Risks of Mixing Drugs with Herbal, Dietary and Energy Supplements

In the past several decades, the number of people taking herbal, dietary and energy supplements has increased exponentially. Whereas, prior to the late 1980s, most patients were unlikely to be supplementing with anything other than multivitamins, now a doctor must expect the majority of the population to have read about their condition on the Internet and be using whatever complementary remedies they think might help, with or without expert guidance. Once seen as natural and harmless, it is now clear that herbal supplements, dietary supplements and energy supplements can interact with conventional medications just as conventional medications can interact with each other.

It is important to note that many complementary medicines are quite safe to take alongside most forms of pharmaceutical drugs, and a cup of nettle or chamomile tea together with your morning pill of whatever form is not going to have any deleterious effect. However, a little awareness goes a long way and it is good to know of the more serious risks of mixing conventional drugs with supplementary remedies.

The risks of taking medications together, whether conventional or complementary, are threefold:

1. The action of the drug, or supplement, may be increased

2. The action of the drug, or supplement, may be reduced

3. The rate and degree at which the drug or supplement is absorbed or eliminated may be altered.

Medications are prescribed at a certain dose in order to achieve a specific effect, so increasing or reducing the effectiveness of a medicine is potentially risky, especially in the case of life sustaining treatments. Many conventional medicines are based on chemicals that are also found in plants, so herbal medicines taken for a particular disease may have the same action as a pharmaceutical taken for the same reason and can result in an effective overdose.

One example of this is aspirin, which was originally derived from plants and herbal anti-inflammatories containing salicylic acid, the active ingredient of aspirin. Such herbs include willow bark, meadowsweet and wintergreen.  Salicylic acid is toxic in large quantities, so these herbs should clearly be avoided if taking aspirin.

Other examples of interactions that increase the effect of medications include taking kelp with drugs for hypothyroidism and herbal diuretics such as dandelion, globe artichoke and celery seed with diuretic drugs. Niacin (vitamin B3), calcium and/or magnesium taken in combination with hypotensive pills can lead to a greater than expected drop in blood pressure. Except under expert guidance, the blood thinner Warfarin should never be taken with a medication that decreases blood clotting, whether conventional or complementary, due to the risk of hemorrhage. Supplements such as cayenne, garlic, feverfew, willow bark, St John’s wort and the drug aspirin all fall into this category. Hawthorn berries increase the action of digoxin on the heart, with potentially fatal effects, and the adaptogen herb Siberian ginseng (Eleutherococcus) also increases digoxin levels in the blood.

Examples of drug and supplement combinations that can decrease the effectiveness of either are taking supplements that stimulate the immune system such as zinc, Astragalus and Echinacea with corticosteroids intended to suppress the immune system, as they are working in opposite directions. Also, remedies with a hyperglycemic (blood sugar raising) action such as celery seed, Bupleurum, rosemary and Gotu kola can counteract the hypoglycemic (blood sugar reducing) work of diabetic drugs. High doses of vitamins A, C and K can all decrease the anticoagulant activity of Warfarin.

If the absorption or elimination of a drug or supplement is altered due to taking something else at the same time, its effectiveness may be at risk. The drug may either be absorbed too quickly or excreted before it has a chance to work. Diuretic remedies are particularly problematic, because of increased elimination, and herbs with this effect include juniper, dandelion, celery seed and licorice. These are certainly to be avoided when taking lithium. Grapefruit juice, while not really a supplement, is also a concern when taken with several drugs, such as hypotensives and the immunosuppressant Cyclosporine, since it reduces the breakdown of the medicine in the body.

Although a comprehensive treatment of the risk of mixing conventional medicines and nutritional and herbal supplements is well outside the intention of this short article, it is hoped that this article serves to communicate the potential problems that may arise and some of the more well-known bad combinations. You should always consult your doctor before taking any combination of drugs and supplements. For further information, there are a number of websites that may prove valuable in flagging most of the riskiest drug-herb-supplement interactions. These include Herb-Drug interactions at i-care.net (http://www.i-care.net/herbdrug.htm), the herb and supplement database at Medline, which includes known drug interactions (http://www.nlm.nih.gov/medlineplus/druginfo/herb_All.html) and a paper on herb-drug interactions published in The Lancet (http://www.ncbi.nlm.nih.gov/pubmed/10675182).

Dr. P. Dubois, CCSP, DC.

Related articles

• Hidden Dangers of Herbal Supplements (rodgermarion.com)
• Physicians Need to Recognise the Use of Herbal Supplements While Breastfeeding (medindia.net)
• Study finds physicians need to better recognize use of herbal supplements while breastfeeding (medicalnewstoday.com)

 

What Type of Glucosamine Supplement is Best?

