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June 18, 2018  |  Login
Mixing Herbs and Pharmaceuticals
By James F. Balch, M.D. and Mark Stengler, N.D.

As herbals became America's fastest-growing branch of alternative medicine, the Western medical community was the last to find out. Herbs are ignored in medical school and have only recently begun to make occasional appearances in medical journals. When doctors are oblivious to the benefits of herbal remedies, patients are often reluctant to reveal that they are taking herbals because of embarrassment at the prospect of a stern lecture on the subject.

Sometimes, the only time a doctor finds out about an herbal-pharmaceutical mix is when a patient suddenly exhibits strange symptoms not seen with the pharmaceutical alone. At times, that mix can be deadly. Add a commercial stimulant to ginseng, and we now know that we are increasing the likelihood of a potential bad reaction. Cardiac glycosides, herbal ingredients that act on the heart, can cause arrythmia-an irregular heartbeat-when taken with a prescription diuretic. The side effects of certain selective serotonin reuptake inhibitors (SSRIs) that are used to treat cases of major depression-marketed under names such as Prozac, Paxil, or Celexa-may be magnified by Saint-John's-wort, a popular herb intended for mild to moderate cases of depression.

But most often, herbs can be an effective complement to conventional therapies. Ginger, for example, has been shown in clinical trials to limit nausea from chemotherapy. Reports from Europe-where herbs have been used longer and studied much more intensely than in the United States-indicate that pharmaceutical-herbal interactions are unusual. The symptoms of an adverse reaction are likely to be muted, if you consider the generally mild nature of herbs. When there is a reaction, it's first likely to surface as an upset stomach or a feeling of discomfort. Your first response should be to stop the remedies and get in touch with a health-care professional.

The use of standardized extracts, which are made up of specified quantities of herbal ingredients in commercially prepared remedies, is a good thing, but is likely to further complicate the use of pharmaceuticals combined with herbals. As herbal remedies are better prepared and quantified, they become more effective-and more dangerous when unknowingly mixed with pharmaceuticals.

Pharmaceutical companies have been quick to pick up on the popularity of herbs and have been careful to note which herbs and which pharmaceuticals may provoke harmful side effects. On the positive side, that has helped educate the public on the dangers of mixing. On the negative side, I've noticed that pharmaceutical companies are also quick to take the knee-jerk position of warning against all mixing-no doubt, at least in part to avoid any potential litigation, as well as a result of the age-old grudge match at work between pharmaceutical giants, which are a virtual global cartel now, and the herbal companies.

Even as doctors are being advised in a growing flood of special alerts about herbs to watch for, don't rely on your physician to make the connection. Too often, doctors are still struggling to understand the basics of herbal remedies. Medical schools typically avoid the subject of herbs in medicine. Pharmacists may understand little or nothing about herbalism, even if they can make the connection between herbs and the active ingredients in many prescription medications.

That means you have to make the connection yourself. Before mixing any herbs with any prescription medication, err on the side of caution. Aggressively go after the facts for yourself, and then go in prepared to ask your doctor questions.

Don't take "no" for an answer. If your doctor flatly rules out an herbal remedy, ask why. If you're not satisfied with your doctor's response, why not track down another physician? Wait until you find a qualified physician who has taken the time to learn how herbs work. Even if he or she may be suspicious of herbs' long-term health effects, you need to see a doctor or a qualified herbalist who can review the potential interactions and help weed out beneficial herbal remedies from the questionable ones. more

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