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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 In China, such injury from Chinese herbal medicine is estimated to be 25% of all reported cases (unpublished work from Dr Qi Xing-shun, General Hospital Shenyang Military District, 8 August 2017).”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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Goji berries are a local Vancouver food

goji berries local Vancouver food healthy nutritionGoji berries are not a food I would normally consider local. Grown mostly in China, goji berries are a challenge to grow in Canada. That’s why so few places do. But, fortunate for us, there is one farm in the Lower Mainland amongst that short list, and this week I visited them.

Why should I care about goji berries?

Well, you don’t have to. But if you’re interested in healthy food options and like to try different foods, why not? After all, goji berries have many health benefits.

  1. goji berries local vancouver food healthy nutritionThey are rich in antioxidants–i.e. cell protectants that help prevent cancer, fight disease, and manage inflammation. 
  2. They are a good source of fibre. Fibre helps stabilize your blood sugar (Traditional Chinese Medicine has long used goji to help manage diabetes), helps you feel full, and supports healthy bowel movements, all of which can help with healthy weight management.
  3. They contain more protein than most berries.
  4. Ounce for ounce, goji berries have more iron than spinach! In TCM they are classified as a Blood Tonic.
  5. TCM has long used goji–except that we call them gou qi zi–for supporting healthy vision, and research supports this.
  6. Gojis may increase men’s testosterone levels and improve sperm count and motility, so it’s no surprise that in TCM, goji are sometimes used to address men’s sexual health. 
  7. For women, goji berries may also boost fertility by helping with ovulation.
  8. Goji are also popular for promoting healthy skin and boosting energy.

When I was doing my internship in China, I noticed that all the TCM doctors I trained with drank hot water with goji berries. As the weather got hot, they added in chrysanthemum flowers, but the goji berries seemed a staple. 

Visiting a Local Goji Farm

goji berries local vancouver food healthy nutritionOn the first day of August, my husband and I made a drive all the way out to Aldergrove because ever since I met the owner (Peter Breederland) of a BC goji farm at a health show, I wanted to visit his goji farm. 

When we arrived, though I had intended to simply buy freshly picked berries, there was only one clamshell of goji available, so I asked about the U-pick. It was hot, hot, hot out, but I was told the goji are super easy to pick. It’s true. They are. And we picked about 3/4 kg of berries in no time.

Fresh goji are super fragile. Their flesh is very soft and there are small seeds inside. The taste of the larger, ripe goji are mildly sweet, slightly tart. I find some of the berries have a bit of a red pepper taste, but others have told me they are reminiscent of huckleberries (I don’t think I’ve ever had them, so I can’t compare). The LA Times described the taste: “The berries had a mild, sweet, tomato-like flavor, with vegetal, rose and red pepper notes.” I think they taste quite different from the dried goji I’m super familiar with, but I’ve been enjoying fresh goji on my oatmeal, just as I typically have the dried ones.

If you come in for an appointment with me this week, ask me for a goji berry (I’ve got them at the clinic!).

In case you’re interested, you can even buy your own goji plant! Check them out at Gojoy, and let them know I sent you! 😉

goji berries local vancouver food healthy nutrition

goji berries local vancouver food healthy nutritiongoji berries local vancouver food healthy nutrition

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Natural health trends for 2017

Every year I attend the CHFA (Canadian Health Food Association) trade show that’s open only to retailers and health professionals. This past Sunday I spent the day wandering through the aisles with my mom (she’s a nurse practitioner), checking out what’s available in health supplements and healthy food options.

This is what I picked up.

CHFA health show 2017 natural health product trends

Now, don’t get me wrong, I love the tried and true stuff. After all, I am practicing a medicine that has a history of thousands of years–Traditional Chinese Medicine’s foundations began 4000+ years ago. But, I also like to find out what’s new. Even TCM continues to evolve, with elements of our practice being fully modern. After all, don’t you prefer your acupuncture with sterile, fine, filiform needles that are thin as hair and glide with ease rather than a sharpened stone? Uh huh, I thought so. Plus, I love being able to offer biopuncture, press needles, silicone cups for cupping, microcurrent stimulation, Swarovski crystal ear seeds (a different post I’ll need to write about soon), and other newer aspects of TCM practice.

