Drug-Herb- Vitamin Interactions

Transcription

1 MEDNA HOLISTIC Drug-Herb- Vitamin Interactions MH32

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3 Drug-Herb-Vitamin Interactions (MH32) CONTENTS 05 Introduction 06 Common Herb-Drug Interactions 08 Common Vitamin-Drug Interaction 09 Common Food-Drug Interactions 11 Contraindications During Pregnancy 13 Herbs to Use with Caution During Pregnancy 15 Some Supplements and Herbs That are Often Used During Pregnancy 16 General Things to Avoid During Pregnancy 17 Conclusion 18 Lesson Review 20 References 3

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5 Drug-Herb-Vitamin Interactions Introduction While herbs and vitamins are much safer than pharmaceutical drugs, there are some potential adverse reactions when taking them in combination. The A-Z Guide to Drug-Herb-Vitamin Interactions offers a comprehensive list by medications; although it makes an indispensable reference, you should become as familiar with it as you are able. In this lesson, we will focus more on popular herbs, foods, and vitamins and how they react with selected drugs. There are two fundamental processes that contribute to interactions: Pharmacokinetic and pharmacodynamic. Pharmacokinetic interactions refer to changes that occur as medicines move in and out of the body, such as with absorption, distribution, metabolism and elimination. Pharmacodynamic interactions refer to how medicines actually behave inside the human body, as they can sometimes increase or cancel out the effectiveness of one another. Absorption, distribution, metabolism and elimination are four cycles that all medicines go through in the body. After a medicine is taken, it is absorbed from the intestines, distributed throughout the body, metabolized (broken down) in the liver, and finally, eliminated from the body through the kidneys. Many factors may interrupt these cycles, leading to interactions. For example, ingestion of an antacid or anti-ulcer medication will reduce the acidity of the stomach, therefore decreasing the absorption of other medications and herbs. In addition, some drugs may interfere with blood circulation and affect the distribution of medicines or herbs to the affected parts of the body. Finally, some drugs may be harmful to the liver or kidneys, impairing the ability of the body to break down and eliminate the medicines or herbs. 5

6 MASTER Common Herb-Drug Interactions Aloe Vera: Should not be taken with Digoxin (heart medication). The combination may contribute to dangerously low potassium levels. Ephedra: For many years Ephedra was the main ingredient in just about every weight loss product on the market. Ephedra was said to increase heart rate, cardiac output and raise blood pressure. Because Ephedra is a potent herb and is prone to misuse, it has been reported to cause more adverse reactions and caused more deaths than any other herb sold in the United States. Although it has been used for thousands of years in China to treat various respiratory conditions, it is no longer available in most countries. Hawthorn: Effective in reducing angina attacks by lowering blood pressure and cholesterol levels, should not be taken with Lanoxin (Digoxin), a medication prescribed for heart ailments. The mix can lower the heart rate too much. Ginger: A gram or so of powdered ginger can help ease nausea, but it can also interfere with platelet action. This means ginger shouldn t be taken with aspirin, Warfarin, or other blood thinners. Garlic: Capsules combined with diabetes medication can cause a dangerous decrease in blood sugars. Often used to help rein in high blood pressure and high cholesterol, garlic or garlic pills taken in large doses also thin the blood. Not surprisingly, people taking warfarin, regular doses of aspirin, or other blood thinners should not use garlic for anything other than seasoning. Ginkgo Biloba: Used to improve blood circulation and in the treatment of memory loss. Ginkgo has blood-thinning properties and should not be used with anti-coagulants or before surgery. Goldenseal: Used for coughs, stomach upsets, menstrual problems and even arthritis. The plant s active ingredient, however, will raise blood pressure, complicating treatment for those taking antihypertensive medications, especially beta-blockers. For patients taking medication to control diabetes or kidney disease, this herb can cause dangerous electrolyte imbalance. INTERESTING FACTS Clinical tests have shown the use of feverfew may reduce the frequency and severity of headaches. It may be more effective than other nonsteroidal anti-inflammatories (NSAIDS), like aspirin. 6 Feverfew: A natural remedy for migraine headaches that should never be taken with Imitrex or other migraine medications. It can result in the patient s heart rate and blood pressure rising. Guarana: An alternative remedy being used as a stimulant and diet aid that contains 3% 5% more caffeine than a cup of coffee. Those taking medications that advise against caffeine consumption should avoid taking this stimulant. Kava: An herb used for the treatment of anxiety, pain, and muscle aches, that should not be taken with substances that affect the central nervous system, such as alcohol, barbiturates, anti-depressants, and antipsychotic drugs. www.

