More Milk Moringa [Discontinued] by Motherlove

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Dyspepsia. Although there has been interest in using oral blessed thistle for dyspepsia, there is insufficient reliable information about the clinical effects of blessed thistle for this purpose. More evidence is needed to rate blessed thistle for this use.

(Read more about BLESSED THISTLE)

POSSIBLY EFFECTIVE

• Dysmenorrhea. Taking fennel oil or extract by mouth may reduce pain in patients with primary dysmenorrhea. This benefit may be similar to ibuprofen or mefenamic acid. Details: Two separate meta-analyses in patients with primary dysmenorrhea show that taking fennel oil or fennel extract for 1-6 menstrual cycles reduces dysmenorrhea pain when compared with placebo. Improvement in pain was similar when compared with ibuprofen or mefenamic acid. In the included studies, doses of fennel oil ranged from 3-30 drops every 4-8 hours, and doses of fennel extract ranged from 30-230 mg daily (104196,108972). However, most studies included in these meta-analyses were small and low-quality, and all studies were conducted in Iran. Higher quality studies in other geographic locations are needed to confirm these findings.

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Anxiety. Although there has been interest in using oral fennel for anxiety, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Bronchitis. Although there has been interest in using oral fennel for bronchitis, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Cancer. Although there has been interest in using oral fennel for cancer prevention, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Cholera. Although there has been interest in using oral fennel for cholera, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Colic. Small clinical studies suggest that oral fennel may reduce crying time in infants with colic. However, most research to date has evaluated fennel in combination with other ingredients. Details: A meta-analysis of three small clinical studies shows that giving fennel to infants with colic can reduce crying time by about 72 minutes daily when compared with placebo (97497). However, the studies included in this meta-analysis were at medium to high risk of bias, and the placebo response rate was high in all of the included studies. Additionally, two of the three studies evaluated combination products (16735,19715,49428). In the one study that used fennel alone, administering 5-20 mL of fennel seed oil 0.1% emulsion daily for one week led to colic relief in 65% of infants, compared with 24% of infants receiving placebo (49428). The other studies evaluated fennel in combination with lemon balm and German chamomile (ColiMil) or in combination with chamomile, vervain, licorice, and lemon balm (Calma-Bebi, Bonomelli). These combination products produced a response in 57% to 85% of infants, compared with 26% to 49% of infants receiving placebo (16735,19715).
• Constipation. Oral fennel has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small crossover trial in patients with constipation shows that drinking an herbal tea containing 3 grams of a combination of fennel, anise, elderberry, and senna daily for 5 days can decrease colonic transit time, increase the number of daily evacuations, and improve the perception of bowel function when compared with placebo (49494). Another small clinical study in elderly patients with constipation shows that drinking a specific tea (Smooth Move, Traditional Medicinals) containing fennel, senna, licorice, orange peel, cassia cinnamon, coriander, and ginger for 28 days can increase the number of bowel movements when compared to baseline (46196). The validity of this finding is limited by the lack of a comparator group. Additionally, a small clinical study in patients aged 60-65 years with functional constipation shows that taking a traditional Iranian combination product containing 5 grams each of fennel seed and rose flower, dissolved in water twice daily before meals for 4 weeks, improves constipation severity and stool consistency when compared with polyethylene glycol 10 grams. Improvements in constipation severity persisted in both groups 4 weeks after treatment completion (108973). However, polyethylene glycol is usually taken at a higher dose of 17 grams daily, limiting the validity of these findings.
• Cough. Although there has been interest in using oral fennel for cough, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Dementia. Although there has been interest in using oral fennel for dementia, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Diabetes. Although there has been interest in using oral fennel for diabetes, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Dyspepsia. Although there has been interest in using oral fennel for dyspepsia, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Flatulence. Although there has been interest in using oral fennel for flatulence, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Hirsutism. It is unclear if topical fennel is beneficial in patients with hirsutism. Details: A small clinical study in females with male pattern body hair due to unknown causes shows that applying a fennel 2% cream twice daily for 12 weeks can reduce hair diameter by approximately 19% when compared with placebo (49429).
• Insomnia. Although there has been interest in using oral fennel for insomnia, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Irritable bowel syndrome (IBS). Oral fennel has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical trial in adults with either diarrhea- or constipation-predominant IBS shows that taking two capsules containing fennel essential oil 25 mg and curcumin 42 mg per capsule (CU-FEO, Alfa Wassermann S.p.A.) twice daily for 30 days improves overall ratings of abdominal pain, abdominal distention, and quality of life by 24% when compared with placebo (97422).
