Herbals and teas

Posted by JK @contentandwell, Apr 20, 2018

I have had some difficulty finding a good reference on what herbals and teas us post-transplant patients should not use. I have found a few that are definitely taboo like echinacea and perhaps licorice root but there are others that I have seen in passing that I have not seen in other lists, like ginger, turmeric, cardamon. I have even seen green tea mentioned.

Does anyone have a fairly comprehensive list of these? If so I would really like to know what they are. I found something from MGH that was FOUR BOOKS of reference on this, about 800 pages in all, and only the first book was available online. This has been my one disappointment at Mass General, that they have not provided a list like this, but maybe other transplant centers have not either.
JK

Interested in more discussions like this? Go to the Transplants Support Group.

@kequick

Hi @contentandwell – @colleenyoung flagged your post for us wondering if we had access to any additional information within Mayo’s transplant center. Unfortunately, we couldn’t find a comprehensive list, but we did consult Heather Bamlet, RDN, LD, transplant clinical dietitian at Mayo Clinic’s campus in Rochester. Here’s what she said: “Your question is a great one – and one that we do not have a quick or easy answer for. As you have found there is NOT a comprehensive list of herbals and teas to avoid post-transplant. This is partially because there is limited information regarding some of the herbals, partially because so many of these products contain multiple ingredients and partially because this market is ever changing – it literally could be a full-time job to keep a list like this up!

Here in our transplant center we advise patients to avoid herbal supplements and teas as an overall statement – however, if there are a few in particular that someone is interested in consuming, we will review the ingredients on a case-by-case or one-by-one basis. You are correct in your findings that Echinacea and licorice root teas would not be recommended. For the others you mentioned, I referenced the Natural Medicines Comprehensive Database (naturalmedicines.therapeuticresearch.com) that our institution subscribes to. Ginger is fine for transplant recipients– especially in the amounts we would normally consume in foods. Turmeric is also likely safe, however does list a side effect of possible constipation and there is a case report of very elevated tacrolimus levels in a post-transplant patient who had started taking 15 spoonfuls of turmeric powder on a daily basis – which we would describe as an excessive amount. We do not see this issue with patients who use turmeric in cooking. Cardamom has no known concerns so should be safe to consume, also. Green tea is a bit more complicated as there are several medications that may interact with green tea such as anticoagulants (Warfarin, Plavix etc.), some types of chemotherapy and Corgard. If you take any of these types of medications it is advisable to not take green tea. Otherwise, again, in normal amounts (not more than 3 caffeinated beverages per day) green tea should be fine to consume.”

Reminder, this is general information that could relate to any patient. For your particular case, we strongly suggest you consult your physician team before you consume any herbal or teas to be sure they are safe with your particular medications and illnesses.

I hope that helps!

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@donnan @rosemarya I've always been fairly conscious about eating healthy and avoiding tobacco & alcohol (not to say I don't have a drink or 2 with dinner on the town or holiday party) and I use herbal remedies like Jasmine tea to sleep. I now know that what I put in my body may effect renal testing so I can only imagine how much more so for recipients. I'm looking forward to meeting the nutrionist for these guidelines. But there is very little to compare to literal experience which is also a wealth of knowledge.

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@beckyjohnson

@kequick @contentandwell @colleenyoung I'm so impressed - when I y'all do not have an answer you go the extra distance to find it. I just want to add another thought to why a list would be difficult. That is one size really does not fit all. I may have an intolerance or am downright allergic to an ingredient that you may need for overall health & of course vice versa

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@rosemarya @contentandwell It is absolutely thrilling to know you do not want to compromise your donated organs (that means someone didn't donate in vain or die for nothing) by contradicting your immunosuppressants. What if your immunosuppressants were no longer part of your diet (if I dare call it diet) for whatever reason? Would you still have to avoid the same foods or just eat a healthy diet based on your individual condition?

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@beckyjohnson

@kequick @contentandwell @colleenyoung I'm so impressed - when I y'all do not have an answer you go the extra distance to find it. I just want to add another thought to why a list would be difficult. That is one size really does not fit all. I may have an intolerance or am downright allergic to an ingredient that you may need for overall health & of course vice versa

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@beckyjohnson, Great question. Immunosuppressants suppress the body’s immune system so that our ‘natural defense/our immune system response does not fight the transplanted organ. Think about how your body has its own defense system to fight off germ (foreign body)of flu, colds, scrape or cut. Well that same response will occur toward the (foreign) transplanted organ. The immunosuppressant drugs slow down the body’s natural response. This protects our transplanted organ from this defense system. If the meds are stopped-the organ fails (rejection). It also makes recipients vulnerable to infections and germs. that is why we take so many precautions and try to be careful.
Does this make sense?
Now it’s my bedtime. See you tomorrow.
Rosemary

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@beckyjohnson

@kequick @contentandwell @colleenyoung I'm so impressed - when I y'all do not have an answer you go the extra distance to find it. I just want to add another thought to why a list would be difficult. That is one size really does not fit all. I may have an intolerance or am downright allergic to an ingredient that you may need for overall health & of course vice versa

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@rosemarya I think more people are beginning to realize that natural can also mean unregulated and that can be dangerous. If you are going with "natural" foods and supplements you really need to make sure that the company is extremely reputable.
There really are so many different opinions though. I did read an article that a nutritionist at MGH sent to me and a lot of what it comes down to is to not overdo it. There are many things that are not problematic if used judiciously, like green tea, but if you drank an inordinate amount of it, it could be harmful.
Pretty much everyone knows that grapefruit juice interferes with a lot of drugs but when I got this list I discovered that pomegranate does also, and so does tangerine juice! These days pomegranates and pomegranate juice are so popular that they really need to be included in all of the information.
JK

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@beckyjohnson

@kequick @contentandwell @colleenyoung I'm so impressed - when I y'all do not have an answer you go the extra distance to find it. I just want to add another thought to why a list would be difficult. That is one size really does not fit all. I may have an intolerance or am downright allergic to an ingredient that you may need for overall health & of course vice versa

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@rosemarya It makes sense but it also makes me sad for both the giver & receivers who are not able to get their meds. I sure hope those links in the discussion thread Journey From the Donors Side helps at least one person (which is really 2, recipient/ donor) to keep whatever organ/s is improving their life to keep functioning well. A fine example of why I appreciate you doing your best to take of your life saving donations.

