All posts in Alternative Medicine

Understanding Herbal Medicine and Liver Toxicity MD Letter

The September 2017 issue of BC Medical Journal (bcmj.org)—a magazine that “provides clinical and review articles written primarily by BC physicians, for BC physicians”—published a letter in the “Personal View” section about herbal medicine and liver toxicity

The letter reports on two patients who were transferred from local hospitals to the Liver Transplant Program of Vancouver General Hospital (VGH) for assessment and liver transplant because of acute liver failure. The patients were reported to be previously healthy, with one middle-aged and the other young. Though one was also on antidepressants, it was “strongly felt” that the cause of illness in both was the use of commercially-obtained herbal remedies—one was traditional Chinese herbal medicine and the other was traditional Indian herbal products.

The authors lament that “These two tragedies could have been avoided, and it behooves physicians to be aware of what nonprescription products their patients are consuming and the associated risks.” 

They then assert that “Drug-induced liver injury from these products is not uncommon. In China, such injury from Chinese herbal medicine is estimated to be 25% of all reported cases (unpublished work from Dr Qi Xing-shun, General Hospital Shenyang Military District, 8 August 2017).”

Next, the letter authors state that they “strongly feel that regulation of these products, on either the federal or provincial level, needs to be consistent with that applied to the pharmaceutical industry” and that “the public needs to be made aware of the potential dangers of these products.”  

I do agree with this letter on a few points.

  1. For those two patients who needed to undergo liver transplants, this was indeed tragic (though I might argue that that word is most often associated with death, and there is no statement that that is what occurred).
  2. It is absolutely important for medical physicians to ask their patients about their use of any herbal products or supplements.
  3. Just because a product is herbal or “natural” doesn’t mean that it is always safe—for everyone, in any dose, for any length of time.

However—and this is clearly the whole reason why I bother to write about this letter—there are several points that I hold issue with.

Firstly, while these two cases are important and may be reflective of a much larger issue, they are basing their letter on two cases, without giving any idea of whether there is a grander scale to consider. That is, is there truly a danger or might these have been isolated incidents?

What are not isolated incidents, are the adverse effects from proper use of pharmaceuticals, improper prescription of pharmaceuticals, and other medical errors. According to the Canadian Institute for Health Information and the Canadian Patient Safety Institute, in 2014-2015, “patients suffered potentially preventable harm in more than 138,000 hospitalizations in Canada.” That’s about 1 in 18 hospitalizations. And “of the patients who experienced harm, about 20% experienced more than 1 harmful event while in hospital.” (summary report: https://www.cihi.ca/sites/default/files/document/hospital_harm_summary_en.pdf; full report: https://www.cihi.ca/sites/default/files/document/cihi_cpsi_hospital_harm_en.pdf; technical notes: https://www.cihi.ca/sites/default/files/document/hospital_harm_technical_notes_en.pdf)

I don’t want to be alarmist. But those are numbers that stand out and should provoke a response. A letter reporting just two cases needs further elaboration.

Furthermore, using unpublished work from a Dr. Qi Xing-shun practicing in China (not in Canada), the authors of this letter state that damage to the liver from Chinese herbal medicine makes up about 25% of all reported cases. That makes it sound like 25% of people who take Chinese herbs end up with liver damage. That’s not the case. Assuming the 25% noted, but not published, by some Dr. in China is correct, we still have no idea of how many people that is. It’s like saying, “Nine out of ten doctors agree, this is the best toothpaste.” It sounds like 90% of all doctors. But it could be that 10 doctors were selected, and 9 of them like the toothpaste. In other words, if there were 8 total reported cases of injury from Chinese herbal medicine in China, then that would be just 2 liver-affected cases. Again, not noteworthy.

Even if the numbers are, in fact, noteworthy, let’s keep in mind that those are unpublished statistics from China, not here. And that brings me to my second point.

Herbal remedies—just like over-the-counter pharmaceuticals, alcohol, and even fibre powder—can be taken inappropriately. They may be taken in combination with other things that don’t mix well with them. They can be taken at dosages that are too high or for too long. They can be taken by the wrong person for the wrong reason. The Chinese herb ma huang (ephedra) is an example of that. The herb is not unsafe. In TCM, we prescribe its ingestion (combined with other herbs), mostly for opening the sinuses and getting rid of a cold. Unfortunately, people started taking it to lose weight. Wrong use. Wrong dose. Wrong duration of use.

medicine liver damageBut you could say the same of alcohol use. Or of cough medicine, nasal decongestants, motion sickness pills, or narcotic painkillers used to get high. Or laxatives or diuretics used to lose weight. And, how many people have caused stomach ulcers because of overusing anti-inflammatory medications?

