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Q: I
take Zantac these days for stomach problems, mostly reflux and heartburn. I've
got to think that this medication must deplete some vitamins or nutrients. Does
it?
 A:
Yes. Because Zantac is a medication that reduces the amount of stomach acid,
therein lies part of the problem. Stomach acid plays an important part in the
absorption of certain nutrients, including iron and vitamin B-12. Stomach acid
releases vitamin B-12 from the food we eat. Chronic use of Zantac may lead to
vitamin B-12 deficiencies. Individuals with bleeding ulcers may already have a
low level of iron in their bodies because of the blood loss. Have their
physician perform a lab test to determine if they may be iron- or vitamin
B-12-deficient. If they are, supplementation may be necessary.
Long-term use of Zantac may also lead to calcium, zinc, and
vitamin D deficiencies. Supplementation with these nutrients may also be
beneficial. But this list of nutrients depleted may just be the tip of the
iceberg. Many have posed the consideration that these types of medications,
because they interfere with the digestion process, may be interfering with
nutrient absorption from our foods in other ways. With our modern hectic pace,
customers are finding themselves suffering from stress related stomach problems
more than ever. More OTC Zantac has found its way into many purses and office
drawers these days for the relief of heartburn and reflux. Reducing the stress
load is always a good idea. But for those customers taking more Zantac
regularly, a good quality vitamin and mineral supplement may be a general
insurance against poor digestion in general.
Q:
I'm concerned that continued use of oral contraceptive pills could deplete the
body of certain vitamins. Am I right?
A:
Pharmacists are more concerned these days about drug-nutrient
depletions. And, yes, oral contraceptives (OCs) may indeed deplete the body of
important nutrients. OCs may deplete vitamin B-2, vitamin B-6, vitamin B-12,
vitamin C, folic acid, magnesium, and zinc. Because vitamins B and C are the
"stress vitamins" that help the body to cope with the stressors of
daily living, it may be beneficial to supplement with these vitamins. Folic acid
deficiency may cause anemia and tiredness. Magnesium is necessary for our bodies
to produce energy by being a catalyst in the enzyme activity of ATP. A
deficiency in magnesium inteferes with the transmission of muscle and nerve
mpulses, leading to nervousness and irritability. Those on OCs experiencing an
inability to cope or fatigue may be experiencing a nutrient depletion. It might
be wise for any woman on birth control pills to supplement with these nutrients
or a good high potency multiple vitamin and mineral supplement.
Q: Are
there herbs that may cause sun-sensitivity, like some of our pharmaceutical
medications?
A:
The popular herb St. John's Wort may cause
photo-sensitivity, wherein a little exposure to the sun can cause a major
sunburn, rashes, swelling, and hyperpigmentation. While it is a rare occurrence,
it's best to be forewarned with the sunny summer months upon us.
Other herbs with potential photo-sensitizing action are:
Angelica, Celery Seed, Rue, Psoralea, and Lime.
If an individual notices that a short exposure to the sun
causes some of these symptoms, they may be experiencing this unusual
side-effect. If they are, suggest that they cover up with plenty of protective
clothing and sun-screen, and seek the shade whenever possible.
Q: The
new buzz-word in my area is something called "MSM." What is it?
A:
MSM stands for methylsulfonylmethane, a sulfur compounds
found in virtually all plants and animals. Humans synthesize MSM from precursors
found in unprocessed foods, often lost in food processing and storage. MSM
provides additional sulfur to help meet total dietary needs. Our bodies need
more sulfur to replace or repair damaged tissue. Sulfur is also an important
component in many of our enzymes, insulin, heparin, biotin, methionine, human
growth factor, hemoglobin, fibrinogen, calcitonin, and muscle proteins. As we
age, we naturally make less MSM.
Proponents claim benefits for GI distress, inflammation,
allergic reactions, immune function, arthritis, and fatigue. MSM is actually a
registered product trademark.
Q: What
are the herb/drug interactions to watch out for with anticoagulant medications?
A:
This is a frequently asked question as to whether herbal
supplements can be taken concomitantly with anticoagulants drugs (such as
warfarin or heparin) or antiplatelet medications (dipyridamole, ticlopidine, and
aspirin, for example). Since there is limited research on the subject, the
definitive answer is usually not known. We do know that the following herbs
contain natural coumarins, or inhibit platelet aggregation by other means, or
contain natural salicylates.
