Potential Danger of Herbal Products
By Rob Danoff, DO, MS

Jim came into the office complaining of a headache and of feeling his heart beat real fast. "Doc, I don't feel right. For the last three days I haven't been able to sleep, although I know I am tired. I do have a lot of energy, but I feel strange. Look at my hands. They're shaking."

I took his blood pressure and found it had sky-rocketed to 194/110 (normal is around 120/80). Jim's heart rate was 124 beats per minute (average is about 72). Fortunately, his EKG was normal. I asked him if he had been taking his blood pressure medication, and he said he was. He said, "Dr. Rob, I have been real good. In fact, I was at a health products store and bought an herbal product which I was told would help me lose weight and have more energy." I said, “Jim, I think I know what is causing your present problem."

Hidden Herbal Danger
Jim was taking an herbal product which contained ma huang. This is a common ingredient in many herbal supplements which claim to help a person build muscle, increase energy and lose weight. What the supplement usually does not say is that it can increase a person's heart rate, blood pressure, chance of stroke, heart attack or the possibility of sudden death.

You see, what is frequently omitted on the label is the ingredient called ephedra. This is a stimulant which can cause dangerous side effects, especially in the concentration contained in these herbal products. Even when the label does list ephedra or ephedrine, many people do not realize the potential danger.

In fact, a recent report on MSNBC stated that in a study conducted at the New England Medical Center in Boston, in 926 reports of possible ephedrine toxicity reported to the U.S. Food and Drug Administration, overall they found 50 serious heart ailments, including 14 sudden deaths, 13 strokes - two of which were fatal, two mini-strokes, nine heart attacks and six cases of rapid heart rates.

Why, you may ask, would something claimed as a natural herbal supplement be dangerous? Well, millions of Americans assume herbal supplements to be safe because they are "natural," but, unfortunately, in 1994 Congress passed the Dietary Supplement Health and Education Act, which President Clinton signed. This act removed the requirement that dietary supplements undergo the same premarket safety evaluations which are required of pharmaceuticals. Bottom line, this act leaves the nutritional supplement industry mostly non-regulated, meaning you can't ever assume the product you are buying is safe, or even has the claimed ingredient in the amount stated! This guideline does not protect the consumer. The U.S. Food and Drug Administration can only intervene after an illness occurs, or if safety concerns are raised based upon evidence and consumer complaints.

Herbs and Your Health
While Jim experienced a side effect of a specific herb adding to his existing high blood pressure, other herbs have the potential to make other medical problems worse. Here are some examples:

Diabetes
Ginseng, ma huang, hawthorn and nettle may affect your blood sugar control.

High blood pressure
Licorice (black natural type, not the candy), ginseng, goldenseal, ma huang, yohimbe and devil's claw may raise your blood pressure even more.

Depression
Valerian and kava-kava may further deepen depression.

Allergies to ragweed, daisy, aster or chrysanthemum
Chamomile, echinacea, feverfew and yarrow may make the allergy even more bothersome.

Allergies to other pollen
Goldenrod, St. John's wort and slippery elm may be a problem.

If you are pregnant or nursing, please do not take an herbal supplement unless approved by your healthcare professional. The following herbs are absolutely not recommended while you are pregnant or nursing: black cohosh, dong qwuai, feverfew, ginseng, kava-kava and saw palmetto.

Potential Herbal and Medication Interactions
If you are on warfarin (Coumadin), aspirin, NSAIDS like ibuprofen, ticlopidine (Ticlid) or clopidogrel (Plavix), caution is advised with ginkgo, ginseng, feverfew, ginger, alfalfa, cinchona bark and clove oil.

If you are taking decongestants, beta 2 agonists (example is albuterol),or if you have a lot of caffeinated products, be very careful with ma huang, St. John's wort, yohimbe, guarana and kola.

If you are taking prescription antidepressant medication, be careful with ginseng, ma huang, St. John's wort, passion flower and yohimbe.

If you are taking medications for anxiety such as the benzodiazepines (example is Valium), or if you are on antihistamines, drink alcohol or are taking any narcotic pain killers, be very careful with hawthorn, kava-kava, skullcap and valerian.

So, just because something is labeled natural or herbal doesn't always mean it is safe. I do believe certain herbal products can be helpful. However, before you take that herbal preparation, please check with your healthcare professional.

©1999. Rob Danoff, DO, MS