• Lactation. Although there has been interest in using oral fennel to stimulate breastmilk production, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Menopausal symptoms. Small clinical studies suggest that oral fennel oil or fennel seed powder may modestly improve menopausal symptoms. Details: One small clinical trial in adults with medium severity menopausal symptoms shows that taking fennel essential oil 60 mg daily for 8 weeks improves scores on the Menopause Rating Scale when compared with a sunflower oil placebo (97498). Another small clinical study in postmenopausal adults shows that taking fennel seed powder 2 grams daily for 8 weeks improves scores on the Kupperman Menopausal Index when compared with placebo (104198). Fennel has also been evaluated in combination with other ingredients. One small clinical study shows that taking a combination of fennel 120 mg, chamomile 1000 mg, and saffron 60 mg daily for 12 weeks reduces physical, psychological, and urogenital symptom scores on the Menopause Rating Scale when compared with placebo or lower doses of the combination (103628). Additionally, a moderate-sized clinical study in postmenopausal women conducted in Iran shows that taking combined fennel and valerian extract 500 mg twice daily for 8 weeks modestly improves self-reported scores for frequency and severity of hot flashes but does not improve sleep quality or duration of hot flashes when compared with placebo (112369). However, it is unclear if these benefits are due to fennel, other ingredients, or the combination.
• Nausea and vomiting. Although there has been interest in using oral fennel for nausea and vomiting, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Nocturnal enuresis. Although there has been interest in using oral fennel for nocturnal enuresis, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Osteoarthritis. It is unclear if oral fennel extract is beneficial in patients with knee osteoarthritis. Details: A small clinical trial in females with osteoarthritis of the knee shows that taking powdered fennel extract 800 mg daily for 2 weeks reduces pain and disability scores, but not stiffness, when compared with placebo (104199).
• Polycystic ovary syndrome (PCOS). It is unclear if oral fennel is beneficial in patients with PCOS. Details: A small clinical study in patients with PCOS shows that taking two fennel capsules, containing anethole 21-27 mg per capsule, daily along with a hypocaloric standard diet or a hypocaloric high-protein diet for 3 months does not reduce body weight or improve androgenic parameters such as testosterone levels, sex hormone-binding globulin levels, or free androgen index, when compared with these diets plus placebo (104197). Fennel has also been evaluated in combination with other ingredients. A clinical study in patients with oligomenorrhea due to PCOS shows that taking a traditional combination product (Aslagh) containing equivalent amounts of essential oils of fennel, wild carrot seeds, and Vitex agnus-castus fruit for 3 months, either alone or in combination with metformin, improves rates of menstrual bleeding and menstrual cyclicity similarly to metformin alone. All three groups experienced a significant improvement from baseline. Aslagh was taken as two, 500-mg capsules twice daily, except during menses; metformin was titrated over one week to a dose of 500 mg three times daily (108974). Additionally, a moderate-sized clinical study in patients with PCOS shows that taking fennel 60 mg and Elwendia persica 25 mg twice daily for 4 months modestly improves number of ovarian follicles and body mass index when compared with placebo; however, when compared to baseline, the combination also improves hirsutism scores and menstrual cycle duration and interval (112370). It is unclear if these effects are due to fennel, other ingredients, or the combination.
• Rheumatoid arthritis (RA). Although there has been interest in using oral fennel for RA, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Sexual desire. It is unclear if oral fennel is beneficial for improving sexual desire. Details: A small clinical study in postmenopausal adults shows that taking fennel seed powder 2 grams daily for 8 weeks does not improve scores on the Hurlbert Index of Sexual Desire when compared with placebo (104198).
• Sunburn. It is unclear if topical fennel emulsion is beneficial for preventing sunburn. Details: A small clinical study shows that applying a fennel 5% emulsion topically prior to ultraviolet (UV) exposure can reduce sunburn by 65% when compared with a control (49518).
• Upper respiratory tract infection (URTI). Although there has been interest in using oral fennel for upper respiratory tract infections, there is insufficient reliable information about the clinical effects of fennel for this purpose.
• Vaginal atrophy. It is unclear if intravaginal application of fennel cream is beneficial in patients with vaginal atrophy. Details: A small clinical study in postmenopausal adults shows that applying 5 grams of a fennel 5% cream to the vagina once daily for 8 weeks seems to reverse vaginal thinning, improve vaginal pH, and reduce symptoms of vaginal atrophy such as itching, dryness, and pain with intercourse when compared with placebo (92509). Patients in the fennel group also rated their sexual function to be improved when compared with those receiving placebo (97496). More evidence is needed to rate fennel for these uses.

