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Herbal Supplements: The Whole Truth

December 2nd, 2013

by Olumami Amaye, PharmD student

Herbal supplements come in all forms. They may be taken internally as pills or powders, dissolved into tinctures or syrups, or brewed in teas. Ointments, shampoos, or poultices may be applied to the skin, scalp, or mucous membranes. What puzzles me, however,  are the unlisted ingredients in the supplements. In fact, an article published by Live-Science on October 11th, 2013 discusses a new study which found that herbal supplements contain unlisted ingredients and may pose a health hazard to consumers.1

In the United States, herbal and other dietary supplements are regulated by the U.S. Food and Drug Administration (FDA) as foods. This means that they do not have to meet the same standards as drugs and over-the-counter medications for proof of safety, effectiveness, and what the FDA calls Good Manufacturing Practices. The active ingredient(s) in many herbs and herbal supplements are not known. There may be dozens, even hundreds, of such compounds in an herbal supplement. In 2011, some researchers conducted a study to verify the contents of 5 known herbal products: St John’s wort, Asian ginseng, echinacea, garlic and ginkgo.2  What they found was so alarming that it forced the European Union (EU) to change some legislation on herbal supplement products.3 Some herbal supplements have been found to be contaminated with metals, unlabeled prescription drugs, microorganisms, or other substances, the researchers said.3

However, in a recent article in the Archives of Internal Medicine, DM Marcus and AP Grollman stated that “Even when the Food and Drug Administration (FDA)” identifies an unsafe product, it lacks authority to mandate its removal from the market because it must meet the very high legal requirement to demonstrate a ‘significant or unreasonable’ risk.3 According to the article published by Live-Science on October 11th, 2013 BMC medicine studied a very new technique “ called DNA  barcoding test” where they analyzed 12 companies herbal products. However, out of the 12 companies that manufacture herbal supplements only 2 products were found to have no substitution, contaminants or fillers.4 The Newmaster et al. study also found that one product labeled as St.John’s wort was substituted with senna alexandrina. It contained only senna barcodes and no St. John’s wort barcoding.1  From my understanding of senna, it’s a stimulant laxative agent which if not properly used can cause  adverse effects such as diarrhea, abdominal pain, skin disorders and blistering.5 Several herbal products contained Parthenium hysterophorus (feverfew), which can cause swelling and numbness in the mouth, oral ulcers and nausea. It also reacts with medications metabolized by the liver and may increase the risk of bleeding, especially if taken with blood-thinning medications, the researchers said.1

The findings of the study are also consistent with earlier studies. For examples, one study shows   51 (75%) of 68 products contained none of the key safety messages, while other studies also share similar results.6   In light of these and other studies conducted in North American and European countries, I believe there should be some regulations in place for testing and approval of herbal products.  Personally, after reading this article I felt that using supplements can be dangerous to a person’s health. I would be very cautious before putting one of these into my body for any reason. I have learned that the improper use of supplements might lead to some health issues.

The limitations to this study are the use of new DNA barcoding methods, lack of barcode library, and not listing the names of herbal supplement manufacturers. The DNA barcoding is not generally accepted by herbal product manufacturers and no set standards are in place for industries to follow. The study also failed to list the herbal products that were tested and the brands or companies that are following unethical activities and false advertising. By not listing the companies involve, the study might mislead other consumers to think that all herbal supplements are totally bad.

Would you take herbal supplements? Do you think they are beneficial to your health?,

 

References:

  1. Newmaster S, Grguric M, Shanmughanandhan D, Ramalingam S, Ragupathy S. DNA barcoding detects contamination and substitution in North American herbal products. BMC Medicine [serial online]. November 2013;11(1):18-35. Available from: Academic Search Complete, Ipswich, MA. Accessed November 12, 2013.
  2. Marcus DM, Grollman AP. The consequences of ineffective regulation of dietary supplements. Arch Intern Med. 2012 Jul 9;172(13):1035-6. PubMed PMID: 22777632.
  3. Linde K, Berner MM, Kriston L. St John’s wort for major depression. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD000448.
  4. Rettner, Rachael. Herbal Supplements Often Contain Unlisted Ingredients. LiveScience, October 11th, 2013. Available at http://www.livescience.com/40357-herbal-products-unlisted-ingredient.html.   Accessed November 12, 2013.
  5. Krinsky, D. L., Berardi, R. R., & Ferreri, S. P. (2011). Handbook of nonprescription drugs: An interactive approach to self-care (17th ed.). Washington, D.C: American Pharmacists Association.
  6. Raynor D, Dickinson R, Knapp P, Long A, Nicolson D. Buyer beware? Does the information provided with herbal products available over the counter enable safe use?. BMC Medicine [serial online]. August 9, 2011;9:94. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed November 12, 2013.

5 Responses to “Herbal Supplements: The Whole Truth”

  1. Anna Smith Says:

    What you wrote is very interesting and somewhat alarming. I do take iron as a dietary supplement because I am anemic and I need it, but other than that, I feel as though I would not take any other supplements. This is because of the various reasons you mentioned in your blog post. It is scary that they are not regulated like prescription drugs. I do believe some can be beneficial, but I think people need to really monitor their use of the supplements and keep a sharp eye out for adverse or unusual effects.

