Traditional herbs: an enemy or friend?

Traditional herbs: an enemy or friend?

LESOTHO is home to extensive and diverse medicinal plant life. For years medicinal herbs have been used by our forefathers and are still used today to treat various diseases. In some areas traditional treatments are the main, if not only treatment, because they are accessible, affordable and culturally accepted.

“Natural equals safe” – true or false?

Various traditional African medicines are undeniably beneficial in treating certain diseases or maintaining good health. Some have even been the source of many prescription medicines. But the major challenge remains that many consumers spontaneously assume “natural equals safe”.

All of these natural remedies are generally considered “safe” or even healthy by consumers since their use is not regulated or restricted. Nothing indicates to the user that “too much of a good thing” could be dangerous.

Another problem arises when people use traditional or herbal remedies together with prescribed medicines. Some traditional African medicines may interfere with the normal metabolism of drugs and some might have synergistic effect.

For example, Aloe Vera, widely available in Lesotho, when used frequently in combination with diabetes medicines such as Metformin without appropriate dose adjustments may lower blood glucose levels resulting in serious/ life-threatening hypoglycemia.

St. John’s Wort is a natural remedy frequently used for depression. But it’s been shown in some studies to increase the removal of medicines, such as some oral contraceptives, from the body thus resulting in sub-therapeutic levels of the prescribed medicine, putting women at risk of pregnancy when they think they are protected.

For some drugs, the interaction could also result in reduced drug clearance from the body. This may lead to higher levels of the prescribed medicine in the body, which produces negative side effects and could even lead to toxicity, the liver and kidney being the most susceptible to damage!

Consumers must understand that these interactions happen at a metabolic level. So even herbal products that are safe when used on their own may pose a risk when taken in combination with Western medicine – that is, the hospital prescribed medicines.
One example of particular significance in Lesotho and other parts of Africa is Cancer bush (Sutherlandia frutescens), locally known as “Musa-pelo-o-moholo-oa-noka” or “Lerumo –la-Mali”. It is widely used in the treatment of diseases such as HIV/AIDS and TB, as it is believed to generally improve quality of life in these patients.

But it has been shown to lower the plasma levels of some antiretroviral drugs (ARVs), e.g atazanavir, to sub-therapeutic levels when they are taken together, reducing the ARVs’ efficacy.

This traditional remedy can also interfere with isoniazid therapy, which is used as a preventative measure in TB treatment.
Clearly more public engagement is needed so patients understand the risks of interaction. Some Basotho tend to be using traditional medicine in combination with prescription medicines. Often none of their healthcare providers know about this and so cannot warn about possible interactions.

They need to be taught about these interactions, whether good or bad, and to tell their healthcare providers about everything they’re taking.

The Secrecy

Prescriptions of traditional African medicines tend to be secretive. They are based on knowledge passed from generation to generation of traditional healers. This often results in vague doses. Patients also overuse some remedies while self-medicating due to ignorance of the fact – “too much of a good thing” could be dangerous. This can have severe health consequences.

Traditional herbal medicines all bad news?

Traditional herbal medicines are NOT all bad news, in fact, interactions between traditional medicines and prescribed medicines can potentially be exploited for good.

In some studies, traditional medicines have been shown to have the ability to increase uptake or decrease the metabolism of prescription drugs.

Therefore, applying these effects could enable the development of new herb-drug combinations with increased efficacy and reduced side-effects.

Lesotho being home to this extensive and diverse medicinal plant life, pharmacists with interest in drug discovery can take up the challenge and work in collaboration with traditional herbalists to come up with more dose controlled and appropriate formulations of drugs.
Whether positive or negative drug interactions are at play, Lesotho needs to improve the regulation around traditional medicines. This would be the responsibility of the Medicines Regulatory Authority, which Lesotho currently does not have, leaving the nation vulnerable and exposed!

By: Retšelisitsoe Nkhahle

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