Using traditional Chinese herbal remedies while also taking prescription medications can cause potentially life-threatening reactions.

After a survey of Chinese immigrants in Vancouver found that many use traditional herbs and fail to disclose it to their doctors, a group of medical students developed a cautionary chart outlining the dangers.

The project began while the four students were at the University of B.C. medical school. Now they are all pursuing specialty training across Canada and are proud of the patient safety tool they’ve just unveiled.

“The use of traditional Chinese herbs is part of our culture. I grew up with it,” said Dr. Janny Xuechen Ke in an interview from Halifax, where she’s doing a residency training program in anesthesiology.

She said when she was a child growing up in China (she moved to Vancouver at age 12), she had an adverse reaction to antibiotics. After that, she recalls her parents’ preference for occasionally trying Traditional Chinese Medicine (TCM), thinking it would be safer.

But Xuechen Ke said anywhere in the world, too few doctors ask patients if they are using herbs. A survey her group conducted of more than 300 Chinese immigrants to Vancouver revealed many don’t disclose their use of such remedies because they feel they’ll be harshly judged. Meanwhile, 80 per cent of the survey respondents said they had previously used Chinese herbs. About half said they took them on the recommendation of family or friends.

A growing number of studies is showing, however, that ingesting commonly prescribed medications like the anticoagulant warfarin at the same time as herbs can be a recipe for disaster. A study in the Singapore Medical Journal earlier this year showed that there are 44 commonly used herbal products, including ginkgo, ginseng, licorice and ginger, which interact with warfarin, causing symptoms like bleeding.

In the communication tool developed by the UBC group — a printed card or an online document — 22 popular herbs are listed with information about what effects they have in the body and any evidence of interactions.

The hope is that TCM practitioners will tick off which herbs they’ve sold to the health consumer. The form can then be shown to patients’ medical doctors so they can see what they are using and then caution patients about potential interactions. Licorice (Gan Cao), for example, may be used to prevent hepatitis B and C but it increases the metabolism of warfarin so patients might need a different dose than the standard. Ginkgo, thought to improve cognition, may also increase blood glucose levels, is an anticoagulant and may cause seizures. Ginseng, widely used to boost energy and stimulate the immune system, has effects on glucose and estrogen levels, depending on the type of plant derivative.

“This is a patient safety issue. People think herbs are natural and benign but they can have potentially dangerous effects in the body,” said Xuechen Ke, who was in the pharmacy program at UBC before she entered medical school. “Our hope is that people will carry this list we’ve created, along with a list of the prescription drugs they are using. It’s important information to share with doctors but patients need to take responsibility for this too.”

The list and a description of the project is published in the current issue of the BC Medical Journal. Dr. Kendall Ho, an emergency department doctor at Vancouver General Hospital and executive director of the interCultural Online Health Network, supervised the project. He said it’s a useful tool since communication between TCM providers and medical doctors is lacking. But with Metro Vancouver’s growing number of Chinese residents and an increase in the use of herbs in the general population, there’s a need to minimize adverse reactions while boosting awareness.

TCM practitioners who prescribe herbs, doctors and health consumers can email icon.support@ubc.ca for the list or view it below.

Herbs by The Vancouver Sun

Sun Health Issues Reporter

pfayerman@vancouversun.com

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