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Good Scientific Evidence : Bromelain : Several preliminary studies suggest that when taken by mouth, bromelain can reduce inflammation or pain caused by inflammation. Better quality studies are needed to confirm these results. Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birth pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour or other members of the Bromeliaceae family. Use cautiously in patients who have a history of bleeding disorders, stomach ulcers, heart disease, liver disease or kidney disease. Use cautiously before dental or surgical procedures or while driving or operating machinery. Avoid if pregnant or breastfeeding due to limited scientific evidence of safety. Also, bromelain may cause abnormal uterine bleeding. Comfrey : In vitro studies have found that comfrey may have anti–inflammatory effects. Clinical trials investigating topical application of comfrey–containing creams have found significant reductions in inflammation and pain associated with sprains and muscle injuries. Overall, these studies have been well designed although some improvements in reporting are needed. Avoid if allergic or hypersensitive to comfrey, its constituents or members of the Boraginaceae family. Avoid oral comfrey due to hepatotoxic (liver toxicity) and carcinogenic (cancer–causing) pyrrolizidine alkaloids. Oral use has caused death. Avoid topical comfrey on broken skin due to hepatotoxic and carcinogenic pyrrolizidine alkaloids. Avoid topical comfrey in individuals with or at risk for hepatic disorders, cancer or immune disorders. Use topical creams containing comfrey cautiously if taking anti–inflammatory medications or cytochrome P450 3A4–inducing agents. Use extreme caution when using topical creams containing comfrey for extended periods. Avoid topical comfrey in pregnant or lactating patients due to potential for absorption of toxic compounds. Probiotics : Limited evidence with day care children suggests supplementation with Lactobacillus GG may reduce number of sick days, frequency of respiratory tract infections, and frequency of related antibiotic treatments. Fermented milk (with yogurt cultures and L. casei DN–114001) may reduce the duration of winter infections (gastrointestinal and respiratory), as well as average body temperature, in elderly people. Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Unclear or Conflicting Scientific Evidence : Astragalus : One clinical trial suggests the potential for benefit of astragalus in patients with tuberculosis. Further well–designed clinical trials are required before recommendations can be made. Beta–sitosterol : Beta–sitosterol and beta–sitosterol glucoside have been studied for the adjunct treatment of tuberculosis with anti–tuberculin regimens. Only one randomized controlled trial, which included a small number of patients, studied beta–sitosterol and beta–sitosterol for this indication. Larger populations of patients with tuberculosis should be evaluated in randomized controlled trials if conclusions are to be made. Black tea : In one small study, inhaled tea catechin was reported as temporarily effective in the reduction of methicillin–resistant Staphylococcus aureus (MRSA) infection and shortening of hospitalization in elderly patients with MRSA infected sputum. Additional research is needed to further explore these results. Blessed thistle : Laboratory studies report that blessed thistle (and chemicals in blessed thistle such as cnicin and polyacetylene) has activity against several types of bacteria and no effects on some types. Reliable human study is lacking. Further evidence is necessary in this area before a firm conclusion can be drawn. Cat's claw : Several laboratory and animal studies suggest that cat's claw may reduce inflammation, and this has led to research of cat's claw for conditions such as rheumatoid arthritis. Large, high–quality human studies are needed comparing effects of cat's claw alone vs. placebo before a conclusion can be drawn. Cranberry : Study results of cranberry as an antibacterial in other conditions show conflicting results. Further studies are needed before a conclusion can be drawn. Dandelion : Research in laboratory animals suggests that dandelion root may possess anti–inflammatory properties. There are no well–conducted human studies currently available in this area. Euphorbia : One clinical trial on patients with acute dental pulpitis has been done with Euphorbia balsamifera and it was concluded that the effect of this herbal was comparable to that of pulpal nerve caustics. Eyebright : Limited evidence from animal research suggests that several iridoid glycosides isolated from eyebright, particularly aucubin, possess anti–inflammatory properties comparable to those of indomethacin. The mechanism of action may be by the inhibition of thromboxane–synthase. The clinical relevance in humans is unclear, and there are no known human clinical observations or controlled trials in this area. Therefore, there is currently insufficient evidence to recommend for or against eyebright as an anti–inflammatory agent. Garlic : Preliminary studies documented potential benefits of oral plus intravenous garlic in the management of cryptococcal meningitis. Further research is needed before recommending for or against the use of garlic in the treatment of this potentially serious condition, for which other treatments are available. Ginseng": In patients treated with Hochu–ekki–to, which contains ginseng and several other herbs, urinary MRSA has been reported to decrease after a 10–week treatment period. Further studies of ginseng alone are necessary in order to draw a firm conclusion. Goldenseal : The goldenseal component berberine has effects against bacteria and inflammation. Several poorly designed human studies report benefits of berberine used in the eye to treat trachoma (infectious eye disease). Better research is needed before a recommendation can be made. Hydrotherapy : There is preliminary evidence that some hydrotherapy techniques may reduce bacteria on the surface of the skin. It is not known if there are benefits (or potentially harmful effects) of reducing skin bacteria. There may be benefits in people with skin wounds or ulcers who are at risk of infection. There is no evidence that infection of the skin itself (cellulitis) is improved. L–carnitine : A preliminary study suggests anti–bacterial activity may be increased in patients who have tuberculosis given acetyl–L–carnitine. Well–designed clinical trials are required before recommendations can be made. Lavender : Early laboratory studies suggest that lavender oils may have antibiotic activity. However, this has not been well tested in animal or human studies. Probiotics : As a bacterial reservoir, the nose may harbor many varieties of potentially disease–causing bacteria. There is limited evidence that probiotic supplementation may reduce the presence of harmful bacteria in the upper respiratory tract. More studies are needed to establish this relationship and its implications for health. Results are mixed regarding the ability of probiotics to reduce infective complications of medical treatment. Reduced incidence of infection has been seen in patients treated for brain injury, abdominal surgery and liver transplantation. Other studies have shown no such reduction in elective abdominal surgery and critical care patients. Seaweed, kelp, bladderwrack : Laboratory studies suggest antifungal and antibacterial activity of bladderwrack. However, there are no reliable human studies to support use as an antibacterial or antifungal agent. Selenium : Preliminary research reports that selenium can be beneficial in the prevention of several types of infection, including recurrence of erysipelas (bacterial skin infection associated with lymphedema) or Mycoplasma pneumonia. Further research is needed to confirm these results before a clear recommendation can be made. Sorrel : There are no well–conducted published studies that demonstrate sorrel to possess activity against viruses or bacteria that are important human pathogens. Tea tree oil : Laboratory studies report that tea tree oil has activity against MRSA. It has been proposed that using tea tree oil ointment in the nose, as well as a tea tree body wash may treat colonization by the bacteria. However, there is currently not enough information from studies in humans to make recommendations for or against this use of tea tree oil. Turmeric : Laboratory and animal studies show anti–inflammatory activity of turmeric and its constituent curcumin. However, reliable human research is lacking. Vitamin D : Preliminary human evidence suggests that vitamin D and its analogues, such as alfacalcidol, may act as immunomodulatory agents. More studies are needed to confirm these results. Fair Negative Evidence : Probiotics : Bacterial translocation (passage of bacteria from the gut to other areas of the body where they can cause disease) is of special concern in surgery. Limited evidence suggests that supplementation with probiotics may not reduce this problem.
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