Frequently Asked Questions - Alternative and Complementary Medications

What is the role of antioxidants in cancer prevention?

Does the vitamin C in Airborne and Emergen-C work for the common cold?

Can melatonin be used to help with insomnia?

Can I drink cranberry juice with my Warfarin (Coumadin)?

Grape seed FAQs

Can an herbal supplement reduce cholesterol?

What is the role of magnesium and vitamin B 2 in migraines?

Can you provide information about Hydroxymethylbutyrate (HMB)?

Can you provide information about creatine?

Is the recreational use of herbal dietary supplements safe?

Can alpha lipoic acid help diabetic neuropathy?

Are there any alternative supplements that may be helpful for menopausal symptoms? What about the use of these alternative supplements for women who have had breast cancer?

Can herbal products relieve inflammation?

Can ginkgo improve my memory? What are the side effects?

Are there any natural supplements that help decrease cholesterol levels?

Should I take vitamins, minerals, antioxidants or other herbal supplements while I am getting cancer treatment?

Are herbal weight loss products safe?

If I’ve decided to take a dietary supplement, how do I know which brand to buy? Are they all the same?

How many people take herbal products or alternative medicines?

What side effects have been reported with herbal products or alternative medicines?

Can herbal products or alternative medications interact with prescription medications?

Should I take Coenzyme Q10 with my “statin”?

What are the effects of Coenzyme Q10  in Parkinson’s disease?

Should you take supplemental vitamin D?

What is the role of antioxidants in cancer prevention?
Antioxidants are one of the largest groups of dietary supplements on the market, and beta-carotene, vitamin E, vitamin C, and coenzyme Q10 can classified as antioxidants. Although few studies have been done involving antioxidants and cancer prevention, there have been two large studies involving beta-carotene. All the studies involving beta-carotene showed increases in cancer. At this point antioxidants, especially beta-carotene, are not recommended for cancer prevention.

Does the vitamin C in Airborne and Emergen-C work for the common cold? Posted Dec 2007
Airborne is a popular remedy that contains 1000 mg of Vitamin C in one dose plus other herbs and vitamins. Emergen-C likewise contains 1000 mg of vitamin C and multivitamins. Both are popular remedies for the common cold and it is thought that the vitamin C component is responsible for helping.

What is vitamin C?
Vitamin C, known also as ascorbic acid, is used by the body to maintain collagen found in cartilage, tendons, and ligaments. Vitamin C is sometimes used to speed wound healing, especially in burn patients. It is a popular remedy to combat the common cold because of its antioxidant properties which help reduce damage inflicted upon the body.
Natural sources of vitamin C are fresh fruits especially citrus fruits such as oranges, grapefruits, lemons, and limes. It can also be found in guavas, tomatoes, cantaloupes, mangos, papayas, and strawberries and vegetables such as broccoli, brussel sprouts, cabbage, and spinach.
8 ounces orange juice 124 mg Vitamin C
8 ounces grapefruit juice 72 mg
1 cup strawberries 85 mg
½ pink/red grapefruit 23 mg
1 papaya 93 mg
½ c boiled broccoli 58 mg
½ mango 28 mg
1 tomato 24 mg
½ c boiled cabbage 18 mg

Is vitamin C effective?
The debate over vitamin C has been going on for more than 60 years and some studies indicate that high doses of vitamin C are effective in bolstering the immune function.
Nobel Prize winner Linus Pauling has long been a proponent of high doses of vitamin C since research he performed during the 1970s. A 2004 meta-analysis, a review of many studies, found that the number of “colds caught” was not decreased by taking vitamin C in any dosage range from 200 mg daily to 8,000 mg daily. A review of 30 studies has found that the duration of a cold during vitamin C supplementation may be reduced by 9%. There are no studies or evidence showing that Airborne or Emergen-C work for the common cold. A daily intake of 100 mg of vitamin C is adequate to maintain normal levels in the body. The recommended daily allowance (RDA) of vitamin C is 75 to 90 mg a day for adults and adolescents. Children recommendations are 30 mg a day. Pregnancy recommendations are 100 mg a day and 150 mg a day if breastfeeding.

