Sunday, October 21, 2001

Dr. Landis Lum at Kaiser Permanente's Kailua clinic
said that herbal remedies and nutritional supplements
may be harmful even if they aren't mixed
with prescribed medicines.

Experts urge caution
in herbal remedy use

They say some users fail to
realize the risk of mixing
medication with supplements

By Helen Altonn

A prominent Honolulu man, 60, was working in his office last October when he said something "knocked me out."

He was taken by ambulance to Kaiser Medical Center, where it was determined he had suffered a grand mal seizure, a life-threatening disorder produced by uncontrolled electrical activity in the brain.

"It came as a complete surprise," said the professional man, who asked not to be identified. "I had been healthy all my life."

His neurologist and family doctor were puzzled because a battery of tests showed no particular reason for the seizure. "They looked at everything; nothing stood out," he said.

Then the doctors learned their patient had been taking a bunch of off-the-shelf medicinal supplements and herbal products. He also slept only a few hours every night.

"His neurologist felt his seizure might have been due to a combination of sleep deprivation and Ginkgo biloba," said Dr. Landis Lum, the man's physician.

He was taking Ginkgo and other herbal and supplementary products to increase his energy, memory and mental alertness. "Things I pulled out of magazines that said, 'Hey, take some of this, it's good for you,' " he explained.

Joy Matsuyama, president of the Hawaii Pharmacists Association and coordinator of education and professional practice at the Queen's Medical Center, said herbals and supplements can have adverse interactions with prescription medicine.

"I think a lot of times patients don't realize it and physicians don't know it, so they're underreported," she said.

For example, St. John's wort, used for depression, interacts with other antidepressants, and some herbal stimulants that people take for weight loss could impact blood pressure, cardiac and other medicines.

"The thing about herbals, you don't know how much is in each product, even bottle to bottle. It doesn't go through the FDA (Food and Drug Administration) and no regulatory agency looks at what's exactly in the product," she said.

A product may be beneficial, Matsuyama said, "but you don't know what you need and you don't know exactly what you're getting. It might be the right dose for one and not another, and if a person is taking a lot of different things, they could interact among themselves."

Also, Matsuyama pointed out, "Some people think more is better, so they take more and more," which could destroy any therapeutic benefits and pose risks.

She urges people on prescribed medicines to clear any supplementary health products with their physician or pharmacist to make sure there are no potential problems.

Lum echoed that message. He is a physician at Kaiser Permanente's Kailua clinic and professor of medicine at the University of Hawaii John A. Burns School of Medicine.

"A lot of people feel herbs and supplements are safe and effective because they're natural," Lum said. "That's not necessarily true."

Herbal remedies and diet supplements may be harmful even without mixing them with prescribed medicines, he said.

His patient wasn't on any prescribed medicine but was using Ginkgo biloba, advanced supplement multi-mineral vitamins, vitamin E for his heart, a fish oil concentrate to maintain the triglyceride level in his blood, some fatty acids for his eyes and brain and a couple of antioxidant products.

"I read this article and it said, 'It's wonderful, all great stuff to be taken,' especially as we get a little older," the patient said. "In my case, I was fine, but all these things said, 'If you're in great shape, this will get you going.' "

The only one he felt made a difference was Ginkgo, he said. "I thought maybe it made me a little crisper."

The morning of the seizure, he had a headache, so he also took four Excederin.

He's taken nothing since the episode except anti-seizure medicine. The doctors also said he should get more sleep, he said. "But not much more because my body doesn't demand it."

He was restricted from driving until free of seizures for a year and is taking medical tests this month to see if he's able to drive again.

He said he never discussed the supplements and herbals with his doctor, which Lum said is typical. About 70 percent of the population won't tell their doctors about health products they're using off the shelf, Lum said.

However, many supplements and herbal remedies may be contaminated, mislabeled or have incorrect ingredients, he said. Since they're not regulated, there's no way of knowing what's in them.

Popular herbal remedies such as ma-huang or ephedrine, ginseng, Feverfew, St. John's wort and garlic could have many potential drug interactions, he said.

Also, some of those products can affect anesthesia and surgery.

"To be on the safe side, all herbal supplements should be stopped two weeks before surgery," Lum said.

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