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7 Things to Beware of When Using Herbal Supplements

It's estimated that 42 percent of Americans use herbs or other nutritional supplements as a part of their self-care routine, and the supplements represent a growing place in the market, with over $20 billion spent each year on herbal remedies to treat everything from obesity to cancer.

Many people swear the botanicals -- valerian root for insomnia, St. John's wort for depression, Echinacea for a cold, and many, many more -- have led to improvements in their health. And although tried-and-true studies proving their effectiveness are few and far between, they do exist.

herbal supplements

Herbal supplements may be beneficial for some, but they can also interact with drugs and cause side effects. Garlic, for instance, has blood-thinning properties so people with bleeding disorders and those who are planning to have surgery or give birth should not take garlic supplements.

One recent study of several traditional herbal remedies by researchers at King's College London, for instance, found that the herbs conferred "real benefits." Among them:

  • Curry-leaf tree extract for diabetes

  • An antibacterial and anti-fungal extract of Commelina diffusa, or climbing dayflower, to help wound healing

  • Ammannia baccifera, a Thai aquatic weed, for lung cancer

  • Star anise for lung cancer

Said Edzard Ernst, professor of complementary medicine at the Peninsula Medical School in Exeter, "This research is very interesting, very promising. We need much more research of this sort. More and more research of this kind is coming out. It is no surprise to those who work in this field."

Herbal Supplements Are Not Regulated

Because herbal supplements are natural and, in many cases, have been used by native cultures for centuries, they have a general connotation of being safe. However, there are some things to consider before adding any new substance to your body.

First, herbal supplements are not required to go through a U.S. Food and Drug Administration (FDA) approval process before they hit the market (as are drugs). They are supposed to contain what their labels say they do, however no governmental agency is regulating this process.

The result is that some herbal supplements are pure and in the exact doses listed on their labels, while others may not be the highest quality or may not contain the amount the label states.

"The lot-to-lot variability and variability between manufacturers is quite great," said David Kroll, senior research pharmacologist at RTI International, an independent research group. "The quality control is still not what it is for comparative over-the-counter drugs."

Further, "Many herbs are very powerful agents," says Dr. Wadie Najm, a geriatrician who specializes in alternative medicine. "In fact, one-quarter of the prescription drugs sold in the U.S. contain at least one active ingredient derived from a plant."

It's true that herbal supplements are derived from nature, and that they're often used with anecdotal success. Still, here are seven things you need to be cautious of when using herbal supplements.

1. Know the Side Effects and Drug Interactions

Herbal supplements do carry side effects, and many can interact with prescription or over-the-counter medications. It is therefore essential that you tell your doctor and pharmacist about every prescription and over-the-counter drug, and herbal supplement, you may be taking. According to the Mayo Clinic, the following medications may interact negatively with herbal supplements (though this is NOT a comprehensive list):

  • Blood pressure medications

  • Blood thinners (anticoagulants, anti-platelet agents, nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen or naproxen)

  • Diabetes medications

  • Drugs that affect the liver

  • Heart medications

  • Monoamine oxidase inhibitors (MAOIs)

The following herbal supplements have been linked to adverse drug reactions (again, this is not a complete list):

  • Black cohosh

  • Dong quai

  • Ephedra

  • Feverfew

  • Garlic

  • Ginger

  • Ginkgo

  • Ginseng

  • Goldenseal

  • Kava

  • Milk thistle

  • Scotch broom

  • St. John's wort

2. Be Aware That the Active Ingredient May Not be Known

So much is still being discovered about herbal supplements that often the active ingredient(s) has not yet been discovered. Because of this, it's best to stick to single-herb supplements (rather than pills that combine two or more), because you will be able to monitor how the herb affects you, and you will know what dose you are getting (with multi-herb supplements, the amount of each herb may not be listed on the label).

3. Choose Standardized Herbs

There are several groups that do certify herbal supplements, including the U.S. Pharmacopeia (look for a "USP Dietary Supplement Verified" seal on the label),, Good Housekeeping and NSF International. Although these groups do not have to report sub-par products, their goal is to put out high-quality herbal supplements. Standardized herbs have been checked for uniformity, cleanliness and freedom from environmental contaminants, although each group has their own specific rules for each.

4. Know That Herbs Affect People Differently

herbal supplements

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Everyone's body reacts to herbs differently, and it's important to start with a small amount of a single herb at a time to judge any adverse reactions. Further, children under 18 and those over 65 should also use caution. Older adults metabolize supplements differently, and safe doses have not yet been established for children.

5. Don't Take Herbal Supplements If …

If you're pregnant or breastfeeding, you shouldn't take herbal supplements without checking with your doctor, as their effects on your baby may not be known. Likewise if you are going to have surgery -- herbal supplements can influence anesthetics or cause excess bleeding or high blood pressure.

6. Buy Reputable Brands

Because herbal supplements are not subject to any kind of regulated standardization tests, you should only buy supplements from brands you know and trust. An increasing number of Web sites selling these supplements have sprung up in recent years, so do your homework before deciding to order. You can also ask an employee at a health food store for high-quality and trustworthy brand recommendations.

7. Consider Checking Out Consumer Reports' Natural Medicine Database

Consumer Reports has released, as of April 2006, a database -- called the Natural Medicines Comprehensive Database -- with information on close to 14,000 herbs, dietary supplements and other natural medicines. There is a $19 annual fee for this information (which also gives you access to Consumer Reports' prescription drug and medical treatment guides).

Recommended Reading

Do You Really Need a Multivitamin Supplement?

Nutritional Deficiency: Symptoms & Recommendations for 24 Common Nutritional Deficiencies


Science Daily: Changing Trends in Herbal Supplement Use

BBC News: Herbal Remedies 'Do Work'

Mayo Clinic: Herb and Drug Interactions

Mayo Clinic: Herbal Supplements

Delaware Online June 20, 2006

The Seattle Times May 28, 2006

UCI Medical Center

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