Frequently Asked Questions
If you’re considering taking a dietary supplement, you may have a lot of questions. Here we’ve answered the most common questions we receive about alternative medications.
Drug Interactions and Side Effects
Herbal and Hormonal Supplements
Vitamin and Mineral Supplements
FAQ: Alternative medicine for cancer
What is the role of antioxidants in cancer prevention?
Antioxidants are chemicals that either the body produces or we get from food or dietary supplements. Antioxidants neutralize free radicals, highly reactive chemicals that can damage cells. Some well-known antioxidants include beta-carotene and vitamins A, C and E.
In research on antioxidants in cancer prevention, none has found clear evidence that dietary antioxidant supplements (including vitamins and minerals) help prevent cancer. In addition, some studies about the effect of antioxidants on people who already have cancer actually showed worse outcomes — increased incidence of cancer and risk of death. At this point, we do not recommend taking antioxidants for either cancer prevention or supplemental therapy.
Should I take vitamins, minerals, antioxidants or other herbal supplements while I am getting cancer treatment?
Although many alternative supplements may be promoted as cancer “cures,” no scientific evidence shows that these products are effective in fighting cancer.
It’s important to tell your physician about any supplements that you are currently taking, to include them on your medication list, because:
- Your physician and pharmacist must make sure that the supplements do not interact with your other medications.
- Your oncologist can tell you if any supplements may interfere with your specific cancer treatment: surgery, chemotherapy or radiation therapy.
Even healthy diets may lack the necessary calories, protein and nutrients to maintain your strength during your cancer treatment. Malnutrition can prevent you from tolerating your treatment plan. For some patients, any major changes to diet or lifestyle can also be stressful and overwhelming while undergoing cancer treatment.
Based on current research, the National Cancer Institute and the American Cancer Society strongly urge cancer patients to:
- Continue a traditional, healthy, balanced diet that provides the majority of your nutrients
- Follow a program prescribed by a physician who uses evidence-based treatments
We recommend consulting with a registered dietitian or naturopathic physician who specializes in cancer, rather than self-prescribing alternative medications. He or she can work with your oncologist to ensure that you’re getting the nutrition you need during cancer treatment.
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FAQ: Alternative medicine for high cholesterol
Can natural supplements help decrease cholesterol levels?
The two kinds of cholesterol in your blood are:
- Low-density lipoprotein (LDL): the “bad” cholesterol
- High-density lipoprotein (HDL): the “good” cholesterol
Some nutritional supplements can lower LDL and raise HDL. Some of these supplements and their potential effects on cholesterol levels include:
- Folic acid (vitamin B9) and vitamin B12: These vitamins may decrease cardiac risk by lowering blood levels of homocysteine, an amino acid associated with heart attack, stroke and blood clots. Vitamins B9 and B12 have not been found to affect cholesterol.
- Garlic: Some studies show that garlic may slightly decrease LDL. Over time, garlic appears to have very little effect on cholesterol levels.
- Niacin, a form of vitamin B3: Dosages over 500 mg may increase HDL but can also cause other health problems including painful flushing or reversible liver damage. Niacin therapy is not recommended without a physician’s supervision.
- Pantethine, also known as coenzyme B5: Mixed research study results show a possible decrease in LDL. There seems to be no risk in taking pantethine.
- Plant sterols found in margarines like Take Control, Benecol and Smart Balance: These substances have been shown to decrease LDL. But, the benefits may be offset by the calories from the amount of margarine you need to consume. Two grams of these margarines (about 1 tablespoon) are estimated to decrease LDL by about 10 percent. Plant sterols may be a positive addition to your diet but not a replacement for other cholesterol-lowering treatments.
- Psyllium, a soluble fiber found in Metamucil: Psyllium does safely lower LDL. Excess amounts can cause severe constipation.
Nutritional supplements that do not improve cholesterol levels and may be harmful include:
- Bitter orange
- Red yeast rice
Should I take Coenzyme Q10 (CoQ10) with my prescription statin?
CoQ10, an antioxidant made in the body, is needed for proper cell function. Clinical trials show that CoQ10 levels can be lower in people who are taking a statin, a cholesterol-lowering drug.
