Roman diet export and rationale for plants as medicines

Ythan estuary

@HealthMed Ground elder (Aegopodium podagraria) is a member of the carrot family, said first to have been recorded in Britain in 1578; but also, like Sweet Cicely (Myrrhis odorata), said to have been introduced by the Romans to Britannia as a food and medicine, the leaves used as herbs and salads. Found at least as far North as the Ythan Estuary in North-East Scotland: now a sanctuary for skylarks, terns and seals. Used as a medicinal plant in Northern Europe by monks (hence Bishopsweed and Bishopswort, and Herb Gerard - after St. Gerard whose name was though to help cure the gout), as well as in South-East Asia. Known as goutweed, in view of its use as a treatment for gout (earlier known as podagra); also used to treat arthritis - in both cases as boiled leaves and roots applied as poultices to the affected parts.
Gout-weed is mentioned by the herbalist and physician Nicholas Culpeper in the Complete Herbal in 1653: ‘the very bearing of it about one eases the pains of the gout and defends him that bears it from the disease.’ The leaves also have diuretic and sedative effects.
Any wild plant should be treated with great respect as an error in identifying a plant may result in a different, highly poisonous plant being eaten by mistake. Also different parts of a plant may be harmless or very poisonous; and plants of different age may have different effects on the body from helpful to neutral to harmful.
Published advice is if eaten at all this is best confined to young ground elder plants, before flowering. Ground elder becomes bitter after flowering, older plants developing laxative effects due to increased gut motility. Bio-active ingredients include the polyacetylene falcarindiol (highest concentration in ground elder flowers). Falcarindiol has COX-1 inhibitary activity, the mode of action of aspirin and other modern non-steroidal anti-inflammatory and analgesic drugs such as ibuprofen. This anti-inflammatory could explain beneficial effects to relieve gout and other forms of arthritis. Other potential bio-actives and trace elements include vitamin C and also iron, calcium, magnesium and beta-carotene. The vitamin C may contribute additional effects of the plant to relieve gout through causing a modest reduction in serum uric acid, the biochemical cause of gout.
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New UK guidelines on managing high blood pressure

High blood pressure is a major preventable and treatable risk factor for heart disease and stroke syndromes both in the developed and the developing world.

In an innovative partnership between a UK government agency - the National Institute for Health and Clinical Excellence (NICE) - and a professional organisation - the British Hypertension Society (BHS), NICE guidelines for managing hypertension in primary care were first issued in 2006. Key elements to those guidelines included a stepped care approach starting with different first line options for younger vs. older patients with a 55 year age boundary, and for patients of black African or Carribean origin compared to other ethnic groups. The 2006 guidelines also highlighted risks of new onset diabetes mellitus from beta-blocker treatment.

On 24th August, five years on, NICE, again supported by experts from the BHS, has released updated hypertension guidelines which include several key developments of interest to prescribers and patients. These include adding blood pressure measurements away from the clinical setting to confirm the diagnosis for patients with mild to moderate increases in clinic blood pressure readings. With even higher office readings, advice remains to treat based on those office readings. There is detailed advice both on blood pressure measurement using ambulatory devices as well as more systematic involvement of patients in their own management, supported by home blood pressure readings. It is of course important that any blood pressure monitoring device, whether for clinical or home use, should be validated. A helpful list of validated devices is is listed on the British Hypertension Society's website.

As an update on treatment options, the new 2011 guidelines now suggest systematic use of calcium channel blockers as first line treatment in older patients, with now specific, named diuretics as alternative options for specified indications. The 2011 guidelines for the first time also highlight the clinical and cost effectiveness of evidence-based treatment of hypertension in older patients, and in particular the over 80s.

For more information, see the summary documents and more detailed reports on the NICE website.

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