(Read more about FENNEL)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Asthma. It is unclear if oral moringa seed is beneficial in patients with asthma. Details: A small clinical study in patients with mild to moderate asthma shows that taking powdered dried moringa seed kernels 3 grams twice daily for 3 weeks reduces the severity of asthma symptoms, including dyspnea, wheezing, chest tightness, and cough, and improves lung function when compared to baseline (19278). The validity of this finding is limited by the lack of a control group.
• Child growth. It is unclear if oral moringa, taken during the second or third trimester or while breastfeeding, can improve infant growth. Details: An observational follow-up of a large randomized clinical trial conducted in Indonesia during the second trimester or 1 month after giving birth shows that taking 500 mg moringa leaf powder or extract daily for 4 months does not reduce stunting in infants followed for up to 11 months when compared with an unspecified dose of iron and folate (105471,105472). Other observational data, also from a large randomized clinical trial conducted in Indonesia, suggests the rate of stunted growth in children aged 36 to 42 months is 25% after taking 500 mg moringa leaf extract daily for 3 months during the third trimester, compared to 42% with 500 mg moringa leaf flour, or 33% with iron 60 mg and 0.2 mcg folic acid (110645). Researchers propose that differences in the nutritional content between moringa leaf extract and flour may account for the variation in results among forms.
• Diabetes. It is unclear if oral moringa leaf is beneficial in patients with diabetes; research is conflicting. Details: A small clinical study in therapy-naïve patients with type 2 diabetes shows that taking 4 grams of moringa leaf powder twice daily for 4 weeks does not affect fasting blood glucose (FBG) or postprandial glucose (PPG) when compared with placebo (105470). These findings are limited by the small size and short duration of the study. A non-randomized clinical study in patients with type 2 diabetes who are taking a sulfonylurea shows that taking 2 tablets containing an unspecified amount of powdered moringa leaf in addition to following a calorie-restricted diet for 90 days does not reduce glycated hemoglobin (HbA1c) when compared with standard treatment, although it modestly reduces PPG when compared with baseline (90572). Another small non-randomized clinical study in patients with type 2 diabetes who are taking hypoglycemic agents shows that taking powdered moringa leaf 8 grams daily for 40 days in addition to following a calorie-restricted diet reduces FBG, PPG, and lipid levels when compared with baseline (97208). It is unclear if any benefit identified in these studies is due to moringa or calorie restriction. Additionally, the validity of these findings is limited by the lack of a statistical comparison to the control group.
• HIV/AIDS. It is unclear if oral moringa leaf is beneficial in patients with HIV; research is conflicting. Details: Preliminary clinical research in normal weight Congolese patients with HIV who are on antiretroviral therapy shows that taking dried moringa leaf powder 10 grams three times daily with meals for 6 months increases body mass index (BMI) by 2 kg/m2 when compared with a nutritional counseling only group. However, there was no difference in immune function as measured by CD4 counts (97210). Results of other research are in conflict. A large clinical study in Nigerian adults treated with standard antivirals for HIV shows that taking moringa leaf powder 5 grams three times daily with meals for 6 months modestly increases CD4 counts but does not impact viral load or anthropometric parameters (i.e., weight, BMI) when compared with placebo. However, most patients were normal or overweight, and over half had an undetectable viral load at baseline (110648). Secondary analysis of this data suggests taking moringa may also improve quality of life (110649). However, the validity of this finding is limited by the inability to mask the taste of moringa leaf powder; patients may have been biased by knowing their study group assignment. Similarly, a small open label clinical study also in Nigerian adults treated with antiviral therapy for HIV shows that taking a moringa 200 mg capsule daily (Formula 10 Herbal Products, Nigeria) for 3 months modestly increases CD4 counts, lymphocyte and platelet counts, and hemoglobin when compared with antiviral therapy alone (110650).
• Hyperlipidemia. It is unclear if oral moringa leaf is beneficial in patients with hyperlipidemia. Details: One small clinical study in patients with hyperlipidemia shows that taking atorvastatin 10 mg daily with powder of an unspecified part of the moringa plant 1 gram twice daily for 45 days modestly reduces levels of total cholesterol and triglycerides when compared with taking atorvastatin alone (112639). Another small clinical study in patients with type 2 diabetes shows that taking powdered moringa leaf 8 grams daily in addition to following a calorie restricted diet for 40 days modestly reduces low-density lipoprotein (LDL) cholesterol, total cholesterol, and triglyceride levels when compared with baseline (97208). The validity of these findings is limited by the lack of a statistical comparison to the control group, as well as small study size and short duration. In contrast, one small clinical study in patients of Indian descent with hyperlipidemia shows that taking 8 tablets of standardized dehydrated moringa drumstick leaf (DDL) 4.6 grams daily for 50 days has no effect on lipid levels when compared with baseline (97212).
• Iron deficiency anemia. It is unclear if oral moringa leaf flour is beneficial for anemia during pregnancy. Details: A small clinical study in pregnant patients with anemia in Indonesia shows that consuming biscuits enriched with 5.6 grams of moringa leaf flour, in addition to iron 500 mg, daily for 60 days increases hemoglobin by 1 g/dL, compared to 0.66 mg/dL with iron 500 mg daily alone. (110647). The validity of this study is limited by poor methodology, including lack of randomization and blinding.
• Impaired glucose tolerance (prediabetes). It is unclear if oral moringa leaf powder is beneficial for patients with prediabetes. Details: A small clinical study in treatment-naïve adults with prediabetes shows that taking moringa leaf powder 2400 mg daily for 12 weeks modestly improves fasting blood glucose and glycated hemoglobin (HbA1c) but does not improve markers of insulin resistance or anthropometric measures (i.e. weight, BMI, waist circumference) when compared with placebo (110646).
• Lactation. Small clinical studies suggest that oral moringa leaf may modestly increase breastmilk volume during the first week of lactation. Details: A meta-analysis of 3 small clinical trials in breastfeeding patients shows that when started on postpartum day 3, moringa leaf increases breastmilk volume by about 120 mL per expression by day 7 when compared to control (90573). Studies included in the analysis used specific capsules containing moringa leaf (Natalac, Gruppo Medica Inc.) 250 mg twice daily on postpartum days 3-5 (20578), and specific capsules containing moringa leaf (Pro-Lacta, Pascual Laboratories, Inc.) 350 mg twice daily starting on postpartum day 3 and continuing for one week (90571). However, due to methodological limitations and the short duration of the included trials, the clinical significance of this finding is uncertain.
• Malnutrition. It is unclear if oral moringa leaf is beneficial for children with malnutrition. Details: One small clinical study in children with mild-to-moderate malnutrition shows that supplementing food with powdered dried moringa leaf 15 grams twice daily for 2 months results in 23 of 30 children having a 20% or greater improvement in weight, compared with only 2 of 30 children receiving no additional intervention (90576). It is unclear if maternal consumption of moringa leaves prevents malnutrition in infants. An observational follow-up of a large randomized clinical trial in Indonesian patients in their second trimester or one month postpartum shows that consuming four capsules, each containing 500 mg moringa leaf powder or extract, daily for 4 months might protect the infant against being underweight, but does not reduce stunting in infants followed for up to 11 months, when compared with an unspecified dose of iron and folate (105471,105472).
• Menopausal symptoms. It is unclear if oral moringa leaf improves menopausal symptoms. Details: A small clinical study in healthy postmenopausal patients shows that taking powdered moringa leaves 7 grams with food daily for 3 months modestly improves menopausal symptoms such as hot flashes and sleeping problems when compared with no dietary additives (90575).
• Obesity. Oral moringa leaf has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small clinical study shows that taking a combination product containing moringa leaf extract 200 mg, green coffee bean extract 300 mg, banaba leaf extract 100 mg, and vitamin D3 500 IU (CraveCheck, Advocare International) daily for 2 months does not reduce body weight when compared with placebo. In fact, patients in the placebo group showed slightly greater weight loss than patients in the treatment group. However, taking the combination product appears to reduce fat mass and increase fat-free or lean mass as measured by dual energy X-ray absorptiometry, suggesting that the combination product might improve body composition (97211). It is not clear if this effect is due to moringa, the other ingredients, or the combination.
• Oral leukoplakia. It is unclear if topical moringa leaf improves oral leukoplakia. Details: Preliminary clinical research in patients with oral leukoplakia shows that topical application 3 times daily for 3 months with a gel providing moringa leaf extract 2% reduces lesion size by about 77% compared to baseline. Moringa gel is modestly more effective for reducing lesion size than a specific cream (Retino-A) (112640). The validity of these findings is limited by the lack of a placebo group.
• Vitamin A deficiency. It is unclear if oral moringa leaf is beneficial in infants deficient in vitamin A. Details: Preliminary clinical research conducted in rural Ghana shows that vitamin A-deficient infants aged 8-12 months who receive cereal supplemented with moringa leaf powder for 6 weeks do not have a significant improvement in vitamin A status when compared with those given cereal without moringa (98455). More evidence is needed to rate moringa for these uses.

