DIP Episode 608 - Herbal Supplements and The USMLEs

All right, welcome to episode 608 of the Divine Intervention Podcasts. Into this podcast, I'm going to be addressing a topic that's actually pretty high you to know for the US Emily exams. It's pretty high you to know for the US Emily exams and it's one of these things where you either know it or you don't. But if you don't know it, you're going to get a lot of questions wrong on your test, right? This is one of those things where it's going to be like maybe like three or four questions on your exams, but it's just one of these things where if you're putting just a little bit of effort, you can really get many of these questions right. And today we're going to be focusing on herbal supplements, herbal supplements and the US Emily's. Let's begin. The first one, what if they give you a question about a patient? They tell you that this patient comes to the physician and this patient is taking something for their mood, you know, something that they found at a herbal store, they're taking it for their mood. And then they then ask you on the exam, which of the following should the patient be instructed about or warned about on the US Emily's? Well, I would really hope you're thinking about St. John's word, right? St. John's word, many people tend to use it for like depression, right? They use it for depression, right? Or they can say, oh, you know, I'm having troubles with attention, right? Or I'm having sleepy shoes. I'm feeling anxious, right? Many people take St.

John's word for many things, but typically many people take it as a herbal supplement to help them with their mood, especially like depressive symptoms. Now, the thing is you need to warn these patients that St. John's word is a sideogram P450 inducer, right? It's a sideogram P450 inducer. So because it's a P450 inducer, it can accelerate the metabolism of many different drugs. And if you accelerate the metabolism of many of these different drugs, that can cause you to get in a lot of trouble, right? That can literally cause you to get in a lot of trouble because those drugs will have a shorter half life. So you may think like, for example, you're taking St. John's word and you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health.

And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health.

And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. And you may think like, you're taking a lot of trouble with your mental health. So that's something I want to be careful about. That's something I want to be careful about. And you know, the thing is just like people that take SSR Is can have sexual dysfunction. People that also take St. John's warts can have sexual dysfunction. That's an angle that you may see our friends at the MBA me's present to you. All right. Now, what if they give you a question about a patient? And they tell you that this patient has a history of BPH. And this patient has been, you know, taking, you know, that he's, he's, the patient is on the right hand. The patient is on due test to ride and is on presourcing. But that this patient, you know, has been taking a supplement that, a herbal supplement that his friends told him at the senior citizen center that it will help with his symptoms. And then you're being told that, oh, this person is about to have, is about to have surgery. Right. What should this person avoid in that situation? Well, again, this person is probably taking so far metal. Right.

So far metal is one of these things that just shows up on the US ML Es from age to age, from year to year, from month to month. Right. So what do people use so pal metal for? Well, people usually use so pal metal for a bunch of things, especially BPH, right? Especially BPH. So it's going to be an elderly male that's taking so pal metal on your exams. But to be honest with you, if you see a male that has decreased libido, that may be another reason why they may be using so pal metal on your test. That may be another reason why they're using so pal metal on your test. Now, what, what, this person that is having surgery should stop so pal metal before surgery. Why? Because so pal metal can cause some very significant bleeding. It can cause some very significant bleeding. Right. So if you see a person that is having surgery and they're taking so pal metal, it's not a good idea for these people to be taking the so pal metal. And to be honest with you, this same rule applies to three G's. There are three G's that apply to this. So let me, because these things certainly is quite a bit of a memorization. So it's just something I want to try to see if I can give you some tips to memorize it. Right. What's so pal metal and the three G's? What are the three G's? The three G's are Ginseng, Garlic and Ginkgo. Right. Ginkgo Biloba. So Ginseng, Garlic and Ginkgo Biloba. Those things in addition to so pal metal, you should not be taking those when you're having surgery. You know why?

