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.

Prayer Heals?

For those of you who have been influenced by media hype about the healing effects of prayer at a distance as further evidence for supernatural phenomena, please read this serious critique of the statistical analysis and study selection methods used by chief promulgator, Larry Dossey.

High-fat dairy food may lower colorectal cancer risk

Something thought provoking for the cheese lovers out there.

Heavy Metal Contamination of Chinese Soil

Something the TCM community has long turned a blind eye to is the heavy metal contamination of chinese soil. While at least one herb importer tests about 50 herbs for a few heavy metals, these tests are mainly focused on cultivated plants and those most commonly used. However the vast majority of plants are not tested and evidence suggests they are highly contaminated. In fact, one proposed solution to the soil contamination is to grow certain plants that are know to have high uptake rates of heavy metals. China's industrialization has increased dramatically in the past decade. They burn many times more coal than they used to and cars have largely replaced bicycles as the main form of transportation on most city streets. When many of us got into this field, even though we all knew China was a very polluted country, the problem has grown exponentially. With all due respect to the few herbs on the American market that are actually tested, we must realize that such herbs are not being tested by independent outsiders, but rather by the very vested interests who sell those herbs.

Many in the herbal community would not trust such a regulatory scheme if it involved your local water or soil, yet have no trouble dispensing huge amounts of herbs to their patients for profit. This is just one more reason, people should be very concerned about any longterm use of Chinese herbs. In addition, issues of species decimation is now also becoming a reality, especially in the aftermath of SARS and the foremath of Avian flu. Things have changed and those changes will only accelerate and worsen as China moves hellbent down its capitalist growth path. Ethical herbalists and those concerned solely about toxicity issues now must seriously consider these problems. It is quite a dilemma as the only alternative is to grow the herbs organically somewhere else. In the US, this would make the cost to your patients prohibitive, so the only option is to find some as yet uncontaminated third world farming country with cheap labor and set up chinese herb farms. Unfortunately many chinese herbs are wildcrafted and we don't even know how to cultivate them. I never thought I would write these words, but I think the only viable solution is to begin a concerted effort to replace the use of chinese herbs with substitute species from this country and other parts of the planet. Here is the link to the complete google search I did. This search was of scholarly journals, not scandalmongering websites, BTW.

TCM's Role in Modern Healthcare

Every so often I like to check out the current stats on leading causes of death in the US to see what impact complementary and alternative medicine (CAM) might be having compared to conventional medicine. I make comments next to each entry and do not include dietary changes as CAM because I consider this part of mainstream medicine . I think the most telling thing about these stats is in modern China, none of the conditions listed below is considered to be effectively treated by TCM alone, except perhaps chronic respiratory diseases. However, except for lifelong asthma, almost all of these conditions are caused by smoking cigarettes or air pollution. Asthma is effectively treated by western medicine and I have never met anyone with severe asthma who is able to completely eliminate their inhalers as a result of the sole use of TCM. In all other cases, the Chinese have shown that combined drug/herb therapy is the way to go and the main use of herbs is minimize the dose of the drugs and offset common side effects, such as hair loss and GI upset in chemotherapy. It is almost always the drug that controls the actual physiological imbalance, whether it be high BP or blood sugar or tumor growth.

Number of deaths for leading causes of death in 2002 in the USA:

Heart Disease: 696,947 - no evidence suggests any form of CAM has impacted this trend at all. changes in diet, exercise and the use of aspirin and drugs such as lipitor, all now part of conventional med appear to have made the most impact. Herbs, vitamins and other natural remedies may relieve symptoms in some cases.

Cancer: 557,271 - no evidence suggests any form of CAM has impacted this trend at all. changes in diet appear to have made the most impact on conditions such as colon cancer and smoking habits on lung cancer; early detection is also a significant factor; prevention is the key here; all supposed cures ultimately fail, whether natural, conventional or combined. The chinese research just shows some increase in 5 year survival rates from combined therapy, but most of the patients still eventually die of cancer

Stroke: 162,672 - diet, exercise and blood pressure meds have had the most impact; TPA right after an occlusive stroke is another great advance in recent years; acupuncture may be helpful post-stroke, but the evidence is weak and anecdotal.

