Hassled by the hazards of -- herbal tea?!?!?!?!?

During the first year of treatment with a cardiologist and heart failure nurse, I asked if I could drink coffee.  The answer was yes.  But I decided to exercise moderation, so I limited myself to one cup of coffee a day.  In the years since, I have switched to a half caff version of coffee, but I might also drink a cup of black tea during the day.  The end result is that I have no more than one cup of caffeine a day.

I have also been drinking my fair share of herbal tea during the day.  In the first year, I tried to find some teas that would help me relax before bedtime.  I decided to drink plain old, reliable chamomile tea.  How harmful could that be?
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But then about three months ago, I had lunch with a good friend who knows that I love herbal tea.  She periodically gives me new brands to try.  At this particular lunch, she gave me a tea that was labeled “heart health”.  It had some herbal ingredients that I was not familiar with like hawthorn berry and gingko.  My friend’s mother is a nurse, and she advised that I might want to check with my heart doctor to see if these herbal ingredients were appropriate for someone with heart failure.

This advice might surprise you.  After all, the grocery stores and pharmacies are filled with vitamin supplements and herbal supplements and other herbal substances.  I think as shoppers we might accept these products without question because we figure they are natural substances or have health benefits, so how can they harm us?  I am apparently not alone in this belief.  According to the website drugs.com, almost 20 percent of Americans currently take some type of herbal or non-herbal supplement.

Well, let’s start first with vitamins.  Several years ago, routine annual bloodwork showed that my vitamin D level was low.  So on the advice of my primary care doctor, I take vitamin D.  My heart doctors are aware that I take this and they do not object.  I do not take any other vitamins because I believe my diet is healthy and provides sufficient levels of the vitamins and minerals that are part of our recommended daily allowance.  Some might tell you that I am missing out on some important health benefits.  But I recently came across an article that might disprove this claim.

An April 4, 2018 article on the Washington Post website contained some comments from Dr. Martha Gulati, who is the chief of cardiology at the University of Arizona, College of Medicine located in Phoenix.  She said that a number of years ago, she noticed that many of her mentors were prescribing vitamin E and folic acid to patients.   Dr. Gulati, encouraged her father to take these supplements. 

But just a few years later, she found herself reversing course.  Why?  Because rigorous clinical trials found neither vitamin E nor folic acid supplements did anything to protect the heart. In fact, studies linked high doses of vitamin E to a higher risk of heart failure, prostrate cancer and death from any cause.  So my advice is to avoid taking vitamins and herbal supplements with abandon until you clear it with your doctor first, who should be familiar with any relevant clinical trials and studies.

Moving on to the herbal tea issue, for some reason, my mind was drawing a distinction between herbal supplements and herbal tea.  I guess I thought that to be harmful, it had to be in a more concentrated form, like a pill.  But according to the website drugs.com, herbal supplements are sold in many different forms - dried leaves for teas, powdered, as capsules or tablets, or in solution.  So I am very grateful that I my friend’s mother advised that I should check with my doctor about my use of herbal tea.    

Unfortunately, after my recent visit with my heart failure doctor, I realized that I had forgotten to bring the tea with me.  So I sent an e-mail to my nurse and asked her if it was okay to drink the tea.  She asked me if I could send her a list of the ingredients, which I did.  After she consulted with the office dietitian she sent me an e-mail with much helpful information.  She advised that there are many unknowns when it comes to teas as they are not regulated by the FDA. Overall, she would not recommend drinking the teas because of some of the ingredients in the teas could interact with heart medications, for example ginger and ginkgo.  She also told me that green tea could interact with heart medications.

After getting this information, I found a reference to a study by the American College of Cardiologists.  I found information on the study in a March 2017 edition of their Journal.  I include the conclusion to the abstract here, as I think it speaks volumes:

• Use of herbal medications for the treatment of cardiovascular diseases is not supported by scientific evidence. Although most of the herbs demonstrate an effect on biological mechanisms associated with cardiovascular disease, available clinical studies are limited in sample size and do not show any impact on relevant clinical outcomes. Therefore, to date, available data do not provide enough evidence to recommend the use of herbal medications in clinical practice. In addition, potential relevant side effects, including increased risk of drug interactions, have been described, and the possibility of contamination or substitution with other medications is a concern. Physicians should improve their knowledge of herbal medications to adequately weigh the clinical implications related to their use, and be able to discuss with patients their possible benefits and side effects, and explain that natural does not always mean safe. 

