Herbal Supplements- What you need to know and how to ask.

1. Herbal Supplements - what
you need to know and how
to ask
Brown Bag series
10/3/13
Elizabeth Bade, MD

2. 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!

3. What do I need to know?
 Are they safe?
 Do they work?

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 Doesn’t have to prove safety prior to supplement release, only can be withdrawn

6. 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

8. 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

9. Pop Quiz!!
 What is the most common herbal supplement taken by Americans?
 A. Glucosamine
 B. Fish oil
 C. Echinacea
 D. Saw Palmetto
 E. Ginseng

10. Pop Quiz!!
 What is the most common herbal supplement taken by Americans?
 A. Glucosamine
 B. Fish oil
 C. Echinacea
 D. Saw Palmetto
 E. Ginsing

11. 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

12. 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

13. Trusted Resources
 http://familydoctor.org/familydoctor/en/prevention-wellness/foodnutrition/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

14. Name of remedy
Uses
Ephedra(Ephedra sinica, To treat coughs and
also called Ma-Huang) obesity
Risks
Dangerous and lifethreatening 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 bloodthinning drugs.
Goldenseal(Hydrastis
canadensis)
May decrease or
increase blood pressure.
Berberine (ingredient of
goldenseal) has also
To alleviate constipation.
been associated with
Acts as an antiheart rhythm
inflammatory
abnormalities. Increases
the risk of bleeding when
taken with bloodthinning drugs.
Hawthorn(Crataegus
species)
To alleviate congestive
heart failure and high
blood pressure
Increases the risk of
bleeding when taken
with blood-thinning
drugs.
May increase blood
Licorice root(Glycyrrhiza To treat coughs, cirrhosis, pressure and has been
glabra)
and stomach ulcers
associated with heart
rhythm abnormalities.

15. 
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.