Dangerous herbs. Poor quality control. Toxic supplements.
If you read the newspaper or watch television, you’ll encounter these and similar phrases that have fueled understandable worry among many consumers.
At Helios Health Center, a holistic medical practice in Boulder, Colorado, several patients have told Robert Rountree, M.D., that they have stopped taking herbs because of negative news about supplements.
“They hear, ‘You can bleed to death if you take garlic,’ even if they feel fine,” Rountree says.
Seattle herbalist K. P. Khalsa’s patients have voiced similar concerns.
“My clients are really in limbo because they don’t know an authoritative source from another,” says Khalsa, board member of the American Herbalists Guild and author of Herbal Defense (Warner, 1997). For many people, even the family doctor may not be a good information source.
“Medical practitioners are begging us not to say [they are knowledgable about herbs] anymore because they don’t know anything,” Khalsa says.
Is it just a stage?
Some alternative health practitioners are perplexed—even dumbfounded—at the mainstream media’s recent treatment of alternative medicine.
“They focus in on a couple of problematic supplements like GHB and ephedra and extrapolate that all supplements are bad,” Rountree says. “That’s a pretty typical ploy. I’m so flabbergasted when I see comments like that from somebody who’s totally ignorant of the industry.”
Others are less surprised. Christopher Hobbs, a licensed acupuncturist and Herbs for Health editorial adviser, sees it as part of a larger process.
“The media has gone through cycles of interest in herbs and also where they put their focus,” Hobbs says.
Ten years ago, the media “discovered” herbs and coverage was often negative, he says. In 1994, the passage of the Dietary Supplement and Health Education Act (DSHEA) sparked an explosion of interest in well-researched herbs such as St. John’s wort and ginkgo, and newspapers and magazines from Life to The Washington Post carried stories about the health benefits of herbs.
“Suddenly the media was on a honeymoon with herbs, and their virtues were extolled to the heavens,” Hobbs says. “Herb and supplement companies took all this positive media coverage as a blank check and began to make many extravagant claims for their products.”
These extravagant claims and a handful of cases of adverse reactions have fueled a flurry of worrisome reports. (See “The scary herbs—are they really so scary?” on 48.) The current backlash focuses more on the dangers, especially single reports of toxicity and interactions between herbs and pharmaceuticals.
“All of this is a sign of the immaturity of the profession,” Khalsa says. “This was exactly where the medical profession was at the turn of the century.”
All about perspective
“I think negative press on pharmaceuticals has gone up, too,” says renowned herb expert James Duke, Ph.D. “There are biased people in both camps who grab onto little puppy-dog tails and make howling wolves out of them.”
We humans are a biochemical factory. Anything we put in our mouths is going to affect all of our systems. —Constance Grauds, pharmacist
The media and mainstream sources of medical information may add to the confusion by underwriting misleading information with their good reputations. For example, take the Mayo Clinic’s website, Health Oasis (www.mayohealth.org). It lists herbs such as echinacea, garlic, and feverfew as beneficial; it also lists several potential interactions between these herbs and pharmaceutical drugs, claiming that “some herbs become toxic if taken with certain drugs, and fatal herb-drug interactions can occur.”
Scary stuff. But is it accurate? Rountree thinks these statements are premature. For example, he says, if high concentrations of an herb make platelets less sticky in the laboratory, scientists theorize that combining the herb with aspirin could cause bleeding.
“But then it turns into ‘Feverfew, garlic, and ginger lead to excessive thinning of the blood,’ ” he says. “This is an emphatic statement, like this is a fact. But there are all kinds of holes in that statement. I would say ‘slightly less likely to clot, so it’s important to monitor your bleeding time.’
“When there’s confusing information, it seems like the finger gets pointed at herbs as being the causative factor,” Rountree says, adding that drugs are almost never identified as the culprit in herb-drug interaction cases.
