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April 17, 2000 (San Francisco) -- If a trip to the grocery store has left you feeling awash in a sea of herbs and dietary supplements, it's no wonder. There are more of these products on the market than ever before, and it's often difficult to know which ones are safe to take.

Earlier this year, for example, researchers at the National Institutes of Health (NIH) discovered that St. John's wort can interfere with AIDS drugs. The Food and Drug Administration (FDA) has warned that this herb may also cause trouble for people who've had organ transplants, as well as those who take common drugs for heart disease, high blood pressure, depression, and certain cancers. Mainstream research on how other herbs might interact with medications is just beginning.

But experts say that following a few basic guidelines can help you use herbs and supplements safely. Start with this basic assumption: If herbs work, then they can interact with other drugs, says Varro Tyler, dean emeritus of the Purdue University School of Pharmacy and Pharmacological Sciences.

"Use a little common sense," he says. Don't use both an herb and a prescription drug for the same purpose. For instance, if you take kava kava to relieve anxiety, don't also take Valium. If you take ephedra as a pick-me-up, don't use it with caffeine. And remember, many herbs such as garlic, ginger, ginkgo, and feverfew can act as blood thinners. So you shouldn't take them with aspirin or other drugs that thin the blood.

What's more, you should inform your physician of any herbs or supplements you're taking. That way, there will be some documentation if there is a problem later on. And be sure to stop taking herbs at least two weeks before surgery, advises the American Society of Anesthesiologists. Some may interfere with anesthetics, while others can trigger changes in heart rate or blood pressure that can raise the risks of whatever procedure you're having.

To learn more about the safe use of herbs and supplements, check out these organizations, publications, and web sites.

  • The American Botanical Council. This organization puts out a quarterly research journal in collaboration with the Herb Research Foundation (http://www.herbs.org) called HerbalGram. They also publish detailed booklets on popular herbs such as gingko biloba and echinacea. They are free to view on the web site, or you can order printed copies. The "Consumer Herbal Information Packet" includes the 12 most popular herbs and costs $18.50. For ordering information, go to http://www.herbalgram.org or call 1-(800)-373-7105.
  • Also from The American Botanical Council is Herbal Medicine: Expanded Commission E Monographs. This updated full-color reference costs $49.95 and includes clinical research and dosage information. It's based on scientific summaries compiled by a government-appointed panel of herbal experts in Germany. For ordering information, go to http://www.herbalgram.org or call 1-(800)-373-7105.
  • Tyler's Honest Herbal by Varro Tyler. Tyler, an internationally renowned expert on herbs and supplements, offers a fact-filled, hype-free guide to the use of herbal remedies. It is available from Haworth Press and costs approximately $25.
  • The National Center for Complementary and Alternative Medicine's (NCCAM) Citation Index contains over 180,000 bibliographic citations from 1963 to 1999. The NCCAM Clearinghouse can answer general alternative medicine questions and keep you up-to-date on the latest research. Go to http://nccam.nih.gov/nccam/resources/cam-ci/ or call 1-(888)-644-6226.
  • For news alerts on government research, keep an eye on the Food and Drug Administration's web site at http://www.fda.gov.

    The following two resources aren't cheap, but if you're looking for more depth and detail than what appears in the consumer-friendly sources above, they are good places to search:

  • Natural Medicines Comprehensive Database (http://www.naturaldatabase.com) is compiled by pharmacists and physicians and contains detailed charts on just about every herbal and dietary supplement used in the Western world. It's published by The Pharmacist's Letter. For information, go to http://www.pharmacistsletter.com. A web-only subscription costs $92 per year.
  • IBISmedical offers two databases of alternative medical therapies, IBIS99: The Integrative BodyMind Information System and Interactions: the IBIS Guide to Drug-Herb and Drug-Nutrient Interactions. While originally intended for physician use, these databases are presented in an easy-to-understand and comprehensive format. Available on CD-ROM, they range in price from $99 to $200. Online subscriptions will be available soon. For information, go to http://www.ibismedical.com.

Elizabeth B. Krieger is an associate editor at Healtheon/WebMD.

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