16 replies to this topic

[Douggers]

How serious is the link between SJW and cataracts? I take SJW everyday and can honestly say it has helped me so much. But with that being said, I could not handle trading my eyesight for extra emotional well being..
Recently, I have seen a lot of SJW - Cataracts business online, but the latest study seems to be 2009. Anyone else here concerned about this? Are there any more recent studies, or was there a definitive answer?

Thanks

[digik]

Oxidation of lens alpha-crystallin in the eye certainly seems like a possibility from my reading, but I've found photosensivity only to be present in the off-brands. This is most likely due to the wildly varying hypericin/hyperforin ratios from poor quality control or using whole herb rather than clinically proven methanolic or CO2 extraction processes.

Anecdotally, I've experienced no photosensitivity issues using WS5570 Perika St. John's Wort and New Chapter SC27; I imagine Kira's LI160 would also be very safe. Both Perika and Kira are produced and regulated as German pharmaceuticals, so quality and consistency will be superior to other SJW supplements. All three are also stabilized against light and oxygen degradation, which effects potency of hyperforin drastically, and anyone who is serious about beating depression with SJW should ONLY use one of those three brands.**

Furthermore, if you're protecting against UV exposure by wearing sunglasses and/or UV filtering contacts daily, you shouldn't have anything to worry about. From my experience, it seems that the compounds that make it into the ocular fluid turnover fairly quickly; so photosensitivity, if experienced, will typically abate within a few days to a week of discontinuation.


**As a future warning to those who might begin taking SJW, Stay away from Vitamin Shoppe's house brand like the plague. It's unstabilized, inconsistent junk, and WILL give you horrible photosensitivity. For quite a while it was being falsely marked as St.JohnSelect by Indena, even though Indena hasn't supplied to US markets for a few years. VShoppe finally withdrew the false labeling from product packaging around January. Following my failed attempts to get their product respresentative to return my calls to discuss the importance of proper SJW labeling and subsequent censoring of a negative review I left for their product on their website, I have ceased giving them any of my business.

Edited by digik, 29 March 2013 - 06:24 AM.

[Douggers]

Thanks for that great info. Yeah I take Kira, and have taken perika too, but never noticed photo sensitivity to the eyes with either brand. But I wasn't sure if that meant that I wasn't at risk for any eye troubles.

- does anyone know if the St Johns Wort - Cataracts was ever a proven thing?

[digik]

No problem. Happy to share my experience and research.

Regarding your question, precipitation has only been shown in vitro with isolated calf eye crystallin as far as I know.
http://www.ncbi.nlm....pubmed/10946573

Edited by digik, 31 March 2013 - 04:10 AM.

[NFP]

i took st johns wort for almost 2 months when i started to notice problems with my vision. stop NOW if your noticing the same thing.

Edited by mastermind57, 31 March 2013 - 08:25 PM.

[ReachMyPotential]

Oxidation of lens alpha-crystallin in the eye certainly seems like a possibility from my reading, but I've found photosensivity only to be present in the off-brands. This is most likely due to the wildly varying hypericin/hyperforin ratios from poor quality control or using whole herb rather than clinically proven methanolic or CO2 extraction processes.

I've done some reading, too, namely this study from PubMed in which they conclude Hypericin, the active ingredient in St. John's Wort, is responsible for photosensitivity and eye damage which could lead to transient or permanent blindness, and they recommend anyone taking the drug avoid light exposure entirely. Since they attribute the issues to the active ingredient itself, we can infer this is not a brand or purity issue. All brands of St. John's Wort will have some level of Hypericin and therefore they are all dangerous; if anything, the most pure and potent forms offer the highest potential for these issues.

