What was your stomach ‘thinking?’

Scientists talk about what they term the “second brain” in the body.

Excuse me?

Researchers are examining the link between the brain and digestion system, and how the gastrointestinal system specifically can influence the central nervous system. So when people say it’s a “gut feeling” they are speaking more than a cliché.

That can be especially surprising when a person experiences feeling sick to their stomach because it may not be simply the result of a physical ailment. The problem may be related to emotions, or feelings such as anxiety or depression that spur symptoms in the gut.

Psychological factors influence the actual makeup of the gut, and contribute to such conditions as irritable bowel syndrome, or digestive inflammations or make someone susceptible to infection.

The brain-and-gut combination is increasingly becoming a focus of medical study as researchers explore mood and digestion, and the impacts that can result depending on the food you put into your body.

The examination of two key areas of the body reflect much of the approaches of Chinese medicine as well as specialists in herbs, wellness and acupuncture. They have the holistic view of the human body, examining both the brain and gut as part of the whole, not as separate parts.

Neurology and the Gut

The nervous system impacts the gut through the enteric nervous system (ENT). The interesting thing is that although neurons go through the ENT, it operates on its own, hence the name “second brain.”  The ENT, within the gastrointestinal system, can operate independently of the brain and the spinal cord, researchers say. The ENT is comprised of two thin layers of more than 100 million nerve cells that line the gastrointestinal tract, from your throat on down.

The ENT can communicate with the central nervous system through other nerves, but can still function on its own, and it actually relays information to the brain. breaks down certain food, and helps absorb nutrients or eliminating them.

Understanding the ENT connection is important because mind-body therapies can have an impact on bowel-disorder treatments. And there is another link, too, because experts say a higher than normal percentage of people with IBS and other related problems develop depression and anxiety.

The signal could sometimes act like an amber or red traffic light – giving a cue to stop eating certain foods. If you feel a little “off” after certain food, the ENS may be reacting to food you ate, and send the signal to the brain.

Getting the Gut Healthy

There is a bacterial population that lives in the intestines called gut microbiota, and there are good bacteria and bad bacteria. There are tens of trillions of microorganisms and people are affected differently. Much of the bacteria we acquire during birth, and the gut microbiome also has an influence on your emotions, through the “brain-gut” connection.

Changes in the gut microbiomes also can impact the brain, and you can have resultant chronic inflammation, stress, or chronic inflammation from “bad” bacteria. The good bacteria have a contrary impact, such as assisting the immune system.

Researchers have said that when there is an imbalance between good and bad bacteria, it can result in disorders including irritable bowel disease, obesity, cancer, and arthritis.

Probiotic Activity.

Probiotic bacteria, called Lactobacillus rhamnosus, contains a neurotransmitter called GABA that helps regulate brain activity and can thwart anxiety, according to the National Center for Complementary and Integrative Health. Changing the make up of bacteria in the gut “through specific diets” may help to treat stress-related and neurodevelopmental disorders, including autism and hyperactivity, the NCCIH says.

Bad and Good Foods for the Gut

Some foods simply can cause problems and illness going through the body, and are responsible for chronic inflammatory conditions and other issues, depending on the person.

Some of the foods that could cause difficulties are processed foods, red meat, sugar, high fructose corn syrup, gluten, dairy, high sugar and carbohydrate diets.

Leaky Gut

When the brain’s protective barriers that insulate it from harmful substances is somewhat broken because of irritating foods or infections that create what is known as a leaky gut. The leaky guts can release antibodies that allow harmful substances into the brain. That can be one of the main factors behind autoimmune and chronic inflammatory conditions.

Eating Better

Researchers say that changing the bacterial makeup in the gut through different diets may help to treat stress-related and neurodevelopment disorders.  People should eat several servings – as many as five – of fruits and vegetables each day to help the good bacteria, and diminish the bad bacteria.