I checked the ingredients on a number of my herbal tea boxes and found that they routinely contain ginger.  I also noticed things like licorice root.  I also perused the ingredient list on the black or decaffeinated teas in pantry, only to learn that they also had herbal ingredients.  A number of these were ingredients not covered in my e-mail exchanges with the nurse.   So I decided to see if there had been any research done by a reliable institution specifically about these herbs and heart health.  I found a number of references to a study conducted by the Mayo Clinic back in 2010.  The study apparently identified 25 herbal substances that could be problematic for heart patients.  However, though I have found references to the study, I have yet to actually lay eyes on the study.

So I decided it would be a wise idea to reach out to the office dietitian once again to see if these ingredients, plus other herbal tea ingredients I thought of as innocent (like chamomile and peppermint) have any side effects that I should be concerned about.  What I found is that sometimes it isn’t a direct impact on my heart that is the problem.  Rather, it is that the herbal supplement or herbal tea can interact adversely with the medications you are taking.

Unhappily, I have decided to swear off chamomile tea because chamomile, the signature ingredient in the tea, might interact with blood thinners.  While I do not take one of the heavy duty blood thinners like Coumadin or Warfarin, I take a low dose aspirin each day, and that medication does have some blood thinning qualities.  This might be overly conservative, but when I have so many variables going on with my heart, why tempt fate?  I will give away my stash of chamomile tea.

What about my peppermint tea stash?  Well the materials the dietitian sent did not indicate that peppermint has an impact on the heart meds I take.  However, I have allergies throughout the year, and it appears that peppermint might slow the absorption of my allergy medication.  Why?  Because the medication is broken down by the body’s liver, and peppermint oil might slow down the rate of breaking the drug down, and as a result can increase the drug’s side effects.  At first, I was willing to just continue taking the tea and monitor my reactions.  But then I got a really horrible sore throat.  Was it the result of a cold, or did my allergy medication function less effectively?  Not wanting to take the chance, I will be giving up my peppermint tea stash.

Going forward, I will continue to investigate the ingredients in black, decaffeinated and herbal teas and choose only those blends that have no questionable ingredients.  I found a black tea that has spearmint in it.  Happily, I cannot find that spearmint has a questionable interaction with any of my medications, so it appears like a good addition to my pantry.  I also found a vanilla/almond black tea blend that is good and appears to have no questionable ingredients.

So how do I feel about having to modify another dietary habit?  On the one hand, it’s a bummer because I really liked all of my herbal teas and black teas that incorporated some herbs.  On the other hand, I’m pleased to say that my reaction has been reasonable.  In the past, I would have grumpily complained about how unfair it was that another favorite in my diet and/or fluid intake was sacrificed on the altar of good health.  But in the colorful language of a close friend, fair is something that you go to in the summer and have cotton candy (and nope, I don't eat that either!). 

In other words, fair is a word that is often overused, especially when one considers the unfortunate symptoms and treatments that others must tolerate.  So now my only reaction to swear off some of my favorite teas is “well this sucks”. But it has opened me up to other flavors that have no questionable interaction, so I can’t really complain too much.

​But I did have a few more questions for the dietitian.  Let’s say I’m having dinner at a friend’s house and she proudly puts in front of me a plate of Ginger Chicken.  Do I have to abstain?  What about Christmas Cookie exchanges?  Do I have to bypass the Gingerbread Men?  I assumed that the amount of herbal ingredients in the various food dishes would not be large enough to cause a problem.  But when it comes to heart failure, I’m learning that I should always check out my assumptions before I act on them. 
 
Happily, the dietitian confirmed my assumption.  She said:  “There is no reason to worry about eating foods that contain ginger or other herbs. The concentration of these ingredients in foods are much lower than what you would find in a tea or supplement.”  I am so happy to have my assumption confirmed because it will make planning meals, eating in restaurants or with friends, and just living in general so much easier!