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People taking the prescription blood thinner warfarin (Coumadin) may up their risk for health complications if they also take herbal or non-herbal supplements, new research reveals.

In fact, eight out of the 10 most popular supplements in the United States could spark safety concerns with respect to warfarin, while also impacting the drug’s effectiveness.

“I specifically looked at warfarin use, but the real issue is that even though herbal supplements fall under the category of food, and they’re not regulated like prescription drugs, they still have the effects of a drug in the body,” cautioned study author Jennifer L. Strohecker, a clinical pharmacist at Intermountain Medical Center in Salt Lake City.

“Warfarin is a very high-risk medication, which can be associated with severe consequences when it’s not managed properly,” she added. “However, warfarin is derived from a plant, sweet clover. In fact, many of our prescription drugs came from plants. So, it’s very important for patients to recognize that just because an herb is marketed not like a prescription drug [that] doesn’t mean it doesn’t have similar effects in the body.”

Strohecker and her colleagues are slated to present their findings Thursday at the Heart Rhythm Society annual meeting in Denver.

The authors note that almost 20 percent of Americans currently take some type of herbal or non-herbal supplement.

To gauge how these products might interact with warfarin, the researchers ranked the 20 most popular herbals and 20 most popular non-herbal supplements based on 2008 sales data, and then looked at how their use affected both clotting tendency and bleeding.

More than half of the herbal and non-herbal supplements were found to have either an indirect or direct impact on warfarin. Nearly two-thirds of all the supplements were found to raise the risk for bleeding among patients taking the blood thinner, while more than one-third hampered the effectiveness of the medication.

An increase in bleeding risk was specifically linked to the use of cranberry, garlic, ginkgo and saw palmetto supplements, the team said.

Glucosamine/chondroitin, essential fatty acids, multi-herb products, evening primrose oil, co-enzyme Q10, soy, melatonin, ginseng and St. John’s wort all affected warfarin’s effectiveness so much so that they prompted a need for adjustments in the drug’s prescribed dosage.

“I’m not against herbal supplement use at all,” Strohecker stressed. “But physicians need to proactively discuss this issue with their patients because of the consequences that can occur.”

Dr. Richard L. Page, a cardiologist and chair of medicine at University of Wisconsin, Madison, and president of the Heart Rhythm Society, believes the larger problem here is poor patient-doctor communication.

“Doctors don’t always know what their patients are taking,” he said. “Supplements may perform a very good service. Or they may not be providing the sort of care that patients are looking for when they’re essentially self-medicating. And where this becomes especially important is that these supplements can interact with the prescription drugs that your doctor may be giving you.”

“This report is important,” Page said, “because they look at a very common drug, warfarin, which has a narrow therapeutic window. Which means too much is bad cause you bleed, and too little is bad because it won’t do the job of thinning the blood that you want. So the bottom line is, be careful of adding new supplements if you are on existing prescription medications, and talk to your doctor if you do.”

A representative of the supplements industry took a slightly different view.

Duffy MacKay, vice president of scientific and regulatory affairs for the D.C.-based Council for Responsible Nutrition, the leading dietary supplement industry trade association, said that, “the issue here is really more with warfarin.”

“It’s just a very sensitive medication,” he said. “Warfarin itself has a huge list of drugs, foods and over-the-counters that it interacts with. If you take too much or too little, it can become dangerous.”

“So it’s sort of a form of sensationalism to suggest that here you have this situation with dietary supplements specifically,” MacKay added.

SOURCES: Jennifer L. Strohecker, Pharm.D., clinical pharmacist, Intermountain Medical Center, Salt Lake City, Utah; Richard L. Page, M.D., FHRS, cardiologist and chair, medicine, University of Wisconsin, Madison, and president of Heart Rhythm Society; Duffy MacKay, N.D., vice president, scientific and regulatory affairs, Council for Responsible Nutrition, Washington, D.C.;

A team from the U.S. Food and Drug Administration is investigating a farm in Arizona as a potential source of E. coli-tainted lettuce that has so far sickened 19 people nationwide, the Associated Press reported Friday.

Possible E. coli contamination prompted the recall of Freshway Foods’ romaine lettuce, which is sold in 23 states and the District of Columbia, the FDA announced Thursday.

The agency said the lettuce may be linked to cases of E. coli illness in Michigan, Ohio and New York that involved the hospitalization of 12 people, three with potentially life-threatening symptoms, the AP reported.

College students at the University of Michigan, Ann Arbor, Ohio State in Columbus and Daemen College in Amherst, N.Y., have been among those sickened in the outbreak, according to local state health departments.

The lettuce was sold to wholesalers, food service outlets, in-store salad bars and delis in Alabama, Connecticut, the District of Columbia, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, West Virginia and Wisconsin, according to Ohio-based Freshway Foods.