(Read more about MORINGA)

POSSIBLY EFFECTIVE

• Diabetes. Oral stinging nettle seems to improve glycemic control in patients with diabetes. Details: A meta-analysis of 8 small heterogeneous clinical trials in adults with type 2 diabetes shows that taking stinging nettle 1.5-10 grams in divided doses daily for 8-12 weeks reduces fasting blood glucose (FBG) by 18 mg/dL when compared with placebo (102865). Glycated hemoglobin (HbA1c) was not improved, but the study durations were not adequate to detect an improvement in this measure. Despite positive results on FBG, taking stinging nettle does not seem to improve insulin secretion or measures of insulin sensitivity (91519,102865,108903). Another meta-analysis of 3 small clinical studies in adults with type 2 diabetes shows that taking stinging nettle reduces HbA1c by about 1.3% when compared with placebo. This analysis also suggests stinging nettle reduces post-prandial blood glucose by about 114 mg/dL; however, this is based on a single study. Stinging nettle did not improve fasting blood glucose or insulin resistance in this analysis (111503). The validity of these findings is limited by the low quality and heterogeneity of included studies, as well as unclear dosing. Furthermore, since most research has been conducted in Iran, it is unknown if these findings are generalizable to other geographic locations. Stinging nettle has also been used in combination with other natural medicines. One small clinical study in adults with type 2 diabetes shows that taking a product containing stinging nettle leaf extract 200 mg, milk thistle 200 mg, and Boswellia serrata gum 200 mg three times daily for 3 months reduces FBP by about 28 mg/dL and HbA1c by about 1.5%, compared with a smaller reduction in the placebo group (96742). It is unclear if this effect is due to stinging nettle, the other ingredients, or the combination.

