daily thereafter until outbreak resolution, decreases the time to outbreak resolution by almost 4 days when compared with previous outbreaks (91434).
• Herpes zoster (shingles). Although there has been interest in using oral reishi mushroom for herpes zoster, there is insufficient reliable information about the clinical effects of reishi mushroom for this purpose.
• Human papillomavirus (HPV). Oral reishi mushroom has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with oral HPV shows that taking a combination of reishi and coriolus mushroom powders, 400 mg orally daily for 2 months, clears HPV in 88% of patients when compared with baseline (91433). The validity of this finding is limited by the lack of a comparator group.
• Hypertension. Limited research suggests that oral reishi mushroom may be beneficial in some types of hypertension. Details: Preliminary clinical research shows that taking reishi mushroom extract 1440 mg daily for 12 weeks does not lower blood pressure in patients with hypertension (70776). However, in other clinical research, taking reishi mushroom extract 330-1440 mg daily for 1-6 months reduces blood pressure in patients with stage II or essential hypertension, but not in those with mild hypertension or diabetes (70786,70802,91435).
• Influenza. Although there has been interest in using reishi mushroom for influenza, there is insufficient reliable information about the clinical effects of reishi mushroom for this purpose.
• Insomnia. Although there has been interest in using reishi mushroom for insomnia, there is insufficient reliable information about the clinical effects of reishi mushroom for this purpose.
• Lung cancer. Small clinical studies suggest that oral reishi mushroom does not reduce the size of lung tumors. Details: A meta-analysis of preliminary clinical research shows that taking reishi mushroom does not reduce the size of lung tumors. However, it may stimulate immune function and improve quality of life in lung cancer patients when compared with control (70779).
• Peptic ulcers. Although there has been interest in using oral reishi mushroom for peptic ulcers, there is insufficient reliable information about the clinical effects of reishi mushroom for this purpose.
• Rheumatoid arthritis (RA). Oral reishi mushroom has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical trial in patients with active RA who are taking disease-modifying antirheumatic drugs shows that taking reishi mushroom extract 4 grams in combination with San Miao San (containing 2.4 grams each of atractylodes, phellodendron, and Achyranthes bidentata) daily for 24 weeks does not increase the percentage of patients achieving a 20% response based on the American College of Rheumatology (ACR) criteria or modify blood markers of disease and inflammation when compared with placebo (70767).
• Stress. Although there has been interest in using oral reishi mushroom for stress, there is insufficient reliable information about the clinical effects of reishi mushroom for this purpose. More evidence is needed to rate reishi mushroom for these uses.

(Read more about REISHI MUSHROOM)

LIKELY SAFE ...when used orally and appropriately, short-term. American ginseng 100-3000 mg daily has been safely used for up to 12 weeks (1018,4225,4236,6461,9732,14804,19552,22367,22368)(22369,22370). Single doses up to 10 grams have also been safely used (6461,89404). A specific American ginseng extract called CVT-E002 (Cold-FX, Afexa Life Sciences) has also been used safely for up to 64 months (11351,13192,14345,91275).

CHILDREN: POSSIBLY SAFE
when used orally and appropriately, short-term. A specific American ginseng extract called CVT-E002 (Cold-FX, Afexa Life Sciences) in doses of 4.5-26 mg daily for 3 days has been used with apparent safety in children aged 3-12 years (22365).

PREGNANCY: POSSIBLY UNSAFE
when used orally. Ginsenoside Rb1, an active constituent of American ginseng, has teratogenic effects in animal models (10447); avoid using.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about AMERICAN GINSENG)

There is insufficient reliable information available about the safety of atractylodes.

PREGNANCY: POSSIBLY UNSAFE
when used orally. In animals, atractylodes has caused reproductive toxicity, including fetal death, as well as changes in gestation, growth, and skeletal formation (94304).

LACTATION:
There is insufficient reliable information available about the safety of atractylodes when used during breast-feeding.

(Read more about ATRACTYLODES)

POSSIBLY SAFE ...when used orally and appropriately. Traditionally, aqueous extract of codonopsis 6-9 grams daily has been used with apparent safety (12).

POSSIBLY UNSAFE ...when used orally in large amounts. Large doses of codonopsis (30-60 grams) have been associated with adverse effects including chest pain, arrhythmia, visual impairment, dizziness, and other conditions (12).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about CODONOPSIS)

POSSIBLY UNSAFE ...when used orally. Fo-ti has been linked to several cases of liver damage (7626,7627,14327,14347,14482,16459,17192,50711,50727,50729) (92892,92895,112231).

