A Doctor GETS REAL About Herbal Supplements

Added: 2026-05-28

[00:00:00]What do I really think of you taking kava supplements for anxiety? Well, let's talk about herbal supplements and why it's important to be open with your doctors about anything you're putting inside your body. Here's an interesting question from my old board review. A 72-year-old man is scheduled for right knee replacement surgery due to severe osteoarthritis. He has no other medical problems. He takes ibuprofen and occasionally oxycodone for knee pain. He also takes herbal supplements that he purchases from a health food store.

[00:00:28]Which of the following herbal supplements increases the risk of bleeding in this patient? A, echinacea, B, ephedra, C, ginkgo biloba, D, kava, or E, St. John's Wort. Well, the answer is C, but next to that you can see that only half the doctors who answered this question actually got it correct. But as you can see by this table, it's a valid question and something that the American Board of Internal Medicine deems an important topic to know. Did you know that ginkgo and ginseng increase your bleeding risk by delaying certain blood clotting factors like 10A or black cohosh can lead to liver injury? Doctors may not prescribe herbal supplements like we write for lisinopril or amlodipine, but we're still responsible for understanding their effects on the human body and interactions with other medications. So, let's dive into it.

[00:01:14]First and foremost, we are doctors. We cannot police what goes on inside your body and we certainly do not report to the authorities when someone does test positive for something like drugs.

[00:01:24]That's not our job and is actually protected by doctor-patient confidentiality laws. Information like that only matters to us when it impacts our work [music] and the medications that we may prescribe. If you come into the hospital with acute onset chest pain, I'm not calling your job and telling your boss that Well, came back positive for cocaine metabolites. What's important to me is that I avoid giving you beta blockers for the chest pain because that'll lead to unopposed alpha agonist activity from the cocaine, putting you in danger of further coronary vasospasm. That's my priority in the moment. I can counsel you on avoiding cocaine use in the future, but it's not my job to go break into your house and confiscate your fun powder.

[00:02:05]I'm sure it looked easier on YouTube.

[00:02:07]>> In a less illicit case, let's go over these herbal supplements and why your doctor's office will ask you if you're taking any on your visit paperwork. Some of these substances on the list are things that are quite commonly sold at your local convenience store. Things like ginkgo, ginseng, saw palmetto, and St. John's Wort capsules are packaged and marketed right alongside your generic multivitamins, CoQ10, and fiber supplements. Again, it's not my business what you decide to take and why, but it does alert me to things that I need to watch out for before I start prescribing my medications. Here's another one. Did you know that grapefruit juice is a potent CYP3A4 enzyme inhibitor and will decrease the metabolic processing of medications that pass through the same enzyme? This means that if I was prescribing you atorvastatin or simvastatin for high cholesterol, your actual dose might actually be double or triple than what I intended because your body is going through the meds at a slower rate. On the other hand, St. John's Wort is a potent inducer of the same enzyme, meaning that it increases the activity of the metabolizer instead.

[00:03:10]So, if you were taking a medication like warfarin for atrial fibrillation or an immunosuppressant like tacrolimus following a kidney transplant, then you would actually be experiencing a lower dose than prescribed since your body is chewing through the available medication twice as fast. So, being honest with each other and just laying out all the cards only helps us take care of you better. As a hospitalist, when I admit you to the hospital, I can control what medicines my nurses are administering to you and when. Of course, I'm going to prioritize things like Plavix for a cardiac patient, but if I find out they also have fibromyalgia and they swear that X or Y supplement is really the only thing that helps their daily pain, then of course, I'm willing to review it. I just need to clear it for potential interactions and call my pharmacist and my nurses can give it to you along your regular medications, no problem. And as important as it is for patients to be open with doctors about the supplements they take, it's important for doctors to know and consider the side effects and interactions of these as well. In residency, I treated a patient in the ICU with acute kratom overdose, something that he bought online and our intensivist had zero experience with treating before. Luckily, the patient made a full recovery. At the same time, I've also lost a patient in the ICU from acute lactic acidosis and renal failure due to metformin toxicity, something prescribed by his doctors and is very commonly used as a first-line diabetes medication. In the end, just be honest with your doctors and we can work with you better. Whatever you say just goes on your chart and only adds more information to your clinical picture.

[00:04:40]And on our end, doctors also need to be better at recognizing supplements and potential interactions instead of demonizing them outright.