black cohosh

Botanical name
Cimicifuga racemosa
Parts used and where grown
Black cohosh is a shrub-like plant native to the eastern deciduous forests of North America, ranging from southern Ontario to Georgia, north to Wisconsin and west to Arkansas. The dried root and rhizome are used medicinally.1 When harvested from the wild, the root is black in color. Cohosh, an Algonquin Indian word meaning “rough,” refers to the plants gnarly root structure.2
Black cohosh has been used in connection with the following conditions (refer to the individual health concern for complete information):
Science Ratings - Health Concerns
*** - Menopause
* - Dysmenorrhea (painful menstruation)
* - Osteoporosis
* - Premenstrual syndrome
*** - Reliable and relatively consistent scientific data showing a substantial health benefit.
** - Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
* - For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.
Historical or traditional use (may or may not be supported by scientific studies)
Native Americans valued the herb and used it for many conditions, ranging from gynecological problems to rattlesnake bites. Some 19th century American physicians used black cohosh for fever, menstrual cramps, arthritis, and insomnia.3
Active constituents
Black cohosh contains several ingredients, including triterpene glycosides (e.g., acetin and 27-deoxyactein) and isoflavones (e.g., formononetin). Other constituents include aromatic acids, tannins, resins, fatty acids, starches, and sugars. As a woman approaches menopause, the signals between the ovaries and pituitary gland diminish, slowing down estrogen production and increasing luteinizing hormone (LH) secretions. Hot flashes can result from these hormonal changes. Earlier animal studies4 5 and a human clinical trial6 suggested that black cohosh had some estrogen activity in the body and also decreased LH secretions. However, more recent animal studies7 and a clinical trial8 have found no estrogen activity for black cohosh extracts. Further clinical trials are needed to determine whether black cohosh has significant estrogenic actions in the body.
Small German clinical trials support the usefulness of black cohosh for women with hot flashes associated with menopause.9 10 A review of eight clinical trials found black cohosh to be both safe and effective for symptomatic relief of menopausal hot flashes.11 Other symptoms which improved included night sweats, insomnia, nervousness, and irritability. A clinical trial compared the effects of 40 mg versus 130 mg of black cohosh in menopausal women with complaints of hot flashes.12 While hot flashes were reduced equally at both amounts, there was no evidence of any estrogenic effect in any of the women. Although further trials are needed, this trial suggests that black cohosh is best reserved only for the symptomatic treatment of hot flashes associated with menopause and is not thought to be a substitute for hormone replacement therapy in menopausal and postmenopausal women.
A recent study suggests black cohosh may protect animals from osteoporosis.13 Human studies have not confirmed this action.
How much is usually taken?
Black cohosh can be taken in several forms, including crude, dried root or rhizome (300–2,000 mg per day), or as a solid, dry powdered extract (250 mg three times per day). Standardized extracts of the herb are available. The recommended amount is 20–40 mg twice per day.14 The best researched extract provides 1 mg of deoxyactein per 20 mg of extract. Tinctures can be taken at 2–4 ml three times per day.15 Black cohosh can be taken for up to six months, and then it should be discontinued.16
Are there any side effects or interactions?
Black cohosh should not be used by pregnant or breast-feeding women.17 Very large amounts (over several grams daily) of this herb may cause abdominal pain, nausea, headaches, and dizziness.
There is one case report of a woman developing autoimmune hepatitis while using black cohosh.18 A cause–effect relationship is in doubt, however, because the hepatitis did not resolve after black cohosh was discontinued. A few cases have also been reported in which severe liver failure was attributed to the use of black cohosh.19 While a cause–effect relationship is difficult to prove, and while such a side effect appears to be rare, people taking black cohosh should be alert to signs of possible liver disease, such as nausea, loss of appetite, fatigue, and tan-colored urine. Black cohosh is not a substitute for hormone replacement therapy during menopause.
At the time of writing, there were no well-known drug interactions with black cohosh.