Anecdotally, I've experienced no photosensitivity issues using WS5570 Perika St. John's Wort and New Chapter SC27; I imagine Kira's LI160 would also be very safe. Both Perika and Kira are produced and regulated as German pharmaceuticals, so quality and consistency will be superior to other SJW supplements. All three are also stabilized against light and oxygen degradation, which effects potency of hyperforin drastically, and anyone who is serious about beating depression with SJW should ONLY use one of those three brands.**

I've read that eye damage caused by Hypericin may take several years to become noticeable. This source in particular notes, "Compounding the risk is the fact that cataracts take five to 10 years to develop and during that period are symptomless." If you still think you're safe, think again. If you haven't been taking SJW for several years already, it may just be a matter of time before the damage accumulates to a noticeable level.

Furthermore, if you're protecting against UV exposure by wearing sunglasses and/or UV filtering contacts daily, you shouldn't have anything to worry about.

This is debatable, I think we all get some direct light exposure from time to time. In theory, it sounds good, but what if you forget your sunglasses one day? What if you participate in outdoor sports where you can't wear sunglasses/UV contacts, like water sports where they'll fall off/fall out? I'd say the average SJW user could try to avoid light but still end up enough to cause the damage they're trying to avoid.

From my experience, it seems that the compounds that make it into the ocular fluid turnover fairly quickly; so photosensitivity, if experienced, will typically abate within a few days to a week of discontinuation.

The median elimination half-life of Hypericin was measured in this study to be between 24.8 - 26.5 hours in 12 healthy male subjects. I think you're pretty much on par by saying a few days to a week -- but to get completely to zero it's a little longer than that.

**As a future warning to those who might begin taking SJW, Stay away from Vitamin Shoppe's house brand like the plague. It's unstabilized, inconsistent junk, and WILL give you horrible photosensitivity. For quite a while it was being falsely marked as St.JohnSelect by Indena, even though Indena hasn't supplied to US markets for a few years. VShoppe finally withdrew the false labeling from product packaging around January. Following my failed attempts to get their product respresentative to return my calls to discuss the importance of proper SJW labeling and subsequent censoring of a negative review I left for their product on their website, I have ceased giving them any of my business.

Seems to me like staying away from ALL St. John's Wort/Hypericin substances would be a good idea. This is unfortunate because like others, I've experienced a myriad of wonderful positive symptoms while taking it. However, the prospect of irreversible eye damage has caused me to discontinue it permanently.

[ReachMyPotential]

- does anyone know if the St Johns Wort - Cataracts was ever a proven thing?

To add a little more to what I posted earlier, here's an analysis of the 2002 NHIS data that shows individuals who reported cataracts were 59% more likely to report SJW usage w/95% confidence interval. Statistics are never an exact science, but this percentage is much too high for comfort.

http://www.ncbi.nlm....pubmed/19895314

The association between self-reported cataracts and St. John's Wort.

Booth JN 3rd, McGwin G.

Source

Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Alabama35294-0009, USA.

Abstract


BACKGROUND/AIMS:

Recent interest in Hypericum perforatum, or St. John's Wort (SJW), is related to its observed utility in treating depression. However, mounting evidence suggests one component, hypericin, may be associated with cataractogenesis. To date, this association has not been evaluated in humans. Therefore, the current study assesses the relationship between self-reported SJW use and cataracts utilizing data from a large, population-based sample.
METHODS:

Self-reported data on SJW use in the past 12 months and cataract were obtained from the 2002 National Health Interview Survey, a nationally representative population-based sample. Crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) between SJW use and cataracts were estimated using logistic regression.
RESULTS:

After adjusting for potential confounding characteristics, participants that reported having cataracts were 59% more likely to report SJW use (OR 1.59; 95% CI 1.02-2.46).
CONCLUSIONS:

The results of the current study provide support for an association between SJW use and cataracts. Based on the methodological limitations of this study, further investigation is required.

--

Another article worth reading for anyone currently using or considering St. John's Wort/Hypericin: http://news.legalexa...googleid=275616

[noobray]

Hi, I recently acquired SJW Felis 650. I have myopia (-6.50 or more) and use LCD screens many hours per day.