Happy Gut, Happy Person

An overwhelming number – 90 percent – of serotonin is stored in the gut.  Serotonin, sometimes called the happy chemical because it is linked to happiness, is a chemical found in the brain and bowels that send messages among nerve cells. Keeping this and other so-called neurotransmitters in the gastrointestinal tract healthy are vital for the brain, too.

— Joe Cantlupe …from my piece at HCPnow.











Homeopathy: Health Thyself, says FDA. We’re Not The Problem, say Practitioners.

Homeopathy is an alternative medical practice developed centuries ago that contends substances that effectively cause illness symptoms in otherwise healthy people can actually be used in diluted form to treat illness. And the more diluted it is, the more potent it may be.

That’s the view of the U.S. Food and Drug Administration, which is now at loggerheads with the $3 billion homeopathic industry and is trying to impose regulations on it.  The homeopathic industry has opposed the FDA plans.

The FDA has proposed boosting enforcement of the manufacturing, marketing and safety regulations of homeopathic products, which have been produced since the 1800s.  Homeopathic drug products are prepared from a variety of sources, including plants, minerals, chemicals and human and animal excretions or secretions. They are sold in pharmacies, retail stores and online.

Homeopath professionals see the body as a holistic system working to heal itself. The medications used work to stimulate the healing process, its proponents say.

That is opposed to naturopathy, often in Chinese medicine, in which practitioners work to discover the root causes of illnesses and eliminate them through elements such as supplements and food to balance the body.

Under the law, homeopathic drug products are subject to the same requirements related to approval, adulteration and misbranding as any other drug product, the FDA says. But prescription and nonprescription drug products labeled as homeopathic have been manufactured and distributed without agency approval since 1988.

Essentially, FDA officials say they are concerned that homeopathic treatments are being marketed for serious disease and conditions, but products may not have shown clinical benefits. Some products labeled as homeopathic contain potentially harmful ingredients or do not meet current good manufacturing practices, and there have been adverse events and death as a result, the FDA says.

Several yards ago, the FDA warned against the use of homeopathic teething devices containing belladonna, a toxic substance associated with serious adverse events, including seizures and deaths in infants and children.

“In recent years, we’ve seen a large uptick in products labeled as homeopathic that are being marketed for a wide array of diseases an conditions, from the common cold to cancer,” said FDA Commissioner Scott Gottlieb, MD. “In many cases, people may be placing their trust and money in therapies that may bring little to no benefit in combating serious ailments or worse.”

Homeopathy officials have spoken out against the FDA plans, with many saying the government should bring together an expert advisory council to examine the issue.

“Homeopathy is beneficial, safe and cost-effective,” wrote Ronald W. Dushkin, MD, the President of the American Institute of Homeopathy, in a comment about the FDA plans. “Integrating it more broadly into the U.S. healthcare system will contribute generously toward the resolution of many pressing social and public health crises affecting our society.”

“If the FDA’s intent is to fully reevaluate its approach to the regulation of homeopathic drugs, then a rush to declare all of them illegal (i.e., unapproved new drugs) is immensely counterproductive,” he added.

Other homeopathy officials, including Paola Brown, President of the Americans for Homeopathy Choice, submitted a petition to the FDA saying that the agency should establish an expert advisory committee on homeopathy. — Joe Cantlupe. (This was part of a piece I wrote for


To Achieve Success, Hospitals Know It’s Not Only About Patient Care -It’s About Data Capture, Meeting Billing Demands, Improving Patient Registration….

See  my story at athenahealth_Insight

With 455 beds and nearly 23,000 patient admissions each year, South Nassau Communities Hospital in Oceanside, New York, practices day-to-day healthcare in a big way.

Officials at the hospital, one of the largest in Nassau County on Long Island and the flagship of the Mount Sinai Health System, know that success at that scale isn’t just about taking care of patients.

It’s about capturing data as the hospital welcomes new practices to its fold. And it’s about meeting billing demands, improving patient registration, and efficiently manning the front desk.

