Question from Storms: Dr. Burstein, I was wondering if you could recommend a herb for my anxiety disorder? I currently take benzodiazepines, and I know not to go off of them on my own. But, if there is a herb that would work as well, I would be willing to try it. I tried valerian, but noticed no effects.

Dr. Aaron Burstein: Generally, I don't like to recommend herbal therapies in a forum such as this. There are so many patient-specific variables that this decision is best made in consultation with your personal physician.

Question from Candyce-CNN: Is it a problem that people may not tell physicians what over-the-counter herbal remedies they may be using, since they don't think of them as "drugs"?

Dr. Aaron Burstein: Absolutely. The most important piece of information a prescriber or pharmacist can have is a knowledge of any over-the-counter medication, including herbal therapies, in anticipating potential drug interactions. Realizing a large number of patients are hesitant to discuss herbal use with their health care providers for fear of censure, it nevertheless is important for open dialogue in a nonjudgmental manner to take place.

Question from DarwaTaiwan: Are there any herbs with the ability to boost the body to produce more hormones?

Dr. Aaron Burstein: There are some herbal therapies that may have as components of them, compounds similar to hormones, or in fact, have compounds similar to estrogen. But, at this point, I'm unable to provide specific names of agents.

Question from Haley-CNN: Are there any herbs that you know of that should under no condition be administered to a child? If so, which ones?

Dr. Aaron Burstein: I am unaware of any specific herbs that absolutely should not be administered to a child. Having said that, we're still learning what the effects of these herbal therapies are in adults. Children often have different physiology. For example, with drug interactions, children may have different rates of elimination of medications, and it is difficult to predict what the magnitude of an interaction may be in this group.

Question from DarwaTaiwan: I known that many professional athletes in the NFL, NBA, etc., use herbal supplements to increase their performance in areas such as stamina and strength. Are they legal, and do they work?

Dr. Aaron Burstein: It's difficult for me to comment on this. I think each sport has its own rules regarding these agents, and they could probably better comment on the legality of their use. Similarly, I am unfamiliar with the literature regarding the efficacy of herbal supplements in boosting athletic performance.

Question from DarwaTaiwan: Do you take any herbs yourself?

Dr. Aaron Burstein: No, I do not.

Question from James: Is there any documented evidence that feverfew is effective in preventing headaches?

Dr. Aaron Burstein: I am unaware of any large clinical studies, completed, that documented feverfew as effective for headaches. There are a number of small studies and case reports suggesting it may be useful. I believe there are groups that are currently studying this question.

Question from Sandy-CNN: What did they find out about the tablet content in the stuff they looked at?

Dr. Aaron Burstein: The two studies were evaluating melatonin and glucosamine/chondroitin. While I don't have the specific results in front of me, the general finding was that many products failed to contain the amount of active component stated on the label. That wasn't to say all products failed to contain the stated content, but these studies helped to define which specific brands may be more consistent than others.

The limitation to the glucosamine/chondroitin study, from the perspective of the consumer, is that the authors blinded the identity of the preparations when reporting the results. So, while it appears that some of those products may not contain the stated content, it is unclear what specific brands those were.

Question from Storms: Are there any herbs that are dangerous to use while consuming alcohol?

Dr. Aaron Burstein: As a general answer, I would say, yes, there are. Whether or not an herb is dangerous will depend on the specific effects of the herb itself. I'm unable at the current time to give specific examples. However, any herbal therapy that causes effects in the central nervous system would be particularly expected to potentially have additive effects with alcohol.

Question from DarwaTaiwan: Do you support the use of herbs, or do you think the current research and facts known about them make them a liability?

Dr. Aaron Burstein: I am typically hesitant to comment on the efficacy of herbal therapies. My position has been that patients will continue to use these therapies, even in the absence of rigorous clinical studies supporting their efficacy. My direction in my research has been to try to clarify the drug interaction potential so that if patients are going to use these agents, we have the information to help promote their safe use.

Chat Moderator: Do you have any final thoughts for our audience?

Dr. Aaron Burstein: The use of herbal supplements is associated with the potential for drug interactions, many of which have yet to be identified. The most important way to minimize this risk is for patients and prescribers to have open dialogue regarding their use. A critical factor in preventing drug interactions is knowing that the medication and herbal therapy are being used in conjunction. I again thank you for inviting me to participate in this chat.

Chat Moderator: Thank you for joining our audience, Dr. Aaron Burstein.

Dr. Aaron Burstein: Goodbye.