Herbal Supplements: The Whole Truth

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December 2, 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.

Posted in: Herbal Products/Natural Supplements