December, 2003 - Do doctors think their patients use alternative therapies? How much do doctors know about those therapies? A questionnaire was given to all 165 PCPs at a continuing medicine education program. Ninety percent of doctors completed the form (150 doctors).
Researchers conclude that doctors underestimate how many of their patients really use complementary medicine, suggesting that many patients don't report using alternative therapies to their doctors.
Since alternative treatments can interact with standard drugs, doctors should ask their patients what alternative treatments they use, especially herbal remedies. Doctors should also teach themselves the risks of alternative treatments.
Title: A survey of primary care physicians' perceptions of their patients' use of complementary medicine.
Authors: Giveon SM, Liberman N, Klang S, Kahan E.
Source: Complement Ther Med. 2003 Dec;11(4):254-60.
May 9, 1999 - This is not related to heart failure - I just thought it was interesting. <g> A component of Gila monster venom called Exendin-4 is being investigated as a promising new drug to treat type 2 diabetes. This peptide stimulates the secretion of insulin in the presence of elevated blood glucose levels. It also slows gastric emptying. Phase I clinical studies have recently begun with this new drug.
Source: John Hopkins' Intellihealth
April, 1996 - Published research as well as various theories, suggest that supplemental intake of taurine, CoQ10, and L-carnitine, as well as the minerals magnesium, potassium and chromium, may help people with CHF. High intakes of fish oil may likewise help. Fish oil may lower cardiac afterload in several ways, it may reduce arrhythmia risk, and may decrease future heart damage by an ACE inhibitor-like action. In patients with coronary disease, fish oil may reduce the risk of blood clots and stroke. Since the measures recommended here are nutritional and carry little, if any risk, there is no reason why fish oil should not be studied as a nutritional addition to CHF therapy.
Title: Fish oil and other nutritional adjuvants for treatment of congestive heart failure
Author: McCarty MF.
Source: Med Hypotheses 1996 Apr;46(4):400-6
ID numbers: PMID: 8733172, MUID: 96310336
July, 1988 - The healing effect of intercessory prayer (prayer for others well being) to the Christian God has received very little attention in medical literature. To test the effects of prayer in a CCU (coronary care unit), a randomized double-blind protocol was followed. For 10 months, 393 patients admitted to the CCU were randomized to an intercessory prayer group (192 patients) or to a control group (201 patients). While hospitalized, the first group were prayed for by participating Christians outside the hospital; the control group was not. At the study's beginning, no statistical difference existed between the groups. After the study started, all patients had follow-up for the duration.
The prayer group had a much lower severity of events. The no-prayer group required ventilators, antibiotics and diuretics more often than patients in the prayer group. This suggests that intercessory prayer to God has a positive effect in patients admitted to CCU.
Title: Positive therapeutic effects of intercessory prayer in a coronary care unit population
Author:Randolph C. Byrd, MD
Source: Southern Medical Journal 1988 Jul; 81(7): 826-9
October 25, 1999 - Intercessory prayer (praying for others) has been a common response to sickness for thousands of years, but it has received little scientific attention. Three recent books on spirituality and healing have noted that the Byrd study is the only published trial of intercessory prayer with clinically significant end points, and that more scientific (randomized, controlled, blinded) studies of prayer are needed. We tried to test the theory that patients who are unknowingly prayed for by unknown intercessors will have fewer complications and a shorter hospital stay than patients not receiving such prayer.
Nine hundred and ninety-nine consecutive patients admitted to the CCU at MidAmerica Cardiology participated in the trial. At time of admission, patients were randomized to receive remote, intercessory prayer (prayer group) or not (usual care group). The hospital chaplain's secretary randomly assigned all new patients to one group or the other based on the last digit of the medical record number. Even numbers were assigned to the prayer group and odd numbers to the usual care group. This left no chance for bias because medical record numbers are assigned on a sequential basis to all new patients, regardless of how sick they are. The first names (the secretary had no other patient information) of patients in the prayer group were given to a team of outside intercessors who prayed for them daily for 4 weeks. Patients were unaware that they were being prayed for, and the intercessors did not know and never met the patients. Intercessors were asked only to pray for "a speedy recovery with no complications" and did not know what was actually wrong with the persons for whom they prayed.
