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Research ArticleOriginal Research

Use of Herbal Remedies by Hispanic Patients: Do They Inform Their Physician?

Laura Howell, Komal Kochhar, Robert Saywell, Terrell Zollinger, Julie Koehler, Christina Mandzuk, Brittany Sutton, Javier Sevilla-Martir and Deborah Allen
The Journal of the American Board of Family Medicine November 2006, 19 (6) 566-578; DOI: https://doi.org/10.3122/jabfm.19.6.566
Laura Howell
MD
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Komal Kochhar
MBBS, MHA
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Robert Saywell Jr
PhD, MPH
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Terrell Zollinger
DrPH
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Julie Koehler
PharmD
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Christina Mandzuk
BSE
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Brittany Sutton
MPH
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Javier Sevilla-Martir
MD
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Deborah Allen
MD
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Article Figures & Data

Tables

    • View popup
    Table 1.

    Use and Physician Knowledge of My Herbal Use

    Have Used the HerbKnow English NameDoctor Aware I Use
    Number%Number%Number%
    Immortal (Spider Milkweed)71.4571.4342.9
    Plumajillo (Pleurisy Root)163.2637.5531.3
    Canela (Cinnamon)41583.38119.5225.3
    Clavo (Cloves)29258.6279.282.7
    Comino (Cumin)29559.2279.2144.7
    Eucalipto (Eucalyptus)21443.03014.0209.3
    Manzanilla (Chamomile)42184.55412.84510.7
    Ajo (Garlic)36873.96517.7226.0
    Jengibre (Ginger)11623.33832.81613.8
    Cebolla (Onion)35270.78825.0195.4
    Granada (Pomegranate)16533.12313.9159.1
    Yerba Buena (Grass Syrup)35370.93810.8246.8
    Anis Estrella (Star Anise)13126.32216.81713.0
    Estafiate (Wormwood)8316.71214.51012.0
    Siete Jarabes (Seven Syrups)295.81344.81137.9
    Cundeamore (Bitter Gourd)142.81178.6642.9
    Savila (Aloe Vera)26152.43413.0186.9
    Una de Gato (Cat’s Claw)6212.41524.21219.4
    Pelos de Elote (Corn Silk)14028.12115.01611.4
    Tlanchalagua (Tea)316.21548.41135.5
    Oregano32264.74112.7226.8
    Limon (Lemon)37875.98221.7225.8
    Valeriana (Valerian)6613.31928.81015.2
    Tomillo (Thyme)13727.5128.896.6
    Epasote (Wormseed)22044.283.662.7
    • *Number using the herb/total number of herb users [7/498 · 100 = 1.4].

    • **Number knowing the English name/number using the herb [5/7 · 100 = 71.4].

    • ***Number indicating Doctor is aware/number using the herb [3/7 · 100 = 42.9].

    • View popup
    Table 2.

    Demographic Characteristics of Herb Users and Nonusers

    Yes (N = 498)No (N = 122)P Value
    Number%Number%
    Do you currently take or have you ever taken an oral herbal remedy?49880.312219.7
    Which language do you feel most comfortable speaking?.001
        Spanish44191.97780.2
        English153.11010.4
        Both24599.4
        Missing1826
    What is your gender?.375
        Male9920.62624.5
        Female38179.48075.5
        Missing1816.0
    What is your age?.477
        0 to 205210.51210.6
        21 to 2413026.42824.8
        25 to 2911323.12219.4
        30 to 349018.21715.0
        35 to 39387.61513.4
        ≥ 407014.21916.8
        Missing59
    What is the highest level of education you completed?.269
        Less than High School21852.74654.8
        High School15337.03440.5
        College or above4310.444.8
        Missing8438
    Are you currently working?
        Yes20342.34747.5.343
        No27757.75252.5
        Missing23
    Do you have health insurance?.760
        Yes14130.03031.6
        No32970.06568.4
        Missing27
    How many times have you seen a medical doctor in the past year?.534
        None12829.82329.5
        One to two times14533.83139.7
        Three or more times15636.42430.8
        Missing6944
    How long have you lived in the United States?.000
        Less than 5 years20747.02729.4
        5 years or more23453.06570.6
        Missing5730
    • View popup
    Table 3.

