Standardized Failure: A cautionary tale of standardized extracts

CONCERN
The trade paper, Natural Product Insider, published a report today, November 4, 2008, about the widespread adulteration of Ginkgo biloba supplements (75% of tested supplements). The adulteration came in the form of "boosting" the count of certain "active" compounds using other plant extracts instead of using high quality Ginkgo leaves.

Three factors came together to form the perfect storm. 1) Ginkgo has a well-deserved reputation for improving circulation and cognitive function. With an aging population in Western countries, the demand for Ginkgo has only grown. 2) The German Commission E, a sort of FDA for natural products, set minimum standards active compounds in Ginkgo extracts. Setting standards for natural products forces a dynamic growth cycles to conform to static demands, and 3) Unscrupulous manufacturers of raw material get on the band wagon to provide supplement makers with "what they want" at any cost. No comment.

EXAMINATION
Let's consider factor number 2: Standardization. The attempt to "standardize" plant products to contain a minimum amount of a certain "active" ingredient comes from an attempt to consider plants as drugs in their own right, control their quality and protect consumers to ensure that they receive a quality product.

All these goals are noble and important. Unfortunately, they represent a form of medical colonialism. Like the old colonial powers of the past, who made native people dress and eat and walk and think like them before they would "accept" them as being civilized or respectable, the predominant academic, scientific, industrial and legal organs of medicine insist on fitting natural products into their reductionist concepts of what the definition of "drug" before they will accept natural healing products as legitimate: the attitude of "I will tolerate you when I can control you."

According to this school of thought, a drug is a single compound that works at a single receptor site. The more of that compound you have, the more of an effect you will have. Time and time again, drug and supplement manufacturers have been surprised at the results. In the case of natural supplements, St. John's Wort for depression is a good example. Researchers jumped to conclusions about hypericin being the active compound in St. John's wort and hundreds of studies were performed using standardized extracts vs. anti-depressants. The studies had mixed results as far as St. John's Wort's effectiveness for mild depression. Currently, scientists think that maybe other compounds are "more active" than hypericin. This is the problem with following the fallacy of active compounds in plants.

In the case of synthetic drugs, Vioxx and Celebrex causing heart attacks, or statins increasing the risk for suicide, or in my sub-speciality of critical care, of nitric oxide inhibitors increasing death from septic shock are all good examples. The spectacular disasters in the form of loss of human life have come about due to a failure to create a holistic understanding of how the body works, why it works the way that it does and what the meaning of illness is.

The aggressiveness and forcefulness of synthetic medications--critical care relies on them for its very existence--is impressive for the extremes of disease. I am not proposing that synthetic drugs are all bad, or natural products are all good. Everything has its place. And sometimes, they have a place together. Read my research on essential oils in the intensive care unit here.

On the spectrum of illness, most people's health issues can be framed as sub-optimal vs. optimal, not disease vs. no disease. So, this idea of what a drug is is good in theory, but it does not match how the body works, or how plants work for that matter. Most people, most the time, need gentle recallibration, not sudden suppression or increase in bodily functions.

The body is a complex, dynamic organism which is not static and passive, waiting for Bayer to invent aspirin. It's a self-regulating, self-healing organism with multiple, redundant pathways of compensation. Plants are polymodal multichemical products--in other words, they have many compounds in them that work in many different ways. Plants have an "intelligence" about them in that they interact with the body and there is a "dance" a back and forth of subtle increases and decreases, of feedback and promotion which occurs.

It is a fallacy to say that one compound is the active compound in a drug, because many, many compounds do different things in the body. What is amazing about plants--and this holds true for essential oils--is that they often contain compounds which do the opposite of the intended effect of the plant, but to a smaller degree. They contain base compounds which can become active compounds if the body needs it, or, be flushed out of the system unused. Plants come with their own antidotes to lower the incidence of side effects and over doses. It would be like every capsule of Tylenol coming with its antidote for overdose, N-acetyl cysteine (NAC). If only humans were as smart as the natural world.

CASE OF AROMATHERAPY AND ESSENTIAL OILS
When you examine the research on essential oils, many interesting observations come to light. For example, there are many instances where the whole essential oil, say, of Clove (Syzygium aromaticum), is more effective than its "active" component in head to head studies for pain control even though the whole oil has less of the "active" component. More importantly, a single essential oil, again, say, clove, not only killls the bacteria, but is anti-inflammatory, stimulates the immune system, and increases emunctory organ activity and detoxification at the same time.

Drs. Jean Claude Lapraz and Christian Duraffourd in the 1970's performed experiments with essential oils and infectious disease to examine the efficacy of various chemical components of essential oils. They performed "aromatograms"--evaluation of the killing power of essential oils in the lab against certain bacteria. What they found was that in this case, oils like Oregano, Thyme ct. thymol, Clove and Cinnamon were the most effective against a range of bacteria. This is to be expected because of the high amount of phenolic compounds in them.

However, much to their surprise, in clinical usage, "gentler" essential oils such as Thyme ct. linalool, lavender and geranium were more effective than the more "powerful" essential oils. The reason for this was that in the body, the essential oils not only directly killed bacteria, but stimulated the body's natural immunity in many different ways. In other words, it is the "terrain" of the body--how the body is functioning or malfunctioning--that determines how effective an appropriately chosen plant product is, not the specific amount a particular compound.

Others studies have shown that "gentler" essential oils used together have an amazing synergy with a significant antibacterial effect without the risk of the stronger compounds in essential oils like oregano.

CONCLUSION
Plant products--phytotherapy--involves complex, dynamic, multi-chemical substances that interact with an equally complex and dynamic living organism--your body. There is no need to standardize natural products to certain levels of this compound or that compound because the whole plant, in the whole body, will have the effect that it needs to have, which is greater than its effect on one cell receptor in the body. Standardizing natural supplements only increases the tendency towards fraud and deception to meet an artificial standard of "potency" and pigeon-holes plants into the category of synthetic pharmaceuticals.

To read more about essential oils and review their clinical effects, go here. for general articles, and here for scientific articles.