Who should NOT take vitamin C supplements?
Do not take vitamin C if you have kidney stones.
If you have diabetes or chronic kidney disease, check with your doctor before taking vitamin C. Having diabetes may increase the risk of experiencing kidney problems while taking vitamin C.
Do not take more than 1000 mg a day of Vitamin C or Airborne or Emergen-C if you are pregnant.
People who take anticoagulants, who have sickle cell anemia, iron overload disorders, or glucose 6 phosphate dehydrogenase deficiencies should not take vitamin C without supervision of their physician.
Before taking vitamin C, talk to your doctor, pharmacist, or health care professional if you have any other medical conditions, allergies, or if you take other medicines or other herbal/health supplements.

How should I take vitamin C?
Take vitamin C exactly as directed by your doctor or as directed on the package. Caution with Airborne as the directions for use is: 1 tablet or 1000 mg at onset of cold and repeat every 3 hours and this far exceeds the amount that can lead to kidney stones.

What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of vitamin C.

What happens if I overdose?
Vitamin C dissolves in water and is referred to as a water-soluble vitamin. This means that it cannot be stored by the body and excess amounts are excreted in the urine.
However, large doses can cause toxicity. Persons with decreased kidney function may be more likely to experience theses effects.
Severe nausea, stomach pain, and diarrhea may mean you have ingested too much vitamin C. You should seek medical attention immediately. Hydration with water may be helpful in theses situations.

What are the possible side effects?
Dizziness, faintness, fatigue, abdominal pain, diarrhea, headache.
Stop taking the vitamin C and contact your physician if you experience: severe nausea, stomach pain, and diarrhea.

What other drugs will affect vitamin C?
When taken at the same time, Vitamin C may increase the body’s absorption of iron supplements. Vitamin C can decrease the effects of oral contraceptives or the blood thinner, warfarin.

Can melatonin be used to help with insomnia? Posted August 2007
Melatonin is a hormone produced by the pineal gland in the brain in response to darkness. It is made available when tryptophan is converted to serotonin and then to melatonin. Levels appear to be low during the day and peak in the early hours of the morning.

Multiple studies have been performed studying Melatonin for sleep. Most of these studies have been small and not well designed; however they have shown promise in helping with insomnia. People who seem to benefit most from Melatonin supplementation are the elderly who have less production of Melatonin and those with problems of sleep latency (getting to sleep).

Reported safe and effective dosages have ranged from 5-75 mg by mouth. However, the recommended dosages have been 0.5-5 mg taken 30 to 60 minutes prior to sleep.

Melatonin has been found to be effective in half the studies to help those with jet lag; reducing the number of days it takes to obtain a normal sleeping pattern after travel. The benefit seems best when 5 or more times zones are crossed and least effective in westward flights. If used, it is recommended to be taken at the target bedtime at destination in a dosage of 0.5-5 mg and 2 to 5 nights thereafter. Though rare, side effects have been noted with Melatonin. These include daytime drowsiness with high doses. Other problems have been disorientation, confusion, sleepwalking, vivid dreams and nightmares. Headaches have also been reported. One case of hepatitis was also linked to Melatonin use. Melatonin also interacts with several medications. Increased effectiveness or decreased effectiveness of the Melatonin has also been noted with varying medications. This includes such medications as Valium, Ativan, anti inflammatory drugs, a variety of blood pressure medications and oral contraceptives. You should check with your pharmacist and physician to learn more about these interactions.

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Can I drink cranberry juice with my Warfarin (Coumadin)? Posted July 2007
Drinking cranberry juice occasionally and in moderation is acceptable with warfarin but one should be aware that there is a potential interaction and their lab INR should be monitored closely for changes.

Cranberry juice is a flavonoid, which can act on the liver enzymes that metabolize warfarin and cause an increase in the lab INR and possible bleeding. Cranberry juice is popular for helping urinary tract infections and people sometimes drink large amounts of cranberry juice to help their infection. A few cases have been reported where people were ill, or had infections, or were not eating a regular diet and were drinking large amounts of cranberry juice. (i.e. 3/4th of a liter to 2 liters). In these cases the people experienced an increase in their lab INR while on warfarin. So far, clinical research trials have not confirmed a problem with cranberry juice and warfarin but it is advised that one should consume juices in moderation while on warfarin. Consult your health care provider before taking any supplements or changing your diet while on warfarin.

