Patients often ask providers about the use and benefits of various herbal supplements. Some of the herbal products on the market can have real and significant benefits. Many offer no real benefit, but have no serious adverse effects for most patients. Some can be dangerous or have dangerous interactions with other medications. A national survey showed a nearly five-fold increase in the number of Americans using herbal supplements from 1990 to 1997. The 2007 National Health Interview Survey (NHIS) Alternative Medicine Supplement showed that 17.7 percent of US adults had used herbs and other naturally occurring supplements in the previous year. Americans commonly use herbal and natural supplements to enhance their health and to help relieve symptoms of common chronic diseases for which conventional western medicine has no straightforward cure. Herbs are appealing because natural products are perceived to be benevolent and healing. Additionally, many herbal medicines are culturally traditional treatments for various ailments.
There is a common mistaken perception that naturally occurring products are always safe. Herbs can contain powerful drugs with serious side effects or interactions with other medications or other herbs. Many pharmaceuticals are derived from botanicals or other naturally occurring substances which are refined and purified. Some supplements have been shown to have serious adverse side effects. One such example is ephedra which was commonly used for weight loss, but was shown to cause heart arrhythmias, heart attacks, heart failure, strokes, seizures, and high blood pressure. Pyrrolizidine alkaloids identified in over 6000 plant species can lead to liver failure. Plants containing aristolochic acid used for weight loss can lead to kidney failure. St John’s Wort alters the metabolism of many other medications and can lead to serious side effects with medicines such as oral contraceptives, warfarin, digoxin, and others. In addition it can interact with many common antidepressants having serious side effects. Ginkgo bilboa has antithrombotic effects and can increase the risk of serious bleeding or spontaneous hemorrhage.
These are only a few examples of possible serious side effects of natural products. Herbal and natural remedies are classified as dietary supplements in the US and are minimally regulated by the Food and Drug Administration. Manufacturers are not required to prove safety, efficacy, or quality of dietary supplements and are not required to report adverse effects of their products. Clinical trials of pharmaceuticals to show their efficacy and safety are typically performed at the expense of the pharmaceutical manufacturers and are very expensive and time consuming. Because of the lack of regulation, there have been very few clinical trials performed on dietary supplements. Additionally, there are few standards related to the maximum safe dosage of these potentially dangerous natural compounds or control over the dosage or purity of products on the market.
All of this presents a difficult situation for health care providers when they are unfamiliar with a particular herb, there is little scientific literature available for it, or it is unclear what the true ingredients of a product are. Additionally, an herb from one manufacturer may be safe while the same herb from another may not be. A further danger arises when a patient chooses to rely on a natural treatment for a condition with no reliable studies to show its effectiveness in place of a more proven conventional treatment. In this case the patient may not receive any effective treatment for a serious health condition.
So what is the answer? Do your homework. Don’t rely on the label on the bottle or an advertisement in a health magazine to tell you whether a supplement is safe or effective. Be sure to tell your provider all of the supplements you are taking. If you are taking medications be sure to talk to your provider before you start any new supplements or stop medications in place of supplements. Just because a product is natural doesn’t mean it is safe for you.
Some resources for information on supplements are listed below: