St. john’s wort and Alcohol / Food Interactions
St. John’s wort ↔ food
Moderate Food Interaction
While you are taking St. John’s wort, you must not eat or drink certain foods and beverages that are high in tyramine. Eating these foods while you are taking St. John’s wort can raise your blood pressure to dangerous levels. This may cause life threatening symptoms such as sudden and severe headache, confusion, blurred vision, problems with speech or balance, nausea, vomiting, chest pain, seizure (convulsions), and sudden numbness or weakness (especially on one side of the body). Call your doctor at once if you have any of these symptoms. Foods that are high in tyramine include: air dried meats, aged or fermented meats, sausage or salami, pickled herring, and any spoiled or improperly stored beef, poultry, fish, or liver, red wine, beer from a tap, beer that has not been pasteurize, aged cheeses, including blue, brick, brie, cheddar, parmesan, romano, and swiss, sauerkraut, over the counter supplements or cough and cold medicines that contain tyramine, soy beans, soy sauce, tofu, miso soup, bean curd, fava beans, or yeast extracts (such as Marmite). Caffeine intake should be limited as well. You should avoid or limit the use of alcohol while being treated with St. John’s wort. Alcohol can increase the nervous system side effects of St. John’s wort such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Talk to your doctor or pharmacist if you have any questions or concerns.
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What is it with particularly bad, black times? Sometimes bad things come along like buses, everything is going nicely then suddenly out of nowhere the pressure cranks up, things you thought you could always rely on start crumbling away. It was a particularly bad time then. My gran had died peacefully in March, followed by my cousin very prematurely a few months later. I was working, but the job(s) were stressful and my employers expected too much of me. I kept quiet and got in with, as many of us do. But it was when my fiancee’s dad died from a protracted battle with cancer by the autumn of that year that things got too hard to hold together.
Friends and family knew my story, or enough of it anyway. They asked if I needed help and largely I said “No, I’m alright thanks” and brushed them off. I can get on with it. Simple. The cool, confident type. He’d been a heavy alcoholic, which probably masked other problems, either way he’d been a huge and negative presence in her life and hence in mine. I was organising the funeral, I just needed something to get through whilst working, whilst keeping together our lives, myself, and everyone else.
In these times of difficulty you start taking on the burdens of the whole world. And so I’d heard about St John’s Wort, a herb recommended informally for mild-moderate depression and sleep problems. A coping device without having to explain my life-story to a sceptical GP. St John’s Wort is pretty common. Reasonably priced, popular in Germany, comes in pill, available in many health food shops, backed largely by anecdotal evidence, e.g. friends who told me to sort my head out when I kept getting wasted and losing it. I was drinking a lot but got through it. Three times a day, bottled up.
But the job didn’t get less stressful – they were impressed at how well I coped under pressure and piled on more responsibilities. Money problems increased for lots of small boring reasons which added to the pressure. 18 months later I was still bottling it up, three times a day. I’ve heard that one in five Londoners apparently suffers from a mental health problem, and that these days you can find traces of prozac in the tap water, but you always think it happens to someone else. It seems like the easier and safer option at the time though to keep quiet and get on with it, don’t bother anyone, I’ll be alright in the end, I’ll get through it. We’re all cool. How many more people are doing exactly the same thing? I have no ideas. But either way, the causes and circumstances of what makes life feel so hard go unaddressed. It bottles it up, but doesn’t really solve anything.
So 18 months later, I’d tried making positive changes in my life – drink less, exercise more (10k runs etc), leave my job and try one of my life ambitions for a year with the money I’d saved from working. I stopped the heavy self-dosage without telling anyone (I hadn’t even told anyone I’d started taking the stuff, and had been hiding the St John’s Wort inside innocuous pots of cod liver oil tablets). Very quickly life got very tough again – I was losing my temper, finding it pretty difficult to do normal things and ‘get on with it’, and so I was drinking a lot, getting wasted a lot, going out of control.