So, without further ado, here are some of the things I was most excited to see at this year’s CHFA trade show: foods with more medicinal benefits, companies giving back, healthy things that are also convenient, people passionate and knowledgeable about health!

Functional foods

Okay, so I’ve often been a bit perplexed about the idea of “functional foods.” After all, aren’t all whole foods functional, i.e. have health benefits? But the term functional foods refers to foods that “have a potentially positive effect on health beyond basic nutrition.” Still, the category is pretty broad. We’re finding out more and more that many foods contain phytonutrients, i.e. chemicals that the plants produce for their own benefit that also provide health perks for us. 

probiotic health food bar CHFA 2017Another definition of functional foods is “processed foods containing ingredients that aid specific bodily functions in addition to being nutritious.” What I saw at the show were foods that have been added to. You get the food…plus you get a supplement of some sort. It’s not a new idea. Vitamin D has long been added to dairy products, you can buy omega-3 eggs, and iodine is added to table salt. What I saw though, were the addition of herbs and other nutrients, like this probiotic granola bar. This one is delicious (if you have a sweet tooth), soft, and chewy. It contains 4 billion active probiotic cultures. That’s a good amount! They also make drinks with their probiotics too, though I haven’t tried it yet. Plus, I see that they’ve partnered with the Creation of Hope initiative to help build water wells in Africa, with 5 cents donated for every bottle they sell.

You may know, I’m a big fan of reishi mushrooms. It’s one of TCM’s top herbs! How can it not be, when its Chinese name “ling zhi” translates to “holy mushroom,” and when it’s also known as the “mushroom of immortality!” I write articles regularly for Mikei Red Reishi Mushroom, so I’ve done lots of research beyond the usual for this particular power herb. So, I was excited to see a snack bar with reishi in it (and one with cordyceps too–another powerful Chinese herb!). Though this brand’s reishi uses only the mycelia (root-like structure of a fungus), rather than the fruiting body (the stem and cap–the part you usually think about when you think “mushroom”)–unlike the Mikei brand–meaning it doesn’t contain all the beneficial compounds, it does still contain many polysaccharides that help with immune health. The powerful medicinal compounds in reishi and cordyceps taste awful. They are bitter. So, I was surprised to see them in a granola bar. But, here they were, and the bars taste good. They are crunchier, much firmer than the probiotic bars, and much less sweet. I’m not giving up my daily reishi supplement, but I’d have these snack bars as a topper up on occasion.

tea health food natural health VancouverOk, this food isn’t about adding something medicinal to a food, but instead, it’s a functional food that is now being used when it was previously tossed away. Do you love coffee? Did you know that the coffee plant leaf has health benefits? Like many teas, it is rich in antioxidants. The cool thing about attending a trade health show is learning the stuff you didn’t know you didn’t know. Like, the coffee plant leaf contains mangiferin (found in mangoes, but not only mangoes), a compound that is anti a lot of things–antioxidant, antimicrobial (kills bad things you don’t want in your body), anti-diabetic, anti-inflammatory, anti-allergic–and analgesic (should I have called it “anti-pain”?). It also contains about as much caffeine as green tea and chlorogenic acids–the same compound that has made green coffee beans popular for weight loss. Bonus is jobs. The coffee industry is huge and many people are employed by it, but only for the 3-4 months per year when coffee beans can be harvested. What can they do during the remainder of the year? By harvesting the coffee leaf instead of tossing it, those people can still be employed. Plus, waste not, want not. This really a wise product: Wize Monkey Coffee Tea Leaf.

Essential Oils

I’ve recently become minorly (my husband might say it’s not that minor) obsessed with essential oils. I blame two of my friends/colleagues (you know who you are!) who are even nuttier than I am about E.O. I’ve spent way too much money stocking up on oils, but the good thing is that I use them regularly, and I find them helpful! It’s a whole huge topic to go into all the health benefits of E.O., but it’s way beyond smelling nice. For one, did you know that your sense of smell is one of your most primitive and powerful senses? Your olfactory (smell) receptors are directly linked to your limbic system, the part of your brain that helps control your drive for survival, emotional stimuli, motivation, and some types of memory. You’ve likely experienced a powerful memory prompted by a smell–I love the smell of ice rinks because I spent a lot of time there as a figure skater, and Chinese herbal stores always make me feel instantly better.