    Knowledge/Behavior about Herbal Remedies

    Users (N = 498)Non Users (N = 122)Total (N = 620)P Value
    Number%Number%Number%
    Herbal remedies are drugs.012
        No6515.11426.47916.4
        Yes26060.52139.628158.2
        Do not know10524.41834.012325.5
        Missing6869137
    Some herbal remedies can interact with prescription medications.327
        No7417.1917.08317.0
        Yes15736.21426.417135.1
        Do not know20346.83056.623347.8
        Missing6469133
    Some herbal remedies can harm a baby if taken during pregnancy.016
        No378.4816.0459.2
        Yes24756.41836.026554.3
        Do not know15435.22448.017836.5
        Missing6072132
    Herbal remedies are safer to use during pregnancy than prescription or over-the-counter drugs.917
        No15435.51733.317135.3
        Yes8419.41121.69519.6
        Do not know19645.22345.121945.2
        Missing6471135
    My family member has recommended an herbal remedy for me to take.000
        No12229.63356.915533.0
        Yes28769.72339.731066.0
        Do not know30.723.451.1
        Missing8664150
    I have given my children (or grandchildren) herbal remedies.004
        No19450.53771.223153.0
        Yes18046.01223.119244.0
        Do not know102.635.8133.0
        Missing11470184
    • View popup
    Table 4.

    Physician Communication

    Users (N = 498)Non Users (N = 122)Total (N = 620)P Value
    Number%Number%Number%
    I am able to communicate easily with my doctor.573
        No7620.21019.28620.1
        Yes27172.14076.931172.7
        Do not know297.723.8317.2
        Missing12270192
    I feel that I can tell my doctor anything
        No5213.4713.25913.4.995
        Yes30177.64177.434277.6
        Do not know359.059.4409.1
        Missing11069179
    My doctor asks me whether I am using any herbal remedies
        No31074.33568.634573.7.081
        Yes7317.5713.78017.1
        Do not know348.2917.6439.2
        Missing8171152
    My doctor has recommended an herbal remedy for me to take.631
        No36289.85493.141690.2
        Yes246.035.2275.9
        Do not know174.211.7183.9
        Missing9564159
    My doctor takes time to listen to me at each appointment.823
        No369.059.3419.0
        Yes33884.14481.538283.8
        Do not know287.059.3337.2
        Missing9668164
    My doctor understands my cultural background.243
        No4211.7919.15112.6
        Yes21158.82859.623958.9
        Do not know10629.51021.311628.6
        Missing1397521452.7
    My doctor works with me (and my family) to improve my health.525
        No5214.2919.66114.8
        Yes27574.93167.430674.1
        Do not know4010.9613.04611.1
        Missing13176207
    If I went to a curandero for treatment, I would tell my doctor about it.531
        No4411.6917.05312.2
        Yes27472.13667.931071.6
        Do not know6216.3815.17016.2
        Missing11869187
    Number%
    Only those who “use” or “ever used” herbal remedies, were asked the following questions:
        What do you tell your doctor about your use of herbal remedies?
            I would tell my doctor about all the remedies that I use3715.0
            I would tell my doctor about some of the remedies that I use4618.7
            My doctor never asks whether I use any herbs16366.3
    Missing252
    What would happen if you told your doctor that you use herbal remedies?
            My doctor would understand the use of these remedies9241.8
            My doctor would not know what these herbal remedies are used for5725.9
            My doctor would tell me to stop using all herbal remedies4520.5
            My doctor would encourage me to keep using the remedies that are safe2310.5
            My doctor would ridicule me31.4
    Missing278
    • View popup
    Table 5.

