FAQ

The decision to use herbs for their health promoting value is, as with all health decisions, a personal one. There are, however, many good reasons to consider herbal products as complements to your own health care. The best reason, however, may be the fact that herbs and herbal products, with their incredibly wide use throughout time and place, continue to provide real health benefits while maintaining a remarkable safety profile. Readily available natural substances were the first medicines used by humans. Primitive and ancient civilizations as well as contemporary cultures throughout the world have always relied on herbs to provide the benefits that have been observed with their use. In fact, the World Health Organization has estimated that 80 percent of the world's population continues to use traditional therapies, a major part of which are derived from plants, as their primary health care tools.(3) In our own time and culture, most herbs are available in the form of "herbal supplements."(4) These products are found in the form of teas, tablets, capsules, liquid extracts, and others. We now have ready access to products that bring the herbal traditions from all over the world in a variety of convenient forms. In addition, scientific inquiries continue to develop our knowledge of the benefits of plants, and often validate the observations made over the past centuries

Plants that enjoy broad culinary and therapeutic usage are generally safe. We can flavor our food with any number of herbs to make a meal more flavorful. We can appreciate a delicious cup of peppermint leaf or ginger root tea, or benefit from the soothing properties of marshmallow root or the bark of slippery elm. We can take an herbal supplement containing dandelion root or saw palmetto berries, or any number of the other herbs. Although allergies and reactions have been recorded for a few herbs that are widely used in foods and supplements, such individual concerns are also seen with many foods, and do not diminish the safety profile of the many herbs that are generally recognized as safe. On the other hand, and as everyone knows, there are any number of plants that are highly toxic, even deadly. Every ten-year-old hiker knows to stay away from poison ivy (Toxicodendron spp.) when walking in the woods. The death sentence imposed on Socrates by an Athenian jury 2,400 years ago was carried out with a fatal dose of poison hemlock (Conium maculatum). The poison curare, a blend of several equatorial rain forest plants (e.g., species of Chondrodendron, Curarea and Strychnos)(5) is used by some South American hunter cultures to make their arrows more deadly. And in the "concrete jungle" of Los Angeles, two young boys died in 2000 from ingesting a few leaves of the ubiquitous oleander (Nerium oleander).(6) Federal law(7) and good common sense, however, prevent the use of any such highly toxic plant in products that are readily available to consumers. The better question then, for today's American consumer, is "Are herbal supplement products safe?"

Herbs are rich mixtures of diverse natural compounds. Although the effects of certain herbs will be observed within a short time after consumption, others are more subtle and provide their health promoting benefits gradually. If you have ever used ginger root (Zingiber officinale) or peppermint leaf (Mentha x piperita) tea to promote healthy digestion, you know that you can feel the comforting effects of these herbs almost as you drink the soothing brew. The sense of well-being that results from the use of kava root (Piper methysticum) should manifest in only a short time when using a well manufactured product. Similarly, all of the herbs that contain anthrones — such as rhubarb root (Rheum spp.) or cascara sagrada bark (Frangula purshiana) — will produce a laxative effect within a half a day or so. Other herbs are known to produce noticeable benefits only after several days or weeks. For example, improvement in sleep when using an extract of valerian root has been shown to be somewhat dependent on continued use.(13) With saw palmetto (Serenoa repens), the berries of which are used to promote the health of the prostate, the full benefits have been shown in one study to be achieved after 12 to 18 months.(15) Other herbs, such as those that are rich in antioxidants, work to improve your health without a noticeable effect. For more information about what to expect from an herbal product (and when to expect it), consult with the product's manufacturer or an herbal health practitioner. You can find a regional list of herbalists the American Herbalists Guild's professional member referral list at http://www.americanherbalistsguild.com, or your local acupuncturist at the American Association of Oriental Medicine http://www.aaom.org.

Two different parts of the Federal laws that govern dietary supplements present manufacturers with guidelines for providing quantitative recommendations on the package of their products. First, all supplement manufacturers are responsible for assuring that their products do not present significant or unreasonable risks under conditions of use recommended in labeling or under ordinary conditions of use.(18) In addition, all dietary supplements, including herbal supplements, are required by Federal regulation to identify the "serving size."(19) A general recommendation then, with regard to how much of an herbal product to use: the amount recommended on the label. The idea that "more is better" is no more relevant for an herbal supplement than for any other food that, while it might be delicious, refreshing or nutritive in moderation, becomes unhealthful when consumed in excess. It may also be useful to speak with a qualified herbal expert. A regional list of herbalists is maintained on the American Herbalists Guild's professional member referral list at http://www.americanherbalistsguild.com. Similarly, a local acupuncturist may be found at the American Association of Oriental Medicine at http://www.aaom.org and naturopathic physicians can be located through the American Association of Naturopathic Physicians at http://naturopathic.org.

Humans have been learning about the diverse effects of ingesting plants throughout our evolution. We have, by trial and error, found both good and bad effects that are related to specific plants, some of which we use as food, and others that are used for therapeutic purposes. The introduction of synthetic and highly purified drugs is an extremely modern development. As researchers observe the interactions that drugs have with common foods and herbs, surprises continue to surface. For example, less than 10 years ago it was found that drinking grapefruit juice increases the serum drug concentration when patients take certain drugs.(23) This effect, which can last for up to 24 hours after consumption, is now thought to inhibit specific enzymatic activities responsible for breaking down the drugs.(24) Similarly, both avocado and leafy vegetables that are high in vitamin K can diminish the effectiveness of blood-thinning drugs.(25) These concerns are not widely known by the public, but now that medical professionals are aware of these effects, they can routinely monitor their patients to assure effective treatment.

