Dr. Michael Tierra L.AC., O.M.D.
The hottest topic on the herbal supplement scene these days seems to be around the problems associated with herb-drug contraindications. It seems that this issue has become the major platform for unskilled, misinformed, medical practitioners and researchers to proffer their largely insubstantial expertise behind the battery of letters that always follow their name. Of course, where the vast wealth of our herbal knowledge emanates is not from such self styled 'experts" but from eons of herbalists, folk healers and people who underwent the real test of using them repeatedly over generations " and the fact is that if we were to encounter such healers, shamans and herbalists, we are not likely to find any degrees after their name but the withered appearance of a wise sage.
For the most part, it is the same tired old pharmaceutically hyped herbs; the St.- Johns-wort, feverfew, ginkgo, kava, and echinacea that are flaunted as replete with possible hazards, as if these were the only herbs that herbalists and people ever use. It is the thesis of this article that this effort, whether conscious or not, often involving well meaning medical spokespersons and even herbalists who are trying to make themselves well versed in scientific jargon, generally serves to confuse the public about the well known efficacy and safety of herbs. This may be a process to create a wedge of doubt concerning the safety and efficacy of most herbs, engendering an alarmist environment in the mainstream, that will ultimately lead to someone claiming some trumped up catastrophic episode, thereby forcing a heightened climate towards further regulation.
With 30 years experience as an herbalist, having seen thousands of people throughout the world (mostly through trial and self training, since there were no official training schools or programs during my early years of interest), I have seen very little evidence of any serious drug-herb complications. I cannot say that I have not seen any, but the problem is that if even one issue is raised, the entire conversation becomes dominated not by the overwhelming efficacy and safety of herbal medicine, but by the hazards and risks. This is disproportionate and, I believe, for a very good reason. First, it raises unwarranted doubts and concerns about herbs which, reasonable or not, takes the heat off the real problems of drug side effects. Lest we forget, the reason that the alternative health movement and the herbal movement specifically achieved its impetus is not because of lifestyle-envy of people who tended to be involved with herbs, but because of the very real and continuing issues of the failure of conventional medicine to offer therapeutic options that were not replete with a wide array of risks and side effects.
Attending one such presentation at an NNFA show in Las Vegas, a symposium of non-herbalist authorities set forth to describe the risks of various herb-drug interactions. I remember one very clearly " that an individual who takes ibuprofen pain medication should probably not take feverfew. The italics are my own because this expert had no solid evidence that there was a problem sufficient to warrant such a claim. Those who attended this lecture and had no experience in the use of herbs were going to leave with two conclusions: 1) that herbs were dangerous and 2) that not only are herbal remedies, in themselves, difficult to learn but that this issue is made even more complex because they would have to learn about the various drugs and the interaction herbs may have with these drugs.
First of all, let's define an herb. The pharmaceutical companies have defined herbs such as ginkgo, St.-Johns-wort, feverfew, kava, and echinacea based on standardized extracts, some of which are highly concentrated to the degree that they are actually herbally derived drugs. Others are simply described by a single supposedly 'active" biochemical constituent. Let's face it " herbs are complex entities made up of thousands of compounds, which, if each of these were isolated, would include a number that are poisonous and a number that are not. Since it is the dose that is the deciding factor, if an herb has a smaller amount of poisonous, toxic compounds than non-poisonous ones, it is probably as safe as a most foods.
I have always felt that there are serious problems commercializing and promoting the use of a single herb. People are capable of reacting against any substance, whether benign or not, including broccoli, carrots and even rice. Why then, would it not be possible for someone to develop an immediate or delayed 'idiosyncratic" reaction to a complex, unfamiliar food-like substance such as a medicinal herb? Traditional herbalists know this, which is one reason why herbs, especially when prescribed for long-term chronic conditions are given in formulas " not as a single substance. Single herbs are traditionally taken short term usually for a specific acute condition or to achieve a specific therapeutic effect and then they are stopped.
So what I heard, amongst other outrageous remarks, was that because ibuprofen is responsible in the US for 9000 deaths a year from stomach hemorrhage and since feverfew has actions that may be similar to ibuprofen (though there actually is no basis for such a thesis), people shouldn't take feverfew with ibuprofen for their headaches. The assumption here is that people should take ibuprofen, known to kill 9000 people a year from gastrointestinal bleeding. Feverfew, on the other hand, has no attributed deaths to its shame but is made an accomplice by implication to the side effects of ibuprofen.
The ignorance of this position is astounding to me as an herbalist. Immediately, one could postulate, 'Well, besides feverfew, this must include willow bark, lemon balm, mint, and even chamomile since these are a few of the other well-known herbs that have been used to relieve headaches and symptoms of colds and flus. The strategy was clear to me, though I don't think it was clear to the speaker: 'We'll begin with feverfew and some other time in the not-too-distant future we'll get to all the other herbs." What I read into this, is that they don't need to get to all the other herbs but simply enough to warrant distrust and suspicion so that all herbs will fall under repressive regulation with distribution only by medical doctors.
One may think that I am reading something into this presentation that didn't exist, or that I am being unduly alarmist. Sorry, it has already happened in just about every other Western country including France, Germany, Italy, the UK, Ireland and Australia, where increasing numbers of some of the most popular herbs are only available from qualified medical personnel. Unfortunately, what is considered to be called a 'qualified" medical practitioner are not the same qualifications that comprise an herbalist " one who dedicates his or her life to the study and practice of herbal medicine.
Furthermore, there are at least two distinct types of herbalism that can be referred to: There is allopathic herbalism, which is based on using herbs like drugs to treat, usually in a very limited way, specific medical conditions; and there is traditional holistic herbal medicine, which uses herbs to adjust functional processes of the body so that the body is able to find its own homeostatic health and well-being.
For example, when you take saw palmetto for a prostate problem you are practicing allopathic herbalism. However, when you take herbs that regulate urination, promote normal circulation and clear inflammation in the pelvic cavity (whether you use herbs from India, China or the great botanical treasures of North or South America), you are using herbs holistically.
So which one is safer? Certainly it is the holistic approach. While the other may only have a statistical reference of efficacy for prostate problems, using herbs holistically guarantees that the only limiting factor on their efficacy is the skill of understanding the complexity of symptoms based on a differential evaluation of the individual's symptoms.
What I have consistently found is that when people take herbs and drugs together the efficacy of the herbs is compromised. The herbs must first be put to the task of dissipating and eliminating the toxicity of the drug, which is the 'drug-herb" toxicity, before they can get to helping the body heal itself. That is why I would say that the chances are excellent that you will not have any complications from the interaction of Ibuprofen with feverfew, but because ibuprofen is toxic and is known to cause severe reactions and death in a significant percentage of people who use it for colds and headaches, you should stop its use and take feverfew or some other applicable herb instead.
In other words, it seems the best of all worlds if we were to stop using drugs to the best of our ability and use herbs instead. I know that is a problem for many but at least it creates a truer impression as to where the risks really reside " with the drugs, not the herbs. Remember, we are looking to herbs because we want to get away from drugs, not simply to use them like another drug.