Putting Safety First

Putting Safety First

I'll be the first to admit that herbal medicine is not risk-free. To benefit from using herbs, you need to have some basic background information. Then you need to have confidence in the herbs you use and in any herbal practitioner you consult. This is no different from conventional medicine, where you need to have confidence in your physician and any pharmaceutical you take.

As a rule, however, rational herbal medicine is safer than conventional medicine because the medicines are more dilute and side effects tend to be less severe.

But you still have to exercise caution when using herbal medicines. You also need to understand that things can go wrong. There are a number of strategies that you can use to protect yourself.

First of all, get the right stuff. Unless you are absolutely sure of an herb's identity, don't take it. This rule applies mainly to people who are picking herbs in the wild, of course. People have been known to eat poisonous or dangerous plants simply because they misidentified an herb and took something other than what they thought they were taking. The classic killer is poison hemlock, which looks rather like wild parsley or wild parsnip.

The Universe of Herbs

While there are some 300,000 higher plant species that are all chemically distinct, fewer than 10 percent of them have been carefully screened for their medicinal and toxic constituents. A really good herbalist might know 1,000 to 2,000 species, rarely more.

This means that experienced as well as inexperienced herbalists can make mistakes. Not too long ago, while gathering herbs for a weekend class in the Blue Ridge Mountains, yours truly got all excited at the discovery of some "wild ginseng." Later, on closer examination, I was chagrined to discover that the supposed ginseng was Virginia creeper.

Of course, herbalists are not alone in making the occasional error. Physicians and pharmacists make them as well. And I personally feel safer consulting a well-informed herbalist than I do consulting most doctors. As for the perils of pharmaceuticals, read the fine print on labels or in the advertisements.

As for the identities of commercially packaged herbal products, especially those that are chemically standardized, you can usually trust the labels. But even with standardized extracts, as with pharmaceuticals, there is a very small but still real chance for error.

Watching Out for Problems

Whatever herb you're taking, I recommend that you learn as much as you can about what to expect from it. If anything unexpected happens, stop taking whatever it is and check with an expert you trust.

In addition, here's some further advice for anyone using herbal medicine.

Make sure of the diagnosis. Herbal devotees sometimes get the idea that they can diagnose illness as well as come up with herbs to treat it. But diagnosis is a separate art and one that is best left to physicians. I discourage self-diagnosis.

Diagnosing illness is not easy, and sometimes even good doctors make mistakes. But physicians' diagnostic batting average is usually better than that of anyone who has not had medical training. Once you're confident of a diagnosis, then you can discuss with your physician how to treat it: drugs, herbs, some combination of the two or any of the foregoing plus diet, exercise and lifestyle changes. Some holistic physicians will stress diet and lifestyle more than drugs for some ailments.

Watch out for side effects. I'm convinced that all medicines, natural or synthetic, have side effects. It's hard to imagine an active plant chemical (phytochemical)--or an herbal mixture containing thousands of them--having just one targeted chemical reaction in our body. Of course we have other reactions, unrelated to the illness, that could appropriately be termed side effects--some desirable and some undesirable. That's why you have to watch yourself when taking any new herb for the first time.

If you have an unpleasant reaction to an herb, such as dizziness, nausea or headache, cut back on your dosage or stop taking the herb. Listen to your body. If the herb doesn't feel right, don't take it.

Be alert for allergic reactions. People can be allergic to anything. Even if you have no known allergies, you might be allergic to a new herb that you try. Be careful. Again, listen to your body. If you develop any unusual symptoms, stop taking the herb and consult an allergist or physician.

If you experience any difficulty breathing within 30 minutes or so of trying a new herb, food or drug, call 911 immediately. You may be having an anaphylactic reaction, the most severe form of allergic reaction, which can prove rapidly fatal unless treated promptly.

Anaphylactic reactions to herbs are rare, and I'm not saying that you need to be unduly apprehensive about trying new things. Just be careful and understand the possible risks.

Beware of interactions. Pharmaceutical medicines sometimes interact badly with each other and with certain foods. The same goes for herbal medicines, although many herbal reference books neglect to mention this. Always be particularly careful when taking more than one drug or herb or a combination of a drug and an herb. Bad interactions are always possible. If you suspect a bad interaction, consult your physician or pharmacist.

Here's one interaction that you should be particularly aware of: Antidepressants known as monoamine oxidase (MAO) inhibitors interact badly with wine, cheese and many other foods. If you take a pharmaceutical MAO inhibitor, you shouldn't eat these foods.

The antidepressant herb St.-John's-wort is also an MAO inhibitor, so the same food restrictions apply. If you take St.-John's-wort regularly, consult a physician, pharmacist or consumer drug guide about which foods to avoid.

Open lines of communication. Too many people listen to both their physicians and their herbalists and do what both advise. Usually there's no problem with this, such as when a physician gives you sleeping pills for insomnia, for example, and an herbalist recommends a hot bath before bed with a blend of sedative aromatherapy oils.

But just as too many cooks can spoil the broth, too many health practitioners can also be too much of a good thing. Let's say your physician prescribes an MAO inhibitor for depression, and your herbalist recommends St.-John's-wort, also an MAO inhibitor. You may wind up taking too much. Or let's say your physician prescribes half an aspirin a day to prevent heart attack, and your herbalist tells you to drink a daily cup of tea made from willow bark or wintergreen. The teas contain the herbal equivalent of aspirin, and you might wind up taking more than you need, with more anti-clotting action than you want.

To avoid the too-many-cooks problem, be sure to tell your physician and your herbalist about all the medicines you're taking as well as any unusual foods you might be eating.