false unicorn

Botanical name
Chamaelirium luteum
Parts used and where grown
False unicorn is native to Mississippi and continues to grow primarily in the southern part of the United States. The roots of false unicorn are most commonly used in herbal medicine.
False unicorn has been used in connection with the following conditions (refer to the individual health concern for complete information):
Science Ratings - Health Concerns
* - Dysmenorrhea (painful menstruation)
*** - Reliable and relatively consistent scientific data showing a substantial health benefit.
** - Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
* - For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.
Historical or traditional use (may or may not be supported by scientific studies)
The medicinal use of false unicorn root is based in traditional Native American herbalism. It was recommended for many women’s health conditions, including dysmenorrhea (painful menstruation) and other irregularities of menstruation, as well as to prevent miscarriages.1 False unicorn was also used as a remedy for morning sickness.
Active constituents
Steroidal saponins are generally credited with providing false unicorn root’s activity.2 However, modern investigations have not confirmed this, and no research exists about the medical applications of this herb.
How much is usually taken?
False unicorn root tincture, 1/2–1 teaspoon (2–5 ml) three times per day, is sometimes recommended .3 The dried root, 1/4–1/2 teaspoon (1–2 grams) three times per day, is also used.
Are there any side effects or interactions?
No adverse effects have been reported with the use of false unicorn. Although false unicorn has been used historically for nausea and vomiting of pregnancy and to prevent miscarriages, its actions as a possible uterine tonic make its use during pregnancy potentially unsafe.
At the time of writing, there were no well-known drug interactions with false unicorn.

blue cohosh

Botanical name
Caulophyllum thalictroides
Parts used and where grown
Blue cohosh grows throughout North America. The roots of this flower are used medicinally. Blue cohosh is not related to black cohosh (Cimicifuga racemosa). However, both herbs are primarily used to treat women’s health problems.
Blue cohosh has been used in connection with the following conditions (refer to the individual health concern for complete information):
Science Ratings - Health Concerns
* - Amenorrhea (lack of menstruation)
* - Dysmenorrhea (painful menstruation)
*** - Reliable and relatively consistent scientific data showing a substantial health benefit.
** - Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
* - For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.
Historical or traditional use (may or may not be supported by scientific studies)
Native Americans are believed to have used blue cohosh flowers to induce labor and menstruation.1 Blue cohosh is a traditional remedy for lack of menstruation. It is considered an emmenagogue (agent that stimulates menstrual flow) and a uterine tonic. No clinical trials have validated this traditional use. It has also been used traditionally to treat painful periods (dysmenorrhea). Early 20th century physicians in the United States who treated with natural remedies (known as Eclectic physicians) used blue cohosh for these same purposes and also to treat kidney infections, arthritis, and other ailments.
Active constituents
A saponin from blue cohosh called caulosaponin is believed to stimulate uterine contractions.2 Several other alkaloids may be active in this herb. However, current research about the active constituents of blue cohosh is insufficient.
How much is usually taken?
Blue cohosh is generally taken as a tincture and should be limited to no more than 1–2 ml taken three times per day. The whole herb (300–1,000 mg per day) is sometimes used. Blue cohosh is generally used in combination with other herbs.
Are there any side effects or interactions?
Large amounts of blue cohosh can cause nausea, headaches, and high blood pressure. Blue cohosh should only be used under medical supervision and in limited amounts. Using blue cohosh during pregnancy has been brought into question by reports of an infant developing a stroke and another infant being born with congestive heart failure.3 4 Safety studies need to be completed to determine whether blue cohosh is safe to use during pregnancy.
At the time of writing, there were no well-known drug interactions with blue cohosh.
Source: www.cncahealth.com

blessed thistle

Common name
St. Benedict Thistle
Botanical name
Cnicus benedictus
Parts used and where grown
Although native to Europe and Asia, blessed thistle is now cultivated in many areas of the world, including the United States. The leaves, stems, and flowers are all used in herbal preparations.
Blessed thistle has been used in connection with the following conditions (refer to the individual health concern for complete information):
Science Ratings - Health Concerns
* - Indigestion and heartburn
* - Poor appetite
*** - Reliable and relatively consistent scientific data showing a substantial health benefit.
** - Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
* - For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.
Historical or traditional use (may or may not be supported by scientific studies)
Folk medicine used blessed thistle tea for digestive problems, including gas, constipation, and stomach upset. This herb was also used—like its well-known relative, milk thistle1 —for liver and gallbladder diseases.
Active constituents
The sesquiterpene lactones, such as cnicin, provide the main beneficial effects of blessed thistle in the treatment of indigestion. The bitterness of these compounds stimulates digestive activity, including the flow of saliva and secretion of gastric juice, which leads to improved appetite and digestion.2 Some pharmacological evidence suggests that blessed thistle may also have anti-inflammatory properties.3
How much is usually taken?
The German Commission E monograph recommends 4–6 grams of blessed thistle per day.4 Alternatively, tincture (1/2 teaspoon [2 ml] three times per day) may be used. Approximately 1/2 teaspoon (2 grams) of the dried herb can also be added to 1 cup (250 ml) of boiling water and steeped 10 to 15 minutes to make a tea. Three cups can be drunk each day.
Are there any side effects or interactions?
Blessed thistle is generally safe and is not associated with side effects. Anyone with allergies to plants in the daisy family should use blessed thistle cautiously.
At the time of writing, there were no well-known drug interactions with blessed thistle.

