#Warning: #Supplements and #medications may not mix! From the #BloodDetective!

Warning: Supplements and medications may not mix!

An article just out by USA TODAY entitled, "Warning: Supplements and medications may not mix," has just hit the stands. This article raises several important issues, but also contains many incomplete, untrue, partially true and misleading statements and concepts. Below I have taken each point of the article and dissected them in an attempt to clarify this very important public health issue. Your life could literally depend upon knowing something about medications and potential nutritional supplement interactions, both positive and negative.  Here we go...

MORE DRUGS AND MORE NUTRITIONAL SUPPLEMENTS

The first point - The article begins by stating a truth.  Americans are taking more medications and more supplements. Consumers are becoming smarter by questioning their doctors. In my practice, my "super smart" patient's question me routinely, and i say, "bring it on!"  I present both the pros and cons of using nutritional supplements with various medications. Unlike some physicians who for the most part unwittingly mislead their patients that supplements are a waste of money, the scientific evidence is overwhelmingly in support of the proper use of supplements by qualified health professionals. I should quickly say that physicians have fewer than 40 hours of nutritional education in medical school, so I would not place them among the "qualified health professionals for nutrition." In 2013, the Center for Disease Control published that drugs killed over 46,000 people and is the ninth leading cause of death. In 2014 drug overdoses killed over 47,000 people. Prescription analgesics nearly 19,000 and prescription opioids over 16,000.

The second point - Risk of internal bleeding:  It is true that certain nutritional supplements may interfere both positively and negatively with blood thinners, particularly coumadin. The article gives statistics regarding participants use of medications and those taking nutritional supplements, but the article failed to provide percentages of those taking nutritional supplements that could potentially interfere with blood thinning medications.  Due to this curious omission, the article did not provide any evidence whatsoever regarding who actually had adverse nutritional interactions while taking blood thinners. It is common in medicine for doctors to advise their patients to discontinue the use of certain nutritional supplements just prior to a surgical procedure. This makes sense to me as most doctors are merely being cautious. What is odd about this suggestion though is that surgical procedures are known to promote inflammation and a tendency towards viscous blood or clotting. If qualified clinical nutritionists were on hand then they could properly use the nutritional supplements to reduce surgical complications such as infections and clotting. Instead, they advise, "stop everything" or "stop taking your vitamin E" which for example helps with repair and rebuilding in the body and as a result does not serve the health and wellbeing of the patient.  In fact, many people that come see me want to get off their blood thinners. There are more than one dozen potential anti-coagulation nutrients that can be tailored to the individual thus eliminating the need for blood thinners, reducing the dosage of these dangerous medications or reducing the potential side effect caused by them. 

Third point - Omega 3 fatty acids and blood thinners are commonly combined.  According to the article bleeding risk is increased and sometimes this is true. My thought is, reduce the dosage of the blood thinner which can carry serious side effects and take an extremely safe omega 3 fatty acid. Natural compounds help regulate to normalize the blood and very rarely cause side effects other than gastrointestinal upset. Blood thinners on the other hand, are very difficult to manage and a large number of people on them still have hemorrhagic strokes or clots.  This is because the testing of the effectiveness of blood thinners is far from perfect or accurate and the medicine is metabolized very differently from person to person. One patient might need 11 mg of coumadin to get his INR (International Normalization Rte) to the desired 2.5 after a deep vein thrombosis (clot in the leg) while another might only need 2 or 3 mg of coumadin for the same effect on the INR. Don't be deceived, people with perfectly controlled INRs on blood thinning medications still get clots, bleed and are thus poorly controlled on these "tricky medications." According to the CDC (Center of Disease Control) it is estimated that more than 700,000 individuals are seen in hospital emergency rooms for adverse drug events each year in the United States. Nearly 120,000 of these patients need to be hospitalized for further treatment. This is an important patient safety problem, but many of these adverse drug events are preventable.  "Regarding children,"...An estimated 71,000 children (18 years old or younger) are seen in emergency rooms each year because of unintentional medication poisonings (excluding recreational drug use)." These sorts of dangers ARE NOT an issue with nutritional supplements - go to the CDC website and check for yourself. 

