Herbal supplements and nutraceuticals

The use of herbal supplements has a long history – dating back thousands of years. Examples of important medicines extracted from botanicals include reserpine, morphine, penicillin, and vinca alkaloid anti-cancer drugs. Today, herbal supplements and nutraceuticals can be purchased over-the-counter (OTC), but that does not always mean they are safe. While these products are intended to boost health, and may make claims to that effect, robust clinical studies may be lacking. Herbal supplements are sold in many different forms – dried leaves for teas, powdered, as capsules or tablets, or in solution. Almost 20 percent of Americans currently take some type of herbal or non-herbal supplement.

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Dr. Stegall’s comments: There are many studies which have evaluated the mechanism of action of natural substances such as herbs, vitamins, minerals, and plant extracts. Some of these studies have been done on cell cultures in the lab, while others have been done on animals or humans. As I have mentioned before, the only reason why “robust clinical studies may be lacking” is because of funding issues. Large scale clinical trials for prescription drugs cost millions of dollars. They require a lot of time and manpower. Drug companies are willing to invest this money because a drug can be patented, and that company would have exclusive rights to produce and market the drug. In contrast, natural products cannot be patented, meaning that any manufacturer could produce the drug. Thus, a company would be foolish to spend the money creating robust clinical trials for a natural product which could be easily made by other companies as well.

Thus, we will likely always have critics of natural medicine pointing to there being “no evidence that natural products work.” This is a misleading statement, because there most certainly is evidence that many of these products work, just not to the degree that prescription drugs are evaluated.

Mixing Herbal Supplements and Prescription Medication

Approximately 20% of the U.S. population admits to taking at least one supplement or herbal preparation daily, and more than 50% of the population admits to having used a natural preparation for medicinal purposes in the past 30 days.7 Therefore, understanding the purpose of the most commonly used substances and potential interactions with other supplements and prescription medications is critically important for health-care practitioners.

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Dr. Stegall’s comments: Any substance which has a clinical effect in the body, whether it be a prescription medication, an herb, or a vitamin, should be treated with respect. Many people incorrectly assume that because something is natural, it can’t have any negative effects in the body. Pharmacology looks at the way substances behave in the body. It not only tells us why a substance is effective, but also how it might interact (positively or negatively) with other substances in the body. Thus, we must be very careful to consider how individual substances behave, and how that behavior impacts the other substances we give. For these reasons, we must look closely at everything in the patient’s protocol – medications as well as nutritional supplements – to be sure they are compatible.

The problem with this is that most health professionals do not have mastery of both pharmaceuticals and nutraceuticals. Ask most medical doctors about herbs and vitamins, and they don’t understand how they work (or even acknowledge that they work at all). Ask most who are trained in exclusively natural medicine, and they are very familiar with herbs but don’t understand prescription medications. Both groups tend to think their methods are “right,” and that other methods are “wrong.” My stance is that we need both prescription medications and nutraceuticals, and that they should both be respected as important parts of an overall integrative treatment program. Failing to recognize this will almost always result in suboptimal results.


The growing danger of mixing prescription drugs and supplements

A growing number of older adults are combining multiple prescription and over-the-counter medications and supplements in ways that could lead to serious side effects, according to a new study.

From 2006 to 2011, the number of older adults (ages 62 to 85) in the United States taking five or more medications or supplements rose from 53.4% to 67.1%.
A common prescription drug, for example, is warfarin, a blood thinner. But combining it with a supplement such as omega-3 fish oils, which skyrocketed in popularity during the period of the study, increases the risk of bleeding for certain patients.

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Dr. Stegall’s comments: Many patients do not tell their regular doctor about the nutraceuticals they are taking. When I ask patients why, they typically tell me one of two things: “My doctor doesn’t understand supplements,” or “My doctor will tell me that supplements don’t work.” This is unfortunate, as high quality nutraceuticals most certainly work. But sadly, as we all know, the training on nutritional supplements and how they work is woefully inadequate in medical training today. In most pharmacology courses, the one lecture on herbs and vitamins only consists of information as to how such substances interact with medications. While this is important knowledge for physicians-in-training to have, I do not feel that it is adequate. Even if a physician does not plan on recommending nutraceuticals, I believe that he or she should at least understand how they work and develop a healthy respect for them – if for no other reason that most of their patients are taking them.