essential oils natural healthSo, when I came across this company, Divine Essence, I was riveted with amount of information I learned about oils. Many of their oils are organic and they can offer the chemical breakdown analysis for proof of purity, if you ask. The thing about essential oils is that quality can vary. I bought one set of E.O. on a Groupon from a different company. Serves me right. It was cheap. Too cheap, and what I found was that the oils they sent are more like water. Good quality essential oils will have the Latin species name (there are many types of lavender, for instance, each with a different profile), where it was sourced, and that it’s 100% pure and natural. You know when you meet someone who is clearly passionate about what they do? These guys are that. Plus knowledgeable. This may be my favourite product I picked up at the CHFA show: organic helichrysum (also called everlasting or immortelle). It’s beautiful for skin health, an antiviral, antifungal, anti-inflammatory, etc. (note that most E.O. should be diluted in oil to use topically and should only be used internally with guided support from someone who’s qualified, despite what some marketing companies say).

essential oils natural health VancouverIf you’re not planning on going E.O. nuts, but you’d like your car or closet or gym bag to smell nice, here’s an option. I’m trying the peppermint one in my car. It’s strongly scented right now, so it’s a good thing I love peppermint. They apparently last for 3 weeks. Please, please, please don’t use the fake scents–those cardboard pine tree-shaped smelly things for your car, Febreeze, fake scented air fresheners, cologne, perfume. The chemicals in those products are harmful to us and to our environment. Raise your hand if you, like me, hold your breath when you walk through the perfume section of a department store or past the store Abercrombie & Fitch (stinks like a cologne war). I love these Purple Frog air fresheners because they combine one of my favourite animals (I collect frog knick knacks) with essential oils. 🙂

Toiletries and Topicals

Toiletries. What an awful name for things that you use to make yourself look better. But, I didn’t create the word and it makes for nice alliteration in my subheading. 😉 

dental health natural health vancouverBrushing your teeth may not be exciting or ground breaking. But this oil (Body Food Dental) used as an alternative to toothpaste is quite different. It doesn’t foam. It doesn’t have chemicals. No SLS (sodium laureth/lauryl sulfate) or fluoride. You don’t need much. Just add 1-2 drops on your wet toothbrush and brush as you normally would. It’s a specially chosen blend of essential oils (you’ve already seen my love for E.O., as mentioned above) in coconut oil. It also tastes great. Not sure yet if I’ll convert over entirely, but I am alternating it with my natural toothpaste.

lymphatic support drainage natural health vancouver bcI often recommend dry brushing. Why? Because your lymphatic system will benefit, as will your skin. Why do I want to support my lymphatic system? Because the lymphatic system is part of your circulatory and immune systems, clearing away the garbage–dead cells, bacteria, viruses, cancer cells, toxins, excess fluid, and other waste products. I’ve written about lymphatic support here and here. This isn’t a new product at all, but it’s one I was happy to pick up–a dry brush. Practice dry brushing before you hop in the shower and you may find you catch fewer colds, have less puffiness, feel more energy, and have healthier skin. This brush by Urban Spa has a nice long handle, but I did notice that some of the bristles came off when brushing, so I might better recommend the Merben brand, as it comes with options for sensitive skin and is ethically sourced and made.

topical natural pain relief natural health Vancouver BCThis product counts as the one I’ve used the most since I picked up a sample. Some of you, as my patients, have already had this EpsomGel applied to your area of pain. I’ve tried topical magnesium products before. But they made me itchy, so I stopped using them. This one didn’t itch. Plus, it also contains arnica, which is good for treating injuries. It does have a light scent, but it’s not overwhelming. If you find that epsom salt baths help you relieve muscle tightness and cramping, then here’s your quick version that doesn’t require you to draw a bath (though you still might like to do that). I find it helpful for menstrual cramps or other muscle cramps, as well as tight muscles in general. If you want something topical for joint pain, and something that you can really feel as cooling and instantly pain relieving, then you might want to try SierraSil’s topical spray (I use that at the clinic). Either way, it’s great to have options for pain relief that won’t damage your liver, stomach, heart, or kidneys. 