Commonly used supplements have not been studied for their potential interactions-either positive or negative: 

This is a true statement. What is also true is that the lack of study does not make nutritional supplements unsafe. In fact, I provided a talk to a large group of healthcare professionals several years back (over 300 professionals of various types including MDs, DC, PSs, DOs, NP, nutritionists, dietitians and others,) on the topic of herbal and vitamin interactions with radiation and chemotherapy. This two hour presentation provided many examples of beneficial interactions among various nutrients including herbs and other drugs. People Need to Know of Potential Adverse Effects. This statement is of course true and the article goes on to say that people assume that because the supplements are natural they are safe.  The concept that just because something is natural does not mean it is safe. What is correct is that a substance, such as a medication, is unnatural (not found in nature) and likely carries an even greater risk of danger than a natural substance and has greater side effects.  My 26 years of using nutrients with patients who are on various medications has taught me that nutrients are very safe. 

Nutrients and the "cancer care setting" - the article states that because various nutrients have not been studied in the cancer care setting that they may cause harmful side effects when combined with chemotherapy. Yes, certain nutrients should not be given with chemotherapy, however, many nutrients have demonstrated to reduce side effects, improve the effectiveness of treatment and increased longevity in many cancer patients. For example, probiotics have been shown to kill more colon cancer cells than chemotherapy alone. The active form of vitamin D has been shown to help block harmful estrogen in those with estrogen related cancers and reduce inflammation in breast cancer. Melatonin has been shown to reduce nerve damage caused by certain forms chemotherapy.  Various natural products have been shown to improve immunity and overall quality of life in late stage cancers including cancer of the bladder, breast, prostate, neuroblastomas, non-small cell lung cancer, colon cancer, mesothelioma, lymphoma, gastric and osteosarcoma. There is a large body of evidence readily available on the National Library of Medicine website that includes more than 3 million nutritional and scientific citations dating back from 1966 to present day. 

The public should seek the advice of a qualified health professional before taking nutritional supplements. This statement makes sense, but I would also like to add that nutritional supplements are far safer than medications.  If you look at the United States population overall and the number of reported health problems resulting from nutrients compared to medications, it is very, very VERY small...meaning that (in my opinion) the risk of trying to help yourself with nutritional supplements is worth the effort.

Harmful nutrient interactions. The article sites a few examples of harmful nutrient interactions, but the article could just as easily provided the beneficial studies. Bottom line, the article is bias, but yes a person should seek out a qualified nutrition professional to discuss nutrition safety since medical professionals are woefully untrained in this area. 

The take away according to Dr. Michael Wald - Continue to do your own research, but realize, that research without a trained background in the area of natural medicine or nutrition, commonly leads to misunderstandings and often wrong or incomplete conclusions. 

-     Seek out the help of a trained, qualified professional. 

-     I believe that it's best to think naturally and always choose foods first, nutrients second. 

-     Base what you may take in terms of supplements on: scientific research, the advice of a                 qualified health professional, lab work and other tests when appropriate as well as a health           and dietary questionnaire.

About Dr. Wald

Dr. Michael Wald, nicknamed The Blood Detective, is the director of Longevity Services at Integrated Nutrition of Mount Kisco, located in Westchester New York. Dr. Wald may be the most qualified clinical nutritionist in the United States having appeared on ABC World News Tonight with Diane Sawyer, Channel 11 PIX, Channel 12 News, CNN, The Food Network and other media outlets. Dr. Wald earned the name Blood Detective for his reputation in finding problems that are often missed by other doctors. He earned an MD degree (unlicensed,) is a doctor of chiropractic and a certified dietician-nutritionist. He is also double-board certified in nutrition. He has published over a dozen books including: "Frankenfoods - Genetically Modified Foods: Controversies," "Lies & Your Health and Gluten-A-Holic: How to Live Gluten Free" and "The Blood Detective's Longevity Secrets." Dr. Wald can be reached at: www.intmedny.com or by calling: 914-242-8844 (Ext. 1).