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Allergic rhinitis (hay fever). It is unclear if oral stinging nettle is beneficial for hay fever. Details: Taking stinging nettle leaf extract 300 mg 3-7 times daily at the first sign of hay fever symptoms seems to provide subjective improvement (7035). However, adding stinging nettle to conventional allergy medication might not provide any additional benefit. One small clinical study shows that adding stinging nettle tablets (Urtidin, Barij Essence Pharmaceutical Co.) 150 mg four times daily for 1 month to treatment with loratadine and nasal saline rinses does not improve symptoms of allergic rhinitis when compared with placebo with loratadine and nasal saline rinses (96743).
• Anemia. Although there is interest in using oral stinging nettle for anemia, there is insufficient reliable information about the clinical effects of stinging nettle for this condition.
• Asthma. Although there is interest in using oral stinging nettle for asthma, there is insufficient reliable information about the clinical effects of stinging nettle for this condition.
• Benign prostatic hyperplasia (BPH). It is unclear if oral stinging nettle is beneficial for BPH. Details: A meta-analysis of clinical research, including 5 clinical studies and 1,128 patients with BPH, shows that taking stinging nettle root extract 360-600 mg in divided doses daily for 2-12 months improves peak urinary flow rate and symptom scores while modestly reducing prostate volume when compared with control. However, the validity of these results is limited by significant heterogeneity due to the variability in the products used and the specific endpoints investigated (96744). In the largest clinical trial in the analysis, patients took stinging nettle root extract 120 mg three times daily for 6 months (76406). Stinging nettle has also been evaluated in combination products. Clinical research in patients with BPH shows that taking a specific combination product (PRO 160/120, Dr. Willmar Schwabe Pharmaceuticals) containing a specific extract of stinging nettle root (WS 1031) 120 mg plus a specific extract of saw palmetto fruit (WS 1473) 160 mg twice daily for 24-48 weeks seems to improve urinary tract symptoms when compared with control; the effect may last at least 48 weeks after treatment (15195,15551,76409). However, taking a different combination product does not seem to be beneficial. A small clinical study in patients with BPH shows that taking a product containing stinging nettle root extract 240 mg, saw palmetto, pumpkin seed oil, lemon bioflavonoid, and beta-carotene, three times daily for 6 months, does not improve symptoms of BPH (5093).
• Bleeding. Topical stinging nettle has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Some preliminary clinical research shows that applying 4 mL of a specific product (Ankaferd blood stopper, Mefar Ilaç Sanayi A.S) containing alpinia, licorice, thyme, stinging nettle, and common grape vine to the affected area reduces bleeding, but does not improve the time for episiotomy repair, when compared with using saline (31010).
• Gingivitis. Stinging nettle in a mouthwash solution has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with moderate gingival inflammation suggests that using 10 mL of mouthwash solution containing a 1:1:1 mixture of stinging nettle, juniper, and yarrow twice daily for 3 months does not reduce plaque or bleeding when compared with control (76443). It is not clear if this effect is due to stinging nettle, the other ingredients, or the combination.
• Gout. Although there is interest in using oral stinging nettle for gout, there is insufficient reliable information about the clinical effects of stinging nettle for this condition.
• Gulf war syndrome. It is unclear if oral stinging nettle is beneficial for Gulf war syndrome. Details: A very small exploratory clinical trial in males with Gulf war syndrome shows that taking stinging nettle leaf (Nature's Way) 1305 mg in two divided doses daily for 30 days modestly improves symptom severity when compared with placebo (108311). The clinical relevance of this finding is limited by the use of an unvalidated scoring scale. Additionally, it appears that most patients had mild, unspecified symptoms at baseline; it is unclear if stinging nettle is beneficial for moderate to severe symptoms.
• Hyperandrogenism. It is unclear if oral stinging nettle is beneficial in patients with hyperandrogenism. Details: Preliminary clinical research in females with hyperandrogenism shows that taking dried extract of stinging nettle root 300-600 mg daily for approximately 4 months decreases total and free testosterone levels, but not menstrual cycle conditions, oily skin, or acne, when compared with taking spironolactone and cyproterone (91520).
• Insect bite. Oral stinging nettle has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that applying a homeopathic after-bite gel, containing stinging nettle, Echinacea, and marsh Labrador tea, on affected areas does not reduce erythema or itching after a mosquito bite when compared with placebo (89235).
• Kidney stones (nephrolithiasis). Although there is interest in using oral stinging nettle for kidney stones, there is insufficient reliable information about the clinical effects of stinging nettle for this condition.
• Myalgia. Although there is interest in using topical stinging nettle for myalgia, there is insufficient reliable information about the clinical effects of stinging nettle for this purpose.
• Osteoarthritis. Small clinical studies suggest that topical stinging nettle may modestly improve pain in patients with osteoarthritis. It is unclear if oral stinging nettle is beneficial. Details: Topically, stinging nettle leaf may have a counterirritant effect which may improve osteoarthritis pain in some patients. A small clinical study in patients ages 45-82 with osteoarthritis of the thumb shows that applying raw stinging nettle leaf to the thumb for 30 seconds daily for 1 week reduces pain and disability when compared with white dead nettle leaf control (12490). However, in another small clinical study in patients with knee osteoarthritis, topical application of raw stinging nettle leaf to the knee for 1 minute daily for 7 days does not seem to be more effective for reducing pain than applying a leaf from a related stingless nettle (76412). Non-raw stinging nettle has also been tried. In a small open-label study, a formulation of stinging nettle extract (Liquid PhytoCaps Nettle Leaf, Gaia Herbs) 13.33% compounded with lipobase oil-in-water emulsion and applied to the affected area twice daily for 2 weeks, modestly improves pain and function in patients with radiologically confirmed osteoarthritis when compared with baseline (76414). The validity of this finding is limited by the lack of a comparator group. Stinging nettle has also been evaluated orally, in combination with other ingredients. A clinical study in adults with knee osteoarthritis shows that taking a specific combination solution (Rosaxan, medAgil Gesundheitsgesellschaft mbH) containing stinging nettle extract 160 mg, rose hip puree 20 grams, devil's claw 108 mg, and vitamin D 200 IU daily for 12 weeks improves symptoms by an additional 28% and pain scores by an additional 33% when compared with placebo (96741). It is unclear if this effect is due to stinging nettle, the other ingredients, or the combination.
• Tinnitus. Oral stinging nettle has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults with tinnitus shows that taking a specific product containing stinging nettle, tansy, and rose hip (Neurotec, Rose Pharmed), 100 mg orally daily for 3 months does not improve auditory thresholds when compared with placebo. However, the product improved some subjective symptoms scores, such as perceived loudness and severity scores (110512).
• Urinary tract infections (UTIs). Although there is interest in using oral stinging nettle for UTIs, there is insufficient reliable information about the clinical effects of stinging nettle for this condition. More evidence is needed to rate stinging nettle for these uses.

(Read more about STINGING NETTLE)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Blessed thistle has Generally Recognized As Safe (GRAS) status in the US (4912). There is insufficient reliable information available about the safety of blessed thistle when used in medicinal amounts.

PREGNANCY: LIKELY UNSAFE
when used orally (4,12); avoid using.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about BLESSED THISTLE)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Fennel has Generally Recognized as Safe (GRAS) status in the US (4912).