CHILDREN: POSSIBLY UNSAFE
when used orally. Fo-ti has been linked to several cases of liver damage in adults and at least one case in a 5-year-old child (14339,92895).

PREGNANCY: POSSIBLY UNSAFE
when used orally. Fo-ti contains anthraquinone constituents, which can exert a stimulant laxative effect. Bulk-forming or emollient laxatives are preferred in pregnancy (272). Fo-ti has also been linked to several cases of liver damage (7626,7627,14327). There is insufficient reliable information available about the safety of fo-ti when used topically during pregnancy.

LACTATION: POSSIBLY UNSAFE
when used orally. Anthraquinone constituents can cross into breast milk and might cause loose stools in some breast-fed infants (272). Fo-ti has also been linked to several cases of liver damage (7626,7627,14327). There is insufficient reliable information available about the safety of fo-ti when used topically during lactation.

(Read more about FO-TI)

POSSIBLY SAFE ...when used orally and appropriately (12).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about GLOSSY PRIVET)

POSSIBLY SAFE ...when goji fruit preparations are used orally and appropriately, short-term. Goji berry whole fruit, boiled or steamed, has been used with apparent safety at a dose of 15 grams daily for 16 weeks (105489). Other goji berry products have also been used with apparent safety in clinical research, including a specific goji fruit juice (GoChi, FreeLife International) 120 mL daily for 30 days (52532), a goji fruit polysaccharide 300 mg daily for 3 months (92117), and a specific milk-based formulation of goji berry (Lacto-Wolfberry, Nestlé Research Center) for 3 months (52539). There has been some concern about the atropine content of goji; however, most analyses show that levels of atropine in goji berries from China and Thailand are far below potentially toxic levels (52524,94667). There is insufficient reliable information available about the safety of oral use of other parts of the goji plant.

PREGNANCY AND LACTATION:
Insufficient reliable information available. Some animal research shows that goji fruit may stimulate the uterus (12). However, this has not been reported in humans. Until more is known, avoid using during pregnancy or lactation.

(Read more about GOJI)

POSSIBLY SAFE ...when an extract of reishi mushroom is used orally and appropriately for up to one year (12,5485,70767,70774,70786,70799,70800,70801,70802). ...when whole powdered reishi mushroom is used orally and appropriately for up to 16 weeks (70776,70799,70800,70801,91433,91435,91436,91437,108309).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using

(Read more about REISHI MUSHROOM)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Theoretically, taking American ginseng with antidiabetes drugs might increase the risk of hypoglycemia.  Details American ginseng seems to lower postprandial blood glucose (1018,6461). Theoretically, concomitant use with antidiabetes drugs might enhance blood glucose lowering effects and possibly cause hypoglycemia.

IMMUNOSUPPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, American ginseng use might interfere with immunosuppressive therapy.  Details American ginseng seems to stimulate immune function (11351,13192,14345,22366). Theoretically, American ginseng might decrease the effectiveness of immunosuppressant drugs.

MONOAMINE OXIDASE INHIBITORS (MAOIs) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, American ginseng can interfere with MAOI therapy.  Details There is one case report of insomnia, headache, and tremors when an unspecified ginseng product was used with phenelzine (Nardil), an MAOI (617). There is also one case report of hypomania when an unspecified ginseng product was used with phenelzine (618). Theoretically, American ginseng may interfere with MAOI therapy.

WARFARIN (Coumadin) Interaction Rating = Major Do not take this combination. Severity = Moderate •  Occurrence = Likely •  Level of Evidence = B American ginseng seems to decrease the effectiveness of warfarin therapy.  Details Healthy patients receiving warfarin 5 mg daily, who also take American ginseng 1 gram twice daily, seem to have a significantly reduced international normalized ratio (INR) (619,12032).

(Read more about AMERICAN GINSENG)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, atractylodes might increase the risk of bleeding when used concomitantly with anticoagulant and antiplatelet drugs.  Details Laboratory research suggests that atractylenolides II and III, constituents of atractylodes, reduce platelet activation (94299). So far, this has not been shown in humans.

AROMATASE INHIBITORS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, atractylodes may have an additive effect when used with other aromatase inhibitors.  Details Laboratory research suggests that atractylodes and its constituents exhibit aromatase inhibitor effects (94302).

HEXOBARBITAL Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking atractylodes may prolong the therapeutic and adverse effects of hexobarbital.  Details In animals, atractylodes has been shown to prolong the effects of hexobarbital (94303). These effects have not been shown in humans.