With the dozens of brands and different types of glucosamine supplements available, how do you know which is the most effective one to choose?  The majority of glucosamine supplements on the market come with other substances included, such as chondroitin sulfate and methylsulfonylmethane (MSM), which are advertised as making glucosamine more effective.  However, in recent years, there have been a host of scientific studies performed on the effectiveness (or ineffectiveness) of glucosamine in treating joint pain, and the studies have revealed that not all glucosamine is the same.

Glucosamine supplements come in two different basic forms: glucosamine sulfate and glucosamine hydrochloride.  A number of meta-analyses that have examined the effectiveness of glucosamine alone have found that glucosamine hydrochloride was essentially no more effective than placebo in reducing joint pain, with or without the addition of chondroitin or other dietary supplements promoted for treating joint pain.  However, in a number of studies, taking 1,500 mg of oral crystalline glucosamine sulfate has proven effective in relieving pain and stiffness in the joints, particularly in those who suffer from knee pain.

Presently, only a single pharmaceutical company (Rottapharm, marketed under the DONA™ brand in the US) manufactures crystalline glucosamine sulfate (using a patented process), so it seems likely that almost anything else you find on the shelves of your local health food store will be ineffective (apart from a possible placebo effect).

Two three-year studies reported that DONA™ crystalline glucosamine sulfate was an effective supplement.  The first study, published in The Lancet in 2001, found that there was less joint space loss in those taking the glucosamine sulfate as compared with placebo.  The second study, reported in JAMA’s Archives of Internal Medicine in 2003,found similar results to the previous study and concluded that these results “suggest that glucosamine sulfate could be a disease modifying agent in osteoarthritis.”  It should be noted, however, that both of these studies were industry-funded, so there may be some bias involved in the results.  That said, if you plan on giving glucosamine a try, DONA™ is the most likely form of glucosamine to be effective in relieving your joint pain.

Though some forms of glucosamine are synthesized from fermented corn, if you are vegan, crystalline glucosamine sulfate will not be for you, as it is made from shellfish exoskeletons and there are no alternatives currently manufactured.  Those with shellfish allergies are in luck, however, as the manufacturer of DONA™ states that there is no problem for those with shellfish allergies taking their product, as it is chemically synthesized from highly purified chitin, which is not the allergen responsible for causing allergic reactions to shellfish.  However, if you do have a shellfish allergy, it’s always a good idea consult your doctor before taking glucosamine sulfate, just to be sure.

 

Dr Dubois, DC, CCSP

Dr. Dubois,a Swiss physician, and a Triangle Certified Sport Chiropractor has over 20 years of experience in the treatment and prevention of disorders of the musculoskeletal system. Amongst his patients, two world champions in martial arts (gold medalists in 2005 WMJA), one carrier of the Olympic flame in 2004, and numerous soccer players, swimmers and athletes of all levels who benefited from his chiropractic care.

 

Do Glucosamine Supplements Really Help Reduce Joint Pain? What Does the Science Say?

Glucosamine is currently one of the most commonly used dietary supplements in the US. With major increases in the rate of obesity and the osteoarthritis that often stems from it, many people are eager to find a solution to their joint pain (particularly in the knees and hips) that does not also cause significant side effects. However, there is still a significant amount of controversy surrounding its efficacy.

An essential element that helps keep joint cartilage healthy, glucosamine levels naturally drop as we age, which can lead to deterioration of the joints. Cartilage is made up of water, collagen and proteoglycans. Proteoglycans hold many times their weight in water and are arranged like a net that is the supporting structure for collagen and that keeps it lubricated. If the proteoglycans weaken, they can break and form “holes” in the net, allowing the collagen to leak out, weaken the structure of the cartilage and reduce the amount of synovial fluid in the joint.

Glucosamine is a major building block of proteoglycan synthesis and stimulates cells to produce more of them. This means that a drop in glucosamine leads to an eventual deterioration of the cartilage. However, the question now is whether glucosamine supplementation makes any difference in the amount of glucosamine in the joints, and if so, whether there is any beneficial effect. Based on recent meta-studies, some researchers believe the jury is still out.

The results of a meta-analysis published in the journal BMJ in 2010, which examined 10 trials consisting of a total of almost 4,000 people, found that glucosamine, chondroitin and the combination of the two did not alleviate joint pain or have any impact on the reduction of joint space, compared with placebo. However, it is important to note that glucosamine comes in different forms (the two primary ones being glucosamine sulfate and glucosamine hydrochloride), and the meta-analysis included trials using both forms. As a result, the analysis did not necessarily compare like with like.