Specifically, when it comes to liver damage, Dr. Michael Rieder, a pediatric clinical pharmacologist at Western University states that acetaminophen is the “most common cause for liver injury. Period. Full stop.” Every year there are about 4500 hospitalizations in Canada caused by acetaminophen overdose, with approximately 700 of those accidental, according to Health Canada

Dr. Yoshida himself, the lead author in this letter, “regularly sees patients with severe liver failure from accidental acetaminophen overdose.”

This is why I wonder about Dr. Yoshida et al’s word of warning to their medical physician colleagues that “the public needs to be made aware of the potential dangers of these [herbal] products.” The problem isn’t necessarily with the herbal remedy being dangerous. It’s the improper use that is the main concern. Just as we don’t need to be warned about the dangers potentially imposed by forks, though you could be seriously injured by one!

Of course, if a patient arrives at your office with four small, closely placed puncture wounds in his leg, you might consider that a fork was the cause. And you should ask.

In fact, health care providers should always ask our patients about their use of medications (both prescription and over-the-counter), recreational drugs, medicinal narcotics, alcohol, cigarettes, and herbal and supplement remedies. We should be specific and ask for details, not just, “Are you taking anything?” When I phrase the question that way, people often answer no. But, when I ask in more detail, they may say, “Oh, yes. I’m on the birth control pill.” Then, “Oh, that. Yes, I take a sleeping pill every night.” And, “Um, yah. The only way I can sleep is if I also smoke a joint.” So, yes, we should ask in detail.

And, we should remember that our attitudes will influence whether they answer us truthfully or not. I’ve heard time and time again from patients that they don’t tell their physicians about their supplements. I encourage them to do so, but they say that their docs will shame them and tell them they are wasting their money. Some patients have even told me they’re afraid that their doctors won’t even see them anymore.

In terms of having regulation of herbal products being on par with that applied to the pharmaceutical industry, I disagree. Some people wrongly think that the world of natural health products is like the wild west—anyone can sell anything with any claim. This is fully false. We already have good regulations in place. All natural health products on the shelves in Canada are required to have a Natural Product Number (NPN). From the Government of Canada website:

“All natural health products must have a product licence before they can be sold in Canada. To get a licence, applicants must give detailed information about the product to Health Canada, including: medicinal ingredients, source, dose, potency, non-medicinal ingredients and recommended use(s).

Once Health Canada has assessed a product and decided it is safe, effective and of high quality, it issues a product licence along with an eight-digit Natural Product Number (NPN) or Homeopathic Medicine Number (DIN-HM), which must appear on the label. This number lets you know that the product has been reviewed and approved by Health Canada.”

If anything, patients can be informed to make sure that any of the natural health products they buy are either from a qualified and licensed health professional or that the product has an NPN. Where did those two liver patients get their herbal products? That’s the question I would ask.

Rather than try to scare medical doctors into scaring their patients away from all herbal products, let’s try to educate ourselves about them. Let’s tell our patients to talk to the right type of healthcare provider when it comes to the remedies they are taking. Traditional Chinese Medicine practitioners (for Chinese herbs in British Columbia, that’s Dr.TCM, R.TCM.P., or R.TCM.H.) can make sure the herbal medicine is prescribed appropriately.

I work in an integrative clinic with medical physicians as part of the team. We fully respect and appreciate each other’s knowledge, skills, and type of practice. And, it was one of those medical physicians who alerted me to this letter in the BC Medical Journal. He told me, “this is what MDs are reading” because he wanted me to respond in a clear fashion that could inform both my TCM and other natural health colleagues, and perhaps help inform medical doctors as well, so we could all work together. With the facts. And with patient interest at the forefront.

While fear might provoke action faster than any other emotion, it doesn’t help us in the long-run when it comes to our health care system.

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Traditional Chinese Medicine in Alive Magazine

 

Traditional Chinese Medicine acupuncture Vancouver BCWhen I was offered a chance to write about Traditional Chinese Medicine (TCM) for Alive Magazine, my answer was a resounding, “YES!” If we haven’t met, I’m a huge fan and supporter of TCM, its principles, and its treatments. After all, I’ve been practicing it for over 16 years. The more people who know about TCM and get a chance to try it in some format–TCM consultation, acupuncture, Chinese herbs, TCM food cures, cupping, or simple lifestyle changes based on TCM foundations–the happier I am!