7 MASTER Licorice: May offset the actions of immunosuppressive drugs, including corticosteroids (prescribed for a wide range of disorders, from asthma to cancer). Licorice may also reverse the effects of the blood-pressure medications and worsen the adverse side effects of the heart medication Digoxin. May also increase the side effects produced by oral contraceptives. Milk Thistle: Used to support liver functions, this herb should not be taken with immunosuppressive drugs and can be dangerous for transplant patients because it can interact with transplant drugs such as Cyclosporine. (Milk Thistle does protect the liver from drug damage and helps reduce drug toxicity in many instances.) St. John s Wort: A popular herb used for the treatment of mild depression. St. John s Wort may mildly mimic MAOI (monoamine oxidase inhibitor) drugs and should not be used when taking antidepressant medication such as Phenelzine. St. John s Wort can also duplicate the effects of SSRIs such as Prozac and Zoloft and should not be taken together. Valerian: A proven sleep aid, valerian may trigger extreme drowsiness if mixed with barbiturates; it s also unwise to mix the herb with alcohol. White Willow: An herb traditionally used for fever, headache, pain, and rheumatic complaints that may exhibit similar reactions as aspirin (which is derived from white willow). Yohimbe: Used for impotence and to increase libido (sexual desire). This herb should not be used with antidepressants or psychotropic drugs. The combination may increase the risk of hypertension. STUDENT FORUM STAY IN TOUCH WITH STUDENTS AND INSTRUCTORS It's simple Just go to: 7

8 MASTER Common Vitamin-Drug Interaction Vitamin C: The absorption of vitamin C is reduced by aspirin. Vitamin D: Phenytoin can reduce serum vitamin D levels. Vitamin K: May reduce the effects of anticoagulants such as Nicoumaline/ Acenocoumarol, Phenindione, and Warfarin. Calcium: When combined with diuretics, may contribute to a higher risk of hypercalcaemia. Folic Acid: Can contribute to reduced serum levels of anticonvulsant drugs. Iodine: When combined with diuretics, can lead to increased risk of hypothyroidism. Iron: Can lead to reduced absorption of the following drugs: dopaminergics (Levodopa), penicillamine, quinolone antibiotics (Ciprofloxacin, Norfloxacin, Ofloxacine). Potassium: When combined with ACE-inhibitors, Cyclosporin and potassium sparing diuretics, can lead to hyperkalemia. Zinc: When combined with iron and Tetracycline antibiotics, reduces absorption of zinc (and visa versa). INTERESTING FACTS Red agar from red algae has many uses in the pharmaceutical industry, as well as the food industry in general. 8 www.

9 MASTER Common Food-Drug Interactions Black licorice: People taking Digoxin should avoid eating licorice. This combination may produce irregular heart rhythms and cardiac arrest. Licorice and diuretics can produce dangerously low potassium levels, putting a client at risk for numbing weakness, muscle pain and even paralysis. Licorice can also interact with blood pressure medication or any calcium channel blockers. Bananas: Due to their high potassium content, do not combine with heart drugs well and can lead to dangerous potassium build-up. Cheese and Sausage: As well as other foods high in tyramine combined with MAO inhibitors can cause a potentially fatal rise in blood pressure. Grapefruit juice: Interacts with calcium channel blockers (including calan, procardia, nifedipine, and verapamil), cholesterol control medications, some psychiatric medications, estrogen, oral contraceptives and many allergy medications (seldane, hismanal). The juice modifies the body s way of metabolizing the medication, affecting the liver s ability to work the drug through a person s system. Orange juice: Shouldn t be consumed with antacids containing aluminum. The juice increases the absorption of the aluminum. Orange Juice and milk should be avoided when taking antibiotics. The juice s acidity decreases the effectiveness of antibiotics, as does milk. Milk: Doesn t mix well with laxatives containing bisacodyl (Correctol and Dulcolax). Leafy green vegetables: High in vitamin K, should not be eaten in large quantities while taking Coumadin. These vegetables may negate the affects of the drug and cause blood clotting. Caffeinated beverages: And asthma drugs taken together can cause excessive excitability. Grilled meat: Can lead to problems for those on asthma medications containing theophyllines. The chemical compounds formed when meat is grilled may prevent this type of medication from working effectively, increasing the possibility of an unmanageable asthma attack. High-fat diets: Consuming a high-fat diet while taking anti-inflammatory and arthritis medications can cause kidney damage and leave the patient feeling drowsy and sedated. Alcoholic drinks: Increase the depressive effects of medications such as benzodiazepines, antihistamines, antipsychotics, antidepressants, muscle relaxants, narcotics, or any sedative drug. STUDENT FORUM STAY IN TOUCH WITH STUDENTS AND INSTRUCTORS It's simple Just go to: 9