I'm concerned about photosensitization and cataracts, and I'm confused about the contrasting infos found on google and other websites http://www.sjwinfo.o...77-side-effects

Could the dazzling light of other cars damage my eyes when I'm driving? Or the costant use of lcd screens? Maybe I'm already a bit sensitized to the sun light because of my lcd use...

Of course, here in Italy, I would use SJW only in winter.

What do you think? thank you

[MizTen]

I can't find in the studies I've read thus far if there was any breakdown of the SJW constituents, hypericin versus hyperforin in terms of increased risk for cataracts.

It's the hyperforin that works for seasonal depression for me. I use Paradise Herbs.

[timar]

The epidemiological study quoted by ReachMyPotential, which shows an association between the use of St. John's Wort and the incidence of cataracts, doesn't convince me at all. Depression is related to inflammation and increased oxidative stress and so are cataracts. This seems to be the likely underlying etiology to me. However, I would avoid any extract that is standardised for hypericin to avoid symptoms of phototoxicity.

I've done some reading, too, namely this study from PubMed in which they conclude Hypericin, the active ingredient in St. John's Wort, is responsible for photosensitivity and eye damage which could lead to transient or permanent blindness, and they recommend anyone taking the drug avoid light exposure entirely. Since they attribute the issues to the active ingredient itself, we can infer this is not a brand or purity issue. All brands of St. John's Wort will have some level of Hypericin and therefore they are all dangerous; if anything, the most pure and potent forms offer the highest potential for these issues.

This is completely wrong. First of all, hypericin is not the active ingredient of St. John's Wort. This once has been thought, but we know for more than ten years now that hypericin likely has no relevance at all for the acitivity of St. John's Wort. The active ingredient is hyperforin (which acts as a potent SSRI) and possibly other polyphenolic constituents as well. Moreover, there are 100% hypericin free CO2 extracts available (hypericin is not soluble in liquid CO2). Unfortunately, many extracts sold in the US are of inferior quality because for some inexplicable reason they are still standardised by the hypericin instead of the hyperforin content. Such extracts should really be deprecated by now!

I've read that eye damage caused by Hypericin may take several years to become noticeable. This source in particular notes, "Compounding the risk is the fact that cataracts take five to 10 years to develop and during that period are symptomless." If you still think you're safe, think again. If you haven't been taking SJW for several years already, it may just be a matter of time before the damage accumulates to a noticeable level.

St. John's Wort is the most frequently prescribed antidepressant drug in Germany for more than fifteen years. It is more frequently prescribed here than Prozac or any other SSRI. Yet we don't have an epidemic of St John's Wort induced cararacts. In fact, the padkage insert listing the possible adverse effect doesn't even mention cataracts - in spite of the fact that adverse effects are monitored by the same strict standards that apply for any pharmaceutical drug. I'm sure that there is even more scrunity applied to St. John's Wort than most other drugs because of its known PXR-mediated effects on the drug metabolizing enzymes. Doctors are very aware of its potential to cause drug interactions.

Seems to me like staying away from ALL St. John's Wort/Hypericin substances would be a good idea. This is unfortunate because like others, I've experienced a myriad of wonderful positive symptoms while taking it. However, the prospect of irreversible eye damage has caused me to discontinue it permanently.

I don't think that there is a significantly increased risk for cataracts if you take a high quality extract, like those low-hypericin extracts defined in the German Monograph and required by law for pharmaceutical products here. If you suffer from light to moderate depression or seasonal affective disorder, the benefits far outweight any risk. In fact, its tolerance is far better than that of any synthetic antidepressant.

Edited by timar, 29 November 2013 - 06:12 PM.

[ReachMyPotential]

The epidemiological quoted by ReachMyPotential, which shows an association between the use of St. John's Wort and the incidence of cataracts doesn't convince me at all. Depression is related to inflammation and increased oxidative stress and so are cataracts. This seems to be the likely underlying etiology to me. However, I would avoid any extract that is standardised for hypericin to avoid symptoms of phototoxicity.