Chronic lower respiratory diseases: 124,816 - changes in smoking habits has had the most impact; no evidence suggests any form of CAM has impacted this at all. Regular use of herbal Formulas may relieve symptoms in some patients and cure others if they remove the offending source such as cigarettes before permanent damage is done.

Accidents (unintentional injuries): 106,742 - most are related to alcohol or guns, not impacted by CAM

Diabetes: 73,249 - insulin for type 1 and antihyperglycemics for type 2 has reduced morbidity and mortality; diet can cure most folks with type 2 if they have the discipline; herbs have blood sugar lowering effects, but all chinese research is now focused on combined drug-herb therapy, mainly to prevent liver toxicity that occurs in about 1% of victims taking drugs to lower the sugar.

Influenza/Pneumonia: 65,681 - these are antibiotic resistant conditions, mostly in the elderly in the last stages of life. it used to be number 1 100 years ago and is the greatest success of western med, IMO. Nothing can be done to save these patients at this point. The best bet is not to get here in the first place. How? Eat well, Exercise and take your necessary meds so you don't end up in a hospital where most folks get such infections. Influenza is just bad luck and a weakened immune system from poor lifestyle choices. It is a complete fallacy that living a natural life protects you from pathogens you have seen before. If that were true, how come the native Americans, robust as they were, eating good food and exercising out in nature were almost completely decimated very soon after being exposed to foreign pathogens. Not after a century of bad food, but almost instantly.

Alzheimer's disease: 58,866 - no evidence suggests any form of CAM has impacted this at all. WM is also helpless. Its still worth trying with this one.

Nephritis, nephrotic syndrome, and nephrosis: 40,974 - mostly impacted by dialysis and transplants; no evidence suggests any form of CAM has impacted this at all. Some herbs help put off the inevitable, but no cures.

Septicemia: 33,865 - these are antibiotic resistant conditions, mostly in the elderly in the last stages of life or those who have suffered accidents or surgery. same as pneumonia.

When looking at the etiological factors that cause these illnesses, the list from 2000 is full of preventable lifestyle choices, not one of which is due to the failure to take herbs or get acupuncture:

Tobacco
435,000
Poor Diet and Physical Inactivity
365,000
Alcohol
85,000
Microbial Agents
75,000
Toxic Agents
55,000
Motor Vehicle Crashes
26,347
Adverse Reactions to Prescription Drugs (usually due to preventable mistakes)
32,000
Suicide
30,622
Incidents Involving Firearms
29,000
Homicide
20,308
Sexual Behaviors
20,000

Chinese medicine thus appears to be a viable primary option only in conditions that are either not life-threatening (like PMS) or still poorly understood (like autoimmune disorders). Musculoskeletal problems is one area of effectiveness, for sure. This is the strongest area as the use of NSAIDs and other pain relievers besides opiates is often quite dangerous. Symptom relief from minor conditions such as sleep disorders, bowel disorders, headaches, dizziness, and menstrual disorders are other areas of effectiveness, IMO. In addition, there may be some as yet unproven role in the vaguely defined conditions such as CFIDS, FMS and Multiple Chemical Sensitivity, none of which seems to respond to any therapy very well and are likely neuropsychiatric disorders, IMO. But in few, if any, cases are any of these conditions actually cured with TCM. They are relieved as long as the patient continues with treatment and the success is largely dependent on external factors such as diet and exercise in almost all cases. So in the end analysis, as I have been saying for years, TCM is really no more "holistic" than western medicine. As I have written in a prior blog, the main benefit seems to be the decreased iatrogenesis from not taking unnecessary drugs (especially pain relievers) for many of these poorly understood illnesses. This is not a minor issue. It is a critical point, actually. And until practitioners realize this and stop making ludicrous claims about healing body, mind and spirit, there will be a smaller and smaller place for TCM in the future of healthcare. If TCM practitioners accept their small niche in providing low tech nontoxic symptom relief, that is the place where some need still exists and will continue to exist for decades to come. However they will need to work closely with MDs in order to avoid silent drug/herb interactions.