I didn’t take a picture, but if there was one line of product I wish would disappear, it’s the bottled water category. I get it, sometimes you’re out and you want water. For sure, buy bottled if you’re in a country where the water will make you sick. Otherwise, drink tap or filtered tap water. I have a filter at home and plenty of re-usable, very nice looking and practical containers (some are collapsible and thus more portable for travel). At the trade show, I saw Mood Water. It was plastic bottles of a clear liquid and labels with pictures of emoticons. Cute, but “what’s in it?” I asked. “Water,” she said. Simply that. It was a marketing gimmick: Water is healthy; people like emoticons. But what an environmental waste. As much as I loved the show and am excited to see the innovations put forth next year, I’d like to no longer see stuff like that.

I’ve now recovered from my sampling of too many gluten-free, dairy-free, free trade, organic, vegan snacks, chocolate bars, cookies, ice cream, pastas, breads, spreads, etc. from last Sunday. But I’m still absorbing all the information that I gleaned from that day!

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Turmeric tea recipe to keep on hand

turmeric tea recipe anti-inflammatory pain reliefDid you know that a simple turmeric tea can help you stave off a number of diseases and treat a large number of symptoms and diseases? Turmeric has long been recognized for its powerful medicinal benefits by Traditional Chinese Medicine and Aryuvedic medicine, but more recently is also being studied by western researchers for its ability to treat a wide variety of health issues. One of the root causes of many health issues is chronic inflammation. 

Turmeric, as a result, has been shown to help treat and manage Crohn’s disease, ulcerative colitis, stomach ulcers, arthritis, dementia, colorectal cancer, surgery recovery, and much, much more.

Is this part of the reason why Okinawans have a well-known reputation for longevity? 

Ukoncha

Ukoncha (ウコン茶?, “turmeric tea“) is a kind of turmeric tea which originates from Okinawa, in southern Japan. Ukoncha is made of the rhizomes of turmeric

While I prescribe standardized, concentrated turmeric in capsule form for treatment, you can certainly also benefit both preventively and as treatment by having a regular turmeric tea. Super easy to prepare in advance, you can keep it on hand so all you have to do is add water.

Turmeric Tea Recipe

Turmeric Honey Tea
An anti-inflammatory daily use tea
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Ingredients
  1. 1/3 cup good quality raw honey
  2. 2-3 tsp powdered turmeric
  3. pepper
  4. lemon (optional)
Instructions
  1. Mix the honey and turmeric and keep it in a jar.
  2. When you want a tea, stir a heaping teaspoon of the turmeric/honey mix into 1 cup of hot water. Add " a good amount" of fresh ground pepper to enhance the absorption of the turmeric and improve its health benefits. Optional to squeeze in lemon, to taste.
Acupuncture, TCM, natural health, Vancouver, BC http://www.activetcm.com/
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The Media Loves to Write About “Dangerous Chinese Herbs”

The Vancouver Sun recently wrote an article titled, “Chinese herbs mixed with medications can be hazardous.” Now, the article doesn’t really say that Chinese herbs themselves are dangerous. It discusses how patients (particularly those from China) often take Chinese herbs, but don’t tell their medical doctors about it. And the onus of blame for health risks from drug-herb interactions always lands on the herbs, not the pharmaceuticals.

Chinese herbs mixed with medications can be hazardous

Using traditional Chinese herbal remedies while also taking prescription medications can cause potentially life-threatening reactions. After a survey of Chinese immigrants in Vancouver found that many use traditional herbs and fail to disclose it to
 
Chinese herbs, drug-herb interactions, Vancouver Sun dangerous Chinese herbs
 

The Good Side of Awareness for Drug-Herb Interactions

A group of medical students is working with an emergency medical doctor at Vancouver General Hospital to provide a checklist of common Chinese herbs with a listing of the herbs’ actions. The intent is to provide the list to TCM practitioners, TCM herbalists, and TCM doctors to have them check the box next to any of the herbs they prescribe to each of their patients. The idea is that the patient would then provide this checklist to their MD.

I do agree that dangerous drug-herb interactions need to be avoided. 

I do agree that it’s important that patients notify their MDs about any herbs or supplements they are taking. And that they also tell their TCM health professional (and any other health providers) about medications they are taking.