You’re probably wondering where the solution or moral of the story kicks in. Well St John’s Wort is routinely self-prescribed to manage rather than resolve feeling down. Until we (and that means me too) start learning how to lean on our mates when we’re feeling down, and let others be there for us in the way that we’d always try to be there for a bro, then the circle of problems will continue. Stuck in the cool self-sufficient superhero mould, secretly messed-up. I know what advice I’d give myself. In trying to keep in control and keep it all together, we’re slowly unravelling. I’m going to try though. St John’s Wort bottles it up, takes the venom out of feeling bad. For a few months, it’s very effective. I’ve used it throughout my teens sporadically when stressed out or fed up over exams, or being skint and feeling like life’s going nowhere. It’s better than other things. But St John’s Wort shouldn’t be taken for life, not to mask other problems.
Kenny Augustus is a musician from north London.
If you’re also taking St. John’s Wort, be sure to check any side-effects and get advice before you do so. If you think you’re suffering from anxiety, depression, alcohol problems or anything else Kenny mentions, talk to CALM, and consider getting support from a medical professional.
St. John’s wort is a popular herbal therapy for depression, but a new Australian study highlights the fact that “natural” does not always equal “safe.”
Using reports filed with Australia’s drug safety agency, the researchers found that adverse reactions to St. John’s wort were similar to those reported for the antidepressant fluoxetine — better known by the brand name Prozac.
Those side effects included anxiety, panic attacks, dizziness, nausea and spikes in blood pressure, the researchers reported in the July issue of Clinical and Experimental Pharmacology and Physiology.
“It’s concerning to see such severe adverse reactions in our population, when people believe they are doing something proactive for their health with little risk,” lead researcher Claire Hoban, of the University of Adelaide, said in a university news release.
Research has shown that St. John’s wort can help ease mild to moderate depression. But the fact that it works also means there is a risk of side effects, said Dr. Samar McCutcheon, a psychiatrist at Ohio State University Wexner Medical Center in Columbus.
“Even if the bottle says ‘natural’ or ‘herbal,’ it still has ingredients that are active in your body,” said McCutcheon, who was not involved in the study.
Are weight loss supplements safe and do they really work?
It has long been recognized that St. John’s wort can have significant side effects and interact with certain medications, McCutcheon pointed out.
But many consumers may not know that, she noted, largely because dietary supplements are not regulated in the way that drugs are.
“I definitely think this is still an issue,” McCutcheon said. “People think St. John’s wort is safe because they can buy it at a health food store.”
In the United States, dietary supplements do not have to be studied for safety and effectiveness before they reach the market.
“Plus,” McCutcheon said, “you’re relying on companies to make sure these products include the ingredients they’re supposed to, and keep out ingredients that they shouldn’t.”
The situation is similar in Australia, and many consumers there are unaware that supplements are largely unregulated, according to Hoban’s team.
The researchers based their findings on doctors’ reports to Australia’s national agency on drug safety. Between 2000 and 2013, there were 84 reports of adverse reactions to St. John’s wort, and 447 reports on Prozac.
But since those are voluntary reports, they do not reflect the actual rate of side effects from either therapy, according to the researchers. And, Hoban said, bad reactions to St. John’s wort are particularly likely to go unreported, since the herb is often not even considered a drug.
According to McCutcheon, it’s important for people with depression symptoms to see a health professional before self-medicating with St. John’s wort. “That will help ensure you have the right diagnosis,” she said.
If your symptoms are actually part of a different disorder, St. John’s wort may be ineffective — or possibly even risky. For example, McCutcheon said that in people with bipolar disorder, the herb might fuel a manic episode.
But possibly the biggest concern, she said, is the potential for St. John’s wort to interact with commonly used medications.
The herb can dampen the effectiveness of birth control pills, blood thinners and heart disease drugs, along with some HIV and cancer drugs, according to the U.S. National Center for Complementary and Integrative Health.
What’s more, it can interact with antidepressants. It’s not clear exactly how St. John’s wort works, McCutcheon said, but it’s thought to boost levels of the brain chemical serotonin — which is how the most commonly used antidepressants work.
“If you use the two together, you run the risk of having too much serotonin,” she said. And that raises the risk of a potentially fatal condition called serotonin syndrome, whose symptoms include confusion, tremors, diarrhea and a drop in body temperature.
