By Conrad Richter

Viagra, how quickly it has entered our lexicon! The most successful new drug introduction ever, Viagra racked up record first-year sales for pharmaceutical giant Pfizer, $788 million (U.S.) worldwide in 1998. In Canada, sales hit $4 million (Canadian) in the first full month on the market in April this year [1999]. Unabashedly, the little blue pill has made talk of male impotence, and the quest for good sex, respectable topics of everyday conversation and humour.

Viagra has caused a subtle but nonetheless important change in the way we perceive pills. For the first time Viagra has made the recreational use of drugs acceptable in the mainstream. Purportedly a treatment for a medical condition – male erectile dysfunction – Viagra is mostly taken by healthy males who can achieve an erection but want to enhance sexual enjoyment. For these men (and women) taking Viagra is a quality-of-life issue, not a medical one. In this sense, Viagra is the first widely accepted ‘lifestyle drug’.

The huge success of Viagra has spawned imitations, particularly ones made with herbs. The Internet search engine, Alta Vista, returned 461 web sites for ‘herbal viagra’. And these are just the brave ones, because the unauthorized use of the word “viagra” is known to elicit a threatening letter from Pfizer’s lawyers in defense of its registered trademark. For example, a British company tried to market a herbal sex-enhancing product called “Viagrene” and was stopped by Pfizer’s lawyers.

No doubt Pfizer is behind a current ban on Viagra alternatives in China. There, herbal drug companies rushed to offer their own versions of sex-enhancing potions. One called “Weige,” or Big Brother, was confidently projected to sell 100 million pills this year before the government banned Viagra look-alikes.

Over the past year reports about herbal viagra alternatives have appeared in news. An African version called “Vuka Vuka,” or Wake Up, Wake Up, is now the most popular drug in Zimbabwe according to the Zimbabwe Independent newspaper. It is liquid extract made of unspecified herbs that is taken only once a month and is claimed to be better than Viagra.

Ferula hormonis dried root and capsules

An Associated Press report described a Lebanese version made from the root of the Hairy Root Plant (“Shirsh Zallouh”). This is identified as Ferula hormonis, a perennial of the parsley family that is found above 6,000 feet in the mountains. According to the report, the roots are soaked in wine or are ground into powder and taken in capsules or mixed with tea. A Lebanese herbalist friend of mine in Toronto insists that Ferula hormonis really works. The roots are scarce but he managed to get me a sample which I have not yet tried.

Even Canadian Press got into the act with a story on “Nature’s Viagra.” According to the report, Edmonton herbalist Robert Rogers recommends an extract of the dried fruits of Tribulus terrestris for male impotence. The extract acts as a “natural steroid” and “muscle enhancer,” presumably by increasing the body’s own testosterone production – by up to 30%, Rogers was quoted as saying. Testosterone is associated with increased athletic performance and helps to restore male fertility. A Bulgarian study of 200 men suffering from impotence which showed that tribulus extracts increase sperm production, sperm survival, and sperm motility.

Tribulus terrestris fruits or “seeds”

Tribulus is a low growing weed now found in much of the world. It is common in California where it is commonly known as Puncturevine because its thorny (horny?) fruits easily puncture tires. In China, the fruits are regarded as having a hypotensive (blood pressure lowering) and diuretic effect. In Turkey tribulus is also used for its hypotensive and diuretic effects, and to treat high cholesterol and colic pains.

Viagra was first proposed as a heart drug for the treatment of angina. It works by dilating blood vessels and increasing blood flow to the heart. A key effect of the drug is to lower blood pressure, which makes it dangerous to take for those with low blood pressure to begin with. I find it interesting that many of the herbal alternatives to Viagra act similarly, with an association between lowering blood pressure, heart disease, and male impotence turning up more often than not. In tribulus, we see this set of effects in the folkloric and clinical history of the herb.

Tribulus dried fruits are rich in steroidal saponins. Saponins are soap-like compounds that increasingly are under study for their medicinal properties. In ginseng, saponins are thought to be responsible for the root’s adaptogenic effects. Saponins in the roots of Kenyan plants may be responsible for keeping blood cholesterol in check among the Masaai of Africa whose diet consists almost entirely of cholesterol-rich milk, meat and blood. In tribulus, saponins were recently shown to reduce smooth muscle spasms, which may explain a Turkish folkloric usage of the fruits for colic. Saponins seem to be turning up more often now as their possible dietary and medicinal benefits become better appreciated.