Traditional Chinese Medicine Vancouver BCOne challenge about sharing information about Traditional Chinese Medicine is that it uses a different language than most of us from the West can comprehend. Yin, Yang, Qi, meridians, Damp-Cold, Liver attacking Spleen–say what?! The thing is, many systems and professionals use their own language, from “lawyerspeak” to medical jargon to tech terms. Understand that this is our way of explaining complex principles and diagnostics, and some of our words are not to be taken literally (for example, your liver is not actually attacking your spleen!). 

It’s not easy to encapsulate all I want to say about TCM in just one article, but check out my link to Traditional Chinese Medicine: Deep, Historical Roots Offer New Medical Insights in June 2017’s issue of Alive. You’ll find a basic intro, my description of how TCM has been changing and evolving, and some info about how to find a qualified TCM in Canada. 

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Powerful Natural Medicine Secret

Powerful natural medicine hope Traditional Chinese Medicine Vancouver acupunctureHere I’m going to start with the bad, so I can illustrate the power of something you could call a natural medicine. A study in the 1950s by Dr. Carl Richter involved taking rats and putting them through a forced swim test. Rats can swim, and the rats they used were, as far as they could tell, equally healthy. The rats gave up swimming and sunk (we’ll pretend they ended up ok), fairly quickly–some in mere minutes, some up to 15 minutes. But, if they were removed from the water for a short amount of time before that, and allowed a brief rest while they were held, they could then be put back in the water and swim for up to 60 hours! From 15 minutes max to 60 HOURS!

What?! How could they somehow bring about a Herculean effort to keep swimming for 240 times longer when they would otherwise have given up? 

A Natural Medicine

Hope.

They had hope that they might again be rescued. Hope is a powerful natural medicine. It helps us try more, push harder, and persist longer. And, often, eventually succeed.

So, when I hear from patients that they’ve been told there’s nothing further that can be done–to manage their pain, help them sleep, improve or cure their illness, or simply function and feel better–I’m disturbed by that. Why 

That’s why I love Traditional Chinese Medicine and most natural medicine practices. The goal is to discover what combination of imbalances have lead to the health issue at hand, and to help strengthen the body, and thus allow healing. There isn’t always cure. There isn’t always a fast fix. But improvement is possible. I don’t know how many times I’ve been told that I’m someone’s last resort. At the very least, I aim to offer hope and support while the body begins the process of healing. 

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2000 Plus Years in 24 Hours

Local newspaper 24 Hours contacted me to ask if I would be interested in writing a short series of articles about alternative/integrative medicine. “Of course!” was my answer. A chance to write about Traditional Chinese Medicine and its role in modern healthcare? Jump!

So, here is a link to part one: Ancient Medicines Find Favour with Canadians (click here for the PDF version)

 

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Think of me like a toothbrush…

Think of this, do you brush your teeth regularly because you have cavities…or because you want to prevent cavities?

Yes, I CAN treat illness, injury, and mystery symptoms…but… you could also think of me to be like a figurative toothbrush. I love to help PREVENT illness and injury and mystery symptoms. Some patients come in regularly, like once a month, to help them manage their health and stop little symptoms from turning into more troubling ones. Some need more frequent visits, some need less frequent. Depends on the individual’s situation.

One preventative measure to consider right now is a biopuncture treatment of Pascoleucyn (contains an herbal quantity of echinacea and ultralow dosage of other natural substances) to boost your immune system so you can improve your chances against being dragged down by the flu this season.

If you brush your teeth–and I hope you do!–ask yourself, do you care for the rest of your body at least as much as you care for your teeth?

Prevention of illness is a cure.

 

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Need Evidence? More Research about TCM

I’ll be honest, I’m not terribly impressed by research in general. I’ve worked as a research assistant. I saw that human need, greed, error, and intention can all sway results and what is published (and how it’s published). However, as someone with a science background and two parents in the field of science (Dad: PhD chemistry; Mom: Nurse), I can’t ignore research. So, here are some links to online publications about my fave topic, TCM:

How does acupuncture work? 

1. Changes in blood flow

2. Changes in the brain

What can it treat?

1. Digestion issues

2. Pain

Osteoarthritis

Migraines

3. Cardiovascular disease

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A good night! G’night!

I recently purchased a new mattress. Ahhhh, how wonderful it is to sleep to well! The thing is, though, I didn’t really recognize that I wasn’t sleeping well until about a month before I decided it was time to buy a new bed. I was waking up feeling stiff. I was having some trouble falling asleep. These were symptoms that are unusual for me.

So, I thought about it. Was I stressed? Not particularly. Was I exercising too hard? No, consistently the same. What else could be going on? … Oh. My mattress was 15 years old!