Some side effects of St. John’s wort are caused by the herb itself, such as skin rash that’s worsened by sunlight, said Dr. John Reed, director of inpatient services at the University of Maryland’s Center for Integrative Medicine in Baltimore.
But the main concern is still its potential for interacting with other medications, he said. “Compared with other herbs, St. John’s has more drug interactions,” Reed explained. “So if you’re using it, don’t take other medications unless it’s under medical supervision.”
He added that anyone on any medication should do some homework before starting an herbal product. “Go online and do a search for drug interactions. Ask your pharmacist or doctor,” Reed advised.
“Unfortunately,” he said, “this type of information doesn’t have to be printed on product labels.”
The bottom line, according to McCutcheon, is that people with depression should talk to their providers about any supplements they take, or want to take. And those providers, she said, should be willing to have nonjudgmental discussions.
“I want all my patients to be comfortable enough to bring up anything with me,” McCutcheon said.
St. John’s Wort: The Benefits and the Dangers
St. John’s wort is natural. It’s an herbal supplement that doesn’t require a prescription and you can buy it at a health food store.
Sounds good, but that doesn’t necessarily make it harmless, according to a study published in 2015 in the journal Clinical and Experimental Pharmacology and Physiology.
Researchers at the University of Adelaide compared adverse events of St. John’s wort and the antidepressant drug fluoxetine (Prozac). The team used information from doctors’ reports to Australia’s national agency on drug safety.
Between 2000 and 2013, there were 84 adverse reaction reports for St. John’s wort. There were 447 reports for Prozac.
Since reporting adverse events is voluntary, researchers said it’s likely that adverse events are underreported.
Side effects of the two substances are similar.
They include vomiting, dizziness, anxiety, panic attacks, aggression, and amnesia. There are also serious concerns about drug interactions.
The benefits of St. John’s wort
St. John’s wort (Hypericum perforatum) is a flowering plant.
The flowers are used to make liquid extracts, pills, and teas. The popular herbal therapy is often used to ease symptoms of depression. People have been using St. John’s wort for centuries.
A Cochrane systematic review found that St. John’s wort can be effective in treating major depression.
A 2016 review of 35 studies concluded that St. John’s wort reduced symptoms of mild to moderate depression more than a placebo and similar to prescription antidepressants.
A 2017 analysis of 27 studies determined that St. John’s wort had similar effects on mild to moderate depression as antidepressants. Those researchers also noted that fewer people stopped taking St. John’s wort, compared to antidepressants.
Another study indicated St. John’s wort can be effective in treating wounds, bruises, burns, and sores.
However, the Food and Drug Administration (FDA) has not approved the substance for depression or any other medical condition.
The FDA, in fact, classifies St. John’s wort as a dietary supplement, not a drug. Therefore, the agency doesn’t test it for safety and effectiveness.
Jeremy Wolf, a licensed naturopathic physician, explained that St. John’s wort creates many actions in the body.
“It is a strong antidepressant and may elevate mood in individuals with mild to moderate depression,” he said.
He notes that St. John’s wort is not recommended for individuals with severe depression.
Wolf said St. John’s wort also has strong antiviral activity that may also promote healing and repair of wounds.
He cautioned that the herb is not a fast-acting cure. It may take weeks or months before you notice any effect.
How much St. John’s wort should you take?
Blair Green Thielemier, PharmD, told Healthline in 2015 that dosing varies due to non-standardized manufacturing.
A normal dose range would be anywhere from 300 to 1200 mg a day. It’s usually taken in divided doses (300 mg three times daily or 600 mg twice daily).
The effects of St. John’s wort on the body are not fully understood.
A number of the supplement’s active ingredients, including hypericin, hyperforin, and adhyperforin, may be responsible for its medicinal benefits.
These ingredients appear to increase the levels of chemical messengers in the brain, such as serotonin, dopamine, and noradrenaline.
These then act to lift and regulate your mood.
The downside of St. John’s wort
FDA regulations for dietary supplements are not the same as those for drug products.
