I know of very few patients who are not taking some form of over-the-counter health supplement, whether it is vitamins, minerals, or herbal supplements. For example, many of my post-menopausal singers refuse to take hormones, but instead eat a lot of soy products, thinking that a vegetable source of estrogen is somehow more in harmony with the music of the spheres. We somehow feel that ‘natural’ is better, and that the more of the natural stuff you take, the healthier you will be.
Both of these assumptions may be wrong. Not only are some of these ‘natural’ products potentially harmful, but even ones that can do some good may hurt you if taken in excess. If we pause to consider the fact that, until recently, most pharmaceuticals (some of them very potent) were derived from plants, we will realize that just because a substance has a ‘natural’ source, it does not mean that it is somehow more gentle and harmless. After all, digitalis, a potentially deadly cardiac medication, is derived from a beautiful flower, the foxglove!
First, we need to distinguish between dietary supplements and herbal medicines. Supplements, which include vitamins and minerals, replace important elements that are missing from our diet. We all need a certain amount of Vitamin C or calcium, and the amount we need may be more than the ‘daily recommended dose’. But how much more? And what happens if we take in a great excess? In the case of vitamins, they are either stored in the body (the fat-soluble vitamins) or excreted in the urine (the water-soluble vitamins). Vitamins that are stored, which include A, D and E, can cause illness, known as hypervitaminosis. They can affect the liver, turn the skin orange, and produce other interesting signs of poisoning.
I would therefore recommend that, unless medically prescribed, you do not take more than twice the recommended daily dose, especially of the fat-soluble vitamins. So, since the Vitamin E daily dose is recommended at 400 I.U., no more therefore than 800 I.U. a day should be taken. With water-soluble vitamins, excess is exreted, so there is more leeway. Since most of us take much more of these substances than our bodies can use, it has been said that Americans have the most expensive urine in the world!
When excreted in the urine, some vitamins, such as Vitamin C, can act to pull water out of the body. For singers, this may affect the voice through dehydration. So, if you are on a temp-orarily excessive dose to eradicate that cold, drink plenty of water.
Herbal medicines are not supplements, but pharmaceuticals that are taken to affect the body in a specific way. The list of these is huge, and you can browse through these either in books, or specific websites (www.herbmed.org is one). A recent paper in the Journal of the American Medical Association by Ang-Lee, Moss and Juan (JAMA, July 11, 2001, Vol. 286, No.2) stresses that herbal medicines cannot be discounted during surgery, since they can thin the blood, raise the blood pressure, or affect your body’s response to anesthetics. Among other suggestions, the authors recommend that you discontinue St. John’s Wort for at least 5 days prior to surgery. Other potent herbal medications include echinacea, ephedra, garlic, gingko, ginseng, and valerian.
And finally, remember that everything you ingest has the potential for additive effect or cross-reaction. If you are prone to vocal fold hemorrhage, for example, the following can be harmful by either dilating the blood vessels or thinning the blood: niacin, Vitamin E, garlic, gingko, and ginseng.
This is not meant to scare you off taking herbal medicines and supplements. Just be aware that these are potentially powerful, and when taken in combination their effects may be enhanced. You are what you eat, and both your health and your voice may be affected.
DISCLAIMER: The suggestions given by Dr. Jahn in these columns are for general inform-ation only, and not to be construed as specific medical advice or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician.
