Taking Herbal Medicines: What Singers Should Know
By Jason B. Surow, M.D. , F.A.C.S.

(The following information was collected by Jason B. Surow, MD, during a recent survey of singers.
Please note that the use of herbal medicines and their effects on voice is not yet well understood.)

Herbal Medicine with Possible Anticoagulation Results (Blood thinning effect)

Dong Quai- "contains coumadin"*
Willow bark- "contains salicylates" *
Primrose
Cowslip
Jack-in-the-Pulpit -
Red root- "causes clotting disorders
"Garlic- "in high dose worsens anticoag" "inhibits platelet aggregation and has fibrinolytic activity"***

Vitamin E - "in high doses"
Gingko Biloba-"inhibits platelet aggregation"***
Feverfew-"inhibits components of the clotting cascade and may inhibit platelet aggregation"***
Ginger-"reduces platelet aggregation"
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*coumadin (warfacin) is a powerful blood-thinning agent
** salicyate= aspirin
***this can cause prolonged bleeding

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Herbal Medicines with Possible Inhalant Allergy Cross-Reactivity with Ragweed:

Chamomile- "long term use can lead to ragweed allergy"
Goldenseal
With Sunflower:
Echinacea
Photosensitization Concerns From Herbal Medicine (skin rash and sensitivity to sunlight)
St. John's Wort
Celery
Dong Qua
iYarrow

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Herbal Medicine with Possible Diuretic Effects (water losing effect)

Elder "strong diuretic"
Feverfew
Dandelion
Nettles

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Herbal Medicine with Possible Blood Pressure Concerns

St. John's Wort*- MAO inhibitor effect. "Don't take with amphetamines, amino acids, asthma inhalers, caffeine, decongestants, beer, wine, yogurt, fermented or smoked foods." [avoid amino acid tyramine] Avoid narcotics due to high incidence of high fever with coma.
Ma Huang (ephedra)*- "avoid in MAO inhibitor use (often used in depression), glaucoma, anxiety, heart problems"
Goldenseal
Ginseng
Licorice root- causes fluid retention.
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*MAO inhibitor is a class of drugs that are commonly used for the treatment of depression
Herbal Medicines with Possible Immune Dysregulation Effects
Echinacea- "may overstimulate immune system and lead to immune suppression" "Increases tumor necrosis factor" "Don't use in HIV" Don't use for more than 2 weeks in a row.
Certain herbs should not be used in autoimmune problems like Multiple Sclerosis, arthritis, and others.

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Problems with Production of Herbal Products

L-Tryptophan - l 989 contamination led to several hundred cases of eosinophilia- myalgia syndrome, and at least one death.
Anticholinergic poisoning from herbal tea yerba de mate (Paraguay tea) contaminated by Belladonna alkaloids from weeds overgrowing in the field
Vitamin Toxicity
Vitamin C- cramps, flatulence, bloating, diarrhea
Vitamin E- "thins blood" "reduces effectiveness of thyroid replacement" "avoid high doses with high blood pressure, congestive heart failure, insulin, dependent diabetes, heart problems"
Uterine Stimulants
yarrow
lady's mantle
dong quai
chamomile
cinnamon
myrrh
yam
licorice root
many others

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Herbal Medicines with Possible Hormonal Effects (the vocal folds are known to change due to some hormones; this can be permanent)

Dong Quai- "increases effects of ovarian and testicular hormones".
Used to treat hormonal problems

Yam- "progesterone-like " chemicals

Licorice root- "has estrogen and progesterone effect. May change pitch of voice"

Hops- "high proportion of estrogens and can lead to loss of libido in men"

Primrose- "natural estrogen promoter"

Melatonin- "major role in production of estrogen & progesterone & other hormones." "acts as contraceptive in high doses"

Yohimbe- "may increase testosterone. Women shouldn't use"


Other Cautions:

Don't use with fever- astragalus(huang qi), goldenseal, others.

Chewing leaves of feverfew is a folk remedy but can cause mouth sores.

Lobelia has "nicotine-like" effects and >50 gms can suppress breathing and depress BP and even lead to coma.

Ginseng lowers blood sugar so shouldn't be used if hypoglycemic.

Nutmeg is toxic in high doses

Sage has chemical (thujone) that can trigger seizures in epileptics.

Melatonin- don't use if severe allergy, immune disorder, or cancer

Peppermint relaxes smooth muscle and can promote gastric acid reflux into the throat.