Alfalfa, red clover, chamomile, angelica, aniseed, arnica,
buchu, capsicum, fenugreek, horse-chestnut, licorice, meadowsweet, nettle,
parsley, passion flower, prickly ash, clove, Panax ginseng, willow, bilberry,
grape seed, garlic, ginger, and ginkgo.
Thyme, goldenseal, and garlic contain antibiotic substances,
which may inhibit the gut's ability to synthesize vitamin K. Prescription
antibiotics exhibit this same action and have been known to prolong bleeding
time.
Since the preceding herbs have anticoagulant properties, it
may be wise to opt for the conservative stance of recommending against
concomitant use until proven otherwise.
Q:
Some books mention the importance of "phosphatidyl serine." What is it
and how does it work?
A:
Phosphatidyl serine is a phospholipid that is vital to brain cell structure and
function. Phospholipids, found in every cell membrane in our bodies, are
molecules with an amino acid component (ex: serine) and a fatty acid component
(ex: lipid). Phosphatidyl serine plays an important role in our neurotransmitter
systems, metabolism levels of the brain, and maintaining nerve connections in
the brain. It appears that phosphatidyl serine levels naturally decline with
age.
Proponents suggest that phosphatidyl serine supplementation
may improve age-related cognitive decline, resulting in improvement in mental
function and fitness.
Q:
I've watched many customers buy lecithin over the years, but to be honest I'm
not really sure exactly what it's supposed to do?
A:
Lecithin is found in many vegetable and animal sources
such as eggs, steak, peanuts, beef liver, soybeans, cauliflower, and oranges.
Lecithin supplements usually contain somewhere between 10-35%
phosphatidylcholine. Lecithin is used commercially as a stabilizing and
emulsifying agent in the pharmaceutical, cosmetic (lipstick, conditioners,
creams), and food (chocolate, margarine) industries. Pharmacological research
shows lecithin may be helpful in the treatment of hypercholesterolemia, liver
ailments, and neurological disorders. It also may modify the immune system by
activating specific and nonspecific defense systems. There are generally no
adverse effects associated with lecithin, although during one rat study showed
possible impaired sensorimotor development in offspring of rats fed crude
lecithin during pregnancy.
Q:
What's this lysine folks buy for cold sores?
A:
Lysine is an essential amino acid found naturally in
foods such as cheese, brewer's yeast, wheat germ, yogurt, fish, pork and other
meats. It is also available synthetically. It has been studied for the treatment
of herpes infections including cold sores, with mixed results. Lysine is known
to improve calcium assimilation. It has also been used to treat rheumatoid
arthritis, Bell's palsy, and to detoxify heroin. It appears to be safe and free
from side effects.
Q
: What's with the new study about garlic supposedly not
reducing cholesterol, my customers are asking?
A
: New studies suggest that garlic doesn't reduce
cholesterol. This is contrary to the accepted knowledge of garlic's
antihyperlipidemic activity. For example, we know that consuming a clove of
garlic a day has been shown to lower cholesterol about 10%. It is known that
garlic oil, ( was used in these new studies), does not contain all the same
compounds found in fresh garlic. So it seems that it is probably the oil
preparation of garlic used in that study that is ineffective, not garlic itself.
Q
: Alarming news about the alleged dangers of vitamin C
supplements have my phone ringing. What's up?
A
: There has been recent attention on the headlines that
vitamin C may cause oxidative DNA damage. Measuring oxidative DNA damage can be
tricky and more is needed to be known before a definite conclusion is reached.
But in simply looking at the study design itself, there are flaws. The tenfold
increase in oxidative DNA damage would have to be a thousand-fold or higher
damage before scientists would consider it significant. Previous studies have
shown that vitamin C is protective against oxidative DNA damage, or have shown
no conclusion. A peer-review and re-testing process of these recent studies,
suggesting vitamin C's damaging effects, should have occurred before proper
significant conclusions were made and put forth as general public knowledge.
Q
: What is MSM?
A
: MSM is one of the active forms of DMSO in the body.
