NATURAL WONDERS

Herbal remedies have been around for thousands of years, but their interaction with modern medicines can be deadly.

by Jon Nalick

People who use herbal remedies to gain relief from minor ills or to boost their memory may be shocked to learn that they are often getting none of the benefits for which they paid—and a lot more danger to their health than they bargained for.

Kathryn Challoner, M.D., associate professor of clinical emergency medicine, warns that while the use of herbal supplements may be useful, people should realize that the products can cause potentially fatal reactions when used in conjunction with common prescription and over-the-counter drugs.

For example:

“You can easily imagine someone with AIDS who is worried about his health, so he takes St. John’s wort for his depression, unaware that it can reduce the effectiveness of his AIDS drugs. We see these kinds of reactions and we know they are becoming increasingly widespread—we just don’t know how bad a problem it is,” Challoner says.

James Adams, Ph.D., associate professor of molecular pharmacology, says the scope of the problem remains unknown largely because no central clearinghouse for such information exists. Still, he notes that U.S. Food and Drug Administration (FDA) statistics hint that the problem is significant.

The FDA recorded 2,621 serious injuries to patients attributable to herbal medicines’ interactions with medication between 1993 and 1998. In 101 of those cases, the patients died, but because there is no requirement to report such deaths, the true numbers may be much higher, Adams notes.

Stanley Azen, Ph.D., professor and co-director of the division of biostatistics, says that the National Institutes of Health has dramatically increased funding for research exploring potentially dangerous drug-herb interactions.

"The deaths we have seen are directly driving that decision," says Azen.

In his recent international presentation, "Trends and Current Status of Clinical Trials of Herbal Medicine in the U.S.," Azen says that “medical journals are increasingly publishing studies on herbs instead of focusing on drugs alone.”

He adds, "Herbs were never an issue before, but now we're starting to see more discussion of their effects. Future trials will also need to look at the ideal dose of a given herb, its toxicity and drug reactions."

Adams agrees: “This is becoming a big concern for surgeons because so many of these supplements people are taking—garlic, ginger, ginkgo, ginseng, soy isoflavones—can encourage bleeding. And in surgery, any bleeding can become potentially life threatening.”

People who take supplements should stop several days before undergoing surgery. Further, people should always consult their physician or pharmacist before taking herbal supplements, he says.

Challoner says that a serious concern is a lack of communication between physicians and patients. Many doctors do not specifically ask if patients are using herbal supplements, and patients are not volunteering that information, possibly because patients do not consider the supplements as real medicine, or fearing that their physicians will not approve of self-medication.

A 1997 study showed that 42 percent of respondents had used alternative therapies, up from 34 percent in 1990. Of those who had used such treatments, 72 percent did not inform their physician.

Even when physicians and patients do communicate, patients often fail to take the proper dosage of the supplement, sometimes deliberately, sometimes accidentally.

“People should not ignore the appropriate dose on the label. If the label says, ‘Take two a day,’ don’t take 10 a day. That’s a bad idea,” Adams says.

Frequently, patients take incorrect dosages through no fault of their own but because the product itself is inconsistent. Herbal products are considered dietary supplements instead of medicines, so they remain virtually unregulated by the federal government.

As a result, Challoner says, “As long as the products don’t say they treat a disease, the FDA will only intervene once a product is known to be harmful. People do not realize that there is no quality control. Many products are fine, but there’s no guarantee that you are getting what you think you are getting.”

In the absence of stringent regulation and safety standards, concoctions frequently contain wildly differing amounts of the active ingredient from dose to dose. In fact, Adams reports that one FDA study showed that 60 percent of all ginseng sold in health stores actually contained no ginseng whatsoever. But 60 percent of all “ginseng” did contain something else: caffeine.

“It’s very common for people to be cheated when they buy the more expensive herbal preparations. In these cases, caffeine was cheaper to put in than ginseng and the people who bought it wanted—and expected—to feel up and motivated right away. And that’s what the caffeine did,” he says.

Additionally, new evidence is calling into question ginseng’s mood-boosting ability. A study published in the Journal of the American Dietary Association showed that participants who consumed a pure form of ginseng saw no psychological benefits compared with those who took a placebo.

In the worst cases, herbal supplements can contain dangerous adulterants such as steroids, lead and mercury.

Challoner recalls a man who came to the emergency room complaining of nerve problems in his extremities.

“The physicians diagnosed him with lead poisoning, but we had no idea where it was coming from until our toxicologist, Dr. Ashok Jain, specifically asked if he took any alternative supplements or herbal extracts. The patient had been taking an orange tonic every morning—and it turned out to contain excessive amounts of lead,” she says.

Challoner emphasizes that herbal medicines are not necessarily bad, but they do need to be used with caution, and never for longer than they are needed. More importantly, consumers need to talk to their physician or pharmacist to avoid any potential harm from interactions between herbal supplements and their medicines.

“Some of these herbs have been around for millennia. Many of our powerful drugs came from people looking at the drugs of other cultures and extracting the active ingredient. But just because something is natural doesn’t mean it’s automatically good for you,” says Challoner.

“Even beneficial medicines can be deadly in the wrong quantities.”

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