10 MASTER Strawberries, Raspberries, Spinach, and Rhubarb: These contain oxalic acid, which can aggravate kidney and bladder stones in susceptible individuals, and reduce the body s ability to absorb iron and calcium. Raspberries: Also contain a natural salicylate that can cause an allergic reaction in aspirin-sensitive people. Horseradish: Very high doses of horseradish can cause vomiting or excessive sweating. Those suffering from hypothyroidism should avoid it. Turmeric: Should be avoided by persons with symptoms from gallstones. INTERESTING FACTS The ancient Greeks used the seeds of Colchicum autumnale to treat gout. Western medicine uses colchicine which is derived from this herb. 10 www.

11 MASTER Contraindications During Pregnancy As an Herbalist or Holistic Health Practitioner you ll need to find out if your client is pregnant or trying to conceive before suggesting an herbal remedy. Some herbs can be very dangerous for pregnant women and unborn children. Always use caution when suggesting any types of treatment to pregnant and nursing mothers. The following is a list of herbs that are considered unsafe to use during pregnancy due to their actions on reproductive organs or because of certain naturally occurring substances found in them. Herbs that have a laxative effect should be avoided due to their stimulating effects on smooth muscle, which can include uterine tissue, causing a potential miscarriage or early labor. Uterine stimulant herbs should be avoided for the same reason. Emmenagogues (herbs that regulate menstruation) can cause spontaneous bleeding and lead to miscarriage or early labor. Alkaloid and bitter herbs or essential oils can also have detrimental effects on the mother and the fetus. Culinary herbs like oregano and thyme are safe in the small amounts used in cooking, but not in the larger doses used for teas or tinctures. Don t assume that an herb is safe just because it s not found on the list below; thoroughly research any herbs that you believe may be useful for a client. Possible Side Effects of Common Herbs During Pregnancy Aloe Vera: Leaves are strongly purgative and should not be taken internally. INSTRUCTIONS For a more complete list please refer to s of The One Earth Herbal Sourcebook. Autumn Crocus: May affect cell division and lead to birth defects. Barberry: Contains high levels of berberine, a substance known to stimulate uterine contractions. Black Cohosh: May lead to premature contractions and should not be used until the end of the pregnancy and only under the professional guidance of a midwife or doctor. Blue Cohosh: A uterine stimulant to avoid during pregnancy. Can be safe to use during labor under professional guidance. Butcher s Broom: Causes uterine contractions and should be avoided during pregnancy. In some parts of Europe it is given after the birth to prevent blood loss. Clove oil: A uterine stimulant used only during labor. Comfrey: Contains toxic chemicals that will cross the placental barrier. Should not be used internally. STUDENT FORUM STAY IN TOUCH WITH STUDENTS AND INSTRUCTORS It's simple Just go to: 11

12 MASTER Devil s Claw: Uterine stimulant that can bring on early labor. Don Quai: Uterine and menstrual stimulant, best avoided during pregnancy. False Unicorn Root: A hormonal stimulant to avoid unless under professional care. Feverfew: Uterine stimulant; may cause premature contractions. Golden Seal: Uterine stimulant; may lead to premature contractions; safe during delivery. Juniper: A uterine stimulant; only to be used during labor. Mistletoe: A uterine stimulant containing toxic chemicals that may cross the placental barrier. Mugwort: A uterine stimulant that may also cause birth defects. Should also be avoided while breastfeeding. American Pennyroyal: Well known uterine stimulant to be avoided during pregnancy. European Pennyroyal: A uterine stimulant that may also cause birth defects. Pokeroot: May cause birth defects. Pulsatilla: Menstrual stimulant best avoided during pregnancy. Rue: Uterine and menstrual stimulant; may cause premature contractions. Sassafras: A uterine stimulant that may also cause birth defects. Senna: Strong laxative that can cause uterine contractions. Shepherd s Purse: A uterine stimulant; use only during labor. Tansy: A uterine stimulant that may also cause birth defects. Wormwood: A uterine stimulant that may also cause birth defects. Should also be avoided while breastfeeding. INTERESTING FACTS Western medical providers often recommend senna and/ or cascara sagrada to treat constipation.. 12 www.

