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There is insufficient reliable information available about the effectiveness of black alder.

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POSSIBLY EFFECTIVE

• Hypercholesterolemia. Small clinical trials show that consuming English walnuts as part of a low-fat diet seems to lower cholesterol. Total cholesterol and lipoproteins are decreased when English walnuts are substituted for other fatty foods and constitute up to 20% of the calories in the diet. When English walnuts are added to a low fat diet, total cholesterol may be decreased by 4% to 12% and low-density lipoprotein (LDL) may be decreased by 8% to 16% (6431,8476,8477). Substituting English walnuts for other dietary fats as part of a diet containing 30% fat seems to improve high-density lipoprotein (HDL) cholesterol-to-total cholesterol ratios in patients with type 2 diabetes. However, there is no effect on levels of low-density lipoprotein (LDL) cholesterol when compared with a 30% fat diet without English walnuts (13300).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Coronary heart disease (CHD). Epidemiological research has found that people who increase dietary consumption of nuts in general might have a lower risk of CHD and death due to coronary events. However, there is no available evidence showing that eating English walnut, specifically, reduces the risk of CHD (8478,13299). In 2004, the US Food and Drug Administration (FDA) determined that it would allow a qualified health claim stating that consuming 1.5 ounces of walnuts per day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of CHD. The FDA has concluded that this claim is based on supporting, rather than conclusive, evidence (102335).
• Diabetes. Data from preliminary clinical research on the effects of English walnuts in people with type 2 diabetes are conflicting. Some clinical research shows that taking English walnut leaf extract 100 mg twice daily for 3 months decreases fasting blood glucose by about 13% when compared with placebo (97750). In contrast, other clinical research shows that taking English walnut leaf extract 100 mg once daily for one week and then twice daily for 7 weeks has no effect on fasting blood glucose levels (97749). In a meta-analysis of 4 studies involving a total of 195 patients, taking English walnut leaf extracts orally, 200-750 mg daily for 8 to 12 weeks, reduces fasting blood glucose by a mean of about 18 mg/dL and increases fasting insulin levels by a mean of about 2 units/L, but does not alter post-prandial glucose levels (113406). The majority of studies do not show a significant effect on glycated hemoglobin (HbA1c), but the meta-analysis shows a reduction when English walnut leaf extracts are taken for more than 8 weeks (97749,97750,113406). Substituting English walnuts for other dietary fats as part of a diet containing 30% fat seems to improve high-density lipoprotein (HDL) cholesterol-to-total cholesterol ratios in patients with type 2 diabetes. However, there is no effect on levels of low-density lipoprotein (LDL) cholesterol when compared with a 30% fat diet without English walnuts (13300). More evidence is needed to rate English walnut for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Atopic dermatitis (eczema). It is unclear if topical fig fruit extract is beneficial in children with eczema. Details: Preliminary clinical research in children 4 months to 14 years of age with mild to moderate atopic dermatitis shows that topical application of a cream containing fig fruit extract 8% twice daily for 14 days reduces the severity of symptoms by 56% and itchiness by 64% when compared with baseline. Fig cream is as effective as a cream containing 1% hydrocortisone and more effective than placebo (99958).
• Constipation. It is unclear if oral fig fruit is beneficial for constipation. Details: A small clinical study in adults with constipation shows that taking fig fruit paste 300 grams daily for 8 weeks improves stool consistency by 58%, compared to a 27% improvement with placebo. Fig paste also modestly improves abdominal discomfort; however, it does not affect stool frequency, abdominal pain, effort, or relief (99956).
• Diabetes. It is unclear if oral fig leaf is beneficial for glycemic control in patients with type 1 diabetes. Details: A very small clinical crossover study in adults with type 1 diabetes shows that consuming a tea made from fig leaves modestly reduces postprandial, but not pre-prandial, glucose levels and also reduces insulin requirements when compared with consuming a non-fig tea (12578).
• Vitiligo. Although there has been interest in using oral fig for vitiligo, there is insufficient reliable information about the clinical effects of fig for this condition.
• Warts. It is unclear if topical fig latex is beneficial for warts in adults and children. Details: Preliminary clinical research in adults and children 5 years of age and older shows that applying fig latex directly to a common wart three times daily for at least 4 days is slightly less effective than cryotherapy for producing complete resolution of the wart after 2 weeks (99962).
• Wound healing. Although there has been interest in using topical fig for wound healing, there is insufficient reliable information about the clinical effects of fig for this purpose. More evidence is needed to rate fig for these uses.

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There is insufficient reliable information available about the safety of black alder.

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

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LIKELY SAFE ...when the fruit (nut), leaf, or hull is consumed in amounts normally found in foods (4912,6431,8476,8477).

POSSIBLY SAFE ...when the leaf extract is used orally at doses of up to 200 mg for up to 3 months (97749,97750).

POSSIBLY UNSAFE ...when the bark is used orally or topically, due to its juglone content (12). When applied topically, juglone-containing bark can cause skin irritation. When used orally on a daily basis, juglone-containing bark is associated with increased risk of tongue cancer and lip leukoplakia (2,12). There is insufficient reliable information available about the safety of the fruit, leaf, or hull when used orally in medicinal amounts or when applied topically.