evening primrose oil

Also indexed as
Black Currant Seed Oil, EPO, Oenothera biennis
Introduction
Evening primrose oil (EPO), comes from the seeds of the evening primrose plant. Like black currant seed oil and borage oil, EPO contains gamma linolenic acid (GLA), a fatty acid that the body converts to a hormone-like substance called prostaglandin E1 (PGE1).
Where is it found?
EPO is found primarily in supplements. Its presumed active ingredient, GLA, can also be found in black currant seed oil and borage oil supplements. However, it is not known whether the effects of these three oils in the body are the same.
Evening primrose oil has been used in connection with the following conditions (refer to the individual health concern for complete information):
Science Ratings - Health Concerns
*** - Type 1 diabetes
*** - Type 2 diabetes
** - Eczema
** - Fibrocystic breast disease
** - Osteoporosis (in combination with fish oil)
** - Premenstrual syndrome (PMS)
** - Rheumatoid arthritis
** - Skin ulcers
* - Alcohol withdrawal
* - Atherosclerosis
* - Attention deficit disorder
* - Chronic obstructive pulmonary disease
* - Intermittent claudication
* - Irritable bowel syndrome (IBS)
* - Multiple sclerosis
* - Raynaud’s disease
* - Scleroderma
* - Sjogren’s syndrome
* - Tardive dyskinesia
*** - Reliable and relatively consistent scientific data showing a substantial health benefit.
** - Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
* - For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.
Who is likely to be deficient?
Those with premenstrual syndrome,1 diabetes,2 scleroderma,3 Sjogren’s syndrome,4 tardive dyskinesia,5 eczema,6 and other skin conditions7 can have a metabolic block that interferes with the body’s ability to make GLA. In preliminary research, supplementation with EPO has helped people with these conditions.8 9 10 11 12
There is evidence that alcoholics may be deficient in GLA, and a double-blind study suggested that alcohol withdrawal may be facilitated with EPO supplementation.13 Many people in Western societies may be at least partially GLA-deficient as a result of aging, glucose intolerance, high dietary fat intake, and other problems. People with deficiencies would presumably benefit from supplemental GLA intake from EPO, black currant seed oil, or borage oil.
How much is usually taken?
Although many people may have inadequate levels of GLA, the optimal intake for this nutrient remains unknown. Researchers often use 3,000–6,000 mg of EPO per day, which provides approximately 270–540 mg of GLA.
Are there any side effects or interactions?
EPO has been reported to exacerbate symptoms of temporal lobe epilepsy, which can sometimes be mistaken for schizophrenia.14 15
Other nutrients are needed by the body, along with EPO, to make PGE1. Consequently, some experts suggest that magnesium, zinc, vitamin C, niacin, and vitamin B6 should be taken along with EPO.
Drug Interactions
Certain medicines interact with evening primrose oil: Some interactions may increase the need for evening primrose oil (+), other interactions may be negative (-) and indicate evening primrose oil should not be taken without first speaking with your physician or pharmacist, others may require further explanation (?). Refer to the individual drug article for specific details about an interaction.
Note: The following list only includes the generic or class name of a medicine. To find a specific brand name, use the Medicines index.
Tamoxifen (+)

