Silent Drug/Herb Interactions

Check out this disturbing abstract from [Cheung MC and others. Antioxidant supplements block the response of HDL to Simvastatin-niacin therapy in patients with coronary artery disease and low HDL. Arteriosclerosis, Thrombosis, and Vascular Biology 21:1320, 2001.]

Antioxidants may interfere with cholesterol drugs. A 1-year study of 153 patients has found that supplements of vitamin C, vitamin E, beta-carotene and selenium may interfere with the ability of simvastatin (Zocor) and niacin to raise the HDL levels of patients with abnormally low HDL levels. The patients receiving antioxidants and drugs had an average HDL increase of 18%, whereas the patients who received drugs alone has a 25% increase. However, HDL2-C, an HDL component thought to account for much of HDL's cardioprotective benefit, rose by 42% with drugs alone but was unchanged in patients who also received antioxidants. Although the study was small and has not been replicated, it casts further doubt on the value of antioxidant supplementation.

There is no free lunch. It is just a reminder that there is a lot that we can't know without controlled studies (a point about which you and I have long agreed). A reminder that even longterm use of Chinese herbs in combination with drugs is not even remotely proven safe. When we talk about drug/herb interactions, we are usually referring to something obvious like getting diarrhea or a headache. But subtler things like alterations in cholesterol are typically silent killers and we don't know until its too late. We need to always keep in mind that despite the lack of any hard data to question the use of combined herb/drug therapy, this is uncharted territory and could easily come back to bite us in the butts someday. Many Chinese herbs have antioxidant properties, thus we need to be very careful when taking any herbs or supplements with any drugs.

Heart disease is still the number one killer in America and will be for a long time to come. Anything an herbalist does that increases the risk of a heart attack is a lawsuit waiting to happen in litiginous America. My guess is that if you get sued under such a scenario, your malpractice carrier will drop you like a hot potato. This is one of many reasons I have recently been advocating the use of Chinese herbs for short term use in acute conditions or to control symptoms. The mere fact that the Chinese themselves have used certain herbs longterm also does not guarantee their safety under these conditions nor do the claims of native Chinese docs that the whole issue is a red herring. Most Chinese docs know little or nothing about pharmacology and their opinions on this topic of drug/herb interaction is really baseless.