Herbals and teas

Posted by JK, Volunteer Mentor @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

@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.

Liked by beckyjohnson

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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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@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 interesting question. I know that many of the things that need to be avoided are due to them either suppressing your immune system more, or less. It’s a delicate balance. I think there may be some things that are to be avoided because your transplanted organ is already fighting to stay healthy and you don’t want to up that battle. As I say that I am thinking specifically of alcohol, but I don’t know that for certain. Alcohol, particularly red wine, in moderation has been shown to have health benefits.
Rosemary or any other transplant recipients, do you know if alcohol does effect the immunosuppressants or is the concern for the transplanted liver?
JK

Liked by beckyjohnson

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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 too love grapefruit flavor. I rarely drank the juice (my husband has it always) but I enjoyed it in non-caloric beverages that have “essence of grapefruit” but even those need to be avoided. I like Pom juice also, and used to drink it because it had some health benefits so I am disappointed in that. We sure do have a lot of restrictions and the irony is that most of the things that are to be avoided are considered to be healthy!
JK

Liked by @tbirdmunchkin

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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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I am allowed one alcoholic beverage per month. I figure there's a reason so I don't have any but I know I can.

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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

Jump to this post

@contentandwell, I agree that grapefruit and pomagranit juice is delish but the main reason we have to avoid it is because it contains an enzyme that will destroy our anti-rejection medications completely anyone that takes high blood pressure meds has to also avoid bot pom and grapefruit for the exact same reason I know as both my kids are on blood pressure meds not for high blood pressure but they use it for their. ADHD

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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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@donnan I wonder if your physician would say the same after a liver transplant. My doctor did say, for very special occasions, I could have a drink, such as a champagne toast at my daughter's wedding. I always prefer asking the doctor because the NP goes strictly by the letter of the law, no exceptions. The doctor knows when he/she can be a tad more lenient.
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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@glinda. Thanks, I did realize it is because of how it affects the medications, and I follow that strictly. I presume grapefruit must be the worst because that tends to be the one they stress. I do not remember any mention of pomegranate until recently, nor does my husband.
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

Jump to this post

@contentandwell I love the way you worded "you don't want to up that battle". Thanks for sharing that.

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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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@donnan I did receive a list but it did not include things that are herbal, and it did not mention pomegranate.
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

Jump to this post

@beckyjohnson My son was the first person to suggest to me that perhaps the not drinking was due to that transplanted liver already fighting for it's life, and alcohol is toxic to your liver. He is not medically inclined at all so when he comes up with something like that, that could be the reason, it always surprises me. As I said previously though, I am now thinking it has to do with the immunosuppressants.
JK

Liked by beckyjohnson

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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

Jump to this post

@contentandwell It has been my experience that when the light comes on for anyone, especially someone without inclination towards the subject matter there is usually something to it. Your son has cause to believe that since he connected those dots. There is no doubt immunosuppressants play a role

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