I do agree that Chinese herbs can have powerful medicinal effects. This actually is refreshing to me to hear medical students and a VGH ER doc note the potent physiological actions of Chinese herbs. TCM offers effective medicinal results, and too often the conventional side questions the efficacy. This group of conventional health providers do not question that there are medicinal effects. Bravo! 

Should We Be Concerned About Dangerous Chinese Herbs?

But, is it really the Chinese herbs themselves that are the problem?

How herbs are being taken

Part of the problem is it that patients may take herbs improperly, taking the health advice of a friend or family member (or Dr. Google), rather than seek the help of a qualified TCM doctor or herbalist.

As a registered doctor of Traditional Chinese Medicine, I know that when we prescribe Chinese herbs, the herbs are almost never prescribed as a single herb. We gather a lot of information from our patients about their health conditions, their medications (we too learn about drug-herb interactions), their other supplements, and a long list of symptoms, life patterns, and medical history. We do this so that we can work to avoid side effects and negative interactions.

British Columbians are lucky. TCM is a regulated profession. TCM herbs are prescribed by health professionals who are registered, licensed, and insured. We are held accountable, just like MDs, nurses, physios, and other health professionals under the Health Professions Act. So, make sure the person who tells you to take your Chinese herbs is actually qualified to do so. Note that if you want Chinese herbs, check our regulatory body’s website and choose only those with Dr.TCM, R.TCM.P., or R.TCM.H. Registered acupuncturists (R.Ac.) are not qualified to prescribe Chinese herbs.

What about the pharmaceuticals?

How about the pharmaceutical medications themselves? Do they hold some responsibility, or is it a dysfunctional blaming relationship? “It’s not me, it’s you.”

For example, the blood thinning drug warfarin (that they mention in the Vancouver Sun article) does not play well with others. Many others. Including A.S.A. (e.g. Aspirin), ibuprofen (e.g. Advil), and acetominophen (e.g. Tylenol); thyroid medicine, some antibiotics, and some antidepressants; and even many foods, like grapefruit, avocado, large amounts of kale or other otherwise healthy dark leafy greens, and store-bought mayo, salad dressings, and margarine.

I’m not against the proper use of pharmaceutical medicine. I work in an integrative medicine clinic with MDs and an ND who prescribe them. My mother is a nurse practitioner. I will take an Advil or Tylenol if I am suffering pain and need quick relief. But, too many people are too over-medicated because it’s easy to do. Because MSP or extended health plans pay for the medications, but not our herbs, vitamins, and other supplements. Because of scary articles like this one in the Vancouver Sun.

Why aren’t patients telling their MDs about their herb use?

Then, of course, there’s the big question…why aren’t patients telling their MDs about the herbs, vitamins, and other supplements they are taking? This article provides an answer, “A survey her group conducted of more than 300 Chinese immigrants to Vancouver revealed many don’t disclose their use of such remedies because they feel they’ll be harshly judged.” 

That is a problem!

And it’s not just Chinese immigrants who feel that way. Many patients have told me that they take supplements or get treatments (like acupuncture, chiropractic, osteopathy, and more) despite the flak they take from their MDs. Some have learned to just shut it when it comes to that discussion. Easier not to have to argue. Or justify. Or try to explain how it’s actually working for them. 

So, will my taking the time to print, fill out, and hand that checklist to each patient who receives Chinese herbs from me help?

Maybe a bit. Maybe it will open up some much needed dialogue between health professions so we can work better together. *I’m lucky because I work in an integrative medical clinic alongside MDs who are open-minded and who practice functional medicine–which really actually uses TCM foundational principles.

But, if only 1% of the herbal formula I make for someone is licorice root, will the MD still have them stop their herbs if they are taking warfarin? 

And, above all, if patients feel they can’t discuss their health choices with their MDs, will they even hand that list to their MD? 

 

http://www.webmd.com/drugs/2/drug-3949/warfarin+oral/details/list-interaction-medication 
http://www.ihtc.org/patient/blood-disorders/clotting-disorders/coumadin-interactions-with-food/ 

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Are your foods, herbs, makeup, and more full of toxins?