whey protein

Also indexed as
Protein [Whey]
See also
Whey protein is a mixture of some of the proteins naturally found in milk. The major proteins found in whey protein include beta-lactoglobulin and alpha-lactalbumin. Whey protein has one of the highest protein digestibility-corrected amino acid scores (PDCAAS; a measure of protein bioavailability) and is more rapidly digested than other proteins, such as casein (another milk protein). 1
Where is it found?
During the process of making milk into cheese, whey protein is separated from the milk. This whey protein is then incorporated into ice cream, bread, canned soup, infant formulas, and other food products. Supplements containing whey protein are also available.
Whey protein has been used in connection with the following conditions (refer to the individual health concern for complete information):
Science Ratings - Health Concerns
** - Athletic performance
* - Cancer
* - Hepatitis
* - HIV infection
* - Immune function
* - Osteoporosis
* - Stress
* - Weight loss and obesity
*** - Reliable and relatively consistent scientific data showing a substantial health benefit.
** - Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
* - For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.
Who is likely to be deficient?
People who do not include dairy foods in their diets do not consume whey protein. However, the amino acids in whey protein are available from other sources, and a deficiency of these amino acids is unlikely.
People who do not include dairy foods in their diets do not consume whey protein. However, the amino acids in whey protein are available from other sources, and a deficiency of these amino acids is unlikely. In fact, most Americans consume too much, rather than too little, protein.
How much is usually taken?
Some benefits of whey protein have been demonstrated with as little as 20 grams per day. For athletes in training a commonly used amount is 25 grams of whey protein per day, and shouldn’t exceed 1.2 grams per 2.2 pounds body weight. Most clinical research has used similar amounts of whey protein.
Are there any side effects or interactions?
People who are allergic to dairy products could react to whey protein and should, therefore, avoid it.2 As with protein in general, long-term, excessive intake may be associated with deteriorating kidney function and possibly osteoporosis. However, neither kidney nor bone problems have been directly associated with consumption of whey protein, and the other dietary sources of protein typically contribute more protein to the diet than does whey protein. The possibility that certain proteins in milk may contribute to the development of diabetes in children is controversial. But since whey proteins include some of the same milk proteins, people who are avoiding milk because of concerns about the risk of diabetes should not consume whey protein either.
At the time of writing, there were no well-known drug interactions with whey protein.

fructo-oligosaccharides (FOS) and other oligosaccharides

Also indexed as
Inulin Oligosaccharides, Oligosaccharides
Introduction
The term “oligosaccharide” refers to a short chain of sugar molecules (“oligo” means “few” and “saccharide” means “sugar.”) Fructo-oligosaccharides (FOS) and inulin, which are found in many vegetables, consist of short chains of fructose molecules. Galacto-oligosaccharides (GOS), which also occur naturally, consist of short chains of galactose molecules. These compounds can be only partially digested by humans.1 2 3 4 When oligosaccharides are consumed, the undigested portion serves as food for “friendly” bacteria, such as Bifidobacteria and Lactobacillus species.
Where is it found?
FOS and inulin are found naturally in Jerusalem artichoke, burdock, chicory, leeks, onions, and asparagus. FOS products derived from chicory root contain significant quantities of inulin,5 a fiber widely distributed in fruits, vegetables and plants, which is classified as a food ingredient (not as an additive) and is considered to be safe to eat.6 In fact, inulin is a significant part of the daily diet of most of the world’s population.7 FOS can also be synthesized by enzymes of the fungus Apergillus niger acting on sucrose. GOS is naturally found in soybeans and can be synthesized from lactose (milk sugar). FOS, GOS, and inulin are available as nutritional supplements in capsules, tablets, and as a powder.
FOS, GOS, and inulin have been used in connection with the following conditions (refer to the individual health concern for complete information):
Science Ratings - Health Concerns
** - Elevated triglyceride levels
* - Pre- and post-surgery health
* - Type 2 diabetes
*** - Reliable and relatively consistent scientific data showing a substantial health benefit.
** - Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
* - For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.
Who is likely to be deficient?
As FOS, GOS, and inulin are not essential nutrients, no deficiency state exists.
How much is usually taken?
The average daily intake of oligosaccharides by people in the United States is estimated to be about 800 to 1,000 mg. For the promotion of healthy bacterial flora, the usual recommendation for FOS, GOS, or inulin is 2,000 to 3,000 mg per day with meals. In the studies on diabetes and high blood lipids (cholesterol and triglycerides), amounts ranged from 8 to 20 grams per day.
Are there any side effects or interactions?
Generally, oligosaccharides are well tolerated. Some people reported increased flatulence in some of the studies. At higher levels of intake, that is, in excess of 40 grams per day, FOS and the other oligosaccharides may induce diarrhea.
There is a report of a 39-year old man having a life-threatening allergic reaction after consuming high amounts of inulin from multiple sources, including FOS.8 Allergy to inulin in this person was confirmed by laboratory tests. Such sensitivities are extremely rare. People with a confirmed sensitivity to inulin should probably avoid FOS.
At the time of writing, there were no well-known drug interactions with Fructo-oligosaccharides (FOS) and Other Oligosaccharides.

