Common Considerations in Natural Medicine Contraindications

These are some of the most common mistakes when it comes to self-prescribing natural medicines. Just because it is natural doesn’t mean it is safe to take in every circumstance.

Walking into a health food store or supplement dispensary and you see a product, read the label and then consider that it would be beneficial for you to take it… Not always. Some of these products are high potency, high dose and highly reactive constituents; much different than getting these constituents from whole foods. Vitamin C is a good example (a pretty harmless supplement but good to show food equivalency). A medium sized orange has about 70mg of ascorbic acid (vitamin C) in it. A typical vitamin C supplement is usually around 1000mg per tablet, that is around 14 medium sized oranges eaten at once. So if you are a whole foods diet junky this is a bit difficult to obtain, especially when a lot of conditions tend to require high doses of vitamin C. The same is with medicinal herbal extracts, BUT many of these cause more intense physiological changes.

St. John’s Wort (Hypericum perforatum) at the Toronto Botanical Gardens

Licorice (Glycyrrhiza glabra)

Probably the most talked about and most commonly known example when it comes to its potential dangers. Licorice extracts in large doses are known to increase blood pressure (hypertension), lower blood potassium levels (hypokalemia) and cause abnormal heart beats (arrhythmia) (1). For the everyday person this isn’t much of a worry (unless you are that individual in 2020 who ate more than a bag of licorice a day for a few weeks and died of cardiac arrest) (2). But, when it comes to pre-existing heart and kidney conditions, especially those involving hypertension, licorice can be counterintuitive and harmful.

Fish Oils (Omega-3s), Vitamin E, Turmeric (Curcuma longa) and many others

There are many supplements/herbs that thin blood. This is a good thing as it helps with keeping your blood vessels clean and free of obstructions, but when you are taking pharmaceuticals like Warfarin it can be harmful. Warfarin is a blood-thinning drug used to prevent clotting in your cardiovascular system (such as the brain), so when you combine high doses of fish oils, vitamin E, Turmeric extracts and/or other of the many known natural blood thinners it may potentiate the effects of Warfarin. This will cause you to bruise easily and raise the chances of developing severe bleeding inside your body, especially after an accident that has caused physical damage (or even intentional physical ‘damage’ such as surgeries) (3). Moderation is key, as well as testing your platelet aggregation (clotting response), but most importantly inform your doctor.

Vitamin K (Leafy vegetable intake?)

Now the opposite can be true, specifically with Vitamin K. This vitamin promotes blood clotting, important in those who bleed easily or may be prone to severe inner bleeding of organs (elderly, Crohn’s disease, endometriosis etc). BUT, this then causes drugs like Warfarin to become less effective in those that are trying to lower their blood clotting. And if a condition is severe enough when it comes to blood clotting, a practitioner may recommend not to eat dark leafy greens (kale, spinach etc) in excess (especially if they normally weren’t in your diet) as they have high amounts of Vitamin K (4).

Zinc

One of my all time favourite minerals, should also not be taken lightly. First of all, prolonged uses of zinc can cause copper deficiency, especially if your diet is not well rounded. A deficiency in copper can result in a weakened immune system, fatigue and weakness, which are all symptoms zinc usually alleviates (5,6). It can also worsen a lot of vision problems.

Now even if your copper intake is adequate zinc is still an immune system stimulant (which can be great for some but..). Many individuals use corticosteroid creams and high doses of zinc lessens their effectiveness. And with many autoimmune conditions, individuals will be on immunosuppressants which zinc may interfere with as well (7).

St. John’s Wort (Hypericum perforatum)

An effective anti-depressant in which the medical community is always wary of. Why? It interacts with everything. Lots of drugs in the body are metabolized (broken down) by a group of liver enzymes called cytochrome P450. What St. John’s Wort does is increase the effectiveness of this enzyme, breaking down and clearing out drugs faster. This may sound great to some, but not to someone who is relying on their medications to work effectively and for a specific amount of time (8). The opposite can also be true with some herbs and most commonly grapefruit juice, where if drank alongside your medication will allow for the drug to be in your body much longer than needed (increasing its potency)! St. John’s Wort not only interacts with drugs this way but many other ways too, so it is important to always chat with a health practitioner who is knowledgeable in medical herbs and drug interactions. Such as a Naturopath.