The intercessors were from a variety of Christian traditions, with 35% listing themselves as non-denominational, 27% as Episcopalian, and the remainder as other Protestant groups or Roman Catholic. The intercessors were 87% women and their average age was 56 years. All attended church at least once a week and prayed daily.
We found lower overall adverse outcomes for CCU patients randomized to the prayer group (466 patients) compared with those in the usual care group (524 patients). Lengths of CCU stay and hospital stay were not affected. These findings are consistent with those of Byrd, who reported that such prayer for hospitalized patients lowered the hospital course score but did not significantly affect length of stay.
There were important differences between Byrd's study and ours. Ours was completely blinded, meaning that neither the patients nor staff even knew a trial was underway. This was possible because the hospital's Internal Review Board granted the study an exemption from the requirement to obtain informed consent, since prayer has not been shown to have ever hurt anyone. In Byrd's trial, both staff and patients were fully aware that the study was in progress, although no one knew which patients were receiving prayer. Another difference was in the kinds of patients enrolled. Since we did not seek informed consent, patients were not asked if they were willing to be prayed for. Of the 450 patients invited to participate in the Byrd study, 57 (13%) refused to do so "for personal reasons or religious convictions." That means only "prayer-receptive" patients were included in Byrd's final groups.
Finally, in Byrd's study, the intercessors were given a considerable amount of information about the patient - diagnoses, general conditions, and updates as their status changed - and they prayed only until the patient left the unit. Our intercessors were asked to pray for 28 days regardless of what happened to the patient, and our intercessors received no feedback about patient progress during this time.
It is important to note that we were most likely studying the effects of extra prayer. Since at least 50% of patients admitted to this hospital say they have a religious preference, it is likely that many patients in both groups were already getting prayer from friends, family, and clergy during their hospital stay. So, there was an unknowable and uncontrollable level of "background" prayer being offered for patients in both groups.
We offer no explanation of how or why prayer helped these patients. By analogy, when James Lind - by clinical trial - determined that lemons and limes cured scurvy aboard the HMS Salisbury in 1753, he not only did not know about ascorbic acid (the real cure), he did not even understand the concept of a "nutrient." There was a natural explanation for his findings that would be explained centuries later, but just because he did not understand it did not make his conclusions any less true or accurate.
This trial studied the impact not of how spiritual any given person was, but of prayer offered for patients regardless of their spiritual beliefs. We have not proven that God answers prayer or that God even exists. It was intercessory prayer, not the existence of God, that was tested here. All we have observed is that when individuals outside of the hospital speak (or think) the first names of hospitalized patients within a framework of prayer, those patients seemed to have a "better" CCU experience.
The main limitation of this study was defining the end point - determining some way to measure how well a patient did during a CCU stay. The score we devised, although evenly applied to both groups, is new, so it has not been validated through experience. We can only say that as a group, the patients in the prayer group "did 10% better."
In conclusion, using our scoring system (MAHI-CCU), we found that supplementary, remote, blinded, intercessory prayer produced a measurable improvement in the medical outcomes of critically ill patients. Our findings support Byrd's conclusions. With 2 randomized, controlled trials now suggesting possible benefits of intercessory prayer, further studies using standardized methods and various prayer strategies are needed. Prayer may be an effective addition to standard medical care.
Title: A Randomized, Controlled Trial of the Effects of Remote, Intercessory Prayer on Outcomes in Patients Admitted to the Coronary Care Unit
Lead Author: William S. Harris
Co-authors: Manohar Gowda, MD; Jerry W. Kolb, MD; Christopher P. Strychacz, PhD; James L. Vacek, MD; Philip G. Jones, MS; Alan Forker, MD; James H. O'Keefe, MD; Ben D. McCallister, MD
Source: Arch Intern Med. 1999;159:2273-2278
June 5, 2000 - Regular attendance at a church, synagogue, mosque, or monastery may prolong your life, according to a report in the journal Health Psychology. Previous research shows that religious involvement reduces risk of health problems such as high blood pressure or heart disease. It is not clear why religion contributes to longevity.
In the report, researchers combined the results of 29 studies that included information about the religious habits of nearly 126,000 people. In those studies, participants gave personal information about how often they attended religious services and how many people they knew who were also members of their particular congregation.