POSSIBLY SAFE ...when fennel essential oil or extract is used orally and appropriately, short-term. Twenty-five drops (about 1.25 mL) of fennel fruit extract standardized to fennel 2% essential oil has been safely used four times daily for 5 days (49422). Also, two 100 mg capsules each containing fennel 30% essential oil standardized to 71-90 mg of anethole has been safely used daily for 8 weeks (97498). Powdered fennel extract has been used with apparent safety at a dose of 800 mg daily for 2 weeks (104199). ...when creams containing fennel 2% to 5% are applied topically (49429,92509).

CHILDREN: POSSIBLY SAFE
when combination products containing fennel are used to treat colic in infants for up to one week. Studied products include up to 20 mL of a fennel seed oil emulsion; a specific product (ColiMil) containing fennel 164 mg, lemon balm 97 mg, and German chamomile 178 mg; and up to 450 mL of a specific tea (Calma-Bebi, Bonomelli) containing fennel, chamomile, vervain, licorice, and lemon balm (16735,19715,49428).

PREGNANCY: POSSIBLY UNSAFE
when used orally. Observational research has found that regular use of fennel during pregnancy is associated with shortened gestation (100513).

LACTATION: POSSIBLY UNSAFE
when used orally. Case reports have linked consumption of an herbal tea containing extracts of fennel, licorice, anise, and goat's rue to neurotoxicity in two breast-feeding infants. The adverse effect was attributed to anethole, a constituent of fennel and anise (16744). However, levels of anethole were not measured in breastmilk, and the herbal tea was not tested for contaminants. Furthermore, other adverse effects related to use of fennel during lactation have not been reported. However, until more is known, avoid using.

(Read more about FENNEL)

LIKELY SAFE ...when used orally in food amounts. The leaves, fruit, and seeds are commonly used in foods (16341,16344,90573).

POSSIBLY SAFE ...when moringa leaf or seed is used orally and appropriately in medicinal amounts, short-term. Tablets and capsules containing up to 30 grams of moringa leaf powder have been used daily with apparent safety in clinical studies lasting up to 6 months (20578,90572,90572,97209,97210). A dried moringa seed kernel powder has also been used with apparent safety in doses of 3 grams twice daily for 3 weeks (19278). ...when moringa leaf extract is used topically and appropriately. Moringa leaf extract 2% has been used 3 times daily with apparent safety in a clinical trial lasting 3 months (112640).

POSSIBLY UNSAFE ...when moringa root or root bark are used orally. Moringa root contains spirochin, a potentially toxic alkaloid, while moringa root bark contains stimulant alkaloids similar to ephedrine. Although spirochin has not been studied in humans, animal data shows that it can cause nerve paralysis (63764).

CHILDREN: POSSIBLY SAFE
when moringa leaf is used orally and appropriately, short-term. Powdered dried moringa leaf has been used with apparent safety in doses of 15 grams twice daily for up to 2 months (90576).

PREGNANCY: POSSIBLY SAFE
when the leaf is used orally during the second or third trimesters, short-term. Moringa leaf powder or extract 500 mg daily for up to 4 months has been used with apparent safety during the second and third trimesters (105469,105471,105472,110645). There is insufficient reliable information available about the safety of using moringa leaf by mouth during the first trimester.

PREGNANCY: POSSIBLY UNSAFE
when the root, bark, or flower are used orally. Traditionally, moringa root bark and gum from moringa trunk bark have been used to induce abortion. When taken orally along with black peppercorns to induce abortion, moringa root bark may cause fatality (63764). Animal research shows that moringa flower can cause uterine contractions (94634); however, this has not been assessed in humans. There is insufficient reliable information about the safety of using moringa seed during pregnancy; avoid using.

LACTATION: POSSIBLY SAFE
when moringa leaf is used orally, short-term. Moringa leaf powder or extract 2 grams daily has been used during lactation with apparent safety for up to 4 months (20578,90571,90573,105471,105472). There is insufficient reliable information available about the safety of using other parts of moringa during lactation; avoid using.

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POSSIBLY SAFE ...when used orally and appropriately. Stinging nettle root 360-600 mg has been used safely for up to 1 year (5093,11230,15195,76406,96744). ...when used topically and appropriately (12490).

PREGNANCY: LIKELY UNSAFE
when used orally due to possible abortifacient and uterine-stimulant effects (4,6,19).

LACTATION:
Insufficient reliable information available; avoid using.

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ANTACIDS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, blessed thistle might decrease the effectiveness of antacids.  Details There are reports that blessed thistle increases stomach acid (19).

H2-BLOCKERS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, blessed thistle might decrease the effectiveness of H2-blockers.  Details There are reports that blessed thistle increases stomach acid (19).

PROTON PUMP INHIBITORS (PPIs) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, blessed thistle might decrease the effectiveness of PPIs.  Details There are reports that blessed thistle increases stomach acid (19).

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, fennel might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.  Details Animal research suggests that fennel oil has antithrombotic and antiplatelet effects (31415,49445).

CIPROFLOXACIN (Cipro) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, fennel might decrease the levels and clinical effects of ciprofloxacin.  Details Animal research shows that fennel reduces ciprofloxacin bioavailability by nearly 50%, possibly due to the metal cations such as calcium, iron, and magnesium contained in fennel. This study also found that fennel increased tissue distribution and slowed elimination of ciprofloxacin (6135).

CONTRACEPTIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking large amounts of fennel might decrease the effects of contraceptive drugs due to competition for estrogen receptors.  Details Some constituents of fennel have estrogenic activity (11).

