Drug Abuse

Supplements and Drugs A Hazardous Combination

By: Marjorie Geiser, RD, NSCA-CPT

As I have become more involved in using functional nutritionaltherapy in my practice, I have come to realize that many people arestill confused about the safety and effectiveness of variousdietary supplements. Because these products are“natural”, many feel they are always safe to use.Although supplements and herbs can be safer than pharmaceuticaldrugs, they can still function as drugs in the body and should beused with caution and respect.

It is estimated that over 80% of the world's populationand 60 million Americans use some form of complementary andalternative medicine (CAM). However, although many believe CAMcompliments their current traditional healthcare, most do notinform their physicians that they are taking these products. And,many providers don't ask or discuss CAM use with theirpatients, although one survey of 181 cardiologists found that halfof them took antioxidant vitamins, themselves.

What many people don't realize is that there is noregulatory agency in charge of the supplement industry. Herbalproducts are not tested for purity, effectiveness and safety asdrugs are. In 1994, the Dietary Supplement Health and Education Act(DSHEA) was enacted that requires the FDA to prove beyond any doubtthat a supplement is unsafe before removing it from the market.Other than regulating what can be included on the label, they areunable to enforce any other regulation.

There is no incentive for supplement companies to conductresearch because they are unable to patent 'natural'products. Those marketing herbs and other supplements save millionsof dollars not spent on research, or worse, yet, conduct their own“research”, which often does not include rigorouscontrols. Although there are many excellent and reputablesupplement companies on the market, the typical consumer isunlikely to know who the credible ones are. Many independent salesrepresentatives only know what the company tells them, and are asunaware as the consumer.

Even if the supplements are pure and not harmful by themselves,problems arise when combined with drugs. Dietary supplements maycompete with drugs, leading to toxicity or treatment failure ofthat drug. An estimated 4 million people are at risk forherbal-prescription drug interactions. Here is a list of the mostcommon interactions between supplements and drugs:

* Warfarin (Coumadin) is used to prevent blood clotting for thoseat risk for deep vein thrombosis, stroke, or heart attack.Supplements that can change bleeding time controlled by this druginclude flaxseed oil and fish oil supplements, goldenseal, sawpalmetto, feverfew, garlic, ginseng, and willow bark, just to namea few.
* Digoxin is another heart medication. Ginseng has been noted tofalsely elevate blood digoxin levels. Some herbs that will affectdrug effectiveness include senna, licorice, aloe, cascara,hawthorne, foxglove, goldenseal and guar gum.
* Phenytoin is a drug used for seizures. Herbal interactions tobe aware of include ginkgo biloba, white willow, lemon balm, skullcap, kava kava, and valerian root, to name a few. It is alsoimportant to know that Folate supplementation is necessary withPhenytoin, but excess Folate can be harmful.
* It's important to take calcium supplements and vitamin Dtwo hours apart from taking either Phenytoin or Digoxin in order tonot 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 adepression remedy. This herb can cause serious consequences whentaken with drugs such as Prozac, Zoloft, or Paxil, as well aswarfarin, cyclosporine, and oral contraceptives. This herb may alsointeract with Digoxin, chemotherapy drugs, and other drugs, causingtreatment failure. Some of these interactions are serious enoughthat if St. John's Wort were a drug, the government wouldrestrict marketing, make it a prescription-only item, or requirelabel warnings.
So, what can one do??

Anyone taking a dietary supplement should first do theirhomework. Know exactly what the purpose of a particular supplementis for and learn all known interactions. There are many excellentinformational websites on the internet. A good rule of thumb is tolook for a site that does not offer products for sale!

It's also important to inform your healthcare professionalwhat supplements you are taking, in order to avoid potentialsupplement-drug interactions that could put you at medical risk.Although many credible professionals sell products, there are justas many who sell products but don't really understand thephysiology of the human body and are just out to make money.Supplement sales is a very popular 'easy' way to makemoney today!

It's just as important to do one's homework whenlooking for a complementary care practitioner. Although this isonly one set of criteria, the best recommendation is to look forone or any of these: A pharmacist or registered dietitian who iseducated in medicinal herbs, a physician who specializes infunctional medicine, or an MD, OD, ND, DC, PharmD or RD who alsohas the CCN credential.

Don't be afraid to take supplements. They serve a verybeneficial purpose. But do know why you're taking eachsupplement, just as you should know why you take any prescriptionmedications. Be an informed consumer and take responsibility foryour health and wellbeing.
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Marjorie Geiser has been teaching health, fitness and nutritionsince 1982. She is a nutritionist, registered dietitian, certifiedpersonal trainer and life coach. As the owner of MEG Fitness,Marjorie's goal for her clients is to help them incorporatehealthy eating and fitness into their busy lives. To learn moreabout the services Margie offers, go to her website at www.megfit.com oremail her at Margie@megfit.