Buhner Got It Wrong!

Mustard Seed,
Thank you for posting this. After looking at my book I realize that C B S can interact with a few pharmaceuticals. So it is definitely something that needs to be considered. I am sure it is an oversight on Buhner's part but it could be one that can hinder the health. It can also cause diarrhea which may be why I am having that issue off and on. Good things to know and good catch!

Ya I'm sure it's just an oversight.
Nevertheless, how do I get in touch with him?

His website is older so I'm not sure it's being checked.

I understand he has faceook. I unfortunately do not.
If someone who uses facebook would like to pose this question to him, that would be great!

It seems Salvia miltiorrhiza (red sage), might be similar. For some reason there isn't a section in the Materia Medica on it, so I'm unsure.

@Mustard Seed: I had s similar question a couple of days ago, if you want to read it: https://www.healingwell.com/community/default.aspx?f=30&m=3649178

I've done a relatively indepth research in antibiotic drug metabolism, and I'm concerned about taking some ABX with herbs. In fact nearly every herb does inihibit enzymes of the Cyp450 family, not just Skullcap, for example also Cat's Claw. If you sum up these effects (because we take many herbs, not just one), I don't know what might happen. I'm not sure if Stephen really did an indepth research on drug metabolism. It would really be good if we could get in contact with him, perhaps via his partner Julie McIntyre, who offers herbal consultations. In fact, I would not take an antibiotic like flagyl or clarythromycin along with herbs. The interaction potential is to high, as far as I see. Doxycycline for example is not that critical, because the side effects of this drug are not so serious. You just have to monitor liver enzymes and blood count regularly. Some antibiotics don't get metabolized at all, they are uncritical, for example Rocephin.

I think this is really an important topic.

Post Edited (_Markus_) : 6/13/2016 2:59:29 PM (GMT-6)

To be honest I've always been a bit nervous of Chinese Skullcap because of this liver enzyme effect. I take it on occasion and it does seem to kill something and make me herx a bit. But I've got other killing tools and I've always wondered if it's worth the risk.

Found this article:

Hepatotoxic Botanicals - An Evidence-based Systematic Review

Skullcap (Scutellaria baicalensis):
Scutellaria baicalensis is an herbaceous herb that
belongs to mint family and has two species. The
first species is S. baicalensis that is alternatively
known as Chinese skullcap, Baikal skullcap or
Huang-qin and commonly used in Chinese
medicine. The second species is S. lateriflora that
also known as blue skullcap, hoodwort or
Virginian skullcap that is native to Americans
(173,174). Scutellaria has been used as a sedative
and anti-inflammatory agents (106) and for
treating several ailments like cancer, jaundice,
hepatitis, anxiety, nervous tension, hysteria and
epilepsy (168,175,176). Both species includes
terpenoid compounds, which can cause
hepatotoxic effects (111). Several case reports of
hepatotoxicity after skullcap ingestion either
alone or in combination with other botanicals
have been reported (173). One case report of 28-
year-old man developed fulminant hepatic failure
with multiple sclerosis after congestion of
skullcap (6 tablets/ day) with pau d’ arco and
Zinc. The patient required liver transplantation
and died shortly after the liver transplant. He was
diagnosed with veno-occlusive disease and fatal
hepatic failure due to contamination of herbs with
toxic plants (176). Another case involved a 78-
year-old woman who took one herbal supplement
called “Move Free Advanced“ with multivitamins
daily for treating arthritis. The woman presented
with significant cholestasis and hepatitis;
however, she improved after discontinuation of
herbal medicine. Move Free Advanced
supplement found to contain Chinese skullcap and
black catecho (173). Another case of skullcap
hepatotoxicity included a 77-year-old female who
presented with weight loss, anorexia and
tiredness. The patient consumed 6 units of alcohol
per week. She was diagnosed with hepatitis with
pulmonary complication. Later, she admitted
taking three herbal preparations, which are BFC
(for wasting diseases), Nervine (for anxiety) and
Bowel tonic (for peristalsis) three times per day
for 6 month. Further investigation reported the
presence of skullcap and comfrey in BFC, which
caused hepatic injury and pulmonary lesions in
the patient (177). Other case reports of
hepatotoxicity due to interaction of skullcap with
other botanical were mentioned earlier
(14,168,172).

/ejournals.library.ualberta.ca/index.php/JPPS/article/viewFile/17973/15135

Okay - now I'm concerned.


So, how much time between the herbs and abx do you think?

I currently do my antibiotics M/W/F - so would it be alright to do my herbs on Tues/Th/Sat/Sun?

Is that enough time between? (12 hours) I'm thinking unless it's an antibiotic with a really long half-life (like azithromycin) - then it's safe?

...but how long are the herbs in our blood?

Here is a good article.

http://www.pharmacytimes.com/publications/issue/2008/2008-09/2008-09-8687

Ya, the issue, for me anyway, isn't about having some sort of terrible interaction. There doesn't seem to be many of these reported.