Because many of these things actually inhibits the aggregation of platelets. They do actually inhibit platelet aggregation. So because they inhibit platelet aggregation, that can cause a person to have bleeding. Right. You can pretty suppose the person to bleeding. But for the most part, other than that, so pal metal doesn't really cause much of any kind of problem. You know, it may cause like some algae, I distress, it can cause some headaches, but it's not a very big deal. Okay. But again, if a person is having surgery, situation where they can bleed, so pal metal and the three G's, not a good idea. The three G's not a good idea. Right. And since I kind of talked about garlic and Ginseng and Ginkgo Biloba, let's kind of talk about those. Right. Again, I already said that Ginkgo Biloba. Most times people take it as part of these memory supplements. Right. These things to enhance their memories and things like that. Again, do not forget. Right. Do not forget that Ginkgo Biloba again can cause bleeding because again, it inhibits platelet aggregation. Right. So for a person is on aspirin or a person is on an anti, you know, any other like anti-plitelet drug. Then it's probably not a very good idea, right, to be taking Ginkgo. Right. Because aspirin already inhibits platelet aggregation, right, by inhibits cox 1 and 2. Right. You're inhibiting the synthesis of thrombocs in A2. You're shutting down platelet aggregation.

Why do you want to potentially its effects by taking something else that also inhibits platelet aggregation? That will not be a very good thing, right. That will not be a very good thing. Right. So kind of keep that at the back of your mind. So they can give you as a question where a person is trying to enhance their memory. Right. They talked about ginseng. Right. Ginseng also can cause bleeding. But again, don't forget, people usually take ginseng for memory, memory, memory. Right. People believe that, ooh, if you take ginseng, your memory is going to be great. Your energy is going to be amazing. Blah, blah, blah, blah, blah, blah, blah, blah. Right. But again, just kind of be careful about that. Right. The big, big, big thing with ginseng is bleeding, bleeding, bleeding. Right. But are there some other problems you may see with ginseng? Well, ginseng may cause people to have like headaches. They can cause insomnia. Right. So you may think you're enhancing your memory. You may think that you're taking like off label, rattling or you're taking off label, a methylphenidide or whatever. But we know that methylphenidide causes people to have insomnia. Cause these people to not eat. You can cause, you know, it can cause, it can really decrease your appetite. Right. So just be careful. Right. You're on EDHD medications and you're taking ginseng. It's probably not a good idea. And again, the thing is just is a very nice way to remember the toxicities of ginseng. Right.

It's like, hey, people take this thing to improve their memory, to boost their memory, to boost their energy, kind of like the EDHD medications. So many of these EDHD medications side effects you have, like headaches, insomnia, right. GI symptoms, right. GI, GI, GI symptoms. And again, don't forget it inhibits, it inhibits platelet aggregation. So that can cause a person to have bleeding. All right. So we've talked about, uh, Ginkgo, we've talked about ginseng, right. And then what's the third G? What's the third G? The third G is garlic, right. The third G is garlic. You know, many people take garlic because they believe it lowers their cholesterol. They believe it lowers their lipids. They believe that it helps with preventing atherosclerosis. Right. They believe it helps with preventing cancer. So those are going to be the primary care situations that a person comes to the physician and says, oh, I'm taking garlic for all these things. Again, remember, garlic can cause bleeding because again, it can inhibit platelet aggregation. Right. It can literally inhibit platelet aggregation. But what are some of the toxicities? What are some of the issues you may see with garlic? Well, the thing is garlic is just a smell, right. Just a smell, smell, smell, smell. The smell, smell, smell, smell. Right. And again, the smell, smell, smell is not ideal. And again, if you're having surgery, you should not take garlic. Right.