People who had more public religious involvement - they attended a church or temple, for example - and those with more private religious involvement - they prayed privately or used religion as a coping mechanism - had lower mortality and increased survival compared to those who did not.
"Survival for religious people was 29% higher than for those who were not religiously active," said study co-author Dr. Michael McCullough. "We found that religious involvement is adding a small piece to the many factors that affect a person's longevity. It is not as important a factor as something like not smoking," McCullough said.
Religious people are less likely to smoke and drink, McCullough notes. They are also more likely to stay married, all of which may positively affect a person's health. Possibly, religious people who experience stress or crisis may maintain a sense of meaning and hope about their lives, which may help them get through the tough situations, added McCullough.
Source: Health Psychology 2000;19
October 9, 1999 - An extract from the bark of the French maritime pine tree called pycnogenol, is as effective as aspirin in preventing the blood cell clumping that occurs with smoking, but it does not increase bleeding time.
"Our research shows that Pycnogenol is a safe option, especially for those who do not tolerate the side effects of aspirin," says Dr. Ronald Watson. Dr. Watson studied the effects of pycnogenol, a mixture of bioflavonoids, in experiments with adult smokers. All of the volunteers smoked at least 15 cigarettes per day at the time of the study.
In the first study, with 16 German adults, both 500mg aspirin and 100mg Pycnogenol prevented any increase in platelet reaction seen 2 hours after smoking a cigarette. However, neither treatment relieved the increases in heart rate and blood pressure seen at the same time. In another study of 19 American smokers, pycnogenol inhibited smoking-induced increases in platelet reaction at 3 different doses - 200mg, 150mg and 100mg - although the highest dose was significantly more effective. A single 200mg dose of pycnogenol inhibited blood cell clumping for more than 6 days, according to a report in the August 15 issue of Thrombosis Research.
The authors note that studies are needed to determine if pycnogenol has similar benefits in patients who cannot tolerate aspirin.
Source: Thromb Res 1999;95:155-161
November 8, 1999 - In people with high blood pressure, adding a pet to ACE inhibitor treatment lowers blood pressure under stress. Dr. Karen Allen studied 48 people in a high-stress occupation - stockbrokers - who had high blood pressure. In both pet owners and non-owners, the researchers compared the effects of lisinopril (an ACE inhibitor) on blood pressure at rest and in reaction to stress, both before and after therapy. Heart rate and blood renin levels were also measured.
"Lisinopril worked on resting blood pressure in all of the patients," Dr. Allen said. "But resting blood pressure is different from blood pressure reactivity. ACE inhibitors work on resting blood pressure. Pets work on blood pressure reactivity." Dr. Allen presented her results at the 72nd annual scientific sessions of the American Heart Association.
Prior to medication and pet ownership, systolic blood pressure rose about 20mm Hg while subjects were under stress. After beginning lisinopril therapy, those without pets continued to show a systolic increase of 20mm Hg during stress, but those with pets had an average increase in systolic pressure of only 6mm Hg. Renin reactivity (what ACE inhibitors inhibit) was also lower in pet owners compared to the others. "As a social psychologist, I've seen that when people are with other people, blood pressure soars while they're under stress," Dr. Allen said. "But people with pets don't feel they're being evaluated; they're loved and accepted by their pets."
Source: Reuters Health, Atlanta
December 10, 1997 - Companion dogs are widespread in western countries, and scientific studies have proved that dogs have a number of positive effects on human health and well-being. Studies have shown reduced systolic blood pressure in dog owners compared to non-owners, as well as lowered concentrations of plasma triglycerides and cholesterol. Studies have also shown improved survival rates following heart attack in dog owners compared to non-owners.
Companion dogs are used systematically in "animal assisted therapy" in various institutions and hospitals, both as specific treatment of a medical condition and to improve well-being in certain groups of patients. The reasons for the positive effects of dogs on human health are not known. The attachment between people and their dogs seems to have important physiological and psychological effects. Companion dogs have been shown to increase physical activity and social contact, which may also influence human health.
