Ethnobotanist warns of mixing herbs with traditional medications

Many patients ‘self-medicate’ and don’t tell physicians

If you take herbs for medical purposes, tell your doctor. If you are a physician or nurse treating a patient, ask what herbs the patient might be taking and consider the consequences related to possible interactions with prescribed medications or how long- term uses may affect diagnosis or treatment.

"Whether Western medicine likes it or not, herbal self-medication has become a part of our everyday existence and its impact on health cannot be ignored," says Memory Elvin-Lewis , Ph.D., professor of microbiology and ethnobotany in biomedicine at Washington University in St. Louis. "For the sake of the patient, reliable data is available through a variety of Internet sources and should be used on a routine basis."

These are among the conclusions Elvin-Lewis reaches in her paper, "Should We Be Concerned about Herbal Remedies? "published in the May issue of the Journal of EthnoPharmacology.

Elvin-Lewis raises the point that Western physicians generally have little understanding of herbalism, not to mention self-medicating patients, many of whom also take traditional or "newly evolved" herbal medicines.

"Clearly, promoting appropriate education at medical schools and through continuing education courses can remedy this situation," Elvin-Lewis says. "However, there still is an uncertainty in the medical community about the value of herbalism, despite the fact that herbs are very much mainstream. People are taking everything from Echinacea to prevent colds to ginseng to boost energy. There has been a groundswell in self-medication since the 'Flower Power Era', and it's only getting larger."

In the midst of that era, Elvin-Lewis and her husband Walter Lewis, Ph.D., >Washington University Professor of Biology, published "Medical Botany, Plants Affecting Man's Health," a book patterned after texts on internal medicine and intended to be a guide to how certain pharmaceuticals evolved from plant sources and how the use of plants and herbs for health reasons has evolved in many cultures. For 20 years, they have worked with native Amazonian indigenous people in identifying and classifying their uses of plants for a variety of medical uses. Also, Elvin-Lewis is a Fellow of the International Society of Herbal Medicine (India).

Overall, when compounded and prescribed appropriately, the safety of traditional herbal medications is high, Elvin-Lewis reports. It is generally recognized that life-threatening events are rare, when compared to the hundreds of thousands of adverse reactions reported for pharmaceutical products.

However, with herbal remedies, in particular, adverse problems are unlikely to be reported since there is often a preconceived notion that the herbs are not harmful. Of particular concern are newer "Neowestern" formulations, found almost everywhere, that are compounded without the skill of the trained practitioners or the understanding of possible interactions that may be taking place by combining herbs derived from different traditional medical systems. Labeling also be misleading and currently there is no universal regulatory system that insures that plant remedies are what they say they are, do what is claimed, or most importantly are safe.

"There are always risks when appropriate regulations do not mandate the appropriate formulation of the remedies, or when self-medication fosters abuse," she warns.

Elvin- Lewis, an ethnobotanist (one who studies different peoples' use of plants) has examined data from more than 180 studies and observations to show how adulteration, the wrong formulation, or simple lack of understanding of plant and drug interactions have led to adverse reactions that are sometimes life-threatening or lethal.

Elvin-Lewis breaks down herbal medicines into Asian, European, indigenous, and Neo-western groups. Each group poses problems, though Neo-Western herbalism (including American and Canadian systems) are continuing to evolve and unlike traditional systems that go back thousands of years, are not based on clear parameters of value or use.

Few North American herbalists are formally trained, except perhaps for Naturopathic physicians or traditional healers from other cultures or indigenous peoples. Many are self-taught and are of the mindset, going back to the "Age of Aquarius, " that anything "natural" is good and preferable to "establishment" medications. These kinds of herbalists or entrepreneurs often incorporate a wide range of herbs and so-called nutritional supplements into mixed formulations, with little regard for side effects.

Regulatory challenges abound across groups, Elvin-Lewis notes. In Europe, for instance, standards vary from country to country, and are particularly refined in Germany where some herbal formulations may be prescribed by allopathic physicians. In the United States and Canada, regulations were nonexistent until a few years ago and are slowly evolving to respond to the increasing need to do so.

Elvin-Lewis cites numerous instances of adverse reactions to herbal remedies. These include allergic reactions, damage to internal organs and transmitting herbal drugs in utero or through mothers' milk. From St. John's wort and ginseng to licorice and horseradish, potential problems exist.

Consider ginseng. Despite its popularity across continents, the herb, touted to increase energy, boost the immune system and maybe even perk up the libido, has not conclusively been analyzed by researchers. No one knows for certain how it is bioreactive. Chinese ginseng, Elvin-Lewis reports in her paper, "must always be suspect since not only can the content of the ginsenoids vary, but commercial formulations can be adulterated with potent and dangerous plants like mandrake" and other substances such as alkaloids and caffeine. Elvin-Lewis says that certain Chinese remedies may bear the same name but can be formulated differently depending upon the unique condition of the patient. While rare, Asian medicines and formulations have been found to contain substitutions of plant ingredients, dangerous levels of toxic plant components, unapproved ingredients like pharmaceuticals and heavy metals in addition to other toxic and allergenic substances".

Thus, without appropriate labeling of ingredients, or the uncommon but possible event of adulteration, it's nearly impossible to identify the source of any adverse effects associated with use of these herbal treatments.

However, formalized forms of herbalism are recognized in Asian countries — particularly in India, China, Korea and Japan — as viable courses of medication, and formulations are prescribed as a part of their traditional medical systems. In India, for example, hospital complexes may host several medical systems, including Western allopathy, with the notion that all are available to benefit optimal treatment of the patient.

This sort of co-existence is possible if allopathic physicians appreciate the benefits of herbalism or other alternative medical practices and is only slowly evolving in the United States. Evaluations of herbal treatments by the National Center for Complementary and Alternative Medicine should aid in promoting an understanding in this area, Elvin-Lewis says.

Thus, drug and herbal interactions can pose real problems for self-medicating individuals. Elvin-Lewis cites instances of hallucinations with cinnamon and tetracycline, sedative effects with Valerian or passion flower and anti-histamines, elevated blood pressure with thizidine diuretic and Ginko biloba, and increased seizures when evening primrose is taken in addition to phenothiazines, an active ingredient in a number of pharmaceuticals. She says a number of herbal treatments, Valerian, for instance,are additive.

Trying to slim down? Avoid sparteine-containing herbal treatments for slimming and diabetes control. Elvin-Lewis shows these treatments have been associated with instances of circulatory collapse ,respiratory arrest and nerve irregularities. Blossoms of germander in herbal teas or capsules to treat obesity have been shown to cause acute hepatitis. Instances of kidney failure have been found in Japan, China and the United Kingdom in people using various herbal slimming agents.

Elvin-Lewis cites a survey of alternative medicine use in the United States between 1990-97 that found more than a third of patients treated themselves with unconventional therapies, and most of them did so for chronic conditions. The same patients also visited traditional doctors but were unlikely to tell their physicians what treatments they were taking.

"It is essential that anyone considering taking herbal medications must be well informed and not rely on unfounded claims found in other than scientific literature," she concludes. "You have to be wary of claims made by authors or so-called experts who have no real credentials.

"The notion that 'natural is safe' has little meaning in reality unless, of course, one puts into the same context the idea that 'pharmaceutically derived 'is not always totally beneficial."