Herbal medicines make most doctors cringe, laugh, or want to put blinders on and pretend they don’t exist. This is understandable. While allopathic medical education hammers pharmaceutical formulas and mechanisms of action into our brains, we learn little-to-nothing about herbs in medical school. Quite the opposite – we are most often told to uniformly discourage our patients from taking herbs out of concern for safety; a conversation stopper with little room for nuance.
In Western medicine, at best, herbs and plants are recognized for their role as an anchor ingredient in many pharmaceutical drugs. At worst, herbs are shunned for being unstudied and unregulated – fraught with reports of contamination, false-advertising and misuse by patients. This is thanks in large part to the Dietary Supplement Act of 1994, which allowed their sale without prescription.
Yet at least 15 million Americans say they take some form of herbal medication, and the dietary supplement market grosses $28 billion dollars annually. In other words, chances are that some of your patients are taking herbs, whether you know it or not.
First, some context: Not all herbs are restricted to mysterious Internet sites or eight hour energy drinks. Far from it. Tumeric root, a staple in Indian food, is a great example of an herbal medicine whose active ingredient, curcumin, has been proven to have anti-inflammatory, antioxidant, adaptogenic, and immunomodulatory properties. Not only has it been widely studied and used, but it also has basically no side-effects.
Ginger, cinnamon, not to mention others less likely to show up in your salad – milk thistle, for example – all have double-blind studies backing their claims. Indeed, many herbs can be a great sources of antioxidants, phytonutrients, and alkaloids, and have properties ranging from the anti-microbial to the anxiolytic. These anti-inflammatory properties can lend them a supportive role in the continuum of health and illness, helping nourish the body properly so it can do what it was designed to do – heal from and resist disease.
So how do you, as a Western doctor, with a responsibility to do no harm, approach herbs intelligently? The following is a pathway for addressing the use of herbal medicine in your practice even if you would never recommend an herb yourself.
1. Do your research. I find that the most easy-to-use and comprehensive guides are the online databases The Natural Standard, and The Natural Medicines Comprehensive Database, as well as the textbook, The Essential Guide to Herbal Safety. For a quick reference, the National Institutes of Health also offers the online “Herbs At A Glance,” patient-focused resource with information on the most common Western herbs. Finally, the American Journal of Cardiology published two helpful lists in 2010 summarizing common herb-drug interactions and herbs to avoid in patients with cardiovascular diseases. The databases and textbook in particular offer a digestible run-down of efficacy, contraindications, side effects, drug interactions, and pregnancy classification.
2. Know your sourcing. Because one of the chief problems in herbal medicine is the lack of manufacturing standardization and FDA oversight, there does exist a risk of contamination, misrepresentation, and poor quality in herbal preparations that have lax growing, processing, and packaging standards. Develop some name-recognition for bad manufactures, and some go-to recommendations for good ones (Banyan Botanicals, Organic India, Mountain Rose Herbs, and Go Energetix are all reputable, well-respected companies).
4. Be versed in your patient’s individual health profile. Note if your patient is taking any medications metabolized by the CYP450 system. Some herbs can inhibit this process, so if the answer is “yes,” look into potential drug interactions for those. Further, if you patient has renal or hepatic insufficiency, or co-morbidities like diabetes, autoimmune disease, cardiovascular disease, or alcoholism, perform liver function tests and a basic metabolic panel. Finally, as a precaution, you should ask that your patient to only take one herb or herbal formula at a time to start, so that any effects – positive or negative – can be pinpointed.
5. Collaborate. If your patient is taking herbs, ask that he or she work with a reputable practitioner. Unless you are an integrative physician, that person probably is not you. Ask around, look at background and reviews, and develop a referral list.
6. Use the opportunity to motivate. People who seek an active role in maintaining their health are the best patients. Individuals interested in herbs are curious and proactive and should be congratulated as such. It is easy enough to make safety a priority while still welcoming these patients, respecting their autonomy and learning from them at the same time.