Herb/drug Interactions

[Guest guest]

 

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Stephen Morrissey

Thursday, May 15, 2003 9:16 PM

RE: herb/drug interactions

 

 

 

 

 

>>>>I get a 0.5% levostatine red yeast rice, the one studied in the US if memory serves me is 0.225% (or 0.125%) -the dosage of mevacor (lovastatin) is usually about 10-80 mg. If you take 2-8g per day which some of my as well as other patients are doing you can easily get the same level of statins, as well as a 40% drop in cholesterol

 

alon

 

 

 

Alon,

 

I realize math is not heavily emphasized in TCM colleges so let’s walk through this together. I don’t claim to be a math genius either so first, read the abstract and first paragraph below of a research study I had translated from Chinese. The study is from a manufacturer that makes the “high content†stuff which is probably similar to the kind of product the FDA came down on and which you probably buy. I’ve left the Chinglish unchanged for your appreciation since you have your own form of inglish (slow/low wins).

Abstract Studies on the effect of commercially available hongqu H-04 and hongqu H-18 made by us on blood lipid and lipoprotein concentration of quail suffering from hyperlipidaemia was carried out. Results demonstrated that the serum TC, TG, LDL-C concentrations in quail with hyperlipidaemia were significantly reduced by hongqu H-04 and hongqu H-18. The effect of hongqu H-18is better than hongqu H-01on blood lipid and lipoprotein concentration.

Keywords Hongqu, Hyperlipidaemia

 

Hongqu was produced by with inoculating Monascus purpureus Went. in rice and allowing to ferment into hypha[1], had actions to promote blood circulation to remove blood stasis, and invigorate the spleen and digest, was used to treat dysphpsia and abdominal pain due to stasis traditional Chinese medicine[2]. Some species or the fermentation products of some species or yeast in fungi Monascus ssp. Contained blood lipid regulator 3-hydroxyl-3-methylpentadiacyl coenzyme A (HMG-Co A) reductase inhibitor, but the content was very slow. We prepared a new hongqu H-18, obtained by mutagenesis breeding and screening, into rice and allowing to ferment, among them the content of lovastatin (4.997 μg/g), an HMG-Co A reductase inhibitor, was higher than that in commercial hongqu crude drug H-04 (0.551 μg/g), raisint appproaching 10 times[3]. To investigate the regulation action either on blood lipid, we compared the blood lipid lowering effects on quail with hyperlipidaemia between hongqu H-18 made by us and commercially available hongqu H-04.

 

 

If you agree that a microgram is 1/1000 of a milligram, then how would you convert the pharma-grade material with 4.997 micrograms? You would divide 4.997 by 1000 to get the number of milligrams. My math says it rounds up to 0.005 milligrams. Let me know if you think the decimal point is in the wrong place.

 

I appreciate that you make the effort to clarify these easily misconstrued issues. Micro vs Milligrams…Left brain overload.

 

Stephen

 

Hi Stephen,

 

I like math. Go figure.

 

Alon says that 10 to 80 mg lovastatin is a dose. Let's pick 50 mg as a middle range dose. You, Stephen, find 5 ug of lovastatin per gram of product. That's 0.000005g lovastatin/1g product. We move the decimal point six places to the left. So the question is, how many grams of product do you need to get the middle range dose of 50 mg = 0.05g lovastatin. I see four zeroes between .000005g and .05g. You need 10,000 grams or 10 kilos of pharma-grade product to get 50 mg of lovastatin.

 

Okie dokie? So then is it reasonable to ingest 10 kg of product? That's 22 pounds for us American types. You've got to hope it's yummy.

 

Per your last post, Stephen, you noted that there's more efficacy in the formula than in the single herb. The commonly used formulas in the Shanghai Hospital #1 don't use Hong Qu at all as it's viewed as low in efficacy. They use the herbs that I've previously posted which show good efficacy with apparently very little statins at all. My guess is that Merck did not figure out how the Chinese herbs really worked to lower cholesterol. They found some handy molecular markers. They did animal tests and went with the strongest results from the force of single molecules. Kind of the Microsoft approach to elegant design.

