If anything, use of herbal supplements is increasing and while patients are well-intentioned, it can wreck havoc of lab results and traditional therapies.
In promoting his recently released book Dennis Citrin, MD, ChP, PhD, Cancer Treatment Centers of America Midwestern Regional Medical Center oncologist, said poor education surrounding herbal supplements caused women to "self-treat" cancer without consulting a medical doctor. Botanicals may interfere with nutrients from therapies. In his study, 73% of women used a dietary supplement and 53% of them did not consult a healthcare professional.
"We must create a dialogue so patients know we are respectful of their beliefs if they've been using alternative medicine for a long time," Citrin said.
Amitava Dagsputa, PhD, DABCC, professor of pathology and laboratory medicine at the University of Texas, has literally written the book on the chaos herbal medicines bring on lab results. Though some herbs are generally safe, others can yield abnormal test results in an otherwise healthy individual, drug-herb interactions, or interference between the herb component and immunoassay.
"The most serious drug interactions occur when herbal supplements interact with warfarin," he said.
Warfarin interfaces dangerously with St. John's Wort, the popular commercially-sold antidepressant for those with mild symptoms. St. John's Wort is dried alcoholic extract of hypericin, which contains about 1% hyperforin, the active ingredient. Interactions with warfarin are said to be clinically significant if hyperforin content is greater than 1%. So, according to Dagsputa, there's a high risk of treatment failure for patients taking immunosuppressants, warfarin or HIV protease inhibitors in addition to St. John's Wort.
"You need INR control in all patients on warfarin," commented Dagsputa. "When herbal supplements come into play, it can really cause serious problems. We tell all of our patients in the Coumadin clinic not to use supplements. If they don't listen, they can have bleeding issues."
Abnormal Liver Function Results
It's all too common for certain herbal supplements to cause significant liver damage. Dagsputa pointed to kava, chaparral, germander, mistletoe, pennyroyal oil, green tea extract, and noni juice as having significant hepatitixicity.
These supplements have elevated concentrations of alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphates (ALP) and gamma glutamyl transpeptidase (GGT) in serum, which are all common causes of elevated liver enzymes.
Consequences can be severe. Dagsputa recalled the case of a 50-year old man who took two to four kava capsules daily for two months, though the maximum recommended dose is three capsules. His liver function test revealed a 60-70-fold increase in AST and ALT. He eventually received a liver transplant.
In a second example, Dagsputa proved that a candid patient-clinician dialogue helped avert a potentially dangerous outcome. A 45-year old man presented to an outpatient department with complaints of nausea, malaise, fatigue, loss of appetite and non-specific thoracic discomfort. Lab tests disclosed significant elevations in LDH and GGT enzymes, although total bilirubin was normal. He was diagnosed with acute viral hepatitis but all serological tests for this condition turned up negative.
When the patient mentioned that he was drinking Noni juice, a Polynesian herbal remedy made from tropical fruit for 3 weeks prior to symptom development, the mystery was solved. He discontinued drinking the juice and liver enzymes returned to normal within a month.
Patients with diabetes have a lot to risk by taking some herbal supplements and omitting this information to providers.
Though many supplements, namely ginseng, fenugreek, garlic, bitter melon, gymnema, psyllium, bilberry, dandelion, burdock, prickly pear cactus and chromium, can lower serum glucose levels, Dagsputa said these levels should be maintained only by diet, exercise, oral drugs and insulin.
"Sometimes, patients take herbal supplements without their doctor's approval and experience low glucose in serum," he said. "Hypoglycemia may cause dizziness, general weakness and fatigue. Severe hypoglycemia (serum glucose less than 50 mg/dL) may create a medical emergency when the patient feels faint. Death may result from serum glucose levels less than 40 mg/dL."
Though some supplements show promise in controlling high glucose in blood, a patient also taking insulin or oral medication for diabetes would need considerably lower amounts of prescription medication or risk severe hypoglycemia.
Renal failure is another serious concern for diabetic patients taking herbal supplements. Renal function is determined by measuring concentrations of creatinine and urea in blood. Creatinine clearance is a measure of the renal function test and is calculated by measuring serum creatinine and 24-hour urine creatinine and then accounting for body mass index. Many Chinese weight loss herbs may induce acute renal failure, said Dagsputa.
Abnormal Thyroid Test
The herbal supplement kelp is rich in iodine, as sea weeds are used in their preparation. Regular salt usually fills the daily iodine requirement. Patients using kelp typically have iodine excesses, which can create an abnormal thyroid profile.
"We know that 25% of the population tries herbal supplements," said Dagsputa. "Though some are safe, the potential for interactions or flawed lab tests is still very high."
Robin Hocevar is on staff at ADVANCE. Contact firstname.lastname@example.org.