13 MASTER Herbs to Use with Caution During Pregnancy Angelica: A uterine stimulant in high doses, but quite safe as a culinary herb. Anise: A uterine stimulant in high doses, but quite safe as a culinary herb. Bitter Orange: A uterine stimulant in high doses, but quite safe as a culinary herb or in moderate use. Caraway: A uterine stimulant in high doses, but quite safe as a culinary herb. Cascara sagrada: Strong laxative that should not be taken in high doses or for long periods of time. Celery (seed and oil): A uterine stimulant in high doses, but quite safe as a culinary herb. Chamomile: The oil is a potent uterine stimulant to be avoided, but the dried or fresh herb is safe in moderation. Chili: Avoid high doses as it may cause heartburn. Moderate culinary use is fine. Cinnamon: A uterine stimulant in high doses, but quite safe as a culinary herb; avoid the essential oil completely during pregnancy. Cowslip: Strongly purgative and a uterine stimulant in high doses. Elder bark: Strong laxative that should not be taken in high doses or for long periods of time. Fennel: A uterine stimulant in high doses, but quite safe as a culinary herb. Entirely avoid using the oil. Fenugreek: A uterine stimulant in high doses, but quite safe as a culinary herb or during labor. Garlic: Avoid high doses as it may cause heartburn. Can change the flavor of breast milk while nursing. Moderate culinary use is fine. Gotu Kola: Possible uterine stimulant; use in moderation for occasional teas only. Jasmine oil: A uterine stimulant best reserved for childbirth to ease labor pain. Korean Ginseng: Clinical reports suggest that high doses in pregnancy can lead to androgynous babies (caused by over-stimulation of male sex hormones); use for short periods only. Lavender: A uterine stimulant in high doses, but quite safe as a culinary herb or for moderate use. STUDENT FORUM STAY IN TOUCH WITH STUDENTS AND INSTRUCTORS It's simple Just go to: 13

14 MASTER Licorice: High doses can exacerbate high blood pressure; safe in moderation. Marjoram: A uterine stimulant in high doses, but quite safe as a culinary herb. Entirely avoid using the oil. Motherwort: A uterine stimulant in high doses. Best limited to the final weeks of pregnancy and during labor. Myrrh: A uterine stimulant that may lead to premature contractions. Avoid high doses. Nutmeg: Inhibits prostaglandin production and contains hallucinogens that may affect the fetus. Safe for normal culinary use only. Oregano: A uterine stimulant in high doses, but quite safe as a culinary herb. The oil should be avoided entirely. Parsley: Uterine stimulant that may also irritate the fetus in high doses. Safe in normal culinary use. Passion Flower: A uterine stimulant in high doses. Safe for moderate use. Peppermint: Avoid the oil entirely. Low doses of the dried herb can be used. Raspberry Leaf: There are conflicting recommendations regarding this herb. Some experts recommend taking it throughout the pregnancy to avoid morning sickness, miscarriage and to prepare the body for an easy labor. While others suggest its use be limited to the final six to eight weeks and during labor. Rhubarb Root: Strong laxative that should not be taken in high doses or for long periods of time. Rosemary: A uterine stimulant in high doses. Safe in moderation and for normal culinary use. The oil should not be used. Saffron: A uterine stimulant in high doses. Safe in normal culinary use. World s most expensive herb by weight. Sage: A uterine and hormonal stimulant in high doses, but quite safe as a culinary herb. The oil should be avoided. INTERESTING FACTS The National Cancer Institute (NCI) is investigating the effectiveness of herbs in treating cancer. An example of this is that the NCI is doing a phase I/II pilot study on the effectiveness of scutellaria barbatae in treating metastatic cancer. 14 Tea (black): Limit to one cup a day, as excess can lead to palpitations and increased heart rate. Thyme oil: Safe for cooking. Vervain: A uterine stimulant in high doses. Best limited to the final weeks and during labor. White Horehound: A uterine stimulant; safe in moderation in cough drops. Yarrow: A uterine stimulant in high doses. Best limited to the final weeks and during labor. www.