24 Hours Traditional Chinese Medicine and AcupunctureOur world is full of chemicals that are toxic to us if allowed to accumulated in our bodies. Toxins are found in food, makeup, skincare products, and cleaning products, but also even in some supplements and herbal products. Canada has much stricter rules regarding these toxic chemicals than some other countries. For this reason, Aryuvedic herbs and Chinese herbal products are highlighted as possible sources for higher levels of these toxins. When patients ask me about the quality of Chinese herbs and other supplements I use–and it’s a good question to ask–I can assure them that the products I use have third party testing for safety and quality. Read more to find out what other things to consider in my 24 Hours Vancouver article, How to Clean Your Food of Toxins.

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Product Review — Kombucha tea

kombucha tea review healthy food nutrition vancouver bcIn March I went to the CHFA (Canadian Health Food Association) show held in Vancouver (they have one in Toronto every year too). Only retailers and health professionals are allowed entry, not general public, because these are the companies that sell to the stores and clinics who then sell to the consumer. I go so that I can see what’s new in the land of natural health products and foods, and every year I learn about at least a few products that I hadn’t known prior.

I’ve been meaning to write about a few of the products I’ve tried, so finally, a couple of months later, here I start.

Kombucha Tea—“Immortal Health Elixir”

Kombucha tea is one of those food/drink products that has been around for a very long time, but didn’t hit mainstream (well, relatively mainstream) until recently. It may not make you immortal, but because it’s rich in antioxidants, vitamins, phytonutrients, and probiotics, it has been shown to help improve joint health, support good digestion, boost under-functioning immune systems, aid detoxification, and perhaps even prevent cancer.

Kombucha is a fermented sweetened tea. Ya, I know, that doesn’t sound yummy, but you’ll find a wide variety of brands and flavours now available in the refrigerated section of many grocery stores. The most common brand I’ve seen is called Synergy. It comes in flavours like Gingerberry, Guava Goddess, and Cosmic Cranberry. Some of them also come with chia seeds that make the drink thicker and more filling—you get a bonus of essential fats, fibre, and protein. These latter options are a much healthier alternative to sugar laden bubble tea with those little balls of tapioca.

I had only tried Synergy before and I prefer it not with the chia seeds. I find that you can taste a bit of a fermented bite—vinegary—with this brand. I like it, but it might not suit everyone’s tastebuds. It does taste “authentic” though, and there are a ton of flavour options, so you can try a different one if the first one you try doesn’t click for you.

At the CHFA show I picked up a bottle of Rise Kombucha in Hibiscus and Rosehips flavour and a bottle of Brew Dr. Kombucha in “Clear Mind” option.

What I like about the Rise Kombucha tea is that it has a lighter taste, so I think it probably will have a wider audience. I’ve tried some other Rise products and could taste the flavours in each—Mint & Chlorophyll, Rose and Schizandra, and of course Ginger. I think I need to buy the Lemongrass one next, as the Rise website lists a couple of recipes (a salad dressing and a marinade for veggies) that use that Lemongrass Rise Kombucha. It’s also nice that it’s a Canadian product—from my home province, Quebec.

The Brew Dr. Kombucha tea is made in Portland, Oregon, as you might guess. It’s bottled in brown glass stubbies, like old school beer. If you check out their website, you’ll get a definite hipster vibe. But don’t hold that against them ;). This brand tasted more like a beer to me. So, if you want a healthy drink that will sub in for a beer and actually help your brain, rather than kill off brain cells, try the Clear Mind Brew Dr. Kombucha.

Oh, and for each of these, I have 2 tips.

  1. Don’t shake the bottle vigourously or you’ll be cleaning up a mess. Rise Kombucha recommends you turn the bottle upside down and gentle swirl it to mix in the sediment (the “mother”—the good stuff!).
  2. I usually find a whole bottle too much for one sitting for me. I pour about half into a glass and cap the remainder to keep in the fridge.

Let me know if you have a fave kombucha and if you have your own tips.

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Ulcerative Colitis and Crohn’s

stomach pain digestive pain chronic illness acupunctureWhile the likelihood of being diagnosed with many diseases increases with age, there are some that are most likely to start in the “prime of life”—ages 20 to 40. Crohn’s and ulcerative colitis (UC), both inflammatory bowel diseases (IBD), fit this pattern. While I’ve written about IBDs before, this is an area of health that I’m particularly passionate about because I have a family connection. My sister has Crohn’s.