(Read more about ATRACTYLODES)

ABIRATERONE (Zytiga) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking codonopsis root with abiraterone might reduce the levels and therapeutic effects of abiraterone.  Details Animal research in rats shows that intragastric administration of codonopsis root along with abiraterone every 2 days for 2 weeks seems to increase the clearance of abiraterone and reduce the overall exposure and time to maximum concentration (105912). This interaction has not been reported in humans.

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, codonopsis liquor might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.  Details A small clinical study in adults with coronary heart disease shows that consuming Codonopsis pilosula liquor for 4 weeks inhibits platelet aggregation but does not affect tissue-type plasminogen activator (t-PA) or plasminogen activator inhibitor (PAI) (43888).

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, codonopsis might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Laboratory and animal research suggest that codonopsis has antidiabetic effects (110743).

(Read more about CODONOPSIS)

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, fo-ti might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Fo-ti reportedly has hypoglycemic effects (5,19).

CONTRACEPTIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, taking large amounts of fo-ti might interfere with contraceptive drugs due to competition for estrogen receptors.  Details In vitro research suggests that fo-ti extract has estrogenic activity (10143,16061,50710).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, fo-ti might increase or decrease the levels and clinical effects of drugs metabolized by CYP1A2.  Details In vitro research suggests that fo-ti might inhibit CYP1A2 (12479,112351). Additionally, in vitro research suggests that the degree of CYP1A2 inhibition depends on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts) (112351). However, in an animal study, an aqueous extract of fo-ti inhibited CYP1A2 while an alcoholic extract of fo-ti induced CYP1A2 (92898). Induction or inhibition of CYP1A2 by fo-ti has not been reported in humans.

CYTOCHROME P450 2B6 (CYP2B6) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP2B6.  Details Animal research suggests that fo-ti might inhibit CYP2B6 (92898). One in vitro study suggests that the degree of CYP2B6 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts) (112351). However, this interaction has not been reported in humans.

CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2C19.  Details Animal and in vitro research suggests that fo-ti may inhibit CYP2C19 (12479,92898,112351). An in vitro study suggests that the degree of CYP2C19 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts) (112351). However, this interaction has not been reported in humans.

CYTOCHROME P450 2C8 (CYP2C8) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP2C8.  Details In vitro research suggests that fo-ti might inhibit CYP2C8 (112351). However, this interaction has not been reported in humans.

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2C9.  Details Animal and in vitro research suggests that fo-ti may inhibit CYP2C9 (12479,92898,112351). However, this interaction has not been reported in humans.

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, fo-ti may increase the levels and clinical effects of drugs metabolized by CYP2D6.  Details Animal research suggests that fo-ti might inhibit CYP2D6 (92898). Additionally, an in vitro study suggests that the degree of CYP2D6 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts) (112351). However, this interaction has not been reported in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, fo-ti might increase the levels and clinical effects of drugs metabolized by CYP3A4.  Details In vitro research suggests that fo-ti might inhibit CYP3A4 (12479,112351). One in vitro study suggests that the degree of CYP3A4 inhibition may depend on the type of fo-ti extract (i.e., the raw plant leads to greater inhibition than extensively processed extracts) (112351). However, this evidence conflicts with animal research suggesting that fo-ti does not inhibit CYP3A4 (92898). This interaction has not been reported in humans.

DIGOXIN (Lanoxin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of hypokalemia and cardiotoxicity when taken with digoxin.  Details Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects (5,16459). In vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root (99855).

DIURETIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of hypokalemia when taken with diuretic drugs.  Details Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects and compound diuretic-induced potassium loss (5,16459). In vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root (99855).

ESTROGENS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, taking large amounts of fo-ti might interfere with hormone replacement therapy through competition for estrogen receptors.  Details In vitro research suggests that fo-ti extract has estrogenic activity (10143,16061,50710).

HEPATOTOXIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, fo-ti might increase the risk of liver damage when taken with hepatotoxic drugs.  Details Fo-ti has been linked to liver damage in many reports (7626,7627,14327,14339,14347,14482,16459,17192,50711,50727,50729,92892,92895).

STIMULANT LAXATIVES Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, fo-ti, particularly raw fo-ti root, might increase the risk of fluid and electrolyte depletion when taken with stimulant laxatives.  Details Raw fo-ti root contains anthraquinone derivatives, which might have stimulant laxative effects (5,16459). However, in vitro research shows that fermented and processed fo-ti root have reduced laxative effects compared with raw fo-ti root (99855).