I've done some reading, too, namely this study from PubMed in which they conclude Hypericin, the active ingredient in St. John's Wort, is responsible for photosensitivity and eye damage which could lead to transient or permanent blindness, and they recommend anyone taking the drug avoid light exposure entirely. Since they attribute the issues to the active ingredient itself, we can infer this is not a brand or purity issue. All brands of St. John's Wort will have some level of Hypericin and therefore they are all dangerous; if anything, the most pure and potent forms offer the highest potential for these issues.

This is completely wrong. First of all, hypericin is not the active ingredient of St. John's Wort. This once has been thought, but we know for more than ten years now that hypericin likely has no relevance at all for the acitivity of St. John's Wort. The active ingredient is hyperforin (which acts as a potent SSRI) and possibly other polyphenolic constituents as well. Moreover, there are 100% hypericin free CO2 extracts available (hypericin is not soluble in liquid CO2). Unfortunately, many extracts sold in the US are of inferior quality because for some inexplicable reason they are still standardised by the hypericin instead of the hyperforin content. Such extracts should really be deprecated by now!

I've read that eye damage caused by Hypericin may take several years to become noticeable. This source in particular notes, "Compounding the risk is the fact that cataracts take five to 10 years to develop and during that period are symptomless." If you still think you're safe, think again. If you haven't been taking SJW for several years already, it may just be a matter of time before the damage accumulates to a noticeable level.

St. John's Wort is the most frequently prescribed antidepressant drug in Germany for more than fifteen years. It is more frequently prescribed here than Prozac or any other SSRI. Yet we don't have an epidemic of St John's Wort induced cararacts. In fact, the leaflet listing the possible adverse effect doesn't even mention that - in spite of the fact that adverse effects are monitored by the strict standards that apply for any pharmaceutical drug. I'm sure that there is even more scrunity applied to St. John's Wort than most other drugs because of its known PXR-mediated effects on the drug metabolizing enzymes.

Seems to me like staying away from ALL St. John's Wort/Hypericin substances would be a good idea. This is unfortunate because like others, I've experienced a myriad of wonderful positive symptoms while taking it. However, the prospect of irreversible eye damage has caused me to discontinue it permanently.

I don't think that there is a significantly increased risk for cataracts if you take a high quality extract, like those low-hypericin extracts defined in the German Monograph and required by law for pharmaceutical products here. If you suffer from light to moderate depression or seasonal affective disorder, the benefits far outweight any risk. In fact, the tolerability is far better than for any synthetic antidepressant.

Timar, thanks for your comments. I've very much been looking for someone (or preferably, a large body of individuals) to present evidence against my case so I can justify using SJW again. In fact, since these postings, I've recently started taking New Chapter's SC27 formulation, which as I understand it, is a supercritical extract of lipid-soluble components, leaving little to no Hypericin in the final product. Do you know of any other formulations that I could obtain here in the US without an Rx?

Also, I'm aware that Hyperforin has been shown to be the main ingredient (along with other flavanoids in SJW) to positively affect depression. Instead of saying Hypericin was "the" active ingredient, I should have said "an" active ingredient. Hyperforin, Hypericin, and the flavanoids are all biologically active in the body in my understanding.

I also agree that it would be strange for Germany to continue prescribing SJW if there was a clear link to cataracts. It does seem to suggest that the link is not as clear as some studies suggest -- but let me ask you this, how many of the German formulations exclude Hypericin? That would be good to know. Either way, some people wouldn't want to risk permanent damage to something like their eyesight unless there is a good body of evidence showing they'll be OK.

In my case, it took lots more research to finally determine that the benefits of SJW outweighed what I perceive to be a minor risk of eye problems by using a supercritical, fat-soluble-only extract standardized to Hyperforin, devoid (hopefully) of most or all Hypericins. In the future, it's my hope that it will be shown that even SJW with Hypericins is OK (due to other compounds in the plant providing protective action) since Hypericin may have other benefits health-wise aside from depression.

Edited by ReachMyPotential, 29 November 2013 - 06:46 PM.