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, fennel might increase levels of drugs metabolized by CYP3A4.  Details In vitro research suggests that fennel inhibits CYP3A4 enzyme activity (38375,49468). This effect has not been reported in humans.

ESTROGENS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking large amounts of fennel might interfere with hormone replacement therapy due to competition for estrogen receptors.  Details Some constituents of fennel have estrogenic activity (11).

TAMOXIFEN (Nolvadex) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking large amounts of fennel might decrease the antiestrogenic effect of tamoxifen.  Details Some constituents of fennel have estrogenic activity (11), which may interfere with the antiestrogenic activity of tamoxifen.

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ANTIDIABETES DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = B Theoretically, moringa might have additive effects when used with antidiabetes drugs; however, research is conflicting.  Details Animal research shows that moringa can lower blood glucose levels (12249,20571,20573,20574). However, research in humans has not shown consistent blood glucose lowering effects (97207,105470).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, moringa might decrease the levels and clinical effects of CYP1A2 substrates.  Details In vitro research shows that moringa extract induces CYP1A2 enzymes (111404).

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, moringa might increase or decrease levels of CYP3A4 substrates.  Details Some in vitro research suggests that moringa inhibits cytochrome P450 3A4 (CYP3A4) (20576). However, other in vitro research suggests that moringa extract induces CYP3A4 enzymes (111404). A pharmacokinetic study in patients with HIV shows no change in the pharmacokinetics of nevirapine, which is partially metabolized by CYP3A4, when administered concomitantly with moringa leaf powder 1.85 grams daily for 14 days (97209).

LEVOTHYROXINE (Synthroid, others) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, moringa leaf can antagonize the effects of levothyroxine.  Details Animal research suggests that moringa aqueous leaf extract might reduce serum triiodothyronine (T3) concentrations by inhibiting the peripheral conversion of thyroxine (T4) to T3 (16348).

NEVIRAPINE (Viramune) Interaction Rating = Minor Be watchful with this combination. Severity = Insignificant •  Occurrence = Unlikely •  Level of Evidence = B Moringa leaf is unlikely to have a clinically significant interaction with nevirapine.  Details Nevirapine is partially metabolized by cytochrome P450 3A4 (CYP3A4). In vitro evidence suggests that moringa inhibits CYP3A4 (20576). However, a pharmacokinetic study in patients with HIV shows no change in nevirapine pharmacokinetics when administered concomitantly with moringa leaf powder 1.85 grams daily for 14 days (97209).

P-GLYCOPROTEIN SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, moringa leaf extract might increase the levels and clinical effects of P-glycoprotein substrates.  Details In vitro research shows that moringa leaf extract inhibits renal P-glycoprotein transport activity (107850). So far, this reaction has not been reported in humans.

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ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, stinging nettle might have additive effects with antidiabetes drugs.  Details Clinical research shows that stinging nettle might decrease blood glucose levels in patients with diabetes (91519,102865).

DIURETIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, combining stinging nettle with diuretic drugs may have additive effects.  Details Animal research suggests that the above ground parts and roots of stinging nettle may have a diuretic effect (1,4,11,76402).

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, stinging nettle might reduce excretion and increase levels of lithium.  Details Animal research suggests that stinging nettle has diuretic and natriuretic properties, which could alter the excretion of lithium (76402). The dose of lithium might need to be decreased.

WARFARIN (Coumadin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D There is some concern that stinging nettle might decrease the effects of anticoagulant drugs such as warfarin.  Details Stinging nettle contains a significant amount of vitamin K (19). When taken in large quantities, this might interfere with the activity of warfarin.

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General ...Orally, there is limited information available about the adverse effects of blessed thistle when used in medicinal amounts.

Dermatologic ...Topically, blessed thistle can cause an allergic reaction, such as dermatitis, in individuals sensitive to the Asteraceae/Compositae family. Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many other herbs (12).

Gastrointestinal ...Orally, when blessed thistle is used in doses higher than 5 grams per cup of tea, it can cause stomach irritation and vomiting (12).

Immunologic ...Blessed thistle can cause allergic reaction in individuals with sensitivity to the Asteraceae/Compositae family, which includes ragweed, chrysanthemums, marigolds, daisies, and many other herbs (12).

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General ...Orally and topically, fennel seems to be well tolerated.
Most Common Adverse Effects:
Orally: Gastrointestinal discomfort, photosensitivity, and allergic reactions in sensitive individuals.
Serious Adverse Effects (Rare):
Orally: Seizures.

Dermatologic ...Advise patients to avoid excessive sunlight or ultraviolet light exposure while using fennel (19). Allergic reactions affecting the skin such as atopic dermatitis and photosensitivity may occur in patients who consume fennel (6178,49507).

Gastrointestinal ...Orally, fennel may cause gastrointestinal complaints, including nausea and vomiting (19146,104196).

Hematologic ...Methemoglobinemia has been reported in four infants following intoxication related to ingestion of a homemade fennel puree that may have been made from improperly stored fennel (49444).

Immunologic ...A case report describes an 11-year-old male who developed an allergy to fennel-containing toothpaste. Immediately after using the toothpaste, the patient experienced sneezing, coughing, itchy mouth, rhinorrhea, nasal congestion, wheezing, difficulty breathing, and palpitations, which resolved within 10 minutes of spitting out the toothpaste and rinsing the mouth. In challenge tests, the patient reacted to chewing fresh fennel root, but not ground fennel seeds (103822).