Fifteen percent of DMSO (oral, IV, or topical) is converted to MSM. MSM is found
in many foods, and is present in the bodies of people and animals normally. MSM
is 34% sulfur by weight and works by providing that mineral to a broad range of
normal biochemical processes in the body. So, MSM may provide the sulfur
component to help build amino acids, vitamins, and hormones. It is touted as
being helpful (like DMSO) in allergies, scleroderma, asthma, arthritis/bursitis
and muscle/joint pain.
Q
: What is "vanadium" or "vanadyl
sulfate"?
A
: Vanadium is mineral that has been found to be an
essential trace mineral for plants and animals. It is probably essential for
humans too, but there is still some debate. It functions primarily as a
co-factor which enhances or inhibits various enzymes. It accumulates primarily
in organ tissues, bones, and in fat/serum lipids.
Dietary sources of vanadium are grains, meats, fish, nuts,
fats and vegetable oils, parsley, and mushrooms. The dietary requirements for
vanadium have not yet been established, and there is no known toxicity as a
dietary nutrient in humans.
Studies have shown that vanadium treatment reduced blood
glucose levels and maintains normal glycemic states for more than 3 months after
withdrawal of treatment. Vanadyl sulfate has been tested on
non-insulin-dependent diabetics (NIDDM) at 50mg BID x 4 weeks. Three-fourths of
the patients registered a 20% decrease in fasting blood glucose levels. These
improvements were maintained during the placebo phase, also. Another study has
shown that 100mg of vanadyl sulfate orally improves hepatic and skeletal muscle
insulin sensitivity in moderately obese with NIDDM.
Q
: What are the important uses of "zinc"?
A
: There have been studies showing the positive influence
of zinc in the treatment of colds, acne, AIDS, and enlarged prostate. The FDA
for zinc is 15mg/day, with pharmacologic doses ranging from 50 to 150mg/day.
Toxicity is relatively uncommon.
Zinc lozenges have been shown to significantly decrease the
length and severity of common cold symptoms. Lozenges are effective when they
are zinc gluconate in a base of glycine. From 12 to 23mg zinc-containing
lozenges dissolved in the mouth every 2-3 hours while awake for several days are
the usual dose. A meta-analysis of 10 clinical trials showed zinc lozenges to
provide 35-40% reduction in cold duration with significant improvements in the
symptoms of sneezing, drainage, coughing, and sore throats.
One 12-week acne study showed 58% of subjects given 68mg/day
of zinc reported significant improvement, whereas there were no improvements
reported for the placebo group.
AIDS patients often experience zinc deficiency, which
contributes to reduced immunity. A 24-month study of zinc supplementation of
45mg/day showed a 56% reduction in opportunistic infections when compared to
controls.
All men reported improvements in enlarged prostate symptoms
when given 34mg of zinc per day for 2 months. Seventy-four percent also had
measurable shrinkage of the prostate gland.
Q
: I've heard so many conflicting reports about
contraindications with the use of St. John's Wort. Can you help clarify?
A
: Until the current major study has been completed and the
results published, healthcare professionals find themselves in a gray area
concerning consultation about the effectiveness, contraindications, side
effects, food restrictions, and potential drug interactions of St. John's Wort.
To quote the St. John's Wort monograph by the American Herbal Pharmacopeia (AHP),
"In the Botanical Safety Index of the American Herbal Products
Association (AHPA), Hypericum has a 2nd classification with notices that
it may potentiate pharmaceutical MAO inhibitors, is a photosensitizing agent,
and contains high amounts of tannins. As previously discussed (in the AHP
monograph), in vivo MAO inhibiting activity has not been demonstrated
with Hypericum and it should not potentiate the effects of standard
MAO inhibitors. Also, photosensitization does not usually occur when Hypericum
is used within its recommended dosage range."
Until the current clinical study of St. John's Wort by the
National Institute of Mental Health is completed and reported, pharmacists are
encouraged to consult from the "do no harm" rule.