IBDs cause a host of challenges, including that there really is not that much known about them and that these diseases can be embarrassing. If you or someone you know has an IBD, here are some things to consider.

Both Crohn’s and UC are more common in first-world countries where a Westernized diet and lifestyle have been shown to increase the risk of IBD. There is thought that regular exposure to environmental toxins, synthetic chemicals, and bacteria are possible causes or at least aggravants. In addition—though IBDs are not caused by gluten—for those that are genetically susceptible, eating gluten can aggravate inflammation. Subsequently, it’s wise to consider a gluten-free diet, avoid processed foods, and try to limit contact with toxic chemicals, including pesticides, synthetic fragrances, and BPA plastics.

There are also some unusual treatments that are currently difficult to arrange, but show some promise. One involves infecting the IBD patient with a parasitic worm. Yup, you read that right. The reasoning is that in countries where parasitic worms are common, IBD incidence is low. This is called the “hygiene hypothesis.” It states that lack of these worm infections may result in immune dysregulation, leading to inflammation of the bowels. One worm that has been tested is called Trichuris suis ova (TSO), or pig whipworm egg. When ingested, the eggs only take up residency for a few weeks, and when they embed in the gut wall they help decrease the overstimulated immune cells and decrease inflammation.

Another type of treatment is fecal implants. Because one of the issues with IBD is an imbalance of intestinal bacteria, implanting a stool sample from a healthy donor has been found to effectively treat IBD. Preliminary studies showed reduction in symptoms (19 of 25 IBD patients), stopping of IBD medications (13 of 17 IBD patients on medications), and disease remission (15 of 24 IBD patients).

The problem with both of these last treatments is that they are not readily available options.

More easily accessible treatments include probiotics to help restore a healthy balance of good bacteria to the gut; omega-3 fatty acids DHA and EPA from fish oils to decrease inflammation; L-glutamine, an amino acid that helps restore intestinal cells; turmeric (curcumin) and boswellia, herbs to reduce inflammation; and slippery elm, marshmallow root, and aloe vera to soothe the gut lining.

A couple of simple things you can consider include extra virgin olive oil (EVOO) and also green tea. These two seemingly simple ingredients may very well help treat IBD. Taking 1-2 Tbsp of EVOO daily can help soothe the gut lining and decrease inflammation. Studies have also shown that green tea may help treat mild to moderate UC, and recommendations are for 5-6 cups daily, particularly of organic matcha green tea powder.

For a more in-depth treatment, Traditional Chinese Medicine offers a customized approach to identify individual digestive and health issues, using acupuncture, Chinese herbs, and nutritional advice.

 

Sourced from:

Roundoc Rx: Optimal Integrative Treatment for Ulcerative Colitis by Robert Roundtree, MD; August 2014

http://www.medscape.com/viewarticle/770009

 

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Don’t use pills for summer insomnia

24 Hours logoI wrote this article and then the very next day had 2 patients email to ask me for information about treating insomnia. That on top of the usual in clinic requests I hear during appointments. That just goes to show how ubiquitous sleep issues are. 

I know many of you take sleeping pills, but I highly recommend looking for other options. I mentioned it in my 24 Hours article, but didn’t include the quote:

Receiving hypnotic prescriptions was associated with greater than threefold increased hazards of death even when prescribed <18 pills/year. 

That’s huge! Here’s a link to that research: Hypnotics Association with Mortality or Cancer

Acupuncture, herbs, and supplements offer healthier alternatives. Check out my article on sleep in 24 Hours by clicking here.

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Get past the “ick” factor

24 Hours logoYes, Chinese herbs tasted awful to most. I tell my patients to be ready for the worst tasting “tea” they’ve ever had. Either they agree it’s the worst, but are prepared for it, or they are happy to report that it’s “not that bad.” The good news is two-fold. One, it doesn’t generally taste that bad by week 2, as your taste buds adapt to bitter–they’re usually much more accustomed to sweet and salty. And two, the health benefits start to kick in.  Click here for the PDF of my article in 24 Hours Vancouver newspaper: Get past ‘ick’ factor for herbal benefits.

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