I'm not even that worried about the "grapefruit" effect of having too much drug in my system. I think you'd notice that pretty quick

No, I'm more worried about interactions that I can't tell are happening.

The best example is the one I gave about Milk Thistle. I haven't ton a huge amount of research on this, but if it's possible that some herbs have a similar effect, and are basically rendering my abx useless, well then that worries me.

Project said...
Maybe he should have included a caveat in the FAQ about the herbs being compatible with antibiotics, I dunno. But the point is all these things can potentially interact and it's up to the individual to read the full book and also listen to their body's reactions.

That's how I totally read it, that yes these plant based medicines can be taken with pharmaceuticals, but the onus is on the user to read the vast information provided in the rest of the book. Now, if he hadn't included the information about the potential drug reactions in the book at all, one would have a point.

The bottom line is plant based medicines are STILL medicines and need to be treated with the respect one has towards pharmaceuticals. Before you take them do your research based on your knowledge of your body and what you are currently taking.

I had raised this concern before & can't find the thread, but I do have a couple of the links:

/umm.edu/health/medical/altmed/herb/skullcap

livertox.nih.gov/Skullcap.

Someone had also said that the potent ingredient in skullcap, baicalein, may react differently to the liver. At least with mice in this Chinese study, listed on the NIH site:
www.ncbi.nlm.nih.gov/pubmed/23236235

Apparently, one must also be VERY careful with antifingals & the liver. It could happen quickly without warning so no one should ever be casual. That is also an important reason to follow up with doctors who can monitor your bloodwork.

Post Edited (happyjo) : 6/13/2016 7:08:10 PM (GMT-6)

Sigh, OK this will be my last post in this thread.

I've decided to stop all my herbs (which I just started 4 weeks ago, sigh) for a few months.
This makes me very sad.
Here's the reason:

I spent the whole day researching because I'm starting Biaxin and Rifampin next week, and both are inducers and/or inhibitors and/or substrates of P450 enzymes.

For those who didn't follow the thread, there are LOTS of herbs recommended by Buhner which interact with these enzymes in your liver. Medication dosage can get all messed up because of these interactions.

For example, your liver could be over-metabolizing a medication because of an enzyme induction from a herb. This means you'd only have a fraction of the actual dose acting medicinally in your body.

The opposite is also possible, potentially dangerously so, leading to much higher dosages of the medication in your body.

The main Lyme antibiotics that react with the P450 enzymes are rifampim, rifabutin, erythromycin, clarithromycin (biaxin), ciprofloxacin (cipro), tinidazole (tindamax), and metronidazole (flagyl).

Here's some herbs I've found which react with the P450 enzymes (and thus, can interact with the above antibiotics): cat's claw, eleuthero, red sage, chinese skullcap, andrographis, cryptolepis, artemisinin, curcurmin, black pepper, licorice, panax ginseng.

There are MANY more.
These are just the herbs I was taking, or thinking of taking, and thus researched, but I came across many more that I recognized from Lyme treatment protocols.

It's important to note that not every herb interacts with every antibiotic in the above lists. It depends on whether they inhibit, induce, or are a substrate of a P450 enzyme, and which enzyme that is exactly.

The bottom line is, there are a lot of interactions which can happen here, and I don't feel great about it, so I have to take the aforementioned break from my herbs.
Sad, sad day.

Girlie, unfortunately I don't know how long the herbs are in your system for.

You are correct about what you're saying. If abx are being processed by your liver first, and you add in herbals sometime after, well then the worst that's going to happen is you'll have more or less of the herbal in your system, depending on whether your liver metabolizes less or more, respectively. No biggie.

The reverse situation is definitely the one to be aware of, where we take the herbal first, and then add in medication. We don't want more or less of a medication in us. We want the prescribed amount. Taking the herbs and drugs in a close cycle creates this situation perpetually.

Here's some interesting information regardless:

www.reddit.com/r/Nootropics/comments/3295ub/how_long_does_piperine_inhibit_cyp3a4/

Piperine is in black pepper
I don't know how reliable this is information is, but according to this guy, it takes 3-12 hours for a "knocked out" P450 cytochrome to be replaced by a new one.

This means that if your herbs hit your liver on Sunday night, 12 hours later your liver is 100% ready to go again, and you won't be over or under metabolizing your medication.

Now, whether or not there's herbs still floating around ready for another round of metabolization throughout the next day when you've already started your abx, I'm not sure, sorry.

Post Edited (Mustard Seed) : 6/23/2016 6:33:41 PM (GMT-6)

You're bang on Questing. I've heard just as many success stories with herbs as I have with abx.

For some reason I'm a little jealous of people just doing herbal (I know it's crazy... I'm very thanksful to have an amazing LLMD). I was just getting so excited about getting used to all the herbs, slowly upping the dosage, visiting my little apothecary every 2 hours, feeling pretty good. It was fun.

However, if I don't improve in the next few months, better to be able to look back and say I took a legit shot at Bart with antibiotics, rather than looking back and wondering if some herb interaction held me back, and never knowing.