Herb, Nutrient and Drug Interactions: Multi-Disciplinary Team Plots Course Out of Paranoia

Summary: Dialogue over the integration of herbs and nutrients into clinical practice has focused on potentially negative impacts on the value of prescribed pharmaceuticals. Missing has been a view which respects these concerns, but which puts the patient, rather than the pharmaceutical regime, in the center of clinical concern. The recently published 930 page Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies (Stargrove, McKee, Treasure) offers a measured walk for clinicians which Tieraona Lowdog, MD, chair of the US Pharmacopoeia Dietary Supplements Information Committee calls, in a forward, "appropriate balance between recommendation and risk based on the overall strength of the scientific evidence and their own clinical experience."

“With the primary emphasis on adverse interactions, the topic of beneficial interactions has received little attention … An integrative approach would utilize therapies that reduce or mitigate the adverse effects of medications deemed necessary for the patient whenever possible.”

Continuous, practical clinical focus

This statement is from Tieraona Lowdog, MD, chair of the United States Pharmacopeia Dietary Supplements Information Expert Committee. Lowdog makes it in the forward to Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies (MosbyElsevier, 2008) The authoritative 930 page text, the collaborative product of a multidisciplinary team, takes a giant step toward balancing the jaundiced, adverse-event oriented view of botanicals and nutrients in the first era of the integrative medicine dialogue.

“The questions raised here and throughout this text challenge the attentive reader to reconsider drug activity within the full context of therapeutic strategy and patient outcomes. Simply put, is it a higher priority to manage therapies for the sake of the patients or the stability of their drug levels? Ultimately the question arises: when do we counsel patients to avoid healthy behavior on the basis of the possible risk of disrupting predictable drug levels.”

Stargrove: Culmination of 20 years of multi-disciplinary work

Yet for those who come to the integration dialogue from the perspective of community-based integrative practices, defensive medicine may instead be framed as using natural therapeutics to help patients protect themselves from the adverse effects of prescribed pharmaceuticals. Patient non-compliance with a prescribed pharmaceutical regime – perhaps because of unwanted adverse effects – is an opportunity to make changes so that the prescribed drug may not be necessary. Many holistic medical doctors, naturopathic physicians, acupuncture and Oriental medicine professionals and broad-scope chiropractors routinely work with patients to back them off of prescribed drugs. They seek to address health issues with natural approaches so they can avoid needing prescriptions for agents with more significant adverse effects.

“The authors demonstrate an appropriate balance between recommendation and risk based on the overall strength of the scientific evidence and their own clinical experience. The text is well-referenced, balanced, and objective, and the use of icons and summary tables allows the clinician to quickly identify areas of potential risk, as well as potential benefit.”

Co-author Dwight McKee, MD

Readers of Herb, Nutrient, and Drug Interactions will find their way into this complex terrain mapped by an “Interactions Evaluation Guide.” Sets of icons are used to facilitate efficient use of the information. Scored components include: interaction probabilities based on a six-category range from “certain” to “improbable” and “unknown;” interaction types and clinical significance;” and the strength and character of the evidence.

• Adverse Drug Effect on Herbal Therapeutics, Strategic Concern
• Drug-Induced Adverse Effect on Nutrient Function, Co-administration Therapeutic, with Professional Management
• Bi-modal or Variable Interaction
• Drug-induced Nutrient Depletion, Supplementation Contraindicated, Professional Management Appropriate

Co-author Jonathan Treasure, MA, MNIMH, RH (AHG)

This volume, conservative, revolutionary, and full of clinical common sense was developed out of 20 years of collaborative research and publishing of multi-disciplinary teams. The first venture, predating the online natural products compendiums, was the visionary Integrative Mind-Body Information System (IBIS) database. The next product came in 2000, an Interactions software database, which Stargrove says grew out of feedback from clinicians. This current volume, a labor of a lifetime, and also largely a labor of love, clearly represents the star toward which the rest of the work was pointed.