Although modern scientific and medical research are accepted modes of generating new knowledge about plants, the vast majority of our knowledge still comes from traditional folkloric knowledge. Most modern research is guided by what was learned about plants and their medicinal effects hundreds and thousands of years ago. But folklore is not merely a historical artifact; it is a living, breathing body of knowledge, to which new folklore is added every day. It may seem strange to think this way, but folklore is continuously evolving and adapting to the needs of the people. For past generations infant mortality was high, life expectancy low, and having children was a form of old age pension, so taking herbs to enhance fertility was very important. Today, there is more interest in contraceptive herbs and in herbs that can enhance the quality of life in middle and old age.

The new folklore is important because it is the product of trying new herbs, or old herbs in new ways. In many cases the new folklore is inspired by the findings of modern research. In other cases it is the product of new usages never tried before. The Internet is speeding up the growth of the new folklore, making it easier to spread and take root.

Herbal viagra alternatives are very much part of the new folklore. Inspired by the success of Viagra, real and wannabe herbalists, quacks and snake oil salesmen are putting forth their alternatives hoping for a piece of the pie. Whether these potions prove to be efficacious successes or limp failures, it is interesting to document some of the ones advertised on the Internet and in the print media. What follows is a sampling I collected in my “herbal viagra” folder over a six month period without seriously trying to collect literature on these products. Please note that mention of any products in this article does not constitute an endorsement of their safety or efficacy. This article is not meant to be a recommendation to try these products.

A number of products in my folder are based on the bark of the yohimbe tree (Pausinystalia yohimbe), a traditional aphrodisiac from West Africa. Studies show that the bark and its main active constituent, the alkaloid yohimbine, have some benefit on erectile dysfunction. It is interesting that yohimbine has been used for angina and arteriosclerosis, and that it lowers blood pressure by dilating the blood vessels. Like tribulus, it is sold as an aphrodisiac and as a dietary supplement alternative to anabolic steroids to enhance athletic performance.

The U.S. Food and Drug Administration reported that commercial yohimbe products contain less than 10% of the yohimbine found in authentic yohimbe bark, and in some cases contained none. The FDA also found that commercial products are missing other alkaloids normally found in the bark which suggests that these products are made with the yohimbine alkaloid only and not the whole bark. Because yohimbine accounts for only 10-15% of the total alkaloid content of the authentic bark, it is possible that important modulating or synergistic compounds are missing in the commercial products. Since most commercial yohimbe products appear to be made with yohimbine alkaloid only, I wonder if the herb – the natural alkaloid-rich bark – has been classified unfairly by the FDA as unsafe. A mantra oft-repeated, one to which I give some credence, is alkaloids can become more dangerous when separated from the crude leaf, bark or root, and administered in purified form. To my way of thinking it seems unlikely, though not impossible, that a traditional use of yohimbe bark could persist in West Africa if it fundamentally unsafe as the FDA insists.

“Yohimbe 2000,” advertised on the Internet, is a powder sold in capsules. The advertising does not specifically make claims for the product but rather for yohimbe bark, the implied ingredient. It states that yohimbe “appears to increase blood flow into the penis while, at the same time, preventing blood from flowing out.” It also says that yohimbe “helps prevent arteries from being clogged” and “has been used for the treatment of congestive heart failure.” From the advertising it is impossible to tell whether the product has yohimbe bark or the yohimbine alkaloid instead.

To some yohimbe-based viagra alternatives other herbs are added. For example, “Herbal V,” promising a “New Sexual Revolution,” contains yohimbine, tribulus, oat (Avena sativa), and androstenedione. Another, “Great Sex For Men” (and its companion product, “Great Sex For Women”), contains oat, Korean ginseng (Panax ginseng), bee pollen, and vitamins, in addition to yohimbe (or yohimbine). Androstenedione, by the way, is the performance enhancing dietary supplement baseball slugger Mark McGwire admited to taking. Although it is found in some plants, I could not ascertain if commercial products such as “Herbal V” contain plant-source androstenedione.

Dried oat straw (Avena sativa)

Oat (“wild oats” tempts me here) is a popular ingredient in viagra alternatives. The dried straw or flowering tops are used by herbalists as a tonic for nerves and for the uterus. The herb has stimulating properties, and is added, as the “Great Sex” advertising puts it, “for the promotion of energy.” According to herbalist John Lust, the tea added to bathwater is useful for a variety of problems mainly in the vicinity of the navel, including liver problems, lower back problems, kidney and bladder problems, intestinal colic, and bedwetting. Lust does not mention specific libido-enhancing merits but perhaps the thinking is that a herb with so many positive effects in the neighbourhood of the genitals can’t be all bad to include in a herbal viagra product.

Oat is the main ingredient of product advertised in a major Toronto daily. Boldly called “The Viagra Alternative,” it is claimed to have “no side effects” and to be “safe for people with high blood pressure & heart problems.” Added are two tonic herbs, saw palmetto (Serenoa repens) and stinging nettle (Urtica dioica). Like oat, nettle is used for a variety of urinary tract problems, including inflammation, gravel, and gout. Saw palmetto, one of the top ten selling herbs today, is the well known herb used for prostate gland enlargement and inflammation. Together, it seems plausible that these herbs may have some beneficial supportive effect on erectile dysfunction.