15 MASTER Some Supplements and Herbs That are Often Used During Pregnancy Bilberry: Will fortify vein and capillary support, aids in kidney function and works as a mild diuretic for bloating. Burdock Root: Helps prevent water retention and jaundice in the baby. Chamomile: Aids digestive and bowel problems and relaxes for a good sleep. Only in moderation. Echinacea: Aids the immune system to help prevent colds, flu and infections. Ginger Root: Excellent for morning sickness. Red Raspberry Leaf: A powerful (and somewhat controversial) herb for pregnancy, or any time. Used once or twice a day as a tea makes a great uterine tonic. Can help relieve morning sickness in pregnancy, limit spotting and prevent leg cramps. Prevents excessive bleeding during and after labor and will facilitate the birth process by stimulating contractions. Nettles: Rich in iron, this herb is great for people with anemia. Especially helpful when taken during the last six weeks of pregnancy. Nettles are rich in vitamin K, and will help promote blood clotting after childbirth, to prevent undue hemorrhaging. Three to six capsules a day recommended. Pulsatilla: This is a homeopathic remedy used to successfully turn babies when they re not positioned head down. The dose is 12X potency tablets, under the tongue, one per day for up to two weeks. (Do not attempt to make your own tea with pulsatilla. This is a homeopathic remedy and must be prepared according to homeopathic principles.) Vitamin E: 400 I.U. per day of natural vitamin E can be effective for spotting or threatened miscarriage. Once the spotting stops reduce to 200 I.U. Continue this amount for another two to four weeks. All refined foods should be avoided and replaced by wholegrain products, which are naturally high in vitamin E. Wild Yam: This is a great anti-spasmodic for the prevention of premature labor or miscarriage. Helps ease pregnancy pain, nausea and cramping. Yellow Dock: Aids in iron assimilation and will help to prevent infant jaundice. Note: This is for your information only! It is best not to recommend any herbs for pregnant women, especially without their doctor s consent. Complications can arise during the healthiest of pregnancies and you don t want to be the one blamed for a totally unrelated and unfortunate incident. It is best to simply offer book titles for the mother-to-be where she can read about herb safety during pregnancy and make up her own mind as to which remedies she would like to utilize. Some books that warrant recommendation STUDENT FORUM STAY IN TOUCH WITH STUDENTS AND INSTRUCTORS It's simple Just go to: 15

16 MASTER include: The Wise Woman Herbal for the Childbearing Years by Susun Weed, and The Complete Woman s Herbal by Anne McIntyre. You may also refer to s of The One Earth Herbal Source Book for tips on using herbs during pregnancy and breastfeeding. You will find a many conflicting opinions in different publications about the use of herbs during pregnancy. This is another reason why you shouldn t make recommendations for pregnant women. Instead, share the tips below: General Things to Avoid During Pregnancy Smoking and alcohol (including beer and wine): These can contribute to birth defects, brain damage and premature labor. Caffeine (including coffee, black tea, cola, and chocolate): Caffeine acts as a teratogen a substance that can cause physical defects in the developing fetus. The FDA s suggested a limit of 500mg of caffeine daily during pregnancy. One cup of regular coffee is 400mg. Drugs: All orthodox drugs should be avoided during pregnancy, especially in the first and third trimesters. All over-the-counter drugs such as painkillers and hay fever medications should be avoided as well. Tranquilizers such as Librium and Valium can cause birth defects. Analgesics and aspirin can prolong pregnancy and childbirth and lead to bleeding in both baby and mother. Antacids like bicarbonate of soda can cause muscle problems in the baby and edema in the mother. Antibiotics may cause abnormalities, Narcotics may cause fetal addictions and sulphur drugs may cause jaundice. Any chemical stimulants and depressants (LSD, psychotropics, phenobarbital, and barbiturates) should be avoided at all cost. Steroids (and herbs containing steroid-like factors including Agave, Ginseng, Licorice, Hops, Sage, Celery, Flax Seed, Soy products, Primrose, Black Cohosh, Sarsaparilla, Damiana, Saw Palmetto, and Don Quai): Large amounts of estrogen in the body can promote miscarriage. INTERESTING FACTS Henna (Lawsonia inermis Linnaeus) has pain-relieving qualities in addition to being a popular dye. 16 Fumes: From paints, thinners, solvents, wood preservatives, varnishes, glues, spray adhesives, benzene, dry cleaning fluids, certain plastics, vinyl chloride, commercial cleaning agents, etc. All petroleum products found in plastics, hand and body products. Never heat food in plastic containers. Heavy metals: Lead, nickel, cadmium, manganese, aluminum, etc. Pesticides, herbicides, and insecticides (especially those containing Carbaryl): These can contribute to birth defects and miscarriage. www.

