More and more people are seeking integrative therapies to treat and prevent heart disease. Complementary and Alternative (also called CAM) therapies include any approach that is considered to be outside the mainstream of traditional healthcare. Many therapies are "holistic," which means the whole person is considered for health and healing. This includes therapies that have physical, mental, emotional and spiritual aspects.

Complementary is different from alternative medicine. While complementary medicine is used with traditional medicine techniques, alternative medicine is used in place of traditional approaches. While some alterative therapies have helped patients feel better, others can be harmful. It is important to note that medical and surgical treatments are studied carefully and tested extensively prior to being used in large numbers of patients. Alternative techniques do not go through the same type of scrutiny, therefore there are questions about the legitimacy and safety of some of these techniques.

The Heart Center chooses to follow an integrative approach. Integrative medicine, as defined by NCCAM (National Center for Complementary and Alternative Medicine)*, "combines mainstream medical therapies and complementary or alternative therapies for which there is some high-quality scientific evidence of safety and effectiveness." Examples of integrative approaches include guided imagery, biofeedback, massage, nutritional counseling, exercise, meditation, Tai Chi, yoga, support groups, hypnosis, music therapy, art therapy, herbal medicine, acupuncture and Reiki (energy therapy).

Before you begin any CAM practices, is important to learn about the therapy, it's safety and effectiveness, the expertise and qualifications of the provider, and and discuss these strategies with your doctor. Although some practices can be very beneficial, others can be harmful for some patients.

Herbal Supplements:Helpful or Harmful? 
How You Can Decide

Taking herbal remedies is tempting.  Testimonials abound from people who have solved their medical problems with “safe, natural” and over-the-counter pills.  And there’s plenty of literature — in print, on the Internet and on TV — from companies that manufacture and sell these products.  But informed consumers need to know that there are very few valid medical studies on herbal remedies, their safety, effectiveness or mechanisms of action.  In fact, most herbs haven’t been studied at all.

Although herbs seem harmless (after all, we use them to season our food), they can be potentially dangerous, especially to anyone taking medication for a heart problem. Unlike conventional medications, herbal supplements do not undergo rigorous scientific study using randomized, controlled clinical trials that are designed to measure objective “end points.” 

Serious, even fatal, interactions have been reported between cardiac medicines and some supplements. Heart Center cardiologists warn that anyone who takes digoxin, diuretics, hypoglycemics, nonsteroidal anti-inflammatory drugs, spironolactone, or warfarin should not use supplements, without first checking with their doctor:  (See chart.)
 

HEART CENTER cardiologists warn cardiac patients againts taking these herbal remedies
If you take digoxin, diuretics, hypoglycemics, nonsteroidal anti-inflammatory drugs, spironolactone, or warfarin, do not use the following supplements, without first checking with your doctor.                                                            

Many of the drug interactions result from the fact that the herbs contain naturally-occurring compounds called coumarins that are anticoagulants.  (In fact, warfarin is a coumarin, as its trade name, Coumadin, implies.)  The additional anticoagulants in the herb interfere with the workings of the prescription drugs,  says Mike Militello, Pharm. D., cardiology clinical pharmacist at The Cleveland Clinic.  For example, dong quai and angelica both contain coumarins, “but there are many others as well,”  Dr. Militello notes.

High levels of vitamin K are also a problem. “Vitamin K actually reverses the effects of warfarin,”  Dr. Militello notes.  He urges anyone taking warfarin to avoid excessive amounts of alfalfa, as well as agrimony, plantain, and stinging nettle.  (Since vitamin K is also found in green, leafy vegetables, they should also be avoided.)

Other supplements are known to cause heart problems, whether or not the consumer is also taking heart medications.  These include:  

• Aloe — used internally to relieve constipation and externally to soothe irritated skin and burns.  When taken internally, aloe can cause abnormal heart rhythms in pregnant women and children.
• Arnica (Arnica montana) — applied externally to reduce pain from bruising, aches and sprains, and to relieve constipation.  Arnica is potentially toxic to the heart and can raise blood pressure if taken internally.
• Black cohosh (Cimicifuga racemosa) — used to relieve menopausal symptoms. Can cause lowered blood pressure when taken at high doses.
• Feverfew (Tanacetum parthenium) — believed to prevent and treat migraines, arthritis and allergies.  Feverfew can interfere with blood clotting when taken internally.
• Ginger — purported to alleviate nausea and motion sickness, lower blood cholesterol, decrease platelet aggregation, and as a digestive aid and antioxidant.  Ginger can interfere with blood clotting.
• Ginseng (Panax ginseng) — supposed to slow aging, increase mental and physical capacity, increase sexual performance, and boost immunity.  It should not be taken by people with hypertension.
• Nettle (Urtica dioica) — thought to fight urinary tract infections, kidney and bladder stones, and rheumatism.  It is used externally to control dandruff.  Nettle should not be taken by people with fluid retention caused by reduced heart or kidney function.

Unlike prescription medications, herbal remedies are classified as dietary supplements and therefore bypass the tight Food and Drug Administration scrutiny that prescription medications must undergo.  In fact, the Dietary Supplement Health Education Act of October 1994 doesn’t require manufacturers of herbal products to prove that their products are either safe or effective.

To make matters worse, computer software used by pharmacists to alert them to potentially dangerous drug interactions don’t recognize adverse interactions with herbal products. If the lure of, say, improved memory or relief from arthritis pain seems strong, do your heart a favor and talk to your doctor before trying a “safe” herbal remedy.