5-HTP (5-hydroxytryptophan)

Not a well known over the counter supplement but very very popular with practitioners. 5-HTP (5-hydroxytryptophan) is a precursor to Serotonin, our happy hormone. Implications being depression, fatigue, fibromyalgia and other Serotonin related disorders. But supplementation of 5-HTP gets complicated. There has been lots of false claims and research on the contraindications of 5-HTP, a big one being how it may decrease dopamine levels (our happy hormone) and another that it can cause serotonin syndrome (a surge of serotonin in the body causing dangerous symptoms). It is not to rule out that these aren’t possible but much of the research that was done (14 articles total) were to promote a medical doctors supplement line (9, retracted article). And with the 1989 Tryptophan incident (a precursor to 5-HTP) where people got sick from contaminated tryptophan supplements, the information on 5-HTP out there is very mixed (10). Bottom line and to be safe, it is not wise to mix 5-HTP with anti-depressants or other drugs for mental health disorders, especially when not supervised by a medical practitioner.

Vitamin A and Beta-Carotene

Lots of multivitamins and supplements have Vitamin A or Beta-carotene. These vitamins have many important functions, from immune system function to healthy eye sight to skin health. Beta-carotene is the provitamin to Vitamin A which is also known as retinol. The provitamin (Beta-carotene) is found in red/orange/yellow pigmented vegetables and fruits, while Vitamin A is found naturally in animal products. As a supplement it can be very beneficial, but a major contraindication is smokers. Those who smoke cigarettes and took Vitamin A supplements were found to have an increased likelihood of developing lung cancer than those who didn’t (11). So not only is your pharmaceutical/medical history important in figuring out contraindications but lifestyle can also be an important factor when deciding what kind of supplements or natural medicines you should be taking.

Conclusion

The few examples above are exactly that, a few. There are numerous of supplements, botanicals and even foods that have contraindications with certain conditions, ailments and/or pharmaceuticals. Even a completely healthy individual can start seeing side effects and negative changes from a wrongly prescribed natural medicine. While many natural health products are fairly safe but if you have a pre-existing condition(s), taking pharmaceuticals or just not sure why you are taking something, it is best to seek advice from a health professional knowledgeable in such matters. The research that develops on natural medicines is becoming more abundant and these health facts are always changing, it gets hard to keep up with, so let someone else do that for you.

I do not cover contraindications related to pregnancy and breastfeeding here as there are lots, and also much of it is based on minor cases/research. There is lots of sensitivity when it comes to such topics and there is much liability. Even with what is written here, it is for educational purposes. Any use of supplements, medications and herbals should be advised by your healthcare practitioner.

References:
(1) Omar HR, Komarova I, El-Ghonemi M, et al. Licorice abuse: time to send a warning message. Ther Adv Endocrinol Metab. 2012;3(4):125-138. doi:10.1177/2042018812454322
(2) https://www.nytimes.com/2020/09/26/health/black-licorice-death-boston.html
(3) Wang CZ, Moss J, Yuan CS. Commonly Used Dietary Supplements on Coagulation Function during Surgery. Medicines (Basel). 2015;2(3):157-185. doi:10.3390/medicines2030157
(4) Park JN, Lee JS, Noh MY, Sung MK. Association Between Usual Vitamin K Intake and Anticoagulation in Patients Under Warfarin Therapy. Clin Nutr Res. 2015;4(4):235-241. doi:10.7762/cnr.2015.4.4.235
(5) Samman S, Roberts DC. The effect of zinc supplements on plasma zinc and copper levels and the reported symptoms in healthy volunteers. Med J Aust. 1987;146(5):246-249. doi:10.5694/j.1326-5377.1987.tb120232.x
(6) Samman S, Roberts DC. The effect of zinc supplements on lipoproteins and copper status. Atherosclerosis. 1988;70(3):247-252. doi:10.1016/0021-9150(88)90175-x
(7) Gammoh NZ, Rink L. Zinc in Infection and Inflammation. Nutrients. 2017;9(6):624. Published 2017 Jun 17. doi:10.3390/nu9060624
(8) Nicolussi S, Drewe J, Butterweck V, Meyer Zu Schwabedissen HE. Clinical relevance of St. John's wort drug interactions revisited. Br J Pharmacol. 2020;177(6):1212-1226. doi:10.1111/bph.14936
(9) Hinz M, Stein A, Uncini T. Amino acid management of Parkinson's disease: a case study [retracted in: Int J Gen Med. 2020 Dec 16;13:1545]. Int J Gen Med. 2011;4:165-174. Published 2011 Feb 28. doi:10.2147/IJGM.S16621
(10) Allen JA, Peterson A, Sufit R, et al. Post-epidemic eosinophilia-myalgia syndrome associated with L-tryptophan. Arthritis Rheum. 2011;63(11):3633-3639. doi:10.1002/art.30514
(11) Demetrius Albanes. β-Carotene and lung cancer: a case study. The American Journal of Clinical Nutrition. 1999;69(6):1345S–1350S. doi.org/10.1093/ajcn/69.6.1345S