Unless there’s a new dietary ingredient, a firm doesn’t have to provide FDA officials with the evidence it relies on to substantiate safety or effectiveness before or after it markets its products.
“Natural” doesn’t mean it can’t cause harm, said Thielemier.
The main concerns about the herb center on the metabolic pathway known as cytochrome 450.
She explained that this pathway consists of the enzymes our body uses to clear drugs and ingested chemicals from the bloodstream.
“These enzymes are responsible for breaking down everything from the glass of wine you may have with dinner to a daily vitamin you take to keep your bones strong,” said Thielemier.
Other substances can influence these enzymes.
“If you have ever heard that grapefruit juice can interfere with your medications, then you know of this process we call enzyme induction,” said Thielemier. “St. John’s wort, like grapefruit juice, induces the body to produce more of these enzymes in order to clear the chemical from the bloodstream .”
That can rob other medications of their power.
Wolf suggests the herb may work similarly to fluoxetine. If it inhibits the reuptake of serotonin, it would explain the similar side effects.
It also interacts with many common pharmaceuticals.
“When combined with SSRIs and MAO inhibitors, it may lead to elevated blood pressure and could induce what is known as serotonin syndrome,” said Wolf. “This includes confusion, fever, agitation, rapid heart rate, shivering, perspiration, diarrhea, and muscle spasms.”
According to the National Center for Complementary and Integrative Health, in addition to antidepressants, St. John’s wort interacts with oral contraceptives, anti-seizure medications, and anticoagulants.
It can also interfere with anti-rejection medications, heart medications, and some drugs used for heart disease, HIV, and cancer.
One 2011 study indicated the herbal supplement can reduce the effectiveness of Xanax, an anxiety medication.
Wolf noted that pregnant or breastfeeding women should avoid St. John’s wort.
So should people who are sensitive to sunlight, as the herb can intensify the effect.
These side effects have prompted the Mayo Clinic in Minnesota to recommend people not use St. John’s wort if they are taking prescription medications.
Regulation process not the same as drugs
Should natural and herbal products include warnings and go through the same rigorous testing as prescription drugs?
Thielemier thinks so.
“How else will we know whether they are safe and effective? The problem lies in the insane costs of proving safety and efficacy through clinical trials,” she said.
“I always advise individuals and remind them of the importance in checking with their healthcare provider or a trained practitioner before starting supplements and herbs due to the potential for side effects and interactions,” said Wolf.
Editor’s Note: This story was originally published on August 6, 2015 and was updated on June 6, 2018.
Breast, affections of.
Brain, concussion of.
Labor, effects of.
Mind, affections of.
Operations, effects of.
The leaves of various species of Hypericum are sprinkled with pellucid dots and black glands which contain an essential oil.
These, which are most conspicuous in H. perforatum, have evidently given the signature which has led to the chief use of the plant in medicine, namely, as a remedy for wounds or perforations of the integuments.
The leaves, moreover, are lance-shaped.
The leaves of H. androsemum, commonly called Tutsan (toute saine), were applied to fresh wounds from olden time.
The word Hypericum means “sub-heather”, indicating its manifest relation to the heaths, which at once leads us to think of Ledum. The proving of Hyp. by Müller and others is very complete and brings out the relation of the drug to wounds and their consequences and also its applicability in maladies of other kinds.
Crawling sensations in hands and feet, they felt fuzzy, sticking in them as from needles.
Tearing, rheumatic, shaking pains, paralytic weakness.
One of the provers had on waking at four AM a feeling as though she were suspended and not lying in bed, at another time as though she were lying very heavy in bed.
The former condition has led to cures in effects of accidents attended with the sensation ” as if being lifted high into the air, and great anxiety lest she should fall fro this height.” The particular kinds of wounds for which Hyp. has been found of signal service are wounds of parts rich in verves, brain, spine (spinal irritation from falls), coccyx, finger-ends, wounds from stepping on nails, or any punctured wounds.
The characteristic of the Hyp. wounds is that they are very sensitive to touch (Led. punctures are not particularly sensitive).
W. J. Guernsey (H. P., x. 475) relates the following case, A boy, nine, was bitten by a pet rat on the first finger of left hand.
