Staying Healthy Archive

A recent study published in the New England Journal of Medicine offers another important reminder on careful use of herbal remedies. This caution is rooted in the absence of strict pharmaceutical controls in the manufacture of such products and how the lack of these requirements can leave room for tragic errors.

In the mid-1990s, doctors at a clinic in Belgium treated 43 patients with end-stage kidney failure, requiring dialysis or transplant. Not surprisingly, these individuals had something in common in their medical histories. Between 1990 and 1992, each had used a Chinese herbal remedy in combination with two other drugs for weight loss. The herbal preparation supposedly contained Stephania tetrandra and Magnolia officinalis. But the sudden appearance of kidney failure in these patients, caused their doctors to suspect that the herb Aristolochia fangchi, which is poisonous to the kidneys, had unintentionally been substituted for S. tetrandra. The Chinese names for A. fangchi and S. tetrandra sound similar and the two are often confused. Analysis showed that the herbal remedy did, in fact, contain aristolochic acids, which are derived from A. fangchi. Aristolochic acids cause cancer in rats and mutations in bacteria and mammals.

Reports of patients who had developed urothelial carcinoma (cancer of the tissues lining the bladder, ureter, and part of the kidney), as well as kidney failure related to the Chinese herbs, drew concern among the Belgian doctors. When one of their patients also developed this cancer, the doctors decided that all patients with end-stage kidney failure related to the use of Chinese herbs should be checked for cancer of these organs. By removing these organs, the doctors hoped to prevent cancer from developing in their patients. Thirty-nine of the 43 patients agreed to undergo the preventive surgery. Of these patients, 46% of them already had cancerous growths in the removed tissues. In addition, 19 of the remaining 21 patients had abnormal growths in the urinary system. The investigators also analyzed DNA samples taken from the kidneys and ureters of each patient. The DNA samples for every patient showed changes typically found after exposure to aristolochic acid. The researchers compared these results to analysis of DNA samples taken from eight patients with end-stage kidney failure unrelated to Chinese herbs. None of these control samples showed DNA changes formed by aristolochic acid.

The doctors calculated the cumulative dose of the implicated herb and other treatments for each patient. They found that the risk of cancer was related to the cumulative dose of A. fangchi. Because many of the patients had also taken appetite suppressants as well as a diuretic, the doctors noted that these drugs might enhance the toxicity of aristolochic acid.

This case study provides strong evidence suggesting a relationship between the Chinese herb A. fangchi and urothelial carcinoma. While a manufacturing mistake led to the introduction of this herb into an herbal preparation for weight loss, this study highlights the risks involved in taking herbal remedies. There is little control over the quality of herbal medicines. This means that the label on an herbal medicine may not accurately represent what is actually in the container, as was the case with S. tetrandra. Several countries have banned the use of herbs that contain aristolochic acid, yet Aristolochia is readily available in the United States in capsule form.

In the United States, the FDA does not have the authority to assess the safety and efficacy of a dietary supplement before it reaches the shelves of stores. The agency is allowed to restrict a supplement only after it proves the substance is harmful as commonly consumed, but there is no adequate system for reporting serious side effects associated with these products. Furthermore, the FDA does not have any way of knowing which herbal remedies contain harmful substances such as aristolochic acid. The case of the Chinese herbal diet pill and its association with urothelial cancer is just one of a number of cases that demonstrate the need for greater oversight of dietary supplements and caution in the use of supplements on the part of consumers.

Update on Fen-Phen and Heart-Valve Problems

Two recent studies are adding to the data concerning fen-phen and heart-valve problems. These studies should offer some reassurance to patients who took this combination of weight-loss drugs.

Researchers from Harvard Medical School evaluated echocardiograms performed on 226 people who took fen-phen as part of a long-term study from September 1994 to September 1997. Shortly after the manufacturer’s voluntary withdrawal of fen-phen, the medications were stopped and the patients underwent testing to determine if any heart-valve problems had developed. The echocardiograms showed that not one patient had severe valvular disease. Mild leaking of the aortic valve was detected in 12 patients, and three patients exhibited moderate aortic-valve leaking — a total of 15 (6.6%) patients. Three subjects (1.3%) had moderate leaking of the mitral valve. To compare the rate of heart-valve problems in these patients to the rate one might expect to see in the general population, investigators turned to data collected as part of the Framingham Heart Study (the long-term epidemiological study being conducted in a Boston suburb). They found nearly the same rates of aortic- and mitral-valve leaking in the Framingham volunteers as in the diet-drug study participants.

