Avoiding
Natural Disaster
A
guide to being smart about using herbs and supplements
with anti-HIV drugs
By Thomas Gegeny
 In
treating their HIV, many patients have taken their healing
into their own hands, oftentimes trying therapies outside
of traditional Western medicine. Studies show that high
percentages of HIV-infected patients—up to 70 percent
in a 1998 study—use herbs, vitamins, or dietary
supplements. A proactive approach is great, and many
alternative therapies can provide a valuable complement
to a more traditional regimen.
However, in approaching alternative or complementary
therapies, patients need to heed the adage: Buyer Beware.
Ever since Congress passed the Dietary Supplement Health
and Education Act of 1994, there has been a marketing
explosion of herbs and supplements, creating a $15 billion-a-year
industry. Unfortunately, they are not regulated according
to any standards. Many products vary considerably from
one brand to another in ingredient composition and content.
Products sometimes make unsubstantiated claims and are
expensive. Consumers, and especially the HIV-infected
population, should educate themselves about such claims
and treat any herb or supplement as a drug.
One dangerous perception about these products is that
they are natural and therefore cannot be harmful. This
cannot be further from the truth. Herbs and supplements
can be harmful alone or in combination with other drugs.
One recent example is the discovery that St. John’s
Wort, a popular herb used for mild to moderate depression,
lowers the blood levels of protease inhibitors—and
some other drugs—by up to 50 percent.
Often patients believe herbs and supplements can be
taken without informing a doctor. Doctors should be
aware of all drugs and therapies that their patients
are taking. There are no exceptions. Even if some therapies
have no potential interactions, it is useful for doctors
to know what works for patients so that they can recommend
such therapies to others.
Several products have proven potentially useful for
people with HIV. For example, milk thistle (for liver
cleansing and regeneration) appears to have been helpful
to many people with complications from drug toxicity,
although there have been no controlled studies to prove
this. Also, preliminary evidence indicates that L-acetyl
carnitine may be useful for treating peripheral neuropathy.
Several supplements may alleviate diarrhea, including
calcium and glutamine.
The amount of clinical research on herbs and supplements
is limited. Only now are medical studies focusing on
the effectiveness of these therapies, especially in
our country. Eventually, these studies will help patients
separate fact from fiction and make some less-appreciated
alternative therapies viable for clinical medicine.
So what should a patient do when starting any therapy?
One important step is to research what the therapy is
for, how can it help, and what potential interactions
could occur with anti-HIV drugs (or any drugs, for that
matter). A second step is to verify all information
using at least two reliable sources. At least one source
should be either consumer-oriented or scientific. Third,
inform your physician about all herbal therapies and
supplements that are taken. Also, observe and note any
body changes when possible. In other words, look for
results to see if the actual symptoms are alleviated
within a reasonable amount of time (one to two months).
Finally, focus on why the therapy is being taken and
weigh the pros and cons (cost, perceived or actual effect,
empowerment, etc.).
Education is a key to effectively using and benefiting
from herbs and supplements. The Texas Medical Center
Library is a great resource, with a Consumer Health
Library section geared toward laymen: You can call and
ask for the Consumer Health reference librarian (713/799-7161);
search their website (library.tmc.edu); or visit the
library and ask the librarians to show you the databases
and journals. Ask to see journals on complementary therapy
or use databases like MEDLINE or Alt-Health Watch. The
Physicians’ Desk Reference (PDR) for Herbal Medicines
is also helpful. You can even get a Consumer Health
library card and check out books. The Center for AIDS
also has a walk-in information/computer center (1407
Hawthorne, 281-HIV-INFO, centerforaids.org). In addition,
individuals schooled in herbology are another potential
resource.
In researching on the web, look at scientific or unbiased
consumer information whenever possible. Commercial sites
can be useful, but they are also trying to sell products;
if nothing negative is being said, be suspicious. Here
are some especially helpful websites:
•
National Center for Complementary & Alternative
Medicine: http://nccam.nih.gov/nccam/
• Guide to medicinal and aromatic plants: www.hort.purdue.edu/newcrop/med-aro/
• MEDLINE from the National Library of Medicine:
ncbi.nlm.nih.gov/PubMed/
• Medical College of Wisconsin’s Healthlink:
healthlink.mcw.edu/nutrition-and-herbs/
• Consumer guide portion of a commercial website:
mothernature.com/cg/
• Herb index from a commercial website: aabhealth.com/herbsdefined1.htm
Thomas
Gegeny, M.S., E.L.S., is the editor of Research Initiative/Treatment
Action! (RITA!), the research and treatment journal
published by the Center for AIDS, Houston’s HIV
treatment information resource center.
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