How to be safe
Trust your own common sense. “When reading news coverage about herbs, ask yourself, ‘What is the potential side effect and what is real?’ ” says Constance Grauds, a pharmacist and Herbs for Health editorial adviser. “Ask, ‘What are the risks and benefits of the particular herb?’ I think this helps keep a balanced perspective; never is any herb, drug, or even aspirin free and clear on either side. Everything is a gray area.”
If something can heal you, it’s strong enough to use judiciously.“Humans are a biochemical factory. Anything we put in our mouths is going to affect all of our systems,” explains Grauds. Nothing is completely free of side effects, and the more potent the herb, the more potent the potential side effects. “We need to respect herbs for the powers that they do have, and when we respect them, that encourages us to find out all that we can about them,” she says.
Ease into new things. When trying a new herb, start with a low dose. And introduce only one herb at a time.
“You become your own experimental lab, and you can judge for yourself,” Grauds says. “There are so many individual variations, we often recommend this self-test.”
Don’t expect perfection. You’re using herbs for a reason: They’re often more gentle than pharmaceuticals, they help the body heal itself, they’re natural. But each of these reasons means that variations in the herbs or your body may not yield instant results.
“Never think, ‘This herb is bad, therefore all herbs are bad,’ ” cautions Grauds. “There are so many herbs, and so many have crossover activities—just like medication. Not everything is universally effective, and not everything has universal side effects. . . . I’m supportive of the herbal movement and of encouraging the herbal industry to . . . move toward pharmaceutical standards,” she says. “But as a realist, I have to say that Rome wasn’t built in a day. It will take time. If an herb isn’t working for you, it’s either not the right herb or you’ve got the wrong brand.”
Be careful if you’re mixing herbs with conventional medication. No one can tell you for sure if or how an herb will interact with prescription drugs. Even the best scientific literature is inconsistent about interactions between herbs and drugs, Grauds says.
“It’s important to understand your own risks and benefits,” she explains. “If you’re on blood thinners, you may want to have your clotting timed and work with it. See for yourself if you can take both herbs and drugs, rather than simply asking for a yes-or-no answer.”
As a general rule, if you have a health condition that requires a doctor’s care, ask that doctor before taking herbs. If he or she isn’t receptive, find someone who is.
“Even if you think your physician will disapprove, I recommend telling them about what you’re taking, so they can note it in your chart,” Grauds says.
Go with products you trust. “There are all kinds of controls within the industry,” Rountree says. “There’s no enforced way, but reputable companies manufacture on the same level as pharmaceuticals.”
Some products have a GMP logo on the label, meaning that the manufacturer has been certified by the National Nutritional Foods Association, an industry trade group, as adhering to good manufacturing practices. This program uses independent auditors to inspect personnel, plant conditions, sanitation, equipment, quality operations, production, and storage and distribution practices.
“Our knowledge of herb quality and how to preserve it is growing,” Hobbs says. “The marketplace will work it out. One company spends the extra money to measure some constituents and insure consistent levels in the finished product, and other companies will have to follow to stay competitive.”
Other firms, such as ConsumerLab.com, work independently to keep the industry honest. ConsumerLab.com tests supplements to ensure they meet label claims, then releases lists of products that pass muster. Products tested include SAMe, glucosamine, chondroitin, ginkgo, and saw palmetto. The company plans to test most major supplements within the year.
“Companies can also be dishonest or just downright clueless as to how to best extract and preserve herb extracts,” Hobbs says. “Some manufacturers who are also marketing companies will try to cut corners because they are in it for the money and have no real appreciation for the healing force . . . in medicinal plants.”
Find knowledgeable practitioners. More medical doctors, nurses, and pharmacists are learning about alternative medicine than ever before. Talk to herbalists or naturopaths in your area to find medical doctors who understand holistic healing. In the next few years, even your family doctor may catch up. Medical schools nationwide are incorporating complementary and alternative medicine (CAM) into their curricula. (See “Tommorow’s medicine today” on 32.)
Lynn Runyan, director of risk management at McKee Medical Center in Loveland, Colorado, says the hospital is supportive of CAM, and integrating these therapies into treatment was one of their strategic plans for 1999.
“We’re not moving away from it, we’re moving toward it,” she says.