To meet those goals, the hospital relies on its clinicians and staff, and on a secret weapon: Management Services Organizations (MSOs).

South Nassau contracts with at least two MSOs at any given time for an array of hospital needs, including billing and help in onboarding new physician practices, says Elizabeth Durante, administrative director of physician integration.

“We use MSOs in a lot of ways. We have another layer of support by utilizing an MSO,” says Durante.


— Joe Cantlupe


Your Doc Wants to Give You the Care. You Want the Care. Insurers are Iffy…..the Prior Authorization Nightmare

A huge headache for the healthcare industry is “prior authorization” – the bureaucratic nightmare of getting approvals from insurers for what doctors say is needed care.

CAQH,  a non-profit Washington, DC-based alliance of health plans and trade associations, released a report last month –  detailed by Health Data Buzz  – that shows how these prior authorizations  have hamstrung the move toward using electronic records, with a resultant significant loss of clinician time and spiraling monetary costs.

That is merely the latest in a string of concerns about payer prior authorization requirements, which increases doctor practice burdens and overwhelms patients, according to multiple organizations.

Major  healthcare associations say there has been a big push the past two years to change the prior authorization system, though progress comes slowly. At this point, there are many pleas for reform and  organizations insist they are  banding together to try to make changes happen.

A HeavyWeight Outcry

Earlier this year, the American Medical Association,  Medical Group Management Association  and other groups issued  an urgent consensus statement that outlined what they termed a shared commitment to establish industry-wide improvements  to reduce the onerous prior authorization process in which approvals are needed by health plans, benefit managers, and others. Last week,  CAQH added their major concerns.

The groups  expressing dismay include other powerhouses, insurers among them:  the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association, among others.

In March, an American Medical Association  survey showed that more than nine in 10 physicians reported that prior authorization programs “have a negative impact on patient clinical outcomes.”

The problems, MGMA says,  are wrapped around agreements between health plans and participating physicians in which “the insurer has the right to determine the medical necessity of surgery, imaging studies, medication and many other procedures.”

Physicians have to divert their attention from clinical and  administrative staff time – as well as resources – to work on submitting preauthorization requests for services, MGMA says.

“Health plan demands for prior approval for physician-ordered medical tests, clinical procedures, medications and medical devices ceaselessly question the judgment of physicians, resulting in less time to treat patients and needlessly drive up administrative costs for medical groups,” said MGMA’s President and CEO Halee Fischer-Wright, MD, in a statement.

Impact on Patients

According to referralmd, while many preauthorization approvals are used for  expensive drugs, generally “66% of prescriptions that get rejected at the pharmacy require prior authorization.”  It adds:  “Not only is this negative for pharmaceutical organizations, most importantly this causes frustration to patients who don’t get the medication that could best treat their condition, or who don’t get any therapy at all.”

“Strict or bureaucratic oversight programs for drug or medical treatments have delayed access to necessary care, wasted limited healthcare resources and antagonized patients and physicians alike,” AMA President Andrew W. Gurman, MD, said in a statement. “The AMA joins the other coalition organizations in urging health insurers and others to apply the reform principles and streamline requirements, lengthy assessments and inconsistent rules in current prior-authorization programs.”

The groups wanting change have outlined a set of 21  principles aimed at helping patients receive what they term timely and medically necessary care and medications and reduce the administrative burden.

Making Things Better

Among other things, they have several suggestions for improvement.

For instance, they said there can be a regular review of medical services and prescription drugs that are subject to prior authorization requirements that would more easily  identify those which may not be necessary because of “low variation in utilization or low prior authorization denial rates.”

In addition, they added:  “effective communication channels between health plans, health care providers and patients are necessary to ensure timely resolution of prior authorization requests to minimize care delays and clearly articulate prior authorization requirements, criteria, rational and program changes”

“Clearly, industry action on prior authorization is needed,” wrote CAQH in a letter last week. “Substantially improving prior authorizations on behalf of the industry ranks among our highest priorities in 2018.”