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@beckyjohnson

@kequick @contentandwell @colleenyoung I'm so impressed - when I y'all do not have an answer you go the extra distance to find it. I just want to add another thought to why a list would be difficult. That is one size really does not fit all. I may have an intolerance or am downright allergic to an ingredient that you may need for overall health & of course vice versa

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@contentandwell That is definitly a notable point to ponder. My 1st thought was I should have said organic only to remind myself there isn't much difference in the 2. What it really comes down to is reading labels & knowing where you food comes from. In doing this we are more likely to know the ingredients, how it was farmed/ raised & how it's processed. I'm blessed to live in the country & get many of my vegetables & fruits from local farmers that I personally know.

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@JustinMcClanahan

Hello @contentandwell, this is a great post. I have done a brief search myself, and the results are overwhelming. Have you tried searching on PubMeb? A lot of Mayo Clinic doctors publish research and most of them end up on PubMeb. Here is a link to the search results I found using "Herbal teas and transplant patients," https://www.ncbi.nlm.nih.gov/pubmed/?term=herbal+teas+and+transplant+patients. It may give you a few articles to look over, but I will continue to see if I can find more Mayo Clinic sources.

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@JustinMcClanahan One of the reasons that keep me going to PubMed is that they often use peer reviewed scholarly articles. This increases their credibility 10 fold.

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@beckyjohnson

@kequick @contentandwell @colleenyoung I'm so impressed - when I y'all do not have an answer you go the extra distance to find it. I just want to add another thought to why a list would be difficult. That is one size really does not fit all. I may have an intolerance or am downright allergic to an ingredient that you may need for overall health & of course vice versa

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@contentandwell, I hear you loud and clear!
I knew about the grapefruit, and the pomegranates. But I had not heard about the tangerines, although I was once told to avoid Seville Oranges. So, for me, I miss the grapefruit, and am not bothered by the others (except for the popularity of pomegranates in everything theses days) Sometimes, I wonder if new medicines and research will make other recommendations in the future - it does keep us alert!
Rosemary

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I seen a lot about supplements and what you should and should not take, for the most part, your average nutritionist knows very little about supplementation and as for not regulated, you just need to make sure you do your homework....I'm sorta glad their not regulated because the federal government would take away a lot of good things.....because they can't be verified but if you watch . television at all you'll see all kinds of commercials of supplements by drug co. and their never question. That's because they have a lot of leverage $$$ but don't get me wrong there's a lot of good and needed drugs out there but everyone knows as well as I do that there way to expensive. I worked for Bayer pharmaceuticals, until 1995 when I went on long term disability and we made a IV product that probably coast a couple hundred dollars to make and a about a 7 liter bulk was worth at that time 600,000, you do the math, that's a huge profit. Now I am for co. making money but not gouging people.

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@kequick

Hi @contentandwell – @colleenyoung flagged your post for us wondering if we had access to any additional information within Mayo’s transplant center. Unfortunately, we couldn’t find a comprehensive list, but we did consult Heather Bamlet, RDN, LD, transplant clinical dietitian at Mayo Clinic’s campus in Rochester. Here’s what she said: “Your question is a great one – and one that we do not have a quick or easy answer for. As you have found there is NOT a comprehensive list of herbals and teas to avoid post-transplant. This is partially because there is limited information regarding some of the herbals, partially because so many of these products contain multiple ingredients and partially because this market is ever changing – it literally could be a full-time job to keep a list like this up!

Here in our transplant center we advise patients to avoid herbal supplements and teas as an overall statement – however, if there are a few in particular that someone is interested in consuming, we will review the ingredients on a case-by-case or one-by-one basis. You are correct in your findings that Echinacea and licorice root teas would not be recommended. For the others you mentioned, I referenced the Natural Medicines Comprehensive Database (naturalmedicines.therapeuticresearch.com) that our institution subscribes to. Ginger is fine for transplant recipients– especially in the amounts we would normally consume in foods. Turmeric is also likely safe, however does list a side effect of possible constipation and there is a case report of very elevated tacrolimus levels in a post-transplant patient who had started taking 15 spoonfuls of turmeric powder on a daily basis – which we would describe as an excessive amount. We do not see this issue with patients who use turmeric in cooking. Cardamom has no known concerns so should be safe to consume, also. Green tea is a bit more complicated as there are several medications that may interact with green tea such as anticoagulants (Warfarin, Plavix etc.), some types of chemotherapy and Corgard. If you take any of these types of medications it is advisable to not take green tea. Otherwise, again, in normal amounts (not more than 3 caffeinated beverages per day) green tea should be fine to consume.”

Reminder, this is general information that could relate to any patient. For your particular case, we strongly suggest you consult your physician team before you consume any herbal or teas to be sure they are safe with your particular medications and illnesses.

I hope that helps!

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@beckyjohnson I would really to have those links. I won’t be at the three year mark until 09.2019, but it’s good to be prepared. Obviously if Medicare D does not cover these pharmaceuticals well we will pay for them, but as seniors on a fixed income it’s good to know how much that will be. Thank you.
JK

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