Herbal Supplements - what

you need to know and how

to askBrown Bag series

10/3/13

Elizabeth Bade, MD

The Issue

$283 million industry in the US

Figures are anywhere from 18% to

40% of Americans are using

supplements on a daily basis

How many tell their health care

provider about it?

NONE! Unless we ask!

What do I need to know?

Are they safe? Do they work?

Are they safe

Natural Safe

Many “supplements” contain lots of different chemicals

Rarely tested in children, pregnant women, breastfeeding women

Unknown components/additives

Many interactions with prescription meds or increase risk of bleeding

FDA regulation very different than pharmaceuticals

Regulates only claims that can or can’t be made

Doesn’t have to prove safety prior to supplement release, only can be withdrawn

Caveat Emptor

Beware of the “one pill fixes everything”

Do not trust testimonials (rarely science based, easy to fake)

Quick fixes – nothing works to solve your life’s problems in 30 days or less

“all natural” – so is cyanide

Miracle cure – death is the only one that you can count on

Conspiracy theories – pharmaceutical companies are not holding out on

the cures for cancer or weight loss.

Top offenders: weight loss, memory, sexual health

Do they Work?

More studies are now ongoing for safety and efficacy of herbal

supplements

Can be a safe, effective, low cost treatment for some ailments

Glutamine really does help with arthritis pain

Co-Q10 can be very helpful for symptoms of CHF, HTN

Probiotics really helps diarrhea

Chromium does lower blood sugars

Pop Quiz!!

What is the most common herbal supplement taken by Americans?

A. Glucosamine

B. Fish oil

C. Echinacea

D. Saw Palmetto

E. Ginseng

Pop Quiz!!

What is the most common herbal supplement taken by Americans?

A. Glucosamine

B. Fish oil

C. Echinacea

D. Saw Palmetto

E. Ginsing

Fish oil – yes? Or no?

• Recent studies show a possible link to increased prostate cancer

• Another study in NEJM showed no beneficial effect in preventing

heart attack or stroke

• Previous initial work show the balance of Omega 6 to Omega 3 fatty acids in our diet has shifted over the last 50-100 years towards Omega 6

• Countries with high omega 3 fatty acid diets naturally (Mediterranean, Japan, etc) have lower rates of heart disease and chronic illnesses that we have

• Definitely recommended still for high TG’s

What about vitamins?

Excessive vitamin E can increase your risk for cancer

Too much Calcium – nothing but trouble

Extra vitamin A – you turn orange

Better to take what your doctor recommends or simply a prenatal vitamin

for a standard dose of safe nutrients

Trusted Resources

http://familydoctor.org/familydoctor/en/prevention-wellness/food-

nutrition/nutrients/dietary-supplements-what-you-need-to-know.html

http://nccam.nih.gov/health/supplements/wiseuse.htm

http://www.uchospitals.edu/online-library/content=P00181

http://www.mayoclinic.com/health/herbal-supplements/SA00044

Name of remedy Uses Risks

Ephedra(Ephedra sinica, also called Ma-Huang)

To treat coughs and obesity

Dangerous and life-threatening increases in

heart rate and blood pressure. Has potentially fatal interactions with many cardiac medicines.

Garlic (Allium sativum)To lower cholesterol; to prevent and treat colds and certain infections.

Increases the risk of bleeding when taken with blood-thinning drugs.

Ginkgo(Ginkgo biloba)

To improve memory, circulation, and mental function as well as to prevent altitude sickness

Increases the risk of excess bleeding when taken with blood-thinning drugs.

Goldenseal(Hydrastis canadensis)

To alleviate constipation. Acts as an anti-inflammatory

May decrease or increase blood pressure. Berberine (ingredient of goldenseal) has also been associated with heart rhythm abnormalities. Increases the risk of bleeding when taken with blood-thinning drugs.

Hawthorn(Crataegus species)

To alleviate congestive heart failure and high blood pressure

Increases the risk of

bleeding when taken with blood-thinning drugs.

Licorice root(Glycyrrhiza glabra)

To treat coughs, cirrhosis, and stomach ulcers

May increase blood pressure and has been associated with heart rhythm abnormalities.

Aloe - used internally to relieve constipation and externally to soothe irritated skin and burns. When taken internally, aloe can cause abnormal heart rhythms with prolonged used.

Arnica ( Arnica montana) - applied externally to reduce pain from bruising, aches and sprains, and to relieve constipation. Arnica is potentially toxic to the heart and can raise blood pressure if taken internally.

Black cohosh ( Cimicifuga racemosa) - used to relieve menopausal symptoms. Can cause lowered blood pressure when taken at high doses.

Feverfew ( Tanacetum parthenium) - believed to prevent and treat migraines, arthritis and allergies. Feverfew can interfere with blood clotting when taken internally.

Ginger - purported to alleviate nausea and motion sickness, lower blood cholesterol, decrease platelet aggregation, and as a digestive aid and antioxidant. Ginger can interfere with blood clotting and increase the risk of bleeding when taken with blood-thinners. High dose has been associated with abnormal heart rhythm and blood pressure changes.

Ginseng ( Panax ginseng) - supposed to slow aging, increase mental and physical capacity, increase sexual performance, and boost immunity. It should not be taken by people with hypertension. Ginseng can interfere with blood clotting and increase risk of bleeding when taken with blood-thinners.

Stinging nettle ( Urtica dioica) - thought to fight urinary tract infections, kidney and bladder stones, and rheumatism. It is used externally to control dandruff. Nettle should not be taken by people with fluid retention caused by reduced heart or kidney function.