Impact on Electronic Record and Efficiencies

According to its 2017  CAQH Index adoption of the standard prior authorization transaction by health plans and providers could result in savings of $6.84 per transaction, one of the most significant per transaction opportunity areas, it said.

But the “proportion of prior authorization transactions using that standard actually declined by more than 10 percentage points” from the previous year’s Index report. According to the CAQH Index, providers conduct 77 million prior authorization transactions manually each year. It said: “Providers could save more than $3.20 per transaction and health plans could save at least $3.64 per transaction with fully electronic prior authorizations.”

The goal of the coalition is to shed a “bright light on today’s prior authorization requirements and offer tangible recommendations for improving the current process.”

Let’s see how far, with its list of principles, and the glare of the spotlight, these organizations can go to change a process that is harming many.

— Joe Cantlupe, HealthDataBuzz.


Healthcare’s Fumbling Over Electronic Records. Or Should They Just Re-Think It?

Think about it. Phones. Faxes. Even email.

A bit rusty, no?

No. This is 2018 healthcare, when it comes to physician offices  handling administrative and insurance claims transactions.

A non-profit healthcare alliance last month found in a significant study that healthcare is losing a big opportunity to save billions of dollars by its failure to switch over fully to electronic claims- related business processes among providers and insurers. The business of healthcare in the U.S. can and should be simpler, less burdensome, and, yes, perhaps most of all, less costly. And it’s not happening.

The CAQH a non-profit Washington, DC-based alliance of health plans and trade associations, uses words like “modest progress” in the transition from manual to fully electronic administrative transactions, but also  “backward,” and “no longer sufficient.” The organization also has been known as the Council for Affordable Healhcare Quality Inc.

“There are billions of dollars at stake. The electronic transactions should be more efficient and accurate and less of an administrative burden,” says Reid Kiser, interim director, CAQH Explorations, and lead researcher for the report. “They support optimized workflows for providers and the focus on the patient that health plans want to deliver and allow them to drive toward population health,” Kiser says. Kiser is an independent consultant with Kiser Healthcare Solutions, LLC.

Physician use of electronic inquiries rose by  6 percentage points for inquiries related to claim status, and 3 percentage points for eligibility and verification inquiries in 2016 compared to the previous year, according to  CAQH, which works to share initiatives to streamline costs and improve the business of healthcare. Its CAQH Index was released in June.  (In its study, CAQH also reviewed dental practices).

At a time they are trying to serve more of their patients, providers are spending up to 30 minutes on manual tasks, like making phone calls, sending faxes – faxes! – and mailing correspondence. Thirty minutes may not seem like much, but when you have only so minutes in a doctor’s office, that means a lot.

That’s a problem, Kiser says. “Once (patients) move over to a new health plan that information is essentially lost if (a patient) comes back to the health plan a few years later. From the (CAQH) perspective, it’s manual work that the provider has to do,” he says.

Beyond adoption levels, the index estimates the cost and time associated with conducting administrative transactions. On average, each manual transaction costs the industry $4.40 more than each electronic transaction and requires five more minutes of provider time.

Think of how many we’re talking about: The annual volume of administrative transactions reported by medical plans increased substantially, rising by 25 percent, from 4.8 billion in the prior year to more than 6 billion.

Going in Reverse: Or Not?

Whatever gains have been made in recent years are actually going backwards in the world of automation of claims related to business transactions. The savings potential from automating clams management increased to $11.1 billion annually in the most recent CAQH Index, with the focus on more than $7.5  billion for medical providers and $2 billion for dental providers and the remaining $1.7 billion for health plans.

That is an increase over $1.8 billion in potential savings from the previous year. The index is described as the industry source for tracking health plan and healthcare provider adoption of electronic administrative transactions for both medical and dental care.

Portals: “Accelerate or Hinder Progress?””