    Examples of Selected Herb Use and Drug Interactions

    HerbUsePotential Interactions with Prescription Medications
    Immortal (Spider Milkweed)Orally, for arthritis, asthma, cough, edema, syphilis, valvular insufficiency, senile heart, to strengthen weak heart muscles following pneumonia, and for diuresis. Topically, for warts.Digoxin, diuretics
    Plumajillo (Pleurisy Root)Orally, for cough, pleurisy, uterine disorders, shortness of breath, pain, spasms, and to promote sweating; for bronchitis, pneumonitis, and influenza.Digoxin, diuretics, estrogen
    Canella (Cinnamon)Orally, for colds, poor circulation, and as a bitter tonic. In foods, as a cooking spice.None known
    Clavo (Cloves)Orally, clove for dyspepsia, as an expectorant, for diarrhea, hernia, halitosis, flatulence, nausea, and vomiting. Topically, for toothache, postextraction alveolitis, pain, a dental anesthetic, mouth and throat inflammation. In combination with other ingredients, topically for premature ejaculation. In foods and beverages, as a flavoring agent. In manufacturing, in toothpaste, soaps, cosmetics, and perfumes.Antiplatelet and anticoagulant agents
    Comino (Cumin)Orally, as an antiflatulent, stimulant, antispasmodic, diuretic, aphrodisiac, for stimulating menstrual flow, treating diarrhea, colic, and flatulence. In foods, spices, and beverages, as a flavoring agent. In manufacturing, as a cosmetic fragrance.Antidiabetic agents
    Manzanilla (Chamomile)Orally, for flatulence, travel sickness, nasal mucous membrane inflammation, allergic rhinitis, nervous diarrhea, attention deficit-hyperactivity disorder, restlessness, insomnia, gastrointestinal spasms, inflammatory diseases of the gastrointestinal tract, gastrointestinal ulcers associated with NSAIDs and alcohol consumption, and as an antispasmodic for menstrual cramps. Topically, for hemorrhoids, leg ulcers; for skin, anogenital, and mucous membrane inflammation; for bacterial skin diseases; for treating or preventing chemotherapy- or radiation-induced oral mucositis. Via inhalation, for inflammation and irritation of the respiratory tract. In foods and beverages, as a flavoring agent. In manufacturing, in cosmetics, soaps, and mouthwashes.Benzodiazepines; CNS depressants (eg, fentanyl, morphine, etc.); contraceptive drugs; cytochrome P450 1a2 (Cyp1a2) substrates (eg, amitriptyline, haloperidol, verapamil, propranolol, theophylline, ondansetron, etc.); cytochrome P450 3a4 (Cyp3a4) substrates (eg, lovastatin, itraconazole, ketoconazole, fexofenadine, triazolam, etc.); estrogens; tamoxifen; warfarin
    Ajo (Garlic)Orally, for hypertension, hyperlipidemia; for prevention of coronary heart disease, age-related vascular changes and atherosclerosis; for reducing reinfarction and mortality rate post-myocardial infarction, earaches, chronic fatigue syndrome, and menstrual disorders; for HIV-drug induced lipid disorders and Helicobacter pylori infection; for prevention of colorectal, gastric, breast, lung, and prostate cancer; for bladder cancer, benign prostatic hyperplasia, diabetes, arthritis, allergies, traveler’s diarrhea, colds and flu; for immune system stimulation, prevention of tick bites, and prevention and treatment of bacterial and fungal infections; for diarrhea, amoebic and bacterial dysentery, tuberculosis, bloody urine, diphtheria, whooping cough, scalp ringworm, hypersensitive teeth, and vaginal trichomoniasis; for fever, cough, headache, stomachache, sinus congestion, athlete’s foot, gout, rheumatism, hemorrhoids, asthma, bronchitis, shortness of breath, arteriosclerosis, low blood pressure, hypoglycemia, hyperglycemia, and snakebites; as a diuretic, stimulant, cathartic, aphrodisiac; for enhancing circulation, fighting stress and fatigue.Anticoagulant and antiplatelet agents; contraceptives; cyclosporine; cytochrome P450 2e1 (Cyp2e1) substrates (eg, acetaminophen, ethanol, theophylline, etc.); cytochrome P450 3a4 (Cyp3a4) substrates (eg, lovastatin, itraconazole, ketoconazole, fexofenadine, triazolam, etc.); non-nucleoside reverse transcriptase inhibitors; saquinavir