Title: Dogs and health. A review of documented connections
Author: Larsen BA, Lingaas F
Source: Tidsskr Nor Laegeforen 1997 Dec 10;117(30):4375-9
PMID: 9456582, UI: 98117698
July 1, 1998 - Cornell University biologists say that spices kill germs that spoil food. Garlic, onion, allspice and oregano are the best all-around bacteria killers, they say, followed by thyme, cinnamon, tarragon and cumin. Chilis and other hot peppers rank twelfth. They kill or inhibit about 75% of bacteria in food, compared with a 100% kill rate for garlic and onion.
Hot pepper plants love water, food and heat. "I make sure they get water and I spray them with Miracle Grow every 2 weeks," says one grower named Mary Esparza. Her garden gets at least 8 hours of sun a day. She pickles some peppers with garlic, vinegar and water. She roasts most of the hot peppers slowly on a pancake grill, stirring until skins turn black, cools them on cookie sheets, packages them 20 to a plastic bag and freezes them in plastic containers.
For seedlings, days from planting to harvest are: Thai Hot, 42 days; Hungarian Wax and Super Cayenne, 60 days; Tam Mild Jalapeno, Jalapeno and Mexibell, 70 days; LongRed Cayenne and Super Chili, 75 days.
Title: Garlic, onion, oregano add great flavor and help kill food bacteria
Author: Marge Hols
Source: Associated Press
July 1, 2000 - Probably one third of adults in the United States use alternative therapies, including herbs. In 1997, herbal medicine sales reached $3.24 billion. A concern is possible interactions between these alternative products and prescription drugs. More food and drug interactions have been reported for Coumadin (warfarin) than for any other prescription drug. Such interactions may lead to bleeding episodes or stroke by increasing or reducing Coumadin's effect. Herbal products that may change Coumadin's effect include:
borage seed oil
Actual documented reports claim interactions with Coumadin, including:
Some natural substances have blood-thinning properties. Coumarins (coumadin-like substances), salicylates (aspirin-like substances) and anti-platelets (substances that prevent blood cells from clumping together) all are "blood thinning." A possible risk exists when taking such a product while also taking Coumadin. Herbs thought to contain blood-thinning substances include:
|Contain coumarin||Contain salicylates||Anti-platelet|
There are no documented reports of a proven interaction between Coumadin and any of these herbs! However, patients taking these herbs while on Coumadin should be closely watched for signs of bleeding. Because of serious consequences in cattle, patients taking both sweet clover and Coumadin should be very closely monitored.
Feverfew (Tanacetum parthenium) is commonly used for treating migraine headaches, arthritis, and various allergies. Feverfew may reduce serotonin release, histamine release, and coagulation. Several lab studies have shown feverfew to interfere with coagulation. There are no documented reports of feverfew interacting with Coumadin in humans, but data suggest risk for a stronger blood thinning effect when taking both. For now, it is recommended that patients taking Coumadin avoid products containing feverfew.
Garlic (Allium sativum) is thought to have several cardiovascular benefits, such as blood pressure lowering, cholesterol lowering, and anti-stroke activity. Garlic oil has been reported to reduce coagulation. One author reported that cells were less likely to clump together (coagulate) in a lab setting when blood samples from healthy adults were mixed with essential garlic oil. There have been no documented reports of serious interaction effects when taking both Coumadin and garlic. However, the available information suggests that a serious interaction is possible. Patients taking Coumadin should avoid garlic supplements. Eating food containing small amounts of garlic should not be a problem.
Ginger (Zingiber officinale), taken for motion sickness and arthritis, has been reported to reduce blood clotting. Ginger supplements - which contain much higher amounts of ginger than food products - may increase risk of bleeding when taken with Coumadin. Patients taking both should have their INR checked regularly and watch for symptoms of bleeding.
Ginkgo (Ginkgo biloba) is a common herbal product advertised to improve mental function. Ginkgolide B, one component of ginkgo, reduces coagulation. Several cases of bleeding thought to be caused by ginkgo use have been reported. A 70 year old man took 40mg of concentrated ginkgo extract twice a day for one week. He complained of blurred vision and was diagnosed with a spontaneous hemorrhage in one eye. He was also taking 325mg aspirin daily. A second report involved a 33 year old woman who complained of headaches and was later diagnosed with bruises around her spine. She had taken 60mg of ginkgo twice a day for 2 years. Another report described a 72 year old woman diagnosed with a subdural bruise after taking 50mg of ginkgo 3 times a day for at least 6 months. There are no reports of bleeding caused by taking both Coumadin and ginkgo. However, it is recommended that patients taking Coumadin not take ginkgo-containing products.