When I went shopping with my husband for a new one, I asked how long a mattress normally lasts. I was told that it depends on the quality, but probably 7 to 12 years. Well, even new, our old mattress was not on the top quality list, that’s for sure! So, how did we manage to get 15 years out of that thing?

I think that part of it was staying healthy. Eating right. Exercising regularly. Getting tune up treatments.

It makes sense that a body that is well cared for is going to be able to handle stressors more readily. Does it cost money to be healthy? Yes, but in the long run it’s probably saving me lots of money too. No pharmaceuticals. No trips to the hospital. Very few sick days off of work. Few injuries. And a cheap mattress and box spring that lasted us for 15 years!

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What drug could be killing you?

Am I exaggerating? Sadly, no. But many people are taking this class of medications…NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). You might recognize the names as ibuprofen, naproxen, indomethacin, or celexocib.

“Since the mid-80s, more than 300,000 Americans have died of NSAID complications, and 1.7 million were hospitalized.”

NSAIDs can cause gastrointestinal bleeds, actually destroy your joints (though they are often taken for joint pain!), increase cardiovascular risk, and even contribute to erectile dysfunction.

The article details: Healing the NSAID Nation

There are many natural supplements, foods, and treatment alternatives for managing inflammation and pain! Inflammation and pain are major causes of many of the health issues I treat daily. So, if you are taking an NSAID, consider that there are other options!

 

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Acupuncture reported: it he accurate?

This morning I just read an article written for the online version of the newspaper The Vancouver Sun. The Sun is a reputable newspaper, but clearly not immune to inaccuracies. Case in point (no pun intended), their recent article called, “The Intricacies of Acupuncture” by Randy Shore.

The question “What is acupuncture?” is posed. The answer they give includes a paragraph that reads, “The theory is that acupuncture unblocks and rebalances the flow of energy, or Qi, through the body. The modern practice of medical acupuncture – as practised by medical doctors – uses wires inserted into known anatomical structures rather than points dictated by ancient philosophy or astrology.”

So much wrong with this last sentence! Acupuncture is medical acupuncture. We treat medical conditions and I don’t follow astrological charts to do so! Yes, acupuncture uses the philosophies of Traditional Chinese Medicine (TCM) to choose acupuncture points, but just because they are founded on ancient practices doesn’t keep them stuck in a time 3000 years ago. Just as we no longer use sharpened stones as acupuncture needles, so too have we modernized our practice. We learn anatomy, physiology, and pharmacology. We recognize the structures that we are needling as acupuncture points and meridians, but also as muscles and other soft tissues.

I have a degree in kinesiology from the University of Guelph where my training in how the body works included anatomy with a cadaver dissection lab, neuromuscular anatomy, basic physiology, respiratory physiology, cardiovascular physiology and applied sciences of human gait analysis and ergonomics. Traditional Chinese Medicine’s “philosophies” are actually observations that were made over thousands of years and came to conclusions about how the body works. The TCM scientists of the time correctly identified many of more modern science’s current understandings.

Many of my colleagues take extra training in modern forms of acupuncture in addition to the 3-5 years of training and 1-3 provincial licensing exams — depending on whether we train to be registered acupuncturists or registered Dr. of Traditional Chinese Medicine, with the latter requiring the most training. Motor point acupuncture, trigger point acupuncture, studies of myofacial tissues, and biopuncture are all modern forms of acupuncture that I trained in that many “medical acupuncture” performing MDs have not studied.

I do not divorce myself of either the principles of Traditional Chinese Medicine or the current understanding of the physiological structures of human anatomy. It’s Yin and Yang. Knowledge, recognition, and practice of both strengthens the results.

Where registered acupuncturists (R.Ac.), registered TCM practitioners (R.TCM.P), and registered Dr. of TCM (Dr.TCM) differ from MD “acupuncturists” is that we have MORE training for the practice of acupuncture. And perhaps even more important is that we can use both the 3000 (or more) years of observational studies of the human body as well as the more modern practice and study of current medical knowledge.

So, while I have asked some stars about their thoughts on acupuncture, those stars are human (acting and sport), not the ones in the sky.

Read more: http://www.vancouversun.com/health/intricacies+acupuncture/6161674/story.html#ixzz1meiRqJ84

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Acupuncture is growing in popularity!


To me, this is a “no kidding, of course it is” statement, but it was great to read this article about the statistics of alternative medicine in the U.S.
http://www.webmd.com/balance/news/20090730/americans-spend-34-billion-alternative-medicine?src=RSS_PUBLIC

Read the second page where they describe a nearly 3-fold increase in acupuncture visits since the last study done in 1997.

So, have you had your acupuncture today?

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