    Jengibre (Ginger)Orally, for motion sickness, morning sickness, colic, dyspepsia, flatulence, chemotherapy-induced nausea, rheumatoid arthritis, osteoarthritis, loss of appetite, post-operative nausea and vomiting, migraine headache, anorexia, upper respiratory tract infections, cough, bronchitis, and as a diaphoretic, diuretic, and a stimulant. Fresh ginger: Orally, for treating acute bacterial dysentery, baldness, malaria, orchitis, poisonous snake bites, rheumatism, and toothaches. Dried ginger: orally, for chest pain, low back pain, and stomach pain. Topically, for thermal burns and as an analgesic. In foods and beverages, as a flavoring agent. In manufacturing, as a fragrance component in soaps and cosmetics.Antiplatelet and anticoagulant agents; antidiabetic agents; calcium channel blockers
    Granada (Pomegranate)Orally, for hypertension, heart failure, myocardial ischemia, atherosclerosis, hyperlipidemia, acidosis, hemorrhage, HIV disease, tapeworm infestations, diarrhea, dysentery, and opportunistic intestinal worms; for preventing prostate cancer, and as an astringent and abortifacient; for chronic obstructive pulmonary disease, influenza, stomatitis, periodontal disease, erectile dysfunction, diabetes, and cancer. Topically, as a gargle for sore throat and to treat hemorrhoids.Antiplatelet and anticoagulant agents; antidiabetic agents; ACE inhibitors; antihypertensive agents; cytochrome P450 3a4 (Cyp3a4) substrates (eg., lovastatin, itraconazole, ketoconazole, fexofenadine, triazolam, etc.); cytochrome P450 2D6 (CYP2D6) substrates (eg, amitriptyline, fluoxetine, codeine, tramadol, ondansetron, etc.)
    Anis Estrella (Star Anise)Orally, for respiratory infections and inflammation, influenza, avian flu, gastrointestinal upset, flatulence, loss of appetite, infant colic, cough, and bronchitis; for increasing milk secretion, promoting menstruation, facilitating childbirth, increasing libido, and treating symptoms of male climacteric. Through inhalation, for respiratory tract congestion. In foods and beverages, as a culinary spice and flavoring agent. In manufacturing, as a fragrance component in soaps, cosmetics, perfumes, and toothpaste, and to mask undesirable odors in drug products.None known
    Estafiate (Wormwood)Orally, for loss of appetite, indigestion and digestive disorders, biliary dyskinesia, fever, and liver disease; as an anthelmintic, aphrodisiac, tonic, antispasmodic, and to stimulate sweating and the imagination. Topically, for healing wounds and insect bites and as a counterirritant. In foods, wormwood as a flavoring agent. In manufacturing, as a fragrance component in soaps, cosmetics, and perfumes, and as an insecticide.Anticonvulsants
    Cundeamore (Bitter Gourd)Orally, for diabetes, psoriasis, gastrointestinal upset, ulcers, colitis, constipation, intestinal worms, kidney stones, fever, hepatic disease, and to induce menstruation. Topically, for skin abscesses and wounds, and anorectal herpes lesions.Antidiabetic agents
    Savila (Aloe Vera)Orally, for osteoarthritis, inflammatory bowel diseases, fever, itching and inflammation, as a general tonic, for gastroduodenal ulcers, diabetes, asthma, and radiation-related mucositis. Topically, for burns, wound healing, psoriasis, sunburn, frostbite, inflammation, osteoarthritis, and cold sores; and as an antiseptic and a moisturizer.Oral medications (in general); sevoflurane; diuretics; digoxin; antidiabetic agents
    Una de Gato (Cat’s Claw)Orally, for diverticulitis, peptic ulcers, colitis, gastritis, hemorrhoids, parasites, Alzheimer’s disease, chronic fatigue syndrome, wound healing, arthritis, asthma, allergic rhinitis, cancer (especially of the urinary tract), glioblastoma, gonorrhea, dysentery, birth control, bone pain, “cleansing” the kidneys, and viral infections, including herpes zoster, herpes simplex, and human immunodeficiency virus (HIV).Antihypertensive agents; immunosuppressants; cytochrome P450 3a4 (Cyp3a4) substrates (eg, lovastatin, itraconazole, ketoconazole, fexofenadine, triazolam, etc.)
