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Making Sense of Herbal Medicine Current regulation has done little to enlighten consumers Take a look at the bottles of echinacea, ginkgo, and St. John’s wort in any drugstore or supermarket, and it’s obvious that herbal medicine has gone mainstream. An estimated one-third of US adults use herbal remedies each year. Still, I’ve found many people are confused about how or when to use herbs, or have misconceptions about them. Unfortunately, the current regulation of herbal products has done little to enlighten consumers. Because herbs are classified as “dietary supplements,” manufacturers are typically prohibited from making label claims that an herb may prevent, treat, or cure a specific condition. And I feel the government has not done enough to regulate the quality and purity of herbal products. I’ve long argued that the Food and Drug Administration should create a new division to oversee natural therapeutic agents, including vitamins, minerals, herbs, and other dietary supplements. Such a division would have to be staffed by people knowledgeable about natural products, whose motive was to help consumers get safe and effective products, not thwart access to them. In the meantime, you’ll find information below on using herbal medicine wisely. Some tips come from my colleague and friend Tieraona Low Dog, MD, a botanical medicine expert in Albuquerque, New Mexico, who recently served on the White House Commission on Complementary and Alternative Medicine Policy. Six Common Misconceptions Here are some misunderstandings about herbs that I frequently come across. Herbs are natural, so they must be safe. Herbal remedies are typically more dilute than conventional drugs and therefore tend to pose less risk of toxicity. But this doesn’t mean all herbs are safe. For instance, recent reports from Europe have linked kava products with liver toxicity in some people. Some herbs may interact with drugs, foods, alcohol, or even sunlight. Others may be inappropriate for pregnant or nursing women, and some products may be tainted with harmful contaminants. Also, people may be allergic or have unusual reactions to herbs. Before taking an herbal remedy, learn as much as you can about any safety concerns. I should take various herbs every day because they’re good for me. With the exception of tonic herbs like astragalus or ginseng, you should only take herbal medicines to deal with health problems. Unlike vitamins and minerals, herbs are not required by your body to function normally. If I don’t want to take a prescription drug, I can take an herb instead. It depends on what health condition you’re dealing with. Dr. Low Dog believes there are some herbs that can substitute for drugs. For instance, saw palmetto has been shown to be as effective as the drug Proscar in treating benign prostatic hyperplasia (prostate enlargement), with fewer side effects. But currently, few herbs have been compared directly to prescription drugs in clinical studies, and Dr. Low Dog wouldn’t advise taking an herb instead of a drug for a serious or life-threatening condition. In general, she says, “the greater the risk of not taking the drug, [the more] you should rely on the drug unless there is solid evidence that the herb works.” Also, Dr. Low Dog emphasizes that simply replacing a drug with an herb is not what integrative medicine is all about. Often, people need to change their lifestyles—their dietary habits, activity levels, and how they manage stress—to solve medical problems, and the use of pharmacologically active substances (whether herbs, drugs, or both) may be only part of a comprehensive treatment program. I can believe the claims I see on labels or in advertising. Do some research to see if claims are supported by human studies or by other credible evidence. Also, just because an herb helps people with a particular condition (i.e., ginkgo can improve mental functioning in Alzheimer’s patients), doesn’t mean it will have the same effect in healthy people. More is better. You can get too much of a good thing. To minimize the risk of adverse reactions, start with a low dose, and don’t exceed the highest dosage listed on the label. Herbs work as quickly as drugs. Because herbal remedies tend to be less concentrated than conventional drugs, they often act more slowly. Depending on the herb, it may take a month or two of regular use before you see results. Be a Savvy Shopper for Herbs The tips below can help you make smart choices when shopping for herbal remedies. But first, some common-sense advice about using herbs: Don’t self-treat serious conditions or persistent symptoms. If you want to use an herbal remedy along with or instead of a prescription drug, talk to your doctor first, and don’t discontinue or reduce your dosage of any prescription medication without your physician’s supervision. Also, if an herbal product causes any adverse reactions like a skin rash or nausea, stop taking it. Educate yourself before shopping. The link below lists some excellent resources about herbs. Don’t rely on health-food-store clerks for dependable advice. Also, know that the information on supplement retailers’ websites may be biased. Buy from reputable companies. Among the ones I trust are Eclectic Institute, Enzymatic Therapy, Herbal Fortress, Mariposa Botanicals, Nature’s Way, PhytoPharmica, Solaray, and Zand. All are available at health food stores or through online supplement retailers, except for PhytoPharmica, which sells primarily to health professionals, and