Nothing particular was observed at the time, but some time after, he became ill, and when Dr. Guernsey was called his state was alarming.
The boy could talk with great difficulty, teeth firmly locked, conscious, neck so stiff the head could scarcely be moved.
There was more tenderness about the wound than the appearance would indicate.
Hence Hyp. was preferred to Led. It was given (8 PM) in the 500th, dissolved in water, at first every fifteen minutes, later every two hours.
At three AM there was improvement, he fell asleep, and the next morning was practically convalescent.
Hyp. is called for in nervous depression following wounds, effects of shock, fright and mesmerism.
Ulceration and sloughing of wounds.
Hard, dry, yellow crusts form on healing wound.
Bunions and corns when the pain in excruciating.
Not only is the pain sense exalted, there is exaltation of the senses of hearing and smell.
Violent labor-pains and after-pains.
Tympanitic distension of abdomen, cutting pains.
Gilchrist says Hyp. 3x, given at intervals of twenty minutes for twelve hours or longer, seems to control perfectly the pain following laparotomy.
But it must not be thought that Hyp. has no sphere outside wounds and their effects.
Like Arnica it has many uses in the respiratory sphere.
It has cured asthma worse in foggy weather, the attacks were better by copious expectoration.
Whooping-cough worse 6 to ten PM
Tightness of chest, stinging worse on moving.
Summer diarrhea with eruption.
Palpitation and local congestions, with or without hemorrhage and nervous depression, following wounds.
Roehrig (H. R., xii. 40) considers Hypericum externally and internally the nearest thing to a specific in bleeding piles.
He gives it to pneumonia patients who have piles, it cures the pneumonia and prevents the arrest of the flux, always a dangerous symptom in these cases.
Usher (H. W., xxvii. 500) confirms this, “pain, bleeding and tenderness” are his indications.
“It seems to suit the plethoric, with great soreness.” He uses the 1X. Toothache better lying on affected side and keeping quiet.
Hyp. is sensitive to cold: worse in cold air, in damp, in fog.
The hacking cough is worse from heat as well as by cold air.
All symptoms worse by least exposure.
Worse From touch.
Makes mistakes in writing, omits letters, forgets what she wanted to say.
Talks wildly in night after four AM
while asleep, apprehensive, gasped for breath.
Mental excitement as after drinking tea.
Weakness of memory.
Great nervous depression following wounds.
Removes consequences of fright and effects of shock.
Great heaviness in the head.
Confusion, vertigo, and heaviness.
Tearing stitches in the brain.
Buzzing sensation in vertex at night as if something living were in brain.
Pulsation, heat and burning in the vertex (afternoon).
Sensation in the forehead as if touched by an icy cold hand.
Sensation as if the head became elongated.
Headache, extending into zygoma or cheek.
Headache, with sore eyes, after a fall.
Hair moist, rest of body burning hot.
Sticking through (right) eye.
Burning stinging in tarsi.
Stye on left lower lid.
Sticking through (right) ear in evening.
Itching in right meatus.
Sensitiveness of hearing during menses.
Pain in bridge of nose on rising.
Sore within nose, itching, continually picking it.
Dryness of nose, with sneezing, of left nostril with crusts in it.
Smell very acute.
Hot and bloated.
Tension in the cheek.
Tearing in cheek, in left zygoma.
Eruption around mouth and on right ear.
Yellowish green scabs with cracking and moisture.
Dryness of the lips and moth.
Dry, burning heat in mouth.
Tongue: coated white, or dirty yellow.
Taste: insipid, of blood.
Thirst, with feeling of heat in mouth.
Sensation as of a worm moving in throat.
Hot risings in esophagus after a fright, or with anxious feelings.
Desire for warm drinks.
Eructation on drinking water.
Desire for wine, pickles.
Appetite increased morning and evening.
Pressure at the stomach on eating but little.
Nausea and inclination to vomit.
Sticking in the stomach, in right hypochondrium.
Tympanitic distension of abdomen, relieved by a stool.
(Effects of laparotomy).
Stool and Anus.
