Dr. Tannis Jurgens (BSc Pharmacy, MSc, PhD Pharmacognosy)
Assistant Professor, Medicinal Chemistry and Natural Health Products,
College of Pharmacy, Dalhousie University
When your pharmacist asks you what medications you are taking, do you think to mention the garlic pill or the Echinacea you are taking? All medicines, no matter if they are “natural” or made in a laboratory, have the potential to act like drugs in your body. Surveys have shown that people often don’t let their pharmacist know they are taking herbal medicines or other Natural Health Products (NHPs). This may be because patients think that their pharmacist won’t approve of the use of an “alternative” type of medicine or they don’t think of NHPs as drugs. People often assume that because many NHPs have been used as medicines for centuries and are made from natural sources, they are somehow safer than “man-made drugs.” There is the perception that whether or not they work, it can’t hurt to give a NHP a try. In order to properly manage your medication profile, your pharmacist needs to know about all of the medications you are taking, including NHPs.
A substantial number of Canadians use NHPs to improve or maintain their health. In fact, in 2001, 75 percent of Canadians surveyed said they had used a NHP in the last 6 months.[1] Health Canada defines Natural Health Products as including herbal medicines, traditional medicines, probiotics, homeopathic products, essential fatty acids, amino acids, vitamins, and minerals. Much is known about vitamins and minerals, such as when supplementation is appropriate, what doses should be used, and what side effects are possible. In addition, manufacturing standards have been well defined for these products.
The same depth of information is not yet available for other NHPs, such as herbal medicines. To meet the criteria for sale of a NHP under the new Canadian NHP regulations currently being phased in, more information regarding the efficacy, safety, and essential ingredients will be required. There is no question that, with further research, some NHPs will prove to have benefit in the treatment of certain conditions and/or be safe, if taken in reasonable doses for specified periods of time.
There are, however, some NHPs that have clearly been shown to adversely affect chronic conditions, such as diabetes, high blood pressure, and heart disease. For example, if a person has diabetes, he may find that there are certain NHPs, such as ginseng, that can affect his blood sugar levels. To make it more complicated, because the actual content of “active” ingredients can vary between ginseng products, the effect that ginseng may have on a person’s blood sugar levels can be unpredictable. Depending on the particular ginseng product or brand, blood sugar levels may be increased, decreased, or remain unchanged. This can make blood sugar control difficult for a person with diabetes, who may want to use an NHP to treat a condition other than diabetes.
It is important, especially if you have a chronic condition, to talk to your pharmacist before starting or stopping any NHP. Abruptly stopping or sometimes even switching brands of NHP can produce unexpected effects, so your health care practitioners should be aware of any changes in your medication use, including NHPs. There are NHPs, such as St. John’s wort, which have been shown to interact with some prescription drugs. There are NHPs that increase the removal of drugs from the body and others that decrease it. If this type of interaction occurs, it can give the effect of taking too much or too little of the prescription medication, depending on the interaction. Another NHP/drug interaction occurs when a person who is already on a prescription blood-thinning medication takes a NHP that can thin the blood. The combined blood-thinning effect can be potentially serious. Your pharmacist, as medication manager, needs to be aware of all medications you are using to ensure that you are not taking any medications that may interact and prevent you from receiving maximum benefit from your therapy.
Pharmacists are accessible health care professionals who are educated in the safe and rational use of all medications, including NHPs. They have up-to-date resources that are used to check the safety of using a NHP in people with chronic disease or in combination with other drugs. Be sure to talk to your pharmacist before you start or stop any NHP. They can help you decide if a Natural Health Product is an appropriate choice for you.
[1] http://www.hc-sc.gc.ca/hpfb-dgpsa/nhpd-dpsn/hpbackpaper.pdf