Q
: What's the scoop on these so-called herbal 'fen-phen'
products--my pharmacy customers are swamping me with questions? Thanks/ MW,
Falcon Heights, MN
A
: Herbal 'fen-phen' Update
Pharmacists are being inundated with questions from consumers
on herbal 'fen-phen' weight-loss products in light of the risks of using fen-phen
and Wyeth-Ayerst's discontinuation of two fenfluramine products. The trend in
weight-loss supplements is moving from thermogenic (fat burning) components to
herbs and amino acids that affect neurotransmitters and brain chemistry.
New natural products are advertised as claiming to be a safe
natural alternative to prescription weight-loss drugs such as fen-phen. Often
these popular products contain ingredients such as St. John's wort, Ma huang (or
ephedra), Chitosan, plus other vitamins, minerals, enzymes and amino acids.
The link to prescription weight-loss medications is made by
the following analogies. Like fenfluramine and fluoxetine, St John's wort may
act on the serotonin levels in the brain. Like phentermine, Ma huang (or ephedra)
as an herbal stimulant may suppress the appetite. One other common ingredient,
Chitosan, is an amino polysaccharide found in shellfish which reportedly reduces
food transit time in the GI, resulting in reduced absorption of dietary fats and
cholesterol. Synephrine, found in bitter orange, is structurally related to the
neurotransmitters epinephrine and norepinephrine. These neurotransmitters are
suggested to have an antidepressant effect as well as a stimulatory effect on
the heart even in small doses. The amino acid found in foods called l-phenylalanine
is a precursor to tyrosine. As such, it is involved in brain biochemical
processes involving neurotransmitters epinephrine, norepinephrine, and dopamine
thereby promoting elevated mood, mental alertness, and appetite suppression.
Pharmacists should be reminded that natural weight-loss
products may be helpful in some consumers, but that some of these ingredients
possess active pharmacology may be contraindicated in certain conditions.
Careful consultation by the pharmacist will help consumers select an appropriate
weight-loss approach with good healthcare outcomes.
Q
: A customer wanted "Passion Flower" for
sleep, but wanted to know if it was addicting?
A
: Passion flower possesses sedative, hypnotic,
antispasmodic, and anodyne properties. It is the herb of choice for treating
intransigent insomnia. It helps in the transition into restful sleep without the
"narcotic" hangover. Passion flower may also be used when an
antispasmodic is needed, for example in Parkinson's disease, seizures and
hysteria. It can be very effective in treating nerve pain such as neuralgias and
the viral infection of nerves called shingles. It has also been used for
bronchial disorders, especially asthma, where there is much spasmodic activity.
This herb is used extensively in homeopathy. Passion flower can also be used as
a compress for burns and inflammation.
Warnings:
In excessive doses sedation/CNS depression may occur and MAOI
therapy may be potentiated. Excessive use of passion flower should be avoided in
pregnancy and lactation.
Dosage:
Dried herb 0.25-1.0 gram or by infusion three times daily
Liquid extract (1:1 in 25% alcohol) 0.5-1.0 milliliter three
times daily
Tincture (1:8 in 45% alcohol) 0.5-2.0 milliliters three times
daily
Q
: What is all the hype about "Green Tea"?
A
: Tea has been known to act as diuretic stimulants
and to relieve headaches. In green tea there are two principle components;
caffeine and tannins. The green tea has a chemoprotective property which may be
due to the fact that tannin components of the green tea suppress the formation
of experimentally-induced chromosome aberration in bone marrow cells of animals.
There has been a decreased risk of developing adenomatous polyps of the sigmoid
colon associated with increased consumption of green tea. Also, there is a
decrease in total cholesterol but not triglycerides or HDL-cholesterol which is
associated with the consumption of green tea. When an evaluation of longevity
was performed on 3300 Japanese women which were practitioners of chanoyu (a
Japanese tea ceremony), the evaluation suggested that their intake of green tea
contributed to their longevity by providing a degree of protection against fatal
diseases.
Warnings:
The FDA suggests that women who are or may become pregnant
avoid caffeine containing products. However, human studies where moderate
amounts of caffeine were consumed showed inconsistent results. Which more recent
studies were unable to show adverse effects on the fetus.
Q
: The neighbor lady pointed to this plant in her yard
calling it "Yarrow". She said it had medicinal properties, so what are
they?