 

I'll copy here to Curt Jacquot at Pacific Biologic and ask him what clinical results he shows for his production formula. There's nothing esoteric about the herbs he's using, and they don't rely on statin content. I'm guessing that Jason Robertson would more quickly find clinical literature on this in Chinese. I'll also ask Dr. Kang for clinical literature in Chinese.

 

Emmanuel Segmen

[Guest guest]

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[Guest guest]

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[Guest guest]

Alon,

Your last 2 posts didn't come through.

 

 

On Friday, May 16, 2003, at 06:51 AM, Alon Marcus wrote:

 

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[Guest guest]

Zev

I was basicly saying that 1. i have seen a certificate of analysis for the red-rice i use which i get from a chinese herb company saying that the lovastin level is 0.5% and the one from Thorn Research is said to be about 0.0125%, they used to curry 0.04% but the new FDA rules do not allow this (even though i still get the 0.5%). At these levels one can defiantly get the same levels of stains as pharm drugs. 2. if the levels that stephan is quating are the true levels available in China, then I am wandering if the red-yeast rice i am getting is spiked with pharmasuticals <zrosenbe wrote: Alon,Your last 2 posts didn't come through.On Friday, May 16, 2003, at 06:51 AM, Alon Marcus wrote:> ?~

[Guest guest]

Marian: I forgot to mention another product of herbal origin which has had very good results lately in reducing cholesterol and triglycerides as well, viz., POLICOSONOL. It is derived from the wax from sugar cane (although sometimes in a rice medium of some kind...two things to bear in mind, appropos patient allergies. Although rice is often characterized as hypoallergenic there are in fact lots of people allergic to rice (including myself)...and also to cane sugar and to yeasts. Anyhow, your patient might want to try the policosonol, now readily available, sometimes combined with the Indian herb Guggul. Neal.

 

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Marian Blum

Traditional Chinese Herbal Medicine (AT) (DOT) Com

Wednesday, May 14, 2003 12:14 AM

herb/drug interactions

Thank-you all for your replies concerning my MS/fibromyalgia case. Sincethere were so many replies, I'll address them all together without thestandard reply format.Her pulses are very deep, practically imperceptible, neither thin nortaut, but soft. The middle (bar) positions are the strongest--liver andspleen from my training. Her tongue body is thin and slightly deviated(no strokes or TIA's), slightly pale and with a thick slimy white coatand red tip.Depakote is to prevent migraines. Klonopin is for sleep (the only thingthat worked). Her psychiatrist is aiming to get her off the Klonopin. Ithink the neurontin is for erythromelalgia (burning feet and, less so,hands). I will check again about that. Propranolol is for hypertension.I will treat this with acup. She's 'always' had 'heartburn'--had anegative endoscopy--the Prevacid got rid of it. She says she had themuscle pain before she was ever on Lipitor, but I will ask again,perhaps suggest a CK level. Wouldn't positive results on SED rate orC-reactive protein indicate inflammation that could be anywhere in thebody, so therefore, it wouldn't directly suggest the Lipitor as culprit?My understanding og red yeast rice is that it is where Mevacororiginated so there are almost identical adverse effects with it, assome of you suggest. Thankfully, after her second treatment she had 4days of relief from hip pain. Her shen, by my reading, is way morevibrant than mine would be if I were on all those meds! I am stilltrying to piece together her diagnosis and the pathogenesis of hercurrent conditions. I'll report if anything particularly interestingdevelops in this case. I have told her we would not pursue herbaltreatment at this time.Professor White, can you say more about panthethine? Anything to do withpantothenic acid? I will suggest alternative cholesterol treatments toher.Marian---Outgoing mail is certified Virus Free.Checked by AVG anti-virus system (http://www.grisoft.com).Version: 6.0.434 / Virus Database: 243 - Release 12/25/2002Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

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Another blank e-mail

 

 

On Friday, May 16, 2003, at 05:22 PM, Alon Marcus wrote:

 

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[Guest guest]

Zev did you get my last couple of email on redyeast?

alon

[Guest guest]

Yes I did.

 

Z'ev

On Saturday, May 17, 2003, at 11:24 AM, Alon Marcus wrote:

 

> Zev did you get my last couple of email on redyeast?