[timar]

Timar, thanks for your comments. I've very much been looking for someone (or preferably, a large body of individuals) to present evidence against my case so I can justify using SJW again. In fact, since these postings, I've recently started taking New Chapter's SC27 formulation, which as I understand it, is a supercritical extract of lipid-soluble components, leaving little to no Hypericin in the final product. Do you know of any other formulations that I could obtain here in the US without an Rx?

I don't really know much about the products available in the US. I just have noticed that there seem to be many brands which are standardised for hypericin. I think this is an unfortunate consequency that hypericin once (as I said, more than 10 years ago) has been thought to be the main active component of St. John's Wort. Therefore my strong disagreement with your ambiguous statement. Of course hypericin is biologically active, as it may induce phototoxicity. However, it is most likely not active in the way that it contributes significantly to the antidepressant and anti-inflammatory effects of St. John's Wort.

I also agree that it would be strange for Germany to continue prescribing SJW if there was a clear link to cataracts. It does seem to suggest that the link is not as clear as some studies suggest -- but let me ask you this, how many of the German formulations exclude Hypericin? That would be good to know. Either way, some people wouldn't want to risk permanent damage to something like their eyesight unless there is a good body of evidence showing they'll be OK.

Actually, they don't exclude hypericin. It is only required that the hypericin content doesn't exceed 0,3% whereas the hyperforin content has to be 2% at least (most often it is between 3% and 5%). This is generally achieved by the addition of polyvidone to an ethanolic solvent. CO2 extracts are not approved as a pharmaceutical by now, because of the lack of RCTs done with such an extract.

In my case, it took lots more research to finally determine that the benefits of SJW outweighed what I perceive to be a minor risk of eye problems by using a supercritical, fat-soluble-only extract standardized to Hyperforin, devoid (hopefully) of most or all Hypericins. In the future, it's my hope that it will be shown that even SJW with Hypericins is OK (due to other compounds in the plant providing protective action) since Hypericin may have other benefits health-wise aside from depression.

I hope that there will be clinical trials with a CO2 extract soon. Those extracts are not only free of hypericin but also far more potent than ethanolic extracts when it comes to the hyperforin content, which can be as high as 15%. If hyperforin is the major active constituent of St. John's Wort, as it most likely is, those extracts are very promising.

[blood]

Fascinating input to this discussion from timar and ReachMyPotential - thank you both!

[Just Kelly]

Could you take something to offset the effects on the eye? For example, carotenoids or taurine? Something that protects the eye? Cannabis? Or do these work by a different mechanism?

[OneScrewLoose]

I haven't researched SJW in a while, and last I checked, hyperforin and hypericin both seemed to be at least somewhat active. If this information has changed in the last couple years, may I get some links please?

It seems the only study linking hypericin to cataracts is this:

http://www.ncbi.nlm....les/PMC3654046/

 

And it's completely in vitro. That doesn't mean it has no possibility of being true, but without a few in-vivo studies, I would not change my SJW intake based on a single in-vitro study.

http://www.ncbi.nlm....pubmed/19895314

This study doesn't tell us much because the causation is backwards. Let's use some formal logic and say:

S = Takes SJW
C = Developed Cataracts

What we are looking for is S->C. What we have is closer to C->S. This fallacy is known as affirming the consequent. I hate to be all logic-douchey right now, but this is the case. There can be many confounding variables be inverting the logic, like people with eye problems or people developing cataracts would be more likely to be depressed and try antidepressants.

I honestly see no data that supports the link between SJW and cataracts in any way more than correlative.

Edited by OneScrewLoose, 28 April 2015 - 06:13 AM.

[Jul89]

@ digik

Why do you think SJW brands do not make an extract that is devoid of hypericin?

It looks like hyperforin is responsible for the effect.

Hypericin is responsible (or can be) for the eye cataracts.

 

Id only feel safe with hyperforin only.

[Jul89]

I tried SJW and it made me pre-psychotic.