I'd like to introduce everyone to Sophia. Sophia is a 26-year-old female who would like to explore options for managing her anxiety and mild stomach upset. You will be making some type of pharmaceutical and/or botanical recommendations for her in a case study following this video. But for now, we will focus on identifying what makes botanicals unique from pharmaceuticals. Before we get into the difference between botanicals and pharmaceuticals, let's start with a quiz. Do you think it's true or false that some pharmaceuticals were actually derived from plants? Botanicals are unique, in that the active constituents of a plant are ingredients, for lack of better word, that impact therapeutic qualities of a particular plant. These constituents are influenced by a lot of different things, including the mineral composition and quality of the soil, what kind of climate the plant is grown in, and what age the plant was when harvested. Some plants have more therapeutic properties when they are harvested young. Others have more medicinal properties when they are harvested at a more mature age. The type of extraction technique when making botanical preparations, such as using water, alcohol, or chemicals, also impacts the medicinal quality of the plants. We'll be discussing extraction techniques in further detail in future weeks. This is in stark contrast to a laboratory that manufacturers pharmaceuticals, where the environmental conditions are tightly regulated and have little to no variation. This results in pharmaceuticals that have the exact same therapeutic action. A tablet of aspirin will work the same if you purchase that tablet in Florida or Alaska because it was made in a laboratory setting. The same is not true for plants. A plant grown in sunny tropical Florida may have different properties than the same plant if it was tried to be cultivated in Alaska, if the plant could even grow there at all. As you can see, there's a lot of different variation in botanical products as compared to pharmaceuticals. This chart helps give a generalized comparison of some of the key differences between pharmaceuticals and botanical, and let's go through each part now. Pharmaceuticals typically have one isolated concentrated active ingredient. For example, let's take the drugs Zocor, which is one of many statin drugs that are used to lower cholesterol. The active ingredient, simvastatin, was isolated and concentrated from the mold Aspergillus. While there are other inactive ingredients, the only active ingredient in a tablet of Zocor is the simvastatin. This is in contrast to botanicals that often have many active ingredients. For example, red raspberry leaf is commonly used as a pregnancy tea to help nourish the uterus. This particular plant exerts its effect in many ways. For example, we know that it contains an ingredient called fragarine, which helps act on the smooth muscle and increase the blood flow to the uterus. But fragarine is definitely not the only active component in red raspberry leaf. Red raspberry leaf is also rich in other nutrients benefits such as vitamin A, vitamin C, vitamin E, as well as calcium, iron, and potassium, all of which are beneficial nutrients in pregnancy. So, as you can see, there are many things that contribute to red raspberry leaf's effectiveness. For many botanicals, we actually don't know what the active ingredients are, or maybe have only discovered one or two. Scientific research is only beginning to scratch the surface of discovering active ingredients of plants, and I'm sure we'll know much more in the coming years. Due the single concentrated active ingredients, pharmaceuticals will have a stronger potency, and thus, a stronger therapeutic effect. Along with this comes an increased risk of more side effects. For example, benzodiazepines, such as Ativan or Xanax are common pharmaceuticals to treat anxiety. Their effects are strong at controlling anxiety, but a major side effect can be sedation. This is in contrast to a botanical that may be used for anxiety such as passion flower. The active ingredients in passion flower are not concentrated, and thus, a milder effect is exerted. This leads to lower potency and fewer side effects. While passion flower may help relieve anxiety, it does not cause the sedation that a benzodiazepine has the potential to induce. The single concentrated ingredient in pharmaceuticals also means it essentially exerts a single action. Zocor helps lower cholesterol. Xanax is used to treat anxiety. It's often felt that one drug for one problem. However, botanicals can have multiple effects due to the wide range of active constituents in a single plant. These active ingredients also work synergistically, or meaning, they work together, and one active constituent benefits another. This is a really key difference between the prescribing practices of pharmaceuticals and botanicals. Finally, we come to the prescribing practices of pharmaceuticals versus botanicals. While exceptions do apply, pharmaceuticals are usually given in pill form, one drug for one problem. A patient who has both high cholesterol and high blood pressure will receive a different pharmaceutical, one for each problem. In this way, the medication is tailored to the disease state, the pill for high cholesterol, the pill for high blood pressure. Now, while single botanicals can be consumed, a more common practice is to blend multiple botanicals, targeted to the individual, not the disease state. So, for example, a patient who is wanting help with anxiety and sleep may be prescribed a blend of valerian, chamomile, and passion flower. However, a different blend for the same symptoms in a different patient maybe used a combination of lemon balm and hops. Also, botanicals can be prescribed in multiple forms, not just pills. Teas and tinctures are also very popular means for which to take botanicals, and it's a really nice option to have. I had one patient wanting to try something botanical for her mild hypertension. She told me that she already takes so many pills, and was there another way that she could take her botanical? We ended up settling on a twice-daily hibiscus tea for her, and she found this to be a really relaxing part of her day. It allowed her to take a few minutes from the daily grind to take a break and quietly sit pretty, which was a good stress reliever and likely further helped her blood pressure beyond the therapeutic aspects of the tea. A really key point that I'm going to continually emphasize in this course is that because botanical tend to have milder effects, they are really only appropriate for mild to moderate symptoms. Anything more severe or absolutely anything life threatening is going to need a pharmaceutical or some type of stronger intervention. Above all else, remember that it is best to tailor medication regimen to fit the needs of the patient. Avoid a one-size-fits-all approach.