Unsurprisingly, the researchers found that industry-funded studies were more likely to report that glucosamine reduced joint pain than independently funded studies. However, a 2005 Cochrane meta-analysis of randomized controlled trials evaluating the effect of glucosamine included 25 studies with nearly 5000 participants. When investigators discarded the low-quality and older studies, they concluded that glucosamine did not have any effect on joint pain that was superior to placebo except for one type, crystalline glucosamine sulfate, manufactured by Rottapharm, which did prove superior to placebo.

BMJ researchers said that many patients believed that glucosamine was beneficial for their joint pain, whether or not it was due to the placebo effect. They also noted, “We are confident that neither of the preparations is dangerous. Therefore, we see no harm in having patients continue these preparations as long as they perceive a benefit and cover the costs of treatment themselves.”

Further high-quality studies of the various types of glucosamine are necessary to sort out the benefits (or lack of benefits). For now the bottom line on the science is that glucosamine may or may not help relieve your joint pain.  That said, the consensus of researchers is that trying it will do no harm.

If you or someone you care about is experiencing joint pain and would like to learn more about treatment options, please give us a call or visit the office.

 

 

Dr. P. Dubois, DC, CCSP.

Dr. Dubois, a Swiss physician, and a Triangle Certified Sport Chiropractor has over 20 years of experience in the treatment and prevention of disorders of the musculoskeletal system. Amongst his patients, two world champions in martial arts (gold medalists in 2005 WMJA), one carrier of the Olympic flame in 2004, and numerous soccer players, swimmers and athletes of all levels who benefited from his chiropractic care.

 

 

Does it Matter Where I Get My Probiotics? Aren’t They All the Same?

 

Our intestines contain over 400 species of microorganism that help with the digestive process and prevent the growth of harmful pathogens in the bowel. Keeping our internal ecology in order is therefore very important, but a number of factors can upset the balance of organisms such as unhealthy eating, age, illness and certain medications.

Probiotics (also known as good or friendly bacteria) are live microorganisms that are similar to those found in the digestive tract. Examples include bacteria from the genus Lactobacillus (such as L. acidophilus and L. casei) and Bifidobacterium (e.g. B. infantalis and B. animalis). Ingesting probiotics in live yogurt (yogurt containing good bacteria) or as a dietary supplement is commonly thought to have a beneficial effect on the intestines by maintaining a healthy balance of gut bacteria.  Advertising reinforces this idea.

Probiotic supplements from a number of different manufacturers can be found in most health food stores at a variety of prices. The question is, do some of these work better than others or should we just buy the cheapest brand and be done with it? Are they effective at all? On the other hand, might it be better to consume probiotics in another form altogether, such as live yogurt or probiotic fruit juice? Probiotics also occur naturally in other foods such as miso, kefir and fermented soy products.  What’s the truth?

Let’s start with yogurt. It has been suggested that live yogurt is actually a very ineffective source of probiotics, as the presence of micro-organisms is at a relatively low dose and they have no protection to ensure that they survive the less than friendly stomach acids to actually make it as far as the bowel. The effect of other natural probiotic foods is thought to be similarly minimal in impact.

Given that the gut contains over 100 trillion microorganisms, it needs a pretty large number of probiotic microbes to have any effect at all on the internal ecology of the bowel. For this reason, low-strength probiotic supplements containing less than 10 million CFU (colony forming units) of bacteria are thought to be just as unhelpful as yogurt or other natural foods, unless the supplement is either enterically coated or contains acid-resistant bacteria, both of which help survival in the stomach.

The CFU number of a probiotic supplement is a good general guide as to how effective it might be, but other factors are also important. A single-strain supplement (containing just a single probiotic species) will not be able to work anywhere near as effectively as one containing multiple strains of good bacteria.

However, it is not necessarily the case that a supplement containing more strains will be better than one containing fewer, since each additional strain is present in proportionally lower numbers. Recent studies suggest that between three and seven strains are optimal for effectiveness, and any species present in numbers fewer than 2 million CFU are pretty much a waste of space. In addition, some species of good bacteria are themselves ineffective. Strains from the genus Lactobacillus and Bifidobacterium are thought to be the most reliable. Some strains of Saccharmyces , such as S. boulardi,  may also be effective.

In addition to buying a quality supplement in the first place, there are some other things you can do to improve the effectiveness of your probiotic. First, always keep your probiotics in the refrigerator. Second, consume foods known as prebiotics that improve the growth of good bacteria. Prebiotics include the amino acids lysine and methionine, which are found in proteins such as whey and fish, and galactose, which is a constituent of dairy products and sugar beets.