A
: Yarrow possesses diaphoretic, antipyretic,
hypotensive, astringent, diuretic, and urinary antiseptic properties. It is one
of the best diaphoretic herbs (aids the skin in the elimination of toxins and
promotes perspiration) and is the standard remedy for helping the body deal with
fevers. It also causes dilation of the blood vessels which lowers blood
pressures. Yarrow can be used in gastrointestinal complaints, such as
inflammation, diarrhea, flatulence, and cramps. It is indicated in infections
such as cystitis due to its urinary antiseptic properties. It can also be
classified as a wound healing herb because it stops the bleeding when applied to
wounds. It can also be used as a bitter aromatic for loss of appetite and to
stimulate bile secretions.
Warnings:
Yarrow can cause contact dermatitis in sensitive individuals.
Therefore it should be stopped immediately if itching or inflammation, with
formation of vessicles, occur. Yarrow should not be taken during pregnancy, it
is considered an abortifacient. Also excessive doses should not be taken because
it will interfer with existing anticoagulant and hypo- , hypertensive therapies
and may cause sedation and diuretic effects.
Dosage :
Dried herb 2-4 grams or by infusion three times daily
Liquid extract (1:1 in 25% alcohol) 2-4 milliliters three
times daily
Tincture (1:5 in 45% alcohol) 2-4 milliliters three times
daily
Q
: A customer came into the store the other day and asked
if we had marshmallow, the only marshmallow I knew was the candy dessert. So
what is the deal?
A:
Marshmallow possesses demulcent, expectorant,
emollient, diuretic, antilithic, and vulnerary properties. It is mainly used as
an antitussive (demulcent, expectorant) when there is an irritable cough and
catarrhal inflammation of the mouth and throat present. This herb can also be
used when there is inflammation of the mucous membranes of the gastrointestinal
tract. This herb is very soothing for any mucous membrane infection anywhere in
the body.
Warnings: The absorption of other drugs may be
delayed if taken at the same time as marshmallow. Marshmallow may also interfer
with existing hyperglycemic therapy.
Dosage: Dried herb 2-5 grams or by cold extraction
three times daily
Root, Liquid extract (1:1 in 25% alcohol) 2-5 milliliters
three times daily
Syrup of Althaea 2-10 milliliters three times daily
Q:
I'm getting the impression listening to my customers
that Saw Palmetto may have some actual medicinal benefits in BPH. How much of
the media hype is true and where's the balanced view in all this?
A: Saw
Palmetto has been shown in clinical trials to be effective in the treatment of
BPH. It provides rapid symptomatic relief as it has the ability to decrease
prostate size. Nocturia and flow rates improve in most cases in a period of 4 to
6 weeks. The German Commission E recommends a dose of 320mg of Saw Palmetto
taken as 160mg, twice a day. Standardized or Guaranteed Potency Saw Palmetto
products are available.
People turn to natural remedies that are effective, less
toxic, and less costly than conventional treatments. For some of these reasons,
Saw Palmetto seems to have some advantages over treatments commonly used in the
US. It does not cause hormonal side effects, hypotension, dizziness, or the
nasal congestion sometimes experienced with other common treatments.
Other factors should be considered and integrated into a total
overall program for a healthy prostate. It is noted that alcohol consumption and
coffee may exacerbate BPH symptoms. Essential fatty acids, selenium, vitamins C
and E, and Zinc are nutrients that are considered to help protect the prostate.
This larger health picture, plus the diagnosis and input of the primary care
physician are always necessary.
Q:
I am looking for information on the product St. John's Wort.
A patient called me tonight wanting to know what it was and what it was used
for. I did find some information at the Herbal Information Center. Could anyone
give me some advice on where to find more information on this product?
A:
Your question is one of many we have received wanting
further information about the currently popular St. John's Wort. While
pharmacists have many specific questions that need answering, the clinical
information answering these questions may have to wait until the recently funded
clinical trials are done by the National Institute of Mental Health (NIMH) and
the Office of Alternative Medicine (OAM).
Dr. Jerry Cott, Chief of Pharmacological Treatment Research
Programs at NIHM, points out that St. John's Wort is the only plant used
historically for depression and that it outsells all other antidepressants in
Germany. Dr. Cott goes on to say that St. John's Wort's side effects are
"very mild" and that there is "hardly any toxicity."
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