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Grape Seed FAQ’sPosted March 2007

Q. Where is grape seed derived from?
A. Grape seeds can be found in white, red and purple grapes. Grape seed extract, which comes from the seed itself, is found to be the most concentrated in purple grapes.

Q. What has grape seed been traditionally used for?
A. The traditional uses of grape seed include cancer treatment and prevention, cholera, smallpox, nausea, eye infections, skin, kidney and liver diseases. Furthermore, grape seed has also traditionally been used for arthritis, bruises, gum disease, ulcers, varicose veins, cardiac and cerebral infarction, vascular problems, seasonal allergies, strengthening connective tissues, improvement of skin elasticity and to treat inflammation.

Q. What is grape seed commonly used for?
A. Although grape seed is not one of the more commonly recognized herbal products, it does have some common uses in today's society. Grape seed has been used to treat seasonal allergies, inflammation, leg swelling, and ophthalmic conditions such as improvement in night vision. In addition, grape seed has been used as an anti-oxidant and most importantly as a supplemental dietary source of essential fatty acids.

Q. What dose of grape seed should you use?
A. The average starting dose is 75-300mg per day for three weeks with a reduction to 40-80 mg maintenance dose daily.

Q. What side effects should you watch out for?
A. Adverse effects are very rare due to low toxicities of this herbal product. If allergic reactions or skin rash occurs, stop taking. Grape seed is likely safe in common foods such as grapes. Excessive intake of grapes or raisins may cause diarrhea due to it’s laxative like action. There is insufficient data and information for its use during pregnancy or breast feeding. It is not advised to take grape seed with Warfarin (Coumadin) as it may cause bleeding or bruising.

Q. How does grape seed work?

A. One of the main uses of grape seed is as an anti-oxidant. Grape Seed is used as a free radical scavanger or neutralizer due to its anti oxidant properties from the high Oligomeric Proanthocyanidin Complex (OPC) content. OPC’s are biflavanoids or polyphenols (monomers, dimers, trimers, tetramers or tannins) with anti oxidant properties. The two most active chemical proanthocyanidin monomers are Catechin and Epicatechin. One OPC molecule can neutralize several free radicals at once where as other antioxidants, vitamin E or vitamin C, can only neutralize one free radical at a time. Free radicals occur naturally in the body, but UV light, radiation, cigarette smoke and air pollution can also increase the number of the damaging particles. These free radicals are molecules that damage DNA cells, tissues and can eventually contribute to cancer or other illnesses.
Another of the major uses of grape seed is as an anti-histamine. The natural anti-histamine effect of Grape Seed is caused by inhibition of the enzyme histidine decarboxylase which is responsible for the production of histamine. Thus, inhibiting the release of histamine into body tissues.
Traditionally, but also in today’s society, grape seed has also been used as an anti-inflammatory. The anti-inflammatory effect of GS occurs by the inhibition of release and synthesis of compounds that promote inflammation. These compounds being histamine, serine protease, prostaglandins, and leukotrienes. Another use of grape seed is as a protectant and a healer of tissues. Grape seed is used to stabilize collagen and elastin and thus acts to protect and heal connective tissues.
The final and probably most important of all the uses of grape seed is as a supplemental dietary source of vitamin E. Grape seed oil can be used as a good supplemental dietary source of essential fatty acids and tocopherols. The oil of grape seed does not contain proanthocyanidins as in other products or as in fresh grapes, juice, or red wine.


Can an herbal supplement reduce cholesterol?
Policosanol is an herbal supplement that has been used for high cholesterol. It is a complex of several fatty acids that can be extracted from sugarcane, yams, rice bran, wheat germ, or beeswax. It is thought that policosanol works in a similar manner as some high cholesterol medications. Although there are some studies promoting the usefulness of policosanol, there are also some studies that suggest policosanol does not lower cholesterol as previously expected.

Up until recently there have been many studies from one group of researchers showing reductions in cholesterol. However, these studies were not published in mainstream journals, and they haven’t been duplicated by other research groups. Recently, there was an article published in the Journal of the American Medical Association. This article showed that there was no benefit when people were taking policosanol to reduce cholesterol. This group did, however, say that more research needs to be done.

So what do you need to know? Policosanol probably does not help reduce cholesterol as previously believed. Currently, it is widely available in health food stores and on the internet. In addition, it is one of the ingredients in One-A-Day Cholesterol Plus multivitamin product. Therefore, many people may be taking policosanol and not be aware. Keep in mind, policosanol can interact with aspirin by increasing the antiplatelet effects. It is always important to tell your healthcare providers what vitamins and herbal supplements you are taking.