> alon

[Guest guest]

> Jeffrey replied:

>> This is where we need to be really careful, if we don't want to

>> end up having to get pharmacology degrees / be under the

>> supervision of pharmacists / etc. Who holds the keys to herb-drug

>> interactions, anyway? Certainly not licensed acupuncturists. I'm

>> not so sure anyone does, at least not outside of China and the

>> Chinese diaspora.

>

> Jeffrey, with respect, I disagree. Yes, much remains unclear on

> herb-drug interactions but there are some data (including WWW

> data) on that area. For example, one would not use a remedy with

> a significant amount of digitalis in a subject already taking

> digitalis-

> type medication.

 

It seems clear to me, too, that one should exercise caution when giving

blood-quickening medicinals to a patient on coumadin, for example.

There are many good examples. Yet it would not be equally clear to a

physician that the dose of drug X could, should be reduced when similar

Chinese herbal treatment is ongoing. I'm just saying that the Chinese

have by far the most information about these issues. Getting proper

attention to it outside of China is of course another matter entirely.

 

> I have argued elsewhere that even air and water (the most vital

> essentials for life) can be toxic under certain circumstances. So

> can salt and sugar!

 

No one could sensibly dispute this. Yet tobacco, which is completely

free of therapeutic effects, is legally and socially condoned in the

U.S. with barely a " caveat emptor " , while we ban ephedra. I'll even

confess that as much as it worries me, I felt strangely vindicated by

the FDA's ruling on ephedra, having told so many people about the

pitfalls of Metabolife. Did I recently hear that Ireland instituted a

ban on public smoking? If Ireland can do that, the U.S. should be able

get its priorities straight. But I nearly forgot -- we are the world's

leading producer of tobacco, among many other dubious distinctions.

 

> If so, IMO, ALL herbs and drugs, without exception, are potentially

> toxic. It is the DOSE and the OTHER ingredients in a remedy that

> decide whether or not toxicity will arise in HEALTHY subjects.

 

You sound like a Chinese doctor, Paul. :-)

 

The medicine of our own culture is inherently and perhaps justly

prejudiced against polypharmacy. Part of the struggle is that

biomedicine has a lot of toxic " herbs " that often don't play well

together, and no " gan cao " , to say nothing of the lack of a rational

model to strategize about interactions. There is a lot to overcome

here.

 

> For example, I understand that circa 2% (?) of cancer-patients lack

> the enzymes to metabolise the agents used in chemotherapy for

> cancer. Those unfortunate people have severe side-effects in the

> days and weeks after administration of the chemo cocktail. [That is

> an area where AP and correctly prescribed herbal formulas might

> help greatly! Depending on the chemo used, and on the organs

> targeted by its side-effects, AP and herbs to support/protect LV,

> KI, HT & SP-ST functions have shown some promise in that area.]

 

It does help a lot, when the patient has access to such care.

 

> Jeffrey, IMO, it is as incumbent on herbalists as on MDs/allopathic

> physicians, surgeons and anaesthetists to be aware of possible

> drug-herb interactions, and of possible interactions between drugs

> OR herbs on a compromised system, especially weakened LV, KI

> or HT function.

 

I agree completely. But we'd have to work together, CM practitioners,

physicians, and regulators, to achieve this. That would rest on

everyone having the right motivations...

 

It is sometimes physicians who would prefer to plant their heads in the

sand with respect not just to herb-drug interactions, but even

drug-drug interactions. It is often easier to tell patients not to get

Chinese medicine, or to assume " it won't do anything anyway. " Also,

I've lost count of the number of patients I have seen who have seen a

GP and one more specialists who prescribed potentially life-threatening

combinations of drugs through sheer lack of communication. Obviously, I

am uncomfortable with the notion of prescribing herbs in such

circumstances. One example, a patient with history of breast cancer

treated by tamoxifen, subsequent liver damage, and GERD. Her doc wanted

to prescribe a drug for the GERD which is known to be hepatotoxic. She

did her research and pointed this out to him, whereupon he replied,

" Oh, but you're a prime candidate for a liver transplant, anyway. " She

told him she was getting Chinese medicine and that it had really helped

her GERD and quite a few other problems. His response, to keep it

brief, came from denial. If this were just an isolated incident, I'd

feel better about our chances.