17 MASTER Electric blankets: Experts warn that the invisible electromagnetic field (EMF) emanating from these may increase the risk of miscarriage and developmental problems. Raw or undercooked meats: These can cause food poisoning, and/or a parasitic infection. Conclusion Historically, herbs and drugs have been two very different treatment modalities which have rarely, if ever, been used together. The line that separates herbs and drugs, however, has been blurred in recent decades with the increased accessibility to the general public of different forms of treatment. INSTRUCTIONS Please look through the A-Z Guide to Drug- Herb-Vitamin Interactions at this time. It is not uncommon for one patient to seek the services of several physicians for the same ailment. As a result, a patient may be taking multiple drugs, herbs and vitamins simultaneously. It becomes very difficult to predict whether such combinations will lead to harmful interactions or not. It is unwise to assume that there will be no interactions. On the other hand, it is just as unwise to abandon treatment simply for the fear of possible interactions. The solution to this situation is in understanding drug-drug, drug-vitamin, and drug-herb interactions. With a deeper understanding of these mechanisms, one can recognize potential interactions and take proper steps to prevent their occurrence. As an Herbalist or Holistic Health Practitioner you need to familiarize yourself with common drugs that many of your clients will be taking and will have to adjust your herbal recommendations accordingly. The A-Z Guide to Drug-Herb-Vitamin Interactions will help you learn which drugs can deplete your body s essential nutrients, which supplements can help your prescriptions work better or reduce drug side effects, and which herbs and drugs should never be taken together. Based on the information from the Healthnotes Online database, this book was written by a highly respected team of natural medicine experts medical doctors, naturopathic physicians, and pharmacists who have created a natural health information resource that is both comprehensive and user-friendly. STUDENT FORUM STAY IN TOUCH WITH STUDENTS AND INSTRUCTORS It's simple Just go to: 17

18 MASTER Lesson Review Circle the correct answer 1. T F Absorption, distribution, metabolism and elimination are four cycles that all medicines go through in the body. 2. T F Aloe Vera is a useful herb for internal use during pregnancy. 3. T F Potassium-depleting diuretics cause the body to lose potassium. 4. T F Aspirin is derived from the herb White Willow. 5. T F Ginkgo Biloba has blood-clotting properties. 6. T F Caffeine can amplify the side effects of ephedrine and pseudoephedrine. 7. T F People taking Digoxin should avoid eating licorice. 8. T F A high-fat diet should be consumed while taking anti-inflammatory drugs. 9. T F Lavender is safe in high doses during pregnancy. 10. T F Guar Gum can reduce penicillin absorption according to research. 18 www.

19 MASTER Fill in the blanks 1. Leafy green vegetables high in vitamin K should not be eaten in large quantities while taking. 2., a natural remedy for migraine headaches, should never be taken with Imitrex or other migraine medications. 3. is an herb known to protect the liver from drug damage and helps reduce drug toxicity in many instances. 4. Taking 500 mg of Vitamin with Tetracycline was shown to increase blood levels of Tetracycline in one study. 5. NSAIDs are drugs that reduce swelling, pain and. 6. contain a natural salicylate that can cause an allergic reaction in aspirin sensitive people. 7. interactions refer to changes that occur as medicines move in and out of the body. 8. are herbs that are rich in iron and great for people with anemia and during pregnancy. 9. contains high levels of berberine, a substance known to stimulate uterine contractions. 10. Taking in high doses during pregnancy can lead to androgynous babies due to an over-stimulation of male sex hormones. Please refer to the Study Guide to check your answers. STUDENT FORUM STAY IN TOUCH WITH STUDENTS AND INSTRUCTORS It's simple Just go to: 19

20 MASTER References and Recommended Reading Principles of Medical Pharmacology by H. Kalant, W. Roschlau A-Z Guide to Drug-Herb-Vitamin Interactions by Healthnotes The Patient s Book of Natural Healing by Jonathan Wright, MD Alternative Medicine: The Definitive Guide by The Burton Goldberg Group Holistic Herbal by David Hoffman The Encyclopedia of Nutrition & Good Health by Robert A. Ronzio, PhD The Herb Bible by Earl Mindell, RPh, PhD The Complete Medicinal Herbal by Penelope Ody School of Natural Healing by Dr. John R. Christopher The New Age Herbalist by Richard Mabey Wise Woman s Herbal for the Pregnancy Years by Susun Weed Healing Yourself During Pregnancy by Joy Gardner-Goodson Online Resources This site is commercial, however, the content of the Health Notes section warrants inclusion as a reference. 20 www.

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