SULINDAC (Clinoril) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, fo-ti might increase or decrease the levels and clinical effects of sulindac.  Details Animal research suggests that the type of fo-ti extract might affect the levels of sulindac differently; the raw plant may increase levels, but processed parts may decrease levels (112351). Induction or inhibition of CYP1A2 by fo-ti has not been reported in humans.

WARFARIN (Coumadin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, fo-ti might increase the effects and adverse effects of warfarin.  Details Fo-ti may have stimulant laxative effects and cause diarrhea, especially when the raw or unprocessed fo-ti root is used (5,12,16459,50733,99855). Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding. Also, fo-ti has been linked to cases of acute liver failure which can decrease clotting factor production and increase the effects of warfarin. In one case, a patient who had been stable on warfarin presented with acute hepatitis and an INR elevated to 14.98. The patient had been taking fo-ti for 90 days prior to admission. Discontinuation of warfarin and fo-ti lead to a decrease in the INR and full recovery (17192).

(Read more about FO-TI)

(Read more about GLOSSY PRIVET)

ANTIDIABETES DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = B Theoretically, concomitant use of goji fruit polysaccharides or goji root bark with antidiabetes drugs might have additive effects.  Details Animal and in vitro research show that goji root bark and fruit polysaccharides might have hypoglycemic effects (7126,92118,94667). However, clinical research has only shown that taking goji fruit polysaccharides with or without antidiabetes drugs modestly reduces postprandial glucose when compared with control, with no reports of hypoglycemia (92117).

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of goji root bark, but not goji fruit, with antihypertensive drugs might have additive effects.  Details Animal and in vitro research suggest that goji root bark has hypotensive effects (7126,94667). However, goji fruit juice does not appear to reduce systolic or diastolic blood pressure in humans (17082).

CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, goji berry might inhibit CYP2C19 and reduce metabolism of CYP2C19 substrates.  Details In vitro research shows that goji berry tincture and juice inhibit CYP2C19 enzymes (105486). Concomitant use with goji may decrease metabolism and increase levels of CYP2C19 substrates. However, this has not been reported in humans.

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, goji berry might inhibit CYP2C9 and reduce metabolism of CYP2C9 substrates.  Details In vitro research shows that goji berry tincture and juice inhibit CYP2C9 enzymes (105486). Additionally, multiple case reports suggest that goji berry concentrated tea and juice inhibit the metabolism of warfarin, a CYP2C9 substrate (7158,105462). Concomitant use with goji may decrease metabolism and increase levels of CYP2C9 substrates.

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, goji berry might inhibit CYP2D6 and reduce metabolism of CYP2D6 substrates.  Details In vitro research shows that goji berry juice inhibits CYP2D6 enzymes (105486). Concomitant use with goji may decrease metabolism and increase levels of CYP2D6 substrates. However, this has not been reported in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, goji berry might inhibit CYP3A4 and reduce metabolism of CYP3A4 substrates.  Details In vitro research shows that goji berry juice inhibits CYP3A4 enzymes (105486). Concomitant use with goji may decrease metabolism and increase levels of CYP3A4 substrates. However, this has not been reported in humans.

FLECAINIDE (Tambocor) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, goji berry might increase the levels and clinical effects of flecainide.  Details In one case report, a 75-year-old patient stable on flecainide and warfarin presented to the emergency room with fainting and pleomorphic arrhythmia caused by flecainide toxicity. Flecainide toxicity was attributed to drinking 1-2 glasses of concentrated goji tea daily for 2 weeks. Theoretically, goji may have inhibited the cytochrome P450 2D6 (CYP2D6) metabolism of flecainide (105462).

WARFARIN (Coumadin) Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = D Goji can increase the effects of warfarin and possibly increase the risk of bleeding.  Details There are at least 5 case reports of increased international normalized ratio (INR) in patients stabilized on warfarin who began drinking goji juice, concentrated goji tea, or goji wine (7158,16529,23896,105462,105487). Goji may inhibit the metabolism of warfarin by cytochrome P450 2C9 (CYP2C9) (7158).

(Read more about GOJI)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, high doses of reishi mushroom might increase the risk of bleeding.  Details A dose of 1.5 grams daily of reishi mushroom does not seem to decrease platelet aggregation, but a higher dose of 3 grams daily does (5476,13235).

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, reishi mushroom might have additive effects with antidiabetes drugs.  Details Animal research suggests that reishi mushroom decreases blood sugar (70769). However, in patients with type 2 diabetes, taking reishi mushroom does not reduce fasting glucose levels, and its effects on glycated hemoglobin are inconsistent (70801,91435).