What is the role of magnesium and vitamin B 2 in migraines?
Are you one of the 18% of women or 6% of men in the United States that suffer from one or more migraines per year? Approximately 24 million people in the United States suffer from migraine headaches. Among theses migraine sufferers, about half experience severe disability temporarily from their migraines.

Migraineurs experience recurrent headache attacks of moderate to severe intensity. Increased symptoms related to gastrointestinal, neurologic, and autonomic symptoms may occur with migraines. These symptoms include nausea, vomiting, diarrhea, irritability, problems with sleep, and change in appetite. Medications to help relieve patients from migraines have been very beneficial. However, many of these patients still have a need to use preventive treatments to reduce the frequency or severity of their migraines. Unfortunately, preventive medications can be difficult to patients due to the possible side effects and toxicities associated with these medications. In addition, preventive treatment is not recommended in patients who plan on becoming pregnant or are pregnant. Therefore, some patients seek out other alternative approaches for preventative treatment. Magnesium and vitamin B2 (riboflavin) are two supplements that have been used for migraine preventive treatment.

Magnesium is a mineral found in dark green leafy vegetables and legumes. Magnesium reduces impulses of the nerves and increases relaxation of the muscles. Low magnesium levels have been found in some patients with migraines and have been linked to increased excitability in the brain. Supplemental magnesium has only shown benefits for patients who do not have enough magnesium in their body. Since magnesium can affect patients who have kidney or heart conditions, they are encouraged to discuss the risk versus benefits with their healthcare provider prior to administration. Diarrhea was the primary side effect with magnesium.

Another agent which has been shown to be helpful in preventive treatment of migraines would be vitamin B2 (riboflavin). Vitamin B2 is found in meat, dairy, and eggs. The initial benefits can be seen during the first month of treatment, however, the full benefits are not seen until three to four months of treatment. Studies showed doses of 40 mg daily decreased the number of days the patient experienced a headache by 50 %. This dose also decreased the number of migraine attacks. The main side effect again included diarrhea and florescent yellow urine.

Magnesium and vitamin B2 are two of many alternatives available for migraine preventative treatments. Although magnesium and vitamin B2 are more obtainable and may appear safe because a prescription is not required for either agent, healthcare providers should be consulted before using either agent to determine safety and efficacy.

Creatine
1) What is Creatine?
a) Creatine is a chemical that is normally found in the body, mostly in muscles. Creatine can also be made in the laboratory.

2) Is Creatine useful to build muscle mass?
a) Many people use creatine to gain weight. This is because creatine causes the muscles to hold water, not because it actually builds muscle.
b) Meat is the best dietary source of creatine, and vegetarians generally have lower muscle creatine concentrations than meat-eaters. People at the lower end of the normal range for muscle creatine are the most likely to benefit from supplementation.

3) Is Creatine safe?
a) Creatine seems to be safe for most people when used at recommended doses. Creatine can cause stomach pain, nausea, diarrhea, and muscle cramping.

4) Does Creatine work?
a) It can improve the athletic performance of young, healthy people during brief, high-intensity exercise such as sprinting. There is conflicting evidence whether or how well this supplement works for other conditions, including building muscle mass. Individual results may vary.

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HMB
1) What is Hydroxymethylbutyrate (HMB)?
a) HMB is a byproduct of the chemical (amino acid) leucine. People use HMB to make medicine.

2) Does HMB work?
a) It can increase body weight and muscle in people with AIDS.

3) Is HMB useful to build muscle mass?
a) HMB might promote muscle growth. It seems to reduce the destructive breakdown of muscle in people with AIDS.

4) Is HMB safe?
a) HMB seems to be safe for most people when used short-term. Doses of 3 grams per day or less for up to eight weeks seem to be safe.