There’s a lot of data here, and CAQH points to one of the possible problems in evaluating the use of full electronic records, and that’s portals, the secure online websites that allows insurers, providers and patients get more involved in care.  While they are certainly helpful,  each one involves  a serious amount of work for physicians, including paper-pushing, such as clinical paperwork needed to support claims.  So it’s seen as being partially electronic in the CAQH Index and that raises all kinds of questions, including: is portal use really a bridge toward better use of electronic record use, does it hold it back: is it advancing, or not?

While the report says portals offer health plans a “highly automated solution,” some provider groups indicate that portals also create “substantial administrative burdens.”

“This is because portals require the provider to sign on and navigate a different online system for each health plan with which the provider is contracted,” the report says. “Also, portals lack advanced features common to clearinghouses and clearinghouse-integrated practice management systems, such as the ability to validate claims and check eligibility and benefits prior to patient appointments.”

That effect,  says CAQH: “may accelerate or hinder progress.”

So is the use of portals for physicians and dentists actually hurting them in using overall electronic records?

“We’re not at that point of our research to clearly understand that,” Kiser says. “Are we getting to fully electronic or are we at the point in the market just accepting all of these partially electronic, or portal transaction?”

Reid Kiser

Reid Kiser, lead researcher for CAQH report

An estimated 925 million manual transactions and nearly 14 billion electronic transactions were conducted by medical plans, a 38 percent increase over the prior year.

This is because a much higher number of administrative transactions were conducted using costlier manual transactions. This includes the portal transactions.

One study estimate with costs associated with healthcare billing and insurance-related administrative activities to reach $315 billion by this year, nearly as much as the 10 highest spending state Medicaid programs paid combined in 2016 to provide care for more than 46 million beneficiaries.

In a call to action, the CAQH Index concludes that the “ the relatively slow, incremental process reported in recent years of the transition from manual to electronic administrative transactions is no longer sufficient.”

It proposes that “industry participants strongly support provider access to robust electronic data interchange systems and expand the understanding for reasons behind increasing portal use, and urges all stakeholders to embrace the transition to fully electronic transactions.”

The research concluded that few vendors support all of the most essential electronic administrative transactions.

Adjustments Needed?

“We’ve seen tremendous cost and time savings from our investment in technology,” said Jody Meza, practice administer, Alpine Medical Group LLC in a statement. “We feel it’s important to do everything we can to deliver care as efficiently as possible for our patients, and automation of our administrative transactions is one way that we deliver on that goal.” — Joe Cantlupe

Note: The 2017 CAQH Index is the fifth annual report assessing industry progress to reduce the use of manual transactions and eliminate cost. Data was submitted from health plans covering more than half of the commercially insured U.S. population in the year studied based on enrollment reported in “AIS’s Directory of Health Plans: 2017.” Medical health plans contributing data covered 155 million lives, or approximately 51 percent of U.S.

It represents collaboration between healthcare providers and health plans. The report reflects data from participating health plans representing 112 million enrollees – almost 45 percent of the privately insured U.S. population – on more than four billion transactions. A range of healthcare facilities and provider practices participated in a day collection process conducted on behalf of CAQH by Milliman Inc.

CAQH Report’s Data:

  • Claim submission had the highest overall adoption level among the electronic transactions studied, at 95 percent – a 1 percentage point increase over the prior year.
  • Fully electronic coordination of benefits/crossover claim transactions increased 19 percentage points to reach 75 percent.
  • Fully electronic eligibility and benefit verifications increased 3 percent over the previous year, reaching 79 percent.
  • Fully electronic claim status inquiries rose 6 percentage points, from 63 percent the previous years to 69 percent. The volume of phone inquiries and the concurrent need for manual labor remained stable.
  • Claim attachment, with a fully electronic adoption level at 6 percent, showed no measurable change as compared to the previous year.
  • Electronic funds transfer adoption for claim payment decreased slightly, falling to 60 percent from 62 percent the previous year.
  • Fully electronic remittance advice transactions increased slightly, increasing to 56 percent, one percentage point over the previous year.
  • Fully electronic remittance advice transactions increased slightly in the 2017 index, rising to 56 percent, one percentage point over the previous year.
  • Fully electronic prior authorization transactions declined by 11 percentage points.
  • Use of partially electronic transactions rose by 10 percentage points.