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Following a diet designed to lower your blood pressure may also reduce your odds of having a stroke, according to a study in the April issue of the journal Stroke.

The study relied on data from diet questionnaires from more than 74,400 people ages 45 to 84. Researchers created scores based on how closely the participants followed the Dietary Approaches to Stop Hypertension (DASH) diet, a plant-focused diet that emphasizes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish, and nuts. The diet has long been touted for its ability to lower blood pressure, which is one of the leading risk factors for stroke.

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News Briefs

A popular smartphone app that estimates your blood pressure doesn't provide reliable readings. In fact, more than three-quarters of people with high blood pressure who use the Instant Blood Pressure app will be falsely reassured that their blood pressure is normal, according to a small study that compared the app results to readings taken with a traditional blood pressure cuff.

To use the app, you put the top edge of your phone on the left side of your chest while holding your right index finger over the smartphone's camera. The app—which was among the top 50 best-selling iPhone apps for about five months—is no longer for sale, for unclear reasons. But it's still installed on a vast number of iPhones, and similar apps are still available, according to a research letter published online March 2 by JAMA Internal Medicine. Bottom line: Don't use any app that uses the phone itself to measure your blood pressure.

A positive view of life and aging may help you live longer.

Giving life two thumbs up may help you stay healthier.
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Do you look forward to the next week? Do you feel younger than your age? Do you have a sense of purpose? If so, you may already have done something to reduce your risk of degenerative diseases and may even be adding years to your life.

Q. I love to soak in the sun and get a nice tan, which makes me look healthier. However, over the years I've acquired a few wrinkles, which I'm not so crazy about. Is there anything I can do to minimize them?

A. As you know, prolonged exposure to the sun can result in premature wrinkles. In addition, age, sex, skin type, geographic location, skin pigmentation, genetics, and total duration of sun exposure throughout life all play a role in how our skin ages. Studies have shown sun exposure induces skin aging in up to 80% to 90% of Europeans and North Americans.

There are several remedies for this common symptom, which is rarely a sign of serious illness.

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Constipation affects women more than men and is more likely to occur at certain times, including pregnancy and in the days preceding menstruation, and becomes increasingly common after menopause. While constipation can cause discomfort and anxiety, it is usually not a symptom of a serious condition. However, it can often be difficult to determine just why someone is constipated.

Constipation isn't a simple problem. It is characterized by fewer than three bowel movements a week, hard dry stools, straining to move one's bowels, and a sense of an incomplete evacuation. "It also has many causes," says Dr. Kyle Staller, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital. He notes the factors that cause symptoms can vary, depending on whether the condition is sporadic (occurring occasionally) or chronic (persisting for months or years).

Over-the-counter medications may be neither safe nor effective if they aren't used properly.

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More than one-third of Americans regularly use nonprescription drugs to treat a number of ailments—pain, fever, cold and allergy symptoms, heartburn, and insomnia, to name a few. The manufacturers of the medications sold on drugstore shelves have demonstrated to the FDA that their products are safe and effective. And using them can spare you the money and time spent making a health care visit and filling a prescription.

But these medications are being used by groups of people who weren't likely to have been included in the clinical trials that furnished evidence of their safety and efficacy, says Dr. Sonia Hernandez-Diaz, professor of epidemiology at Harvard T.H. Chan School of Public Health. "FDA approval for prescription drugs is based on clinical trials of people who have specific conditions. When the same drugs are released over the counter [OTC], anyone can take them. It's also harder to trace the side effects because people aren't being monitored, and it's more difficult for the FDA to recall a drug once it's OTC."

Research we’re watching

The American Diabetes Association counsels women with diabetes to follow the recommendations for alcohol consumption that apply to most adult women: a drink a day is fine, especially because it may reduce your risk of cardiovascular disease. A new analysis by a team of Chinese researchers indicates that the same drink could reduce the risk of developing type 2 diabetes in the first place.

The researchers poured over 26 studies on alcohol and diabetes that involved 706,716 people, over half of whom were women. They determined that compared with teetotalers, light drinkers (those who averaged up to one drink a day) had a 17% lower risk of developing diabetes, and that those who averaged one to two drinks daily had a 26% lower risk. However, alcohol consumption heavier than that had little or no effect on diabetes risk. When they broke down the data further, they found that the benefits of light to moderate drinking were greater for women than men.