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concurrent use of reishi mushroom with antihypertensive drugs might increase the risk of hypotension.  Details Reishi mushroom has shown hypotensive activity in animal research (5488,70784). Clinical evidence suggests that reishi mushroom reduces blood pressure in some, but not all, patients with hypertension (70786,70802).

(Read more about REISHI MUSHROOM)

General ...Orally, American ginseng is well tolerated. Few side effects have been reported when used at suggested doses. In rare cases, headaches have been reported (22369).

Neurologic/CNS ...Orally, headache has been reported with American ginseng use (22369).

(Read more about AMERICAN GINSENG)

General ...There is currently a limited amount of information on the adverse effects of atractylodes. A thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Orally: Allergic reaction, dry mouth, nausea.

Gastrointestinal ...Orally, atractylenolide I, an isolated constituent of atractylodes, can cause bad taste, nausea, and dry mouth (15706).

Immunologic ...Atractylodes can cause an allergic reaction in people sensitive to the Asteraceae/Compositae family (12450). Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many other herbs.

(Read more about ATRACTYLODES)

General ...Orally, codonopsis seems to be well tolerated when used appropriately; however, a thorough evaluation of safety outcomes has not been conducted.
Serious Adverse Effects (Rare):
Orally: Allergic reactions such as anaphylaxis.

Cardiovascular ...Orally, very large doses of codonopsis (30-60 grams) may cause chest pain or arrhythmia (12).

Gastrointestinal ...Orally, very large doses of codonopsis (30-60 grams) may cause throat pain and loss of voice (12).

Immunologic ...Orally, codonopsis can cause allergic reactions including anaphylaxis and urticaria. In one case report, an 18-year-old male developed anaphylaxis after ingesting codonopsis roots. In an oral re-challenge test, he developed anaphylaxis and urticaria again 30 minutes after consuming 20 grams of codonopsis root. Although codonopsis is in the same family as mugwort, the patient did not appear to be sensitized to mugwort pollen (100060).

Neurologic/CNS ...Orally, very large doses of codonopsis (30-60 grams) may cause vision problems, dizziness, loss of balance, leg spasms, and confusion (12).

(Read more about CODONOPSIS)

General ...Orally, fo-ti may be unsafe.
Most Common Adverse Effects:
Orally: Abdominal pain, diarrhea, nausea, and vomiting with use of unprocessed fo-ti.
Serious Adverse Effects (Rare):
Orally: Hepatotoxicity with processed or unprocessed fo-ti.

Dermatologic ...Orally, one case of a fine maculopapular rash was reported in a patient taking the herbal product known as Shen-Min, which contains fo-ti. Symptoms resolved within three weeks after discontinuing the product (14482). It is unclear if the rash was due to fo-ti or other ingredients in the herbal product.

Gastrointestinal ...Orally, unprocessed fo-ti may cause diarrhea, abdominal pain, nausea, and vomiting (12,50733).

Hematologic ...Orally, one case of mild eosinophilia was reported in a patient taking the herbal product known as Shen-Min, which contains fo-ti. Symptoms resolved within three weeks after discontinuing the product (14482). It is unclear if this reaction was due to fo-ti or other ingredients in the herbal product. A case of agranulocytosis was reported in a 65-year-old female taking fo-ti 30 grams/day for 17 days. The patient recovered gradually following a 15-day hospitalization, which included treatment with intravenous steroids and granulocyte colony-stimulating factor (112231).