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Is the recreational use of herbal dietary supplements safe?
Recreational use of an herbal dietary supplement is the pursuit of a psychological effect rather than the intended medical benefit, or just seeking a “high.” Emergency care and hospitalizations have been increasingly reported among patients who are pursuing a “legal” and/or “safe high” from herbal dietary supplements. Several such products are sold with claims to have effects similar to illicit drugs such as marijuana, LSD, Ecstasy, cocaine or speed. According to a study by Dennehy[1] and colleagues, many of these products actually are not safe or legal. In fact, Dennehy found that several herbal dietary supplement products contain Ephedra which was banned from herbal dietary supplements by the Federal Drug Administration (FDA) in April 2004 because of the risk of heart attack, stroke or death. Even more disturbing is the fact that many of these products contained substances known to be toxic such as Kava Kava (liver damage), high doses of caffeine or other stimulants (cardiac effects), and Salvia (loss of consciousness with higher doses). Also the Dennehy study found that many of these supplements did not have the FDA required labeling. In summary, use of recreational herbal supplements may be neither “safe” nor “legal.”


1Dennehy CE, Tsourounis C, Miller AE. Evaluation of herbal dietary supplements marketed on the internet for recreational use. Ann Pharmacother 2005;39:1634-9.

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Can alpha lipoic acid help diabetic neuropathy?
Alpha Lipoic Acid is an herbal or dietary supplement that has been used for diabetic neuropathy to help with symptoms of numbness, burning pain, and tingling of feet and legs. It is thought to act as an antioxidant but unlike other antioxidants (e.g. Vitamin C or E) it may eliminate metals such as iron and copper from the body and also cause a deficiency of a B-vitamin, thiamine, from the body.

High doses of alpha lipoic acid (600 mg to 1200 mg) are used in Germany for treatment of diabetic neuropathy and lower doses may not be effective. Unfortunately in the U.S. it is only available as 30 to 300 mg tablets/capsules and therefore cost may be a factor. There is only about 30% absorption from the tablets/capsules and this may be the reason for higher doses. Avoid taking it with antacids, as this will cause lower absorption of the tablets. Other product names are Lipoic and Thioctic acid. It is not readily available as an injection in the U.S., although this route has been studied. It has been tried for alcohol related liver disease, cardiac nerve function, dementia, poisonings, and in HIV and cancer patients, but it has not proven significantly effective in these disorders.

Consult your health care provider before taking Alpha Lipoic Acid as it can decrease blood glucose levels, and adjustments in insulin and oral medications for diabetes may be necessary. It may also interfere with thyroid medications and can cause hypothyroid and hyperthyroid conditions. Deficiencies in iron, minerals, thiamine, and other vitamins should be monitored. Worsening of peripheral neuropathy has been reported at the beginning of therapy. Skin rash, headache, stomach upset and vomiting can also occur and should be reported to your health care provider before continuing the supplement.
08/2005

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Are there any alternative supplements that may be helpful for menopausal symptoms? What about the use of these alternative supplements for women who have had breast cancer?
The mean age for menopause in the United States is 51.3 years. The most common menopausal symptoms include hot flashes, mood changes, sleep disturbances, decreased libido and vaginal dryness. Based on the Women’s Health Initiative study, the long-term use of estrogen replacement may increase risk of cardiac disease, stroke and breast cancer.

For premenopausal women diagnosed with breast cancer, the treatment itself can rapidly “push” them into menopause causing more severe symptoms of depression, poor sleep quality, frequent hot flashes and severe fatigue. Women who have breast cancer should not use estrogen replacement therapy. It is important to consult with your cancer doctor regarding safe treatments for menopausal symptoms so that you do not interfere with your treatment. Prescription medications known as SSRI’s (Selective Serotonin Reuptake Inhibitors) have been proven to be helpful in managing many of these menopausal symptoms and are safe to take while undergoing chemotherapy or radiation therapy. Exercise is also a safe and effective way to combat cancer treatment related fatigue and may help prevent weight gain although it does not seem to decrease hot flashes in observational studies.

Many women are interested in alternative therapies for menopausal symptoms. The following list summarizes the safety and efficacy of the most common products marketed for menopausal symptoms.

Phytoestrogens are plant sources that contain weakly estrogenic properties. Of the many components, isoflavones found in soy products are the strongest (although still 600-1000 times weaker than estrogen pills). In some studies, 60 grams of soy protein has been shown to reduce hot flashes, improve bone mineral density and reduce cholesterol levels, however, this generally requires supplementation to achieve this level. Isoflavones have properties that may block the promotion of cancer cells. However, due to their weakly estrogenic properties, women with a history of estrogen-sensitive breast cancer or those who take tamoxifen or raloxifene are advised by the American Cancer Society not to take soy containing pills, powders or supplements. However, it does appear to be safe to consume a moderate amount of whole soy foods such as soy milk and tofu as part of a plant based diet. Two studies are currently underway to study the safety and efficacy of soy in women with breast cancer.