bitter orange

See also
Seville Orange, Zhi Shi, Chongcao
Botanical names
Citrus x aurantium
Parts used and where grown
The dried outer peel of the fruit of bitter orange, with the white pulp layer removed, is used medicinally. The leaves are also commonly used in many folk traditions. The bitter orange tree is indigenous to eastern Africa, Arabia, and Syria, and cultivated in Spain, Italy, and North America.
Bitter orange has been used in connection with the following conditions (refer to the individual health concern for complete information):
Science Ratings - Health Concerns
** - Indigestion
** - Loss of appetite
* - Insomnia
* - Weight loss
*** - Reliable and relatively consistent scientific data showing a substantial health benefit.
** - Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
* - For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.
Historical or traditional use (may or may not be supported by scientific studies)
Bitter orange is used similarly in a wide variety of traditions. In Mexico and South America the leaf is used as a tonic, as a laxative, as a sedative for insomnia, and to calm frazzled nerves.1 2 The peel of the fruit is used for stomach aches and high blood pressure.3 4 The Basque people in Europe use the leaves for stomach aches, insomnia, and palpitations and the bitter orange peel as an anti-spasmodic.5 In traditional Chinese medicine, the peel of the immature fruit is used for indigestion, abdominal pain, constipation, and dysenteric diarrhea. Where the patient is weak, the milder, mature fruit is used similarly.6 Bitter orange continues to be widely used for insomnia and indigestion in many parts of the world.7
Active constituents
Bitter orange has a complex chemical makeup, though it is perhaps most known for the volatile oil in the peel. The familiar oily residue that appears after peeling citrus fruit, including bitter orange, is this volatile oil. It gives bitter orange its strong odor and flavor, and accounts for many of its medicinal effects. Besides the volatile oil, the peel contains flavones, the alkaloids synephrine, octopamine, and N-methyltyramine, and carotenoids.8 9
How much is usually taken?
Usually 1 to 2 grams of dried peel is simmered for 10 to 15 minutes in a cup of water; three cups are drunk daily. As a tincture, 2 to 3 ml (with a weight-to-volume ratio ranging from 1:1 to 1:5) is often recommended for use three times per day. 10 The purified volatile oil is generally avoided for reasons discussed in the side effects section.
Are there any side effects or interactions?
Bitter orange oil may possibly cause light sensitivity (photosensitivity), especially in fair-skinned individuals.11 Generally this occurs only if the oil is applied directly to the skin and then exposed to bright light; in rare cases it has also been known to occur in people who have taken bitter orange internally. The oil should not be applied topically and anyone who uses it internally should avoid bright light, including tanning booths.
Internal use of the volatile oil of bitter orange is also potentially unsafe and should not be undertaken without expert guidance. Large amounts of orange peel have caused intestinal colic, convulsions, and death in children.12 The amounts recommended above for internal use should not be exceeded.
One text on Chinese medicine cautions against the use of bitter orange in pregnancy.13 This concern is not raised in any other reference, and the American Herbal Products Association classifies the herb as "class 1," an herb that can be safely consumed during pregnancy when used appropriately.14
Decoctions of bitter orange substantially increased blood levels of cyclosporine in pigs, causing toxicity.15 Bitter orange also inhibited human cytochrome P450 3A (CYP3A) in the test tube.16 This is an enzyme that helps the liver get rid of numerous toxins, and strongly affects metabolism of certain drugs. Bitter orange might, therefore, interact with drugs that are metabolized by CYP3A. To be on the safe side, bitter orange should not be combined with prescription medications, unless someone is under the care of an experienced natural medicine clinician.
At the time of writing, there were no well-known drug interactions with bitter orange.

