OnHealth It's Natural, But Is It Safe

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MARCH 17, 2000

It's Natural, But Is It Safe?

About Dr. Dillard | Alternative Health Archive

Q: I heard something on the news about herbal medicines being dangerous,

something about interactions with prescription medicines. I thought they

were natural. How can they sell them on TV if they're dangerous?

A: I know what you mean. Maybe not everything you see actors selling on

television is necessarily good for you. There are some new studies, and I

want to tell you about them. We need to talk about what's sensible and

what's safe. This is a good time to do it.

During the 1990s, the use of herbal medicines suddenly skyrocketed.

Five times more people were taking herbs in 1997 than in 1990. During the

late '90s, several big drug manufacturers started producing and marketing

herbal remedies to get in on the action. It is now estimated that one in

five Americans is taking an herbal medicine. Twenty percent of these people

are also taking prescription medications. This causes many of us to worry:

It was among the topics this week at the Complementary and Alternative

Medicine symposia at Harvard.

We don't know why herbal remedies have become so popular, but it's

probably a combination of reasons. Many people aren't satisfied with

conventional medical treatments and drugs. They see them as harsh and

dangerous. And we've seen recent studies that pharmaceutical drugs can have

some bad effects. Many people don't like going to doctors or may have a hard

time getting in to see a doctor. Sixty million of us are uninsured and can't

afford medical care. Others like the idea of using something " natural " to

treat an illness. Twenty years ago, people who went to health food stores

were considered nuts. Now with everything being sold over the Internet,

taking a lot of supplements seems normal. In any case, the use of herbal

medicines is at an all-time high.

Many folks think that they can treat themselves with herbs, because

herbal remedies " are not really medicines. " This is incorrect. The vast

majority of well-made herbal remedies absolutely do have medicinal

properties, side effects and potential adverse reactions. They are not the

same as just eating a salad or a vegetable. Most of these effects have been

documented.

Most herbal medicines are pretty safe, but that's only pretty safe,

not absolutely safe. They become potentially dangerous when they are mixed

with prescription drugs. Taking herbs along with conventional medications

may increase or oppose the effects of the medications. This is not something

you want to fool around with. In an important review article in the journal

The Lancet on Jan. 8, 2000, my friend Dr. e Fugh-Berman tells us about

the most important of these interactions. Let me summarize her findings.

We worry particularly about herbs that can increase the tendency to

bleed. Poorly controlled bleeding can result in hemorrhage, anemia or a

bleeding stroke. If you're taking aspirin, or particularly if you're taking

the blood thinner Coumadin (warfarin), you do not want to use the herbs

ginkgo, garlic, dong quai, papaya or danshen. These herbs can increase the

thinning of your blood and could cause trouble.

St. 's wort can decrease the absorption and effectiveness of

medications such as digoxin (digitalis), theophylline, cyclosporine and

phenprocoumon. If you mix St. 's wort with antidepressant medications

like Prozac , Zoloft or Paxil, you can get way too much of the

neurotransmitter serotonin in your system. St. 's wort may also

interfere with the effectiveness of the birth control pill. A word to the

wise should be sufficient.

Ginseng of the Panax variety should not be taken along with the

antidepressant phenelzine (Nardil). If you're taking one of the tricyclic

antidepressants like Elavil or Pamelor you should avoid the herb yohimbine.

Licorice can adversely increase the effect of oral or topical

corticosteroids. Betel nut can cause serious neurological side effects when

mixed with the neuroleptic drugs fluphenazine (Prolixin), flupenthixol and

procyclidine. Stimulant laxatives containing senna or cascara, and the

soluble fibers guar gum and psyllium, can interfere with the intestinal

absorption of almost any medication. Even grapefruit juice can interfere

with the absorption of the calcium channel blocker drugs. As Dr. Fugh-Berman

says in her paper, " all ingested substances have the potential to interact. "

Chinese herbal preparations can cause trouble, too. These combination

products may be contaminated with other plants or adulterated with things

like caffeine, steroids, sedatives, painkillers, diuretics or heavy metal

poisons like mercury and arsenic. If you're going to take Chinese herbs, get

them from a reliable source or have them specially made up for you.

These are some of the major herb-drug interactions, but really, this

is only scratching the surface. Very little is even known about drug-drug

interactions, so we are certainly just at the beginning of understanding

herb-drug and supplement-drug interactions.

If you are using anything to " treat " an illness, you are playing

doctor. You must consult with your own physician before you take any

prescription medication along with supplements or herbs. If your doctor

doesn't know about these interactions, he or she can look up the Lancet

article mentioned above for starters.

You can't always be sure that what's on the label is actually in the

bottle. Recent studies have shown that as much as one-third to one-half of

supplements or herbs that you find in the store do not have as much active

ingredient as the label states. Some of these products have no active

ingredients in them at all! The joke at our Columbia University botanical

medicine course is that these are the extra-safe brands.

So how can people sell you herbal medicines and supplements on

television that could be totally ineffective or potentially dangerous? The

whole reason they can sell them is that they're not regulated like drugs.

Back in 1994, Congress passed the Dietary Supplement, Health and Education

Act. It said that all herbal preparations and supplements are classified as

supplements like vitamins, not as medicines, so the U.S. Food and Drug

Administration can't closely regulate them. Most American herbal experts

don't think that this is sensible. Many are calling for a change in the

laws. We should set up an expert panel to help the FDA regulate these

products. This is what the Germans have done and it works pretty well.

But until that happens, you need to get expert advice before you try

mixing any drugs with any herbs or supplements. Try to get your own doctor

to read up on this literature, or find a well-trained herbalist to help you.

This would not be the clerk in the health food store, who might have been

working down the street last month as a highly trained mattress

professional. Herbals can be helpful if used correctly. Keep your eyes open

to the risks and take good care.

Ask Dr. Dillard a Question

This information is provided for educational purposes only and is not

intended as a substitute for professional medical advice. Do not use this

information to diagnose or treat a health problem. Please consult your

health care provider if you suspect you are ill, or have questions about

your condition.

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