    Pelos de Elote (Corn Silk)Orally, for cystitis, urethritis, nocturnal enuresis, prostatitis, inflammation of the urinary tract, diabetes, hypertension, and as a diuretic for congestive heart failure.Antihypertensive agents; antidiabetic agents; diuretics; corticosteroids; warfarin
    OreganoOrally, for respiratory tract disorders, including cough, asthma, croup, and bronchitis; for gastrointestinal disorders, such as dyspepsia and bloating; for dysmenorrhea, rheumatoid arthritis, urinary tract infections, headaches, heart conditions, intestinal parasites, allergies, sinusitis, arthritis, cold and flu, earaches, and fatigue. Topically, for acne, athlete’s foot, dandruff, insect and spider bites, canker sores, gum disease, toothaches, psoriasis, seborrhea, ringworm, rosacea, muscle pain, varicose veins, and warts, and as an insect repellent. In foods and beverages, as a culinary spice and a preservative.None known
    Limon (Lemon)Orally, as a source of vitamin C in the treatment of scurvy and colds; as a digestive aid, an anti-inflammatory, diuretic, and to improve vascular permeability. In foods, as a food and flavoring agent.None known
    Valeriana (Valerian)Orally, as a sedative-hypnotic for insomnia and as an anxiolytic for restlessness; for mood disorders such as depression, mild tremors, epilepsy, attention deficit-hyperactivity disorder, and chronic fatigue syndrome; for muscle and joint pain, asthma, hysterical states, excitability, hypochondria, headaches, migraine, stomach upset, menstrual cramps and symptoms associated with menopause, including hot flashes and anxiety. Topically, as a bath additive for restlessness and sleep disorders. In manufacturing, as flavoring in foods and beverages.Alcohol; benzodiazepines; CNS depressants; cytochrome P450 3a4 (Cyp3a4) substrates (eg, lovastatin, itraconazole, ketoconazole, fexofenadine, triazolam, etc.)
    Tomillo (Thyme)Orally, for bronchitis, pertussis, sore throat, colic, arthritis, dyspepsia, gastritis, diarrhea, enuresis, dyspraxia, flatulence, skin disorders, as a diuretic, urinary disinfectant, anthelmintic, and as an appetite stimulant. Topically, for laryngitis, tonsillitis, stomatitis, and halitosis; as a counterirritant, an antiseptic in mouthwashes and liniments, and for alopecia areata. Otically, as an antibacterial and antifungal ingredient. In foods, as a flavoring agent. In manufacturing, in perfumes, soaps, cosmetics, and toothpastes.Antiplatelet and anticoagulant agents
    Epasote (Wormseed)Orally, for ascaris and oxyuris infestations.None known
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The Journal of the American Board of Family Medicine: 19 (6)
The Journal of the American Board of Family Medicine
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November-December 2006
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Use of Herbal Remedies by Hispanic Patients: Do They Inform Their Physician?
Laura Howell, Komal Kochhar, Robert Saywell, Terrell Zollinger, Julie Koehler, Christina Mandzuk, Brittany Sutton, Javier Sevilla-Martir, Deborah Allen
The Journal of the American Board of Family Medicine Nov 2006, 19 (6) 566-578; DOI: 10.3122/jabfm.19.6.566

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Use of Herbal Remedies by Hispanic Patients: Do They Inform Their Physician?
Laura Howell, Komal Kochhar, Robert Saywell, Terrell Zollinger, Julie Koehler, Christina Mandzuk, Brittany Sutton, Javier Sevilla-Martir, Deborah Allen
The Journal of the American Board of Family Medicine Nov 2006, 19 (6) 566-578; DOI: 10.3122/jabfm.19.6.566
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