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Combining Medicines – Is There a Safe Mix

Prescription medicines being taken alongside complementary medicines? Is this a safe habit? We’re warned about the potential “danger” but are those warnings perceived,  real or contrived? Integrative pharmacist Gerard Quigley tackles the questions.

I ’m continually puzzled with this conundrum. Prescribed drugs are invariably accompanied by verbal precautions, written consumer medicines information leaflets (which  very few people read) and the invariable ‘google’ search.  I contend strongly that there are multiple benefits in addressing nutritional deficiencies associated with prescription drugs, and there’s little balance in the ‘warning’ systems available, many of which are theoretical anyway.

It’s all about integration.

We hear the word ‘integration’ so much these days, in terms of the role played in the proliferation of complementary. Integration implies a more ‘holistic’ view of seeking the pathway from illness to wellness by combining a number of therapies, and based on professional considerations of the patient’s expectations. Essentially, the word ‘integration’ has come about because of the expectations we now have about becoming empowered in many aspects of our own health.

Why has this come about?

There has been an explosion of so-called ‘natural’ medicines, many of which make rather sensational, unsubstantiated claims. However, these products have been accompanied by a range of clinically proven, widely used in Europe, herbal medicines that are becoming available here in Australia. Some of these products are used in the same context and for the same medical indications as many of our prescribed medicines are used here.

“Overall, there is a perception that all complementary medicines can interact  with all prescribed medicines, but there’s  actually nothing further from the truth!”

Additionally, the downgrading of what we might call ‘primary care’ means that minor health challenges seem to be more ‘urgent’. It seems that a hospital is now the first port of call whenever any health issue surfaces, which puts enormous strain on our already-strained services.  Quality time with the local, over-worked general practitioner is difficult. Even the local pharmacist, who might be viewed as a commercial retailer rather than a trusted, reliable, local health advisor, has lost his primary care role.

So, where does that leave the patient?

In many instances, the patient has to start taking responsibility for their own health and wellness issues. Notice that I haven’t said ‘sickness’ or ‘illness’ …that seems to be the focus these days. However, there’s a vital part to play in the role of complementary medicine in addressing nutrient deficiencies caused by lifestyle choices, nutrient deficiencies caused by prescribed medicines, and in reducing the risk for the development of many ‘diseases of civilization’ we see such as diabetes, obesity, cardiovascular disease and dementia- related illnesses.

As an example, Alzheimer’s Australia claim that about half the Alzheimers and dementia-related illnesses diagnosed today are preventable. And, those prevention steps are not all that complicated either, showing that a healthy heart, social interaction, wise food choices, regular physical exercise, and mental challenges for your brain have clinical evidence to support their enthusiastic uptake.

Look after your heart by maintaining healthy levels of cholesterol, blood sugar and blood pressure. Eat healthy foods like fish with plenty of omega-3 fatty acids. Keep your weight in check and quit smoking.

Be physically active with about half an hour of moving and getting out and about each day.  Exercise doesn’t have to be intense. Any exercise is better than no exercise at all.

Mentally challenge your brain by either learning a language, taking up a new hobby or interest, learning to play a musical instrument, learning how to paint, or attending some adult educational classes.

Choose what you eat wisely by focussing on lots of veggies, brightly coloured fruits (in season), and avoid saturated fats and take-away foods.

Lastly, be socially active by going out with friends, playing a group sport and keeping in touch with your family network.

Interestingly, these clinically proven suggestions don’t involve any prescribed drugs. Let me add some nutritionals that have been shown to further reduce that risk.

I mentioned eating fish, and that needs to be oily fish like salmon, tuna and sardines. Eating oily fish three times a week is a start, but you can also supplement with fish oil capsules, krill oil capsules or calamari oil capsules. Omega-3 supplements like these are amazingly under-rated perhaps because they are so economical and so readily available. Omega-3’s also help reduce cardiovascular risk and the stiffness associated with osteoarthritis and the gradual deterioration in the structure and integrity of our joints.