american ginseng

See also
Panax quinquefolius
Parts used and where grown
Like its more familiar cousin Asian ginseng (Panax ginseng), the root of American ginseng is used medicinally. The plant grows wild in shady forests of the northern and central United States, as well as in parts of Canada. It is cultivated in the United States, China, and France.
American ginseng has been used in connection with the following conditions (refer to the individual health concern for complete information):
Science Ratings - Health Concerns
** - Common cold
** - Type 2 diabetes
* - Athletic performance
* - Infection
* - Stress
*** - Reliable and relatively consistent scientific data showing a substantial health benefit.
** - Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
* - For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.
Historical or traditional use (may or may not be supported by scientific studies)
Many Native American tribes used American ginseng. Medicinal applications ranged from digestive disorders to sexual problems.1 The Chinese began to use American ginseng after it was imported during the 1700s.2 The traditional applications of American ginseng in China are significantly different from those for Panax ginseng (Asian ginseng).3
Active constituents
American ginseng contains ginsenosides, which are thought to fight fatigue and stress by supporting the adrenal glands and the use of oxygen by exercising muscles.4 The type and ratio of ginsenosides are somewhat different in American and Asian ginseng. The extent to which this affects their medicinal properties is unclear. A recent preliminary trial with healthy volunteers found no benefit in exercise performance after one week of taking American ginseng.5
In a small pilot study, 3 grams of American ginseng was found to lower the rise in blood sugar following the consumption of a drink high in glucose by people with type 2 diabetes.6 The study found no difference in blood sugar lowering effect if the herb was taken either 40 minutes before the drink or at the same time. A follow-up to this study found that increasing the amount of American ginseng to either 6 or 9 grams did not increase the effect on blood sugar following the high-glucose drink in people with type 2 diabetes.7 This study also found that American ginseng was equally effective in controlling the rise in blood sugar if it was given up to two hours before or together with the drink.
How much is usually taken?
Standardized extracts of American ginseng, unlike Asian ginseng, are not available. However, dried root powder, 1–3 grams per day in capsule or tablet form, can be used.8 Some herbalists also recommend 3–5 ml of tincture three times per day.
Are there any side effects or interactions?
Occasional cases of insomnia or agitation have been reported with the use of American ginseng. These conditions are more likely, however, when caffeine-containing foods and beverages are also being consumed.9
Drug Interactions
Certain medicines interact with American ginseng: Some interactions may increase the need for American ginseng (+), other interactions may be negative (-) and indicate American ginseng should not be taken without first speaking with your physician or pharmacist, others may require further explanation (?). Refer to the individual drug article for specific details about an interaction.
Note: The following list only includes the generic or class name of a medicine. To find a specific brand name, use the Medicines index.
Warfarin (-)