A Mexican entry in the viagra stakes is damiana (Turnera diffusa; syn. T. aphrodisiaca). This small aromatic bush from Texas and northern Mexico is used to flavour a liqueur by the same name. It is used in other alcoholic and non-alcoholic beverages, as well as candies and desserts. The tea made with the leaves is considered an aphrodisiac and tonic in Mexico, and a recent animal study provides some support. The study showed that a damiana extract boosts “copulatory performance” in sexually-sluggish or impotent rats. The percentage of rats achieving ejaculation increased while the interval between copulations decreased.

Ginseng has a secure place in the lore on sex-enhancing herbs. For thousands of years it was recommended for flagging libidos in China. The root’s passing resemblance to a human body only added to its mystique. Most sought after were roots with an appendage attached in a suggestive place, commanding even today hundreds or thousands of dollars a root for the very best. There are several plants that go by the name, ‘ginseng’. The best known ones are the chinese (or korean) variety, Panax ginseng, and its close american cousin, Panax quinquefolius. The Panax ginsengs are very rich in saponins thought to be responsible for the myriad of effects attributed to ginseng. Ginseng products are now sold widely in North America, probably the best known brand being “Ginsana.” Again, like other herbal viagra alternatives, ginseng can lower high blood pressure, and can lower cholesterol, and can presumably increase blood flow.

As my octagenarian mother once told a television crew with a glint in her eye: “I don’t know if ginseng is an aphrodisiac, but it makes you feel better, and if you feel better everything works better.” Ever the teaser, she gleefully takes credit for my wife’s two rapidfire pregnancies during a stretch when she personally administered a piece of root to me every morning. Now, in deference to my wife’s protestations about the idea of a third child, my mother stopped giving me ginseng because, as she loves to tell everybody, my wife “needs a break.”

Taking ginseng is not without risk. I remember a UPS driver in the 1970s who used to eat fresh ginseng roots like carrots – a root a day. He had found a large stand of wild plants in a nearby forest so he had a virtually unlimited supply of the fresh roots. At first, the effect was “fantastic” he told me as we regularly struck a conversation during his delivery stops at Richters. He laughingly boasted about his “amazing” sexual virility and endurance, and said he never felt stronger or happier. But soon he began to be more muted about ginseng and then was no longer seen with a half eaten root dangling cigarette-like between fingers. It was not long after that we didn’t see him anymore, and later I heard that he had become so weak he had to quit UPS.

Whether the UPS driver’s weakness was due to excessive intake of ginseng is a matter of speculation, but traditional Chinese herbalists warn about inappropriate use of ginseng. For example, the American variety is considered “cooling” and should not be taken by elderly patients, while the Chinese or Korean variety is “warming” and should not be taken by younger patients. Excessive or long term use of either ginseng can lead to debility, herbalists warn, which raises questions about the recent practice of adding ginseng to foods and drinks for everyday use.

Besides the true Panax ginsengs, there are other “ginsengs” gaining popularity in North America for effects superficially similar to those of the real ginsengs. The root of “Indian ginseng,” better known as “ashwaghanda” (Withania somnifera), is a traditional sexual stimulant in East Africa. In ashwaghanda one finds, once again, an aphrodisiac herb that is also known to lower blood pressure. But, like many herbs, this herb is not without potential side effects when used improperly, having narcotic, abortifacient, and sedative properties, among others.

“Brazil ginseng” (Pfaffia paniculata) is a newcomer to the faux “ginseng” trade in North America. In the damiana study mentioned earlier involving sexually sluggish rats, pfaffia root extract was shown to be similarly effective in improving “copulatory performance.” As in the experiments with damiana, ejaculations were more numerous, and intervals shorter, in rats receiving the pfaffia extract. Although there are no confirming studies yet, I bet pfaffia dilates blood vessels, increases blood flow, and lowers high blood pressure just like Viagra and many of the herbal alternatives do.

The ‘lifestyle’ herbs are here to stay. Pfizer’s Viagra has had a big influence on how we think about enhancing our lives with drugs and herbs. What’s the next big taboo the drug companies will turn into a lifestyle issue? I would not be surprised that the recreational use of ‘feel good’ euphoriants, stimulants, and even hallucinogens will be next. It may be difficult to picture now, but not long ago it was hard also to imagine a drug company making millions on a drug sold to enhance sex. Of course, there are plenty of herbs with precisely these ‘feel good’ effects.

Originally published in The Gilded Herb, Autumn 1999 (Vol. 1, Issue 5).