Health Articles
Supplements and Drugs: A Hazardous
Combination
by: Marjorie Geiser, RD, NSCA-CPT
As I have become more involved in using functional nutritional
therapy in my practice, I have come to realize that many
people are still confused about the safety and effectiveness
of various dietary supplements. Because these products
are “natural”, many feel they are always safe
to use. Although supplements and herbs can be safer than
pharmaceutical drugs, they can still function as drugs
in the body and should be used with caution and respect.
It is estimated that over 80% of the world’s population
and 60 million Americans use some form of complementary
and alternative medicine (CAM). However, although many
believe CAM compliments their current traditional healthcare,
most do not inform their physicians that they are taking
these products. And, many providers don’t ask or
discuss CAM use with their patients, although one survey
of 181 cardiologists found that half of them took antioxidant
vitamins, themselves.
What many people don’t realize is that there is no
regulatory agency in charge of the supplement industry.
Herbal products are not tested for purity, effectiveness
and safety as drugs are. In 1994, the Dietary Supplement
Health and Education Act (DSHEA) was enacted that requires
the FDA to prove beyond any doubt that a supplement is
unsafe before removing it from the market. Other than
regulating what can be included on the label, they are
unable to enforce any other regulation.
There is no incentive for supplement companies to conduct
research because they are unable to patent ‘natural’
products. Those marketing herbs and other supplements
save millions of dollars not spent on research, or worse,
yet, conduct their own “research”, which often
does not include rigorous controls. Although there are
many excellent and reputable supplement companies on the
market, the typical consumer is unlikely to know who the
credible ones are. Many independent sales representatives
only know what the company tells them, and are as unaware
as the consumer.
Even if the supplements are pure and not harmful by themselves,
problems arise when combined with drugs. Dietary supplements
may compete with drugs, leading to toxicity or treatment
failure of that drug. An estimated 4 million people are
at risk for herbal-prescription drug interactions. Here
is a list of the most common interactions between supplements
and drugs:
Warfarin (Coumadin) is used to prevent blood clotting
for those at risk for deep vein thrombosis, stroke, or
heart attack. Supplements that can change bleeding time
controlled by this drug include flaxseed oil and fish
oil supplements, goldenseal, saw palmetto, feverfew, garlic,
ginseng, and willow bark, just to name a few.
Digoxin is another heart medication. Ginseng has been
noted to falsely elevate blood digoxin levels. Some herbs
that will affect drug effectiveness include senna, licorice,
aloe, cascara, hawthorne, foxglove, goldenseal and guar
gum.
Phenytoin is a drug used for seizures. Herbal interactions
to be aware of include ginkgo biloba, white willow, lemon
balm, skull cap, kava kava, and valerian root, to name
a few. It is also important to know that Folate supplementation
is necessary with Phenytoin, but excess Folate can be
harmful.
It’s important to take calcium supplements and vitamin
D two hours apart from taking either Phenytoin or Digoxin
in order to not interfere with these drug’s effects.
Of particular concern are interactions with the herb St.
John’s Wort, which is taken by 7.5 million Americans
as a depression remedy. This herb can cause serious consequences
when taken with drugs such as Prozac, Zoloft, or Paxil,
as well as warfarin, cyclosporine, and oral contraceptives.
This herb may also interact with Digoxin, chemotherapy
drugs, and other drugs, causing treatment failure. Some
of these interactions are serious enough that if St. John’s
Wort were a drug, the government would restrict marketing,
make it a prescription-only item, or require label warnings.
So, what can one do??
Anyone taking a dietary supplement should first do their
homework. Know exactly what the purpose of a particular
supplement is for and learn all known interactions. There
are many excellent informational websites on the internet.
A good rule of thumb is to look for a site that does not
offer products for sale!
It’s also important to inform your healthcare professional
what supplements you are taking, in order to avoid potential
supplement-drug interactions that could put you at medical
risk. Although many credible professionals sell products,
there are just as many who sell products but don’t
really understand the physiology of the human body and
are just out to make money. Supplement sales is a very
popular ‘easy’ way to make money today!
It’s just as important to do one’s homework
when looking for a complementary care practitioner. Although
this is only one set of criteria, the best recommendation
is to look for one or any of these: A pharmacist or registered
dietitian who is educated in medicinal herbs, a physician
who specializes in functional medicine, or an MD, OD,
ND, DC, PharmD or RD who also has the CCN credential.
Don’t be afraid to take supplements. They serve a
very beneficial purpose. But do know why you’re taking
each supplement, just as you should know why you take
any prescription medications. Be an informed consumer
and take responsibility for your health and wellbeing.
About The Author
Marjorie Geiser has been teaching health, fitness and
nutrition since 1982. She is a nutritionist, registered
dietitian, certified personal trainer and life coach.
As the owner of MEG Fitness, Marjorie’s goal for
her clients is to help them incorporate healthy eating
and fitness into their busy lives. To learn more about
the services Margie offers, go to her website at www.megfit.com
or email her at Margie@megfit.com. |
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