A wise man tries myrrh

Szapary holding gugulipid pills

Photo Daniel R. Burke

Philippe Szapary, assistant professor of general internal medicine, is a high-energy guy. He’s a lean-over-the-desk-at-you, talk-very-fast kind of guy. And he’s on a crusade to gain mainstream acceptance for alternative medical remedies.

He’s starting with myrrh, a fragrant Western Indian shrub closely related to the Middle Eastern strain that yielded biblical gifts. Some believe it can keep cholesterol in check. In India, the use of myrrh to combat obesity, arthritis and hardening of the arteries dates back more than 2,000 years and is mentioned in ancient ayurvedic health texts. In the 1970s and 1980s, Indian clinical trials found that gugulipid, an extract from the resin exuded by the myrrh plant, was indeed effective in lowering cholesterol. Gugulipid was approved in 1987 in India for cholesterol treatment and is now widely used there.

But in the United States, where no clinical trials have been completed, gugulipid’s status remains that of dietary supplement, an alternative remedy whose effectiveness has not been verified officially.

As a supplement unregulated by the Food and Drug Administration, myrrh is in the company of countless other alternative remedies that are gaining popularity among patients while physicians are left with little information.

“In my clinical practice, I kept seeing patients who were taking alternatives I knew nothing about,” said Szapary. “We weren’t taught about alternative medications in med school, but my patients were self-medicating for conditions like cholesterol, arthritis, memory problems and hot flashes.”

The popularity of alternative medications has several possible reasons, Szapary said. Many people are interested in assuming a more active role in their health, particularly in prevention. They may become dissatisfied with Western medicine when the system fails them. They’re curious about more holistic conceptions of health involved in treatments such as acupuncture. And alternative therapists are often free to spend more time with patients than traditional physicians.

Szapary tried to research some alternative therapies, only to find that scientific information just didn’t exist about many of them. “I could find case studies where 10 people took something and said they felt good, but that’s not enough. You need [double-blind] studies, placebo trials.”

So last March, aided by grants from the National Center for Complementary and Alternative Medicine, Penn’s General Clinical Research Center and a manufacturer of gugulipid, he set about initiating the extract’s first clinical trial in the United States. The study will test 90 subjects with moderate cholesterol level. So far, 60 have participated, and Szapary is eager to recruit the rest of the subjects. Because the study is double-blind, he won’t know any results until the whole study is completed. But for now, he’s pleased that side effects have been no worse than for standard cholesterol-lowering medications.

His study may lead to a more involved, multi-center study on gugulipid. Szapary hopes that studies like his will lead the FDA to lend their stamp of approval to gugulipid and other alternative therapies. Myrrh treatments are much cheaper than commonly-prescribed cholesterol drugs, and for some patients, gugulipid may have fewer side effects.

But don’t look for myrrh to take the place of mainstream pharmaceuticals any time soon.

“Testing of these substances is really in its infancy in this country,” Szpary said.

Originally published on November 30, 2000