iron

Also indexed as
Ferrous Sulfate
See also
Iron is an essential mineral. It is part of hemoglobin, the oxygen-carrying component of the blood. Iron-deficient people tire easily in part because their bodies are starved for oxygen. Iron is also part of myoglobin, which helps muscle cells store oxygen. Without enough iron, adenosine triphosphate (ATP; the fuel the body runs on) cannot be properly synthesized. As a result, some iron-deficient people become fatigued even when their hemoglobin levels are normal (i.e., when they are not anemic).
Where is it found?
The most absorbable form of iron, called “heme” iron, is found in oysters, meat and poultry, and fish. Non-heme iron is also found in these foods, as well as in dried fruit, molasses, leafy green vegetables, wine, and iron supplements. Acidic foods (such as tomato sauce) cooked in an iron pan can also be a source of dietary iron.
Iron has been used in connection with the following conditions (refer to the individual health concern for complete information):
Science Ratings - Health Concerns
*** - Childhood intelligence (for deficiency only)
*** - Depression (for deficiency only)
*** - Iron-deficiency anemia
*** - Menorrhagia (heavy menstruation) (for deficiency only)
** - Athletic performance (for deficiency only)
** - Attention deficit–hyperactivity disorder (for deficiency only)
** - Breast-feeding support
** - Canker sores
** - Celiac disease (for deficiency only)
** - Pre- and post-surgery health (for deficiency or for major surgery)
** - Pregnancy and postpartum support (with medical supervision)
** - Restless legs syndrome (for deficiency only)
* - Alzheimer’s disease (in combination with coenzyme Q10 and vitamin B6)
* - Dermatitis herpetiformis
* - HIV support
* - Infertility (female) (for deficiency only)
*** - Reliable and relatively consistent scientific data showing a substantial health benefit.
** - Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
* - For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.
Who is likely to be deficient?
Vegetarians eat less iron than non-vegetarians, and the iron they eat is somewhat less absorbable. As a result, vegetarians are more likely to have reduced iron stores.1 However, iron deficiency is not usually caused by a lack of iron in the diet alone. An underlying cause, such as iron loss in menstrual blood, often exists.
Pregnant women, marathon runners, people who take aspirin, and those who have parasitic infections, hemorrhoids, ulcers, ulcerative colitis, Crohn’s disease, gastrointestinal cancers, or other conditions that cause blood loss or malabsorption are likely to become deficient.
Infants living in inner city areas may be at increased risk of iron-deficiency anemia2 and suffer more often from developmental delays as a result.3 4 Supplementation of infant formula with iron up to 18 months of age in inner city infants has been shown to prevent iron-deficiency anemia and to reduce the decline in mental development seen in such infants in some,5 but not all,6 studies.
Breath-holding spells are a common problem affecting about 27% of healthy children.7 These spells have been associated with iron-deficiency anemia,8 and several studies have reported improvement of breath-holding spells with iron supplementation.9 10 11 12
People who fit into one of these groups, even pregnant women, shouldn’t automatically take iron supplements. Fatigue, the first symptom of iron deficiency, can be caused by many other things. A doctor should assess the need for iron supplements, since taking iron when it isn’t needed does no good and may do some harm.
Which forms of supplemental iron are best?
All iron supplements are not the same. Ferrous iron (e.g. ferrous sulfate) is much better absorbed than ferric iron (e.g. ferric citrate).13 14 The most common form of iron supplement is ferrous sulfate, but it is known to produce intestinal side effects (such as constipation, nausea, and bloating) in many users.15 Some forms of ferrous sulfate are enteric-coated to delay tablet dissolving and prevent some side effects,16 but enteric-coated iron may not absorb as well as iron from standard supplements.17 18 19 Other forms of iron supplements, such as ferrous fumarate,20 21 ferrous gluconate,22 heme iron concentrate,23 24 25 26 and iron glycine amino acid chelate27 28 are readily absorbed and less likely to cause intestinal side effects.
How much is usually taken?
If a doctor diagnoses iron deficiency, iron supplementation is essential. To treat iron deficiency, a common recommended amount for an adult is 100 mg per day; that amount is usually reduced after the deficiency is corrected. When iron deficiency is diagnosed, the doctor must also determine the cause. Usually it’s not serious (such as normal menstrual blood loss or blood donation). Occasionally, however, iron deficiency signals ulcers or even colon cancer.
Some premenopausal women become marginally iron deficient unless they supplement with iron. However, the 18 mg of iron present in many multivitamin-mineral supplements is often adequate to prevent deficiency. A doctor should be consulted to determine the amount of iron that is needed.
Are there any side effects or interactions?
Iron (ferrous sulfate) is the leading cause of accidental poisonings in children.29 30 31 The incidence of iron poisonings in young children increased dramatically in 1986. Many of these children obtained the iron from a child-resistant container opened by themselves or another child, or left open or improperly closed by an adult.32 Deaths in children have occurred from ingesting as little as 200 mg to as much as 5.85 grams of iron.33 Keep iron-containing supplements out of a child’s reach.
Hemochromatosis, hemosiderosis, polycythemia, and iron-loading anemias (such as thalassemia and sickle cell anemia) are conditions involving excessive storage of iron. Supplementing iron can be quite dangerous for people with these diseases.
