The Associated Press

CLEMSON, SC -- St. John's Wort, a yellow-flowered plant with a 2,000-year history as an herbal remedy, has the attention of Clemson researchers as a possible moneymaker for South Carolina farmers moving away from tobacco and other traditional crops.
Dwight Camper, a professor of plant pathology and physiology, and student Joe-Ann McCoy are identifying strains of St. John's Wort that produce the most of its active ingredient, hypericum.
''We're putting science behind the herbal medicine movement,'' said Camper, Clemson's principal investigator of plant medicine research. Aided by a grant from the U.S. Agriculture Department, Camper has studied St. John's Wort for about two years.
The plant is widely used in Europe as an antidepressant and now is becoming popular in the United States. American psychiatrists say their patients ask about the herb and say that they take it.
McCoy found a species of St. John's Wort that thrives in South Carolina's tough red clay, but it does not appear to produce as much hypericum as its commercial brethren. Once McCoy pinpoints which of the commercial strains produces the most hypericum, scientists can use it to try and breed a high-yield strain of St. John's Wort that also is hardy in South Carolina.
There are 20 to 30 species of St. John's Wort, but not all have medicinal qualities. Researchers aren't sure how St. John's Wort works. Some believe that, like Prozac, the herb enhances serotonin and other feel-good substances, or that it inhibits enzymes in the brain that harm these substances. It also can cause problems. Gayle Fesperman, who began taking the herb to ease stress, irritability and sleepless, broke out in hives. Other people who take St. John's Wort suffer side effects like sensitivity to sunlight, dizziness and nausea.

John Hendren/Associated Press

For years, German doctors have prescribed an herb called St. John's wort to lift sagging
spirits. Now millions of Americans have started using it to lift drooping bellies and
backsides as well.
St. John's wort has soared in popularity as a weight-loss supplement since two diet drugs
were pulled from the market last month.
Half the nearly 250,000 dieters at Nutri/System weight loss centers use the herb, which
shows its golden flowers at their brightest around June 24 -- St. John the Baptist's birthday.
``I lost 46 pounds in about three and a half months,'' said Kathie Spina of Collingdale, Pa.,
who at 5-foot-7 weighs 138 pounds after a Nutri/System doctor prescribed a St. John's
wort blend. ``I'd tried over-the-counter products before and dieting and eating fruits and
stuff like that. Nothing seemed to work.''
The sudden rise of St. John's wort, or hypericum, is hard to miss. Health food store shelves
are newly lined with Herbal Phen Fuel, Diet Phen and other St. John's wort blends
designed to sound like the now-unavailable diet cocktail ``fen-phen.'' And many doctors
now enthusiastically prescribe the herbal remedy.
But many doctors who praise its depression-easing powers question its use as a weight-loss
drug.
``I think it's a lousy idea,'' said Dr. Norman E. Rosenthal, a Rockville, Md., psychiatrist and
researcher who is working on a book on St. John's wort tentatively titled ``Nature's
Prozac.'' ``There's not a smidgen of evidence for it as a diet drug.''
Dr. Harold H. Bloomfield, a Del Mar, Calif., psychiatrist and author of ``Hypericum &
Depression,'' said: ``The only justification for it is for people who eat as a symptom of an
underlying depression.''
Nutri/System uses St. John's wort and another herb, ephedra, in a mixture called Herbal
Phen-Fen. Dr. Joseph DiBartolomeo, a psychiatrist and a spokesman for Nutri/System, said
the diet center doesn't know exactly how the herbs work together, just that they do.
``We believe from using the products in our centers that there is a synergistic action with
the St. John's and the ephedra, when you put them together, that works to suppress
appetite,'' he said.
The FDA has linked ephedra to several deaths and about 800 adverse health reports from
doctors. But no cause-and-effect relationship has been established.
St. John's wort, native to Europe, North Africa, Asia and the western United States, has a
2,400-year history in folk medicine and is said to have been prescribed by Hippocrates, the
father of modern medicine.
German psychiatrists prescribe the herb four times as often as the prescription
anti-depressant Prozac. The German market for the herb this year is about $72 million, said
Petra Mueller of herb seller Lichtwer Pharma GmbH. But Germans use it strictly as an
anti-depressant, she said.
The biggest U.S. seller of St. John's wort, Twin Laboratories of Ronkonkoma, N.Y., has
sold the pills for 10 years at Wal-Mart and nutrition stores, promoting the herb vaguely as a
diet supplement, or something akin to a vitamin pill.
But when the Mayo Clinic warned in May that Redux and fen-phen may cause dangerous
heart valve problems, Twin launched its new Herbal Phen Fuel -- a mixture of St. John's
wort and bitter orange -- as a diet drug.
Twin's marketing chief, Steve Blechman, said he expects it to be among the company's top
sellers.
Because federal law bars companies from making health claims about dietary supplements,
St. John's wort packages make no mention of depression or weight loss. But Twin
Laboratories' ads in Fitness, Glamour, Self and other magazines tread the line: ``The safe
way to lose weight doesn't come from a drug. It comes from a garden.''
St. John's wort, like Prozac and the two recalled diet drugs, raises levels of serotonin, a
chemical messenger in the brain. Short-term studies have found no serious health concerns.