Similar information has surfaced about some of the herbs that we use. For example, we now know that the use of an extract of St. John's wort (Hypericum perforatum) may cause certain prescription medications to be eliminated more quickly,(26, 27) leading one researcher to caution that, "As with grapefruit juice, a food product, physicians should also be aware of potential drug-herb interactions."(26) In response to this new information, the American Herbal Products Association has recommended that products containing St. John's wort be labeled to suggest that the advice of your prescribing physician be requested if you are taking any prescription drugs. Speculation on the exact mechanism of St. John's wort has led to reports that the use of this herb might affect oral contraceptives, leading to ineffectiveness and unwanted pregnancies. To date, there have been no reports of any such actual occurrence. Nevertheless, women taking oral contraceptives such as ethinyl estradiol and desogestrel should be aware that, if you experience break-through bleeding, you might experience a reduction in protection against pregnancy.

As can be seen by the above examples, the effect of a drug can be either increased or decreased in the presence of other factors in the diet, including herbal use. Although it is likely that most such factors have little or no influence on drug metabolism, continued research will add to our knowledge of such interactions and responsible food and supplement manufacturers will be expected to inform their customers of any new findings. There is now an ongoing interest in other drugs that are suspected of interacting with certain specific herbs, with most contemporary emphasis on the use of herbs with blood-thinning drugs such as warfarin. Although the current concerns are either conceptual or based on isolated and inconclusive reports, it is advisable to inform your prescribing physician or pharmacist that you are using herbs when undergoing any drug therapy. As close monitoring of the effect of warfarin is an established standard of medical practice, this additional information will assist your physician in maintaining good supervision of your drug levels. In order to understand the potential for an herbal product to interact with prescription drugs, it may also be useful to consult with a qualified herbal expert. You can find a regional list of herbalists the American Herbalists Guild's professional member referral list at http://www.americanherbalistsguild.com, or your local acupuncturist at the American Association of Oriental Medicine http://www.aaom.org. A similar database of naturopathic physicians is maintained by the American Assoc. of Naturopathic Physicians

Single herb or combination product? Capsule, tablet, extract or tea? Which brand? Standardized or not? Sometimes it seems that there are just too many choices!! Some of these choices are ultimately matters of personal choice. The issue of product form is one example — are you attracted to the rich history of herbal extracts and decoctions? ...or do you have trouble swallowing tablets and capsules? Then you may want to try a liquid extract or tea product. On the other hand, if you can't bear the taste of valerian or echinacea, or if you like the convenience of non-liquid forms, you might choose a tablet or capsule. Similarly, there are separate values attached to both single herb products and to herbal formulas. You might appreciate the experience and knowledge that many manufacturers have brought to designing combination products, with a goal toward attaining a higher synergy for the intended use. Multi-ingredient formulas have been the standard in Asian and Indian herbal traditions for centuries. Then again, you might prefer the simplicity of taking only one herb at a time, an approach that has more historical acceptance in the West.(28)

The U.S. herbal marketplace has seen the introduction of a number of "standardized" botanical extracts. The purpose of standardization is commonly believed to be control of the content of one or several "marker" compounds,(29) which are perceived of as those constituents in the plant that are responsible for its therapeutic activity. In fact, standardization — when properly performed — entails a lot more than merely controlling the content of a particular marker compound. Rather, standardization consists of the body of information and manufacturing steps that ensure product consistency from one batch to the next. As such, it comprises a wide variety of raw material and process controls, as well as use of a consistent recipe.

The goal in standardizing an extract is to control the complete chemical composition of the extract, rather than one particular identified constituent or group of constituents. The heightened interest in standardized products is due to the belief that standardization is directly related to the potency of the extract. This is not necessarily the case and can unfortunately lead to a "more is better" perception. It is important to know that the use of marker compounds is not essential to the production of quality botanical products and that many companies market high quality and consistent herbal extracts without reference to these. In addition, any manufacturing process that is too specifically concentrated on maximizing one constituent may place an undue emphasis on that single compound. On the other hand, there can be value in a manufacturing process that implements measures to control the entire spectrum of an herb's constituents and that also includes attention to marker compounds. Consumers should understand that label information about markers is usually provided to communicate product consistency and a degree of quality control rather than potency.

Of course you should! And because your doctor is, ideally, your primary partner in managing your health, you should insist that your doctor, no matter their degree of training in herbs, receive that information respectfully. In telling your doctor of your decision to use an herbal product, however, don't be surprised if you find that your knowledge of herbs is more advanced than theirs. You might suggest (again, respectfully) that they expand their education by using some of the internet resources listed below, or by purchasing and studying some of the written references identified there. At the same time, remember that your prescribing physician has a responsibility to safely oversee your use of any prescription drugs. If your doctor is concerned that a pharmaceutical substance might interact with an herbal product, it is prudent to accept such advice.