And the thing is garlic sometimes on your exams can be an unusual cause of contact dermatitis. Right. It can be an unusual cause of what of contact dermatitis, especially when you're using it, especially when you're using it, especially when you're using it, like on your skin. Some people actually use topical garlic. They use garlic on their skin. So just going to be careful about that for your exam purposes. Right. Okay. Let's talk about another one. Let's talk about a person that comes to the physician. And they're saying that they are taking something for like the common code. Right. You're thinking something for the common code. What kind of supplement are they thinking about here? Where you should be thinking about a kinesia, right? A kinesia, a kinesia, a kinesia. That's a big one. They love to test on the exams. Many people use it for the common code, for the flu. Right. The belief is going to help with your symptoms. Right. So if you have an operator-restruct infection, and you see a herbal supplement, think of a kinesia. Now, the problem with a kinesia is that a kinesia can cause very, very serious hypersensitivity reactions. Right. It can cause very, very serious hypersensitivity reactions. So that's like the big thing you want to kind of zoning on with a kinesia. It's spelled ECHI and ACEA. It can cause big problems for you with high-pressensitivity. Right. It can cause some GI problems, right? But those are kind of like the big things to do with a kinesia.

It doesn't really work. But people take it all the time, but whatever. All right. Now, what if they give you a question about a person? And they tell you that this person comes in with significant retoprochodren pain. You're told that it is a 49-year-old female. She comes into the emergency room with significant retoprochodren pain. And you're told that she's been taking, you know, how husband or whatever tells you that she's been taking this herbal supplement. To help with many of her menopause symptoms. Then what should you be thinking about on your exams? Should you be thinking about black corosh, black corosh. Right. Many people take these things from menopausal symptoms. They think it for like pre-manstrual syndrome. Right. In fact, some people take it towards the end of pregnancy to help with like to induce labor. Right. But what's like the big, big, big thing you want to know about black corosh? Black corosh is the lever injury. Is the lever injury. Right. The thing is black corosh. I don't think the mechanism behind lever injury is fully understood. But as far as I know, black corosh has the ability, I think, to cause oxidative damage to the lever. Kind of like I said, a menophen in a sense. Right. So it can cause oxidative damage to the lever. So again, if you're a person that's, if you see a person that has retoprochodren pain and it's going to be in a woman on your exams. It's going to be in a woman on your exams.

And she's taking something from menopausal symptoms or like pre-manstrual syndrome. Think of black corosh. Black corosh can cause a very severe hepatitis. Okay. Black corosh can absolutely positively cause a very severe hepatitis. And then what if they give you a question about a person that is taking like a weight loss supplement. Right. And then you notice that this person is having very high blood pressures. Right. If you see that, I would really hope you're seeing all divine. This sounds like a fedra. A fedra. A fedra. A fedra. A fedra is something that some people can be taking for weight loss. It contains a fedrine. Remember, a fedrine is an alpha-1 agonist. So you can cause viso-construction. That viso-construction can cause a very, very big time rise in a person's blood pressure. Right. So if you're a person that has a history of hypertension, a fedra is not a good idea. You see a person that's taking a weight loss supplement and their blood pressure is rising like crazy. Think of a fedra. A fedra. A fedra. On your exams. Again, these things are easy points. If you just kind of know what you're looking for. And I'm pretty much just trying to highlight the very high-yield associations that we tend to see on the exams with these. We tend to see an association with these. Another one you may see on your exams is cover cover. Right. You know, many people take it for like anxiety. They take it for insomnia. Right. Cover cover.

And I remember the things people take it for the word AI. They take it for anxiety for insomnia. Right. Well, this is very, very high yield to know. Is that this thing can cause really bad liver damage. Right. So kind of like black cohosh that can cause severe hepatitis. Uh, cover cover can be very, very hepatotoxic. It can be extremely hepatotoxic. Right. It can be extremely hepatotoxic. And the thing is the hepatotoxic is it may not be immediately. It may actually be something that arises like weeks after you've taken the cover cover. Right. It may arise literally like weeks after you've taken the cover cover. Right. So that's something I want to keep at the back of your mind for, for example. Right. Another herbal supplement that, you know, I cannot talk about how a phageramy reads your blood pressure. Another herbal supplement that may read your blood pressure is licorice. Right. Licorice contains something known as glyceritic acid. Gliceritic acid. Right. And that glyceritic acid is going to inhibit an enzyme that is necessary for the conversion of cortisol to cortisol. The thing is many people do not realize this. But cortisol has, cortisol has mild activity on mineralocorticoid receptors. So you can cause many of those same outdoor gerogenic side effects like hypochylemia, hypertension, metabolic alkylosis. So that's why the body has an enzyme. That's why the body has an enzyme. Right. That's why the body has an enzyme that converts cortisol to cortisol.