Neurologic/CNS ...Orally, fennel oil has been associated with tonic clonic and generalized seizures (12868). New-onset cluster headaches are reported in a 24-year-old female while using a toothpaste containing fennel and camphor for 3 months. The headaches resolved upon stopping the toothpaste (112368). It is unclear if this adverse effect can be attributed to fennel, camphor, or the combination.

Pulmonary/Respiratory ...Orally, fennel and fennel seed have been reported to cause bronchial asthma (49478).

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General ...Orally and topically, moringa leaf and seed seem to be well tolerated. Orally, moringa root and root bark might be unsafe. However, a thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Orally: Transient diarrhea.
Serious Adverse Effects (Rare):
Orally: Allergic reactions, including anaphylaxis, have been reported.

Cardiovascular ...Orally, a case of bilateral pulmonary embolism after a 5-month history of taking moringa leaf extract is reported in a 63-year-old female without other risks for venous thromboembolism. The patient recovered with standard anticoagulant treatment. Researchers speculate that possible procoagulant effects of moringa may have played a role in this event (110644).

Dermatologic ...Orally, Stevens-Johnson syndrome has been linked to the consumption of moringa leaves. A 53-year-old male presented with fever and generalized maculopapular rash 14 hours after eating food containing moringa leaves. Painful oral ulcers developed by the next day. The patient also reported a similar episode of oral ulcers after eating food containing moringa leaves three months earlier. The patient was treated with oral prednisolone and omeprazole and recovered within two weeks. Researchers speculate that the immunomodulatory effects of moringa may have played a role in this reaction (99876). There are also cases of fixed food eruption to moringa. In one case, suspected fixed food eruption occurred on the trunk and face of a 60-year-old female, reoccurring 8 hours after self reintroduction (112641).

Gastrointestinal ...Orally, moringa leaf powder can cause diarrhea. In a clinical trial, taking moringa leaf powder 8 grams daily resulted in transient diarrhea in 4 of 16 patients (25%) (105470).

Immunologic ...Orally, cases of anaphylaxis are reported after ingestion of young moringa leaves and seedpods. In these cases, positive skin-prick testing confirmed moringa as the causative allergen. The patients recovered after standard treatment (110597,110643). There are also cases of fixed food eruption to moringa. In one case, suspected fixed food eruption occurred on the trunk and face of a 60-year-old female, reoccurring 8 hours after self reintroduction (112641).

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General ...Orally, stinging nettle seems to be generally well tolerated.
Most Common Adverse Effects:
Orally: Constipation, diarrhea.
Topically: Contact with the raw plant causes itching, rash, and stinging.

Dermatologic ...Topically, fresh stinging nettle leaves and stalk can cause localized rash, itching, and stinging (12490,76399,76412,76414,76417,76428,76448,96746). Usually, short exposure to stinging nettle results in a transient urticarial reaction and a stinging sensation which may persist for more than 12 hours (76399,76414,76417,96746). In one report, a patient placed a fresh stinging nettle leaf on the tongue to suck out the sap of the leaf. Severe tongue edema, pain, and urticaria developed within 5 minutes. Symptoms continued for several hours after the leaf was removed (15197). In another case report, a young couple intoxicated with methamphetamine fell and laid in a stinging nettle bush for 20 minutes, after which urticaria and pain continued for 2-3 weeks, and a heightened sensitivity to cold persisted for several months (96746).

Endocrine ...A case of gynecomastia has been reported for a 33-year-old male who consumed stinging nettle tea 2 cups daily for one month prior to symptom onset. The condition subsided one month after discontinuing stinging nettle tea (76410).
There have been two cases of galactorrhea associated with the consumption of stinging nettle for one month (76410,108902). In one case, a 33-year-old female consuming stinging nettle tea showed high levels of estradiol and low levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH). The levels of these hormones normalized 6 weeks after discontinuing stinging nettle tea (76410). In the other case report describing a 30-year-old female self-treating with stinging nettle 500 mg daily, hormone levels were not reported; however, a mammogram showed scattered areas of fibroglandular density and benign-appearing calcifications. This patient had complete resolution of symptoms 1 week after discontinuation of stinging nettle (108902).

Gastrointestinal ...Orally, stinging nettle root can cause gastrointestinal complaints, including diarrhea and constipation (1,7,11230). Stinging nettle above ground parts may cause mild gastrointestinal discomfort when taken on an empty stomach (7035). Stinging nettle juice may cause diarrhea (1). One patient taking a combination product containing stinging nettle root extract and pygeum bark extract (Prostatonin, Pharmaton) experienced continual gastrointestinal pain and hyperperistalsis. It is not clear if this effect was due to stinging nettle or pygeum (70230).

Genitourinary ...There is a case report of decreased ejaculatory volume associated with an herbal blend product containing stinging nettle root extract, saw palmetto extract, pumpkin seed oil extract, lemon bioflavonoid extract, and beta-carotene (5093). It is unclear if this was due to stinging nettle, other ingredients, or the combination.

Hepatic ...A case of idiosyncratic drug-induced liver disease (DILI) is reported in a 36-year-old female who presented with abdominal pain after 1 month of taking an herbal liver detox tea containing stinging nettle and other ingredients. Remarkable laboratory values included elevated liver enzymes, alkaline phosphatase, and total bilirubin. The patient received a loading dose of N-acetylcysteine and was hospitalized for 12 days (112178). However, it is unclear if the adverse effect was due to the stinging nettle, other ingredients, or the combination.

Other ...Orally, stinging nettle root can cause sweating (1,7).

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