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 …
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?
I wrote this article for my TCM colleagues, but the info is really for all of you…people who want to be healthier and know your options!
Researchers from the University of British Columbia looked at data from more than 8900 people using four gold standard (randomized placebo-controlled) studies. The subjects all had mild hypertension—systolic blood pressure of 140-159 mm Hg or diastolic blood pressure of 90-99 mm Hg. The medications investigated included beta-blockers, thiazide, and thiazide-like diuretics. The studies lasted between four to five years and some patients were taking more than one of these drugs at a time. Compared to placebo groups, there were no measurable benefits in coronary heart disease, cardiovascular events, or mortality. One study showed a trend toward reduced risk of stroke (0.3% with anti-hypertensives vs 0.7% control group).
However, there were significant side effects for those on the drug treatment. Five times more people dropped out of the studies because of adverse events than those taking the placebo and 9% of the drug-treated group experienced negative side effects.
As TCMs, we know that there are effective alternatives to the pharmaceutical approach. Traditional Chinese Medicine herbs dan shen, shan zha, and hou po are examples of herbs that have research supporting their anti-hypertensive potential. Most of us have also witnessed that acupuncture can also lower blood pressure, and the American Heart Association journal also notes the benefits of acupuncture in lowering blood pressure. One of the mechanisms for this may be a lowering of sympathetic response.
Do you know your blood pressure? Ask your doctor, ask me when I see you next, or go to a pharmacy to check it out. Then know your options. One of them may be a TCM treatment.
I recently did a talk for a class of pharmacy students at the University of British Columbia. I wasn’t sure what they might already know about Traditional Chinese Medicine and what their views on it would be. I was happy when they asked me lots of questions though and I thought you might have some of those same questions.
What is the training for becoming a TCM health provider?
Every province (and state) is different, but these are the regulations in BC:
There are 4 levels of registration for TCM in BC and each allows a different type of assessment and treatment. Both Registered Acupuncturist (R.Ac.) and Registered Chinese Herbalist (R.TCM.H.) require 3 years of training with a minimum of 1900 hours of study and training. A Registered TCM Practitioner (R.TCM.P.) can practice both herbs and acupuncture and they receive a minimum of 4 years with at least 2600 hours. A Registered Dr. of TCM (Dr.TCM) has the highest level of training of 5 years at 3250 hours.
In addition to the schooling, we also need to pass 2 examinations for each (written and practical), take safety courses for each, maintain requirements for good standing of the regulatory body, complete 50 hours of continuing education credits every 2 years, and be insured for liability and malpractice for minimum amount required by the college.
Lotsa hoops to jump! But all of that should be reassuring to you that we’re well-trained and practiced in what we do! All of this happens through the CTCMA (College of Traditional Chinese Medicine Association). The role of the CTCMA is to protect the public by making sure that we follow the rules. If you want to know if someone is a registrant (they should not be practicing in BC if they are not!), check out the listing here: http://www.ctcma.bc.ca/public.asp?cat=search
How many Chinese herbs are there?
There are more than 6000 herbs–including plants, minerals, and animal parts–with 600 used commonly.
Do you prescribe things like tiger bone, bear gallbladder, and rhinoceros horn?
NO! A big emphatic NO! Though they have been used traditionally in TCM in the past, they are illegal in Canada. Not only that, but they are not necessary to use. There are many substitutes that are effective and ethical to use.
What herb is best to treat…[fill in the blank, e.g. headaches]?
In TCM, the key is to obtain a TCM pattern diagnosis. Everyone is different, so 10 people with a headache might all have different herbs and treatments. Not only that, but Chinese herbs are almost always prescribed in combination, almost never as single herbs.
How do you make sure that herbs you prescribe are safe?
An herbal prescription is chosen with safety at top of mind. We consider the length of time that the herbs will be prescribed, the quantity of herbs prescribed, the methods of processing the herbs, whether there’s any risk of conflicting with any pharmaceuticals or other nutraceuticals, each individual’s health issues, and allergies and sensitivities.
Do the herbs come from China? Is the quality safe?
Some of my patients are concerned about the quality of the herbs I prescribe as they hear about quality issues with come products and foods that come from China and other countries. Some problems include that poor quality herbs can low quality or incorrect herbs; can be adulterated with pharmaceuticals; laden with heavy metals, pesticides, fungus, molds; and manufactured in substandard facilities.
But, not all herbs can be painted with this same brush! The herbs I use go through rigorous testing. They are extremely high quality herbs that much attain a Certificate of Analysis (COA). They must pass the strictest criteria of standards from U.S., Singapore, Japan, and E.U. Herbs go through a process of identification that includes selection by qualified professionals, microscopic inspection, chemical identification, and chemical “fingerprinting” (thin layer chromatography) to make sure that the right herb is chosen. Herbs are cleansed of dirt and other foreign particles, prepared with traditional methods, and extracted while making sure to maintain the integrity of the volatile essential oils. They are then concentrated with low temperature methods so as to not destroy any of the components. Every batch is tested with microbiological assays to make sure there is no e.coli, salmonella, molds, yeast, or other contaminants. Gas Chromatography tests for safety, making sure there are no pesticides, fungicides, and herbicides. High Performance Liquid Chromatography measures for key active ingredients while Inductively Coupled Plasma – Mass Spectrometer tests for heavy metals.
Phew! So, as you have learned, there is a lot that goes into the selection of each herbal formula that I create!
Any questions? Ask me!
This blog is not just for me to blab on about what I think. It is for others to express their opinions about various health topics. That said, here are some links to interesting polls I thought were thought-provoking:
To what degree do you think clinicians’ prescribing practices are or are not influenced by pharmaceutical company advertising?
In May, the top 3 soft-drink companies agreed to a ban on sweetened drinks like Coke, Pepsi, and iced teas in all school cafeterias and vending machines nationwide in response to the threat of lawsuits and state legislation. Sales are not expected to be affected; the sweetened drinks will be replaced by others. Do you favor or oppose this ban?
Recent reports of sleep-driving and behavioral changes (aggressiveness, obliviousness) after taking the sleep aid Ambien have prompted calls for increased FDA warnings on the drug. Do you think Ambien needs more warnings added to its label or are current warnings not to drive or drink alcohol after taking the drug adequate?
What are your opinions?