So if you give, if you take a lot of licorice, which contains glyceritic acid, that's going to not down that cortisol to cortisol production because you kill that enzyme that makes the cortisol. So you're going to have a lot of cortisol. You're going to have a lot of activity on mineralocorticoid receptors. And that can absolutely get you in trouble on your exams. So there's something you want to keep at the back of your mind. It can cause high blood pressure, right. Because that cortisol that's now in excess is stimulating mineralocorticoid receptors and is putting you in a lot of trouble, is putting you in a lot of trouble. Right. And then don't forget that, you know, patients may come in saying that they're taking like glucose and mean, right. Remember, that contains like congeuritin that, you know, they take it for like joint problems, they take it for like joint problems again. It may have some interactions with anticoagulants because a little bit of bleeding. But honestly, it's not that big of a deal. You know, sometimes it can even cause kidney damage. But again, most people use it for osteoarthritis. Just be able to recognize that on your exams. You know, you see that on a test. All right. So I think these are kind of like the high-yield ones we're going to talk about. I think that's pretty much it for here today. But again, please make sure you know these things, right. Again, they're heavily tested on the USML Es.

And again, I also offer a bunch of classes for the USML Es, you know, starting later this month on the 17th of a test taking class. And these classes are for step one to three, test taking class, bio-stats class, and social sciences quality improvement and ethics class. And these classes are updated all the time. So I can get the most recent information for the USML Es. And then for step two and three specifically, I have a last minute review. And I have a 20 hour step two, step three class. Again, if you're interested in these classes, shoot me an email. I can give you some more information. There are many people that have taken these classes and done extremely well on the exams. I know these exams are easy for many, many people. And then also offer one or one tutoring for all the USMLE exams, all the complex exams. And I also have this podcast on Apple, Google and Spotify. And I have a You Tube channel that you can check out where I post the videos that I make. And then I have another website called, a divineinterventionlifelessons.com. Divineinterventionlifelessons.com. Every week I post like two to three podcasts where from a biblical perspective, I address a life lesson. There's actually an Apple podcast associated with that quarter, the Divine Intervention Life Lessons podcast. Again, there's almost like 340 episodes on there. Many people listen to those and find those to be helpful. So thank you for listening to me today. Again, very, very high your topic.

Pay attention to this. Comment this to memory. It's going to help you a lot, a lot, a lot on your exams. So have a wonderful day. God bless you and bye for now. Thank you.

St. John's Wort (Hypericum perforatum).

Ginseng, Garlic, and Ginkgo Biloba (The Three G's).

Severe hepatitis/liver injury.

Hypertension and hypokalemia (due to mineralocorticoid excess).

Risk of hypertension due to $\alpha$-1 agonist activity.

Kinesia (Echinacea).

It is a potent CYP450 inducer, accelerating metabolism and reducing efficacy of co-administered drugs.

Black Cohosh.

It inhibits the conversion of cortisol to corticosterone (or similar enzymes), increasing mineralocorticoid activity.

Ginkgo Biloba (and Garlic/Ginseng).

Contact dermatitis.

Hypertension (due to vasoconstriction).

It is a potent CYP450 inducer, accelerating metabolism and reducing efficacy of co-administered drugs.

Black Cohosh.

It inhibits the conversion of cortisol to corticosterone (or similar enzymes), increasing mineralocorticoid activity.

Ginkgo Biloba (and Garlic/Ginseng).

Contact dermatitis.

Hypertension (due to vasoconstriction).