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St. John’s wort - The Cataract Connection

Posted by Jane Akre
Thursday, December 10, 2009 11:46 AM EST
Category: Major Medical
Tags: St. John's wort, Hypericin, Cataracts, Ocular Lens, Macular Degeneration, University of Alabama, FDA, Depression, SSRI, Prozac

St. John's wort active ingredient, hypericin, is found to be photo toxic to the eye correlated with cataracts in this study.
St. John's wort flower

St. John’s wort Revisited


IMAGE SOURCE: © Wikimedia Commons/ St. John’s wort Flowers

Mary Jones * (not her real name) had been taking the ancient and versatile herb, St. John’s wort (SJW) for depression to keep the blues at bay after several personal traumas in her life.

It seemed to be working to keep her mood steady and to improve her mild depression.

In 2002, she was one of 31,044 adults interviewed as part of the National Health Interview Survey (NHIS), an ongoing federal snapshot on the health of the nation. Jones told researchers she had recently been diagnosed with cataracts, a diagnosis somewhat unusual for someone in their 50s.

It turns out Mary Jones was not alone.

She was one of 257,052 individuals taking SJW for at least a year who also reported having cataracts, the clouding of an eye lens usually associated with old age that can eventually lead to blindness.

Mary Jones story, and the story of others with cataracts who had been taking SJW as an alternative to prescription drugs, came to light when researchers from the University of Alabama’s Department of Epidemiology wanted to find if mounting evidence in a laboratory about the phototoxicity of St. John’s wort (SJW) correlated to real life.

Using data from the 2002 National Health Interview survey, researchers cross-compared SJW use and cataracts and came away with a statistically significant result - participants with cataracts were 59 percent more likely to report SJW use, and users of the plant to treat depression were equally likely to experience cataracts.

Published in the October issue of Current Eye Research, lead researcher, Dr. Gerald McGwin tells IB News more work needs to be done before any conclusions can be made about this correlation.

“Based upon our results the association could be a low as 2% and as high as 146%, that underscores the amount of uncertainly in respect to this relationship.”

McGwin is very cautious to go out on a limb with any conclusions, but when asked what he would tell friends taking St. John’s wort?

“I would tell them that a recent study reported an association with cataracts but that the relationship is far from being confirmed but if they are not having their eyes examined regularly they should.”

Dr. McGwin’s work is the first to evaluate the association between SWJ use and cataracts in humans who use SWJ, but echoes the cause-and-effect that’s been seen in the lab for more than a decade.

St. John’s Wort Revisited

St. John’s wort (wort means plant in Old English) is a plant that has been valued for its medicinal properties for over 2,400 years.

Herbalists used it in ancient Greece, while the Roman Emperor Nero is said to have used the plant to treat himself for depression.

Native Americans used it as an antibiotic, anti-inflammatory, and to induce abortions.

The showy yellow flower, named for its traditional flowering and harvesting on St. John’s day (June 24), has long been valued for its ability to fight mild to moderate depression, especially in Germany, where it is treated like a drug.

German manufacturers must register their product with the government and adhere to premarket standards for quality. Patients get SJW via a doctor’s prescription and is more commonly prescribed than SSRI (Selective Serotonin Reuptake Inhibitor) medications, such as Prozac, used in the U.S.

The plant is even prescribed to children and adolescents in Germany as a low cost alternative to prescription drugs.

“Nature’s Prozac” as St. John’s wort is called, is also known by its Latin name, Hypericum perforatum. The herb received much media attention in the U.S. after 27 studies found it to be as effective as Prozac and Zoloft in treating mild to moderate depression.

In the Cochrane Systematic Review, a collection of databases containing high-quality independent evidence for making health care decisions, in all but one of the 27 clinical studies investigators concluded SJW was either more effective than placebo or as effective as older pharmaceuticals for mild to moderate depression.

Recently, more recently 13 additional clinical trials have been published with investigators finding SJW was superior to placebo or as effective as the standard prescribed pharmaceuticals such as amitriptyline [Elavil; fluoxetine [Prozac]; imipramine [Tofranil]; and sertraline [Zoloft], in the treatment of mild to moderate depression with far fewer side effects of standard antidepressants.

A daily 300-mg dose of Hypericum extract appears sufficient against symptoms and complaints of depression.

But a more recent U.S. clinical trial conducted under the National Center for Complementary and Alternative Medicine (NCCAM) under the National Institutes of Health, found St. John’s wort to be no more effective than a placebo to treat major depression.

With the bulk of studies, most from Europe, coming in favorably on the side of SJW as a depression fighter, the drug’s effectiveness has become the problem, says Dr. Joan Roberts, a chemist from of Fordham University in New York, who is considered a leading expert in the herbs’ effects on the human eye.

Dr. Joan Roberts

Dr. Roberts dealt a blow to the rising popularity of St. John’s wort in 2003 when she announced to scientists at a meeting of the American Society of Photobiology that one of the herb’s active compounds, hypericin, is photosensitive and readily produces free radicals which, when exposed to visible light or ultra-violet light and can bind to the ocular lens proteins triggering cataracts and leading to the irreversible macular degeneration from a damaged retina.

“If the proteins are damaged, they precipitate out of solution and make the lens cloudy. That’s what a cataract is.”

Referring to her 1999 research published in New Scientist, Dr. Roberts found hypericin did not cause any protein damage when kept in the dark. At that time, she advised patients on SJW to wear wrap-around sunglasses and a hat to avoid eye damage.

And for sufferers of seasonal affective disorder (SAD), who combine St John's wort with light-box therapy she advised, "Certainly never take this drug and use light therapy," says Roberts.

Today, Dr. Roberts, who says she is supportive of alternative and complementary medicine, believes this herbal supplement should come off the market or at least be labeled.

She tells IB News, "The herbs and over-the-counter drugs need to be safe as well as effective. Trading blindness for a reduction in depression is not, in my opinion, an acceptable risk.” (Continue to Part 2 - Emerging Doubts About the Safety of SJW) #

1 Comment

Anonymous User
Posted by Steve Lombardi
Thursday, December 17, 2009 1:55 PM EST

Interesting legal situation. I've had no contact with people in Iowa who have drawn any connection to the use of this product and side effects. So if in the future there are any Iowans suffering from cataracts that have used this product feel free to give me a call. I'm more than a little curious. You'll find my contact information under the Iowa - Des Moines market. Steve Lombardi

Comments for this article are closed.

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