Tough Pill to Swallow? Pfizer Trumped On Price Hike …

A day after President Trump lambasted Pfizer on a previously announced July 1 price hike on three dozen drugs, the pharmaceutical company backed down following what  the company CEO described as an “extensive discussion” with the president.

Trump said he spoke with Ian Read, the head of Pfizer, and the Health and Human Services Secretary Alex Azar and the drug company decided it was  “rolling back price hikes” that Pfizer already put in place.

Trump has been fairly consistent on admonishing the pharmaceutical drug-makers on their extravagant pricing. For the administration, its blueprint to reduce prescription drug costs is one of its hallmark efforts. Among other things, the administration  is seeking a “more competitive pharmaceutical marketplace” and “bring down out-of-pocket costs for Americans, Trump’s plan states.  For critics, the blueprint has been too loosely defined, and not tough enough.

In the meeting with the Pfizer chairman and CEO, the blueprint apparently took center stage.

“Just talked with Pfizer CEO and @SecAzar on our drug pricing blueprint,” Trump tweeted. “Pfizer is rolling back price hikes, so American patients don’t pay any more.”

“We applaud Pfizer for this decision and hope other companies do the same,” he added in the @realDonaldTrump tweet. “Great news for the American people.”

A day earlier, Trump scolded the company, saying it should be ashamed “that they have raised drug prices for no reason.”

“They are merely taking advantage of the poor & Others unable to defend themselves while at the same time giving bargain basement prices to other countries in Europe & elsewhere. We will respond!….” Trump tweeted.

After the meeting with Trump today,  Pfizer ‘s  Read said the company would “defer the company’s price increases that were effective on July 1.” That would give the president “an opportunity to work on his blueprint to strengthen the healthcare system and provide more access for patients,” Read said.

The company said it will maintain prices on three dozen drugs to their pre-July 1 levels as soon as technically possible. And, the prices will stay in place until the president’s blueprint goes into effect or the end of the year – whichever is sooner.

“Pfizer shares the President’s concern for patients and commitment to providing affordable access to the medicines they need,” said  Read.

— Joe Cantlupe


You Take Medications. You Take Herbs. Do They Mix?

One of the most important things you should consider when are taking medications, herbs or just about anything is how they interact with each other, and whether they can have complications that can harm you.

The danger is that with different types of medications even regular doses may become an overdose, depending on the interaction.

It’s important that everyone learns about their medications and become aware of the herbs they use, the supplements they take, and their response to them. It is best to check with responsible professionals and providers.


Some of the herbs used in Chinese medicine may be safe, but others can interact with drugs and have serious side effects or be unsafe for people with certain medical conditions. Some of the most serious drug interactions involve prescription medications and supplements.

That is becoming increasingly important as the popularity of herbal medicine increases. The World Health Organization estimates that 80 percent of the world’s population uses herbal medicine.  Many Americans, not happy with Western medicine for their ailments, have turned to alternative and complementary medicine, studies show.


Herbal medicines used in Traditional Chinese Medicine are sometimes marketed in the U.S. as dietary supplements. The U.S. Food and Drug Administration regulations for dietary supplements are not as stringent as for over the counter medications. The supplements are not as likely to have the same regulations as those for over the counter drugs. Supplements are also not as likely to be listed in a database of drug interactions.

Herbal Supplements and Drug Interactions

Nearly 25 percent of U.S. adults report also taking a prescription medication with a dietary supplement, according to an American Academy of Family Physicians study. 