Herbal Fortress which makes Chinese herbal tonics. Look for standardized extracts. Standardized liquid or solid extracts contain a specific amount of the herb’s presumed active compounds. Liquid extracts are taken by the drop or dropperful in warm water or fruit juice, while solid extracts come in tablets or capsules. Other good choices are tinctures (less concentrated than liquid extracts) and capsules of freeze-dried herbs. Less potent are herbal teas, powdered herbs in capsules, and bulk herbs sold in bins at health food stores. Check for certification marks. Organizations like the United States Pharmacopeia and NSF International, as well as the internet-based company ConsumerLab.com, have begun certifying herbs and other supplements that contain the ingredients and dosages they claim and are free of contaminants. Look for certification marks on product labels. While certification does not guarantee a product is safe or effective, it offers some measure of quality assurance. Read labels carefully. Check the expiration date to make sure a product is fresh. Look at the dosage size to make sure you don’t have to take a ridiculous number of pills per day. And check the price, but know that if one brand costs significantly less than the other brands, it may be of inferior quality. Store safely. Place herbal medicines out of children’s reach. Keep them in a cool, dry place, not in the bathroom. You can use an herbal remedy past its expiration date, but it may be less effective. Cautions for Specific Situations There’s not much hard data on the safety of herbs in the following situations, but here are some general guidelines. Herb-drug interactions. Be careful about mixing herbs and drugs that have similar actions. Examples include ginkgo (a natural blood thinner) and anticoagulant drugs; valerian (a sedative herb) and prescription sleeping pills; and ephedra* (an herbal stimulant) and over-the-counter decongestants containing pseudoephedrine, another stimulant. Also, avoid mixing herbs and drugs that have opposite actions: Ephedra, for example, can increase blood pressure and may counter the effects of drugs that lower blood pressure. Plus, St. John’s wort may reduce the effectiveness of various drugs by causing them to be metabolized too quickly. Some pharmacists can offer guidance on herb-drug interactions, and some chain pharmacies now have databases to check for such interactions. To learn more, I recommend Herb Contraindications and Drug Interactions (third edition) by Francis Brinker, ND (Eclectic Medical Publications, 2001). Herbs before surgery. Certain herbs could cause problems if taken before surgery. Herbs with blood-thinning properties (like dong quai, feverfew, supplemental garlic or ginger, and ginkgo) may increase the risk of bleeding. Other herbs may affect heart rate and blood pressure, like ephedra, ginseng, and licorice root. And sedative herbs like kava and valerian may increase the effects of anesthesia. To be safe, stop taking any of these herbs at least one week before surgery, and tell your doctors about all the herbs, supplements, and medications you take if you’re expecting surgery. Herbs during pregnancy or while nursing. Unless you are under the care of a knowledgeable practitioner, I’d avoid taking any herbs during pregnancy, especially during the first trimester. But there are exceptions: It’s safe to take up to 1,000 mg a day of ginger in capsule or candied form (about two slices) to treat morning sickness, and it also appears safe to use echinacea during pregnancy to treat a cold or the flu. Dr. Low Dog suggests avoiding most medicinal herbs during the first four to six months of a baby’s life when breastfeeding. Exceptions include so-called galactagogue herbs believed to stimulate breast-milk production, such as fenugreek, blessed thistle, and alfalfa, as well as gentle remedies like chamomile tea (to promote relaxation) and echinacea. Women who are breastfeeding beyond six months may have more leeway, but should still be cautious about taking herbs (see the Brinker book mentioned above). Herbs and children. Just because a medicinal herb is generally safe for adults (such as St. John’s wort) doesn’t necessarily mean it’s safe for children. For reliable advice on useful herbs for kids, see Healthy Child, Whole Child by Stuart Ditchek, MD, and Russell Greenfield, MD, with Lynn Murray Willeford (HarperResource, 2001) Andrew Weil, MD, is a Harvard Medical School graduate who also holds an AB degree in biology (botany) from Harvard University. He is a clinical professor of internal medicine as well as the founder and director of the Program in Integrative Medicine at the University of Arizona’s Health Sciences Center in Tucson, where he is training a new generation of physicians. Dr. Weil is an internationally recognized expert on medicinal herbs, mind-body interactions, and integrative medicine. He is the author of eight books including the national bestsellers Spontaneous Healing, Eight Weeks to Optimum Health, and Eating Well for Optimum Health. Dr. Weil will be appearing at the McAninch Arts Center, Colege of DuPage on June 5th for a lecture and private reception sponsored by Marianjoy Rehabilitation Hospital. *Editor’s note: Ephedra or ma huang was banned by the FDA effective April 12, 2004, although it is still available as a constituent of some products. Appeals are currently underway to reverse this ban. For more information, see www.nowfoods.com, enter “Levin” in the search box. |
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