Hepatic ...Orally, cases of liver damage due to both processed and unprocessed fo-ti have been well documented in the medical literature. (7626,7627,14327,14339,14347,14482,16459,17192,50711,50726)(50727,50729,92892,92895,112231).
In a systematic review, around 450 cases of hepatitis associated with fo-ti were identified. These cases occurred in patients 5-78 years of age. Liver damage occurred at a wide range of doses, formulations, and durations of intake. The type of liver injury ranged from hepatocellular, to cholestatic, or mixed. Outcomes ranged from full recovery to cirrhosis, liver transplantation, and/or death. The evidence suggests that when the daily fo-ti dose is less than 12 grams, the median time to occurrence of liver damage is 60 days. When the daily fo-ti dose is more than 12 grams, the median time to liver damage is 30 days (92895). Presenting signs and symptoms may include jaundice, abdominal pain, nausea, fatigue, loss of appetite, dark urine, myalgias, and elevations in liver function tests (LFTs), ferritin, transferrin, prothrombin time, and INR (17192,92892). Other manifestations may include fever, skin rash, thrombocytopenia, pancytopenia, and arthralgias. Symptoms and increased LFTs usually seem to resolve within a month after discontinuing fo-ti (7626,7627,14339,14347,14482,16459). In one case series, liver enzymes began to normalize 48 hours after discontinuation of fo-ti and treatment with S-adenosylmethionine, compound glycyrrhizin injection, polyene phosphatidylcholine, and reduced glutathione. All patients were eventually discharged home in stable condition (92892). Rechallenge with fo-ti should not be attempted. A patient who had recovered from hepatitis associated with fo-ti use presented with myalgias and markedly elevated LFTs after a single dose of the herb (17192).
It is thought that this idiosyncratic reaction leading to liver damage is at least partially related to genetic polymorphisms. Cytochrome P450 1A2 (CYP1A2) is the predominant enzyme involved in biotransformation of emodin, a constituent of fo-ti thought to play a role in liver damage. In one genetic study, the frequency of CYP1A2*1C mutation in fo-ti induced drug-induced liver injury patients was 46.5%, which is significantly higher than the 27.9% frequency of liver injury reported in healthy patients without the mutation. Patients with a CYP1A2*1C mutation may have decreased activity of the CYP1A2 enzyme, which could inhibit the metabolism of fo-ti, causing an accumulation of toxic substances (92897).

(Read more about FO-TI)

General ...None reported. However, respiratory allergies (allergic rhinitis, asthma) and cross-allergenicity have been reported with the pollen of other Oleaceae species including common privet (Ligustrum vulgare), olive, ash, and lilac (416,417).

(Read more about GLOSSY PRIVET)

General ...Orally, goji fruit seems to be well tolerated.
Serious Adverse Effects (Rare):
Orally: Allergic reactions including anaphylaxis.

Dermatologic ...A case of photosensitivity secondary to consumption of goji berries has been reported. The patient presented with a pruriginous eruption that had lasted for 2 weeks. The patient had been taking goji berries for 5 months and cat's claw for 3 months. Upon testing, it was revealed that the patient tested positive to goji berries in a photoprovocation test, but not to cat's claw (40263).

Hepatic ...Orally, consumption of goji berries has been associated with a single case report of autoimmune hepatitis (52541). A case of acute hepatitis has also been reported in a female who consumed 2 ounces of a specific combination product (Euforia, Nuverus International) containing goji berry, pomegranate, curcumin, green tea, noni, acai berry, aloe vera, blueberry, resveratrol, mangosteen, and black seed, daily for one month. It is unclear whether the liver injury was caused by goji berry, other ingredients, or the combination (90125).

Immunologic ...Several cases of allergic reactions secondary to consumption of goji berries have been reported. Symptoms included facial angioedema with dyspnea, pharyngeal itching, itching in the mouth, ears, and axilla, labial angioedema, and perioral skin rash (92116). Anaphylaxis has also been reported (52538).

(Read more about GOJI)

General ...Orally, reishi mushroom is generally well tolerated.
Most Common Adverse Effects:
Orally: Dizziness, dry mouth, itching, nausea, rash, and stomach upset.

Dermatologic ...Orally, reishi mushroom can cause itching, rash, and other skin reactions (12,5479).

Gastrointestinal ...Orally, reishi mushroom can cause dryness of the mouth, throat, or nasal cavity, nausea, stomach upset, and, more rarely, diarrhea (12,70779,91438,108309).

Hematologic ...Orally, reishi mushroom can cause nosebleed and bloody stools (12,91438).

Hepatic ...One case of hepatotoxicity and one case of fatal fulminant hepatitis have been reported in patients who had used reishi mushroom powder for 1-2 months (70766). There is a case report of a 61-year-old male with hypereosinophilia associated with hepatic nodules following the use of reishi mushroom powder for about 2 months. Symptoms resolved after discontinuation of the product. Although these side effects were thought to be associated with the use of reishi mushroom powder, it is unclear if other factors played a role. The patient had been taking tegafur, gimeracil, and oteracil potassium for about 4 months following anterior resection for rectal adenocarcinoma but discontinued these agents and initiated reishi mushroom due to liver injury (108312).

Neurologic/CNS ...Orally, reishi mushroom can cause dizziness (91438). Other rare symptoms include insomnia and headache (70776,70779).

Pulmonary/Respiratory ...Respiratory allergy to reishi spores can occur (12,5479). Sore throat and runny nose have also been reported (70776,91438).

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