Herbal interactions with prescription medications can interfere with how the drug may be broken down in the body, enhance side effects of prescription medications, or block the intended therapeutic effect of a drug.

Herb-drug interactions are complicated because many chemical components can be involved, and these compounds may possess diverse pharmacological activities, according to one study of the issue. 

The interactions potentially cause changes in drug levels and drug activities, which can sometimes have dire consequences.  Even though herbal supplements may be from plants, the ingredients can be chemical-related. As a result, herbal supplements may have drug interactions, not only with each other, but food or alcohol. And there may be no safety warnings so it may be difficult for someone to know if there is an interaction.

Different kinds of drug interactions

Some supplements, such as St. John’s Wort and Goldenseal, are known to cause drug interactions. As a result, they should be avoided with any pharmacological products.

Yet some supplements may cause interactions with some medications, but are safe with others, such as curcumin, Echinacea, garlic, Asian ginseng, green tea extract, and kava kava.

The kinds of interactions

Drug interactions can be in both pharmcokinetics and pharmacodynamics terms. Pharmacokinetics, sometimes described as what the body does to a drug, refers to the movement of drugs in, through and out of the body. Pharmacodynamics is the reverse: what a drug does to the body, such as the biochemical and molecular impacts.

Herbs may affect the behavior of a drug used at the same time by changing their absorption, distribution, metabolism and excretion.

Contamination of herbs

The National Center for Complementary and Integrative Health says there have been reports of Chinese herbal products being contaminated with drugs, toxins or heavy metals not containing the listed ingredients.

The Chinese herb ephedra (ma huang) has been linked to serious health complications, including heart attack and stroke. In 2004, the FDA banned the sale of ephedra-containing dietary supplements, but does not include Traditional Chinese Medicine remedies.

Interaction Examples

There are a host of interaction issues involving herbs and pharmaceuticals, with many related to bleeding, according to Drugs.com.

Among the herbs which could have potentially negative impacts in interactions with drugs:

Evening Primrose Oil

The flowering plant Evening primrose is known by other names such as Oenothera biennis, scabish, or King’s cure-all. Drugs or herbs that have the potential to thin blood may have a reaction with Evening Primrose Oil.

American Ginseng

Ginseng has been used for many purposes, ranging from stress to endurance.  There are many different kinds of ginseng, but American ginseng has a blood thinner impact and may decrease the effectiveness of blood-thinning medications, and also should not be used with anticoagulants.

Ginkgo Biloba

Ginkgo Biloba has been used for dementia, Alzheimer’s disease and related ailments, but it may impact patients who take blood thinners, diabetes drugs or seizure medications. Ginkgo has been known to have interactions with about 500 drugs.


Goldenseal, also a flowering herb, is used for a range of conditions, including cold, flu and skin ailments, but there are dozens of drug interactions linked with goldenseal.

Green Tea

Green tea has been used for many health related issues, such as being an antioxidant. But it should not be used in connection with some blood-thinning drugs.

Getting advice from healthcare providers

Healthcare providers can give the best advice for any serious health impacts from drug interactions.

Advice to providers

Clinicians have been told they should consult reliable dietary supplement resources, or clinical pharmacists or pharmacologists, to help assess the safety of specific herbal supplement – drug combinations.  Often, patients do not mention supplements they use to clinicians.


18 Herbal Supplements With Risky Drug Interactions, medically reviewed, L. Anderson, PharmD, Drugs.Com

Asher, G, Corbett, A, et al. Common Herbal Dietary Supplement-Drug Interactions. 

American Family Physician. 2017. July 15; 96 (2): 101-107.University of North Carolina, Chapel Hill, NC.

Singh, A, Zhao, K. Herb-Drug Interactions of Commonly Used Chinese Medical Herbs. 

International Review of Neurobiology. 2017. 2017;135:197-232. doi: 10.1016/bs.irn.2017.02.010. Epub 2017 Apr 14.