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From The Spring 2002 Issue of Nutrition Science News
At the Counter With Dan Lukaczer, N.D.
Herbs And Surgical Drug Interactions
Q: Do the drugs used by anesthesiologists for surgery have any adverse interactions with kava kava (Piper methysticum)?
A: A recent survey published in Prevention magazine indicated that 49 percent of Americans used an herbal remedy during the previous year, and that 24 percent used herbs on a regular basis.1 Researchers in a similar survey reported that of 980 patients scheduled for surgery, 170 reported they were taking an herbal or dietary supplement.2
The drugs anesthesiologists use for surgery can adversely interact with many herbal medications, including kava. For example, kava may increase anesthetic sedation and should be discontinued at least 24 hours before surgery. Patients can resume taking the herb the following day.
Such interactions may also interfere with postoperative healing. For instance, because of the blood-thinning effects of ginkgo (Ginkgo biloba), some experts believe it may decrease blood clotting and interfere with blood coagulation necessary for surgical incisions to heal rapidly.
Authors of a recent article in the Journal of the American Medical Association addressed preoperative precautions for patients taking the most widely used herbs.3 There are numerous reliable resources on drug and herb interactions, including Francis Brinker's Herb Contraindications and Drug Interactions (Eclectic Medical Publications, 1998). Patients should also consult a health care professional about potential herb and drug interactions prior to surgery.
Inflammation May Be A Disease Warning
Q: How can a person determine if chronic inflmaation is a sign of heart disease?
A: Current research is linking chronic inflammation to heart disease and diabetes. The blood test hs-CRP, or highly sensitive C-reactive protein test, is used to measure inflammation in the body. Scientists believe this low-level chronic inflammation, and the the inflammatory cells (cytokines), can damage blood vessels and affect the body's glucose control. High hs-CRP levels may provide an early warning of the damaing inflammatory process and indicate heart disease and diabetes risk.5
Obesity may contribute to inflammation. Results of a recent study showed women who lost weight experienced a drop in their hs-CRP level.6 Researchers also offer evidence that statin-lowering drugs may reduce CRP levels, independent of their effects on cholesterol.7 Aspirin may also lower hs-CRP.8
Excess Iron Can Pose Health Hazard
Q: Is is possible to decrese high iron levels in the blood without regularly drawing blood?
A: Excessive iron build-up in the blood is a condition called hemochromatosis. Humans need iron to transport oxygen via red blood cells, but too much iron can be toxic and result in health conditions such as diabetes, heart and liver disease and pituitary failure.9
Because humans have no process for excreting excess iron (other than menstruation), it is important to pay attention to the amount of iron ingested through foods and supplements. Nutrition programs in the United States and abroad often include iron-fortified foods and supplments because iron deficiency is relatively frequent and serious. However, although iron deficiency is a significant health issue, iron overload poses a serious problem as well. Many asymptomatic people carry the hemochromatosis gene, which increases the potential to accumulate excess iron in the body. It is a slow and insidious process that generally goes undiagnosed until middle age.
The only means of reducing iron in the blood to normal levels is through blood extraction. People with hemochromatosis would have to give blood only once or twice a year thereafter. These people should avoid taking iron supplements or iron-fortified foods and eliminate iron-rich foods, such as red meat, liver, oysters and clams, and even stop cooking in iron pots. In general, the only people who may require additional dietary iron are children and pregnant and menstruating women. The first two groups need iron for blood cell productiom and the third group for replenishing monthly iron loss. Men and postmenopausal women do not need iron supplementation unless they have been diagnosed with iron-deficiency anemia.
Dan Lukaczer, N.D., is director of clinical research at the Functional Medicine Research Center, a division of Metagenics Inc., in Gig Harbor, Wash.
References
1. Word of mouth is consumers' top source of supplement information survey. The Tan Sheet 1999 Sep 20;7(38):13.
2. Complications in surgery may be linked to herbal supplements, anesthesiologists warn. Food Labeling Nutr News 1999 Oct 20;8(2):4.
3. Ang-Lee MK, et al. Herbal medicines and perioperative care. JAMA 2001;286:208-16.
4. Pradhan AD, et al. C-reactive protein, interleukin 6, and risk of developing Type 2 diabetes mellitus. JAMA 2001;286(3):261-74.
5. Chambers JC, et al. C-reactive protein, insulin resistance, central obesity, and coronary heart disease risk in Indian Asians from the United Kingdom compared with European whites. Circulation 2001;104:145-50.
6. Heilbronn LK, et al. Energy restriction and weight loss on very-low-fat diets reduce C-reactive protein concentrations in obese, healthy women. Arterioscler Thromb Vasc Biol 2001;21:968-70.
7. Albert MA, et al. Effect of statin therapy on C-reactive protein levels: the pravastatin inflammation/CRP evaluation (PRINCE): a randomized trial and cohort study. JAMA 2001 Jul 4;286(1):64-70.
8. Kennon S, et al. The effect of aspirin on C-reactive protein as a marker of risk in unstable angina. J Am Coll Cardiol 2001 Apr;37(5):1266-70.
9. Kang JO. Chronic iron overload and toxicity: clinical chemistry perspective. Clin Lab Sci 2001;14(3):209-19.
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