110 The Professional Counselor | Volume 12, Issue 2 (Liu et al., 2018). Additional findings indicated only limited risk of liver toxicity when kava was used appropriately, and in 2015 the kava ban in Germany was lifted; however, kava products remain strictly regulated and monitored. In the United States, kava remains available over the counter (Liu et al., 2018). Ginkgo Ginkgo has been used in Chinese medicine for a millennium. The herbal remedy is derived from an ancient tree native to China, Japan, and Korea (Gruenwald et al., 2007; Ingersoll, 2005). Ginkgo biloba extract is made from the ginkgo tree leaves (S. K. Singh et al., 2019). It can be difficult to obtain a high-quality product because of poor oversight and regulation of herbal remedies (Booker et al., 2016); however, a standardized ginkgo biloba extract (EGb761) is available (Hashiguchi et al., 2015). Ginkgo shows some effectiveness in the treatment of dementia, Alzheimer’s disease, and other neurodegenerative disorders (S. K. Singh et al., 2019). Several meta-analyses have confirmed the effectiveness of ginkgo biloba. For example, a meta-analysis conducted by Liao et al. (2020) that included seven studies and 939 participants found that standardized gingko extract was effective in improving cognitive function in Alzheimer’s patients. It has been shown that ginkgo has anti-inflammatory, vascular, and cognition enhancing effects. Ginkgo is considered a GABA agonist as well as an antioxidant (S. K. Singh et al., 2019). In addition to improving cognitive function, it may also lessen oxidative damage, which has been implicated in the development of Alzheimer’s disease (S. K. Singh et al., 2019; Solas et al., 2015). Ginkgo appears to be effective in the treatment of mild to moderate memory loss in the elderly and it may slow the deterioration rate in severe dementia. In addition to neuroprotective properties, ginkgo also appears to be effective in the treatment of asthma, depression, and vascular deficiencies (S. K. Singh et al., 2019.) In terms of adverse effects, it may cause mild gastrointestinal upset, and it may also lower the seizure threshold in vulnerable individuals (Gruenwald et al., 2007). Cannabidiol Cannabidiol (CBD) is an active compound found in the cannabis plant (FDA, 2020a) and is most commonly promoted online as a remedy for anxiety and physical pain (Tran & Kavuluru, 2020). It also has promising potential for anti-inflammatory effects and has shown positive results in treating schizophrenia and social anxiety disorder (Burstein, 2015; Millar et al., 2019). CBD is a cannabinoid system modulator (Darkovska-Serafimovska et al., 2018) and differs from delta-9-tetrahydrocannabinol (THC) in that it does not produce intoxication (Burstein, 2015). The FDA has approved EpidiolexTM, a prescribed CBD-derived oral solution, for use with treating rare forms of epilepsy (FDA, 2020a). Although under federal law it is currently illegal to add CBD to food or beverages, individual states have differing laws regarding the distribution of CBD, so the dosage of CBD products remains mostly unregulated (FDA, 2020b). Researchers examined 84 CBD products including vaporization liquids, oils, and tinctures and found that 69% of dosage labels were inaccurate (Bonn-Miller et al., 2017). Although unlikely, it is possible for consumers to test positive for THC in some drug screening tests because up to 0.3% THC may be allowed in CBD products in the United States (Gerace et al., 2021; Spindle et al., 2020). CBD taken in combination with other drugs can cause adverse drug reactions and drug–drug interactions (J. D. Brown & Winterstein, 2019). For example, when CBD is taken with a benzodiazepine (e.g., alprazolam for anxiety), it can increase the risk of side effects of alprazolam. It should be noted that researchers mainly examined EpidiolexTM in studies exploring drug–drug interactions and adverse side effects, as the CBD dosage is controlled in this formulation (J. D. Brown & Winterstein, 2019). Because of the wide dosage variance in unregulated CBD products, it is difficult to research and predict the effects. In a review of clinical studies, the therapeutic window appears to be wide, but phase III trials have not been conducted to provide conclusive evidence (Millar et al., 2019).
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