Although the consequences of lower CoQ10 levels remain unclear, more research is needed to understand the effect over the long term. CoQ10 has important functions, including:
- Lowering LDL (bad cholesterol)
- Maintaining cellular mitochondrial function (create energy to fuel cells)
For people taking statins, a daily supplement of 100 to 200 mg of CoQ10 is safe and effective.
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Alternative medicine: Drug interactions and side effects
Can I drink cranberry juice with my warfarin (Coumadin)?
Cranberry juice can increase the effects of warfarin, which can increase your international normalized ratio (INR). INR measures how long it takes for your blood to clot. Drinking moderate amounts of cranberry juice occasionally is acceptable. But you should tell your physician so that he or she can monitor your INR closely.
If I’ve decided to take a dietary supplement, how do I know which brand to buy?
The U.S. Food and Drug Administration Dietary regulates supplements as foods rather than medications. That means they don’t have to meet the same standards as medications to prove safety, effectiveness or adherence to 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 different amounts of the listed ingredients, some supplements can 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—or that it’s safe.
You can find reliable information about supplements at these websites:
- Consumerlab.com: This company does independent testing of supplements and publishes results of brand names that meet its requirements. Those that meet the requirements are eligible to bear the CL Seal of Approval.
- U.S. Pharmacopeia’s Dietary Supplement Verification Program: This organization sets standards for the identity, strength, quality and purity of medicines, food ingredients and dietary supplements. Those that meet the requirements are awarded the USP Verified Mark.
Are herbal weight loss products safe?
Herbal supplements for weight loss don’t have scientific evidence that they are effective, and many are not safe. At this time, no herbal product has been proven safe and effective for weight loss.
The following supplements are considered stimulants and can increase blood pressure, heart rate and the risk of stroke, heart attack and death:
- Bitter orange, or citrus aurantium, which contains synephrine
- Ephedra, also known as ma huang, which was banned by the U.S. Food and Drug Administration
What side effects have been reported with herbal products or alternative medicines?
Common side effects reported in surveys include:
- Allergic reactions, including rash and itchiness
- Gastrointestinal problems, such as abdominal cramping, nausea and vomiting and diarrhea
- Rapid heart rate
- Weakness or fatigue
Can herbal products or alternative medications interact with prescription medications?
Yes. Although alternative medications are not required to undergo testing or research, medical experts have learned more about drug interactions as more people take these supplements.
Supplements or foods that can interact with prescription medications include:
- Coenzyme Q10
- Juices such as cranberry and grapefruit
- John’s wort
Speak with your physician if you are taking or considering taking any dietary supplements to find out about any potential interactions.
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Alternative medicine: Herbal and hormonal supplements
Can melatonin supplements be used to help with insomnia?
Melatonin is a natural hormone produced by the pineal gland in the brain in response to darkness. It helps control our sleep and wake cycles.
Studies on the use of melatonin supplements for sleep disorders show that:
- For disruptions of the body’s internal “clock,” melatonin can help people with delayed sleep phase disorder even out their sleep cycles.
- For insomnia, there is not enough evidence that melatonin is safe and effective for children, and results are mixed for adults.
- For jet lag, melatonin may help.
- For shift work sleep disorder, melatonin may help daytime sleep but not nighttime alertness.
People who benefit most from melatonin supplements are those:
- Over age 55 whose bodies produce less melatonin
- With problems getting to sleep (sleep latency)
The recommended doses for melatonin are:
- Insomnia: 0.3 to 5 mg at bedtime
- Jet lag: 0.5 to 5 mg at bedtime on the arrival day and for two to five nights after
Melatonin can have rare side effects, including:
- Daytime drowsiness (high doses)
- Disorientation and confusion
- Vivid dreams and nightmares
Melatonin also interacts with several medications, including:
- Anti-inflammatory drugs
- Blood pressure medications
- Oral contraceptives
Check with your pharmacist and physician to learn more about these interactions.
What is creatine, and is it safe and effective for building muscle?
Creatine is an amino acid that is made in the kidneys and liver and stored in muscles. It is also found in meat and fish, and it can be commercially produced.
Some studies show that creatine supplements can increase lean body mass and strength when combined with exercise. Creatine causes muscles to draw in water, which can increase muscle fiber growth.