Supplemental amounts required to overcome iron deficiency can cause constipation. Sometimes switching the form of iron (see “Which forms of supplemental iron are best?” above), getting more exercise, or treating the constipation with fiber and fluids is helpful, though fiber can reduce iron absorption (see below). Sometimes the amount of iron must be reduced if constipation occurs.
Some researchers have linked excess iron levels to diabetes,34 cancer,35 increased risk of infection,36 systemic lupus erythematosus (SLE),37 exacerbation of rheumatoid arthritis,38 and Huntington’s disease.39 The greatest concern has surrounded the possibility that excess storage of iron in the body increases the risk of heart disease.40 41 42 Two analyses of published studies came to different conclusions about whether iron could increase heart disease risk.43 44 One trial has suggested that such a link may exist, but only in some people (possibly smokers or those with elevated cholesterol levels).45 The link between excess iron and any of the diseases mentioned earlier in this paragraph has not been definitively proven. Nonetheless, too much iron causes free radical damage, which can, in theory, promote or exacerbate most of these diseases. People who are not iron deficient should generally not take iron supplements.
Patients on kidney dialysis who are given injections of iron frequently experience “oxidative stress”. This is because iron is a pro-oxidant, meaning that it interacts with oxygen molecules in ways that can damage tissues. These adverse effects of iron therapy may be counteracted by supplementation with vitamin E.46
Supplementation with iron, or iron and zinc, has been found to improve vitamin A status among children at high risk for deficiency of the three nutrients. 47
People with hepatitis C who have failed to respond to interferon therapy have been found to have higher amounts of iron within the liver. Moreover, reduction of iron levels by drawing blood has been shown to decrease liver injury caused by hepatitis C.48 Therefore, people with hepatitis C should avoid iron supplements.
In some people, particularly those with diabetes, insulin resistance syndrome, or liver disease, a genetic susceptibility to iron overload has been reported.49
Many foods, beverages, and supplements have been shown to affect the absorption of iron.50
Foods, beverages and supplements that interfere with iron absorption include
- Green tea (Camellia sinensis).51 52 53 54 This effect may be desirable for people with iron overload diseases, such as hemochromatosis. The inhibitory effect of green tea on iron absorption was 26% in one study.55
- Coffee (Coffea arabica, C. robusta).56 57 58
- Red wine, particularly the polyphenol component (also found in tea).59 60 Since wine is also a dietary source of iron, it is not clear whether drinking red wine would lead to a deficiency of iron.
- Phytate (phytic acid), found in unleavened wheat products such as matzoh, pita, and some rye crackers; in wheat germ, oats, nuts, cacao powder, vanilla extract, beans, and many other foods, and in IP-6 supplements.61 62 63
- Whole wheat bran, independent of its phytate content, has been shown to inhibit iron absorption.64
- Calcium from food and supplements interferes with heme-iron absorption.65 66
- Soy protein.67 68
- Eggs.69 70
Foods and supplements that increase iron absorption include
- Meat, poultry, and fish.71 72 73 74 75
Although vitamin C increases iron absorption,76 77 78 79 the effect is relatively minor.80
Taking vitamin A with iron helps treat iron deficiency, since vitamin A improves the absorption and/or utilization of iron.81 82
Although soy protein has been shown to decrease iron absorption (see above), certain soy-containing foods (e.g. tofu, miso, tempeh) have significantly improved iron absorption.83 Some soy sauces may also enhance iron absorption.84
Alcohol, but not red wine, has been reported to increase the absorption of ferric, but not ferrous, iron.85 86
Iron has been reported to potentially interfere with manganese absorption. In one trial, women with high iron status had relatively poor absorption of manganese.87 In another trial studying manganese/iron interactions in women, increased intake of “non-heme iron”—the kind of iron found in most supplements—decreased manganese status.88 These interactions suggest that taking multiminerals that include manganese may protect against manganese deficiencies that might otherwise be triggered by taking isolated iron supplements.
Drug Interactions
Certain medicines interact with iron: Some interactions may increase the need for iron (+), other interactions may be negative (-) and indicate iron should not be taken without first speaking with your physician or pharmacist, others may require further explanation (?). Refer to the individual drug article for specific details about an interaction.
Note: The following list only includes the generic or class name of a medicine. To find a specific brand name, use the Medicines index.
Angiotensin-Converting Enzyme Inhibitors (+)
Aspirin (+)
Benazepril (+)
Captopril (+)
Carbidopa (-)
Carbidopa/Levodopa (-)
Chlorhexidine (-)
Cimetidine (+)
Ciprofloxacin (-)
Deferoxamine (-)
Dipyridamole (+)
Doxycycline (-)
Enalapril (+)
Etodolac (+)
Famotidine (+)
Gemifloxacin (-)
Haloperidol (+)
Hyoscyamine (+)
Ibuprofen (+)
Indomethacin (?)
Levofloxacin (-)
Lotrel (+)
Magnesium Hydroxide (+)
Methyldopa (-)
Minocycline (+) (-)
Moexipril (+)
Nabumetone (+)
Naproxen/Naproxen Sodium (+)
Neomycin (+)
Nizatidine (+)
Ofloxacin (-)
Oral Contraceptives (?)
Oxaprozin (+)
Penicillamine (-)
Quinapril (+)
Ramipril (+)
Ranitidine (+)
Risedronate (-)
Sodium Bicarbonate (+)
Stanozolol (+)
Sulfasalazine (-)
Tetracycline (-)
Tetracyclines (-)
Thyroid Hormones (?)
Warfarin (-)
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