North Hills News Record, April 1, 1999
RISKY HERBS
Know the danger natural remedies, supplements can pose, doctors say
By Laure Cioffi, Staff writer

After going through chemotherapy and taking other drugs to ward off breast cancer, Rita Kirin decided she wanted to take a natural route.

"I've always believed in vitamins," said the 77-year-old Hampton woman.

But she worried about the effects those natural remedies could have on her cancer treatment medication and went to her doctor for answers.

It is a good practice, medical experts say but not something everyone does.

The American Medical Association reports that about 70 percent of people taking herbs do not tell their doctors or pharmacists.

"They figure because it's natural, that it's OK. They don't think about interaction with other medications. It's a real problem. Some of these things are actually dangerous," said Dr. Randy Dalbow, an internist who practices in Pine and is on staff at UPMC Passavant.

Dalbow has had patients come into his office with elevated blood pressure, and after a little investigation, he has found they were taking herbal drugs such as mahuang or ephedra - both billed as stimulants that can be dangerous for someone who already has high blood pressure.

Elevated blood pressure is just one result, other risks range from an increased chance at getting a sunburn to heart attack or stroke.

There are no regulations stipulating how or where these natural remedies are sold. They can be found in grocery stores, convenience stores and nutritional outlets.

"They can do a lot of harm. Unfortunately, the people in a lot of these stores (that sell herbs and vitamins), they mean well but are limited in their training," said Linda Mehri, an alternative health counselor who works in Mars.

She advises people who come to her for vitamins and herbs to consult medical doctor.

"You should never exclude a doctor. If he doesn't have any idea you are on an herbal medication, he could prescribe something that could end up harming you," she said.

But most still keep what they take from their doctors.

"Most people will not tell their doctors they are taking an herb. They fear being reprimanded or laughed at," said Dan Wagner, owner of NutriFarmacy in Hampton. Wagner is a pharmacist who sells herbs and vitamins and counsels people on their uses.

Not knowing the effects of a vitamin or mineral or how it can react to other medication and foods can be dangerous.

Overdosing or double dosing with an herb or vitamin is common, Mehri said.

For example, ginseng, a natural blood pressure elevator, could make high blood pressure medicine ineffective; garlic and aspirin both work as blood thinners, giving a person a double dose; and some vitamins cannot be digested unless taken with food, she said.

There also are concerns about where some of these herbs are grown.

"There are a lot of irregularities in this business. It's always important to have professional intervention," Wagner said.

There are no regulations to say how herbs should be grown, and some are not grown in the best conditions, he said.

"Some of them have been toxic to the liver in the past. They are not regulated by the Food and Drug Administration, so they are not tested to be nontoxic. Just because they are labeled as being natural, people assume this is safe," Dalbow said.

Wagner and Mehri say they use brands they know and trust. But natural remedies are not always the best way to treat a problem.

"The bottom line is, 'let's eat a better diet,'" Wagner said. "You won't need to supplement your diet if you eat a better diet."

But if you do want to take a dietary supplement, consult a doctor or pharmacist, Dalbow said.

Pharmacist Dan Wagner, owner if NutriFarmacy in Hampton, sells herbs and vitamins and counsels people on their uses. Not knowing the effects of an herb, vitamin or mineral and how it can react to other medication and foods can be dangerous.


VITAMINS (Source: The Allegheny County Health Department)

*Vitamin A from animal sources, such as cod liver oil or desiccated liver, must be limited per day to 5,000 International Units, or 1000 micrograms RE, retinol equivalence, unless prescribed by a physician. Larger amounts of this type of Vitamin A can harm the liver over time.

*Vitamin D can be harmful in large amounts. Adults should take no more than 2000 International Units per day, unless prescribed by a physician. The recommended daily allowance for adults is 200 to 400 international units, an amount often found in multi-vitamin supplements and some calcium supplements.

*If you do not have 2-4 servings per day of dairy products you might need supplements for calcium, but never exceed 2500 milligrams per day. Ask your doctor or dietician how much you should have. Because multi-vitamins and mineral supplements do not provide large amounts of calcium, you might have to take a calcium supplement as well.

*The recommended daily dosage for niacin, one of the B vitamins, is 15 milligrams for adults. When taken in doses of 100 milligrams or more per day, niacin can cause headaches, leg cramps and flushing of the skin.

*Supplements with large doses of only one or two minerals such as zinc and magnesium, can cause problems. Too much of one can prevent you from absorbing another.

*No one, especially women who are no longer menstruating and men, should take an iron supplement unless they have iron deficiency-anemia, and iron is prescribed by their physician. Take iron supplements with orange juice or water, not milk. When taking an iron supplement, you should be re-tested in a few months to see whether your condition is improved and you can stop taking the supplement.


HERBS (Source: Pharmacist Dan Wagner)

*Echinacea could cause problems for insulin-dependent diabetics or people with auto-immune disease like lupus, rheumatoid arthritis, hepatitis, ulcerative colitis and scleroderma.

*Ginko might alter the effects Coumadin, a drug that keeps blood from clotting, so do not mix. It might alter insulin requirements in diabetics. This herb has estrogenic activity. Do not use it with Tamoxifin.

*Ginseng might antagonize the use of Coumadin, so do not mix. Also, be cautious when using it in combination with other psychoactive drugs and CNS depressants, such as Phenobarbital and Meprobamate. It is recommended that people with kidney disease not use it.

*Garlic should not be used in combination with Colchicine, which is used for gout attacks. Garlic might alter the effects of Coumadin. Also do not take it with some drugs used in cancer treatments.

*Saw Palmetto should be used with caution by diabetic and hypertensive patients. Saw Palmetto's increased diuretic action might increase renal excretion of sodium, which can increase blood pressure. It might inversely affect oral and injectable diabetes agents.

*Ginger will affect absorption of some drugs, such as tetracycline. Avoid ginger when on chemotherapy because it might negatively affect platelets. Taking ginger regularly might decrease the absorption of dietary iron.


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