Organics Better Than We Thought

How long have we suspected this? New government-funded research adds to the concern. A study of children whose diets were changed from regular to organic found their pesticide levels plunged almost immediately. The amount of pesticide detected in the children remained imperceptible until their diets were switched back to conventional food. "We didn't expect that to drop in such dramatic fashion," said Emory University's Chensheng Lu, who led the Environmental Protection Agency-funded research. Lu's findings will be published in February in the journal Environmental Health Perspectives.

Nanomedicine Update

In order to be aware of what may be on the horizon so you may embrace it or resist it, as you will, take a look at the latest news in cancer treatment. Its good to know what our patient's options might be in a few years. These development are happening faster than I expected. Computer power and miniaturization double every 18 months and no end is in sight to this acceleration for about two decades with current materials. We appear to have reached that part of an exponential growth curve in technology analogous (yet not proportional) to what happens when you put a penny in the bank and double it every day. On day 10 you have about 10 dollars. But, in the last 10 days of the first month, value rockets from 10,000 to over 5 million dollars. Lets say that most of the history of technology was that first ten days of the month and we recently made it to day 21. That's when it really gets hairy and changes occur at almost unfathomable rate. If you all you ever knew were the amazing but predictable developments of the 20th century such as electric light, movies, radio and nuclear bombs, you might be pretty impressed with how much occurred in that era. But you could always see what was coming over the horizon. Now what is coming over the horizon is already there before you could even conceive it.

Marijuana and Schizophrenia

Smoking pot apparently causes similar brain changes as schizophrenia and hastens the onset of the disease in those who are otherwise susceptible. I have often dismissed such research in the past as drug war propaganda, but this is pretty solid stuff done in the fairly liberal socialist democracy of Denmark. Perhaps most disturbing was this passage:

A second study by researchers at the Zucker Hillside Hospital in New York looked at the brains of teenagers, comparing some who were heavy cannabis users with schizophrenic patients and healthy adolescents.

The team used a sophisticated scanning technique called diffusion tensor imaging (DTI) which measures the motion of water molecules in the brain which can indicate microscopic abnormalities.

They found similar abnormalities in an area of the brain linked to high level linguistic and auditory skill in cannabis users and those with schizophrenia.

They focused on the arcuate fasciculus, a bundle of fibres connecting the Broca's area in the left frontal lobe and the Wernicke's area in the left temporal lobe.

The abnormalities were not seen in healthy teenagers.

Dr Mazar Ashtari, of the Albert Einstein College of Medicine who led the study, said: "Because this language/auditory pathway continues to develop during adolescence, it is most susceptible to the neurotoxins introduced into the body through marijuana use."

This means even if one has no familial tendency to develop schizophrenia, chronic pot smoking may cause schizoid like changes in the brain.

Some users of marijuana and other psychedelic (or entheogenic) substances like to think they have opened the doors of perception through their indulgence and that those who don't partake just have blinders on. I will grant this may be true for occasional use of mind altering substances like pot and mushrooms in an ideal set and setting (as advocated by Timothy Leary back in his serious research days). However, mounting evidence suggests chronic daily use disturbs the mind of almost all users, particularly those who became habituated in their teens. If you resist this idea, then how do you reconcile the fact that the brain structure of a daily lifelong marijuana user probably looks more like someone with psychosis than it does like that of an enlightened sage. Just because a little of something may be desirable under certain conditions doesn't mean a lot all the time is even more beneficial.