Neck Pain? Back Pain? Call us, we can help 919-484-1400

Dr. P. Dubois, DC, CCSP

Dr. Dubois,a Swiss physician, and a Triangle Certified Sport Chiropractor has over 20 years of experience in the treatment and prevention of disorders of the musculoskeletal system.Amongst his patients, two world champions in martial arts (gold medalists in 2005 WMJA), one carrier of the Olympic flame in 2004, and numerous soccer players, swimmers and athletes of all levels who benefited from his chiropractic care.

 

Risks of Mixing Drugs with Herbal, Dietary and Energy Supplements

In the past several decades, the number of people taking herbal, dietary and energy supplements has increased exponentially. Whereas, prior to the late 1980s, most patients were unlikely to be supplementing with anything other than multivitamins, now a doctor must expect the majority of the population to have read about their condition on the Internet and be using whatever complementary remedies they think might help, with or without expert guidance. Once seen as natural and harmless, it is now clear that herbal supplements, dietary supplements and energy supplements can interact with conventional medications just as conventional medications can interact with each other.

It is important to note that many complementary medicines are quite safe to take alongside most forms of pharmaceutical drugs, and a cup of nettle or chamomile tea together with your morning pill of whatever form is not going to have any deleterious effect. However, a little awareness goes a long way and it is good to know of the more serious risks of mixing conventional drugs with supplementary remedies.

The risks of taking medications together, whether conventional or complementary, are threefold:

1. The action of the drug, or supplement, may be increased

2. The action of the drug, or supplement, may be reduced

3. The rate and degree at which the drug or supplement is absorbed or eliminated may be altered.

 

Medications are prescribed at a certain dose in order to achieve a specific effect, so increasing or reducing the effectiveness of a medicine is potentially risky, especially in the case of life sustaining treatments. Many conventional medicines are based on chemicals that are also found in plants, so herbal medicines taken for a particular disease may have the same action as a pharmaceutical taken for the same reason and can result in an effective overdose.

One example of this is aspirin, which was originally derived from plants and herbal anti-inflammatories containing salicylic acid, the active ingredient of aspirin. Such herbs include willow bark, meadowsweet and wintergreen.  Salicylic acid is toxic in large quantities, so these herbs should clearly be avoided if taking aspirin.

Other examples of interactions that increase the effect of medications include taking kelp with drugs for hypothyroidism and herbal diuretics such as dandelion, globe artichoke and celery seed with diuretic drugs. Niacin (vitamin B3), calcium and/or magnesium taken in combination with hypotensive pills can lead to a greater than expected drop in blood pressure. Except under expert guidance, the blood thinner Warfarin should never be taken with a medication that decreases blood clotting, whether conventional or complementary, due to the risk of hemorrhage. Supplements such as cayenne, garlic, feverfew, willow bark, St John’s wort and the drug aspirin all fall into this category. Hawthorn berries increase the action of digoxin on the heart, with potentially fatal effects, and the adaptogen herb Siberian ginseng (Eleutherococcus) also increases digoxin levels in the blood.

Examples of drug and supplement combinations that can decrease the effectiveness of either are taking supplements that stimulate the immune system such as zinc, Astragalus and Echinacea with corticosteroids intended to suppress the immune system, as they are working in opposite directions. Also, remedies with a hyperglycemic (blood sugar raising) action such as celery seed, Bupleurum, rosemary and Gotu kola can counteract the hypoglycemic (blood sugar reducing) work of diabetic drugs. High doses of vitamins A, C and K can all decrease the anticoagulant activity of Warfarin.

If the absorption or elimination of a drug or supplement is altered due to taking something else at the same time, its effectiveness may be at risk. The drug may either be absorbed too quickly or excreted before it has a chance to work. Diuretic remedies are particularly problematic, because of increased elimination, and herbs with this effect include juniper, dandelion, celery seed and licorice. These are certainly to be avoided when taking lithium. Grapefruit juice, while not really a supplement, is also a concern when taken with several drugs, such as hypotensives and the immunosuppressant Cyclosporine, since it reduces the breakdown of the medicine in the body.

Although a comprehensive treatment of the risk of mixing conventional medicines and nutritional and herbal supplements is well outside the intention of this short article, it is hoped that this article serves to communicate the potential problems that may arise and some of the more well-known bad combinations. You should always consult your doctor before taking any combination of drugs and supplements. For further information, there are a number of websites that may prove valuable in flagging most of the riskiest drug-herb-supplement interactions. These include Herb–Drug interactions at i-care.net (http://www.i-care.net/herbdrug.htm), the herb and supplement database at Medline, which includes known drug interactions (http://www.nlm.nih.gov/medlineplus/druginfo/herb_All.html) and a paper on herb-drug interactions published in The Lancet (http://www.ncbi.nlm.nih.gov/pubmed/10675182).

Dr. P. Dubois, DC, CCSP.