Now more than ever, people are turning to home remedies like herbal medicines, dietary supplements, and homeopathic products, and activities such as yoga, massage therapy, and acupuncture to treat what ails them. The alternative medicine market reached $100 billion in 2021 and projections show that value more than tripling in the next five years, according to a 2022 report from Research and Markets.
The use of alternative medicines was a topic of discussion at a panel held on Sunday, November 6 at the AHA Scientific Sessions 2022. Experts addressed myths related to alternative medicines in people with heart disease, such as heart failure. Want to know what the experts think about alternative medicine? Here’s a rundown of what they discussed.
“It's critical for us to educate our patients about potential interactions with heart failure medications, ” said session moderator Biykem Bozkurt, MD, an advanced heart failure and cardiac transplantation cardiologist and professor of medicine at Baylor College of Medicine in Houston. Dr. Bozkurt stressed that standard therapies today are having a critical impact on survivorship for people with heart failure, and it’s a myth that “significantly marketed” herbal or alternative therapies should ever be used in place of standard therapies, which are proven to improve cardiovascular death and heart failure hospitalizations.
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Other research presented at the AHA meeting supported this premise. A Cleveland Clinic trial published in the Journal of the American College of Cardiology showed that six commonly used dietary supplements marketed for improving heart health did not lower LDL cholesterol when compared with a low-dose cholesterol-lowering medication (also known as a statin) or placebo. The six supplements studied included fish oil, garlic, cinnamon, turmeric, plant sterols, and red yeast rice.
Certain alternative medicines can do more harm than good, according to panelist Prateeti Khazanie, MD, who specializes in advanced heart failure and transplant cardiology at the UCHealth Heart Failure Clinic at the Anschutz Medical Campus in Colorado. Dr. Khazanie shared the story of a patient who was drinking herbal tea, which happened to contain a lot of licorice root. Too much licorice can lower a person’s potassium levels and disrupt normal heart function.
“He was probably drinking 5 to 10 cups of this tea a day, and his blood pressure was incredibly high, ” said Khazanie. “But we were able to take him off the licorice root tea and found that his blood pressure went down and he didn't need as much medication.”
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This is why reading product labels is important. She added that the upcoming AHA guidelines will highlight several other products — depending on the dose and medications being taken — that can be potentially harmful, such as grapefruit juice, gingko, bitter orange, blue cohosh, and vitamin E supplements.
For Khazanie, healthcare practitioners should know what alternative products patients may be taking so they we can better counsel them and work with them as partners on their health.
Figuring out how to talk to patients about alternative medicine, however, can be challenging, noted Khazanie. “Some of the complementary and alternative medications come in tea form or in some other supplement that they're taking and they don't really think of it as a medicine, ” she said. On top of that, some patients want to feel empowered by their decision to take something natural as opposed to “unnatural, ” so Khazanie says that healthcare providers need to learn to communicate in such as way that doesn’t undervalue a patient’s opinion.
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Not all alternative medicines are “bad” for your heart. Panelist Barry Bleske, PharmD, professor and chair of the department of pharmacy practice and administrative sciences at University of New Mexico Health Sciences in Albuquerque, highlighted that fish oil is recommended as a potential complementary therapy to reduce cardiovascular deaths and hospitalizations in people who have heart failure with reduced ejection fraction (when the muscle of the left ventricle is not pumping enough oxygen-rich blood out to the body).
He also noted that some studies have shown CoQ10 (coenzyme Q10) supplements and vitamin D as potentially beneficial, but research has produced mixed results.
“When it comes to some of these alternative treatments, they appear to be safe — there's no really significant drug interactions, ” said Dr. Bleske. “So if the patient does take it, it probably won't interact with their heart failure medication and it could possibly help the patient in some regard. I have patients who've been on coenzyme Q who say it’s the best thing they've ever taken.”
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Bleske also noted that mind-body practices such as yoga and tai chi fit the category of safe practices that may enhance physical health and mental attitude contributing in a positive way to whatever medical treatment a patient may be receiving. Another study presented at the AHA Sessions (which has not been published in a peer-reviewed journal) showed that mindfulness behavior, teaching individuals to develop a healthy relationship with their diet, exercise, and medication adherence, could lead to a significant drop in blood pressure.
In some cases, a “natural” product may be providing no real benefit but possibly be producing a placebo effect where patients improve simply because they believe the product is working. “The mind is a powerful thing, ” said Bleske. “If people believe something works and it improves their life, that all goes in to making it a positive therapy.”
Because many of these supplements and herbal remedies are sold at pharmacies, pharmacist William Baker, PharmD, a panelist and an associate professor of pharmacy practice at the University of Connecticut in Storrs, says that pharmacists can contribute to educating consumers on these products.
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“Pharmacists may be more readily available than a physician and they may be able to give expert advice on whether a product may be good for a patient, ” says Dr. Baker. “I’ve worked in retail pharmacy and there are many times that people would ask for my opinion. Many people just assume a supplement will work because it’s sold in the store, but I might advise them if I’m uncertain if the product is going to be of any benefit or if it may cause harm.”
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