Creatine supplements can improve the athletic performance of young, healthy people during brief, high-intensity activity, such as sprinting and most sports. It does not appear to significantly improve endurance performance or aerobic exercise.
Creatine seems to be safe for most people when used at recommended doses. Possible side effects include stomach pain, nausea, diarrhea and muscle cramping.
Can alpha lipoic acid help diabetic neuropathy?
Alpha-lipoic acid is an herbal dietary supplement that may reduce symptoms of diabetic neuropathy, such as numbness, burning pain and tingling of feet and legs. It is thought to act as an antioxidant, but unlike other antioxidants such as vitamin C or E, it may lower levels of iron, copper and vitamin B1 (thiamine) in the body.
In Germany, physicians use high doses of alpha-lipoic acid (600 to 1200 mg) to treat diabetic neuropathy. Although lower doses may not be effective, it is available only as 30 to 300 mg tablets or capsules in the United States. Other considerations include:
- The body absorbs only about 30 percent from tablets and capsules, which may be the reason that higher doses work better.
- Avoid taking it with antacids, because they will cause lower absorption.
- Because alpha-lipoic acid can decrease your blood glucose levels, consult your physician before taking it. You may need to adjust your insulin and oral medications for diabetes.
- Alpha-lipoic acid may interfere with thyroid medications and can cause hypothyroid and hyperthyroid conditions.
- Your physician should monitor your blood levels of iron, minerals, thiamine and other vitamins for deficiencies.
- Alpha-lipoic acid may cause skin rash, headache, stomach upset or vomiting. If you experience any of these problems, talk with your physician.
Can herbal products relieve inflammation?
Several herbs possess anti-inflammatory qualities. The two best known such herbs are white willow bark and arnica.
White willow bark contains salicin, a form of salicylic acid, which makes up aspirin. White willow can cause an allergic reaction in those individuals sensitive to willow plant or aspirin. The common daily dose of salicin is 60 to 240 mg. White willow bark might be effective for minor pain (e.g., lower back pain) but not for osteoarthritis or rheumatoid arthritis.
Arnica can reduce tissue inflammation, swelling, bruising and symptoms of osteoarthritis. The herb can be mixed with oil and applied like an ointment.
Arnica can cause a contact allergic reaction when applied and should not be used on open wounds or broken skin or in eyes. Do not take arnica orally; it may cause harm to the kidneys, heart and liver.
Can ginkgo improve my memory? What are the side effects?
Ginkgo biloba is an herbal supplement obtained from the leaves of the ginkgo tree. Concentrations of the active compounds can vary with the seasons, with the highest concentrations in autumn.
Ginkgo biloba can increase blood flow to the brain and regulate the tone and elasticity of the blood vessels. Results of clinical studies on ginkgo biloba are mixed. It:
- Can reduce memory problems in people who have dementia and Alzheimer’s disease
- Can slow the progression of dementia symptoms
- Does not seem to prevent Alzheimer’s or dementia
- May help some circulation problems, such as leg pain caused by clogged arteries
Speak with your physician before taking gingko. Interactions or other risks include:
- Side effects such as:
- Allergic reactions
- Heart palpitations
- Nausea, gas or diarrhea
- Interactions with medications that can increase the risk of bleeding, including:
- Antiplatelet drugs (clopidogrel/Plavix)
- Blood thinners (warfarin/Coumadin)
- Interactions with other herbs that can increase the risk of bleeding, including:
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Alternative medicine: Vitamin and mineral supplements
Does the vitamin C in Airborne and Emergen-C cure the common cold?
Airborne and Emergen-C are over-the-counter (OTC) medications that each contain 1,000 mg of vitamin C per dose.
Although no clinical trials have specifically studied either product, research studies into vitamin C as a cold remedy show mixed results:
- Regularly taking moderate amounts of vitamin C (no more than 2,000 mg daily) can help reduce the frequency of catching a cold.
- Taking vitamin C does not help treat a cold once you are already sick: It does not reduce the duration or severity of a cold.
Can magnesium and vitamin B2 help migraine headache?