 

I perceive, as do others, that where knowledge, experience, and

communication are, Chinese herbal medicine does not pose much of a

risk, even when pharmaceutical drugs and liver/kidney hypofunction are

part of the picture. Still, we have had very little success at

persuading the FDA, EU equivalent thereof, or indeed physicians

generally, to even look at what evidence exists, much less accept it.

It's not enough for them that China (representing more than 1/6th of

the world population) integrates CM and biomedicine successfully

already. It's not enough for them that there is an abundance of

research (written in Chinese). Even if we translate it into English,

the Not Invented Here mentality then comes into play. How do we

overcome this inertia? It is much easier to dismiss a given thing than

it is to embrace and understand it.

 

>> FDA could destroy us just as effectively with the interaction

>> question. We say, " we know what we're doing. " FDA then says, " Okay,

>> prove it. " How do we do that? Just as important, how do we afford

>> to do it? Jeffrey

>

> IMO, the FDA and EU Regulators will destroy us faster if we try to

> AVOID the issue! We must face up to it and carefully document

> the background health (esp PREVIOUSLY compromised LV, HT

> and KI function), and the use of concomitant allopathic and herbal

> remedies in any patients that suffer adverse reactions while taking

> (or shortly after stopping) herbal remedies.

 

Even assuming that all practitioners are keeping such documentation

independently, which is doubtful, it still amounts to nothing more than

isolated, anecdotal reports in the eyes of regulators. The FDA is not

known for taking people's word for it. Guilty until proven innocent is

the standard.

 

I agree with what you are saying, Phil, and I realize that I must seem

awfully pessimistic about it. It's the right thing to do and it must be

done, sooner or later, whatever the cost. China has been working on it

for at least half a century, and it's a shame that we should have to

keep reinventing the wheel over here - it is expensive in terms of time

and money, though I deem the greatest loss is in not being able to

offer more people the advantage of integrated medicine.

 

Avoidance is not my proposal. I dearly love Chinese herbal medicine and

have devoted the past twelve years of my life to it. I'd be sorry to

lose the privilege. I just don't know if our profession has the kind of

money and clout we would realistically need to achieve the goal. Maybe

it's different in the EU, but over here we are in the thick of the most

short-sighted, the most fearful, the most greed-driven period any of us

has seen in a lifetime. What are your thoughts? Do we really have the

information? Can we present it effectively? I'm up for a revolution,

but I think that is essentially what we are discussing here.

[Guest guest]

I would use John Chen's materials to start with. He's a Lac and PharmD.

I've found them to be helpful for concerns with interaction issues, and

best source you're likely to find in the western world. Remember -

there isn't only 1 relationship - not just 'harmful interaction'.

There's also 'reducing interaction' eg, proton pump inhibitors decrease

absorption of other meds (this includes herbs) and therefore you need to

increase your dosage.

Geoff

> __________

>

> Message: 10

> Tue, 24 Feb 2004 12:02:54 -0700

> Jeffrey Chapman <cha

> Re: herb/drug interactions

>

> > Jeffrey replied:

> >> This is where we need to be really careful, if we don't want to

> >> end up having to get pharmacology degrees / be under the

> >> supervision of pharmacists / etc. Who holds the keys to herb-drug

> >> interactions, anyway? Certainly not licensed acupuncturists. I'm

> >> not so sure anyone does, at least not outside of China and the

> >> Chinese diaspora.

> >

> > Jeffrey, with respect, I disagree. Yes, much remains unclear on

> > herb-drug interactions but there are some data (including WWW

> > data) on that area. For example, one would not use a remedy with

> > a significant amount of digitalis in a subject already taking

> > digitalis-

> > type medication.

[Guest guest]

Joyce:

 

You may want to take a look at Francis Brinker's book

" Herb Contraindications & Drug Interactions " .

Although it has good information, I don't care for the

way it is written, but that's just my opinion.

 

If you want to see a sample of what the book looks

like, here's a link to an online update:

 

http://www.eclecticherb.com/emp/updatesHCDI.html

 

Best regards,

 

Kay King