Two additional herbal remedies from Europe have also been shown to help memory, recall, and overall brain function. Bacopa, which is also commonly called brahmi, has a wonderfully long and safe history in Ayurvedic or Indian medicine, bacopa is neuro-protective, which means that it offers protection from nerve damage in the brain. This herb also enhances cognitive function, and who among us doesn’t need help to remember things? Learning, memory and intelligence are the qualities associated with brahmi. And reassuringly, the German extracts have no adverse effects or interactions with prescribed medicines.

The other brain herb is ginkgo biloba which originated in China. This herb seems to help circulation into our brain, and is also neuro-protective. The clinical evidence shows that ginkgo improves cognitive function in people with mild-to-moderate cognitive impairment, but is less successful in people with normal cognitive function. The particular extract studied intensely is called EGb761 and is certainly worth considering. Adverse effects have been associated with poor quality extracts of ginkgo biloba, and that’s why I’ve specified a particular one.

Overall, there is a perception that all complementary medicines can interact with all prescribed medicines, but there’s actually nothing further from the truth!

Interestingly, the adverse effect profile within prescribed and over-the-counter medicines is incredibly slanted towards the drug-based group and away from the more balancing nutritional supplements available here. I could facetiously suggest that there’s some rather biased reporting about this adverse effect balance, but the Australian consumer concerned about their individual health can easily see through that.

The manufacturing standards here in Australia are world class. Most importantly, it highlights the importance of always buying complementary medicines registered either with an “Aust L” or “Aust R” number on any label. That ensures compliance with Australian regulations. Buying medicines of any sort, either prescription or natural, on the internet is fraught with potential danger.

Nutritional deficiencies form a major part of my practice. For example,  I see many people who are taking acid-blocking drugs called proton pump inhibitors, and have been taking them for a long time. The prescribing guidelines for these drugs are quite clear – they are to be used in the short term to correct a problem. Sadly, these drugs are soon to available over-the-counter. It has been well documented that these drugs block the body’s ability to absorb vitamin B12 – a fundamental requirement for nervous function. As a result, many B12 deficiencies in an older person can be directly linked to these drugs. Similarly, the absorption of calcium and magnesium, each fundamentally required for muscle function and heart health, is also blocked.

Another common example with my patients occurs as a result of the high acceptance of the statin class of drugs, prescribed often to reduce the risk of cardiovascular disease, although many experts are divided on this issue. Statins block the production of coenzyme Q10, which we produce at cellular level to enable the production of energy. Adverse effects with statins include a fuzzy brain, fatigue and muscle soreness. Supplementing with an appropriate dose of coenzyme Q10 offsets these annoying side-effects.

As we age, our joints tend to show signs of “wearing out” and that’s commonly called osteoarthritis.

The prescribing guidelines for the class of drug called a non-steroidal anti-inflammatory substance, clearly direct these drugs to be used in the lowest doses for the shortest period of time. Sadly, with long- term use, the risks of hypertension (elevated blood pressure), gastric ulceration, asthma and accelerated joint deterioration are common. Interestingly, the comforting and slick medical marketing of these particular drugs means that many are available without prescription. Each of these, if used by a person on blood pressure medication, carries a high risk for a cardiovascular event, and should be avoided.

In recent times, research has shown that herbal remedies like curcumin, green-lipped mussel, ginger and rose-hip can give pain-relieving and anti-inflammatory effects similar to those attributed to non-steroidal anti-inflammatory drugs. This means that the person who has been directed to try and relieve pain with long-term, high-dose paracetamol, which has its own health risks, now has some effective options available.

I’ve touched on a mere few of the complementary options available – all of which can be used safely and effectively, without fearing adverse interactions and consequences. However, getting to know your caring and local health practitioner is a fundamental requirement for the safe and effective use of prescription drugs and complementary medicines in combination.

Remember though, that in some instances, you’ll be informed with a definite ‘no’ to a question about integrating particular complementary medicines within your treatment options. Never be afraid to ask why, and seek some evidence as to the objections raised. Alternatively, ask somebody else.

After all, your health is all about you. No two of us are the same,  but that means a health solution can easily be tailored exactly to your expectations.

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Gerald Quigley is a community pharmacist and Master herbalist with skills in the integration of complementary medicines with prescribed medicines.  He maintains a busy website and consults as an integrative pharmacist and medical herbalist at in Malvern, Victoria.

About the author

Alana Lowes

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