Herbal products reported to interact with Coumadin include danshen, devil's claw, dong quai, green tea, ginseng, and papain. Nutrients such as CoQ10 and also vitamin E have been reported to affect blood thinner therapy. It should be noted that all this information is taken mainly from individual case reports so it is not too reliable.
Coenzyme Q10 is found in plant, animal, and human cells. It is involved in electron transport and may be a free-radical scavenger, an antioxidant, and a membrane stabilizer. CoQ10 is promoted to treat heart failure, high blood pressure and angina. Since CoQ10 is structurally similar to vitamin K 2, it may have blood-coagulating effects. The vitamin K-like effects of CoQ10 have been demonstrated in a lab setting and in 4 case reports. In Denmark, a 72 year old woman had a decreased response to Coumadin while she was taking CoQ10. Proper INR was achieved only when she stopped taking the product. A 68 year old man with a history of stroke who was stabilized with Coumadin for 6 years saw his INR drop after taking 30mg CoQ10 daily for 2 weeks. The other case reports involved a 72 year old man and a 70 year old woman who saw their INR go down within 2 weeks of starting CoQ10. Each of these patients returned to normal INR after stopping CoQ10. If CoQ10 and Coumadin are taken, patients should be monitored carefully for the first 2 weeks.
Danshen (the root of Salvia miltiorrhiza), also known as tan seng, is a very popular herb recommended in the Chinese community for heart disease. Danshen's effects include low blood pressure, making the heart beat more strongly, vasodilation, and reduced coagulation. Studies in rats show that danshen definitely alters the effects of Coumadin. There have been several case reports of Coumadin-danshen interaction. A 62 year old man who had been taking 5mg Coumadin daily after a mitral valve replacement and who had a stable INR for several weeks was admitted to a Hong Kong hospital with bleeding in lungs and heart. His INR was over 8.4. The man said he had taken a danshen extract daily for 2 weeks before his admission. A 66 year old man who had been taking 2.5mg Coumadin daily for nearly a year was hospitalized for internal bleeding. His INR was 5.5. He reported consuming danshen 3 and 5 days before admission. Both this man and another 48 year old woman achieved a proper INR after stopping danshen. Available evidence strongly discourages use of both Coumadin and danshen.
Devil's Claw (Harpagophytum procumbens) is an expensive herbal product that has been promoted as a pain reliever for arthritis, gout, and myalgia. Although information about devil's claw is limited, one case of rash-like skin bruising was reported in a patient taking both Coumadin and devil's claw. Until more is known about this possible interaction, patients taking Coumadin are advised to avoid devil's claw.
Dong quai (Angelica sinensis) is a Chinese herb promoted in the US for treating menopausal complaints and menstrual disorders. Dong quai contains at least 6 coumarin derivatives; these substances may promote vasodilation and have anti-inflammatory, antipyretic, antispasmodic, immunosuppressant, and estrogen-like effects. Dong quai may also reduce coagulation. A study in rabbits also suggests risk of increased PT times when this herb is taken with Coumadin. A recent case report supports this idea. A 46 year old woman who had been taking 5mg Coumadin a day for 2 years saw a sudden increase in her INR to 4.9. The patient denied any changes in routine except for adding 565mg dong quai once or twice a day during the previous 4 weeks for menopausal symptoms (her herbalist had recommended this). After 4 weeks off dong quai, her INR returned to normal. In light of this information, patients taking Coumadin are advised to avoid dong quai.
Ginseng Three ginseng species are claimed to enhance energy, reduce effects of stress, and improve mood - American ginseng (Panax quinquefolius), Oriental ginseng (Panax ginseng), and Siberian ginseng (Eleutherococcus senticosus). The active components of ginseng and their potency vary widely among ginseng products. This makes it difficult to study the safety of ginseng products. One published case report suggests that Oriental ginseng (Ginsana) may alter Coumadin's effect. The INR of a 47 year old man who had been taking Coumadin for 9 months for his mechanical heart valve began taking Oriental ginseng, and within 2 weeks his INR fell to 1.5. His INR returned to proper level 2 weeks after stopping ginseng. A 1999 study in rats did not show a significant interaction between Coumadin and pure ginseng extract. It is unknown whether patients taking Coumadin should avoid ginseng.