    Many people believe that since supplements are “natural” it makes them safe, which is untrue. Some people do not know that dietary and herbal supplements are not regulated or tested for safety and efficacy like prescription drugs. As you discussed in your post, these supplements may contain substances that are not supposed to be in them or may not contain the right substances at all. Even when these products are found to have many adverse effects or contain substances that can be harmful, it is scary that they cannot be taken off the market because of the high legal requirements to be proven to have a “significant or unreasonable” risk.

    I think supplements need more testing and regulation because many people take them. Not only this, but people need to be informed of the lack of testing and regulation on these supplements. If people knew more about the origins and testing of dietary and herbal supplements, I think they might be more cautious when taking them.

  2. Tirhas Mekonnen Says:

    I agree that it is important to be cautious to take herbal supplements. It is unfortunate that contamination does happen. It is also unfortunate that products discontinued or recalled including recalls for herbal supplements happen after the fact; after damages to people happen. However, If someone needs to tryout herbal supplements for a reason, there are some precautions and product selection measures we could use. For instance patients need to let their health care professional that they are about to take supplements, and give list of supplements (if they are taking) as well as other prescriptions and nonprescription drugs. Also select the supplements based on criterions such as select supplements manufactured by well-known manufacturer, look into the supplement bottle and see if there is dosage of the supplement; if there is information on how to take it; and also information like the manufacturers address are a few to mention.

    I would tell my doctor about herbal supplement I am taking, if I take any. Many people might think that herbal supplements are just supplements, or food that they are not getting from their daily herbal. However, herbal supplements can harm or on the other hand help us in many ways. For instance green tea helps me wake up and be alert in the mornings. I feel the stimulant effect of green tea working when I get up and have a cup of tea in the morning.
    Also to get herbal supplements from a company that is well known and has a good name may be important. I would look the name on the bottle and see if the company actually put address on it. I wouldn’t pick a supplement bottle from the store shelf if it doesn’t have a manufacturers name and address. I would pick a supplement that has instructions on how to take the supplement. Also to pick a supplement that

    Finally to answer to your question, I wouldn’t completely avoid herbal supplements. It depends on what it is that I would want to take. I would research, and also take advice from health care professionals before I decide to take one. There are many beneficial ones and there are also some herbal supplements that are not proven to provide the result that those herbals supplements claimed to provide. Therefore, I agree that we need to be cautious when taking herbal supplements.

  3. Maria Miller Says:

    Herbal supplementation is scary business! It amazes me that these products are not regulated in similar fashions as drugs. Yet people think natural is better and healthier! Scary to think that you may not even know what you’re actually taking when you do take a supplement. This is the kind of information that the public should know about and a change should happen! The FDA shouldn’t have to do their own studies and find out if the herb has an unreasonable risk. The manufacturing companies should be the ones conducting the studies and proving to the FDA that their product works and is safe. I feel like the labeling is the one thing that should tell the consumer what they’re receiving when they purchase a product, but unfortunately that’s not the case. Knowing that any ingredient can be substituted and not mentioned on the label is some what angering because it can be harmful to those who are trying to use it for good. It’s sad to think that manufacturing companies can get away with that and make a lot of money of their product.

    The barcoding test that you mentioned seemed really fascinating and it would be interesting to see if that will continue showing the false claims that herbal manufacturers are making on their products.

    Personally I haven’t taken herbal products because I wouldn’t really know where to begin when it comes to what I could take. There’s so many of them and they all have multiple uses that it’s overwhelming. Knowing now that they can be harmful I’ll probably stay away until more evidence comes out about their safety and efficacy.

  4. Elizabeth Ledbetter Says:

    Dietary supplements are definitely not to be taken carelessly. Your post makes it clear that adequate research must be done to ensure the products we recommend and take ourselves are safe! My research project is actually on dietary supplement regulation, and it has been fascinating to learn about these products. As you mentioned, there are certain products that contain contaminants, but another issue is that these products may not contain the actual amount of active ingredient that is advertised. Whether the actual amount is more or less than what is advertised, many people might be getting ripped off (if there is less active ingredient than what is advertised) or experience harmful side effects (if there is more active ingredient than what is advertised).

    I am fascinated as well by this barcode process you mentioned. I would like to read a little more about that and how it could impact product testing. Could this process test the exact amounts of ingredients present in the supplement? If so, it would be a great way to see which companies are not advertising truthfully.

    You mentioned in your last paragraph that the studies failed to list which manufacturers were tested. We have found through our research project that this is a legal issue. If these studies were to give the names of these “culprits,” they would be susceptible to lawsuits! Companies that are accused of faulty manufacturing would probably react poorly to that study being published, and I bet the authors are trying to avoid that!

  5. Yevgeniy Solokha Says:

    I personally don’t take herbal supplements, but I believe that they may be beneficial in certain circumstances, especially if the patient has a chronic deficiency of specific nutrients. I would imagine, however, that most of the people who take herbal supplements are relatively healthy individuals who have good immune systems that are able to deal with any contaminants. The active products in the formulation may actually help maintain the overall health by mechanisms for which there may be no technology available to pinpoint. For this reason, I believe that it is ultimately the responsibility of the consumers to make educated decisions about what herbal supplements are taking.

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