Loose, bilious, yellow stools evening or morning.
Summer diarrhea with eruption.
Diarrhea driving out of bed in morning.
Very unusual severe urging.
Constipation, violent tenesmus, with discharge of a hard little ball, with nausea.
Rectum feels dry, morning.
Burning, biting, and feeling of dryness in rectum.
(Piles, with much pain, bleeding, and great soreness.)
Nightly urging to urinate, with vertigo.
Desire to urinate, with violent tearing in the genital organs.
Swelling and hardness of female urethra, with burning soreness and sensitiveness.
Female Sexual Organs.
Menses too late, headache, sickening pain in abdomen, sensitive to noises.
Tension in region of uterus, as from a tight bandage.
After-pains after instrumental delivery.
Scirrhus of breast from injury.
Hoarseness, Scraping and roughness in larynx, upper part of pharynx and nares in foggy weather.
Asthma worse in foggy weather.
Frequent dry hacking cough, short, barking cough.
Whooping-cough, worse 6 to ten PM
Anxiety in chest in forenoon, with short breath.
Stitches in the chest, below the breasts.
Stitches from within outward, through left breast and sternum, worse from motion.
Pressure and burning in the chest.
Tightness in the chest.
Worse In foggy weather.
(Pneumonia in persons who have piles.)
Stinging in left chest, worse when moving.
The heart feels as though it would fall down, in the evening.
Pulse rapid and hard.
Local congestions and capillary erethism, with or without hemorrhages and great nervous depression, following wounds.
Neck and Back.
After a fall, slightest motion of arms or neck extorts cries.
Cervical vertebrae very sensitive to the touch.
Consequence of spinal concussion.
Violent pains and inability to walk or stoop, after a fall on the coccyx.
Aching pain and sensation of lameness in the small of the back.
Stitches in the small of the back.
Lies on back jerking head backward.
Cannot walk, from affection of the spine.
Feeling of weakness and trembling of all the limbs.
Sensation of lameness of the left arm and right foot.
Articular rheumatism (knees mostly), much effusion, muddy urine.
Rheumatism of small joints.
Numbness and crawling in the limbs, hands, and feet.
Hands and feet feel fuzzy.
Affections of joints.
Stitches on the top of the shoulder at every inspiration.
Flying pains in right shoulder.
Neuralgia and paralytic pain in left upper arm.
Tension in both arms and in the hands.
Numbness in left arm, better by rubbing.
Sensation as if the left foot was strained of dislocated.
The feet feel pithy, as if pricked with needles.
Fearful sharp pain in knees, could hardly touch them.
Coxalgia after confinement.
Sciatica, rheumatism, from injury.
Left leg numb, cold while sitting.
Effects of running nail or pin into foot.
Feet much swollen.
Consequences of shock or fight.
Prevents lockjaw from wounds in soles, in fingers, and in palms of the hands.
Convulsions from blows or concussions.
After a fall, slightest motion of arms or neck extorts cries.
Flesh sore, feels bruised all over.
Injuries to parts rich in sentient nerves, especially fingers, toes, and matrices of nails.
Mechanical injuries, wounds by nails or splinters in the feet, needles under the nails, squeezing, hammering, of the toes and fingers, especially the tips of the fingers, when the nerves have been lacerated, wounded, torn, with excruciating pains.
Lacerations, when intolerable, excruciating pain shows nerves are severely involved.
Next to the nervous tissues, the joints are affected.
Sensation as of being lifted up high into air.
Smarting eruption, like nettle-rash, on the hands.
Painful scars in tissues rich in nerves.
Spasmodic jerks in arms or legs on going to sleep, twitching.
Dreams: with activity, travelling, vivid, distressing.
At four AM talks nonsense in sleep, distorted staring eyes, throbbing arteries.
Wakes four AM with sense of levitation.
On awaking: weary, better by noon, feels refreshed, bowels distended.
Pulse hard, accelerated.
Shuddering over the whole body, with desire to urinate.
Heat, with delirium, wild, staring look, hot head, throbbing of the carotids, bright-red, bloated face, moist hair on the head, burning heat of the skin, great oppression and anguish.