Lignans are another group of phytoestrogens that include linseed, rye, flaxseed and berries. Although there are some studies that support the use of flaxseed to reduce the risk of breast cancer or its recurrence, questions linger about its potential to promote existing tumors. At this time woman who now have or have had breast cancer, or are taking tamoxifen, should not take flaxseed supplements.

Vitamin E has had very limited studies to support its use for menopausal symptoms although it may improve hot flashes, mood swings and vaginal dryness in high doses (i.e. 800 IU per day). In some studies, Vitamin E inhibits growth of breast cancer cells, while in others; it seems to increase tumor growth. Vitamin E is a powerful antioxidant and may interfere with radiation therapy for breast cancer so supplementation should be avoided during treatment. It is safe to consume dietary sources of Vitamin E (sunflower seeds, wheat germ, dry roasted peanuts, almonds, walnuts, asparagus and spinach) that may also offer protection against heart disease.

DHEA has shown mixed results in only two studies for relief of hot flashes and vaginal dryness. An Australian study found that DHEA prompted normal white blood cells to change into the cells that promote plaque to form on artery walls increasing risk of heart disease.

Black cohosh may be helpful for relieving hot flashes based on one randomized, controlled study and has been approved by the German Commission E for this menopausal symptom.

Dong quai, kava, evening primrose, chaste tree, wild yam and St. John’s Wort have shown little or no efficacy for menopausal symptoms and may have adverse effects. For example, kava has resulted in deaths and St. John’s Wort is known to interact with several prescription drugs including chemotherapy (etoposide).
3/28/2005

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Can herbal products relieve inflammation?
Several herbs possess anti-inflammatory action with the two best known being white willow bark and arnica.

White willow bark contains salicin, a form of salicyclic acid, which is what aspirin consists of. White willow can cause an allergic reaction in those individuals sensitive to willow plant or aspirin. Common daily dose is 60 to 240 mg of salicin. White willow bark might be effective for minor pain (e.g. lower back pain) but not for osteoarthritis or rheumatoid arthritis.

Arnica is used for tissue inflammation, swelling, bruises, aches, and sprains. The herb can be mixed with oil and applied like an ointment. There is no evidence of benefit to support it’s use topically. Arnica can cause a contact allergic reaction when applied and should not be used on open wounds, broken skin, or eyes.

The internal use of arnica is not recommended. When taken internally may cause harm to the kidneys, heart, and liver.

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Can ginkgo improve my memory? What are the side effects?
Ginkgo Biloba is a herbal supplement obtained from the ginkgo tree and the active compounds for memory enhancement are found in the leaves and not in the seeds. Variations in the concentration of the active compounds occur with seasons and the highest concentrations are in autumn. The compounds can increase blood flow to the brain and regulate the tone and elasticity of the blood vessels. A study in which patients who were older than 60 years were given 120 mg/day (40 mg three times a day) of ginkgo for 6 weeks and no difference was found in memory over placebo (sugar pill). Many studies are short term and therefore the long-term effects are not known. Side effects to ginkgo include stomach complaints, dizziness, headaches, allergic reactions, and seizures. Ginkgo can have serious drug interactions with aspirin, ibuprofen, blood thinners (Coumadin/warfarin), or antiplatelet drugs (Plavix) by causing increased risk of bleeding. Caution should be taken with combining with other herbs or supplements that increase the risk of bleeding such as angelica, garlic, ginseng, and ginger.
11/2004

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Are there any natural supplements that help decrease cholesterol levels?
There are 2 kinds of cholesterol in your blood, good cholesterol (HDL) and bad cholesterol (LDL). Nutritional supplements vary in their effect on these lipids. The following is a list of a few of these supplements and their potential impact on cholesterol levels:

  • Panthethine also knows as co-enzyme B-5. Some research shows a decrease in LDL others do not when using Panthethine. There seems to be no risk in taking this supplement.
  • Psyllium a soluble fiber found in Metamucil. This has been found to safely lower LDL. Keep in mind however if taken in excess psyllium may cause severe constipation.
  • Niacin, also known as nicotinamide. Dosages greater than 500 mg may increase HDL, however, can also cause other health problems. This includes, painful flushing or reversible liver damage. This therapy is not recommended without the supervision of a health care professional.
  • Plant sterols found in margarines like Take Control, Benecol and Smart Balance. These substances have been shown to decrease LDL however the benefits may be offset by the calories from the margarine required for this positive effect. 2 grams of these margarine (approximately 1 tablespoon) is estimated to decrease LDL by approximately 10 % and may be a positive addition but not replacement to other lipid lowering treatments.
  • Folic acid and vitamin B-12. These vitamins may decrease cardiac risk by lowering homocysteine levels but have not been found to have an effect on lipids in the blood.
  • Garlic. Some studies show a slight decrease in LDL with garlic but in the long run garlic appears to have very little effect on lipid levels.

The following supplement have been advertised as beneficial but may actually be more harmful than good:
Guggul
Tocotrienols
Isoflavones
Red yeast rice
Bitter orange
Bees wax
11/2004

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Should I take vitamins, minerals, antioxidants or other herbal supplements while I am getting cancer treatment?
Many cancer patients are interested in alternative or complementary nutrition care including ultra-healthy diets and alternative nutritional or herbal supplements. While many alternative supplements may be touted as “cancer cures”, to date there is no evidence that these products are effective for treatment of the disease.

It is important that you tell your doctor the names of any supplements that you are currently taking so that they can be included on your medication list. First of all, your doctor and pharmacist will want to make sure that they do not interact with your other medications. Your oncologist may also have concerns with supplement use during your specific cancer treatment such surgery, chemotherapy or radiation therapy.

Some ultra-healthy diets may lack the necessary calories, protein and nutrients to maintain your strength. We do know that malnutrition can keep you from tolerating your treatment plan. For some patients, any major changes in their diet or lifestyle can also be stressful and overwhelming while undergoing cancer treatment.

The National Cancer Institute and the American Cancer Society, based on all current research, strongly urges patients to continue to depend upon a traditional, healthy, balanced diet for the majority of nutrients and to follow a program prescribed by a doctor who uses accepted and proven treatments. A registered dietitian or naturopathic physician who specialize in cancer and are willing to work with your oncologist is a better choice than self-prescribing alternative medications.
11/2004

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Are herbal weight loss products safe?
No, recently the FDA banned the sale of ephedra (also known as Ma Haung) in herbal products. Ephedra products have caused increased blood pressure, heart rate, strokes, heart attacks, and death in people taking them. Since the ban on ephedra, some ephedra free products have been promoted for weight loss. One of these is bitter orange or citrus aurantium that contains synephrine which can have dangerous effects on heart and blood pressure. Manufacturers may boost the synephrine in their products and combine them with other stimulants such as caffeine and guarana. These are often contained in sport drinks and if used during exercise workouts can increase heart rate and blood pressure leading to heart attacks or strokes. At this time there is no herbal product proven safe and effective for weight loss.
11/2004

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If I’ve decided to take a dietary supplement, how do I know which brand to buy? Are they all the same?
All dietary supplements are not created equal. Because they are regulated by the U.S. Food and Drug Administration as foods rather than medications, they don’t have to meet the same standards as drugs to prove safety or effectiveness, or adhere to any manufacturing standards before going on the market. Scientific analyses of some supplements have found differences between what’s listed on the label and what’s in the bottle. Besides containing more or less of the listed ingredients, some supplements could be contaminated with metals, unlabeled prescription drugs, microorganisms or other substances. Just because the label says the product is “natural” or “standardized” doesn’t mean it really is.

One place to check for objective information about these products is Consumerlab.com. This company does independent testing of supplements and publishes results of brand names that meet its requirements. Those that pass are eligible to bear the CL Seal of Approval.