The two herbal remedies readers seem most interested in lately are
ginkgo and St. John's wort. I recently wrote about ginkgo, so today's
spotlight falls on St. John's wort.
St. John's wort (Hypericum perforatum) is the treatment most widely
prescribed by physicians in Germany for depression. Wort, by the way,
means "plant."
Glowing TV newsmagazine coverage this past June elevated this herb
to instant stardom in the United States. Some interviewees claimed that
St. John's wort worked for them and had fewer side effects than the
prescription antidepressants they had taken.
A big caution: Individuals with severe depression or bipolar disorder
should not try to self-medicate, but should see their physicians for
treatment as soon as possible.
Another caution: If you're taking a prescription medication for
depression, do not switch to St. John's wort or take the herb along with
the prescription antidepressant without discussing this with your
physician.
Cautions aside, St. John's wort may be effective for mild to moderate
depression.
An impressive sheaf of European studies indicates that St. John's wort
works significantly better than pla- cebo (inactive pill) in mild to
moderate depression. The efficacy of the herb has not, however, been
compared with standard antidepressant drugs.
A new three-year study launched this month by the National Institutes
of Health may answer further questions. In this first U.S. clinical trial,
the herb will be rigorously examined for its benefits in treating moderate
depression.
The two most widely discussed potential adverse effects associated
with using St. John's wort are the "cheese" reaction and
photosensitization.
It was originally thought that St. John's worked like prescription
antidepressants called MAO inhibitors, which are known to cause the
"cheese" or tyramine reaction. Tyramine is an amino acid found in
cheese, wine, some meats and aged foods. Eating tyramine-containing
foods while taking an MAO inhibitor can result in a sudden, dangerous
rise in blood pressure.
However, most researchers now agree that St. John's wort is a
relatively weak MAO inhibitor, and that apparently no significant
interaction occurs with tyramine-containing foods at recommended
doses, and none have been reported in the literature.
It seems more likely that St. John's wort may be similar to the Prozac
family of antidepressants, which work by enhancing serotonin
transmission in the brain. It's relatively weak MAO inhibition may also
enhance serotonin neurotransmission, and to a lesser degree, that of
norepinephrine and dopamine.
Depression is thought to result from faulty neurotransmission. It may be
this combined effect that gives the herb its antidepressant activity.
Photosensitization has occurred in the form of toxic skin reactions in
grazing animals who have ingested large amounts of St. John's wort.
There is at least one reported case of a woman experiencing a similar
reaction after taking St. John's wort extract for three years. So it would
be prudent to wear protective clothing or a sunscreen before exposure
to the sun or ultraviolet lamps.
Fatigue, stomach upset and allergic reactions have been reported by
human users. Other possible long-term adverse effects are not known.
The dose used in most adult human studies has been 300 mg taken three
times daily (a total daily dose of 900 mg). The 300 mg dose corresponds
to an extract standardized to 0.3 percent hypericin (one of many
ingredients making up the herb). It may take up to six weeks to see
results.
But remember, as I've said before: The FDA has no say over quality
control in the manufacture of alternative remedies. A big downside is
that you can't be sure that you're getting what the label promises.
A Consumer Reports test on ginseng products from several different
companies showed that the amount of active ingredient varied widely
among brands. Similar variation has been found in other products.
These problems may be corrected in the future, because herbal products
are apparently here to stay.

FAQ - St. John's Wort (a lengthy but exhaustive one)
Botanical com: St. John's Wort
Using St. John's Wort With Other Antidepressants