Complementary and Alternative Medications (CAMs)
In view of the Straits Times article about the woman who died from extensive post-op bleeding in her brain, who had ingested cordyceps the week before an operation to remove a benign brain tumour, but failed to inform her doctors, (http://www.straitstimes.com/singapore/courts-crime/cordyceps-likely-led-to-post-op-bleeding) I have decided to write up on CAMs and the effects that they can have on our bodies.
CAMs consist of natural products such as herbs, vitamins, minerals and other nutritional substances that are taken to promote health. They are classified as dietary supplements and are not regulated by FDA. They are therefore not subject to the same standards for quality and purity as conventional medicines. The quality of CAMs can vary between different products and poor quality can result in a lack of therapeutic effect or an increased risk of toxic effects. Some consumers presume that because they are natural, they are very safe, and take unlimited amounts with the idea that natural products can do no harm. However, as seen from the Straits Times article, this can lead to tragic consequences. People should adhere to proper dosages as CAMs can have the same potential problems as conventional medicines. Excessive dosages of CAMs can produce toxic effects on various tissues and organs, particularly the liver.
People should tell their doctors of their CAM use and other nontraditional interventions. CAMs can produce adverse effects similar to conventional medicines. CAMs can also interact with conventional medicines and either increase or decrease these medicines’ effects. This may lead to a necessary adjustment of the dose of the conventional medicines to either maintain efficacy or to avoid an adverse drug reaction.
The table below will show the indication/use of a few CAMs and their adverse effects.
| Complementary and Alternative Medications | ||
| Common name | Indication/Use | Adverse effects |
| Echinacea | Boosts immune system; treats colds and respiratory tract infections. | Gastrointestinal upset, skin rash, other allergic or hypersensitivity reactions |
| Garlic | Decrease cholesterol and plasma lipids; anti-inflammatory; antimicrobial; antioxidant, etc | Gastrointestinal upset.
Can cause serious bleeding if taken with conventional anticoagulants (heparin, warfarin or aspirin, etc). |
| Ginger | Antiemetic; anti-inflammatory; antioxidant; migraine; indigestion; infection; fever, etc | Nausea and vomiting and allergic reactions. |
| Ginkgo | Improve memory and cognition; increase blood flow to brain and other organs; antioxidant; anti-inflammatory | Increased risk of serious bleeding, and should be avoided in people at risk for bleeding or people who are taking anticoagulants (heparin, warfarin or aspirin, etc). |
| Ginseng | Increase well-being; reduce fatigue; treat cancer, diabetes, cardiovascular dysfunction, etc | Can reduce the effectiveness of anticoagulants (ie: leading to increased risk of blood clots).
Increase the effects of antihyperglycemic medication (eg: insulin and oral antidiabetic drugs, which can lead to hypoglycemic shock). |
| Melatonin | Regulate sleep-wake cycles; antioxidant; immunomodulating effects | Headache; change in sleep cycles; vivid dreams; Gastrointestinal disturbances and allergic reactions (skin rashes and itching). |
Vitamins and minerals are not considered medicines, but are essential for maintaining good health. Usually only small amounts of vitamins or minerals are needed for normal growth and development, and to maintain optimal health. Most vitamins and minerals are not produced by the body and must be obtained from dietary sources. Eating a balanced diet of healthy food regularly will provide the body with the vitamins and minerals that it needs. There is usually no need for vitamin or mineral supplementation, unless the dietary supply is insufficient to meet the body’s daily requirements. For example, people with diets that are poor in nutrients or lacking in certain foods, certain metabolic disorders that affect the absorption of certain vitamins or minerals, situations where the body’s need for certain vitamins or minerals increase (pregnancy, etc.). Excessive intake of vitamins and minerals is unnecessary and can be harmful if they start to accumulate in certain organs in the body. This applies especially to fat-soluble vitamins such as vitamin A, D, E and K, which can accumulate in adipose tissue, liver and other sites throughout the body. Excessive consumption of certain vitamins or minerals can result in toxicity, causing headaches, nausea, muscle weakness and enlargement of liver and spleen.
| Vitamins | ||
| Name | Function | Adverse effects of excessive intake |
| Biotin | Assists in fat, glycogen and amino acids synthesis | None reported |
| Folic acid | Assists in metabolism of nucleic/amino acids.
Prevents anemia |
None reported.
High doses may mask neurological complications in Vit B12 deficiency. |
| Niacin | Assists in energy metabolism | Gastrointestinal distress; vasomotor reactions (flushing) |
| Pantothenic acid | Fatty acid metabolism | None reported |
| Vitamin A (retinol) | Required for normal vision, gene expression, reproduction, embryonic development, and immune function | Teratological effects (may cause birth defects); liver toxicity |
| Vitamin B1 (thiamin) | Assists in metabolism of carbohydrates and certain amino acids; prevents beriberi | None reported |
| Vitamin B2 (riboflavin) | Assists in numerous oxidative metabolic reactions | None reported |
| Vitamin B6 (pyridoxine) | Assists in metabolism of amino acids and glycogen | None reported |
| Vitamin B12 (cobalamin) | Assists in nucleic acid metabolism; prevents anemia | None reported |
| Vitamin C | Protective antioxidant; prevents scurvy | Gastrointestinal disturbances; kidney stones; excess iron absorption |
| Vitamin D | Maintain serum calcium and phosphate; prevents rickets | Excessive serum calcium due to elevated vitamin D metabolites in plasma |
| Vitamin E | Antioxidant effects | Haemorrhagic toxicity |
| Vitamin K | Assists in protein synthesis needed for blood clotting and bone metabolism | None reported |
| Minerals (major minerals) | |
| Name | Function |
| Calcium | Mineralisation of bone and teeth; synaptic transmission; muscle contraction; blood clotting |
| Chloride | Helps maintain electrochemical and water balance across cell membrane (together with sodium and potassium). |
| Magnesium | Assists in enzyme systems |
| Phosphate | Facilitates energy storage and release; nucleotide synthesis and maintenance of acid-base balance in body fluids |
| Potassium | Helps maintain electrochemical and water balance across cell membrane (together with sodium and chloride); promotes nerve /muscle relaxation (repolarisation of nerve and muscle tissues) |
| Sodium | Helps maintain electrochemical and water balance across cell membrane (together with potassium and chloride); promotes good nerve conduction (initiates depolarisation of nerve and muscle tissues). |
| Inorganic Sulfate | Provides precursors for sulfur-containing compounds |
| Trace minerals | |
| Chromium | Helps maintain normal blood glucose levels |
| Copper | Part of enzymes in iron metabolism |
| Fluoride | Stimulates new bone formation; prevents formation of dental cavities |
| Iodine | Part of thyroid hormones; prevents goiter and cretinism |
| Iron | Part of haemoglobin and numerous enzymes; prevents certain anemias |
| Manganese | Involved in bone formation and enzymes involved in amino acid, cholesterol and carbohydrate metabolism |
| Selenium | Defence against oxidative stress; regulates thyroid hormone action and metabolism of vitamin C |
| Zinc | Part of many enzymes and proteins; involved in regulation of gene expression |
Adapted from Complementary and Alternative Medications. In Charles D. Ciccone. Pharmacology in Rehabilitation. 4th edition. FA Davis. 2007: 605-618.