Green Tea (Camellia sinensis), also known as Chinese tea, is claimed to prevent cancers, treat stomach disorders, and improve mental function. Although dried green tea leaves contain substantial amounts of vitamin K, brewed green tea is not a significant source of the vitamin. However, large amounts of brewed green tea might alter Comadin's effects. The INR of a 44 year old patient with a mechanical heart valve went way down when he started drinking large amounts of brewed green tea. The patient reported to a clinic with an INR of 1.37; his INR 22 days earlier had been 3.79. The man said he had begun drinking ½ - 1 gallon of brewed green tea daily about a week before his INR dropped. A significant drop in INR would not usually be expected from drinking moderate amounts of brewed green tea.
Papain is a mixture of enzymes found in extract of papaya, the fruit of the papaya tree (Carica papaya). It is taken orally in the belief that it reduces edema, inflammation, diarrhea, and psoriasis. One case has been seen of a patient who had maintained proper INR on Coumadin, then began taking papaya extract containing papain as a weight-loss aid. The patient was admitted for heart surgery with an INR of 7.4. After withdrawal of both papaya extract and Coumadin, the patient's INR went down to 2. The details of the case have not been published. Patients on Coumadin should probably avoid papain for now
Vitamin E has received much publicity for treating heart disease. Vitamin E may slow oxidation of vitamin K. Vitamin K oxidation is necessary for blood to clot. Information about the effect of vitamin E on PT time varies. A 55 year old man on Coumadin and 1200 IU of vitamin E daily developed blood vessel ruptures under the skin, bloody urine, and high PT time. After re-stabilizing off vitamin E, he was given 800 IU of vitamin E again to see if that was the problem. The same problems reappeared. Within a week after stopping vitamin E again, his PT time went back down.
Humans consuming adequate vitamin K and not taking Coumadin have no unexpected bleeding problems. However, vitamin K-deficient animals show a tendency toward bleeding with vitamin E. A study in 12 patients on Coumadin who took 100 or 400 IU of vitamin E daily for one month found that neither dose caused bleeding. Kim and White did a randomized, double-blind study in which 4 patients took 1200 IU vitamin E daily, 3 patients took 800 IU daily, and 4 took placebo, all for 4 weeks. During the study's second phase, which was single-blind and not randomized, 6 subjects were told they would receive placebo or vitamin E, but all were given 1200 IU daily for another 4 weeks. Their INR did not increase to a point requiring Coumadin dose adjustment. Vitamin E up to 400 units per day does not seem to affect PT time in patients on Coumadin. Patients on Coumadin who begin taking vitamin E - especially dosages greater than 400 IU daily - should have INR measurements done 1 - 2 weeks after starting vitamin E. This should be followed by INR monitoring every 2 - 4 weeks during the first 2 months of combination therapy.
Limitations Nearly all available information on herb-Coumadin interactions is based on lab studies, animal studies, or individual case reports. Cause and effect relationships have not been proven. Available reports give limited information about the severity of these interactions. There is little reliable information about the safety and effectiveness of most
herbal products. There are no regulations governing purity and potency of herbal products during manufacturing.
Note The FDA recently established the Special Nutritionals Adverse Event Monitoring System, a searchable database. This database includes reports that have been submitted to MedWatch and can be accessed at http://vm.cfsan.fda.gov/~dms/aems.html.
|May increase bleeding risk||Does increase bleeding risk||May lessen Coumadin's effect|
Borage seed oil
Title: Potential Interactions Between Alternative Therapies and Warfarin
Authors: Amy M. Heck, Beth A. Dewitt, and Anita L. Lukes
Source: Am J Health-Syst Pharm 57(13):1221-1227, 2000
All information on this site is opinion only. All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor. Use the reference information at the end of each article to search MedLine for more complete and accurate information. All original copyrights apply. No information on this page should be used by any person to affect their medical, legal, educational, social, or psychological treatment in any way. I am not a doctor. This web site and all its pages, graphics, and content copyright © 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006 Jon C.