A migraine headache causes throbbing or pulsing pain of moderate to severe intensity in one area of the head. Related symptoms include:
- Change in appetite
- Nausea or vomiting
- Sleep problems
Medications that prevent migraines or relieve their symptoms do work. But, these medications are not recommended for everyone because some have serious side effects. Some patients take supplements such as magnesium and vitamin B2 (riboflavin) to prevent or treat migraine headaches.
Found in dark green, leafy vegetables and legumes, magnesium is a mineral that can reduce the frequency of migraine headaches. But, magnesium can affect people with kidney or heart conditions. You must take magnesium for at least three months before feeling the effects.
Vitamin B2 (riboflavin), found in meat, dairy products and eggs, may also help reduce the frequency of migraines. High doses (400 mg per day) of vitamin B2 can significantly reduce the number of migraine headaches a person gets. But, riboflavin does not seem to reduce the amount of pain or time that a migraine lasts.
Please consult your physician before taking magnesium or vitamin B2, to ensure that the supplements are safe and effective for you to use.
Should I take a vitamin D supplement?
Some clinical studies have shown that vitamin D is important for:
- Increasing calcium absorption for bone health
- Preventing osteoporosis, Alzheimer’s disease, cardiovascular (heart) disease and some types of cancer
The body produces vitamin D when your skin is exposed to sunlight. Most people get enough vitamin D that way or in the foods they eat.
Your physician can check your vitamin D level with a simple blood test. If your level is low, he or she may recommend a supplement. After another blood test in about eight to 12 weeks, you can stop taking the supplement if your level returns to normal. You need testing only every two to three years unless you have any major health changes.
If you have chronic kidney, liver or parathyroid disease, talk with your physician. You may need alternative supplements of activated vitamin D by prescription.
Women who are pregnant or breastfeeding should take vitamin D supplements as long as their Ob/Gyn prescribes them.
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FAQ: Alternative medicine for women’s health
Are any alternative supplements helpful for menopausal symptoms? What about the use of these alternative supplements for women who have had breast cancer?
Based on the Women’s Health Initiative study at the National Institutes of Health, the long-term use of estrogen replacement may increase women’s risk of cardiac disease, stroke and breast cancer.
Women who have breast cancer should not use estrogen replacement therapy. For premenopausal women diagnosed with breast cancer, the treatment can actually bring on menopause, causing symptoms of depression, poor sleep, frequent hot flashes and fatigue.
If you have breast cancer, talk with your cancer physician about safe treatments for menopausal symptoms that do not interfere with your treatment. Here are the most common alternative medications for menopausal symptoms along with their safety and effectiveness:
Phytoestrogens are plant sources with weakly estrogenic properties. Of the many components, isoflavones found in soy products are the strongest (although still 600 to 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, most women need to take supplements to achieve this level.
Isoflavones have properties that may prevent cancer cell growth. However, because of 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. It appears 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 effectiveness of soy in women with breast cancer.
Lignans are another group of phytoestrogens that include linseed, rye, flaxseed and berries. Although some studies support the use of flaxseed to prevent breast cancer or its recurrence, it may promote existing tumors. At this time, we recommend that women who now have or have had breast cancer or are taking tamoxifen not take flaxseed supplements.
Studies supporting the use of Vitamin E for menopausal symptoms are limited. However, high doses (such as 800 IU per day) may improve hot flashes, mood swings and vaginal dryness. In some studies, vitamin E inhibits breast cancer cell growth, while in others, it seems to increase tumor growth.
Vitamin E may interfere with radiation therapy for breast cancer, so women should avoid taking supplements during treatment. It is safe to consume dietary sources of vitamin E that may also offer protection against heart disease, such as almonds, asparagus, dry-roasted peanuts, spinach, sunflower seeds, walnuts and wheat germ.
DHEA (dehydroepiandrosterone) 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 type that promote plaque to form on artery walls, increasing the risk of heart disease.
Black cohosh may be helpful for relieving hot flashes based on one randomized, controlled study. It 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 death, and St. John’s wort interacts with several prescription drugs including chemotherapy (etoposide).
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Talk with your doctor about integrating complementary or alternative therapies into your care. Need a primary care doctor? Find a doctor and make an appointment to begin your journey to wellness.