The recall covers lettuce with a “best if used by” date of May 12 or earlier, as well as “grab and go” salads sold at Kroger, Giant Eagle, Ingles Markets and Marsh grocery stores, the AP reported.

The lettuce does not include any bulk or prepackaged romaine or bagged salad mixes in retail supermarkets, the company stressed.

“Freshway Foods does not produce bulk, prepackaged romaine or bagged salad mixes containing romaine for sale in supermarkets, and therefore these products are not included in this recall,” the company said in a news release.

According to the AP, Freshway Vice President Devon Beer, said the company has been working with FDA to trace the contaminated lettuce back to the (as yet unidentified) grower in Yuma, Ariz.

The health effects of E. coli infection can range from mild diarrhea to more severe illness, including kidney damage. According to the AP, the three patients with life-threatening illness have developed a condition called hemolytic uremic syndrome, which can trigger hemorrhage in the brain or kidneys.

Complicating matters is the fact that the strain identified in the lettuce is E.coli 0145, not the much more common and more easily identified and reported E.coli 0157, the AP said.

In the meantime, restaurants across the nation are rushing to assure customers that their salads are safe to eat. According to CNN, Yum! Brands — which owns chains such as KFC, Pizza Hut, Taco Bell and Long John Silver’s — has said that Freshway Foods does not supply lettuce to any of its restaurants.

SOURCES: 2010, news release, Freshway Foods;

If losing weight feels like a never-ending battle, new research may explain why: Diets that restrict calories can actually make it harder to lose weight and keep it off.

Cutting calories increases production of cortisol, the stress hormone, which is linked to added belly fat, a new study finds.

“For the first time in humans, we are finding out that cutting your calories increases cortisol,” said lead researcher A. Janet Tomiyama, a Robert Wood Johnson Foundation Health & Society Scholar at the University of California, San Francisco.

“We think this may be one reason dieters tend to have a hard time keeping weight off in the long-term,” she said.

People who count calories feel stressed, she said, but it’s the reduction in calories that increases cortisol, which, in turn, stresses the body and leads to weight retention.

“No matter how you cut calories, whether that’s doing it on your own, or doing something like Nutrisystem or Jenny Craig, it doesn’t matter, it’s still going to increase your cortisol level,” she said.

At any given time, 47 percent of U.S. adults are dieting, but up to 64 percent gain back more weight than they lost, according to background information in the report published online April 6 in Psychosomatic Medicine.

For the study, Tomiyama’s team randomly assigned 121 women to one of four diets. One group tracked their calories, keeping them to 1,200 a day; another group ate normally but recorded the number of calories they consumed; a third group ate 1,200 calories a day, but did not have to record them, and the fourth group ate normally without any calorie-tracking.

At the start and end of the three-week trial, the researchers measured each woman’s cortisol and stress levels. When calories were restricted, cortisol levels increased. In addition, calorie-counting also increased the women’s perceived stress, the researchers found.

“The term ‘dieting’ brings to mind deprivation, starvation, being miserable and uncomfortable and ultimately failing in weight loss efforts,” Samantha Heller, a dietitian, nutritionist and exercise physiologist who is familiar with the study, said.

Burning more calories than you consume is how your body loses weight, she said. “However, severe calorie restriction, diet fads, pills and potions, detox cleanses and other quacky approaches to weight loss only contribute to people’s diet failures and, in fact, may increase the likelihood of regaining even more weight than what was lost — if any,” Heller added.

The best way to drop unwanted pounds is to adopt healthy lifestyle behaviors that include eating a variety of healthy foods, physical activity, patience and a game plan, she said.

“Many people want to lose weight and do not know how to begin. Creating a step-by-step plan is one piece of the puzzle a lot of people forgo,” Heller said.

Starting a weight-loss program takes discipline, motivation and a desire to make behavioral changes and finding support can be very helpful, Heller added.

Another expert, Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine in New Haven, Conn., said while dieting isn’t easy, certain strategies can help reduce stress and achieve a healthier lifestyle.

“Food itself, a reliable source of immediate gratification, may be used to relieve stress,” Katz said. “When food intake is restricted, something else should replace it.”

In general, dieting alone is not all that useful, Katz added. “Eating well and being active for life is the way to go,” he said.

“By eating foods of higher overall nutritional quality, fullness can generally be achieved on fewer calories, eliminating the need for deprivation,” Katz said. “In addition, physical activity can accelerate weight loss, promote health and alleviate stress in the bargain.”

SOURCES: A. Janet Tomiyama, Ph.D., Robert Wood Johnson Foundation Health & Society Scholar, University of California, San Francisco; David L. Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; Samantha Heller, M.S., R.D., dietitian, nutritionist, exercise physiologist, Fairfield, Conn;