PREGNANCY AND LACTATION: LIKELY SAFE
when the fruit (nut), leaf, or hull is consumed in amounts normally found in foods (4912).

PREGNANCY AND LACTATION: POSSIBLY UNSAFE
when the bark is used orally or topically (12); avoid using. There is insufficient reliable information available about the safety of the fruit, leaf, or hull when used orally in medicinal amounts during pregnancy and lactation; avoid using.

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LIKELY SAFE ...when the fresh or dried fruit is used orally in amounts commonly found in foods.

POSSIBLY SAFE ...when fig fruit paste is consumed orally in amounts of up to 300 grams daily for up to 8 weeks (99956).

POSSIBLY UNSAFE ...when fig leaf decoctions are used topically. Fig leaf contains psoralens (12579,12581). There have been reports of photodermatitis with burn-like lesions and rashes after fig decoctions were applied prior to sun exposure (49962,49968,49973,49975,49981). There is insufficient reliable information available about the safety of fig leaf when used orally.

PREGNANCY AND LACTATION: LIKELY SAFE
when the fresh or dried fruit is used orally in amounts commonly found in foods. There is insufficient reliable information available about the safety of fig leaf or fruit used in medicinal amounts during pregnancy and lactation; avoid use.

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ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Theoretically, fig leaf might enhance the blood glucose lowering effects of hypoglycemic drugs.  Details A small clinical study in patients with type 1 diabetes shows that consuming a tea made from fig leaves modestly reduces postprandial glucose levels and insulin requirements (12578).

INSULIN Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Fig leaf may enhance the blood glucose lowering effects of insulin.  Details A small clinical study in patients with type 1 diabetes shows that consuming a tea made from fig leaves modestly reduces postprandial glucose levels and insulin requirements (12578).

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...None reported.

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General ...Orally, the fruit (nut) of English walnut is well tolerated (8476,8477); however, it can cause softening of stools and mild bloating (6431). Oral allergy syndrome may occur in people who are allergic to English walnuts. This is characterized by itching of the oral cavity immediately after consumption. Rarely this syndrome may cause swelling of the lips and tongue (angioedema) (8479). English walnut leaf extract has been reported to cause gastrointestinal adverse events, especially mild diarrhea (97750). Daily use of English walnut bark is associated with increased risk of tongue cancer and lip leukoplakia due to its juglone content (2,12).
Topically, English walnut hull preparations can lead to yellow or brown discoloration of skin and mucous membranes due to its juglone content. It can also cause contact dermatitis (12,12980).

Dermatologic ...Topically, English walnut hull preparations, which contain juglone, can cause a temporary yellow or brown discoloration of skin and mucous membranes. It can also cause contact dermatitis (12,12980).

Gastrointestinal ...Orally, the fruit (nut) of English walnut might cause softening of stools and mild bloating (6431). Oral allergy syndrome may occur in people who are allergic to English walnuts. This is characterized by itching of the oral cavity immediately after consumption. Rarely this syndrome may cause swelling of the lips and tongue (angioedema) (8479). Walnut leaf extract has been reported to cause gastrointestinal adverse events, especially mild diarrhea, in 39% of adults in one study (97750). Daily use of walnut bark is associated with increased risk of tongue cancer and lip leukoplakia due to its juglone content (2,12).

Immunologic ...Tree nuts, which include English walnuts, can cause allergic reactions in sensitive individuals. Due to the prevalence of this allergy in the general population, tree nuts are classified as a major food allergen in the United States (105410).
Oral allergy syndrome may occur in people who are allergic to English walnuts. This is characterized by itching of the oral cavity immediately after consumption. Rarely this syndrome may cause swelling of the lips and tongue (angioedema) (8479).

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General ...Orally, the fresh or dried fig fruit is well tolerated in amounts commonly found in foods. A thorough evaluation of safety outcomes has not been conducted when fig fruit is used orally as medicine.
Topically, fig leaf may cause photodermatitis. There is limited reliable information available about the safety of fig fruit or latex when applied topically.
Serious Adverse Effects (Rare):
Orally: Allergy and, in rare cases, anaphylaxis.
Topically: The fig leaf may cause photodermatitis.

Dermatologic ...Topically, fig leaf might cause photodermatitis. The leaf contains psoralens (12579,12581). Many cases of photodermatitis from fig leaf have been reported (49962,49968,49973,49975,49981). In at least two cases, the burns were serious enough to require hospitalization. Severe anemia and sepsis developed in one patient (49962). Avoid excessive sunlight or ultraviolet light exposure while using products containing fig leaf.

Orally, fig fruit is unlikely to cause photodermatitis (12581).

Immunologic ...Orally, fig fruit can cause allergy and, in rare cases, anaphylaxis (8815,12580). Topically, exposure to fig fruit and leaves can cause contact dermatitis. In some cases, sun exposure can make contact dermatitis worse (12689,99961).

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