Another source of reliable information is the U.S. Pharmacopeia’s Dietary Supplement Verification Program.
11/2004

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How many people take herbal products or alternative medicines?
It is estimated that 40% of Americans take herbal supplements on a daily basis. A survey of 165 hospitalized patients at St. Joseph Medical Center in 2001 revealed 40% were taking alternative medications and an additional 16% had tried alternative medications in the past. Close to 60% of patients do not tell their doctors about their use of alternative medications. Health care providers fail to ask their patients about herbal product use and toxicities and interactions are unmonitored. Be sure to consult your pharmacist or health care provider before taking alternative medications.
11/2004

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What side effects have been reported with herbal products or alternative medicines?
Common side effects reported in surveys are related to gastrointestinal problems such as abdominal cramping, nausea, vomiting, and diarrhea. Herbal products can cause allergic reactions and rash and itchiness have been reported. Other common side effects are malaise, nervousness, anxiety, rapid heart rate, insomnia.
11/2004

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Can herbal products or alternative medications interact with prescription medications?
Yes. Manufacturers of alternative medicines are not required to do testing and research. Little is known about interactions. What we do know is that the herbal product St. John’s Wort can lower the effectiveness or prescriptions medicines such as antivirals for HIV, digoxin, theophylline, and birth control pills. Many herbal medicines have been reported to interact with Warfarin (brand name Coumadin), a blood thinner. See patient information sheet on herbal-Warfarin interactions.
11/2004

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Should I take Coenzyme Q10 with my “statin”?
Several studies indicate lower serum levels of Coenzyme Q10 with “statin” (cholesterol lowering drug i.e. simvastatin, pravastatin, lovastatin) use. The consequence of this lower coenzyme Q10 level remains unclear. Supplementation of 100-200 mg tends to return levels to normal range. Since the role of coenzyme Q10 is to lower LDL oxidation, maintain cellular mitochondrial function, in addition to acting as a strong antioxidant , there remains a concern of what effect lower coenzyme Q10 levels may have long-term. It appears that daily supplementation of 100 mg of coenzyme Q10 with long-term use “statin” usage is acceptable.
11/2004

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What are the effects of Coenzyme Q10 in Parkinson’s disease?
A small study of 80 patients with early Parkinson’s disease not requiring treatment were given Coenzyme Q10 at dosages of 300, 600, or 1200 mg a day. The study concluded that Coenzyme Q10 seemed to slow the progression of movement dysfunction necessitating the need of prescription medication in Parkinson disease. The greatest gain was at the highest dose, 300 mg four times a day. Because this was a small study group, the results need to be confirmed in a larger study before being recommended for Parkinson’s disease. This therapy is costly (greater than $150 month). Other references indicate that possible side effects are nausea, vomiting, diarrhea, and stomach discomfort. Dividing the dose four times a day can help these symptoms.
11/2004
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Should you take supplemental vitamin D?
Vitamin D has many roles throughout the life cycle. This includes increasing calcium absorption, bone health; cancer, autoimmune and cardiovascular heart disease prevention.

The term vitamin D actually refers to a group of molecules; two that require activation (not active themselves) and one that is already activated . For simplicity we will refer to these as cholecalciferol.

It is estimated that most people do not meet their needs for cholecalciferol. 90- 95% of our cholecalciferol needs comes from sun exposure. Thus the absence of sun exposure, and the use of topical sun screens are huge barriers to meeting our vitamin D needs. There is also a risk of deficiency in obesity, the aging process and certain disease processes.

It has been estimated that the body uses an average of 3000-5000 International Units of cholecalciferol per day. For adequate cholecalciferol stores it has been recommended to obtain approximately 5 to10 minutes of sun exposure without topical sun screen daily to meet this need. If this is not possible 1000 International Units supplement of vitamin D or an equivalent amount of cholecalciferol from food is recommended to maintain healthy stores. If you live in the Pacific Northwest a blood test for vitamin D is recommended since deficiency is very high due to lack of sun exposure. If a deficiency is found, a much higher dose of vitamin D will be required, which is best met with a prescriptive vitamin D.

Following are some foods containing vitamin D. Other potential foods are fortified juices, cheeses and yogurts.

Vitamin D from selected foods:

FOOD SERVING VITAMIN D
Milk 1 cup 98 Units
Salmon 3 1/2 oz 360 Units
Whole egg 1 25 Units
Cod Liver oil 1 Tablespoonful 360 Units
Dry cereals fortified 3/4 cup 40-50 Units



Because vitamin D is activated by the kidney and liver, if you have kidney disease or liver disease alternative supplements of activated vitamin D may be needed to meet your needs. This requires prescriptive vitamin D and needs to be discussed with your physician.
6/2009
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