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Bring Herbal Remedies Into Doctor Dialogue, Experts Caution

Use of herbal teas should be considered in diagnosing liver problems

MONDAY, Feb. 18, 2002 (HealthDayNews) -- Herbal remedies may seem like safe alternatives to conventional medicines, but experts say recent cases of liver toxicity underscore the need for caution when taking such supplements.

In one such instance, a 40-year-old woman from Brooklyn, N.Y., was diagnosed with liver toxicity that was traced to the consumption of Chinese rice tea.

According to Dr. T.C. Chauhan, who treated the woman, she had apparently been drinking just a few cups of the tea each day because she believed the tea helped control her diabetes.

The woman was from Sri Lanka, where some believe Chinese rice tea strengthens the pancreas, and hence lessens the diabetes risk, according to Chauhan, a gastroenterology fellow at the Brooklyn Hospital Center.

Chauhan says the tea was targeted because the woman had no other liver problems, and the symptoms disappeared after she stopped drinking the tea.

While Chinese rice tea isn't known to be a toxin, Chauhan says it can, like so many other herbal remedies, have a toxic effect for any number of reasons.

"The active ingredients contained in many herbal remedies aren't standardized, so it could be that some people, like this woman, may find themselves with stronger concentrations that can be harmful," he says.

In another case related to herbal tea, doctors from the Wyckoff Heights Medical Center, also in Brooklyn, reported that a patient suffered the toxic effects of lead consumption after consuming an herbal tea that had actually been contaminated with lead.

The patient is estimated to have inadvertently consumed more than three grams of lead, say the doctors. After being diagnosed and treated, the patient recovered.

In addition, in the third, more stark case, doctors with Cook County Hospital in Chicago reported that a 45-year-old woman experienced liver failure after consuming almost 30 different herbal remedies over several months.

The woman had been reluctant to admit she was using the alternative therapies, but after she was diagnosed, she successfully underwent a liver transplant.

Doctors say the case illustrates the problem of patients hiding information that might be crucial in diagnosing a serious problem.

"Because patients are not aware of the potential danger of these alternative therapies, they may be reluctant to admit to their use," explains Chauhan.

Chauhan says his patient also withheld information on her use of herbal remedies until symptoms became serious.

"Until she was hospitalized for jaundice and other signs of hepatotoxicity, our patient denied her use of herbs and over-the-counter remedies," he says.

But Robert Bonakdar, a family physician and clinical and research fellow in integrative medicine at the Scripps Center for Integrative Medicine in La Jolla, Calif., says patients bear only part of the responsibility.

Doctors must also be more assertive in inquiring about patient use of alternative remedies, he says.

"It's really a two-pronged problem, because a lot of doctors don't even ask if their patients are taking herbal medicines. I've seen statistics that say between 60 and 80 percent don't ask their patients," he says.

In addition, it's not always because doctors aren't concerned about potential problems. In fact, Bonakdar says, it's those concerns that actually may prevent them from inquiring in some cases.

"For one thing, doctors have legal considerations to think about," Bonakdar adds. "If they don't know enough about a supplement a patient is taking and problems do arise, they may fear being liable in some way."

Another factor can be ego, he adds.

"Some doctors may fear that if they ask about herbal remedies and are told a patient is taking something they haven't heard of, they look like an idiot for not knowing, so they just won't even ask," he says.

Whatever the reasons, by not asking patients about herbal remedies, doctors compound patients' notions that it's not all that important.

"Patients may think that if the doctor asks about things like medicines, exercise and smoking, but not about supplements, then it must not be that important. And that's a complete misconception," Bonakdar says.

The possible role of herbal remedies or alternative therapies should be especially considered in patients showing up at doctor's offices with symptoms of liver problems, Chauhan says.

"Problems from misuse of herbal remedies are often seen in the liver because the liver is sort of their first pass," he says. "Once taken, the medicine changes to chemically different components, which have an effect on the body and can affect liver cells down the road."

Experts say some of the most popular herbal remedies - - garlic, for instance - - are generally harmless and indeed, potentially beneficial, in acceptable doses.

But problems can arise from other herbal remedies even if consumers think they are taking correct doses because, since such supplements aren't regulated, there is no oversight of levels of active ingredients a product contains, explains Bonakdar.

"Tests on selected herbal remedies have shown everything from products containing far less or even no amounts of the active ingredient advertised, to others containing several times more of the ingredient than is described on the label, which can be especially dangerous," he says.

One company that does performs such tests recently found that only about half of products that claimed to contain the sleep-inducing herb Valerian had the amounts indicated on their labels, and four out of the 17 contained no detectable levels of the ingredient.

The U.S. Food and Drug Administration (FDA) reports that sales of herbal and botanical products totaled $3 billion in 1999. The figures represented a 20 percent increase from 1995, constituting the highest increase of all dietary supplement products.

Some of the highest selling herbal products include garlic, ginseng, ginkgo biloba and echinacea.

What To Do

Visit the National Institute of Health's National Center for Complementary and Alternative Medicine for more information on what's considered safe and what's not.

In addition, visit the FDA's site on Dietary Supplements for more information.

The FDA also offers extensive information on Illnesses and Injuries Associated With the Use of Selected Dietary Supplements.

SOURCES: Interviews with T.C. Chauhan, M.D., fellow, gastroenterology and hepatology, Brooklyn Hospital Center, Brooklyn, N.Y.; Robert Bonakdar, M.D., family physician, and clinical and research fellow, integrative medicine, Scripps Center for Integrative Medicine, La Jolla, Calif.; American Academy of Gastroenterology press release
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